Top 10: Last 21 Days

By C. Hoffmann & B. S. Kamps
Copy-editor: Rob Camp

16 January

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15 January

Epidemiology

Ledford H. COVID reinfections are unusual — but could still help the virus to spread. Nature 2021, published 14 January. Full-text: https://www.nature.com/articles/d41586-021-00071-6

A large study of UK healthcare workers suggests that most people are immune for months after catching COVID-19 for the first time.

 

Ashby B, Best A. Herd immunity. Curr Biol 2021, published 12 January. Full-text: https://doi.org/10.1016/j.cub.2021.01.006

If you want to do some math, read this short paper and revise a concept neither Boris Johnson (how could he!) nor his advisers really understood. In short: as immunity accumulates in a population — naturally during the course of an epidemic or through vaccination — the spread of infectious disease is limited by the depletion of susceptible hosts. In this primer, Ben Ashby and Alex Best discuss the concept of herd immunity from first principles, clarify common misconceptions, and consider the implications for disease control.

 

Vaccine

Sadoff J, Le Gars M, Shukarev G, et al. Interim Results of a Phase 1–2a Trial of Ad26.COV2.S Covid-19 Vaccine. N Engl J Med 2021, published 13 January. Full-text: https://doi.org/10.1056/NEJMoa2034201

Hanneke Schuitemaker, Jerald Sadoff and colleagues describe the safety and immunogenicity profiles of Ad26.COV2.S. As with other SARS-CoV-2 vaccines, the most frequent adverse events were fatigue, headache, myalgia, and injection site pain. Systemic adverse events were less common in people 65 years or older than in those 18 to 55 years of age. Neutralizing-antibody titers against wild type virus were detected in 90% or more of all participants on day 29 after the first vaccine dose and reached 100% by day 57 with a further increase in titers (GMT, 288 to 488), regardless of vaccine dose or age group. Ad26.COV2.S, developed by Janssen Pharmaceutical Companies of Johnson & Johnson, is a recombinant replication-incompetent adenovirus type 26 (Ad26) vector-based COVID-19 vaccine encoding a prefusion-stabilized SARS-CoV-2 Spike immunogen.

 

Efrati I. Israel to Share Vaccination Data With Pfizer as Part of Secret Deal. Haaretz 2021, published 10 January. Full-text: https://www.haaretz.com/israel-news/.premium-israel-to-share-covid-vaccine-data-with-pfizer-but-agreement-remains-secret-1.9438504

The Israeli newspaper reports a deal between Israel and Pfizer: Pfizer will receive anonymized data about consequences of the inoculations, side effects, efficacy, and the amount of time it takes to develop antibodies, according to different types of population, age, gender, pre-existing conditions, and other factors.

 

Long COVID

Venkatesan P. NICE guideline on long COVID. Lancet Respir Med 2021, published 13 January. Full-text: https://doi.org/10.1016/S2213-2600(21)00031-X

While discussing the NICE guidelines on long COVID published a few weeks ago, Priya Venkatesan gives a short overview of the condition. The guideline defines long COVID as (1) ongoing symptomatic COVID-19 for people who still have symptoms between 4 and 12 weeks after the start of acute symptoms; and (2) post-COVID-19 syndrome for people who still have symptoms for more than 12 weeks after the start of acute symptoms. Patients with new or ongoing symptoms 4 weeks or later after acute infection should receive a full blood count, kidney and liver function tests, a C-reactive protein test, and an exercise tolerance test (recording level of breathlessness, heart rate, and O2 saturation). The guidelines also recommend that a chest x-ray should be offered to all patients by 12 weeks after acute infection if they have continuing respiratory symptoms. [COVID-19 rapid guideline: managing the long-term effects of COVID-19 – NICE guideline [NG188]. Access: https://www.nice.org.uk/guidance/NG188]

 

Treatment

Joyner MJ, Carter RD, Senefeld JW, et al. Convalescent Plasma Antibody Levels and the Risk of Death from Covid-19. N Engl J Med 2021, published 13 January. Full-text:

Patients who have not yet received mechanical ventilation may benefit from transfusion of plasma with high anti–SARS-CoV-2 IgG antibody levels. However, in this study of 3082 patients there was no effect on the risk of death among patients who had received mechanical ventilation.

 

Barbui T, Vannucchi AM, Alvarez-Larran A, et al. High mortality rate in COVID-19 patients with myeloproliferative neoplasms after abrupt withdrawal of ruxolitinib. Leukemia (2021). Full-text: https://doi.org/10.1038/s41375-020-01107-y

This study found an association between ruxolitinib and overall mortality in 40% of the 45 cases treated with this drug. This effect was due not so much to drug exposure but to its rapid discontinuation (median 0,5 days), that accounted for 75% of deaths. The authors speculate about the reasons for stopping the treatment: uncertainties about possible adverse events? risk of interactions with other drugs? missing interactions between managing physicians and referring hematologist?

 

Severe COVID

Downar J, Kekewich M. Improving family access to dying patients during the COVID-19 pandemic. Lancet Respir Med 2021, published 12 January. Full-text: https://doi.org/10.1016/S2213-2600(21)00025-4

James Downar and Mike Kekewich propose elements of an end-of-life visitor policy: 1) Visitors (up to 4, according to the size of the room) should be allowed during normal visiting hours, 2) preferably 1 h at a time, and 3) when physical circumstances allow, one family member can remain with the patient outside of these hours. 4) Avoid cycling of visitors and 5) make visitors comply with proper infection prevention and control procedures to limit the risks to patients, staff, and to themselves.

 

Pediatrics

Levin Z, Choyke K, Georgiou A, et al. Trends in Pediatric Hospitalizations for Coronavirus Disease 2019. JAMA Pediatr 2021, published 11 January. Full-text: https://doi.org/10.1001/jamapediatrics.2020.5535

Between May 15, 2020, and November 15, 2020, there was an increase in hospitalizations among infected children and adolescents in the US. Using data extracted from the University of Minnesota COVID-19 Hospitalization Tracking Project, Pinar Karaca-Mandic, Zachary Levin and colleagues identified 5364 patients aged 19 and under who were hospitalized in 22 US states. The cumulative average rate rose to 17,2 hospitalizations per 100.000 children in November from 2 per 100.000 children in May.

 

Education

Rubin EJ, Baden LR, Morrissey S. Covid-19 in South Africa and a New SARS-CoV-2 Variant. Audio interview (40:45). N Engl J Med 2021; 384:e14. Access: https://doi.org/10.1056/NEJMe2100736

The editors discuss Covid-19 in Africa and the impact of a newly discovered SARS-CoV-2 variant.

 

Spanish

If you read Spanish, read Sevillano EG, Abril G. Preocupación en la UE por la expansión de la nueva variante de coronavirus. Le País 2021, published 14 January. Full-text: https://elpais.com/sociedad/2021-01-13/preocupacion-en-la-ue-por-la-expansion-de-la-nueva-variante-de-coronavirus.html

Alemania se prepara para extender el confinamiento más allá de enero ante las “ocho o diez semanas muy duras” de contagios que prevé Merkel.

 

Naranjo J. África se queda rezagada en la carrera por vacunar a la población. Le País 2021, published 13 January. Full-text: https://elpais.com/sociedad/2021-01-13/africa-se-queda-rezagada-en-la-carrera-por-vacunar-a-la-poblacion.html

La falta de recursos para conseguir dosis, los problemas de aceptación y una logística compleja dificultan que el continente alcance la inmunidad de grupo el año próximo.

 

French

If you read French, read Cosnard D. Covid-19 : l’analyse des eaux usées annonce un rebond en Ile-de-France. Le Monde 2021, published 14 January. Full-text : https://www.lemonde.fr/planete/article/2021/01/14/covid-19-l-analyse-des-eaux-usees-annonce-un-rebond-en-ile-de-france_6066288_3244.html

La concentration de virus dans les eaux usées de la région a crû d’environ 50 % en trois semaines, montrent les prélèvements effectués par le réseau Obépine.

 

German

If you read German, read Erdmann E, Schumann F. Jagd auf die mutierten Coronaviren. Die Zeit 2021, published 14 January. Full-text: https://www.zeit.de/wissen/gesundheit/2021-01/corona-mutationen-variante-b-1-1-7-deutschland-verbreitung-sequenzierung

Neue Corona-Varianten haben Deutschland erreicht. Um rauszufinden, wie verbreitet sie sind, muss das Virenerbgut untersucht werden. Doch wird das ausreichend getan?

 

Theile G. Auch die Schweiz nimmt Corona jetzt ernst. Der Spiegel 2021, published 14 January. Full-text: https://www.spiegel.de/politik/ausland/corona-in-der-schweiz-regierung-verkuendet-strengere-massnahmen-a-f5767103-64a9-431f-a55a-799cc081f4a2

Der Sonderweg ist teilweise zu Ende: Britische Urlauber haben die hochansteckende Virusvariante ins Land gebracht – nun verkündet die Schweizer Regierung einen härteren Shutdown. Skipisten bleiben aber auf. (Sono pazzi!, Ed.)

 

14 January

Epidemiology

Vang KE, Krow-Lucal ER, James AE, et al. Participation in Fraternity and Sorority Activities and the Spread of COVID-19 Among Residential University Communities – Arkansas, August 21-September 5, 2020. MMWR Morb Mortal Wkly Rep. 2021 Jan 8;70(1):20-23. PubMed: https://pubmed.gov/33411698. Full-text: https://doi.org/10.15585/mmwr.mm7001a5

In the US, the start of the 2020–21 academic year was sometimes the beginning of local epidemics. Kristyn Vang et al. describe SARS-CoV-2 transmission by on- and off-campus congregate living settings and activities. Their analysis indicates that 91% of gatherings were associated with fraternity or sorority activities. Interestingly, at one university, women accounted for 70% of COVID-19 cases although they constituted only 54% of the university’s student body. Among linked gatherings, women accounted for 86% of cases. The authors speculate about possible explanations (involvement in gender-specific activities? sorority rush week?).

 

Transmission

Kasloff SB, Leung A, Strong JE, et al. Stability of SARS-CoV-2 on critical personal protective equipment. Sci Rep 11, 984 (2021). Full-text: https://doi.org/10.1038/s41598-020-80098-3

Cotton provides the lowest environmental stability to SARS-CoV-2. When applied to 100% cotton fabric, the virus underwent rapid degradation and became undetectable by TCID50 assay within 24 h. However, viable SARS-CoV-2 was recovered after 21 days on plastic, 14 days on stainless steel, 7 days on nitrile gloves and 4 days on chemical resistant gloves.

 

Hwang SE, Chang JH, Bumjo O, Heo J. Possible Aerosol Transmission of COVID-19 Associated with an Outbreak in an Apartment in Seoul, South Korea, 2020. Int J Infect Dis. 2020 Dec 17:S1201-9712(20)32558-3. PubMed: https://pubmed.gov/33346125. Full-text: https://doi.org/10.1016/j.ijid.2020.12.035

Indoor aerosol aerosol transmission might be underappreciated. This is the suggestion by Jongho Heo, Seo Eun Hwang and colleague who investigated a cluster of 9 COVID-19 infections in an apartment building in Seoul, South Korea. The investigation found no other possible contact between the cases than the airborne infection through a single air duct in the bathroom. All infected cases (living from the 2nd to the 11th floor of the building) were found along two vertical lines of the building, and each line was connected through a single air duct in the bathroom for natural ventilation. The authors assume that the first infected person probably released the virus during a shower in the bathroom by coughing, breathing, singing, or flushing and that SARS-CoV-2 may have combined with water vapor and became aerosols in the humid environment.

 

Prevention

Fuller JA, Hakim A, Victory KR, et al. Mitigation Policies and COVID-19–Associated Mortality — 37 European Countries, January 23–June 30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 12 January 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7002e4

European countries that implemented more stringent mitigation policies by the time they reached an early mortality threshold in spring 2020 (closure of non-essential businesses, restrictions on gatherings and movement, and stay-at-home orders) tended to report fewer COVID-19–associated deaths through the end of June. These countries have saved tens of thousands of lives relative to those countries that implemented similar policies, but later. These findings suggest that earlier implementation, even by just a few weeks (even one week!), may prevent widespread transmission and large numbers of deaths.

 

Immunology

Sette A, Crotty S. Adaptive immunity to SARS-CoV-2 and COVID-19. Cell 2021, published 12 January. Full-text: https://doi.org/10.1016/j.cell.2021.01.007

In this review, Alessandro Sette and Shane Crotty describe how CD4+ T cells, CD8+ T cells, and neutralizing antibodies all contribute to the control of SARS-CoV-2, in both non-hospitalized and hospitalized cases of COVID-19. The authors discuss the specific functions and kinetics of these adaptive immune responses, as well as their interplay with innate immunity and implications for COVID-19 vaccines and immune memory against re-infection.

 

Legros V, Denolly S, Vogrig M, et al. A longitudinal study of SARS-CoV-2-infected patients reveals a high correlation between neutralizing antibodies and COVID-19 severity. Cell Mol Immunol (2021). Full-text: https://doi.org/10.1038/s41423-020-00588-2

In a cohort of 140 SARS-CoV-2 individuals with confirmed SARS-CoV-2 infection, nAb titers correlated strongly with disease severity and with anti-spike IgG levels. Patients from intensive care units exhibited high nAb titers; conversely, patients with milder disease symptoms had heterogeneous nAb titers, and asymptomatic or exclusively outpatient patients had no or low nAbs. nAb activity in SARS-CoV-2-infected patients displayed a relatively rapid decline after recovery compared to individuals infected with other coronaviruses.

 

Vaccine

Dolgin E. How COVID unlocked the power of RNA vaccines. Nature 2021, published 12 January. Full-text: https://www.nature.com/articles/d41586-021-00019-w

The technology could revolutionize efforts to immunize against HIV, malaria, influenza and more.

 

Mahase E. How the Oxford-AstraZeneca covid-19 vaccine was made. BMJ 2021; 372. Full-text: https://doi.org/10.1136/bmj.n86

Andrew Pollard has been leading the Oxford vaccine clinical trials in the UK, Brazil, and South Africa. He tells how the Oxford vaccine came to be, how dosing was worked out, and whether it will stand up to the new variants.

 

Severe COVID

Supady A, Curtis JR, Abrams D, et al. Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks. Lancet Respir Med 2021, published 12 January. Full-text: https://doi.org/10.1016/S2213-2600(20)30580-4

In the coming weeks, available medical resources will not always meet the increased demand for life-saving intensive care. Alexander Supady, Randall Curtis and colleagues propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care.

 

Comorbidities

Möhn N, Konen FF, Pul R, et al. Experience in Multiple Sclerosis Patients with COVID-19 and Disease-Modifying Therapies: A Review of 873 Published Cases. J Clin Med. 2020 Dec 16;9(12):4067. PubMed: https://pubmed.gov/33339436. Full-text: https://doi.org/10.3390/jcm9124067

Patients without disease modifying therapies (DMTs), with previous cardiovascular diseases, or with a severe degree of disability may be at a higher risk of severe COVID-19. In this review of 873 published cases, immunosuppressive therapy itself did not appear to be a substantial risk factor. The authors argue that it might be reasonable to assume that these therapies could be protective, either directly by mitigating the cytokine storm, or indirectly by reducing the disease activity of MS.

 

Spanish

If you read Spanish, read Criado MA. Cuanto más leve es la infección por coronavirus, peor olfato. El País 2021, published 13 January. Full-text: https://elpais.com/ciencia/2021-01-12/cuanto-mas-leve-es-la-infeccion-por-coronavirus-peor-olfato.html

Un estudio europeo muestra que muchos de los casos menos graves sufren alucinaciones olfatorias.

 

Sastre A. ‘La peste’ se extiende por las villas miseria de Buenos Aires. El País 2021, published 11 January. Full-text: https://elpais.com/planeta-futuro/2021-01-11/la-peste-se-extiende-por-las-villas-miseria-de-buenos-aires.html

Crece el temor a que la segunda ola de COVID-19 arrase con las barriadas más pobres de la capital, cuyos habitantes apenas han podido resistir a los estragos de la primera. Un recorrido por algunas de ellas.

 

French

If you read French, read Sénécat A. Covid-19 : comment établir ou écarter le lien entre le vaccin et un décès ? Le Monde 2021, published 13 January. Full-text : https://www.lemonde.fr/les-decodeurs/article/2021/01/13/covid-19-comment-etablir-ou-ecarter-le-lien-entre-le-vaccin-et-un-deces_6066110_4355770.html

Plusieurs articles évoquant la mort de personnes peu après une injection alimentent la défiance envers la vaccination. Comment sont analysés ces décès et que peut-on en conclure ?

 

German

If you read German, read Fischer L. Dieses mutierte Coronavirus könnte alles ändern. Die Zeit 2021, published 13 Januar. Full-text: https://www.zeit.de/wissen/2021-01/corona-variante-b-1-1-7-mutation-gefahr-massnahmen-angela-merkel

Die schneller übertragbare Corona-Variante B117 hat Deutschland erreicht. Sie könnte die Fallzahlen explodieren lassen. Warum wir die Mutante jetzt eindämmen müssten.

 

13 January

Treatment

Salman D, Vishnubala D, Le Feuvre P, et al. Returning to physical activity after covid-19. BMJ. 2021 Jan 8;372:m4721. PubMed: https://pubmed.gov/33419740. Full-text: https://doi.org/10.1136/bmj.m4721

“Only return to exercise after at least seven days free of symptoms and begin with at least two weeks of minimal exertion. Use daily self-monitoring to track progress, including when to seek further help.” In this nice 6-page paper, David Salman and colleagues give an excellent guide to physical activity after COVID-19. Clearly, patients with ongoing symptoms or who had severe COVID-19 or a history suggestive of cardiac involvement need thorough clinical assessment.

 

Epidemiology

Bagchi S, Mak J, Li Q, et al. Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 January 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7002e2

Increases in community rates might be associated with increases in nursing home COVID-19 incidence, and nursing home mitigation strategies need to include a comprehensive plan to monitor local SARS-CoV-2 transmission and minimize high-risk exposures within facilities.

 

Transmission

Volz E, Mishra W, Chand M, et al. Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data. medRxiv 2021, posted 4 January. Full-text: https://doi.org/10.1101/2020.12.30.20249034

The new SARS-CoV-2 lineage B117 (B.1.1.7, also named VOC 202012/01), originated in England in late Summer to early Autumn 2020. Available data indicate a larger share of under 20-year-olds among reported B117 than non-B117 cases. B117 seems to have a substantial transmission advantage, with the estimated difference in reproduction numbers between B117 and non-B117 ranging between 0.4 and 0.7. Neil Ferguson, Erik Volz and colleagues note that these estimates of transmission advantage apply to a period where high levels of social distancing were in place in England; extrapolation to other transmission contexts therefore requires caution.

