COVID-19 LITERATURE SITUATION REPORT DEC. 18, 2020

• A review of 42 studies that assessed measures to reopen or keep schools open during the COVID-19 pandemic found a heterogenous set of interventions implemented in school settings, including organizational (n=36) and structural or environmental measures (n=11) to reduce transmission, as well as surveillance and response measures to detect SARS-CoV-2 infections (n=19). Most studies assessed transmission‐related outcomes (n=29), while others assessed healthcare utilization (n=8), other health outcomes (n=3), and societal, economic, and ecological outcomes (n=5).

Krishnaratne et al. (Dec 17, 2020). Measures Implemented in the School Setting to Contain the COVID-19 Pandemic: A Scoping Review. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD013812

• Infectious SARS-CoV-2 virus is persistent in postmortem tissue. A study of SARS-CoV-2 postmortem viral RNA stability found evidence for maintained infectivity of the virus from the tissues of deceased individuals, and no time-dependent decrease in viral load. There was also no correlation between the postmortem interval (time of death until cooling at 4°C; median 17.8 hours) and the viral RNA loads of detected in deceased individuals. The authors note that the infectivity study relies on a limited number of cases and patients with severe immunosuppression, and suggest further research investigating viral persistence in individuals with longer postmortem intervals (>1 week) and those exhibiting lower initial viral loads.

Heinrich et al. (Dec 16, 2020). Postmortem Stability of SARS-CoV-2 in Nasopharyngeal Mucosa. Emerging Infectious Diseases. https://wwwnc.cdc.gov/eid/article/27/1/20-3112

• Tocilizumab reduced the rate of mechanical ventilation, but did not prevent deaths among hospitalized COVID-19 patients. In a randomized trial of patients hospitalized with COVID-19 pneumonia who were not receiving mechanical ventilation, tocilizumab reduced the likelihood of progression to the composite outcome of mechanical ventilation or death, but did not improve survival. The cumulative percentage of patients who had received mechanical ventilation or who had died by day 28 was 12% in the tocilizumab group and 19% in the placebo group (HR=0.56). Death from any cause by day 28 occurred in 10% of the patients in the tocilizumab group and 9% of those in the placebo group. No new safety concerns were identified. Study site selection emphasized enrolling individuals from high-risk and racial and ethnic minority populations. [EDITORIAL NOTE: A version of this manuscript was summarized in this report as a pre-print on October 23, 2020]

Salama et al. (Dec 17, 2020). Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2030340

• Results from a nationwide survey conducted in May 2020 in China indicated that many respondents expressed probable (55%) or definite (29%) intent to receive a COVID-19 vaccine. The study examined the applicability of the health belief model to vaccine demand and hesitancy, and found that perceived benefits and barriers (namely related to efficacy and outcomes) were significant predictors of vaccine intention. A substantial proportion of respondents were concerned about fake or faulty vaccines, but this was not a predictor of vaccine intention. Almost two thirds of respondents also reported a preference for vaccines made in China.

Lin et al. (Dec 17, 2020). Understanding COVID-19 Vaccine Demand and Hesitancy: A Nationwide Online Survey in China. PLOS Neglected Tropical Diseases. https://doi.org/10.1371/journal.pntd.0008961

• A prospective observational cohort study in the Netherlands indicated that abdominal adiposity was an independent risk factor for respiratory distress in patients with COVID-19 when adjusted for metabolic syndrome, age, gender and BMI (aOR=1.11). Among 86 patients with COVID-19, the prevalence of metabolic syndrome did not differ between patients with or without the need for intubation, or level of supportive care (5% vs 48.4%).

van Zelst et al. (Dec 16, 2020). Analyses of Abdominal Adiposity and Metabolic Syndrome as Risk Factors for Respiratory Distress in COVID-19. BMJ Open Respiratory Research. https://doi.org/10.1136/bmjresp-2020-000792

• Using a mouse experimental model, intravenously injected SARS-CoV-2 spike protein subunit S1 was found to readily cross the blood-brain barrier (BBB) and enter the parenchymal brain space, and was also taken up by the lungs, spleen, kidney, and liver. Intranasally administered S1 also entered the brain, although at levels roughly ten times lower than after intravenous administration. Mechanistic studies indicated that injected S1 crosses the blood–brain barrier by adsorptive transcytosis and that ACE2 was involved in brain and lung uptake, but not in kidney, liver or spleen uptake. The authors conclude that the widespread entry of S1 into brain could explain the diverse effects of SARS-CoV-2 such as encephalitis, respiratory difficulties, and loss of sense of smell.

Rhea et al. (Dec 16, 2020). The S1 Protein of SARS-CoV-2 Crosses the Blood–Brain Barrier in Mice. Nature Neuroscience. https://doi.org/10.1038/s41593-020-00771-8

• A multi-center retrospective cohort study of COVID-19 survivors in China found that a significant proportion experienced disability and anxiety after discharge from the hospital. Prevalence of at least one problem on a measure assessing independent living skills (Lawton IADL) was 37%, dependence in personal care and mobility (as assessed by the Barthel Index) was present in 16% of individuals, and 29% screened positive for clinical anxiety. Age was an additional independent risk factor for independent living skills limitations and dependence.

