COVID-19 LITERATURE SITUATION REPORT DEC. 10, 2020

• Fitted filtration efficiency (FFE) of consumer-grade masks and improvised face coverings was similar to FFE of non-N95 respirator medical procedure masks with modifications to enhance fit, suggesting they are comparable in their ability to protect the wearer. FFE of consumer grade masks ranged from 26.5% to 79.5%. The highest performing consumer-grade mask was a 2-layer, woven nylon mask with optional aluminum nose bridge designed to be worn by an adult male without a beard, while FFE for medical procedure masks with modifications ranged from 38.5% (no modifications) up to 80.2%.

Clapp et al. (Dec 10, 2020). Evaluation of Cloth Masks and Modified Procedure Masks as Personal Protective Equipment for the Public During the COVID-19 Pandemic. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2020.8168

• An internet panel survey (n=858) conducted in July 2020 found parents of school-aged children who identified as members of racial and ethnic minority groups expressed more concerns about some aspects of school re-opening than their peers who identified as non-Hispanic white. Though the majority (56.5%) strongly or somewhat agreed that schools should reopen in fall 2020, non-Hispanic white parents were significantly more likely than Black or Hispanic parents to support school reopening. Minority racial/ethnic groups were also more likely to report concerns about schools opening at full capacity, student mitigation compliance, and their child contracting COVID-19 from school and bringing it home.

Gilbert et al. (Dec 11, 2020). Racial and Ethnic Differences in Parental Attitudes and Concerns About School Reopening During the COVID-19 Pandemic — United States, July 2020. MMWR. Morbidity and Mortality Weekly Report. https://doi.org/10.15585/mmwr.mm6949a2

• A questionnaire administered to 12,434 UK National Health Service users found that people who believe they had COVID-19 and recovered from it were 27% less likely to be willing to download a contract tracing app than people who do not believe they had COVID-19. While 60.3% were willing to participate, the authors report this proportion is insufficient for the app to be an effective intervention.

Bachtiger et al. (Nov 6, 2020). Belief of Having Had Unconfirmed Covid-19 Infection Reduces Willingness to Participate in App-Based Contact Tracing. Npj Digital Medicine. https://doi.org/10.1038/s41746-020-00357-5

• In a retrospective study of 28 COVID-19 patients in Japan, median viral load at initial sample collection was significantly higher in symptomatic than asymptomatic patients, and also higher among adults than children. Among symptomatic patients (n=18), median viral load was consistently higher in patients identified as household cluster index cases than in non-index cases up to 10 days after symptom onset. Viral load was also higher among index patients than in non-index patients among adults (both symptomatic and asymptomatic; n=21).

Kawasuji et al. (Dec 9, 2020). Transmissibility of COVID-19 Depends on the Viral Load around Onset in Adult and Symptomatic Patients. PLOS ONE. https://doi.org/10.1371/journal.pone.0243597

• A high rate of SARS-CoV-2 infection was identified among residents in a large refugee shelter in Toronto in April 2020, with 25 (41.7%) of 60 adults testing positive. Only 5 (20%) residents were symptomatic at the time of testing, while 21 (87.5%) were symptomatic 14 days after testing. The authors state these results highlight the need for timely asymptomatic surveillance testing in congregate living settings.

Redditt et al. (Dec 8, 2020). Outbreak of SARS-CoV-2 Infection at a Large Refugee Shelter in Toronto, April 2020: A Clinical and Epidemiologic Descriptive Analysis. CMAJ Open. https://doi.org/10.9778/cmajo.20200165

• Evaluation of the Xpert Xpress SARS-CoV-2/Flu/RSV panel test showed high sensitivity and accuracy to distinguish SARS-CoV-2 from influenza and respiratory syncytial virus (RSV). Among 319 nasopharyngeal swab specimens (n=228 positive for SARS-CoV-2, influenza, or RSV; n=91 negative for all 3 infections), positive agreement for SARS-CoV-2 was 98.7% (n=74/75) and negative agreement was 100% (n=91), while all other pathogens showed 100% total agreement.

Mostafa et al. (Dec 9, 2020). Multi-Center Evaluation of the Cepheid Xpert® Xpress SARS-CoV-2/Flu/RSV Test. Journal of Clinical Microbiology. https://doi.org/10.1128/JCM.02955-20

• Results of the phase 3 double-blind, randomized, placebo-controlled trial for the BioNTech and Pfizer mRNA vaccine BNT162b2 (n=21,720 in vaccine group, and 21,728 in placebo group) showed a vaccine efficacy of 95% (95% CI 90.3-97.6), with 8 cases of COVID-19 (1 severe case) in the vaccine group and 162 cases (9 severe cases) in the placebo group. Efficacy was similar across subgroups defined by age, sex, race, ethnicity, body-mass index, and presence of co-existing conditions.
• Reactogenicity events were common among vaccine recipients, including arm pain, fatigue and headache. Fever (temperature ≥38C) was reported after the second vaccine dose by 16% of participants <55 years old and 11% of participants >55. Few participants in either group had severe or serious adverse events, and the 6 deaths (2 in vaccine group, 4 in placebo group) were determined by investigators not to be related to the vaccine or placebo by investigators.
• Participants were included from 152 sites in 6 countries (130 sites in the US). The majority were aged 18-55 (58%), white (83%), and male (51%). 35% were obese and 21% had at least one coexisting condition.

