Top 10: March 4

Copy-editor: Rob Camp


Paper of the Day

Oliver SE, Gargano JW, Scobie H, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Janssen COVID-19 Vaccine — United States, February 2021. MMWR Morb Mortal Wkly Rep. ePub: 2 March 2021. DOI:

The Janssen COVID-19 vaccine is a recombinant, replication-incompetent adenovirus serotype 26 (Ad26) vector vaccine, encoding the stabilized prefusion spike glycoprotein of SARS-CoV-2. On February 27, 2021, the FDA issued an Emergency Use Authorization (EUA). This is an interim recommendation for use in persons aged ≥ 18 years for the prevention of COVID-19, discussing the available data and the question who to vaccinate and when. Answer: everybody, ASAP. Of note, the Janssen vaccine seems to work in the B.1.351 lineage from South Africa as well in the P.2 lineage from Brazil.



Van Loon W, Hommes F, Theuring S, et al. Renewed absence of SARS-CoV-2 infections in the day care context in Berlin, January 2021. Clinical Infectious Diseases March 2.  Full-text:

The second round of a longitudinal study in 12 randomly selected kindergartens across Berlin including 156 children, 80 staff, and 488 household members of children and staff. According to the authors, repeated absence of SARS-CoV-2 infection four months apart, at weekly community incidences of 38 (first round in September) and 110/100,000, support the initial interpretation that kindergartens are not silent transmission reservoirs.



Phuong HVM, Tung TS, Trang UTH, et al. Novel mutation of SARS-CoV-2, Vietnam, July 2020. Emerg Infect Dis. 2021 May [date cited].

Now that the whole world is sequencing the virus, we are likely to see many such studies. A cluster in Danang, Vietnam, began July 25, 2020, and resulted in 551 confirmed cases and 35 deaths. The authors analyzed 26 sequences from this cluster and identified a novel shared mutation in non-structural protein 9, suggesting a single introduction into Vietnam. The single-nucleotide polymorphism, C835T, was not reported in any other sequences collected globally. However, it has no known associations with virulence or transmissibility.



Plante JA, Mitchell BM, Plante KS, et al. The Variant Gambit: COVID’s Next Move. Cell Host Microbe March 01, 2021.

Nice review that outlines factors driving SARS-CoV-2 variant evolution, explores the potential impact of specific mutations and examines the risk of further mutations. Jessica A. Plante and colleagues from the World Reference Center for Emerging Viruses and Arboviruses consider also the experimental studies needed to understand the threat these variants pose.


Transmission, Prevention

Lubrano R, Bliose S, Testa A, et al. Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic. JAMA Netw Open March 2, 2021. 4(3):e210414.

Are surgical masks associated with episodes of oxygen desaturation or respiratory distress among children? This study from Italy says no. Among 47 children (22 aged 24 months or younger!) the use of facial masks was not associated with significant changes in Sao2 or Petco2.


Wilmes P, Zimmer J, Schulz J, et al. SARS-CoV-2 transmission risk from asymptomatic carriers: Results from a mass screening programme in Luxembourg. Lancet Regional Health February 27, 2021. DOI:

To accompany the lifting of COVID-19 lockdown measures, Luxembourg implemented a mass screening (MS) program. Based on a participation of 49% amongst the resident population and 22% amongst cross-border workers, the MS program allowed identification of 1099 cases corresponding to 26% of positive cases related to an early summer epidemic wave. Among the index cases, 567 (67%) reported symptoms at the time of being informed of their positive test result (these may have been pre-symptomatic at the time of the test), whereas 283 (33%) were asymptomatic. Asymptomatic individuals had significant secondary attack rates, both in households and among close contacts, but these were lower compared to those for symptomatic cases.



Van den Hurk K, Merz EM, Prinsze FJ, et al. Low awareness of past SARS-CoV-2 infection in healthy plasma donors. Cell Reports Med February 25, 2021.

See title. They know nothing. Katja van den Hurk and colleagues asked individuals donating plasma across the Netherlands between May 11th and 18th 2020. Among 3676 with antibody and questionnaire data, 239 (6.5%) were positive for SARS-CoV-2 antibodies. Of those, 48% did not suspect COVID-19 despite the majority reporting symptoms. 11% of seropositive individuals reported no symptims and 27% very mild symptoms at any time during the first peak of the epidemic. Anosmia/ageusia and fever were most strongly associated with seropositivity. Almost 13% of the individuals who tested negative for SARS-CoV-2 did suspect a SARS-CoV-2 infection, a large majority (84%) because of symptoms indicative of COVID-19.


Baldassarri M, Picchiotti N, Fava F, et al. Shorter androgen receptor polyQ alleles protect against life-threatening COVID-19 disease in European males. EBioMedicine. 2021 Feb 26;65:103246. PubMed: Full-text:

A genetic polymorphism predisposing some men to develop a more severe disease irrespective of age: in a cohort of 1178 men and women with COVID-19, Margherita Baldassarri from Siena, Italy, and colleagues used a supervised Machine Learning approach on a synthetic representation of genetic variability due to poly-amino acid repeats. Comparing the genotype of patients with extreme manifestations (severe vs. asymptomatic), they found an association between the poly-glutamine repeat number of the androgen receptor (AR) gene, serum testosterone concentrations, and COVID-19 outcome in male patients. Failure of the endocrine feedback to overcome AR signaling defects by increasing testosterone levels during the infection leads to the fact that polyQ ≥ 23 becomes dominant to testosterone levels for the clinical outcome.


Strålin K, Wahlström E, Walther S, et al. Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study. Lancet Regional Health February 26, 2021 DOI:

There was a gradual decline in mortality during the spring of 2020 in Swedish hospitalised COVID-19 patients. The results remained after adjustment for age, sex, co-morbidities, level of care dependency, country of birth, healthcare region, and SAPS3 (ICU treated patients). Read about the many explanations for this phenomenon. However, the bottom line is that in studies using mortality as an endpoint, the timing of inclusion may play a crucial role regarding outcome. The results of before-and-after studies on specific interventions should be interpreted with caution.


Collateral damage (today: benefit)

Shepherd JP, Moore SC, Long A, et al. Association Between COVID-19 Lockdown Measures and Emergency Department Visits for Violence-Related Injuries in Cardiff, Wales. JAMA March 2, 2021. 2021; 325(9):885-887.

Less violence during lockdown. In Cardiff, Wales, the average weekly number of violent injury admissions dropped from 28.4 to 16.5 during lockdown. There was also a 92% reduction in weapon use. This may reflect closure of city center pubs and clubs where most violence takes place. Cheers.


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