 

Prevention

Atherstone C, Peterson ML, Malone M, et al. Time from Start of Quarantine to SARS-CoV-2 Positive Test Among Quarantined College and University Athletes — 17 States, June–October 2020. MMWR Morb Mortal Wkly Rep 2021;70:7–11. DOI: http://dx.doi.org/10.15585/mmwr.mm7001a2

Quarantine after SARS-CoV-2 exposure is critical to preventing transmission. Among young, healthy athletes, the probability of receiving positive test results after day 10 of quarantine is low. A shorter quarantine after COVID-19 exposure could increase adherence but still pose a small residual risk for transmission.

 

Jones A, Fialkowski V, Prinzing L, Trites J, Kelso P, Levine M. Assessment of Day-7 Postexposure Testing of Asymptomatic Contacts of COVID-19 Patients to Evaluate Early Release from Quarantine — Vermont, May–November 2020. MMWR Morb Mortal Wkly Rep 2021;70:12–13. DOI: http://dx.doi.org/10.15585/mmwr.mm7001a3

Among the persons in quarantine who tested negative at day 7 after exposure, none who were retested between days 8 and 14 were positive. Allowing asymptomatic persons to shorten quarantine with a negative test at day 7 or later has not been demonstrated to result in transmission of SARS-CoV-2.

 

Immunology

Zuniga M, Gomes C, Carsons SE, et al. Autoimmunity to the Lung Protective Phospholipid-Binding Protein Annexin A2 Predicts Mortality Among Hospitalized COVID-19 Patients. medRxiv 2021, posted on 4 January. Full-text: https://doi.org/10.1101/2020.12.28.20248807

Anti-Annexin A2 antibodies were elevated among hospitalized COVID-19 patients and these levels predicted mortality. This is the message of a pre-print paper by Ana Rodriguez, Marisol Zuniga and colleagues. The authors explain that inhibition of Annexin A2 induces systemic thrombosis, cell death, and non-cardiogenic pulmonary edema and that autoimmunity to Annexin A2 might explain key clinical findings of severe COVID-19. (Annexin A2 is a phospholipid-binding protein involved in fibrinolysis, cell membrane stabilization and repair, that ensures the integrity of the pulmonary microvasculature.)

 

Vaccine

Marjot T, Webb GJ, Barritt AS. SARS-CoV-2 vaccination in patients with liver disease: responding to the next big question. Lancet Gastroenterol Hepatol 2021, published 11 January. Full-text: https://doi.org/10.1016/S2468-1253(21)00008-X

Patients with advanced liver disease have well recognized deficiencies in innate and humoral immunity, termed cirrhosis-associated immune dysfunction (CAID). Nonetheless, given the high COVID-19-related mortality in patients with decompensated cirrhosis, it remains of utmost importance to prioritize vaccinations in this sub-group. Eleanor Barne, Thomas Marjot and colleagues express their belief that patients with advanced liver disease should be prioritized for vaccination, with the likely benefits far outweighing any potential risks. Until it is established whether patients with liver disease and transplantation achieve optimal protection after immunization, clinicians should remain vigilant for post-vaccination COVID-19 in these cohorts.

 

Clinical

Chen W, Tian Y, Li Z, et al. Potential interaction between SARS-CoV-2 and thyroid: a review. Endocrinology 2021, published 11 January. Full-text: https://doi.org/10.1210/endocr/bqab004

Certain thyroid diseases may have a negative impact on the prevention and control of COVID-19; some anti-COVID-19 agents may cause thyroid injury; and COVID-19 and thyroid disease may mutually aggravate the disease burden.

 

Editorial. Vitamin D and COVID-19: why the controversy? Lancet Diabetes Endocrinol 2021, published 11 January. Full-text: https://doi.org/10.1016/S2213-8587(21)00003-6

In December, NICE published an updated rapid review of recent studies on vitamin D and COVID-19. Their recommendations: everyone should take vitamin D supplements to maintain bone and muscle health during the autumn and winter months. Later, new guidance from the UK government allowed extremely clinically vulnerable people to opt in to receive a free 4-month supply of daily vitamin D supplements—similar to an initiative launched earlier in Scotland. Several clinical trials on vitamin D and COVID-19 outcomes are underway.

 

Severe COVID

Gupta RK, Harrison WM, Ho A, et al. Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study. Lancet Respir Med 2021, published 11 January. Full-text: DOI:https://doi.org/10.1016/S2213-2600(20)30559-2

How would you predict the risk of clinical deterioration in acute COVID-19 cases? Mahdad Noursadeghi, Rishi K Gupta and colleagues developed and validated a prognostic model for in-hospital clinical deterioration which integrated 11 routinely available predictors: age, sex, nosocomial infection, Glasgow coma scale score, peripheral oxygen saturation (SpO2) at admission, breathing room air or oxygen therapy (contemporaneous with SpO2 measurement), respiratory rate, urea concentration, C-reactive protein concentration, lymphocyte count, and presence of radiographic chest infiltrates.

 

12 January

Virology

Chen Y, Li S, Wu W, Geng S, Mao M. Distinct mutations and lineages of SARS-CoV-2 virus in the early phase of COVID-19 pandemic and subsequent global expansion. bioRxiv 2021, published 8 January. Full-text: https://doi.org/10.1101/2021.01.05.425339

Mao Mao, Yan Chen and colleagues analyzed 4013 full-length SARS-CoV-2 genomes from different continents over a 14-week timespan since the outbreak in Wuhan. 2954 unique nucleotide substitutions were identified with 31 of the 4013 genomes remaining as ancestral type, and 952 (32,2%) mutations recurring in more than one genome. The authors used the same approach to analyze 261.350 full-length SARS-CoV-2 genomes available in the GISAID database as of 25 December 2020. They suggest that viral genotypes can be utilized as molecular barcodes in combination with epidemiologic data to monitor the spreading routes of the pandemic and evaluate the effectiveness of control measures.

 

Zahradnik J, Marciano S, Shemesh M, et al. SARS-CoV-2 RBD in vitro evolution follows contagious mutation spread, yet generates an able infection inhibitor. bioRxiv 2021, posted 8 January. Full-text: https://www.biorxiv.org/content/10.1101/2021.01.06.425392v2

SARS-CoV-2 is constantly evolving, with more contagious mutations spreading rapidly, in particular in England and South Africa. Here, Gideon Schreiber, Jiří Zahradník and colleagues show that the naturally selected mutations S477N, E484K, and N501Y of the Spike protein RBD, which show higher infectivity, were also selected by yeast surface display affinity maturation already in the first round, giving rise to the South African, E484K, N501Y, and British variants that bind ACE2 13 and 3,5-fold tighter than RBD-WT.

 

Prevention

Meidan D, Schulmann N, Cohen R, et al. Alternating quarantine for sustainable epidemic mitigation. Nat Commun 12, 220 (2021). Full-text: https://doi.org/10.1038/s41467-020-20324-8

To ease the potentially devastating socioeconomic consequences of pharmaceutical interventions, social distancing, lock-downs and mobility restrictions, Baruch Barzel, Dror Meidan and colleagues, propose an alternative alternaitng quarantine strategy: at any moment, half of the population remains under lockdown while the other half continues to be active – maintaining a routine of weekly alternation of activity and quarantine. This regime would minimize infectious interactions, as it allows only half of the population to interact for just half of the time. Dramatic reduction in transmission despite sustaining socioeconomic continuity at ~50% capacity?

 

Pathogenesis

Grant RA, Morales-Nebreda L, Markov NS, et al. Circuits between infected macrophages and T cells in SARS-CoV-2 pneumonia. Nature 2021, published 11 January. Full-text: https://doi.org/10.1038/s41586-020-03148-w

SARS-CoV-2 might cause a slowly unfolding, spatially limited alveolitis in which alveolar macrophages harboring SARS-CoV-2 and T cells form a positive feedback loop that drives persistent alveolar inflammation. This is the result of a study that collected bronchoalveolar lavage fluid samples from 88 patients with SARS-CoV-2-induced respiratory failure and 211 patients with known or suspected pneumonia from other pathogens and subjected them to flow cytometry and bulk transcriptomic profiling.

 

Vaccine

Bordon, Y. Immune readouts from the Oxford COVID-19 vaccine. Nat Rev Immunol 2021, published 11 January. Full-text: https://doi.org/10.1038/s41577-021-00503-4

Yvonne Bordon comments on two recent reports from the Oxford COVID-19 vaccine team which detail the immune outcomes observed in a Phase I/II trial of their ChAdOx1 nCoV-19 vaccine. In one of the papers we presented on 21 December, the authors give a detailed description of the immune response after administration of one dose of ChAdOx1 nCoV-19 in 88 adults (ages 18-55 years) (Ewer 2020). They define the isotypes, subclasses and antibody avidity induced after vaccination. They also performed multiplex cytokine profiling and intracellular cytokine staining analysis, demonstrating that ChAdOx1 nCoV-19 vaccination induces a predominantly Th1-type response (that appears to be good). See also Barrett JR, Belij-Rammerstorfer S, Dold C, et al. Phase 1/2 trial of SARS-CoV-2 vaccine ChAdOx1 nCoV-19 with a booster dose induces multifunctional antibody responses. Nat Med. 2020 Dec 17. PubMed: https://pubmed.gov/33335322. Full-text: https://doi.org/10.1038/s41591-020-01179-4

 

Clinical

McGonagle D, Bridgewood C, Ramanan AV, Meaney JFM, Watad A. COVID-19 vasculitis and novel vasculitis mimics. Lancet Rheumatology 2021, published 7 January. Full-text: https://doi.org/10.1016/S2665-9913(20)30420-3

In this Viewpoint article, Dennis McGonagle et al. highlight how imaging and post-mortem findings point to a novel vasculitis mimic related to COVID-19 that might lead to cryptogenic strokes across multivessel territories, acute kidney injury with hematuria, a skin vasculitis mimic, intestinal ischemia, and other organ ischemic manifestations.

 

Solomon T. Neurological infection with SARS-CoV-2 — the story so far. Nat Rev Neurol 2021, published 7 January. Full-text: https://doi.org/10.1038/s41582-020-00453-w

As the COVID-19 pandemic developed and neurological manifestations were reported, concern grew that SARS-CoV-2 might directly invade neuronal cells. However, research throughout the year to address this concern has revealed a different story with inflammatory processes at its center.

 

Treatment

Garber, K. Hunt for improved monoclonals against coronavirus gathers pace. Nat Biotechnol 39, 9–12 (2021). Full-text: https://doi.org/10.1038/s41587-020-00791-6

Bamlanivimab (Lilly) and the double-antibody cocktail casirivimab + imdevimab (Regeneron) have been recently given an Emergency Use Authorization (EUA) for use in high-risk COVID-19 patients with mild or moderate disease. Though both drugs represent new options for treating the coronavirus infection, neither is ideal. The future of monoclonals remains uncertain.

 

Cohen JB, Hanff TC, William P, et al. Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial. Lancet Respir Health 2021, published 7 January. Full-text: https://doi.org/10.1016/S2213-2600(20)30558-0

Consistent with international society recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), inhibitors of the renin–angiotensin system, can be safely continued in patients admitted to hospital with COVID-19. A confirmation from a small study that enrolled 152 participants randomly assigned them to either continue or discontinue renin–angiotensin system inhibitor therapy. There were 16 (21%) of 75 participants in the continuation arm versus 14 (18%) of 77 in the discontinuation arm who required intensive care unit admission or invasive mechanical ventilation, and 11 (15%) of 75 participants in the continuation group versus ten (13%) of 77 in the discontinuation group who died.

 

Severe COVID

Co-morbidities

Accili D. Can COVID-19 cause diabetes? Nat Metab 2021 published 11 January. Full-text: https://doi.org/10.1038/s42255-020-00339-7

Whether a separate entity of post-COVID-19 diabetes possibly associated with lasting β-cell damage also exists is not yet clear.

 

Spanish

If you read Spanish, read Jericó P. Reducir la fatiga pandémica. El País 2021, published 10 January. Full-text: https://elpais.com/elpais/2021/01/08/eps/1610126355_684003.html

Casi un año enfrentándonos al coronavirus pasa factura. El cansancio puede hacer que relajemos las medidas preventivas. Pero también hay remedio para ello.

 

French

If you read French, read Gatinois C, Aeberhardt C. Comment le français Sanofi s’est retrouvé distancé dans la course au vaccin. Le Monde 2021, published 11 January. Full-text : https://www.lemonde.fr/economie/article/2021/01/11/covid-19-le-destin-contrarie-du-vaccin-de-sanofi_6065825_3234.html

Après des débuts prometteurs, une erreur de laboratoire a fait perdre cinq à six mois au groupe. Nouveau rebondissement, vendredi 8 janvier : sous la pression de Bercy, le groupe français pourrait mettre son outil industriel à disposition de ses concurrents les plus avancés, et dont les capacités de production sont limitées.

 

11 January

Epidemiology

Charron N, Lapuente V, Rodriguez-Pose A. Uncooperative Society, Uncooperative Politics or Both? How Trust, Polarization and Populism Explain Excess Mortality for COVID-19 across European regions. The Quality of Government (QoG) Institute 2020 (December). Full-text: https://gupea.ub.gu.se/handle/2077/67189

Why have some places performed better than others in the fight against COVID-19? The authors found that societal polarization played a significant role. When the divide in political trust between supporters and opponents of incumbent governments within societies is high, the authors observe consistently higher COVID-19-related excess mortality deaths during the first wave of the pandemic. They also find that regions with a political elite less supportive of European integration are regions where excess deaths have been significantly higher. Vive l’Europe!

 

Virology

Greaney AJ, Loes AN, Crawford KHD, et al. Comprehensive mapping of mutations to the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human serum antibodies. bioRxiv 2021, posted 4 January. Full-text: https://doi.org/10.1101/2020.12.31.425021

Jesse Bloom, Allison Greaney and colleagues comprehensively mapped how mutations to the SARS-CoV-2 RBD affected binding by the antibodies in convalescent human serum. One major finding is that serum antibody binding is predominantly affected by mutations at just a few dominant epitopes in the RBD. The most important site is E484, where neutralization by some sera is reduced > 10-fold by several mutations, including one in emerging viral lineages in South Africa and Brazil. Don’t miss this pre-print paper.

 

Andreano E, Piccini G, Licastro D, et al. SARS-CoV-2 escape in vitro from a highly neutralizing COVID-19 convalescent plasma. bioRxiv. 2020 Dec 28:2020.12.28.424451. PubMed: https://pubmed.gov/33398278. Full-text: https://doi.org/10.1101/2020.12.28.424451

If constantly pressured, SARS-CoV-2 virus has the ability to escape even a potent polyclonal serum targeting multiple neutralizing epitopes. By Rino Rappuoli, Emanuele Andreano and colleagues.

 

Transmission

Swadi T, Geoghegan JL, Devine T, et al. Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing. Emerg Infect Dis. 2021 Jan 5;27(3). PubMed: https://pubmed.gov/33400642. Full-text: https://doi.org/10.3201/eid2703.204714

SARS-CoV-2 transmission may occur on aircraft and the risk may be increased during long-distance flights. Joep de Ligt, Tara Swadi and colleagues from New Zealand describe an air travel cluster where among the 7 eventually-infected passengers, 2 were probably index case-patients infected before the flight, 4 were probably infected during the flight, and the remaining passenger was probably infected while in New Zealand under “managed isolation and quarantine”. All 7 passengers were seated in aisle seats within 2 rows of where the presumed index case-patient(s) were seated.

 

Vaccine

Xie X, Zou J, Fonte-Garfias CR, et al. Neutralization of N501Y mutant SARS-CoV-2 by BNT162b2 vaccine-elicited sera. bioRxiv 2021, posted 7 January. Full-text: https://doi.org/10.1101/2021.01.07.425740

Recent SARS-CoV-2 variants in the United Kingdom and South Africa have multiple mutations in their S glycoproteins, which are key targets of viral neutralizing antibodies. These rapidly spreading variants share the spike N501Y substitution. Pei-Yong Shi, Philip R. Dormitzer and Xuping Xie generated isogenic N501 and Y501 SARS-CoV-2. Sera of participants in a previously reported trial of the mRNA-based COVID-19 vaccine BNT162b2 had equivalent neutralizing titers to the N501 and Y501 viruses.

 

Clinical

Nehme M, Braillard O, Alcoba G, et al. COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings. Ann Intern Med. 2020 Dec 8:M20-5926. PubMed: https://pubmed.gov/33284676. Full-text: https://doi.org/10.7326/M20-5926

In this cohort of 669 persons (mean age 43, 60% women, 24,6% health care workers, 68,8% with no underlying risk factors), symptoms persisted in one third of ambulatory patients 30 to 45 days after diagnosis. Fatigue, dyspnea, and loss of taste or smell were the main persistent symptoms.

 

Salmon-Ceron D, Slama D, De Broucker T, et al. Clinical, virological and imaging profile in patients with prolonged forms of COVID-19: A cross-sectional study. J Infect. 2020 Dec 4:S0163-4453(20)30762-3. PubMed: https://pubmed.gov/33285216. Full-text: https://doi.org/10.1016/j.jinf.2020.12.002

Cross-sectional mono-center survey on 70 consecutive patients presenting with an initial symptomatic COVID-19 infection who developed prolonged COVID symptoms defined as persistent symptoms (> 2 months after the first day of the initial episode) or resurgent symptoms (at least 3 weeks after the 1st episode). Median age was 45 (range 23–75), 78,6% were female. The authors classify the characteristics of late symptoms in 7 main categories:­

  • Major fatigue or exhaustion for 51 patients (72,9%)
  • ­Neurological symptoms, in 54 (77,1%), divided into neuro-cognitive disorders (such as memory, mood or attention disorders), headaches, sensory disturbances (such as balance disorders, tingling, burning sensations and neurogenic pains), or others (swallowing or speech disorders, thermoregulation disorders).
  • ­Cardiothoracic symptoms in 50 patients (71,4%): chest pain and tightness, palpitations, cough, dyspnea.
  • ­Muscular or/and articular pains for 20 (25,7%).
  • ­ENT symptoms: persistent or recurrent anosmia, hyposmia and/or dysgeusia for 21 (30%).
  • ­Gastro-intestinal symptoms for 17 (24,3%): diarrhea, nausea/vomiting, epigastric or abdominal pain.
  • ­Skin and vascular symptoms in 10 (14,4%).

 

Pun BT, Badenes R, La Calle GH, et al. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Health 2021, published 8 January. Full-text: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30552-X/fulltext

Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Now, Brenda Pun, Rafael Badenes and colleagues publish the results of a cohort study on 2088 patients treated in 69 adult intensive care units (ICUs) across 14 countries. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium. The authors conclude that their data present an opportunity to reduce acute brain dysfunction in patients with COVID-19.

 

Comorbidities

Marjot T, Moon AM, Cook JA, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2020 Oct 6:S0168-8278(20)33667-9. PubMed: https://pubmed.gov/33035628. Full-text: https://doi.org/10.1016/j.jhep.2020.09.024

No comment needed. The key messages presented at the beginning of the paper:

  • Patients with cirrhosis experience high rates of hepatic decompensation and death following SARS-CoV-2 infection.
  • Mortality increased in stepwise fashion according to Child-Pugh class.
  • Other risk factors for death included advancing age and alcohol-related liver disease.
  • Mortality risk was higher in patients with advanced cirrhosis than propensity-score-matched controls without liver disease.
  • The majority of deaths in patients with cirrhosis were from COVID-19-related lung disease.

