Top 10: September 7

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By Christian Hoffmann &
Bernd S. Kamps

7 September


If you read Vietnamese, read Khanh Phan Nguyen Quoc, Ha Xuan Nam, Kim Le Thi Anh, et al: CR Việt Nam (4th edition, 290 pages). Published 6 September. Chapters: Lời nói đầu | Dịch tễ học | Sự lây truyền | Dự phòng | Vi rút học | Miễn dịch học | Các quy trình xét nghiệm chẩn đoán | Biểu hiện lâm sàng | Điều trị | Quản lý bệnh nhân COVID-19 nặng | Bệnh nền | Nhi khoa | Tuyên bố miễn trừ trách nhiệm | Chính sách bảo mật



Khan A, Bieh KL, El-Ganainy A, et al. Estimating the COVID-19 Risk during the Hajj Pilgrimage.  Journal of Travel Medicine, 05 September 2020. Full-text:

The Hajj, which is held in Makkah, Kingdom of Saudi Arabia (KSA), attracts around 2.5 million Muslim pilgrims from over 150 countries annually. Based on risk estimates, the Ministry of Hajj and Umra announced a reduction in the number of pilgrims and the exclusion of foreign pilgrims from the 2020 Hajj. This was probably a wise decision: The authors calculate that the existing number of designated ward and ICU beds in the Hajj areas would be saturated once the total Hajj population exceeds around 10-15% of the previous five years’ average.


Nayar KR, Koya SF, Ramakrishnan V, et al. Call to avert acceleration of COVID-19 from India’s Sabarimala pilgrimage of 25 million devotees. Journal of Travel Medicine, 05 September 2020, taaa153. Full-text:

The next problem. The forthcoming Sabarimala annual Hindu pilgrimage of 41 days duration normally held during the months of November to December at the Sabarimala peak in India is attended by (yes, you’re reading correctly) an average of 25 million pilgrims.  Currently, for routine non-mass gathering visits to Sabarimala, the State Government requires all pilgrims to submit a negative SARS-CoV-2 antigen test result through the online queue system. But this may be impractical and insufficient when 25 million devotees or more congregate during the annual pilgrimage. Unlike the Hajj pilgrimage (see above) which is international, the quota is based on and restricted through a visa process, participation in Sabarimala pilgrimage, a domestic event, is uncoordinated and required no registration for participation until last year. The authors discuss the options.


Moreland A, Herlihy C, Tynan MA, et al. Timing of State and Territorial COVID-19 Stay-at-Home Orders and Changes in Population Movement – United States, March 1-May 31, 2020. MMWR Morb Mortal Wkly Rep. 2020 Sep 4;69(35):1198-1203. PubMed: . Full-text:

People are compliant to mandatory stay-at-home orders. Based on location data from mobile devices, in 97.6% of counties these orders were associated with decreased median population movement after the order start date, relative to the period before the order was implemented.



Li W, Schäfer A, Kulkarni SS, et al. High potency of a bivalent human VH domain in SARS-CoV-2 animal models. Cell September 04, 2020. Full-text:

Antibody domains and fragments such as VH (heavy chain variable domain, 15 kDa) are attractive antibody formats for candidate therapeutics. They may have better tissue penetration compared to full-sized antibodies. Wei Li and colleagues from Pittsburgh have isolated and screened several VH binders for their affinities, ACE2 competition and stabilities. One of those VHs, ab8, in an Fc (human IgG1, crystallizable fragment) fusion format, showed potent neutralization activity and specificity against SARS-CoV-2 both in vitro and in mice and hamsters, possibly enhanced by its relatively small size.


Cañete PF, Vinuesa CG. COVID-19 makes B cells forget, but T cells remember. Cell, September 04, 2020. Full-text:

Based on two papers recently published in Cell (see below, Sekine et al, Kaneko et al.), Pablo F. Cañete and Carola G. Vinuesa speculate in their editorial that although SARS-CoV-2 may blunt long-lived antibody responses, immune memory might still be achieved through virus-specific memory T cells.

Sekine T, Perez-Potti A, Rivera-Ballesteros  O, et al. Robust T cell immunity in convalescent individuals with asymptomatic or mild COVID-19. Cell 2020, published 14 August. Full-text: (see our presentation on 14 August).

Kaneko N, Kuo HH Boucau J, et al. Loss of Bcl-6-expressing T follicular helper cells and germinal centers in COVID-19. Cell August 19, 2020. Full-text: (see our presentation on 20 August).



Blackburn, Yiannoutsos CT, Carroll AE, et al. Infection Fatality Ratios for COVID-19 Among Noninstitutionalized Persons 12 and Older: Results of a Random-Sample Prevalence. Ann Intern Medicine, 2 September 2020. Full-text:

This study combines prevalence estimates from a state-wide random sample with Indiana (US) vital statistics data of confirmed COVID-19 deaths. The overall non-institutionalized IFR in the state was remarkably low: 0.26%. The demographic-stratified IFR varied most by age, race, ethnicity, and sex. Persons younger than 40 years had an IFR of 0.01%; those aged 60 or older had an IFR of 1.71%. Whites had an IFR of 0.18%; non-Whites had an IFR of 0.59%.


Quast T, Andel R, Gregory S, Storch EA. Years of life lost associated with COVID-19 deaths in the United States. Journal of Public Health, 07 September 2020, fdaa159. Full-text:

Years of life lost (YLL) estimates the number of years that those who died would have lived if they had not contracted the specified condition. This study of roughly the first 5 months of the COVID-19 epidemic in the USA, calculating the YLLs by jurisdiction and gender, estimates 1.2 million YLLs due to COVID-19.



Squillace N, Pozzi MR, Gustinetti G, et al. Therapy of SARS-Coronavirus-2 pneumonia: is there an optimal IL-6 cut-off for successful tocilizumab treatment? Clin Infect Dis. 2020 Sep 4:ciaa1282. PubMed: . Full-text:

Nicola Squillace from Milano compared 16 patients who were discharged within 30 days from first tocilizumab (TCZ) dose (group A) vs 16 patients who had prolonged hospitalization or died within 30 days from first TCZ administration (group B). Before and after TCZ, IL-6 levels were markedly higher in group B, suggesting a high burden of inflammation, not sufficiently inhibited by receptor blockade. Larger, controlled trials on TCZ are urgently needed.


De Oliveira B, Mallat J. Efficacy of Tocilizumab for treatment of severe COVID-19 Pneumonia: more evidence is needed. Clin Infect Dis. 2020 Sep 4:ciaa1284. PubMed: . Full-text:

This is exactly what this comment on another retrospective study is saying. Bruno De Oliveira and Jihad Mallat argue that the current level of evidence supporting the use of TCZ is weak and based on lower-quality studies.


Pregnancy, pediatrics

Pirjani R, Hosseini R, Soori T, et al. Maternal and neonatal outcomes in COVID-19 infected pregnancies: a prospective cohort study. Journal of Travel Medicine, 05 September 2020, taaa158. Full-text:

In this prospective study, a total of 66 COVID-19 infected pregnant women who were admitted to Arash Hospital in Tehran, Iran from March 1 to Sep 1, 2020, were compared with 133 non-infected pregnant women. No differences were found with regard to preterm birth, low birth weight, gestational diabetes, preeclampsia, intrauterine growth restriction, preterm rupture of membrane, stillbirth, postpartum hemorrhage, neonatal intensive care unit admission and sepsis.




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.