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January 11, 2022

Clinical outcomes among patients infected with Omicron (B.1.1.529) SARS-CoV-2 variant in southern California

Rates of ICU admission and mortality after an outpatient positive test were 0.26 (0.10-0.73) and 0.09 (0.01-0.75) fold as high among cases with Omicron variant infection as compared to cases with Delta variant infection. Zero cases with Omicron variant infection received mechanical ventilation, as compared to 11 cases with Delta variant infections throughout the period of follow-up (two-sided p<0.001). Median duration of hospital stay was 3.4 (2.8-4.1) days shorter for hospitalized cases with Omicron variant infections as compared to hospitalized patients with Delta variant infections, reflecting a 69.6% (64.0-74.5%) reduction in hospital length of stay. Conclusions: During a period with mixed Delta and Omicron variant circulation, SARS-CoV-2 infections with presumed Omicron variant infection were associated with substantially reduced risk of severe clinical endpoints and shorter durations of hospital stay.

Plasma SARS-CoV-2 RNA levels as a biomarker of lower respiratory tract SARS-CoV-2 infection in critically ill patients with COVID-19.

Plasma SARS-CoV-2 viral RNA (vRNA) levels are predictive of COVID-19 outcomes in hospitalized patients, but whether plasma vRNA reflects lower respiratory tract (LRT) vRNA levels is unclear. We compared plasma and LRT vRNA levels in simultaneously collected longitudinal samples from mechanically-ventilated patients with COVID-19. LRT and plasma vRNA levels were strongly correlated at first sampling (r=0.83, p<10-8) and then declined in parallel except in non-survivors who exhibited delayed vRNA clearance in LRT samples. Plasma vRNA measurement may offer a practical surrogate of LRT vRNA burden in critically ill patients, especially early in severe disease.

January 10, 2022

Mild respiratory SARS-CoV-2 infection can cause multi-lineage cellular dysregulation and myelin loss in the brain

Humans experiencing long-COVID with cognitive symptoms (48 subjects) similarly demonstrate elevated CCL11 levels compared to those with long-COVID who lack cognitive symptoms (15 subjects). Impaired hippocampal neurogenesis, decreased oligodendrocytes and myelin loss in subcortical white matter were evident at 1 week, and persisted until at least 7 weeks, following mild respiratory SARS-CoV-2 infection in mice. Taken together, the findings presented here illustrate striking similarities between neuropathophysiology after cancer therapy and after SARS-CoV-2 infection, and elucidate cellular deficits that may contribute to lasting neurological symptoms following even mild SARS-CoV-2 infection.

The Dynamics of SARS-CoV-2 Infectivity with Changes in Aerosol Microenvironment

The aerosol microenvironment is highly dynamic exposing pathogens, such as the SARS-CoV-2 virus when exhaled in respiratory aerosol, to extreme conditions of solute concentration, pH and evaporative cooling. Yet surviving this environment is a key step in the transmission of such pathogens. Understanding the impact that airborne transport has on pathogens and the influence of environmental conditions on pathogen survival can inform the implementation of strategies to mitigate the spread of diseases such as COVID-19. We report changes in the infectivity of the airborne virus over timescales spanning from 5 s to 20 minutes and demonstrate the role of two microphysical processes in this infectivity loss: particle crystallisation and aerosol droplet pH change.

Cross-reactive memory T cells associate with protection against SARS-CoV-2 infection in COVID-19 contacts

Our results are thus consistent with pre-existing non-spike cross-reactive memory T cells protecting SARS-CoV-2-naïve contacts from infection, thereby supporting the inclusion of non-spike antigens in second-generation vaccines.

January 7, 2022

Rapid Diagnostic Testing for SARS-CoV-2

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations.

Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12–18 Years — United States, July–December 2021

Receipt of 2 doses of Pfizer-BioNTech vaccine is highly effective in preventing MIS-C in persons aged 12–18 years. These findings further reinforce the COVID-19 vaccination recommendation for eligible children.

Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 years — United States, March 1, 2020–June 28, 2021

The increased diabetes risk among persons aged <18 years following COVID-19 highlights the importance of COVID-19 prevention strategies in this age group, including vaccination for all eligible persons and chronic disease prevention and treatment.

Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa

Here, we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity.

False-Positive Results in Rapid Antigen Tests for SARS-CoV-2

The overall rate of false-positive results among the total rapid antigen test screens for SARS-CoV-2 was very low, consistent with other, smaller studies. The cluster of false-positive results from 1 batch was likely the result of manufacturing issues rather than implementation. These results inform the discussion of whether rapid antigen tests will result in too many false-positives that could overwhelm PCR testing capacity in other settings. Also, the results demonstrate the importance of having a comprehensive data system to quickly identify potential issues. With the ability to identify batch issues within 24 hours, workers could return to work, problematic test batches could be discarded, and the public health authorities and manufacturer could be informed. Aside from issues with the batch, false-positives are possible due to the timing of the test (ie, too early or too late in the infectious stage) or quality issues in how the self-test was completed.

SARS-CoV-2 Antibody Response to 2 or 3 Doses of the BNT162b2 Vaccine in Patients Treated With Anticancer Agents

In this cohort study including 163 patients, a third vaccine dose strengthened the immune response in 75% of the patients treated with chemotherapy or targeted therapy presenting a weak humoral response after the second dose. The data of this study appear to support the use of a third vaccine dose as a booster dose among patients with active cancer treatment for solid tumors.

January 6, 2022

A mighty antibody is the bane of multiple coronaviruses

A newly isolated antibody that blocks SARS-CoV-2 from infecting cells could one day be used to treat infections caused by current and future variants of the virus that causes COVID-19, and even infections from related viruses.

A National Strategy for COVID-19 Medical Countermeasures

The US needs a strategy for a “new normal” of living that includes COVID-19. This “new normal” will occur when total respiratory viral infections, hospitalizations, and deaths inclusive of those from COVID-19 are no higher than what typically occurred in the most severe influenza years before the current pandemic. Integral to achieving and sustaining this “new normal” are both faster development and more efficient deployment of vaccines and therapeutics. While COVID-19 has ushered in new vaccine platforms, repurposed existing therapies, and stimulated rapid development of monoclonal antibody and oral antiviral treatments in record time, much remains to be done to ensure these life-saving medicines are accessible to all.

Comprehensive Chemosensory Psychophysical Evaluation of Self-reported Gustatory Dysfunction in Patients With Long-term COVID-19A Cross-sectional Study

It is widely believed that self-reported loss of taste can be an indirect consequence of retronasal olfactory dysfunction6; indeed, our study found that even when specifically asked about basic tastes, more than half of patients self-reporting an altered taste perception exhibited a normal gustatory function, while most of them had an olfactory impairment. However, 42% were found to have true hypogeusia. Following evaluation of the scores in relation to age, still 29% exhibited hypogeusia, which has largely been overlooked to date. While olfactory training may help the former group, additional strategies may be needed for those with gustatory impairment.

January 5, 2022

Effect of Covid-19 Vaccination on Transmission of Alpha and Delta Variants

Vaccination was associated with a smaller reduction in transmission of the delta variant than of the alpha variant, and the effects of vaccination decreased over time. PCR Ct values at diagnosis of the index patient only partially explained decreased transmission.

January 4, 2022

Receipt of COVID-19 Vaccine During Pregnancy and Preterm or Small-for-Gestational-Age at Birth — Eight Integrated Health Care Organizations, United States, December 15, 2020–July 22, 2021

These data support the safety of COVID-19 vaccination during pregnancy. CDC recommends COVID-19 vaccination for women who are pregnant, recently pregnant, who are trying to become pregnant now, or who might become pregnant in the future.

Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection

In this cohort study of 255 infants born between March and December 2020, exposure to maternal SARS-CoV-2 infection was not associated with differences on any Ages & Stages Questionnaire, 3rd Edition, subdomain at age 6 months, regardless of infection timing or severity. However, both exposed and unexposed infants born during that period had significantly lower scores on gross motor, fine motor, and personal-social subdomains compared with a historical cohort of infants born before the onset of the COVID-19 pandemic.

Understanding the Effects of the Pandemic on Infant Development—The Preterm Problem

As the COVID-19 pandemic grinds toward the end of another year, it makes sense to wonder about the effect on children conceived and born in its shadow. Some of the consequences can be seen in the increasing rates of COVID-19 among infants and young children, particularly among those with comorbid medical conditions. But we must also consider less obvious sequelae: are infants born during the pandemic at greater risk for behavioral or neurodevelopmental problems, either due to exposure to maternal SARS-CoV-2 infection or to the more global effects of trauma and stress? Pregnant women and their infants are vulnerable to the effects of disasters, and evidence suggests that disaster affects maternal mental health and some perinatal health outcomes, particularly among highly exposed women. Prenatal exposure to some viral infections, such as rubella and HIV, increases the risk of neurobehavioral problems in children, and some have hypothesized that SARS-CoV-2 infection could have a similar outcome via in utero exposure to maternal fever, hypoxia, or inflammation.

COVID-19 Deaths Helped Drive Largest Drop in US Life Expectancy in More than 75 Years

Mortality rates for US residents 15 years or older increased sharply in 2020, fueled by nearly 351 000 deaths attributed to COVID-19 during the year. As a result, average US life expectancy at birth declined by nearly 2 years from that in 2019, according to a data brief from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

Persistent hesitancy for SARS-CoV-2 vaccines among healthcare workers in the United Kingdom: analysis of longitudinal data from the UK-REACH cohort study

Healthcare workers (HCWs) in the United Kingdom (UK) have been prioritised in the SARS-CoV-2 vaccination agenda, including the ongoing booster programme. We previously reported that 23% of 11,584 HCWs who completed the baseline UK-REACH (UK Research study into Ethnicity And Covid-19 outcomes in Healthcare workers) cohort study questionnaire were hesitant about receiving a SARS-CoV-2 vaccine between 4th December 2020 and 28th February 2021. Vaccine hesitancy was more likely amongst certain ethnic minority groups and was associated with lower trust in employing healthcare organisations and in vaccines themselves. HCWs who were hesitant also reported concerns about vaccine safety and side effects, especially given the speed of vaccine development and roll-out, and expressed a desire to delay vaccination until more people had been vaccinated.

January 3, 2022

Psychological Predictors of Self-reported COVID-19 Outcomes: Results From a Prospective Cohort Study

COVID-19 infection and symptoms may be more common among those experiencing elevated psychological distress. Further research to elucidate the mechanisms underlying these associations is needed.

January 1, 2022

COVID-19 vaccine hesitancy and media channel use in Japan: could media campaigns be a possible solution?

As coronavirus disease 2019 (COVID-19) vaccination is undoubtedly a key to controlling the transmission of COVID-19, owing to its effectiveness, increasing the willingness to receive COVID-19 vaccines is a crucial mission for both vaccine coverage and subsequent global infection control. In this context, COVID-19 vaccine hesitancy, the reluctance to receive COVID-19 vaccines, has become a significant growing public health concern. Although COVID-19 vaccine hesitancy varies across cultural and geographical contexts, general mistrust for vaccines and fear of future adverse events are major concerns among the hesitant. Such mistrust, fear, and the unwillingness to vaccinate, based on misinformation or disinformation, are often cultivated by mass and social media. Since individuals generally use multiple media channels, identifying specific media use, including combinations of media use among the hesitant, is essential to prevent the development of COVID-19 vaccine hesitancy.

Caution required with use of ritonavir-boosted PF-07321332 in COVID-19 management

We read with interest the news that the UK Government has announced deals to procure the oral antivirals for SARS-CoV-2, molnupiravir (Lagevrio, Merck [Branchburg, NJ, USA]) and ritonavir in combination with PF-07321332 (Paxlovid, Pfizer [New York, NY, USA]). Although we welcome further partnership between the government and pharmaceutical industry in the provision of effective agents to manage the COVID-19 pandemic, we urge caution with the widescale use of ritonavir, given its propensity for causing clinically significant drug–drug interactions with commonly prescribed and over-the-counter medications.

December 31, 2021

COVID-19 Vaccine Safety in Children Aged 5–11 Years — United States, November 3–December 19, 2021

Parents and guardians of children aged 5–11 years should be advised that local and systemic reactions are expected after vaccination with Pfizer-BioNTech COVID-19 vaccine and are more common after the second dose.

Interim Estimate of Vaccine Effectiveness of BNT162b2 (Pfizer-BioNTech) Vaccine in Preventing SARS-CoV-2 Infection Among Adolescents Aged 12–17 Years — Arizona, July–December 2021

In real-world conditions among adolescents aged 12–17 years, the Pfizer-BioNTech vaccine was highly effective in preventing SARS-CoV-2 infection.

Characteristics and Clinical Outcomes of Children and Adolescents Aged <18 Years Hospitalized with COVID-19 — Six Hospitals, United States, July–August 2021

COVID-19 vaccination and other prevention strategies are important to protect children from COVID-19, particularly children with obesity and other underlying health conditions.

Activity of convalescent and vaccine serum against SARS-CoV-2 Omicron

Here, we investigated the neutralizing and binding activity of sera from convalescent, mRNA double vaccinated, mRNA boosted, convalescent double vaccinated, and convalescent boosted individuals against wild type, B.1.351 and B.1.1.529 SARS-CoV-2 isolates. Neutralizing activity of sera from convalescent and double vaccinated participants was undetectable to very low against B.1.1.529 while neutralizing activity of sera from individuals who had been exposed to spike three or four times was maintained, albeit at significantly reduced levels. Binding to the B.1.1.529 receptor binding domain (RBD) and N-terminal domain (NTD) was reduced in convalescent not vaccinated individuals, but was mostly retained in vaccinated individuals.

December 30, 2021

Plasma Neutralization of the SARS-CoV-2 Omicron Variant

The newly emerged B.1.1.159 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a large number of changes — 32 — in its spike protein relative to that of the original virus (Wuhan-hu-1), particularly in the receptor-binding domain and the N-terminal domain, the primary targets of neutralizing antibodies. Previously, we showed that approximately 20 changes introduced into a synthetic polymutant spike protein (PMS20) are sufficient for substantial evasion of the polyclonal neutralizing antibodies elicited in the majority of persons who have recovered from coronavirus disease 2019 (Covid-19) or have received two doses of an mRNA vaccine. Of note, several changes in the PMS20 spike protein are the same as or similar to changes in the omicron variant.

Paradoxical sex-specific patterns of autoantibody response to SARS-CoV-2 infection

Our results reveal that prior SARS-CoV-2 infection, even in the absence of severe clinical disease, can lead to a broad AAB response that exhibits sex-specific patterns of prevalence and antigen selectivity. Further understanding of the nature of triggered AAB activation among men and women exposed to SARS-CoV-2 will be essential for developing effective interventions against immune-mediated sequelae of COVID-19.

December 29, 2021

Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa

Thus, during the proxy omicron period, we saw a maintenance of effectiveness of the BNT162b2 vaccine (albeit at a reduced level) against hospital admission for Covid-19 that was presumed to have been caused by the omicron variant as compared with the rate associated with the delta variant earlier in the year. The addition of a booster dose of vaccine may mitigate this reduction in vaccine effectiveness.

Third BNT162b2 Vaccination Neutralization of SARS-CoV-2 Omicron Infection

Nevertheless, we found low neutralization efficiency with two doses of the BNT162b2 vaccine against the wild-type virus and the delta variant, assessed more than 5 months after receipt of the second dose, and no neutralization efficiency against the omicron variant. The importance of a third vaccine dose is clear, owing to the higher neutralization efficiency (by a factor of 100) against the omicron variant after the third dose than after the second dose; however, even with three vaccine doses, neutralization against the omicron variant was lower (by a factor of 4) than that against the delta variant. The durability of the effect of the third dose of vaccine against Covid-19 is yet to be determined.

Emergence in Southern France of a new SARS-CoV-2 variant of probably Cameroonian origin harbouring both substitutions N501Y and E484K in the spike protein

Fourteen amino acid substitutions, including N501Y and E484K, and 9 deletions are located in the spike protein. This genotype pattern led to create a new Pangolin lineage named B.1.640.2, which is a phylogenetic sister group to the old B.1.640 lineage renamed B.1.640.1. Both lineages differ by 25 nucleotide substitutions and 33 deletions. The mutation set and phylogenetic position of the genomes obtained here indicate based on our previous definition a new variant we named “IHU”. These data are another example of the unpredictability of the emergence of SARS-CoV-2 variants, and of their introduction in a given geographical area from abroad.

December 28, 2021

Investigation of a SARS-CoV-2 B.1.1.529 (Omicron) Variant Cluster — Nebraska, November–December 2021

The B.1.1.529 (Omicron) variant of SARS-CoV-2 (the virus that causes COVID-19) was first detected in specimens collected on November 11, 2021, in Botswana and on November 14 in South Africa; the first confirmed case of Omicron in the United States was identified in California on December 1, 2021 (1). On November 29, the Nebraska Department of Health and Human Services was notified of six probable cases of COVID-19 in one household, including one case in a man aged 48 years (the index patient) who had recently returned from Nigeria.

December 23, 2021

Efficacy and safety of two neutralising monoclonal antibody therapies, sotrovimab and BRII-196 plus BRII-198, for adults hospitalised with COVID-19 (TICO): a randomised controlled trial

Neither sotrovimab nor BRII-196 plus BRII-198 showed efficacy for improving clinical outcomes among adults hospitalised with COVID-19.

Considerable escape of SARS-CoV-2 Omicron to antibody neutralization

Omicron was totally or partially resistant to neutralization by all mAbs tested. Sera from Pfizer or AstraZeneca vaccine recipients, sampled 5 months after complete vaccination, barely inhibited Omicron. Sera from COVID-19 convalescent patients collected 6 or 12 months post symptoms displayed low or no neutralizing activity against Omicron. Administration of a booster Pfizer dose as well as vaccination of previously infected individuals generated an anti-Omicron neutralizing response, with titers 6 to 23 fold lower against Omicron than against Delta. Thus, Omicron escapes most therapeutic monoclonal antibodies and to a large extent vaccine-elicited antibodies. Omicron remains however neutralized by antibodies generated by a booster vaccine dose.

Evolution of enhanced innate immune evasion by SARS-CoV-2

Here we used unbiased abundance proteomics, phosphoproteomics, RNAseq and viral replication assays to show that isolates of the Alpha (B.1.1.7) variant more effectively suppress innate immune responses in airway epithelial cells, compared to first wave isolates. We found that Alpha has dramatically increased subgenomic RNA and protein levels of N, Orf9b and Orf6, all known innate immune antagonists. Expression of Orf9b alone suppressed the innate immune response through interaction with TOM70, a mitochondrial protein required for RNA sensing adaptor MAVS activation. Moreover, the activity of Orf9b and its association with TOM70 was regulated by phosphorylation. We propose that more effective innate immune suppression, through enhanced expression of specific viral antagonist proteins, increases the likelihood of successful Alpha transmission, and may increase in vivo replication and duration of infection. The importance of mutations outside Spike in adaptation of SARS-CoV-2 to humans is underscored by the observation that similar mutations exist in the Delta and Omicron N/Orf9b regulatory regions.

Striking Antibody Evasion Manifested by the Omicron Variant of SARS-CoV-2

By evaluating a panel of monoclonal antibodies to all known epitope clusters on the spike protein, we noted that the activity of 17 of the 19 antibodies tested were either abolished or impaired, including ones currently authorized or approved for use in patients. In addition, we also identified four new spike mutations (S371L, N440K, G446S, and Q493R) that confer greater antibody resistance to B.1.1.529. The Omicron variant presents a serious threat to many existing COVID-19 vaccines and therapies, compelling the development of new interventions that anticipate the evolutionary trajectory of SARS-CoV-2.

Omicron escapes the majority of existing SARS-CoV-2 neutralizing antibodies

In total, over 85% of the tested NAbs are escaped by Omicron. Regarding NAb drugs, the neutralization potency of LY-CoV016/LY-CoV555, REGN10933/REGN10987, AZD1061/AZD8895, and BRII-196 were greatly reduced by Omicron, while VIR-7831 and DXP-604 still function at reduced efficacy. Together, data suggest Omicron would cause significant humoral immune evasion, while NAbs targeting the sarbecovirus conserved region remain most effective. Our results offer instructions for developing NAb drugs and vaccines against Omicron and future variants.

Evolution of enhanced innate immune evasion by SARS-CoV-2

Expression of Orf9b alone suppressed the innate immune response through interaction with TOM70, a mitochondrial protein required for RNA sensing adaptor MAVS activation. Moreover, the activity of Orf9b and its association with TOM70 was regulated by phosphorylation. We propose that more effective innate immune suppression, through enhanced expression of specific viral antagonist proteins, increases the likelihood of successful Alpha transmission, and may increase in vivo replication and duration of infection4. The importance of mutations outside Spike in adaptation of SARS-CoV-2 to humans is underscored by the observation that similar mutations exist in the Delta and Omicron N/Orf9b regulatory regions.

SARS-CoV-2 infection in free-ranging white-tailed deer

The B.1.2 viruses, dominant in humans in Ohio at the time, infected deer in four locations. Probable deer-to-deer transmission of B.1.2, B.1.582, and B.1.596 viruses was observed, allowing the virus to acquire amino acid substitutions in the spike protein (including the receptor-binding domain) and ORF1 that are infrequently seen in humans. No spillback to humans was observed, but these findings demonstrate that SARS-CoV-2 viruses have the capacity to transmit in US wildlife, potentially opening new pathways for evolution. There is an urgent need to establish comprehensive “One Health” programs to monitor deer, the environment, and other wildlife hosts globally.

Considerable escape of SARS-CoV-2 Omicron to antibody neutralization

Omicron was totally or partially resistant to neutralization by all mAbs tested. Sera from Pfizer or AstraZeneca vaccine recipients, sampled 5 months after complete vaccination, barely inhibited Omicron. Sera from COVID-19 convalescent patients collected 6 or 12 months post symptoms displayed low or no neutralizing activity against Omicron. Administration of a booster Pfizer dose as well as vaccination of previously infected individuals generated an anti-Omicron neutralizing response, with titers 6 to 23 fold lower against Omicron than against Delta. Thus, Omicron escapes most therapeutic monoclonal antibodies and to a large extent vaccine-elicited antibodies. Omicron remains however neutralized by antibodies generated by a booster vaccine dose.

Omicron extensively but incompletely escapes Pfizer BNT162b2 neutralization

Neutralization of ancestral virus was much higher in infected and vaccinated versus vaccinated only participants but both groups showed a 22-fold escape from vaccine elicited neutralization by the Omicron variant. However, in the previously infected and vaccinated group, the level of residual neutralization of Omicron was similar to the level of neutralization of ancestral virus observed in the vaccination only group. These data support the notion that, provided high neutralization capacity is elicited by vaccination/boosting approaches, reasonable effectiveness against Omicron may be maintained.

BNT162b2 Vaccine Booster and Mortality Due to Covid-19

A total of 843,208 participants met the eligibility criteria, of whom 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day). The adjusted hazard ratio for death due to Covid-19 in the booster group, as compared with the nonbooster group, was 0.10 (95% confidence interval, 0.07 to 0.14; P<0.001).

Protection against Covid-19 by BNT162b2 Booster across Age Groups

Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.

mRNA-based COVID-19 vaccine boosters induce neutralizing immunity against SARS-CoV-2 Omicron variant

Recent surveillance has revealed the emergence of the SARS-CoV-2 Omicron variant (BA.1/B.1.1.529) harboring up to 36 mutations in spike protein, the target of neutralizing antibodies. Given its potential to escape vaccine-induced humoral immunity, we measured the neutralization potency of sera from 88 mRNA-1273, 111 BNT162b, and 40 Ad26.COV2.S vaccine recipients against wild-type, Delta, and Omicron SARS-CoV-2 pseudoviruses. We included individuals that received their primary series recently (<3 months), distantly (6–12 months), or an additional “booster” dose, while accounting for prior SARS-CoV-2 infection. Remarkably, neutralization of Omicron was undetectable in most vaccinees. However, individuals boosted with mRNA vaccines exhibited potent neutralization of Omicron, only 4–6-fold lower than wild type, suggesting enhanced cross-reactivity of neutralizing antibody responses. In addition, we find that Omicron pseudovirus infects more efficiently than other variants tested. Overall, this study highlights the importance of additional mRNA doses to broaden neutralizing antibody responses against highly divergent SARS-CoV-2 variants.

December 22, 2021

Anti-spike antibodies and neutralising antibody activity in people living with HIV vaccinated with COVID-19 mRNA-1273 vaccine: a prospective single-centre cohort study

In our cohort of PLWHIV with well-controlled ART, stable viral suppression and robust CD4+ T cell count, inoculation with mRNA-1273 vaccine given 4 weeks apart produced detectable humoral immune response, similar to individuals without HIV infection, supporting vaccination in PLWHIV.

Immune escape of SARS-CoV-2 Omicron variant from mRNA vaccination-elicited RBD-specific memory B cells

Memory B cells (MBCs) represent a second layer of immune protection against SARS-CoV-2. Whether MBCs elicited by mRNA vaccines can recognize the Omicron variant is of major concern. We used bio-layer interferometry to assess the affinity against the receptor-binding-domain (RBD) of Omicron spike of 313 naturally expressed monoclonal IgG that were previously tested for affinity and neutralization against VOC prior to Omicron. We report here that Omicron evades recognition from a larger fraction of these antibodies than any of the previous VOCs. Additionally, whereas 30% of these antibodies retained high affinity against Omicron-RBD, our analysis suggest that Omicron specifically evades antibodies displaying potent neutralizing activity against the D614G and Beta variant viruses. Further studies are warranted to understand the consequences of a lower memory B cell potency on the overall protection associated with current vaccines.

Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: A Danish cohort study

Our study provides evidence of protection against infection with the Omicron variant after completion of a primary vaccination series with the BNT162b2 or mRNA-1273 vaccines; in particular, we found a VE against the Omicron variant of 55.2% (95% confidence interval (CI): 23.5 to 73.7%) and 36.7% (95% CI: 69.9 to 76.4%) for the BNT162b2 and mRNA-1273 vaccines, respectively, in the first month after primary vaccination. However, the VE is significantly lower than that against Delta infection and declines rapidly over just a few months. The VE is re-established upon revaccination with the BNT162b2 vaccine (54.6%, 95% CI: 30.4 to 70.4%).

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients

Among nonhospitalized patients who were at high risk for Covid-19 progression, a 3-day course of remdesivir had an acceptable safety profile and resulted in an 87% lower risk of hospitalization or death than placebo

December 21, 2021

Randomized Controlled Trial of Early Outpatient COVID-19 Treatment with High-Titer Convalescent Plasma

Early administration of high titer SARS-CoV-2 convalescent plasma reduced outpatient hospitalizations by more than 50%. High titer convalescent plasma is an effective early outpatient COVID-19 treatment with the advantages of low cost, wide availability, and rapid resilience to variant emergence from viral genetic drift in the face of a changing pandemic.

Numerical investigation of droplets in a cross-ventilated space with sitting passengers under asymptomatic virus transmission conditions

A domain with three sitting female passengers was defined. Dynamics of droplets released from the mouth of the different passengers during the vocalization of vowel /ɑ/ were investigated in detail. For the conditions evaluated, the droplets were initially driven by the exhaled jet and buoyancy and mainly occupied the back region of a hypothetical front row. This effect was more noticeable when droplets were released from positions closer to the ventilation system such as window and middle seat positions. The droplets from the passenger located farthest from the ventilation inlet, such as the one in the aisle, were more affected by the flow from the beginning of the exhalation, and many of the droplets were initially moved to the bottom of the domain. The droplets then encountered primary and secondary flows, which were responsible for the longitudinal and transverse migration. The combination of both these effects made local particle concentrations lower near the mouth or nose regions of other occupants, at the expense of contaminating other rows. Between 19.5% and 27.4% of drops were removed through the outlet during the first 40 s and none of the droplets hit the mouth of the passengers. During their trajectory, the distance of drops to the mouth of the passengers was evaluated, showing that the majority of them passed at a relatively safe distance. However, a few of them passed at a close distance of the order of magnitude of 1 cm.

Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories

The marked magnitude and global scale of immunisation disruption evokes the dangers of vaccine-preventable disease outbreaks in the future. Trends indicating partial resumption of services highlight the urgent need for ongoing assessment of recovery, catch-up vaccination strategy implementation for vulnerable populations, and ensuring vaccine coverage equity and health system resilience.

Responses to a Neutralizing Monoclonal Antibody for Hospitalized Patients With COVID-19 According to Baseline Antibody and Antigen Levels

Efficacy and safety of bamlanivimab may differ depending on whether an endogenous nAb response has been mounted. The limited sample size of the study does not allow firm conclusions based on these findings, and further independent trials are required that assess other types of passive immune therapies in the same patient setting.

December 20, 2021

Two-dose ChAdOx1 nCoV-19 vaccine protection against COVID-19 hospital admissions and deaths over time: a retrospective, population-based cohort study in Scotland and Brazil

We found waning vaccine protection of ChAdOx1 nCoV-19 against COVID-19 hospital admissions and deaths in both Scotland and Brazil, this becoming evident within three months of the second vaccine dose. Consideration needs to be given to providing booster vaccine doses for people who have received ChAdOx1 nCoV-19.

December 17, 2021

Evaluation of Test to Stay Strategy on Secondary and Tertiary Transmission of SARS-CoV-2 in K–12 Schools — Lake County, Illinois, August 9–October 29, 2021

During fall 2021, 90 Lake County, Illinois, schools implemented Test to Stay (TTS), permitting eligible close contacts with masked COVID-19 exposures to remain in school. Secondary transmission among TTS participants was 1.5%; no tertiary transmission was observed among school-based contacts; however, tertiary cases were identified among household contacts. Implementation of TTS preserved up to 8,152 in-person learning days. Although vaccination remains the leading recommendation to protect against COVID-19, TTS allows close contacts to remain in the classroom as an alternative to home quarantine.

Evaluation of a Test to Stay Strategy in Transitional Kindergarten Through Grade 12 Schools — Los Angeles County, California, August 16–October 31, 2021

One in five LAC public schools adopted TTS. In TTS schools, student case rates did not increase, and tertiary transmission was not identified. A higher percentage of disadvantaged schools did not implement TTS. TTS does not appear to increase transmission risk in public schools and might greatly reduce loss of in-person school days. Implementation requires resources that might be currently unavailable for some schools. Vaccination remains the leading recommendation to protect against COVID-19; TTS allows students with a school exposure to remain in the classroom as an alternative to home quarantine.

Report of Health Care Provider Recommendation for COVID-19 Vaccination Among Adults, by Recipient COVID-19 Vaccination Status and Attitudes — United States, April–September 2021

Adults who reported a provider COVID-19 vaccination recommendation were more likely to have been vaccinated, to be concerned about COVID-19, to have confidence that COVID-19 vaccines are important and safe, and to perceive that family and friends had been vaccinated. A health care provider recommendation for COVID-19 vaccines at every visit could increase coverage and confidence in vaccines, particularly among groups with lower COVID-19 vaccination coverage, including younger adults, racial/ethnic minorities, and rural residents.

December 16, 2021

Report 49: Growth, population distribution and immune escape of Omicron in England

We find strong evidence of immune evasion, both from natural infection, where the risk of reinfection
is 5.41 (95% CI: 4.87-6.00) fold higher for Omicron than for Delta, and from vaccine-induced
protection. Our VE estimates largely agree with those from UKHSA’s TNCC study (11) and predictions
from predicting VE from neutralising antibody titres (4,14), suggesting very limited remaining
protection against symptomatic infection afforded by two doses of AZ, low protection afforded by two doses of Pfizer, but moderate to high (55-80%) protection in people boosted with an mRNA vaccine.

We find no evidence (for both risk of hospitalisation attendance and symptom status) of Omicron
having different severity from Delta, though data on hospitalisations are still very limited.

Our analysis reinforces the still emerging but increasingly clear picture that Omicron poses an

immediate and substantial threat to public health in England and more widely.

Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients

Early treatment with molnupiravir reduced the risk of hospitalization or death in at-risk, unvaccinated adults with Covid-19.

Molnupiravir — A Step toward Orally Bioavailable Therapies for Covid-19

The Covid-19 pandemic has resulted in substantial global morbidity and mortality as well as disruption of the economies of virtually every country. Some of this tragedy could have been averted with the development of deliverable, orally bioavailable, direct-acting antiviral therapeutics. Molnupiravir, the orally bioavailable prodrug of N4-hydroxycytidine (NHC), begins to address this need.

Omicron blindspots: why it’s hard to track coronavirus variants

Researchers are racing to detect Omicron, the latest SARS-CoV-2 variant of concern, by sequencing the genomes of coronaviruses infecting people. But surveillance through genomic sequencing can be slow and patchy, complicating the picture of how and where Omicron spreads.

Modeling the onset of symptoms of COVID-19: Effects of SARS-CoV-2 variant

We developed a mathematical model to predict symptom order of symptomatic COVID-19 cases from patient characteristics data in the USA and China. Surprisingly, our model predicted that cough occurs first in the USA, while fever occurs first in China.

COVID-19 trends and severity among symptomatic children aged 0–17 years in 10 European Union countries, 3 August 2020 to 3 October 2021 separator

Understanding the burden of coronavirus disease (COVID-19) among children is essential for evidence-based decision-making regarding the vaccination of children and for assessing the importance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mitigation measures in specific settings, such as schools. Here, we report on the burden and severity of symptomatic notified COVID-19 cases among children in the European Union (EU)

December 15, 2021

HKUMed finds Omicron SARS-CoV-2 can infect faster and better than Delta in human bronchus but with less severe infection in lung

A study led by researchers from the LKS Faculty of Medicine at The University of Hong Kong (HKUMed) provides the first information on how the novel Variant of Concern (VOC) of SARS-CoV-2, the Omicron SARS-CoV-2 infect human respiratory tract. The researchers found that Omicron SARS-CoV-2 infects and multiplies 70 times faster than the Delta variant and original SARS-CoV-2 in human bronchus, which may explain why Omicron may transmit faster between humans than previous variants. Their study also showed that the Omicron infection in the lung is significantly lower than the original SARS-CoV-2, which may be an indicator of lower disease severity. This research is currently under peer review for publication.

Booster of mRNA-1273 Vaccine Reduces SARS-CoV-2 Omicron Escape from Neutralizing Antibodies

The Omicron variant of SARS-CoV-2 is raising concerns because of its increased transmissibility and potential for reduced susceptibility to antibody neutralization. To assess the potential risk of this variant to existing vaccines, serum samples from mRNA-1273 vaccine recipients were tested for neutralizing activity against Omicron and compared to neutralization titers against D614G and Beta in a pseudovirus assay in two different laboratories. Omicron was 49-84-fold less sensitive to neutralization than D614G and 5.3-6.2-fold less sensitive than Beta when assayed with serum samples obtained 4 weeks after 2 standard inoculations with 100 µg mRNA-1273. A 50 µg boost increased Omicron neutralization titers and may substantially reduce the risk of symptomatic vaccine breakthrough infections.

Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial

In patients at high risk discharged after hospitalisation due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis.

Spatial epidemiology and genetic diversity of SARS-CoV-2 and related coronaviruses in domestic and wild animals

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) showed susceptibility to diverse animal species. We conducted this study to understand the spatial epidemiology, genetic diversity, and statistically significant genetic similarity along with per-gene recombination events of SARS-CoV-2 and related viruses (SC2r-CoVs) in animals globally.

Universal Coronavirus Vaccines — An Urgent Need

The past 20 years have witnessed four fatal coronavirus outbreaks: SARS (severe acute respiratory syndrome, 2002 and 2003), MERS (Middle East respiratory syndrome, since 2012), and now Covid-19 (since 2019). Scientific evidence and ecologic reality suggest that coronaviruses will emerge again in the future, potentially posing an existential threat.

December 14, 2021

Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift

Here, we show that the Omicron RBD binds to human ACE2 with enhanced affinity relative to the Wuhan-Hu-1 RBD and acquires binding to mouse ACE2. Severe reductions of plasma neutralizing activity were observed against Omicron compared to the ancestral pseudovirus for vaccinated and convalescent individuals

mRNA-based COVID-19 vaccine boosters induce neutralizing immunity against SARS-
CoV-2 Omicron variant

Recent surveillance has revealed the emergence of the SARS-CoV-2 Omicron variant
(BA.1/B.1.1.529) harboring up to 36 mutations in spike protein, the target of vaccine-induced
neutralizing antibodies. Given its potential to escape vaccine-induced humoral immunity, we
measured neutralization potency of sera from 88 mRNA-1273, 111 BNT162b, and 40
Ad26.COV2.S vaccine recipients against wild type, Delta, and Omicron SARS-CoV-2
pseudoviruses. We included individuals that were vaccinated recently (<3 months), distantly (6-
12 months), or recently boosted, and accounted for prior SARS-CoV-2 infection. Remarkably,
neutralization of Omicron was undetectable in most vaccinated individuals. However, individuals
boosted with mRNA vaccines exhibited potent neutralization of Omicron only 4-6-fold lower than
wild type, suggesting that boosters enhance the cross-reactivity of neutralizing antibody
responses. In addition, we find Omicron pseudovirus is more infectious than any other variant
tested. Overall, this study highlights the importance of boosters to broaden neutralizing antibody
responses against highly divergent SARS-CoV-2 variants.

Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection

We found increased risks of myocarditis associated with the first dose of ChAdOx1 and BNT162b2 vaccines and the first and second doses of the mRNA-1273 vaccine over the 1–28 days postvaccination period, and after a SARS-CoV-2 positive test. We estimated an extra two (95% confidence interval (CI) 0, 3), one (95% CI 0, 2) and six (95% CI 2, 8) myocarditis events per 1 million people vaccinated with ChAdOx1, BNT162b2 and mRNA-1273, respectively, in the 28 days following a first dose and an extra ten (95% CI 7, 11) myocarditis events per 1 million vaccinated in the 28 days after a second dose of mRNA-1273. This compares with an extra 40 (95% CI 38, 41) myocarditis events per 1 million patients in the 28 days following a SARS-CoV-2 positive test. We also observed increased risks of pericarditis and cardiac arrhythmias following a positive SARS-CoV-2 test. Similar associations were not observed with any of the COVID-19 vaccines, apart from an increased risk of arrhythmia following a second dose of mRNA-1273.

Discovery Health, South Africa’s largest private health insurance administrator, releases at-scale, real-world analysis of Omicron outbreak based on 211 000 COVID-19 test results in South Africa, including collaboration with the South Africa

The Omicron variant of SARS-CoV-2 was first identified in Southern Africa during November 2021. It was brought to the world’s attention by scientists in South Africa and Botswana and declared a Variant of Concern by the World Health Organization shortly thereafter. South Africa experienced rapid community spread (concentrated in the Gauteng), dominated by the Omicron variant, fuelling South Africa’s fourth wave of COVID-19.

Latest on Omicron Variant and COVID-19 Vaccine Protection

There’s been great concern about the new Omicron variant of SARS-CoV-2, the coronavirus that causes COVID-19. A major reason is Omicron has accumulated over 50 mutations, including about 30 in the spike protein, the part of the coronavirus that mRNA vaccines teach our immune systems to attack. All of these genetic changes raise the possibility that Omicron could cause breakthrough infections in people who’ve already received a Pfizer or Moderna mRNA vaccine.

December 13, 2021

The effect of mandatory COVID-19 certificates on vaccine uptake: synthetic-control modelling of six countries

COVID-19 certification led to increased vaccinations 20 days before implementation in anticipation, with a lasting effect up to 40 days after. Countries with pre-intervention uptake that was below average had a more pronounced increase in daily vaccinations compared with those where uptake was already average or higher. In France, doses exceeded 55 672 (95% CI 49 668–73 707) vaccines per million population or, in absolute terms, 3 761 440 (3 355 761–4 979 952) doses before mandatory certification and 72 151 (37 940–114 140) per million population after certification (4 874 857 [2 563 396–7 711 769] doses). We found no effect in countries that already had average uptake (Germany), or an unclear effect when certificates were introduced during a period of limited vaccine supply (Denmark). Increase in uptake was highest for people younger than 30 years after the introduction of certification. Access restrictions linked to certain settings (nightclubs and events with >1000 people) were associated with increased uptake in those younger than 20 years. When certification was extended to broader settings, uptake remained high in the youngest group, but increases were also observed in those aged 30–49 years.

Study of the Veterans Affairs Health Care System highlights the impact of COVID-19 on cancer diagnoses in the USA

As health-care professionals and researchers worldwide continue to warn of the complications of COVID-19 on cancer, a new US-based study has now further highlighted the link between the pandemic and worsening cancer care. The time-frame study published on Dec 6, 2021, included the pre-pandemic phase and the primary surge of COVID-19 infections.

December 11, 2021

High-dose budesonide for early COVID-19

We were encouraged by the results of the PRINCIPLE trial, which in vulnerable individuals showed inhaled budesonide to confer a non-significant –25% (95% CI –45 to 3) relative reduction in the composite coprimary endpoint of hospital admission or death, with the number needed to treat being 50. Notably, the study had 90% power to detect a 50% reduction in the composite endpoint. The investigators appear to have attributed any protective effects of budesonide to its local glucocorticoid activity in the lung.

High-dose budesonide for early COVID-19

It is important to understand the illness severity of the study population, such as how many participants were symptomatic versus asymptomatic at enrolment, how many were compliant with treatment versus non-adherent, and if there were any outcome differences among them. We are curious if time from enrolment to treatment initiation differed among participants. The Article's Table 1 includes 833 participants from the inhaled budesonide group and 1126 participants from the usual care group, respectively, which does not coincide with the 787 and 1069 included for primary analysis.

December 10, 2021

Comparative Effectiveness and Antibody Responses to Moderna and Pfizer-BioNTech COVID-19 Vaccines among Hospitalized Veterans — Five Veterans Affairs Medical Centers, United States, February 1–September 30, 2021

These findings from a cohort of older, hospitalized veterans with high prevalences of underlying conditions suggest the importance of booster doses to help maintain long-term protection against severe COVID-19.

Community-Based Testing Sites for SARS-CoV-2 — United States, March 2020–November 2021

The CBTS program demonstrated the value of successful partnerships and collaboration for providing testing services that are responsive to local community needs. These lessons can guide current community-based screening, surveillance, and disease control programs and responses to future public health emergencies.

SARS-CoV-2 B.1.1.529 (Omicron) Variant — United States, December 1–8, 2021

During December 1–8, 2021, 22 U.S. states reported at least one COVID-19 case attributed to the Omicron variant. Among 43 cases with initial follow-up, one hospitalization and no deaths were reported. Implementation of concurrent prevention strategies, including vaccination, masking, improving ventilation, testing, quarantine, and isolation are recommended to slow transmission of SARS-CoV-2, including variants such as Omicron, to protect against severe illness and death from COVID-19.

Booster and Additional Primary Dose COVID-19 Vaccinations Among Adults Aged ≥65 Years — United States, August 13, 2021–November 19, 2021

During August 13–November 19, 2021, 18.7 million persons aged ≥65 years received a booster or additional primary dose of COVID-19 vaccine, constituting 44.1% of eligible persons aged ≥65 years. Coverage differed by primary series vaccine product and race/ethnicity. Strategic efforts are needed to encourage eligible persons aged ≥18 years, especially those aged ≥65 years and those who are immunocompromised, to receive a booster and/or additional primary dose to ensure maximal protection against COVID-19.

Effectiveness of COVID-19 vaccines against the Omicron (B.1.1.529) variant of concern

Our findings indicate that 2 doses of vaccination with BNT162b2 or ChAdOx1 are insufficient to give adequate levels of protection against infection and mild disease with the Omicron variant, although we cannot comment on protection against severe disease. Booster doses of BNT162b2 provide a significant increase in protection against mild disease and are likely to offer even greater levels of protection against severe disease. As such our findings support maximising coverage with third doses of vaccine in highly vaccinated populations such as the UK. Further follow-up will be needed to assess the duration of protection of booster vaccination.

December 9, 2021

Audio Interview: Waning Immunity against SARS-CoV-2

In this audio interview conducted on December 7, 2021, the editors discuss new studies of the duration of immunity conferred by Covid-19 vaccines.

Emerging SARS-CoV-2 variants: shooting the messenger

On Nov 24, South Africa alerted the world to the latest SARS-CoV-2 variant, omicron (B.1.1.529). The omicron variant distinguishes itself from previous variants by harbouring in its genomic sequence 49 mutations (30 of which occur within the spike protein)—a jump from the 13 mutations found within the delta variant (B.1.617.2). More mutations does not intrinsically mean that a variant is more dangerous, but almost immediately omicron generated concern within the global health community regarding its transmissibility and ability to evade both vaccine-induced and natural immunity. The report of the new variant has caused national governments to react with the reintroduction of non-pharmaceutical measures and ramped up vaccine booster programmes in the hope of delaying the spread of omicron. Controversially, however, for some governments the immediate response was to issue travel bans against South Africa. The UK was the first to adopt such a proposal, and was swiftly followed by the USA, Israel, and others.

December 8, 2021

Reduced Neutralization of SARS-CoV-2 Omicron Variant by Vaccine Sera and monoclonal antibodies

Since SARS-CoV-2 Omicron was resistant to casirivimab and imdevimab genotyping of SARS-CoV-2 may be needed before initiating mAb treatment. Variant-specific vaccines and mAb agents may be required to treat Omicron and other emerging variants of concern.

Omicron likely to weaken COVID vaccine protection

But the preliminary results — released overnight by teams in South Africa, Germany, and Sweden, as well as the Pfizer-BioNtech collaboration — hint that protection conferred by existing COVID-19 vaccines won’t be totally wiped out, and that boosters should improve immunity to Omicron.

BNT162b2 Vaccine Booster and Mortality Due to Covid-19

Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.

Protection against Covid-19 by BNT162b2 Booster across Age Groups

Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.

Analysis of Attitudes About COVID-19 Contact Tracing and Public Health Guidelines Among Undocumented Immigrants in the US

More than 10.7 million undocumented immigrants and 8 million citizens with at least 1 undocumented family member live in the US. Evidence shows that immigrants are at increased risk for COVID-19 infection and have high levels of distrust in public systems. Contact tracing is an effective way to mitigate disease transmission but requires trust and cooperation among infected persons and their contacts. Using the Centers for Disease Control and Prevention sample contact tracing script as a framework, we describe undocumented immigrants’ attitudes about contact tracing and challenges that may be a factor in their ability to follow contact tracing and public health guidelines.

Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic

These findings suggest that health systems learned to adapt and were able to self-regulate, maintaining surgical procedure volume during the largest peak in volume of patients with COVID-19.

December 7, 2021

International risk of SARS-CoV-2 Omicron variant importations originating in South Africa

Omicron, a fast-spreading SARS-CoV-2 variant of concern reported to the World Health Organization on November 24, 2021, has raised international alarm. We estimated there is at least 50% chance that Omicron had been introduced by travelers from South Africa into all of the 30 countries studied by November 27, 2021.

Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19

A Randomized Clinical Trial

Among patients with severe COVID-19, treatment with high-flow oxygen therapy compared with conventional oxygen therapy reduced the likelihood of invasive mechanical ventilation and decreased time to clinical recovery.

December 6, 2021

S glycoprotein diversity of the Omicron variant

On the backdrop of ongoing Delta variant infection and vaccine-induced immunity, the emergence of the new Variant of Concern, the Omicron, has again fuelled the fears of COVID-19 around the world. Currently, very little information is available about the S glycoprotein mutations, transmissibility, severity, and immune evasion behaviour of the Omicron variant. In the present study, we have performed a comprehensive analysis of the S glycoprotein mutations of 309 strains of the Omicron variant and also discussed the probable effects of observed mutations on several aspects of virus biology based on known available knowledge of mutational effects on S glycoprotein structure, function, and immune evasion characteristics.

Omicron Has Reached the US—Here’s What Infectious Disease Experts Know About the Variant

On December 1, JAMA convened a panel of experts to discuss what’s known—and unknown—about Omicron, the newest SARS-CoV-2 variant of concern.

Intention to Vaccinate Children Against COVID-19 Among Vaccinated and Unvaccinated US Parents

In September 2021, one-fourth of the COVID-19 cases in the US were among children. Vaccinating children against COVID-19 is the most effective way to reduce disease burden and ensure safe return to in-person schooling and other social activities. National surveys show hesitancy among parents to vaccinate children, even when they are vaccinated themselves. We measured parental intention to vaccinate children and related sociodemographic factors in a national sample of US parents.

December 5, 2021

Ad26.COV2.S or BNT162b2 Boosting of BNT162b2 Vaccinated Individuals

Previous studies have reported that a third dose of the BNT162b2 (Pfizer) COVID-19 vaccine increased antibody titers and protective efficacy. Here we compare humoral and cellular immune responses in 65 individuals who were vaccinated with the BNT162b2 vaccine and were boosted after at least 6 months with either Ad26.COV2.S (Johnson & Johnson; N=41) or BNT162b2 (Pfizer; N=24).

December 3, 2021

Notes from the Field: COVID-19 Vaccination Coverage Among Persons Experiencing Homelessness — Six U.S. Jurisdictions, December 2020–August 2021

COVID-19 outbreaks have been reported in homeless shelters across the United States. Many persons experiencing homelessness are older adults or persons with underlying medical conditions, placing them at increased risk for severe COVID-19–associated illness. The proportion of persons experiencing homelessness who are fully vaccinated against COVID-19 in the United States is currently unknown. Many persons experiencing homelessness express a willingness to receive the COVID-19 vaccine.

Immunogenicity of Extended mRNA SARS-CoV-2 Vaccine Dosing Intervals

Standard dosing intervals for BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines are 21 and 28 days, respectively.1 Data suggest improved effectiveness of ChAdOx1 adenoviral2 and other nonreplicating vaccines3 with increased dosing intervals, but little data exist for mRNA vaccines. This study investigated the immunogenicity of extended mRNA vaccine dosing intervals.

Data Emerge From the UK’s COVID-19 Vaccine Extended Dosing Interval

Late last year, UK health authorities announced that the second dose of authorized COVID-19 vaccines would be administered up to 12 weeks instead of 3 to 4 weeks after the first dose. The change was intended to free up initial doses for more people, but it also created an opportunity to investigate a vaccine schedule that hadn’t been tested in clinical trials.

December 2, 2021

Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa

Population-level evidence suggests that the Omicron variant is associated with substantial ability to evade immunity from prior infection. In contrast, there is no population-wide epidemiological evidence of immune escape associated with the Beta or Delta variants. This finding has important implications for public health planning, particularly in countries like South Africa with high rates of immunity from prior infection. Urgent questions remain regarding whether Omicron is also able to evade vaccine-induced immunity and the potential implications of reduced immunity to infection on protection against severe disease and death.

Tajima D test accurately forecasts Omicron / COVID-19 outbreak

On 26 November 2021, the World Health Organization designated the SARS-CoV-2 variant B.1.1.529, Omicron, a variant of concern. However, the phylogenetic and evolutionary dynamics of this variant remain unclear. An analysis of the 131 Omicron variant sequences from November 9 to November 28, 2021 reveals that variants have diverged into at least 6 major subgroups. 86.3% of the cases have an insertion at amino acid 214 (INS214EPE) of the spike protein.

US State-Level Legal Interventions Related to COVID-19 Vaccine Mandates

Mandates can increase vaccine uptake, but their effectiveness is associated with who is covered, penalties, and exemptions. The US federal government recently required federal employees to be vaccinated against SARS-CoV-2 and developed standards for large employers. However, individual states traditionally take the lead in regulating public health via vaccine mandates. Some states have attempted to introduce requirements to increase uptake of COVID-19 vaccines. However, others have attempted to impede COVID-19 vaccine mandates. Most efforts have been considered by legislatures; also, some governors and regulatory agencies have issued executive orders. We assessed state-level legal interventions to promote or impede COVID-19 vaccine mandates since the beginning of the pandemic.

December 1, 2021

Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines in U.S. Veterans

The 24-week risk of Covid-19 outcomes was low after vaccination with mRNA-1273 or BNT162b2, although risks were lower with mRNA-1273 than with BNT162b2. This pattern was consistent across periods marked by alpha- and delta-variant predominance.

Covid-19 Vaccine Effectiveness in New York State

The effectiveness of the three vaccines against Covid-19 declined after the delta variant became predominant. The effectiveness against hospitalization remained high, with modest declines limited to BNT162b2 and mRNA-1273 recipients 65 years of age or older.

Lenzilumab in hospitalised patients with COVID-19 pneumonia (LIVE-AIR): a phase 3, randomised, placebo-controlled trial

Lenzilumab significantly improved survival without invasive mechanical ventilation in hospitalised patients with COVID-19, with a safety profile similar to that of placebo. The added value of lenzilumab beyond other immunomodulators used to treat COVID-19 alongside steroids remains unknown.

Reinfection with new variants of SARS-CoV-2 after natural infection: a prospective observational cohort in 13 care homes in England

SARS-CoV-2 reinfections were rare in older residents and younger staff. Protection from SARS-CoV-2 was sustained for longer than 9 months, including against the alpha variant. Reinfection was associated with no or low neutralising antibody before reinfection, but significant boosting occurred on reinfection.

Factors Associated With COVID-19 Vaccine Receipt by Health Care Personnel at a Major Academic Hospital During the First Months of Vaccine Availability

In this cross-sectional study of 12 610 HCP at a major US academic hospital, two-thirds received a first dose within the first 4 months; 98% of those received 2 doses. Adjusted for age, sex, job position, and area-level social vulnerability, Black or African American and multiracial HCP were less likely to receive the vaccine compared with White HCP, with narrower disparities observed for nurses and no disparities found among physicians.

Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care

In this survey study of 2080 adults, most respondents were willing to use video visits in the future but, when presented with the choice between an in-person or a video visit for nonemergency care, most preferred in-person care. Willingness to pay for preferred visit modality was higher for those who preferred in-person care, and those who preferred video visits were more sensitive to out-of-pocket cost.

Stimulating severe COVID-19: the potential role of GM-CSF antagonism

Over the past 20 months of the COVID-19 pandemic, a great deal has been crystallised about the ideal therapeutic targets for infected patients. For very sick patients who require hospitalisation, we now know that targeting the dysregulated host response is of greater value than targeting the virus. Through steroids, interleukin(IL)-6 blockade, IL-1 blockade, tyrosine kinase inhibition, or Janus kinase inhibition, we have a breadth of clinical trials that show the possible mortality benefits of both broad and focused immunomodulation in severely ill patients with COVID-19. As the pandemic continues, there is a need to understand whether combinations or different agents that target alternative pathways would continue to improve clinical outcomes, or whether there are ways of identifying specific patients with a higher likelihood of benefit from specific therapies.

Covid-19 mRNA Vaccines — Six of One, Half a Dozen of the Other

In many countries, the availability of vaccines has marked a turning point in the Covid-19 pandemic. Although the vaccines are imperfect, breakthrough infections in fully vaccinated people remain quite rare, even with recently emerging variants. Countries with high vaccination rates have largely been able to reopen, and rates of severe illness and death have dropped dramatically. But this has not been a smooth process.

