Top 10: October 7

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By Christian Hoffmann &
Bernd S. Kamps

 

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7 October

Epidemiology

Gallaway MS, Rigler J, Robinson S, et al. Trends in COVID-19 Incidence After Implementation of Mitigation Measures — Arizona, January 22–August 7, 2020. MMWR Morb Mortal Wkly Rep. ePub: 6 October 2020. Full-text: http://dx.doi.org/10.15585/mmwr.mm6940e3

How community mitigation measures can help slow the spread of COVID-19. Case numbers in Arizona stabilized and then decreased after sustained implementation and enforcement of statewide and locally enhanced mitigation measures, beginning approximately 2 weeks after implementation and enforcement of mask mandates and enhanced sanitations practices began on June 17; further decreases were observed during July 13–August 7, after statewide limitations and closures of certain services and businesses.

 

Calcagno A, Ghisetti V, Emanuele T, et al. Risk of SARS-CoV-2 infection in healthcare workers, Turin, Italy. Emerg Infect Dis. 2021 Jan. Full-text: https://doi.org/10.3201/eid2701.203027

Among 5,444 healthcare workers in Italy, seroprevalence was 6.9%. Seroprevalence was highest in laboratory personnel (18/175, 10.3%), although numbers were small, followed by nurse assistants (44/520, 8.5%), nurses (150/1983, 7.6%), and doctors (55/755, 7.3%).

 

Vogel G. It’s been so, so surreal.’ Critics of Sweden’s lax pandemic policies face fierce backlash. Science October 6, 2020. Full-text: https://doi.org/10.1126/science.abf1247

Sweden’s approach to the coronavirus pandemic is out of step with much of the world. Until last month, Sweden’s official policy stated people without obvious symptoms are very unlikely to spread the virus. Read how the Vetenskapsforum COVID-19 (Science Forum COVID-19) is fighting for tougher measures and how members have been pilloried or reprimanded.

 

Transmission

Prather KA, Marr LC, Schooley RT, et al. Airborne transmission of SARS-CoV-2. Science 05 Oct 2020: eabf0521. Full-text: https://doi.org/10.1126/science.abf0521

According to Kimberly Prather and colleagues, we must clarify the terminology to distinguish between aerosols and droplets using a size threshold of 100 μm, not the historical 5 μm. This size more effectively separates their aerodynamic behavior, ability to be inhaled, and efficacy of interventions. Viruses in droplets (larger than 100 μm) typically fall to the ground in seconds within 2 m of the source and can be sprayed like tiny cannonballs onto nearby individuals.

 

Clinical

Matschke J, Lütgehetmann M, Hagel C, et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. Lancet Neurology, October 5, 2020. Full-text: https://doi.org/10.1016/S1474-4422(20)30308-2

Jakob Matschke and colleagues from Hamburg/Germany have investigated the neuropathological features in the brains of 43 patients who died from COVID-19. Neuropathological changes seemed to be mild, with pronounced neuroinflammatory changes in the brainstem being the most common finding. There was no evidence for CNS damage directly caused by SARS-CoV-2. SARS-CoV-2 could be detected in the brains of 21 (53%) of 40 examined patients but was not associated with the severity of neuropathological changes.

 

Frontera JA, Sabadia S, Lalchan R, et al. A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City. Neurology. 2020 Oct 5:10.1212/WNL.0000000000010979. PubMed: https://pubmed.gov/33020166. Full-text: https://doi.org/10.1212/WNL.0000000000010979

Of 4,491 hospitalized COVID-19 patients, 606 (13.5%) developed a new neurologic disorder. The most common diagnoses were: toxic/metabolic encephalopathy (6.8%, temporary/reversible changes in mental status in the absence of focal neurologic deficits or primary structural brain disease, excluding patients in whom sedative or other drug effects or hypotension explained this), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis, or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were RT-PCR negative for SARS-CoV-2. In-hospital mortality was increased for patients with neurological disorders (Hazard Ratio 1.38, 95% CI 1.17-1.62).

