Top 10: November 13

Copy-editor: Rob Camp


Uyoga S, Adetifa IMO, Karanja HK, et al. Seroprevalence of anti–SARS-CoV-2 IgG antibodies in Kenyan blood donors. Science 2020, published 11 November. Full-text:

In April-June 2020, the crude prevalence of anti–SARS-CoV-2 IgG among blood donors in Kenya was 5,6% (174/3098). It was highest in urban counties, Mombasa (8,0%), Nairobi (7,3%) and Kisumu (5,5%). Of note, Kenya reported only 341 deaths by the end of that period. The authors conclude that the sharp contrast between the reported COVID-19 cases and deaths suggests that the disease might be attenuated in Africa.


Waterfield T, Watson C, Moore R, et al. Seroprevalence of SARS-CoV-2 antibodies in children: a prospective multicentre cohort study. Arch Dis Child. 2020 Nov 10:archdischild-2020-320558. PubMed: Full-text:

Fatigue, gastrointestinal symptoms and changes in sense of smell or taste were the symptoms most strongly associated with SARS-CoV-1 antibody positivity in children. Thomas Waterfield et al. report 68/992 (6,9%) children aged 2-15 years with positive SARS-CoV-2 antibody tests. Of these, 34/68 (50%) reported no symptoms prior to testing. Four independent variables were identified as significantly associated with SARS-CoV-2 seropositivity: known infected household contact OR=10,9; fatigue OR=16,8; gastrointestinal symptoms OR=6,6; and changes in sense of smell or taste OR=10,0.


Slot E, Hogema BM, Reusken CBEM, et al. Low SARS-CoV-2 seroprevalence in blood donors in the early COVID-19 epidemic in the Netherlands. Nat Commun 11, 5744 (2020). Full-text:

One month into the outbreak and more than 2 weeks after social distancing and lockdown interventions were implemented, the proportion of SARS-CoV-2 antibody-positive individuals in the Dutch population tested was 2,7%. Hans Zaaijer, Ed Slot and colleagues also demonstrate that the hardest-hit areas had a seroprevalence of up to 9,5%; the seroprevalence was sex-independent throughout age groups (18–72 years); and antibodies were significantly more often present in young people aged 18–30 years.



The pre-print paper we presented on October 25 has been published in Science: Hou YJ, Chiba S, Halfmann P, et al. SARS-CoV-2 D614G variant exhibits efficient replication ex vivo and transmission in vivo. Science 2020, published 12 November. Full-text:

This paper is a milestone work: Ralph Baric and colleagues (among the leading labs in the world) provide the possible explanation for the exploding numbers of SARS-CoV-2 infections. Engineering SARS-CoV-2 variants harboring the D614G substitution (the most prevalent SARS-CoV-2 strain circulating globally), they show that the D614G variant replicates more efficiency in primary human proximal airway epithelial cells and is more fit than wildtype virus in competition studies. Infection of human ACE2 transgenic mice and Syrian hamsters with the wildtype or D614G viruses produced similar titers in respiratory tissue and pulmonary disease. However, the D614G variant exhibited significantly faster droplet transmission between hamsters than the WT virus, early after infection. No more doubts that the SARS-CoV2 D614G substitution enhances infectivity, replication fitness, and early transmission.


Liu J, Li Y, Liu L, et al. Infection of human sweat glands by SARS-CoV-2. Cell Discov 6, 84 (2020). Full-text:

Manli Wang, Jia Liu and colleagues from Wuhan Institute of Virology describe skin autopsy samples from five patients with COVID-19. Immunofluorescence and immunohistochemical analyses detected SARS-CoV-2 spike proteins in three of the five patients. In these cases, the virus resided primarily in the sweat glands and sweat ducts with apparently higher amounts in the former than in the latter; in contrast, the virus was rarely detected in the epidermis or sebaceous glands. The authors conclude that “it is important to further assess the potential risk of viral transmission via perspiration and skin contact.” Editor’s note: This paper will not change my standard protection measures.