Viral Dynamics of SARS-CoV-2 Variants in Vaccinated and Unvaccinated Persons

Two opposing forces that are shaping the coronavirus disease 2019 (Covid-19) pandemic are the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern and the uptake of vaccines. Measurement of SARS-CoV-2 viral load over the course of acute infection can inform hypotheses about the mechanisms that underlie variation in transmissibility according to variant and vaccination status.

Therapeutic implications of ongoing alveolar viral replication in COVID-19

In patients with moderate-to-severe COVID-19 pneumonia, an aberrant post-viral alveolitis with excessive inflammatory responses and immunothrombosis underpins use of immunomodulatory therapy (eg, corticosteroids and interleukin-6 receptor antagonism). By contrast, immunosuppression in individuals with mild COVID-19 who do not require oxygen therapy or in those with critical disease undergoing prolonged ventilation is of no proven benefit.

COVID-19 wastewater epidemiology: a model to estimate infected populations

The SEIR model provides a robust method to estimate the total number of infected individuals in a sewershed on the basis of the mass rate of RNA copies released per day. This approach overcomes some of the limitations associated with individual testing campaigns and thereby provides an additional tool that can be used to inform policy decisions.

November 30, 2021

Odds of Testing Positive for SARS-CoV-2 Following Receipt of 3 vs 2 Doses of the BNT162b2 mRNA Vaccine

In this case-control study that included 306 710 Israeli adults 40 years and older, there was an estimated significant reduction in the odds of SARS-CoV-2 infection within a few weeks of receiving the booster compared with receiving just the 2 primary doses. Those receiving the booster also had lower odds of hospitalization.

November 29, 2021

Effect of High-Titer Convalescent Plasma on Progression to Severe Respiratory Failure or Death in Hospitalized Patients With COVID-19 Pneumonia

In this randomized clinical trial of 487 patients with COVID-19 pneumonia and a partial pressure of arterial oxygen–to–fraction of inspired oxygen (Pao2/Fio2) ratio between 350 and 200 mm Hg at enrollment, the rate of the primary clinical end point (need for mechanical ventilation, defined as Pao2/Fio2 ratio <150 mm Hg, or death) was not significantly different between the convalescent plasma group and the control group.

November 26, 2021

Immune dysregulation and immunopathology induced by SARS-CoV-2 and related coronaviruses — are we our own worst enemy?

Analyses of patients have revealed marked dysregulation of the immune system in severe cases of human coronavirus infection, and there is ample evidence that aberrant immune responses to human coronaviruses are typified by impaired induction of interferons, exuberant inflammatory responses and delayed adaptive immune responses. In addition, various viral proteins have been shown to impair interferon induction and signalling and to induce inflammasome activation. This suggests that severe disease associated with human coronaviruses is mediated by both dysregulated host immune responses and active viral interference. Here we discuss our current understanding of the mechanisms involved in each of these scenarios.

Prevention of SARS-CoV-2 transmission during a large, live, indoor gathering (SPRING): a non-inferiority, randomised, controlled trial

Participation in a large, indoor, live gathering without physical distancing was not associated with increased SARS-CoV-2–transmission risk, provided a comprehensive preventive intervention was implemented.

November 25, 2021

Effectiveness of ChAdOx1 nCoV-19 vaccine against SARS-CoV-2 infection during the delta (B.1.617.2) variant surge in India: a test-negative, case-control study and a mechanistic study of post-vaccination immune responses

The ChAdOx1 nCoV-19 vaccine remained effective against moderate-to-severe COVID-19, even during a surge that was dominated by the highly transmissible delta variant of SARS-CoV-2. Spike-specific T-cell responses were maintained against the delta variant. Such cellular immune protection might compensate for waning humoral immunity.

The emergence of powerful oral anti-COVID-19 drugs in the post-vaccine era

The quest for effective drugs to treat COVID-19 has been a priority since the outbreak of the disease. The clinical application of remdesivir has been greatly restricted by the need for intravenous administration, as well as unstable concentrations in plasma and variable antiviral activity in different organelles.

November 24, 2021

Severity of SARS-CoV-2 Reinfections as Compared with Primary Infections

Qatar had a first wave of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March through June 2020, after which approximately 40% of the population had detectable antibodies against SARS-CoV-2.

Assessment of 4 Doses of SARS-CoV-2 Messenger RNA–Based Vaccine in Recipients of a Solid Organ Transplant

In this case series study, our findings were similar to those of the study by Alejo et al,5 in which a fourth dose of SARS-CoV-2 vaccine was associated with slightly improved humoral response among patients with a weak response after 3 doses and with no improvement among those with no response after 3 doses. Neutralizing antibody titers and cellular response were low in both groups.

Morally Injurious Experiences and Emotions of Health Care Professionals During the COVID-19 Pandemic Before Vaccine Availability

Moral injury can result from chronic stressors in morally injurious environments; leadership must identify and address these stressors to effectively support health care professionals as COVID-19 continues to strain staff’s physical, mental, and emotional resources.

A Possible Role for Anti-idiotype Antibodies in SARS-CoV-2 Infection and Vaccination

he pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is incompletely understood, with its effects on multiple organ systems and the syndrome of “long Covid” occurring long after the resolution of infection. The development of multiple efficacious vaccines has been critical in the control of the pandemic, but their efficacy has been limited by the appearance of viral variants, and the vaccines can be associated with rare off-target or toxic effects, including allergic reactions, myocarditis, and immune-mediated thrombosis and thrombocytopenia in some healthy adults. Many of these phenomena are likely to be immune-mediated.

November 19, 2021

Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization — United States, March 2020–September 2021

Among 1,249,634 delivery hospitalizations during March 2020–September 2021, U.S. women with COVID-19 were at increased risk for stillbirth compared with women without COVID-19 (adjusted relative risk [aRR] = 1.90; 95% CI = 1.69–2.15). The magnitude of association was higher during the period of SARS-CoV-2 B.1.617.2 (Delta) variant predominance than during the pre-Delta period. Implementing evidence-based COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to reduce the impact of COVID-19 on stillbirths.

COVID-19–Associated Deaths After SARS-CoV-2 Infection During Pregnancy — Mississippi, March 1, 2020–October 6, 2021

Pregnant and recently pregnant women are at increased risk for severe illness and death from COVID-19 compared with women who are not pregnant or were not recently pregnant. CDC recommends COVID-19 vaccination for women who are pregnant, recently pregnant, trying to become pregnant, or might become pregnant in the future.

Incidence of SARS-CoV-2 Infection, Emergency Department Visits, and Hospitalizations Because of COVID-19 Among Persons Aged ≥12 Years, by COVID-19 Vaccination Status — Oregon and Washington, July 4–September 25, 2021

Among persons aged ≥12 years enrolled in a Pacific Northwest health plan, unvaccinated persons with SARS-CoV-2 infection were approximately twice as likely to receive ED care or to be hospitalized than were vaccinated persons with COVID-19. The findings in this report support CDC’s current recommendation that all persons aged ≥5 years should receive full COVID-19 vaccination, including additional and booster doses, to prevent illness and reduce transmission of SARS-CoV-2.

Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

Among adults with diabetes, those aged 18–29 years reported the most disruption in access to and use of medical care and the least engagement in prevention of COVID-19, including vaccination intent. Efforts are warranted to enhance access to diabetes care during the COVID-19 pandemic, and to deliver public health messages emphasizing the importance of diabetes management and COVID-19 prevention, including vaccination, especially among younger adults with diabetes.

Automated Digital Notification of COVID-19 Diagnoses Through Text and Email Messaging — North Carolina, December 2020–January 2021

Overall, 56% of patients with a positive SARS-CoV-2 test result were notified by telephone call or digital notification within 24 hours of report in January 2021, compared with 15% during November 23–December 23, 2020. Differences in text notification by age, race, and ethnicity were observed. Automated digital notification can provide a more timely means for reaching persons with COVID-19 and can likely facilitate more rapid patient isolation and increase efficiency of case investigation.

Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic — United States, July 2020–July 2021

The conditions of hospital strain during July 2020–July 2021, which included the presence of SARS-CoV-2 B.1.617.2 (Delta) variant, predicted that intensive care unit bed use at 75% capacity is associated with an estimated additional 12,000 excess deaths 2 weeks later. As hospitals exceed 100% ICU bed capacity, 80,000 excess deaths would be expected 2 weeks later.

November 18, 2021

Early Convalescent Plasma for High-Risk Outpatients with Covid-19

The administration of Covid-19 convalescent plasma to high-risk outpatients within 1 week after the onset of symptoms of Covid-19 did not prevent disease progression.

COVID-19 Severity among Women of Reproductive Age with Symptomatic Laboratory-Confirmed SARS-CoV-2 by Pregnancy Status – United States, Jan 1, 2020 – Sep 30, 2021

The overall risk for severe COVID-19 among WRA remains low; however, symptomatic pregnant WRA remain at increased risk for severe outcomes compared with symptomatic nonpregnant WRA during Delta variant predominance. Compared with the pre-Delta period, pregnant and nonpregnant WRA are at increased risk for severe COVID-19 in the Delta period.

Population impact of SARS-CoV-2 variants with enhanced transmissibility and/or partial immune escape

SARS-CoV-2 variants of concern exhibit varying degrees of transmissibility and, in some cases, escape from acquired immunity. Much effort has been devoted to measuring these phenotypes, but understanding their impact on the course of the pandemic – especially that of immune escape – has remained a challenge. Here, we use a mathematical model to simulate the dynamics of wildtype and variant strains of SARS-CoV-2 in the context of vaccine rollout and nonpharmaceutical interventions. We show that variants with enhanced transmissibility frequently increase epidemic severity, whereas those with partial immune escape either fail to spread widely, or primarily cause reinfections and breakthrough infections. However, when these phenotypes are combined, a variant can continue spreading even as immunity builds up in the population, limiting the impact of vaccination and exacerbating the epidemic. These findings help explain the trajectories of past and present SARS-CoV-2 variants and may inform variant assessment and response in the future.

Emergent SARS-CoV-2 variants: comparative replication dynamics and high sensitivity to thapsigargin

The struggle to control the COVID-19 pandemic is made challenging by the emergence of virulent SARS-CoV-2 variants. To gain insight into their replication dynamics, emergent Alpha (A), Beta (B) and Delta (D) SARS-CoV-2 variants were assessed for their infection performance in single variant- and co-infections. The effectiveness of thapsigargin (TG), a recently discovered broad-spectrum antiviral, against these variants was also examined. Of the 3 viruses, the D variant exhibited the highest replication rate and was most able to spread to in-contact cells; its replication rate at 24 h post-infection (hpi) based on progeny viral RNA production was over 4 times that of variant A and 9 times more than the B variant. In co-infections, the D variant boosted the replication of its co-infected partners at the expense of its own initial performance. Furthermore, co-infection with AD or AB combination conferred replication synergy where total progeny (RNA) output was greater than the sum of corresponding single-variant infections. All variants were highly sensitive to TG inhibition.

Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis

This systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination.

November 17, 2021

Green Pass and COVID-19 Vaccine Booster Shots in Israel – A More ‘Realistic’ Empirical Assessment Analyzing the National Airport Data

The analysis suggests that the relative protection of the booster shot against infection is likely to be significantly smaller than the initial estimates of 10-11-fold (over 90%) reported by the MOH, probably around 60% at best. This also implies that the absolute number of infected individuals in the Vaccinated group is likely to be at least as high as in the Unvaccinated, raising serious concerns that the new Green Pass is inefficient in preventing infection spread, and could expose high risk individuals to risk.

November 15, 2021

Do the Selective Serotonin Reuptake Inhibitor Antidepressants Fluoxetine and Fluvoxamine Reduce Mortality Among Patients With COVID-19?

In a large, multicenter, retrospective cohort study of 83 584 patients with laboratory-confirmed COVID-19 who had an emergency department or urgent care visit or were admitted for observation or hospitalized across 87 health care centers in the US, Oskotsky et al observed an association between selective serotonin reuptake inhibitor (SSRI) administration and reduced mortality in 3401 patients with COVID-19 compared with 6802 matched control patients who were not given SSRIs but shared similar sociodemographic characteristics, medical comorbidities, and medication indication.

Long Covid after Breakthrough COVID-19: the post-acute sequelae of breakthrough COVID-19

Altogether, our findings show increased risks of death and post-acute sequalae in people with breakthrough COVID-19; the risks are evident among those who were not hospitalized during the acute phase of the disease. Our comparative approach provides context for understanding the risks in relation to COVID-19 without prior vaccination and seasonal influenza. The findings will inform the ongoing effort to optimize strategies for prevention of breakthrough SARS-CoV-2 infections and will guide development and optimization of post-acute care pathways for people with breakthrough COVID-19.

Maternal COVID-19 leaves a lasting immunological impression on the fetus

In summary, these new data show that fetal exposure to SARS-CoV-2 acutely increases the frequencies of fetal NK cell and γδ T cell immune effector cells, and also accelerates the maturation and non-specific activation of multiple fetal immune cell populations. Although the effect of these changes on neonatal immunity might not be known for many years, fetal exposure to a maternal SARS-CoV-2 infection — even in the absence of a congenital infection — can imprint the fetal immune system.

November 12, 2021

The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Children Aged 5–11 Years — United States, November 2021

On November 2, 2021, after a systematic review of available data, the Advisory Committee on Immunization Practices made an interim recommendation for use of the Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years in the United States for prevention of COVID-19. The Pfizer-BioNTech COVID-19 vaccine has high efficacy (>90%) against COVID-19 in children aged 5–11 years, and benefits outweigh risks for vaccination. Vaccination is important to protect children against COVID-19 and reduce community transmission of SARS-CoV-2.

November 5, 2021

The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Children Aged 5–11 Years — United States, November 2021

On November 2, 2021, after a systematic review of available data, the Advisory Committee on Immunization Practices made an interim recommendation for use of the Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years in the United States for prevention of COVID-19. The Pfizer-BioNTech COVID-19 vaccine has high efficacy (>90%) against COVID-19 in children aged 5–11 years, and benefits outweigh risks for vaccination. Vaccination is important to protect children against COVID-19 and reduce community transmission of SARS-CoV-2.

November 2, 2021

Effectiveness of 2-Dose Vaccination with mRNA COVID-19 Vaccines Against COVID-19–Associated Hospitalizations Among Immunocompromised Adults — Nine States, January–September 2021

Effectiveness of mRNA vaccination against laboratory-confirmed COVID-19–associated hospitalization was lower (77%) among immunocompromised adults than among immunocompetent adults (90%). Vaccine effectiveness varied considerably among immunocompromised patient subgroups. Immunocompromised persons benefit from COVID-19 mRNA vaccination but are less protected from severe COVID-19 outcomes than are immunocompetent persons. Immunocompromised persons receiving mRNA COVID-19 vaccines should receive 3 doses and a booster, consistent with CDC recommendations, practice nonpharmaceutical interventions, and, if infected, be monitored closely and considered early for proven therapies that can prevent severe outcomes.

October 29, 2021

Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19–Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January–September 2021

Among COVID-19–like illness hospitalizations among adults aged ≥18 years whose previous infection or vaccination occurred 90–179 days earlier, the adjusted odds of laboratory-confirmed COVID-19 among unvaccinated adults with previous SARS-CoV-2 infection were 5.49-fold higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine who had no previous documented infection (95% confidence interval = 2.75–10.99). All eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2.

The Advisory Committee on Immunization Practices’ Interim Recommendations for Additional Primary and Booster Doses of COVID-19 Vaccines — United States, 2021

The Advisory Committee on Immunization Practices issued recommendations for an additional primary mRNA COVID-19 vaccine dose for immunocompromised persons and a COVID-19 vaccine booster dose in eligible groups. Health care professionals play a critical role in COVID-19 vaccination efforts, including for primary, additional primary, and booster vaccination, particularly to protect patients who are at increased risk for severe illness and death.

Detection of SARS-CoV-2 by rapid antigen tests on saliva in hospitalized patients with COVID-19

Our study therefore supports saliva testing as an alternative diagnostic procedure to NPH testing, and that rapid antigen test on saliva provides a potential complement to PCR test to meet increasing screening demand.

Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study

Vaccination reduces the risk of delta variant infection and accelerates viral clearance. Nonetheless, fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts. Host–virus interactions early in infection may shape the entire viral trajectory.

October 27, 2021

Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial

Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital.

Invincibility threatens vaccination intentions during a pandemic

Our results suggest that despite the prevalence of personal feelings of invincibility across cultures, the effects of perceived invincibility on prosocial beliefs and behaviors depend on the extent to which individuals maintain an interdependent self-construal and feel responsible for the wellbeing of their community members. In turn, health communications should encourage a collectivistic mindset so as to promote prosocial beliefs and behaviors, despite personal feelings of invincibility. In the context of COVID-19, this is especially important in less collectivistic or individualistic cultures such as the U.S., U.K., and France.

Non-pharmaceutical interventions, vaccination, and the SARS-CoV-2 delta variant in England: a mathematical modelling study

Our findings show that the risk of a large wave of COVID-19 hospital admissions resulting from lifting NPIs can be substantially mitigated if the timing of NPI relaxation is carefully balanced against vaccination coverage. However, with the delta variant, it might not be possible to fully lift NPIs without a third wave of hospital admissions and deaths, even if vaccination coverage is high. Variants of concern, their transmissibility, vaccine uptake, and vaccine effectiveness must be carefully monitored as countries relax pandemic control measures.

What COVID vaccines for young kids could mean for the pandemic

“It will save lives in that age group,” says Emma McBryde, an infectious-diseases modeller at the Australian Institute of Tropical Health and Medicine in Townsville. But it could also have a broader impact, given that many US children aged 5 to 11 have returned to school unvaccinated in the past few months, and the group now accounts for a significant portion of new COVID-19 cases, capable of transmitting the coronavirus SARS-CoV-2 to others. “For every child’s life you save, you may well save many, many more adult lives,” she says.

October 26, 2021

Aspergillosis Is Common Among COVID-19 Patients in the ICU

Damage to the lining of airways from severe SARS-CoV-2 infection allows Aspergillus fungi to invade the tissue, according to a recent consensus guidance from the European Confederation of Medical Mycology and the International Society for Human and Animal Mycology. These secondary fungal infections can worsen patient outcomes, and they’ve raised concern about emerging evidence of Aspergillus resistance to voriconazole and isavuconazole, the first-line therapies.

October 25, 2021

SARS-CoV-2 infects human adipose tissue and elicits an inflammatory response consistent with severe COVID-19

Our work provides the first in vivo evidence of SARS-CoV-2 infection in human adipose tissue and describes the associated inflammation.

Association of University Student Gatherings With Community COVID-19 Infections Before and After the NCAA March Madness Tournament

The findings of this cross-sectional study suggest that social gatherings among unvaccinated students were associated with increased COVID-19 infections (in this scenario, slowing the previous downward trend and briefly increasing) in a university’s community beginning 8 days after the event, which corresponds with the 75th percentile of time to symptom onset. This study identifies an urgent gap in evidence on the risk of COVID-19 spread at social gatherings among university students, although the increase in transmission was brief. This increase in transmission may have been brief because of increases in the vaccination rate of university students during this time or because some students may have completed their semester before the end of the study period.

October 22, 2021

COVID-19 Vaccination and Non–COVID-19 Mortality Risk — Seven Integrated Health Care Organizations, United States, December 14, 2020–July 31, 2021

During December 2020–July 2021, COVID-19 vaccine recipients had lower rates of non–COVID-19 mortality than did unvaccinated persons after adjusting for age, sex, race and ethnicity, and study site. There is no increased risk for mortality among COVID-19 vaccine recipients. This finding reinforces the safety profile of currently approved COVID-19 vaccines in the United States. All persons aged ≥12 years should receive a COVID-19 vaccine.

Severity of Disease Among Adults Hospitalized with Laboratory-Confirmed COVID-19 Before and During the Period of SARS-CoV-2 B.1.617.2 (Delta) Predominance — COVID-NET, 14 States, January–August 2021

Analysis of COVID-NET data from 14 states found no significant increases in the proportion of hospitalized COVID-19 patients with severe outcomes during the Delta period. The proportion of hospitalized unvaccinated COVID-19 patients aged 18–49 years significantly increased during the Delta period. Lower vaccination coverage in adults aged 18–49 years likely contributed to the increase in hospitalized patients during the Delta period. COVID-19 vaccination is critical for all eligible adults, including adults aged <50 years who have relatively low vaccination rates compared with older adults.

Assessment of Cognitive Function in Patients After COVID-19 Infection

The association of COVID-19 with executive functioning raises key questions regarding patients’ long-term treatment. Future studies are needed to identify the risk factors and mechanisms underlying cognitive dysfunction as well as options for rehabilitation.

October 21, 2021

Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia

In this randomized trial that included 1000 patients with COVID-19 and severe hypoxemia, treatment with 12 mg/d of dexamethasone resulted in 22.0 days alive without life support at 28 days compared with 20.5 days in those receiving 6 mg/d of dexamethasone. This difference was not statistically significant. Compared with 6 mg of dexamethasone, 12 mg of dexamethasone did not statistically significantly reduce the number of days alive without life support at 28 days.

October 19, 2021

Pregnancy influences immune responses to SARS-CoV-2

Infections during pregnancy contribute to high rates of maternal and fetal morbidity and mortality. However, the study of maternal-fetal immune responses to such infections remains underwhelming. The studies by Atyeo et al. and Bordt et al. on the immune responses to SARS-CoV-2 vaccination and infection demonstrate the critical nature of investigating maternal-fetal immune responses during pregnancy, a highly unique biological state. The findings of these studies have direct clinical implications for the COVID-19 pandemic and future maternal-fetal vaccination strategies, as they reveal that pregnant and lactating women have distinct immune responses to immunization and natural infection. Furthermore, these studies echo the call to action to incorporate women at different stages of gestation into clinical trials, thereby increasing their representation in the development of vaccines.

October 8, 2021

Distribution of SARS-CoV-2 Variants in a Large Integrated Health Care System — California, March–July 2021

During March 4–July 21, 2021, sequencing data from 6,798 SARS-CoV-2–positive specimens were linked to electronic health records among Kaiser Permanente Southern California members. The weekly percentage of all infections attributed to the Delta variant rapidly increased to 95% during this period. Infection with the Delta variant was more common among younger persons and among non-Hispanic Black persons. These findings reinforce the importance of continued monitoring of SARS-CoV-2 variants and implementing multicomponent COVID-19 prevention strategies, particularly during the current period in which Delta is the predominant circulating variant in the United States.

October 7, 2021

Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings

Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection.

Bamlanivimab plus Etesevimab in Mild or Moderate Covid-19

Among high-risk ambulatory patients, bamlanivimab plus etesevimab led to a lower incidence of Covid-19–related hospitalization and death than did placebo and accelerated the decline in the SARS-CoV-2 viral load.

COVID-19-Associated Orphanhood and Caregiver Death in the United States

We report overall and US state-specific findings, disaggregated by race/ethnicity, for COVID-19-associated orphanhood and death of grandparent caregivers. High rates of orphanhood, marked disparities, and state-specific differences show the overlooked burden among children at greatest risk, in states most affected. 

October 6, 2021

Myocarditis after Covid-19 Vaccination in a Large Health Care Organization

Among patients in a large Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the highest incidence was among male patients between the ages of 16 and 29 years. Most cases of myocarditis were mild or moderate in severity.

Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.

Waning Immune Humoral Response to BNT162b2 Covid-19 Vaccine over 6 Months

Six months after receipt of the second dose of the BNT162b2 vaccine, humoral response was substantially decreased, especially among men, among persons 65 years of age or older, and among persons with immunosuppression.

Waning of BNT162b2 Vaccine Protection against SARS-CoV-2 Infection in Qatar

BNT162b2-induced protection against SARS-COV-2 infection appeared to wane rapidly following its peak after the second dose, but protection against hospitalization and death persisted at a robust level for 6 months after the second dose.

Real-world data show that filters clean COVID-causing virus from air

Research at a hospital swamped by people with COVID-19 has confirmed that portable air filters effectively remove SARS-CoV-2 particles from the air — the first such evidence in a real-world setting. The results suggest that air filters could be used to reduce the risk of patients and medical staff contracting SARS-CoV-2 in hospitals, the study’s authors say.

Deaths involving COVID-19 by self-reported disability status during the first two waves of the COVID-19 pandemic in England: a retrospective, population-based cohort study

Given the association between disability and mortality involving COVID-19, verification of these findings and consideration of recommendations for protective measures are now required.

Coverage and Estimated Effectiveness of mRNA COVID-19 Vaccines Among US Veterans

In this case-control study including 6 647 733 veterans, 23% of veterans received at least 1 COVID-19 vaccination during the first 3 months of vaccine rollout. VE against infection was estimated to be 95% for full vaccination; estimated VE against COVID-19-related hospitalization was 91%, and there were no COVID-19–related deaths among fully vaccinated veterans.

COVID-19 Incidence and Mortality in Federal and State Prisons Compared With the US Population, April 5, 2020, to April 3, 2021

COVID-19 incidence and standardized mortality rates remained consistently higher among the prison population than the overall US population in the first year of the pandemic. While COVID-19 incidence and mortality rates peaked in late 2020 and early 2021 and have since declined, the cumulative toll of COVID-19 has been several times greater among the prison population than the overall US population.

October 5, 2021

National and State Trends in Anxiety and Depression Severity Scores Among Adults During the COVID-19 Pandemic — United States, 2020–2021

Nationwide, average anxiety severity scores increased 13% from August to December 2020 and then decreased 26.8% from December 2020 to June 2021. Similar increases and decreases occurred in depression severity scores.

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.

October 4, 2021

Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study

Our results provide support for high effectiveness of BNT162b2 against hospital admissions up until around 6 months after being fully vaccinated, even in the face of widespread dissemination of the delta variant. Reduction in vaccine effectiveness against SARS-CoV-2 infections over time is probably primarily due to waning immunity with time rather than the delta variant escaping vaccine protection.

Immunological responses to SARS-CoV-2 vaccines in kidney transplant recipients

Although the immune correlates of protection from disease have yet to be defined, we show markedly diminished humoral and cellular immune responses to both vector and mRNA SARS-CoV-2 vaccines in kidney transplant recipients. The planning of intervention studies to optimise vaccine platform and dosing are urgently required in this group, and preliminary reports suggest encouraging responses to third vaccine doses. In the interim, strategic planning to protect this susceptible population is required. This planning could include, but is not limited to, educating patients to maintain physical distancing rules and immunising household members, including prioritisation of children older than 12 years.

Effect of Convalescent Plasma on Organ Support–Free Days in Critically Ill Patients With COVID-19

This international bayesian randomized clinical trial that included 2011 participants treated with 2 units of high-titer convalescent plasma, compared with no convalescent plasma, resulted in a posterior probability of futility of 99.4% for the primary outcome of organ support–free days up to day 21.

October 1, 2021

The durability of immunity against reinfection by SARS-CoV-2: a comparative evolutionary study

These data provided a means to estimate profiles of the typical antibody decline and probabilities of reinfection over time under endemic conditions. Reinfection by SARS-CoV-2 under endemic conditions would likely occur between 3 months and 5·1 years after peak antibody response, with a median of 16 months. This protection is less than half the duration revealed for the endemic coronaviruses circulating among humans (5–95% quantiles 15 months to 10 years for HCoV-OC43, 31 months to 12 years for HCoV-NL63, and 16 months to 12 years for HCoV-229E). For SARS-CoV, the 5–95% quantiles were 4 months to 6 years, whereas the 95% quantiles for MERS-CoV were inconsistent by dataset.

COVID-19 Outbreaks at Youth Summer Camps — Louisiana, June–July 2021

The increased number of outbreaks and cases observed in Louisiana youth summer camps in 2021 compared with the previous year coincided with the widespread circulation of the highly transmissible Delta variant. This period also coincided with apparent underutilization of preventive measures such as vaccination, masking, and physical distancing. Multicomponent prevention measures, including vaccination of all eligible adults and adolescents, wearing masks indoors, regular screening testing, physical distancing and cohorting, and increasing ventilation can help prevent transmission of SARS-CoV-2 in settings with youths who cannot be vaccinated.

Multicomponent Strategies to Prevent SARS-CoV-2 Transmission — Nine Overnight Youth Summer Camps, United States, June–August 2021

Implementation of high vaccination coverage coupled with multiple prevention strategies is critical to averting COVID-19 outbreaks in congregate settings, including overnight camps. These findings highlight important guiding principles for school and youth-based COVID-19 prevention protocols.

Disparities in COVID-19 Vaccination Status, Intent, and Perceived Access for Noninstitutionalized Adults, by Disability Status — National Immunization Survey Adult COVID Module, United States, May 30–June 26, 2021

Analysis of the National Immunization Survey Adult COVID Module found that, compared with adults without a disability, those with a disability had a lower likelihood of having received COVID-19 vaccination, despite being less likely to report hesitancy about getting vaccinated. Adults with a disability reported more difficulties obtaining a COVID-19 vaccine than did persons without a disability.

September 30, 2021

Humoral Immune Response in Hematooncological Patients and Health Care Workers Who Received SARS-CoV-2 Vaccinations

In this cohort study of 901 samples from 595 patients with hematooncological diseases and a control group of health care workers, anti–SARS-CoV-2 spike antibodies after full immunization could be detected, although antibody levels were lower in patients than in health care workers. However, specific subgroups, such as patients who received B-cell–targeting therapy, showed impaired seroconversion. The study findings suggest that lower SARS-CoV-2 antibody levels in patients with cancer after vaccination compared with vaccinated health care workers, and particularly weak seroconversion in specific subgroups, highlight the need for dedicated vaccination trials in patients with cancer.

COVID-19 Vaccine Decision-making Factors in Racial and Ethnic Minority Communities in Los Angeles, California

In this qualitative study, 70 participants from racial and ethnic minority communities in Los Angeles County described a complex vaccination decision-making process influenced by misinformation and politicization, deep apprehension related to historical inequity and mistreatment, access barriers related to social disadvantage, and a need for community engagement and trusted messengers. This study suggests that COVID-19 vaccine equity will require multifaceted policies and programming that respect community concerns and the need for informed deliberation, invest in community-based engagement, improve accessibility and transparency of information, and reduce structural barriers in vaccination.

Assessment of Communication Strategies for Mitigating COVID-19 Vaccine-Specific Hesitancy in Canada

In a between-participants survey study of adult Canadian citizens, individuals who were provided information on the death prevention potential of less-preferred vaccines, such as AstraZeneca and Johnson & Johnson, reported more confidence in their effectiveness and a higher likelihood of taking these vaccines if offered compared with those who did not receive this information. Information on the overall effectiveness of these vaccines at preventing symptomatic COVID-19 showed the opposite result. These findings suggest that communication strategies that focus on the death prevention potential of less-preferred COVID-19 vaccines have the potential to improve their uptake, whereas focusing on such metrics as their comparatively less impressive overall effectiveness at preventing symptomatic COVID-19 could undermine these efforts.

Patient Adherence to Hemoglobin A1c Testing Recommendations in Telemedicine and In-Office Cohorts During COVID-19

Our most notable finding was no difference in adherence rates for patients without diabetes who had telemedicine encounters. This demonstrates the benefit of telemedicine in preventive care—comparable quality with lower cost. Similar to recent literature, during the pandemic, telemedicine met a care demand in our study; but moving forward, telemedicine may be a valuable care venue, especially in primary care.

September 29, 2021

REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19

REGEN-COV reduced the risk of Covid-19–related hospitalization or death from any cause, and it resolved symptoms and reduced the SARS-CoV-2 viral load more rapidly than placebo.

Phase 3 Safety and Efficacy of AZD1222 (ChAdOx1 nCoV-19) Covid-19 Vaccine

AZD1222 was safe and efficacious in preventing symptomatic and severe Covid-19 across diverse populations that included older adults.

COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study

COVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation.

Symptoms and Health Outcomes Among Survivors of COVID-19 Infection 1 Year After Discharge From Hospitals in Wuhan, China

This study reported prolonged symptoms of COVID-19 and found that severe disease during hospitalization was a risk factor for more symptoms and higher chronic obstructive pulmonary disease assessment test scores.

September 28, 2021

Safety Monitoring of an Additional Dose of COVID-19 Vaccine — United States, August 12–September 19, 2021

During August 12–September 19, 2021, among 12,591 v-safe registrants who completed a health check-in survey after all 3 doses of an mRNA COVID-19 vaccine, 79.4% and 74.1% reported local or systemic reactions, respectively, after the third dose; 77.6% and 76.5% reported local or systemic reactions after the second dose, respectively. Voluntary reports to v-safe found no unexpected patterns of adverse reactions after an additional dose of COVID-19 vaccine. CDC will continue to monitor vaccine safety, including for additional COVID-19 doses.

Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19

Long-COVID clinical features occurred and co-occurred frequently and showed some specificity to COVID-19, though they were also observed after influenza. Different long-COVID clinical profiles were observed based on demographics and illness severity.

Disparities and Temporal Trends in COVID-19 Exposures and Mitigating Behaviors Among Black and Hispanic Adults in an Urban Setting

In this survey study of adults living in a large US city, consistent masking was associated with a decrease in SARS-CoV-2 acquisition; however, Hispanic individuals were at higher risk for infection, more often worked outside the home, and were less likely to have received economic aid through stimulus checks or unemployment benefits.

September 24, 2021

CDC Statement on ACIP Booster Recommendations

Today, CDC Director Rochelle P. Walensky, M.D., M.P.H., endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for a booster shot of the Pfizer-BioNTech COVID-19 vaccine in certain populations and also recommended a booster dose for those in high risk occupational and institutional settings. The Food and Drug Administration’s (FDA) authorization and CDC’s guidance for use are important steps forward as we work to stay ahead of the virus and keep Americans safe.

Association Between K–12 School Mask Policies and School-Associated COVID-19 Outbreaks — Maricopa and Pima Counties, Arizona, July–August 2021

In the crude analysis, the odds of a school-associated COVID-19 outbreak in schools with no mask requirement were 3.7 times higher than those in schools with an early mask requirement (odds ratio [OR] = 3.7; 95% CI = 2.2–6.5). After adjusting for potential described confounders, the odds of a school-associated COVID-19 outbreak in schools without a mask requirement were 3.5 times higher than those in schools with an early mask requirement (OR = 3.5; 95% CI = 1.8–6.9).

COVID-19–Related School Closures and Learning Modality Changes — United States, August 1–September 17, 2021

For the week ending September 17, 2021, HMM data were available for 73% of kindergarten through grade 12 public school students in 8,700 districts nationwide and varied by state (Supplementary Figure, Among these districts, 8,343 (96%) were offering full in-person learning, 322 (4%) were offering hybrid learning, and 35 (0.4%) were offering full remote learning. The largest number of districts with full remote learning (14) were in the West Census Region, followed by the South (11). Seven Midwest and two Northeast districts offered full remote learning. During August 2–September 17, 2021, systematic Internet searches identified announcements of 248 public districtwide closures and 384 individual school closures for ≥1 day attributable to COVID-19. Closures affected 1,801 schools (1.5% of all schools), 933,913 students, and 59,846 teachers in 44 states (Figure). The number of closures was highest in the South.

Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements — United States, July 1–September 4, 2021

Counties without school mask requirements experienced larger increases in pediatric COVID-19 case rates after the start of school compared with counties that had school mask requirements (p<0.001) (Figure). The average change from week −1 (1–7 days before the start of school) to week 1 (7–13 days after the start of school) for counties with school mask requirements (16.32 cases per 100,000 children and adolescents aged <18 years per day) was 18.53 cases per 100,000 per day lower than the average change for counties without school mask requirements (34.85 per 100,000 per day) (p<0.001). Comparisons between pediatric COVID-19 case rates during the weeks before (weeks −3, −2, and −1) and after (weeks 0, 1, and 2) the start of school indicate that counties without school mask requirements experienced larger increases than those with school mask requirements (p<0.05). After controlling for covariates, school mask requirements remained associated with lower daily case rates of pediatric COVID-19 (β = −1.31; 95% confidence interval = −1.51 to −1.11) (p<0.001).

Trajectory of COVID-19 Vaccine Hesitancy Over Time and Association of Initial Vaccine Hesitancy With Subsequent Vaccination

Vaccine hesitancy is waning, yet inequities in receipt remain. There is a clear public health opportunity to convert higher vaccine willingness into successfully delivered vaccinations.

Evaluation of the Association Between Medicare Eligibility and Excess Deaths During the COVID-19 Pandemic in the US

Eligibility for Medicare at age 65 years, which has been associated with an immediate and substantial reduction in the uninsurance rate and improvements in measures of access to care, was not associated with mortality during the COVID-19 pandemic. These null findings may reflect the influence of state and federal policies that directed payments to hospitals for COVID-19 treatment and eliminated cost sharing for COVID-19 testing, both of which aimed to broaden access to COVID-19 testing and treatment.

September 23, 2021

Association of Disease-Modifying Treatment and Anti-CD20 Infusion Timing With Humoral Response to 2 SARS-CoV-2 Vaccines in Patients With Multiple Sclerosis

In this study, the humoral response against SARS-CoV-2 at 1 month after vaccination was appropriate under treatment with cladribine and teriflunomide and diminished/absent under treatment with anti-CD20 therapies and S1P modulators. Delaying anti-CD20 infusions by 3 to 6 months before vaccination could, however, increase the probability of developing appropriate humoral responses, especially in selected clinically and radiologically stable patients. Limitations of the study include the short follow-up (only 1 month after vaccination), the relatively small sample size (especially of S1P modulators and cladribine groups), and the lack of data on additional DMTs. Future studies should aim at investigating antibody dynamics over time, if and how T cell–mediated responses after vaccination are influenced by DMTs, and whether these biological measures actually reflect vaccine efficacy in terms of preventing severe SARS-CoV-2 infection.

Ways That Mental Health Professionals Can Encourage COVID-19 Vaccination

Uptake of COVID-19 and other vaccines is low among younger adults, the age at onset for any mental health problems. Uptake is also lower in communities disproportionately affected by COVID-19. Creating opportunities for equitable access to COVID-19 vaccination has helped US efforts reach disproportionately affected communities to increase vaccine uptake. Engaging new approaches for increasing adult vaccination is a national priority. Although mental health is not the first thing that comes to mind when thinking about vaccination, strategic use of mental health professionals’ expertise could provide new opportunities to encourage COVID-19 vaccination. A better understanding of how mental health affects receipt of COVID-19 vaccines and better defining how mental health professionals can help, particularly for disproportionately affected communities, is fundamentally important now and could strengthen vaccination efforts. Engagement by mental health professionals’ organizations, and possibly trainings for their members, could be another important step.

September 22, 2021

Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel

The BNT162b2 and mRNA-1273 vaccines were highly effective under real-world conditions in preventing symptomatic Covid-19 in health care personnel, including those at risk for severe Covid-19 and those in racial and ethnic groups that have been disproportionately affected by the pandemic.

Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase

The mRNA-1273 vaccine continued to be efficacious in preventing Covid-19 illness and severe disease at more than 5 months, with an acceptable safety profile, and protection against asymptomatic infection was observed.

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

These findings suggest that MIS-A is a serious hyperinflammatory condition that presents approximately 4 weeks after onset of acute COVID-19 with extrapulmonary multiorgan dysfunction.

September 17, 2021

Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions — United States, March–August 2021

Among U.S. adults without immunocompromising conditions, vaccine effectiveness against COVID-19 hospitalization during March 11–August 15, 2021, was higher for the Moderna vaccine (93%) than the Pfizer-BioNTech vaccine (88%) and the Janssen vaccine (71%). Although these real-world data suggest some variation in levels of protection by vaccine, all FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization.

Disaggregating Data to Measure Racial Disparities in COVID-19 Outcomes and Guide Community Response — Hawaii, March 1, 2020–February 28, 2021

Disaggregating race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams and tailored public health interventions and vaccination campaigns to more effectively address health disparities.

Post-Acute Sequelae of SARS-CoV-2 Infection Among Adults Aged ≥18 Years — Long Beach, California, April 1–December 10, 2020

In a random sample of recovered COVID-19 patients in Long Beach, California, one third of participants reported post-acute sequelae 2 months after their positive test result, with higher rates reported among persons aged ≥40 years, females, persons with preexisting conditions, and Black persons.

Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020

Among a cohort of 432,302 persons aged 2–19 years, the rate of body mass index (BMI) increase approximately doubled during the pandemic compared to a prepandemic period. Persons with prepandemic overweight or obesity and younger school-aged children experienced the largest increases.

New COVID-19 Cases and Hospitalizations Among Adults, by Vaccination Status — New York, May 3–July 25, 2021

This report has been corrected and republished. Below is the republished report. Please click here to view the detailed changes to the report.

During May 3–July 25, 2021, the overall age-adjusted vaccine effectiveness against hospitalization in New York was relatively stable 89.5%–95.1%). The overall age-adjusted vaccine effectiveness against infection for all New York adults declined from 91.8% to 75.0%.

September 16, 2021

Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting

Preapproval trials showed that messenger RNA (mRNA)–based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a good safety profile, yet these trials were subject to size and patient-mix limitations. An evaluation of the safety of the BNT162b2 mRNA vaccine with respect to a broad range of potential adverse events is needed.

Effectiveness of the Single-Dose Ad26.COV2.S COVID Vaccine

These non-randomized data across U.S. clinical practices show high and stable vaccine effectiveness of Ad26.COV2.S over time before the Delta variant emerged to when the Delta variant was dominant.

The Importance of Context in Covid-19 Vaccine Safety

Vaccine safety is critical for the successful implementation of any vaccination program, especially during a pandemic. In February 1976, the Centers for Disease Control and Prevention confirmed a cluster of cases of severe influenza-like illness among Army recruits at Fort Dix, New Jersey.

September 15, 2021

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months

BNT162b2 is a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine encoding a prefusion-stabilized, membrane-anchored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) full-length spike protein. BNT162b2 is highly efficacious against coronavirus disease 2019 (Covid-19) and is currently approved, conditionally approved, or authorized for emergency use worldwide. At the time of initial authorization, data beyond 2 months after vaccination were unavailable.

Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel

In this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.

Vaccine-Induced Thrombocytopenia with Severe Headache

Vaccine-induced immune thrombotic thrombocytopenia (VITT), a serious adverse event after vaccination with ChAdOx1 nCoV-19 (AstraZeneca) or Ad26.COV2.S (Johnson & Johnson–Janssen), is caused by platelet factor 4 (PF4)–dependent, platelet-activating antibodies. High-dose immune globulins and anticoagulation are the main treatments. In this report, we present evidence that vaccine-induced thrombocytopenia (VIT) without associated cerebral venous sinus thrombosis (CVST) or other thromboses and with severe headache as the heraldic symptom may precede VITT (“pre-VITT syndrome”).

SARS-CoV-2 Neutralization with BNT162b2 Vaccine Dose 3

We conducted a global, randomized, placebo-controlled, phase 1–2–3 pivotal trial in which two 30-μg doses of BNT162b2 (Pfizer–BioNTech) were administered 21 days apart ( number, NCT04368728. opens in new tab). These doses of vaccine had mainly low-grade side effects and provided 95% efficacy against coronavirus disease 2019 (Covid-19) from 7 days to approximately 2 months after dose 2. Efficacy waned to 84% between 4 and approximately 6 months after dose 2. Since vaccine authorization, viral variants have replaced the original strain, with the highly transmissible B.1.617.2 (delta) variant currently dominant. Although the effectiveness of the vaccine against severe disease, hospitalization, and death remains high, waning immunity and viral diversification create a possible need for a third vaccine dose.

Safety and immunogenicity of an inactivated COVID-19 vaccine, BBIBP-CorV, in people younger than 18 years: a randomised, double-blind, controlled, phase 1/2 trial

The inactivated COVID-19 vaccine BBIBP-CorV is safe and well tolerated at all tested dose levels in participants aged 3–17 years. BBIBP-CorV also elicited robust humoral responses against SARS-CoV-2 infection after two doses. Our findings support the use of a 4 μg dose and two-shot regimen BBIBP-CorV in phase 3 trials in the population younger than 18 years to further ascertain its safety and protection efficacy against COVID-19.

September 14, 2021

Daily testing for contacts of individuals with SARS-CoV-2 infection and attendance and SARS-CoV-2 transmission in English secondary schools and colleges: an open-label, cluster-randomised trial

Daily contact testing of school-based contacts was non-inferior to self-isolation for control of COVID-19 transmission, with similar rates of symptomatic infections among students and staff with both approaches. Infection rates in school-based contacts were low, with very few school contacts testing positive. Daily contact testing should be considered for implementation as a safe alternative to home isolation following school-based exposures.

September 13, 2021

Considerations in boosting COVID-19 vaccine immune responses

A new wave of COVID-19 cases caused by the highly transmissible delta variant is exacerbating the worldwide public health crisis, and has led to consideration of the potential need for, and optimal timing of, booster doses for vaccinated populations.1 Although the idea of further reducing the number of COVID-19 cases by enhancing immunity in vaccinated people is appealing, any decision to do so should be evidence-based and consider the benefits and risks for individuals and society.

September 10, 2021

Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021

Across 13 U.S. jurisdictions, incidence rate ratios for hospitalization and death changed relatively little after the SARS-CoV-2 B.1.617.2 (Delta) variant reached predominance, suggesting high, continued vaccine effectiveness against severe COVID-19. Case IRRs decreased, suggesting reduced vaccine effectiveness for prevention of SARS-CoV-2 infections.

Interim Estimates of COVID-19 Vaccine Effectiveness Against COVID-19–Associated Emergency Department or Urgent Care Clinic Encounters and Hospitalizations Among Adults During SARS-CoV-2 B.1.617.2 (Delta) Variant Predominance — Nine States, June–August 2021

Data on COVID-19 vaccine effectiveness (VE) since the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, became the predominant circulating strain in the United States are limited. CDC used the VISION Network* to examine medical encounters (32,867) from 187 hospitals and 221 emergency departments (EDs) and urgent care (UC) clinics across nine states during June–August 2021, beginning on the date the Delta variant accounted for >50% of sequenced isolates in each medical facility’s state. VISION Network methods have been published.

Effectiveness of COVID-19 mRNA Vaccines Against COVID-19–Associated Hospitalization — Five Veterans Affairs Medical Centers, United States, February 1–August 6, 2021

During February 1–August 6, 2021, vaccine effectiveness among U.S. veterans hospitalized at five Veterans Affairs Medical Centers was 87%. mRNA COVID-19 vaccines remain highly effective, including during periods of widespread circulation of the SARS-CoV-2 B.1.617.2 (Delta) variant. Vaccine effectiveness in preventing COVID-19–related hospitalization was 80% among adults aged ≥65 years compared with 95% among adults aged 18–64 years.

Long-Term Symptoms Among Adults Tested for SARS-CoV-2 — United States, January 2020–April 2021

In a nonprobability-based sample of U.S. adults tested for SARS-CoV-2, symptoms often associated with SARS-CoV-2 infection were common; 65.9% of respondents whose SARS-CoV-2 test results were positive reported symptoms lasting >4 weeks compared with 42.9% of those whose test results were negative. More persons who received positive test results (76.2%) reported persistence (>4 weeks) of at least one initially occurring symptom compared with those whose test results were negative (69.6%).

Using Wastewater Surveillance Data to Support the COVID-19 Response — United States, 2020–2021

Wastewater surveillance data have been used to deploy clinical testing resources, investigate possible irregularities in traditional surveillance, refine health messaging, and forecast clinical resource needs.

SARS-CoV-2 Transmission to Masked and Unmasked Close Contacts of University Students with COVID-19 — St. Louis, Missouri, January–May 2021

Compared with only masked exposure, close contacts with any unmasked exposure had higher adjusted odds of a positive test result. Each additional exposure was associated with a 40% increase in odds of a positive test.

Probenecid inhibits SARS-CoV-2 replication in vivo and in vitro

Effective vaccines are slowing the COVID-19 pandemic, but SARS-CoV-2 will likely remain an issue in the future making it important to have therapeutics to treat patients. There are few options for treating patients with COVID-19. We show probenecid potently blocks SARS-CoV-2 replication in mammalian cells and virus replication in a hamster model. Furthermore, we demonstrate that plasma concentrations up to 50-fold higher than the protein binding adjusted IC90 value are achievable for 24 h following a single oral dose. These data support the potential clinical utility of probenecid to control SARS-CoV-2 infection in humans.

September 9, 2021

Face masks for COVID pass their largest test yet

Face masks protect against COVID-19. That’s the conclusion of a gold-standard clinical trial in Bangladesh, which backs up the findings of hundreds of previous observational and laboratory studies.

Sequences in the cytoplasmic tail of SARS-CoV-2 Spike facilitate expression at the cell surface and syncytia formation

The Spike (S) protein of SARS-CoV-2 binds ACE2 to direct fusion with host cells. S comprises a large external domain, a transmembrane domain, and a short cytoplasmic tail. Understanding the intracellular trafficking of S is relevant to SARS-CoV-2 infection, and to vaccines expressing full-length S from mRNA or adenovirus vectors. Here we report a proteomic screen for cellular factors that interact with the cytoplasmic tail of S. We confirm interactions with the COPI and COPII vesicle coats, ERM family actin regulators, and the WIPI3 autophagy component. The COPII binding site promotes exit from the endoplasmic reticulum, and although binding to COPI should retain S in the early Golgi where viral budding occurs, there is a suboptimal histidine residue in the recognition motif. As a result, S leaks to the surface where it accumulates and can direct the formation of multinucleate syncytia. Thus, the trafficking signals in the tail of S indicate that syncytia play a role in the SARS-CoV-2 lifecycle.

In-house reverse transcriptase polymerase chain reaction for detection of SARS-CoV-2 with increased sensitivity

As the COVID-19 infection continues to ravage the world, the advent of an efficient as well as the economization of the existing RT-PCR based detection assay essentially can become a blessing in these testing times and significantly help in the management of the pandemic. This study demonstrated an innovative and rapid corroboration of COVID-19 test based on innovative multiplex PCR. An assessment of optimal PCR conditions to simultaneously amplify the SARS-CoV-2 genes E, S and RdRp has been made by fast-conventional and HRM coupled multiplex real-time PCR using the same sets of primers. All variables of practical value were studied by amplifying known target-sequences from ten-fold dilutions of archived positive samples of COVID-19 disease. The multiplexing with newly designed E, S and RdRp primers have shown an efficient amplification of the target region of SARS-CoV-2. A distinct amplification was observed in 37 min using thermal cycler while it took 96 min in HRM coupled real time detection using SYBR green over a wide range of template concentrations. Our findings revealed decent concordance with other commercially available detection kits. This fast HRM coupled multiplex real-time PCR with SYBR green approach offers rapid and sensitive detection of SARS-CoV-2 in a cost-effective manner apart from the added advantage of primer compatibility for use in conventional multiplex PCR. The highly reproducible novel approach can propel extended applicability for developing sustainable commercial product besides providing relief to a resource limited setting.

September 8, 2021

Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings

There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic.

Covid-19 Vaccine Effectiveness and the Test-Negative Design

Observational studies are emerging as fundamental sources of information about vaccine effectiveness outside the controlled environment of randomized trials, and they are being used to generate evidence of effectiveness against outcomes that are underpowered in trials, such as hospitalization or intensive care unit (ICU) admission, or for narrow subgroups. These studies can monitor the waning of vaccine effectiveness or measure the performance of vaccines against novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants when large randomized, controlled trials are not feasible.

Decline in Pathogenic Antibodies over Time in VITT

Vaccine-induced immune thrombotic thrombocytopenia (VITT) has been described after vaccination with the adenoviral vector vaccines ChAdOx1 nCoV-19 (Oxford–AstraZeneca) and Ad26.COV2.S (Johnson & Johnson–Janssen). VITT is caused by platelet-activating anti–platelet factor 4 (PF4) IgG antibodies, the presence of which can be confirmed by anti–PF4–heparin IgG enzyme-linked immunosorbent assay (ELISA) in combination with PF4-enhanced washed-platelet–activation assays. Clinical and in vitro characteristics of acute VITT closely resemble (autoimmune) heparin-induced thrombocytopenia. A hallmark of heparin-induced thrombocytopenia is the transience of anti-PF4 antibodies. The persistence of pathogenic anti-PF4 antibodies in VITT is not well understood.

Effect of Vaccination on Transmission of SARS-CoV-2

Whether vaccination of individual persons for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) protects members of their households is unclear. We investigated the effect of vaccination of health care workers in Scotland (who were among the earliest groups to be vaccinated worldwide) on the risk of coronavirus disease 2019 (Covid-19) among members of their households.

September 7, 2021

Implementation of an efficient SARS-CoV-2 specimen pooling strategy for high throughput diagnostic testing

The rapid identification and isolation of infected individuals remains a key strategy for controlling the spread of SARS-CoV-2. Frequent testing of populations to detect infection early in asymptomatic or presymptomatic individuals can be a powerful tool for intercepting transmission, especially when the viral prevalence is low. However, RT-PCR testing—the gold standard of SARS-CoV-2 diagnosis—is expensive, making regular testing of every individual unfeasible. Sample pooling is one approach to lowering costs. By combining samples and testing them in groups the number of tests required is reduced, substantially lowering costs. Here we report on the implementation of pooling strategies using 3-d and 4-d hypercubes to test a professional sports team in South Africa. We have shown that infected samples can be reliably detected in groups of 27 and 81, with minimal loss of assay sensitivity for samples with individual Ct values of up to 32. We report on the automation of sample pooling, using a liquid-handling robot and an automated web interface to identify positive samples. We conclude that hypercube pooling allows for the reliable RT-PCR detection of SARS-CoV-2 infection, at significantly lower costs than lateral flow antigen (LFA) tests.

September 6, 2021

SARS-CoV-2 B.1.617.2 Delta variant replication and immune evasion

The SARS-CoV-2 B.1.617.2 (Delta) variant was first identified in the state of Maharashtra in late 2020 and spread throughout India, outcompeting pre-existing lineages including B.1.617.1 (Kappa) and B.1.1.7 (Alpha)1. In vitro, B.1.617.2 is 6-fold less sensitive to serum neutralising antibodies from recovered individuals, and 8-fold less sensitive to vaccine-elicited antibodies as compared to wild type (WT) Wuhan-1 bearing D614G. Serum neutralising titres against B.1.617.2 were lower in ChAdOx-1 versus BNT162b2 vaccinees. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies against the receptor binding domain (RBD) and N- terminal domain (NTD). B.1.617.2 demonstrated higher replication efficiency in both airway organoid and human airway epithelial systems compared to B.1.1.7, associated with B.1.617.2 spike in a predominantly cleaved state compared to B.1.1.7. The B.1.617.2 spike protein was able to mediate highly efficient syncytium formation that was less sensitive to inhibition by neutralising antibody as compared to WT spike. Additionally we observed that B.1.617.2 had higher replication and spike mediated entry as compared to B.1.617.1, potentially explaining B.1.617.2 dominance. In an analysis of over 130 SARS-CoV-2 infected healthcare workers across three centres in India during a period of mixed lineage circulation, we observed reduced ChAdOx-1 vaccine effectiveness against B.1.617.2 relative to non- B.1.617.2, with the caveat of possible residual confounding. Compromised vaccine efficacy against the highly fit and immune evasive B.1.617.2 Delta variant warrants continued infection control measures in the post-vaccination era.

Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February–April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60–76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06–4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04–1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality.

September 3, 2021

Multiple Variants of SARS-CoV-2 in a University Outbreak After Spring Break — Chicago, Illinois, March–May 2021

After spring break 2021, COVID-19 cases increased rapidly at a Chicago university despite mitigation measures. Interviews indicated that the majority of cases occurred in unvaccinated persons with a history of recent travel. Sequencing corroborated multiple introductions to campus and demonstrated that even a single importation can result in many cases.

National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2020

In 2020, adolescent coverage with Tdap and the first dose of MenACWY remained high and continued to improve for HPV vaccines, with some disparities. Adolescents living outside a metropolitan statistical area (MSA) had lower vaccination coverage compared with adolescents living in MSA principal cities.

Screening Programs for SARS-CoV-2 Infections on a University Campus — Austin, Texas, September 30–November 30, 2020

Targeted screening identified 48 cases of COVID-19 during September–November 2020, 18 (38%) of which were in asymptomatic persons. This population of infected students was demographically different from those identified through other testing programs, more risk-tolerant, and less willing to participate in public health prevention activities.

Trends in COVID-19 Cases, Emergency Department Visits, and Hospital Admissions Among Children and Adolescents Aged 0–17 Years — United States, August 2020–August 2021

COVID-19 cases, emergency department visits, and hospital admissions increased from June to August 2021 among persons aged 0-17 years. Emergency department visits and hospital admissions in a 2-week period in August 2021 were higher in states with lower population vaccination coverage and lower in states with higher vaccination coverage.

Hospitalizations Associated with COVID-19 Among Children and Adolescents — COVID-NET, 14 States, March 1, 2020–August 14, 2021

Weekly COVID-19–associated hospitalization rates among children and adolescents rose nearly five-fold during late June–mid-August 2021, coinciding with increased circulation of the highly transmissible SARS-CoV-2 Delta variant. The proportions of hospitalized children and adolescents with severe disease were similar before and during the period of Delta predominance. Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents.

Development of ACE2 autoantibodies after SARS-CoV-2 infection

Many patients with a history of SARS-CoV-2 infection have antibodies specific for ACE2. Patients with ACE2 antibodies have lower activity of soluble ACE2 in plasma. Plasma from these patients also inhibits exogenous ACE2 activity. These findings are consistent with the hypothesis that ACE2 antibodies develop after SARS-CoV-2 infection and decrease ACE2 activity. This could lead to an increase in the abundance of Ang II, which causes a proinflammatory state that triggers symptoms of PASC.

September 2, 2021

Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile

Our results suggest that the inactivated SARS-CoV-2 vaccine effectively prevented Covid-19, including severe disease and death, a finding that is consistent with results of phase 2 trials of the vaccine. (Funded by Agencia Nacional de Investigación y Desarrollo and others.)

Covid-Induced Changes in Health Care Delivery — Can They Last?

COVID-19 shook the U.S. health care system. The immediate-term fallout was predictable: in-person utilization plummeted and many adults deferred routine care. Health care professionals, hospitals, and patients had to — and did — adapt rapidly to this unprecedented crisis, quickly flexing to increase the use of delivery modes such as telemedicine and home-based care.

September 1, 2021

Resurgence of SARS-CoV-2 Infection in a Highly Vaccinated Health System Workforce

In December 2020, the University of California San Diego Health (UCSDH) workforce experienced a dramatic increase in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Vaccination with mRNA vaccines began in mid-December 2020; by March, 76% of the workforce had been fully vaccinated, and by July, the percentage had risen to 87%. Infections had decreased dramatically by early February 2021.

Public Health Law after Covid-19

COVID-19 has spurred an outbreak of a different kind: litigation. To combat the pandemic, officials imposed extensive community-level mitigation measures using their broad but largely untested emergency powers. In response, more than 1000 suits challenged orders shuttering businesses, banning indoor worship services, restricting travel, and mandating mask wearing.1 As with other social aspects of the pandemic, this litigation will have lasting effects.

August 31, 2021

Epidemiologically Linked COVID-19 Outbreaks at a Youth Camp and Men’s Conference — Illinois, June–July 2021

Neither COVID-19 vaccination nor COVID-19 testing was required before either event. Among 122 primary cases, 104 (85%) were in persons who were not fully vaccinated, and 18 (15%) were in fully vaccinated persons. Eight of 38 (21%) close contacts of the 18 fully vaccinated persons subsequently became infected with SARS-CoV-2. No vaccinated persons with COVID-19 were hospitalized.

Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021

During March 2020–January 2021, patients with COVID-19 had nearly 16 times the risk for myocarditis compared with patients who did not have COVID-19, and risk varied by sex and age.

Ultrarapid detection of SARS-CoV-2 RNA using a reverse transcription–free exponential amplification reaction, RTF-EXPAR

In conclusion, through the use of an isothermal, reverse transcription-free (RTF) amplification method, RTF-EXPAR, involving a DNA-selective restriction endonuclease, we have demonstrated the successful detection of SARS-CoV-2 RNA in a total assay time of less than 10 min. In comparison to existing molecular tests, RTF-EXPAR holds a number of advantages.

August 27, 2021

Outbreak Associated with SARS-CoV-2 B.1.617.2 (Delta) Variant in an Elementary School — Marin County, California, May–June 2021

During May 23–June 12, 2021, 26 laboratory-confirmed COVID-19 cases occurred among Marin County, California, elementary school students and their contacts following exposure to an unvaccinated infected teacher. The attack rate in one affected classroom was 50%; risk correlated with seating proximity to the teacher.

COVID-19 Vaccination Coverage Among Adolescents Aged 12–17 Years — United States, December 14, 2020–July 31, 2021

As of July 31, 2021, coverage with ≥1 dose of COVID-19 vaccine among adolescents aged 12–17 years was 42%, and 32% had completed the series. Series completion rates varied widely by state, ranging from 11% to 60%, and was 25% for adolescents aged 12–13 years, 30% for those aged 14–15 years, and 40% for those aged 16–17 years.

COVID-19 Case Rates in Transitional Kindergarten Through Grade 12 Schools and in the Community — Los Angeles County, California, September 2020–March 2021

During September 1, 2020–March 31, 2021, a total of 463 school-associated cases were reported among students attending public TK–12 schools in person and 3,927 among staff members working on-site. During the same period, 105,577 cases among children and adolescents aged 5–17 years and 771,409 cases among adults aged 18–79 years were reported in LAC. School-associated case rates remained low among students, ranging from 110 per 100,000 in September to 859 in December 2020 (Figure). Case rates among all children and adolescents aged 5–17 years in the county were higher during most of the period, ranging from 167 per 100,000 in September to 2,938 in December 2020. School-associated case rates among staff members were lowest in September 2020 (125 per 100,000), peaked in December 2020 (4,109), and fell sharply through March 2021 (188).

August 24, 2021

Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020–August 2021

During December 14, 2020–April 10, 2021, data from the HEROES-RECOVER Cohorts,* a network of prospective cohorts among frontline workers, showed that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines were approximately 90% effective in preventing symptomatic and asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, in real-world conditions. This report updates vaccine effectiveness (VE) estimates including all COVID-19 vaccines available through August 14, 2021, and examines whether VE differs for adults with increasing time since completion of all recommended vaccine doses. VE before and during SARS-CoV-2 B.1.617. (Delta) variant predominance, which coincided with an increase in reported COVID-19 vaccine breakthrough infections, were compared.

SARS-CoV-2 Infections and Hospitalizations Among Persons Aged ≥16 Years, by Vaccination Status — Los Angeles County, California, May 1–July 25, 2021

During May 1–July 25, 2021, among 43,127 SARS-CoV-2 infections in residents of Los Angeles County, California, 10,895 (25.3%) were in fully vaccinated persons, 1,431 (3.3%) were in partially vaccinated persons, and 30,801 (71.4%) were in unvaccinated persons. On July 25, infection and hospitalization rates among unvaccinated persons were 4.9 and 29.2 times, respectively, those in fully vaccinated persons. In July, when the Delta variant was predominant, cycle threshold values were similar for unvaccinated, partially vaccinated, and vaccinated persons.

August 20, 2021

Use of Rapid Antigen Testing for SARS-CoV-2 in Remote Communities — Yukon-Kuskokwim Delta Region, Alaska, September 15, 2020–March 1, 2021

Rapid point-of-care antigen testing shortens the turn-around time and might be a valuable tool in reducing transmission of SARS-CoV-2 in rural communities by facilitating rapid isolation and quarantine.

Disparities in Excess Mortality Associated with COVID-19 — United States, 2020

These findings could help guide targeted public health messaging and mitigation efforts to reduce disparities in COVID-19–associated mortality in the United States, by identifying the racial/ethnic and age groups with the highest excess mortality rates.

August 19, 2021

Impact of Delta on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK

The effectiveness of BNT162b2, ChAdOx1, and mRNA-1273 vaccines against new SARS-CoV-2 infections requires continuous re-evaluation, given the increasingly dominant Delta variant. We investigated theeffectiveness of the vaccines in a large community-based survey of randomly selected households across the UK. We found that the effectiveness of BNT162b2 and ChAd0x1 against any infections (new PCR positives) and infections with symptoms or high viral burden is reduced with the Delta variant. A single dose of the mRNA-1273 vaccine had similar or greater effectiveness compared to a single dose of BNT162b2 or ChAdOx1. Effectiveness of two doses remains at least as great as protection afforded by prior natural infection. The dynamics of immunity following second doses differed significantly between BNT162b2 and ChAdOx1, with greater initial effectiveness against new PCR-positives but faster declines in protection against high viral burden and symptomatic infection with BNT162b2. There was no evidence that effectiveness varied by dosing interval, but protection was higher among those vaccinated following a prior infection and younger adults. With Delta, infections occurring following two vaccinations had similar peak viral burden to those in unvaccinated individuals. SARS-CoV-2 vaccination still reduces new infections, but effectiveness and attenuation of peak viral burden are reduced with Delta.

The Covid-19 Infodemic — Applying the Epidemiologic Model to Counter Misinformation

hroughout the world, including the United States, medical professionals and patients are facing both a pandemic and an infodemic — the first caused by SARS-CoV-2 and the second by misinformation and disinformation. The Annenberg Public Policy Center’s tracking of social and legacy media has found that millions of people have been exposed to deceptive material alleging that SARS-CoV-2 is a hoax or that experts are exaggerating its severity and the extent of its spread, that masks are ineffective or increase infection risk, or that Covid-19 vaccines cause the disease, alter the recipient’s DNA, or include tracking devices. Believing such claims is associated with a lower likelihood of engaging in preventive behavior and a lower willingness to be vaccinated.

August 18, 2021

Joint Statement from HHS Public Health and Medical Experts on COVID-19 Booster Shots

Today, public health and medical experts from the U.S. Department of Health and Human Services (HHS) released the following statement on the Administration’s plan for COVID-19 booster shots for the American people.

New COVID-19 Cases and Hospitalizations Among Adults, by Vaccination Status — New York, May 3–July 25, 2021

These findings support the implementation of multicomponent approach to controlling the pandemic, centered on vaccination, as well as other prevention strategies such as masking and physical distancing.

Sustained Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Associated Hospitalizations Among Adults — United States, March–July 2021

mRNA vaccine effectiveness against COVID-19–associated hospitalizations was sustained over 24 weeks; ongoing monitoring is needed as new SARS-CoV-2 variants emerge. To reduce hospitalization, all eligible persons should be offered COVID-19 vaccination.

Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant — National Healthcare Safety Network, March 1–August 1, 2021

Multicomponent COVID-19 prevention strategies, including vaccination of nursing home staff members, residents, and visitors, are critical. An additional dose of COVID-19 vaccine might be considered for nursing home and long-term care facility residents to optimize a protective immune response.

Early Convalescent Plasma for High-Risk Outpatients with Covid-19

The administration of Covid-19 convalescent plasma to high-risk outpatients within 1 week after the onset of symptoms of Covid-19 did not prevent disease progression.

Pan-Sarbecovirus Neutralizing Antibodies in BNT162b2-Immunized SARS-CoV-1 Survivors

Emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern pose a challenge to the effectiveness of current vaccines. A vaccine that could prevent infection caused by known and future variants of concern as well as infection with pre-emergent sarbecoviruses (i.e., those with potential to cause disease in humans in the future) would be ideal. Here we provide data showing that potent cross-clade pan-sarbecovirus neutralizing antibodies are induced in survivors of severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) infection who have been immunized with the BNT162b2 messenger RNA (mRNA) vaccine. The antibodies are high-level and broad-spectrum, capable of neutralizing not only known variants of concern but also sarbecoviruses that have been identified in bats and pangolins and that have the potential to cause human infection. These findings show the feasibility of a pan-sarbecovirus vaccine strategy.

Breakthrough Infections in BNT162b2-Vaccinated Health Care Workers

Vaccinated health care workers can be infected with variants of concern transmitted from unvaccinated household contacts and may transmit SARS-CoV-2 in the hospital if not screened early enough. Finally, variants of concern may not only be more transmissible than the original SARS-CoV-2 but may also escape vaccine protection more frequently.

Myocarditis after Covid-19 mRNA Vaccination

In these two adult cases of histologically confirmed, fulminant myocarditis that had developed within 2 weeks after Covid-19 vaccination, a direct causal relationship cannot be definitively established because we did not perform testing for viral genomes or autoantibodies in the tissue specimens. However, no other causes were identified by PCR assay or serologic examination.

August 17, 2021

Short-term Reactions Among Pregnant and Lactating Individuals in the First Wave of the COVID-19 Vaccine Rollout

This large prospective cohort study found that COVID-19 vaccines were well-tolerated among individuals who were pregnant, lactating, or planning pregnancy. A strength of this study was the ability to compare vaccine reactions and perceptions in pregnant and lactating individuals vs individuals of similar age and fertility intentions who were neither pregnant nor lactating. Vaccination reactions for day 1 were similar among groups and comparable with findings among pregnant individuals previously reported.6 All groups reported increased reactions following dose 2 of BNT162b2 and mRNA-1273 vaccines.

A vaccine-induced public antibody protects against SARS-CoV-2 and emerging variants

Of five monoclonal antibodies that potently neutralized the WA1/2020 D614G strain, all retained neutralizing capacity against the B.1.617.2 variant, four also neutralized the B.1.1.7 variant, and only one, 2C08, also neutralized the B.1.351 and B.1.1.28 variants. 2C08 reduced lung viral load and morbidity in hamsters challenged with the WA1/2020 D614G, B.1.351, or B.1.617.2 strains. Clonal analysis identified 2C08-like public clonotypes among B cells responding to SARS-CoV-2 infection or vaccination in 41 out of 181 individuals. Thus, 2C08-like antibodies can be induced by SARS-CoV-2 vaccines and mitigate resistance by circulating variants of concern.

Oral Bacteria Combined with an Intranasal Vaccine Protect from Influenza A Virus and SARS-CoV-2 Infection

Intranasal vaccination induces the nasal IgA antibody which is protective against respiratory viruses, such as influenza virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, understanding how mucosal immune responses are elicited following viral infection is important for developing better vaccines. Here, we focused on the role of nasal commensal bacteria in the induction of immune responses following influenza virus infection. To deplete nasal bacteria, we intranasally administered antibiotics to mice before influenza virus infection and found that antibiotic-induced disruption of nasal bacteria could release bacterial components which stimulate the virus-specific antibody responses. Since commensal bacteria in nasal mucosa were significantly lower than those in the oral cavity, intranasal administration of split virus vaccine alone was insufficient to induce the vaccine-specific antibody response. However, intranasal supplementation of cultured oral bacteria from a healthy human volunteer enhanced antibody responses to the intranasally administered vaccine. Therefore, both integrity and amounts of nasal bacteria may be critical for an effective intranasal vaccine.

SARS-CoV-2 delta variant neutralisation after heterologous ChAdOx1-S/BNT162b2 vaccination

Safety considerations associated with the Oxford–AstraZeneca COVID-19 ChAdOx1-S vaccine (AZD1222) have led many public health agencies to recommend a heterologous boost with an mRNA vaccine after prime vaccination with ChAdOx1-S instead of a homologous boost. The first results of a phase 2 trial from Spain and additional reports from observational studies suggest robust immune responses accompanied by acceptable reactogenicity after ChAdOx1-S prime and BNT162b2.

Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in people living with and without HIV in South Africa: an interim analysis of a randomised, double-blind, placebo-controlled, phase 1B/2A trial

ChAdOx1 nCoV-19 was well tolerated, showing favourable safety and immunogenicity in people with HIV, including heightened immunogenicity in SARS-CoV-2 baseline-seropositive participants. People with HIV showed cross-reactive binding antibodies to the beta variant and Asp614Gly wild-type, and high responders retained neutralisation against beta.

COVID-19 vaccine uptake in patients with psychiatric disorders admitted to or residing in a university psychiatric hospital

People with psychiatric disorders, especially severe mental illness, have increased morbidity and mortality from COVID-19 infection; therefore, vaccination against COVID-19 should be prioritised for this vulnerable group, which has been done in several countries (eg, Denmark, Germany, The Netherlands, and the UK).

August 16, 2021

Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection

Younger children may have greater risk of transmitting SARS-CoV-2 to caregivers and siblings in the household than older children.

Association of Vaccine Type and Prior SARS-CoV-2 Infection With Symptoms and Antibody Measurements Following Vaccination Among Health Care Workers

Regardless of symptoms, the vast majority of participants (953 of 954, greater than 99.9%) developed spike IgG antibodies 14 or more days following dose 2; 1 participant who was taking immunosuppressant medication did not develop IgG antibodies (Figure). Reporting clinically significant symptoms, age younger than 60 years, female sex, receipt of Moderna vaccine, and prior SARS-CoV-2 exposure were independently associated with higher median IgG measurements, after adjusting for time after dose 2.

Bell's palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study

Our findings suggest an overall increased risk of Bell's palsy after CoronaVac vaccination. However, the beneficial and protective effects of the inactivated COVID-19 vaccine far outweigh the risk of this generally self-limiting adverse event. Additional studies are needed in other regions to confirm our findings.

Perceiving a Pandemic: Global–Local Incompatibility and COVID-19 Superspreading Events

Supporting our theory, we find that localized county-level infection rates of COVID-19 are unreliable predictors of national infection rates. However, they explain a significant proportion of variance in judgments of national infection rates, contributing to judgment errors. These results support our theoretical approach for modeling this unique judgment context as an incompatibility between global and local information, providing a framework to predict how citizens will react to novel large-scale (global) risks. Our results also help explain the extreme polarization witnessed in the U.S. regarding perceptions of the risks of the COVID-19 pandemic. Accounting for the variability of local experiences with a pandemic can help future generations prepare for how to respond to similar threats more effectively.

August 15, 2021

Immune Correlates Analysis of the mRNA-1273 COVID-19 Vaccine Efficacy Trial

Binding and neutralizing antibodies correlated with COVID-19 risk and vaccine efficacy and likely have utility in predicting mRNA-1273 vaccine efficacy against COVID-19.

August 13, 2021

SARS-CoV-2 infection and mortality during the first epidemic wave in Madurai, south India: a prospective, active surveillance study

In a large-scale SARS-CoV-2 surveillance programme in Madurai, India, we identified equal risk of asymptomatic infection among children, teenagers, and working-age adults, and increasing risk of infection and death associated with older age and comorbidities. Establishing whether surveillance practices or differences in infection severity account for gaps between observed and expected mortality is of crucial importance to establishing the burden of COVID-19 in India.

Rapid genome sequencing in hospitals to identify potential vaccine-escape SARS-CoV-2 variants

SARS-CoV-2 genome sequencing is embedded in academic and public health laboratories, but whether there are benefits to rapid sequencing in front-line hospital laboratories is unclear. We did rapid genome sequencing of SARS-CoV-2-positive nose and throat swabs from patients admitted to our hospital since July 7, 2021, to identify potential SARS-CoV-2 vaccine-escape variants for infection control and public health purposes.

Change in Saliva RT-PCR Sensitivity Over the Course of SARS-CoV-2 Infection

Saliva was sensitive for detecting SARS-CoV-2 in symptomatic individuals during initial weeks of infection, but sensitivity in asymptomatic SARS-CoV-2 carriers was less than 60% at all time points. As COVID-19 testing strategies in workplaces, schools, and other shared spaces are optimized, low saliva sensitivity in asymptomatic infections must be considered.5 This study suggests saliva-based RT-PCR should not be used for asymptomatic COVID-19 screening.

Midcareer Medical School Research Faculty Perspectives on Vitality and Professionalism During the COVID-19 Pandemic

In this study of a diverse group of midcareer medical school faculty, the experience of working during the pandemic appeared to have had important positive impacts on physician investigators and PhD scientists, contributing to their vitality and professional dedication that were associated with intrinsic motivators.

Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States

New section on considerations for use of an additional dose of COVID-19 vaccine following a primary vaccine series

New section on considerations for use of an additional mRNA COVID-19 vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series for immunocompromised people

COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States

These findings suggest that the COVID-19 pandemic affected insurance coverage and the ability of low-income people to access health care, but it appears that the presence of Medicaid expansion was protective for Black and Latinx individuals.

CRISPR-based peptide library display and programmable microarray self-assembly for rapid quantitative protein binding assays

CRISPR-inspired systems have been extensively developed for applications in genome editing and nucleic acid detection. Here, we introduce a CRISPR-based peptide display technology to facilitate customized, high-throughput in vitro protein interaction studies. We show that bespoke peptide libraries fused to catalytically inactive Cas9 (dCas9) and barcoded with unique single guide RNA (sgRNA) molecules self-assemble from a single mixed pool to programmable positions on a DNA microarray surface for rapid, multiplexed binding assays. We develop dCas9-displayed saturation mutagenesis libraries to characterize antibody-epitope binding for a commercial anti-FLAG monoclonal antibody and human serum antibodies. We also show that our platform can be used for viral epitope mapping and exhibits promise as a multiplexed diagnostics tool. Our CRISPR-based peptide display platform and the principles of complex library self-assembly using dCas9 could be adapted for rapid interrogation of varied customized protein libraries or biological materials assembly using DNA scaffolding.

August 12, 2021

Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant

Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations.

Heterologous ChAdOx1-nCoV19–BNT162b2 vaccination provides superior immunogenicity against COVID-19

At the height of the COVID-19 vaccination campaign, supply and local availability issues for the approved vaccines—together with worries about rare side-effects (thrombotic thrombocytopenia)—necessitated the switch to heterologous vaccination schedules, commonly known as mixing vaccines. Several studies have now been completed addressing the efficacy and safety of this practice during the battle for immunisation against SARS-CoV-2 and its variants.

Rapid induction of antigen-specific CD4+ T cells is associated with coordinated humoral and cellular immune responses to SARS-CoV-2 mRNA vaccination

SARS-CoV-2 mRNA vaccines have shown remarkable clinical efficacy, but questions remain about the nature and kinetics of T cell priming. We performed longitudinal antigen-specific T cell analyses on healthy SARS-CoV-2 naïve and recovered individuals prior to and following mRNA prime and boost vaccination. Vaccination induced rapid antigen-specific CD4+ T cell responses in naïve subjects after the first dose, whereas CD8+ T cell responses developed gradually and were variable in magnitude. Vaccine-induced Th1 and Tfh cell responses following the first dose correlated with post-boost CD8+ T cell and neutralizing antibody, respectively. Integrated analysis revealed coordinated immune responses with distinct trajectories in SARS-CoV-2 naïve and recovered individuals. Lastly, whereas booster vaccination improved T cell responses in SARS-CoV-2 naïve subjects, the second dose had little effect in SARS-CoV-2 recovered individuals. These findings highlight the role of rapidly primed CD4+ T cells in coordinating responses to the second vaccine dose in SARS-CoV-2 naïve individuals.

Confronting Our Next National Health Disaster — Long-Haul Covid

Now that more than half of U.S. adults have been vaccinated against SARS-CoV-2, masking and distancing mandates have been relaxed, and Covid-19 cases and deaths are on the decline, there is a palpable sense that life can return to normal. Though most Americans may be able to do so, restoration of normality does not apply to the 10% to 30% of those who are still experiencing debilitating symptoms months after being infected with Covid-19.

The COVID States Project #60: COVID-19 vaccine misinformation: From uncertainty to resistance

In mid-July 2021, President Biden emphatically claimed that social media platforms were “killing people” by facilitating the spread of vaccine misinformation. Not long after, Senate Republican leader Mitch McConnell similarly declared that misinformation was to be blamed for the low vaccination rates of Americans. The public debate that followed brought to the forefront a series of important questions. How prevalent is the public’s belief in vaccine misinformation? Is that belief associated with vaccine resistance? Are some social groups more susceptible to it than others? Are social media companies responsible for the higher levels of vaccine resistance among some of their users?

This report focuses on the first three questions, exploring misinformation beliefs across social groups and their connection with vaccine attitudes. We address the last question in our previous report and in a post published by the Washington Post’s Monkey Cage blog.

Hospital-acquired SARS-CoV-2 infection in the UK's first COVID-19 pandemic wave

Prevention of hospital-acquired infections is a critical aspect of clinical management of COVID-19 as hospital-acquired infections have been a common feature of previous novel coronavirus outbreaks.1 The number of COVID-19 patients in UK hospitals reached high levels during the first pandemic wave of 2020, and higher levels still in the subsequent winter wave. We assessed the magnitude of nosocomial COVID-19 in acute and long-term National Health Service (NHS) hospital facilities in the UK during the first pandmic wave.

Safety, reactogenicity, and immunogenicity of homologous and heterologous prime-boost immunisation with ChAdOx1 nCoV-19 and BNT162b2: a prospective cohort study

The heterologous ChAdOx1 nCov-19–BNT162b2 immunisation with 10–12-week interval, recommended in Germany, is well tolerated and improves immunogenicity compared with homologous ChAdOx1 nCov-19 vaccination with 10–12-week interval and BNT162b2 vaccination with 3-week interval. Heterologous prime-boost immunisation strategies for COVID-19 might be generally applicable.

COVID-19 vaccine equity and booster doses

The debate on COVID-19 vaccine equity has been long-running, and we have previously weighed in on the topic. However, the facts that (1) by Aug 9, only 12·6 million of the 4·46 billion doses administered globally were in low-income countries, (2) 3·65 billion have been administered in high-income (HICs) and upper-middle-income countries, and (3) WHO Director-General Tedros Adhanom Ghebreyesus actually had to issue a plea for a moratorium on third-dose boosters in HICs on Aug 4, mean that we, again, need to add our voice to the demand for equitable access to vaccines.

August 11, 2021

Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents

The mRNA-1273 vaccine had an acceptable safety profile in adolescents. The immune response was similar to that in young adults, and the vaccine was efficacious in preventing Covid-19.

Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis

The high mortality associated with VITT was highest among patients with a low platelet count and intracranial hemorrhage. Treatment remains uncertain, but identification of prognostic markers may help guide effective management.

Randomized Trial of a Third Dose of mRNA-1273 Vaccine in Transplant Recipients

In organ-transplant recipients, the standard two-dose vaccination strategy for coronavirus disease 2019 (Covid-19) has suboptimal immunogenicity.1 Both patients and health care providers have questioned whether a third-dose booster in transplant recipients would be safe and enhance immune response.

Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic

This cohort study examines 869 079 adult women, including 18 715 women with COVID-19, who underwent childbirth at 499 US medical centers between March 1, 2020, and February 28, 2021. Women with COVID-19 had increased mortality, need for intubation and ventilation, and intensive care unit admission. These findings suggest that COVID-19 was associated with increased risk of morbidity and mortality for women giving birth.

Quantification of Specific Antibodies Against SARS-CoV-2 in Breast Milk of Lactating Women Vaccinated With an mRNA Vaccine

Our results suggest that breast milk from women vaccinated with the novel mRNA-based Pfizer-BioNTech vaccine contains specific anti–SARS-CoV-2 IgG(S1) antibodies. Furthermore, we found that after the second dose, breast milk IgG(S1) levels increased and were positively associated with corresponding serum levels.

Immunogenicity of single vaccination with BNT162b2 or ChAdOx1 nCoV-19 at 5–6 weeks post vaccine in participants aged 80 years or older: an exploratory analysis

Single doses of either BNT162b2 or ChAdOx1 nCoV-19 in older people induces humoral immunity in most participants, and is markedly enhanced by previous infection. Cellular responses were weaker, but showed enhancement after the ChAdOx1 nCoV-19 vaccine at the 5–6 week timepoint.

Mechanism of molnupiravir-induced SARS-CoV-2 mutagenesis

Molnupiravir is an orally available antiviral drug candidate currently in phase III trials for the treatment of patients with COVID-19. Molnupiravir increases the frequency of viral RNA mutations and impairs SARS-CoV-2 replication in animal models and in humans. Here, we establish the molecular mechanisms underlying molnupiravir-induced RNA mutagenesis by the viral RNA-dependent RNA polymerase (RdRp). Biochemical assays show that the RdRp uses the active form of molnupiravir, β-d-N4-hydroxycytidine (NHC) triphosphate, as a substrate instead of cytidine triphosphate or uridine triphosphate. When the RdRp uses the resulting RNA as a template, NHC directs incorporation of either G or A, leading to mutated RNA products. Structural analysis of RdRp–RNA complexes that contain mutagenesis products shows that NHC can form stable base pairs with either G or A in the RdRp active center, explaining how the polymerase escapes proofreading and synthesizes mutated RNA. This two-step mutagenesis mechanism probably applies to various viral polymerases and can explain the broad-spectrum antiviral activity of molnupiravir.

August 10, 2021

Persistent Endotheliopathy in the Pathogenesis of Long COVID Syndrome

Collectively, our findings demonstrate that sustained endotheliopathy is common in convalescent COVID-19 and raise the intriguing possibility that this may contribute to Long COVID pathogenesis.

August 10, 2021

Use of COVID-19 Vaccines After Reports of Adverse Events Among Adult Recipients of Janssen (Johnson & Johnson) and mRNA COVID-19 Vaccines (Pfizer-BioNTech and Moderna): Update from the Advisory Committee on Immunization Practices — United States, July 2021

On July 22, 2021, the Advisory Committee on Immunization Practices reviewed updated benefit-risk analyses after Janssen and mRNA COVID-19 vaccination and concluded that the benefits outweigh the risks for rare serious adverse events after COVID-19 vaccination.

Emphasize personal health benefits to boost COVID-19 vaccination rates

Based on a nationally quota representative sample of 3,048 adults in the United States, our findings suggest that several forms of public messages can increase vaccine intentions, but messaging that emphasizes personal health benefits had the largest impact.

Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial

Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths (although our results did not meet the superiority threshold), in people with COVID-19 in the community who are at higher risk of complications.

Effects of adjusting public health, travel, and social measures during the roll-out of COVID-19 vaccination: a modelling study

Gradual relaxation of PHSMs should be carefully planned during the roll-out of vaccination programmes, and easing of travel restrictions weighed against risk of reintroducing outbreaks, to avoid overwhelming health systems and minimise deaths related to COVID-19.

August 9, 2021

Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence

In Florida, which is currently experiencing its largest COVID-19 surge to date, the risk of infection in July after full vaccination with mRNA-1273 was about 60% lower than after full vaccination with BNT162b2 (IRR: 0.39, 95% CI: 0.24-0.62). Our observational study highlights that while both mRNA COVID-19 vaccines strongly protect against infection and severe disease, further evaluation of mechanisms underlying differences in their effectiveness such as dosing regimens and vaccine composition are warranted.

COVID-19 admission risk tools should include multiethnic age structures, multimorbidity and deprivation metrics for air pollution, household overcrowding, housing quality and adult skills

Ethnic minorities exhibit higher multimorbidity despite younger age structures and disproportionate exposure to unscored risk factors including obesity and deprivation. Household overcrowding, air pollution, housing quality and adult skills deprivation are associated with multilobar pneumonia on presentation and ICU admission which are mortality risk factors. Risk tools need to reflect risks predominantly affecting ethnic minorities.

Sensitive extraction-free SARS-CoV-2 RNA virus detection using a chelating resin

Current conventional detection of SARS-CoV-2 involves collection of a patient sample with a nasopharyngeal swab, storage of the swab during transport in a viral transport medium, extraction of RNA, and quantitative reverse transcription PCR (RT-qPCR). We developed a simplified preparation method using a chelating resin, Chelex, that obviates RNA extraction during viral testing. Direct detection RT-qPCR and digital-droplet PCR was compared to the current conventional method with RNA extraction for simulated samples and patient specimens. The heat-treatment in the presence of Chelex markedly improved detection sensitivity as compared to heat alone, and lack of RNA extraction shortens the overall diagnostic workflow. Furthermore, the initial sample heating step inactivates SARS-CoV-2 infectivity, thus improving workflow safety. This fast RNA preparation and detection method is versatile for a variety of samples, safe for testing personnel, and suitable for standard clinical collection and testing on high throughput platforms.

August 6, 2021

Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination — Kentucky, May–June 2021

Among Kentucky residents infected with SARS-CoV-2 in 2020, vaccination status of those reinfected during May–June 2021 was compared with that of residents who were not reinfected. In this case-control study, being unvaccinated was associated with 2.34 times the odds of reinfection compared with being fully vaccinated. To reduce their likelihood for future infection, all eligible persons should be offered COVID-19 vaccine, even those with previous SARS-CoV-2 infection.

Effectiveness of COVID-19 Vaccines in Preventing Hospitalization Among Adults Aged ≥65 Years — COVID-NET, 13 States, February–April 2021

Among adults aged 65–74 years, effectiveness of full vaccination for preventing hospitalization was 96% for Pfizer-BioNTech, 96% for Moderna, and 84% for Janssen COVID-19 vaccines; among adults aged ≥75 years, effectiveness of full vaccination for preventing hospitalization was 91% for Pfizer-BioNTech, 96% for Moderna, and 85% for Janssen COVID-19 vaccines. Efforts to increase vaccination coverage are critical to reducing the risk for COVID-19–related hospitalization, particularly in older adults.

Rapid Increase in Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant — Mesa County, Colorado, April–June 2021

During April–June 2021, COVID-19 cases caused by the Delta variant increased rapidly in Mesa County, Colorado. Compared with that in other Colorado counties, incidence, intensive care unit admissions, COVID-19 case fatality ratios, and the proportion of cases in fully vaccinated persons were significantly higher in Mesa County. Crude vaccine effectiveness against symptomatic infection was estimated to be 78% for Mesa County and 89% for other Colorado counties. Vaccination is critical for preventing infection, serious illness, and death associated with SARS-CoV-2 infection (including the Delta variant). Multicomponent prevention strategies, such as masking in indoor settings irrespective of vaccination status as well as optimal surveillance testing and infection prevention and control, should be considered in areas of high incidence.

The Hyperlipidaemic Drug Fenofibrate Significantly Reduces Infection by SARS-CoV-2 in Cell Culture Models

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has caused a significant number of fatalities and worldwide disruption. To identify drugs to repurpose to treat SARS-CoV-2 infections, we established a screen to measure the dimerization of angiotensin-converting enzyme 2 (ACE2), the primary receptor for the virus. This screen identified fenofibric acid, the active metabolite of fenofibrate. Fenofibric acid also destabilized the receptor-binding domain (RBD) of the viral spike protein and inhibited RBD binding to ACE2 in enzyme-linked immunosorbent assay (ELISA) and whole cell-binding assays. Fenofibrate and fenofibric acid were tested by two independent laboratories measuring infection of cultured Vero cells using two different SARS-CoV-2 isolates. In both settings at drug concentrations, which are clinically achievable, fenofibrate and fenofibric acid reduced viral infection by up to 70%. Together with its extensive history of clinical use and its relatively good safety profile, this study identifies fenofibrate as a potential therapeutic agent requiring an urgent clinical evaluation to treat SARS-CoV-2 infection.

August 5, 2021

Contact Tracing for Covid-19 — A Digital Inoculation against Future Pandemics

Outbreaks of coronavirus disease 2019 (Covid-19) emerged in the United States and in European countries in February 2020. Urgent action was called for, since experts estimated that 30 to 70% of people in these Western countries could become infected — a frightening projection at a time when the Covid-19 mortality rate was estimated to be substantially higher than we now know it to be.

SARS-CoV-2 Variants in Patients with Immunosuppression

Patients with immunosuppression are at risk for prolonged infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In several case reports, investigators have indicated that multimutational SARS-CoV-2 variants can arise during the course of such persistent cases of coronavirus disease 2019 (Covid-19).

August 4, 2021

Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19

Subcutaneous REGEN-COV prevented symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection in previously uninfected household contacts of infected persons. Among the participants who became infected, REGEN-COV reduced the duration of symptomatic disease and the duration of a high viral load.

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19

In critically ill patients with Covid-19, an initial strategy of therapeutic-dose anticoagulation with heparin did not result in a greater probability of survival to hospital discharge or a greater number of days free of cardiovascular or respiratory organ support than did usual-care pharmacologic thromboprophylaxis.

Surviving Covid-19 with Heparin?

Patients who are admitted to the hospital with coronavirus disease 2019 (Covid-19) are at high risk for thrombosis, particularly venous thromboembolism (VTE). In a meta-analysis of 66 studies, the overall prevalence of VTE among patients with Covid-19 was 14.1%, with the highest incidence (22.7%) among those admitted to intensive care units (ICUs).

Myocarditis and Pericarditis After Vaccination for COVID-19

Some vaccines are associated with myocarditis, including mRNA vaccines, and the Centers for Disease Control and Prevention recently reported a possible association between COVID-19 mRNA vaccines and myocarditis, primarily in younger male individuals within a few days after the second vaccination, at an incidence of about 4.8 cases per 1 million. This study shows a similar pattern, although at higher incidence, suggesting vaccine adverse event underreporting. Additionally, pericarditis may be more common than myocarditis among older patients.

Variation of National and International Guidelines on Respiratory Protection for Health Care Professionals During the COVID-19 Pandemic

Conflicting evidence surrounding SARS-CoV-2 transmission, particularly airborne transmission, may have contributed to heterogeneous recommendations for respiratory protection across countries and organizations.1 Variability among guidelines may generate confusion, anxiety, and mistrust among health care professionals (HCPs) regarding the ability of respiratory protection to prevent SARS-CoV-2 transmission. We assessed variation in international and national guidelines on respiratory protection for HCPs in hospital settings during the first year of the COVID-19 pandemic.

Is oropharyngeal sampling a reliable test to detect SARS-CoV-2?

The authors concluded that, compared with a nasopharyngeal swab, a pooled nasal and oropharyngeal swab offered the best alternative sampling approach to diagnose SARS-CoV-2 infection, followed by saliva and nasal swabs. Oropharyngeal swabs were not recommended for diagnosis because of low sensitivity and positive predictive value.

Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT

There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30–250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1–20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.

Mucormycosis after COVID-19 in a patient with diabetes

A 44-year-old man attended our hospital reporting reduced vision in his left eye. 10 days earlier he had been started on treatment with supplemental oxygen, intravenous antibiotics, and corticosteroids because of a moderately severe pneumonia caused by SARS-CoV-2. The patient explained that a blackish patch—extending from just below his left eye to the left side of his face to the level of his mouth—had also developed 2 days earlier.

Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: A rapid systematic review

Although most countries and healthcare systems worldwide have been affected by the COVID-19 pandemic, some groups of the population may be more vulnerable to detrimental effects of the pandemic on mental health than others. The aim of this systematic review was to synthesise evidence currently available from systematic reviews on the impact of COVID-19 and other coronavirus outbreaks on mental health for groups of the population thought to be at increased risk of detrimental mental health impacts.

August 3, 2021

Estimating SARS-CoV-2 infections from deaths, confirmed cases, tests, and random surveys

The novel coronavirus SARS-CoV-2 has infected over 33 million people in the United States. Nationwide, over 600,000 have died in the COVID-19 pandemic, which has necessitated shutdowns of schools and sectors of the economy. The extent of the virus’ spread remains uncertain due to biases in test data. We combine multiple data sources to estimate the true number of infections in all US states. These data include representative random testing surveys from Indiana and Ohio, which provide potentially unbiased prevalence estimates. We find that approximately 60% of infections have gone unreported. Even so, only about 20% of the United States had been infected as of early March 2021, suggesting that the country was far from herd immunity at that point.

New Federal Guidance Says COVID-19’s Long-term Effects Can Qualify as a Disability

People in the US who experience persistent, recurring, or new symptoms after infection with COVID-19—a condition known as long COVID—can qualify as having a disability under federal civil rights laws and receive appropriate accommodations and services, the Biden-Harris administration announced last week.

Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2

Although COVID-19 in children is usually of short duration with low symptom burden, some children with COVID-19 experience prolonged illness duration. Reassuringly, symptom burden in these children did not increase with time, and most recovered by day 56. Some children who tested negative for SARS-CoV-2 also had persistent and burdensome illness. A holistic approach for all children with persistent illness during the pandemic is appropriate.

Endomembrane targeting of human OAS1 p46 augments antiviral activity

Many host RNA sensors are positioned in the cytosol to detect viral RNA during infection. However, most positive-strand RNA viruses replicate within a modified organelle co-opted from intracellular membranes of the endomembrane system, which shields viral products from cellular innate immune sensors. Targeting innate RNA sensors to the endomembrane system may enhance their ability to sense RNA generated by viruses that use these compartments for replication. Here, we reveal that an isoform of oligoadenylate synthetase 1, OAS1 p46, is prenylated and targeted to the endomembrane system. Membrane localization of OAS1 p46 confers enhanced access to viral replication sites and results in increased antiviral activity against a subset of RNA viruses including flaviviruses, picornaviruses, and SARS-CoV-2. Finally, our human genetic analysis shows that the OAS1 splice-site SNP responsible for production of the OAS1 p46 isoform correlates with protection from severe COVID-19. This study highlights the importance of endomembrane targeting for the antiviral specificity of OAS1 and suggests that early control of SARS-CoV-2 replication through OAS1 p46 is an important determinant of COVID-19 severity.

August 2, 2021

The Effect of Social and Stress-Related Factors on Alcohol Use Among College Students During the Covid-19 Pandemic

Unless new drinking habits are formed during the pandemic, decreases in alcohol use among college students are unlikely to be sustained as social distancing measures are removed. Colleges may want to target interventions to students who have responded to stress with increased alcohol use, partly by addressing difficulties with distance learning.

Setting Priorities to Address Research Gaps in Long-term COVID-19 Outcomes in Children

Increasing numbers of people with prolonged symptoms after recovery from COVID-19 infection (long COVID) have been reported, prompting calls for research. Symptoms of long COVID are poorly characterized, with several phenotypes described, and the causes, treatments, and outcomes are unknown. Calls for research fail to address long COVID in children and adolescents. Given the demand for appropriate care for patients with this condition, agencies have published guidelines on treatment. However, these guidelines inappropriately combine research requirements and services for the children and older adults.

Flawed ivermectin preprint highlights challenges of COVID drug studies

Throughout the pandemic, the anti-parasite drug ivermectin has attracted much attention, particularly in Latin America, as a potential way to treat COVID-19. But scientists say that recent, shocking revelations of widespread flaws in the data of a preprint study reporting that the medication greatly reduces COVID-19 deaths dampens ivermectin’s promise — and highlights the challenges of investigating drug efficacy during a pandemic.

Ivermectin (Still) Lacks Scientific Support as a COVID-19 Drug

The available scientific evidence does not support the use of ivermectin, an antiparastic drug, for the treatment or prevention of COVID-19 outside the context of clinical trials, according to a new report from Cochrane, an international organization that reviews medical research and provides guidance about clinical practice.

July 30, 2021

The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California

In a large population-based study, COVID-19 diagnosis increased the risk of VPTB, PTB, and early term birth, particularly among people with medical comorbidities. Considering increased circulation of COVID-19 variants, preventative measures, including vaccination, should be prioritized for birthing persons.

Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021

Jurisdictions might consider expanded prevention strategies, including universal masking in indoor public settings, particularly for large public gatherings that include travelers from many areas with differing levels of SARS-CoV-2 transmission.

Statement from CDC Director Rochelle P. Walensky, MD, MPH on Today’s MMWR

Today, some of those data were published in CDC’s Morbidity and Mortality Weekly Report (MMWR), demonstrating that Delta infection resulted in similarly high SARS-CoV-2 viral loads in vaccinated and unvaccinated people. High viral loads suggest an increased risk of transmission and raised concern that, unlike with other variants, vaccinated people infected with Delta can transmit the virus. This finding is concerning and was a pivotal discovery leading to CDC’s updated mask recommendation. The masking recommendation was updated to ensure the vaccinated public would not unknowingly transmit virus to others, including their unvaccinated or immunocompromised loved ones.

COVID-19 Vaccine Safety in Adolescents Aged 12–17 Years — United States, December 14, 2020–July 16, 2021

Mild local and systemic reactions are common among adolescents following Pfizer-BioNTech vaccine, and serious adverse events are rare. The Advisory Committee on Immunization Practices conducted a risk-benefit assessment and continues to recommend the Pfizer-BioNTech COVID-19 vaccine for all persons aged ≥12 years.

Disparities in COVID-19 Vaccination Coverage Among Health Care Personnel Working in Long-Term Care Facilities, by Job Category, National Healthcare Safety Network — United States, March 2021

During March 2021, 300 LTCFs reported COVID-19 vaccination coverage for their HCP. COVID-19 vaccination coverage was highest among physicians (75.1%) and lowest among aides (45.6%). Vaccination coverage among aides was lower in facilities located in zip code areas with higher levels of social vulnerability.

SARS-CoV-2 Infection in Public School District Employees Following a District-Wide Vaccination Program — Philadelphia County, Pennsylvania, March 21–April 23, 2021

Weekly SARS-CoV-2 antigen screening tests required of all employees returning for in-school instruction in the School District of Philadelphia found a 95% lower percentage of positive test results among persons who reported receipt of 2 doses of COVID-19 mRNA vaccine (0.09%) than among those who were unvaccinated (1.77%).

Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial

CoronaVac, an inactivated SARS-CoV-2 vaccine, has been approved for emergency use in several countries. However, its immunogenicity in immunocompromised individuals has not been well established. We initiated a prospective phase 4 controlled trial (no. NCT04754698, CoronavRheum) in 910 adults with autoimmune rheumatic diseases (ARD) and 182 age- and sex-frequency-matched healthy adults (control group, CG), who received two doses of CoronaVac. The primary outcomes were reduction of ≥15% in both anti-SARS-CoV-2 IgG seroconversion (SC) and neutralizing antibody (NAb) positivity 6 weeks (day 69 (D69)) after the second dose in the ARD group compared with that in the CG. Secondary outcomes were IgG SC and NAb positivity at D28, IgG titers and neutralizing activity at D28 and D69 and vaccine safety. Prespecified endpoints were met, with lower anti-SARS-Cov-2 IgG SC (70.4 versus 95.5%, P < 0.001) and NAb positivity (56.3 versus 79.3%, P < 0.001) at D69 in the ARD group than in the CG. Moreover, IgG titers (12.1 versus 29.7, P < 0.001) and median neutralization activity (58.7 versus 64.5%, P = 0.013) were also lower at D69 in patients with ARD. At D28, patients with ARD presented with lower IgG frequency (18.7 versus 34.6%, P < 0.001) and NAb positivity (20.6 versus 36.3%, P < 0.001) than that of the CG. There were no moderate/severe adverse events. These data support the use of CoronaVac in patients with ARD, suggesting reduced but acceptable short-term immunogenicity. The trial is still ongoing to evaluate the long-term effectiveness/immunogenicity.

July 29, 2021

Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia

Among patients hospitalized with Covid-19 pneumonia, tofacitinib led to a lower risk of death or respiratory failure through day 28 than placebo.

BNT162b2-Elicited Neutralization against New SARS-CoV-2 Spike Variants

Because these data show that the newly emerged B.1.526, B.1.429, and B.1.1.7+E484K variants remain susceptible to an important vaccine-elicited immune effector (neutralizing antibody), they confirm the importance of mass immunization with current, highly effective, authorized vaccines as a central strategy to end the Covid-19 pandemic.

July 28, 2021

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers

Among fully vaccinated health care workers, the occurrence of breakthrough infections with SARS-CoV-2 was correlated with neutralizing antibody titers during the peri-infection period. Most breakthrough infections were mild or asymptomatic, although persistent symptoms did occur.

Serologic Surveillance and Phylogenetic Analysis of SARS-CoV-2 Infection Among Hospital Health Care Workers

In this cohort study of 801 hospital health care workers (HCWs), the risk of getting infected with SARS-CoV-2 was nearly 4-fold higher among HCWs on COVID-19 wards compared with HCWs not in patient care. Combined phylogenetic and epidemiological analyses found no patient-to-HCW transmission but several occurrences of HCW-to-HCW transmission.

Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death

In this systematic review and meta-analysis of more than 91 million people, individuals with preexisting mood disorders, compared with those without mood disorders, had significantly higher pooled odds ratios for COVID-19 hospitalization and death. There were no associations between preexisting mood disorders and risk of COVID-19 infection or severe events.

Effect of Targeted Behavioral Science Messages on COVID-19 Vaccination Registration Among Employees of a Large Health System

During the 3-day study period, an individual email nudge caused more than twice as many HCWs to register for a COVID-19 vaccination compared with HCWs in the control condition, with no significant difference between the 2 emails. A limitation of this trial is that due to the imminent closure of employee-only vaccination clinics, we could only delay the intervention in the control group by 3 days. Moreover, by choosing to compare 2 behaviorally informed emails, we are unable to exclude the possibility that a plain reminder might have had the same effect. Furthermore, we could not measure actual vaccination, as appointment slots were unexpectedly unavailable for many who registered for one.

Aberrant glycosylation of anti-SARS-CoV-2 IgG is a pro-thrombotic stimulus for platelets

Aberrant glycosylation of anti-SARS-CoV-2 IgG immune complexes increases platelet thrombus formation on vWF

Inhibition of syk, btk, P2Y12 or FcγRIIA reverses enhancement of thrombus formation mediated by anti-SARS-CoV-2 immune complexes

SARS-CoV-2 Lambda variant exhibits higher infectivity and immune resistance

SARS-CoV-2 Lambda, a new variant of interest, is now spreading in some South American countries; however, its virological features and evolutionary trait remain unknown. Here we reveal that the spike protein of the Lambda variant is more infectious and it is attributed to the T76I and L452Q mutations. The RSYLTPGD246-253N mutation, a unique 7-amino-acid deletion mutation in the N-terminal domain of the Lambda spike protein, is responsible for evasion from neutralizing antibodies.

Reproducible Breath Metabolite Changes in Children with SARS-CoV-2 Infection

SARS-CoV-2 infection is diagnosed through detection of specific viral nucleic acid or antigens from respiratory samples. These techniques are relatively expensive, slow, and susceptible to false-negative results. A rapid noninvasive method to detect infection would be highly advantageous. Compelling evidence from canine biosensors and studies of adults with COVID-19 suggests that infection reproducibly alters human volatile organic compound (VOC) profiles. To determine whether pediatric infection is associated with VOC changes, we enrolled SARS-CoV-2 infected and uninfected children admitted to a major pediatric academic medical center. Breath samples were collected from children and analyzed through state-of-the-art GCxGC-ToFMS. Isolated features included 84 targeted VOCs. Candidate biomarkers that were correlated with infection status were subsequently validated in a second, independent cohort of children. We thus find that six volatile organic compounds are significantly and reproducibly increased in the breath of SARS-CoV-2 infected children. Three aldehydes (octanal, nonanal, and heptanal) drew special attention, as aldehydes are also elevated in the breath of adults with COVID-19. Together, these biomarkers demonstrate high accuracy for distinguishing pediatric SARS-CoV-2 infection and support the ongoing development of novel breath-based diagnostics.

Ivermectin for preventing and treating COVID‐19

Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials.

July 27, 2021

Guidance for Implementing COVID-19 Prevention Strategies in the Context of Varying Community Transmission Levels and Vaccination Coverage

Given the spread of the highly transmissible Delta variant, local decision-makers should assess the following factors to inform the need for layered prevention strategies across a range of settings: level of SARS-CoV-2 community transmission, health system capacity, vaccination coverage, capacity for early detection of increases in COVID-19 cases, and populations at risk for severe outcomes from COVID-19.

Lower serum 25(OH)D levels associated with higher risk of COVID-19 infection in U.S. Black women

The present results suggest that U.S. Black women with lower levels of 25(OH)D are at increased risk of infection with COVID-19. Further work is needed to confirm these findings and determine the optimal level of 25(OH)D for a beneficial effect.

Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries

In this systematic review and meta-analysis of 16 observational studies in 7 countries with 19 086 patients, mental health disorders were associated with increased COVID-19 mortality according to both pooled crude and adjusted odds ratios. Patients with severe mental health disorders had the highest odds ratios.

July 26, 2021

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

Corneal confocal microscopy identifies corneal small nerve fibre loss and increased DCs in patients with long COVID, especially those with neurological symptoms. CCM could be used to objectively identify patients with long COVID.

A ‘mix and match’ approach to SARS-CoV-2 vaccination

Heterologous dosing with the adenovirus-based ChAdOx1 (AstraZeneca) vaccine followed by an mRNA vaccine induced stronger immune responses than did the homologous ChAdOx1 vaccine series, according to recent immunogenicity studies.

Immunogenicity and reactogenicity of heterologous ChAdOx1 nCoV-19/mRNA vaccination

Recipients of both the homologous vector regimen and the heterologous vector/mRNA combination reported greater reactogenicity following the priming vector vaccination, whereas heterologous boosting was well tolerated and comparable to homologous mRNA boosting. Taken together, heterologous vector/mRNA boosting induces strong humoral and cellular immune responses with acceptable reactogenicity profiles.

Safety Evaluation of the Second Dose of Messenger RNA COVID-19 Vaccines in Patients With Immediate Reactions to the First Dose

Because the Janssen vaccine received emergency use authorization, the US Centers for Disease Control and Prevention recommended that individuals with an immediate and potentially allergic reaction to the first dose of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccine could receive a Janssen single dose subsequently. However, our data suggest that most patients with immediate and potentially allergic reactions to mRNA COVID-19 vaccines tolerate a second dose. Therefore, it may not be necessary to consider this, to our knowledge, largely unstudied alternative mixed series approach. Although earlier work provided a shared framework for the clinical approach, our pooled study was limited by its retrospective study design, referral bias, and lack of a shared evaluation protocol among participating institutions.

