Top 10: September 10

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By Christian Hoffmann &
Bernd S. Kamps

10 September


Salas RN, Schultz JM, Solomon CG. The Climate Crisis and Covid-19 — A Major Threat to the Pandemic Response. N Engl J Med 2020, 383:e70. Published 10 September. Full-text:

Will the climate crisis challenge our response to the COVID-19 pandemic? Yes, it might, reply Renee Salas, James Shultz and Caren G. Solomon. They propose short-term strategies for managing climate-related extreme events during the COVID-19 Pandemic:

  1. Extreme events (e.g., hurricanes, wildfires): evacuation and sheltering
  2. Extreme heat: remaining at home and in cool locations

Find the details in this Perspective article.



Abbasi J. COVID-19 and mRNA Vaccines-First Large Test for a New Approach. JAMA. 2020 Sep 3. PubMed: Full-text:

mRNA vaccines like BNT162b2 from BioNTech and Pfizer and mRNA-1273 by Moderna have ‘the potential to be truly transformative’ (Drew Weissman) but have never been tested in large-scale human trials. Now both vaccines have entered Phase 3 trials, which together will enroll an estimated 60,000 volunteers. Follow Jennifer Abbasi on a tour of ‘proof in the pudding’ and mRNA vaccines beyond COVID-19.



Tromberg BJ, Schwetz, TA, Pérez-Stable EJ, et al. Rapid Scaling Up of Covid-19 Diagnostic Testing in the United States — The NIH RADx Initiative. N Engl J Med 2020, published 10 September. Full-text:

Expanding the capacity, throughput, and speed of returning results will contribute to curb the COVID-19 pandemic. Francis Collins, Bruce Tromberg and colleagues describe the US Rapid Acceleration of Diagnostics (RADx) program, its goals, and its focus on underserved populations.



Cunningham JW, Vaduganathan M, Claggett BL, et al. Clinical Outcomes in Young US Adults Hospitalized With COVID-19. JAMA Intern Med 2020, published 9 September. Full-text:

Does COVID-19 spare young people? Of course not. Here is the proof by Scott Solomon, Jonathan Cunningham and colleagues. They investigated the outcomes of 3222 young adults (age 18 to 34 years) hospitalized for COVID-19. 684 patients (21%) required intensive care, 331 (10%) mechanical ventilation, and 88 patients (2.7%) died. Morbid obesity and hypertension were associated with a greater risk of death or mechanical ventilation. Importantly, young adults age 18 to 34 years with multiple risk factors (morbid obesity, hypertension, and diabetes) faced risks similar to 8862 middle-aged (age 35-64 years) adults without these conditions.

See also the short comment by Katz MH. Regardless of Age, Obesity and Hypertension Increase Risks With COVID-19. JAMA Intern Med 2020, published 9 September. Full-text: and


Rhee C, Baker M, Vaidya V, et al. Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large US Academic Medical Center. JAMA Netw Open. 2020;3(9):e2020498. Full-text:

How adequate are COVID-19 infection control practices in acute care hospitals? Look at nosocomial transmission of SARS-CoV-2! Here, Chanu Rhee et al. analyzed 9149 patients admitted to a large academic medical center, 697 of whom tested positive for SARS-CoV-2 infection. Of these, only 1 case was deemed to be hospital-acquired, most likely from a pre-symptomatic spouse who was visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented. The authors conclude that nosocomial COVID-19 was rare even during the height of the pandemic. At least at Brigham and Women’s Hospital, Boston, USA.



Cao L, Goreshnik I, Coventry B, et al. De novo design of picomolar SARS-CoV-2 miniprotein inhibitors. Science 2020, published 9 September. Full-text:

Targeting the interaction between the SARS-CoV-2 Spike protein and the human ACE2 receptor has become a global sport. The ultimate goal: delivery of a viral inhibitor into the nose and into the respiratory system for treatment of early infection, maybe even for prophylaxis. Now David Baker, Longxing Cao and colleagues report computer-designed mini-proteins (20-fold smaller than a full antibody molecule ) that might rival SARS-CoV-2 neutralizing antibodies in its protective actions. The authors believe that in the future it will become possible to generate ultra-high-affinity, pathogen-neutralizing designs within weeks of obtaining a genome sequence.



Rodgers GP, Gibbons GH. Obesity and Hypertension in the Time of COVID-19. JAMA 2020, published 9 September. Full-text:

If you are interested in US prevalence and trends for obesity and controlled hypertension from 1999 through 2018, read this editorial about the following two papers:

Ogden CL, Fryar  CD, Martin  CB,  et al.  Trends in obesity prevalence by race and Hispanic origin—1999-2000 to 2017-2018.  JAMA 2020, published 9 September. Full-text:
Muntner  P, Hardy  ST, Fine  LJ,  et al.  Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018.  JAMA 2020, published 9 September. Full-text:


Rubin EJ, Baden LR, Morrissey S. Guidelines for Covid-19 Vaccine Deployment. Audio interview (30:04). N Engl J Med 2020; 383:e88. Access:

The editors discuss guidelines for the deployment of potential SARS-CoV-2 vaccines from the CDC and the National Academies, as well as new information on two candidate vaccines.



Tambyraja AL. New Order, New Hope. N Engl J Med 2020, published 9 September. Full-text:

Try this with your medical students who join you in an operating room. “There’s a giant flood coming that will devastate the earth and its inhabitants. You’ve got a big boat in which to preserve human civilization. There’s room for 100 citizens of the world and 5 doctors. Which doctors do you want to take on the boat?” Join Andrew Tambyraja in this game.




Farrar J. Let’s get real. No vaccine will work as if by magic, returning us to ‘normal’. The Guardian 2020, published 6 September. Full-text:

Jeremy Farrar about accelerating vaccine development without compromising safety, vaccinating priority groups worldwide, and European political leadership.