Meppiel E, Peiffer-Smadja N, Maury A, et al. Neurological manifestations associated with COVID-19: a multicentric registry. Clin Microbiol Infect 2020, published 12 November. Full-text:

Clinical spectrum and outcomes of neurological manifestations associated with SARS-CoV-2 infection may be broad and heterogeneous, suggesting different underlying pathogenic processes. This is the conclusion of a French multicenter study describing 222 patients. The most common neurological diseases were COVID-19 associated encephalopathy (30,2%), acute ischemic cerebrovascular syndrome (25,7%), encephalitis (9,5%), and Guillain-Barré Syndrome (6,8%). Neurologic manifestations appeared after the first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19 associated encephalopathy, 7 (5-10) days in encephalitis, 12 (7-18) days in acute ischemic cerebrovascular syndrome and 18 (15-28) days in Guillain-Barré Syndrome.



Lenze EJ, Mattar C, Zorumski CF, et al. Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19A Randomized Clinical Trial. JAMA 2020, published 12 November. Full-text:

Fluvoxamine (a potent agonist of the sigma-1 receptor (σ1R)), is an antidepressant which functions pharmacologically as a selective serotonin reuptake inhibitor. In this small randomized trial that included 152 adult outpatients with COVID-19 and symptom onset within 7 days, Eric Lenze et al. found that clinical deterioration occurred in 0 patients treated with fluvoxamine vs 6 (8.3%) patients treated with placebo over 15 days. The authors acknowledge the limitations of their study: a small number of endpoint events, which makes the findings fragile; 20% of study participants stopped responding to surveys during the 15-day trial; the follow-up duration was short and did not measure the effect of fluvoxamine on persistent symptoms or late deterioration. The potential advantages of fluvoxamine for outpatient treatment of COVID-19 would include its safety, widespread availability, low cost, and oral administration. Note that fluvoxamine can cause drug-drug interactions, particularly via inhibition of cytochromes P450 1A2 and 2C19. Eagerly awaiting data from larger trials. See also the comment by SeymourCW, Bauchner H, Golub RM. COVID-19 Infection—Preventing Clinical Deterioration. JAMA 2020, published 12 November. Full-text:

Monk PD, Marsden R, Tear VJ, et al. Safety and efficacy of inhaled nebulised interferon beta-1a (SNG001) for treatment of SARS-CoV-2 infection: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Respir Med 2020, published 12 November. Full-text:

SNG001 is a formulation of recombinant interferon beta for inhaled delivery by nebuliser that is in development for the treatment of virus-induced lower respiratory tract illnesses. In this pilot trial, Tom Wilkinson, Phillip Monk and colleagues show that patients randomly assigned to SNG001 (n = 48) had greater odds of improvement versus placebo on the WHO Ordinal Scale for Clinical Improvement (OSCI) and more rapid recovery to a point where patients were no longer limited in their activity, with a greater proportion of patients recovering during the 28-day study period. Note that there was no significant difference between treatment groups in the odds of hospital discharge by day 28 – so await results from larger trials before drawing any conclusions.

See also the comment by Peiffer-Smadja N, Yazdanpanah Y. Nebulised interferon beta-1a for patients with COVID-19. Lancet Respir Med 2020, published 12 November. Full-text:



Rubin EJ, Baden LR, Morrissey S. An Update from Operation Warp Speed. Audio interview (28:20). N Engl J Med 2020; 383: e127. Access:

The editors discuss the pace of discovery in the US response to COVID-19.



If you read Spanish, read Domínguez N. La vacuna de la gripe puede potenciar la inmunidad contra el coronavirus. El País 2020, published 13 November. Full-text:

Varios estudios observan que la inmunización refuerza las defensas contra el SARS-CoV-2 y disminuye la mortalidad por COVID.



If you read French, read Rosier F. Comment les données mobiles peuvent aider à connaître les sources de contamination par le Covid-19. Le Monde 2020, published 13 November. Full-text :

L’étude des communications de 98 millions d’Américains suggère qu’un petit nombre de lieux publics favorise la majorité des infections.


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