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

Corneal confocal microscopy identifies corneal small nerve fibre loss and increased DCs in patients with long COVID, especially those with neurological symptoms. CCM could be used to objectively identify patients with long COVID.

July 24, 2021

Tocilizumab in COVID-19 therapy: who benefits, and how?

There is clinical evidence to suggest tocilizumab therapy in patients with COVID-19 may be associated with thrombotic events. To better analyse the efficacy and safety of tocilizumab, the RECOVERY Collaborative Group should specify the number of thrombotic or thromboembolic events observed in their study and specifically detail the proportion of patients receiving therapeutic anticoagulation in both groups. These results will better inform clinical practice on the use of tocilizumab for patients with COVID-19.

Tocilizumab in COVID-19 therapy: who benefits, and how?

In conclusion, clinical trials of IL-6 antagonist therapy, such as RECOVERY and sarilumab COVID-19 global studies, should consider reanalysis of their results as a function of IL-6 baseline concentrations. More generally, clinical trials of personalised precision medicine, based on cytokine profiling, are needed for optimisation of COVID-19 therapy.

Tocilizumab in COVID-19 therapy: who benefits, and how? – Authors' reply

These data do not, therefore, support the hypothesis of restricting treatment with tocilizumab to those patients with the highest levels of CRP or other biomarkers of inflammation. On the contrary, these data raise the question of whether even more COVID-19 patients could benefit from IL-6 inhibition if a lower threshold (CRP <75 mg/L) were used to initiate treatment.

July 23, 2021

Memory B Cell Repertoire for Recognition of Evolving SARS-CoV-2 Spike

Although emerging SARS-CoV-2 variants of concern escaped binding by many members of the groups associated with the most potent neutralizing activity, some antibodies in each of those groups retained affinity—suggesting that otherwise redundant components of a primary immune response are important for durable protection from evolving pathogens. Our results furnish a global atlas of S-specific memory B cell repertoires and illustrate properties driving viral escape and conferring robustness against emerging variants.

Strategies for disseminating guidance to dentists during the COVID-19 pandemic

This presentation summarizes and evaluates the clinical guidance and other evidence-based resources developed for dentists and patients by the American Dental Association (ADA) during the COVID-19 pandemic.

SARS-CoV-2 Infection in Public School District Employees Following a District-Wide Vaccination Program — Philadelphia County, Pennsylvania, March 21–April 23, 2021

Weekly SARS-CoV-2 antigen screening tests required of all employees returning for in-school instruction in the School District of Philadelphia found a 95% lower percentage of positive test results among persons who reported receipt of 2 doses of COVID-19 mRNA vaccine (0.09%) than among those who were unvaccinated (1.77%).

Scent of a vaccine

The highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the respiratory tract and is transmitted, in part, by respiratory droplets and aerosols. Consequently, unvaccinated people are encouraged to wear masks in public, self-quarantine if symptomatic, and practice social distancing. Despite these precautions, millions are dying. As the pandemic takes its toll, vaccines are once again headline news, notably for the speed of their development and the success of messenger RNA (mRNA) vaccines. Given the respiratory tropism of the virus, however, it seems surprising that only seven of the nearly 100 SARS-CoV-2 vaccines currently in clinical trials are delivered intranasally. Advantages of intranasal vaccines include needle-free administration, delivery of antigen to the site of infection, and the elicitation of mucosal immunity in the respiratory tract.

Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic — United States, 2020–2021

Influenza viruses and human metapneumovirus circulated at historic lows through May 2021. In April 2021, respiratory syncytial virus activity increased. Common human coronaviruses, parainfluenza viruses, and respiratory adenoviruses have been increasing since January or February 2021. Rhinoviruses and enteroviruses began to increase in June 2020.

Coronavirus Disease 2019 as a Possible Cause of Severe Orbital Cellulitis

Infection by severe respiratory syndrome coronavirus 2 (coronavirus disease 2019) has been the most important public health event of the last 100 years. The number of cases and deaths caused by this disease, its potential to rapidly spread and the search for a vaccine have been the center of discussion all over the world for over 1 year. In addition to the number of cases and all social, economic, and public health consequences of the pandemic, the variety of symptoms and clinical signs presented by infected patients has been subject of several studies and case reports.

July 22, 2021

Impaired local intrinsic immunity to SARS-CoV-2 infection in severe COVID-19

SARS-CoV-2 infection can cause severe respiratory COVID-19. However, many individuals present with isolated upper respiratory symptoms, suggesting potential to constrain viral pathology to the nasopharynx. Which cells SARS-CoV-2 primarily targets and how infection influences the respiratory epithelium remains incompletely understood. We performed scRNA-seq on nasopharyngeal swabs from 58 healthy and COVID-19 participants. During COVID-19, we observe expansion of secretory, loss of ciliated, and epithelial cell repopulation via deuterosomal expansion. In mild/moderate COVID-19, epithelial cells express anti-viral/interferon-responsive genes, while cells in severe COVID-19 have muted anti-viral responses despite equivalent viral loads. SARS-CoV-2 RNA+ host-target cells are highly heterogenous, including developing ciliated, interferon-responsive ciliated, AZGP1high goblet, and KRT13+ “hillock”-like cells, and we identify genes associated with susceptibility, resistance, or infection response. Our study defines protective and detrimental responses to SARS-CoV-2, the direct viral targets of infection, and suggests that failed nasal epithelial anti-viral immunity may underlie and precede severe COVID-19.

Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study

This study identified several work environment factors that have significantly affected health care workers' well-being and resilience during the COVID-19 pandemic. This knowledge has practical relevance for health care leaders who aim to better understand and address the well-being and resilience of the health care workforce during this pandemic and beyond.

Spatiotemporal invasion dynamics of SARS-CoV-2 lineage B.1.1.7 emergence

We identify a multi-stage spatial invasion process in which early B.1.1.7 growth rates were associated with mobility and asymmetric lineage export from a dominant source location, enhancing the effects of B.1.1.7’s increased intrinsic transmissibility. We further explore how B.1.1.7 spread was shaped by non-pharmaceutical interventions and spatial variation in previous attack rates. Our findings show that careful accounting of the behavioral and epidemiological context within which variants of concern emerge is necessary to interpret correctly their observed relative growth rates.

Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines

Authorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.)

July 21, 2021

Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant

Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant.

Vaccine Effectiveness Studies in the Field

The original trials of vaccines against infection with severe acute respiratory disease coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), have clearly shown vaccine efficacy. However, questions crucial to vaccination policy remain, at best, only partially answered. These include the effect of new virus variants, the timing between vaccine doses, the effect of vaccines on asymptomatic infection in contrast to severe disease, the waning of vaccine immunity, and the potentially enhanced effectiveness of mix-and-match strategies that might be used with booster shots.

Household Transmission of SARS-CoV-2 from Children and Adolescents

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is often asymptomatic or results in only mild disease. Data on the extent of transmission of SARS-CoV-2 from children and adolescents in the household setting, including transmission to older persons who are at increased risk for severe disease, are limited. After an outbreak of coronavirus disease 2019 (Covid-19) at an overnight camp, we conducted a retrospective cohort study involving camp attendees and their household contacts to assess secondary transmission and factors associated with household transmission.

SARS-CoV-2 Human Challenge Studies — Establishing the Model during an Evolving Pandemic

Human challenge studies (also called controlled human infection models), in which researchers intentionally administer an infectious agent to volunteers, have played major roles in vaccine and treatment development and in elucidation of pathogenesis and immunity. Such studies are not normally undertaken during a pandemic, however, and the potential risks and benefits of such research with SARS-CoV-2 in this setting have triggered widespread debate. While other commentators have made theoretical arguments for and against SARS-CoV-2 challenge studies, a consortium of academics, industry collaborators, and the British government (through the Human Challenge Programme of the U.K. Vaccines Taskforce) has now proceeded to address the technical and ethical considerations to enable such studies. The consortium’s practical application of ethical principles against a backdrop of rapidly emerging evidence carries lessons for future outbreaks.

July 20, 2021

More Genetic Clues to COVID-19 Susceptibility and Severity

Many factors influence our risk of illness from SARS-CoV-2, the coronavirus responsible for COVID-19. That includes being careful to limit our possible exposures to the virus, as well as whether we have acquired immunity from a vaccine or an earlier infection. But once a person is infected, a host of other biological factors, including age and pre-existing medical conditions, will influence one’s risk of becoming severely ill.

July 19, 2021

Abelacimab for Prevention of Venous Thromboembolism

This trial showed that factor XI is important for the development of postoperative venous thromboembolism. Factor XI inhibition with a single intravenous dose of abelacimab after total knee arthroplasty was effective for the prevention of venous thromboembolism and was associated with a low risk of bleeding.

Inhibitors of VPS34 and fatty-acid metabolism suppress SARS-CoV-2 replication

Mechanistic studies with compounds targeting multiple steps up- and downstream of fatty acid synthase (FASN) identify the importance of triacylglycerol production and protein palmitoylation as requirements for efficient viral RNA synthesis and infectious virus production. Further, FASN knockout results in significantly impaired SARS-CoV-2 replication that can be rescued with fatty acid supplementation. Together, these studies clarify roles for VPS34 and fatty acid metabolism in SARS-CoV-2 replication and identify promising avenues for the development of countermeasures against SARS-CoV-2.

July 16, 2021

COVID-19 Vaccine Administration, by Race and Ethnicity — North Carolina, December 14, 2020–April 6, 2021

Among persons vaccinated during March 29–April 6, 2021, compared with December 14, 2020–January 3, 2021, in North Carolina, the proportion who were Black nearly doubled, and the share of vaccine doses administered to Hispanic persons doubled during this period, approaching the proportion of the state population for these groups aged ≥16 years.

July 15, 2021

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

Pre-existing mental disorders, in particular psychotic and mood disorders, and exposure to antipsychotics and anxiolytics were associated with COVID-19 mortality in both crude and adjusted models. Although further research is required to determine the underlying mechanisms, our findings highlight the need for targeted approaches to manage and prevent COVID-19 in at-risk patient groups identified in this study.

July 14, 2021

Covid-19: Regional policies and local infection risk: Evidence from Italy with a modelling study

Even within the same region, Italy’s provinces differ in exposure to covid-19 infection risk due to local characteristics. Regional policies did not eliminate these differences, but may have dampened them. Our evidence can be relevant for policy-makers who need to design non-pharmaceutical interventions. It also provides a methodological suggestion for researchers who attempt to estimate their causal effects.

July 13, 2021

Antibody response after second BNT162b2 dose in allogeneic HSCT recipients

In this first evaluation of immunogenicity in allogeneic HSCT recipients after two vaccine doses, we observed overall frequent and high levels of humoral responses, which contrasts with recent observations in solid organ transplant recipients who are receiving very long-term pharmacological immunosuppression.4 We identified lymphocyte count as well as recent pharmacological immunosuppression, rather than the sole timing of vaccination after HSCT, as determinants of humoral response. Our findings support the large scale vaccination of allogeneic HSCT recipients, although additional multicentre and long-term studies are needed to specify the level of immunological protection against infection, also taking into account the effect of a third vaccine dose in non-responding patients.

mRNA Vaccines May Pack More Persistent Punch Against COVID-19 Than Thought

Many people, including me, have experienced a sense of gratitude and relief after receiving the new COVID-19 mRNA vaccines. But all of us are also wondering how long the vaccines will remain protective against SARS-CoV-2, the coronavirus responsible for COVID-19.

July 9, 2021

Disrupted Resolution Mechanisms Favor Altered Phagocyte Responses in Covid-19

The present findings suggest that downregulation of systemic SPM concentrations is linked with both increased disease severity and dysregulated phagocyte function. They also identify the upregulation of these mediators by dexamethasone as a potential mechanism in host protective activities elicited by this drug in COVID-19 patients. Taken together, our findings elucidate a role for altered resolution mechanisms in the disruption of phagocyte responses and the propagation of systemic inflammation in COVID-19.

July 8, 2021

The quest to find genes that drive severe COVID

Since last March, research teams around the world have scoured the genomes of more than 100,000 people with COVID-19, hoping to find genetic clues to who will be hit hardest by an infection with the virus SARS-CoV-2. What’s emerged from this effort is a dozen or so genetic variants that have a strong statistical association with a person’s chances of developing COVID-19 and becoming gravely ill with the disease, the teams report in a summary analysis published on 8 July in Nature.

Mapping the human genetic architecture of COVID-19

The identification of novel host genetic factors associated with COVID-19, with unprecedented speed, was made possible by the community of human genetic researchers coming together to prioritize sharing of data, results, resources and analytical frameworks. This working model of international collaboration underscores what is possible for future genetic discoveries in emerging pandemics, or indeed for any complex human disease.

Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization

Variant Delta was resistant to neutralization by some anti-NTD and anti-RBD mAbs including Bamlanivimab, which were impaired in binding to the Spike. Sera from convalescent patients collected up to 12 months post symptoms were 4 fold less potent against variant Delta, relative to variant Alpha (B.1.1.7). Sera from individuals having received one dose of Pfizer or AstraZeneca vaccines barely inhibited variant Delta. Administration of two doses generated a neutralizing response in 95% of individuals, with titers 3 to 5 fold lower against Delta than Alpha. Thus, variant Delta spread is associated with an escape to antibodies targeting non-RBD and RBD Spike epitopes.

July 7, 2021

Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile

Our results suggest that the inactivated SARS-CoV-2 vaccine effectively prevented Covid-19, including severe disease and death, a finding that is consistent with results of phase 2 trials of the vaccine.

Therapeutic Plasma Exchange in Vaccine-Induced Immune Thrombotic Thrombocytopenia

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is characterized by thrombosis and thrombocytopenia that occurs 5 to 30 days after ChAdOx1 nCoV-19 vaccination and is associated with heparin-independent platelet factor 4 (PF4) antibodies.

Infection and Vaccine-Induced Neutralizing-Antibody Responses to the SARS-CoV-2 B.1.617 Variants

A second wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in India is leading to the emergence of SARS-CoV-2 variants. The B.1.617.1 (or kappa) and B.1.617.2 (or delta) variants were first identified in India and have rapidly spread to several countries throughout the world. These variants contain mutations within the spike protein located in antigenic sites recognized by antibodies with potent neutralizing activity.

Myocarditis associated with Covid-19 disease: A systematic review of published case reports and case series

Because of the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.

Drugs repurposed for COVID-19 by virtual screening of 6,218 drugs and cell-based assay

To tackle the challenges, we report advanced virtual screening with pre- and postdocking pharmacophore filtering of 6,218 drugs for COVID-19. Notably, 7 out of 38 compounds showed efficacies in inhibiting SARS-CoV-2 in Vero cells. Three of these were also found to inhibit SARS-CoV-2 in human Calu-3 cells. Furthermore, three drug combinations showed strong synergistic effects in SARS-CoV-2 inhibition at their clinically achievable concentrations.

Deaths and Hospitalizations Averted by Rapid U.S. Vaccination Rollout

The COVID-19 pandemic has unleashed devastating health and economic crises worldwide, causing more than 3.9 million deaths and 183 million reported infections globally.

Antibody epitopes in vaccine-induced immune thrombotic thrombocytopenia

Our data indicates VITT antibodies can mimic the effect of heparin by binding to a similar site on PF4, allowing PF4 tetramers to cluster and form immune complexes, which in turn cause FcγRIIa-dependent platelet activation. These results provide an explanation for VITT antibody-induced platelet activation that could contribute to thrombosis.

SARS-CoV-2 Nsp3 unique domain SUD interacts with guanine quadruplexes and G4-ligands inhibit this interaction

We show herein that the SARS-CoV-2 Nsp3 protein also contains a SUD domain that interacts with G4s. Indeed, interactions between SUD proteins and both DNA and RNA G4s were evidenced by G4 pull-down, Surface Plasmon Resonance and Homogenous Time Resolved Fluorescence. These interactions can be disrupted by mutations that prevent oligonucleotides from folding into G4 structures and, interestingly, by molecules known as specific ligands of these G4s. Structural models for these interactions are proposed and reveal significant differences with the crystallographic and modeled 3D structures of the SARS-CoV SUD-NM/G4 interaction. Altogether, our results pave the way for further studies on the role of SUD/G4 interactions during SARS-CoV-2 replication and the use of inhibitors of these interactions as potential antiviral compounds.

July 6, 2021

Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices — United States, June 2021

On June 23, 2021, the Advisory Committee on Immunization Practices concluded that the benefits of COVID-19 vaccination to individual persons and at the population level clearly outweighed the risks of myocarditis after vaccination.

SARS-CoV-2 neutralizing antibodies: Longevity, breadth, and evasion by emerging viral variants

A broad and sustained polyantigenic immunoreactivity against SARS-CoV-2 Spike, Membrane, and Nucleocapsid proteins, along with high viral neutralization, was associated with COVID-19 severity. A subgroup of “high responders” maintained high neutralizing responses over time, representing ideal convalescent plasma donors. Antibodies generated against SARS-CoV-2 during the first COVID-19 wave had reduced immunoreactivity and neutralization potency to emerging Spike variants and VOC. Accurate monitoring of SARS-CoV-2 antibody responses would be essential for selection of optimal responders and vaccine monitoring and design.

July 5, 2021

Firearm purchasing and firearm violence during the coronavirus pandemic in the United States: a cross-sectional study

Nationwide, firearm purchasing and firearm violence increased substantially during the first months of the coronavirus pandemic. At the state level, the magnitude of the increase in purchasing was not associated with the magnitude of the increase in firearm violence. Increases in purchasing may have contributed to additional firearm injuries from domestic violence in April and May. Results suggest much of the rise in firearm violence during our study period was attributable to other factors, indicating a need for additional research.

July 2, 2021

Efficacy of Portable Air Cleaners and Masking for Reducing Indoor Exposure to Simulated Exhaled SARS-CoV-2 Aerosols — United States, 2021

A simulated infected meeting participant who was exhaling aerosols was placed in a room with two simulated uninfected participants and a simulated uninfected speaker. Using two HEPA air cleaners close to the aerosol source reduced the aerosol exposure of the uninfected participants and speaker by up to 65%. A combination of HEPA air cleaners and universal masking reduced exposure by up to 90%.

July 1, 2021

Risk for Acquiring COVID-19 Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures

The 1 case attributed to a COVID-19 patient encounter occurred within an at-risk period and involved an AGP. We observed a very low risk for COVID-19 infection attributable to patient encounters among EMS first responders, supporting clinical strategies that maintain established practices for treating patients in emergency conditions.

June 29, 2021

Disparities in Learning Mode Access Among K–12 Students During the COVID-19 Pandemic, by Race/Ethnicity, Geography, and Grade Level — United States, September 2020–April 2021

Although access to in-person, hybrid, and virtual learning modes varied throughout the school year, during January–April 2021, access to full-time in-person learning for non-Hispanic White students increased by 36.6 percentage points, 31.1 percentage points for non-Hispanic Black students, 22.0 percentage points for Hispanic students, and 26.6 percentage points for students of other race/ethnicities.

June 25, 2021

Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic — United States, March–April 2021

Among 26,174 surveyed state, tribal, local, and territorial public health workers, 53.0% reported symptoms of at least one mental health condition in the past 2 weeks. Symptoms were more prevalent among those who were unable to take time off or worked ≥41 hours per week.

June 24, 2021

New Metric Identifies Coronavirus Hotspots in Real Time

During the pandemic, it’s been critical to track in real time where the coronavirus is spreading at home and abroad. But it’s often hard for public health officials to know whether changes in the reported number of COVID-19 cases over time truly reflect the spread of the virus or whether they are confounded by changes in testing levels or lags in the reporting of results.

SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness

In summary, we show that the Delta VOC in Scotland was found mainly in younger, more affluent groups. Risk of COVID-19 hospital admission was approximately doubled in those with the Delta VOC when compared to the Alpha VOC, with risk of admission particularly increased in those with five or more relevant comorbidities. Both the Oxford–AstraZeneca and Pfizer–BioNTech COVID-19 vaccines were effective in reducing the risk of SARS-CoV-2 infection and COVID-19 hospitalisation in people with the Delta VOC, but these effects on infection appeared to be diminished when compared to those with the Alpha VOC. We had insufficient numbers of hospital admissions to compare between vaccines in this respect. The Oxford–AstraZeneca vaccine appeared less effective than the Pfizer–BioNTech vaccine in preventing SARS-CoV-2 infection in those with the Delta VOC. Given the observational nature of these data, estimates of vaccine effectiveness need to be interpreted with caution.

June 21, 2021

COVID-19 Vaccination Coverage Among Adults — United States, December 14, 2020–May 22, 2021

By May 22, 2021, 57.0% of U.S. adults aged ≥18 years had received ≥1 vaccine dose; coverage was lower and increased more slowly over time among younger adults. If the current rate of vaccination continues through August, coverage among young adults will remain substantially lower than among older adults.

COVID-19 Vaccination Coverage and Intent Among Adults Aged 18–39 Years — United States, March–May 2021

Overall, 34% of adults aged 18–39 years reported having received a COVID-19 vaccine. Adults aged 18–24 years, as well as non-Hispanic Black adults and those with less education, no insurance, and lower household incomes, had the lowest reported vaccination coverage and intent to get vaccinated. Concerns about vaccine safety and effectiveness were commonly cited barriers to vaccination.

Assessing the Association Between Social Gatherings and COVID-19 Risk Using Birthdays

This study suggests that events that lead to small and informal social gatherings, such as birthdays, and in particular, children’s birthdays, are a potentially important source in SARS-CoV-2 transmission.

June 18, 2021

Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in HIV infection: a single-arm substudy of a phase 2/3 clinical trial

In this study of people with HIV, ChAdOx1 nCoV-19 was safe and immunogenic, supporting vaccination for those well controlled on ART.

June 17, 2021

mRNA Covid-19 Vaccines in Pregnant Women

After Emergency Use Authorization was granted for the messenger RNA (mRNA) vaccines BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna), persons at the highest risk for coronavirus disease 2019 (Covid-19)–related illness and death were prioritized for vaccination.

June 16, 2021

Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia

Among patients hospitalized with Covid-19 pneumonia, tofacitinib led to a lower risk of death or respiratory failure through day 28 than placebo.

Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes

Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone.

Treatment of Multisystem Inflammatory Syndrome in Children

We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue.

Immunotherapy for MIS-C — IVIG, Glucocorticoids, and Biologics

Since the sudden emergence of multisystem inflammatory disease in children (MIS-C) in April 2020 as a novel and severe presentation of coronavirus disease 2019 (Covid-19), nearly 4000 cases of MIS-C and 35 deaths have been reported in the United States and many more internationally.

ELV-N32 and RvD6 isomer decrease pro-inflammatory cytokines, senescence programming, ACE2 and SARS-CoV-2-spike protein RBD binding in injured cornea

We found that the lipid mediators, elovanoid (ELV)-N32 or Resolvin D6-isomer (RvD6i) decreased the expression of the ACE2 receptor, furin, and integrins in damaged corneas or IFNγ-stimulated HCEC. There was also a concomitant decrease in the binding of Spike RBD with the lipid treatments. Using RNA-seq analysis, we uncovered that the lipid mediators also attenuated the expression of pro-inflammatoy cytokines participating in hyper-inflammation and senescence programming. Thus, the bioactivity of these lipid mediators will contribute to open therapeutic avenues to counteract virus attachment and entrance to the body.

An ACE2 Triple Decoy that neutralizes SARS-CoV-2 shows enhanced affinity for virus variants

The ACE2 Triple Decoy maintains high affinity for mutated S RBD, displays enhanced affinity for S RBD N501Y or L452R, and has the highest affinity for S RBD with both E484K and N501Y mutations, making it a viable therapeutic option for the prevention or treatment of SARS-CoV-2 infection with a high likelihood of efficacy against variants.

June 15, 2021

COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy — Eight Integrated Health Care Organizations, United States, December 14, 2020–May 8, 2021

As of May 8, 2021, 16.3% of pregnant women identified in CDC’s Vaccine Safety Datalink had received ≥1 dose of a COVID-19 vaccine during pregnancy in the United States. Vaccination was lowest among Hispanic (11.9%) and non-Hispanic Black women (6.0%) and women aged 18–24 years (5.5%) and highest among non-Hispanic Asian women (24.7%) and women aged 35–49 years (22.7%).

June 14, 2021

Naturally enhanced neutralizing breadth against SARS-CoV-2 one year after infection

Vaccination increases all components of the humoral response and, as expected, results in serum neutralizing activities against variants of concern similar to or greater than the neutralizing activity against the original Wuhan Hu-1 strain achieved by vaccination of naive individuals. The mechanism underlying these broad-based responses involves ongoing antibody somatic mutation, memory B cell clonal turnover and development of monoclonal antibodies that are exceptionally resistant to SARS-CoV-2 RBD mutations, including those found in the variants of concern4,9. In addition, B cell clones expressing broad and potent antibodies are selectively retained in the repertoire over time and expand markedly after vaccination. The data suggest that immunity in convalescent individuals will be very long lasting and that convalescent individuals who receive available mRNA vaccines will produce antibodies and memory B cells that should be protective against circulating SARS-CoV-2 variants.

June 10, 2021

Elovanoids downregulate SARS-CoV-2 cell-entry, canonical mediators and enhance protective signaling in human alveolar cells

The pro-homeostatic lipid mediators elovanoids (ELVs) attenuate cell binding and entrance of the SARS-CoV-2 receptor-binding domain (RBD) as well as of the SARS-CoV-2 virus in human primary alveoli cells in culture. We uncovered that very-long-chain polyunsaturated fatty acid precursors (VLC-PUFA, n-3) activate ELV biosynthesis in lung cells. Both ELVs and their precursors reduce the binding to RBD.

June 9, 2021

A simple, home-therapy algorithm to prevent hospitalisation for COVID-19 patients: A retrospective observational matched-cohort study

All patients achieved complete remission. The median [IQR] time to resolution of major symptoms was 18 [14–23] days in the ‘recommended schedule' cohort and 14 [7–30] days in the matched ‘control’ cohort (p = 0·033). Other symptoms persisted in a lower percentage of patients in the ‘recommended’ than in the ‘control’ cohort (23·3% versus 73·3%, respectively, p<0·0001) and for a shorter period (p = 0·0107). Two patients in the ‘recommended’ cohort were hospitalised compared to 13 (14·4%) controls (p = 0·0103). The prevention algorithm reduced the days and cumulative costs of hospitalisation by >90%.

June 8, 2021

Breathing, speaking, coughing or sneezing: What drives transmission of SARS-CoV-2?

The abundance of this speech-generated aerosol, combined with its high viral load in pre- and asymptomatic individuals, strongly implicates airborne transmission of SARS-CoV-2 through speech as the primary contributor to its rapid spread.

Inflammatory biomarkers in COVID-19-associated multisystem inflammatory syndrome in children, Kawasaki disease, and macrophage activation syndrome: a cohort study

Our findings show MIS-C is distinguishable from Kawasaki disease primarily by elevated CXCL9 concentrations. The stratification of patients with MIS-C by high or low CXCL9 concentrations provides support for MAS-like pathophysiology in patients with severe MIS-C, suggesting new approaches for diagnosis and management.

How COVID-19 Can Lead to Diabetes

Along with the pneumonia, blood clots, and other serious health concerns caused by SARS-CoV-2, the COVID-19 virus, some studies have also identified another troubling connection. Some people can develop diabetes after an acute COVID-19 infection.

Decreases in COVID-19 Cases, Emergency Department Visits, Hospital Admissions, and Deaths Among Older Adults Following the Introduction of COVID-19 Vaccine — United States, September 6, 2020–May 1, 2021

By May 1, 2021, 82%, 63%, and 42% of adults aged ≥65, 50–64, and 18–49 years, respectively, had received ≥1 vaccine dose. From November 29–December 12, 2020 to April 18–May 1, 2021, the rate ratios of COVID-19 incidence, emergency department visits, hospital admissions, and deaths among adults aged ≥65 years (≥70 years for hospitalizations) to adults aged 18–49 years declined 40%, 59%, 65%, and 66%, respectively.

COVID-19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta-analysis of the relationship to CSF SARS-CoV-2

The presence of CNS hyperintense lesions or leptomeningeal enhancement on neuroimaging from patients with COVID-19 is associated with increased likelihood of a positive CSF SARS-CoV-2 PCR. However, a positive CSF SARS-CoV-2 PCR is uncommon in patients with these neuroimaging findings, suggesting they are often related to other etiologies, such as inflammation, hypoxia, or ischemia.

A versatile reverse genetics platform for SARS-CoV-2 and other positive-strand RNA viruses

Transfection of the circular cDNA into mammalian cells results in the recovery of infectious SARS-CoV-2 virus that exhibits properties comparable to the parental virus in vitro and in vivo. CPER is also used to generate insect-specific Casuarina virus with ~20 kb genome and the human pathogens Ross River virus (Alphavirus) and Norovirus (Calicivirus), with the latter from a clinical sample. Additionally, reporter and mutant viruses are generated and employed to study virus replication and virus-receptor interactions.

SARS-CoV-2 emerging variants in Africa: view from Gabon

Since SARS-CoV-2 appeared in late 2019 in Wuhan, China, variants have emerged around the world. The general concern is that these variants appear to cause more severe disease, spread more easily between humans, and might change the effectiveness of current treatment and vaccines.

Senolytics reduce coronavirus-related mortality in old mice

Old mice acutely infected with pathogens that included a SARS-CoV-2-related mouse β-coronavirus experienced increased senescence and inflammation with nearly 100% mortality. Targeting SnCs using senolytic drugs before or after pathogen exposure significantly reduced mortality, cellular senescence, and inflammatory markers and increased anti-viral antibodies. Thus, reducing the SnC burden in diseased or aged individuals should enhance resilience and reduce mortality following viral infection, including SARS-CoV-2.

Definition and validation of serum biomarkers for optimal differentiation of hyperferritinaemic cytokine storm conditions in children: a retrospective cohort study

At initial presentation, when it is unclear whether a patient with excessive hyperferritinaemic inflammation has primary HLH, infection-associated secondary HLH, or MAS, high serum concentrations of S100A12 indicate an initial differential diagnosis of systemic JIA-MAS, thus helping to guide subsequent treatment decisions. We therefore suggest the inclusion of serum S100A12 and IL-18 in the diagnostic investigations for hyperferritinaemic syndromes; however, the definition and introduction of universially applicable cutoff values are still required.

Umbilical cord mesenchymal stromal cells as critical COVID-19 adjuvant therapy: A randomized controlled trial

Application of intravenous umbilical cord mesenchymal stromal cell infusion as an adjuvant treatment for critically ill patients with COVID-19 increases the survival rate by modulating the immune system toward an anti-inflammatory state.

Mitigating airborne transmission of SARS-CoV-2

Ventilation is a key mitigation measure against airborne transmission, and recommendations and funding should be provided to business and schools for assessments and upgrades.

Portal vein thrombosis associated with ChAdOx1 nCov-19 vaccination

A 41-year-old man with an unremarkable medical history presented to the emergency department with a headache that woke him and persisted despite painkillers. He had no neurological symptoms. The initial evaluation revealed severe thrombocytopenia (64 000 per μL) and increased D-dimer (42 028 μg/L). Cranial CT identified no findings of haematoma or ischaemia, and there was no sign of dural venous thrombosis on CT angiography.

Epidemiology, not geopolitics, should guide COVID-19 vaccine donations

With COVID-19 vaccine supplies shifting from scarcity to abundance in high-income settings, such as Canada, the EU, the USA, and the UK, the June 11–13, 2021, Group of Seven (G7) summit in Cornwall, UK, is the time when leaders from those countries should act on their promises to send surplus COVID-19 vaccine supplies to the many other countries where doses remain scarce.

Contextualising evidence-based recommendations for the second wave of the COVID-19 pandemic in India

During the second wave of the COVID-19 pandemic in India, which began in March, 2021, demand on the health-care system has far exceeded capacity. Despite crippling shortages, patients are prescribed a battery of ineffective therapeutic interventions.1 Ivermectin, hydroxychloroquine, and herbal cocktails continue to receive state patronage.

Deciphering the cytokine fingerprint of macrophage activation syndrome

Combatting cytokine storm syndromes is an increasingly frequent challenge faced by paediatric rheumatologists. The rising rate of encounters with these conditions is due in part to heightened awareness of paediatric hyperinflammatory syndromes coupled with an expanding armamentarium of anticytokine therapies that practitioners in our field can wield effectively.

June 5, 2021

Necessity of COVID-19 vaccination in previously infected individuals

Individuals who have had SARS-CoV-2 infection are unlikely to benefit from COVID-19 vaccination, and vaccines can be safely prioritized to those who have not been infected before.

June 4, 2021

Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021

COVID-19 adolescent hospitalization rates from COVID-NET peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and rose to 1.3 in April. Among hospitalized adolescents, nearly one third required intensive care unit admission, and 5% required invasive mechanical ventilation; no associated deaths occurred.

June 3, 2021

Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination

Vaccination with ChAdOx1 nCov-19 can result in the rare development of immune thrombotic thrombocytopenia mediated by platelet-activating antibodies against PF4, which clinically mimics autoimmune heparin-induced thrombocytopenia. (Funded by the German Research Foundation.)

Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination

We report findings in five patients who presented with venous thrombosis and thrombocytopenia 7 to 10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against coronavirus disease 2019 (Covid-19). The patients were health care workers who were 32 to 54 years of age. All the patients had high levels of antibodies to platelet factor 4–polyanion complexes; however, they had had no previous exposure to heparin. Because the five cases occurred in a population of more than 130,000 vaccinated persons, we propose that they represent a rare vaccine-related variant of spontaneous heparin-induced thrombocytopenia that we refer to as vaccine-induced immune thrombotic thrombocytopenia.

Effect of Bamlanivimab vs Placebo on Incidence of COVID-19 Among Residents and Staff of Skilled Nursing and Assisted Living Facilities

This randomized phase 3 clinical trial included 966 participants who were residents and staff at US skilled nursing and assisted living facilities with at least 1 confirmed SARS-CoV-2 index case and who were negative at baseline for SARS-CoV-2 infection and serology, enrolled from August to November 2020. The incidence of COVID-19 infection among those treated with bamlanivimab vs placebo was 8.5% vs 15.2%, respectively, a difference that was statistically significant.

Bamlanivimab for Prevention of COVID-19

Passive immunotherapy has played an essential role in the prevention and treatment of infectious diseases since Emil von Behring’s Nobel Prize–winning work in the 1890s on the use of antiserum raised in horses to treat diphtheria. This work paved the way for use of antiserum to treat tetanus and prevent rabies, and for Rufus Cole’s development of type-specific immune serum to treat pneumococcal pneumonia, published in 1913.

Could Statins Do More Than Lower Cholesterol in Patients With COVID-19?

Practically every day this spring, New York University cardiologist Aakriti Gupta, MD, MS, has received a phone call from friends or relatives in India who have COVID-19.

June 2, 2021

Changes in Patterns of Hospital Visits for Acute Myocardial Infarction or Ischemic Stroke During COVID-19 Surges

In contrast to the initial COVID-19 surge during March to April 2020 in the US and to recent data from the UK, no significant declines in AMI hospitalization or stroke alerts were observed during the largest and most recent surge during October 2020 to January 2021 in KPNC. A modest decline was observed for stroke alerts during the summer COVID-19 surge but quickly rebounded. Study limitations include an inability to delineate specific reasons for observed declines in AMI and stroke alerts and potential lack of generalizability to other regions or systems. These patterns may reflect changing patient attitudes during the COVID-19 pandemic or the success of health system and public health campaigns to reassure patients about the safety of seeking emergency care when needed.

June 1, 2021

Studies Confirm COVID-19 mRNA Vaccines Safe, Effective for Pregnant Women

Clinical trials have shown that COVID-19 vaccines are remarkably effective in protecting those age 12 and up against infection by the coronavirus SARS-CoV-2. The expectation was that they would work just as well to protect pregnant women. But because pregnant women were excluded from the initial clinical trials, hard data on their safety and efficacy in this important group has been limited.

May 28, 2021

Early Covid-19 Treatment With SARS-CoV-2 Neutralizing Antibody Sotrovimab

Sotrovimab reduced progression of Covid-19 in patients with mild/moderate disease, was well tolerated, and no safety signals were identified.

Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity — United States, December 14, 2020–May 1, 2021

Disparities in county-level vaccination coverage by social vulnerability have increased as vaccine eligibility has expanded, especially in large fringe metropolitan (areas surrounding large cities, e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage among adults was lower among those living in counties with lower socioeconomic status and with higher percentages of households with children, single parents, and persons with disabilities.

Clinical Considerations: Myocarditis and Pericarditis after Receipt of mRNA COVID-19 Vaccines Among Adolescents and Young Adults

In most cases, patients who presented for medical care have responded well to medications and rest and had prompt improvement of symptoms. Reported cases have occurred predominantly in male adolescents and young adults 16 years of age and older. Onset was typically within several days after mRNA COVID-19 vaccination, and cases have occurred more often after the second dose than the first dose. CDC and its partners are investigating these reports of myocarditis and pericarditis following mRNA COVID-19 vaccination.

KFF COVID-19 Vaccine Monitor: May 2021

The latest KFF COVID-19 Vaccine Monitor shows continued steady progress in vaccine uptake, with 62% of U.S. adults saying they’ve gotten at least one dose of a vaccine (up from 56% in April) and the share saying they will “wait and see” down slightly from 15% to 12%. This leaves few remaining eager to get vaccinated, while the shares saying they will get vaccinated “only if required” (7%) or will “definitely not” get a vaccine (13%) essentially unchanged over the last several months. Yet findings also suggest the overall adult vaccination rates could reach 70% over the next several months, with 4% saying they want the vaccine as soon as possible and about a third of the “wait and see group” (or 4% of all adults) saying they have already scheduled an appointment or plan to get the vaccine in the next 3 months.

May 27, 2021

Safety, Immunogenicity, and Efficacy of the BNT162b2 Covid-19 Vaccine in Adolescents

Until very recently, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had not been authorized for emergency use in persons younger than 16 years of age. Safe, effective vaccines are needed to protect this population, facilitate in-person learning and socialization, and contribute to herd immunity.

Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial

In community-treated patients including those without a mandatory diagnostic test, the effect of colchicine on COVID-19-related clinical events was not statistically significant. Among patients with PCR-confirmed COVID-19, colchicine led to a lower rate of the composite of death or hospital admission than placebo. Given the absence of orally administered therapies to prevent COVID-19 complications in community-treated patients and the benefit of colchicine in patients with PCR-proven COVID-19, this safe and inexpensive anti-inflammatory agent could be considered for use in those at risk of complications. Notwithstanding these considerations, replication in other studies of PCR-positive community-treated patients is recommended.

Reduced sensitivity of infectious SARS-CoV-2 variant B.1.617.2 to monoclonal antibodies and sera from convalescent and vaccinated individuals

The SARS-CoV-2 B.1.617 lineage emerged in October 2020 in India. It has since then become dominant in some indian regions and further spread to many countries. The lineage includes three main subtypes (B1.617.1, B.1617.2 and B.1.617.3), which harbour diverse Spike mutations in the Nterminal domain (NTD) and the receptor binding domain (RBD) which may increase their immune evasion potential. B.1.617.2 is believed to spread faster than the other versions. Here, we isolated infectious B.1.617.2 from a traveller returning from India. We examined itssensitivity to monoclonal antibodies (mAbs) and to antibodies present in sera from COVID-19 convalescent individuals or vaccine recipients, in comparison to other viral lineages. B.1.617.2 was resistant to neutralization by some anti-NTD and anti-RBD mAbs, including Bamlanivimab, which were impaired in binding to the B.1.617.2 Spike.

May 26, 2021

Incentives for Immunity — Strategies for Increasing Covid-19 Vaccine Uptake

The once-promising pace of Covid-19 vaccination in the United States has slowed, from a peak of 3.38 million shots on April 13, 2021, to fewer than 2 million doses per day in May. Until recently, Americans were competing for limited vaccination slots — a situation that raised equity concerns — but now supply exceeds demand in much of the country, and mass vaccination clinics are closing.

Longitudinal immune dynamics of mild COVID-19 define signatures of recovery and persistence

We characterized signals associated with recovery and convalescence to define a new signature of inflammatory cytokines, gene expression, and chromatin accessibility that persists in individuals with post-acute sequelae of SARS-CoV-2 infection (PASC).

Effect of 2 Inactivated SARS-CoV-2 Vaccines on Symptomatic COVID-19 Infection in Adults

This prespecified interim analysis of a randomized clinical trial included 40 382 participants who received at least 1 dose of a 2-dose inactivated vaccine series developed from either SARS-CoV-2 WIV04 (5 µg/dose) or HB02 (4 µg/dose) strains or an aluminum hydroxide–only control, with a primary end point of the incidence of symptomatic COVID-19 at least 14 days after the second injection. The efficacy for the 2 vaccines, compared with an aluminum hydroxide–only control, was 72.8% in the WIV04 group and 78.1% in the HB02 group; both comparisons were statistically significant.

May 25, 2021

Association Between Bitter Taste Receptor Phenotype and Clinical Outcomes Among Patients With COVID-19

This study suggests that bitter taste receptor allelic variants are associated with innate immune fitness toward SARS-CoV-2 and can be used to correlate with clinical course and prognosis of COVID-19.

COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021

As of April 30, 2021, approximately 101 million persons in the United States had been fully vaccinated against COVID-19. However, during the surveillance period, SARS-CoV-2 transmission continued at high levels in many parts of the country, with approximately 355,000 COVID-19 cases reported nationally during the week of April 24–30, 2021. Even though FDA-authorized vaccines are highly effective, breakthrough cases are expected, especially before population immunity reaches sufficient levels to further decrease transmission. However, vaccine breakthrough infections occur in only a small fraction of all vaccinated persons and account for a small percentage of all COVID-19 cases. The number of COVID-19 cases, hospitalizations, and deaths that will be prevented among vaccinated persons will far exceed the number of vaccine breakthrough cases. To date, the age and sex distribution of reported vaccine breakthrough infections reflects the fully vaccinated U.S. population. The proportion of reported vaccine breakthrough infections attributed to variants of concern has also been similar to the proportion of these variants circulating throughout the United States. During March 28–April 10, 2021, the aforementioned variants of concern accounted for 70% of the weighted estimates of SARS-CoV-2 lineages submitted to CDC’s national genomic surveillance.

Absence of Humoral Response After Two-Dose SARS-CoV-2 Messenger RNA Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: A Case Series

Patients with rheumatic and musculoskeletal diseases (RMDs) are at increased risk for SARS-CoV-2 infection because of both the immunomodulatory effects of their underlying diseases and treatment with immunosuppressive agents.

May 21, 2021

Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools — Georgia, November 16–December 11, 2020

COVID-19 incidence was 37% lower in schools that required teachers and staff members to use masks and 39% lower in schools that improved ventilation. Ventilation strategies associated with lower school incidence included dilution methods alone (35% lower incidence) or in combination with filtration methods (48% lower incidence).

COVID-19 Testing to Sustain In-Person Instruction and Extracurricular Activities in High Schools — Utah, November 2020–March 2021

Utah implemented two high school COVID-19 testing programs to sustain in-person instruction and extracurricular activities. During November 30, 2020–March 20, 2021, among 59,552 students who received testing, 1,886 (3.2%) had a positive result. These programs facilitated the completion of approximately 95% of high school extracurricular competition events and saved an estimated 109,752 in-person instruction student-days.

May 20, 2021

Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant

A two-dose regimen of the ChAdOx1 nCoV-19 vaccine did not show protection against mild-to-moderate Covid-19 due to the B.1.351 variant.

Frequency and Characteristics of Nodal and Deltoid FDG and 11C-Choline Uptake on PET Imaging Performed After COVID-19 Vaccination

Increased axillary lymph node or ipsilateral deltoid uptake is occasionally observed on FDG or 11C-choline PET performed after Pfizer-BioNTech or Moderna COVID-19 vaccination.

May 19, 2021

A novel strategy for SARS-CoV-2 mass screening with quantitative antigen testing of saliva: a diagnostic accuracy study

Quantitative RT-PCR (RT-qPCR) of nasopharyngeal swab (NPS) samples for SARS-CoV-2 detection requires medical personnel and is time consuming, and thus is poorly suited to mass screening. In June, 2020, a chemiluminescent enzyme immunoassay (CLEIA; Lumipulse G SARS-CoV-2 Ag kit, Fujirebio, Tokyo, Japan) was developed that can detect SARS-CoV-2 nucleoproteins in NPS or saliva samples within 35 min. In this study, we assessed the utility of CLEIA in mass SARS-CoV-2 screening.

PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia

Our results provide further support to show that rapid immunoassays should be avoided in the detection of PF4-specific antibodies in patients with suspected VITT. Therefore, the use of a sensitive, quantitative, immunologic test is strongly recommended, because according to the recently proposed algorithm, nonheparin anticoagulants should be preferred when clinically significant levels of anti-PF4 antibodies are detected.

Incident SARS-CoV-2 Infection among mRNA-Vaccinated and Unvaccinated Nursing Home Residents

Across all the study groups, most infections were asymptomatic, and the incidence of both asymptomatic and symptomatic infections decreased. Nursing homes that were located in counties with the highest incidence of SARS-CoV-2 infection had the most incident cases but still had large decreases. We observed inconsistent patterns in the incidence of infection among residents relative to rates of vaccination among staff members.

Diverse Functional Autoantibodies in Patients with COVID-19

Analysis of autoantibodies against tissue-associated antigens revealed associations with specific clinical characteristics and disease severity. In summary, these findings implicate a pathological role for exoproteome-directed autoantibodies in COVID-19 with diverse impacts on immune functionality and associations with clinical outcomes.

Characteristics Associated With Multisystem Inflammatory Syndrome Among Adults With SARS-CoV-2 Infection

The goal of this cohort study was to describe the spectrum of MIS-A presentation after SARS-CoV-2 infection. We identified cases of MIS-A among all adults with laboratory-proven subacute or convalescent SARS-CoV-2 infection at a single tertiary care medical center and described their clinical characteristics and outcomes.

The Multisystem Inflammatory Syndrome in Adults With SARS-CoV-2 Infection—Another Piece of an Expanding Puzzle

The COVID-19 pandemic has upended our societal status quo. SARS-CoV-2, the virus responsible for COVID-19, has led to a myriad of clinical presentations, many of which were different from the diseases caused by other respiratory viral infections. Among the manifestations were olfactory dysfunction and so-called COVID toes, leading to a constant change of what we understood as the spectrum of illness caused by SARS-CoV-2. To help understand this complex clinical picture, a framework for the spectrum of SARS-CoV-2 infection has been proposed. Now, more than a year after the initial discovery of COVID-19, that complete clinical picture continues to be evasive as new features of SARS-CoV-2 are described.

Assessment of the Association of Vitamin D Level With SARS-CoV-2 Seropositivity Among Working-Age Adults

In this cohort study of 18 148 individuals whose vitamin D levels were measured before the COVID-19 pandemic, low levels of vitamin D were associated with SARS-CoV-2 seropositivity in unadjusted univariable analysis. However, after adjusting for potentially confounding factors, including age, sex, race/ethnicity, education, body mass index, blood pressure, smoking status, and geographical location, vitamin D level was not associated with SARS-CoV-2 seropositivity.

Consumer Views on Using Digital Data for COVID-19 Control in the United States

In this cross-sectional survey study of 6284 US adults, approval was generally low for use of consumer digital data for activities such as case identification, digital contact tracing, policy setting, and enforcing quarantines. Political ideology and race/ethnicity were associated with approval for scenarios in which digital data were used, whereas local COVID-19 incidence and family experience with COVID were not.

May 18, 2021

Pharmacological activation of STING blocks SARS-CoV-2 infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic, resulting millions of infections and deaths with few effective interventions available. Here, we demonstrate that SARS-CoV-2 evades interferon (IFN) activation in respiratory epithelial cells, resulting in a delayed response in bystander cells. Since pretreatment with IFNs can block viral infection, we reasoned that pharmacological activation of innate immune pathways could control SARS-CoV-2 infection.

Seropositivity in blood donors and pregnant women during the first year of SARS-CoV-2 transmission in Stockholm, Sweden

These data indicate that in the first year since the start of community transmission, seropositivity levels in metropolitan in Stockholm had reached approximately one in five persons, providing important baseline seroprevalence information prior to the start of vaccination.

Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–April 10, 2021

COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%); disparities persisted among age groups and by sex.

Rare PEG Allergy Triggered Postvaccination Anaphylaxis

Researchers in the UK have linked anaphylaxis in a patient who received the Pfizer-BioNTech COVID-19 vaccine with her allergy to polyethylene glycol (PEG), which stabilizes lipid nanoparticles that deliver mRNA in the vaccine to cells in the body.

May 17, 2021

Assessment of Feasibility of Face Covering in School-Aged Children With Autism Spectrum Disorders and Attention-Deficit/Hyperactivity Disorder

Our carefully tracked interval data indicate that a group of school-aged children, most of whom had ASD and/or ADHD, were capable of face covering across activities. Our findings are consistent with recent reports of face covering in school-aged children6 but included direct observation and extended to children with greater special education needs. Limitations include a small sample size, a high staff to child ratio, no data on prior masking behavior, and no interrater reliability. As policy makers and school personnel consider plans for in-person activities, face covering can be used as part of a constellation of practices to reduce the transmission of SARS-CoV-2 in pediatric settings.

Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic

In this cohort study of 478 US hospitals with 324 013 patients with IS, substantial decreases in the number of patients discharged with IS were observed at the beginning of the pandemic in February 2020, but these rates returned to prepandemic levels by July 2020. Compared with patients with IS in 2019, those with IS and comorbid COVID-19 in 2020 were less likely to have conventional vascular risk factors or stroke at hospital admission and were more likely to be Black or Hispanic and to experience medical complications and in-hospital death.

May 14, 2021

Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel — 33 U.S. Sites, January–March 2021

The first U.S. multisite test-negative design vaccine effectiveness study among HCP found a single dose of Pfizer-BioNTech or Moderna COVID-19 vaccines to be 82% effective against symptomatic COVID-19 and 2 doses to be 94% effective.

The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Adolescents Aged 12–15 Years — United States, May 2021

On May 12, 2021, after a systematic review of all available data, the Advisory Committee on Immunization Practices made an interim recommendation for use of the Pfizer-BioNTech COVID-19 vaccine in adolescents aged 12–15 years for the prevention of COVID-19.

Structural modeling of the SARS-CoV-2 Spike/human ACE2 complex interface can identify high-affinity variants associated with increased transmissibility

By combining predicted affinities and available antibody escape data, we show that fast-spreading viral variants exploit combinatorial mutations possessing both enhanced affinity and antibody resistance, including S477N/E484K, E484K/N501Y and K417T/E484K/N501Y. Thus, three-dimensional modeling of the Spike/hACE2 complex predicts changes in structure and binding affinity that correlate with transmissibility and therefore can help inform future intervention strategies.

Assessment of a Crowdsourcing Open Call for Approaches to University Community Engagement and Strategic Planning During COVID-19

This qualitative study evaluated 82 submissions to a university open call for creative solutions from students, faculty, and staff to inform safety in the fall 2020 semester. Solutions were shared with university leadership, and several are being further developed.

The rocky road to universal COVID-19 vaccination

As of May 9, 2021, the COVID-19 pandemic has caused 3 277 272 deaths and disrupted the lives of billions of people. Global equitable access to COVID-19 vaccines is the only way to mitigate the public health and economic impact of the pandemic. That is why 1 year ago the COVAX scheme, co-led by the Coalition for Epidemic Preparedness Innovations, Gavi, the Vaccine Alliance, and WHO, was set up to try to ensure fair access to vaccines, by guaranteeing that each country would receive vaccine doses for at least 20% of its population.

May 13, 2021

Interim Results of a Phase 1–2a Trial of Ad26.COV2.S Covid-19 Vaccine

The safety and immunogenicity profiles of Ad26.COV2.S support further development of this vaccine candidate.

Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women

In this cohort study involving 103 women who received a COVID-19 mRNA vaccine, 30 of whom were pregnant and 16 of whom were lactating, immunogenicity was demonstrated in all, and vaccine-elicited antibodies were found in infant cord blood and breast milk. Pregnant and nonpregnant vaccinated women developed cross-reactive immune responses against SARS-CoV-2 variants of concern.

May 12, 2021

BNT162b2-Elicited Neutralization against New SARS-CoV-2 Spike Variants

Because these data show that the newly emerged B.1.526, B.1.429, and B.1.1.7+E484K variants remain susceptible to an important vaccine-elicited immune effector (neutralizing antibody), they confirm the importance of mass immunization with current, highly effective, authorized vaccines as a central strategy to end the Covid-19 pandemic.

Perinatal Outcomes During the COVID-19 Pandemic in Ontario, Canada

Public health measures to control the COVID-19 pandemic may be associated with reduced risk of preterm birth (PTB).1,2 Conversely, avoidance of health care may be associated with increased risk of stillbirth.3 We evaluated rates of PTB and stillbirth during the first 6 months of the pandemic because previous studies conducted early in the pandemic have had inconsistent results.

Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine

The Moderna COVID-19 vaccine may cause a delayed localized hypersensitivity reaction with a median latency to onset of 7 days after vaccine administration. This pruritic and variably tender reaction has a median duration of 5 days, but may persist for up to 21 days, and may occur again and sooner after the second vaccine dose; no serious adverse events were observed in association with this cutaneous reaction to the Moderna COVID-19 vaccine.

The Covid-19 Infodemic — Applying the Epidemiologic Model to Counter Misinformation

Throughout the world, including the United States, medical professionals and patients are facing both a pandemic and an infodemic — the first caused by SARS-CoV-2 and the second by misinformation and disinformation.

May 11, 2021

Reversed-engineered human alveolar lung-on-a-chip model

This work reports the development of a physiologically relevant human alveolar lung-on-a-chip model, composed of a three-dimensional (3D) porous hydrogel made of gelatin methacryloyl (GelMA) featuring an inverse opal structure, bonded to a compartmentalized chip device that provides air–liquid interface and cyclic breathing motions. Significantly, this GelMA structure has a high similarity to native human alveolar sacs in that they both possess sac-like pores and interconnecting windows between the sacs, in addition to a stiffness similar to the native human distal lung. We showed through multiscale analyses that our 3D GelMA inverse opal structure was better able to maintain the functions of primary human alveolar epithelial cells in a more in vivo-like manner compared with planar models.

May 8, 2021

COVID-19 and endocrine and metabolic diseases. An updated statement from the European Society of Endocrinology

COVID-19 has completely changed our daily clinical practice as well as our social relations. Many organs and biological systems are involved in SARS-Cov-2 infection, either due to direct virus-induced damage or to indirect effects that can have systemic consequences. Endocrine system is not only an exception but its involvement in COVID-19 is so relevant that an “endocrine phenotype” of COVID-19 has progressively acquired clinical relevance.

