Top 10: October 30

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Bassi F, Arbia G, Falorsi PD. Observed and estimated prevalence of Covid-19 in Italy: How to estimate the total cases from medical swabs data. Sci Total Environ. 2020 Oct 8:142799. PubMed: Full-text:

A national survey in Italy from May to July 2020 found a nationwide seropositivity rate of 2.5% (Sabbadini 2020). Insiders never believed these figures and favored a seropositivity rate of 5-10% like in Spain or in France. Now we have a new estimate of COVID-19 prevalence in Italy by Francesca Bassi and colleagues: 9%, corresponding to almost 6 million Italians.


Pasco RF, Fox SJ, Jonston SC, et al. Estimated Association of Construction Work With Risks of COVID-19 Infection and Hospitalization in Texas. JAMA Netw Open 2020, published 29 October. Full-text:

In central Texas, US, construction work is associated with increased community transmission of SARS-CoV-2. This study found that resuming construction work during shelter-in-place orders was associated with increased transmission in the surrounding community. Construction workers had a nearly 5-fold increased risk of hospitalization compared with other occupational categories.



Chan NC, Li K, Hirsh J. Peripheral Oxygen Saturation in Older Persons Wearing Nonmedical Face Masks in Community Settings. JAMA. Published online October 30, 2020. Full-text:

Social media campaigns have claimed that masks can cause hypoxia and are therefore dangerous. (Following this reasoning, almost all surgeons would suffer from chronic hypoxia…) Consequently, concerns have emerged about the safety of wearing face masks. In this small crossover study, wearing a 3-layer nonmedical face mask was not associated with a decline in oxygen saturation in older participants.



Gudbjartsson DF, Norddahl GL, Melsted P, et al. Humoral Immune Response to SARS-CoV-2 in Iceland. N Engl J Med 2020, published 1 September. Full-text:

Yesterday the NEJM published a paper we presented on September 2. In this study by Kari Stefansson, Daniel Gudbjartsson and colleagues, over 90% of 1,215 qPCR-positive persons tested positive with two pan-Ig SARS-CoV-2 antibody assays and remained seropositive 120 days after diagnosis, with no decrease of antibody levels. Another piece of good news: the infection fatality risk in Iceland was 0.3%.  See also the editorial by Galit Alter and Robert Seder: Alter G, Seder R: The Power of Antibody-Based Surveillance. N Engl J Med 2020, published 1 September. Full-text:



Fajnzylber J, Regan J, Coxen K, et al. SARS-CoV-2 viral load is associated with increased disease severity and mortality. Nat Commun 11, 5493 (2020).

SARS-CoV-2 viral loads, especially plasma viremia, are associated with increased risk of mortality. This is the result of a study by Jonathan Li, Jesse Fajnzylber and colleagues who report SARS-CoV-2 respiratory tract, plasma, and urine viral loads of 235 participants who were either hospitalized with COVID-19 (n=88), evaluated as symptomatic outpatients (n=94), or had recovered from COVID-19 disease (n=53). The prevalence of SARS-CoV-2 plasma viremia in hospitalized individuals with severe disease was relatively high, but plasma viremia was also detected in symptomatic non-hospitalized participants. Compared to individuals who were discharged from the hospital, those who eventually died had significantly higher levels of plasma viremia at the time of initial sampling (median plasma viral load 1.0 vs 2.0 log10 RNA copies/mL). For hospitalized individuals with initial detectable viremia, 32% died vs. 8% of those without initial viremia (odds ratio (OR) 5.5).


An C, Lim H, Kim D, et al. Machine learning prediction for mortality of patients diagnosed with COVID-19: a nationwide Korean cohort study. Sci Rep 10, 18716 (2020). Full-text:

At the height of pandemic waves, healthcare services may be overwhelmed by huge numbers of patients. Here, the authors propose a prediction model which might be helpful for the quick triage of patients without having to wait for the results of additional tests such as laboratory or radiologic studies. They demonstrate that machine learning models utilizing sociodemographic characteristics and medical history might accurately predict the prognosis of COVID-19 patients after diagnosis. Their models predicted not only the final outcome (i.e., mortality vs. recovery) but also early mortality (i.e., 14- or 30-day mortality).


Severe COVID

Mueller AA, Tamura T, Crowley CP, et al. Inflammatory biomarker trends predict respiratory decline in COVID-19 patients. Cell Rep Med 2020, published 28 October. Full-text:

Increasing C-reactive protein (CRP) values during the first 48 hours of hospitalization is a better predictor of respiratory decline than initial CRP levels. A rapid rise in CRP levels precedes respiratory deterioration and intubation, while CRP levels plateau in patients that remain stable. A finding of a single-center retrospective cohort analysis of 100 hospitalized COVID-19 patients.



Hippich M, Holthaus L, Assfalg R, et al. Public health antibody screening indicates a six-fold higher SARS-CoV-2 exposure rate than reported cases in children. Med 2020, published 28 October. Full-text:

In Bavaria, Germany, antibody surveillance in children during 2020 showed frequencies of 0.08% in January to March, 0.61% in April, 0.74% in May, 1.13% in June and 0.91% in July. Antibody prevalence from April 2020 was six-fold higher than the incidence of authority-reported cases (156 per 100,000 children) and was not associated with age or sex. Another important finding: the authors found no association between SARS-Cov-2 antibodies and type 1 diabetes autoimmunity.


Collateral Effects

Garrett-Mayer E, Rini BI. To Treat or Not to Treat—Balancing Benefits and Risks of Treatment Delay Among Patients With Cancer During the COVID-19 Pandemic. JAMA Oncol 2020, published 29 October. Full-text:

To treat or not to treat after balancing the benefits and risks of immediate treatment for cancer with the potential risk of COVID-19 and its associated complications, including death? Elizabeth Garrett-Mayer and Brian Rini discuss the paper by Hartman HE, Sun Y, Devasia TP, et al: Integrated Survival Estimates for Cancer Treatment Delay Among Adults With Cancer During the COVID-19 Pandemic. JAMA Oncol 2020, published 29 October. Full-text:


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