Top 10: October 3

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By Christian Hoffmann &
Bernd S. Kamps

 

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3 October

Epidemiology

Boehmer TK, DeVies J, Caruso E, et al. Changing Age Distribution of the COVID-19 Pandemic — United States, May–August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1404–1409. DOI: http://dx.doi.org/10.15585/mmwr.mm6939e1

First the kids, then the parents and, finally, the grandparents (with unknown outcome)? During June–August 2020, SARS-CoV-2 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. Across the southern United States in June 2020, increases in percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among those aged ≥60 years by 4–15 days. The authors’ recommendations:

  • Restrict in-person gatherings and events
  • Recommend mask use and social distancing in settings where persons socialize
  • Implement safe practices at on-site eating and drinking venues
  • Enforce protection measures for essential and service industry workers

 

Virology

Transmission

Tufekci Z. This Overlooked Variable Is the Key to the Pandemic. The Atlantic 2020, published 30 September. Full-text: https://www.theatlantic.com/health/archive/2020/09/k-overlooked-variable-driving-pandemic/616548/

Even non-scientists have heard about R0 (pronounced as “r-naught”)—the basic reproductive number of a pathogen, a measure of its contagiousness on average. But even some scientists may not have yet encountered k, the measure of its dispersion. If you haven’t done it before, do it now: explore k. It’s simply a way of asking whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once.

 

Gebrekidan S, Bennhold K, Apuzzo M, Kirkpatrick DD. Ski, Party, Seed a Pandemic: The Travel Rules That Let Covid-19 Take Flight. The New York Times 2020 published 1 October. Full-text: https://www.nytimes.com/2020/09/30/world/europe/ski-party-pandemic-travel-coronavirus.html

ISCHGL, Austria — They came from across the world to ski in the most famous resorts of the Austrian alps…

 

Immunology

Goldman JD, Wang K, Roltgen K, et al. Reinfection with SARS-CoV-2 and Failure of Humoral Immunity: a case report. medRxiv. 2020 Sep 25:2020.09.22.20192443. PubMed: https://pubmed.gov/32995830. Full-text: https://doi.org/10.1101/2020.09.22.20192443

The authors describe a care-home resident in their sixties with two distinct episodes of symptomatic COVID-19 separated by 144 days. After the second infection, the patient produced only low levels of antibodies which decreased over time. The authors hope getting near to the point where we understand the correlates of humoral immunity required to prevent reinfection. Attention: This paper has not yet been peer reviewed.

 

Pathogenesis

Hewitt JA, Lutz C, Florence WC, et al. on behalf of the ACTIV Preclinical Working Group. ACTIVating Resources for the COVID-19 Pandemic: In vivo Models for Vaccines and Therapeutics. Cell Host Microbe 2020, published 1 October. Full-text: https://doi.org/10.1016/j.chom.2020.09.016

This review provides a snapshot that recommends the suitability of models for testing vaccines and therapeutics. Several species are permissive for SARS-CoV-2 replication, and more severe disease develops in a few models (some associated with advanced age, a risk factor for human disease). The key models appear to be mice (various), hamsters and for non-human primates, rhesus macaques and African green monkeys. The authors show that no single animal model recapitulates the totality of COVID-19 pathogenesis faithfully as in the human; therefore, the coordination and assessment of animal models is imperative.

 

Clinical

Morris SB, Schwartz NG, Patel P, et al. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020. MMWR Morb Mortal Wkly Rep. ePub: 2 October 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6940e1

MIS-C (multisystem inflammatory syndrome in children) in adults? The authors report a multisystem inflammatory syndrome in adults (MIS-A), describing 27 patients who had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness. The authors call for clinicians to consider MIS-A in adults with compatible signs and symptoms. Recall that these patients may not have positive SARS-CoV-2 PCR or antigen test results; antibody testing might be needed to confirm previous SARS-CoV-2 infection.

 

Drug Development

Grobler JA, Anderson AS, Fernandes P, et al. Accelerated preclinical paths to support rapid development of COVID-19 therapeutics. Cell Host Microbe 2020, published 1 October. Full-text: https://doi.org/10.1016/j.chom.2020.09.017

Traditional drug discovery and development usually takes years from start to finish. To accelerate this process, the authors propose the minimum data package required to move a compound into clinical development safely. Follow them on an accelerated path for antivirals, immunomodulators, anticoagulants and other agents.

 

Severe COVID

Liu YM, Xie J, Chen MM, et al. Kidney function indicators predict adverse outcomes of COVID-19. Med 2020, published 2 October. Full-text: https://doi.org/10.1016/j.medj.2020.09.001

Kidney injury is a part of the clinical COVID-19 complications. In this retrospective study, the authors analyzed the data of 12,413 patients. At admission, the prevalence of elevated blood urea nitrogen (BUN), elevated serum creatinine (Scr), and decreased blood uric acid (BUA) at admission was 6.29%, 5.22%, 11.66%, respectively. The authors found that elevated baseline levels of BUN and Scr, and decreased level of BUA, were associated with a high risk of mortality.

 

Collateral Effects

Bakouny Z, Hawley JE, Choueiri TK, et al. COVID-19 and Cancer:Current Challenges and Perspectives. Cancer Cell 2020, published 1 October. Full-text: https://doi.org/10.1016/j.ccell.2020.09.018

The SARS-CoV-2 pandemic has affected patients with cancer in many ways (adverse outcomes in those who developed COVID-19, impact on the delivery of cancer care, etc.). In this review, the authors discuss the biological interplay between the two diseases and give practical recommendations for the management of patients with cancer during the pandemic. They also provide some insights from the cancer research community that might help develop novel therapies for all patients with COVID-19.

 

Education

Rubin EJ, Baden LR, Morrissey S. Covid-19 Testing and the Individual Physician. Audio interview (23:56). N Engl J Med 2020; 383:e99. Access: https://www.nejm.org/doi/full/10.1056/NEJMe2030753

The editors discuss how clinicians should respond to the results of various SARS-CoV-2 tests their patients might receive.

 

Spanish

If you read Spanish, read Sampedro J. El evento de Ischgl. El País 2020, published 3 October. Full-text: https://elpais.com/ciencia/2020-10-02/el-evento-de-ischgl.html

Una estación de esquí tirolesa propagó la covid a 40 países de cinco continentes.

 

French

If you read French, read Reverchon A. Robert Boyer: « Le capitalisme sort considérablement renforcé par cette pandémie » – Le Monde 2020, published 2 October. Full-text : https://www.lemonde.fr/idees/article/2020/10/02/robert-boyer-le-capitalisme-sort-considerablement-renforce-par-cette-pandemie_6054441_3232.html

Le cofondateur, dans les années 1970, de « l’école de la régulation », livre, dans un entretien au « Monde », son diagnostic du choc qui ébranle aujourd’hui l’économie mondiale, et de ses devenirs possibles.

 

Ratti C. « Et si le Covid-19 nous permettait de passer du tourisme effréné au tourisme raisonné ? » – Le Monde 2020, published 2 October. Full-text : https://www.lemonde.fr/smart-cities/article/2020/10/02/et-si-le-covid-19-nous-permettait-de-passer-du-tourisme-effrene-au-tourisme-raisonne_6054584_4811534.html

Dans une tribune au « Monde », l’architecte italien Carlo Ratti, chercheur au MIT, propose aux villes d’imaginer un nouveau modèle de tourisme, plus « raisonné », davantage fondé sur la durée.