COVID-19 Literature Situation Report May 4, 2021

• Air sampling in residential rooms of COVID-19 patients (n=7) in Spain showed that 100% of samples were positive for SARS-CoV-2 RNA (cycle threshold (Ct) cutoff 41), but only 15% (1 of 7) of samples were positive after installation of a portable air cleaner (PAC) with a HEPA filter. Notably, the one positive sample after installation of a PAC was detected in a room larger than the PAC recommended specifications.

Rodríguez et al. (Apr 29, 2021). Are the Portable Air Cleaners (PAC) Really Effective to Terminate Airborne SARS-CoV-2? Science of The Total Environment. https://doi.org/10.1016/j.scitotenv.2021.147300

• In a quality improvement study, median weekly face mask compliance among healthcare personnel (HCP) in a tertiary care center in Connecticut was higher (93% vs 82%) after implementation of a multimodal intervention developed from semi-structured interviews of HCP. No difference in face mask compliance was observed between COVID-19 and non-COVID-19 units. The intervention consisted of audit and passive feedback, active discussion, and increased communication from leadership.

Datta et al. (May 3, 2021). Increasing Facemask Compliance among Healthcare Personnel during the COVID-19 Pandemic. Infection Control & Hospital Epidemiology. https://doi.org/10.1017/ice.2021.205

• Among 397 individuals aged ≤18 years with confirmed COVID-19 during the first 3 waves in Hong Kong (January to December 2020), imported infections comprised 79% and 93% of all cases during the first and second wave, respectively, but domestic infections comprised 73% of all cases during the third wave. Overall among domestic infections, 91% had a known history of contact with an infected individual, of which 90% were family members. While schools were intermittently closed nationally during the study period, only 3 cases were associated with in-school transmission.

Chua et al. (May 3, 2021). Clinical Characteristics and Transmission of COVID-19 in Children and Youths During 3 Waves of Outbreaks in Hong Kong. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2021.8824

• In a study of 2,679 US participants reporting new onset of fever from April 2020 to October 2020, only 17% indicated ever taking a SARS-CoV-2 test within 2 weeks of symptom onset, and only 12% indicated receiving a result. Among those who received a SARS-CoV-2 test result, only 21% received their test result within 7 days of febrile illness onset. The proportion of participants who received test results within 7 days of febrile illness was 10% during early April and rose to 24% by July, then only marginally increased to 26% by the end of the study in October at the start of the winter surge. Participants responded to daily surveys on COVID-19 symptoms and weekly surveys about COVID-19 testing. Estimates of time from onset to test were obtained using serial survey responses and time-to-event modeling.

Pletcher et al. (May 3, 2021). Factors Associated With Access to and Timing of Coronavirus Testing Among US Adults After Onset of Febrile Illness. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2021.8500

• In a study of 55 patients with SARS-CoV-2 PCR-positive nasopharyngeal (NPS) swabs, whole mouth fluid (WMF) samples had detectable SARS-CoV-2 RNA in 44 (80%) patients and had overall similar viral loads compared to NPS samples. Patients with severe disease course produced WMF samples with significantly higher virus copies. The authors suggest indicates that WMF, which is easier to collect, could be an alternative methods of diagnosing SARS-CoV-2 infections in individuals a highest risk of severe disease. Respiratory droplet (RD) samples had detectable RNA in 17 (31%) patients and had higher viral loads when sourced from patients with increased IL-6.

Kannian et al. (Apr 30, 2021). Implications in the Quantification of SARS-CoV2 Copies in Concurrent Nasopharyngeal Swabs, Whole Mouth Fluid and Respiratory Droplets. Virus Research. https://doi.org/10.1016/j.virusres.2021.198442

• A series of 5 cases of herpes zoster reactivation were observed among a healthcare worker cohort in Spain that received at least the first dose of the Pfizer-BioNTech vaccine (n=3,707) over a period of four weeks. Three patients presented with herpes zoster after the first dose, while two presented after the second dose. All patients were young, healthy adults with no blood count abnormalities. Compared to a background herpes zoster incidence of 249-359 cases per 100,000 person-years, the incidence in this case series would correspond to 1,995 cases per 100,000 person-years.