 

Spanish

If you read Spanish, read Ansede M. Un caldo de cultivo para variantes del virus que escapen de las vacunas. El País 2021, published 10 January. Full-text: https://elpais.com/ciencia/2021-01-09/el-peor-escenario-posible-nuevas-variantes-del-virus-que-escapen-de-las-vacunas.html

La expansión fuera de control del coronavirus y el retraso de la segunda dosis vacunal pueden favorecer la aparición de mutantes resistentes.

 

Alessi G. Brasil, una trinchera especialmente letal para los enfermeros que luchan contra la covid-19. El País 2021, published 9 January. Full-text: https://elpais.com/america/internacional/2021-01-09/brasil-una-trinchera-especialmente-letal-para-los-enfermeros-que-luchan-contra-la-covid-19.html

Un tercio de los 1.500 sanitarios fallecidos en todo el mundo trabajaba en el gigante sudamericano. A la falta inicial de equipos de protección se suma el agotamiento y la llegada de personal inexperto.

 

10 January

Prevention

Brainard J, Jones NR, Lake IR, Hooper L, Hunter PR. Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review. Euro Surveill. 2020 Dec;25(49):2000725. PubMed: https://pubmed.gov/33303066. Full-text: https://doi.org/10.2807/1560-7917.ES.2020.25.49.2000725

Does wearing face masks reduce primary respiratory infection risk by only 6–15%? See also the comment by Cowling BJ, Leung GM. Face masks and COVID-19: don’t let perfect be the enemy of good. Euro Surveill. 2020 Dec;25(49):2001998. PubMed: https://pubmed.gov/33303063. Full-text: https://doi.org/10.2807/1560-7917.ES.2020.25.49.2001998

 

Pathogenesis

Wei C, Wan L, Yan Q, et al. HDL-scavenger receptor B type 1 facilitates SARS-CoV-2 entry. Nat Metab. 2020 Dec;2(12):1391-1400. PubMed: https://pubmed.gov/33244168. Full-text: https://doi.org/10.1038/s42255-020-00324-0

Could high-density lipoprotein (HDL) scavenger receptor B type 1 (SR-B1) facilitate ACE2-dependent entry of SARS-CoV-2? That is the statement by Hui Zhong, Congwen Wei, finding that the S1 subunit of SARS-2-S binds to cholesterol and possibly to HDL components and facilitates SARS-CoV-2 cellular attachment, entry and infection. SARS-CoV-2 entry is inhibited by silencing SR-B1 expression and by SR-B1 antagonists. Blockade of the cholesterol-binding site on SARS-2-S1 with a monoclonal antibody inhibited HDL-enhanced SARS-CoV-2 infection.

See also the comment by Di Guardo G. SARS-CoV-2-Cholesterol Interaction: A Lot of Food for Thought. Pathogens 2021, 10(1), 32- Full-text: https://doi.org/10.3390/pathogens10010032

 

Vaccines

Wood S, Schulman K. Beyond Politics — Promoting Covid-19 Vaccination in the United States. N Engl J Med 2021, published 6 January. Full-text: https://doi.org/10.1056/NEJMms2033790

In France, some 60% of the population is skeptic about getting vaccinated. In search of inspiration, French authorities should take a look at this paper by Stacy Wood & Kevin Schulman. They should be ready to revise their marketing skills. Communication needs to become more a part of regular science.

 

EMA 20201221. Comirnaty. European Medicines Agency 2020, published 23 December. Full-text: https://www.ema.europa.eu/en/medicines/human/EPAR/comirnaty

Find the 32-page product information of the EMA.

 

EMA 20210106. COVID-19 Vaccine Moderna. European Medicines Agency 2021, published 6 January. Full-text: https://www.ema.europa.eu/en/medicines/human/summaries-opinion/covid-19-vaccine-moderna

Find the product information as approved by the CHMP on 6 January 2021, pending endorsement by the European Commission.

 

Garde D. ‘I haven’t even told my wife’. Stat 2020. Full-text: https://www.statnews.com/2020/12/15/inside-the-frantic-and-secretive-sprint-to-name-the-covid-19-vaccines/

Naming a vaccine is almost always a matter of threading semantic needles, branding experts said, where the goal is to evoke positive vibes without irking the world’s more conservative regulatory bodies. And it takes time.

 

Clinical

Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021, 8 January. Full-text: https://doi.org/10.1016/S0140-6736(20)32656-8

At 6 months after acute infection, more than 70% of COVID-19 survivors in Wuhan, China, were troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. This is the result of a cohort study of discharges from Jin Yin-tan Hospital between 7 January and 29 May 2020. Bin Cao, Chaolin Huang and colleagues enrolled 1733 of 2469 discharged patients with COVID-19 (median age 57 years, 52% men). Fatigue or muscle weakness (63%) and sleep difficulties (26%) were the most common symptoms. Anxiety or depression was reported among 23% of patients. 13% of patients without acute kidney injury and with normal eGFR at the acute phase had decreased eGFR at follow-up. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations. See also the comment by Cortinovis M, Perico N, Remuzzi G. Long-term follow-up of recovered patients with COVID-19. Lancet 2021, published 8 January. Full-text: https://doi.org/10.1016/S0140-6736(21)00039-8

 

Treatment

Hashimoto K. Repurposing of CNS drugs to treat COVID-19 infection: targeting the sigma-1 receptor. Eur Arch Psychiatry Clin Neurosci. 2021 Jan 5. PubMed: https://pubmed.gov/33403480. Full-text: https://doi.org/10.1007/s00406-020-01231-x

Traditional central nervous system (CNS) drugs that have a high affinity at the sigma-1 receptor (i.e., fluvoxamine, donepezil, ifenprodil) for the treatment of SARS-CoV-2-infected patients? In this review, Kenji Hashimoto discusses the brief history of the sigma-1 receptor and its role in SARS-CoV-2 replication in cells.

 

Collateral Effects

Adeniji N, Carr RM, Aby ES, Catana AM, Wegermann K, Dhanasekaran R. Socioeconomic Factors Contribute to the Higher Risk of COVID-19 in Racial and Ethnic Minorities with Chronic Liver Diseases (CLD). Gastroenterology. 2020 Nov 20:S0016-5085(20)35438-X. PubMed: https://pubmed.gov/33227281. Full-text: https://doi.org/10.1053/j.gastro.2020.11.035

Recent studies have shown that patients with chronic liver disease (CLD) in general, and especially those with decompensated cirrhosis and alcohol-related liver disease, are at higher risk COVID-19-related mortality. In this multi-center US cohort study, Renumathy Dhanasekaran, Nia Adeniji and colleagues included 909 patients with CLD and COVID-19 from 21 US centers. They show that non-Hispanic Blacks (NHB) and Hispanics are disproportionately represented in patients with CLD who acquire COVID-19. Both non-Hispanic Blacks and Hispanics had lower household income, lower rates of private insurance, and Hispanics had higher rates of being uninsured. Additionally, the authors show that both NHB and Hispanics had a higher likelihood of living in multifamily housing and in neighborhoods with higher rates of poverty and overcrowding than non-Hispanic Whites.

 

Journal Feature

Glausiusz J. Rethinking travel in a post-pandemic world. Nature 2021, published 5 January. Full-text: https://www.nature.com/articles/d41586-020-03649-8

Climate scientists recommend ways to boost the value of virtual conferences and reduce carbon footprints even when travel curbs ease.

 

French

If you read French, read Santi P. Covid-19 : après leur hospitalisation, trois patients sur quatre présenteraient des symptômes durables, selon une étude chinoise. Le Monde 2021, published 9 January. Full-text : https://www.lemonde.fr/planete/article/2021/01/09/covid-19-fatigue-faiblesse-musculaire-atteintes-renales-ou-pulmonaires-trois-patients-sur-quatre-presenteraient-des-symptomes-durables_6065727_3244.html

« The Lancet  » a publié samedi une étude portant sur une cohorte de plus de 1 700 patients chinois hospitalisés au printemps 2020, qui montre que 76 % d’entre eux souffraient encore, six mois plus tard, d’au moins un symptôme.

 

9 January

Epidemiology

Leung K, Shum MH, Leung GM, Lam TT, Wu JT. Early transmissibility assessment of the N501Y mutant strains of SARS-CoV-2 in the United Kingdom, October to November 2020. Euro Surveill. 2021 Jan;26(1). PubMed: https://pubmed.gov/33413740. Full-text: https://doi.org/10.2807/1560-7917.ES.2020.26.1.2002106

Two new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineages carrying the amino acid substitution N501Y in the receptor-binding domain (RBD) of the spike protein have spread rapidly in the United Kingdom (UK) during late autumn 2020. Tommy Lam, Joseph Wu, Kathy Leung and colleagues explain that 501Y Variant 2 (also named B.1.1.7, 20B/501Y.V1 and VOC-202012/01) is estimated to present an R0 1.75 times higher than 501N, meaning it is 75% more transmissible compared with the 501N strain.

 

du Plessis L, McCrone JT, Zarebski AE, et al. Establishment and lineage dynamics of the SARS-CoV-2 epidemic in the UK. Science 2021, published 8 January. Full-text: https://doi.org/10.1126/science.abf2946

In early 2020, pre-lockdown, high travel volumes and few restrictions on international arrivals led to the establishment and co-circulation of >1000 identifiable UK transmission lineages, jointly contributing to accelerated epidemic growth that quickly exceeded national contact tracing capacity. The authors reveal the fine-scale genetic lineage structure of this early epidemic through analysis of 50,887 SARS-CoV-2 genomes, including 26,181 from the UK sampled throughout the country’s first wave of infection.

 

Yang DD, Ouldali N, Gajdos V, et al. Common pediatric respiratory infectious diseases may serve as an early predictor for SARS-CoV-2 new wave of infections. Clin Infect Dis. 2020 Sep 7:ciaa1359. PubMed: https://pubmed.gov/32894752. Full-text: https://doi.org/10.1093/cid/ciaa1359

Lockdowns lead to a decrease in the common cold, bronchiolitis, acute otitis media, and acute gastroenteritis (AGE) in children. Having found that, François Angoulvant, David Yang and colleagues were curious to know what would happen after the end of the lockdown and analyzed a total of 908.887 pediatric emergency visits from 6 academic hospitals over the last three years. As expected, two weeks after the lockdown, observed values reached expected values for the common cold, bronchiolitis, and acute asthma exacerbation. There was one surprise, though: there was no increase in AGE after the end of lockdown. The authors suggest continued regular handwashing and the use of alcohol-based sanitizers as an explanation for this finding. They conclude that the positive lessons learned from SARS-CoV-2, especially handwashing and social distancing, should not be forgotten after the pandemic.

 

Virology

Lauring AS, Hodcroft EB. Genetic Variants of SARS-CoV-2—What Do They Mean? JAMA 2021, published 6 January. Full-text: https://doi.org/10.1001/jama.2020.27124

The emergence of the new “UK variant”—lineage B.1.1.7—has raised widespread concern. Adam Lauring and Emma Hodcroft explain virus evolution and the genomic epidemiology of SARS-CoV-2. They conclude that it is possible that mutations in spike that are “good” for the virus right now could also make it less fit in the context of population-level immunity in the future. Defining these dynamics, and their potential influence on vaccine effectiveness, will require large-scale monitoring of SARS-CoV-2 evolution and host immunity for a long time to come.

 

Transmission

Oude Munnink BB, Sikkema RS, Nieuwenhuijse DF, et al. Transmission of SARS-CoV-2 on mink farms between humans and mink and back to humans. Science. 2021 Jan 8;371(6525):172-177. PubMed: https://pubmed.gov/33172935. Full-text: https://doi.org/10.1126/science.abe5901

We know that humans can infect animals with SARS-CoV-2, for example, cats and dogs, hamsters and rabbits. Here, Oude Munnink and colleagues show that that mink-to-human transmission also occurred. See also the perspective by Zhou P, Shi ZL. SARS-CoV-2 spillover events. Science. 2021 Jan 8;371(6525):120-122. PubMed: https://pubmed.gov/33414206. Full-text: https://doi.org/10.1126/science.abf6097

 

Prevention

Davidson BL, Tapson VF, Irwin RS, French CL, Elliott CG, Levi M. Commentary: Pharyngeal Antisepsis to Reduce COVID-19 Pneumonia. Am J Med. 2020 Dec 15:S0002-9343(20)31114-1. PubMed: https://pubmed.gov/33338507. Full-text: https://doi.org/10.1016/j.amjmed.2020.12.001

Might “washing your throat” with a pharyngeal antisepsis before sleeping, when healthy adults of all ages aspirate material from above the larynx, help protect individuals against COVID-19 pneumonia? Find out why Bruce Davidson et al think it may.

 

Vaccine

Callaway E. Could new COVID variants undermine vaccines? Labs scramble to find out. Nature 2021, published 8 January. Full-text: https://www.nature.com/articles/d41586-021-00031-0

Researchers race to determine why variants identified in Britain and South Africa spread so quickly and whether they’ll compromise vaccines.

Graph

 

Diagnostics

Watson J, Richter A, Deeks J. Testing for SARS-CoV-2 antibodies. BMJ 2020. PubMed: https://pubmed.gov/32900692. Full-text: https://doi.org/10.1136/bmj.m3325

Everything you always wanted to know about pre-test probability, test sensitivity and test specificity* (*But Were Afraid to Ask). Jessica Watson and Alex Richter have prepared an interactive page where you can define any of these values. Get a feel for it.

 

Treatment

Alschuler L, Chiasson AM, Horwitz R, et al. Integrative medicine considerations for convalescence from mild-to-moderate COVID-19 disease. Explore (NY). 2020 Dec 23:S1550-8307(20)30417-1. PubMed: https://pubmed.gov/33358750. Full-text: https://doi.org/10.1016/j.explore.2020.12.005

Could convalescence from mild-to-moderate (MtoM) COVID-19 disease be supported by integrative medicine (IM) strategies? Lise Alschuler et al. suggest adoption of an anti-inflammatory diet, supplementation with vitamin D, glutathione, melatonin, cordyceps, astragalus and garlic have potential utility. If you are also interested in osteopathic manipulation, qigong, breathing exercises and aerobic exercise, you should read this paper with 146 references.

 

Education

Rubin EJ, Baden LR, Barocas JA, Morrissey S. Planning for the SARS-CoV-2 Vaccine Rollout. Audio interview (26:52). N Engl J Med 2021; 384:e13. Access: https://doi.org/10.1056/NEJMe2100295

The editors discuss how health care organizations are planning vaccine rollout and uptake both among their staff and in their communities.

 

French

If you read French, read Larousserie D et al. Covid-19 : l’efficacité des vaccins mise au défi des nouveaux variants du virus. Le Monde 2021, pubished 8 January. Full-text : https://www.lemonde.fr/planete/article/2021/01/08/les-vaccins-au-defi-des-nouveaux-variants_6065556_3244.html

Des chercheurs américains ont montré en laboratoire qu’une mutation présente dans le variant sud-africain du SARS-CoV-2 affaiblissait sensiblement le pouvoir des anticorps de patients contaminés par la souche dominante. Des variants déjà retrouvés en France.

 

German

If you read German, read Beyer S. US-Philosophin zum Angriff aufs Kapitol: »Er ist ein Faschist« – Der Spiegel 2021, published 8 January. Full-text: https://www.spiegel.de/politik/ausland/angriff-aufs-us-kapitol-jetzt-muessen-wir-die-dinge-beim-namen-nennen-trump-ist-ein-faschist-a-d9a4ff0f-6ea6-4672-b3ed-15f78be82219

Wodurch ist denn der Begriff des Faschismus definiert? Gehen wir es mal durch: Unterstützung paramilitärischer Gruppen. Angriffe auf den freien Journalismus. Dämonisierung von politischen Gegnern und Intellektuellen im Allgemeinen. Die Nostalgie für eine mythische, meist ländliche, jedenfalls nicht urbane Vergangenheit. Die Idee, dass einige Volksgruppen echt national sind und andere nicht. Der Versuch, eine unabhängige Justiz zu unterminieren. Die Propagandatechnik, eine Lüge so oft zu wiederholen, dass sie irgendwann für wahr gehalten wird. All das hat er getan! Somit ist er ein Faschist.

 

8 January

Epidemiology

Kirby T. New variant of SARS-CoV-2 in UK causes surge of COVID-19. Lancet Respir Med 2021, published 5 January. Full-text: https://doi.org/10.1016/S2213-2600(21)00005-9

The UK remains one of the most badly affected countries. As of 6 January 2021, it had recorded more than 2,8 million cases of SARS-CoV-2 infection and almost 80.000 deaths. Driven by the new variant’s increased infectiousness, the UK has recently reported more than 60.000 cases a day, and there are fears that the pandemic may get very much worse before it gets better. The only hope now is that deaths and hospitalizations will plummet as the number of elderly and vulnerable people receiving a vaccine sharply increases in the coming weeks.

 

Pathogenesis

Meinhardt J, Radke J, Dittmayer C, et al. Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci (2020). Full-text: https://doi.org/10.1038/s41593-020-00758-5

Given the neurological symptoms observed in a large majority of individuals with COVID-19, does SARS-CoV-2 penetrate into the CNS? Here Frank Heppner, Jenny Meinhardt and colleagues demonstrate the presence of SARS-CoV-2 RNA and protein in anatomically distinct regions of the nasopharynx and brain. Watch SARS-CoV-2 crossing the neural–mucosal interface in olfactory mucosa (exploiting the close vicinity of olfactory mucosal, endothelial and nervous tissue), following neuroanatomical structures and penetrating defined neuroanatomical areas including the primary respiratory and cardiovascular control center in the medulla oblongata.

See also the comment by Yates D. A CNS gateway for SARS-CoV-2. Nat Rev Neurosci (2021). Full-text: https://doi.org/10.1038/s41583-020-00427-3

 

Immunology

Dan JM, Mateus J, Kato Y, et al. Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection. Science 2021, published 6 January. Full-text: https://doi.org/10.1126/science.abf4063

After Year 1 of the SARS-CoV-2 pandemic, we realize that although millions of people were infected during spring 2020, there is no sizeable epidemic of re-infections. This observation suggests that SARS-CoV-2 infection might confer a solid immunity. Now, Shane Crotty, Alessandro Sette, Daniela Weiskopf, Jennifer Dan and colleagues publish in Science the pre-print paper we presented on 13 November. The authors analyzed multiple compartments of circulating immune memory to SARS-CoV-2 in 188 COVID-19 cases, including 43 cases at > 6 months post-infection. The result: Spike-specific memory B cells were more abundant at 6 months than at 1 month post symptom onset. SARS-CoV-2-specific CD4+ T cells and CD8+ T cells declined with a half-life of 3-5 months. These findings might suggest that after SARS-CoV-2 infection (or after vaccination), the vast majority of people could be protected from severe COVID-19 for years. Read also the NYTimes article by Mandavilli A. Immunity to the Coronavirus May Last Years, New Data Hint. The New York Times 2020, published 17 November. Full-text: https://www.nytimes.com/2020/11/17/health/coronavirus-immunity.html

 

Widge AT, Rouphael NG, Jackson LA, et al. Durability of Responses after SARS-CoV-2 mRNA-1273 Vaccination. N Engl J Med 2021; 384:80-82. Full-text: https://doi.org/10.1056/NEJMc2032195

Correlates of protection against SARS-CoV-2 infection in humans are not yet established. Here, Alicia Widge et al. describe immunogenicity data 119 days after the first vaccination in 34 healthy adult participants. Despite a slight expected decline in titers of binding and neutralizing antibodies, mRNA-1273 might have the potential to provide durable humoral immunity.