May 7, 2021

Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years — United States, January–March 2021

In a multistate network of U.S. hospitals during January–March 2021, receipt of Pfizer-BioNTech or Moderna COVID-19 vaccines was 94% effective against COVID-19 hospitalization among fully vaccinated adults and 64% effective among partially vaccinated adults aged ≥65 years.

May 6, 2021

Association Between Vaccination With BNT162b2 and Incidence of Symptomatic and Asymptomatic SARS-CoV-2 Infections Among Health Care Workers

In this retrospective cohort study conducted in Tel Aviv, Israel, that included 6710 health care workers who underwent periodic testing for SARS-CoV-2 infection, vaccination with the BNT162b2 vaccine was associated with an adjusted incidence rate ratio of 0.03 for symptomatic infection and 0.14 for asymptomatic infection more than 7 days after the second dose. Both incidence rate ratios were statistically significant.

The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity

Some similarities exist between COVID-19 and respiratory failure of other origins, but evidence for many distinctive mechanistic features indicates that COVID-19 constitutes a new disease entity, with emerging data suggesting involvement of an endotheliopathy-centred pathophysiology. Further research, combining basic and clinical studies, is needed to advance understanding of pathophysiological mechanisms and to characterise immuno-inflammatory derangements across the range of phenotypes to enable optimum care for patients with COVID-19.

May 5, 2021

Efficacy of NVX-CoV2373 Covid-19 Vaccine against the B.1.351 Variant

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants threatens progress toward control of the coronavirus disease 2019 (Covid-19) pandemic. In a phase 1–2 trial involving healthy adults, the NVX-CoV2373 nanoparticle vaccine had an acceptable safety profile and was associated with strong neutralizing-antibody and antigen-specific polyfunctional CD4+ T-cell responses. Evaluation of vaccine efficacy was needed in a setting of ongoing SARS-CoV-2 transmission.

Interplay between Emerging SARS-CoV-2 Variants and Pandemic Control

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of a diverse family of enveloped, nonsegmented RNA viruses. The coronavirus genomic RNA is unusually large, the RNA polymerase is error-prone, and mutations accumulate with increasing frequency during infections. With continued uncontrolled transmission and viral replication, mutations that give the virus a fitness advantage will emerge. A SARS-CoV-2 variant of concern has one or more mutations that confer worrisome epidemiologic, immunologic, or pathogenic properties.

Effectiveness of the BNT162b2 Covid-19 Vaccine against the B.1.1.7 and B.1.351 Variants

The messenger RNA vaccine BNT162b2 (Pfizer–BioNTech) has 95% efficacy against coronavirus disease 2019 (Covid-19).1 Qatar launched a mass immunization campaign with this vaccine on December 21, 2020. As of March 31, 2021, a total of 385,853 persons had received at least one vaccine dose and 265,410 had completed the two doses.

Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data

Two doses of BNT162b2 are highly effective across all age groups (≥16 years, including older adults aged ≥85 years) in preventing symptomatic and asymptomatic SARS-CoV-2 infections and COVID-19-related hospitalisations, severe disease, and death, including those caused by the B.1.1.7 SARS-CoV-2 variant. There were marked and sustained declines in SARS-CoV-2 incidence corresponding to increasing vaccine coverage. These findings suggest that COVID-19 vaccination can help to control the pandemic.

Missing the Point — How Primary Care Can Overcome Covid-19 Vaccine “Hesitancy”

By the end of April 2021, the United States had fully vaccinated just under a third of its population against Covid-19. Initial federal and state vaccination strategies focused on hospitals, mass-vaccination centers, and retail pharmacies, quickly vaccinating health care workers and residents of long-term care facilities who were at high risk for Covid-19.

Rapid Emergence and Epidemiologic Characteristics of the SARS-CoV-2 B.1.526 Variant — New York City, New York, January 1–April 5, 2021

The NYC Department of Health and Mental Hygiene analyzed laboratory and epidemiologic data to characterize cases of B.1.526 infection and the associated potential for breakthrough infection and reinfection. Preliminary evidence suggests that, to date, B.1.526 does not lead to more severe disease or increased risk for infection after vaccination.

Identification of and Surveillance for the SARS-CoV-2 Variants B.1.427 and B.1.429 — Colorado, January–March 2021

The B.1.427 and B.1.429 variants of SARS-CoV-2, the virus that causes COVID-19, were first described in Southern California on January 20, 2021 (1); on March 16 they were designated variants of concern* (2). Data on these variants are limited, but initial reports suggest that, compared with other lineages, they might be more infectious (1,2), cause more severe illness (2), and be less susceptible to neutralizing monoclonal antibody products such as bamlanivimab, an investigational treatment for mild-to-moderate COVID-19 (1–3). On January 24, the Colorado Department of Public Health and Environment (CDPHE) identified the first Colorado case of COVID-19 attributed to these variants. B.1.427 and B.1.429 were considered a single variant described as CAL.20C or B.1.427/B.1.429 in the 20C clade (1,3); in this report “B.1.427/B.1.429” refers to B.1.427 or B.1.429 lineage, including those reported as B.1.427/B.1.429 without further differentiation.

Modeling of Future COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Rates and Nonpharmaceutical Intervention Scenarios — United States, April–September 2021

Data from six models indicate that with high vaccination coverage and moderate NPI adherence, hospitalizations and deaths will likely remain low nationally, with a sharp decline in cases projected by July 2021. Lower NPI adherence could lead to substantial increases in severe COVID-19 outcomes, even with improved vaccination coverage.

Researchers Tie Severe Immunosuppression to Chronic COVID-19 and Virus Variants

Last summer, a UK man in his 70s was admitted to Addenbrooke’s Hospital in Cambridge with COVID-19 pneumonia. He hadn’t been able to shake his illness since testing positive for SARS-CoV-2 more than a month earlier. Despite interventions including multiple rounds of the antiviral remdesivir and convalescent plasma, he died in the hospital’s intensive care unit about 9 weeks after his arrival.

May 3, 2021

A human-airway-on-a-chip for the rapid identification of candidate antiviral therapeutics and prophylactics

The rapid repurposing of antivirals is particularly pressing during pandemics. However, rapid assays for assessing candidate drugs typically involve in vitro screens and cell lines that do not recapitulate human physiology at the tissue and organ levels. Here we show that a microfluidic bronchial-airway-on-a-chip lined by highly differentiated human bronchial-airway epithelium and pulmonary endothelium can model viral infection, strain-dependent virulence, cytokine production and the recruitment of circulating immune cells.

Factors Associated With Access to and Timing of Coronavirus Testing Among US Adults After Onset of Febrile Illness

In this cohort study, generally low rates of coronavirus testing were observed in 2679 participants reporting new onset of febrile illness. Although testing rates improved somewhat during the study period, timely coronavirus test results were sought and received by only 25.9% of newly febrile persons at the end of the study analysis period in late October 2020.

Clinical Characteristics and Transmission of COVID-19 in Children and Youths During 3 Waves of Outbreaks in Hong Kong

In this cross-sectional study of 397 children and youths with COVID-19 in the first 3 waves of outbreaks in Hong Kong, in 2020, the largest group had no recent international travel, and nearly all individuals were reported to have other family members with COVID-19. Three students studying in the same school contracted COVID-19, and few children or youths with no recent international travel reported unknown contact histories.

Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic

In this cohort study of 20 736 patients, in-hospital mortality rates decreased in the US between March and November 2020, even after accounting for the changing mix in patient age, sex, comorbidities, and disease severity at the time of admission. Hospital and intensive care unit length of stay and use of mechanical ventilation decreased over time, whereas the use of glucocorticoids and remdesivir increased.

Association Between Income Inequality and County-Level COVID-19 Cases and Deaths in the US

This ecological cohort study found that there was a positive correlation between Gini coefficients and county-level COVID-19 cases and deaths during the study period. The association between income inequality and COVID-19 cases and deaths varied over time and was strongest in the summer months of 2020.

May 1, 2021

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids.

April 30, 2021

Anxiety-Related Adverse Event Clusters After Janssen COVID-19 Vaccination — Five U.S. Mass Vaccination Sites, April 2021

Five mass vaccination sites reported 64 anxiety-related events, including 17 events of syncope (fainting) after receipt of Janssen COVID-19 vaccine. The reporting rates of syncope to VAERS after Janssen COVID-19 and influenza vaccines (2019–20) were 8.2 and 0.05 per 100,000 doses, respectively.

Safety Monitoring of the Janssen (Johnson & Johnson) COVID-19 Vaccine — United States, March–April 2021

By April 21, nearly 8 million doses of the Janssen COVID-19 vaccine had been administered. Review of safety monitoring data found that 97% of reported reactions after vaccine receipt were nonserious, consistent with preauthorization clinical trials data. Seventeen thrombotic events with thrombocytopenia have been reported, including three non-CVST events.

Linked Clusters of SARS-CoV-2 Variant B.1.351 — Maryland, January–February 2021

Investigation identified two linked clusters of SARS-CoV-2 infection, comprising 17 total patients (two were hospitalized and one died) who did not report recent travel. Four patients’ specimens were sequenced; all were the B.1.351 variant.

US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021

In this case series of 12 patients, all were women, younger than 60 years, and had symptom onset ranging from 6 to 15 days after vaccination requiring hospitalization. Of 11 patients with heparin-platelet factor 4 enzyme-linked immunosorbent assay (ELISA) heparin-induced thrombocytopenia (HIT) antibody test results, all were positive. At last follow-up, outcomes were death (n = 3), intensive care unit (ICU) care (n = 3), non-ICU hospitalization (n = 2), and discharge to home (n = 4).

Ethnic differences in SARS-CoV-2 infection and COVID-19-related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform

Some minority ethnic populations in England have excess risks of testing positive for SARS-CoV-2 and of adverse COVID-19 outcomes compared with the White population, even after accounting for differences in sociodemographic, clinical, and household characteristics. Causes are likely to be multifactorial, and delineating the exact mechanisms is crucial. Tackling ethnic inequalities will require action across many fronts, including reducing structural inequalities, addressing barriers to equitable care, and improving uptake of testing and vaccination.

COVID-19 and disparities affecting ethnic minorities

Longstanding health disparities affecting ethnic minorities in the UK have been made acutely visible by the COVID-19 pandemic. The disproportionate effects of COVID-19 among minority ethnic groups were present from the beginning, with Black and Asian patients in the UK being over-represented among those with COVID-19 receiving advanced respiratory support.

COVID research updates: One vaccine dose can nearly halve transmission risk

Nature wades through the literature on the coronavirus — and summarizes key papers as they appear.

April 29, 2021

Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes

Maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in the absolute risk of respiratory disorders and some other neonatal morbidities.

Leveraging Open Science to Accelerate Research

The United States has mobilized the full force of its clinical research enterprise to address the Covid-19 pandemic, allocating billions of dollars to support timely research.

Choices in a Crisis — Individual Preferences among SARS-CoV-2 Vaccines

The extraordinarily swift development of effective vaccines against SARS-CoV-2 offers new optimism about combating the Covid-19 pandemic. So far, vaccine demand far exceeds supply, and people generally cannot choose which vaccine they receive. In the United States, this lack of choice has generated little debate given the similar mechanism of action, number of required doses, safety profile, and efficacy of the two vaccines approved in December 2020, both based on mRNA technology.

Should homes and workplaces purchase portable air filters to reduce the transmission of SARS-CoV-2 and other respiratory infections? A systematic review

Respiratory infections, including SARS-CoV-2, are spread via inhalation or ingestion of airborne pathogens. Airborne transmission is difficult to control, particularly indoors. Manufacturers of high efficiency particulate air (HEPA) filters claim they remove almost all small particles including airborne bacteria and viruses. This study investigates whether modern portable, commercially available air filters reduce the incidence of respiratory infections and/or remove bacteria and viruses from indoor air.

A molecular single-cell lung atlas of lethal COVID-19

Respiratory failure is the leading cause of death in patients with severe SARS-CoV-2 infection, yet the host response at the lung tissue-level is poorly understood. Here, we performed single-nucleus RNA-sequencing of ~116,000 nuclei of lungs from 19 COVID-19 decedents who underwent rapid autopsy and 7 control lungs.

Diagnosis and Management of Cerebral Venous Sinus Thrombosis with Vaccine-Induced Thrombotic Thrombocytopenia

Cerebral venous sinus thrombosis (CVST) is a rare manifestation of cerebrovascular disease. Recent reports from the Centers of Disease Control and the U.S. Food and Drug Administration identified six cases of CVST associated with thrombocytopenia in U.S. patients who had received the Ad26.COV2.S (Janssen) Coronavirus disease 2019 (COVID-19) vaccine.

April 28, 2021

Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years — United States, January–March 2021

In a multistate network of U.S. hospitals during January–March 2021, receipt of Pfizer-BioNTech or Moderna COVID-19 vaccines was 94% effective against COVID-19 hospitalization among fully vaccinated adults and 64% effective among partially vaccinated adults aged ≥65 years.

Assessment of Length and Readability of Informed Consent Documents for COVID-19 Vaccine Trials

These findings suggest that informed consent documents may fail to succinctly explain the studies to participants of all reading levels and that it is possible to improve these documents to increase participant accessibility.

Beyond the First Dose — Covid-19 Vaccine Follow-through and Continued Protective Measures

In December 2020, the United States began an ambitious vaccination program to inoculate Americans against Covid-19. Just a year after the first known Covid case in the United States, more than 40 million Americans had received the first dose of a vaccine developed by Pfizer and BioNTech or one by Moderna. The herculean effort has grappled with immense technological and logistic challenges in developing, producing, and distributing vaccines at unprecedented scale and speed. Its ultimate success, however, hinges on the public’s behavior.

April 27, 2021

Updated Recommendations from the Advisory Committee on Immunization Practices for Use of the Janssen (Johnson & Johnson) COVID-19 Vaccine After Reports of Thrombosis with Thrombocytopenia Syndrome Among Vaccine Recipients — United States, April 2021

On April 23, the Advisory Committee on Immunization Practices concluded that the benefits of resuming Janssen COVID-19 vaccination among persons aged ≥18 years outweighed the risks and reaffirmed its interim recommendation under FDA’s Emergency Use Authorization, which includes a new warning for rare clotting events among women aged 18–49 years.

Reasons for Admissions to US Children’s Hospitals During the COVID-19 Pandemic

Measures to mitigate the COVID-19 pandemic affected children’s access to health services and their physical and mental health. Reductions in hospitalizations for children occurred in 2020 compared with prior years.1 Little is known about the reasons for the decline and whether it varied by patient characteristics.

April 26, 2021

Genomic Epidemiology of SARS-CoV-2 Infection During the Initial Pandemic Wave and Association With Disease Severity

These findings suggest that SARS-CoV-2 clade assignment is an important factor that may aid in estimating patient outcomes.

April 24, 2021

More stringent measures against COVID-19 are associated with lower cases and deaths in Florida and Miami-Dade

Since the outset of 2020, the COVID-19 pandemic has caused widespread havoc to the lives of millions around the world disrupting families, education, and the employment sector. As of March 26, 2021, the CDC reports over 100 million cases and 2 million deaths worldwide.

April 23, 2021

Simulated Identification of Silent COVID-19 Infections Among Children and Estimated Future Infection Rates With Vaccination

In this simulation modeling study, identifying 10% to 20% of silent infections among children within 3 days after infection would bring attack rates below 5% if only adults were vaccinated. If silent infections among children remained undetected, achieving the same attack rate would require an unrealistically high vaccination coverage (≥81%) of this age group, in addition to vaccination of adults.

Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts

In this cohort study of 255 neonates born to women with positive SARS-CoV-2 test results within 2 weeks before and 72 hours after delivery, 88.2% of newborns were tested for the virus during the birth hospitalization and 2.2% had positive results. A main risk factor for neonatal test result positivity was maternal social vulnerability, and the burden of SARS-CoV-2 exposure on newborn health was associated with preterm delivery, which was prompted by worsening maternal COVID-19 illness.

Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic

In this cohort study of 965 patients with and without COVID-19 infection, multivariable modeling showed that COVID-19 positivity was associated with significant mean QTc prolongation from baseline during a 5-day observation period compared with no significant mean QTc change in patients without COVID-19. A greater proportion of patients with COVID-19 infection had incidence of QTc of 500 milliseconds or greater compared with patients without COVID-19 infection.

Health Care Utilization and Clinical Characteristics of Nonhospitalized Adults in an Integrated Health Care System 28–180 Days After COVID-19 Diagnosis — Georgia, May 2020–March 2021

Among 3,171 nonhospitalized adult COVID-19 patients, 69% had one or more outpatient visits 28–180 days after the diagnosis. Two thirds had a visit for a new primary diagnosis, and approximately one third had a new specialist visit. Symptoms potentially related to COVID-19 were common new visit diagnoses. Visits for these symptoms decreased after 60 days but for some patients continued through 120–180 days.

Airport Traveler Testing Program for SARS-CoV-2 — Alaska, June–November 2020

SARS-CoV-2 testing on arrival in Alaska airports identified 951 SARS-CoV-2 infections, or one per 406 arriving travelers, and might have contributed to Alaska’s low incidence during the summer by reducing opportunities for community transmission at travelers’ destination locations.

One million coronavirus sequences: popular genome site hits mega milestone

GISAID’s impressive effort to understand the spread of COVID-19 has seen scientists upload sequences from most nations on Earth.

April 22, 2021

Effect of Early Treatment With Hydroxychloroquine or Lopinavir and Ritonavir on Risk of Hospitalization Among Patients With COVID-19

In this trial that included 685 patients, rates of COVID-19–associated hospitalization in patients treated with hydroxychloroquine or lopinavir-ritonavir were not significantly different compared with those who received placebo.

Detection of SARS‐CoV‐2 in respiratory samples from cats in the UK associated with human‐to‐cat transmission

These findings indicate that human‐to‐cat transmission of SARS‐CoV‐2 occurred during the COVID‐19 pandemic in the UK, with the infected cats developing mild or severe respiratory disease. Given the ability of the new coronavirus to infect different species, it will be important to monitor for human‐to‐cat, cat‐to‐cat and cat‐to‐human transmission.

April 21, 2021

Vaccine Breakthrough Infections with SARS-CoV-2 Variants

Emerging variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are of clinical concern. In a cohort of 417 persons who had received the second dose of BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) vaccine at least 2 weeks previously, we identified 2 women with vaccine breakthrough infection. Despite evidence of vaccine efficacy in both women, symptoms of coronavirus disease 2019 developed, and they tested positive for SARS-CoV-2 by polymerase-chain-reaction testing. Viral sequencing revealed variants of likely clinical importance, including E484K in 1 woman and three mutations (T95I, del142–144, and D614G) in both. These observations indicate a potential risk of illness after successful vaccination and subsequent infection with variant virus, and they provide support for continued efforts to prevent and diagnose infection and to characterize variants in vaccinated persons. (Funded by the National Institutes of Health and others.)

Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19

A single dose of Ad26.COV2.S protected against symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection and was effective against severe–critical disease, including hospitalization and death. Safety appeared to be similar to that in other phase 3 trials of Covid-19 vaccines.

Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons

Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy, and infant outcomes.

Postvaccination SARS-CoV-2 Infections Among Skilled Nursing Facility Residents and Staff Members — Chicago, Illinois, December 2020–March 2021

Twenty-two possible breakthrough SARS-CoV-2 infections occurred among fully vaccinated persons ≥14 days after their second dose of COVID-19 vaccine. Two thirds of persons were asymptomatic. A minority of persons with breakthrough infection experienced mild to moderate COVID-19–like symptoms; two COVID-19–related hospitalizations and one death occurred. No facility-associated secondary transmission was identified.

COVID-19 Outbreak Associated with a SARS-CoV-2 R.1 Lineage Variant in a Skilled Nursing Facility After Vaccination Program — Kentucky, March 2021

In a COVID-19 outbreak at a Kentucky SNF involving a newly introduced variant to the region, unvaccinated residents and health care personnel (HCP) had 3.0 and 4.1 times the risk of infection as did vaccinated residents and HCP. Vaccine was 86.5% protective against symptomatic illness among residents and 87.1% protective among HCP.

April 20, 2021

Discrimination of COVID‐19 from inflammation‐induced cytokine storm syndromes by disease‐related blood biomarkers

Serum biomarker profiles clearly separate COVID‐19 from MAS or sHLH, which questions the significance of systemic hyperinflammation following SARS‐CoV‐2 infection as well as the efficacy of drugs targeting key molecules and pathways specifically associated with systemic cytokine storm conditions in the treatment of COVID‐19.

International student mobilities in a contagion: (Im)mobilising higher education?

Remaking international higher education via digital infrastructure and remote learning can only be successful if it addresses the centrality of embodied and experiential dimensions of learning. Travel restrictions and health concerns may lead to increasing regionalisation of international student mobilities. The rapid digitalisation of universities during the COVID‐19 pandemic may accelerate their further commercialisation and privatisation. Institutions and governments seeking to rebuild international higher education through and after the COVID‐19 pandemic need address social justice and sustainability challenges.

Asymptomatic and symptomatic SARS-CoV-2 infections elicit polyfunctional antibodies.

Antibody functions are correlated, regardless of disease severity. Longitudinal samplings show that antibody functions follow similar kinetics of induction and contraction. Overall, asymptomatic SARS-CoV-2 infection elicits polyfunctional antibodies neutralizing the virus and targeting infected cells.

The SARS‐unique domain (SUD) of SARS‐CoV and SARS‐CoV‐2 interacts with human Paip1 to enhance viral RNA translation

The three‐dimensional structure of the N‐terminal domain of SARS‐CoV SUD (“macrodomain II”, Mac2) in complex with the middle domain of Paip1, determined by X‐ray crystallography and small‐angle X‐ray scattering, provides insights into the structural determinants of the complex formation. In cellulo, SUD enhances synthesis of viral but not host proteins via binding to Paip1 in pBAC‐SARS‐CoV replicon‐transfected cells. We propose a possible mechanism for stimulation of viral translation by the SUD of SARS‐CoV and SARS‐CoV‐2.

Circulating Adaptive Immune Cells Expressing the Gut Homing Marker α4β7 Integrin Are Decreased in COVID-19

COVID-19 is associated with a decrease in circulating adaptive immune cells expressing the key gut homing marker α4β7 suggesting that these cells are preferentially recruited to extra-intestinal tissues independently of α4β7 or that the systemic immune response against SARS-CoV-2 is at least numerically dominated by extraintestinal, particularly pulmonary, immune cell priming.

April 19, 2021

Sero-monitoring of health care workers reveals complex relationships between common coronavirus antibodies and SARS-CoV-2 severity

Our data suggest that recent βCoV infections potentially limit the severity of SARS-CoV-2 infections through mechanisms that do not involve cross-reactive antibodies. Our data are consistent with the emerging hypothesis that cellular immune responses elicited by recent common βCoV infections transiently reduce disease severity following SARS-CoV-2 infections.

Incidence and prognosis of COVID‐19 in psoriasis patients on biologic therapy: a multicenter retrospective cohort study

Current guidelines recommend continuing biologic therapy in dermatologic patients who have not tested positive for or exhibited signs/symptoms of COVID‐19 and postponing biologic therapy in patients who have tested positive for or exhibited signs/symptoms of COVID‐19.

COVID‐19 vaccine acceptance in pregnant women

The present study reported low acceptance of COVID‐19 vaccination in a sample of pregnant women. Concern about vaccine safety was the major hesitancy reason. Identifying attitudes among priority groups will be useful to create vaccination strategies in the prevention current pandemic.

COVID-19 Vaccination Preparedness Policies in U.S. Hospitals

We surveyed infectious disease specialists about early COVID-19 vaccination preparedness. Almost all respondents’ institutions rated their facility’s preparedness plan as either excellent or adequate. Vaccine hesitancy and concern about adverse reactions were the most common anticipated barriers to COVID-19 vaccination. Only 60% believed currently that COVID-19 vaccination should be mandatory.

Safety and immunogenicity of an MF59-adjuvanted spike glycoprotein-clamp vaccine for SARS-CoV-2: a randomised, double-blind, placebo-controlled, phase 1 trial

This first-in-human trial shows that a subunit vaccine comprising mammalian cell culture-derived, MF59-adjuvanted, molecular clamp-stabilised recombinant spike protein elicits strong immune responses with a promising safety profile. However, the glycoprotein 41 peptide present in the clamp created HIV diagnostic assay interference, a possible barrier to widespread use highlighting the criticality of potential non-spike directed immunogenicity during vaccine development. Studies are ongoing with alternative molecular clamp trimerisation domains to ameliorate this response.

April 17, 2021

Myelopathy associated with SARS-COV-2 infection. A systematic review

Considering the imminent arrival of new vaccines against COVID-19 pandemic, and their potential risk for postvaccination transverse myelitis, this characterization of COVID-19 related myelopathy is of utmost importance.

April 16, 2021

COVID vaccines and blood clots: five key questions

As safety concerns delay the use of two COVID-19 vaccines, Nature looks at the questions that scientists want answered.

Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2 mRNA vaccinated individuals

Those who tested positive between two weeks after the first dose and one week after the second dose, were disproportionally infected by B.1.1.7 (odds ratio of 26:10), suggesting reduced vaccine effectiveness against both VOCs at particular time windows following vaccination. Nevertheless, the B.1.351 incidence in Israel to-date remains low and vaccine effectiveness remains high among those fully vaccinated. These results overall suggest that vaccine breakthrough infection may be more frequent with both VOCs, yet a combination of mass-vaccination with two doses coupled with non-pharmaceutical interventions control and contain their spread.

Update: COVID-19 Pandemic–Associated Changes in Emergency Department Visits — United States, December 2020–January 2021

ED visits during December 2020–January 2021 were 25% lower than during the same months the year before. Higher proportions of ED patients are seeking care for mental and behavioral health–related concerns, especially pediatric patients.

Notes from the Field: Update on Excess Deaths Associated with the COVID-19 Pandemic — United States, January 26, 2020–February 27, 2021

Estimates of excess deaths, defined as the number of persons who have died from all causes, above the expected number of deaths for a given place and time, can provide a comprehensive account of mortality likely related to the COVID-19 pandemic, including deaths that are both directly and indirectly associated with COVID-19. Since April 2020, CDC’s National Center for Health Statistics (NCHS) has published weekly data on excess deaths associated with the COVID-19 pandemic (1). A previous report identified nearly 300,000 excess deaths during January 26–October 3, 2020, with two thirds directly associated with COVID-19 (2). Using more recent data from the National Vital Statistics System (NVSS), CDC estimated that 545,600–660,200 excess deaths occurred in the United States during January 26, 2020–February 27, 2021.

COVID-19 Stats: COVID-19* and Influenza† Discharge Diagnoses as a Percentage of Emergency Department (ED) Visits,§ by Year — United States, June 2018–March 2021

In late June 2020, the percentage of ED visits for COVID-19 increased and reached a peak of 2.8% of all ED visits in early July before declining through August. This decline was followed by a larger and more prolonged increase beginning in September 2020 that reached a peak (7.2%) in early January 2021. Influenza activity generally begins in October with increased activity throughout the winter months. By the beginning of February 2018, the percentage of ED visits for influenza reached 3.1%, and by the beginning of February 2019, reached 5.0%. During June 2020–March 2021, ED visits for influenza accounted for less than 0.1% of all visits.

Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination

Vaccination against SARS-CoV-2 remains critical for control of the Covid-19 pandemic. A pathogenic PF4-dependent syndrome, unrelated to the use of heparin therapy, can occur after the administration of the ChAdOx1 nCoV-19 vaccine. Rapid identification of this rare syndrome is important because of the therapeutic implications.

SARS-CoV-2 Vaccine–Induced Immune Thrombotic Thrombocytopenia

The coronavirus disease 2019 (Covid-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulated the development of highly effective vaccines that were produced with unprecedented speed with the use of diverse technologies. No major safety warnings, other than rare cases of anaphylaxis, were reported in the initial trials, which involved tens of thousands of adults, and the risk of serious adverse effects has remained remarkably low after vaccination of more than 400 million people worldwide to date.

Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination — Response from the Manufacturer

A case report by Muir et al.1 describes thrombosis, including cerebral venous sinus thrombosis (CVST), associated with severe thrombocytopenia and disseminated intravascular coagulation in a recipient of the Ad26.COV2.S vaccine (Johnson & Johnson/Janssen) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Indoor Air Changes and Potential Implications for SARS-CoV-2 Transmission

Buildings have been associated with spread of infectious diseases, such as outbreaks of measles, influenza, and Legionella. With SARS-CoV-2, the majority of outbreaks involving 3 or more people have been linked with time spent indoors, and evidence confirms that far-field airborne transmission (defined as within-room but beyond 6 feet) of SARS-CoV-2 is occurring.

Fitted Filtration Efficiency of Double Masking During the COVID-19 Pandemic

Although global vaccination efforts against SARS-CoV-2 are underway, the public is urged to continue using face masks as a primary intervention to control transmission.

April 15, 2021

Cerebral venous thrombosis: a retrospective cohort study of 513,284 confirmed COVID-19 cases and a comparison with 489,871 people receiving a COVID-19 mRNA vaccine

These data show that the incidence of CVT is significantly increased after COVID-19,andgreater than that observed with BNT162b2 and mRNA-1273 COVID-19 vaccines. The risk of CVT following COVID-19 is also higher than the latest estimate from the European Medicines Agency for the incidence associated withChAdOx1 nCoV-19 vaccine (5.0 per million people, 95% CI 4.3–5.8). Although requiring replication and corroboration, the present data highlight the risk of serious thrombotic events in COVID-19, and can help contextualize the risks and benefits of vaccination in this regard.

BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting

This study in a nationwide mass vaccination setting suggests that the BNT162b2 mRNA vaccine is effective for a wide range of Covid-19–related outcomes, a finding consistent with that of the randomized trial.

Identifying clinical and biochemical phenotypes in acute respiratory distress syndrome secondary to coronavirus disease-2019

We identified two distinct phenotypes of COVID-19-associated ARDS, with substantial differences in biochemical profiles despite minimal differences in respiratory dynamics. The minority phenotype (class 2, n = 70, 26·6%) demonstrated increased markers of coagulopathy, with mild relative hyper-inflammation and dramatically increased markers of end-organ dysfunction (e.g., creatinine, troponin). The odds of 28-day mortality among the class 2 phenotype was more than double that of the class 1 phenotype (40·0% vs.· 23·3%, OR = 2·2, 95% CI [1·2, 3·9]).

Evidence of the pathogenic HERV-W envelope expression in T lymphocytes in association with the respiratory outcome of COVID-19 patients

Given the known immuno- and neuro-pathogenicity of HERV-W ENV protein, it could promote certain pathogenic features of COVID-19 and therefore serve as a biomarker to predict clinical progression of disease and open to further studies for therapeutic intervention.

Epigenome-wide association study of COVID-19 severity with respiratory failure

We identified DNA methylation sites as epigenetic susceptibility loci for respiratory failure in COVID-19 patients. These candidate biomarkers, combined with other clinical, cellular and genetic factors, could be useful in the clinical stratification and management of patients infected with the SARS-CoV-2.

Vaccines that can protect against many coronaviruses could prevent another pandemic

In 2017, three leading vaccine researchers submitted a grant application with an ambitious goal. At the time, no one had proved a vaccine could stop even a single beta coronavirus—the notorious viral group then known to include the lethal agents of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), as well as several causes of the common cold and many bat viruses. But these researchers wanted to develop a vaccine against them all.

Impact of cancer history on outcomes among hospitalized COVID‐19 patients

Patients with a history of cancer hospitalized for COVID‐19 had similar mortality to matched hospitalized COVID‐19‐positive patients without cancer, and a lower risk of complications. In this population, patients with active cancer or recent cancer treatment had a similar risk for adverse outcomes compared to cancer survivors.

Evaluation of a laboratory-based high-throughput SARS-CoV-2 antigen assay for non-COVID-19 patient screening at hospital admission

Several rapid antigen tests (RATs) for the detection of SARS-CoV-2 were evaluated recently. However, reliable performance data for laboratory-based, high-throughput antigen tests are lacking. Therefore and in response to a short-term shortage of PCR reagents, we evaluated DiaSorin's LIAISON SARS-CoV-2 antigen test in comparison to RT-qPCR, and concerning the application of screening non-COVID-19 patients on hospital admission.

Patterns of Media Use, Strength of Belief in COVID-19 Conspiracy Theories, and the Prevention of COVID-19 from March to July 2020 in the US

Holding conspiracy beliefs regarding the coronavirus pandemic in the US has been associated with reductions in both actions to prevent the spread of the infection (e.g., mask wearing) and intentions to accept a vaccine when one becomes available.

Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies — the Polish experience

Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.

Laboratory correlates of SARS-CoV-2 seropositivity in a nationwide sample of patients on dialysis in the U.S.

Patients on dialysis are at high risk for death due to COVID-19, yet a significant proportion do survive as evidenced by presence of SARS-CoV-2 antibodies in 8% of patients in the U.S. in July 2020. It is unclear whether patients with seropositivity represent the subgroup with robust health status, who would be more likely to mount a durable antibody response.

Machine learning based on clinical characteristics and chest CT quantitative measurements for prediction of adverse clinical outcomes in hospitalized patients with COVID-19

We presented a machine learning model that could be effectively used as a predictor of adverse outcomes in hospitalized patients with COVID-19, opening up the possibility for patient stratification and treatment allocation.

COVID-19 neuropathology at Columbia University Irving Medical Center/New York Presbyterian Hospital

Many patients with SARS-CoV-2 infection develop neurological signs and symptoms, though, to date, little evidence exists that primary infection of the brain is a significant contributing factor. We present the clinical, neuropathological, and molecular findings of 41 consecutive patients with SARS-CoV-2 infections who died and underwent autopsy in our medical center.

Spike Antibody Levels of Nursing Home Residents With or Without Prior COVID-19 3 Weeks After a Single BNT162b2 Vaccine Dose

Recent studies have suggested that, to reach immunity, immunocompetent SARS-CoV-2 seropositive adults may only require 1 dose rather than 2 doses of a messenger RNA vaccine; however, these studies did not include older adults. Older adults living in nursing homes are at higher risk for severe COVID-19, and the immune response to the vaccine may differ from that of younger, healthier adults.

Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic

This cross-sectional study analyzed prescriptions from 90 420 353 patients and found that from March 18 to May 19, 2020, total morphine milligram equivalents of opioid analgesics prescribed to existing patients followed prepandemic trends; prescriptions to opioid-naive patients were 34% below projected levels but rebounded by August 2020. Prescribing of buprenorphine for opioid use disorder followed prepandemic trends for existing patients, while prescriptions to new patients were 18% below projected levels, rebounding to 90% of projected levels by August 2020.

SARS-CoV-2 seropositivity and subsequent infection risk in healthy young adults: a prospective cohort study

Seropositive young adults had about one-fifth the risk of subsequent infection compared with seronegative individuals. Although antibodies induced by initial infection are largely protective, they do not guarantee effective SARS-CoV-2 neutralisation activity or immunity against subsequent infection. These findings might be relevant for optimisation of mass vaccination strategies.

SARS-CoV-2 reinfection in a closed setting: lessons for the community

In a study published in The Lancet Respiratory Medicine, Andrew Letizia and colleagues analysed the subsequent infection risk for SARS-CoV-2 in healthy young adults with and without previous antispike IgG antibodies. They followed Marine recruits for 6 weeks after a 2-week supervised quarantine period. Serology and PCR tests for SARS-CoV-2 were performed upon arrival to supervised quarantine, and PCR was repeated on weeks 1 and 2 of quarantine, and then every other week (weeks 2, 4, and 6) thereafter.

April 14, 2021

Laboratory Modeling of SARS-CoV-2 Exposure Reduction Through Physically Distanced Seating in Aircraft Cabins Using Bacteriophage Aerosol — November 2020

Based on laboratory modeling of exposure to SARS-CoV-2 on single-aisle and twin-aisle aircraft, exposures in scenarios in which the middle seat was vacant were reduced by 23% to 57%, compared with full aircraft occupancy, depending upon the model.

Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination

Thrombosis and thrombocytopenia have been reported after vaccination with the ChAdOx1 nCoV-19 vaccine (Oxford–AstraZeneca), a recombinant chimpanzee adenoviral vector encoding the spike glycoprotein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

SARS-CoV-2 Antibody Response in Persons with Past Natural Infection

Whether or not persons who have already been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) should be vaccinated is unclear. Only a few studies have shown that vaccinees who were previously infected with SARS-CoV-2 had a significantly higher antibody response than previously uninfected vaccinees.

Spatiotemporal pattern of COVID-19 spread in Brazil

Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We use daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures show that while no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.

The effect of cognition and affect on preventive behaviors during the COVID-19 pandemic: a cross-sectional study in China

After the rising period of the COVID-19 outbreak in mainland China, cognitive and affective variables still played important roles in predicting behavioral responses. Compared with cognitive factors, affective factors demonstrated stronger explanatory power in predicting behavioral responses toward COVID-19. The findings may have implications for enhancing individual compliance with guidelines of adopting preventive behaviors in response to COVID-19.

Risk stratification scores for hospitalization duration and disease progression in moderate and severe patients with COVID-19

Two easy-to-use risk stratification score systems were built to predict the outcomes in COVID-19 patients with different clinical types. Identifying high risk patients with longer stay or poor prognosis could assist healthcare providers in triaging patients when allocating limited healthcare during COVID-19 outbreak.

Hospital pharmacy response to COVID-19 at two UK teaching hospitals: a departmental review of actions implemented to inform future strategy

This study has provided a number of recommendations for how hospital pharmacy departments may respond to a global pandemic. These experiences derived from the pharmacy departments at two large UK NHS Trusts may be used by other healthcare providers to help inform the pharmacy response to a global pandemic.

Development and validation of a 3D printed antiviral ventilator filter - a comparative study

Our filter may be of particular importance to those working in low middle-income countries unable to compete with stronger economies. Our design relies on products available outside the healthcare supply chain, much of which can be purchased in grocery stores, hardware stores, or industrial and academic institutions. We hope that these HMEs and viral filters may be beneficial to clinicians who face critical supply chain issues during the COVID-19 pandemic.

April 13, 2021

COVID-19 Presenting as Acute Necrotizing Pancreatitis

The ongoing pandemic of the novel coronavirus disease 2019 (COVID-19) originated in Wuhan, China, in December 2019. Various manifestations of coronavirus (SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) have been reported since the pandemic began. Some articles have reported acute pancreatitis in several patients due to COVID-19 infection.

COVID-19 Precautions Are Scarce in Non–Health Care Workplaces

Less than half of US workers in non–health care fields had COVID-19 prevention measures in place at work as of June 2020, based on an online survey of 4000 US, nonremote workers.

April 12, 2021

Inhaled budesonide for COVID-19 in people at higher risk of adverse outcomes in the community: interim analyses from the PRINCIPLE trial

In this updated interim analysis, inhaled budesonide reduced time to recovery by a median of 3 days in people with COVID-19 with risk factors for adverse outcomes. Once 28 day follow up is complete for all participants randomized to budesonide, final analyses of time to recovery and hospitalization/death will be published.

Incorporating HIV Screening With COVID-19 Testing in an Urban Emergency Department During the Pandemic

The COVID-19 pandemic has had negative consequences on HIV care and prevention programs, including routine HIV screening in health care settings.

Rapid Response System Adaptations at 40 US Hospitals During the COVID-19 Pandemic

Most RRSs reported pandemic-related adjustments, most commonly through increasing resources and implementation of protocol changes. There was a reduction in the number of sites that performed simulation training.

Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection

Several small studies have suggested that patients with positive test results for COVID-19 infection may experience worse perioperative outcomes and increased mortality after surgery.

Genomic characteristics and clinical effect of the emergent SARS-CoV-2 B.1.1.7 lineage in London, UK: a whole-genome sequencing and hospital-based cohort study

Emerging evidence exists of increased transmissibility of B.1.1.7, and we found increased virus load by proxy for B.1.1.7 in our data. We did not identify an association of the variant with severe disease in this hospitalised cohort.

Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study

The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant.

Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region — United States, March–December 2020

Within each U.S. Census region, the proportion of hospitalized patients with COVID-19 was highest for Hispanic or Latino patients. Racial and ethnic disparities were largest during May–July 2020 and became less pronounced as the pandemic spread throughout the country; however, disparities remained in December 2020 in all regions.

Emergency Department Visits for COVID-19 by Race and Ethnicity — 13 States, October–December 2020

Data from 13 states indicate that compared with White persons, Hispanic and American Indian or Alaska Native persons experienced 1.7 times the rate, and Black persons experienced 1.4 times the rate of emergency department care visits for COVID-19 during October–December 2020.

SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women

This study found robust secretion of SARS-CoV-2 specific IgA and IgG antibodies in breast milk for 6 weeks after vaccination. IgA secretion was evident as early as 2 weeks after vaccination followed by a spike in IgG after 4 weeks (a week after the second vaccine). A few other studies have shown similar findings in women infected with COVID-19.5 Antibodies found in breast milk of these women showed strong neutralizing effects, suggesting a potential protective effect against infection in the infant.

Herpes zoster following BNT162b2 mRNA Covid-19 vaccination in patients with autoimmune inflammatory rheumatic diseases: a case series

Epidemiologic studies on the safety of the mRNA-based COVID-19 vaccines in patients with AIIRD are needed to clarify the association between the BNT162b2 mRNA vaccination and reactivation of zoster.

Lack of detail in population-level data impedes analysis of SARS-CoV-2 variants of concern and clinical outcomes

The SARS-CoV-2 lineage B.1.1.7 is characterised by a suite of defining mutations in the immunodominant spike protein, including a signature Asp501Tyr substitution in the receptor-binding domain.

First reported in December 2020, in the UK, the variant's discovery coincided with a substantial surge in case numbers and fatalities in the UK, raising concerns that this variant was both more infectious and virulent than previous variants. Epidemiological and modelling studies have yielded good evidence that B.1.1.7 is more transmissible than other variants.

Monitoring differences between the SARS-CoV-2 B.1.1.7 variant and other lineages

As focus in the SARS-CoV-2 pandemic shifts to the emergence of new variants of concern (VOC), characterising the differences between new variants and non-VOC lineages will become increasingly important for surveillance and maintaining the effectiveness of both public health and vaccination programmes.

April 11, 2021

Social distancing mediated generalized model to predict epidemic spread of COVID-19

The extensive proliferation of recent coronavirus (COVID-19), all over the world, is the outcome of social interactions through massive transportation, gatherings and population growth. To disrupt the widespread of COVID-19, a mechanism for social distancing is indispensable.

April 9, 2021

Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination

Several cases of unusual thrombotic events and thrombocytopenia have developed after vaccination with the recombinant adenoviral vector encoding the spike protein antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (ChAdOx1 nCov-19, AstraZeneca). More data were needed on the pathogenesis of this unusual clotting disorder.

Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination

We report findings in five patients who presented with venous thrombosis and thrombocytopenia 7 to 10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against coronavirus disease 2019 (Covid-19). The patients were health care workers who were 32 to 54 years of age.

How could a COVID vaccine cause blood clots? Scientists race to investigate

The very rare occurrence of a mysterious blood-clotting disorder among some recipients of the Oxford–AstraZeneca COVID-19 vaccine has got researchers scrambling to uncover whether, and if so, how the inoculation could trigger such an unusual reaction.

Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2 mRNA vaccinated individuals

Those infected between two weeks after the first dose and one week after the second dose, were disproportionally infected by B.1.1.7 (odds ratio of 26:10), suggesting reduced vaccine effectiveness against both VOCs under different dosage/timing conditions. Nevertheless, the B.1.351 incidence in Israel to-date remains low and vaccine effectiveness remains high against B.1.1.7, among those fully vaccinated. These results overall suggest that vaccine breakthrough infection is more frequent with both VOCs, yet a combination of mass-vaccination with two doses coupled with non-pharmaceutical interventions control and contain their spread.

Public Perspectives on COVID-19 Vaccine Prioritization

In this survey study of 4735 US adults, respondents of all demographic and political affiliations agreed with prioritizing health care workers, adults of any age with serious comorbid conditions, frontline workers (eg, teachers and grocery workers), and Black, Hispanic, Native American, and other communities that have been disproportionately affected by COVID-19. Older adult respondents were less likely than younger respondents to list healthy people older than 65 years as 1 of their top 4 priority groups.

Genome Analysis for Sequence Variants in SARS-CoV-2 Among Asymptomatic Individuals in a Long-term Care Facility

Studies have suggested that sequence variants in the genome of SARS-CoV-2 may affect infectivity, transmission, and pathogenicity of the virus.1-3 In this study, genome analysis was performed on SARS-CoV-2 RNA recovered from 7 individuals in a long-term care facility who were asymptomatic at time of screening.

IL-33 expression in response to SARS-CoV-2 correlates with seropositivity in COVID-19 convalescent individuals

Our understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still developing. We perform an observational study to investigate seroprevalence and immune responses in subjects professionally exposed to SARS-CoV-2 and their family members (155 individuals; ages 5–79 years). Seropositivity for SARS-CoV-2 Spike glycoprotein aligns with PCR results that confirm the previous infection. Anti-Spike IgG/IgM titers remain high 60 days post-infection and do not strongly associate with symptoms, except for fever.

Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations

By the end of January 2021, more than 97.3 million doses globally and 31.8 million doses in the United States have been administered of the COVID-19 vaccine. Although important postmarketing surveillance is ongoing, it is currently highly effective and safe, with adverse effects including transient symptoms such as fever/chills, headache, fatigue, myalgia/arthralgia, lymphadenopathy, nausea, or local effects of swelling, erythema, or pain.

Death Certificate–Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance — United States, January–December 2020

Among 378,048 death certificates from 2020 listing COVID-19, 5.5% listed COVID-19 without codes for any other conditions. Among 357,133 death certificates with at least one other condition, 97% had a co-occurring diagnosis of a plausible chain-of-event condition (e.g., pneumonia or respiratory failure), or a significant contributing condition (e.g., hypertension or diabetes), or both.

April 8, 2021

S-Gene Target Failure as a Marker of Variant B.1.1.7 Among SARS-CoV-2 Isolates in the Greater Toronto Area, December 2020 to March 2021

A novel variant of SARS-CoV-2, B.1.1.7, originally discovered in the UK, is rapidly overtaking wild-type SARS-CoV-2 globally, due to a substantial transmission advantage. This variant is estimated to be 40% to 80% more transmissible and 35% more lethal3 than the wild-type virus.

Mortality Among US Patients Hospitalized With SARS-CoV-2 Infection in 2020

This cohort study of 503 409 patients from 209 US acute care hospitals found a decrease in in-hospital mortality among patients with SARS-CoV-2–positive tests. Mortality rates were 10.6% in March, increased to 19.7% in April, and decreased to 9.3% in November.

Covid-19: Involvement of the nervous system. Identifying neurological predictors defining the course of the disease

The main objective of this study was to analyse neurological symptoms during a Covid-19 infection and determine the pattern of symptoms by comparing outpatients with inpatients. A further goal was to identify possible predictors, such as pre-existing conditions and neurological symptoms.

April 7, 2021

Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers

The results of this study showed that a considerable portion of low-risk individuals with mild COVID-19 reported a diversity of long-term symptoms, and that these symptoms disrupted work, social, and home life. Limitations of the study include the possibility of recall bias and the subjective rating of symptoms. Further research is needed to understand the mechanisms underlying COVID-19–related long-term sequalae.

Association of Human Mobility Restrictions and Race/Ethnicity–Based, Sex-Based, and Income-Based Factors With Inequities in Well-being During the COVID-19 Pandemic in the United States

In this cross-sectional study of 1 088 314 US adults, African American individuals with low income, Hispanic individuals, and women of all racial/ethnic groups had higher risks of experiencing unemployment, class cancellations, food insufficiency, and mental health problems during the first wave of the COVID-19 pandemic.

Comparison of seven commercial SARS-CoV-2 rapid point-of-care antigen tests: a single-centre laboratory evaluation study

Antigen point-of-care tests (AgPOCTs) can accelerate SARS-CoV-2 testing. As some AgPOCTs have become available, interest is growing in their utility and performance. Here we aimed to compare the analytical sensitivity and specificity of seven commercially available AgPOCT devices.

The relationship of large city out-of-hospital cardiac arrests and the prevalence of COVID-19

Though variable, many major metropolitan cities reported profound and unprecedented increases in out-of-hospital cardiac arrest (OHCA) in early 2020. This study examined the relative magnitude of those increases and their relationship to COVID-19 prevalence.

Association of SARS-CoV-2 clades with clinical, inflammatory and virologic outcomes: An observational study

Host determinants of severe coronavirus disease 2019 include advanced age, comorbidities and male sex. Virologic factors may also be important in determining clinical outcome and transmission rates, but limited patient-level data is available.

Factors Associated with Participation in Elementary School–Based SARS-CoV-2 Testing — Salt Lake County, Utah, December 2020–January 2021

During December 3, 2020–January 31, 2021, CDC, in collaboration with the University of Utah Health and Economic Recovery Outreach Project, Utah Department of Health (UDOH), Salt Lake County Health Department, and one Salt Lake county school district, offered free, in-school, real-time reverse transcription–polymerase chain reaction (RT-PCR) saliva testing as part of a transmission investigation of SARS-CoV-2, the virus that causes COVID-19, in elementary school settings.

April 6, 2021

Development of COVIDVax Model to Estimate the Risk of SARS-CoV-2–Related Death Among 7.6 Million US Veterans for Use in Vaccination Prioritization

In this prognostic study of more than 7.6 million individuals enrolled in the Veterans Affairs health care system, a logistic regression model (COVIDVax) was developed to estimate risk of SARS-CoV-2–related death using the following 10 characteristics: sex, age, race, ethnicity, body mass index, Charlson Comorbidity Index, diabetes, chronic kidney disease, congestive heart failure, and the Care Assessment Need score. The model was estimated to save more lives than prioritizing vaccination based on age or on the US Centers for Disease Control and Prevention vaccination allocation.

Assessment of Pediatric Admissions for Kawasaki Disease or Infectious Disease During the COVID-19 State of Emergency in Japan

In this cross-sectional study of 17 235 pediatric patients, the number of admissions for KD showed no significant change (27.4% decrease) during quarantine owing to the COVID-19 pandemic, whereas there were significant decreases in numbers of hospital admissions for droplet-transmitted or contact-transmitted respiratory tract infections (75.3% decrease) and gastrointestinal infections (86.3% decrease). Thus, the ratio of KD admissions to admissions for these infections increased.

Antibody Persistence through 6 Months after the Second Dose of mRNA-1273 Vaccine for Covid-19

Interim results from a phase 3 trial of the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine indicated 94% efficacy in preventing coronavirus disease 2019 (Covid-19).1 The durability of protection is currently unknown.

April 5, 2021

Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19

In this cross-sectional study of 176 781 ambulatory cardiology visits, patients using COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals, have private insurance, and have cardiovascular comorbidities. Compared with pre-COVID in-person visits, clinicians during COVID-era video and telephone visits had a significantly lower odds of ordering any medication as well as most tests.

Association of Sociodemographic Factors and Blood Group Type With Risk of COVID-19 in a US Population

The observed variability in susceptibility to SARS-CoV-2 and severity of the ensuing COVID-19 have raised intense interest in their environmental and genetic risk factors. An early report from China suggested that blood group A was associated with increased susceptibility and blood group O was associated with reduced susceptibility to SARS-CoV-2 infection.

Community Transmission of SARS-CoV-2 Associated with a Local Bar Opening Event — Illinois, February 2021

Forty-six cases of COVID-19 were linked to an indoor bar opening event that occurred during February 2021 in a rural Illinois county. Event patrons were linked to secondary cases among household, long-term care facility, and school contacts, resulting in one hospitalization and one school closure affecting 650 students.

April 3, 2021

A Public Health Antibody Screening Indicates a Marked Increase of SARS-CoV-2 Exposure Rate in Children during the Second Wave

The  frequency  of  SARS-CoV-2  infections  in  preschool  and  school  children  is  an  important parameter  for  decisions  regarding  kindergarten  and school  openings  and  procedures.  Evidence indicates  that  children  have  lower  susceptibility  to  SARS-CoV-2  infection  than  adults,  but  data in children  from the  general population are relatively  few  (Viner et al., 2021).

April 2, 2021

Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021

Prospective cohorts of 3,950 health care personnel, first responders, and other essential and frontline workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks. Under real-world conditions, mRNA vaccine effectiveness of full immunization (≥14 days after second dose) was 90% against SARS-CoV-2 infections regardless of symptom status; vaccine effectiveness of partial immunization (≥14 days after first dose but before second dose) was 80%.

April 1, 2021

Analysis of SARS-CoV-2 genomic epidemiology reveals disease transmission coupled to variant emergence and allelic variation

The spread of SARS-CoV-2 created a pandemic crisis with > 150,000 cumulative cases in > 65 countries within a few months. The reproductive number (R) is a metric to estimate the transmission of a pathogen during an outbreak. Preliminary published estimates were based on the initial outbreak in China.

Risk for International Importations of Variant SARS-CoV-2 Originating in the United Kingdom

The United Kingdom has detected a variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent coronavirus disease (COVID-19), from samples initially collected in Kent on September 20 and London on September 21, 2020. The variant was associated with increased transmissibility and includes deletions at amino acid sites 69 and 70 of the spike protein. In mid-December, the UK government tightened measures in London and southeastern England to mitigate transmission of the fast-spreading virus variant.

Can technology increase COVID-19 vaccination rates?

Vaccine ready is the theme of the National Minority Health Month in April, 2021. This initiative aims to educate the public on health problems facing minority populations in the USA. The vaccine theme has been chosen because, paradoxically, although minority populations have been disproportionately impacted by COVID-19, they are also reported to be the least likely to be vaccinated. Barriers against vaccination among minority populations have been widely reported, including low confidence in the vaccine, poor access, and distrust of the health system.

March 31, 2021

Provisional Mortality Data — United States, 2020

The age-adjusted death rate increased by 15.9% in 2020. Overall death rates were highest among non-Hispanic Black persons and non-Hispanic American Indian or Alaska Native persons. COVID-19 was the third leading cause of death, and the COVID-19 death rate was highest among Hispanics.

Death Certificate–Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance — United States, January–December 2020

Among 378,048 death certificates from 2020 listing COVID-19, 5.5% listed COVID-19 without codes for any other conditions. Among 357,133 death certificates with at least one other condition, 97% had a co-occurring diagnosis of a plausible chain-of-event condition (e.g., pneumonia or respiratory failure), or a significant contributing condition (e.g., hypertension or diabetes), or both.

