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July 27 | Daily COVID-19 LST Report

Epidemiology

· Authors at Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan, China conducted a retrospective study of 4,254 cases across 6 types of nucleic acid collection sites and found that the highest proportion SARS-CoV-2 positive individuals at hospital wards (24.71%, n=84), close COVID-19 contact sites had the lowest (0.17%, n=1), and the most afflicted age group was middle-aged to elderly, suggesting a need for continued development in prevention education and safety protocols.

· Researchers modeled the transmission of COVID-19 across Europe from Google and Vodafone data and found a greater drop in local COVID-19 cases in synchronous simulations (each country following the same intervention) compared to unsynchronized ones (elimination rate 5%). While the researchers acknowledge a population bias in the data, they recommend that countries coordinate lockdown efforts to further improve transmission rates.

Understanding the Pathology

· A literature review examining the neuroinvasive potential of SARS-CoV-2 showed potential mechanisms of central nervous system (CNS) infection include blood-brain barrier (BBB) disruption and infection of peripheral nerves leading to trafficking of virions into the CNS, leading authors to believe a government regulated registry to routinely track COVID-19 patients with neurological manifestations may be critical to determine long-term health consequences, and note the possibility of neurodegenerative disorders as seen with other neurotropic RNA viruses.

Transmission & Prevention

· Physicians at Massachusetts General Hospital, Boston, review a recent study by Haver et al. (2020) regarding serosurveillance efforts to measure incidence of COVID-19 and suggest that the minimal herd immunity threshold in the United States is unlikely to be met as uncontrolled cases are increasing every day, in addition to evidence suggesting that acquired immunity may be temporary and short-lived. They propose implementation of active surveillance strategies including mass COVID-19 testing to better drive public health initiatives to contain the pandemic.

Management

· A retrospective cohort study of 398 hospitalized COVID-19 patients with cancer (n=45) and without cancer (n=353) at Beth Israel Deaconess Medical Center, investigated the incidences of thrombotic events at day 28 of hospitalization, and though acknowledging the study’s limitation in power, reported no significant differences between active cancer cohort, 14.2% (95% CI, 4.7%-28.7%), and non-cancer cohort, 18.2% (95% CI, 10.2%-27.9%). The researchers believe the overall elevated thrombo-inflammatory state of COVID-19 outcompetes a more moderate hypercoagulable state of cancer.

Adjusting Practice During COVID-19

· A review from authors in India of articles making recommendations on the management of solid tumors, hematologic cancers, and radiation/chemotherapy treatment during the pandemic found highly variable recommendations revealing the importance of examining new literature with scrutiny and also highlighting the need for sharing information to collect high quality and coherent data on COVID-19.

· A population-based cohort study using United Kingdom Biobank data of patients with mental illness, rates of COVID-19 testing, and diagnoses in individuals with and without psychiatric disorders found that patients with psychiatric illnesses were more frequently tested and had lower chances of testing positive than those without - possibly due to higher anxiety about contracting COVID-19, higher frequency of comorbid conditions or somatic symptoms, and increased social isolation.