COVID-19 Literature Situation Report May 7, 2021

• A large, retrospective study (N=47,000) comparing unobserved self-collected anterior nasal swabs  and healthcare provider-collected nasopharyngeal swabs found that cycle threshold values for  detection of human RNase P (RP), an indicator of sample adequacy for RT-PCR testing, were not  significantly different. However, cycle thresholds for detection of SARS-CoV-2 were significantly  higher for self-collected than provider-collected swabs, particularly among persons with  asymptomatic infection. These results suggest that patient self-collection can provide adequate  samples for SARS-CoV-2 testing with low risk of false-negative results. 

Kagan et al. (Apr 1, 2021). Performance of Unobserved Self-Collected Nasal Swabs for Detection  of SARS-CoV-2 by RT-PCR Utilizing a Remote Specimen Collection Strategy. Open Forum  Infectious Diseases. https://doi.org/10.1093/ofid/ofab039

• [Pre-print, not peer-reviewed] Preliminary results from a clinical trial (N=80) of a modified Moderna  mRNA COVID-19 vaccine administered as a booster 6 months after the two-dose vaccine series  induced increases in antibody neutralization titers to the wild type and variant strains B.1.351 and  P.1. The authors note that these results demonstrate the ability of a third vaccine dose to boost  immunity to titers that may exceed peak titers following the primary two-dose vaccination series  against both wild-type virus and variants.  

Wu et al. (May 6, 2021). Preliminary Analysis of Safety and Immunogenicity of a SARS-CoV-2  Variant Vaccine Booster. Pre-print downloaded May 7 from  https://doi.org/10.1101/2021.05.05.21256716 

• A study of kidney transplant recipients who received the Pfizer-BioNTech vaccine (N=308) found that  only 36% tested positive for anti-SARS-CoV-2 antibodies 2-4 weeks after receiving the second dose.  Factors associated with antibody detection included younger age, higher renal function, and  reduced immunosuppression. The authors note that although correlation between antibody levels  and protection has not been proven, detection of antibodies is much higher in non immunocompromised persons after receipt of the vaccine. These results may indicate a need for  additional booster doses, modified vaccine dosing, or mixing vaccine types to improve immune  response to vaccinations in transplant recipients. 

Rozen-Zvi et al. (May 2021). Antibody Response to MRNA SARS-CoV-2 Vaccine among Kidney  Transplant Recipients – Prospective Cohort Study. Clinical Microbiology and Infection.  https://doi.org/10.1016/j.cmi.2021.04.028 

• A study of humoral immune responses among 229 patients with asymptomatic, mild, moderate, and  severe COVID-19 found that persons with delayed neutralizing antibody generation had a higher risk  of mortality compared to survivors. Investigators collected multiple serum samples from patients  during the course of their illness and examined SARS-CoV-2 neutralizing antibodies and IgG levels. Although nearly all persons (85%) displayed some level of SARS-CoV-2 neutralization, development  of neutralizing antibodies within 14 days of symptom onset was associated with improved disease  trajectory. The authors note that antibody therapy may be most effective when administered as  early as possible after symptom onset. 

Lucas et al. (May 5, 2021). Delayed Production of Neutralizing Antibodies Correlates with Fatal  COVID-19. Nature Medicine. https://doi.org/10.1038/s41591-021-01355-0 

•  [Pre-print, not peer-reviewed] A prospective cohort study of SpaceX employees (N=4,111) found a 91% lower odds of SARS-CoV-2 reinfection over 6 months of follow-up among participants with  detectable SARS-CoV-2 antibodies at baseline. The study authors adjusted for underlying health  conditions and increased risk of exposure as potential confounders. The results suggest that previous infection may provide at least 6 months of protection from SARS-CoV-2 reinfection for  most individuals. 

Finch et al. (May 6, 2021). SARS-CoV-2 Infection and Reinfection in a Seroepidemiological  Workplace Cohort in the United States. Pre-print downloaded May 7 from  https://doi.org/10.1101/2021.05.04.21256609

• A meta-analysis of 118 studies reporting the clinical features and outcomes of persons with SARS CoV-2 infection found that up to 19% had co-infections (pathogens detected at the time of SARS CoV-2 diagnosis) and 24% had superinfections (other pathogens detected during SARS-CoV-2 care). Persons with co- and super-infections had a higher risk of mortality (OR = 3.3) compared to persons  with only SARS-CoV-2 infection. The most frequently detected pathogens among co-infected  persons were influenza A and B, and respiratory syncytial virus. The authors suggest that testing and  treatment for other pathogens may be necessary to improve outcomes in persons with COVID-19. 