The Leading Causes of Death in the US for 2020

Vital statistics data provide the most complete assessment of annual mortality burden and contribute key measurements of the direct and indirect mortality burden during a public health pandemic. While mortality statistics have historically been produced annually, the COVID-19 pandemic introduced a pressing need for the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) to rapidly release reliable provisional mortality data. Provisional estimates indicate a 17.7% increase in the number of deaths in 2020 (the increase in the age-adjusted rate was 15.9%) compared with 2019, with increases in many leading causes of death.

Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19

The study’s findings suggest that ACEIs and ARBs may be associated with protective benefits for patients with COVID-19 and that patients may continue receiving ACEIs and ARBs for the treatment of any condition without an increased risk of worse outcomes unless specifically advised to avoid them by treating clinicians.

Risk Factors Associated With SARS-CoV-2 Infections, Hospitalization, and Mortality Among US Nursing Home Residents

In this cohort study among 482 323 long-stay residents, risk of SARS-CoV-2 infections were associated with geographic area and the specific facility, not by characteristics of the residents. Among residents diagnosed with SARS-CoV-2 infections, the risk of hospitalization associated with individual resident characteristics differed from the risk of death.

Simulation-Based Estimation of SARS-CoV-2 Infections Associated With School Closures and Community-Based Nonpharmaceutical Interventions in Ontario, Canada

In this decision analytical modelling study of a synthetic population of 1 000 000 individuals in Ontario, Canada, compared with community-based nonpharmaceutical interventions, school closure was associated with a small change in estimated COVID-19 incidence trajectories and cumulative case counts.

Association Between Risk Factors for Complications From COVID-19, Perceived Chances of Infection and Complications, and Protective Behavior in the US

In this survey study of 6084 US adults, those with 7 of 9 medical risk factors for COVID-19 complications reported higher perceived chance of hospitalization or death from COVID-19 if infected compared with those without the factor. While nearly all adults reported recent mask wearing, during several common activities the majority, including susceptible adults, did not consistently wear masks.

Addressing Vaccine Hesitancy in BIPOC Communities — Toward Trustworthiness, Partnership, and Reciprocity

The devastation of the Covid-19 pandemic has been rippling through Black, Indigenous, and People of Color (BIPOC) communities throughout the United States. The Centers for Disease Control and Prevention has reported horrifyingly disproportionate age-adjusted rates of cases, hospitalizations, and deaths. Black Americans have had hospitalization and death rates 9 times as high as those for White Americans; American Indians and Alaska Natives have seen 9 times as many cases and 4 times as many deaths as White Americans; and Latinx/Hispanic Americans have faced 3 times as many deaths as their White counterparts.

“Vaccine Passport” Certification — Policy and Ethical Considerations

As the Covid-19 pandemic enters its next phase, fervent desires to return to normalcy coupled with the rollout of efficacious vaccines have intensified discussions of “vaccine passports” — certifications of vaccination that reduce public health restrictions for their bearers.

Scaling Up Covid-19 Vaccination in Africa — Lessons from the HIV Pandemic

Concerns regarding access to Covid-19 vaccines in Africa are reminiscent of concerns raised about responding to the HIV pandemic in the mid-1990s and early 2000s, when highly active antiretroviral treatment (ART) was accessible in high-income countries but had limited availability in African countries — a disparity that resulted in many preventable deaths in these high-burden settings.

March 30, 2021

Efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 variant of concern 202012/01 (B.1.1.7): an exploratory analysis of a randomised controlled trial

A new variant of SARS-CoV-2, B.1.1.7, emerged as the dominant cause of COVID-19 disease in the UK from November, 2020. We report a post-hoc analysis of the efficacy of the adenoviral vector vaccine, ChAdOx1 nCoV-19 (AZD1222), against this variant.

Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England

In patients with type 2 diabetes, hyperglycaemia is an independent risk factor for COVID-19-related mortality. Associations between pre-infection prescription for glucose-lowering drugs and COVID-19-related mortality in people with type 2 diabetes have been postulated but only investigated in small studies and limited to a few agents. We investigated whether there are associations between prescription of different classes of glucose-lowering drugs and risk of COVID-19-related mortality in people with type 2 diabetes.

A qualitative study of bereaved relatives’ end of life experiences during the COVID-19 pandemic

Health and social care professionals can have an important role in mitigating the absence of relatives’ visits at end of life during a pandemic. Strategies include prioritising virtual connectedness and creating alternative opportunities for relatives to ‘say goodbye’.

CD8+ T cell responses in COVID-19 convalescent individuals target conserved epitopes from multiple prominent SARS-CoV-2 circulating variants

This study examined whether CD8+ T-cell responses from COVID-19 convalescent individuals (n=30) potentially maintain recognition of the major SARS-CoV-2 variants (n=45 mutations assessed). Only one mutation found in B.1.351-Spike overlapped with a previously identified epitope (1/52), suggesting that virtually all anti-SARS-CoV-2 CD8+ T-cell responses should recognize these newly described variants.

Researchers reveal SARS-CoV-2 distribution and relation to tissue damage in patients

Researchers have mapped the distribution of SARS-CoV-2, the virus that causes COVID-19, in deceased patients with the disease, and shed new light on how viral load relates to tissue damage.

Association of Race/Ethnicity With Likeliness of COVID-19 Vaccine Uptake Among Health Workers and the General Population in the San Francisco Bay Area

Surveys have demonstrated racial differences in the public’s willingness to receive a COVID-19 vaccine but have not directly compared vaccine intentions among health workers and the general public. We investigated COVID-19 vaccine intentions among racially and ethnically diverse samples of health workers and the general population.

March 29, 2021

Disparate temperature-dependent virus–host dynamics for SARS-CoV-2 and SARS-CoV in the human respiratory epithelium

Since its emergence in December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread globally and become a major public health burden. Despite its close phylogenetic relationship to SARS-CoV, SARS-CoV-2 exhibits increased human-to-human transmission dynamics, likely due to efficient early replication in the upper respiratory epithelium of infected individuals.

Assessment of Simulated SARS-CoV-2 Infection and Mortality Risk Associated With Radiation Therapy Among Patients in 8 Randomized Clinical Trials

In this comparative effectiveness study reanalyzing data from 8 randomized trials across oncology, radiation fractionation was not associated with outcomes in low COVID-19–risk scenarios. In higher-risk scenarios, aggressive hypofractionation was associated with a survival benefit, whereas moderate hypofractionation was not.

COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021

Prospective cohorts of 3,950 health care personnel, first responders, and other essential and frontline workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks. Under real-world conditions, mRNA vaccine effectiveness of full immunization (≥14 days after second dose) was 90% against SARS-CoV-2 infections regardless of symptom status; vaccine effectiveness of partial immunization (≥14 days after first dose but before second dose) was 80%.

March 26, 2021

Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021

During August 2020–February 2021, the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an unmet mental health care need increased from 9.2% to 11.7%. Increases were largest among adults aged 18–29 years and those with less than a high school education.

March 25, 2021

COVID-19 vaccine response in pregnant and lactating women: a cohort study

COVID-19 mRNA vaccines generated robust humoral immunity in pregnant and lactating women, with immunogenicity and reactogenicity similar to that observed in non-pregnant women. Vaccine-induced immune responses were significantly greater than the response to natural infection. Immune transfer to neonates occurred via placenta and breastmilk.

Effect of Helmet Noninvasive Ventilation vs High-Flow Nasal Oxygen on Days Free of Respiratory Support in Patients With COVID-19 and Moderate to Severe Hypoxemic Respiratory Failure

In this randomized trial that included 109 patients, the median number of days free of respiratory support within 28 days was 20 days in the group that received helmet noninvasive ventilation and 18 days in the group that received high-flow nasal oxygen, a difference that was not statistically significant.

Respiratory Support During the COVID-19 PandemicIs It Time to Consider Using a Helmet?

Acute hypoxemic respiratory failure (AHRF) is the most common organ failure and cause of admission to the intensive care unit (ICU) among patients with COVID-19. As with all forms of AHRF, ICU management is supportive while treating the underlying cause. Because the traditional respiratory support of invasive ventilation, ie, intubation and coupling of the patient to the mechanical ventilator, carries high morbidity and mortality, less invasive respiratory support methods have been studied for decades. The overwhelming demands on ICU resources seen during waves of the SARS-CoV-2 pandemic have accelerated interest in the applicability of alternative respiratory support.

Performance and operational feasibility of antigen and antibody rapid diagnostic tests for COVID-19 in symptomatic and asymptomatic patients in Cameroon: a clinical, prospective, diagnostic accuracy study

Rapid diagnostic tests had good overall sensitivity for diagnosing SARS-CoV-2 infection. Rapid diagnostic tests could be incorporated into efficient testing algorithms as an alternative to PCR to decrease diagnostic delays and onward viral transmission.

COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases.

COVID-19: A retrospective by the numbers

Since January of last year, the medical and public health worlds have been transfixed by the SARS-CoV2 virus and the COVID-19 pandemic it generated. This all-consuming focus on the medical, public health and socio-economic impacts of the pandemic has resulted in a plethora of scientific articles submitted to medical and public health publications and by December 2020 the number of new manuscripts approached 200, 000 by one estimate.

March 24, 2021

Emergence and rapid transmission of SARS-CoV-2 B.1.1.7 in the United States

The highly transmissible  B.1.1.7 variant of SARS-CoV-2, first identified in  the United Kingdom, has  gained  a foothold  across the  world. Using  S  gene  target failure  (SGTF)  and  SARS-CoV-2 genomic sequencing, we investigated the prevalence and dynamics of this variant in the United States (U.S.), tracking it back to its early emergence.

Counties with High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations — United States, April 1–December 22, 2020

During April 1–14, 11.4% of counties reported high COVID-19 incidence, including 28.7% and 27.9% of counties with large Asian and Black populations, respectively. During August 5–18, this percentage was 64.7%, including 92.4% and 74.5% of counties with large Black and Hispanic populations, respectively. By December 9–22, 99.1% of counties reported high incidence.

Compliance without fear: Individual‐level protective behaviour during the first wave of the COVID‐19 pandemic

To address future waves of the pandemic, health authorities should thus focus on facilitating self‐efficacy in the public.

TOP1 inhibition therapy protects against SARS-CoV-2-induced lethal inflammation.

The  ongoing  pandemic  caused  by  Severe  Acute  Respiratory  Syndrome  Coronavirus  2 63 (SARS-CoV-2)  is  currently  affecting  millions  of  lives  worldwide.  Large  retrospective 64 studies  indicate  that  an  elevated  level  of  inflammatory  cytokines  and  pro-inflammatory 65 factors  are  associated  with  both  increased  disease  severity  and  mortality.  Here,  using 66 multidimensional epigenetic, transcriptional, in vitro and in vivo analyses, we report that 67 Topoisomerase  1  (TOP1)  inhibition  suppresses  lethal  inflammation  induced  by  SARS-68 CoV-2.

March 23, 2021

SARS-CoV-2 Infection after Vaccination in Health Care Workers in California

Data from phase 3 clinical trials of messenger RNA (mRNA) vaccines through November 2020 showed 94.1% efficacy for the prevention of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at 14 days after the second dose of the mRNA-1273 vaccine (Moderna) and 95% efficacy at 7 days after the second dose of the BNT162b2 vaccine (Pfizer).

March 19, 2021

COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening — Florida, August–December 2020

COVID-19 school-related disease incidence among Florida students was correlated with community incidence in the counties observed and was highest in smaller counties, districts without mask requirements, and those that reopened earliest after closure in March 2020. Incidence increased with the proportion of students receiving in-person instruction. Fewer than 1% of registered students were identified as having school-related COVID-19.

Low SARS-CoV-2 Transmission in Elementary Schools — Salt Lake County, Utah, December 3, 2020–January 31, 2021

SARS-CoV-2 testing was offered to 1,041 school contacts of 51 index patients across 20 elementary schools in Salt Lake County, Utah. In a high community transmission setting, low school-associated transmission was observed with a 0.7% secondary attack rate. Mask adherence was high, but students’ classroom seats were <6 ft apart and a median of 3 ft apart.

Pilot Investigation of SARS-CoV-2 Secondary Transmission in Kindergarten Through Grade 12 Schools Implementing Mitigation Strategies — St. Louis County and City of Springfield, Missouri, December 2020

In 22 participating K–12 schools implementing multiple COVID-19 mitigation strategies, school-based SARS-CoV-2 secondary transmission was detected in two of 102 tested close contacts of 37 persons with COVID-19. Among 21 tested student contacts participating in a modified quarantine, all SARS-CoV-2 test results were negative.

Association of Children’s Mode of School Instruction with Child and Parent Experiences and Well-Being During the COVID-19 Pandemic — COVID Experiences Survey, United States, October 8–November 13, 2020

In a probability-based survey of parents of children aged 5–12 years, 45.7% reported that their children received virtual instruction only, 30.9% in-person only, and 23.4% combined virtual and in-person instruction. Findings suggest that virtual instruction might present more risks than does in-person instruction related to child and parental mental and emotional health and some health-supporting behaviors.

Minimal SARS-CoV-2 Transmission After Implementation of a Comprehensive Mitigation Strategy at a School — New Jersey, August 20–November 27, 2020

Frequent facility-wide SARS-CoV-2 testing in a high school with both residential and commuter students was part of a comprehensive strategy, including universal masking, that reduced in-school SARS-CoV-2 transmission while allowing significant daily on- and off-campus movement. Of 19 cases among faculty and staff members and eight among students, two (7%) were considered to represent on-campus transmission.

March 18, 2021

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit

In this randomized clinical trial that included 562 patients with COVID-19 admitted to the ICU, the primary outcome (a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days) occurred in 45.7% of patients in the intermediate-dose prophylactic anticoagulation group and 44.1% of patients in the standard-dose prophylactic anticoagulation group, a difference that was not statistically significant (odds ratio, 1.06).

March 17, 2021

County-Level COVID-19 Vaccination Coverage and Social Vulnerability — United States, December 14, 2020–March 1, 2021

In the first 2.5 months of the U.S. vaccination program, high social vulnerability counties had lower COVID-19 vaccination coverage than did low social vulnerability counties. Although vaccination coverage estimates by county-level social vulnerability varied widely among states, disparities in vaccination coverage were observed in the majority of states.

Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic

This cross-sectional study found that racial/ethnic disparities in very preterm birth and preterm birth among 8026 women were similar during the first wave of the COVID-19 pandemic in New York City compared with the same period the year prior.

Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19

Four months after hospitalization, in an uncontrolled cohort study of 478 survivors of COVID-19, at least 1 new-onset symptom was reported by telephone interview by 244 patients (51%), including fatigue in 134 of 431 (31%), cognitive symptoms in 86 of 416 (21%), and dyspnea in 78 of 478 (16%). Computed tomographic lung scan abnormalities were reported in 63% of 171 patients assessed at an ambulatory visit, mainly subtle ground-glass opacities. Fibrotic lesions were observed in 19% of these 171 patients.

March 16, 2021

Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant

A two-dose regimen of the ChAdOx1 nCoV-19 vaccine did not show protection against mild-to-moderate Covid-19 due to the B.1.351 variant.

March 15, 2021

COVID-19 Vaccine Second-Dose Completion and Interval Between First and Second Doses Among Vaccinated Persons — United States, December 14, 2020−February 14, 2021

Among persons who received a first dose and for whom sufficient time had elapsed to receive the second dose, 88.0% had completed the series; 8.6% had not received the second dose but were still within the allowable interval to receive it. Among all 2-dose recipients, 95.6% received the second dose within the recommended interval. Differences in missed doses or second doses administered outside the recommended interval were identified among jurisdictions and demographic groups.

Effectiveness of the Pfizer-BioNTech COVID-19 Vaccine Among Residents of Two Skilled Nursing Facilities Experiencing COVID-19 Outbreaks — Connecticut, December 2020–February 2021

A retrospective cohort analysis in two Connecticut SNFs found partial vaccination with Pfizer-BioNTech COVID-19 vaccine (from >14 days after dose 1 through 7 days after dose 2) to be 63% (95% confidence interval = 33%–79%) effective against SARS-CoV-2 infection.

Immunogenicity of a Single Dose of SARS-CoV-2 Messenger RNA Vaccine in Solid Organ Transplant Recipients

In this study of immunogenicity of the first dose of the mRNA SARS-CoV-2 vaccine among solid organ transplant recipients, the majority of participants did not mount appreciable antispike antibody responses. However, younger participants, those not receiving anti–metabolite maintenance immunosuppression, and those who received mRNA-1273 were more likely to develop antibody responses. These results contrast with the robust early immunogenicity observed in mRNA vaccine trials, including 100% antispike seroconversion by day 15 following vaccination with mRNA-12735 and by day 21 following vaccination with BNT162b2.

Incentivizing Vaccination Uptake

Vaccine hesitancy, identified in 2019 by the World Health Organization as one of the major threats to global health, has become a potentially more important issue during the COVID-19 pandemic. After a year of worldwide morbidity, mortality, social distancing, and lockdowns, and despite the development of several clinically tested and efficacious vaccines, not everyone is willing to be vaccinated. In light of the devastating health, economic, and social effects of the pandemic, the availability of effective vaccines represents an important component of the hope to return society to normalcy.

March 11, 2021

Immunogenicity of the Ad26.COV2.S Vaccine for COVID-19

This randomized, double-blind, placebo-controlled phase 1 clinical trial of Ad26.COV2.S enrolled 25 participants. Antibodies were detected in vaccine recipients by day 8 and were observed in all vaccine recipients by day 57 after a single immunization. T-cell responses were also generated in vaccine recipients.

Experiences of Latinx Individuals Hospitalized for COVID-19

In this qualitative study of 60 Latinx adults, participants reported COVID-19 misinformation, felt COVID-19 compounded existing social disadvantage, and risked infection because of the need to work. Participants hesitated to seek hospital care because of immigration and economic concerns.

Assessment of Use and Fit of Face Masks Among Individuals in Public During the COVID-19 Pandemic in China

This cross-sectional study, including 6003 participants wearing face masks in public places, found that face mask airtightness was commonly suboptimal, mostly secondary to gaps at the upper face mask edge. Using simple and tolerable approach of sealing the upper face mask edge with an adhesive tape was associated with significant improvement of face mask airtightness.

March 10, 2021

Racial and Ethnic Disparities in COVID-19 Incidence by Age, Sex, and Period Among Persons Aged <25 Years — 16 U.S. Jurisdictions, January 1–December 31, 2020

Racial and ethnic disparities in COVID-19 incidence among persons aged <25 years in 16 U.S. jurisdictions evolved during the pandemic. Disparities were substantial during January–April and generally decreased during May–December, largely because of a greater increase in incidence among White persons, rather than a decline among racial and ethnic minority groups. The largest persistent disparities involved Native Hawaiian and Pacific Islander, American Indian or Alaska Native, and Hispanic persons.

March 9, 2021

Association Between Changes in Social Distancing Policies in Ohio and Traffic Volume and Injuries, January Through July 2020

To minimize transmission of coronavirus disease 2019 (COVID-19), most US states in spring 2020 passed policies promoting social distancing through stay-at-home orders prohibiting nonessential travel.1 While vehicle miles traveled in the US decreased by 41% in April 2020 compared with 2019,2 the effect of this mobility decrease on motor vehicle crashes (MVCs) is poorly understood. We estimated associations between COVID-19–related social distancing policies, traffic volume, and MVC-related outcomes in Ohio.

March 8, 2021

Acute Allergic Reactions to mRNA COVID-19 Vaccines

Anaphylaxis to the mRNA COVID-19 vaccines is currently estimated to occur in 2.5 to 11.1 cases per million doses, largely in individuals with a history of allergy.1 Allergic concerns contribute to vaccine hesitancy; we investigated acute allergic reaction incidence after more than 60 000 mRNA COVID-19 vaccine administrations.

March 5, 2021

Why You Should Not Use Ivermectin to Treat or Prevent COVID-19

FDA has not approved ivermectin for use in treating or preventing COVID-19 in humans. Ivermectin tablets are approved at very specific doses for some parasitic worms, and there are topical (on the skin) formulations for head lice and skin conditions like rosacea. Ivermectin is not an anti-viral (a drug for treating viruses).

Association of State-Issued Mask Mandates and Allowing On-Premises Restaurant Dining with County-Level COVID-19 Case and Death Growth Rates — United States, March 1–December 31, 2020

Mandating masks was associated with a decrease in daily COVID-19 case and death growth rates within 20 days of implementation. Allowing on-premises restaurant dining was associated with an increase in daily COVID-19 case growth rates 41–100 days after implementation and an increase in daily death growth rates 61–100 days after implementation.

Estimated SARS-CoV-2 Seroprevalence Among Persons Aged <18 Years — Mississippi, May–September 2020

Serologic testing of residual blood specimens collected during May–September 2020, from 1,603 persons aged <18 years suggested that approximately 113,842 (16.3%) of 698,420 young persons in Mississippi might have been infected with SARS-CoV-2 by mid-September 2020, and only 8,993 confirmed and probable COVID-19 cases among young persons had been reported to the Mississippi State Department of Health by August 31.

On secondary atomization and blockage of surrogate cough droplets in single- and multilayer face masks

The possibility of secondary atomization of high-momentum cough droplets by hydrodynamic focusing and extrusion through the microscale pores in the fibrous network of the single/double-layer mask material needs to be considered in determining mask efficacy. Three-layer masks can effectively block these droplets and thus could be ubiquitously used as a key tool against COVID-19 or similar respiratory diseases.

The Future of Health Policy in a Partisan United States

Using recent probability-based national polls, with sample sizes ranging between 1007 and 15 590, this Viewpoint describes the views on 4 issues among those who identify with the majority and minority parties.

March 4, 2021

Resistance of SARS-CoV-2 variants to neutralization by monoclonal and serum-derived polyclonal antibodies

Many highly neutralizing mAbs engaging the receptor-binding domain or N-terminal domain and most convalescent sera and mRNA vaccine-induced immune sera showed reduced inhibitory activity against viruses containing an E484K spike mutation. As antibodies binding to spike receptor-binding domain and N-terminal domain demonstrate diminished neutralization potency in vitro against some emerging variants, updated mAb cocktails targeting highly conserved regions, enhancement of mAb potency or adjustments to the spike sequences of vaccines may be needed to prevent loss of protection in vivo.

Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial

Our findings do not justify the routine use of azithromycin for reducing time to recovery or risk of hospitalisation for people with suspected COVID-19 in the community. These findings have important antibiotic stewardship implications during this pandemic, as inappropriate use of antibiotics leads to increased antimicrobial resistance, and there is evidence that azithromycin use increased during the pandemic in the UK.

Interferon antagonism by SARS-CoV-2: a functional study using reverse genetics

SARS-CoV-2 ORF6 interferes less efficiently with human interferon induction and interferon signalling than SARS-CoV ORF6. Because of the homology of the genes, onward selection for fitness could involve functional optimisation of interferon antagonism. Charged amino acids at positions 51 and 56 in ORF6 should be monitored for potential adaptive changes.

Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19

The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand effects on other clinically relevant outcomes.

March 3, 2021

First Identified Cases of SARS-CoV-2 Variant P.1 in the United States — Minnesota, January 2021

Since December 2020, the Minnesota Department of Health (MDH) Public Health Laboratory has been receiving 100 specimens per week (50 from each of two clinical partners) with low cycle threshold (Ct) values for routine surveillance for SARS-CoV-2, the virus that causes COVID-19. On January 25, 2021, MDH identified the SARS-CoV-2 variant P.1 in one specimen through this surveillance system using whole genome sequencing, representing the first identified case of this variant in the United States.

Travel from the United Kingdom to the United States by a Symptomatic Patient Infected with the SARS-CoV-2 B.1.1.7 Variant — Texas, January 2021

In December 2020, the B.1.1.7 genetic variant of SARS-CoV-2, the virus that causes COVID-19, was first reported after emergence and rapid circulation in the United Kingdom (1). Evidence suggests that the B.1.1.7 variant is more efficiently transmitted than are other SARS-CoV-2 variants, and widespread circulation could thereby increase SARS-CoV-2 infection and hospitalization rates (1,2). The first reported SARS-CoV-2 B.1.1.7 variant case in the United States was confirmed by sequencing in Colorado on December 29, 2020.

Delayed Large Local Reactions to mRNA-1273 Vaccine against SARS-CoV-2

Baden et al. report on a phase 3 clinical trial of the mRNA-1273 vaccine against SARS-CoV-2, and they provide information on immediate injection-site reactions, which were observed in 84.2% of the participants after the first dose. The trial also showed that delayed injection-site reactions (defined in that trial as those with an onset on or after day 8) occurred in 244 of the 30,420 participants (0.8%) after the first dose and in 68 participants (0.2%) after the second dose.

The Potential Future of the COVID-19 Pandemic

Will SARS-CoV-2 Become a Recurrent Seasonal Infection?

There is growing optimism and hope that by virtue of ongoing immunization efforts, seasonality (declining infections through August), and naturally acquired immunity, by spring and early summer 2021 in the US there will be a substantial decline in the number of deaths and hospitalizations related to COVID-19. However, this optimism must be tempered by several important factors.

Filtering Facepiece Respirator (N95 Respirator) ReprocessingA Systematic Review

Five decontamination processes and 42 studies were reviewed. Ultraviolet germicidal irradiation, moist heat, and microwave-generated steam processing were effective for pathogen removal, preserved respirator filtration, and had short treatment times and readily available equipment. Vaporized hydrogen peroxide is a suitable alternative with longer decontamination durations and is more expensive. Ethylene oxide may leave toxic residues and is less easily implemented.

Camostat mesylate inhibits SARS-CoV-2 activation by TMPRSS2-related proteases and its metabolite GBPA exerts antiviral activity

Our results suggest that SARS-CoV-2 can use TMPRSS2 and closely related proteases for spread in the upper respiratory tract and that spread in the human lung can be blocked by Camostat mesylate and its metabolite GBPA.

Frequent and Persistent Salivary Gland Ectasia and Oral Disease After COVID-19

Overall, this retrospective and prospective cohort study of COVID-19 survivors revealed that residual damage of the oral cavity persists in the vast majority of patients far beyond clinical recovery, and suggests that the oral cavity represents a preferential target for SARS-CoV-2 infection. Further studies are needed to clarify the connection between SARS-CoV-2 infection and oral disorders.

March 2, 2021

The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Janssen COVID-19 Vaccine — United States, February 2021

On February 28, 2021, after a transparent evidence-based review of all available data, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Janssen COVID-19 vaccine in persons aged ≥18 years for the prevention of COVID-19.

Development of Severe COVID-19 Adaptive Risk Predictor (SCARP), a Calculator to Predict Severe Disease or Death in Hospitalized Patients With COVID-19

Predicting the clinical trajectory of individual patients hospitalized with coronavirus disease 2019 (COVID-19) is challenging but necessary to inform clinical care.

Retail Alcohol and Tobacco Sales During COVID-19

Stress during the coronavirus disease 2019 (COVID-19) pandemic may increase substance use.

Alcohol Sales and Alcohol-Related Emergencies During the COVID-19 Pandemic

During the coronavirus disease 2019 (COVID-19) pandemic, many regions across the world recommended stay-at-home orders, closure of public spaces, and physical distancing to reduce community transmission.

March 1, 2021

What Contributes to COVID-19 Vaccine Hesitancy in Black Communities, and How Can It Be Addressed?

Recent polls show that Black Americans are less willing than Americans of other races or ethnicities to be vaccinated for COVID-19. These lower vaccination rates among Black Americans would further widen COVID-19 inequities in diagnosis, hospitalization, and mortality.

Binding and Neutralization Antibody Titers After a Single Vaccine Dose in Health Care Workers Previously Infected With SARS-CoV-2

Current shortages in COVID-19 vaccine production and distribution have led some experts to suggest untested regimens. Persons who have had COVID-19 are thought to have protective immunity and memory responses for at least 6 months; however, neither recall responses nor ideal vaccine dosing regimens have been studied in those previously infected with SARS-CoV-2.

SARS-CoV-2 Causes a Different Cytokine Response Compared to Other Cytokine Storm-Causing Respiratory Viruses in Severely Ill Patients

Comparing the collated cytokine responses caused by the analyzed viruses highlights a SARS-CoV-2-specific dysregulation of the type-I interferon (IFN) response and its downstream cytokine signatures. The map of responses gathered in this study could help specialists identify interventions that alleviate CRS in different diseases and evaluate whether they could be used in the COVID-19 cases.

The Johnson & Johnson Vaccine for COVID-19

Johnson & Johnson has developed a vaccine that works differently than the Pfizer and Moderna vaccines and is highly effective for preventing moderate to severe COVID-19.

Want to track pandemic variants faster? Fix the bioinformatics bottleneck

Tools, rules and incentives are buckling under the flood of coronavirus genome sequences — to help control the pandemic, researchers need new approaches.

Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis

COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic.

February 26, 2021

Reduction in COVID-19 Patients Requiring Mechanical Ventilation Following Implementation of a National COVID-19 Vaccination Program — Israel, December 2020–February 2021

By February 2021, 2-dose vaccination coverage was 84% among persons aged ≥70 years and 10% among those aged <50 years. The ratio of COVID-19 patients aged ≥70 years requiring mechanical ventilation to those aged <50 years declined 67% from October–December 2020 to February 2021.

SARS-CoV-2 Vaccines

Shortly after SARS-CoV emerged at the turn of the 21st century, the spike (S) protein (particularly in its prefusion [native] conformation) was identified as the immunodominant antigen of the virus.

Association of Convalescent Plasma Treatment With Clinical Outcomes in Patients With COVID-19

In a meta-analysis of 4 peer-reviewed and published randomized clinical trials including 1060 patients with COVID-19 treated with convalescent plasma vs control, the risk ratio for mortality was 0.93 and after the addition of 6 unpublished randomized clinical trials and 10 722 patients, the risk ratio for mortality was 1.02; neither finding was statistically significant. No significant associations with benefit were shown for hospital length of stay, mechanical ventilation use, clinical improvement, or clinical deterioration.

February 25, 2021

Dexamethasone in Hospitalized Patients with Covid-19

In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.

Research in the Context of a Pandemic

The current literature on the treatment of coronavirus disease 2019 (Covid-19) is filled with anecdotal reports of therapeutic successes in clinical trials with small numbers of patients and observational cohort studies claiming efficacy with little regard to the effect of unrecognized confounders.

Last-Mile Logistics of Covid Vaccination — The Role of Health Care Organizations

The development, evaluation, and production of vaccines for Covid-19 was the remarkable success story of 2020; the challenge for 2021 is getting those vaccines into the bodies of a critical mass of the world’s population.

Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19

The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear.

Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia

Coronavirus disease 2019 (Covid-19) is associated with immune dysregulation and hyperinflammation, including elevated interleukin-6 levels. The use of tocilizumab, a monoclonal antibody against the interleukin-6 receptor, has resulted in better outcomes in patients with severe Covid-19 pneumonia in case reports and retrospective observational cohort studies. Data are needed from randomized, placebo-controlled trials.

Interleukin-6 Receptor Inhibition in Covid-19 — Cooling the Inflammatory Soup

Viruses cannot replicate by themselves. Instead, they rely on the host for almost all their replicative functions. Similarly, many viruses are unable to cause damage without the host immune system. Because of this, two strategies can often ameliorate disease — antivirals, which block replication, and antiinflammatories, which can limit the damage induced by infection. In the lung, this latter strategy is exemplified by the treatment of Pneumocystis jiroveci, in which treatment with glucocorticoids reduces the severity of disease and the risk of death.

February 24, 2021

COVID-19 Outbreak Among Attendees of an Exercise Facility — Chicago, Illinois, August–September 2020

In August 2020, 55 COVID-19 cases were identified among 81 attendees of indoor high-intensity classes at a Chicago exercise facility. Twenty-two (40%) persons with COVID-19 attended on or after the day symptoms began. Most attendees (76%) wore masks infrequently, including persons with (84%) and without COVID-19 (60%).

Community Transmission of SARS-CoV-2 at Three Fitness Facilities — Hawaii, June–July 2020

Twenty-one COVID-19 cases were linked to an index case in a fitness instructor, who, along with a patient who was also an instructor, taught classes <1 day, 1 to <2 days, and ≥2 days before symptom onset; aggregate attack rates were 95%, 13%, and 0%, respectively.

BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting

This study in a nationwide mass vaccination setting suggests that the BNT162b2 mRNA vaccine is effective for a wide range of Covid-19–related outcomes, a finding consistent with that of the randomized trial.

Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19

In this case series that included 539 patients with MIS-C and 577 patients with severe COVID-19, patients with MIS-C were more likely than those with severe COVID-19 to be 6 to 12 years old, be non-Hispanic Black, and have severe cardiovascular or mucocutaneous involvement and more extreme inflammation.

Pregnant People’s Paradox—Excluded From Vaccine Trials Despite Having a Higher Risk of COVID-19 Complications

Growing evidence that pregnant individuals are more likely to experience COVID-19 complications than nonpregnant individuals includes these 3 studies reported in late January:

February 23, 2021

SARS-CoV-2 lineage B.1.526 emerging in the New York region detected by software utility created to query the spike mutational landscape

This lineage appeared in late November 2020, and isolates from this lineage account for ~25% of coronavirus genomes sequenced and deposited from New York during February 2021.

Identification and validation of clinical phenotypes with prognostic implications in patients admitted to hospital with COVID-19: a multicentre cohort study

Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated.

February 22, 2021

Clusters of SARS-CoV-2 Infection Among Elementary School Educators and Students in One School District — Georgia, December 2020–January 2021

An investigation of SARS-CoV-2 transmission in a Georgia school district during December 1, 2020–January 22, 2021, identified nine clusters of COVID-19 cases involving 13 educators and 32 students at six elementary schools. Two clusters involved probable educator-to-educator transmission that was followed by educator-to-student transmission in classrooms and resulted in approximately one half (15 of 31) of school-associated cases.

Identifying COVID-19 Risk Through Observational Studies to Inform Control Measures

A year into the coronavirus disease 2019 (COVID-19) pandemic there remains an urgent need to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread and to curb the pandemic in the US through nonpharmaceutical interventions. Clear evidence supports the effectiveness of simple strategies in identifying risks and mitigating the spread of infection, with much of this evidence coming from observational studies.

Medical vulnerability of individuals with down syndrome to severe COVID-19 – data from the trisomy 21 research society and the UK ISARIC4C survey

Leading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of medical complications and mortality, especially from age 40.

February 19, 2021

Sequelae in Adults at 6 Months After COVID-19 Infection

A total of 177 of 234 participants (75.6%; mean [range] age, 48.0 [18-94] years; 101 [57.1%] women) with COVID-19 completed the survey. Overall, 11 (6.2%) were asymptomatic, 150 (84.7%) were outpatients with mild illness, and 16 (9.0%) had moderate or severe disease requiring hospitalization (Table). Hypertension was the most common comorbidity (23 [13.0%]). The follow-up survey was completed a median (range) of 169 (31-300) days after illness onset among participants with COVID-19 (Figure, A) and 87 (71-144) days after enrollment among 21 patients in the control group. Among participants with COVID-19, persistent symptoms were reported by 17 of 64 patients (26.6%) aged 18 to 39 years, 25 of 83 patients (30.1%) aged 40 to 64 years, and 13 of 30 patients (43.3%) aged 65 years and older.

Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials

The results of this primary analysis of two doses of ChAdOx1 nCoV-19 were consistent with those seen in the interim analysis of the trials and confirm that the vaccine is efficacious, with results varying by dose interval in exploratory analyses. A 3-month dose interval might have advantages over a programme with a short dose interval for roll-out of a pandemic vaccine to protect the largest number of individuals in the population as early as possible when supplies are scarce, while also improving protection after receiving a second dose.

SARS-CoV-2 Positivity on or After 9 Days Among Quarantined Student Contacts of Confirmed Cases

Schools reopened during the fall of 2020 with various approaches to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. At that time, the US Centers for Disease Control and Prevention (CDC) recommended a 14-day quarantine without testing for close contacts of anyone diagnosed with coronavirus disease 2019 (COVID-19).

February 18, 2021

Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study

There were substantial reductions in primary care contacts for acute physical and mental conditions following the introduction of restrictions, with limited recovery by July, 2020. Further research is needed to ascertain whether these reductions reflect changes in disease frequency or missed opportunities for care. Maintaining health-care access should be a key priority in future public health planning, including further restrictions. The conditions we studied are sufficiently severe that any unmet need will have substantial ramifications for the people with the conditions as well as health-care provision.

February 17, 2021

Neutralizing Activity of BNT162b2-Elicited Serum — Preliminary Report

BNT162b2 is a nucleoside-modified RNA vaccine expressing the full-length prefusion spike glycoprotein (S) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In a randomized, placebo-controlled clinical trial involving approximately 44,000 participants, immunization conferred 95% efficacy against coronavirus disease 2019 (Covid-19).

SARS-CoV-2 Variants of Concern in the United States—Challenges and Opportunities

On January 10, 2020, the first genomic sequence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolated from a patient in Wuhan, China, was posted online. As of February 3, 2021, 468 000 sequences of SARS-CoV-2 from COVID-19 cases globally have been uploaded into publicly available databases, including more than 93 000 from individuals in the US. SARS-CoV-2, like other RNA viruses, constantly changes through mutation, with new variants occurring over time.

First Identified Cases of SARS-CoV-2 Variant B.1.1.7 in Minnesota — December 2020–January 2021

On January 9, 2021, the Minnesota Department of Health (MDH) announced the identification of the SARS-CoV-2 variant of concern (VOC) B.1.1.7, also referred to as 20I/501Y.V1 and VOC 202012/01, in specimens from five persons; on January 25, MDH announced the identification of this variant in specimens from three additional persons.

Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19

The study does not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19 in hospitalized patients.

February 16, 2021

COVID vaccines and safety: what the research says

It is clear that coronavirus vaccines are safe and effective, but as more are rolled out, researchers are learning about the extent and nature of side effects.

Ocular MRI Findings in Patients with Severe COVID-19: A Retrospective Multicenter Observational Study

All patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region. Screening of these patients might improve the management of potentially severe ophthalmological manifestations of the virus.

February 12, 2021

Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US—December 14, 2020-January 18, 2021

In December 2020, the US Food and Drug Administration (FDA) issued Emergency Use Authorizations for 2 mRNA-based vaccines for prevention of coronavirus disease 2019 (COVID-19): Pfizer-BioNTech COVID-19 vaccine (EUA issued December 11; 2 doses, 3 weeks apart) and Moderna COVID-19 vaccine (EUA issued December 18; 2 doses, 1 month apart). Shortly after each authorization, the Advisory Committee on Immunization Practices issued interim recommendations for use.

February 11, 2021

Emergence of a Novel SARS-CoV-2 Variant in Southern California

A spike in coronavirus disease 2019 (COVID-19) has occurred in Southern California since October 2020. Analysis of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) in Southern California prior to October indicated most isolates originated from clade 20C that likely emerged from New York via Europe early in the pandemic.

February 10, 2021

Summary of recent changes (last updated February 10, 2021): Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States

Updated quarantine recommendations for vaccinated persons. Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID-19. Additional considerations for patients and residents in healthcare settings are provided.

Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021

CDC conducted experiments to assess two ways of improving the fit of medical procedure masks: fitting a cloth mask over a medical procedure mask, and knotting the ear loops of a medical procedure mask and then tucking in and flattening the extra material close to the face. Each modification substantially improved source control and reduced wearer exposure.

February 9, 2021

COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination — United States, September and December 2020

From September to December 2020, intent to receive COVID-19 vaccination increased from 39.4% to 49.1% among adults and across all priority groups, and nonintent decreased from 38.1% to 32.1%. Despite decreases in nonintent from September to December, younger adults, women, non-Hispanic Black adults, adults living in nonmetropolitan areas, and adults with less education and income, and without health insurance continue to have the highest estimates of nonintent to receive COVID-19 vaccination.

February 8, 2021

Decreased SARS-CoV-2 viral load following vaccination

Beyond their substantial protection of individual vaccinees, it is hoped that the COVID-19 vaccines would reduce viral load in breakthrough infections thereby further suppress onward transmission. Here, analyzing positive SARS-CoV-2 test results following inoculation with the BNT162b2 mRNA vaccine, we find that the viral load is reduced 4-fold for infections occurring 12-28 days after the first dose of vaccine. These reduced viral loads hint to lower infectiousness, further contributing to vaccine impact on virus spread.

Assessment of Seroprevalence of SARS-CoV-2 and Risk Factors Associated With COVID-19 Infection Among Outpatients in Virginia

This study found that, as of August 2020, the population of Virginia remained largely immunologically naive to the virus.

Variant-proof vaccines — invest now for the next pandemic

The rapid development and delivery of highly effective COVID-19 vaccines less than a year after the emergence of the disease is a huge success story. This was possible, in part, because of certain properties of the coronavirus SARS-CoV-2 that favour vaccine design — in particular, the spike protein on the virus’s surface.

COVID research updates: Why it matters that COVID viruses are losing parts of their genome

Again and again, the new coronavirus has sloughed off small chunks of its genome, leading to changes in a viral protein that is frequently targeted by antibodies.

Pregnancy, Postpartum Care, and COVID-19 Vaccination in 2021

This JAMA Insights review summarizes the epidemiology of SARS-CoV-2 infection in pregnant and lactating women, its effects on perinatal outcomes, and compiles guidance from the Centers for Disease Control and Prevention, the Food and Drug Administration and obstetrics-gynecology specialty organizations on the safety of coronavirus vaccines during pregnancy and while breastfeeding.

COVID-19 Vaccination in Pregnant and Lactating Women

This Viewpoint discusses the need for shared decision-making when counseling pregnant and nursing women about the unstudied benefits and risks COVID-19 vaccination, calling for rigorously designed studies with real-time, proactive data collection to establish evidence as quickly as possible about coronavirus vaccine safety in mothers and their infants.

February 5, 2021

SARS-CoV-2 evolution during treatment of chronic infection

SARS-CoV-2 Spike protein is critical for virus infection via engagement of ACE21, and is a major antibody target. Here we report chronic SARS-CoV-2 with reduced sensitivity to neutralising antibodies in an immune suppressed individual treated with convalescent plasma, generating whole genome ultradeep sequences over 23 time points spanning 101 days. Little change was observed in the overall viral population structure following two courses of remdesivir over the first 57 days. However, following convalescent plasma therapy we observed large, dynamic virus population shifts, with the emergence of a dominant viral strain bearing D796H in S2 and ΔH69/ΔV70 in the S1 N-terminal domain NTD of the Spike protein.

February 4, 2021

Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine

Vaccines are needed to prevent coronavirus disease 2019 (Covid-19) and to protect persons who are at high risk for complications. The mRNA-1273 vaccine is a lipid nanoparticle–encapsulated mRNA-based vaccine that encodes the prefusion stabilized full-length spike protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19.

A Cluster-Randomized Trial of Hydroxychloroquine for Prevention of Covid-19

Current strategies for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited to nonpharmacologic interventions. Hydroxychloroquine has been proposed as a postexposure therapy to prevent coronavirus disease 2019 (Covid-19), but definitive evidence is lacking.

Merck Statement on Ivermectin use During the COVID-19 Pandemic

It is important to note that, to-date, our analysis has identified:

 No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies;

 No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and;

 A concerning lack of safety data in the majority of studies.

February 3, 2021

Necessity of 2 Doses of the Pfizer and Moderna COVID-19 Vaccines

Two doses of the Pfizer and Moderna COVID-19 vaccines are necessary to confer adequate immunity.

The new vaccines for coronavirus disease 2019 (COVID-19) are highly effective, but controversy exists about whether a second dose should be delayed in order to immunize more people. The second dose is necessary and should be given.

February 2, 2021

Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study

Scarce data are available on what variables affect the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the development of symptomatic COVID-19, and, particularly, the relationship with viral load. We aimed to analyse data from linked index cases of COVID-19 and their contacts to explore factors associated with transmission of SARS-CoV-2.

Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia

A heterologous recombinant adenovirus (rAd)-based vaccine, Gam-COVID-Vac (Sputnik V), showed a good safety profile and induced strong humoral and cellular immune responses in participants in phase 1/2 clinical trials. Here, we report preliminary results on the efficacy and safety of Gam-COVID-Vac from the interim analysis of this phase 3 trial.

February 1, 2021

Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children

Combined treatment with methylprednisolone vs IVIG alone was associated with a better course of fever in MIS-C.

Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program — United States, December 14, 2020–January 14, 2021

As the vaccination program expands, it is critical to ensure efficient and equitable administration to persons in each successive vaccine priority category, especially those at highest risk for infection and severe health outcomes.

January 29, 2021

Response to a COVID-19 Outbreak on a University Campus — Indiana, August 2020

Enhanced testing, timely contact tracing, provision of adequate isolation and quarantine space, increased screening of asymptomatic persons, and communication promoting adherence to mitigation strategies can help control COVID-19 outbreaks on college and university campuses while minimizing disruptions to in-person instruction.

Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, August 9–November 21, 2020

Assessment of the context of each interaction, including mask use, indoor versus outdoor setting, and ventilation, in addition to duration and proximity, can improve identification of high-risk contacts during contact tracing. Postexposure quarantine based on redefined high-risk criteria, combined with testing and environment-specific intensive protocols, can protect communities before and after case identification.

Association Between Receipt of Unemployment Insurance and Food Insecurity Among People Who Lost Employment During the COVID-19 Pandemic in the United States

These findings suggest that expanding the amount and duration of unemployment insurance may be an effective approach to reducing food insecurity.

Vaccine Distribution—Equity Left Behind?

Over the past 2 weeks numerous states have announced a major shift in coronavirus disease 2019 (COVID-19) vaccination programs—from a textured approach that includes individual risk factors for morbidity and mortality (eg, age and high-risk medical conditions), occupational risk factors for exposure (eg, first responders and correctional officers), and other societal priorities (eg, essential workers such as teachers, grocery store employees, and public transportation workers) to an approach focused on vaccinating all individuals aged 65 years and older.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, December 21, 2020–January 10, 2021

Locations administering COVID-19 vaccines should adhere to CDC guidance, including screening recipients for contraindications and precautions, having necessary supplies and staff members available to manage anaphylaxis, implementing recommended postvaccination observation periods, and immediately treating suspected anaphylaxis with intramuscular epinephrine injection.

Impact of COVID-19 on Cervical Cancer Screening Rates Among Women Aged 21–65 Years in a Large Integrated Health Care System — Southern California, January 1–September 30, 2019, and January 1–September 30, 2020

During California’s stay-at-home order, cervical cancer screening rates among approximately 1.5 million women in the Kaiser Permanente Southern California (KPSC) network decreased approximately 80% compared with baseline. The decrease was similar across all racial/ethnic groups of KPSC and returned to near normal after reopening.

Trends in Outbreak-Associated Cases of COVID-19 — Wisconsin, March–November 2020

COVID-19 surveillance and mitigation planning should be prioritized for highly affected settings such as long-term care facilities, correctional facilities, and colleges and universities, which could represent early indicators of broader community transmission.

January 28, 2021

Remdesivir is a delayed translocation inhibitor of SARS CoV-2 replication

Remdesivir is a nucleoside analog approved by the FDA for treatment of COVID-19. Here, we present a 3.9-Å-resolution cryoEM reconstruction of a remdesivir-stalled RNA-dependent RNA polymerase complex, revealing full incorporation of three copies of remdesivir monophosphate (RMP) and a partially incorporated fourth RMP in the active site. The structure reveals that RMP blocks RNA translocation after incorporation of three bases following RMP, resulting in delayed chain termination, which can guide the rational design of improved antiviral drugs.

January 27, 2021

Meta and consensus forecast of COVID-19 targets

Our aim is to provide two types of probabilistic forecasts of the evolving US COVID-19 outbreak to support public health officials, infectious disease modeling groups, and the general public

De novo design of modular and tunable protein biosensors

Naturally occurring protein switches have been repurposed for developing novel biosensors and reporters for cellular and clinical applications, but the number of such switches is limited, and engineering them is often challenging as each is different. Here, we show that a very general class of protein-based biosensors can be created by inverting the flow of information through de novo designed protein switches in which binding of a peptide key triggers biological outputs of interest.

January 26, 2021

Monoclonal antibodies protect against COVID-19 in a second study

A second company has provided preliminary evidence that proactively infusing healthy people with monoclonal antibodies against SARS-CoV-2 prevents them from developing noticeable symptoms of COVID-19 if they are exposed to the coronavirus.

January 25, 2021

Prospective mapping of viral mutations that escape antibodies used to treat COVID-19

Antibodies are a potential therapy for SARS-CoV-2, but the risk of the virus evolving to escape them remains unclear. Here we map how all mutations to SARS-CoV-2’s receptor-binding domain (RBD) affect binding by the antibodies in the REGN-COV2 cocktail and the antibody LY-CoV016. These complete maps uncover a single amino-acid mutation that fully escapes the REGN-COV2 cocktail, which consists of two antibodies targeting distinct structural epitopes. The maps also identify viral mutations that are selected in a persistently infected patient treated with REGN-COV2, as well as during in vitro viral escape selections.

January 21, 2021

SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19

In this interim analysis of a phase 2 trial, one of three doses of neutralizing antibody LY-CoV555 appeared to accelerate the natural decline in viral load over time, whereas the other doses had not by day 11.

REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19

In this interim analysis, the REGN-COV2 antibody cocktail reduced viral load, with a greater effect in patients whose immune response had not yet been initiated or who had a high viral load at baseline. Safety outcomes were similar in the combined REGN-COV2 dose groups and the placebo group.

COVID-19 Cases and Transmission in 17 K–12 Schools — Wood County, Wisconsin, August 31–November 29, 2020

Among 17 rural Wisconsin schools, reported student mask-wearing was high, and the COVID-19 incidence among students and staff members was lower than in the county overall (3,453 versus 5,466 per 100,000). Among 191 cases identified in students and staff members, only seven (3.7%) cases, all among students, were linked to in-school spread.

Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: a double-blind, randomised, phase 1 trial

BBV152 led to tolerable safety outcomes and enhanced immune responses. Both Algel-IMDG formulations were selected for phase 2 immunogenicity trials. Further efficacy trials are warranted.

January 15, 2021

Emergence of SARS-CoV-2 B.1.1.7 Lineage — United States, December 29, 2020–January 12, 2021

The increased transmissibility of the B.1.1.7 variant warrants universal and increased compliance with mitigation strategies, including distancing and masking. Higher vaccination coverage might need to be achieved to protect the public. Genomic sequence analysis through the National SARS-CoV-2 Strain Surveillance program will enable a targeted approach to identifying variants of concern in the United States.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020

Locations administering COVID-19 vaccines should adhere to CDC guidance for use of COVID-19 vaccines, including screening recipients for contraindications and precautions, having the necessary supplies available to manage anaphylaxis, implementing the recommended postvaccination observation periods, and immediately treating suspected cases of anaphylaxis with intramuscular injection of epinephrine.

January 14, 2021

COVID reinfections are unusual — but could still help the virus to spread

Most people who catch and recover from COVID-19 are likely to be immune for several months afterwards, a study of more than 20,000 health-care workers in the United Kingdom has found.

January 13, 2021

Convalescent Plasma Antibody Levels and the Risk of Death from Covid-19

Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti–SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels.

COVID-19 Trends Among Persons Aged 0–24 Years — United States, March 1–December 12, 2020

To enable safer in-person learning, schools and communities should fully implement and strictly adhere to multiple mitigation strategies, especially universal and proper mask wearing, to reduce both school and community COVID-19 incidence to help protect students, teachers, and staff members from COVID-19.

Interim Results of a Phase 1–2a Trial of Ad26.COV2.S Covid-19 Vaccine

The safety and immunogenicity profiles of Ad26.COV2.S support further development of this vaccine candidate.

(A Little) Clarity on Convalescent Plasma for Covid-19

Passive immunotherapy has been used since the late 19th century, and in 1901, the first Nobel Prize in Physiology or Medicine was awarded for serum therapy for patients with diphtheria. During the 1918 pandemic, serum from convalescent patients was used to treat influenza, with some apparent success.

January 12, 2021

Immunological characteristics govern the transition of COVID-19 to endemicity

We are currently faced with the question of how the CoV-2 severity may change in the years ahead. Our analysis of immunological and epidemiological data on endemic human coronaviruses (HCoVs) shows that infection-blocking immunity wanes rapidly, but disease-reducing immunity is long-lived. Our model, incorporating these components of immunity, recapitulates both the current severity of CoV-2 and the benign nature of HCoVs, suggesting that once the endemic phase is reached and primary exposure is in childhood, CoV-2 may be no more virulent than the common cold.

January 9, 2021

Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey

Nearly two in five adults were hesitant about getting a COVID-19 vaccine. Male, older, white, married, and higher SES individuals more likely to vaccinate. Republicans and Fox News viewers were less likely to vaccinate. Being currently immunized against influenza predicted COVID-19 vaccination intent. A better understanding of COVID-19 vaccination hesitancy is needed.

January 8, 2021

Opening of Large Institutions of Higher Education and County-Level COVID-19 Incidence — United States, July 6–September 17, 2020

Additional implementation of effective mitigation activities at colleges and universities with in-person instruction could minimize on-campus COVID-19 transmission and reduce county-level incidence.

Time from Start of Quarantine to SARS-CoV-2 Positive Test Among Quarantined College and University Athletes — 17 States, June–October 2020

Among young, healthy athletes, the probability of receiving positive test results after day 10 of quarantine is low. A shorter quarantine after COVID-19 exposure could increase adherence but still poses a small residual risk for transmission.

6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.

Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020

Rates of COVID-19 among nursing home residents and staff members increased during June and July 2020, and again in November. Trends in reported COVID-19 cases among nursing home residents and staff members were similar to trends in incidence of COVID-19 in surrounding communities.

Candida auris Outbreak in a COVID-19 Specialty Care Unit — Florida, July–August 2020

In July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A).

January 7, 2021

SARS-CoV-2 Transmission From People Without COVID-19 Symptoms

The findings of this study suggest that the identification and isolation of persons with symptomatic COVID-19 alone will not control the ongoing spread of SARS-CoV-2.

January 6, 2021

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020

During December 14–23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination.

Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection

Understanding immune memory to SARS-CoV-2 is critical for improving diagnostics and vaccines, and for assessing the likely future course of the COVID-19 pandemic. We analyzed multiple compartments of circulating immune memory to SARS-CoV-2 in 254 samples from 188 COVID-19 cases, including 43 samples at ≥ 6 months post-infection.

Genetic Variants of SARS-CoV-2—What Do They Mean?

Over the course of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the clinical, scientific, and public health communities have had to respond to new viral genetic variants. Each one has triggered a flurry of media attention, a range of reactions from the scientific community, and calls from governments to either “stay calm” or pursue immediate countermeasures.