Zhu et al. (Dec 17, 2020). Prevalence and Risk Factors of Disability and Anxiety in a Retrospective Cohort of 432 Survivors of Coronavirus Disease-2019 (Covid-19) from China. PLOS ONE. https://doi.org/10.1371/journal.pone.0243883

• Inpatients who identify as Black who were receiving supplemental oxygen had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry when compared to white patients in a two separate cohorts. In a cohort from the University of Michigan, among the patients who had an oxygen saturation of 92 to 96% on pulse oximetry, an arterial oxygen saturation of less than 88% was found in 12% of arterial blood gas measurements in Black patients and in 4% of measurements in White patients. In the multicenter cohort, there was an arterial blood gas oxygen saturation of less than 88% in 17% of measurements in Black patients and in 6% of measurements in white patients.

Sjoding et al. (Dec 17, 2020). Racial Bias in Pulse Oximetry Measurement. New England Journal of Medicine. https://doi.org/10.1056/NEJMc2029240

• Among youth ages 11-21 years, the rates of suicidal ideation and attempts were higher during some months of 2020 compared to 2019, according to analyses of positive suicide risk screens from a Texas pediatric emergency department. There was a significantly higher rate of suicidal ideation in March and July, and the odds of a suicide attempt were higher in 2020 in February (OR=1.58), March (OR=2.34), April (OR=1.75), and July (OR=1.77), compared to the same months in 2019. Months with significantly higher rates of suicide-related behaviors appeared to correspond to times when COVID-related stressors and community responses were heightened.

Hill et al. (Dec 16, 2020). Suicide Ideation and Attempts in a Pediatric Emergency Department Before and During COVID-19. Pediatrics. https://doi.org/10.1542/peds.2020-029280

• [Pre-print, not peer-reviewed] A study examining parental stress before and during the COVID-19 pandemic demonstrated an initial spike in stress in May followed by a decrease in September to levels still elevated when compared to pre-pandemic responses. The parental stress score (PSS) pre-COVID-19 was 16.3±5.7 and increased to 22.0±6.4 by May of 2020. By September of 2020, the PSS had fallen to 19.2±6.0, which was still elevated as compared to pre-COVID-19 levels. 71% of parents reported an increase in parenting-specific stress from before COVID-19 to the May timepoint, which continued to increase for 55% of parents in September. Common stressors that impacted parenting during COVID-19 were changes in children’s routines, worry about COVID-19, and online schooling demands. Strategies to manage parenting difficulties included doing family activities together, keeping in touch with family/friends virtually, and keeping children on daily routines.

Adams et al. (Dec 9, 2020). Parents Are Stressed! Patterns of Parent Stress across COVID-19. Research Square. https://doi.org/10.21203/rs.3.rs-66730/v2

• A study examining the relationship between cyberchondria (excessively searching the web for health-related information) and COVID-19 concern and safety behaviors in Croatia found that high cyberchondria and high levels of concern were associated with intense avoidance behaviors. There was a pronounced increase in concerns regarding COVID-19 as well as significant behavioral changes between the day of the first confirmed case of COVID-19 in Croatia (February 24th, 2020) and the day of the first COVID-19 fatality (March 19th, 2020). Results indicated that cyberchondria played a role in these changes, and the authors suggest that cyberchondria may be a contributing factor to long-term anxiety.

Jokic-Begic et al. (Dec 17, 2020). Cyberchondria in the Age of COVID-19. PLOS ONE. https://doi.org/10.1371/journal.pone.0243704

• A study of the impacts of the COVID-19 pandemic on people living in rural communities in the western US found significant negative impacts on self-reported overall life satisfaction, mental health, and economic outlook. These impacts were generally consistent across age, ethnicity, education, and sex. More than half of all respondents reported some level of negative impact to overall life, and 28% had at least one form of direct experience with the COVID-19 virus.

Mueller et al. (Jan 5, 2021). Impacts of the COVID-19 Pandemic on Rural America. Proceedings of the National Academy of Sciences. https://doi.org/10.1073/pnas.2019378118

• By October 2020, COVID-19 had become the leading cause of death in the United States for people over age 35. In October 2020, COVID-19 had become the third leading cause of death for persons aged 45 through 84 years and the second leading cause of death for those aged 85 years or older. COVID-19 mortality rates now exceed deaths due to heart disease and cancer (1,700 and 1,600 deaths per day, respectively), and it is estimated that excess deaths may be 20% higher than publicly reported COVID-19 death counts.

Woolf et al. (Dec 17, 2020). COVID-19 as the Leading Cause of Death in the United States. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2774465