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February 04 | Daily COVID-19 LST Report

Epidemiology

· A multidisciplinary team of researchers from various hospitals use a stem cell donor registry in Dresden, Germany to conduct a cross-sectional study among 6257 COVID-positive patients found blood group A was a risk factor for contracting SARS-CoV-2 compared to blood group O. The data also demonstrated blood group B was associated with higher risk of severe respiratory tract infection and respiratory hospitalizations compared to blood group O. These findings provide insight into the association between genetic variance in ABO blood type genes and risk for COVID-19 infection and associated severe disease complications.



· Researchers from Stanford University utilize data-driven modeling from data reported by 30 colleges during Fall of 2020 to assess COVID-19 transmission associated with reopening campuses. Results demonstrated a spike in infections during the first 2 weeks of in-person or hybrid instruction in nearly half of the institutions (14/30), with peak seven-day instances well above 1,000 per 100,000. They also found that while all colleges were able to quickly reduce transmission on campus, many failed to control the spread of the virus into the surrounding communities. These results suggest that the first 2 weeks of college reopenings are an especially high risk time period, with potential to cause superspreader events. The authors call for better control of viral spreading when reopening campuses, implementing limitation of the number of students during the initial weeks, regulation of testing, stressing the importance of isolation and quarantine, and continued rapid response regarding outbreaks.

· The Geneva Pediatric COVID Group characterized viral co-infections in 51 children infected with SARS-CoV-2 between March 1 and April 30, 2020, 30 of whom lived in a household with an infected adult. Four children from a household cluster (4/30 [13.3%]) were co-infected with picornaviruses (n=3), hMPV (n=1), and/or HCoV-NL63 (n=1) while no adult household contacts (0/41) had a co-infection. The frequency of circulating respiratory viruses in all children was lower than in the same period in 2019 (73.0% [27/37] vs 11.7 [6/51] in 2020; p<0.001). Authors suggest COVID-19 lockdown measures have reduced circulation of other respiratory viruses, but children remain more vulnerable to respiratory viruses than the adults with the same community-level exposure.

Understanding the Pathology

· The Clinical Research in Intensive Care, Sepsis Trial Group from Strasbourg, France evaluated the viral loads and outcomes of 287 patients hospitalized with SARS-CoV-2 between March 3 and April 5, 2020. They found a median viral load of 4.76 log 10 copies/reaction on the initial upper respiratory swab at admission, with no difference between survivors and non-survivors (p=0.332). Respiratory viral load measurement was not predictive of in-hospital mortality (AOR=1.05, 95%CI: 0.85-1.31 [p=0.637]) or disease severity (AOR=0.88, 95%CI: 0.73-1.06 [p=0.167]). Authors conclude there is no correlation between viral load and disease severity, and suggest individual co-morbidities and immune responses to the virus contribute more to outcomes.

Transmission & Prevention

· Statisticians from the National Chiao Tung University in Taiwan used the Johns Hopkins Coronavirus Resource Center data dashboard to evaluate the relationship between COVID-19 prevalence and mortality from COVID-19 in 36 countries. They found a positive correlation between the number of cases and COVID-19 mortality (Spearman R: 0.8304, P<.001), with a mortality increase of 1.29268% per every 1 in 1000 increase in prevalence, though there was significant heterogeneity between countries. The authors suggest a mortality-prevalence ratio can help detect undocumented infections, and emphasize the importance of infection prevention practices to minimize mortality from COVID-19.

· A virologist from the Laboratory of Retrovirology at The Rockefeller University in New York argues against withholding second doses of SARS-CoV-2 vaccines. He suggests there is not enough evidence that single dose vaccination provides long-term immunity, citing data showing 50-fold higher neutralizing antibody titers after the second dose of mRNA vaccination. The author also raises concerns that insufficient immunity after a single vaccine dose could drive antigenic drift leading to antibody resistant variants.

· Scientists associated with BioNTech, Pfizer and TRON gGmBH assessed the ability of the BioNTech-Pfizer mRNA vaccine BNT162b2 to induce a neutralizing response against the new B.1.1.7 lineage of the SARS-CoV-2 virus. They found antibodies from individuals previously vaccinated with BNT162b2 (n=40) neutralized the B.1.1.7 strain with a slightly reduced response compared to their action against the native Wuhan strain based on the 50% neutralization geometric mean titer (GMT). The authors suggest BNT162b2 appears to offer sustained neutralization of new variants of the SARS-CoV-2 virus.

· An interdisciplinary group of researchers from the USA, Canada, and Brazil developed a model of SARS-CoV-2 transmission in the United States assuming 40% vaccination coverage in 284 days. With healthcare workers and high-risk individuals prioritized and no vaccine given to those under 18, vaccination reduced the overall attack rate (9.0% to 4.6%) and adverse outcomes (non-ICU hospitalizations, ICU hospitalizations, and mortality decreased by 63.5%, 65.6%, and 69.3%, respectively). The authors suggest even low rates of vaccination could reduce the burden of COVID-19 in the United Sates if non-pharmaceutical public health interventions such as masking and handwashing continue.

Management

· A prospective cohort study conducted by cardiologists in Bologna, Italy found a significant correlation between major adverse events (MAEs) and abnormal EKG findings in patients hospitalized with COVID-19. EKG abnormalities were associated with increased MAEs when present both at hospital admission (p=0.04) and on hospital day #7 (p=0.001), with MAEs defined as mortality, ICU admission, invasive mechanical ventilation, and renal replacement therapy. The results of this study highlight the potential role of EKGs in triaging and prognosticating patients with COVID-19.

R&D: Diagnosis & Treatments

· Microbiologists from Columbia, Venezuela, and the United States assessed whether the Berlin-Charité protocol for RT-PCR assays could detect the new SARS-CoV-2 B.1.1.7 lineage from the United Kingdom. Using 3,296 full genome sequences, they found the primer and probes detected 98% of the RdRp, N, and E genes targeted in the protocol, though several sequences were missed. The authors suggest that while the Berlin-Charité protocol can detect most SARS-CoV-2 B.1.1.7 variants, future variants may evade detection and incorporating different regions of the viral genome into existing testing could build redundancies that increase the likelihood of their detection.

· A scoping review conducted by medical institutions and laboratories in New Delhi, India in June 2020 identified 17 articles finding saliva-based molecular diagnostics as a simpler, time-conscious, and less technical alternative to nasopharyngeal swab collection for detection of SARS-CoV-2 based on parameters of gene targets, viral load, sensitivity, and point-of-care testing for initial screening in community and hospital-based settings. Salivary testing also allows for simpler self-collection, which decreases the amount of medical staff and personal protective equipment needed for screening settings. This article suggests more robust studies be performed to further assess salivary testing in asymptomatic cases, oral symptoms of infection, and accounting for age, sex, and other comorbidities.

· A review article from medical institutions in Manipal, India discusses that saliva, tears, and breath samples may offer more readily available, reliable, and faster techniques for rapid detection of SARS-CoV-2. Their findings support use of these methods and indicate they may be more suitable for large-scale screening compared to the current gold standard of nasopharyngeal testing.

· A literature review conducted at Carlsbad, California during 2021 by Active Motif Inc. found epigenetic pathways may serve as invaluable targets for future therapeutic targets designed to reduce the spread and pathogenesis of COVID-19 infections.


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