COVID-19 Literature Situation Report Aug. 28, 2020

• A systematic review of stool testing for SARS-CoV-2 (95 studies) showed that 934/2149 (43%) patients tested positive by stool sample or by anal swab, with positive results up to 70 days after symptom onset. Fecal samples of 282/443 (64%) remained positive even after respiratory samples became negative, for a mean of 12.5 days, and viable SARS-CoV-2 was found in 6/17 (35%) patients in whom this was specifically investigated.

van Doorn et al. (Aug 27, 2020). Systematic Review with Meta-Analysis: SARS-CoV-2 Stool Testing and the Potential for Faecal-Oral Transmission. Alimentary Pharmacology & Therapeutics. https://pubmed.ncbi.nlm.nih.gov/32852082

• A prospective observational cohort study found that people with multiple sclerosis (MS) and those taking immunomodulatory disease-modifying therapies were not at elevated risk of COVID-19. Among people with MS, 237 of 3,910 (6%) participants reported self-diagnosed COVID-19, which was a similar risk to among their siblings without MS (OR: 1.2, 95%CI: 0.9-1.6). Participants taking disease-modifying therapies were less likely to have self-diagnosed COVID-19 (OR=0.64, 95% CI: 0.43-0.96).

Evangelou et al. (Aug 27, 2020). Self-Diagnosed COVID-19 in People with Multiple Sclerosis: A Community-Based Cohort of the UK MS Register. Journal of Neurology, Neurosurgery & Psychiatry. https://doi.org/10.1136/jnnp-2020-324449

• Catteau et al. conducted a retrospective analysis of in-hospital mortality using Belgian national COVID-19 hospital surveillance data (n=8,075) and found that, after adjusting for clinical and demographic features, mortality was lower among patients who received low-dose hydroxychloroquine (2400 mg over 5 days) compared to supportive care alone (HR=0.7, 95%CI: 0.6-0.8).

Catteau et al. (Aug 24, 2020). Low-Dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients with COVID-19: A Nationwide Observational Study of 8075 Participants. International Journal of Antimicrobial Agents. https://doi.org/10.1016/j.ijantimicag.2020.106144

• A retrospective propensity-matched observational study (n=878) found that famotidine, a histamine-2 blocker used to treat acid reflux and ulcers, was associated with a decreased risk of in-hospital mortality (OR=0.4, 95% CI: 0.2-0.96) as well as combined outcome of death or intubation (OR=0.5, 95% CI: 0.2-0.96). While patients treated with famotidine were younger (63.5 +/- 15 vs 67.5 +/- 15.8), propensity score matching to adjust for age did not change the associations. Forty-eight of 83 (58%) patients in the famotidine group received corticosteroids versus 329/689 (48%) of patients in the non-famotidine group.

Mather et al. (Aug 26, 2020). Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19. American Journal of Gastroenterology. https://journals.lww.com/ajg/Documents/AJG-20-2074_R1.pdf

• In a quality improvement study of a radiation oncology department in New Jersey, 128 environmental swabs were obtained following WHO protocols over 6 days from May 1 to May 13 (peak daily rate for New Jersey), of which none were positive for SARS-CoV-2. The investigators suggest routine cleaning and disinfecting protocols appear to be adequate for limiting fomite transmission of SARS-CoV-2.

Jan et al. (Aug 27, 2020). Prevalence of Surface Contamination With SARS-CoV-2 in a Radiation Oncology Clinic. JAMA Oncology. https://doi.org/10.1001/jamaoncol.2020.3552

• A retrospective cohort study of 1,419 patients with COVID-19 who were seen in emergency departments and discharged found that 66 (5%) returned to a hospital within 72 hours and were admitted. Those age > 60 years were more likely to experience a return hospital admission compared to those age 18-39 (aOR=4.6). Hypoxia (aOR=2.9), presentation with fever (aOR=2.4), and abnormal chest radiography (aOR=2.4) were also associated with return hospital admission.

Kilaru et al. (Aug 27, 2020). Return Hospital Admissions Among 1419 Covid‐19 Patients Discharged from Five US Emergency Departments. Academic Emergency Medicine. https://doi.org/10.1111/acem.14117

• Han et al. report a case series of children (age <19 years; n=91) with SARS-CoV-2 across 20 hospitals and 2 isolation facilities across Korea (mid-February to March) and found that 22% of children were asymptomatic. Only 9% of symptomatic cases were diagnosed at the time of symptom onset, while among those with symptoms, 66% had unrecognized symptoms before diagnosis and 25% developed symptoms after diagnosis. SARS-CoV-2 RNA persisted in upper respiratory samples for a mean of 17.6 days among all children and 14.1 days among asymptomatic children. Among the symptomatic children, 65% had mild illness, 28% had moderate illness, and 3% had severe illness and received supplemental oxygen via nasal prongs. No children required mechanical ventilation.

Han et al. (Aug 28, 2020). Clinical Characteristics and Viral RNA Detection in Children with Coronavirus Disease 2019 in the Republic of Korea. JAMA Pediatrics. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2770150

• A prospective observational cohort study in the UK of children and young adults (n=651, median age=4.6, IQR 0.3-13.7) found that 52/456 (11%) participants met the WHO case definition for multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 (MIS-C). Children who met criteria for MIS-C were older than children who did not (median 10.7 years vs 1.6 years) and were more likely to be of non-white ethnicity (64% vs 42%). The most common symptom clusters among the whole cohort were a respiratory illness followed by a systemic mucocutaneous enteric illness cluster that included headache, muscle ache, sore throat, vomiting, abdominal pain, rash, swollen lymph nodes and conjunctivitis. In multivariable analysis, acute COVID-19 was associated with age <1 month (OR: 3.2, 95% CI 1.4-7.7), age 10-14 years (OR: 3.2, 95% CI: 1.6-7.0), and Black ethnicity (OR: 2.8, 1.4 to 5.6).

Swann et al. (Aug 27, 2020). Clinical Characteristics of Children and Young People Admitted to Hospital with Covid-19 in United Kingdom: Prospective Multicentre Observational Cohort Study. BMJ. https://doi.org/10.1136/bmj.m3249

• An online survey of a random sample of adults from the US and Canada who were not healthcare workers (HCWs) (n=3,551) found that over a quarter of respondents believed that restrictions should placed on HCWs, such as being isolated from their communities and families, and over a third of respondents avoided HCWs for fear of infection. Demographic factors were not associated with HCW stigmatization, while variables related to COVID-19 Stress Syndrome had a stronger association.

Taylor et al. (Aug 19, 2020). Fear and Avoidance of Healthcare Workers: An Important, under-Recognized Form of Stigmatization during the COVID-19 Pandemic. Journal of Anxiety Disorders. https://doi.org/10.1016/j.janxdis.2020.102289