 

Vaccine

CDC 20210106. Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020. MMWR Morb Mortal Wkly Rep. ePub: 6 January 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7002e1

One case of anaphylaxis in 100.000 vaccine recipients of the BioNTech/Pfizer vaccine Comirnaty. That is the result of the 10 days of monitoring (14-23 December) by the Vaccine Adverse Event Reporting System which detected 21 cases of anaphylaxis after administration of a reported 1.893.360 first doses of the vaccine (11,1 cases per million doses). Note that 71% of these occurred within 15 minutes of vaccination. Screen recipients for contraindications and precautions; have the necessary supplies available to manage anaphylaxis; implement the recommended post-vaccination observation periods; and immediately treat suspected cases of anaphylaxis with intramuscular injection of epinephrine! For detailed insight, check also Castells MC, Phillips EJ. Maintaining Safety with SARS-CoV-2 Vaccines. N Engl J Med 2020, published 30 December. Full-text: https://doi.org/10.1056/NEJMra2035343 which we presented on 1 January.

 

Iacobucci G, Mahase E. Covid-19 vaccination: What’s the evidence for extending the dosing interval? BMJ 2021, published 6 January. Full-text: https://doi.org/10.1136/bmj.n18

On 30 December the four UK chief medical officers announced that the second doses of the COVID vaccines should be given towards the end of 12 weeks rather than in the previously recommended 3-4 weeks. German authorities will issue a similar recommendation soon. Gareth Iacobucci and Elisabeth Mahase look at the questions this has raised.

 

Treatment

Libster R, Marc PG, Wappner D, et al. Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults. N Engl J Med 2021, published 6 January. Full-text: https://doi.org/10.1056/NEJMoa2033700

Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults might reduce the progression of COVID-19. This is the result of a randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against SARS-CoV-2 by Fernando P. Polack, Romina Libster and colleagues. The authors randomized 160 patients. Severe respiratory disease developed in 13 of 80 patients (16%) who received convalescent plasma and 25 of 80 patients (31%) who received placebo (relative risk, 0.52; 95% confidence interval [CI], 0.29 to 0.94; p = 0.03). Relative risk reduction: 48%.

 

Salama C, Han J, Yau L, et al. Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med 2021; 384:20-30. Full-text: https://doi.org/10.1056/NEJMoa2030340

In hospitalized patients with COVID-19 pneumonia who were not receiving mechanical ventilation, tocilizumab did not improve survival, but it reduced the likelihood of progression to the composite outcome of mechanical ventilation or death. This is the result of a trial that randomized 249 patients into the tocilizumab group and 128 patients into the placebo group. Shalini Mohan, Carlos Salama and colleagues report that death from any cause by day 28 occurred in 10,4% of the patients in the tocilizumab group and 8,6% of those in the placebo group.

 

Collateral Effects

Sarvey D, Welsh JW. Adolescent substance use: Challenges and opportunities related to COVID-19. J Subst Abuse Treat. 2020 Nov 24:108212. PubMed: https://pubmed.gov/33272731. Full-text: https://doi.org/10.1016/j.jsat.2020.108212

Adolescent substance use is a significant and largely undertreated public health concern. The COVID-19 pandemic has exacerbated many pre-existing risk factors for adolescent substance use, such as early life stress, social isolation, school connections, and boredom. Here, Dana Sarvey and Justine Welsh give a short overview of changing risk and protective factors for substance use and potential opportunities during the pandemic. They recommend that practitioners should consider any and all means of reaching out to these youth and their families and addressing other co-occurring psychiatric symptoms, such as depression and anxiety.

 

Beyond Corona

Smith D. Fears mount that final 13 days pose a security threat. The Guardian 2021, published 7 January. Full-text: https://www.theguardian.com/us-news/2021/jan/07/donald-trump-final-13-days-security-threat-politicians-activists-warn

“Twitter at one point decided he shouldn’t be able to have access to his Twitter, and yet this is someone who has access to our launch nuclear launch codes. There’s an incongruity there.”

 

French

Ducourtieux C. Possibilité de « mélange » vaccinal et délai de douze semaines entre deux injections : le pari britannique contre le Covid-19. Le Monde 2021, published 7 January. Full-text : https://www.lemonde.fr/international/article/2021/01/07/covid-19-le-pari-vaccinal-britannique_6065503_3210.html

Le Royaume-Uni s’est lancé dans une course de vitesse contre le virus et son variant apparu dans le Kent, à l’heure où la mortalité causée par la pandémie reste très importante.

 

7 January

Epidemiology

Veldhoen M, Simas JP. Endemic SARS-CoV-2 will maintain post-pandemic immunity. Nat Rev Immunol (2021). Full-text: https://doi.org/10.1038/s41577-020-00493-9

Marc Veldhoen and J. Pedro Simas predict that the maintenance of population immunity will not depend on continued vaccinations but on the endemic presence of SARS-CoV-2. The authors offer an intriguing long-term perspective: “Endemic SARS-CoV-2 will ensure maintenance of seroprevalence and mucosal immunity in the population, which will increase over time in new generations. As such, most infected individuals will ultimately endure a largely asymptomatic or mild course of disease, although similarly to the other common cold HCoVs, SARS-CoV-2 may cause fatalities in extremely vulnerable elderly or immunocompromised individuals.”

 

Ives AR, Bozzuto C. Estimating and explaining the spread of COVID-19 at the county level in the USA. Commun Biol 4, 60 (2021). Full-text: https://doi.org/10.1038/s42003-020-01609-6

Different states and counties in the USA, and different countries in the world, have experienced COVID-19 epidemics differently. Here, Anthony Ives and Claudio Bozzuto put numbers on these differences in the USA. The authors show that most of the high inter-county variance is explained by four factors (R2 = 0.70): the timing of the outbreak, population size, the population density, and spatial location. Their recommendation for the future: design public health interventions at the county level.

 

Transmission

Davies NG, Barnard RC, Jarvis CI, et al. Estimated transmissibility and severity of novel SARS-CoV-2 Variant of Concern 202012/01 in England. medRxiv 2020, posted 26 December. Full-text: https://doi.org/10.1101/2020.12.24.20248822

Nicolas Davies et al. estimate that the novel SARS-CoV-2 variant emerged in southeast England in November 2020, is 56% more transmissible (95% credible interval across three regions 50-74%) than preexisting variants of SARS-CoV-2. The author did not find evidence that VOC 202012/01 resulted in greater or lesser severity of disease than pre-existing variants. However, the increase in transmissibility is likely to lead to a large increase in incidence, with COVID-19 hospitalizations and deaths projected to reach higher levels in 2021 than were observed in 2020.

 

Immunology

Röltgen K, Powell AE, Wirz OF, et al. Defining the features and duration of antibody responses to SARS-CoV-2 infection associated with disease severity and outcome. Sci Immunol. 2020 Dec 7;5(54):eabe0240. PubMed: https://pubmed.gov/33288645. Full-text: https://doi.org/10.1126/sciimmunol.abe0240

Outpatients and asymptomatic individuals might have higher ratios of spike protein receptor-binding domain-specific IgG versus nucleoprotein-targeted IgG antibodies than hospitalized patients. This is the result of a study by Scott Boyd, Katharina Röltgen and colleagues who analyzed 983 longitudinal plasma samples from 79 hospitalized COVID-19 patients and 175 SARS-CoV-2-infected outpatients and asymptomatic individuals. Plasma antibody increases correlated with decreases in viral RNAemia, but antibody responses in acute illness were insufficient to predict inpatient outcomes.

 

Treatment

Meduri GU, Annane D, Confalonieri M, et al. Pharmacological principles guiding prolonged glucocorticoid treatment in ARDS. Intensive Care Med. 2020 Dec;46(12):2284-2296. PubMed: https://pubmed.gov/33150472. Full-text: https://doi.org/10.1007/s00134-020-06289-8

In this review, Gianfranco Umberto Meduri et al. examine the pharmacological principles guiding glucocorticoids (GC) treatment in ARDS that demonstrates how each component of the treatment protocol is relevant to achieve optimal results. The authors integrate current clinical pharmacology knowledge of various GCs, including hydrocortisone, methylprednisolone and dexamethasone. Find more about the dosage, timing of initiation, mode of administration, duration, and tapering.

 

Severe COVID

Contou D, Fraissé M, Pajot O, Tirolien JA, Mentec H, Plantefève G. Comparison between first and second wave among critically ill COVID-19 patients admitted to a French ICU: no prognostic improvement during the second wave? Crit Care. 2021 Jan 4;25(1):3. PubMed: https://pubmed.gov/33397421. Full-text: https://doi.org/10.1186/s13054-020-03449-6

During the first wave of the SARS-CoV-2 pandemic in Spring 2020, intensive care physicians discovered specificities of severe COVID-19 including the need for deep sedation and neuromuscular blockade, the increased risk of thrombotic and hemorrhagic events, the prolonged duration of mechanical ventilation with high rate of delirium, and the beneficial effects of early administration of glucocorticoids. Here, Damien Contou et al. report their experience during the second SARS-CoV-2 wave in Autumn 2020. Their sobering discovery: compared to the first wave, less patients required invasive mechanical ventilation, thrombotic events were less frequent and the delay between ICU admission and tracheal intubation was longer. However, ICU mortality (50% vs. 52%, p = 0.96) and duration of ICU stay did not differ between the two waves. The Kaplan–Meier survival analysis did not show a significant difference between the two waves (p = 0.90, log-rank test).

 

Collateral Effects

Evans DP, Hawk SR, Ripkey CE. Domestic Violence in Atlanta, Georgia Before and During COVID-19. Violence Gend 2020, published 11 December. Full-text: https://doi.org/10.1089/vio.2020.0061

Cumulative counts of domestic crimes were higher during the COVID-19 period of 2020 than in the preceeding two years suggesting increased occurrence of domestic violence, especially during shelter-in-place orders. This is the result of an analysis of 30 weeks of crime data collected from the Atlanta Police Department (APD). Dabney Evans, Shila René Hawk and Carrie Ripkey found that a spike in domestic crimes was recorded after city and statewide shelter-in-place orders. The authors summarize that the “co-occurring pandemics of COVID-19 and domestic violence come amidst a period of racial justice reckoning in the United States and that both have a disproportionate impact on Black, Indigenous, and People of Color. As the country grapples with how to deal with health and safety concerns related to the pandemic, and the unacceptable harms being perpetrated by police, a public health approach is strongly warranted to address both universal health care and violence prevention.”

 

French

If you read French, read Delfraissy JF, Duault LA, Benamouzig D, et al. Le clone anglais «VUI-UK » – Anticiper une reprise épidémique en janvier. Conseil scientifique COVID-19 2020, published 22 December. Full-text : https://afpa.org/recommandation/covid-19-note-dalerte-conseil-scientifique/

Les données actuelles fournies par les autorités britanniques rapportent une augmen-tation du risque de transmission (R0 augmenté de +0.4 en comparaison des autres virus), avec une augmentation modérée de la « charge virale » estimée à partir des valeurs de RT-PCR (augmentation de 0.66 log soit 2 Ct en moins), mais aucune différence n’est notée à ce jour en termes de pathogénicité (manifestations cliniques, durée de la maladie) ou d’échappement à la réponse immunitaire des personnes déjà infectées au cours de deux premières vagues.

 

Herzberg N. Les vaccins anti-Covid évitent-ils la transmission du SARS-CoV-2 ? Le Monde 2021, published 6 January. Full-text : https://www.lemonde.fr/planete/article/2021/01/06/les-vaccins-anti-covid-evitent-ils-la-transmission-du-sars-cov-2_6065356_3244.html

Les essais ont montré leur efficacité à combattre les symptômes du Covid, mais on ignore encore s’ils peuvent bloquer la contamination d’autres personnes.

 

Bettinelli M, Casteele AV. Covid-19, paludisme, sida : l’immense bilan humain de pandémies toujours actives. Full-text : https://www.lemonde.fr/planete/video/2020/12/20/covid-19-paludisme-sida-l-immense-bilan-humain-de-pandemies-toujours-actives_6064005_3244.html

Un an après la première alarme sur l’apparition d’un « virus inconnu », finalement reconnu comme un nouveau coronavirus et dont la maladie qu’il provoque fut baptisée « Covid-19 », la planète déplore des dizaines de millions de contaminations, et plus d’1,6 million de morts. Au même moment, d’autres pandémies, parfois vieilles de plusieurs milliers d’années, continuent de faucher des milliers de vies.

 

Kauffmann S. « Ce qui se passe depuis quatre ans aux Etats-Unis est grave, on le savait ; ce qui s’y passe depuis deux mois est gravissime »  – Le Monde 2021, published 6 January. Full-text : https://www.lemonde.fr/idees/article/2021/01/06/ce-qui-se-passe-depuis-quatre-ans-aux-etats-unis-est-grave-on-le-savait-ce-qui-s-y-passe-depuis-deux-mois-est-gravissime_6065311_3232.html

En refusant de quitter le pouvoir après les élections, Donald Trump expose, dans une ultime offensive destructrice, la fragilité du système américain. Une leçon pour toutes les démocraties, estime Sylvie Kauffmann, éditorialiste au « Monde ».

 

6 January

Transmission

ECDC 20201223. COVID-19 in children and the role of school settings in transmission – first update. ECDC 2020, published 23 December. Full-text: https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission

An update on the role of children in the transmission of SARS-CoV-2 and the role of schools in the COVID-19 pandemic, based on experience in the EU from August through December 2020. The document also addresses transmission to and from staff in school settings, school-related mitigation measures including risk communication, testing, contact tracing and the efficacy of partial and full school closures.

 

Children’s Task and Finish Group. Update to 4th Nov 2020 paper on children, schools and transmission. UK Government 2020, published 17 December. Full-text: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948617/s0998-tfc-update-to-4-november-2020-paper-on-children-schools-transmission.pdf  + https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/935102/sage-65-meeting-covid-19-s0863.pdf

This paper presents evidence for increased transmission occurring among school children when schools are open, particularly in children of secondary school age (high confidence). Multiple data sources show a reduction in transmission in children following schools closing for half-term, and transmission rates increasing again following the post-half-term return to school.

 

Pathogenesis

Henkel M, Weikert T, Marston K, et al. Lethal COVID-19: Radiological-Pathological Correlation of the Lungs. Radiol Cardiothorac Imaging 2020. Full-text:  https://doi.org/10.1148/ryct.2020200406

A report of 14 patients who died from RT-PCR confirmed COVID-19. All patients underwent ante-mortem CT and autopsy. A significant proportion of ground glass opacities (GGO) correlates with the pathologic processes of diffuse alveolar damage, capillary dilatation and congestion and micro-thrombosis. Maurice Henkel, Thomas Weikert and colleagues conclude that these results underline the importance of vascular alterations as a key pathophysiological driver in lethal COVID-19.

 

Clinical

Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis. 2021 Jan;21(1):52-58. PubMed: https://pubmed.gov/33058797. Full-text: https://doi.org/10.1016/S1473-3099(20)30764-7

Re-infections with SARS-CoV-2 are possible, but don’t seem to be the rule within the first 9 months after the original infection. As a matter of fact, we don’t currently see an epidemic of re-infections in people who were infected during the spring of 2020. Here, Marc Pandori, Richard Tillett and colleagues present the case of a 25-year-old man who presented to health authorities on two occasions with symptoms of viral infection, once at a community testing event in April 2020, and a second time to primary care then hospital at the end of May and beginning of June 2020. The authors show that the patient was infected by SARS-CoV-2 on two separate occasions by a genetically distinct virus.

See also the comment by Iwasaki A. What reinfections mean for COVID-19. Lancet Infect Dis. 2021 Jan;21(1):3-5. PubMed: https://pubmed.gov/33058796. Full-text: https://doi.org/10.1016/S1473-3099(20)30783-0

 

Treatment

McCullough PA, Alexander PE, Armstrong R, et al. Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19). Rev Cardiovasc Med. 2020 Dec 30;21(4):517-530. PubMed: https://pubmed.gov/33387997. Full-text: https://doi.org/10.31083/j.rcm.2020.04.264

Prompt early initiation of sequenced multi-drug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. Here, Peter McCullough et al. present a multi-pronged therapeutic approach that includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine.

 

Severe COVID

Le Breton C, Besset S, Freita-Ramos S, et al. Extracorporeal membrane oxygenation for refractory COVID-19 acute respiratory distress syndrome. J Crit Care. 2020 Dec;60:10-12. PubMed: https://pubmed.gov/32731100. Full-text: https://doi.org/10.1016/j.jcrc.2020.07.013

Extra-corporeal membrane oxygenation (ECMO) in patients with severe COVID-1 has been associated with high mortality rates. Here, Jean-Damien Ricard, D. Roux, C. Le Breton and colleagues report on 13 patients who required VV-ECMO (femoro-jugular cannulation). All 13 patients were weaned from ECMO after a median of 13 days (range 3 to 34). Two patients died while still on mechanical ventilation. As of June 28th, 2020 all surviving patients were weaned from the ventilator after a median duration of 29 days (range 20 to 51) and were discharged alive from the ICU after a mean stay of 34 days (range 23 to 55). The authors conclude that ECMO should be an integral part of intensive care for properly selected COVID-19 patients without life-threatening co-morbidities.

 

5 January

Vaccine

De Vrieze J. Suspicions grow that nanoparticles in Pfizer’s COVID-19 vaccine trigger rare allergic reactions. Science 2020, published 21 December (sorry for being late!). Full-text: https://www.sciencemag.org/news/2020/12/suspicions-grow-nanoparticles-pfizer-s-covid-19-vaccine-trigger-rare-allergic-reactions

Severe allergy-like reactions in at least eight people who received the COVID-19 vaccine produced by Pfizer and BioNTech over the past 2 weeks may be due to a compound in the packaging of the messenger RNA (mRNA) that forms the vaccine’s main ingredient, scientists say. A similar mRNA vaccine developed by Moderna, which was authorized for emergency use in the United States on Friday, also contains the compound, polyethylene glycol (PEG).