Polack et al. (Dec 10, 2020). Safety and Efficacy of the BNT162b2 MRNA Covid-19 Vaccine. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2034577

• A retrospective study juxtaposing longitudinal SARS-CoV-2 PCR positivity with IgG antibody seropositivity (n=851) found patients who seroconverted may still actively shed viral RNA. Out of 90 patients with positive IgG results (mean upper bound from initial PCR test = 37.8 days), 14 were actively shedding viral RNA (positive PCR test) between 0 and 64 days after an IgG positive test. Though PCR positivity does not imply infectiousness, the authors suggest longitudinally monitoring viral loads and neutralizing antibody titers to characterize the infection lifecycle.

Agarwal et al. (Dec 2, 2020). Long-Term SARS-CoV-2 RNA Shedding and Its Temporal Association to IgG Seropositivity. Cell Death Discovery. https://doi.org/10.1038/s41420-020-00375-y

• A retrospective and prospective observational study of all children in the UK under 16 diagnosed with cancer suggests that children with cancer do not appear to be at increased risk of severe SARS-CoV-2 infection compared to the general pediatric population. 54 cases were identified between March-July 2020 (3% estimated cumulative incidence); 5 (28%) were asymptomatic, 34 (63%) had mild infections, 5 (10%) had moderate, severe or critical infection, and no deaths were observed.

Millen et al. (Dec 10, 2020). Severity of COVID-19 in Children with Cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project. British Journal of Cancer. https://doi.org/10.1038/s41416-020-01181-0

• In an online survey of a culturally diverse sample of 3,273 adults in Quebec, mental health impacts of the COVID-19 pandemic varied significantly based on socioeconomic status and ethno-cultural group. Compared to other socioeconomic and ethno-cultural groups, participants with lower incomes and Arab participants reported higher psychological distress. Black participants exposed to COVID-19 (personal diagnosis or knew someone with diagnosis) or who reported discrimination reported higher mental distress.

Miconi et al. (Dec 9, 2020). Ethno-Cultural Disparities in Mental Health during the COVID-19 Pandemic: A Cross-Sectional Study on the Impact of Exposure to the Virus and COVID-19-Related Discrimination and Stigma on Mental Health across Ethno-Cultural Groups in Quebec (Canada). BJPsych Open. https://doi.org/10.1192/bjo.2020.146

• Modeling based on King County, Washington State indicates that returning to a level of 75% of pre-COVID-19 physical interactions between May 15-July 15 was projected to result in 350 daily deaths by early September 2020. Maintaining less than 45% of pre-COVID-19 physical interactions was required to ensure low levels of daily infections and deaths. A combination of increased testing, isolation of symptomatic infections, and contact tracing permitted 60% of pre-COVID-19 physical interactions and allowed opening of schools with <15 daily deaths. [EDITORIAL NOTE: This manuscript was previously summarized as a pre-print on Aug. 16]

Bracis et al. (Nov 13, 2020). Widespread Testing, Case Isolation and Contact Tracing May Allow Safe School Reopening with Continued Moderate Physical Distancing: A Modeling Analysis of King County, WA Data. Infectious Disease Modelling. https://doi.org/10.1016/j.idm.2020.11.003

• Early in the pandemic during March-April 2020, the total number of US emergency department (ED) visits related to child abuse and neglect among individuals aged <18 years decreased by 53% compared to 2019, but the weekly number of these visits ending in hospitalization remained stable. As a result, the percentage of ED visits for child abuse and neglect resulting in hospitalization increased significantly for all age groups, from an overall 2.1% in 2019 to 3.2%. These findings suggest that while child-abuse related ED visits decreased during the pandemic, injury severity did not decrease.

Swedo et al. (Dec 11, 2020). Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic — United States, January 2019–September 2020. MMWR. Morbidity and Mortality Weekly Report. https://doi.org/10.15585/mmwr.mm6949a1

• Data from 14 states, including Washington, show that age-adjusted COVID-19-associated mortality was 1.8 times higher among American Indian/Alaskan Native (AI/AN) than non-Hispanic white individuals. People aged 20-29 years, 30-39 years, and 40-49 years experienced the largest disparities, with mortality rates 10.5, 11.6, and 8.2 times higher, respectively. Overall, AI/AN persons dying from COVID-19 were younger than their white peers, with 35.1% of AI/AN COVID-19-associated deaths among persons aged <60 years, compared with 6.3% of deaths among white persons. Mortality was higher among men for both AI/AN and white persons.

Arrazola et al. (Dec 11, 2020). COVID-19 Mortality Among American Indian and Alaska Native Persons — 14 States, January–June 2020. MMWR. Morbidity and Mortality Weekly Report. https://doi.org/10.15585/mmwr.mm6949a3