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Nagler AR, Goldberg ER, Aguero-Rosenfeld ME, et al. Early Results from SARS-CoV-2 PCR testing of Healthcare Workers at an Academic Medical Center in New York City. Clin Inf Dis, June 28, 2020. Full-text: https://doi.org/10.1093/cid/ciaa867
Widespread testing of HCW offers valuable information for hospital workflow and workforce amid an epidemic that threatened to overwhelm the healthcare system. Over eight weeks, 14,764 employees were tested: 33% of employees were symptomatic, 8% of asymptomatic employees reported COVID-19 exposure, 3% of employees returning to work were antibody-positive. Positivity rates declined over time.
Hong LX, Lin A, He ZB, et al. Mask wearing in pre-symptomatic patients prevents SARS-CoV-2 transmission: An epidemiological analysis. Travel Med Infect Dis. 2020 Jun 24;36:101803. PubMed: https://pubmed.gov/32592903. Full-text: https://doi.org/10.1016/j.tmaid.2020.101803
The incidence of COVID-19 doubled (19.0% vs. 8.1%) for local residents who had close contact with people returning from Wuhan, who did not wear masks and turned out to be pre-symptomatic COVID-19 patients. In this study, a cluster of 21 local COVID-19 patients originated from a couple returning from Wuhan who played cards sequentially in a space-limited Chess and Card Room or who were living together over a longer-term with pre-symptomatic or asymptomatic relatives. No bridge for grandma during these days.
Maltezou HC, Dedoukou X, Tseroni M, et al. SARS-CoV-2 infection in healthcare personnel with high-risk occupational exposure: evaluation of seven-day exclusion from work policy. Clin Inf Dis June 29, 2020. Full-text: https://doi.org/10.1093/cid/ciaa888
In this study, 3,398 occupationally-exposed HCW were followed prospectively, among them 1,599 (47.1%) with low-risk, 765 (22.5%) with moderate-risk, and 1,031 (30.4%) with high-risk exposures. Of the 66 HCW with COVID-19, 46, 7, and 13 had a history of high-, moderate- or low-risk exposure. Male gender, administrative personnel, underlying disease and high-risk exposure were significantly associated with an increased risk for the onset of COVID-19. HCW with high-risk occupational exposure to COVID-19 had increased probability of serious morbidity, healthcare seeking, hospitalization and absenteeism.
Shrestha NK, Canosa FM, Nowacki AS, et al. Distribution of Transmission Potential during Non-Severe COVID-19 Illness. Clin Inf Dis 29 June 2020. Full-text: https://doi.org/10.1093/cid/ciaa886
Infectivity lasts ten days. In 230 HCW with non-severe COVID-19, viral loads declined by orders of magnitude within a few days of symptom onset. Of the area under the curve (the distribution of transmission potential over time during the course of illness) spanning symptom onset to 30 days, 86.3% lay within the first 5 days, 96.9% within the first 7 days, and 99.7% within the first 10 days. The only variable significantly associated with viral load was time from onset of symptoms.
Pastorino B, Touret F, Gilles M, de Lamballerie X, Charrel RN. Prolonged infectivity of SARS-CoV-2 in fomites. Emerg Infect Dis. 2020 Sep [date cited]. Full-text: https://doi.org/10.3201/eid2609.201788
Clean surfaces! The authors observed a steady infectivity (< 1 log10 drop) on plastic, a 3.5 log10 decrease on glass, and a 6 log10 drop on aluminum within 96 hours. Data showed that SARS-CoV-2 infectivity was remarkably preserved in the presence of proteins (bovine serum albumin), regardless of the type of surface.