 

Clinical

Rabin R. Some Covid Survivors Haunted by Loss of Smell and Taste. The New York Time 2021, published 2 January. Full-text: https://www.nytimes.com/2021/01/02/health/coronavirus-smell-taste.html

As the coronavirus claims more victims, a once-rare diagnosis is receiving new attention from scientists, who fear it may affect nutrition and mental health. Not peer-reviewed, not even from a medical journal, but worth reading.

 

Hoehl S, Kreutzer E, Schenk B, et al. Longitudinal testing for respiratory and gastrointestinal shedding of SARS-CoV-2 in day care centres in Hesse, Germany. Clin Infect Dis 2021, published 3 January. Full-text: https://doi.org/10.1093/cid/ciaa1912

Detection of either respiratory or gastrointestinal shedding of SARS-CoV-2 RNA in children and staff members attending day-care centers. This is the result of a longitudinal study over a period of 12 weeks from June to September 2020 to screen children and staff from day-care centers in the state of Hesse, Germany. 859 children (ages 3 months to 8 years) and 376 staff members from 50 day-care centers participated. The authors caution that the study was conducted at a time when activity of other respiratory pathogens was also low in Hesse, Germany, and children with symptoms of upper respiratory infection, other than runny nose only, were excluded from attending day care due to restricts set in place during pandemic.

 

Severe COVID

Maltezou HC, Raftopoulos V, Vorou R, et al. Association between upper respiratory tract viral load, comorbidities, disease severity and outcome of patients with SARS-CoV-2 infection. J Infect Dis 2021, published 3 January. Full-text: https://doi.org/10.1093/infdis/jiaa804

Upper respiratory tract (URT) viral load could be used to identify patients at higher risk for morbidity or severe outcome. This is the result of a study that included 1122 patients (mean age: 46 years), both asymptomatic and symptomatic patients, either hospitalized or cared for in the community. Helena Maltezou et al. categorized URT as high, moderate or low. A high URT viral load was more often detected in patients with COVID-19 than in asymptomatic patients. Patients with the following co-morbidities more often had high URT viral load than moderate or low URT viral load: chronic cardiovascular disease, hypertension, chronic pulmonary disease, immunosuppression, obesity, and chronic neurological disease (p values < 0.05 for all comparisons). A high SARS-CoV-2 URT viral load was significantly associated with an increased risk for intubation or a fatal outcome in the course of COVID-19, as well as with prolonged disease severity.

 

Collateral Effects

COVIDSurg Collaborative. Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study. Cancer. 2020 Dec 21. PubMed: https://pubmed.gov/33345297. Full-text: https://doi.org/10.1002/cncr.33320

Head and neck cancer surgery in the COVID‐19 era appears safe even when surgery is prolonged and complex. This is the result of an international, observational cohort study comprised of 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. The overall 30‐day mortality was 1.2%. Twenty‐nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care.

Note of the editor: The original text said: “and 3.51 (10.3%) died.” Too much alcohol during pre-Christmas proof-reading?

 

Seitlinger J, Wollbrett C, Mazzella A, et al. Safety and feasibility of thoracic malignancy surgery during the COVID-19 pandemic. Ann Thorac Surg. 2020 Dec 14:S0003-4975(20)32115-9. PubMed: https://pubmed.gov/33333085. Full-text: https://doi.org/10.1016/j.athoracsur.2020.12.001

Maintaining surgical oncologic activity in the era of the COVID-19 pandemic seems safe and feasible, with low postoperative morbidity and mortality. The authors collected data on thoracic malignancy surgeries from January 1 to April 30, 2020, including patients from high-volume thoracic surgery departments in Nancy, Strasbourg, Freiburg, Milano, Torino and Montreal. In the cohort of 731 patients, 9 cases (1.2%) of COVID-19 were confirmed by PCR, including 5 in-hospital contaminants. The total number of deaths was 22 (3%). Only one death was related to COVID-19 (0,14%).

 

COVID History

Watts J. A cardiac arrest showed me what dying feels like. How should I live in Life 2.0? The Guardian 2020, published 28 December. Full-text: https://www.theguardian.com/commentisfree/2020/dec/28/cardiac-arrest-dying

I realized I was dying about half an hour earlier. My heart had gone loco during a kick-around on Tooting Common, South London. I suddenly felt tired and asked to go on the bench for a rest. Then I keeled over. I remember being confused at finding myself lying on the grass and too weak to move.

 

French

If you read French, read Mraffko C. Israël a lancé au pas de course la vaccination contre le Covid-19. Le Monde 2021, published 4 January. Full-text : https://www.lemonde.fr/international/article/2021/01/04/israel-s-est-lance-dans-une-course-folle-a-la-vaccination-contre-le-covid-19_6065106_3210.html

Déjà plus de 10 % de la population a reçu une première injection. Le premier ministre, Benyamin Nétanyahou, en campagne pour sa réélection, espère ainsi contrebalancer sa gestion désastreuse de la crise sanitaire.

 

Sénécat A, Sanchez L. Covid-19 : six questions pour comprendre les lenteurs de la vaccination en France. Le Monde 2021, published 4 January. Full-text : https://www.lemonde.fr/les-decodeurs/article/2021/01/04/covid-19-six-questions-pour-comprendre-les-lenteurs-de-la-vaccination-en-france_6065175_4355770.html

Quelle est la stratégie française ? Pourquoi si peu de vaccinés depuis le 27 décembre ? Que font les autres pays ?

 

4 January

Epidemiology

Maeda JM, NkengasongJN. The puzzle of the COVID-19 pandemic in Africa. Science 2021, published 1 January. Full-text: https://doi.org/10.1126/science.abf8832

As of 22 November 2020, the continent of Africa, comprising 1,3 billion people, had recorded two million cases of COVID-19 and 50.000 deaths, representing ∼ 3.6% of total global cases. Why? Justin Maeda and John Nkengasong comment on a paper we previously presented on 13 November: Uyoga S, Adetifa IMO, Karanja HK, et al. Seroprevalence of anti–SARS-CoV-2 IgG antibodies in Kenyan blood donors. Science 2020, published 11 November. Full-text: https://doi.org/10.1126/science.abe1916 | In April-June 2020, the crude prevalence of anti–SARS-CoV-2 IgG among blood donors in Kenya was 5.6% (174/3098). It was highest in urban counties, Mombasa (8.0%), Nairobi (7.3%) and Kisumu (5.5%). Of note, Kenya had reported only 341 deaths by the end of that period. The authors conclude that the sharp contrast between the reported COVID-19 cases and deaths suggests that the disease might be attenuated in Africa.

 

Transmission

Sun K, Gu L, Ma L, Duan Y. Atlas of ACE2 gene expression reveals novel insights into transmission of SARS-CoV-2. Heliyon 2020, published 25 December. Full-text: https://doi.org/10.1016/j.heliyon.2020.e05850

Could cats and dogs serve as intermediate hosts of SARS-CoV-2 infection? Here, Kun Sun from Shenzhen, China, describe the conservation of ACE2 and its expression pattern among various mammalian species that are close to human beings. Let’s keep an eye on cats and dogs.

 

Prevention

Storm N, McKay LGA, Downs SN, et al. Rapid and complete inactivation of SARS-CoV-2 by ultraviolet-C irradiation. Sci Rep. 2020 Dec 30;10(1):22421. PubMed: https://pubmed.gov/33380727. Full-text: https://doi.org/10.1038/s41598-020-79600-8

SARS-CoV-2 is able to survive on surfaces for extended periods of time. Although contact with surfaces contaminated with droplets generated by infected persons through exhaling, talking, coughing and sneezing is not the major driver of SARS-CoV-2 transmission (the main driver is speaking to and coughing, shouting and sneezing at people), it would be useful to inactivate SARS-CoV-2 on contaminated surfaces. Here, Anthony Griffiths, Nadia Storm and colleagues describe the almost instantaneous inactivation of SARS-CoV-2 in both wet and dry format using radiation generated by a commercially available ultraviolet (UV)-C light source at 254 nm.

 

Vaccines

CDC 20201231. Interim considerations: preparing for the potential management of anaphylaxis after COVID-19 vaccination. Vaccines & Immunizations 2020, last reviewed: December 31, 2020. Full-text: https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/anaphylaxis-management.html

Anaphylaxis has been reported following COVID-19 vaccination. The incidence of anaphylaxis associated with the Pfizer SARS-CoV-2 mRNA vaccine appears to be approximately 10 times as high as the incidence reported with all previous vaccines, at approximately 1 in 100,000, as compared 1 in 1,000,000 (Castells 2020). The CDC recommends that appropriate medical treatment for severe allergic reactions must be immediately available in the event that an acute anaphylactic reaction occurs following administration of an mRNA COVID-19 vaccine. In particular, persons without contraindications to vaccination who receive an mRNA COVID-19 vaccine be observed after vaccination for the following time periods:

  • 30 minutes: Persons with a history of an immediate allergic reaction of any severity to a vaccine or injectable therapy and persons with a history of anaphylaxis due to any cause.
  • 15 minutes: All other persons

 

Diagnostics

Barclay RA, Akhrymuk I, Patnaik A, et al. Hydrogel particles improve detection of SARS-CoV-2 RNA from multiple sample types. Sci Rep. 2020 Dec 30;10(1):22425. PubMed: https://pubmed.gov/33380736. Full-text: https://doi.org/10.1038/s41598-020-78771-8

To improve detection of SARS-CoV-2 when used with CDC-recommended assays, researchers from Ceres Nanosciences developed affinity-capture hydrogel particles (Nanotrap particles) that capture and concentrate the virus prior to RNA purification. A 5-min Nanotrap particle capture step substantially increases the sensitivity of SARS-CoV-2 RT-PCR assays when used in conjunction with either commercial RNA extraction kits or a simple heat and detergent extraction method in both saliva and transport medium samples. Furthermore, the authors identified viral RNA in several diagnostic remnant samples that previously had tested negative for SARS-CoV-2.

 

Severe COVID

Park J, Kim H, Kim SY, et al. In-depth blood proteome profiling analysis revealed distinct functional characteristics of plasma proteins between severe and non-severe COVID-19 patients. Sci Rep. 2020 Dec 29;10(1):22418. PubMed: https://pubmed.gov/33376242. Full-text: https://doi.org/10.1038/s41598-020-80120-8

The authors found 76 previously unreported proteins which could be novel prognostic biomarker candidates. Their plasma proteome signatures highlighted the role of neutrophil activation, complement activation, platelet function, and T cell suppression as well as pro-inflammatory factors upstream and downstream of interleukin-6, interleukin-1B, and tumor necrosis factor.

 

Collateral Effects

Kosten TR, Petrakis IL. The Hidden Epidemic of Opioid Overdoses During the Coronavirus Disease 2019 Pandemic. JAMA Psychiatry. 2020 Dec 30. PubMed: https://pubmed.gov/33377967. Full-text: https://doi.org/10.1001/jamapsychiatry.2020.4148

An unexpected tragedy of the coronavirus disease 2019 (COVID-19) pandemic is increased opioid and fentanyl overdoses, since many factors could have helped in reducing opioid use disorder (OUD) and overdoses during the pandemic. Follow Thomas Kosten and Ismene Petrakis on this short trip through drug addiction and society’s response.

 

French

If you read French, read Mazaurette M. Au lit, les hommes aussi font leur âge. Le Monde 2021, published 2 January. Full-text : https://www.lemonde.fr/m-perso/article/2021/01/02/au-lit-les-hommes-aussi-font-leur-age_6065054_4497916.html

Le mythe d’une éternelle jeunesse sexuelle flatte l’ego masculin mais invisibilise les effets du vieillissement, explique la chroniqueuse de La Matinale Maïa Mazaurette, qui observe que tout se passe comme si seules les femmes subissaient les assauts du temps.

 

German

If you read German, read Böhm A. Reiche zuerst. Die Zeit 2020, published 29 December. Full-text: https://www.zeit.de/2021/01/corona-impfstoff-pharmaindustrie-logistik-reichtum-armut

Reiche Länder teilen seit Monaten den größten Teil der Vakzinen unter sich auf. Regierungen wohlhabender Staaten, die 14 Prozent der Weltbevölkerung repräsentieren, haben sich schon jetzt über die Hälfte aller Impfstoffdosen gesichert, die bereits in der Produktion sind oder demnächst auf den Markt kommen.

 

3 January

Epidemiology

Duca LM, Xu L,Price SF, McLean C. COVID-19 Stats: COVID-19 Incidence, by Age Group — United States, March 1–November 14, 2020. MMWR Morb Mortal Wkly Rep 2021;69:1664. http://dx.doi.org/10.15585/mmwr.mm695152a8

Illustration

 

Prevention

Rolfes MA, Grijalva CG, Zhu Y, et al. Implications of Shortened Quarantine Among Household Contacts of Index Patients with Confirmed SARS-CoV-2 Infection – Tennessee and Wisconsin, April-September 2020. MMWR Morb Mortal Wkly Rep. 2021 Jan 1;69(5152):1633-1637. PubMed: https://pubmed.gov/33382676. Full-text: https://doi.org/10.15585/mmwr.mm695152a1

One of your household members is diagnosed with SARS-CoV-2 infection. Is a 7-day quarantine enough (7 days after the symptom onset of the index patient) even if you are asymptomatic and have a negative laboratory test result? Not always, because 19% of people in your situation will experience symptoms or receive positive test results in the following week. The recommendation by Melissa Rolfes, et al.: persons released from quarantine before 14 days should continue to avoid close contact and wear masks when around others until 14 days after their last exposure.

 

Okyere I, Chuku EO, Ekumah B, et al. Physical distancing and risk of COVID-19 in small-scale fisheries: a remote sensing assessment in coastal Ghana. Sci Rep. 2020 Dec 29;10(1):22407. PubMed: https://pubmed.gov/33376254. Full-text: https://doi.org/10.1038/s41598-020-79898-4

Fish landing sites along the Ghana coast could be transmission hotspots. To get a clearer picture, Isaac Okyere et al. employed an unmanned aerial vehicle. Aerial measurements taken at times of peak landing beach activity indicated that the highest proportion of people, representing 56%, 48%, 39% and 78% in Elmina, Winneba, Apam and Mumford respectively, were located at distances of less than one meter from their nearest neighbor.

 

Vaccine

Editorial. Messengers of hope. Nat Biotechnol. 2020 Dec 29:1. PubMed: https://pubmed.gov/33376248. Full-text: https://doi.org/10.1038/s41587-020-00807-1

Emergency Use Authorizations for two mRNA COVID-19 vaccines represent a turning point in the pandemic. They also herald a new era for vaccinology – an era where vaccines are designed on computers, iteratively optimized in discovery and manufactured on demand — all without expensive and finicky cell culture.

 

Oliver S, Gargano J, Marin M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Moderna COVID-19 Vaccine — United States, December 2020. MMWR Morb Mortal Wkly Rep 2021;69:1653-1656. Full-text:  http://dx.doi.org/10.15585/mmwr.mm695152e1

Use of all COVID-19 vaccines authorized under an EUA should be implemented in conjunction with ACIP’s interim recommendations for allocating initial supplies of COVID-19 vaccines. Before vaccination, the EUA Fact Sheet should be provided to recipients and caregivers. Providers should counsel Moderna COVID-19 vaccine recipients about expected local and systemic reactogenicity.

 

Clinical

Heming M. Li X, Räuber S, et al. Neurological Manifestations of COVID-19 Feature T Cell Exhaustion and Dedifferentiated Monocytes in Cerebrospinal Fluid. Immunity 2020, published 22 December. Full-text: https://doi.org/10.1016/j.immuni.2020.12.011

Neuro-COVID – headache and neuroinflammatory or cerebrovascular disease – are frequent in patients with severe COVID-19. Here, Gerd Meyer zu Hörste, Michael Heming and colleagues identified specific immune alterations in the CSF of neuro-COVID patients featuring an increase of de-differentiated monocytes and exhausted T cells. They observed an IFN response in neuro-COVID that was attenuated compared with viral encephalitis. Severe neuro-COVID exhibited a broad clonal T cell expansion and curtailed IFN response compared with mild neuro-COVID.

 

Treatment

Padhi AK, Shukla R, Saudagar P, Tripathi T. High-Throughput Rational Design of the Remdesivir Binding Site in the RdRp of SARS-CoV-2: Implications for Potential Resistance. iScience 2020, published 26 December. Full-text: https://doi.org/10.1016/j.isci.2020.101992

SARS-CoV-2 can undergo positive selection and attain remdesivir resistance with very few mutations. This is the result of a study that generated a total of 100.000 mutations and provided insight into the functional outcomes of mutations in the remdesivir binding site in the nsp12 subunit of RdRp.

 

Severe COVID

Lee MH, Perl DP, Nair G, et al. Microvascular Injury in the Brains of Patients with Covid-19. N Engl J Med 2020, published 30 December. Full-text: https://doi.org/10.1056/NEJMc2033369

Avindra Nath, Myoung-Hwa Lee and colleagues from the US National Institute of Neurological Disorders and Stroke in Bethesda observed multifocal microvascular injury in the brain and olfactory bulbs in the brains of 13 patients. They found no evidence of viral infection after PCR with multiple primer sets, RNA sequencing of several areas of the brain, and RNA in situ hybridization and immunostaining.

 

Press

Tufekci Z. The Mutated Virus Is a Ticking Time Bomb. The Atlantic 2020, published 31 December. Full-text: https://www.theatlantic.com/science/archive/2020/12/virus-mutation-catastrophe/617531/

A new variant of the coronavirus, known as B.1.1.7, is spreading across the globe. It is thought that this variant will not decrease vaccine efficacy much, if at all. There is no evidence for more severe COVID-19 either. All good and no cause for alarm? Maybe not.

 

2 January

Prevention

Madas BG, Füri P, Farkas Á, et al. Deposition distribution of the new coronavirus (SARS-CoV-2) in the human airways upon exposure to cough-generated droplets and aerosol particles. Sci Rep 2020, published 31 December. Full-text: https://doi.org/10.1038/s41598-020-79985-6

Severe, potentially fatal pneumonia supposes that SARS-CoV-2 reaches the acinar airways. What if we reduced the number of viruses getting there? After characterizing the deposition distribution of SARS-CoV-2 in the airways upon exposure to cough-generated droplets and aerosol particles, Balázs Madas et al. found that the number of viruses deposited in the extra-thoracic airways is about 7 times higher than in the acinar airways. The authors hypothesize that most cases of COVID-19 pneumonia might be preceded by SARS-CoV-2 infection of the upper airways and that without the enhancement of viral load in the upper airways, COVID-19 would be much less dangerous. Ergo, we should use the period between the onset of initial symptoms and the potential clinical deterioration to block or significantly reduce the transport of virus towards the acinar airways, for example with non-specific treatment forms like disinfection of the throat and nasal and oral mucosa. In any case, recommend the authors, use a tissue or cloth in order to absorb droplets and aerosol particles emitted by your own coughs and sneezes… before re-inhalation! Even if you are alone in quarantine.

