Top 10: June 22

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By Christian Hoffmann &
Bernd S. Kamps

22 June

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Percivalle E, Cambiè G, Cassaniti I, et al. Prevalence of SARS-CoV-2 specific neutralising antibodies in blood donors from the Lodi Red Zone in Lombardy, Italy, as at 06 April 2020. Euro Surveill. 2020;25(24. Full-text:

This study evaluated SARS-CoV-2 RNA and neutralizing antibodies in blood donors (BD) residing in the highly affected “Lodi Red Zone”, Italy (an area of 169 km2, including 10 municipalities and 51,500 inhabitants, which went into lockdown in February 2020). Of 390 BDs recruited after 20 February − when the first COVID-19 case in Lombardy was identified, 91 (23%) aged 19–70 years were antibody positive.


Savulescu J, Cameron J. Why lockdown of the elderly is not ageist and why levelling down equality is wrong. J Med Ethics. 2020 Jun 19:medethics-2020-106336. PubMed: Full-text:

Some intelligent thoughts on a “partial” lockdown for the elderly. The authors think that ethically, selective isolation is permissible. It is not unjust discrimination. It is analogous to only screening women for breast cancer: selecting those at a higher probability of suffering from a disease. Even if it were unjust discrimination, it would be proportionate because it brings benefits to the elderly and is necessary given the grave risks to the economy and subsequent well-being of the larger population of an indiscriminate lockdown. To oppose selective isolation of the elderly is to engage in a levelling down of equality which is itself morally questionable. There is no Hollywood happy ending here where everyone is a winner. Everything has its upsides and its downsides.



Rickman HM, Rampling T, Shaw K, et al. Nosocomial transmission of COVID-19: a retrospective study of 66 hospital-acquired cases in a London teaching hospital. Clin Infect Dis. 2020 Jun 20. PubMed: Full-text:

A good example for working up a catastrophy, learning from mistakes. Of 435 cases of PCR-positive inpatients in a London hospital, 47 (11%) met the definition for definite hospital acquisition, with a further 19 (4%) probable hospital-acquired. Symptom onset for these 66 hospital acquired cases was a median of 26 days (IQR 13-55) from admission. 24 (36%) patients died. Evidence of patient-to-patient transmission through contact in the same hospital bay was found in 55%.



Münchhoff M, Mairhofer H, Nitschko H, et al. Multicentre comparison of quantitative PCR-based assays to detect SARS-CoV-2, Germany, March 2020. Eurosurveillance 2020, June 18. 25(24). Full-text:

The authors compared 11 different RT-PCR test systems used in seven diagnostic laboratories in Germany in March 2020. The majority of RT-PCR assays detected ca 5 RNA copies per reaction, reflecting a high sensitivity and their suitability for screening purposes worldwide. A reduced sensitivity was noted for the original Charité RdRp gene confirmatory protocol, which may have impacted the confirmation of some cases in the early weeks of the pandemic. The CDC N1 primer/probe set was sensitive and robust for detection of SARS-CoV-2 in nucleic acid extracts from respiratory material, stool and serum from COVID-19 patients.


Chi Y, Ge Y, Wu B, et al. Serum Cytokine and Chemokine profile in Relation to the Severity of Coronavirus disease 2019 (COVID-19) in China. J Infect Dis. 2020 Jun 21:jiaa363. PubMed: Full-text:

In this study, the authors detected the serum levels of 48 cytokines and chemokines (!) in a cohort of 74 patients including asymptomatic, mild, moderate and severe cases with laboratory confirmed COVID-19 in Jiangsu, China. IL-6, IL-7, IL-10, IL-18, G-CSF, M-CSF, MCP-1, MCP-3, IP-10, MIG, and MIP-1α were found to be associated with the severity of COVID-19. Some cytokines were significantly higher in men and many were elevated in asymptomatic patients.



Bangalore S, Sharma A, Slotwiner A. ST-Segment Elevation in Patients with Covid-19 — A Case Series.  N Engl J Med June 18, 2020; 382:2478-2480. Full-text:

Among 18 patients with COVID-19 who had ST-segment elevation indicating potential acute myocardial infarction 6/9 patients who underwent coronary angiography had obstructive disease. However, prognosis was dismal: A total of 13 patients (72%) died in the hospital (4 with myocardial infarction and 9 with noncoronary myocardial injury).


Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol. 2020 Jun 19. PubMed: Full-text:

In a systematic review of the literature, 82 cases of COVID-19 with neurological complications were identified. Conclusion: Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain–Barré syndrome, and meningoencephalitis.


Schaefer IM, Padera RF, Solomon IH, et al. In situ detection of SARS-CoV-2 in lungs and airways of patients with COVID-19. Mod Pathol. 2020 Jun 19. PubMed: Full-text:

In 5/5 patients with acute phase DAD (≤ 7 days from onset of respiratory failure), SARS-CoV-2 was detected in pulmonary pneumocytes and ciliated airway cells, and in 2/5 in upper airway epithelium. In two patients with organizing DAD (> 14 days from onset of respiratory failure), no virus was detected in the lungs or airways. No endothelial cell infection was observed. The findings suggest that the virus is absent in the organizing phase.



El-Sharkawi D, Iyengar S. Haematological Cancers and the risk of severe COVID-19: Exploration and critical evaluation of the evidence to date. Br J Haematol. 2020 Jun 19. PubMed: Full-text:

The authors review the evidence to date to see whether a history of hematological malignancy is associated with increased risk of COVID‐19. Results: Multivariable analysis does indicate that patients with hematological malignancy, especially those diagnosed recently, are at increased risk of death with COVID‐19 compared to the general population. The evidence that this risk is higher than for those with solid malignancies is conflicting. There is suggestive evidence from smaller cohort studies that those with myeloid malignancy may be at increased risk within the blood cancer population, but this needs to be confirmed through larger studies.


Ibáñez-Samaniego L, Bighelli F, Usón C, et al. Elevation of liver fibrosis index FIB-4 is associated with poor clinical outcomes in patients with COVID-19. J Infect Dis. 2020 Jun 21:jiaa355. PubMed: Full-text:

In middle-aged patients with COVID-19, the FIB-4 index may have a relevant prognostic role. In a multivariate analysis, among other risk factors, a FIB-4 > 2.67 increased the risk of ICU admission significantly (OR 3.41; 95% CI 1.30-8.92).