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By Christian Hoffmann &
Bernd S. Kamps
Among other topics, SARS-CoV-2 Infection infection among incarcerated and detained persons in a correctional and detention facility; antibody responses after classroom exposure to teacher with coronavirus disease; why N95 should be the standard for all COVID-19 inpatient care; pulmonary intravascular coagulopathy in COVID-19 pneumonia; cytokine storms: understanding COVID-19; and multisystem inflammatory syndrome in U.S. children and adolescents.
Among other topics, social distancing alters the clinical course of COVID-19 in young adults; mask wearing in pre-symptomatic patients prevents SARS-CoV-2 transmission; SARS-CoV-2 infection in healthcare personnel with high-risk occupational exposure; prolonged infectivity of SARS-CoV-2 in fomites; and hospitalization and mortality among black patients and white patients with covid-19.
Here we present the best or weirdest (depending on your point of view) case reports on COVID-19 published in the first 6 months. Focus of this first issue will be gastrointestinal manifestations…
Among other topics, “The second wave”; personal protective equipment and covid-19; reducing transmission of SARS-CoV-2; in vitro microneutralization assay for SARS-CoV-2 serology; why is obesity associated with increased COVID-19 mortality; and why high-dose but not low-dose corticosteroids potentially delay viral shedding of patients with COVID-19.
Among other topics, the immunology of COVID-19; acute acral lesions in a case series of children and adolescents; neurological and neuropsychiatric complications of COVID-19; the impact of physical activity on psychological health during the COVID-19 pandemic; clues suggesting SARS-CoV-2 might trigger diabetes; COVID-19 in 7 multiple sclerosis patients in treatment with ANTI-CD20 therapies; and COVID-19 mortality in patients on anticoagulants and antiplatelet agents.
Among other topics, Covid-19 outbreak among college students after a spring break trip to Mexico; asymptomatic SARS-CoV-2 infection in nursing homes, Barcelona; in-hospital use of statins; determinants of COVID-19 disease severity in patients with cancer; and tocilizumab in patients with severe COVID-19.
Among other topics, common epitopes and recurrent features of antibodies; transmission of COVID-19 virus by droplets and aerosols; transmission risk from environmental matrices and surfaces; super-factors associated with transmission… and herd immunity at 43%?
Among other topics, (bad) performance of some commercial antibody tests, a warning against use conjunctival swabs, a review of studies of asymptomatic patients as a source of COVID-19 infections, a paper of state-of-the-art application of respiratory support, and outcomes in patients with severe COVID-19 disease treated with tocilizumab (n=96).
Among other topics, prevalence of SARS-CoV-2 specific neutralising antibodies in blood donors from the Lodi Red Zone in Lombardy, nosocomial transmission of COVID-19, a multicentre comparison of quantitative PCR-based assays, serum cytokine and chemokine profile, and ST-segment elevation in patients with Covid-19.
Among other topics, COVID-19 across Africa, SARS-CoV-2 among asymptomatic workers in China screened to go back to work, hijacking the host cell’s machinery, COVID-19-associated coagulopathy, and duration of hepatic and intestinal CYP3A inhibition after stopping lopinavir/r treatment.
Among other topics, impact of COVID-19 in refugee camps, amplifying RNA vaccine development, destruction of the prefusion Spike, mediastinal lymphadenopathy and prognosis, and prone positioning in non-intubated patients.
Among other topics, estimation of super-spreading events, prevalence of COVID-19 infection and outcomes among symptomatic healthcare workers in Seattle, immunological assessment of asymptomatic SARS-CoV-2, COVID-19 resurgence in Iran, and and prognosis of patients with sickle cell disease.
Among other topics, SARS-CoV-2 antibodies in adults in Madrid, household secondary attack rate in Guangzhou, persistence of SARS-CoV-2 virus RNA in feces, GM-CSF blockade with mavrilimumab, and everything you always wanted to know about… coughs and sneezes.
Among other topics, age-dependent effects in the transmission and control of COVID-19, hospital-wide SARS-CoV-2 antibody screening in 3056 staff, asymptomatic SARS-CoV-2 infection, JAK-STAT signaling, and more on isolation, testing, contact tracing, and physical distancing.