 

Schwartz A, Yogev Y, Zilberman A, et al. Detection of SARS-CoV-2 in vaginal swabs of women with acute SARS-CoV-2 infection: a prospective study. BJOG. 2020 Oct 5. PubMed: https://pubmed.gov/33021026. Full-text: https://doi.org/10.1111/1471-0528.16556

In this prospective study of 35 women who were diagnosed with acute SARS‐CoV‐2 infection by a nasopharyngeal RT‐PCR test, vaginal RT‐PCR swabs were positive in 2 (5.7%). One was pre‐menopausal and the other was a post‐menopausal woman. Both women had mild disease.

 

Severe COVID-19

Moiseev S, Avdeev S, Brovko M, et al. Outcomes of intensive care unit patients with COVID-19: a nationwide analysis in Russia. Anaesthesia. 2020 Oct 5. PubMed: https://pubmed.gov/33015828. Full-text: https://doi.org/10.1111/anae.15265

Same bad outcome of ICU patients in Russia. In a nationwide study, the authors have evaluated the mortality rate in 1522 consecutive ICU patients with SARS‐CoV‐2 pneumonia who had completed their hospital stay (death or recovery) up to 7 July 2020. The 14 and 28 day mortality rates were 44.0% and 63.6%, respectively.

 

Brown J, Gregson FKA, Shrimpton A, et al. A quantitative evaluation of aerosol generation during tracheal intubation and extubation. Anaesthesia. 2020 Oct 6. PubMed: https://pubmed.gov/33022093. Full-text: https://doi.org/10.1111/anae.15292

This group conducted real‐time, high‐resolution environmental monitoring in ultraclean ventilation operating theatres during tracheal intubation and extubation sequences. Interestingly, both intubation and extubation sequences produced less aerosol than voluntary coughing. For the sequence of tracheal intubation, in particular, the concentration of aerosol generated was several orders of magnitude less than a single cough and was only very modestly above background levels of circulating particles.

 

Treatment

Abi Jaoude J, Kouzy R, El Alam MB, et al. Exclusion of Older Adults in COVID-19 Clinical Trials. Mayo Clin Proc. 2020 Oct;95(10):2293-2294. PubMed: https://pubmed.gov/33012364. Full-text: https://doi.org/10.1016/j.mayocp.2020.08.018

This data query of the ClinicalTrials.gov registry for trials regarding COVID-19 on June 8 revealed that 206/674 COVID-19 interventional trials (30.6%) had an upper age exclusion criterion. The median upper age exclusion was 75 years. Exclusion of older patients from clinical trials dramatically increases the risk of nonrepresentative trial populations compared with real-world counterparts.

 




German

If you read German, read Schumann F, Simmank J. “Wir haben es selbst in der Hand”. Die Zeit 2020, published 6 October. Full-text: https://www.zeit.de/wissen/2020-10/christian-drosten-corona-massnahmen-neuinfektionen-herbst-winter-covid-19

Quarantäne vor Familientreffen, Halskratzen ernst nehmen und mögliche Impfungen nicht überschätzen: Was der Virologe Christian Drosten jetzt für den Corona-Winter rät.

 

Merlot J. Wenn das Gehirn Schaden nimmt. Der Spiegel 2020, published 7 October. Full-text: https://www.spiegel.de/wissenschaft/medizin/covid-19-patienten-kollateralschaden-im-gehirn-a-2b0fdc5b-7a24-4328-8593-a8ad6007796e

Gedächtnisschwund, Aufmerksamkeitsstörungen, Koma: Einige Covid-19-Patienten entwickeln neurologische Beschwerden. US-Forscher haben untersucht, wie häufig diese Leiden vorkommen.

 

French

If you read French, read Covid-19 : en Ile-de-France, plus de 40 % des lits en réanimation sont occupés par des patients contaminés. Le Monde 2020, published 6 October. Full-text : https://www.lemonde.fr/planete/article/2020/10/06/en-ile-de-france-plus-de-40-des-lits-en-reanimation-sont-occupes-par-des-malades-du-covid-19_6055013_3244.html

L’agence régionale de santé d’Ile-de-France prévoit un taux d’occupation de 50 % « dans les quinze prochains jours ». Selon des modélisations de l’Institut Pasteur, ce chiffre pourrait atteindre 100 % avant la fin du mois.