Top 10: June 18

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By Christian Hoffmann &
Bernd S. Kamps

18 June

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Soriano V, Meiriño R, Corral O, Guallar MP. SARS-CoV-2 antibodies in adults in Madrid, Spain. Clin Infect Dis. 2020 Jun 16:ciaa769. PubMed: . Full-text:

Madrid has been the most deeply hit region by COVID-19 in Spain, with 65,000 confirmed cases and 9,000 deaths up to May 10th, eight weeks after the country’s lockdown had been implemented on March 14th. The authors found that roughly 10.9% of adults in Madrid (excluding those living in communities of 10 to 25 persons) had SARS-CoV-2 antibodies at the time of lockdown release on May 10th.



Jing JQ, Liu MJ, Yuan J. Household secondary attack rate of COVID-19 and associated determinants in Guangzhou, China: a retrospective cohort study. Lancet Infect Dis. 2020; (published online June 17.)

Are children less susceptible? Using a comprehensive contact tracing dataset, the authors estimated secondary attack rate among household contacts to be 12.4% (95% CI 9.8–15.4) when household contacts were defined on the basis of close relatives, and 17.1% (13.3–21.8) when household contacts were defined on the basis of residential address. Compared with the oldest age group (≥ 60 years), the risk of household infection was lower in the youngest age group (< 20 years; odds ratio 0.23) and among adults aged 20–59 years (OR 0.64).


Du W, Yu J, Liu X, Chen H, Lin L, Li Q. Persistence of SARS-CoV-2 virus RNA in feces: A case series of children. J Infect Public Health. 2020 Jun 7. PubMed: . Full-text:

During follow-up examination after discharge, seven out of ten children contained SARS-CoV-2 virus RNA in their fecal specimens, despite all patients showing negative results in respiratory tract specimens. One out of those seven patients relapsed. The median time from onset to being negative in respiratory tract and fecal specimens was 9 days and 34.43 days, respectively.


Dhand R, Li J. Coughs and Sneezes: Their Role in Transmission of Respiratory Viral Infections, Including SARS-CoV-2. Am J Respir Crit Care Med. 2020 Jun 16. PubMed: . Full-text:

Everything you always wanted to know about… coughs and sneezes. A total of 79 references are used to explain how larger droplets produced by coughing and sneezing settle quickly, and the force with which they are expelled determines how far they are dispersed. Nice visuals in the supplement at the end of the paper.



Lyu W, Wehby GL. Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US. Health Aff (Millwood). 2020 Jun 16. PubMed: . Full-text:

Masks, masks, masks. This study provides evidence from a natural experiment on the effects of state government mandates in the US for face mask use in public issued by 15 states plus DC between April 8 and May 15. Mandating face mask use in public was associated with a decline in the daily COVID-19 growth rate by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage-points in 1–5, 6–10, 11–15, 16–20, and 21+ days after implementation, respectively. Estimates suggest as many as 230,000–450,000 COVID-19 cases possibly averted by May 22, 2020 due to these mandates.



Elinghaus D, Degenhardt F, Bujanda L, et al. Genomewide Association Study of Severe Covid-19 with Respiratory Failure. NEJM, June 17, 2020. Full-text:

The authors identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with COVID-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. A blood-group–specific analysis showed a higher risk in blood group A than in other blood groups (odds ratio, 1.45; 95% CI, 1.20 to 1.75) and a protective effect in blood group O as compared with other blood groups (odds ratio, 0.65; 95% CI, 0.53 to 0.79). However, please don’t measure the blood groups of your patients now. The risk elevations are low (male gender possibly, see below). These results are much more relevant with regard to the underlying pathophysiology (the locus also contains genes encoding chemokine receptors).


Clark A, Jit M, Warren-Gash C, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. The Lancet Global Health June 15, 2020. Full-text:

No good prospects. Analyzing data from 188 nations, the team estimates that 1.7 billion people worldwide have an elevated risk of ‘severe’ illness. The researchers also estimate that 349 million (186–787) people (4% of the global population) are at high risk of severe COVID-19 and would require hospital admission if infected (ranging from < 1% of those younger than 20 years to approximately 20% of those aged 70 years or older). In total, 6% of males were found to be at high risk compared with 3% of females.


Severe COVID-19

Thompson AE, Ranard BL, Wei Y. Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure. JAMA Intern Med June 17, 2020. Full-text:

The next study on proning. In this small single-center cohort study, use of the prone position for 25 awake, spontaneously breathing patients with COVID-19 was associated with improved oxygenation. In addition, patients with an Spo2 of 95% or greater after 1 hour of the prone position was associated with a lower rate of intubation. Unfortunately, there was no control group and the sample size was very small. Ongoing clinical trials of prone positioning in non–mechanically ventilated patients (NCT04383613, NCT04359797) will hopefully help clarify the role of this simple, low-cost approach for patients with acute hypoxemic respiratory failure.



De Luca G, Cavalli G, Campochiaro C, et al. GM-CSF blockade with mavrilimumab in severe COVID-19 pneumonia and systemic hyperinflammation: a single-centre, prospective cohort study. Lancet Rheumatology 2020, June 16. Full-text:

Mavrilimumab, an anti-granulocyte macrophage colony stimulating factor receptor-α monoclonal antibody, was added as a single intravenous dose to standard management in 13 patients with severe COVID-19 pneumonia, hypoxia, and systemic hyperinflammation (26 patients with “contemporaneous patients with similar baseline characteristics“ were used a control group. During the 28-day follow-up, no patients in the mavrilimumab group died, and seven (27%) patients in the control group died (p=0.086). At day 28, all patients in the mavrilimumab group and 17 (65%) patients in the control group showed clinical improvement (p=0.030), with earlier improvement in the mavrilimumab than in the control group. Comment: Interesting, but larger trials are needed. Small sample size, an absence of randomisation, and a short follow-up period may reduce the full generalisability.


Mehta P, Porter JC, Manson JJ, et al. Therapeutic blockade of granulocyte macrophage colony-stimulating factor in COVID-19-associated hyperinflammation: challenges and opportunities. Lancet Respiratory Medicine June 16, 2020. Full-text:

Granulocyte macrophage colony-stimulating factor (GM-CSF) is an immunoregulatory cytokine with a pivotal role in initiation and perpetuation of inflammatory diseases. In this nice review, the authors consider the scientific rationale and potential risks for therapeutic targeting of GM-CSF in COVID-19-associated hyperinflammation.