 

Clinical

Shapiro J, McDonald TB. Supporting Clinicians during Covid-19 and Beyond — Learning from Past Failures and Envisioning New Strategies. N Engl J Med 2020, published 31 December. Full-text: https://doi.org/10.1056/NEJMp2024834

Clinicians are facing important emotional stressors during the COVID-19 pandemic, including grief from seeing so many patients die, fears of contracting the virus and infecting their family members, and anger over health care disparities and other systems failures. Jo Shapiro and Timothy McDonald show the way medical institutions should follow to design emotional-support programs that clinicians will embrace. The last of four suggestions: institutional leadership should be accountable for clinicians’ well-being. Leaders should empower clinicians to speak up about unsafe, highly stressful or morally challenging workplace conditions and ensure that concerns are listened to and, whenever possible, acted on.

 

Severe COVID

Maximous S, Brotherton BJ, Achilleos A, et al. Pragmatic Recommendations for the Management of COVID-19 Patients with Shock in Low- and Middle-Income Countries. Am J Trop Med Hyg. 2020 Dec 21. PubMed: https://pubmed.gov/33350378. Full-text: https://doi.org/10.4269/ajtmh.20-1105

The authors suggest using Sequential Organ Failure Assessment (qSOFA) and point-of-care ultrasound (POCUS) for evaluation purposes to use fluid therapy, norepinephrine and low-dose corticosteroids depending on etiology. The authors also recommend avoiding the routine use of central venous or arterial catheters and using simple bedside measures such as capillary refill time to address targets of resuscitation.

 

Comorbidities

Fernandez-Ruiz R, Paredes J, Niewold TB. COVID-19 in patients with Systemic Lupus Erythematosus: Lessons learned from the inflammatory disease. Transl Res. 2020 Dec 19:S1931-5244(20)30302-9. PubMed: https://pubmed.gov/33352298. Full-text: https://doi.org/10.1016/j.trsl.2020.12.007

The authors review the literature to date on COVID-19 in patients with systemic lupus erythematosus (SLE) and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in patients with SLE.

 

Collateral Effects

Van Haren RM, Delman AM, Turner KM, et al. Impact of the COVID-19 Pandemic on Lung Cancer Screening Program and Subsequent Lung Cancer. J Am Coll Surg. 2020 Dec 12:S1072-7515(20)32525-4. PubMed: https://pubmed.gov/33346080. Full-text: https://doi.org/10.1016/j.jamcollsurg.2020.12.002

Low-dose computed tomography (LDCT) screening reduces lung cancer mortality by at least 20%. At the University of Cincinnati, COVID-19 caused significant disruption in lung cancer screening, leading to a decrease in new patients screened and an increased proportion of nodules suspicious for malignancy once screening resumed.

 

Education

Rubin EJ, Baden LR, Barocas JA, Morrissey S. A Look at Covid-19 Prevention and Care in 2020. Audio interview (26:46). N Engl J Med 2020; 383: e147. Access: https://doi.org/10.1056/NEJMe2036225

The editors discuss the new mRNA-1273 vaccine against SARS-CoV-2, along with other studies of native and exogenous antibodies.

 

1 January

Vaccines

Baden LR, El Sahly HM, Essink B, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med 2020, published 30 December. Full-text: https://doi.org/10.1056/NEJMoa2035389

Finally – after press releases, an emergency use authorization and the start of mass vaccinations – the scientific paper by Lindsey Baden et al.! Nothing new: the mRNA-1273 vaccine developed by Moderna and the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID), within the National Institutes of Health (NIH), has more than 90% efficacy at preventing COVID-19 illness, including severe disease. Moderate-to-severe systemic side effects, such as fatigue, myalgia, arthralgia, and headache, were noted in about 50% of participants in the mRNA-1273 group after the second dose. These side effects were transient, starting about 15 hours after vaccination and resolving in most participants by day 2, without sequelae. The incidence of serious adverse events reported throughout the entire trial was similar for mRNA-1273 and placebo. Importantly, mRNA-1273 did not show evidence in the short term of enhanced respiratory disease after infection, a concern that had emerged from animal models used in evaluating SARS and Middle East Respiratory Syndrome (MERS) vaccine constructs. The authors rightly conclude that the safety of the mRNA-1273 vaccine regimen seems to be reassuring.

 

Castells MC, Phillips EJ. Maintaining Safety with SARS-CoV-2 Vaccines. N Engl J Med 2020, published 30 December. Full-text: https://doi.org/10.1056/NEJMra2035343

On December 8, 2020, within 24 hours after the start of the U.K. mass vaccination program for health care workers and elderly adults, the program reported probable cases of anaphylaxis in two women, 40 and 49 years of age, who had known food and drug allergies and were carrying auto-injectable epinephrine. One week later, a 32-year-old female health care worker in Alaska who had no known allergies presented with an anaphylactic reaction within 10 minutes after receiving the first dose of the vaccine. Since then, several more cases of anaphylaxis associated with the Pfizer mRNA vaccine have been reported in the United States after vaccination of almost 2 million health care workers, and the incidence of anaphylaxis associated with the Pfizer SARS-CoV-2 mRNA vaccine appears to be approximately 10 times as high as the incidence reported with all previous vaccines, at approximately 1 in 100,000, as compared 1 in 1,000,000. Mariana Castells and Elizabeth Phillips explain what is at stake: “It is critical that we focus on safe and efficient approaches to implementing mass vaccination. In the future, these new vaccines may mark the beginning of an era of personalized vaccinology in which we can tailor the safest and most effective vaccine on an individual and a population level.” Happy New Year!

 

Comorbidities

Hoffmann C, Casado JL, Härter G, et al. Immune deficiency is a risk factor for severe COVID-19 in people living with HIV. HIV Med. 2020 Dec 27. PubMed: https://pubmed.gov/33368966. Full-text: https://doi.org/10.1111/hiv.13037

In people living with HIV (PLWH), immune deficiency is a possible risk factor for severe COVID‐19, even in the setting of HIV virologic suppression. There is no evidence for a protective effect of PIs or tenofovir alafenamide. This is the result of a multi-center cohort study which evaluated risk factors for morbidity and mortality of COVID‐19 in PLWH infected with SARS‐CoV‐2 in three countries. Patients with severe COVID‐19 had a lower current CD4 T cell count and a lower CD4 T cell nadir, compared with patients with mild‐to‐moderate COVID‐19. In a multivariate analysis, the only factor associated with risk for severe COVID‐19 was a current CD4+ T cell count of < 350/µl (adjusted odds ratio 2.85, 95% confidence interval 1.26‐6.44, p = 0.01). The only factor associated with mortality was a low CD4 T cell nadir.

 

Epidemiology

Public Health England. Investigation of novel SARS-COV-2 variant: Variant of Concern 202012/01. UK Government 2020, updated 28 December. Full-text: https://www.gov.uk/government/publications/investigation-of-novel-sars-cov-2-variant-variant-of-concern-20201201

The investigation into the new SARS-CoV-2 variant which has spread rapidly within the UK. The authors found that the new variant substantially increases transmissibility.

 

Clinical

Nasomsong W, Luvira V, Phiboonbanakit D. Case Report: Dengue and COVID-19 Coinfection in Thailand. Am J Trop Med Hyg. 2020 Dec 15. PubMed: https://pubmed.gov/33331264. Full-text: https://doi.org/10.4269/ajtmh.20-1340

The authors report a 50-year-old Thai woman who presented with acute high-grade fever, vomiting, and myalgia for 1 day. RT-PCR of the nasopharyngeal swab detected SARS-CoV-2, and RT-PCR of the blood detected dengue virus serotype 2.

 

Collateral Effects

Rattka M, Dreyhaupt J, Winsauer C, et al. Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis. Heart. 2020 Dec 17:heartjnl-2020-318360. PubMed: https://pubmed.gov/33334863. Full-text: https://doi.org/10.1136/heartjnl-2020-318360

In this meta-analysis, the authors assessed outcomes of 50.123 patients from 10 studies. Did the analyzed data show that acute and timely medical care of these patients had been maintained during the pandemic in most countries? Yes, they did. Consequently, despite a significant reduction in overall admission rates of patients with STEMI during the COVID-19 pandemic (incidence rate ratio = 0.789, 95% CI 0.730 to 0.852, I2=77%, p < 0.01), there was no significant difference in hospital mortality (OR = 1.178, 95% CI 0.926 to 1.498, I2=57%, p = 0.01) compared with patients with STEMI admitted before the outbreak.

 

French

If you read French, read Hecketsweiler C. Covid-19 : Le nouveau variant britannique du SARS-CoV-2, « un risque élevé » pour l’Europe. Le Monde 2020, published 31 December. Full-text : https://www.lemonde.fr/planete/article/2020/12/31/le-nouveau-variant-britannique-du-sars-cov-2-un-risque-eleve-pour-l-europe_6064879_3244.html

Ce variant baptisé « VoC 202012/01 » présente plusieurs mutations susceptibles d’accroître sa contagiosité.

 

L’Algérie va acquérir le vaccin russe Spoutnik V. Le Monde 2020, published 31 December. Full-text : https://www.lemonde.fr/afrique/article/2020/12/31/l-algerie-va-acquerir-le-vaccin-russe-spoutnik-v_6064899_3212.html

La campagne de vaccination contre le Covid-19 est censée commencer en janvier dans le pays qui prévoit d’acquérir 500 000 doses.

 

31 December

Vaccines

Our World in Data. COVID-19 vaccination doses administered per 100 people. 30 December 2020. Link: https://ourworldindata.org/grapher/covid-vaccination-doses-per-capita

 

GOV.UK 20201230. Regulatory approval of COVID-19 Vaccine AstraZeneca. https://www.gov.uk 2020, published 30 December. Full-texts: https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazeneca

On December 30, UK regulatory authorities approved the Oxford University/AstraZeneca vaccine. ChAdOx1 nCoV-19 (AZD1222) needs only normal refrigeration at 2-8°C and is far cheaper than the previously approved vaccines Comirnaty (BioNTech/Pfizer) and mRNA-1273 (Moderna).

 

Joint Committee on Vaccination and Immunisation. JCVI issues advice on the AstraZeneca COVID-19 vaccine.  JCVI 2020, published 30 December 2020. Full-text: https://www.gov.uk/government/news/jcvi-issues-advice-on-the-astrazeneca-covid-19-vaccine

The Joint Committee on Vaccination and Immunisation (JCVI) recommends that both the AstraZeneca (ChAdOx1) and the BioNTech/Pfizer (Comirnaty) vaccines are safe and provide high-levels of protection against COVID-19, including severe COVID-19. As protection is obtained around 2 weeks after the first vaccine dose, the committee recommends that vaccinating more people with the first dose is prioritized above offering others their second dose. This would provide the greatest public health benefits in the short term and save more lives. For the BioNTech/Pfizer vaccine, the second vaccine dose can be offered between 3 to 12 weeks after the first dose. (Pfizer is not amused.) For the AstraZeneca vaccine, the second dose can be offered 4 to 12 weeks after the first dose.

 

Prevention

Chiba H, Lewis M, Benjamin ER, et al. “Safer at Home”: The effect of the Covid-19 Lockdown on Epidemiology, Resource Utilization and Outcomes at a Large Urban Trauma Center. J Trauma Acute Care Surg. 2020 Dec 17. PubMed: https://pubmed.gov/33347094. Full-text: https://doi.org/10.1097/TA.0000000000003061

Spring 2020 lockdown in California. At the largest trauma center in Los Angeles, there was a reduction in the automobile versus pedestrian admissions by 42,5%, motorcycle injuries by 38,7%, and bicycle accidents by 28,4%, but no significant effect on the number of motor vehicle accident admissions. There was an increase in ground level falls by 32,5%, especially in the elderly group. The absolute number of gunshot wounds increased by 6,2% and knife injuries by 39,3%. Suicides increased by 38,5%. L

 

Pediatrics

Viner RM, Ward JL, Hudson LD, et al. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch Dis Child. 2020 Dec 17:archdischild-2020-320972. PubMed: https://pubmed.gov/33334728. Full-text: https://doi.org/10.1136/archdischild-2020-320972

In case you didn’t know it, there are reviews and reviews of reviews! Here is one of the latter species: fever and cough are the most common symptoms in children and young people (CYP) under age 20 years with COVID-19, with other symptoms infrequent. The conclusion of this review of reviews by Viner et al.: further research is needed. Praise be.

 

Collateral Effects

Santoro GA, Grossi U, Murad-Regadas S, et al. DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey. Surgery. 2020 Nov 17:S0039-6060(20)30778-9. PubMed: https://pubmed.gov/33353731. Full-text: https://doi.org/10.1016/j.surg.2020.11.008

The authors analyzed the impact of the SARS-CoV-2 pandemic on pre-operative assessment, elective surgery, and post-operative management of colorectal cancer patients, using a 35-item survey, which was answered by a total of 1051 respondents from 84 countries. The result: both diagnostic and therapeutic practices changed. Endoscopic and radiologic procedures were highly affected and elective CRC surgery was impacted for almost all respondents (97,3%), with planned procedures being temporarily suspended (46,8%) or capacity reduced (50,5%).

 

Spanish

If you read Spanish, read de Miguel R. El Reino Unido se convierte en el primer país del mundo en autorizar la vacuna de Oxford y AstraZeneca. El País 2020, published 30 December. Full-text: https://elpais.com/sociedad/2020-12-30/el-reino-unido-se-convierte-en-el-primer-pais-del-mundo-en-autorizar-la-vacuna-de-oxfordastrazeneca.html

El Gobierno de Johnson anuncia que extiende el nivel 4 de Alerta Máxima impuesto en Londres a amplias zonas del centro y norte de Inglaterra. El regreso escolar de Secundaria se retrasa al 18 de enero

 

French

If you read French, read Ducourtieux C. Le Royaume-Uni donne son feu vert au vaccin Oxford-AstraZeneca. Le Monde 2020, published 30 December. Full-text : https://www.lemonde.fr/international/article/2020/12/30/le-royaume-uni-donne-son-feu-vert-au-vaccin-oxford-astrazeneca_6064818_3210.html

Le gouvernement britannique veut amplifier sa campagne de vaccination, tandis que les hôpitaux saturent.

 

Le groupe pharmaceutique chinois Sinopharm annonce que son vaccin contre le Covid-19 est efficace à plus de 79 %. Le Monde 2020, published 30 December. Full-text : https://www.lemonde.fr/planete/article/2020/12/30/covid-19-le-groupe-pharmaceutique-chinois-sinopharm-annonce-que-son-vaccin-est-efficace-a-plus-de-79_6064806_3244.html

Sinopharm n’a pas précisé si les essais cliniques étaient achevés pour ce premier vaccin, qui fait l’objet d’une demande d’homologation auprès des autorités chinoises.

 

German

If you read German, read Schulz B. “Die erleben gerade Furchtbares” – Die Zeit 2020, published 30 December. Full-text: https://www.zeit.de/politik/ausland/2020-12/coronavirus-grossbritannien-impfungen-infektionszahlen-gesundheitssystem-nhs

In Großbritannien wird massenhaft geimpft, aber die Corona-Fälle steigen weiter rasant. Das Gesundheitssystem kollabiert, Intensivstationen suchen freiwillige Helfer.

 

Römer J. Studien liefern erste Erkenntnisse zur Gefahr durch die Corona-Mutation. Der Spiegel 2020, published 30 December. Full-text: https://www.spiegel.de/wissenschaft/mensch/grossbritannien-corona-mutation-fuehrt-nicht-haeufiger-zu-schweren-verlaeufen-a-8c22d51c-bea3-4aa3-aea4-67fdadea2e93

Eine Studie zeigt: Die auch in Deutschland entdeckte Corona-Variante B.1.1.7 verursacht schwere Erkrankungen nicht häufiger als andere Viruslinien. Aber ein Grund zur Entwarnung ist das nicht.

 

30 December

Clinical

Aziz M, Goyal H, Haghbin H, Lee-Smith WM, Gajendran M, Perisetti A. The Association of “Loss of Smell” to COVID-19: A Systematic Review and Meta-Nnalysis. Am J Med Sci. 2020 Nov 1:S0002-9629(20)30427-4. PubMed: https://pubmed.gov/33349441. Full-text: https://doi.org/10.1016/j.amjms.2020.09.017

Patients with olfactory dysfunction or “loss of smell” might have a milder course of the disease. This is the result of a “Systematic Review and Meta-Nnalysis” (sic!) of 51 studies with 11.074 confirmed COVID-19 patients. Let’s hope that the analysis is more accurate than the copy-editor of The American Journal of the Medical Sciences. J

 

Severe COVID

Shashikumar SP, Wardi G, Paul P, et al. Development and Prospective Validation of a Deep Learning Algorithm for Predicting Need for Mechanical Ventilation. Chest. 2020 Dec 17:S0012-3692(20)35454-4. PubMed: https://pubmed.gov/33345948. Full-text: https://doi.org/10.1016/j.chest.2020.12.009

Can a transparent deep learning (DL) model predict the need for MV in hospitalized patients and those with COVID-19 up to 24 hours in advance?  The authors used commonly available data in electronic health records as well as commonly used clinical criteria (heart rate, oxygen saturation, respiratory rate, FiO2 and pH) to feed their deep learning algorithm. The model provided significant improvement over traditional clinical criteria (p < 0.001).

 

Comorbidities

Shields AM, Burns SO, Savic S, Richter AG; UK PIN COVID-19 consortium. COVID-19 in patients with primary and secondary immunodeficiency: the United Kingdom experience. J Allergy Clin Immunol. 2020 Dec 15:S0091-6749(20)32406-4. PubMed: https://pubmed.gov/33338534. Full-text: https://doi.org/10.1016/j.jaci.2020.12.620

In comparison to the general population, adult patients with primary immunodeficiency (PID) and symptomatic secondary immunodeficiency (SID) display greater morbidity and mortality from COVID-19. This is the result of a study that enrolled 100 patients by 1 July 2020, 60 with PID, 7 with other inborn errors of immunity including autoinflammatory diseases and C1 inhibitor deficiency and 33 with SID.

 

Pediatrics

Marlais M, Wlodkowski T, Al-Akash S, et al. COVID-19 in children treated with immunosuppressive medication for kidney diseases. Arch Dis Child. 2020 Dec 21:archdischild-2020-320616. PubMed: https://pubmed.gov/33355203. Full-text: https://doi.org/10.1136/archdischild-2020-320616

Most children with kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. This is the result of a cross-sectional study by the European Rare Kidney Disease Reference Network which included 113 children from 30 different countries. The main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). The authors suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.

 

Collateral Effects

Mourouvaye M, Bottemanne H, Bonny G, et al. Association between suicide behaviours in children and adolescents and the COVID-19 lockdown in Paris, France: a retrospective observational study. Arch Dis Child. 2020 Dec 22:archdischild-2020-320628. PubMed: https://pubmed.gov/33355154. Full-text: https://doi.org/10.1136/archdischild-2020-320628

There was a 50% decrease in the incidence of suicidal behaviors in children and adolescents during the COVID-19 lockdown in Paris, France. The authors of this retrospective observational study conducted in Necker Hospital for Sick Children, Paris (January 2018–June 2020), speculate about the reasons for this decline.

