Top 10: September 12

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By Christian Hoffmann &
Bernd S. Kamps

12 September


Silver SR, Li J, Boal WL, Shockey TL, Groenewold MR. Prevalence of Underlying Medical Conditions Among Selected Essential Critical Infrastructure Workers — Behavioral Risk Factor Surveillance System, 31 States, 2017–2018. MMWR Morb Mortal Wkly Rep 2020;69:1244–1249. Full-text:

Many essential workers are at risk of SARS-CoV-2 infection because their jobs require close contact with patients, the public, or coworkers. Now Sharon Silver et al. analyzed 6 occupation groups:

  1. health practitioners (licensed health care professionals except technicians/technologists)
  2. health technicians and technologists
  3. other health care support (except home health)
  4. patient and personal care aides in the home health industry (home health aides)
  5. protective services (correctional officers, police, sheriffs, patrol officers, firefighters, and their supervisors)
  6. teachers (preschool through grade 12)


and 7 industry groups:

  1. ambulatory health care
  2. hospitals
  3. nursing homes (nursing and residential care facilities)
  4. essential retail (grocery/other food stores, alcohol stores, pharmacies, and gas stations)
  5. food manufacturing
  6. transit (bus service/urban transit, taxi/limousine, postal services, and couriers/messengers)
  7. trucking


The results: A high prevalence of underlying medical conditions increases the risks for severe COVID-19 illness among home health aides, other health care support workers, and nursing home, trucking, and transit industry workers. The authors recommend that for all essential workers, and particularly those at high risk because of underlying medical conditions, exposure controls should be intensified. In addition, health care access should be optimized to prevent and treat underlying conditions.



Yang J, Petitjean SJL, Koehler M. Molecular interaction and inhibition of SARS-CoV-2 binding to the ACE2 receptor. Nat Commun 11, 4541 (2020). Full-text:

What do we know about the dynamics of the binding of the spike (S) glycoprotein to the ACE2 receptor at the single-molecule level? Try atomic force microscopy. David Alsteens, Jinsung Yang and colleagues demonstrate, both on model surfaces and on living cells, that the receptor binding domain serves as the binding interface within the S-glycoprotein with the ACE2 receptor and extract the kinetic and thermodynamic properties of this binding pocket. Then they examined how several ACE2-derived peptide fragments could interfere with the S1–ACE2 complex formation. Peptides mimicking the N-terminal helix of the ACE2 receptor showed the best results. New therapeutic candidates?



If you read German, read Anonymous. Deutsche Box-Olympiamannschaft mit Coronavirus infiziert. Die Zeit 2020, published 12 September. Full-text:

In an unintentional experiment, the German national team of amateur boxers has proved that you can achieve a 100% transmission rate in a small group within days. In a training camp, some of the 18 athletes and 7 coaches and supervisors had cold symptoms four days ago. Now all 25 persons have tested positive for SARS-CoV-2. So far, no serious cases.


Ehrhardt J , Ekinci A , Krehl H , et al. Transmission of SARS-CoV-2 in children aged 0 to 19 years in childcare facilities and schools after their reopening in May 2020, Baden-Württemberg, Germany. Euro Surveill. 2020;25(36). Full-text:

After post-lockdown reopening of schools and childcare facilities in May 2020 in Baden-Württemberg, Germany, child-to-child transmission appeared uncommon. Stefan Brockmann, Jonas Ehrhardt and colleagues anticipate that, with face mask use and frequent ventilation of rooms, transmission rates in schools/childcare facilities could remain low, even if class group sizes were increased.


Lopez AS, Hill M, Antezano J, et al. Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020. MMWR Morb Mortal Wkly Rep. ePub: 11 September 2020. Full-text:

Cuc Tran, Adriana Lopez and colleagues describe 12 children who acquired SARS-CoV-2 infection in child-care facilities. All had mild or no symptoms. They transmitted the virus to at least 12 (26%) of 46 non-facility contacts. The authors conclude that testing children who might not have symptoms could improve control of transmission from child-care attendees to family members.


Fisher KA, Tenforde MW, Feldstein LR, et al. Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults ≥18 Years in 11 Outpatient Health Care Facilities — United States, July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1258–1264. Full-text:

Eating and drinking and socializing? Everything may well return to normal in about two years. In the meantime, note that adults with a positive SARS-CoV-2 test result were found to be twice as likely to have had dinner at a restaurant than those with negative test results. Kiva Fisher and colleagues conclude that eating and drinking on-site at locations that offer such options might be important risk factors associated with SARS-CoV-2 infection. Bars and restaurants are in for a rough autumn and winter season.



Fauter M, Viel S, Zaepfel S, et al. Low glycosylated ferritin is a sensitive biomarker of severe COVID-19. Cell Mol Immunol (2020). Full-text:



Crameri GAG, Bielecki M, Züst R, et al. Reduced maximal aerobic capacity after COVID-19 in young adult recruits, Switzerland, May 2020. Euro Surveill. 2020;25(36):pii=2001542. Full-text:

Take a cohort of young, predominantly male military recruits (173 men, 26 women) with a median age of 21 years and compare a fitness test after a diagnosis of SARS-CoV-2 infection (median: 45 days; range: 31–58 days) with a baseline test performed 3 months before the infection. What did Jeremy Werner Deuel, Giovanni Crameri and colleagues find? A decrease in maximal aerobic capacity (VO2 max) among COVID-19 convalescent but not among asymptomatic and not-infected recruits. Ca 19% of COVID-19 convalescent recruits showed a decrease of VO2 max of more than 10% as compared with baseline before infection. Never stop following your patients.


Rajpal S, Tong MS, Borchers J, et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol. Published online September 11, 2020. Full-text:

Recent studies have raised concerns of myocardial inflammation after recovery from COVID-19, even in asymptomatic or mildly symptomatic patients. Here, Saurabh Rajpal et al. performed a comprehensive cardiac magnetic resonance (CMR) examination including cine, T1 and T2 mapping, extracellular volume fraction, and late gadolinium enhancement (LGE), on a 1.5-T scanner in 26 SARS-CoV-2 infected competitive athletes. Four of them (15%) had CMR findings suggestive of myocarditis and 8 additional athletes (30.8%) exhibited LGE without T2 elevation suggestive of prior myocardial injury. Long-term follow-up is required to understand CMR changes in competitive athletes.



Boseley S. The Covid-19 vaccine gamble: where bets have been placed and why. The Guardian 2020, published 11 September. Full-text:

Wealthy nations have ordered millions of doses of unproven candidate vaccines, but equal access will be the key to beating the virus.


Bland A, Murphy S, Busby M. ‘It’s world-leadingly bad, is what it is’: the week Covid surged again in UK. The Guardian 2020, published 11 September. Full-text:

Queues for tests are growing, Tory MPs are agitated and doctors are sceptical about the ‘moonshot’.



If you read Spanish, read Ansede M. Ocho meses sin tratamiento curativo contra la covid y sin solución a la vista. El País 2020, published 12 September. Full-text:

La investigación de terapias contra el coronavirus acumula fracasos, pero los especialistas han optimizado sus escasas armas y han logrado reducir la mortalidad.