Top 10: September 28

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By Christian Hoffmann &
Bernd S. Kamps

28 September


Anand S, Montez-rath M, Han J, et al. Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study. Lancet 2020, published 25 September. Full-text:

During the first wave of the COVID-19 pandemic, fewer than 10% of the US adult population formed antibodies against SARS-CoV-2, and fewer than 10% of those with antibodies were diagnosed. That is the result of a cross-sectional US study by Shuchi Anand et al. after testing 28,503 randomly selected adult patients receiving dialysis in July 2020. When standardized to the US dialysis population, seroprevalence ranged from 3.5% in the west to 27.2% in the northeast. Residents of non-Hispanic Black and Hispanic neighborhoods experienced higher odds of seropositivity.

See also the comment by Barnaby Flower and Christina Atchison: Flower B, Atchison C. SARS-CoV-2 antibody seroprevalence in patients receiving dialysis in the USA. Lancet 2020, published 25 September. Full-text:


Hallal PC, Hartwig FP, Horta BL, et al. SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys. Lancet Global Health 2020, published 23 September. Full-text:

A long way to herd immunity – and very different data from the projected 66% seropositivity rate in Manaus we presented two days ago. Cesar G Victora, Pedro Hallal and colleagues report two seroprevalence surveys in 133 sentinel cities in all Brazilian states. They included 25,025 participants in the first survey (May 14–21) and 31,165 in the second (June 4–7). Prevalence was strongly associated with Indigenous ancestry and low socioeconomic status. In the second survey, the authors observed an increased prevalence in participants aged 20–59 years and those living in crowded conditions (4.4% for those living with households with six or more people). Prevalence among Indigenous people was 6.4% compared with 1.4% among White people. Prevalence in the poorest socioeconomic quintile was 3.7% compared with 1.7% in the wealthiest quintile. The authors conclude that “these population subgroups are unlikely to be protected if the policy response to the pandemic by the national government continues to downplay scientific evidence.”


Gupta V, Bhoyar RC, Jain A, et al. Asymptomatic reinfection in two healthcare workers from India with genetically distinct SARS-CoV-2. Clin Infect Dis 2020, published 23 September. Full-text:

The next paper on reinfection. Vinod Scaria, Vivek Gupta and colleagues describe two healthcare workers, 25 and 28 years old, who tested positive for SARS-CoV-2 in May and again, after resuming duties in the hospital, on 21 August and 5 September, respectively. Genomic analysis showed that the SARS-CoV-2 of the reinfection was different from the virus of the first episode. Both individuals were asymptomatic in May and in August/September.



Brooke GN Prischi F. Structural and functional modelling of SARS-CoV-2 entry in animal models. Sci Rep 10, 15917 (2020). Full-text:

Greg Brooke and Filippo Prischi compared the ACE2 receptor, and TMPRSS2 and Furin proteases usage of the SARS-CoV-2 Spike glycoprotein in human and in a panel of animal models (guinea pig, dog, cat, rat, rabbit, ferret, mouse, hamster, macaque) and find that ACE2, but not TMPRSS2 or Furin, has a higher level of sequence variability in the Spike protein interaction surface, which greatly influences Spike protein binding mode. The authors also show that the Spike (S) protein recognizes macaque, hamster, and ferret in a comparable way to human ACE2. However, there were substantial differences in the binding mode of the SARS-CoV and SARS-CoV-2 S protein to guinea pigs, mice and rats ACE2.



Han E, Tan MMJ, Turk E, et al. Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe. Lancet 2020, published 24 September. Full-text:

Lockdowns cannot be sustained for the long term and governments worldwide face the challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. Now Helena Legido-Quigley, Emeline Han and colleagues examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (i.e., Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (i.e., Germany, Norway, Spain, and the UK). What can we learn from these experiences?



Bos R, Rutten L, van der Lubbe JEM, et al. Ad26 vector-based COVID-19 vaccine encoding a prefusion-stabilized SARS-CoV-2 Spike immunogen induces potent humoral and cellular immune responses. npj Vaccines 5, 91 (2020). Full-text:

Hanneke Schuitemaker, Rinke Bos and colleagues report more details about Ad26.COV2.S which is currently being evaluated in a clinical trial ( NCT04436276). Vaccines based on transgenes delivered by recombinant replication-incompetent adenovirus type 26 vectors (Ad26) have previously been shown to have an acceptable safety profile in humans and are able to induce neutralizing and binding antibodies, CD4 and CD8 T cell responses and a Th1-biased immune response in animals and humans.



Smyrlaki I, Ekman M, Lentini A, et al. Massive and rapid COVID-19 testing is feasible by extraction-free SARS-CoV-2 RT-PCR. Nat Commun 11, 4812 (2020). Full-text:

Scalable, rapid, and affordable COVID-19 diagnostics could help to limit the spread of SARS-CoV-2, consequently saving lives. Here, Björn Reinius, Ioanna Smyrlaki and colleagues explored procedures to circumvent RNA extraction by performing RT-PCR directly on heat-inactivated subject samples and sample lysates. Significant savings in time and cost are achieved through RNA-extraction-free protocols that are directly compatible with established PCR-based testing pipelines. The authors suggest that the direct method might be attractive in settings where repeated, cheaper, and quicker testing is desirable, for example in frequent testing of healthcare personnel.



Schultze A Walker AJ, MacKenna B, et al. Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform. Lancet Respir Med 2020, published 24 September. Full-text:

There has been speculation that inhaled corticosteroids (ICSs) might protect against infection with SARS-CoV-2 or the development of severe COVID-19. Now Ben Goldacre, Anna Schultze and colleagues show that regular ICS use does not seem to protect against COVID-19-related death among people with asthma or COPD.



If you read Spanish, read Sadin E. El peligro acuciante de una ‘telesociedad’ generalizada. El País 2020, published 28 September. Full-text:

El trabajo, la escuela y una gran parte de la vida social se han pixelizado de un día para otro. Ese cambio repentino pone en riesgo la cohesión de una sociedad fracturada, que sigue dependiendo en gran medida de los vínculos físicos y carnales.



If you read French, read Le Covid-19 a fait au moins un million de morts dans le monde. Le Monde 2020, published 28 September. Full-text:

Le coronavirus SARS-CoV-2 a toujours une circulation très active, notamment en Europe, en Amérique et en Asie.