Today, a detailed picture of the epidemic in the US. Demographic characteristics, underlying health conditions, symptoms, and outcomes among 1,320,488 laboratory-confirmed COVID-19 cases individually reported to CDC during January 22–May 30, 2020. Some key messages: Overall, 14% of patients were hospitalized, 2% were admitted to an intensive care unit (ICU), and 5% died.
Among other topics: religious tourism and COVID, Sweden‘s COVID strategy, reverse transcription-loop-mediated isothermal amplification, acute kidney injury and major pulmonary embolism.
Warburton E, Raniolo G. Domestic Abuse during COVID-19: What about the boys? Psychiatry Research. Volume 291, September 2020, 113155.
Harsh criticism on a previous article, summarizing that, during the COVID-19 pandemic, domestic abuse experienced by men is of ‘lower severity’. The authors want to steer the domestic abuse conversation away from a gender divide and open up the discussion to promote zero tolerance of domestic abuse towards both men and women. They propose that “domestic abuse towards men, although less frequent, is of equal severity to the domestic abuse suffered by women”. Best conclusion of the day: “Abuse is abuse.”
Sakurai A, Sasaki T, Kato S, et al. Natural History of Asymptomatic SARS-CoV-2 Infection. NEJM June 12, 2020.
More on asymptomatic infection: The authors followed 90 persons from the cruise ship Diamond Princess who were asymptomatic at the time of the positive PCR test and remained so until the resolution of infection (as determined by two consecutive negative PCR tests). 27% had coexisting medical conditions. The median time between the first positive PCR test result (either on the ship or at the hospital) and the first of the two serial negative PCR results was 9 days (range, 3 to 21), and the cumulative percentages of persons with resolution of infection 8 and 15 days after the first positive PCR were 48% and 90%, respectively.
Furuse Y, Sando E, Tsuchiya N, et al. Clusters of Coronavirus Disease in Communities, Japan. January-April 2020. Emerg Infect Dis. 2020 Jun 10;26(9). | Bye, bye, karaoke. The Japanese authors defined a cluster as > 5 cases with primary exposure reported at a common event or venue, excluding within-household transmissions. In total, 61 COVID-19 clusters were found in various communities in the country: 18 (30%) in healthcare facilities; 10 (16%) in care facilities of other types, such as nursing homes and day care centers; 10 (16%) in restaurants or bars; 8 (13%) in workplaces; 7 (11%) in music-related events, such as live music concerts, chorus group rehearsals, and karaoke parties; 5 (8%) in gymnasiums; 2 (3%) in ceremonial functions; and 1 (2%) in transportation-related incident in an airplane. Of note, 41% of probable primary case-patients were pre-symptomatic or asymptomatic at the time of transmission. 45% had cough. Many clusters were associated with heavy breathing in close proximity.
Piller C. Who’s to blame? These three scientists are at the heart of the Surgisphere COVID-19 scandal. Science Mag 2020, June 8.
More insights into the research scandal about two fake COVID-19 treatment papers (published in The Lancet and the NEJM) that were retracted last week. There were several red flags that the studies warranted intensive scrutiny – scrutiny that the two journals unforgivably failed to provide. This scandal tells us a lot about scientific publishing. Answers, comments, explanations by the two journals are still pending.
El-Boghdadly K, Wong DJN, Owen R, et al. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. Anaesthesia. 2020 Jun 9.
Around 1 in 10 HCW becomes infected: This prospective international multicentre cohort study recruited 1,718 healthcare workers participating in 5,148 tracheal intubation episodes of patients with suspected or confirmed COVID‐19 from 503 hospitals in 17 countries. The overall incidence of the primary endpoint (lab‐confirmed COVID‐19 diagnosis or new symptoms requiring self‐isolation or hospitalisation) was 10.7% over a median follow‐up of 32 days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1%, and 8.5%, respectively. The risk varied by country and was higher in females, but was not associated with other factors.
Gutierrez L, Beckford J, Alachkar H. Deciphering the TCR repertoire to solve the COVID-19 mystery. Trends Pharmacol Sci. June 03, 2020.
Outstanding article on unresolved questions. Why do some patients develop severe disease, while others do not; and what roles do genetic variabilities play in the individual immune response to this viral infection? The authors discuss the critical role T-cells play in the orchestration of the antiviral response underlying the pathogenesis of COVID-19. They highlight the scientific rationale for that analyzing TCR repertoire would reveal important findings that may explain the outcome disparity.
