COVID-19 LITERATURE SITUATION REPORT NOV. 23, 2020

A meta-analysis with 67 pre-COVID-19 trials reported no significant reduction in respiratory viral infection with the use of medical/surgical masks during influenza season (9 trials; 3507 participants), and no clear differences between the use of medical/surgical masks versus N95/P2 respirators in healthcare workers (5 trials; 8407 participants). Hand hygiene was associated with an 11% relative reduction of respiratory illness (7 trials; 44,129 participants) but with low-certainty evidence and high heterogeneity. 

Jefferson et al. (Nov 20, 2020). Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD006207.pub5

Older age was associated with a longer duration of SARS-CoV-2 viral shedding among a cohort of 384 patients admitted from January 11, 2020 to March 24, 2020 in Wuhan, China (adjusted OR=1.02, 95%CI=1.01-1.04; p=0.003). The median duration of viral RNA shedding was 32 days (range 4-111 days).

Zhou et al. (Nov 15, 2020). Impact of Age on Duration of Viral RNA Shedding in Patients with COVID-19. Aging. https://doi.org/10.18632/aging.104114

Inoculation of SARS-CoV-2 or MERS-CoV into 5 poultry species (chickens, turkeys, ducks, quail, and geese; 10 birds of each species included) did not show clinical signs of disease, virus replication in oropharyngeal and cloacal swabs, nor serum antibody response in serum at 14 days post-challenge. The authors suggest that poultry are unlikely to support replication of either virus.

Suarez et al. (Nov 23, 2020). Lack of Susceptibility to SARS-CoV-2 and MERS-CoV in Poultry. Emerging Infectious Diseases. https://doi.org/10.3201/eid2612.202989

Genetic sequencing among 6 patients who retested positive for SARS-CoV-2 via rRT-PCR after recovery from initial infection identified one reinfection with a subtype of SARS-CoV-2 strain in the spike protein D614G substitution, that was genetically distinct from the initial infection. The positive test with the new strain occurred 26 days after the initial positive test and was associated with worsening respiratory symptoms. The participant tested positive in a third episode with viral fragments that matched the initial strain. The authors conclude that SARS-CoV-2 infection may not confer immunity against a different SARS-CoV-2 strain.

Lee et al. (Nov 21, 2020). Evidence of Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection After Recovery from Mild Coronavirus Disease 2019. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa1421

Pooling strategies for SARS-CoV-2 RT-PCR screening showed low sensitivity compared to single sample testing in medical staff in a hospital in Germany. Among 280 samples tested (8 positive, 3%), the sensitivity was 29% in pooling with 10 samples (2/7 pools) and 76% in pooling with 5 samples (13/17 pools). In contrast to other studies, the majority of samples were from throat washes (247/280, 88%), and a minority were 32/280 (11%) were from swabs, owing to a lack of available swabs. Samples were prospectively tested both individually and in pools to make the comparisons.

Lüsebrink et al. (Nov 20, 2020). Pooling Is an Insufficient Strategy to Avoid Health Care Staff to Patient Transmission of SARS-CoV-2. Infection Control & Hospital Epidemiology. https://doi.org/10.1017/ice.2020.1340

A home-based finger‐prick dried blood spot collection kit demonstrated 100% sensitivity and 100% specificity in detecting SARS-CoV-2 antibodies against S1 protein in 111 specimens collected at home from 31 patients with COVID-19 and 80 healthy participants. The authors conclude such methods may facilitate the test within hard-to reach-populations and help reduce the sample collection burden of serological testing on both health care systems and individuals. 

Karp et al. (Nov 19, 2020). A Serological Assay to Detect SARS-CoV-2 Antibodies in at-Home Collected Finger-Prick Dried Blood Spots. Scientific Reports. https://doi.org/10.1038/s41598-020-76913-6

A novel chimpanzee adenovirus-vectored vaccine, ChAdOx1 nCoV-19, was reported to be safe and well tolerated with reduced reactogenicity in healthy adults aged ≥18 years. A single-blind, randomized phase 2/3 trial in UK (n=552) found that compared to adults who received a control vaccine for meningitis, adults who received ChAdOx1 nCoV-19 developed antibody responses against the SARS-CoV-2 spike protein and sustained them at 28 days after booster vaccination. T-cell immune responses were also induced and peaked at day 14 after vaccination. Results were similar across age groups (18–55 years, 56–69 years, and ≥70 years). As of Oct 26, 2020, 13 serious adverse events occurred during the study period, none of which were considered to be related to either study vaccine. 

