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August 18 | Daily COVID-19 LST Report

Climate

· A journalist reports on efforts to include minority patients in COVID-19 vaccine trials given the pandemic's disproportionate impact on Black and Hispanic communities. The author suggests barriers to inclusive vaccine trials include failure to effectively connect with Black and Hispanic communities for recruitment, trepidation due to abusive research practices targeting these groups, fear of deportation, and lack of guidelines for measuring sufficient diversity in enrollment.

Epidemiology

· A multidisciplinary team from Johns Hopkins University conducted an observational study of a SARS-CoV-2 outbreak at a skilled nursing facility in Maryland and found residents undergoing dialysis were significantly more likely to contract COVID-19 compared to residents not receiving dialysis (47% SARS-CoV-2 positive by RT-PCR vs. 16%, p<0.001). While there were also differences by floor of residence (41% of nursing home patients on the second floor vs 4.5% on the first floor, p<0.001), authors suggest that dialysis may be a significant risk factor for COVID-19 due to associated behaviors (mask wearing, exposure to other patients and staff) and more serious underlying medical conditions and advocate for improved communication between dialysis centers and nursing homes as well as improved safety measures to promote mask wearing and physical distancing.

Understanding the Pathology

· Clinicians from Mount Sinai Hospital in New York present a case report of a COVID-19 positive 25-year-old multigravida patient with known red blood cell isoimmunization, undergoing percutaneous umbilical blood sampling (PUBS) and intrauterine transfusions due to evidence of fetal anemia. There was no evidence of transfer of passive immunity in the fetus either in utero or immediately after birth (via 2 intrauterine and neonatal cord blood samples) despite persistent maternal antibodies, implicating the need for further research in understanding of COVID-19 passive immunity to aid in vaccine development and fetal protection. · Researchers in Beijing, China conducted a challenge-rechallenge study of SARS-CoV-2 infection in rhesus macaques with a 28 day interval period and found that rechallenged monkeys had a transient fever but no other clinical symptoms, negative viral load, and significantly increased serum IgG compared to initial challenge. Such findings suggest that rhesus macaques develop protection after primary exposure to SARS-CoV-2; however the exact protective mechanism and length of protection remain unclear, warranting further study with a longer interval period. · An interdisciplinary group of researchers across the United States conducted a rhesus macaque infection model by inoculating 9 rhesus macaques with SARS-CoV-2 to determine if animal models could form immunity against re-infection. After inoculation and viral load assessments, all 9 macaques were re-infected on day 35 to assess the immunity response and the researchers found that:

· Bronchoalveolar lavage viral loads were >5.1 log10 lower during the re-infection (re-challenge) assessment compared to initial infection (p<0.001)

· Re-challenge group showed increased virus-specific ELISA titers (P=0.0034)

· No recoverable virus was found in bronchoalveolar lavage and nasal swab plaque assay in the re-challenge group (P = 0.009) This study supports that animal models can mount an immunity to re-infection with SARS-CoV-2 and could be promising for its immunological prevention.

· A group of researchers from the United States and the Netherlands conducted a rhesus macaque infection model by developing six prototype DNA vaccines expressing different SARS-CoV-2 spike (S) protein variants and inoculating rhesus macaques (n=35). The authors found vaccine-elicited neutralizing antibodies and observed significantly low levels of RNA in the bronchoalveolar lavage and nasal mucosa samples from the vaccine groups compared to the control. This study shows a substantial viral load reduction using vaccines with S immunogens, suggesting for further studies with animal models and SARS-CoV-2 vaccine development for the prevention of SARS-CoV-2.

Transmission & Prevention

· A cross sectional study of emergency department patients (n=2022) conducted at Merano General Hospital in Italy found implementing a pre-triage protocol and dividing the emergency department (ED) into “clean” (patients presumed not to be infected; n=1840) and “infected” (patients with suspected infection; n=182) areas resulted in proper triage of 91.1% of COVID-19 positive patients and no healthcare worker infections, suggesting restructuring emergency departments to include a pre-triage system may effectively optimize resources and limit COVID-19 transmission in the ED while protecting healthcare workers.

· A review of methanol toxicity reports and World Health Organization (WHO) hand sanitizer formulation standards were summarized by authors from Australia to warn against the potential dangers of distilleries producing alcohol-based hand rubs (ABHR) that use methylated spirits (denatured alcohol), which can contain methanol as a substitute for ethanol or isopropyl alcohol. These findings suggest that the general public should not be producing homemade ABHRs and that businesses such as pharmacies and distilleries should follow WHO guidelines in ABHR formulation to avoid potential methanol toxicity via inhalation/ingestion/transdermal absorption.

R&D: Diagnosis & Treatments

· Greek radiologists discuss the use of lung ultrasound (LUS) during the COVID-19 pandemic by proposing an 18-point lateral decubitus LUS with advantages including extensive lung surface inspection, elimination of gravity-related B-line changes (number and morphology), rapid single-operator performance, and minimized contamination risk by reducing patient repositioning and contact. Authors recommend using LUS as a safe, quick, and noninvasive alternative to computed tomography within the emergency department or intensive care unit for assessing lung involvement in COVID-19 pneumonia patients.

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