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By Christian Hoffmann &
Bernd S. Kamps
Epidemiology
Njuguna H, Wallace M, Simonson S, et al. Serial Laboratory Testing for SARS-CoV-2 Infection Among Incarcerated and Detained Persons in a Correctional and Detention Facility — Louisiana, April–May 2020. MMWR Morb Mortal Wkly Rep. ePub: 29 June 2020. Full-text: http://dx.doi.org/10.15585/mmwr.mm6926e2
High COVID-19 attack rates can occur in correctional and detention facilities. During May 7–21, among 98 incarcerated and detained persons in Louisiana who were quarantined because of virus exposure , 71 (72%) had lab-confirmed SARS-CoV-2 infection identified through serial testing, among them 45% without any symptoms at the time of testing. These findings suggest ongoing transmission among quarantined persons living in close settings; therefore, serial testing of contacts of persons with COVID-19 in correctional and detention facilities can identify asymptomatic and presymptomatic persons who would be missed through symptom screening alone.
Brown NE, Bryant-Genevier J, Bandy U, Browning CA, Berns AL, Dott M, et al. Antibody responses after classroom exposure to teacher with coronavirus disease, March 2020. Emerg Infect Dis. 2020 Sep [date cited]. https://doi.org/10.3201/eid2609.201802
No big surprise: classroom interaction between an infected teacher and students might result in virus transmission. After returning from Europe to the United States on March 1, 2020, a symptomatic teacher received positive test results. In total 2/21 students exposed to the teacher in the classroom had positive serologic results.
Pulla P. ‘The epidemic is growing very rapidly’: Indian government adviser fears coronavirus crisis will worsen. Nature 2020, June 26. Full-text: https://www.nature.com/articles/d41586-020-01865-w
Interview with Jayaprakash Muliyil, an epidemiologist and advisor of the Indian government, providing insight into the epidemic in India where the virus seems to spread much faster and the infection rates are higher. A discussion on why officials in some badly affected cities seem reluctant to say that outbreaks are being driven by community transmission — where cases cannot be linked to known sources.
Immunology, Vaccine
Cohen J. The line is forming for a COVID-19 vaccine. Who should be at the front? Science Mag 2020, June 29. Full-text: https://www.sciencemag.org/news/2020/06/line-forming-covid-19-vaccine-who-should-be-front
Even if the optimists are right and a COVID-19 vaccine is approved for widespread use as early as this fall, it is likely to be in short supply at first. This article summarizes WHO’s and CDC’s plans to deal with this problem. For the US, a top tier includes 12 million people referred to as “critical health care and other workers,” with the first doses going to a subset of these people who are the “highest risk medical, national security, and other essential workers”. Tiers two and three would include 110 million people who also work in health care and other essential jobs, or are in these groups: 65 and older, living in long-term care facilities, or those with medical conditions known to increase the risk of developing severe COVID-19. And then everyone else.
Transmission
Dau NQ, Lau H, Skinner C. Why N95 Should Be the Standard for All COVID-19 Inpatient Care. Ann Int Med 2020, Jun 29. Full-text: https://doi.org/10.7326/M20-2623
Important viewpoint emphasizing that N95 respirators achieve better filtration of airborne particles than medical masks if used properly and continuously. According to the authors, guideline recommendations that do not support N95 use for all inpatient COVID-19 management should consider reevaluating existing data or at least acknowledge the issues raised.
Oosterhoff B, Palmer CA. Attitudes and Psychological Factors Associated With News Monitoring, Social Distancing, Disinfecting, and Hoarding Behaviors Among US Adolescents During the Coronavirus Disease 2019 Pandemic. JAMA Pediatr. Published online June 29, 2020. Full-text: https://doi.org/10.1001/jamapediatrics.2020.1876
Interesting survey on 770 adolescents’ beliefs about COVID-19 and community attachment as well as attitudes and psychological factors that inform their response to the pandemic. Many teens reported not engaging in pure social distancing (69%), but they were monitoring the news (89%) and disinfecting daily (88%). Some teens reported hoarding (20%). Greater social responsibility was associated with more disinfecting and news monitoring and less hoarding. Greater self-interest values were associated with less social distancing and more hoarding.
Diagnostics
Choe PG, Kang CK, Suh HJ, Jung J, Kang EK, Lee SY, et al. Antibody responses to SARS-CoV-2 at 8 weeks postinfection in asymptomatic patients. Emerg Infect Dis. 2020 Sep [date cited]. Full-text: https://doi.org/10.3201/eid2610.202211
The authors compared levels of SARS-CoV-2 neutralizing antibodies in recovery plasma from 7 completely asymptomatic patients with those in symptomatic patients in South Korea. Serologic diagnostic testing was positive for 71% (5/7) of completely asymptomatic patients, but neutralizing antibody response occurred in all 7 patients.
Comorbidities
Tison GH, Avram R, Kuhar P, et al. Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study. Ann Int Med 2020, June 29. Full-text: https://doi.org/10.7326/M20-2665
Big data: Using data from a popular health and wellness smartphone app (Argus), a rapid worldwide step count decrease was seen during the COVID-19 pandemic, with regional variability. Samples from different countries varied widely in the number of days after pandemic declaration that a 15% step count decrease was seen: Italy (5 days), Spain (9 days), France (12 days), India (14 days), the United States (15 days), the United Kingdom (17 days), Australia (19 days), and Japan (24 days).
Severe COVID-19
McGonagle D, O’Donnell JS, Sharif K. Pulmonary intravascular coagulopathy in COVID-19 pneumonia – Authors’ reply. Lancet June 29, 2020. Full-text: https://doi.org/10.1016/S2665-9913(20)30174-0
Interesting discussion about the diffuse, alveolar-centred inflammation that triggers immunothrombosis in the lung microvasculature of patients with COVID-19 pneumonia. It seems highly probable that multiple mechanisms contribute to the pulmonary intravascular coagulopathy.
Mangalmurti N, Hunter CA. Cytokine Storms: Understanding COVID-19. Immunity June 28, 2020. Full-text: https://doi.org/10.1016/j.immuni.2020.06.017
Facing the storm: In their nice overview, the authors explain the protective function of cytokines in “ideal” responses; the multi-factorial origins that can drive these responses to become pathological; and how this ultimately leads to vascular damage, immunopathology, and worsening clinical outcomes. Of note, not all cytokine storms are the same, and there are many variables—the nature of the insult, host immune status, tissue affected, crosstalk with immune thrombosis, and complement activation—that influence the magnitude and kinetics of these responses and thus the clinical manifestations.
Pediatrics
Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. NEJM June 29, 2020. Full-text: https://doi.org/10.1056/NEJMoa2021680
The largest study on multisystem inflammatory syndrome in children (MIS-C) to date. The authors report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing. Detailed analysis of clinical manifestation revealed the gastrointestinal system (92%), cardiovascular (80%), hematologic (76%), mucocutaneous (74%), and respiratory involvement (70%). In total 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, and 4 (2%) died. Coronary-artery aneurysms were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%).