Top 10: September 15

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By Christian Hoffmann &
Bernd S. Kamps

15 September


Schäfer R, Spohn G, Bechtel M, et al. Human Mesenchymal Stromal Cells are resistant to SARS-CoV-2 Infection under Steady State, Inflammatory Conditions and in the Presence of SARS-CoV-2 infected Cells. Stem Cell Rep September 11, 2020. Full-text:

Mesenchymal Stem/Stromal Cells (MSC) may ameliorate pulmonary inflammation in ARDS and clinical trials assessing the potential of MSC for COVID-19 treatment are underway. Richard Schäfer and colleagues from Frankfurt show that MSC are resistant to SARS-CoV-2 infection. MSC carry ACE2 and TMPRSS2 only at very low levels on the cell surface and retain their immunomodulation potential supporting their potential applicability for COVID-19 treatment.


Luo K, Lei Z, Hai Z, et al. Transmission of SARS-CoV-2 in Public Transportation Vehicles: A Case Study in Hunan Province, China. Open Forum Infectious Diseases 13 September 2020, ofaa430. Full-text:

Transmission in a bus. The tour coach was 11.3 meters long and 2.5 meters wide with 49 seats, fully occupied with all windows closed and the ventilation system on during the 2.5-hour trip. Among the 49 passengers (including the driver) who shared the ride with the index person, eight tested positive and eight developed symptoms. The index person sat in the second-to-last row, and the infected passengers were distributed over the middle and rear rows.



Poon KS, Tee NW. Caveats of Reporting Cycles Threshold from SARS-CoV-2 Qualitative PCR Assays: A Molecular Diagnostic Laboratory Perspective. Clinical Infectious Diseases, 15 September 2020, ciaa1399. Full-text:

A note of caution regarding Ct values as a surrogate indicator of ‘quantity’ in a qualitative PCR assay (“viral load”). Lok-Siong Poon and Nancy Wen-Sim Tee argue that results are not portable across different assays, different gene targets and different specimen types.



Kiang MV, Irizarry RA, Buckee CO, et al. Every Body Counts: Measuring Mortality From the COVID-19 Pandemic. Ann Int Med, September 11, 2020. Full-text:

This brilliant article discusses the current difficulties of disaster death attribution and describes the strengths and limitations of relying on death counts from death certificates, estimations of indirect deaths, and estimations of excess mortality.


Muscatello DJ, McIntyre PB. Comparing mortalities of the first wave of coronavirus disease 2019 (COVID-19) and of the 1918–19 winter pandemic influenza wave in the USA. International Journal of Epidemiology, 15 September 2020, dyaa186. Full-text:

David J Muscatello and Peter B McIntyre used indirect age standardization to calculate standardized mortality ratios (SMRs) for the 1918–19 winter influenza pandemic wave, with the reference mortality rate being COVID-19 death rates for New York City. They also used mortality data for the 2009 pandemic and the severe 2017–18 season as comparators. All-age COVID-19 mortality rates remain substantially lower than those documented in the 1918–19 influenza pandemic, recognizing that 1918–19 mortality was inflated by lack of now routine treatments. The age-adjusted, all-age mortality rate for the 1918–19 winter wave of the influenza pandemic was 6.7 times higher than COVID-19 cumulative mortality rates to 2 June 2020. In < 45-year-olds, the SMR was 42 times higher for influenza in 1918–19 than for COVID in 2020. However, in ≥ 45-year-olds, the SMR was 44% lower in 1918–19 than for COVID in 2020. COVID-19 mortality was more than 10-fold higher than a severe influenza season, and more than 300-fold higher than the 2009–10 influenza pandemic.


Marshall M. The lasting misery of coronavirus long-haulers. Nature September 14, 2020, 585, 339-341. Full-text:

Doctors are now concerned that the pandemic will lead to a significant surge of people battling lasting illnesses and disabilities. Because the disease is so new, no one knows yet what the long-term impacts will be. This article gives some insights on how some people are still battling crushing fatigue, lung damage and other symptoms of ‘long COVID’, several months after acute illness.


Zong Y, Gu Y, Yu H, et al. Thrombocytopenia Is Associated with COVID-19 Severity and Outcome: An Updated Meta-Analysis of 5637 Patients with Multiple Outcomes. Laboratory Medicine, 15 September 2020, lmaa067. Full-text:

A meta-analysis of 24 studies, showing a weighted incidence of thrombocytopenia in COVID-19 patients of 12.4% (95% CI 7.9%–17.7%). The meta-analysis of binary outcomes (with and without thrombocytopenia) indicated the association between thrombocytopenia and a 3-fold enhanced risk of a composite outcome of intensive care unit admission, progression to acute respiratory distress syndrome, and mortality (odds ratio 3.49; 95% CI, 1.57–7.78).


De Souza L, Nwanji V, Kaur G. An auspicious triumph of recovery from dialysis-requiring acute kidney injury in COVID-19 in a patient with chronic kidney disease, α-1 antitrypsin deficiency, and liver transplant: A case report. Clin Nephrol. 2020 Sep 10. PubMed: Full-text:

Never give up. Luisa De Souza and colleagues report a unique case of an immunosuppressed 67-year-old female with A1AT deficiency and liver transplant with baseline chronic kidney disease (CKD) stage IIIa, recovering from COVID-19 mediated hypoxic respiratory failure complicated by AKI requiring provisional renal replacement therapy.



Dandachi D, Geiger G, Montgomery MW, et al. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19. Clin Inf Dis 2020 Sep 9. Full-text:

Among 286 HIV-infected patients who were included by US healthcare providers, mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (< 200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes.


Fraser J, Mousley J, Testro A, Smibert OC, Koshy AN. Clinical Presentation, Treatment, and Mortality Rate in Liver Transplant Recipients With Coronavirus Disease 2019: A Systematic Review and Quantitative Analysis. Transplant Proc. 2020 Jul 30:S0041-1345(20)32634-8. PubMed: Full-text:

A systematic search was performed for articles published up to June 15, 2020, revealing 223 liver transplant recipients with COVID-19 in 15 studies. Immunosuppression was modified in 32.8% of recipients. The case fatality rate was 19.3%. Dyspnea on presentation, diabetes mellitus, and age 60 years or older were significantly associated with increased mortality (P ≤ 0.01) with a trend to a higher mortality rate observed in those with hypertension and those receiving corticosteroids at the time of COVID-19 diagnosis.