COVID-19 Literature Situation Report May 25, 2021

• The IL-6 inhibitor tocilizumab was not associated with a reduction in 90-day mortality (HR=0.64, 95%CI 0.25-1.65) in a follow-up of a randomized, placebo-controlled trial of patients hospitalized with COVID-19 who were receiving oxygen but did not require high-flow or mechanical ventilation (n=130). However, in a subgroup analysis including participants with baseline C-reactive protein levels greater than 15 mg/dL, 90-day mortality was 9% in the tocilizumab group and 35% the usual care group (HR, 0.18; 95%CI 0.04-0.89). The authors caution interpretation of the findings given the small sample size and narrow study criteria (patients with a WHO Cognitive Performance Scale score of 5 exactly and requiring at least 3 L/min of oxygen).

Mariette et al. (May 24, 2021). Effectiveness of Tocilizumab in Patients Hospitalized With COVID-19. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2021.2209

• Mean anti-SARS-CoV-2 spike IgG antibody titers exhibited a biphasic decay with a rapid decay during the first 4 months followed by a more gradual decline up to 11 months in an analysis of sera from 77 convalescent individuals, most of whom had recovered from mild COVID-19. Analysis of bone marrow aspirates collected at 7-8 months and at 11 months in a subset of participants showed that frequency of spike-specific bone marrow plasma cells (BMPCs) correlated with spike-specific antibody titers, compared to aspirates from healthy controls in which BMPCs were not detected.

Turner et al. (May 24, 2021). SARS-CoV-2 Infection Induces Long-Lived Bone Marrow Plasma Cells in Humans. Nature. https://doi.org/10.1038/s41586-021-03647-4

• Prevalence of anti-SARS-CoV-2 antibodies in a cohort of 367 solid organ transplant recipients in France who received an mRNA COVID-19 vaccine was 1.4% at baseline, 6.3% prior to the second dose, and 34% at 1 month after the second dose. The vaccines were well tolerated with only one serious adverse event reported.

Marion et al. (May 25, 2021). Safety and Immunogenicity of Anti–SARS-CoV-2 Messenger RNA Vaccines in Recipients of Solid Organ Transplants. Annals of Internal Medicine. https://doi.org/10.7326/M21-1341

• In a case series of 36 participants from the UK with persistent COVID-19 symptoms 8 months after hospitalization, 71% of reported symptoms present prior to vaccination with a COVID-19 vaccine were unchanged a median of 1 month after receiving the first dose. 23% of symptoms had improved, and 6% had worsened. Prior to vaccination, participants had a median of 4 symptoms across multiple organ systems, the most common of which were fatigue (75%)  breathlessness (61%) and insomnia (53%). 72% of participants reported transient systemic effects after vaccination, including fever, myalgia, and headache. No difference in any outcome measure was identified across the vaccines received (Pifzer-BioNTech or Oxford-AstraZeneca).

Arnold et al. (May 25, 2021). Symptoms After COVID-19 Vaccination in Patients With Persistent Symptoms After Acute Infection: A Case Series. Annals of Internal Medicine. https://doi.org/10.7326/M21-1976

• Estimated vaccine hesitancy in the US declined from 46% in October 2020 to 35% in March 2021, according to an analysis of 42,154 survey responses from 7,420 participants in 7 waves of the probability-based Understanding America Study (UAS). Declines in hesitancy were observed across demographic groups and were largest among Hispanic (52% to 37%) and Black participants (64% to 43%). Concurrently, estimates of public trust in vaccination increased from a score of 1.7 on a 0-6 point scale in October 2020 to 3.1 in March 2021. Vaccine hesitancy as of March 2021 was highest among adults aged 18-39 years (44%), those without a college degree (43%), and households with an income of $50,000 or less (44%).

Daly et al. (May 24, 2021). Public Trust and Willingness to Vaccinate Against COVID-19 in the US From October 14, 2020, to March 29, 2021. JAMA. https://doi.org/10.1001/jama.2021.8246

• A total of 10,262 SARS-CoV-2 vaccine breakthrough cases were reported to the CDC across the US as of April 30, 2021, out of approximately 101 million fully vaccinated individuals (0.01%). 27% of vaccine breakthrough infections were asymptomatic. Of the 10% of infected individuals who were hospitalized, of whom 29% were asymptomatic or hospitalized for reasons unrelated to COVID-19. 2% of infections resulted in death (median age 82 years), of whom 18% were asymptomatic or died due to reasons unrelated to COVID-19. Of the 555 breakthrough cases with sequence data, 356 (64%) were identified as variants of concern, including B.1.1.7 (56%), B.1.429 (25%), B.1.427 (8%), P.1 (8%), and B.1.351 (4%). High levels of SARS-CoV-2 transmission were observed during the surveillance period, with approximately 355,000 COVID-19 cases reported nationally during the week of April 24–30, 2021.

