Top 10: September 27

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By Christian Hoffmann &
Bernd S. Kamps

27 September


Asadi S, Cappa CD, Barreda S, et al. Efficacy of masks and face coverings in controlling outward aerosol particle emission from expiratory activities. Sci Rep 10, 15665 (2020). Full-text:

Masks work with super-emittors! William D. Ristenpart, Sima Asadi and colleagues measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators reduced the outward particle emission rates by 90% and 74% on average during speaking and coughing. These masks similarly decreased the outward particle emission of a coughing super-emitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. An interesting collateral finding: people speak more loudly, but do not cough more loudly, when wearing a mask.



Wei Y, Ye Z, Cui M, Wei X. COVID-19 prevention and control in China: grid governance. Journal Public Health 2020, published 26 September. Full-text:

Grid governance is a key measure that helps to promote decentralization at the grassroots level, applied in both urban and rural communities in China. It may not be to everyone’s taste as it seeks to divide the basic level of society into many responsible grids, and accordingly it inserts affairs, organizations and people into particular grids, and also uses modern technology to comprehensively and quickly complete basic information collection. But it may have been helpful in bringing the Chinese epidemic under control. Find out more about ‘grid governance’.

Number of



Schurink B, Roos E, Radonic T, et al. Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study. Lancet Microbe 2020, published 25 September. Full-text:

The authors report the full body autopsy results of 21 patients at Amsterdam University Medical Centers (UMC), the Netherlands. In histological analyses of organs (sampled from nine to 21 patients per organ), an extensive inflammatory response was present in the lungs, heart, liver, kidneys, and brain. In the brain, extensive inflammation was detected, which was most pronounced in the olfactory bulbs and medulla oblongata. Their findings also suggest involvement of neutrophil extracellular traps

(NETs) in coagulopathy and prolonged activation of neutrophils in lethal COVID-19, or at least a delayed resolution of these NETs.


Nie J, Li Q, Wu J, et al. Quantification of SARS-CoV-2 neutralizing antibody by a pseudotyped virus-based assay. Nat Protoc 2020, published 25 September. Full-text:

The authors developed a pseudotyped virus-based neutralization assay against SARS-CoV-2 in biosafety level 2 facilities. The authors caution that experience in handling cells is needed before implementing this protocol.


Severe COVID

Barbaro RP, MacLaren G, Boonstra PS, et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet 2020, published 25 September. Full-text:

Initial reports of extracorporeal membrane oxygenation (ECMO) use in patients with COVID-19 described very high mortality. Here Ryan Barbaro et al. report data for 1035 patients who received ECMO support from 213 hospitals in 36 countries. Of these, 6% remained hospitalized, 30% were discharged home or to an acute rehabilitation center, 10% were discharged to a long-term acute care center or unspecified location, 17% were discharged to another hospital, and 37% died.


Yadaw AS, Li YC, Bose S, et al. Clinical features of COVID-19 mortality: development and validation of a clinical prediction model. Lancet Digital Health 2020, published 1 October. Full-text:

Predicting mortality among patients with COVID-19 is difficult. Here, the authors developed a COVID-19 mortality prediction model that showed high accuracy when applied to test datasets of retrospective (n=961) and prospective (n=249) patients. The authors showed that input of three highly accessible clinical parameters for a patient—age, minimum oxygen saturation, and type of patient encounter—into an automatable eXtreme Gradient Boosting (XGBoost) algorithm has the potential to accurately classify patients as likely to live or die.


Ho EP, Neo HY. COVID 19: Prioritise Autonomy, Beneficence and Conversations Before Score-based Triage. Age Ageing 2020, published 25 September. Full-text:

In the coming weeks, demand for intensive COVID-19 care may overwhelm ICU capacities in Spain, France, the UK and other European countries. Decisions regarding ICU admission are particularly challenging in older people, who are most likely to require critical care, but for whom benefits are most uncertain. The authors suggest that physicians should first discern if older people will benefit from critical care (beneficence) and second, if they want critical care (autonomy). Decisions should be based on individualized risk-stratification and survival weighed against burden of treatment, as well as longer-term functional deficits and quality-of-life. Tough times ahead.


Collateral Effects

Weiss DJ, Bertozzi-Villa A, Rumisha SF, et al. Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis. Lancet Infect Dis 2020, published 25 September. Full-text:

Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years.


Ueda Oshima, M., Sandmaier, B.M., Petersdorf, E. et al. Blood and marrow transplantation during the emerging COVID-19 pandemic: the Seattle approach. Bone Marrow Transplant 2020, published 26 September. Full-text:

Increasing numbers of COVID-19 hospitalizations and deaths, pandemic-related stresses on healthcare resources, shelter-in-place public health measures – how can you safely perform potentially life-saving stem cell transplants in this setting? Masumi Oshima et al. describe the challenges and the collateral impact of directing clinical resources toward COVID-19-related care on cancer patients in need of stem cell transplantation.



The world officially records 1 million deaths from Covid-19. The real tally may be almost double that. If you read Spanish, read the articles of today’s El País Special:


Bassets M. Un millón de muertos. El País 2020, published 27 September. Full-text:

El mundo, en plena transformación y ante una crisis económica y política, alcanza la cifra simbólica sin perspectivas de un final cercano de la pandemia, pero mejor armado ante la segunda ola y con la esperanza de las vacunas.


Hustvedt S. Las Pandoras de la pandemia. El País 2020, published 27 September. Full-text:

Los déspotas buscan un enemigo mitológico a quien culpar del virus. Sin embargo, si algo hemos aprendido de la pandemia es que la acción colectiva es lo único que puede cambiar las cosas.


De Senegal a Yakarta, una diversa geografía del dolor. El País 2020, published 27 September. Full-text:

Familias destrozadas de todo el mundo rememoran la muerte de sus seres queridos y lamentan el duelo que les robó el virus. Son los padres, hermanos, viudos y huérfanos de la COVID.


Sampedro J. Un regalo envenenado de la madre naturaleza. El País 2020, published 27 September. Full-text:

Los gobiernos occidentales, incluido el español, minimizaron los riesgos de la COVID y la experiencia adquirida en China, un error que se puede medir en vidas humanas.


Spinney L. Solo recordaremos su nombre. El País 2020, published 27 September. Full-text:

Pese a sumar millones de muertos, otras enfermedades del pasado han desaparecido de la memoria colectiva.