COVID-19 Literature Situation Report May 19, 2020

• Patterson et al. evaluated a clinical triaging tool with four categories based on likelihood of having COVID-19 and risk of having a poor health outcome. Individuals with lowest likelihood of having COVID-19 and highest risk of having a poor outcome were prioritized for single-occupancy rooms while the others groups were “cohorted” by putting them in reduced occupancy multi-bedded bays on wards designated for suspected COVID-19 patients. Among 93 patients suspected of having COVID-19, 79 (85%) received a COVID-19 diagnosis at some point during admission. Of the 14 without COVID-19, 10 had been placed in the low-likelihood/high-risk category and were admitted to single-occupancy rooms. 28 (30%) of the suspected COVID-19 patients were evaluated to be low risk and thus eligible for cohorting. No symptomatic hospital acquired infections were detected in the cohorted patients.

Patterson et al. (May18,2020). A Novel Cohorting and Isolation Strategy for Suspected COVID-19 Cases during a Pandemic. Pre-print downloaded May 19 from https://doi.org/10.1101/2020.05.14.20091843

• Infectious SARS-CoV-2 virus was isolated from feces of a patient in China who died of COVID-19 disease, suggesting there could be potential for fecal-oral or fecal-respiratory transmission.

Xiao et al. (May18, 2020). Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19. Emerging Infectious Diseases. https://doi.org/10.3201/eid2608.200681

• Jiang et al. investigated environmental contamination in quarantine hotel rooms after being occupied by 2 pre-symptomatic SARS-CoV-2 positive patients. SARS-CoV-2 RNA was detected on 36% (8/22) of tested surfaces, as well as on the pillow cover, sheets, and duvet cover.

Jiang et al. (May18, 2020). Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms. Emerging Infectious Diseases. https://doi.org/10.3201/eid2609.201435

• Gerard et al. investigated the cardiac safety of hydroxychloroquine, azithromycin, lopinavir-ritonavir and chloroquine for “off-label” use among COVID-19 patients. Over a one month period, 120 cardiac adverse drug reactions among COVID-19 patients were reported to the Nice Regional Center of Pharmacovigilance in France. 86% of these adverse events were associated with hydroxychloroquine, alone or in combination with azithromycin. The authors estimated the incidence of cardiac adverse drug reactions to be 0.77% to 1.54% of COVID-19 patients. These findings are suggestive of an elevated risk of cardiac adverse events associated with “off-label” treatments among COVID-19 patients.

Gerard et al. (May7, 2020). “Off-Label” Use of Hydroxychloroquine, Azithromycin, Lopinavir-Ritonavir and Chloroquine in COVID-19: A Survey of Cardiac Adverse Drug Reactions by the French Network of Pharmacovigilance Centers. Therapie. https://doi.org/10.1016/j.therap.2020.05.002

• The authors describe clinical outcomes for the first tocilizumab-treated cohort of 11 critically-ill patients with COVID-19 in the United States. Patients experienced mixed outcomes, highlighting the need for randomized trial data.
• Although C-reactive protein levels decreased in all patients following treatment (median211.6 mg/L pre-treatment vs. 19.7 mg/L at 5 days post-treatment), patients had higher IL-6 concentrations after tocilizumab treatment and no clinical improvement in fever or oxygen requirements. Among the 11 patients, 3 died, 6 remained in the intensive care unit, and 2 were discharged.

Rimland et al. (May19,2020). Clinical Characteristics and Early Outcomes in Patients with COVID-19 Treated with Tocilizumab at a United States Academic Center. Pre-print downloaded May 19 from https://doi.org/10.1101/2020.05.13.20100404

• Current confirmed COVID-19 case counts in the US underestimate the total burden of the SARS-CoV-2 due to incomplete testing, driven by limited test availability, which is restricted primarily to individuals with moderate to severe symptoms. Imperfect diagnostic accuracy of the tests also contributes to an undercount of cases.
• Wu et al. estimated that there were 6,275,072 cumulative SARS-CoV-2 infections in the US, compared to 721,245 confirmed cases (1.9% vs. 0.2% of the population) as of April 18, 2020. The authors estimated that approximately 86% of this difference was due to incomplete testing, while 14% was due to imperfect test accuracy.

Wu et al. (May 18,2020). Substantial Underestimation of SARS-CoV-2 Infection in the United States Due to Incomplete Testing and Imperfect Test Accuracy. Pre-print downloaded May 19 from https://doi.org/10.1101/2020.05.12.20091744

• Pinto et al. describe an antibody(S309) that neutralizes SARS-CoV-2. This antibody was identified from memory B cells of a person infected with SARS-CoV in 2003. The S309 antibody functions by engaging the SARS-CoV-2 spike glycoprotein receptor-binding domain, the region that facilitates the SARS-CoV-2 virus’ entry into host cells.
• These findings can be used to facilitate development of S309-and S309-containing antibody therapies for prophylactic use in individuals at high risk of exposure or as a post-exposure therapy to limit or treat severe disease.

Pinto et al. (May18, 2020). Cross-Neutralization of SARS-CoV-2 by a Human Monoclonal SARS-CoV Antibody. Nature. https://doi.org/10.1038/s41586-020-2349-y

• A retrospective analysis of children in France and Switzerland suggests that children may experience acute heart failure and multisystem inflammatory syndrome following SARS-CoV-2 infection. Among 35 children admitted to pediatric intensive care for cardiogenic shock, left ventricular dysfunction, or a severe inflammatory state, 88% (31/35) of patients tested positive for SARS-CoV-2 infection.

Belhadjer et al. (May17,2020). Acute Heart Failure in Multisystem Inflammatory Syndrome in Children (MIS-C) in the Context of Global SARS-CoV-2 Pandemic. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.120.048360

• Selva et al. investigated the cross-reactivity of SARS-CoV-2 and other circulating human coronavirus antibody responses in healthy children (n=89), adults (n=98), elderly (n=57), and COVID-19 patients (n=19). Their results suggest that less-experienced humoral immunity that is observed in children, associated with higher IgM, may have the potential to induce more potent antibodies upon SARS-CoV-2 infection, potentially making a future vaccine more effective among children.

Selva et al. (May 18,2020). Distinct Systems Serology Features in Children Elderly and COVID Patients. Pre-print downloaded May 19 from https://doi.org/10.1101/2020.05.11.20098459

• Bicher et al. developed an agent-base model of SARS-CoV-2 transmission in Austria that incorporates information about the disease course, contact networks(households, workplaces, schools), and infection control policies (lock down, contact tracing). The authors found that individual contact tracing (compared to household-level or workplace-level contact tracing) was the most effective policy, and could result in an81% reduction in incident cases while quarantining only 28% of the population.

Bicher et al. (May19,2020). Agent-Based Simulation for Evaluation of Contact-Tracing Policies Against the Spread of SARS-CoV-2. Pre-print downloaded May 19 from https://doi.org/10.1101/2020.05.12.20098970

• The author estimates that the number of daily confirmed COVID-19 cases in King County will decrease by 50% every 24.5 days (95% CI: 21.2 -28.8). Using this empirical model, the predicted number of daily incidentCOVID-19 cases in King County will be40 cases by May 24,and 20 cases by June 18, 2020.

Roach. (May18,2020). Empirical Model of Spring 2020 Decrease in Daily Confirmed COVID-19 Cases in King County Washington. Pre-print downloaded May 19 from https://doi.org/10.1101/2020.05.11.20098798