Rodríguez-Jiménez et al. (Apr 17, 2021). Varicella-Zoster Virus Reactivation after SARS-Cov2 BNT162b2 MRNA Vaccination: Report of Five Cases. JAAD Case Reports. https://doi.org/10.1016/j.jdcr.2021.04.014

• [Pre-print, not peer-reviewed] A study using two standardized, functional assays to measure memory T cell immunity to SARS-CoV-2 found that individuals vaccinated with the COVID-19 mRNA vaccines (n=29) mounted a more robust T cell response than convalescent patients (n=19) or healthy controls with no prior infection (n=25). The assay was based upon the “Quantiferon Gold” test for tuberculosis and measured secreted interferon gamma. T cell responses among vaccinated individuals to variants of concern B.1.1.7, B.1.351, and B.1.1.248 were detected but diminished, with median responses lower though not statistically significant among those receiving the Pfizer-BioNTech vaccine than the Moderna vaccine.

Gallagher et al. (May 3, 2021). SARS -CoV-2 T-Cell Immunity to Variants of Concern Following Vaccination. Pre-print downloaded May 4 from https://doi.org/10.1101/2021.05.03.442455

• Incidence of SARS-CoV-2 infection was 95% lower among persons with prior SARS-CoV-2 infection, indicated by seropositivity, in a cohort study in Qatar. In the study, 129 of 43,044 seropositive persons (0.3%) followed for a median of 16 weeks had at least one positive PCR test supported by evidence of reinfection at least 14 days after their first antibody-positive test, corresponding to an estimated incidence of reinfection of 0.66 cases per 10,000 person weeks. By contrast, 3,185 of 149,923 (2.1%) persons seronegative at baseline followed for a median of 17 weeks had at least one positive PCR, corresponding to 14 cases per 10,000 person-weeks.

Abu-Raddad et al. (May 27, 2021). SARS-CoV-2 antibody-positivity protects against reinfection for at least seven months with 95% efficacy. EClinicalMedicine. https://doi.org/10.1016/j.eclinm.2021.100861

• [Pre-print, not peer-reviewed] In an in vitro human organoid system, the SARS-CoV-2 B.1.1.7 variant was shown to produce higher levels of infectious virus late in infection and higher replicative fitness in human airway, alveolar, and intestinal organoid models compared to the ancestral strain.

Lamers et al. (May 3, 2021). Human Organoid Systems Reveal in Vitro Correlates of Fitness for SARS-CoV-2 B.1.1.7. Pre-print downloaded May 4 from https://doi.org/10.1101/2021.05.03.441080

• A transmission model of a pre-K-12 US school setting found that even in the context of low community incidence of SARS-CoV-2, mitigation strategies and contact tracing with a net effectiveness of 27% could result in 75% of the school population being infected within 6 months. The model is based on the CDC COVIDTracer modeling tool. Improving mitigation strategies to be 69% effective could result in less than 0.9% of the school population being infected. Even in this scenario, substantial importation from a community with high incidence could result in infections in up to 20% of the school population. Across all scenarios of mitigation strategies and community incidence, hospitalizations did not exceed 0.5% of the school population.

Miller et al. (Apr 30, 2021). Modeling the Transmission of Covid-19. Journal of Public Health Management and Practice. https://doi.org/10.1097/PHH.0000000000001373

• Among 350 women admitted for delivery at a safety net hospital in Maricopa County, Arizona in July 2020, women with refugee status (n=45) had a 2-fold higher prevalence of PCR-positive SARS-CoV-2 infection compared to nonrefugee patients (18% vs 9%).

Johnson-Agbakwu et al. (Mar 21, 2021). Severe Acute Respiratory Syndrome Coronavirus 2: A Canary in the Coal Mine for Public Safety Net Hospitals. AJOG Global Reports. https://doi.org/10.1016/j.xagr.2021.100009