COVID-19 Literature Situation Report Jan 7, 2021

Incidence of severe COVID-19 was low among school-aged children in Sweden from March to June 2020, despite keeping schools open and the absence of face mask policies. A total of 15 children (0.77 per 100,000) were admitted to the ICU, four of whom had an underlying condition. All children survived. Risk of severe COVID-19 among schoolteachers and preschool teachers was similar to other occupations (excluding healthcare workers), after adjusting for sex and age.

Ludvigsson et al. (Jan 6, 2021). Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden. New England Journal of Medicine. https://doi.org/10.1056/NEJMc2026670 

In a randomized, double-blind, placebo-controlled trial of non-hospitalized adults aged ≥75 years (n=160) with mild COVID-19, patients who received convalescent plasma within 72 hours after onset of symptoms were 48% less likely to develop severe respiratory disease than patients receiving placebo (RR = 0.52, 95% CI: 0.29-0.94). Risk of severe disease was 60% lower (RR = 0.40, 95% CI: 0.20-0.81) when patients who developed severe respiratory disease before infusion of treatment or placebo were excluded. 

Libster et al. (Jan 6, 2021). Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2033700 

Serum samples from a cohort of 140 SARS-CoV-2 positive patients suggest that increasing symptom severity is correlated with higher neutralizing antibody (nAb) titers. Only 1 of 44 patients admitted to the ICU did not develop a nAb response by the time of sampling, while nAb response was more heterogenous and less frequently observed among hospitalized non-ICU patients and outpatients. Further analysis of the serum samples also showed an absence of cross-reactivity to other coronaviruses, and no effect of the D614G mutation on neutralization activity.

Legros et al. (Jan 6, 2021). A Longitudinal Study of SARS-CoV-2-Infected Patients Reveals a High Correlation between Neutralizing Antibodies and COVID-19 Severity. Cellular & Molecular Immunology. https://doi.org/10.1038/s41423-020-00588-2 

IgG antibodies against the Spike protein and the receptor binding domain (RBD) were relatively stable over 6 months in a cohort study of individuals with confirmed COVID-19 (n=188). Among 40 individuals with blood samples 6-8 months post-symptom onset, 90%, 88%, and 90% remained seropositive for anti-spike IgG, anti-RBD IgG, and neutralizing antibodies, respectively. Paired timepoint analysis showed that anti-spike and anti-RBD IgG declined with a half-life of 68 and 69 days, respectively. Spike-specific memory B cells were more abundant at 6 months than at 1 month post-symptom onset, while SARS-CoV-2-specific CD4+ T cells and CD8+ T cells declined with a half-life of 3-5 months.

Dan et al. (Jan 6, 2021). Immunological Memory to SARS-CoV-2 Assessed for up to 8 Months after Infection. Science. https://doi.org/10.1126/science.abf4063 

Among 713 nursing homes in California, the size of outbreaks in for-profit nursing homes was 12.7 times larger than their non-profit counterparts. Nursing homes with higher ratings on Centers for Medicare & Medicaid Services (CMS) health inspections were associated with a lower number of infections among both staff and residents, while higher self-reported ratings were associated with a greater number of infections. Nursing homes with larger discrepancies between CMS and self-reported ratings had more infections among both staff and residents. Improvements in CMS-reported staff ratings were associated with fewer infections among residents, though this association was highly dependent on staff-to-resident ratio.

Gopal et al. (Jan 6, 2021). Compress the Curve: A Cross-Sectional Study of Variations in COVID-19 Infections across California Nursing Homes. BMJ Open. https://doi.org/10.1136/bmjopen-2020-042804

Solid organ transplant (SOT) recipients with COVID-19 were more likely to experience adverse outcomes than matched non-SOT recipients in a cohort study conducted between March and September 2020. SOT recipients (n=128) were 1.9 times more likely to die within the study period compared to non-SOT patients (n=3,907). SOT recipients were also more than twice as likely to receive invasive mechanical ventilation, develop acute kidney injury, or receive vasopressor support during hospitalization.

Fisher et al. (Jan 6, 2021). Outcomes of COVID-19 in Hospitalized Solid Organ Transplant Recipients Compared to a Matched Cohort of Non-Transplant Patients at a National Healthcare System in the United States. Clinical Transplantation. https://pubmed.ncbi.nlm.nih.gov/33406279/

A cohort study (n=681) in Italy found that older age was independently associated with prolonged viral shedding. Patients who first had two consecutive negative nasopharyngeal swabs 1-2 days apart within <3 weeks, 3-6 weeks, and >6 weeks, had a mean age of 50.5 years, 57 years, and 65.8 years, respectively (p<0.05). 

Bongiovanni et al. (Jan 3, 2021).cInsight into the Reason of Prolonged Viral RNA Shedding in Patients with COVID-19 Infection. Journal of Infection. https://doi.org/10.1016/j.jinf.2020.12.030 

A study of 303 parent-child pairs in the US found that parental impacts from COVID-19 (e.g. knowing someone who tested positive or died from COVID-19, reporting loss of job or income) and worry about COVID-19 did not correlate with parenting practices characterized as harsh or warm. In contrast, COVID-19-related parental worries were associated with higher levels of child conduct problems. Parental worries about a household member contracting the virus were, in particular, related to higher levels of child conduct problems.

Waller et al. (Jan 6, 2021). The Impact of the COVID-19 Pandemic on Children’s Conduct Problems and Callous-Unemotional Traits. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-020-01109-y

In a cohort study in Korea matched on age, gender and a co-morbidity index, there was no association between mental disorders and SARS-CoV-2 infection. Among COVID-19 patients, those with mental disorders (n=24,558) had a 2-fold risk of death compared to those without mental disorders (n=97,966). In a subgroup analysis, individuals with schizophrenia-related disorders had a 1.5-fold risk SARS-CoV-2 infection compared to those without, while COVID-19 patients with mood disorders had a 2.3-fold risk of death compared to those without mental disorders.

Jeon et al. (Jan 7, 2021). Association of Mental Disorders with SARS-CoV-2 Infection and Severe Health Outcomes: Nationwide Cohort Study. The British Journal of Psychiatry. https://doi.org/10.1192/bjp.2020.251

[Pre-print, not peer reviewed] In a model parametrized to long-term care facility populations, high vaccination coverage among staff combined with strong adherence to nonpharmaceutical interventions (NPIs) produced the least morbidity and mortality, even among unvaccinated residents. However, in scenarios where adherence to NPIs was waning or low, vaccination among residents had a stronger impact on reducing morbidity and mortality than vaccinating staff.

Love et al. (Jan 6, 2021). Continued Need for Non-Pharmaceutical Interventions after COVID-19 Vaccination in Long-Term-Care Facilities. Pre-print downloaded Jan 7 from https://doi.org/10.1101/2021.01.06.21249339 

The Michigan emergency medical services (EMS) Information System identified 1,854 out-of-hospital cardiac arrest (OHCA) calls between March to May 2020, a 60% increase from the same period in 2019. Though the spike in OHCAs closely mirror the COVID-19 epidemic curve with a slight lag, it is not clear from these data whether COVID-19 infections directly affect the increase in OHCAs or the two are indirectly linked through changes in EMS utilization during the pandemic.

Nickles et al. (Jan 6, 2021). Comparison of Out-of-Hospital Cardiac Arrests and Fatalities in the Metro Detroit Area During the COVID-19 Pandemic With Previous-Year Events. JAMA Network Open. 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774638