Pinninti S, Trieu C, Pati SK; et al. Comparing Nasopharyngeal and Mid-Turbinate Nasal Swab Testing for the Identification of SARS-CoV-2. Clin Inf Dis 29 June 2020. Full-text: https://doi.org/10.1093/cid/ciaa882
Mid-turbinate nasal swab is not sufficient. Testing of paired MT nasal and nasopharyngeal (NP) swabs, collected by trained personnel from 40 patients with COVID-19 showed more NP (76/95, 80%) than MT swabs tested positive (61/95, 64%; p=0.02). Among samples collected a week after study enrollment, fewer MT than NP samples were positive (45% vs 76%; p=0.001). Patients whose NP swabs are PCR-positive but have a lower viral load as suggested by high CT values (> 30), may often test negative by MT swab.
Nicol T, Lefeuvre C, Serri O, et al. Assessment of SARS-CoV-2 serological tests for the diagnosis of COVID-19 through the evaluation of three immunoassays: Two automated immunoassays (Euroimmun and Abbott) and one rapid lateral flow immunoassay (NG Biotech). J Clin Virol. 2020 Jun 15;129:104511. PubMed: https://pubmed.gov/32593133. Full-text: https://doi.org/10.1016/j.jcv.2020.104511
Lateral flow immunoassay (LFIA) can be used easily as point of care tests or in the laboratory, with a result in less than 15 min. In this study, a LFIA (NG-Test®) was reliable and accurate. The authors compared LFIA and two immunoassays (Abbott CLIA and Euroimmun ELISA) in 293 specimens. Overall sensitivity for IgG was equivalent (around 80%) among all tests and reached 100% > 14 days after onset of symptoms. Overall specificity for IgG was greater for CLIA and LFIA (more than 98%) compared to ELISA (95.8%). Specificity was significantly different between IgA ELISA (78.9%) and IgM LFIA (95.8%) (p < 0.05).
Price-Haywood EG, Burton J, Fort D, et al. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med 2020; June 25, 382:2534-2543. Full-text: https://doi.org/10.1056/NEJMsa2011686
It’s not ethnicity. Of a total of 3,481 COVID-19 patients, seen within an integrated-delivery health system in Louisiana, 70.4% were black non-Hispanic. Although black patients represent 31% of the patients routinely cared for in the system, they made up 76.9% of hospitalized COVID-19 patients. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. However, black race was NOT associated with higher in-hospital mortality than white race, after adjustment for sociodemographic and clinical differences on admission. Of note, there were racial differences in several laboratory results, indicating a longer wait to access care among black patients, resulting in more severe illness on presentation to health care facilities.
Bielecki M, Züst R, Siegrist D, et al. Social distancing alters the clinical course of COVID-19 in young adults: A comparative cohort study. Clin Inf Dis, June 29, 2020. Full-text: https://doi.org/10.1093/cid/ciaa889
Important finding that was long suspected: viral inoculum during infection or mode of transmission may be key factors determining the clinical course of COVID-19. The authors prospectively studied an outbreak in Switzerland among a population of 508 predominantly male soldiers with a median age of 21 years. Infections were followed in two spatially separated cohorts with almost identical baseline characteristics – before and after implementation of stringent social distancing. Results: of 354 soldiers infected prior to the implementation of social distancing, 30% fell ill. In contrast, none out of 154 soldiers in which infections (confirmed by NP swabs or serology) appeared after implementation of social distancing developed COVID-19.
Leegwater E, Strik A, Wilms EB, et al. Drug-induced liver injury in a COVID-19 patient: potential interaction of remdesivir with P-glycoprotein inhibitors. Clin Inf Dis, 28 June 2020. Full-text: https://doi.org/10.1093/cid/ciaa883
Acute hepatotoxicity related to remdesivir (now sold under the brand name Veklury®), with probable interaction of P-glycoprotein (P-gp) inhibitors. Five days after start of remdesivir, a patient developed an acute increase in ALT (1305 IU/L) and AST (1461 U/L). Total bilirubin was 8 μmol/L. The patient was treated with the P-gp inhibitors chloroquine (last administration nine days before remdesivir, with a half-life of two weeks) and amiodarone (concomitantly with remdesivir). Authors recommend physicians to be cautious with the prescription of P-gp inhibitors in patients receiving remdesivir therapy.