Top 10: November 21

Copy-editor: Rob Camp


Firestone MJ, Wienkes H, Garfin J, et al. COVID-19 Outbreak Associated with a 10-Day Motorcycle Rally in a Neighboring State — Minnesota, August–September 2020. MMWR Morb Mortal Wkly Rep. ePub: 20 November 2020. DOI:

August 2020? Too soon for news about SARS-CoV-2 to have spread through western South Dakota, USA. Unaware of the pandemic, approximately 460.000 persons attended a motorcycle rally with numerous indoor and outdoor events over a 10-day period. The results: 51 confirmed primary event-associated cases, 21 secondary cases, and five tertiary cases. An additional nine likely rally-associated secondary or tertiary cases occurred. Four patients were hospitalized, and one died.


Cao S, Gan Y, Wang C, et al. Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China. Nat Commun 11, 5917 (2020). Full-text:

Which government wouldn’t like to have correct estimates of the prevalence of SARS-CoV-2 infection following the release of lockdown restrictions? Here is what happened in Wuhan between May 14 and June 1, 2020, where authorities ordered a city-wide SARS-CoV-2 screening program. All city residents aged six years or older were eligible and 9.899.828 (92,9%) participated. No new symptomatic cases and 300 asymptomatic cases (detection rate 0,303/10.000) were identified. There were no positive tests amongst 1174 close contacts of asymptomatic cases.


Al-Mandhari AS, Brennan RJ Abubakar A, Hajjeh R. Tackling COVID-19 in the Eastern Mediterranean Region. Lancet 2020, published 19 November. Full-text:

Most countries in the Eastern Mediterranean region saw fairly slow transmission of SARS-CoV-2 during the early months of the pandemic but in May, as social measures, such as restrictions and partial or full lockdowns, were relaxed during the holy month of Ramadan, disease transmission accelerated.



Bourdon M, Manet C, Montagutelli X. Host genetic susceptibility to viral infections: the role of type I interferon induction. Genes Immun (2020).

The innate immune response is the major front line of defense against viral infections. It involves hundreds of genes with antiviral properties whose expression is induced by type I interferons (IFNs) and are therefore called interferon-stimulated genes (ISGs). The authors review the role of the molecular partners of the type I IFNs induction pathway and their implication in the control of viral infections and of their complications. Be prepared: not all mechanisms are yet fully understood.


Meyerholz DK, Perlman S. Does common cold coronavirus infection protect against severe SARS-CoV-2 disease? J Clin Invest 2020, published 20 November. Full-text:

Read this comment by David Meyerholz and Stanley Perlman on a paper we presented on 9 October [Sagar M, Reifler K, Rossi M, et al. Recent endemic coronavirus infection is associated with less severe COVID-19. J Clin Invest. 2020 Sep 30:143380. PubMed: Full-text:] where Joseph Mizgerd, Manish Sagar and colleagues showed that individuals with a previously detected eCoV infection had less severe COVID-19 illness.



Qian J, Boswell SA, Chidley C, et al. An enhanced isothermal amplification assay for viral detection. Nat Commun 11, 5920 (2020). Full-text:

Michael Springer, Jason Qian and colleagues from Harvard Medical School report the development of a molecular diagnostic test for SARS-CoV-2 based on an enhanced recombinase polymerase amplification (eRPA) reaction. eRPA has a detection limit on patient samples down to 5 viral copies, requires minimal instrumentation, and is highly scalable and inexpensive. The protocol reported here was developed and optimized in less than 3 weeks, with an additional 4 weeks for sample preparation optimization, and patient sample acquisition. Good news for future pandemics.


Arizti-Sanz J, Freije CA, Stanton AC, et al. Streamlined inactivation, amplification, and Cas13-based detection of SARS-CoV-2. Nat Commun 11, 5921 (2020). Full-text:

Cameron Myhrvold, Jon Arizti-Sanz and colleagues from Princeton University describe SHINE (Streamlined Highlighting of Infections to Navigate Epidemics), an extraction-free, rapid, and sensitive detection tool for SARS-CoV-2 RNA. The results can be visualized with an in-tube fluorescent readout — reducing contamination risk as amplification reaction tubes remain sealed — and interpreted by a companion smartphone application. Validation on 50 nasopharyngeal patient samples showed 90% sensitivity and 100% specificity with a sample-to-answer time of 50 min.



Datta SD, Talwar A, Lee JT. A Proposed Framework and Timeline of the Spectrum of Disease Due to SARS-CoV-2 Infection: Illness Beyond Acute Infection and Public Health Implications. JAMA. Published online November 18, 2020. Full-text:

Morbidity from SARS-CoV-2 goes beyond acute infection. Amish Talwar, Deblina Datta and James Lee from the CDC propose a framework of three distinct illness periods associated with SARS-CoV-2 infection: 1) acute infection; 2) a rare post-acute hyperinflammatory illness after roughly two weeks; and 3) a stage of late inflammatory and virological sequelae. These illness periods also capture distinct phases of host-viral interaction.


Severe COVID

Al-Salameh A, Lanoix JP, Bennis Y, et al. The association between body mass index class and coronavirus disease 2019 outcomes. Int J Obes (2020). Full-text:

Being overweight (and not only obesity) is associated with ICU admission, but is not associated with death. This is the result of a retrospective study from Amiens University Hospital, France. In total, 433 consecutive patients were included, and BMI data were available for 329: 20 were underweight (6,1%), 95 had a normal weight (28,9%), 90 were overweight (27,4%), and 124 were obese (37,7%). The ORs for ICU admission were similar for overweight (3.16) and obesity (3.05).


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