COVID-19 Literature Situation Report Sept. 2, 2020

• A survey of Americans in ten states and eight metropolitan areas (n=25,269) found that knowing someone who had COVID-19 and/or died from it was strongly associated with taking protective health measures like washing hands, avoiding public places, and canceling social engagements.

Qeadan et al. (Aug 29, 2020). What Protective Health Measures Are Americans Taking in Response to COVID-19? Results from the COVID Impact Survey. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph17176295

• Six of eight children who had SARS-CoV-2 antibodies detected in leftover clinical samples had not been suspected of having COVID-19. Dingens et al. screened 1,775 leftover serum samples from children seeking medical care at Seattle Children’s Hospital during the early Seattle outbreak period and found one child was seropositive with SARS-CoV-2 in March and seven were seropositive in April, for a seroprevalence of 1% during this period among this population of children seeking care. Only two of the children with positive antibodies had tested positive for SARS-CoV-2 by RT-PCR. [EDITORIAL NOTE: A summary of a pre-print version of this manuscript appeared in the Lit Rep on May 28]

Dingens et al. (Sept 1, 2020). Serological Identification of SARS-CoV-2 Infections among Children Visiting a Hospital during the Initial Seattle Outbreak. Nature Communications. https://doi.org/10.1038/s41467-020-18178-1

• A meta-analysis of 7 randomized trials conducted in 12 countries and including 1,703 critically ill patients with COVID-19 found that administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality (OR=0.7, 95%CI 0.5-0.8). Serious adverse events occurred in 64/354 (18%) patients who were randomized to corticosteroids and 80 events occurred among 342 patient randomized to usual care or placebo in the six trials that reported serious adverse events.

The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. (Sept 2, 2020). Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19 A Meta-Analysis. JAMA. https://doi.org/10.1001/jama.2020.17023

• Between March 29 and May 13, 2020, 16 skilled nursing facilities (SNFs) in the Seattle area (1,583 employees and 1,208 residents) were tested for SARS-CoV-2 by PCR, of which 11 (69%) SNFs had one or more employees or residents positive. Overall prevalence of SARS-CoV-2 was 3% among employees and 9% among residents. Despite facility policies that employees with new respiratory symptoms should not come to work, 42 (3%) employees reported respiratory symptoms (22 with cough, 39 with sore throat, 7 with fever) during the on-site testing. Out of 13 who tested positive and had symptom information available, 9 (69%) were asymptomatic.

Weil et al. (Sept 1, 2020). Cross-Sectional Prevalence of SARS-CoV-2 Among Skilled Nursing Facility Employees and Residents Across Facilities in Seattle. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-020-06165-7

• A study among people with confirmed, locally transmitted SARS-CoV-2 in Singapore (n=164) reported that patients older than 70 years had significantly longer incubation periods for COVID-19 than those younger than 70 years (median 8 days vs. 5 days, p=0.04). Researchers concluded that elderly people may benefit from earlier and proactive testing, especially after exposure to a positive case.

Tan et al. (Sept 2, 2020). Does Incubation Period of COVID-19 Vary with Age? A Study of Epidemiologically Linked Cases in Singapore. Epidemiology and Infection. https://doi.org/10.1017/S0950268820001995

• Initial SARS-CoV-2 viral load in nasopharyngeal samples was significantly higher among hospitalized patients who required mechanical ventilation and/or subsequently died (n=21) compared to non-mechanically ventilated patients who survived (n=149). Initial SARS-CoV-2 viral load has negatively associated with the lowest level of blood oxygen saturation recorded during hospitalization, but was not associated with other clinical parameters in this study that took place March-July, 2020.

Shlomai et al. (Sept 1, 2020). Nasopharyngeal Viral Load Predicts Hypoxemia and Disease Outcome in Admitted COVID-19 Patients. Critical Care. https://doi.org/10.1186/s13054-020-03244-3

• Among 1,500 undergraduates at Arizona State University, COVID-19 has led to negative effects on students’ current and expected outcomes: 13% have delayed graduation, 40% have lost a job, internship, or job offer, and 29% expect to earn less at age 35. These effects have been highly heterogeneous and followed existing socioeconomic divides. Lower-income students were 55% more likely than their higher-income peers to have delayed graduation due to COVID-19.