 

Spanish

If you read Spanish, read Peiró P. Cómo la polio dejó de aterrorizar al mundo y otros momentos en que la ciencia venció a la muerte. El País 2020, published 29 December. Full-text: https://elpais.com/sociedad/2020-12-28/como-la-polio-dejo-de-aterrorizar-al-mundo-y-otros-momentos-en-que-la-ciencia-vencio-a-la-muerte.html

De la expedición de Balmis para llevar la vacuna de la viruela por todo el mundo, a la fabricación en masa de penicilina en la segunda Guerra Mundial, la humanidad ha superado retos como los que plantea ahora la covid.

 

Güell O. El toque de queda de París también ‘funciona’ en Burdeos. El País 2020, published 29 December. Full-text: https://elpais.com/sociedad/2020-12-28/el-toque-de-queda-de-paris-tambien-funciona-en-burdeos.html

Una investigación en Francia revela cómo la medida benefició a ciudades donde no fue aplicada.

 

González B. Razones por las que, aunque se vacune, no podrá quitarse la mascarilla. El País 2020, published 29 December. Full-text: https://elpais.com/buenavida/salud/2020-12-28/razones-por-las-que-aunque-te-vacunes-no-podras-quitarte-la-mascarilla.html

Aunque el final de esta pesadilla parezca cada vez más cerca, todavía queda recorrido.

 

Llaneras K. ¿Adiós a un año malo? 42 buenas noticias para empezar 2021 con optimismo. El País 2020, published 29 December. Full-text: https://elpais.com/politica/2020/12/27/actualidad/1609093070_533150.html

Una lista de datos positivos para el año nuevo, en la ‘newsletter’ de Kiko Llaneras.

 

French

If you understand French, listen to Le vaccin contre le Covid-19 va-t-il nous sauver rapidement de l’épidémie ? Le Monde 2020, published 27 December. Video : https://www.lemonde.fr/planete/video/2020/12/27/covid-19-le-vaccin-va-t-il-nous-sauver-rapidement-de-l-epidemie_6064589_3244.html

Pfizer, Moderna, AstraZeneca… les vaccins de ces laboratoires vont-ils assurer une immunité globale suffisante pour arrêter la transmission du coronavirus ?

 

Roucaute D. La seconde vague de Covid-19 en France est plus meurtrière que la première. Le Monde 2020, published 29 December. Video : https://www.lemonde.fr/planete/article/2020/12/29/une-deuxieme-vague-plus-meurtriere-que-la-premiere_6064736_3244.html

Si le taux de mortalité dans les hôpitaux a été divisé par deux depuis avril, près de 32 500 personnes sont mortes des suites de la maladie lors des cinq derniers mois, contre un peu moins de 30 300 entre février et juillet.

 

German

If you read German, read Albrecht H. Zwischen Euphorie und Panik. Die Zeit, published 29 December. Full-text: https://www.zeit.de/2021/01/corona-impfungen-virologen-mutation-grossbritannien-herdenimmunitaet-usa

Der Beginn der Impfkampagne darf nicht täuschen: Sars-CoV-2 steckt voller Überraschungen.

 

29 December

Virology

Mahase E. Covid-19: What have we learnt about the new variant in the UK? BMJ 2020, published 23 December. Full-text: https://doi.org/10.1136/bmj.m4944

The new SARS-CoV-2 variant has evoked scenes reminiscent of the early days of COVID-19 when much of the world banned travel to and from Wuhan, China. With large parts of south-east England locked down, Elisabeth Mahase looks at what we know so far.

 

Prevention

Tinson A, Clair A. Better housing is crucial for our health and the COVID-19 recovery. The Health Foundation 2020, published 28 December. Full-text: https://www.health.org.uk/publications/long-reads/better-housing-is-crucial-for-our-health-and-the-covid-19-recovery

In this Long read, Adam Tinson and Amy Clair summarize why housing problems are likely to be a significant component of the SARS-CoV-2 pandemic that has led to greater risks of COVID-19 infection and serious complications for certain social groups. The authors conclude that overcrowding, poor quality and unaffordable homes are a threat to health.

 

Diagnostics

Pilarowski G, Marquez C, Rubio L, et al. Field performance and public health response using the BinaxNOW TM Rapid SARS-CoV-2 antigen detection assay during community-based testing. Clin Infect Dis 2020, published 27 December. Full-text: https://doi.org/10.1093/cid/ciaa1890

SARS-CoV-2 pandemic control calls for fast, low-barrier, high-performing field assays accessible to people who will not otherwise be tested or who will receive results too late for results to make a difference. Here, Diane Havlir, Genay Pilarowski and colleagues evaluated the Abbott BinaxNOWTM COVID-19 antigen card rapid assay performance for detection of persons with high levels of virus and measured the time to isolation in a community walk-up “test and respond” program. Among 3302 persons tested by BinaxNOWTM and RT-PCR in a community setting, rapid assay sensitivity was 100%/98.5%/89% using RT-PCR Ct thresholds of 30, 35 and 0. The specificity was 99.9%. Performance was high across ages and those both with and without symptoms. Rapid results may permit immediate public health action.

 

Clinical

Narang K, Szymanski LM, Kane SV, Rose CH. Acute Pancreatitis in a Pregnant Patient With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2020, published 22 December. PubMed: https://pubmed.gov/33355431. Full-text: https://doi.org/10.1097/AOG.0000000000004287

Coronavirus disease 2019 may present in pregnancy with a myriad of clinical symptoms other than respiratory. Acute pancreatitis represents an infrequent complication of primary COVID-19 infection.

 

Severe COVID

Feng Z, Zhao H, Kang W, et al. Association of Paraspinal Muscle Measurements on Chest Computed Tomography with Clinical Outcomes in Patients with Severe Coronavirus Disease 2019. J Gerontol A Biol Sci Med Sci. 2020 Dec 23:glaa317. PubMed: https://pubmed.gov/33355656. Full-text: https://doi.org/10.1093/gerona/glaa317

For elderly patients in intensive care units or with critical illness, skeletal muscle loss adversely affects clinical outcomes. Here, Pengfei Rong, Zhishao Feng and colleagues from Third Xiangya Hospital, Central South University, Changsha, report that higher paraspinal muscle radiodensity (PMD), a proxy measure of lower muscle fat deposition, may be associated with a reduced risk of disease deterioration and decreased likelihood of prolonged viral shedding among female patients with severe COVID-19.

 

Collateral Effects

Gergen AK, Madsen HJ, Tilva KR, Smith JB, Weyant MJ. Coronavirus Disease 2019 in Lung Transplant Recipients. Ann Thorac Surg. 2020 Dec 18:S0003-4975(20)32134-2. PubMed: https://pubmed.gov/33347850. Full-text: https://doi.org/10.1016/j.athoracsur.2020.11.032

The authors report risk factors, clinical manifestations, and treatment course of two lung transplant recipients diagnosed with COVID-19 pneumonia. After being hospitalized and later discharged home, both patients were readmitted several days later with significant worsening of respiratory status and infectious symptoms.

 

Martire LM, Isaacowitz DM. What Can We Learn About Psychological Aging By Studying Covid-19? The Journals of Gerontology: Series B 2020, published 26 December. Full-text:  https://doi.org/10.1093/geronb/gbaa217

The authors give a short overview of papers about Americans living under varying social and travel restrictions; individuals living in Sweden during a period of voluntary social distancing; individuals living in Spain during a mandatory lockdown; older age predicting better or worse functioning; the ability of elderly people to deal with adversity; and the importance of using behavioral research to reduce ageism and promote intergenerational solidarity.

 

Spanish

If you read Spanish, read Sabatés R, Vande Rusten P. 21 recuerdos para 2021. El País 2020, published 28 December. Full-text: https://elpais.com/elpais/2020/12/11/album/1607645873_709495.html

El fútbol español ha intentado aportar un poco de alegría y de entretenimiento al mundo entero en este año marcado por la pandemia. Estos son los momentos que más recordaremos

 

Domínguez N. La madre de la vacuna contra la covid: “En verano podremos, probablemente, volver a la vida normal” – El País 2020, published 28 December. Full-text: https://elpais.com/ciencia/2020-12-26/la-madre-de-la-vacuna-contra-la-covid-en-verano-podremos-probablemente-volver-a-la-vida-normal.html

La bioquímica húngara Katalin Karikó pasó 40 años trabajando en la sombra y desarrollando avances claves para las inyecciones de Moderna y BioNTech

 

Bassets M. Futuro, año cero. El País 2020, published 28 December. Full-text: https://elpais.com/ideas/2020-12-26/2021-ano-del-aterrizaje.html

Tras meses fuera de órbita, en 2021 toca poner los pies en el suelo. ¿Emprenderemos la recuperación de la crisis sanitaria y económica? ¿Lucharemos seriamente contra el cambio climático? ¿Se reforzarán las fronteras y se beneficiarán los demagogos? Especialistas de la economía, el pensamiento o la geopolítica hacen sus apuestas

 

French

If you read French, read Truong N. Claire Marin : « Il va falloir peut-être admettre que 2020 nous prépare douloureusement à l’idée de devoir vivre autrement » – Le Monde 2020, published 27 December. Full-text : https://www.lemonde.fr/idees/article/2020/12/27/claire-marin-nous-sommes-confines-mentalement-bien-plus-encore-que-nous-ne-l-avons-ete-physiquement_6064576_3232.html

Entretien« Les penseurs de l’intime » (5/10). Philosophe des épreuves de la vie, Claire Marin explique dans un entretien au « Monde » comment la crise sanitaire accentue les ruptures sociales, professionnelles ou familiales et nous prépare « douloureusement à vivre autrement » en 2021.

 

German

If you read German, read Schöps C. Diese Impfreaktionen sind ganz normal. Die Zeit 2020, published 23 December. Full-text: https://www.zeit.de/wissen/gesundheit/2020-12/corona-impfung-risiken-nebenwirkungen-fieber-immunsystem

Arm geschwollen, Kopfschmerz, Fieber, all das kann nach der Impfung gegen das Coronavirus passieren. Sorgen muss man sich deshalb aber keineswegs machen.

 

28 December

Vaccine

The Pfizer–BioNTech COVID-19 vaccine, codenamed BNT162b2, is now being sold under the brand name Comirnaty™ (INN: Tozinameran). Find here a summary of the product characteristics and the package leaflet if you want to be able to answer the questions of your patients: https://www.ema.europa.eu/en/documents/product-information/comirnaty-epar-product-information_en.pdf

 

Transmission

Birgand G, Pfeiffer-Smadja N, Fournier S, et al. Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings. JAMA Netw Open 2020;3(12):e2033232. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.33232

Controversy remains regarding the level of air contamination from SARS-CoV-2 in hospitals. After reviewing 24 cross-sectional observational studies, the authors report that the air close to and distant from patients with coronavirus disease 2019 was frequently contaminated with SARS-CoV-2 RNA; however, few of these samples contained viable viruses. High viral loads were found in toilets and bathrooms, staff areas, and public hallways.

 

Prevention

Baggett TP, Scott JA, Le MH, et al. Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for Adults Experiencing Sheltered Homelessness During the COVID-19 Pandemic. JAMA Netw Open. 2020;3(12):e2028195. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.28195

A modeling study of simulated adults living in homeless shelters. Daily symptom screening with PCR testing of individuals who had positive symptom screening paired with nonhospital care site management of people with mild to moderate coronavirus disease 2019 (COVID-19) was associated with a substantial decrease in infections and lowered costs.

 

Severe COVID

Asch DA, Sheils NE, Islam N, et al. Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic. JAMA Intern Med. Published online December 22, 2020. Full-text: https://doi.org/10.1001/jamainternmed.2020.8193

COVID-19 mortality in hospitals seems to be lower when the prevalence of SARS-CoV-2 infection in their surrounding communities is lower; and hospital outcomes for patients with COVID-19 have been improving throughout the year 2020. These are the key messages of a cohort study of 38 517 adult patients by David Asch and colleagues from the University of Pennsylvania. See also the comment by Boudourakis L. Decreased COVID-19 Mortality—A Cause for Optimism. JAMA Intern Med. Published online December 22, 2020. Full-text: https://doi.org/10.1001/jamainternmed.2020.8438.

 

Pediatrics

Edlow AG, Li JZ, Collier AY, et al. Assessment of Maternal and Neonatal SARS-CoV-2 Viral Load, Transplacental Antibody Transfer, and Placental Pathology in Pregnancies During the COVID-19 Pandemic. JAMA Netw Open. 2020;3(12):e2030455. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.30455

Knowledge is scarce about the factors that determine SARS-CoV-2 transmission to the newborn child. In this prospective cohort study including 127 pregnancies, Andrea Edlow et al. found no maternal viremia, placental infection, or vertical transmission of SARS-CoV-2. However, the authors describe also a compromised transplacental transfer of anti–SARS-CoV-2 antibodies. Discover the implications and read the comment by Jamieson DJ, Rasmussen SA. Protecting Pregnant Women and Their Infants From COVID-19: Clues From Maternal Viral Loads, Antibody Responses, and Placentas. JAMA Netw Open. 2020;3(12):e2030564. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.30564

 

Journal Feature

Callaway E, Ledford H, Viglione G, Watson T, Witze A. COVID and 2020: An extraordinary year for science. Nature, December 2020. Full-text: https://www.nature.com/immersive/d41586-020-03437-4/index.html

The coronavirus pandemic shaped the year in research — from vaccines and treatments to campus shutdowns and virtual meetings.

 

Spanish

If you read Spanish, read de Lis PF. El año de la ciencia. El País 2020, published 27 December. Full-text: https://elpais.com/elpais/2020/12/22/eps/1608637752_983427.html

La investigación científica resulta tan compleja que muchos sintieron que era poco relevante para su vida. Pero el virus SARS-CoV-2 cambió de golpe esta percepción. Nunca en la historia se había logrado una vacuna en tan poco tiempo. Hemos visto lo mejor y lo peor de la ciencia este 2020. ¿Mantendrá ese esencial reconocimiento y apoyo en el futuro?

El virus que lo cambió todo. Esta imagen de microscopio electrónico de barrido muestra el SARS-CoV-2 (coloreado en azul) emergiendo de la superficie de células cultivadas en laboratorio. Fotografía de NIAID

 

Silva R, Alonso A, Linde P. España se vacuna. El País 2020, published 27 December. Full-text: https://elpais.com/sociedad/2020-12-26/espana-se-vacuna.html

Tras la aprobación por parte de la Agencia Europea del Medicamento y de la Comisión Europea, el fármaco de Pfizer comienza a distribuirse en la mayor parte del territorio europeo. Un viaje ultrafrío a 70 grados bajo cero desde una fábrica de Puurs (Bélgica) hasta los almacenes de cada comunidad

 

Sampedro J. La revolución del ARN. El País 2020, published 27 December. Full-text: https://elpais.com/ciencia/2020-12-26/la-revolucion-del-arn.html

Así se ha gestado la innovación tecnológica radical que ha permitido desarrollar las vacunas de la covid en un tiempo récord

 

French

If you read French, read Audureau W, Maad A. Nos conseils pour identifier les discours complotistes et ne pas tomber dans leurs pièges. Le Monde 2020, published 22 December. Full-text : https://www.lemonde.fr/les-decodeurs/article/2020/12/22/nos-conseils-pour-identifier-les-discours-complotistes-et-ne-pas-tomber-dans-leurs-pieges_6064200_4355770.html

En 2020, les discours expliquant la pandémie de Covid-19 par des complots ont séduit des millions d’adeptes. Leur succès tient moins à leur véracité qu’à des ficelles rhétoriques éprouvées. Notre guide pour les débusquer. (Netflix, tout comme Amazon Prime Video, propose des documentaires conspirationnistes.)

 

Foucart S. Les silences de la Chine, un virus repéré dès 2013, la fausse piste du pangolin… Enquête sur les origines du SARS-CoV-2. Le Monde 2020, published 22 December. Full-text : https://www.lemonde.fr/sciences/article/2020/12/22/a-l-origine-de-la-pandemie-de-covid-19-un-virus-sars-cov-2-aux-sources-toujours-enigmatiques_6064168_1650684.html

Du pangolin à la chauve-souris, en passant par des expériences de laboratoire controversées, « Le Monde » a tenté de remonter jusqu’aux origines de l’épidémie, responsable de plus d’un million et demi de morts dans le monde.

 

Cabut S. Dagorn G, Maad A. Covid-19 : neuf questions sur le nouveau variant du SARS-CoV-2 observé au Royaume-Uni. Le Monde 2020, published 21 December. Full-text : https://www.lemonde.fr/les-decodeurs/article/2020/12/21/neuf-questions-sur-le-nouveau-variant-du-sars-cov-2-observe-au-royaume-uni_6064152_4355770.html

Un variant du virus, porteur de plusieurs mutations génétiques, semble être associé à une hausse brutale du nombre de cas dans la région de Londres. Mais la preuve d’une contagiosité accrue n’a pas été faite.

 

27 December

Prevention

Martin CA, Jenkins DR, Patel P, et al. No cases of asymptomatic SARS-CoV-2 infection among healthcare staff in a city under lockdown restrictions: lessons to inform ‘Operation Moonshot’. J Pub Health 2020, published 26 December. Full-text: https://doi.org/10.1093/pubmed/fdaa237

Imagine inviting more than 13.000 healthcare workers (HCWs) to get SARS-CoV-2 testied. Now about 8% (n = 1150) of the workforce volunteer and you find no cases of asymptomatic SARS-CoV-2 infection. You would probably conclude, like Manish Pareek, Christopher Martin and colleagues, that voluntary testing of asymptomatic staff may not be cost-effective.

 

Vaccine

Burki T. Equitable distribution of COVID-19 vaccines. Lancet Infect Dis 2021, published 1 January. Full-text: https://doi.org/10.1016/S1473-3099(20)30949-X

If everything goes according to plan, November 2020 will be remembered as the beginning of the end of the COVID-19 pandemic. Countries will have to ensure that they have the infrastructure for mass immunization campaigns. Those without experience in distributing influenza vaccines must learn how to establish platforms for adult vaccination. Vaccine hesitancy will have to be overcome.

 

Lucia VC, Kelekar A, Afonso NM. COVID-19 vaccine hesitancy among medical students, Journal of Public Health. J Pub Health 2020, published 26 December. Full-text: https://doi.org/10.1093/pubmed/fdaa230

Medical students are among the group of frontline healthcare providers likely to be exposed to COVID-19 patients. It is important to achieve high COVID-19 vaccination coverage rates in this group as soon as a vaccine is available. In this survey completed by 168 of 494 medical students (response rate = 34%), the vast majority had positive attitudes regarding immunizations in general and the importance of vaccines for themselves and patients. 53% indicated they would participate in a COVID-19 vaccine trial; only 23% were unwilling to take a COVID-19 vaccine immediately upon FDA approval.

