COVID-19 Literature Situation Report Sept. 15, 2020

• A cross-sectional study in April 2020 of asymptomatic healthcare workers (n=545) in the UK found a 2.4% point prevalence of SARS-CoV-2, and 24.4% seroprevalence. Those who reported prior symptomatic illness had higher seroprevalence and greater antibody responses. Healthcare workers who were Black, Asian or minority ethnicity were more likely to be seropositive (OR=1.9), while those who worked in the ICU were less likely to be seropositive (OR=0.3).

Shields et al. (Sept 11, 2020). SARS-CoV-2 Seroprevalence and Asymptomatic Viral Carriage in Healthcare Workers: A Cross-Sectional Study. Thorax.
https://doi.org/10.1136/thoraxjnl-2020-215414

• A German study analyzed new SARS-CoV-2 infections among children ages 0-19 years old from the time of school reopening through summer holiday (May to August 2020). A total of 137 index cases were identified who attended school or childcare settings for at least 1 day in their infectious period and among these, 6 (4%) index cases infected at least one additional student, with a total of 11 secondary infections among students.

Ehrhardt et al. (Sept 10, 2020). Transmission of SARS-CoV-2 in Children Aged 0 to 19 Years in Childcare Facilities and Schools after Their Reopening in May 2020, Baden-Württemberg, Germany. Eurosurveillance. https://doi.org/10.2807/1560-7917.ES.2020.25.36.2001587

• An analysis of 453 SARS-CoV-2 genomes collected during February and March 2020 in Washington State found that SARS-CoV-2 infections during that time period were derived from a single introduction in late January or early February 2020 that spread undetected before community surveillance was implemented.

Bedford et al. (Sept 10, 2020). Cryptic Transmission of SARS-CoV-2 in Washington State. Science. https://doi.org/10.1126/science.abc0523

• A systematic review found that the estimated cumulative proportion of recurrent RNA positivity in recovered COVID-19 patients was 12% (95% CI: 12-13%), ranging from 7-23% across studies and with follow-up testing between 1 and 60 days.

Mattiuzzi et al. (Sept 7, 2020). SARS-CoV-2 Recurrent RNA Positivity after Recovering from Coronavirus Disease 2019 (COVID-19): A Meta-Analysis. Acta Bio-Medica. https://doi.org/10.23750/abm.v91i3.10303

• A 10-specimen manual pooling algorithm was the optimal pool size for surveillance of asymptomatic healthcare workers. Das et al. found that pool sizes up to 10 were able to detect positive samples with a threshold of cycle time (Ct) <36. An evaluation of this approach included 700 pools (7,000 total samples) and found eight positive pools, with every positive pool yielding only one positive specimen upon deconvolution in a population with an estimated prevalence of 0.1%.

Das et al. (Sept 3, 2020). Pooled Testing for Surveillance of SARS-CoV-2 in Asymptomatic Individuals. Journal of Clinical Virology. https://doi.org/10.1016/j.jcv.2020.104619

• Contact tracing events (“surge testing”) identified a much larger proportion of the positive SARS-CoV-2 cases among residents and staff in homeless shelters across King County (Washington State) compared to routine surveillance. Among 29 SARS-CoV-2 positive cases identified from 1,434 encounters of shelter residents and staff in homeless shelters, 72% of cases were detected during “surge testing”. Individuals who were 60 years or older more were more likely to test positive (45% vs 16%) and 86% of positive cases slept in a communal space.

Rogers et al. (Sept 15, 2020). Characteristics of COVID-19 in Homeless Shelters. Annals of Internal Medicine. https://doi.org/10.7326/M20-3799

• Elevated fasting blood glucose (≥ 7.0 mmol/L), an indicator of pre-diabetes, was associated with COVID-19 mortality (HR=2.2), independent of diabetes history, in a Chinese cohort of 941 hospitalized patients. The authors conclude fasting blood glucose could be used to screen high-risk patients.

Cai et al. (Sept 10, 2020). Fasting Blood Glucose Level Is a Predictor of Mortality in Patients with COVID-19 Independent of Diabetes History. Diabetes Research and Clinical Practice. https://doi.org/10.1016/j.diabres.2020.108437

• Older age, male sex, and being Black or African American were significantly associated with mortality from COVID-19 across different age groups in a retrospective cohort study of patients age 18-90 years in the US (n=31,461). Comorbidities associated with higher odds of death varied across age groups and included heart attack history, congestive heart failure, dementia, chronic pulmonary disease, liver disease, renal disease, and metastatic tumors.

Harrison et al. (Sept 10, 2020). Comorbidities Associated with Mortality in 31,461 Adults with COVID-19 in the United States: A Federated Electronic Medical Record Analysis. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1003321

• A study among parents in the US (n=1,003) identified greater suicide risk among people reporting stress from COVID-19, with a perceived burden to others as a mediating factor. Responses such as attempting to suppress unpleasant experiences, getting caught up in negative thoughts, or being on “autopilot” (collectively termed psychological inflexibility) intensified the pathway to greater suicide risk. The majority of participants were women (73%) and 82% were white.

Crasta et al. (Sept 8, 2020). Modeling Suicide Risk among Parents during the COVID-19 Pandemic: Psychological Inflexibility Exacerbates the Impact of COVID-19 Stressors on Interpersonal Risk Factors for Suicide. Journal of Contextual Behavioral Science. https://doi.org/10.1016/j.jcbs.2020.09.003

• In an SEIR model of a COVID-10 outbreak in a large US jail system, Puglisi et al. found that within 30 days, 6% of prisoners and 8% of staff will have symptomatic infections, predicting 5,695 cases, among whom there would be 3,388 symptomatic infections, 474 hospitalizations, and 34 deaths.

Puglisi et al. (Sept 9, 2020). Estimation of COVID-19 Basic Reproduction Ratio in a Large Urban Jail in the United States. Annals of Epidemiology. https://doi.org/10.1016/j.annepidem.2020.09.002

• In a model considering asymptomatic, presymptomatic, and symptomatic transmission, the level of viral shedding was found to have the greatest impact on the total number of infections, followed by the probability of social distancing and individually initiated social isolation given a threshold number of infected contacts.

Braun et al. (Sept 10, 2020). Simulating Phase Transitions and Control Measures for Network Epidemics Caused by Infections with Presymptomatic, Asymptomatic, and Symptomatic Stages. PLOS ONE. https://doi.org/10.1371/journal.pone.0238412

• Increasing case counts of SARS-CoV-2 during June 2020 were associated at the US county level with being a metropolitan area (250,000-1 million population), having a higher percentage of Black residents, and a 10-point or greater Republican victory in 2016.

Mourad et al. (Sept 11, 2020). Social Disadvantage, Politics, and SARS-CoV-2 Trends: A County-Level Analysis of United States Data. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa1374

• A total of 121 SARS-CoV-2-associated deaths among people younger than 21 years of age had been reported to the CDC by July 31, 2020, accounting for 0.08% of all deaths due to COVID-19. Of these 121 deaths, 70% of were among those 10-20 years old and 10% were among infants. 78% of deaths were among members of racial and ethnic minority groups, and 33% of deaths occurred outside of a hospital. The authors conclude that these results imply the need for ongoing surveillance for infants, children, and adolescents as schools reopen.

Bixler et al. (Sept 15, 2020). SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020. MMWR. https://doi.org/10.15585/mmwr.mm6937e4