COVID-19 and mental health deterioration by ethnicity and gender in the UK

We use the UK Household Longitudinal Study and compare pre-COVID-19 pandemic (2017-2019) and during-COVID-19 pandemic data (April 2020) for the same group of individuals to assess and quantify changes in mental health as measured by changes in the GHQ-12 (General Health Questionnaire), among ethnic groups in the UK. We confirm the previously documented average deterioration in mental health for the whole sample of individuals interviewed before and during the COVID-19 pandemic.

Modeling the Binding Mechanism of Remdesivir, Favilavir, and Ribavirin to SARS-CoV-2 RNA-Dependent RNA Polymerase

Through molecular simulation, possible mechanisms of action of the nucleotide-analogue inhibitors remdesivir, favilavir, and ribavirin on the RNA-dependent RNA polymerase of SARS-CoV-2 are elucidated.

January 1, 2021

Performance of an Antigen-Based Test for Asymptomatic and Symptomatic SARS-CoV-2 Testing at Two University Campuses — Wisconsin, September–October 2020

Compared with real-time reverse transcription–polymerase chain reaction (RT-PCR) testing, the Sofia antigen test had a sensitivity of 80.0% and specificity of 98.9% among symptomatic persons; accuracy was lower (sensitivity 41.2% and specificity 98.4%) when used for screening of asymptomatic persons.

Implications of Shortened Quarantine Among Household Contacts of Index Patients with Confirmed SARS-CoV-2 Infection — Tennessee and Wisconsin, April–September 2020

Among persons exposed to COVID-19 in the household who were asymptomatic and had negative laboratory test results through 7 days after symptom onset in the index patient, 19% experienced symptoms or received positive test results in the following week.

December 23, 2020

Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers

The presence of anti-spike or anti-nucleocapsid IgG antibodies was associated with a substantially reduced risk of SARS-CoV-2 reinfection in the ensuing 6 months.

December 22, 2020

The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine — United States, December 2020

On December 20, ACIP updated interim vaccine allocation recommendations. In Phase 1b, COVID-19 vaccine should be offered to persons aged ≥75 years and non–health care frontline essential workers, and in Phase 1c, to persons aged 65–74 years, persons aged 16–64 years with high-risk medical conditions, and essential workers not included in Phase 1b.

Implications of the Emerging SARS-CoV-2 Variant VUI 202012/01

A new variant strain of SARS-CoV-2 that contains a series of mutations has been described in the United Kingdom (UK) and become highly prevalent in London and southeast England. Based on these mutations, this variant strain has been predicted to potentially be more rapidly transmissible than other circulating strains of SARS-CoV-2.

A Neutralizing Monoclonal Antibody for Hospitalized Patients with Covid-19

Monoclonal antibody LY-CoV555, when co-administered with remdesivir, did not demonstrate efficacy among hospitalized patients who had Covid-19 without end-organ failure.

COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States

Patients with CLD, especially African Americans, were at increased risk for COVID-19, highlighting the need to protect these patients from exposure to virus infection.

December 21, 2020

COVID research updates: How 90% of French COVID cases evaded detection

In the weeks after France ended its first lockdown, nine residents with COVID-19 symptoms went undetected for every person confirmed to have the disease — despite a nationwide surveillance programme.

What’s your risk of catching COVID? These tools help you to find out

A look at apps that predict the chance of infection and illness depending on what you’re doing and where you are.

December 18, 2020

Preliminary genomic characterisation of an emergent SARS-CoV-2 lineage in the UK defined by a novel set of spike mutations

Recently a distinct phylogenetic cluster (named lineage B.1.1.7) was detected within the COG-UK surveillance dataset. This cluster has been growing rapidly over the past 4 weeks and since been observed in other UK locations, indicating further spread.

Telehealth Practice Among Health Centers During the COVID-19 Pandemic — United States, July 11–17, 2020

During July 11–17, 2020, 963 (95.4%) of 1,009 Health Resources and Services Administration–funded health centers that responded to a voluntary weekly survey reported providing telehealth services. Health centers in urban areas were more likely to provide >30% of visits virtually than were those in rural areas.

December 17, 2020

Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia

Coronavirus disease 2019 (Covid-19) pneumonia is often associated with hyperinflammation. Despite the disproportionate incidence of Covid-19 among underserved and racial and ethnic minority populations, the safety and efficacy of the anti–interleukin-6 receptor antibody tocilizumab in patients from these populations who are hospitalized with Covid-19 pneumonia are unclear.

REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19

Recent data suggest that complications and death from coronavirus disease 2019 (Covid-19) may be related to high viral loads.

A toolkit for the collection of thrombosis-related data elements in COVID-19 clinical studies

Thrombosis has emerged as an important complication of coronavirus disease 2019 (COVID-19), particularly among individuals with severe illness. However, the precise incidence of thrombotic events remains uncertain due to differences in study design, patient populations, outcome ascertainment, event definitions, and reporting. In an effort to overcome some of these challenges and promote standardized data collection and reporting in clinical studies, the American Society of Hematology Research Collaborative COVID-19 Non-Malignant Hematology Task Force, in collaboration with the International Society on Thrombosis and Haemostasis COVID-19 Task Force, developed sets of data elements in the following domains: venous thromboembolism, myocardial infarction, stroke/transient ischemic attack, peripheral arterial thrombosis, bleeding, laboratory investigations, and antithrombotic therapy.

December 16, 2020

Mechanisms of Atomization from Rotary Dental Instruments and Its Mitigation

Since the onset of coronavirus disease 2019, the potential risk of dental procedural generated spray emissions (including aerosols and splatters), for severe acute respiratory syndrome coronavirus 2 transmission, has challenged care providers and policy makers alike. New studies have described the production and dissemination of sprays during simulated dental procedures, but findings lack generalizability beyond their measurements setting.

Emergence of a Highly Fit SARS-CoV-2 Variant

Sarbecoviruses have emerged twice in the 21st century, causing a worldwide epidemic and pandemic. The ongoing pandemic of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused unprecedented disruption of human society.

The S1 protein of SARS-CoV-2 crosses the blood–brain barrier in mice

It is unclear whether severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019, can enter the brain. Severe acute respiratory syndrome coronavirus 2 binds to cells via the S1 subunit of its spike protein. We show that intravenously injected radioiodinated S1 (I-S1) readily crossed the blood–brain barrier in male mice, was taken up by brain regions and entered the parenchymal brain space. I-S1 was also taken up by the lung, spleen, kidney and liver. Intranasally administered I-S1 also entered the brain, although at levels roughly ten times lower than after intravenous administration.

All-Cause Excess Mortality and COVID-19–Related Mortality Among US Adults Aged 25-44 Years, March-July 2020

Coronavirus disease 2019 (COVID-19) has caused a marked increase in all-cause deaths in the US, mostly among older adults. Although the burden of COVID-19 among hospitalized younger adults has been described, fewer data focus on mortality in this demographic, owing to lower case-fatality rates.

Surgeon Fills COVID-19 Testing Gap in Philadelphia’s Black Neighborhoods

As coronavirus disease 2019 (COVID-19) surged last spring, pediatric surgeon Ala Stanford, MD, heard from Black residents in her hometown of Philadelphia, Pennsylvania, who had symptoms but were hitting roadblocks in getting tested.

December 15, 2020

SARS-CoV-2 antibody seroprevalence in the general population and high-risk occupational groups across 18 cities in Iran: a population-based cross-sectional study

Rapid increases in cases of COVID-19 were observed in multiple cities in Iran towards the start of the pandemic. However, the true infection rate remains unknown. We aimed to assess the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 18 cities of Iran as an indicator of the infection rate.

Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study

The CNS manifestations of COVID-19 in children have primarily been described in case reports, which limit the ability to appreciate the full spectrum of the disease in paediatric patients. We aimed to identify enough cases that could be evaluated in aggregate to better understand the neuroimaging manifestations of COVID-19 in the paediatric population.

December 14, 2020

Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance

Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported.

Readmission and Death After Initial Hospital Discharge Among Patients With COVID-19 in a Large Multihospital System

Although more patients are surviving severe coronavirus disease 2019 (COVID-19), there are limited data on outcomes after initial hospitalization. We therefore measured the rate of readmission, reasons for readmission, and rate of death after hospital discharge among patients with COVID-19 in the nationwide Veterans Affairs (VA) health care system.

COVID research updates: A drug duo that helps people with severe COVID

A combination of the drugs baricitinib and remdesivir shaved one day off the recovery of people hospitalized with COVID-19.

December 13, 2020

The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine — United States, December 2020

On December 12, 2020, after an explicit, evidence-based review of all available data, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19.

December 11, 2020

Genetic mechanisms of critical illness in Covid-19

Host-mediated lung inflammation is present, and drives mortality, in critical illness caused by Covid-19. Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development.

Rapid triage for COVID-19 using routine clinical data for patients attending hospital: development and prospective validation of an artificial intelligence screening test

The early clinical course of COVID-19 can be difficult to distinguish from other illnesses driving presentation to hospital. However, viral-specific PCR testing has limited sensitivity and results can take up to 72 h for operational reasons. We aimed to develop and validate two early-detection models for COVID-19, screening for the disease among patients attending the emergency department and the subset being admitted to hospital, using routinely collected health-care data (laboratory tests, blood gas measurements, and vital signs). These data are typically available within the first hour of presentation to hospitals in high-income and middle-income countries, within the existing laboratory infrastructure.

HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform

Whether HIV infection is associated with risk of death due to COVID-19 is unclear. We aimed to investigate this association in a large-scale population-based study in England.

An EUA for Bamlanivimab—A Monoclonal Antibody for COVID-19

Monoclonal antibodies, such as bamlanivimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation. Bamlanivimab is not authorized for use in patients who are hospitalized or require oxygen therapy because of COVID-19.

Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19

Severe coronavirus disease 2019 (Covid-19) is associated with dysregulated inflammation. The effects of combination treatment with baricitinib, a Janus kinase inhibitor, plus remdesivir are not known.

Estimated Resource Costs for Implementation of CDC’s Recommended COVID-19 Mitigation Strategies in Pre-Kindergarten through Grade 12 Public Schools — United States, 2020–21 School Year

Costs per student for implementation of strategies range from a mean of $55 (materials and consumables only) to $442 (materials and consumables, additional custodial staff members, and potential additional transportation). Incremental costs across states range from an additional 0.3% to 7.1% in costs needed above reported fiscal year 2018 school expenditures per student.

Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic — United States, January 2019–September 2020

During the COVID-19 pandemic, the total number of emergency department visits related to child abuse and neglect decreased, but the percentage of such visits resulting in hospitalization increased, compared with 2019.

Racial and Ethnic Differences in Parental Attitudes and Concerns About School Reopening During the COVID-19 Pandemic — United States, July 2020

Among parents of school-aged children who participated in an Internet panel survey, racial and ethnic minority parents were more concerned about some aspects of school reopening, such as compliance with mitigation measures, safety, and their child contracting or bringing home COVID-19, than were non-Hispanic White parents.

December 10. 2020

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently.

December 9, 2020

Development and external validation of a prognostic tool for COVID-19 critical disease

The rapid spread of coronavirus disease 2019 (COVID-19) revealed significant constraints in critical care capacity. In anticipation of subsequent waves, reliable prediction of disease severity is essential for critical care capacity management and may enable earlier targeted interventions to improve patient outcomes.

December 7, 2020

Implementing Mitigation Strategies in Early Care and Education Settings for Prevention of SARS-CoV-2 Transmission — Eight States, September–October 2020

Head Start and Early Head Start programs successfully implemented CDC-recommended guidance and other ancillary measures for child care programs that remained open, allowing them to continue offering in-person learning. These approaches were documented to guide implementation of mitigation strategies in child care settings.

December 4, 2020

Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020

COVID-19 pandemic control requires a multipronged application of evidence-based strategies while improving health equity: universal face mask use, physical distancing, avoiding nonessential indoor spaces, increasing testing, prompt quarantine of exposed persons, safeguarding those at increased risk for severe illness or death, protecting essential workers, postponing travel, enhancing ventilation and hand hygiene, and achieving widespread COVID-19 vaccination coverage.

Effect of High-Dose Trivalent vs Standard-Dose Quadrivalent Influenza Vaccine on Mortality or Cardiopulmonary Hospitalization in Patients With High-risk Cardiovascular Disease

In this randomized clinical trial that involved 5260 adults and was conducted over 3 influenza seasons, there was no significant difference in the time to first occurrence of all-cause death or cardiopulmonary hospitalization during each enrolling season for those in the high-dose group vs the standard-dose group (hazard ratio, 1.06).

December 3, 2020

Metformin and risk of mortality in patients hospitalised with COVID-19: a retrospective cohort analysis

Metformin was significantly associated with reduced mortality in women with obesity or type 2 diabetes who were admitted to hospital for COVID-19. Prospective studies are needed to understand mechanism and causality. If findings are reproducible, metformin could be widely distributed for prevention of COVID-19 mortality, because it is safe and inexpensive.

Detecting COVID-19 infection hotspots in England using large-scale self-reported data from a mobile application: a prospective, observational study

Our method could help to detect rapid case increases in regions where government testing provision is lower. Self-reported data from mobile applications can provide an agile resource to inform policy makers during a quickly moving pandemic, serving as a complementary resource to more traditional instruments for disease surveillance.

December 1, 2020

Successful double-lung transplantation from a donor previously infected with SARS-CoV-2

In late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resulting respiratory disease, COVID-19, emerged. As the pandemic continues, with more than 62 million people with documented SARS-CoV-2 infection, a growing number of potential organ donors will have been infected.

Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020

A New Jersey hospital reported a cluster of 34 CRAB cases that peaked during a surge in COVID-19 hospitalizations. Strategies to preserve continuity of care led to deviations in IPC practices; CRAB cases decreased when normal operations resumed.

November 27, 2020

Decline in SARS-CoV-2 Antibodies After Mild Infection Among Frontline Health Care Personnel in a Multistate Hospital Network — 12 States, April–August 2020

Among 156 frontline health care personnel who had positive SARS-CoV-2 antibody test results in spring 2020, 94% experienced a decline at repeat testing approximately 60 days later, and 28% seroreverted to below the threshold of positivity. Participants with higher initial antibody responses were more likely to have antibodies detected at the follow-up test than were those who had a lower initial antibody response.

COVID-19 Outbreak Associated with a 10-Day Motorcycle Rally in a Neighboring State — Minnesota, August–September 2020

The impact of gatherings as a source of virus transmission underscores the importance of reducing the number of attendees at gatherings, using face masks, and encouraging physical distancing to prevent ongoing transmission of SARS-CoV-2. Furthermore, these findings demonstrate the rationale for consistent mitigation measures across states.

Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate — Kansas, June 1–August 23, 2020

Countywide mask mandates appear to have contributed to the mitigation of COVID-19 transmission in mandated counties. Community-level mitigation strategies emphasizing use of masks, physical distancing, staying at home when ill, and enhanced hygiene practices can help reduce the transmission of SARS-CoV-2.

November 24, 2020

A Cluster-Randomized Trial of Hydroxychloroquine for Prevention of Covid-19

Postexposure therapy with hydroxychloroquine did not prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons exposed to a PCR-positive case patient. (Funded by the crowdfunding campaign YoMeCorono and others; BCN-PEP-CoV2 number, NCT04304053. opens in new tab.)

A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia

Convalescent plasma is frequently administered to patients with Covid-19 and has been reported, largely on the basis of observational data, to improve clinical outcomes. Minimal data are available from adequately powered randomized, controlled trials.

November 23, 2020

The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020

In addition to scientific data and implementation feasibility, four ethical principles will assist ACIP in formulating recommendations for the initial allocation of COVID-19 vaccine: 1) maximizing benefits and minimizing harms; 2) promoting justice; 3) mitigating health inequities; and 4) promoting transparency.

Psychological Distress and COVID-19–Related Stressors Reported in a Longitudinal Cohort of US Adults in April and July 2020

Serious psychological distress was reported by 13.6% of US adults in April 2020 vs 3.9% in 2018.1 How psychological distress has changed over the course of the coronavirus disease 2019 (COVID-19) pandemic is unknown.

Diagnosis, Management, and Pathophysiology of Arterial and Venous Thrombosis in COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with arterial and venous thrombotic complications. In a US registry of patients with coronavirus disease 2019 (COVID-19), thrombotic complications occurred in 2.6% of 229 non–critically ill hospitalized patients and in 35.3% of 170 hospitalized critically ill patients.

November 20, 2020

COVID research updates: Immune responses to coronavirus persist beyond 6 months

Nature wades through the literature on the new coronavirus — and summarizes key papers as they appear.

Effect of COVID-19 on maternal and neonatal services

Globally, the COVID-19 pandemic has badly affected almost all sectors, including health. Ashish KC and colleagues1 showed that, in Nepal, institutional birth rates declined by almost 50% and that institutional neonatal mortality increased by more than 200% in selected referral hospitals between January and May, 2020. However, convincing explanations for such a drastic change in maternal and neonatal health services are yet to be explored. Here we aim to provide possible reasons for such a decline in maternal and neonatal health services and provide perspectives on the potential ways to improve them.

November 19, 2020

Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection

These findings suggest that SARS-CoV-2 infection in pregnancy is not associated with adverse pregnancy outcomes.

SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis

Viral load kinetics and duration of viral shedding are important determinants for disease transmission. We aimed to characterise viral load dynamics, duration of viral RNA shedding, and viable virus shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various body fluids, and to compare SARS-CoV-2, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV) viral dynamics.

November 18, 2020

Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial

Older adults (aged ≥70 years) are at increased risk of severe disease and death if they develop COVID-19 and are therefore a priority for immunisation should an efficacious vaccine be developed. Immunogenicity of vaccines is often worse in older adults as a result of immunosenescence. We have reported the immunogenicity of a novel chimpanzee adenovirus-vectored vaccine, ChAdOx1 nCoV-19, in young adults, and now describe the safety and immunogenicity of this vaccine in a wider range of participants, including adults aged 70 years and older.

November 13, 2020

JAK inhibition reduces SARS-CoV-2 liver infectivity and modulates inflammatory responses to reduce morbidity and mortality

Using viral load quantifications and super-resolution microscopy, baricitinib exerts activity rapidly through the inhibition of host proteins (numb associated kinases), uniquely amongst anti-virals. This reveals mechanistic actions of a Janus kinase-1/2 inhibitor targeting viral entry, replication and the cytokine storm, and is associated with beneficial outcomes including in severely ill elderly patients, data that incentivizes further randomized controlled trials.

Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine — August 7–September 14, 2020

A wedding reception with 55 persons in a rural Maine town led to COVID-19 outbreaks in the local community, as well as at a long-term care facility and a correctional facility in other counties. Overall, 177 COVID-19 cases were linked to the event, including seven hospitalizations and seven deaths (four in hospitalized persons). Investigation revealed noncompliance with CDC’s recommended mitigation measures.

November 12, 2020

Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19

In this randomized trial that included 152 adult outpatients with confirmed COVID-19 and symptom onset within 7 days, clinical deterioration occurred in 0 patients treated with fluvoxamine vs 6 (8.3%) patients treated with placebo over 15 days, a difference that was statistically significant.

November 11, 2020

An Outbreak of Covid-19 on an Aircraft Carrier

An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel.

SARS-CoV-2 Transmission among Marine Recruits during Quarantine

The efficacy of public health measures to control the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been well studied in young adults.

November 10, 2020

Mobility network models of COVID-19 explain inequities and inform reopening

The COVID-19 pandemic dramatically changed human mobility patterns, necessitating epidemiological models which capture the effects of changes in mobility on virus spread1. We introduce a metapopulation SEIR model that integrates fine-grained, dynamic mobility networks to simulate the spread of SARS-CoV-2 in 10 of the largest US metropolitan statistical areas.

November 9, 2020

Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA

Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors.

November 3, 2020

Persistence of viral RNA, pneumocyte syncytia and thrombosis are hallmarks of advanced COVID-19 pathology

COVID-19 is characterized by extensive alveolar damage (41/41 of patients) and thrombosis of the lung micro- and macro-vasculature (29/41, 71%). Thrombi were in different stages of organization, consistent with their local origin. Pneumocytes and endothelial cells contained viral RNA even at the later stages of the disease.

November 2, 2020

Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19

Patients with COVID-19 are at high risk for thrombotic arterial and venous occlusions. Lung histopathology often reveals fibrin-based occlusions in the small blood vessels of patients who succumb to the disease.

Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy — SET-NET, 16 Jurisdictions, March 29–October 14, 2020

Among 3,912 infants with known gestational age born to women with SARS-CoV-2 infection, 12.9% were preterm (<37 weeks), higher than a national estimate of 10.2%. Among 610 (21.3%) infants with testing results, 2.6% had positive SARS-CoV-2 results, primarily those born to women with infection at delivery.

Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020

In an analysis of approximately 400,000 women aged 15–44 years with symptomatic COVID-19, intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation, and death were more likely in pregnant women than in nonpregnant women.

Science Denial and COVID Conspiracy Theories

The US public health response to coronavirus disease 2019 (COVID-19) has been dismal, characterized by antimask behavior, antivaccine beliefs, conspiracy theories about the origins of COVID-19, and vocal support by elected officials for unproven therapies.

November 2020

Propolis and its potential against SARS-CoV-2 infection mechanisms and COVID-19 disease: Running title: Propolis against SARS-CoV-2 infection and COVID-19

Propolis, a resinous material produced by honey bees from plant exudates, has long been used in traditional herbal medicine and is widely consumed as a health aid and immune system booster. The COVID-19 pandemic has renewed interest in propolis products worldwide; fortunately, various aspects of the SARS-CoV-2 infection mechanism are potential targets for propolis compounds.

Quantitative phylogenomic evidence reveals a spatially structured SARS-CoV-2 diversity

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent RNA virus that spread around the planet in about 4 months. The consequences of this rapid dispersion are under investigation. In this work, we analyzed thousands of genomes and protein sequences from Africa, America, Asia, Europe, and Oceania.

October 30, 2020

Peripheral Oxygen Saturation in Older Persons Wearing Nonmedical Face Masks in Community Settings

Based on the evidence that nonmedical face masks prevent the spread of severe acute respiratory syndrome coronavirus, many governments are mandating the wearing of masks in the community. However, fueled partly by claims on social media that masks can cause hypoxia and are therefore dangerous, concerns have emerged about the safety of wearing face masks. We examined whether wearing nonmedical face masks was associated with a change in oxygen saturation.

Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020

Findings from a prospective household study with intensive daily observation for ≥7 consecutive days indicate that transmission of SARS-CoV-2 among household members was frequent from either children or adults.

COVID-19 Outbreak at an Overnight Summer School Retreat ― Wisconsin, July–August 2020

During July 2–August 11, 2020, a COVID-19 outbreak at an overnight high-school retreat likely began with a single student who had received a negative SARS-CoV-2 molecular test result <1 week before the retreat and led to 116 (76%) diagnosed COVID-19 cases among attendees.

October 29, 2020

Elective Surgery during the Covid-19 Pandemic

You are a physician leader on a senior committee that is responsible for your hospital’s Covid-19 response. For the past week, the hospital census has been over 90% of capacity, and almost all usual intensive care unit (ICU) beds have been occupied, more than half with patients who have Covid-19. You are using 10% of the ICU surge capacity created by your hospital to accommodate patients with Covid-19.

October 28, 2020

SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (Covid-19), which is most frequently mild yet can be severe and life-threatening. Virus-neutralizing monoclonal antibodies are predicted to reduce viral load, ameliorate symptoms, and prevent hospitalization.

October 27, 2020

Shifting Hydroxychloroquine Patterns Raise Concern

The number of hydroxychloroquine prescriptions by specialists who don’t typically prescribe the drug skyrocketed after preliminary reports in March suggested potential benefits for patients with coronavirus disease 2019 (COVID-19).

October 21, 2020

CDC Revised Statement on Close Contact

Someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period* starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated.

* Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes). Data are limited, making it difficult to precisely define “close contact;” however, 15 cumulative minutes of exposure at a distance of 6 feet or less can be used as an operational definition for contact investigation.

COVID-19 in a Correctional Facility Employee Following Multiple Brief Exposures to Persons with COVID-19 — Vermont, July–August 2020

Data are limited to precisely define “close contact”; however, 15 minutes of close exposure is used as an operational definition for contact tracing investigations in many settings. Additional factors to consider when defining close contact include proximity, the duration of exposure, whether the infected person has symptoms, whether the infected person was likely to generate respiratory aerosols, and environmental factors such as adequacy of ventilation and crowding. A primary purpose of contact tracing is to identify persons with higher risk exposures and therefore higher probabilities of developing infection, which can guide decisions on quarantining and work restrictions. Although the initial assessment did not suggest that the officer had close contact exposures, detailed review of video footage identified that the cumulative duration of exposures exceeded 15 minutes.

The Challenges of Expanding Rapid Tests to Curb COVID-19

If Michael Mina, MD, PhD, had his way, testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) would become simple and routine—as easy as brushing one’s teeth in the morning.

October 20, 2020

Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity — United States, January 26–October 3, 2020

Overall, an estimated 299,028 excess deaths occurred from late January through October 3, 2020, with 198,081 (66%) excess deaths attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino persons.

Risk for In-Hospital Complications Associated with COVID-19 and Influenza — Veterans Health Administration, United States, October 1, 2018–May 31, 2020

Hospitalized patients with COVID-19 in the Veterans Health Administration had a more than five times higher risk for in-hospital death and increased risk for 17 respiratory and nonrespiratory complications than did hospitalized patients with influenza. The risks for sepsis and respiratory, neurologic, and renal complications of COVID-19 were higher among non-Hispanic Black or African American and Hispanic patients than among non-Hispanic White patients.

Latin America’s embrace of an unproven COVID treatment is hindering drug trials

As much of the world waits for an effective vaccine to curb the COVID-19 pandemic, some in Latin America are turning to an unproven treatment. There isn’t enough evidence that the drug, ivermectin, is safe or effective as a coronavirus therapy, however. So researchers are cautioning against using it outside clinical trials.

October 16, 2020

Demographic Characteristics, Experiences, and Beliefs Associated with Hand Hygiene Among Adults During the COVID-19 Pandemic — United States, June 24–30, 2020

COVID-19 messages should continue promoting hand hygiene, particularly among men and young adults. Messages addressing COVID-19 risk perceptions and making handwashing accessible and hand sanitizer available by facilities in public settings should be considered to encourage and facilitate hand hygiene.

Transmission Dynamics by Age Group in COVID-19 Hotspot Counties — United States, April–September 2020

CDC works with other federal agencies to identify counties with increasing coronavirus disease 2019 (COVID-19) incidence (hotspots) and offers support to state, tribal, local, and territorial health departments to limit the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Understanding whether increasing incidence in hotspot counties is predominantly occurring in specific age groups is important for identifying opportunities to prevent or reduce transmission.

An Outbreak of COVID-19 Associated with a Recreational Hockey Game — Florida, June 2020

On June 16, 2020, a recreational ice hockey game was played at an ice rink in the Tampa Bay, Florida, metropolitan area. Teams A and B, each consisting of 11 players (typically six on the ice and five on the bench at any given time), included men aged 19–53 years. During the 5 days after the game, 15 persons (14 of the 22 players and a rink staff member) experienced signs and symptoms compatible with coronavirus disease 2019 (COVID-19)*; 13 of the 15 ill persons had positive laboratory test results indicating infection with SARS-CoV-2, the virus that causes COVID-19.

Factors Influencing Risk for COVID-19 Exposure Among Young Adults Aged 18–23 Years — Winnebago County, Wisconsin, March–July 2020

Identifying factors that influence risk for COVID-19 exposure and framing messaging to target those factors could help persuade young adults to adhere to public health guidelines that prevent the spread of COVID-19. Providing clear and consistent messages regarding the need for and effectiveness of masks could help increase widespread adoption of evidence-based guidance.

October 19, 2020

Herd Immunity and Implications for SARS-CoV-2 Control

Herd immunity, also known as indirect protection, community immunity, or community protection, refers to the protection of susceptible individuals against an infection when a sufficiently large proportion of immune individuals exist in a population. In other words, herd immunity is the inability of infected individuals to propagate an epidemic outbreak due to lack of contact with sufficient numbers of susceptible individuals.

October 16, 2020

Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 — United States, May–August 2020

Analysis of 114,411 COVID-19–associated deaths reported to National Vital Statistics System during May–August 2020, found that 51.3% of decedents were non-Hispanic White, 24.2% were Hispanic or Latino (Hispanic), and 18.7% were non-Hispanic Black. The percentage of Hispanic decedents increased from 16.3% in May to 26.4% in August.

COVID-19 in Spain: a predictable storm?

As of Oct 12, there have been 861 112 confirmed cases and 32 929 deaths due to COVID-19 in Spain. More than 63 000 health-care workers have been infected. Spain was one of the most affected countries during the first wave of COVID-19 (March to June), and it has now been hit hard again by a second wave of COVID-19 infections.

October 15, 2020

Scientific consensus on the COVID-19 pandemic: we need to act now

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by WHO as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19.

October 14, 2020

Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries

The Coronavirus Disease 2019 (COVID-19) pandemic has changed many social, economic, environmental and healthcare determinants of health. We applied an ensemble of 16 Bayesian models to vital statistics data to estimate the all-cause mortality effect of the pandemic for 21 industrialized countries.

Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the resulting disease, coronavirus disease 2019 (Covid-19), have spread to millions of persons worldwide.

Supporting Clinicians during Covid-19 and Beyond — Learning from Past Failures and Envisioning New Strategies

Clinicians are facing important emotional stressors during the Covid-19 pandemic, including grief from seeing so many patients die, fears of contracting the virus and infecting their family members, and anger over health care disparities and other systems failures. For some, these stressors have caused or exacerbated burnout, depression, or post-traumatic stress disorder, and they have been implicated in suicides.

October 13, 2020

COVID-19 in New Zealand and the impact of the national response: a descriptive epidemiological study

In early 2020, during the COVID-19 pandemic, New Zealand implemented graduated, risk-informed national COVID-19 suppression measures aimed at disease elimination. We investigated their impacts on the epidemiology of the first wave of COVID-19 in the country and response performance measures.

Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study

Preterm birth is the leading cause of child mortality globally, with many survivors experiencing long-term adverse consequences. Preliminary evidence suggests that numbers of preterm births greatly reduced following implementation of policy measures aimed at mitigating the effects of the COVID-19 pandemic. We aimed to study the impact of the COVID-19 mitigation measures implemented in the Netherlands in a stepwise fashion on March 9, March 15, and March 23, 2020, on the incidence of preterm birth.

October 12, 2020

What reinfections mean for COVID-19

One of the key questions in predicting the course of the COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is how well and how long the immune responses protect the host from reinfection. For some viruses, the first infection can provide lifelong immunity; for seasonal coronaviruses, protective immunity is short-lived.

October 9, 2020

Transmission Dynamics by Age Group in COVID-19 Hotspot Counties — United States, April–September 2020

Understanding whether increasing incidence in hotspot counties is predominantly occurring in specific age groups is important for identifying opportunities to prevent or reduce transmission. The percentage of positive SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) test results (percent positivity) is an important indicator of community transmission.

Factors Influencing Risk for COVID-19 Exposure Among Young Adults Aged 18–23 Years — Winnebago County, Wisconsin, March–July 2020

In Winnebago County, Wisconsin, perceived low severity of disease outcome; perceived responsibility to others; peer pressure; and exposure to misinformation, conflicting messages, or opposing views regarding masks were identified as drivers of behaviors that might influence risk for COVID-19 exposure among young adults.

COVID research updates: Dense cities should brace for long coronavirus outbreaks

The new coronavirus tears through areas where residents generally keep to their own small, close-knit communities. But the virus takes its time spreading in crowded cities where residents of different neighbourhoods tend to intermingle, ultimately infecting more people than in the relatively isolated areas.

October 8, 2020

Clinical impact of molecular point-of-care testing for suspected COVID-19 in hospital (COV-19POC): a prospective, interventional, non-randomised, controlled study

Point-of-care testing is associated with large reductions in time to results and could lead to improvements in infection control measures and patient flow compared with centralised laboratory PCR testing.

Remdesivir for the Treatment of Covid-19 — Final Report

We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults who were hospitalized with Covid-19 and had evidence of lower respiratory tract infection. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days.

October 7, 2020

Covid-19, Ebola, and HIV — Leveraging Lessons to Maximize Impact

As researchers who have long experience with HIV/AIDS prevention, vaccines, and therapies, some of whom also have experience with Ebola, we believe it is critical to build the response to the Covid-19 pandemic on lessons from the HIV pandemic and recent Ebola outbreaks.

Lessons We’ve Learned — Covid-19 and the Undocumented Latinx Community

In March 2020, when there were 30,000 confirmed Covid-19 cases in the United States, one of us wrote about the pandemic’s effects on undocumented immigrants.1 By August, there were about 50,000 new U.S. cases per day, and we had spent several months caring for patients with Covid-19.

Seizing the Teachable Moment — Lessons from Eisenhower’s Heart Attack

One reason to study history is to avoid repeating past mistakes; another is to understand what went right.

Improving Clinical Trial Enrollment — In the Covid-19 Era and Beyond

More than 3 million people in the United States are known to have been infected with SARS-CoV-2.1 If every study registered on as of mid-June meets its target enrollment, less than 4% of those diagnosed with Covid-19 will have been enrolled in a randomized, controlled trial. In the face of a new disease in dire need of proven treatments, every patient not offered enrollment in a well-designed, well-conducted study represents a missed opportunity to advance scientific knowledge, develop therapeutic strategies, and ultimately improve care for everyone who will come next.

October 6, 2020

Trends in COVID-19 Incidence After Implementation of Mitigation Measures — Arizona, January 22–August 7, 2020

The number of COVID-19 cases in Arizona stabilized and then decreased after sustained implementation and enforcement of statewide and locally enhanced mitigation measures, beginning approximately 2 weeks after implementation and enforcement of mask mandates and enhanced sanitations practices began on June 17; further decreases were observed during July 13–August 7, after statewide limitations and closures of certain services and businesses.

COVID research updates: Teenager spreads coronavirus on family holiday

A 13-year-old girl gave the new coronavirus to her grandparents and 9 other relatives who occupied the same holiday house for up to 3½ weeks, confirming that adolescents can seed clusters of COVID-19 cases.

October 5, 2020

How COVID-19 Spreads

COVID-19 can sometimes be spread by airborne transmission

Some infections can be spread by exposure to virus in small droplets and particles that can linger in the air for minutes to hours. These viruses may be able to infect people who are further than 6 feet away from the person who is infected or after that person has left the space.

This kind of spread is referred to as airborne transmission and is an important way that infections like tuberculosis, measles, and chicken pox are spread.

There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away. These transmissions occurred within enclosed spaces that had inadequate ventilation.

Adolescent with COVID-19 as the Source of an Outbreak at a 3-Week Family Gathering — Four States, June–July 2020

There is increasing evidence that children and adolescents can efficiently transmit SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1–3). During July–August 2020, four state health departments and CDC investigated a COVID-19 outbreak that occurred during a 3-week family gathering of five households in which an adolescent aged 13 years was the index and suspected primary patient; 11 subsequent cases occurred.

Long-term Health Consequences of COVID-19

With more than 30 million documented infections and 1 million deaths worldwide, the coronavirus disease 2019 (COVID-19) pandemic continues unabated. The clinical spectrum of severe acute respiratory syndrome coronavirus (SARS-CoV) 2 infection ranges from asymptomatic infection to life-threatening and fatal disease. Current estimates are that approximately 20 million people globally have “recovered”; however, clinicians are observing and reading reports of patients with persistent severe symptoms and even substantial end-organ dysfunction after SARS-CoV-2 infection.

Preserving Elective Surgeries in the COVID-19 Pandemic and the Future

Cancel everything” has trended as a hashtag during the coronavirus disease 2019 (COVID-19) pandemic, and for good reason. The pandemic has touched virtually every aspect of society, substantially altering, and at its onset halting, the very ways nearly every person in the United States works, learns, lives, and maintains health.

Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients

Neurologic manifestations occur in most hospitalized Covid‐19 patients. Encephalopathy was associated with increased morbidity and mortality, independent of respiratory disease severity.

October 2, 2020

Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020

Clinical suspicion and indicated SARS-CoV-2 testing, including antibody testing, might be needed to recognize and treat adults with MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this condition. Ultimately, the recognition of MIS-A reinforces the need for prevention efforts to limit spread of SARS-CoV-2.

A call for diagnostic tests to report viral load

Ever since the coronavirus pandemic began, battles have raged over testing: Which tests should be given, to whom, and how often? Now, epidemiologists and public health experts are opening a new debate. They say testing centers should report not just whether a person is positive, but also a number known as the cycle threshold (CT) value, which indicates how much virus an infected person harbors.

October 1, 2020

Risk of COVID-19 During Air Travel

The risk of contracting coronavirus disease 2019 (COVID-19) during air travel is lower than from an office building, classroom, supermarket, or commuter train.

Ensuring Uptake of Vaccines against SARS-CoV-2

As Covid-19 continues to exact a heavy toll, development of a vaccine appears the most promising means of restoring normalcy to civil life. Perhaps no scientific breakthrough is more eagerly anticipated. But bringing a vaccine to market is only half the challenge; also critical is ensuring a high enough vaccination rate to achieve herd immunity.

September 30, 2020

COVID-19 and Heart Failure With Preserved Ejection Fraction

Patients with preexisting cardiovascular disease (CVD) who develop coronavirus disease 2019 (COVID-19) have worse outcomes than patients without CVD. Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly or indirectly lead to myocardial injury. Although fulminant viral myocarditis due to COVID-19 appears to be uncommon, recent data, although limited, suggest that direct myocardial injury may occur in some individuals.

Rethinking Covid-19 Test Sensitivity — A Strategy for Containment

It’s time to change how we think about the sensitivity of testing for Covid-19. The Food and Drug Administration (FDA) and the scientific community are currently almost exclusively focused on test sensitivity, a measure of how well an individual assay can detect viral protein or RNA molecules. Critically, this measure neglects the context of how the test is being used.

September 29, 2020

Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults

Testing of vaccine candidates to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an older population is important, since increased incidences of illness and death from coronavirus disease 2019 (Covid-19) have been associated with an older age.

Multiple COVID-19 Clusters on a University Campus — North Carolina, August 2020

A North Carolina university experienced a rapid increase in COVID-19 cases and clusters within 2 weeks of opening the campus to students. Student gatherings and congregate living settings, both on and off campus, likely contributed to the rapid spread of COVID-19 in this setting.

Recent Increase in COVID-19 Cases Reported Among Adults Aged 18–22 Years — United States, May 31–September 5, 2020

During August 2–September 5, 2020, weekly COVID-19 cases among persons aged 18–22 years increased 55% nationally. Increases were greatest in the Northeast (144%) and Midwest (123%). Increases in cases were not solely attributable to increased testing.

Preventing and Responding to COVID-19 on College Campuses

The coronavirus disease 2019 (COVID-19) pandemic continues to present public health and societal challenges worldwide. Concerted public health efforts in the US at the local, state, territorial, national, and tribal levels remain paramount to protecting the population, particularly those at greatest risk for severe illness and death.

September 28, 2020

COVID-19 Trends Among School-Aged Children — United States, March 1–September 19, 2020

It is important for schools and communities to monitor multiple indicators of COVID-19 among school-aged children and layer prevention strategies to reduce COVID-19 disease risk for students, teachers, school staff, and families. These results can provide a baseline for monitoring trends and evaluating mitigation strategies.

COVID research updates: Tests reveal silent reinfections in hospital workers

Nature wades through the literature on the new coronavirus — and summarizes key papers as they appear.

September 25, 2020

Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets multiple organs and causes severe coagulopathy. Histopathological organ changes might not only be attributable to a direct virus-induced effect, but also the immune response. The aims of this study were to assess the duration of viral presence, identify the extent of inflammatory response, and investigate the underlying cause of coagulopathy.

Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study

Many patients receiving dialysis in the USA share the socioeconomic characteristics of underserved communities, and undergo routine monthly laboratory testing, facilitating a practical, unbiased, and repeatable assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence.

September 24, 2020

Inborn errors of type I IFN immunity in patients with life-threatening COVID-19

Clinical outcome upon infection with SARS-CoV-2 ranges from silent infection to lethal COVID-19. We have found an enrichment in rare variants predicted to be loss-of-function (LOF) at the 13 human loci known to govern TLR3- and IRF7-dependent type I interferon (IFN) immunity to influenza virus, in 659 patients with life-threatening COVID-19 pneumonia, relative to 534 subjects with asymptomatic or benign infection.

Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Coronavirus disease 2019 (COVID-19) appears to have significant extrapulmonary complications affecting multiple organ systems. Critically ill patients with COVID-19 often develop gastrointestinal complications during their hospital stay, including bowel ischemia, transaminitis, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, and severe ileus.

September 23, 2020

As Their Numbers Grow, COVID-19 “Long Haulers” Stump Experts

Overall, approximately 10% of people who’ve had COVID-19 experience prolonged symptoms, a UK team estimated in a recently published Practice Pointer on postacute COVID-19 management. And yet, the authors wrote, primary care physicians have little evidence to guide their care.

Changing Age Distribution of the COVID-19 Pandemic — United States, May–August 2020

Strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce infection and subsequent transmission to persons at higher risk for severe illness.

Association of SARS-CoV-2 Test Status and Pregnancy Outcomes

Associations of coronavirus disease 2019 (COVID-19) and pregnancy outcomes remain unclear because most studies are case reports or case series without contemporary comparators.

September 22, 2020

COVID-19 Contact Tracing in Two Counties — North Carolina, June–July 2020

Despite aggressive efforts by health departments, many COVID-19 patients do not report contacts, and many contacts cannot be reached. Improved timeliness of contact tracing, community engagement, and community-wide mitigation are needed to reduce SARS-CoV-2 transmission.

September 21, 2020

Long-term hydroxychloroquine use in patients with rheumatic conditions and development of SARS-CoV-2 infection: a retrospective cohort study

Hydroxychloroquine is one of several agents being evaluated in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to examine whether patients with rheumatological conditions receiving chronic hydroxychloroquine therapy are at less risk of developing SARS-CoV-2 infection than those not receiving hydroxychloroquine.

September 18, 2020

Who gets a COVID vaccine first? Access plans are taking shape

Advisory groups around the world release guidance to prioritize health-care workers and those in front-line jobs.

Nonfatal Opioid Overdoses at an Urban Emergency Department During the COVID-19 Pandemic

Psychosocial consequences related to coronavirus disease 2019 (COVID-19) may place individuals at a heightened likelihood of opioid overdose or relapse.

Analysis of Drug Test Results Before and After the US Declaration of a National Emergency Concerning the COVID-19 Outbreak

The novel coronavirus disease 2019 (COVID-19) pandemic has exacerbated challenges for millions of adults with substance use disorders. New obstacles for obtaining treatment exist as do increasing stressors, including isolation, unemployment, and illness.

September 17, 2020

Covid-19: Do many people have pre-existing immunity?

It seemed a truth universally acknowledged that the human population had no pre-existing immunity to SARS-CoV-2, but is that actually the case?

Assessing a novel, lab-free, point-of-care test for SARS-CoV-2 (CovidNudge): a diagnostic accuracy study

Access to rapid diagnosis is key to the control and management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory RT-PCR testing is the current standard of care but usually requires a centralised laboratory and significant infrastructure. We describe our diagnostic accuracy assessment of a novel, rapid point-of-care real time RT-PCR CovidNudge test, which requires no laboratory handling or sample pre-processing.

Efforts to prevent COVID-19 led to global decline in flu

Interventions to prevent SARS-CoV-2 transmission have led to a global decline in influenza during the COVID-19 pandemic, researchers reported in MMWR.

Change in Antibodies to SARS-CoV-2 Over 60 Days Among Health Care Personnel in Nashville, Tennessee

Declines in immunoglobulin antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among patients with symptomatic or asymptomatic infections have been documented.

September 16, 2020

Detection of SARS-CoV-2 with SHERLOCK One-Pot Testing

CRISPR (clustered regularly interspaced short palindromic repeats)–based diagnostic tests1,2 collectively provide a nascent platform for the detection of viral and bacterial pathogens. Methods such as SHERLOCK (specific high-sensitivity enzymatic reporter unlocking), which typically use a two-step process (target amplification followed by CRISPR-mediated nucleic acid detection),1,2 have been used to detect SARS-CoV-2.3

Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020

Pregnant women and health care providers should be aware of potential risks for severe COVID-19, including adverse pregnancy outcomes. Identifying COVID-19 during birth hospitalizations is important to guide preventive measures to protect pregnant women, parents, newborns, other patients, and hospital personnel.

SARS-CoV-2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics — Eight U.S. Health Care Centers, March 1–May 30, 2020

Antenatal counseling emphasizing preventive measures, including use of masks, frequent hand washing, and social distancing, might help prevent COVID-19 among pregnant women, especially those with prepregnancy obesity and gestational diabetes.

Occupational Safety and Health Administration (OSHA) and Worker Safety During the COVID-19 Pandemic

With the coronavirus disease 2019 (COVID-19) pandemic, the US is facing an unprecedented, massive worker safety crisis.

September 15, 2020

SARS-CoV-2–Associated Deaths Among Persons Aged >21 Years — United States, February 12–July 31, 2020

Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2–associated deaths have  been  reported  in  the  United  States.

September 14, 2020

Seasonal coronavirus protective immunity is short-lasting

A key unsolved question in the current coronavirus disease 2019 (COVID-19) pandemic is the duration of acquired immunity. Insights from infections with the four seasonal human coronaviruses might reveal common characteristics applicable to all human coronaviruses. We monitored healthy individuals for more than 35 years and determined that reinfection with the same seasonal coronavirus occurred frequently at 12 months after infection.

Change in Donor Characteristics and Antibodies to SARS-CoV-2 in Donated Blood in the US, June-August 2020

The coronavirus disease 2019 (COVID-19) pandemic has challenged the adequacy of the blood supply. To attract new donors and support the collection of convalescent plasma,1 many blood collection organizations have implemented and publicized routine testing of donations for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies.

September 11, 2020

Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults ≥18 Years in 11 Outpatient Health Care Facilities — United States, July 2020

Findings from a case-control investigation of symptomatic outpatients from 11 U.S. health care facilities found that close contact with persons with known COVID-19 or going to locations that offer on-site eating and drinking options were associated with COVID-19 positivity. Adults with positive SARS-CoV-2 test results were approximately twice as likely to have reported dining at a restaurant than were those with negative SARS-CoV-2 test results.

Eating and drinking on-site at locations that offer such options might be important risk factors associated with SARS-CoV-2 infection. Efforts to reduce possible exposures where mask use and social distancing are difficult to maintain, such as when eating and drinking, should be considered to protect customers, employees, and communities.

September 10, 2020

Rapid Decay of Anti–SARS-CoV-2 Antibodies in Persons with Mild Covid-19

A recent article suggested the rapid decay of anti–SARS-CoV-2 IgG in early infection,1 but the rate was not described in detail. We evaluated persons who had recovered from Covid-19 and referred themselves to our institution for observational research.

The emergence of SARS-CoV-2 in Europe and North America

Our analyses demonstrate the effectiveness of public health measures in preventing onward transmission and show that intensive testing and contact tracing could have prevented SARS-CoV-2 from becoming established.

September 8, 2020

Prevalence of Third-Party Tracking on COVID-19–Related Web Pages

The internet provides ready access to information related to coronavirus disease 2019 (COVID-19). With a simple web search, individuals can find symptom checkers, locate testing sites, and get tips for keeping themselves safe.

September 3, 2020

Cytokine Levels in Critically Ill Patients With COVID-19 and Other Conditions

An abnormally strong proinflammatory response known as “cytokine storm” may play an important role in the pathophysiology of coronavirus disease 2019 (COVID-19), although cytokine storm remains ill defined.1 Sinha and colleagues2 reported that although IL-6 levels are elevated in severe COVID-19, they are lower than levels usually observed in (non–COVID-19) acute respiratory distress syndrome (ARDS). However, this comparison is limited by the use of different assays, which are not well standardized.3 We compared cytokine levels in critically ill patients with COVID-19 vs levels in patients with other critical illnesses.

September 2, 2020

Phase 1–2 Trial of a SARS-CoV-2 Recombinant Spike Protein Nanoparticle Vaccine

NVX-CoV2373 is a recombinant severe acute respiratory syndrome coronavirus 2 (rSARS-CoV-2) nanoparticle vaccine composed of trimeric full-length SARS-CoV-2 spike glycoproteins and Matrix-M1 adjuvant.

September 1, 2020

The COVID-19 Treatment Guidelines Panel’s Statement on the Emergency Use Authorization of Convalescent Plasma for the Treatment of COVID-19

On August 23, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA)* for COVID-19 convalescent plasma for the treatment of hospitalized patients with COVID-19.

Humoral Immune Response to SARS-CoV-2 in Iceland

Little is known about the nature and durability of the humoral immune response to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The Power of Antibody-Based Surveillance

Antibodies are immune proteins that mark the evolution of the host immune response to infection. Antibodies can be measured in a sensitive and specific manner, providing an archive that reflects recent or previous infection. If maintained at sufficiently high levels, antibodies can rapidly block infection on reexposure, conferring long-lived protection.

Even octogenarians develop potent antibodies

As the new coronavirus ripped through several care homes in England, more than 80% of the residents mounted an antibody response to the virus, including 82% of those over the age of 80.

August 31, 2020

Seroprevalence of SARS-CoV-2 Among Frontline Health Care Personnel in a Multistate Hospital Network — 13 Academic Medical Centers, April–June 2020

Among 3,248 personnel observed, 6% had antibody evidence of previous SARS-CoV-2 infection; 29% of personnel with SARS-CoV-2 antibodies were asymptomatic in the preceding months, and 69% had not previously received a diagnosis of SARS-CoV-2 infection. Prevalence of SARS-CoV-2 antibodies was lower among personnel who reported always wearing a face covering while caring for patients (6%), compared with those who did not (9%).

SARS-CoV-2 Testing and Changes in Primary Care Services in a Multistate Network of Community Health Centers During the COVID-19 Pandemic

The effect of the coronavirus disease 2019 (COVID-19) pandemic on the primary care community health centers (CHCs) in the US has not been well described. CHCs serve approximately 30 million people, including high proportions of patients susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and adverse outcomes.

Emergency Use Authorizations During the COVID-19 Pandemic

In response to the novel coronavirus disease 2019 (COVID-19) crisis, the Food and Drug Administration (FDA), via its Emergency Use Authorization (EUA) authority, initially provided, and then revoked, authorization for use of hydroxychloroquine for treating patients with COVID-19. This process was politically and scientifically contentious and illustrates central problems that can arise with emergency drug authorizations during crises.

August 29, 2020

Research and higher education in the time of COVID-19

The COVID-19 pandemic has propelled the research and higher education sectors to the forefront of public attention. Laboratory capacity has been crucial for diagnostic testing; experts in infectious diseases, epidemiology, public health, mathematical modelling, and economics are central to national policy making and media coverage; clinical research has been vital to improving COVID-19 management; and our collective global future relies heavily on the development of an effective vaccine against severe acute respiratory syndrome coronavirus 2.

August 28, 2020

Testing for responses to the wrong SARS-CoV-2 antigen?

Two commercial antibody tests (Abbott SARS-CoV-2 IgG, Abbott Diagnostics, Abbott Park, IL, USA; and Roche Elecsys Anti-SARS-CoV-2, Roche Diagnostics, Basel, Switzerland), both targeting antibodies to nucleoprotein (anti-NP), constitute the cornerstone of the UK Government's response to the COVID-19 pandemic.

Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2

Rapid and accurate diagnostic tests are essential for controlling the ongoing Covid-19 pandemic. Although the current standard involves testing of nasopharyngeal swab specimens by quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) to detect SARS-CoV-2, saliva specimens may be an alternative diagnostic sample.

Salivary Detection of COVID-19

Standard testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires a nasopharyngeal or oropharyngeal swab but is limited by modest sensitivity, the need for health care human resources and personal protective equipment, and the potential for transmission in transit to or at the testing center.

August 27, 2020

Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study

Patients with COVID-19-associated ARDS have a form of injury that, in many aspects, is similar to that of those with ARDS unrelated to COVID-19. Notably, patients with COVID-19-related ARDS who have a reduction in respiratory system compliance together with increased D-dimer concentrations have high mortality rates.

Prevalence of phenotypes of acute respiratory distress syndrome in critically ill patients with COVID-19: a prospective observational study

In this exploratory analysis of 39 patients, ARDS due to COVID-19 was not associated with higher systemic inflammation and was associated with a lower prevalence of the hyperinflammatory phenotype than that observed in historical ARDS data. This finding suggests that the excess mortality observed in COVID-19-related ARDS is unlikely to be due to the upregulation of inflammatory pathways described by the parsimonious model.

Covid-19 and Immunity in Aging Populations — A New Research Agenda

The race is on throughout the world to develop Covid-19 vaccines and therapeutics and end a pandemic that threatens to infect a substantial portion of the planet’s population and perhaps kill millions of people, especially older adults.

August 26, 2020

Developing Safe and Effective Covid Vaccines — Operation Warp Speed’s Strategy and Approach

Announced on May 15, Operation Warp Speed (OWS) — a partnership of the Department of Health and Human Services (HHS), the Department of Defense (DOD), and the private sector — aims to accelerate control of the Covid-19 pandemic by advancing development, manufacturing, and distribution of vaccines, therapeutics, and diagnostics.

Preventing and Mitigating SARS-CoV-2 Transmission — Four Overnight Camps, Maine, June–August 2020

During the 2020 summer camp season, four Maine overnight camps with 1,022 attendees from 41 states and international locations implemented a multilayered prevention and mitigation strategy that was successful in identifying and isolating three asymptomatic COVID-19 cases and preventing secondary transmission.

The Transformational Effects of COVID-19 on Medical Education

In 2010, a Global Independent Commission on Education of Health Professionals for the 21st Century, composed of experts in public health and health care from around the world, asserted that the purpose of health professions education was to improve the health of communities.

August 25, 2020

Two metres or one: what is the evidence for physical distancing in covid-19?

Rigid safe distancing rules are an oversimplification based on outdated science and experiences of past viruses, argue Nicholas R Jones and colleagues

Primary Indicators to Systematically Monitor COVID-19 Mitigation and Response — Kentucky, May 19–July 15, 2020

State and local health departments in other jurisdictions might benefit from implementation of systematic indicator monitoring to guide decision-making for COVID-19 reopening, mitigation, and response efforts.

August 24, 2020

First Case of COVID-19 Reinfection Confirmed

The man was diagnosed with COVID-19 on March 26, hospitalized, then recovered. He tested positive for SARS-CoV-2 again on August 15, and whole genome sequencing of viral isolates from the two episodes indicated they were from different clades, reported Kwok-Yung Yuen, MD, of the University of Hong Kong, and colleagues in a manuscript they said had been accepted for publication in Clinical Infectious Diseases, but not yet published.

