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September 9 | Daily COVID-19 LST Report

Epidemiology

· Public health experts affiliated with Indiana University estimated the infection fatality ratios (IFR) of SARS-CoV2 based on antibody tests in a random sample of residents aged 12+ in Indiana. The average age of decedents was 76.9 (SD 13.1). 1099 COVID-19 deaths were recorded and the average IFR was 0.26%, but stratified IFR varied by age: >60yo IFR 1.71%, <40yo IFR 0.01%; and by race: whites IFR 0.18% and non-whites IFR 0.59%. These results from the SARS-CoV-2 population prevalence data suggest that risk of death increases with age and varies by race.


· A retrospective single center study (Hospital of the University of Paris, France) of 100 adult patients with confirmed SARS-CoV-2 admitted to the ICU, 81/100 of whom had mortality-associated varying severity of acute kidney injury (AKI), found no statistically significant association between complement activation/inflammatory markers (C3, IL-6, ferritin) and AKI as defined by urinary output and the Kidney Disease Improving Global Outcomes (KDIGO) criteria after adjusting for confounders. They also reported 80% incidence of AKI during the first 7 days in ICU and found 90% of patients with AKI required mechanical ventilation. Due to its high incidence, the authors suggest AKI is an important co-morbidity to monitor and investigate in critically-ill COVID-19 patients.

Understanding the Pathology

· Cardiologists at Johns Hopkins University School of Medicine and Harvard Medical School discuss how direct and indirect SARS-CoV-2 triggered endothelial exocytosis could be responsible for widespread thrombosis and hyper-inflammation seen in patients with severe COVID-19, proposing that endothelial exocytosis releases secretory granules containing von Willebrand factor (VWF) and P-selectin thus causing platelet aggregation and leukocyte adherence, resulting in microvascular obstruction and release of pro-inflammatory cytokines. Authors suggest better understanding the role of endothelial exocytosis by SARS-CoV-2 and underlying mechanisms could provide potential therapeutic targets for novel drug development and drug repurposing.

· This in vitro study by researchers from several medical academic centers in Germany found that SARS-CoV-2 targeted cortical plate neurons of human central nervous system tissue models (brain organoids derived from pluripotent stem cells which are comparable to complex neural epithelium), which caused changes in Tau distribution, hyperphosphorylation of Tau, and neuronal death; however, compared to respiratory and renal epithelium the virus did not appear to have a high level of replication in neuronal cells. Authors present these findings to offer insight on SARS-CoV-2 neuronal targeting mechanisms and suggest organoids may serve well as screening tools for anti-SARS-CoV-2 agents.

Transmission & Prevention

· A case series conducted by infectious disease experts at Luigi Sacco University Hospital in Milan, Italy found that among 7 patients persistently carrying SARS-CoV-2, treatment with an Atomix Wave kit to wash their nasopharynx with 3% H2O2 solution for 14 days resulted in negative nasopharyngeal SARS-CoV-2 swabs for at least the first 48 hours (one patient tested weakly positive at 72 hours, and four tested weakly positive at day 7) and up to the full 14 days (2 patients). This study indicates that H2O2 washes could be used to disrupt viral shedding, and further studies with more intensive nasopharyngeal washing are required to determine if better viral shedding suppression can be achieved to prevent transmission from long term SARS-CoV-2 carriers.


· A retrospective study in Incheon, Korea of 19,296 people self-quarantined for a mandatory 14-days (due to close contact with confirmed COVID-19 or return from overseas travel) helped identify 56 (0.3%) cases of COVID-19, 18 of which were asymptomatic, through self-reported symptoms or mandatory pre-release RT-PCR testing. These findings suggest that mandatory diagnostics prior to release from quarantine may assist in identifying asymptomatic COVID-19 cases to help control potential spread of the virus.


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