Newman A, Smith D, Ghai RR. First Reported Cases of SARS-CoV-2 Infection in Companion Animals — New York, March–April 2020. MMWR, June 8, 2020, 69.
American cats are not protected: Two domestic cats with respiratory illnesses lasting 8 and 10 days were the first reported companion animals with SARS-CoV-2 infection in the United States. Both cats were owned by persons with suspected or confirmed COVID-19. According to the authors, persons with COVID-19 should avoid contact with animals. Companion animals that test positive for SARS-CoV-2 should be monitored and separated from persons and other animals until they recover. Good news: both cats fully recovered.
Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020 Jun 3;369:m2094.
Of 21 children and adolescents (3.7-16.6 years, 19 with recent SARS-CoV-2 infection) with features of Kawasaki disease who were admitted between 27 April and 11 May 2020, 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms and high levels of inflammatory markers. All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients.
First, develop a policy perspective to protect healthcare workers during the COVID-19 pandemic; write a systematic review about physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2; and investigate the effectiveness of N95 respirator decontamination and reuse against SARS-CoV-2.
Afterwards, build a mouse model of SARS-CoV-2 infection and pathogenesis; discuss the challenges and implications of false negative tests for SARS-CoV-2 infection; and ask 530 patients with upper respiratory infection to collect tongue, nasal, and mid-turbinate samples.
Finally, review the available evidence on asymptomatic SARS-CoV-2 infection; describe the rate and severity of hemostatic and thrombotic complications of 400 hospital-admitted COVID-19 patients; and analyze the effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19.
Lancet and the NEJM: Retractions | We suspected it. Yesterday, two papers that were considered milestones in COVID-19 research (and were well-reviewed in our Top Ten section) were retracted by the authors.
Which papers are we talking about?
Voice: Google Cloud Text-to-Speech / US
First, calculate the number of COVID-19 cases, deaths, and demand for hospital services in the UK in the absence of non-pharmaceutical interventions; retract an article about the effectiveness of surgical and cotton masks; and discuss the ethical issues of COVID-19 human challenge studies.
Afterwards, test the clinical performance of several serologic assays; study the effect of extensive wildlife trade bans on zoonotic disease burden; and describe the psychosocial burden of COVID-19.
Finally, investigate the airborne spread of SARS-CoV-2 and a potential role for air disinfection; and write an editor’s comment on a study you just published and don’t trust anymore.
Hydroxychloroquine – no better than placebo? Telling a day full of turnaround.
Boulware DR, Pullen MF, Bangdiwala AS, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med 2020, June 3. Full-text: https://www.nejm.org/doi/full/10.1056/NEJMoa2016638
Voice: Google Cloud Text-to-Speech / Australia
Summer is coming! The next edition of COVID Reference (around 350 pages) will be published within days! Today we have some more good news. Please read here why.
First, discuss with your colleagues that famotidine use is associated with improved clinical outcomes in hospitalized COVID-19 patients; plan pharmacokinetic studies that will help to optimize dosage and formulation of favipiravir; and determine if positive PCR means infectivity.
Afterwards, discover the influence of COVID-19 on seasonal influenza activity; reduce the titer of SARS-CoV-2 in human plasma using riboflavin and UV light; describe why a decrease in B cells was independently associated with prolonged viral RNA shedding; and describe the characteristics associated with hospitalization for COVID-19 in people with rheumatic disease.
Finally, find out that of 509 medical staff working to treat COVID-19 patients at the Hyogo Prefectural Kakogawa Medical Center, none had IgG antibodies for SARS-CoV-2 in early May; write a systematic review of chest CT findings in 4410 adult patients with COVID-19; and evaluate a recently released assay which uses isothermal nucleic acid amplification of the RdRp viral target and is capable of producing positive results in as little as 5 minutes.
Voice: Google Cloud Text-to-Speech / India
First, test them all if there is a SARS-CoV-2 case in a nursing facility; summarize the “new normal” in Japan; and detect SARS-CoV-2 in human breast milk.
Afterwards, characterize the clinical course of 1000 patients in New York; learn that WHO halts one arm of the SOLIDARITY trial; and describe the impact of anticoagulation prior to COVID-19 infection.
Finally, investigate small droplet aerosols in poorly ventilated spaces; present to your colleagues the spectrum of cardiac manifestations in COVID-19; and discuss the outcomes of 31 people living with HIV who were hospitalized for COVID-19.