Aucejo et al. (Aug 27, 2020). The Impact of COVID-19 on Student Experiences and Expectations: Evidence from a Survey. Journal of Public Economics. https://doi.org/10.1016/j.jpubeco.2020.104271

• Initial SARS-CoV-2 viral load in nasopharyngeal samples was significantly higher among hospitalized patients who required mechanical ventilation and/or subsequently died (n=21) compared to non-mechanically ventilated patients who survived (n=149). Initial SARS-CoV-2 viral load has negatively associated with the lowest level of blood oxygen saturation recorded during hospitalization, but was not associated with other clinical parameters in this study that took place March-July, 2020.

Shlomai et al. (Sept 1, 2020). Nasopharyngeal Viral Load Predicts Hypoxemia and Disease Outcome in Admitted COVID-19 Patients. Critical Care. https://doi.org/10.1186/s13054-020-03244-3

• [Preprint, not peer reviewed] A modeling study found that the observed peak in PCR-detected SARS-CoV-2 infections can follow the peak of true infection incidence due to prolonged shedding of SARS-CoV-2 by approximately ten days in a scenario with an R0 of 1.6 versus 5 days when R0 is 3. Half of those who tested positive by PCR prior to the observed epidemic peak were actually in the prolonged PCR positivity stage. Additionally, the observed seroprevalence substantially underestimated true prevalence of ever having infection, with the underestimation most pronounced around the time of epidemic peak.

Makhoul et al. (Sept 2, 2020). Analyzing Inherent Biases in SARS-CoV-2 PCR and Serological Epidemiologic Metrics. Preprint downloaded Sep 2 from https://doi.org/10.1101/2020.08.30.20184705

• [Preprint, not peer reviewed] A modeling study of various US college and university reopening plans (various fully open, hybrid, and fully virtual approaches) shows common reopening strategies could reduce student SARS-CoV-2 infections by 24%-26% and deaths by 36%-50%. Perfect testing and immediate quarantining of all students on arrival to campus at the start of term could further reduce infections by 58%-95% and deaths by 95%-100%. All scenarios were simulated assuming best/worst case ranges for disease prevalence among community residents and arriving students, precaution compliance, contact frequency, virus attack rates, and tracing and isolation effectiveness.

Benneyan et al. (Sept 2, 2020). Potential Community and Campus Covid-19 Outcomes Under University and College Reopening Scenarios. Preprint downloaded Sep 2 from https://doi.org/10.1101/2020.08.29.20184366

• [Preprint, not peer reviewed] A modeling study based on three counties in Washington state predicts that if 15% of the population participates a in digital exposure notification system, it could reduce SARS-CoV-2 infections by 8% and COVID-19 related deaths by 6%. The authors conclude that this approach could complement traditional contact tracing.

Abueg et al. (Sept 2, 2020). Modeling the Combined Effect of Digital Exposure Notification and Non-Pharmaceutical Interventions on the COVID-19 Epidemic in Washington State. Preprint downloaded Sep 2 from https://doi.org/10.1101/2020.08.29.20184135

• In an online survey among 1,204 adults from a UK research panel, Waller et al. reported that by using the term “immunity” (vs “antibody”) to describe antibody tests for SARS-CoV-2, participants were more likely to perceive no risk of catching coronavirus given an positive antibody test result (OR 2.9). Perceiving no risk of infection was associated with an intention to wash hands less frequently (aOR=2.3)

Waller et al. (Sept 2, 2020). “Immunity Passports” for SARS-CoV-2: An Online Experimental Study of the Impact of Antibody Test Terminology on Perceived Risk and Behaviour. BMJ Open. https://doi.org/10.1136/bmjopen-2020-040448