Top 10: March 8

Copy-editor: Rob Camp


Firestone MJ, Lorentz AJ, Meyer S, et al. First Identified Cases of SARS-CoV-2 Variant P.1 in the United States — Minnesota, January 2021. MMWR Morb Mortal Wkly Rep. ePub: 3 March 2021.

The arrival of P.1 in the US. Both guys had returned from southeastern Brazil. According to the authors, this “underscores the importance of community prevention strategies to slow transmission of SARS-CoV-2 including use of well-fitting masks, physical distancing, washing hands, quarantine, testing of persons who have had contact with a person with laboratory-confirmed COVID-19, isolating persons with symptoms of COVID-19 or with diagnosed COVID-19 and” (drumroll, please) “adhering to CDC recommendations to delay travel”. Maybe it’s not the best idea to vacation in Brazil (or anywhere!) right now.


Ojelade M, Rodriguez A, Gonzalez D, et al. Travel from the United Kingdom to the United States by a Symptomatic Patient Infected with the SARS-CoV-2 B.1.1.7 Variant — Texas, January 2021. MMWR Morb Mortal Wkly Rep. ePub: 3 March 2021.

Another jerk who traveled from UK to US after experiencing COVID-19–compatible symptoms, infected with the B.1.1.7 variant. “Persons should not travel if they are experiencing symptoms compatible with COVID-19 or if they have received a positive SARS-CoV-2 test result and have not met criteria to discontinue isolation, have had close contact with a person with suspected or confirmed COVID-19 and have not subsequently met criteria to end quarantine, or have a pending SARS-CoV-2 viral test result”. Questions?


Fujino T, Nomoto H, Kutsuna S, Ujiie M, Suzuki T, Sato R, et al. Novel SARS-CoV-2 variant identified in travelers from Brazil to Japan. Emerg Infect Dis. 2021 Apr [date cited].

A family of four, traveling in early January to Tokyo, Japan, from Amazonas state in Brazil via Istanbul, Turkey (by the way, wouldn’t it have been shorter heading west?). Souvenir: A new lineage, resembling P.1, but with some interesting new mutations. Cringe.


Maggi F, Novazzi F, Genoni A, Baj A, Spezia PG, Focosi D, et al. Imported SARS-CoV-2 variant P.1 detected in traveler returning from Brazil to Italy. Emerg Infect Dis. 2021 Apr [date cited].

A family of three, flying from São Paulo, Brazil, via Madrid, Spain, to Milan (Malpensa Airport) in Italy, in mid-January. In the luggage: P.1.



Ott IM, Strine MS, Watkins AE, Boot M, Kalinich CC, Harden CA, et al. Stability of SARS-CoV-2 RNA in nonsupplemented saliva. Emerg Infect Dis. 2021 Apr [date cited].

Use saliva and simple plastic tubes! For this (important) study, saliva from COVID-19 inpatients and at-risk healthcare workers was collected into sterile wide-mouth containers without preservatives (non-supplemented) to evaluate the temporal stability of SARS-CoV-2 RNA at different holding temperatures. Of note, SARS-CoV-2 RNA from saliva was consistently detected at similar levels regardless of the holding time and temperatures tested.



Nguyen NT, Chinn J, Nahmias J, et al. Outcomes and Mortality Among Adults Hospitalized With COVID-19 at US Medical Centers. JAMA Netw Open March 5, 2021;4(3):e210417.

The largest US cohort of hospitalized COVID-19 adults to date. Among 192,550 adults hospitalized with COVID-19, 55,593 (28.9%) were admitted to the ICU and 26,221 (13.6%) died during hospitalization. Not surprisingly, in-hospital mortality increased with age; 179 of 12,644 patients (1.4%) aged 18 to 29 years died, and 8277 of 31,135 patients (26.6%) 80 years or older died. Of the patients admitted to the ICU, 15,431 of 55,593 (27.8%) died. The median hospital length of stay among patients who were not admitted to the ICU was 6 days, with a median cost per admission of $10,520. The median hospital length of stay for those admitted to the ICU was 15 days, with a median cost per admission of $39,825. Of note, mortality declined over the course of the 6 month period, from 22.1% in March to 6.5% in August.


