Copy-editor: Rob Camp
Epidemiology
Brown KA, Jones A, Daneman N, et al. Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada. JAMA Intern Med. November 9, 2020. Full-text: https://doi.org/10.1001/jamainternmed.2020.6466
In this cohort study that included 78,607 residents of 618 nursing homes in Ontario, Canada, 5218 (6.6%) developed COVID-19 infection and 1452 (1.8%) died of COVID-19 infection as of May 20, 2020. The case fatality rate was 27.8% (1452/5218). Of note, COVID-19 mortality in homes with low crowding (number of occupants per room and bathroom across an entire home) was less than half (1.3%) than that of homes with high crowding (2.7%).
Virology
Relman DA. Opinion: To stop the next pandemic, we need to unravel the origins of COVID-19. PNAS first published November 3, 2020. Full-text: https://doi.org/10.1073/pnas.2021133117
Important comment. According to David A. Relman from Stanford, “a more complete understanding of the origins of COVID-19 clearly serves the interests of every person in every country on this planet. It will limit further recriminations and diminish the likelihood of conflict; it will lead to more effective responses to this pandemic, as well as efforts to anticipate and prevent the next one. It will also advance our discussions about risky science. And it will do something else: Delineating COVID-19’s origin story will help elucidate the nature of our very precarious coexistence within the biosphere.”
Vaccine
Callaway E. What Pfizer’s landmark COVID vaccine results mean for the pandemic. Nature NEWS 09 November 2020. Full-text: https://www.nature.com/articles/d41586-020-03166-8
Yesterday, Pfizer and BioNTech announced that their mRNA-based vaccine candidate, BNT162b2, demonstrated “evidence of efficacy“, based on the first interim efficacy and safety analysis conducted on November 8, 2020 by an external, independent Data Monitoring Committee from the Phase III clinical study.
- BNT162b2 was found to be “more than 90% effective” in preventing COVID-19 in participants without evidence of prior SARS-CoV-2 infection
- Analysis evaluated 94 confirmed cases of COVID-19 in trial participants
- Study enrolled 43,538 participants, with 42% having diverse backgrounds, and no serious safety concerns have been observed
- Clinical trial to continue through to final analysis at 164 confirmed cases in order to collect further data and characterize the vaccine candidate’s performance against other study endpoints
That’s what we know. Read how scientists welcome the first compelling evidence that a vaccine can prevent COVID-19. But many questions remain about how much protection it offers, to whom and for how long.
Che Y, Liu X, Pu Y, et al. Randomized, double-blinded and placebo-controlled phase II trial of an inactivated SARS-CoV-2 vaccine in healthy adults. Clinical Infectious Diseases, 09 November 2020 ciaa1703. Full-text: https://doi.org/10.1093/cid/ciaa1703
In this randomized, double-blinded Phase II trial, 742 healthy adults received a medium (MD) or a high dose (HD) of an inactivated vaccine at an interval of either 14 days or 28 days. Neutralizing antibody (NAb) and anti-S and anti-N antibodies were detected at different times, and adverse reactions were monitored for 28 days after full immunization. The seroconversion rates of NAb in MD and HD groups were 89% and 96% at day 14 and 92% and 96% at day 28 after immunization. Of note, the vaccine was safe (still an issue with inactivated vaccines), and no severe adverse effects were reported.
Clinical
Lavery AM, Preston LE, Ko JY, et al. Characteristics of Hospitalized COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission — United States, March–August 2020. MMWR Morb Mortal Wkly Rep. ePub: 9 November 2020. Full-text: http://dx.doi.org/10.15585/mmwr.mm6945e2
Who will be re-admitted? In a cohort of 106,543 patients discharged after an index COVID-19 hospitalization, 9% experienced at least one readmission to the same hospital within 2 months of discharge. Multiple readmissions occurred in 1.6% of patients. Not very surprising: risk factors for readmission included age ≥ 65 years, presence of certain chronic conditions (chronic obstructive pulmonary disease, heart failure, diabetes with chronic complications, chronic kidney disease, and obesity), hospitalization within the 3 months preceding the first COVID-19 hospitalization, and discharge to a skilled nursing facility or with home health care.
Comorbidities
Taquet M, Luciano S, Geddes JR, et al. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62,354 COVID-19 cases in the USA. Lancet Psychiatry November 09, 2020. Full-text: https://doi.org/10.1016/S2215-0366(20)30462-4
Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae. Here, Maxime Taquet and colleagues used a global federated network that captures anonymized data from electronic health records in 54 health care organizations in the US, totaling 69.8 million patients and 62,354 patients diagnosed with COVID-19. In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (i.e., hazard ratio [HR] 2.1 vs influenza). The HR was greatest for anxiety disorders, insomnia, and dementia. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1.6% in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1.65).
Treatment
Hoang TN, Pino M, Boddapati AK. Baricitinib treatment resolves lower airway macrophage inflammation and neutrophil recruitment in SARS-CoV-2-infected rhesus macaques. Cell November 09, 2020.ft https://doi.org/10.1016/j.cell.2020.11.007
Timothy Hoang and colleagues investigated the immunologic and virologic efficacy of baricitinib (approved JAK1/2 inhibitor) in rhesus macaques. Viral shedding measured from nasal and throat swabs, bronchoalveolar lavages and tissues was NOT reduced with baricitinib and type I IFN antiviral responses and SARS-CoV-2-specific T cell responses remained similar between the two groups. However, animals treated with baricitinib showed reduced inflammation, decreased lung infiltration of inflammatory cells, reduced NETosis activity, and more limited lung pathology. Importantly, baricitinib-treated animals had a rapid and remarkably potent suppression of lung macrophage production of cytokines and chemokines responsible for inflammation and neutrophil recruitment.
Self WH, Semler MW, Leither LM. Effect of Hydroxychloroquine on Clinical Status at 14 Days in Hospitalized Patients With COVID-19 – A Randomized Clinical Trial. JAMA. November 9, 2020. Full-text: https://doi.org/10.1001/jama.2020.22240
No, there was no effect of HCQ in this RCT among 479 adults hospitalized with respiratory illness from COVID-19. Do we need more clinical studies?
Saag MS. Misguided Use of Hydroxychloroquine for COVID-19. The Infusion of Politics Into Science. JAMA. November 9, 2020. Full-text: https://doi.org/10.1001/jama.2020.22389
Nice comment on the HCQ story. According to Michael Saag, the clear, unambiguous, and compelling lesson from the hydroxychloroquine story for the medical community and the public is that science and politics do not mix.
Pediatrics
Gale C, Quigley MA, Placzek A, et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. Lancet November 09, 2020. Full-text: https://doi.org/10.1016/S2352-4642(20)30342-4
A prospective UK population-based cohort study of 66 babies with confirmed SARS-CoV-2 infection in the first 28 days of life who received in-patient care between March and April. Of these, 28 (42%) had severe neonatal SARS-CoV-2 infection and 16 (24%) were born preterm. Only half were of white ethnic groups. Of 17 (26%) babies with confirmed infection who were born to mothers with known perinatal SARS-CoV-2 infection, only two (3%) were considered to have possible vertically acquired infection. As of July 28, 2020, 58 (88%) babies had been discharged home, seven (11%) were still in hospital, and one (2%) had died of a cause unrelated to SARS-CoV-2 infection.