Ramasamy et al. (Nov 18, 2020). Safety and Immunogenicity of ChAdOx1 NCoV-19 Vaccine Administered in a Prime-Boost Regimen in Young and Old Adults (COV002): A Single-Blind, Randomised, Controlled, Phase 2/3 Trial. Lancet. https://doi.org/10.1016/S0140-6736(20)32466-1 

The Advisory Committee on Immunization Practices announced 4 ethical principles, in addition to scientific data and implementation feasibility, to assist in developing implementation strategies for the initial allocation of a SARS-CoV-2 vaccine: 1) maximizing benefits and minimizing harms; 2) promoting justice; 3) mitigating health inequities; and 4) promoting transparency. 

McClung et al. (Nov 23, 2020). The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020. MMWR. https://doi.org/10.15585/mmwr.mm6947e3

A study following patients (n = 124) for 3 months after they were discharged from the hospital following recovery from COVID-19 in the Netherlands reported that a substantial proportion reported severe problems in several health domains including functional impairment (64%), fatigue (69%) and quality of life (72%) after recovery from acute COVID-19. 

van den Borst et al. (Nov 21, 2020). Comprehensive Health Assessment Three Months after Recovery from Acute COVID-19. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa1750

A meta-analysis (n = 96 studies) of the clinical characteristics of SARS-CoV-2 in children (mean age 6.5 years) reported that 90% had household contact with an individual with SARS-CoV-2, 23% were asymptomatic, 27% had at least one comorbidity, and 29% had a co-infection, such as with mycoplasma or influenza. The pooled incubation period was 9.6 days and SARS-CoV-2 viral shedding in the upper respiratory tract lasted 11.4 days. The discharge rate was 79% and the death rate was 1%. 

Li et al. (Nov 2, 2020). Epidemiological and Clinical Characteristics of COVID-19 in Children: A Systematic Review and Meta-Analysis. Frontiers in Pediatrics. https://doi.org/10.3389/fped.2020.591132 

50% of long-term care workers (LTC) in the US are at increased risk of severe illness from COVID-19 due to age >65, obesity, or medical co-morbidities based on data from the 2017 and 2018 National Health Interview Surveys and risk categories developed by the CDC. Severe illness was defined as hospitalization, intubation, or death. A greater proportion of LTC workers were Black, female and low income compared to the general population.  

Greene and Gibson. (Nov 19, 2020). Workers at Long-Term Care Facilities and Their Risk for Severe COVID-19 Illness. Preventive Medicine. https://doi.org/10.1016/j.ypmed.2020.106328 

A case-control study of women hospitalized with severe or critical COVID-19 in New York City and Philadelphia reported that pregnant women (n=38) were more likely to experience severe outcomes, including death and need for intubation or ventilation, when compared to the non-pregnant (n=94) women (34% vs. 15%, aOR=4.6). Pregnant patients also experienced higher rates of ICU admission than non-pregnant patients (39% vs. 17%, aOR=5.2). The mean age and BMI were significantly higher among women in the non-pregnant group. 

DeBolt et al. (Nov 19, 2020). Pregnant Women with Severe or Critical COVID-19 Have Increased Composite Morbidity Compared to Non-Pregnant Matched Controls. Ame

In a cohort of 48 university student athletes who recovered from SARS-CoV-2 infection and returned to campus in July 2020 in West Virginia (30% asymptomatic), more than 1 in 3 showed signs of resolving heart inflammation on imaging studies. 27 student athletes (56%) had cardiac abnormalities, including 19 students with late enhancement of the pericardium and associated pericardial effusion. No student athlete showed specific imaging features of ongoing myocardial inflammation.

Brito et al. (Nov 4, 2020). High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19. JACC. Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2020.10.023

[Preprint, not peer-reviewed] A modeling study based on a scenario of one million individuals in Ontario, Canada predicted that school reopening would result in a small change in COVID-19 case numbers among students and teachers in a setting with community-based prevention measures. The model showed that the increase was driven mostly by acquisition in the community, and fewer than 5% of infections among students and teachers were acquired within schools. It also indicated that implementation of community-based prevention measures would reduce 39,355 COVID-19 incident cases by October 31, 2020, while school closure vs. reopening on September 15 would reduce 2,040 cases.

Naimark et al. (Nov 21, 2020). The Potential Impact of School Closure Relative to Community-Based Non-Pharmaceutical Interventions on COVID-19 Cases in Ontario Canada. Pre-print downloaded Nov 23 from https://doi.org/10.1101/2020.11.18.20234351