Top 10: October 18

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By Christian Hoffmann &
Bernd S. Kamps

18 October


Sugano N, Ando W, Fukushima W. Cluster of Severe Acute Respiratory Syndrome Coronavirus 2 Infections Linked to Music Clubs in Osaka, Japan. J Infect Dis. 2020 Oct 13;222(10):1635-1640. PubMed: Full-text:

Detailed contact tracing in Osaka, Japan: The data of 108 cases comprising a cluster were linked to 4 music clubs. In total, 51 cases attended a live music club only once and all index cases for secondary transmission were asymptomatic at the time of contact with other people. Substantial exposure occurred within a few hours. Asymptomatically infected persons can transmit the virus as soon as 2 days after infection. Bad news for music clubs.


Okarska-Napierała M, Mańdziuk J, Kuchar E. SARS-CoV-2 cluster in nursery, Poland. Emerg Infect Dis. 2021 Jan. Full-text:

Several reports have implied little to no SARS-CoV-2 transmission among children and from children to adults. In this cluster that emerged in a single nursery in Poland within 2 weeks of its reopening, a high infection attack rate among children was found. The cluster involved a total of 29 persons; 8 were children attending the nursery, and 12 were the children’s family members who did not enter the facility. The high attack rates could be explained by prolonged close contact between very young children, who are less able to adjust to control measures. However, these observations question the role of young children in driving the COVID-19 pandemic.



Lai CKC, Chen Z, Lui G, et al. Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019. J Infect Dis. 2020 Oct 13;222(10):1612-1619. PubMed: Full-text:

Use sputum, not deep throat saliva. This study prospectively examined 563 serial samples collected during the virus shedding periods of 50 patients: 150 deep throat saliva (DTS, patients first cleared their throat by gargling with their own saliva, and then they spit out the DTS into a sterile bottle), 309 pooled-nasopharyngeal (NP) and throat swabs, and 104 sputum (self-collected, patients were asked to cough out sputum and spit into a sterile plastic bottle). Deep throat saliva had the lowest overall RT-PCR-positive rate (69% vs 89% for sputum and 81% for pooled NP and throat swabs) and the lowest viral RNA concentration (mean log copy/mL 3.54 vs 5.03 and 4.63, respectively).



Kontis V, Bennett JE, Rashid T, et al. Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries. Nat Med (2020). Full-text:

The total death toll for the first wave of the COVID-19 pandemic for 21 industrialized countries (not including US or Germany). England, Wales and Spain experienced the largest effect: ~100 excess deaths per 100,000 people, equivalent to a 37% (30–44%) relative increase in England and Wales and 38% (31–45%) in Spain.


Bilinski A, Emanuel EJ. COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries. JAMA  October 12, 2020. Full-text:

Alyssa Bilinski and Ezekiel Emanuel have compared 14 countries with all-cause mortality data, finding similar patterns. In countries with moderate COVID-19 mortality, excess all-cause mortality remained negligible throughout the pandemic. In countries with high COVID-19 mortality, excess all-cause mortality reached as high as 102/100,000 in Spain, while in the US it was 72/100,000. However, since May, excess all-cause mortality was higher in the US than in all high-mortality countries, due possibly to several factors, including weak public health infrastructure and a decentralized, inconsistent US response to the pandemic.


Gold JA, Rossen LM, Ahmad FB, et al. Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 — United States, May–August 2020. MMWR Morb Mortal Wkly Rep. ePub: 16 October 2020. Full-text:

This report provides information on how demographic and geographic factors have changed among COVID-19–associated deaths during May–August 2020. Of 114,411 COVID-19–associated deaths, 51% of decedents were non-Hispanic White, 24% were Hispanic or Latino (Hispanic), and 19% were non-Hispanic Black. The percentage of Hispanic decedents increased from 16.3% in May to 26.4% in August. Data suggest that the geographic shift from the Northeast to the South and West alone does not entirely account for this increase.


Mascitti H, Bonsang B, Dinh A, et al. Clinical cutaneous features of patients infected with SARS-CoV-2 hospitalized for pneumonia: a cross-sectional study. Open Forum Infectious Diseases, 18 October 2020. Full-text:

Various dermatological signs were seen in 59 COVID-19 patients, a macular rash being the most frequent. All cutaneous features could be related to a vascular leak process.


Severe COVID­-19

Thomas R, Lotfi T, Morgano GP, et al. Update Alert 2: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19. Annals Int Med 13 October 2020. Full-text:

Update of a living systematic review on ventilation techniques, analyzing all new studies published until the end of July. Bottom line: Nothing new. Non-invasive ventilation may have similar effects to IMV on mortality, but the evidence is uncertain.


Collateral damage

Marchetti D, Fontanesi L, Mazza C, et al. Parenting-Related Exhaustion During the Italian COVID-19 Lockdown. Journal of Pediatric Psychology,17 October 2020. Full-text:

Who suffers the most? While many countries prepare for a second lockdown, this study took a look on the psychological consequences during the first wave, performing interviews with a total of 1226 parents via a demographic questionnaire. Seventeen percent reported significant parenting-related exhaustion and most parents reported a clinically alarming level of distress. Multiple regression analyses showed that greater parenting-related exhaustion was predicted by psychological distress, lower parental resilience, motherhood, fewer perceived social connections, and being single, as well as having a child with special needs, having a large number of children, and having younger children.



Rajasingham R, Bangdiwala AS, Nicol MR, et al. Hydroxychloroquine as pre-exposure prophylaxis for COVID-19 in healthcare workers: a randomized trial. Clinical Infectious Diseases 17 October 2020. Full-text:

No, HCQ does not work as prophylaxis, even in HCW. This huge double-blinded RCT included 1483 healthcare workers with ongoing exposure to persons with SARS-CoV-2. Participants across the US and Canada were randomized to HCQ 400 mg once weekly or twice weekly for 12 weeks. The incidence of COVID-19 (laboratory-confirmed or symptomatic compatible illness) was 0.27 events per person-year with once-weekly and 0.28 events per person-year with twice-weekly hydroxychloroquine, compared with 0.38 events per person-year with placebo. This was not statistically significant.



Dumitriu D, Emeruwa UN, Hanft E, et al. Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. JAMA Pediatr. Published online October 12, 2020. Full-text:

Of 101 neonates born to mothers with perinatal SARS-CoV-2 infections at a single institution, 2 (2.0%) had positive test results for SARS-CoV-2, but none had clinical evidence of COVID-19, despite most infants sleeping in the same room with mothers and direct breastfeeding. This study endorses the benefits of sleeping in the same room, breastfeeding, and delayed bathing on newborn outcomes and suggests that separating mothers positive for SARS-CoV-2 and their newborns and avoiding direct breastfeeding may not be warranted to prevent SARS-CoV-2 transmission.