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By Christian Hoffmann &
Bernd S. Kamps
1 September
Epidemiology
Seemann T, Lance CR, Sherry NL, et al. Tracking the COVID-19 pandemic in Australia using genomics. Nat Commun 11, 4376 (2020). Full-text: https://doi.org/10.1038/s41467-020-18314-x
Genomic sequencing for rapid identification of SARS-CoV-2 transmission chains? That’s what Benjamin P. Howden and Torsten Seemann did in Victoria, Australia (1,333 COVID-19 cases). They combined extensive whole-genome sequencing and epidemiologic data to investigate the source of individual cases and identify distinct genomic clusters, including large clusters associated with social venues, healthcare visits and cruise ships. The authors demonstrate the critical role of multiple SARS-CoV-2 importations by returned international travelers in driving transmission in Australia, with travel-related cases responsible for establishing ongoing transmission lineages (each with 3–9 cases) accounting for over half of locally acquired cases.
Immunology
Thieme CJ, Anft M, Paniskaki K, et al. Robust T cell response towards spike, membrane, and nucleocapsid SARS-CoV-2 proteins is not associated with recovery in critical COVID-19 patients. Cell Reports Medicine 2020, published 29 August. Full-text: https://doi.org/10.1016/j.xcrm.2020.100092
Nina Babel, Constantin Thieme and colleagues performed a comprehensive characterization of the T cell response against S-, M- and N- SARS-CoV-2 proteins in patients with different COVID-19 severity and unexposed donors. Surprise: the T cell response of critical COVID-19 patients is robust and comparable or even superior to non-critical patients. The authors would thus disprove the hypothesis of insufficient SARS-CoV-2-reactive immunity in critical COVID-19. Expect some intense discussions.
Hunting for antibodies to combat COVID‑19. Biopharma dealmakers 2020, published 1 September. Full-text: https://www.nature.com/articles/d43747-020-01115-y
The development of highly successful monoclonal antibody-based therapies for cancer and immune disorders has created a wealth of expertise and manufacturing capabilities. Is there room for monoclonals for prevention or treatment of severe COVID-19 before the general availability of vaccines and efficient antiviral drugs? Find out how the ‘COVID-19 antibodysphere’ (Amgen, AstraZeneca, Vir, Regeneron, Lilly, Adagio) is building partnerships.
Pediatrics
Han MS, Choi EH, Chang SH, et al. Clinical Characteristics and Viral RNA Detection in Children With Coronavirus Disease 2019 in the Republic of Korea. JAMA Pediatr. Published online August 28, 2020. Full-text: https://doi.org/10.1001/jamapediatrics.2020.3988
How many pediatric SARS-CoV-2 cases would doctors miss if they focused on only testing symptomatic patients? Maybe up to 90%, say Jong-Hyun Kim, Eun Hwa Choi, Mi Seon Han and colleagues from Korea. In this case series of children with COVID-19, 20 children (22%) were asymptomatic during the entire observation period. Among 71 symptomatic cases, only 6 (9%) were diagnosed at the time of symptom onset while 47 children (66%) had unrecognized symptoms before diagnosis and 18 (25%) developed symptoms after diagnosis. The authors conclude that there is no other good alternative to extensive testing for early detection of SARS-CoV-2 infection.
Summary of the clinical symptoms (91 patients):
| Asymptomatic | 22% |
| Cough | 41% |
| Fever > 38º C | 30% |
| Sore throat | 29% |
| Runny nose | 27% |
| Diarrhea | 12% |
| Loss of sense of taste | 12% |
Fifty-one percent had “mild” disease, 22% “moderate” disease and 2% “severe” disease. No patient required intensive care.
DeBiasi RL, Delaney M. Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Under the Surface. JAMA Pediatr. Published online August 28, 2020. Full-text: https://doi.org/10.1001/jamapediatrics.2020.3996
Roberta DeBiasi and Meghan Delaney comment on the previous study and underline the three “take-home points”:
- Not all infected children have symptoms, and even those with symptoms are not necessarily recognized in a timely fashion.
- Duration of symptoms in symptomatic infected pediatric patients varies widely.
- Virus was detectable for a mean of 17.6 days overall and was detectable for a prolonged period of time in all cohorts of children, whether symptoms were present or not. (Detectability does not mean infectivity in all cases, though.)
Important summary in view of the current school re-openings.
Journal Feature
Viglione G. How many people has the coronavirus killed? Nature 2020, published 1 September. Full-text: https://www.nature.com/articles/d41586-020-02497-w
Excess mortality, the comparison of expected deaths with ones that actually happened, may be the most robust way to gauge the impact of the pandemic. According to data from more than 30 countries for which estimates of excess deaths are available, Giuliana Viglione shows there could be more deaths than those officially attributed to COVID-19.
Education
Centor RM, D’Alessio FR. Annals On Call – Regulatory T Cells: Treatment for COVID-19? Ann Intern Med 2020, published 1 September. Audio podcast (23:29): https://www.acpjournals.org/doi/10.7326/A19-0037
Discussion of the potential use of regulatory T cells to treat patients with acute respiratory distress syndrome associated with COVID-19. Annals articles discussed include [Gladstone DE, Kim BS, Mooney K, et al. Regulatory T Cells for Treating Patients With COVID-19 and Acute Respiratory Distress Syndrome: Two Case Reports. Ann Int Med 2020, Jul 6. Full-text: https://www.acpjournals.org/doi/10.7326/L20-0681] which we presented in the July 8 Top 10.
French
If you read French, read Bellier U. De l’« inutilité » pour le grand public à l’obligation généralisée, sept mois de consignes sur le masque en France. Le Monde 2020, publié le 29 août. Texte intégral : https://www.lemonde.fr/societe/article/2020/08/29/six-mois-de-consignes-sur-le-masque-en-france_6050316_3224.html
Ulysse Bellier rappelle l’usage du masque depuis le début de l’épidémie et sept mois de recommendations parfois contradictoires.