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February 16 | Daily COVID-19 LST Report

Climate

· Infectious Disease Society of America (IDSA) made 4 strong recommendations for preventing COVID-19 infection in health care personnel. A pulmonologist and interventional cardiologist from the Cleveland Clinic and Emory University critique recently published IDSA guidelines for preventing COVID-19 infection in healthcare workers. They argue the recommendation to use either respirators or surgical masks conflicts with Centers for Disease Control guidance to use respirators, and believe the guidelines are missing recommendations on proper gloving strategies, which are crucial to avoid self-contamination. The authors suggest the IDSA must clarify these points to alleviate confusion for healthcare workers who are inundated with recommendations from multiple organizations.

Transmission & Prevention

· A retrospective observational study conducted by physicians at the Military Instruction Hospital during April 2020 found that among 1,739 crew members aboard a French aircraft carrier in April 2020, 64% tested positive for COVID-19 via real-time polymerase chain reaction (RT-PCR), with there being significant variations in symptomatic presentation and antibody development. This article suggests viral circulation in local outbreaks requires further testing and analysis.

· Can COVID-19 be detected by dogs? Physicians from the Lebanese American University in Beirut, Lebanon review current literature regarding the potential role of dogs as a more mobile and cost-efficient community detection system for COVID-19 screening. They review dogs' olfactory capabilities, evidence that diseases create distinct odor profiles and a recent study showing dogs identified COVID-19 specific sweat odor with a positive detection rate of 83-100%. Authors suggest that while these results are promising, real-life operational settings may diminish dogs' performance due to confounding factors and sensory associations.

· Mask wearing continues to show improvement in community spread of SARS-CoV-2. In this review article, physicians from the Centers for Disease Control and Prevention (CDC), detail the current known benefits of community mask wearing as an effective non-pharmacological intervention during the COVID-19 pandemic, citing several recent studies . They suggest mask wearing is beneficial for both infected and uninfected people, and when combined with additional mitigation measures, compliance will protect the greater community especially in the setting of emerging SARS-CoV-2 variants.

Management

· Remdesivir for adults with COVID-19 may decrease time on mechanical ventilation. A multi-specialty team from Minnesota and Oregon conducted a systematic review of 5 randomized-controlled trials evaluating remdesivir as a treatment for adults with COVID-19. They found that a 10-day course of remdesivir may reduce the proportion of patients receiving mechanical ventilation (RR: 0.71 [CI, 0.56 to 0.90]; 3 RCTs), but was associated with a statistically insignificant decrease in mortality (RR: 0.93 [95% CI, 0.82 to 1.06]; 4 RCTs) compared to control groups. Authors suggest that remdesivir use probably confers little to no mortality benefit, but may improve recovery by reducing time on mechanical ventilation.

· Allergy testing can help maintain safety with SARS-CoV-2 vaccines. In this letter to the editor, Italian researchers at the University of Turin and Mauriziano Hospital discuss SARS-CoV-2 vaccine safety, highlighting data showing a similar rate of anaphylaxis with the Pfizer-BioNTech vaccine (1 in 100,000) compared to quadrivalent human papilloma virus (HPV) vaccine (Gardasil) (1 in 190,000). They note that the excipient polysorbate 80 was identified as the culprit in one case of anaphylaxis to the Gardasil vaccine, and since this molecule and other polyethylene glycol (PEG) derivatives are also utilized in current SARS-CoV-2 vaccines, they recommend potential use of skin allergy testing for at-risk populations to ensure safe vaccine administration.

· American Society of Hematology (ASH) 2021 released guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. The ASH conditionally recommended both critically and acutely ill COVID-19 patients without suspected or diagnosed venous thromboembolism (VTE) receive prophylactic rather than intermediate or therapeutic intensity anticoagulation. The panel recognized potential benefit in these therapy recommendations, but noted evidence is low certainty, and therefore encourage clinicians to exercise their own clinical judgment.

Adjusting Practice During COVID-19

· Methodological quality has been lower in some COVID-19 clinical research. As part of a systemic review of COVID-19 research quality, a team of molecular biologists, physicians, and statisticians from the University of Ottawa compared the quality of 686 research articles published during the COVID-19 pandemic to 593 historical controls matched for journal and study design published pre-pandemic. COVID-19 publications had a shorter time to acceptance (13.0 vs. 110 days, p<0.0001) and lower methodological quality scores compared to historical controls. Authors suggest the push for rapid research during the pandemic may result in lower quality research, and highlight the need for higher quality evidence.

R&D: Diagnosis & Treatments

· SARS-CoV-2 lethal infected with K18-hACE2 transgenic mice may offer post-exposure protection. Researchers from the Israel Institute for Biological Research in Ness-Ziona, Israel analyzed the efficacy of monoclonal MD65 antibodies in K18-hACE2 transgenic mice with SARS-CoV-2 infection, finding a greater survival rate compared to mice without MD65 antibodies, in the setting of both prophylactic and post-exposure administration, as well as decreased viral load in lung tissue. 100% of mice treated with MD65 antibodies within 3 days of exposure survived infection, while only 20% without antibodies survived. The authors suggest these results demonstrate promising outcomes that may translate to human prophylaxis and treatment of COVID-19.

· SARS-CoV-2 infection may be treated and prevented by EIDD-2801. Translational scientists, molecular biologists, and drug development experts from the University of North Carolina, Chapel Hill created human lung-only mice (LoM) models to evaluate the replication of the three human coronaviruses (SARS-CoV, MERS-CoV, and SARS-CoV-2) and test a newly emerging antiviral treatment (EIDD-2801). They found SARS-CoV-2 successfully replicated in LoM models (Figure 1) and that EIDD-2801 reduced the number of infectious particles by 4.4 logs within as quickly as two days of treatment. Authors suggest their results indicate the potential strength of a new therapy (EIDD-280) and further supports the use of LoM models as a means for viral research.

· Remdesivir Metabolite GS-441524 was shown to inhibit SARS-CoV-2 infection in mouse models. Drug discovery and synthesis experts from Shenzhen, China compared the anti-SARS-CoV-2 activity of remdesivir and its metabolite GS-441524 in an in-vitro and in-vivo laboratory study. They found GS-441524 more effectively inhibited SARS-CoV-2 replication in Vero E6 than remdesivir (IC50 0.70 vs 1.35μM). In vivo, GS-441524 significantly decreased viral titers by qRT-PCR in both AAV-hACE2 and MHV infected mouse models. Authors suggest GS-441524, which has a longer half-life than remdesivir, is a valuable potential therapeutic option for COVID-19.

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