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By Christian Hoffmann &
Bernd S. Kamps
8 May
Epidemiology
Wallace M, Hagan L, Curran KG, et al. COVID-19 in Correctional and Detention Facilities — United States, February–April 2020. MMWR Early Release, May 6, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e1.htm
First documentation of the epidemic in correctional and detention facilities. Aggregated data on COVID-19 cases reported to CDC by 37 of 54 state and territorial health department jurisdictions in the US. Prison bars do not work: As of April 21, 2020, 4,893 cases and 88 deaths among incarcerated and detained persons and 2,778 cases and 15 deaths among staff members have been reported.
Wells CR, Stearns JK, Lutumba P, Galvani AP. COVID-19 on the African continent. Lancet Infect Dis May 06, 2020. Full-text: https://doi.org/10.1016/S1473-3099(20)30374-1
Brief review. The transmissibility of SARS-CoV-2, combined with the scarcity of crucial health equipment and the challenges of implementing widespread physical distancing and case isolation, poses a grave threat to the African continent.
Fusaroli P, Balena S, Lisotti A. On the death of 100+ Italian doctors from COVID-19. Infection 2020. https://doi.org/10.1007/s15010-020-01436-1. Full-text: https://link.springer.com/article/10.1007/s15010-020-01436-1.
Authors speculate on the reasons why 95/100 of deceased Italian doctors were men. Could different habits between men and women have played a role too? According to some research, women are supposedly more scrupulous in performing hand hygiene than men.
Virology
Bao L, Deng W, Huang B, et al. The pathogenicity of SARS-CoV-2 in hACE2 transgenic mice. Nature. 2020 May 7. PubMed: https://pubmed.gov/32380511. Full-text: https://doi.org/10.1038/s41586-020-2312-y
In transgenic mice bearing human ACE2 and infected with SARS-CoV-2, pathogenicity of the virus was demonstrated. This mouse model will be valuable for evaluating antiviral therapeutics and vaccines as well as understanding the pathogenesis of COVID-19.
Xiao K, Zhai J, Feng Y, et al. Isolation of SARS-CoV-2-related coronavirus from Malayan pangolins. Nature. 2020 May 7. PubMed: https://pubmed.gov/32380510. Full-text: https://doi.org/10.1038/s41586-020-2313-x
In a wildlife rescue center, authors found coronavirus in 25 Malayan pangolins (some of whom were very sick), showing 90-100% amino acid identity with SARS-CoV-2 in different genes. Comparative genomic analysis suggested that SARS-CoV-2 might have originated from the recombination of a Pangolin-CoV-like virus with a Bat-CoV-RaTG13-like virus. As the RBD of Pangolin-CoV is virtually identical to that of SARS-CoV-2, the virus in pangolins presents a potential future threat to public health. Pangolins and bats are both nocturnal animals, eat insects, and share overlapping ecological niches, which make pangolins the ideal intermediate host. Stop illegal pangolin trade!
Clinical
Jiang M, Guo Y, Luo Q, et al. T cell subset counts in peripheral blood can be used as discriminatory biomarkers for diagnosis and severity prediction of COVID-19. J Infect Dis. 2020 May 7. PubMed: https://pubmed.gov/32379887. Full-text: https://doi.org/10.1093/infdis/jiaa252
CD3+, CD4+ and CD8+T cells but also NK cells were significantly decreased in COVID-19 patients and related to the severity of the disease. Thresholds of CD8+T and CD4+T used for distinguishing between COVID-19 patients and healthy controls were 285.5/µl and 386.0/µl. According to the authors, CD8+T and CD4+T cell counts can be used as diagnostic markers of COVID-19 and predictors of disease severity.
Metlay JP, Waterer GW. Treatment of Community-Acquired Pneumonia During the Coronavirus Disease 2019 (COVID-19) Pandemic. Ann Intern Med. 2020 May 7. PubMed: https://pubmed.gov/32379883. Full-text: https://doi.org/10.7326/M20-2189
Some ideas on how to treat community-acquired pneumonia (CAP) during these days and how to interpret CAP guidelines.
Thornton J. Covid-19: the challenge of patient rehabilitation after intensive care. BMJ. 2020 May 6;369:m1787. PubMed: https://pubmed.gov/32376670. Full-text: https://doi.org/10.1136/bmj.m1787
Discharge from ICU is not the end. Challenges remain for appropriate rehabilitation—physical, cognitive, and psychological. And whether this will be available for the huge numbers of people who will need to deal with the enormous impact of a stay in critical care.
Treatment
Geleris J, Sun Y, Platt J, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med. 2020 May 7. PubMed: https://pubmed.gov/32379955. Full-text: https://doi.org/10.1056/NEJMoa2012410
The end of hydroxychloroquine (HCQ)? Incredible large observational study from New York City. Of 1,376 consecutive hospitalized patients, 811 (59%) received HCQ (600 mg BID day 1, then 400 mg QD, 60% also received azithromycin). The decision to prescribe the drugs was “left to the discretion of the treating team for each individual patient”. HCQ-treated patients were more severely ill at baseline. Authors adjusted for likely confounders, including age, race and ethnic group, body-mass index, diabetes, underlying kidney or lung disease, hypertension, baseline vital signs, Pao2:Fio2, and inflammatory markers of the severity of illness. There was no significant association between HCQ use and intubation or death. However, despite this extensive adjustment, it is still possible that some amount of unmeasured confounding remains. According to the authors, the study should not be taken to rule out either benefit or harm of HCQ but the results do not support the use of HCQ outside randomized clinical trials.
Hanley B, Roufosse CA, Osborn M, Naresh KN. Convalescent donor SARS-COV-2-specific cytotoxic T lymphocyte infusion as a possible treatment option for COVID-19 patients with severe disease – has not received enough attention till date. Br J Haematol. 2020 May 5. PubMed: https://pubmed.gov/32369628. Full-text: https://doi.org/10.1111/bjh.16780
Authors argue that therapeutic off-the-shelf SARS-COV-2-specific HLA-matched cytotoxic T cells prepared from convalescent COVID-19 patients is the most pressing need. It remains unclear why.