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February 12 | Daily COVID-19 LST Report

Epidemiology

· A phylogenetic analysis of SARS-CoV-2 genomes during the early period of the Boston-area epidemic analyzed the viral strains responsible for two superspreader events. Analysis identified that they occurred at a skilled nursing facility (SNF) and an international business conference. The outbreak at the SNF was found to have higher mortality but limited subsequent community spread, while the conference lead to significant community transmission. This led to subsequent outbreaks, especially in homeless and higher-risk populations throughout Boston and beyond. Genetic analysis of both strains revealed significant variation, implicating mutation as a possible explanation for increased transmissibility. The authors highlight the utility of genomic epidemiology in "understanding the link between individual clusters and wider community spread.”




Management

· This retrospective cohort study from the University of Missouri investigates differences in risk factors and outcomes in COVID-19 patients with acute ischemic stroke using de-identified patient data and ICD-10 codes. Results showed that while only 1.3% of COVID-19 patients developed acute ischemic stroke, the presence of stroke and COVID-19 was associated with discharge to a location other than home (relative risk, 2.1, P<0.0001). The authors conclude that the incidence of ischemic stroke in patients with COVID-19 is low, and the presence of other risk factors such as hypertension, diabetes, atrial fibrillation and heart failure are better indictors for stroke rather than COVID-19 alone.

· A prospective cohort study conducted at multiple institutions in Spain analyzed 2,225 pregnant persons, 317 of which had evidence of SARS-CoV-2 infection, and found no difference in pregnancy complications but a significant increase in intrapartum fetal distress in SARS-CoV-2-positive women. Rates of preterm delivery, intrapartum fetal distress, and proportion of severe small-for-gestational age newborns were higher in those with symptomatic compared to asymptomatic COVID-19. Presence of SARS-CoV-2 IgG antibodies in umbilical cord blood were found in 61/143 fetuses with infected mothers but no IgM or IgA, signifying uncommon vertical transmission of active infection with IgM antibodies. These findings signify similar overall rates of pregnancy complications in both infected women and non-infected women but an increased prevalence of significant complications among symptomatic women, emphasizing clinical surveillance of COVID-19 in pregnancy/delivery especially with symptomatic patients.

R&D: Diagnosis & Treatments

This health journalism piece discusses a new technology from the University of California, San Francisco, utilizing clustered regularly interspaced short palindromic repeats (CRISPR) gene editing technology to detect SARS-CoV-2 RNA viral particles from patient nasal swabs. The test, which quantifies viral load based off time to detection, is not available for mass use by the public as it currently requires RNA extraction and medical-grade equipment. However the research team, including Jennifer Doudna, PhD, who holds a Nobel Prize for developing CRISPR-based gene editing, is hoping to make this technology available to the public in the future, potentially adding another testing modality.


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