Top 10: May 31

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By Christian Hoffmann &
Bernd S. Kamps

31 May

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First, investigate whether daily maximum temperature, precipitation and UV index are related to COVID-19 incidence; find out whether surgical mask partition reduces the risk of transmission in a golden Syrian hamster model; and discover that the COVID-19 incidence in January and February was too low in the US to be detected through emergency department syndromic surveillance data.

Afterwards, determine the association between acute liver injury and clinical outcome in patients with SARS-CoV-2 infection; compare the performance of four commercial ELISAs and two rapid tests; and investigate co-infections in people with COVID-19.

Finally, analyze the incidence of out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France; and present 25 patients treated with convalescent plasma and discuss with your colleagues the challenges of this treatment approach.


Jorden MA, Rudman SL, et al. Evidence for Limited Early Spread of COVID-19 Within the United States, January–February 2020. MMWR Morb Mortal Wkly Rep. 29 May 2020. Full-text:

Information from diverse data sources suggests that limited community transmission of SARS-CoV-2 in the United States occurred between the latter half of January and the beginning of February, following an importation from China. This importation initiated a lineage, the Washington State clade, which subsequently spread throughout the Seattle metropolitan area and possibly elsewhere. Several importations of SARS-CoV-2 from Europe followed in February and March. Of note, overall disease incidence before February 28 was too low to be detected through emergency department syndromic surveillance data.


Sehra ST, Salciccioli JD, Wiebe DJ, Fundin S, Baker JF. Maximum Daily Temperature, Precipitation, Ultra-Violet Light and Rates of Transmission of SARS-Cov-2 in the United States. Clin Infect Dis. 2020 May 30. PubMed: Full-text:

Transmission is likely to remain high at warmer temperatures. Using negative binomial regression modelling, authors investigated whether daily maximum temperature, precipitation and UV index were related to COVID-19 incidence. Incidence declined with increasing temperature up to 52°F and was somewhat lower at warmer versus cooler temperatures. However, the association between temperature and transmission was small.



Chan JF, Yuan S, Zhang AJ, et al. Surgical mask partition reduces the risk of non-contact transmission in a golden Syrian hamster model for Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2020 May 30. PubMed: Full-text:

They work! Even in a hamster model. Surgical mask partition for challenged index or naïve hamsters significantly reduced transmission.



Traugott M, Aberle SW, Aberle JH, et al. Performance of SARS-CoV-2 antibody assays in different stages of the infection: Comparison of commercial ELISA and rapid tests. J Infect Dis. 2020 May. PubMed: Full-text:

Four commercial ELISAs and two rapid tests performed well in 77 patients with PCR-confirmed SARS-CoV-2 infection, grouped by intervals from symptom onset. While test sensitivities were low (<40%) within the first 5 days post disease onset, IgM-, IgA- and total antibody-ELISAs increased in sensitivity to >80% between the 6th and 10th day post-symptom onset. The evaluated tests (including IgG and rapid tests) provided positive results in all patients at or after the 11th day post-onset of disease.



Phipps MM, Barraza LH, LaSota ED, et al. Acute Liver Injury in COVID-19: Prevalence and Association with Clinical Outcomes in a Large US Cohort. Hepatology. 2020 May 30. PubMed: Full-text:

One of the largest studies evaluating liver injury. Among 2,273 patients who tested positive, 45% had mild, 21% moderate, and 6.4% severe liver injury. In multivariate analysis, severe acute liver injury was significantly associated with elevated inflammatory markers including ferritin and IL‐6. Peak ALT was significantly associated with death or discharge to hospice (OR 1.14, p = 0.044), controlling for age, body mass index, diabetes, hypertension, intubation, and renal replacement therapy.


Marijon E, Karam N, Jost D, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020 May 27:S2468-2667(20)30117-1. PubMed: Full-text:

Staying at home is not always the best decision. During the COVID-19 pandemic in the Paris area, authors observed a significant (two-fold) and transient increase in the incidence of out-of-hospital cardiac arrest (OHCA), coupled with a major reduction in survival at hospital admission. Although this finding might be partly related to direct COVID-19 deaths, indirect effects related to lockdown and reorganisation of healthcare systems may account for a substantial part.


Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020 May 27:S0163-4453(20)30323-6. PubMed: Full-text:

According to this review, low proportions of COVID-19 patients have a bacterial co-infection, less than in previous influenza pandemics. These findings do not support the routine use of antibiotics in the management of confirmed COVID-19 infection.



Kupferschmidt K. Scientists put survivors’ blood plasma to the test. Science  29 May 2020: Vol. 368, Issue 6494, pp. 922-923. Full-text:

Nice article describing convalescent plasma as a promising new strategy. However, controlled clinical data are still lacking. Other issues such as supply (may become a challenge), consistency (concentration differs) and risks (transfusion-related acute lung injury, in which transferred antibodies damage pulmonary blood vessels, or transfusion-associated circulatory overload) are also discussed.


Salazar E, Perez KK, Ashraf M, et al. Treatment of COVID-19 Patients with Convalescent Plasma. Am J Pathol. 2020 May 27. PubMed: Full-text:

Some more clinical data on this strategy. In 25 patients with severe and/or life-threatening COVID-19 disease enrolled at a Houston hospital, convalescent plasma was safe. By day 14 post-transfusion, 19 (76%) patients had at least a 1-point improvement in clinical status and 11 were discharged.