 

Diagnostics

Rathe JA, Hemann EA, Eggenberger J, et al. SARS-CoV-2 Serologic Assays in Control and Unknown Populations Demonstrate the Necessity of Virus Neutralization Testing. J Infect Dis 2020, published 25 December. Full-text: https://doi.org/10.1093/infdis/jiaa797

How does serologic antibody testing outcome link with virus neutralization of SARS-CoV-2? To answer this question, Jennifer Rathe et al. compared serum Ig levels across platforms of viral antigens and antibodies with 15 positive and 30 negative SARS-CoV-2 controls followed by viral neutralization assessment. After applying these platforms to a clinically relevant cohort of 114 individuals with unknown histories of SARS-CoV-2 infection, they confirmed that no single serologic assay provides perfect prediction for viral neutralizing ability. Spike IgG3 provided the highest accuracy for predicting serologically positive individuals with virus neutralization activity.

 

Clinical

Hampshire A. Trender W, Chamberlain SR, et al. Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study. medRxiv 2020, posted 21 October. Full-text: https://doi.org/10.1101/2020.10.20.20215863

SARS-CoV-2 infection may exhibit cognitive deficits that persist into the recovery phase. This is what Adam Hampshire and colleagues from the Imperial College in London suggest after analyzing cognitive test data from 84.285 Great British Intelligence Test participants who completed a questionnaire regarding suspected and biologically confirmed COVID-19 infection. Deficits were most pronounced in individuals who had been hospitalized, but were also detectable in individuals with mild but biologically confirmed cases who reported no breathing difficulty. The scale of the observed deficits was substantial; for the hospitalized patients who needed ventilator support they were equivalent to the average 10-year decline in global performance between the ages of 20 to 70 – comparable to a 8.5-point difference in IQ. Let’s hope that the results of this pre-print paper posted in October will be proved wrong and not be accepted for publication.

 

Gerkin RC, Ohla K, Veldhuizen MG, et al. Recent smell loss is the best predictor of COVID-19 among individuals with recent respiratory symptoms. Chemical Senses 2020, published 25 December. Full-text: https://doi.org/10.1093/chemse/bjaa081

Might quantified smell loss be the best predictor of COVID-19 amongst those with symptoms of respiratory illness? That’s the suggestion by Valentina Parma, Richard Gerkin and colleagues after quantifying changes in chemosensory abilities in individuals with a positive (C19+; n = 4148) or negative (C19-; n = 546) COVID-19 laboratory test outcome.

 

Co-morbidities

Guillet H, Gallet R, Pham V, et al. Clinical spectrum of ischaemic arterial diseases associated with COVID-19: a series of four illustrative cases. Eur Heart J 2020, published 25 December. Full-text: https://doi.org/10.1093/ehjcr/ytaa488

Henri Guillet et al. from Hôpital Henri Mondor, Paris, describe four different cases of COVID-19 infection with ischemic arterial events: a myocardial infarction with high thrombus load, ischemic stroke on spontaneous thrombosis of the aortic valve, floating thrombus with mesenteric, splenic and renal infarction, and acute limb ischemia.

 

Allen B, El Shahawy O, Rogers ES, et al. Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January–October 2020, Journal of Public Health. J Pub Health 2020, published 26 December. Full-text: https://doi.org/10.1093/pubmed/fdaa241

What do you know about the relationships between substance use disorders (SUDs), overdose and COVID-19 severity and mortality? Patients with histories of SUD and drug overdose could face disproportionate risk of critical COVID-19 illness, is the answer by Bennett Allen et al. However, the authors concede that they cannot assure whether the outcomes were due to COVID-19 or unrelated because they adjusted for few comorbidities. In particular, due to missing data, body mass index was not assessed.

 

Beyond Corona

Editors. Tuberculosis and malaria in the age of COVID-19. Lancet Infect Dis 2021, published 1 January. Full-text: https://doi.org/10.1016/S1473-3099(20)30946-4

Tuberculosis and malaria are greater long-term threats than COVID-19 and planning of resource allocation must account for that.

 

German

If you read German, read Kattwinkel T. Covid-19 im Kopf. Die Zeit 2020, published 25 December. Full-text: https://www.zeit.de/wissen/gesundheit/2020-12/corona-langzeitfolgen-psyche-depression-konzentration-neurologie

Vergesslich, unkonzentriert oder sogar depressiv: Eine Corona-Infektion kann Spuren im Gehirn hinterlassen. Was über neurologische Schäden bekannt ist.

 

French

If you read French, read Herzberg N. Vaccins contre le Covid-19 : les raisons d’un record de vitesse. Le Monde 2020, published 23 December. Full-text : https://www.lemonde.fr/planete/article/2020/12/23/vaccin-anti-covid-les-raisons-de-ce-record-de-vitesse_6064337_3244.html

Il a fallu moins d’un an pour mettre au point les premiers vaccins, au lieu de dix habituellement.

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Roucaute D. Covid-19 : les différentes étapes de la réponse immunitaire face au coronavirus. Le Monde 2020, published 23 December. Full-text : https://www.lemonde.fr/planete/article/2020/12/23/les-differentes-etapes-de-la-reponse-immunitaire-face-au-coronavirus_6064322_3244.html

Les anticorps activés par l’organisme infecté par le SARS-CoV-2 n’ont pas la même durée de vie chez les hommes et chez les femmes.

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Meyerfeld B. Brésil : à Manaus, le mirage de l’immunité collective contre le Covid-19. Le Monde 2020, published 23 December. Full-text : https://www.lemonde.fr/planete/article/2020/12/23/bresil-a-manaus-le-mirage-de-l-immunite-collective_6064323_3244.html

Une étude estime que 76 % des habitants de la métropole amazonienne posséderaient des anticorps contre le coronavirus. Sur place, les médecins confrontés à la deuxième vague restent sceptiques.

 

Spanish

If you read Spanish, read Ansede M. Respuestas para las principales dudas sobre las vacunas contra la covid. El País 2020, published 19 December. Full-text: https://elpais.com/ciencia/2020-12-19/respuestas-para-las-principales-incognitas-sobre-las-vacunas-contra-la-covid.html

Media docena de expertos responden a cuestiones como la seguridad a largo plazo de las inyecciones y la duración de la protección en los vacunados.

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Carbajosa a. Cómo Alemania ha pasado de país ejemplar a ver cómo las muertes por covid se disparan. El País 2020, published 19 December. Full-text: https://elpais.com/sociedad/2020-12-16/alemania-se-asoma-al-descontrol.html

Una mezcla de medidas demasiado suaves, tardanza en reaccionar y falsa sensación de seguridad llevan al alumno aventajado en la prevención a ser uno de los más golpeados por el virus.

 

26 December

Epidemiology

Millán-Guerrero RO, Caballero-Hoyos R, Monárrez-Espino J. Poverty and survival from COVID-19 in Mexico. J Pub Health 2020, published 24 December. Full-text: https://doi.org/10.1093/pubmed/fdaa228

Individuals living in municipalities with extreme poverty had a 9% higher risk of dying than those living in municipalities classified as not poor. This is the result of a retrospective Mexican cohort study of nearly 250.000 COVID-19 patients. Mortality was 12,3% reaching 59,3% in patients with ≥ 1 co-morbidities. Combating extreme poverty needs to be a central preventive strategy.

 

Niu J, Rodriguez JA, Sareli C, et al. COVID-19 infection among first responders in Broward County, Florida, March–April 2020. Journal of Public Health 2020, published 24 December. Full-text: https://doi.org/10.1093/pubmed/fdaa231

Due to job-related exposures, first responders (FRs) are at a higher risk of SARS-CoV-2 infection than the general population. Here, Paula Eckardt, Jianli Niu and colleagues from Memorial Healthcare System, Hollywood, screened a total of 3375 FRs between March and April 2020. Overall, 289 (8,6%) were positive, with the highest rates among those aged 25-49 years. Of those testing positive, 235 (81,3%) were asymptomatic.

 

Transmission

Aydillo T, Gonzales-Reiche AS, Aslam S, et al. Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer. N Engl J Med 2020, published 24 December. Full-text: https://doi.org/10.1056/NEJMc2031670

Patients with profound immunosuppression may shed viable SARS-CoV-2 for at least 2 months. This is the results of a study by Mini Kamboj, Teresa Aydillo and colleagues from Memorial Sloan Kettering Cancer Center, New York. The authors used cell cultures to detect viable virus in serially collected respiratory samples obtained from 18 recipients of hematopoietic stem cell transplants or chimeric antigen receptor (CAR) T cell therapy and 2 patients with lymphoma.

 

Treatment

Trump S, Lukassen S, Anker MS, et al. Hypertension delays viral clearance and exacerbates airway hyperinflammation in patients with COVID-19. Nat Biotechnol 2020, published 24 December. Full-text:  https://doi.org/10.1038/s41587-020-00796-1

ACEI treatment in patients with SARS-CoV-2 infection and hypertension might warrant further investigation. This is the suggestion by Irina Lehmann, Saskia Trump and colleagues from Charité, Berlin, who combined clinical data (n = 144) and single cell sequencing data of airway samples (n = 48) with in vitro experiments. The authors observed a distinct inflammatory predisposition of immune cells in patients with hypertension that correlated with critical COVID-19 progression. ACEI treatment was associated with dampened COVID-19-related hyperinflammation and with increased cell intrinsic antiviral responses.

 

Severe COVID

Jorge A, D’Silva KM, Cohen A, et al. Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study. Lancet Rheumatology 2020, published 23 December. Full-text: https://doi.org/10.1016/S2665-9913(20)30422-7

In this cohort study of patients with rheumatic and musculoskeletal diseases, Hyon Choi, April Jorge and colleagues from Massachusetts General Hospital compared 2811 patients who were diagnosed with COVID-19 during the first 90 days of the pandemic (early cohort) with 5729 patients diagnosed during the second 90 days of the pandemic (late cohort). The late cohort fared better: the risk of hospitalization, intensive care unit admission, mechanical ventilation, acute kidney injury, renal replacement therapy, and death was lower in the late cohort than in the early cohort. This finding is probably multifactorial, due to increased testing capacity allowing for detection of milder cases, improved supportive care, and improved treatments. The lesson for the future: use historical comparators cautiously in observational studies of new therapies for COVID-19!

 

Co-morbidities

McGurnaghan SJ, Weir A, Bishop J, et al. Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland. Lancet Diabetes Endocrinol 2020, published 23 December. Full-text: https://doi.org/10.1016/S2213-8587(20)30405-8

Of the total Scottish population on March 1, 2020 (n = 5.463.300), the population with diabetes was 319.349 (5,8%), 1082 (0,3%) of whom developed fatal or critical care unit treated COVID-19 by July 31, 2020. In the population without diabetes, 4081 (0,1%) of 5.143.951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1,395 compared with the risk in those without diabetes. The OR was 2,4 in type 1 diabetes and 1,4 in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycemic control, have had a diabetic ketoacidosis or hypoglycemia hospitalization in the past 5 years, be on more anti-diabetic and other medication (all p < 0.0001), and have been a smoker (p = 0.0011).

See also the comment by Stehouwer CDA. Observational research on severe COVID-19 in diabetes. Lancet Diabetes Endocrinol 2020, published 23 December. Full-text: https://doi.org/10.1016/S2213-8587(20)30432-0

 

Tisminetzky M, Delude C, Hebert T, et al. Multiple Chronic Conditions, and COVID-19: A literature review. J Gerontol 2020, published 24 December. Full-text: https://doi.org/10.1093/gerona/glaa320

Nothing new in this short review about the most frequent SARS-CoV-2 comorbidities: hypertension, diabetes mellitus, cardiovascular disease, chronic pulmonary disease, and chronic kidney disease. And: men had a higher risk of dying than women. But if you want a concise literature overview, here you go.

 

Collateral Effects

Silverman ME, Burgos L, Rodriguez ZI, et al. Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City. Sci Rep 10, 22380 (2020). Full-text: https://doi.org/10.1038/s41598-020-79564-9

Post-partum depression, the most common complication of childbearing, is a prevalent, cross-cultural disorder. Even in the best environments, the period following childbirth represents a time of heightened stress and vulnerability for most, if not all, new parents. In this study of 516 post-partum patients, Michael Silverman et al. now demonstrate a differentiated response in the post-partum mood of those living in New York City during the COVID-19 pandemic… based on socioeconomic status! While those in areas with higher socioeconomic status (SES) demonstrated no change in post-partum mood after implementation of social restrictions in New York, those living in lower SES expressed improved mood over the same time period. Try to find out why.

 

Education

Tambyraja AL. New Order, New Hope. N Engl J Med 2020, published 24 December. Full-text: https://doi.org/10.1056/NEJMp2016142

In this Christmas Perspective, Andrew Tambyraja reminds us about traditional strengths in medicine: agility and patient focus, humility and the pursuit of the greater good.

 

Beyond Corona

Else H. Climate change and COVID-19 vaccines are among the themes set to shape research. Nature 2020, published 22 December. Full-text: https://www.nature.com/articles/d41586-020-03651-0

The science events to watch for in 2021: Climate comeback | COVID vaccines | Open access drive | Stem cell revamp  | Crunch time for Alzheimer’s drug  | Mars gets busy | Long-awaited telescope launch  | Ripple effect

 

25 December

In Memoriam

Normile D, Huihui B, Hicks L, et al. Ones we’ve lost. Science. 2020 Dec 18;370(6523):1398-1401. PubMed: https://pubmed.gov/33335047. Full-text: https://science.sciencemag.org/content/370/6523/1398

 

Epidemiology

Wurtzer S, Marechal V, Mouchel JM, et al. Evaluation of lockdown effect on SARS-CoV-2 dynamics through viral genome quantification in waste water, Greater Paris, France, 5 March to 23 April 2020. Euro Surveill. 2020 Dec;25(50). PubMed: https://pubmed.gov/33334397. Full-text: https://doi.org/10.2807/1560-7917.ES.2020.25.50.2000776

Management of epidemics requires careful monitoring of the infected population because exceptional measures such as lockdowns rely on this kind of information. Here, Laurent Moulin and colleagues from Eau de Paris report the analysis of raw waste water (WW) collected at the inlets of waste water treatment plants (WWTPs). They demonstrate that a quantitative detection of SARS-CoV-2 in WW reflected the circulation of the virus in the human population in Greater Paris.

 

Transmission

Kemp SA, Collier DA, Datir R, et al. Neutralising antibodies drive Spike mediated SARS-CoV-2 evasion. medRxiv 2020, posted 19 December. Full-text: https://doi.org/10.1101/2020.12.05.20241927

In immune suppressed individuals, treatment with convalescent plasma might lead to the emergence of a mutated SARS-CoV-2 strain. Here, Ravindra Gupta from the Cambridge Institute for Therapeutic Immunology and Infectious Diseases report the case of a repeated evolutionary response by SARS-CoV-2 against antibody therapy during the course of a persistent and eventually fatal infection in an immunocompromised host. The authors describe a 69-70 deletion in the spike protein which was twice as infectious in a lentivirus model. The 69-70 deletion is also present in the new UK strain B.1.1.7.

Read also Kupferschmidt K. Mutant coronavirus in the United Kingdom sets off alarms, but its importance remains unclear. Nature 2020, published 20 December. Full-text: https://www.sciencemag.org/news/2020/12/mutant-coronavirus-united-kingdom-sets-alarms-its-importance-remains-unclear

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Kupferschmidt K. U.K. variant puts spotlight on immunocompromised patients’ role in the COVID-19 pandemic. Nature 2020, published 23 December. Full-text: https://www.sciencemag.org/news/2020/12/uk-variant-puts-spotlight-immunocompromised-patients-role-covid-19-pandemic

 

Prevention

Brown M. Flay your fart: viral clip calls on public to alter speech to curb Covid. The Guardian 2020, published 21 December. Full-text: https://www.theguardian.com/culture/2020/dec/21/flay-your-fart-viral-clip-calls-on-public-to-alter-speech-to-curb-covid?utm

A retired PR consultant and translator has produced a video suggesting the government is to ban certain sounds and letters of the alphabet because they increase the transmission of Covid-19. Instead of “please take care”, we should say “flease nake lare”, the skit says.

 

Immunology

Lumley SF, O’Donnell D, Stoesser NE, et al. Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers. N Engl J Med 2020, published 23 December. Full-text: https://doi.org/10.1056/NEJMoa2034545

Christmas 2020 – good news for people with SARS-CoV-2 antibodies. In this longitudinal cohort study, there were no symptomatic infections in 1.265workers with anti-spike antibodies. Two anti-spike–seropositive health care workers had a positive PCR test (0.13 per 10,000 days at risk), and both workers were asymptomatic when tested. The authors conclude that the presence of anti-spike or anti-nucleocapsid IgG antibodies are associated with a substantially reduced risk of SARS-CoV-2 reinfection in the ensuing 6 months.

 

Treatment

Zhang LK, Sun Y, Zeng H, et al. Calcium channel blocker amlodipine besylate therapy is associated with reduced case fatality rate of COVID-19 patients with hypertension. Cell Discov. 2020 Dec 22;6(1):96. PubMed: https://pubmed.gov/33349633. Full-text: https://doi.org/10.1038/s41421-020-00235-0

Might antihypertensive treatment with amlidopine be associated with a decreased case fatality rate of SARS-CoV-2 infection? Gengfu Xiao and Lei-Ke Zhang from Wuhan Institute of Virology, Center for Biosafety Mega-Science, report 96 patients who had only hypertension as a comorbidity. 19 patients received amlodipine besylate, 14 received nifedipine, 8 received ARBs/ACEIs, 45 had no drug information, and 10 had no antihypertension drug treatment. The numbers are too small to draw any conclusions.

 

Esparza TJ, Martin NP, Anderson GP, Goldman ER, Brody DL. High affinity nanobodies block SARS-CoV-2 spike receptor binding domain interaction with human angiotensin converting enzyme. Sci Rep. 2020 Dec 22;10(1):22370. PubMed: https://pubmed.gov/33353972. Full-text: https://doi.org/10.1038/s41598-020-79036-0

Nanobodies are 12–15 kDa single-domain antibody fragments that can be delivered by inhalation and are amenable to relatively inexpensive large scale production. Here, David Brody, Thomas Esparza and colleagues describe the nanobody candidate NIH-CoVnb-112 which binds to the SARS-CoV-2 spike protein RBD and blocks spike protein interaction with the ACE2 receptor. They are optimistic about the possibility that low-cost, stable, and safe nanobody-based therapeutics will be developed for inhaled use in the home and outside of formal healthcare environments.

 

Severe COVID

Jiang Y, Abudurexiti S, An MM, et al. Risk factors associated with 28-day all-cause mortality in older severe COVID-19 patients in Wuhan, China: a retrospective observational study. Sci Rep 10, 22369 (2020). https://doi.org/10.1038/s41598-020-79508-3

Studies about risk factors for increased COVID-19 mortality abound. In this retrospective study from Wuhan including 281 older patients with severe COVID-19 categorized into two age groups (60–79 years and ≥ 80 years), LDH had the highest predictive value for 28-day all-cause mortality.

 

Adieu

 

 


Find earlier Top 10 papers at https://covidreference.com/archive.


By Christian Hoffmann &
Bernd S. Kamps

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