Musuuza et al. (May 6, 2021). Prevalence and Outcomes of Co-Infection and Superinfection with  SARS-CoV-2 and Other Pathogens: A Systematic Review and Meta-Analysis. PLOS ONE.  https://doi.org/10.1371/journal.pone.0251170 

• A prospective cohort study of persons with autoimmune or inflammatory conditions (N=4,666)  found that persons with diabetes (OR=1.7), cardiovascular disease (OR=1.7) and kidney disease  (OR=1.8) and patients taking glucocorticoid drugs (OR=1.4) had higher risks of COVID-19. Interruptions to healthcare were common, and persons with changes in their ability to pay for  healthcare costs and those who experienced a COVID-19-related change to employment were most  vulnerable to care disruptions. The authors note that these results suggest that persons with  autoimmune or inflammatory disorders may be particularly vulnerable to downstream effects of pandemic-related disruptions to healthcare access. 

Fitzgerald et al. (May 6, 2021). Risk Factors For Infection And Health Impacts Of The Covid-19  Pandemic In People With Autoimmune Diseases. Clinical Infectious Diseases.  https://doi.org/10.1093/cid/ciab407

• A matched cohort study of US veterans (N=66,772) found that persons with rheumatoid arthritis had  a higher risk of COVID-19 disease (HR=1.25) and COVID-19 associated hospitalization or death  (HR=1.35) compared to age-, sex-, and Veterans Administration-site-matched persons without  rheumatoid arthritis. Persons on immunosuppressant drugs (DMARDS and prednisone) had the highest risk of COVID-19 and severe disease after controlling for demographics, other comorbidities,  healthcare utilization, and county-level COVID-19 incidence. The authors suggest that persons with rheumatoid arthritis should be prioritized for COVID-19 prevention and management. 

England et al. (May 5, 2021). Risk of COVID-19 in Rheumatoid Arthritis: A National Veterans  Affairs Matched Cohort Study in At-Risk Individuals. Arthritis & Rheumatology.  https://doi.org/10.1002/art.41800 

• A modeling study of US population dynamics and COVID-19 vaccination scenarios demonstrated that every 1% increase in coverage could avert an average of 876,800 cases, depending on the number of  people already vaccinated, with the greatest gains achieved when increasing vaccine coverage in the  population from 0% to 50%. Additionally, the study demonstrated that increasing vaccination coverage may avert more cases compared to increasing vaccine efficacy. For example, increasing  vaccination coverage from 50% to 70% would prevent 9.2 million cases at a vaccine efficacy of 70%,  while increasing vaccine efficacy from 70% to 90% would prevent 7.1 million cases with 50%  vaccination coverage. The authors note these results emphasize the need to reach high vaccination  coverage levels as soon as possible before the fall/winter to prevent another surge in cases and  deaths. 

Bartsch et al. (May 6, 2021). Lives and Costs Saved by Expanding and Expediting COVID-19  Vaccination. The Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiab233

• An internet survey of US adults with a history of tobacco and/or cannabis use (N=387) found that  26% were unwilling to receive a COVID-19 vaccine while another 25% were unsure about willingness  to be vaccinated. Respondents who reported living with 5 or more other persons or by themselves,  living in a suburban or rural area, and those who were not stressed about the COVID-19 pandemic  were less likely to report being willing to receive a vaccine, while those who reported receiving an  influenza vaccine every year were more likely to be willing to receive a COVID-19 vaccine. The use of  cigarettes, e-cigarettes, cannabis, and heavy alcohol use were not associated with willingness to  receive a vaccine. 

Yang et al. (May 6, 2021). COVID-19 Vaccine Hesitancy and Its Determinants Among Adults with  a History of Tobacco or Marijuana Use. Journal of Community Health.  https://doi.org/10.1007/s10900-021-00993-2 

• A retrospective study of emergency medical service activations between 2018 and 2020 found that  while the number of activations decreased in 2020, increases in the proportion of activations for on scene death (1.3% to 2.4%), cardiac arrest (1.3% to 2.2%), and opioid use/overdose (0.6 to 1.6%) were observed compared to 2018-2019. These frequencies subsequently declined but remained  above pre-pandemic levels through the end of 2020. The authors suggest that these changes may be  related to disruptions in access to healthcare, particularly for substance use disorders and mental  health conditions. 

Handberry et al. (May 2021). Changes in Emergency Medical Services before and during COVID 19 in the United States, January 2018-December 2020. Clinical Infectious Diseases: An Official  Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/cid/ciab373

• A retrospective cohort study of non-COVID related emergency department visits among US adults  found that visits for acute myocardial infarction (AMI), stroke, and sepsis declined precipitously  during the early pandemic period and remained lower than pre-pandemic levels through the  summer and fall, particularly among adults age ≥75. In contrast, visits for hip fractures and falls did  not significantly change between January 2019 and November 2020. The authors suggest this  difference may be attributable to vague or atypical symptoms in AMI or stroke that were not  recognized by older adults, coupled with isolation from family and friends who may have otherwise  recognized changes in health status and assisted with accessing medical care. The authors note that  these changes in care seeking may be one cause of excess non-COVID-19 mortality in older adults  during the pandemic. 

Janke et al. (May 6, 2021). Emergency Department Visits for Emergent Conditions Among Older  Adults During the COVID -19 Pandemic. Journal of the American Geriatrics Society.  https://doi.org/10.1111/jgs.17227