Birhane et al. (May 25, 2021). COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021. MMWR. https://doi.org/10.15585/mmwr.mm7021e3

• [Pre-print, not peer-reviewed] Effectiveness of the Pfizer-BioNTech vaccine against symptomatic SARS-CoV-2 infection following 1 dose was 34% against the B.1.617.2 variant of concern (first described in India) compared to 51% against the B.1.1.7 variant in a case control analysis of 12,675 sequenced cases in England (92% B.1.1.7). Two-dose effectiveness was modestly lower, with 88% against the B.1.617.2 variant compared to 93% against the B.1.1.7 variant. Single-dose effectiveness of the Oxford-AstraZeneca vaccine was similar to that of the Pfizer-BioNTech vaccine, but 2-dose effectiveness was 60% against the B.1.617.2 variant compared to 66% against the B.1.1.7 variant. Vaccine breakthrough infections were 40% more likely to be caused by the B.1.617.2 variant in sequenced cases with 1 dose of any vaccine and 60% more likely in sequenced cases with 2 doses of any vaccine compared to sequenced cases in unvaccinated individuals.

Bernal et al. (May 24, 2021). Effectiveness of COVID-19 Vaccines against the B.1.617.2 Variant. Pre-print downloaded May 25 from https://doi.org/10.1101/2021.05.22.21257658

• 73% of patients hospitalized for COVID-19 were at high risk of muscle tissue loss (sarcopenia) and 22% of patients experienced serious acute weight loss (>5kg), according to a prospective observational cohort in the Netherlands conducted from April to December 2020 (n=407). Muscle tissue loss was defined as ≥4 points on the SARC-F questionnaire during hospitalization. The median length of in-hospital stay was 15 days and 85% were admitted to the ICU during hospitalization. The most commonly reported complaints were decreased appetite (58%), feeling of being full (49%), and shortness of breath (43%). 

Wierdsma et al. (Apr 12, 2021). Poor Nutritional Status, Risk of Sarcopenia and Nutrition Related Complaints Are Prevalent in COVID-19 Patients during and after Hospital Admission. Clinical Nutrition ESPEN. https://doi.org/10.1016/j.clnesp.2021.03.021

• Complete inactivation of coronaviruses on surfaces and in aerosols required at least 15 minutes within a maximum distance from the UV emitter up to 1 meter, according to a systematic review of 18 studies reporting on the efficacy of UV technologies against coronaviruses (n=6 against SARS-CoV-2). The authors noted significant heterogeneity among the studies in studied variables, such as viral medium and UV intensity used.

Chiappa et al. (May 20, 2021). The Efficacy of UV Light-Emitting Technology against Coronaviruses: A Systematic Review. Journal of Hospital Infection. https://doi.org/10.1016/j.jhin.2021.05.005

• Shortness of breath, fatigue, loss of smell, and loss of taste persisted in 9%, 10%, 12%, and 11%, respectively, in a cohort of 442 individuals with COVID-19 (mostly mild cases) who were followed up at 4 months post-infection in Germany. At least one of these characteristic symptoms was present in 123 participants at both the 4-month and 7-month follow-up. Risk of prolonged symptoms at 7 months post infection was associated with a lower level of anti-SARS-CoV-2 IgG antibodies, loss of smell, and diarrhea during the acute phase of the infection.

Augustin et al. (May 18, 2021). Post-COVID Syndrome in Non-Hospitalised Patients with COVID-19: A Longitudinal Prospective Cohort Study. The Lancet Regional Health – Europe. https://doi.org/10.1016/j.lanepe.2021.100122 

• Breast cancer screening declined by 49% in Washington State during the COVID-19 pandemic compared to pre-pandemic screening, according to an analysis of completed mammograms within a large non-profit community health care system. 55,678 screenings were conducted between April to December 2019 whereas only 27,522 screenings occurred during the same period in 2020. Greater declines in screenings were observed among women who were Hispanic (64%), American Indian/Alaska Native (61%), multiracial (56%), and other minorities compared to declines among white women (49%). Declines were greater among women living in rural vs urban areas as well as those who self-paid for treatment or were insured by Medicaid compared to those with commercial insurance or insured by Medicare. 

Amram et al. (May 24, 2021). Socioeconomic and Racial Inequities in Breast Cancer Screening During the COVID-19 Pandemic in Washington State. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2021.10946