Top 10: November 12

Copy-editor: Rob Camp


Letizia AG, Ramos I, Obla A, et al. SARS-CoV-2 Transmission among Marine Recruits during Quarantine. N Engl J Med 2020, published 11 November. Full-text:

A two-week quarantine at home is not sufficient to prevent SARS-CoV-2 from entering into a closed college campus. That’s one of the results of a study by Stuart Sealfon, Andrew Letizia and colleagues who investigated SARS-CoV-2 infections among US Marine Corps. Around 2% of recruits who had had negative results for SARS-CoV-2 at the beginning of a supervised quarantine tested positive within two weeks. Most recruits who tested positive were asymptomatic, and no infections were detected through daily symptom monitoring. The author’s short conclusion: “Transmission clusters occur within platoons.”

See also the comment by Michael NL. SARS-CoV-2 in the U.S. Military — Lessons for Civil Society. N Engl J Med 2020, published 11 November. Full-text:


Kasper MR, Geibe JR, Sears CL, et al. An outbreak of Covid-19 on an aircraft carrier. N Engl J Med 2020, published 11 November. Full-text:

Do you remember March 30? SARS-CoV-2 is spreading aboard the aircraft carrier USS Theodore Roosevelt. The ship’s commanding officer, Captain Brett Crozier, sends an email to three admirals in his chain of command, recommending that he be given permission to evacuate all non-essential sailors, to quarantine known COVID-19 cases, and sanitize the ship. “We are not at war. Sailors do not need to die,” writes Crozier in his four-page memo. The letter leaks to the media and generates several headlines. Three days later, 2 April, Captain Crozier is sacked.

You can now read the final report of the outbreak. A total of 1271 crew members (26.6% of the crew) tested positive for SARS-CoV-2. Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop some time during the clinical course. Among the 1331 crew members with suspected or confirmed COVID-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected. The conclusion: transmission of SARS-CoV-2 is facilitated by close-quarters conditions and by asymptomatic and pre-symptomatic infected crew members.


Nissen K, Krambrich J, Akaberi D, et al. Long-distance airborne dispersal of SARS-CoV-2 in COVID-19 wards. Sci Rep 10, 19589 (2020). Full-text:

Detection of coronavirus RNA, including SARS-CoV-2, in hospital and other ventilation systems has been reported. Here, Erik Salaneck, Karolina Nissen and colleagues present further evidence for SARS-CoV-2’s ability to disperse from patients to ward vent openings. They detected viral RNA in ventilation exhaust filters located at least 50 m from patient room vent openings. Although the authors did not isolate infectious virus, they suggest that there may be a risk for airborne dissemination and transmission, especially at much closer distances to contagious persons in confined spaces, both in and outside hospital environments.



Tosif S, Neeland MR, Sutton P, et al. Immune responses to SARS-CoV-2 in three children of parents with symptomatic COVID-19. Nat Commun 11, 5703 (2020), published 11 November.

Children can mount an immune response to SARS-CoV-2 without virological confirmation of infection. This is the exciting result from a study by Shidan Tosif et al. who describe clinical features, virology, longitudinal cellular, and cytokine immune profile, SARS-CoV-2-specific serology and salivary antibody responses in a family of two parents with PCR-confirmed symptomatic SARS-CoV-2 infection and their three children, who tested repeatedly SARS-CoV-2 PCR-negative. These findings raise the possibility that immunity in children can prevent the establishment of SARS-CoV-2 infection.


Thomson EC, Rosen LE, Shepherd JG, et al. The circulating SARS-CoV-2 spike variant N439K maintains fitness while evading antibody-mediated immunity. bioRxiv 2020, posted 5 November. Full-text:

A widespread variant of SARS-CoV-2 which has been identified in 12 countries might have the potential to evade recently acquired immunity. That’s the result of a study by David Robertson, Gyorgy Snell, Emma Thomson and colleagues who examined the N439K mutation in the receptor binding motif (RBM) of the SARS-CoV-2 spike (S) protein. The authors found that the N439K mutation resulted in immune escape from a panel of neutralizing monoclonal antibodies (including some that are currently being developed for treatment of SARS-CoV-2 infection) as well as from polyclonal sera from a sizeable fraction of persons recovered from infection. The authors conclude that their findings might have consequences for the efficacy of emerging vaccines and antibody therapeutics.



Teerawattananon Y, Dabak SV. COVID vaccination logistics: five steps to take now. Nature 2020, published 9 November. Full-text:

The authors point out that creating a safe and effective vaccine is just Act 1 of the 2021 Vaccine Play. Developing a comprehensive and strategic plan for vaccine roll-out is Act 2.


Strassle C, Jardas E, Ochoa J, et al. Covid-19 Vaccine Trials and Incarcerated People — The Ethics of Inclusion. N Engl J Med 2020; 383:1897-1899; published 12 November. Full-text:

The most severe COVID-19 outbreaks in the US are no longer occurring in nursing homes or meat packing plants, but in correctional facilities. Find an audio interview (19:26) with Holly Taylor on the ethical issues involved in conducting COVID-19 vaccine research in correctional facilities (19:26).


Severe COVID

Ledford H. Why do COVID death rates seem to be falling? Nature 2020, published 11 November. Full-text:

Hard-won experience, changing demographics and reduced strain on hospitals are all possibilities — but no one knows how long this change will last. By Heidi Ledford.



Hashimoto DA, Axtell AL, Auchincloss HG. Percutaneous Tracheostomy. N N Engl J Med 2020; 383:e112, published 12 November. Text and video:

A tracheostomy is a surgically created airway that is kept open with a breathing tube, or tracheostomy tube. It can take place in the operating room or at the patient’s bedside. Find out more about indications and contraindications; procedural modifications in patients with COVID-19; equipment and preparation; patient and provider positioning; identification of anatomical landmarks; and, finally, procedure, aftercare and complications.



If you read Spanish, read Criado  MA. Mujer, joven y enferma seis meses después de curarse: así son los afectados por la covid de larga duración. El País 2020, published 11 November. Full-text:

Una encuesta a 2000 contagiados en España muestra la persistencia del coronavirus y sus secuelas.


Carbajosa A. De hijos de inmigrantes turcos en Alemania a creadores de una posible vacuna contra la covid. El País 2020, published 11 November. Full-text:

Los fundadores de BioNTech, la empresa alemana que trabaja en una inmunización contra la COVID, son un matrimonio de expertos en cáncer.



Schittly R, Rof G, Wenger S. « On ne veut pas d’applaudissements, on veut que les gens respectent les consignes » : la grande fatigue des soignants face à la deuxième vague du Covid-19. Le Monde 2020, published 12 November. Full-text:

Peu reposés depuis le printemps, en manques de moyens et de reconnaissance, les soignants témoignent de leur lassitude et de leurs craintes face au nouveau pic épidémique.


Moreau A, Longueville E, Maufay D, Da Fonseca M. Covid-19 : quels sont les lieux les plus à risque pour attraper le Covid-19 ? Le Monde 2020, published 11 November. Video (8 minutes) :

Quels sont les lieux les plus à risque pour attraper le Covid-19 ? Pour le savoir, de nombreux chercheurs mènent des études afin d’identifier les contextes les plus propices à la propagation du coronavirus. Parmi elles, une étude, publiée en septembre 2020 dans le revue JAMA Internal Medicine…



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