Top 10: November 29

Copy-editor: Rob Camp


Trieu MC, Bansal A, Madsen A, et al. SARS-CoV-2-specific neutralizing antibody responses in Norwegian healthcare workers after the first wave of COVID-19 pandemic: a prospective cohort study. J Infect Dis. 2020 Nov 28:jiaa737. PubMed: . Full-text:

A low number of SARS-CoV-2-seropositive HCWs in a low prevalence setting. In this study from Norway, 607 HCW were evaluated pre- and post-the first COVID-19 pandemic wave, using a 2-step ELISA. Exposure history, COVID-19-like symptoms and serum samples were collected. Only 32 HCW (5.3%) had spike-specific antibodies (11 seroconverted with ≥ 4-fold increase, 21 were seropositive at baseline). The infection rate was only 1,7-fold higher in HCW with COVID-19 patient-exposure (2,4%) than in HCW with no exposure (1,4%).


Santos-Hövener C, Neuhauser HK, Schaffrath Rosario A, et al, CoMoLo Study Group. Serology- and PCR-based cumulative incidence of SARS-CoV-2 infection in adults in a successfully contained early hotspot (CoMoLo study), Germany, May to June 2020. Euro Surveill. 2020;25(47):pii=2001752.

After a large church concert on March 1 and the first detected infection on March 9, the southern German community of Kupferzell in the federal state Baden-Württemberg faced a steep increase of SARS-CoV-2 infections. The cumulative incidence of 1.760 per 100.000 by the end of April was one of the highest in Germany. The authors set out to analyze the SARS-CoV-2 seroprevalence in a random sample of this community from 20 May to 9 June. Results: 12%. This study confirmed that even in areas with high COVID-19 prevalence, only a small proportion of the population is infected.



Vogel G, Couzin-Frankel J. Grade: incomplete. Science 27 November 2020: Vol. 370, Issue 6520, pp. 1023-1027. Full-text:

Schools around the world are again the site of a large, and largely uncontrolled, experiment. Scrutiny of school openings in countries where the virus is resurgent paints a complex picture of the risks and how they might be managed. In their well-balanced article, Gretchen Vogel and Jennifer Couzin-Frankel summarize the main questions. How common are school outbreaks? (answer: less common than initially feared, although data are sparse). Do open schools change risk perception? (answer: probably). How much fresh air is enough? (answer: we don’t know, but high-quality carbon dioxide monitors may help) Does testing make a difference? (answer: yes, but it takes up potentially scarce resources and can give a false picture). Should schools stay open as cases surge? (answer: let’s better think about what we need to do to keep schools open).



Bowman ER, Cameron CMA,Avery A, et al. Levels of Soluble CD14 and Tumor Necrosis Factor Receptors 1 and 2 may be predictive of death in Severe Coronavirus Disease 2019 (COVID-19). J Inf Dis. Full-text:

Emily Bowman and colleagues from Cleveland measured serum biomarkers in 14 uninfected individuals and in 44 individuals with mild, moderate, or critical COVID-19 disease. Levels of monocyte activation (sCD14 and FABP4) and inflammation (TNFR1 and 2) were increased in COVID-19 individuals, regardless of disease severity. Among patients with critical disease, individuals who recovered from COVID-19 had lower levels of TNFR1 and TNFR2 at hospital admission compared to the levels in patients with critical disease who ultimately died.



Wadman M. Public needs to prep for vaccine side effects. Science 27 November 2020: Vol. 370, Issue 6520, pp. 1022. Full-text:

Expect a rough night after vaccination: A subset of people may face intense, if transient, side effects, called reactogenicity. In this interesting article, Meredith Wadman argues that transparency is key. Rather than minimizing the chance of fever, vaccine administrators could alert people that they may experience a fever that can feel severe but is temporary.



Pastor-Barriuso PR, Pérez-Gómez B, Hernán MA, et al. Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study. BMJ 2020, published 27 November. Full-text:

In this large study from Spain, SARS-CoV-2 infections were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61.098 participants in the ENE-COVID nationwide survey between 27 April and 22 June 2020. The overall infection fatality risk (IFR) was 0,8% for confirmed COVID-19 deaths and 1,1% for excess deaths. IFR was higher in men than in women (1,1 versus 0,6%). The IFR increased sharply in the elderly age groups, ranging from 1,5% (60-70 years) to 11,6% (80+) in men, and from 0,53 (60-70) to 4,62 (80+) in women.Check your individual risk from Table 1.


Severe COVID-19

Knoouhuizen SA, Aday A, Lee WM. KetamineInduced Sclerosing Cholangitis (KISC) in a Critically Ill Patient with COVID19. Hepatology 23 November 2020. Full-text:

Prior reports of recreational ketamine abuse have been associated with findings of secondary sclerosing cholangitis. The authors report here a novel presentation of the syndrome in association with prolonged ketamine use in the intensive care unit.


Collateral damage (and benefits)

Simões D, Stengaard AR, Combs L, The EuroTEST COVID-19 impact assessment consortium of partners. Impact of the COVID-19 pandemic on testing services for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region, March to August 2020. Euro Surveill 2020;25(47):pii=2001943. Full-text:

The pandemic has had considerable impact on testing for HIV, viral hepatitis and STIs in the WHO European Region. Preliminary results show that 95% of respondents from 34 countries reported testing less than half the expected number of people during the first months of the COVID-19 pandemic between March and May 2020. This continued, although to a lesser degree, between June and August 2020, when measures were less strict in most countries.


Sullivan SG, Carlson S, Cheng AC, et al. Where has all the influenza gone? The impact of COVID-19 on the circulation of influenza and other respiratory viruses, Australia, March to September 2020. Euro Surveill. 2020;25(47). Full-text:

In Australia, influenza activity was at an all-time low during the southern hemisphere’s 2020 winter. The 2020 pandemic restrictions may substantially ameliorate winter respiratory pathogen epidemics in 2021 and beyond.



Perrine CG, Chiang KV, Anstey EH, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1767–1770. Full-text:

Women with suspected or confirmed COVID-19 who are separated from their newborns and whose newborns are not feeding directly at the breast might need timely, professional, breastfeeding support. CDC conducted a COVID-19 survey (July 15–August 20, 2020) among 1.344 hospitals to assess current practices and breastfeeding support while in hospital. Among mothers with suspected or confirmed COVID-19, 14,0% of hospitals discouraged and 6,5% prohibited skin-to-skin care; 37,8% discouraged and 5,3% prohibited rooming-in; 20,1% discouraged direct breastfeeding but allowed it if the mother chose; and 12,7% did not support direct breastfeeding, but encouraged feeding of expressed breast milk. In response to the pandemic, 17,9% of hospitals reported reduced in-person lactation support, and 72,9% reported discharging mothers and their newborns < 48 hours after birth.


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