Karagiannidis C, Windisch W, McAuley DF, et al. Major differences in ICU admissions during the first and second COVID-19 wave in Germany. Lancet Resp Med March 05, 2021.

According to Christian Karagiannidis and colleagues who analyzed the data from the federal German hospital payment institute, the data “clearly suggests a dramatic improvement in the management of patients with COVID-19”. Compared with the first wave, 50% fewer of all hospitalized patients were admitted to the ICU during the second wave of the pandemic. By contrast, the prognosis of ICU patients, those requiring mechanical ventilation and those not, remained steady.



Attauabi M, Seidelin J, Burisch J; Danish COVID-IBD Study Group. Association between 5-aminosalicylates in patients with IBD and risk of severe COVID-19: an artefactual result of research methodology? Gut. 2021 Mar 3:gutjnl-2021-324397. PubMed: Full-text:

Discussion whether mesalamine/sulfasalazine is associated with an increased risk of severe COVID-19 in people with inflammatory bowel disease (IBD). And how to adjust for any potential effect modifiers and confounders in order to determine the granular effect of IBD-related medications. No definitive answer yet.

Ungaro RC, Brenner EJ, Gearry RB, et al. Effect of IBD medications on COVID-19 outcomes: results from an international registry. Gut. 2020 Oct 20:gutjnl-2020-322539. PubMed: Full-text:



PRINCIPLE Trial Collaborative Group. Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet March 04, 2021.

Azithromycin makes no sense. This UK-based, open-label, adaptive platform randomized trial of interventions against COVID-19 in people at increased risk of an adverse clinical course (PRINCIPLE) randomly assigned people aged 65 years and older, or 50 years and older, with at least one co-morbidity, who had been unwell for 14 days or less with suspected COVID-19, to usual care plus azithromycin 500 mg daily for three days, usual care plus other interventions, or usual care alone. In total, 402 (80%) of 500 participants in the azithromycin group and 631 (77%) of 823 participants in the usual care alone group reported feeling recovered within 28 days.



LaRovere KL, Riggs BJ, Poussaint TY, et al. Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome. JAMA Neurol March 5, 2021. doi:10.1001/jamaneurol.2021.0504.

In this study of 1695 patients 21 years or under, hospitalized at 61 US hospitals for acute COVID-19 or multisystem inflammatory syndrome, 365 (22%) had neurologic involvement. Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), CNS infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4).



If you read Spanish, read Zafra M, Linde P, López JV. Así puede pasar el aire (y el coronavirus) de unas viviendas a otras a través del baño. El País 2021, published 7 March. Full-text:

Los conductos de ventilación de los baños en edificios antiguos conectan los pisos y, en circunstancias muy concretas, se sospecha que pueden ser una vía de contagio de la covid.



If you read French, read Covid-19 : l’appel des ordres de santé à tous les soignants, « faites-vous vacciner », c’est un « devoir déontologique ». Le Monde 2021, published 7 March. Full-text :

Ils sont fous, les Gaulois? Seul un tiers des soignants sont actuellement vaccinés en France. « Ce n’est pas tolérable », estime Alain Fischer, le coordinateur de la campagne de vaccination. Les soignants sont « les plus exposés au virus, tout en étant au contact des populations les plus fragiles », estiment les organisations signataires. Ils doivent se faire vacciner « parce que cela relève de leur devoir déontologique, protéger leurs patients en toutes circonstances, et parce qu’il est impératif qu’ils puissent eux-mêmes se protéger contre le virus, ainsi que leurs proches, et freiner la propagation de l’épidémie », poursuivent-elles. Soyons plus clair encore (the CR Editors): Si vous êtes incapables de vous faire vacciner, changez de métier.



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