Top 10: June 15

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By Christian Hoffmann &
Bernd S. Kamps

15 June

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Mubarak N, Zin CS. Religious tourism and mass religious gatherings – The potential link in the spread of COVID-19. Current perspective and future implications. Travel Med Infect Dis. 2020 Jun 9;36:101786. PubMed: Full-text:

Important comment on mass religious gatherings. The authors recommend restrictions on the entry of Hajj pilgrims who are from epicentres and hotspots, from countries with suboptimal disease surveillance systems or with inadequate quarantine and diagnostic infrastructure for returning pilgrims who are over 50 years old or suffer from chronic disease, ie patients with diabetes and cardiovascular complications. Saudi Arabia needs to deploy a pre-emptive approach. We’ll see whether this is feasible.


Habib H. Has Sweden’s controversial covid-19 strategy been successful? BMJ 2020; 369. Full-text:

Probably not. Some thoughts on Sweden’s controversial decision not to lock down the country. They are still far away from herd immunity (an ongoing nationwide study on 20 May found that just 7.3% of Stockholm residents had developed antibodies) and the death toll is immense.


Okell LC, Verity R, Watson OJ, et al. Have deaths from COVID-19 in Europe plateaued due to herd immunity? Lancet. 2020 Jun 11:S0140-6736(20)31357-X. PubMed: Full-text:

No. Epidemiological data suggest that no country has yet seen infection rates sufficient to prevent a second wave of transmission, should controls or behavioural precautions be relaxed without compensatory measures in place.



Rempel D, Members of the N95DECON Consortium. Scientific Collaboration During the COVID-19 Pandemic: Annals of Work Exposures and Health 2020, June 13. Full-text:

This commentary describes the spontaneous formation of an international team of 115 researchers who summarized the literature on safe methods for decontaminating N95 filtering facepiece respirators in response to the supply crisis. The summary reports and fact sheets on the website are frequently being updated with new research findings and have had more than 200,000 visits.



Kam KG, Yung CF, Maiwald M, et al. Clinical Utility of Buccal Swabs for Severe Acute Respiratory Syndrome Coronavirus 2 Detection in Coronavirus Disease 2019–Infected Children. J Ped Inf Dis 2020, Jun 13. Full-text:

Best conclusion of the day: “Buccal swabs are not good” as COVID-19 screening specimens in children. In 11 children positive via nasopharyngeal swabs, 2 remained negative using buccal swabs. There was a general trend for buccal specimens to contain lower SARS-CoV-2 viral loads (higher Ct values) compared with nasopharyngeal specimens. The sensitivity of buccal swabs compared with nasopharyngeal swabs ranged from 25% to 71.4% on different days of collection during the first week of illness/diagnosis. Buccal SARS-CoV-2 was undetectable by day 8 of admission/diagnosis, although the nasopharyngeal SARS-CoV-2 was still detectable.


Lamb LE, Bartolone SN, Ward E, Chancellor MB. Rapid detection of novel coronavirus/Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by reverse transcription-loop-mediated isothermal amplification. PLoS One. 2020 Jun 12;15(6):e0234682. PubMed: Full-text: eCollection 2020

The authors describe a “fast and robust assay for detection of SARS-CoV-2 in 30–45 minutes”. This simple assay (Reverse Transcription Loop-Mediated Isothermal Amplification, RT-LAMP) could be used outside of a central laboratory on various types of biological samples. This assay can be completed by individuals without specialty training or equipment and may provide a new diagnostic strategy for combatting the spread of SARS-CoV-2 at the point-of-risk. However, numbers of tested samples were low. Sensitivity and specificity have to be tested in larger populations.


Chia WN, Tan CW, Foo R, et al. Serological differentiation between COVID-19 and SARS infections. Emerg Microbes Infect. 2020 Jun 12:1-23. PubMed: Full-text:

The authors examined the performance of N, S1 and RBD proteins from SARS-CoV-2 and SARS-CoV in four different test platforms. Results show that the RBD protein provides the best specificity, whereas the N protein of either virus is not suitable to detect virus-specific antibodies due to a very high level of cross-reactivity.


Severe COVID-19

Endeman H, van der Zee P, van Genderen ME, van den Akker JPC, Gommers D. Progressive respiratory failure in COVID-19: a hypothesis. Lancet Infect Dis. 2020 Apr 29:S1473-3099(20)30366-2. PubMed: Full-text:

Of 90 patients with severe COVID-19, 17 deteriorated within 2 weeks and no longer responded to prone positioning. All (!) of these patients had major pulmonary embolism established by lung CT or cardiac ultrasound. A plasma D-dimer concentration greater than 4 μg/mL, combined with increasing inflammatory markers such as interleukin-6 (the authors recommend to measure it regularly), and loss of response to prone positioning might be useful parameters to identify patients at risk of pulmonary embolism.


Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020 Jun 12. PubMed: Full-text:

One of the best reviews on this topic to date. AKI is prevalent in critically ill COVID-19 patients. Several mechanisms are possibly involved, including direct invasion of SARS-CoV-2 into the renal parenchyma, an imbalanced RAAS and microthrombosis, but also kidney injury secondary to hemodynamic instability, inflammatory cytokines and the consequences of therapeutics that are used in ICU (nephrotoxic drugs, mechanical ventilation).



Doglietto F, Vezzoli M, Gheza F, et al. Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy. JAMA Surg. 2020 Jun 12. PubMed: Full-text:

There is no good time for surgery: In this cohort study of 41 surgical patients with COVID-19 and 82 tightly matched control patients, significant differences were documented regarding rates of early mortality and complications (odds ratios 9.5 and 5.0, respectively), mainly pneumonia and thrombotic complications, were significantly associated with COVID-19, and different models identified COVID-19 as the first variable associated with surgical complications. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.