August 22, 2020

Unraveling the Immune Response in Severe COVID-19

An outbreak of coronavirus disease 2019 (COVID-19) emerged in China’s Hubei province and spread rapidly across the globe leading to millions of cases worldwide. The causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel enveloped RNA-virus of the family of beta-coronavirus, was quickly identified and sequences distributed, initiating a race to develop vaccines and therapeutics that is unprecedented in history.

Convergence between global BCG vaccination and COVID‐19 pandemic

The novel coronavirus SARS‐CoV‐2 has kept the whole world in tenterhooks due to its severe life‐threatening infectious disease, COVID‐19.

Mental health interventions and supports during COVID- 19 and other medical pandemics: A rapid systematic review of the evidence

Various mental health interventions have been developed for medical pandemics, and research on their effectiveness is growing.

Fuzzy Clustering method to Compare the Spread Rate of Covid-19 in the High Risks Countries

The numbers of confirmed cases of new coronavirus (Covid-19) are increased daily in different countries. To determine the policies and plans, the study of the relations between the distributions of the spread of this virus in other countries is critical. In this work, the distributions of the spread of Covid-19 in Unites States America, Spain, Italy, Germany, United Kingdom, France, and Iran were compared and clustered using fuzzy clustering technique.

August 19, 2020

A SARS-CoV-2 mRNA Vaccine — Preliminary Report

The authors reply: We agree with Schachar and Schachar that the interim findings of the phase 1 trial of the mRNA-1273 vaccine against SARS-CoV-2 are promising; these findings provided support for the initiation of the phase 2 and 3 trials that are under way.

COVID-19 Among American Indian and Alaska Native Persons — 23 States, January 31–July 3, 2020

Adequate health care and public health infrastructure resources are needed to support a culturally responsive public health effort that sustains the strengths of AI/AN communities. These resources would facilitate the collection and reporting of more complete case report data to support evidence-based public health efforts.

August 17, 2020

Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks by Industry Sector — Utah, March 6–June 5, 2020

During March 6–June 5, 2020, workplace outbreaks occurred in 15 Utah industry sectors; 58% of workplace outbreak-associated COVID-19 cases were in three sectors: Manufacturing, Wholesale Trade, and Construction. Despite representing 24% of Utah workers in all affected sectors, Hispanic and nonwhite workers accounted for 73% of workplace outbreak-associated COVID-19 cases.

SARS-CoV-2 Infection Among Community Health Workers in India Before and After Use of Face Shields

The transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to be predominantly through respiratory droplets from infected persons in close proximity to uninfected persons,1 although airborne transmission may also play a role.2,3 Face shields have been proposed to prevent transmission in the community,4 but data are lacking. We describe transmission in a community setting before and after the use of face shields.

August 15, 2020

Neck Gaiters

Neck gaiters provide similar performance to other cloth masks we have tested on manikins.

August 14, 2020

Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study

Tocilizumab, a monoclonal antibody directed against the interleukin-6 receptor, has been proposed to mitigate the cytokine storm syndrome associated with severe COVID-19. We aimed to investigate the association between tocilizumab exposure and hospital-related mortality among patients requiring intensive care unit (ICU) support for COVID-19.

Disparities in Incidence of COVID-19 Among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots During June 5–18, 2020 — 22 States, February–June 2020

Among 79 counties identified as hotspots during June 5–18, 2020 that also had sufficient data on race, a disproportionate number of COVID-19 cases among underrepresented racial/ethnic groups occurred in almost all areas during February–June 2020.

Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020

During June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.

August 13, 2020

Characteristics and Outcomes of COVID-19 Patients During Initial Peak and Resurgence in the Houston Metropolitan Area

Texas is experiencing resurgence of coronavirus disease 2019 (COVID-19). We report sociodemographic, clinical, and outcome differences across the first and second surges of COVID-19 hospitalizations at Houston Methodist, an 8-hospital health care system in Houston, Texas.

Effect of an Inactivated Vaccine Against SARS-CoV-2 on Safety and Immunogenicity Outcomes

This inactivated COVID-19 vaccine had a low rate of adverse reactions and demonstrated immunogenicity, but longer-term assessment of safety and efficacy will require phase 3 trials.

Caring for Someone With COVID-19

Care of individuals with COVID-19 is 2-fold: support the patient and prevent yourself and others from contracting SARS-CoV-2.

August 11, 2020

Transmission of SARS-CoV-2 Involving Residents Receiving Dialysis in a Nursing Home — Maryland, April 2020

Investigation of a COVID-19 outbreak in a Maryland nursing home identified a significantly higher prevalence among residents receiving dialysis (47%) than among those not receiving dialysis (16%); 72% were asymptomatic at the time of testing.

Facility-Wide Testing for SARS-CoV-2 in Nursing Homes — Seven U.S. Jurisdictions, March–June 2020

In two health department jurisdictions, testing in facilities without a previous COVID-19 case identified a prevalence of 0.4%. Five health department jurisdictions that targeted facility-wide testing after identification of a case found a prevalence of 12%; for each additional day before completion of initial facility-wide testing, an estimated 1.3 additional cases were identified.

August 10, 2020

Association of Nursing Home Ratings on Health Inspections, Quality of Care, and Nurse Staffing With COVID-19 Cases

In the US, approximately 27% of deaths due to coronavirus disease 2019 (COVID-19) have occurred among residents of nursing homes (NHs).1 However, why some facilities have been more successful at limiting the spread of infection than others is unclear. For example, those with greater staffing or higher performance on quality measures may be better at containing the spread of COVID-19 among staff and residents.

COVID-19 in Canada

As of July 13, 2020, Canada has documented 107 861 cases of coronavirus disease 2019 (COVID-19) (286 per 100 000 people) and 8787 COVID-19–related deaths.

August 7, 2020

Low-cost measurement of facemask efficacy for filtering expelled droplets during speech

Mandates for mask use in public during the recent COVID-19 pandemic, worsened by global shortage of commercial supplies, have led to widespread use of homemade masks and mask alternatives. It is assumed that wearing such masks reduces the likelihood for an infected person to spread the disease, but many of these mask designs have not been tested in practice. We have demonstrated a simple optical measurement method to evaluate the efficacy of masks to reduce the transmission of respiratory droplets during regular speech. In proof-of-principle studies, we compared a variety of commonly available mask types and observed that some mask types approach the performance of standard surgical masks, while some mask alternatives, such as neck fleece or bandanas, offer very little protection.

COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020

Most cases of MIS-C have features of shock, with cardiac involvement, gastrointestinal symptoms, and significantly elevated markers of inflammation, with positive laboratory test results for SARS-CoV-2. Of the 565 patients who underwent SARS-CoV-2 testing, all had a positive test result by RT-PCR or serology.

Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020

Analysis of pediatric COVID-19 hospitalization data from 14 states found that although the cumulative rate of COVID-19–associated hospitalization among children (8.0 per 100,000 population) is low compared with that in adults (164.5), one in three hospitalized children was admitted to an intensive care unit.

Low-cost measurement of facemask efficacy for filtering expelled droplets during speech

Mandates for mask use in public during the recent COVID-19 pandemic, worsened by global shortage of commercial supplies, have led to widespread use of homemade masks and mask alternatives. It is assumed that wearing such masks reduces the likelihood for an infected person to spread the disease, but many of these mask designs have not been tested in practice.

Allocation of COVID-19 Relief Funding to Disproportionately Black Counties

The Coronavirus Aid, Relief, and Economic Security (CARES) Act and Paycheck Protection Program together designated $175 billion for coronavirus disease 2019 (COVID-19) response efforts and reimbursement to health care entities for expenses or lost revenues.

Case Rates, Treatment Approaches, and Outcomes in Acute Myocardial Infarction During the Coronavirus Disease 2019 Pandemic

In this cross-sectional study of 15 244 hospitalizations involving 14 724 patients with AMI, case rates began to decrease on February 23, 2020, followed by a modest recovery after 5 weeks. Although no statistically significant difference in treatment approaches was found, the risk-adjusted mortality rate among patients with ST-segment elevation myocardial infarction increased substantially.

COVID-19 Outbreak Among Employees at a Meat Processing Facility — South Dakota, March–April 2020

Implementing control measures before, or soon after, SARS-CoV-2 introduction into meat processing facilities, especially in areas where employees have prolonged, close contact with others, might substantially reduce the risk for SARS-CoV-2 spread within facilities.

August 6, 2020

Perspectives on Oncology-Specific Language During the Coronavirus Disease 2019 Pandemic

In this qualitative study of 8 physicians and 48 patients with cancer, the physicians identified 8 oncology-specific scenarios in which communication with patients had been challenging, and the patients provided their reactions to each scenario. These physician and patient insights, along with principles identified through literature review by health communication experts, were synthesized for application to the clinical scenarios.

Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area

The greater New York City (NYC) area, including the 5 boroughs and surrounding counties, has a high incidence of coronavirus disease 2019 (COVID-19),1 and health care personnel (HCP) working there have a high exposure risk. HCP have expressed concerns about access to testing so that infection spread to patients, other HCP, and their families can be minimized.2 The Northwell Health System, the largest in New York State, sought to address this concern by offering voluntary antibody testing to all HCP.

August 5, 2020

Experts Discuss COVID-19—Remdesivir, Vaccines, and More

JAMA Live Highlights features comments from livestream interviews by JAMA Network Editor in Chief Howard Bauchner, MD. His discussions with experts in clinical care, public health, and health policy focus on critical issues related to the coronavirus disease 2019 (COVID-19) pandemic. Comments have been edited for clarity.

Livedoid and Purpuric Skin Eruptions Associated With Coagulopathy in Severe COVID-19

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads globally, dermatologists are recognizing a variety of cutaneous manifestations in patients with coronavirus disease 2019 (COVID-19). A recent Spanish report1 categorized skin findings in 375 patients with suspected and confirmed COVID-19, including livedoid and necrotic eruptions, which were noted in patients with more severe disease. The authors suggested that these skin manifestations may be associated with occlusive vascular disease.

Practice Patterns and Responsiveness to Simulated Common Ocular Complaints Among US Ophthalmology Centers During the COVID-19 Pandemic

In this cross-sectional study of 60 US ophthalmology practices, there were fairly uniform responses to 3 common ocular complaints across comprehensive ophthalmological practices. Private practices were more likely to schedule cataract evaluations and patients with posterior vitreous detachments sooner than university centers, while all practices were likely to ask about COVID-19 symptoms when scheduling urgent visits.

Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol — Arizona and New Mexico, May–June 2020

Alcohol-based hand sanitizer products should never be ingested. In patients with compatible signs and symptoms or after having swallowed hand sanitizer, prompt evaluation for methanol poisoning is required. Health departments in all states should coordinate with poison centers to identify cases of methanol poisoning.

Attacks on Public Health Officials During COVID-19

On June 24, 2020, California Governor Gavin Newsom remarked on a disturbing phenomenon: health officers are “getting attacked, getting death threats, they’re being demeaned and demoralized.”

Recovery From Severe COVID-19

As of July 30, 2020, more than 17 million people worldwide have been diagnosed with coronavirus disease 2019 (COVID-19), and more than 665 000 have died. In many countries, the rate of diagnosis continues to increase; for example, more than 50 000 new cases per day were reported in the US during the last week of July.

August 3, 2020

Characteristics and Outcomes of Contacts of COVID-19 Patients Monitored Using an Automated Symptom Monitoring Tool — Maine, May–June 2020

Maine found that using automated symptom monitoring as a part of the state’s contact tracing program was well received, with the majority of monitored contacts (96.4%) agreeing to automated symptom monitoring. Automated symptom monitoring promptly identified COVID-19 diagnoses among monitored contacts. Among 1,622 persons enrolled into an automated symptom monitoring system, 190 (11.7%) developed COVID-19.

July 31, 2020

SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020

Limited data are available about transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), among youths. During June 17–20, an overnight camp in Georgia (camp A) held orientation for 138 trainees and 120 staff members; staff members remained for the first camp session, scheduled during June 21–27, and were joined by 363 campers and three senior staff members on June 21.

Assessment of SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United States

In this modeling study, symptom-based screening alone was not sufficient to contain an outbreak, and the safe reopening of campuses in fall 2020 may require screening every 2 days, uncompromising vigilance, and continuous attention to good prevention practices.

July 30, 2020

Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19)

Our analyses suggest children younger than 5 years with mild to moderate COVID-19 have high amounts of SARS-CoV-2 viral RNA in their nasopharynx compared with older children and adults. Our study is limited to detection of viral nucleic acid, rather than infectious virus, although SARS-CoV-2 pediatric studies reported a correlation between higher nucleic acid levels and the ability to culture infectious virus. Thus, young children can potentially be important drivers of SARS-CoV-2 spread in the general population, as has been demonstrated with respiratory syncytial virus, where children with high viral loads are more likely to transmit.

COVID-19 and Dexamethasone

A widely publicized press release and subsequent preliminary report of the RECOVERY trial, a randomized study conducted in the UK, noted a survival benefit with the use of dexamethasone in hospitalized patients with coronavirus disease 2019 (COVID-19).1 The use of dexamethasone for management of COVID-19 has already increased, particularly given the recent National Institutes of Health COVID-19 Treatment Panel guidelines that recommend its use.

July 29, 2020

Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US

There was a temporal association between statewide school closure and lower COVID-19 incidence and mortality, although some of the reductions may have been related to other concurrent nonpharmaceutical interventions.

Reopening K-12 Schools During the COVID-19 Pandemic -- A Report From the National Academies of Sciences, Engineering, and Medicine

The coronavirus disease 2019 (COVID-19) pandemic has presented unprecedented challenges to the nation’s kindergarten-grade 12 education system. The rush to respond to the pandemic led to closures of school buildings across the country, with little time to ensure continuity of instruction or to create a framework for deciding when and how to reopen schools. States and school districts are now grappling with the complex questions of whether and how to reopen school buildings in the context of rapidly changing patterns of community spread.

Comparison of Face-Touching Behaviors Before and During the Coronavirus Disease 2019 Pandemic

These findings suggest that mandatory mask-wearing policies were associated with reducing face-touching behavior among the general population in public areas, which may help to prevent contact transmission of COVID-19.

Reopening Primary Schools during the Pandemic

For the past 6 months, policymakers and the U.S. public have weighed economic against public health considerations in debating what limits to set on individual and collective behaviors in attempting to control the Covid-19 pandemic. As fall approaches, attention has turned to a third pillar of a pandemic-resilient society: schools.

Public Health Decision Making during Covid-19 — Fulfilling the CDC Pledge to the American People

In May 2020, the Centers for Disease Control and Prevention (CDC) released considerations for the opening of elementary and high schools. opens in new tab in the fall in light of the Covid-19 pandemic. The agency also developed a decision tool. opens in new tab to guide school systems in deciding when schools should be opened and a 9-page checklist. opens in new tab for school administrators with policies and procedures, facilities and supplies, and education and training needed for safe reopening of schools.

July 28, 2020

Comparison of Weighted and Unweighted Population Data to Assess Inequities in Coronavirus Disease 2019 Deaths by Race/Ethnicity Reported by the US Centers for Disease Control and Prevention

Surveillance and mortality data show large inequities in the impact of coronavirus disease 2019 (COVID-19) by race/ethnicity. Currently, the US Centers for Disease Control and Prevention (CDC) does not report mortality rates by race/ethnicity. Instead, the percentage distribution of COVID-19 deaths by race/ethnicity is presented alongside a weighted distribution of the population from the CDC’s National Center for Health Statistics, which weights each county’s population by its share of COVID-19 deaths, not population.

Assessment of Community-Level Disparities in Coronavirus Disease 2019 (COVID-19) Infections and Deaths in Large US Metropolitan Areas

While the excess burden of both infections and deaths was experienced by poorer and more diverse areas, racial and ethnic disparities in COVID-19 infections and deaths existed beyond those explained by differences in income. Lack of access to disaggregated data precludes us from further exploring causal mechanisms, such as structural racism or other social drivers. Studies that leverage community information with individual-level health data are likely to provide additional insights.

July 27,2020

Characteristics and Strength of Evidence of COVID-19 Studies Registered on

The coronavirus disease 2019 (COVID-19) pandemic has led to a massive activation of clinical research. The methodological strength of these studies is not well characterized but has implications for the quality of evidence produced. We evaluated the characteristics and expected strength of evidence of COVID-19 studies registered on

Illness-Related Work Absence in Mid-April Was Highest on Record

Our findings shed light on the combined health and economic effects of the COVID-19 pandemic, particularly for immigrant, older, and less-educated workers. Finally, our study suggests that routinely collected CPS data on work absence may provide a rapidly available tool for surveillance of the effect of public health crises on the workforce.

Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.

Estimation of Viral Aerosol Emissions From Simulated Individuals With Asymptomatic to Moderate Coronavirus Disease 2019

In this mathematical modeling study, breathing and coughing by a simulated individual with COVID-19 were estimated to release large numbers of viruses in a poorly ventilated room with a coughing person. However, the estimated infectious risk posed by a person with typical viral load who breathes normally was low, and only few people with very high viral load posed an infection risk in a poorly ventilated closed environment.

Prevalence of SARS-CoV-2 Infection Among Asymptomatic Health Care Workers in the Greater Houston, Texas, Area

Asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a major public health concern. Health care workers (HCWs) are at higher risk of infection and can become inadvertent vehicles of transmission. Therefore, Houston Methodist initiated a coronavirus disease 2019 (COVID-19) surveillance program among asymptomatic HCWs and expanded to asymptomatic community residents. We report prevalence of SARS-CoV-2 among the first group tested.

July 26, 2020

Evaluation of the mRNA-1273 Vaccine against SARS-CoV-2 in Nonhuman Primates

Vaccines to prevent coronavirus disease 2019 (Covid-19) are urgently needed. The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines on viral replication in both upper and lower airways is important to evaluate in nonhuman primates.

July 24, 2020

Estimated County-Level Prevalence of Selected Underlying Medical Conditions Associated with Increased Risk for Severe COVID-19 Illness — United States, 2018

The median model-based estimate of the prevalence of any of five underlying medical conditions associated with increased risk for severe COVID-19–associated illness among U.S. adults was 47.2% among 3,142 U.S. counties. The estimated number of persons with these conditions followed population distributions, but prevalence was higher in more rural counties.

Population Point Prevalence of SARS-CoV-2 Infection Based on a Statewide Random Sample — Indiana, April 25–29, 2020

The number of reported cases represents an estimated one of 10 infections. Given that many persons in Indiana remain susceptible, adherence to evidence-based public health mitigation measures (e.g., social distancing, consistent and correct use of face coverings, and hand hygiene) is needed to reduce surge in hospitalizations and prevent morbidity and mortality from COVID-19.

Estimated Community Seroprevalence of SARS-CoV-2 Antibodies — Two Georgia Counties, April 28–May 3, 2020

Serologic surveillance can complement case-based and syndromic surveillance. At the time of this survey, most of the two-county population had not been previously infected with SARS-CoV-2, highlighting the importance of continued mitigation measures to prevent infection, including social distancing, consistent and correct use of face coverings, and hand hygiene.

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.

Presence of Genetic Variants Among Young Men With Severe COVID-19

In a case series that included 4 young male patients with severe COVID-19 from 2 families, rare loss-of-function variants of the X-chromosomal TLR7 were identified, with immunological defects in type I and II interferon production.

July 23, 2020

Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19

Hydroxychloroquine and azithromycin have been used to treat patients with coronavirus disease 2019 (Covid-19). However, evidence on the safety and efficacy of these therapies is limited.

July 22, 2020

Rapid Scaling Up of Covid-19 Diagnostic Testing in the United States — The NIH RADx Initiative

The first reports of an unusual cluster of pneumonia cases in the city of Wuhan, China, emerged in December 2019, heralding a global pandemic. As of July 13, 2020, more than 3.3 million U.S. residents have received a diagnosis of coronavirus disease 2019 (Covid-19), and more than 135,000 have died.

Pooling Data From Individual Clinical Trials in the COVID-19 Era

The rapid pace of the coronavirus disease 2019 (COVID-19) pandemic caused many research efforts to be initiated quickly. In some cases, nationally based platform trials have begun to report results.1 More frequently, however, randomized clinical trials (RCTs) were launched in local settings and in several cases missed the peak of the pandemic in their region.

The Advisory Committee on Immunization Practices and Its Role in the Pandemic Vaccine Response

More than 3.7 million infections and more than 140 000 deaths due to coronavirus disease 2019 (COVID-19) have occurred in the US in the past 6 months. As case counts continue to increase, robust vaccine development efforts unprecedented in scale and speed are being pursued.

July 21, 2020

Rapid Decay of Anti–SARS-CoV-2 Antibodies in Persons with Mild Covid-19

A recent article suggested the rapid decay of anti–SARS-CoV-2 IgG in early infection,1 but the rate was not described in detail. We evaluated persons who had recovered from Covid-19 and referred themselves to our institution for observational research. Written informed consent was obtained from all the participants, with approval by the institutional review board.

Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020

For most sites, it is likely that greater than 10 times more SARS-CoV-2 infections occurred than the number of reported COVID-19 cases; most persons in each site, however, likely had no detectable SARS-CoV-2 antibodies.

Population Point Prevalence of SARS-CoV-2 Infection Based on a Statewide Random Sample — Indiana, April 25–29, 2020

In a random sample of Indiana residents aged ≥12 years, the estimated prevalence of current or previous SARS-CoV-2 infection in late April 2020 was 2.79%. Among persons with active infection, 44% reported no symptoms.

Estimated Community Seroprevalence of SARS-CoV-2 Antibodies — Two Georgia Counties, April 28–May 3, 2020

A community seroprevalence survey, conducted in two counties in metropolitan Atlanta during April 28–May 3, using a two-stage cluster sampling design and serologic testing, estimated that 2.5% of the population had antibodies to SARS-CoV-2.

Autopsies reveal surprising cardiac changes in COVID-19 patients

A series of autopsies conducted by LSU Health New Orleans pathologists shows the damage to the hearts of COVID-19 patients is not the expected typical inflammation of the heart muscle associated with myocarditis, but rather a unique pattern of cell death in scattered individual heart muscle cells.

COVID-19 patient autopsies reveal surprising results in LSU

“We identified key gross and microscopic changes that challenge the notion that typical myocarditis is present in severe SARS-CoV-2 infection,” says Dr. Richard Vander Heide, Professor and Director of Pathology Research at LSU Health New Orleans School of Medicine. “While the mechanism of cardiac injury in COVID-19 is unknown, we propose several theories that bear further investigation that will lead to greater understanding and potential treatment interventions.”

Autopsies by LSU Health pathologists show surprising cardiac changes in COVID-19 patients

A series of autopsies conducted by LSU Health New Orleans pathologists shows the damage to the hearts of COVID-19 patients is not the expected typical inflammation of the heart muscle associated with myocarditis, but rather a unique pattern of cell death in scattered individual heart muscle cells.

July 20, 2020

Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System

Patients with coronavirus disease 2019 (COVID-19) are at increased risk of thrombosis.1 However, studies have been limited in size, did not report all thrombotic events, and focused on patients with severe disease hospitalized in intensive care units (ICUs). We assessed the incidence of, and risk factors for, venous and arterial thrombotic events in all hospitalized patients with COVID-19 at a large health system consisting of 4 hospitals in New York City.

Ketoacidosis in Children and Adolescents With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic in Germany

During the coronavirus disease 2019 (COVID-19) pandemic, a significantly lower rate of health care use has been reported, potentially leading to delayed medical care. Diabetic ketoacidosis is an acute life-threatening complication of a delayed diagnosis of type 1 diabetes.

July 17, 2020

Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (

Research in the Context of a Pandemic

The current literature on the treatment of coronavirus disease 2019 (Covid-19) is filled with anecdotal reports of therapeutic successes in clinical trials with small numbers of patients and observational cohort studies claiming efficacy with little regard to the effect of unrecognized confounders. For the field to move forward and for patients’ outcomes to improve, there will need to be fewer small or inconclusive studies and more studies such as the dexamethasone trial now reported by the RECOVERY Collaborative Group in the Journal.

July 16, 2020

Dressing Up

When the dread starts to set in, when it gets hard to breathe, I adjust my N95 mask and remind myself of this: I am the granddaughter of a man who worked the depths of Idaho mines and knew a thing or two about personal protective equipment (PPE) hell.

July 15, 2020

What Is the Burden of Excess Deaths Due to COVID-19 in the U.S.?

Estimating excess deaths suggests that mortality related to COVID-19 has been undercounted.

Hydroxychloroquine as Postexposure Prophylaxis for Covid-19

The window for postexposure prophylaxis against Covid-19 is narrow. Therapy that is initiated up to 4 days after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is early treatment, not postexposure prophylaxis. The trial described in the article by Boulware et al. (published online on June 3 at was therefore largely about the prevention of symptoms in persons who may already have been infected.

July 14, 2020

Risk Factors for Death from COVID-19 in a Cohort of 17 Million People

Those more likely to die with COVID-19 were older, male, had various medical conditions and socioeconomic deprivation, and — disturbingly — were members of a racial or ethnic minority.

Studies Show Importance of Face Coverings in Limiting Spread of COVID-19

A trio of studies takes a closer look at face mask use in the U.S.

Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now

In this issue of JAMA, Wang et al present evidence that universal masking of health care workers (HCWs) and patients can help reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.1 In the largest health care system in Massachusetts with more than 75 000 employees, in tandem with routine symptom screening and diagnostic testing of symptomatic HCWs for SARS-CoV-2 infection, leadership mandated a policy of universal masking for all HCWs as well as for all patients.

An mRNA Vaccine against SARS-CoV-2 — Preliminary Report

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in late 2019 and spread globally, prompting an international effort to accelerate development of a vaccine. The candidate vaccine mRNA-1273 encodes the stabilized prefusion SARS-CoV-2 spike protein.

The Covid-19 Vaccine-Development Multiverse

Leaving in its wake more than 12 million infections, over 550,000 deaths, and an economic toll in the trillions of dollars to date, the SARS-CoV-2 pandemic has devastated the most vulnerable in our society — adults 65 years of age or older, persons with underlying conditions, and the economically deprived. A vaccine is urgently needed to prevent Covid-19 and thereby stem complications and deaths resulting from transmission of the disease.

Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has severely affected health care workers (HCWs). As a result, hospital systems began testing HCWs and implementing infection control measures to mitigate workforce depletion and prevent disease spread.

Evidence-Based Practice for Public Health Emergency Preparedness and Response

The coronavirus disease 2019 (COVID-19) pandemic has brought national attention to the importance of the work of state, local, tribal, and territorial public health agencies in protecting and securing the nation’s health. These agencies are routinely making difficult decisions about how to respond effectively to COVID-19, such as implementing nonpharmaceutical interventions and addressing the needs of at-risk populations.

Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020

As stay-at-home orders are lifted, professional and social interactions in the community will present more opportunities for spread of SARS-CoV-2. Broader implementation of face covering policies could mitigate the spread of infection in the general population.

Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic — United States, April and May 2020

Public health messages should target audiences not wearing cloth face coverings and reinforce positive attitudes, perceived norms, personal agency, and physical and health benefits of obtaining and wearing cloth face coverings consistently and correctly.

July 13, 2020

Critical Insights from Patients during the Covid-19 Pandemic

As health care systems look to resume normal operations during the Covid-19 pandemic, we must understand why patients are concerned about seeking care. This understanding will help guide strategies to ensure patient safety. In a survey of more than 1,300 patients at Vanderbilt University Medical Center, they said their biggest fear in returning to routine health care is the risk of getting sick from other patients.

A Mutation in SARS-CoV-2 Spike Protein Is Associated with Increased Infectivity

Virus with a spike protein variant, G614, spread rapidly worldwide and reached higher titers than virus with the original D614 protein.

Airborne Transmission of SARS-CoV-2

The coronavirus disease 2019 (COVID-19) pandemic has reawakened the long-standing debate about the extent to which common respiratory viruses, including the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are transmitted via respiratory droplets vs aerosols.

Communicating Science in the Time of a Pandemic

During the global SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, disseminating study findings (such as by preprints, news releases, news stories, or social media) and publishing the results of studies of testing and treatment in scientific journals increased quickly. As of July 6, a PubMed search for COVID-19 yielded almost 30 000 reports.

July 9, 2020

Audio Interview: Acute Lung Injury in Covid-19

The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal.

Persistent Symptoms in Patients After Acute COVID-19

In Italy, a large proportion of patients with coronavirus disease 2019 (COVID-19) presented with symptoms (71.4% of 31 845 confirmed cases as of June 3, 2020).1 Common symptoms include cough, fever, dyspnea, musculoskeletal symptoms (myalgia, joint pain, fatigue), gastrointestinal symptoms, and anosmia/dysgeusia.2-4 However, information is lacking on symptoms that persist after recovery. We assessed persistent symptoms in patients who were discharged from the hospital after recovery from COVID-19.

July 8, 2020

The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings

Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders.

Challenges Estimating Total Lives Lost in COVID-19 Decisions

The coronavirus disease 2019 (COVID-19) pandemic has claimed hundreds of thousands of lives, directly and indirectly, and threatens to claim many more. Nations have made different policy decisions that have affected the rate of infection, mortality, the economy, and the life of the country differently.

July 7, 2020

Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities ― United States, April–May 2020

Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19–associated occupational risk and health disparities among vulnerable populations.

July 6, 2020

The Disproportionate Impact of Covid-19 on Communities of Color

Racism, cultural mistrust, miscommunication, chronic illness bred by limited food and living choices, and lived experience bind together communities of color as disparate as the Navajo Nation and Chelsea, Massachusetts. Why are we surprised? Because we are complacent.

On the Resources for the Public Page, at the top of the left column:

Gov. Edwards Orders Statewide Mask Mandate, Closes Bars to On Premises Consumption as COVID-19 Continues to Spread Across Louisiana

Today, Gov. John Bel Edwards announced a mandatory mask requirement for Louisiana and ordered bars in the state closed to on-premises consumption, as the state experiences increasing spread of COVID-19. The Governor also limited indoor social gatherings like wedding receptions, class reunions and parties to 50 total people. With these additional restrictions, Louisiana remains in Phase Two of the Roadmap for a Resilient Louisiana.

On the Resources for LSU Health New Orleans Page, at the top of the left column:

Gov. Edwards Orders Statewide Mask Mandate, Closes Bars to On Premises Consumption as COVID-19 Continues to Spread Across Louisiana

Today, Gov. John Bel Edwards announced a mandatory mask requirement for Louisiana and ordered bars in the state closed to on-premises consumption, as the state experiences increasing spread of COVID-19. The Governor also limited indoor social gatherings like wedding receptions, class reunions and parties to 50 total people. With these additional restrictions, Louisiana remains in Phase Two of the Roadmap for a Resilient Louisiana.

Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level.

It is Time to Address Airborne Transmission of COVID-19

We  appeal  to  the  medical  community  and  to  the  relevant  national  and  international  bodies  to recognize the potential for airborne spread of COVID-19. There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission.

Developing a SARS-CoV-2 Vaccine at Warp Speed

With this background, the US Department of Health and Human Services (HHS) launched Operation Warp Speed—a partnership between government and industry—with the goal of delivering 300 million doses of a safe and effective vaccine by January 2021.3 This ambitious plan initially focused on 125 potential vaccine candidates, but was rapidly narrowed to 14 candidates in May 2020, and, as reported in June 2020, the current administration plans to narrow this list to 5 core candidates.

The Development of COVID-19 Vaccines

A safe and effective vaccine against coronavirus disease 2019 (COVID-19) is the best way to control and ultimately end the pandemic. Vaccine development is moving at unprecedented speed, with more than 200 candidates, billions of dollars committed, and manufacturing often proceeding before even knowing whether a given vaccine candidate will succeed.

June 30, 2020

Characteristics of Adult Outpatients and Inpatients with COVID-19 — 11 Academic Medical Centers, United States, March–May 2020

Case investigation, contact tracing, and isolation of infected persons are needed to prevent ongoing community transmission, given the frequent lack of a known contact. Enhanced measures to ensure workplace safety, including social distancing and more widespread use of cloth face coverings, are warranted.

Finding Antibodies that Neutralize SARS-CoV-2

It’s now clear that nearly everyone who recovers from coronavirus disease 2019 (COVID-19) produces antibodies that specifically target SARS-CoV-2, the novel coronavirus that causes the infection. Yet many critical questions remain. A major one is: just how well do those particular antibodies neutralize the virus to fight off the infection and help someone recover from COVID-19? Fortunately, most people get better—but should the typical antibody response take the credit?

June 29, 2020

Serial Laboratory Testing for SARS-CoV-2 Infection Among Incarcerated and Detained Persons in a Correctional and Detention Facility — Louisiana, April–May 2020

Early detection and isolation of persons with COVID-19, along with testing of close contacts, can slow the transmission of SARS-CoV-2 in correctional and detention facilities. Serial testing, particularly for close contacts of patients, is important for complete identification of cases and prompt public health response in congregate settings.

Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)

Multisystem Inflammatory Syndrome in Children in New York State

The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.

Childhood Multisystem Inflammatory Syndrome — A New Challenge in the Pandemic

The recognition and description of new diseases often resemble the parable of the blind men and the elephant, with each declaring that the part of the beast they have touched fully defines it. As the coronavirus disease 2019 (Covid-19) pandemic has evolved, case reports have appeared describing children with unusual febrile illnesses that have features of Kawasaki’s disease, toxic shock syndrome, acute abdominal conditions, and encephalopathy, along with other reports of children with fever, elevated inflammatory markers, and multisystem involvement. It is now apparent that these reports were describing different clinical presentations of a new childhood inflammatory disorder.

Cognitive Bias and Public Health Policy During the COVID-19 Pandemic

As the coronavirus disease 2019 (COVID-19) pandemic abates in many countries worldwide, and a new normal phase arrives, critically assessing policy responses to this public health crisis may promote better preparedness for the next wave or the next pandemic. A key lesson is revealed by one of the earliest and most sizeable US federal responses to the pandemic: the investment of $3 billion to build more ventilators. These extra ventilators, even had they been needed, would likely have done little to improve population survival because of the high mortality among patients with COVID-19 who require mechanical ventilation and diversion of clinicians away from more health-promoting endeavors.

Taking a Closer Look at COVID-19, Health Inequities, and Racism

Meanwhile, the COVID-19 crisis also revealed the nation’s eroding public health readiness, according to Murray, an adjunct assistant professor at the University of Illinois at Chicago School of Public Health and a past president of the American Public Health Association.

June 26, 2020

Infectability of human BrainSphere neurons suggests neurotropism of SARS-CoV-2

Reports from Wuhan suggest that 36% of COVID-19 patients show neurological symptoms, and cases of viral encephalitis have been reported, suggesting that the virus is neurotropic under unknown circumstances. This is well established for other coronaviruses.

Editorial Evaluation and Peer Review During a Pandemic

Concerns have been raised about how journals maintain their standards during the current coronavirus disease 2019 (COVID-19) pandemic, given the rapid pace and unprecedented volume of research being conducted in such a short time, and the large number of reports submitted to journals.

June 25, 2020

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.

Covid-19 and the Need for Health Care Reform

The Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care. Although all aspects of U.S. health care will face incredible challenges in the coming months, the patchwork way we govern and pay for health care is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.

June 24, 2020

COVID-19 Outbreak Among College Students After a Spring Break Trip to Mexico — Austin, Texas, March 26–April 5, 2020

A coordinated response with contact tracing and testing of all contacts, including those who are asymptomatic, is important in controlling future COVID-19 outbreaks that might occur as schools and universities consider reopening.

Mortality, Admissions, and Patient Census at SNFs in 3 US Cities During the COVID-19 Pandemic

Mortality from coronavirus disease 2019 (COVID-19) is disproportionately concentrated in skilled nursing facilities (SNFs). As of June 18, 2020, 50 185 residents died of COVID-19 in the 41 states reporting deaths at SNFs, accounting for 45% of their total COVID-19 deaths statewide.

A Proposed Lottery System to Allocate Scarce COVID-19 Medications

These problems are not specific to remdesivir or to the current pandemic: governments and health systems will predictably encounter situations during pandemics in which novel therapeutics are in short supply and knowledge about their harms and benefits is limited.

Missed Opportunities on Emergency Remdesivir Use

In the case of remdesivir, the decision to grant an EUA followed the release of a summary interim finding of shorter time to recovery among patients treated with the drug in a National Institute of Allergy and Infectious Diseases (NIAID)–funded phase 3 placebo-controlled clinical trial.

June 23, 2020

A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2

Despite various levels of preventive measures, in 2020 many countries have suffered severely from the coronavirus 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. We show that population heterogeneity can significantly impact disease-induced immunity as the proportion infected in groups with the highest contact rates is greater than in groups with low contact rates.

Plans and Pandemics

It was the first week of my oncology fellowship, and Dr. E., a senior fellow, was handing his patients over to me, as he was shifting from clinical work to research. He had emailed signout the night before, but this in-person meeting communicated all the nuance that a spreadsheet lacked — how Mr. R., for example, liked his chemotherapy scheduled around calving season. Having been a medicine resident just a week earlier, I knew minimal oncology. But this meeting was not about the science. It was about the stories.

June 22, 2020

Using influenza surveillance networks to estimate state-specific prevalence of SARS-CoV-2 in the United States

Detection of SARS-CoV-2 infections to date has relied heavily on RT-PCR testing. However, limited test availability, high false-negative rates, and the existence of asymptomatic or sub-clinical infections have resulted in an under-counting of the true prevalence of SARS-CoV-2.

Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions — United States, January–May 2020

In the 10 weeks following declaration of the COVID-19 national emergency, ED visits declined 23% for heart attack, 20% for stroke, and 10% for hyperglycemic crisis.

June 18, 2020

Challenges of “Return to Work” in an Ongoing Pandemic

As economic and political pressure has built to relax “shelter in place” public health orders for control of coronavirus disease 2019 (Covid-19), industry, professional service firms, retail and service establishments, and educational institutions seek to establish norms that protect workers, customers, clients, students, and visitors. A public health order represents a minimum disease-prevention standard, adherence to which is not elective, but may not satisfy all legal requirements with respect to the personal safety of workers and others.

Association between high serum total cortisol concentrations and mortality from COVID-19

Physiological stress from critical illness and elective surgery increases serum cortisol concentrations and bioavailability by activation of the hypothalamic–pituitary–adrenal axis, decreased metabolism of cortisol, and a reduction in the amount of binding proteins (eg, cortisol-binding globulin).

Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections

These data suggest that asymptomatic individuals had a weaker immune response to SARS-CoV-2 infection. The reduction in IgG and neutralizing antibody levels in the early convalescent phase might have implications for immunity strategy and serological surveys.

June 17, 2020

Genomewide Association Study of Severe Covid-19 with Respiratory Failure

We identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.)

June 15, 2020

Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020

As of May 30, 2020, among COVID-19 cases, the most common underlying health conditions were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported.

Hospital-Wide SARS-CoV-2 Antibody Screening in 3056 Staff in a Tertiary Center in Belgium

Belgium has a high burden of coronavirus disease 2019 (COVID-19), especially the region surrounding the Hospital East-Limburg, a tertiary care center.1 Infection prevention measures were instituted in the hospital beginning March 4, 2020, including testing and contact tracing of all symptomatic patients and staff, changes in hospital operations, and provision of personal protective equipment (PPE). The first case was detected March 13 (Figure 1). We investigated the prevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among hospital staff.

Monoclonal Antibodies for Prevention and Treatment of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has created a worldwide crisis and inspired an urgent search for prevention and treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Attention has focused on the development of vaccines, new antiviral agents, and convalescent plasma infusions. Monoclonal antibodies have received less attention even though neutralizing antibodies are a key component of protective immunity for most viral diseases. Neutralizing monoclonal antibodies to SARS-CoV-2 have the potential for both therapeutic and prophylactic applications, and can help to guide vaccine design and development.

June 13, 2020

COVID-19 vaccines for all?

The   third   replenishment   meeting   for   Gavi,   the   Vaccine   Alliance,   on  June  4,  which  raised  a  record  US$8·8  billion  for  the  next  5  years,  was overshadowed by the COVID-19 global  pandemic  and  the  burning  question  of  how  to  ensure  equita-ble   access   to   any   vaccines   that   become   available.  

June 11, 2020

The Dual Epidemics of COVID-19 and Influenza

The health system, and wider society, must prepare for the likelihood of co-epidemics of COVID-19 and influenza. What are the most effective strategies for increasing influenza vaccine coverage across the population and particularly in schools, businesses, and hospitals? Should states or businesses require vaccinations? Influenza vaccination, moreover, could offer valuable lessons for ensuring vaccine acceptance and uptake when COVID-19 vaccines become available.

June 10, 2020

The Importance of Proper Death Certification During the COVID-19 Pandemic

Death certificate data are used to monitor local, regional, and national mortality trends to improve public health and public safety. Accurate death certification related to coronavirus disease 2019 (COVID-19) is vital to understand the extent and progression of the pandemic.

Sustaining Rural Hospitals After COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is a financial stress test for US hospitals.1,2 Revenues have declined from the suspension of elective procedures and nonessential services, and many hospitals have experienced a surge of critically ill patients.

June 8, 2020

Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City

Severe coronavirus disease 2019 (COVID-19) has been reported rarely in children.1,2 International data suggest the development of a proinflammatory syndrome with features of Kawasaki disease (KD) or toxic shock syndrome (TSS) in children, possibly related to COVID-19.

Association Between Mode of Delivery Among Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain

Data from China found severe complications in 8% of pregnant women with coronavirus disease 2019 (COVID-19).1 However, the high rate of cesarean deliveries (>90%) in Chinese reports is concerning,2 and whether mode of delivery is associated with maternal complications or neonatal transmission is unknown.3 We assessed births to women with COVID-19 by mode of delivery.

Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2

These findings help characterize the clinical features of hospitalized, seriously ill children with PIMS-TS and provide insights into this apparently novel syndrome.

June 5, 2020

False Negative Tests for SARS-CoV-2 Infection — Challenges and Implications

There is broad consensus that widespread SARS-CoV-2 testing is essential to safely reopening the United States. A big concern has been test availability, but test accuracy may prove a larger long-term problem.

Waiting for Certainty on Covid-19 Antibody Tests — At What Cost?

Governments around the world and throughout the United States are beginning to “reopen their economies” in stages. Some have been considering the use of serologic antibody testing to screen for possible immunity and to identify people who could return to the workplace with less severe mitigation measures or be assigned to higher-exposure tasks. Although availability of antibody tests is lagging and successful mitigation has kept seroprevalence too low to rely fully on positive test results, at some point in the near future antibody testing will become a viable option. This idea is not without its critics.

June 4, 2020

Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2007621.

Because all the authors were not granted access to the raw data and the raw data could not be made available to a third-party auditor, we are unable to validate the primary data sources underlying our article, “Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19.”

June 3, 2020

Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study

The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.

June 1, 2020

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.

Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection

Although clear evidence of person-to-person airborne transmission of SARS-CoV-2 has not been published, an airborne component of transmission is likely based on other respiratory viruses such as SARS, Middle East respiratory syndrome, and influenza. While air sampling for SARS-CoV-2, in a clinical setting, has demonstrated detectable viral RNA, the extent of transmission resulting from airborne particles relative to large respiratory droplets, directly and on surfaces, is not yet known.

The Urgency and Challenge of Opening K-12 Schools in the Fall of 2020

Reopening schools this fall is an urgent national priority. To achieve this goal as safely as possible and reduce the chances that schools are required to close again, policy makers at every level should consider embracing a framework with these 6 components.

May 29, 2020

A COVID-19 vaccine has passed its first human trial. But is it the frontrunner?

A promising coronavirus vaccine candidate cleared a key hurdle this week, when Moderna Therapeutics entered phase two of clinical trials. The move signals that the company’s mRNA vaccine has passed its initial safety checks and has met an important milestone in bringing this drug closer to the public and commercial markets.

May 28, 2020

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.

COVID-19: in the footsteps of Ernest Shackleton

We describe what we believe is the first instance of complete COVID-19 testing of all passengers and crew on an isolated cruise ship during the current COVID-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription–PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.

May 27, 2020

Reducing transmission of SARS-CoV-2

Respiratory infections occur through the transmission of virus-containing droplets (>5 to 10 μm) and aerosols (≤5 μm) exhaled from infected individuals during breathing, speaking, coughing, and sneezing. Traditional respiratory disease control measures are designed to reduce transmission by droplets produced in the sneezes and coughs of infected individuals. However, a large proportion of the spread of coronavirus disease 2019 (COVID-19) appears to be occurring through airborne transmission of aerosols produced by asymptomatic individuals during breathing and speaking.

How can airborne transmission of COVID-19 indoors be minimised?

Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.

Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans

Important findings include the presence of thrombosis and microangiopathy in the small vessels and capillaries of the lungs, with associated haemorrhage, that significantly contributed to death. Features of diffuse alveolar damage, including hyaline membranes, were present, even in patients who had not been ventilated. Cardiac findings included individual cell necrosis without lymphocytic myocarditis. There was no evidence of secondary pulmonary infection by microorganisms.

Comparison of Clinical Characteristics of Patients with Asymptomatic vs Symptomatic Coronavirus Disease 2019 in Wuhan, China

Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019 and has spread globally with sustained human-to-human transmission outside China.1,2 To control the spread of COVID-19 and isolate patients as early as possible, the Chinese government requested that close contacts of individuals with COVID-19 must be screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. During the screening process, we found some patients whose test results were positive for SARS-CoV-2 but who had no symptoms or signs throughout the course of the disease.

May 26, 2020

One Key Factor in whether COVID-19 Will Wane This Summer

So far, scientists have identified at least nine distinct viruses that can cause respiratory tract infection and that express seasonality in their outbreak pattern in temperate regions. Of these, three viruses—influenza, human coronavirus and human respiratory syncytial virus (RSV) – clearly peak during winter months.

Prevalence of SARS-CoV-2 Among Patients Admitted for Childbirth in Southern Connecticut

Developing an approach to care for pregnancy and childbirth during the coronavirus disease 2019 (COVID-19) crisis is a priority to (1) provide safe care to pregnant women and newborns; and (2) protect health care workers from infection. A study conducted in New York City reported a 13.5% prevalence of asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in women presenting for childbirth.1 On March 30, 2020, an initially asymptomatic woman admitted to the Yale New Haven Health system developed cough and fever soon after childbirth; testing confirmed SARS-CoV-2 infection. This event prompted the development of a SARS-CoV-2 screening and testing program of patients presenting for childbirth; we report the prevalence detected in the first weeks of the program.

Adverse Consequences of Rushing a SARS-CoV-2 Vaccine

As the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic persists across the US and the world, the spotlight on vaccine science has never been more intense. Researchers across the globe are working rapidly to produce a potential vaccine, and 7 candidates are already in clinical trials. Operation Warp Speed, the vaccine development project announced by President Trump, has advocated for a vaccine to be made available in the US by the beginning of 2021. But for scientists and physicians, the term “warp speed” should trigger concern. Good science requires rigor, discipline, and deliberate caution. Any medical therapy approved for public use in the absence of extensive safeguards has the potential to cause harm, not only for COVID-19 prevention efforts and vaccine recipients, but also for public trust in vaccination efforts worldwide.

May 25, 2020

COVID-19-associated hyperviscosity: a link between inflammation and thrombophilia?

Reports of thrombotic complications in patients with COVID-19 are increasingly prominent, and these reports include patients receiving therapeutic anticoagulation.At our institution, multiple occurrences of anticoagulation failure prompted us to search for alternative aetiologies contributing to refractory hypercoagulability.

May 22, 2020

Remdesivir for the Treatment of Covid-19 — Preliminary Report

Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious.

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.

Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach

Physical distancing, hand hygiene, and disinfection of surfaces are the cornerstones of infection control during the coronavirus disease 2019 (COVID-19) pandemic. At the same time, governments, international agencies, policymakers, and public health officials have been debating the validity of recommending use of nonmedical masks by the general public to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We believe that these decisions should be informed by evidence.

Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial

A vaccine to protect against COVID-19 is urgently needed. We aimed to assess the safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 (Ad5) vectored COVID-19 vaccine expressing the spike glycoprotein of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain.

Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans — Los Angeles, California, 2020

After identification of two cases of COVID-19 in an SNF in Los Angeles, universal, serial reverse transcription–polymerase chain reaction (RT-PCR) testing of residents and staff members aided in rapid identification of additional cases and isolation and cohorting of these residents and interruption of transmission in the facility.

Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020

On March 13, 2020, the United States declared a national state of emergency to control the pandemic spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) . Public health response measures to mitigate the pandemic have centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders.

High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020

Faith-based organizations should work with local health officials to determine how to implement the U.S. Government guidelines for modifying activities during the COVID-19 pandemic to prevent transmission of the virus to their members and their communities.

May 21, 2020

Enlisting Monoclonal Antibodies in the Fight Against COVID-19

We now know that the immune system of nearly everyone who recovers from COVID-19 produces antibodies against SARS-CoV-2, the novel coronavirus that causes this easily transmitted respiratory disease [1]. The presence of such antibodies has spurred hope that people exposed to SARS-CoV-2 may be protected, at least for a time, from getting COVID-19 again. But, in this post, I want to examine another potential use of antibodies: their promise for being developed as therapeutics for people who are sick with COVID-19.

Postmortem Examination of Patients With COVID-19

Approximately 15% of individuals affected by coronavirus disease 2019 (COVID-19) develop severe disease, and 5% to 6% are critically ill (respiratory failure and/or multiple organ dysfunction or failure).1,2 Severely ill and critically ill patients have a high mortality rate, especially with older age and coexisting medical conditions. Because there are still insufficient data on cause of death, we describe postmortem examinations in a case series of patients with COVID-19.

Coronavirus Antibody Tests—What They Tell Us


Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.

Covid-19, Angiogenesis, and ARDS Endotypes

The SARS-CoV-2 pandemic has inspired new interest in understanding the fundamental pathology of acute respiratory distress syndrome (ARDS), which has been associated with severe coronavirus disease 2019 (Covid-19). ARDS has long been recognized to be remarkably heterogeneous, with not only a wide range of causes but also a broad spectrum of severity, abnormalities on imaging, and gas-exchange impairment. The form of ARDS that is associated with Covid-19 is no different.

May 20, 2020

Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults

Children account for less than 2% of identified cases of coronavirus disease 2019 (COVID-19).1,2 It is hypothesized that the lower risk among children is due to differential expression of angiotensin-converting enzyme 2 (ACE2),3 the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for host entry.4 We investigated ACE2 gene expression in the nasal epithelium of children and adults.

May 19, 2020

Personal Protective Equipment and Covid-19

Given the threat of coronavirus disease 2019, or Covid-19, it is important to emphasize the use of proper precautions for infection control in health care settings. Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, is the virus that causes Covid-19.

The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction

During the Covid-19 pandemic, reports have suggested a decrease in the number of patients presenting to hospitals because of emergency conditions such as acute myocardial infarction.

Renin–Angiotensin–Aldosterone System Inhibitors in Covid-19

In their Special Report, Vaduganathan and colleagues (April 23 issue)1 describe the use of renin–angiotensin–aldosterone system (RAAS) inhibitors in patients with coronavirus disease 2019 (Covid-19).

May 18, 2020

Silent COVID-19: what your skin can reveal

Clinical manifestations of coronavirus disease 2019 (COVID-19) are rare or absent in children and adolescents hence, early clinical detection is fundamental to prevent further spreading. We report three young patients presenting with chilblain-like lesions who were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Seroprevalence of SARS-CoV-2–Specific Antibodies Among Adults in Los Angeles County, California, on April 10-11, 2020

Inadequate knowledge about the extent of the coronavirus disease 2019 (COVID-19) epidemic challenges public health response and planning. Most reports of confirmed cases rely on polymerase chain reaction–based testing of symptomatic patients.1 These estimates of confirmed cases miss individuals who have recovered from infection, with mild or no symptoms, and individuals with symptoms who have not been tested due to limited availability of tests.

Planning for a COVID-19 Vaccination Program

The long-term solution to the coronavirus disease 2019 (COVID-19) pandemic, hopefully, will be a globally implemented, safe vaccination program that has broad clinical and socioeconomic benefits. Dozens of vaccines are in development, with 8 currently in phase 1 trials. Some scenarios predict the earliest, widespread availability of a COVID-19 vaccine to be in 2021.

Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)

It has been more than a century since the world has encountered a pandemic like coronavirus disease 2019 (COVID-19), and the rate of spread of COVID-19 around the globe and the associated morbidity and mortality have been staggering.

Implications for Telehealth in a Postpandemic Future

The coronavirus disease 2019 (COVID-19) pandemic has required health care systems to radically and rapidly rethink the delivery of care. One of the most remarkable ongoing changes has been the unprecedented accelerated expansion of telehealth. T

COVID-19 and the Need for a National Health Information Technology Infrastructure

The need for timely, accurate, and reliable data about the health of the US population has never been greater. Critical questions include the following: (1) how many individuals test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and how many are affected by the disease it causes—novel coronavirus disease 2019 (COVID-19) in a given geographic area; (2) what are the age and race of these individuals; (3) how many people sought care at a health care facility; (4) how many were hospitalized; (5) within individual hospitals, how many patients required intensive care, received ventilator support, or died; and (6) what was the length of stay in the hospital and in the intensive care unit for patients who survived and for those who died.

Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)

It has been more than a century since the world has encountered a pandemic like coronavirus disease 2019 (COVID-19), and the rate of spread of COVID-19 around the globe and the associated morbidity and mortality have been staggering.

May 17, 2020

Factors associated with duration of viral shedding in adults with COVID-19 outside of Wuhan, China: A retrospective cohort study

This is the study with relatively large sample size that mainly focused on the duration of viral shedding and relevant factors in patients with COVID-19 outside of Wuhan, China. Potential risk factors were identified and should be taken into consideration for the strategy of quarantine of infected patients.

May 16, 2020

Reviving the US CDC

The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80 684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of 2 months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.

May 15, 2020

Severe Covid-19

The most common initial symptoms of coronavirus disease 2019 (Covid-19) are fever, cough, fatigue, anorexia, myalgias, and diarrhea.1 Severe illness usually begins approximately 1 week after the onset of symptoms. Dyspnea is the most common symptom of severe disease and is often accompanied by hypoxemia2,3 (Figure 1).

Pandemic Could Add Noise to Clinical Trial Data

Investigational ChAdOx1 nCoV-19 vaccine protects monkeys against COVID-19 pneumonia

A single dose of ChAdOx1 nCoV-19, an investigational vaccine against SARS-CoV-2, has protected six rhesus macaques from pneumonia caused by the virus, according to National Institutes of Health scientists and University of Oxford collaborators. SARS-CoV-2 is the virus that causes COVID-19.

May 14, 2020

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)

The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.

Asymptomatic Seroconversion of Immunoglobulins to SARS-CoV-2 in a Pediatric Dialysis Unit

Dialysis units are at especially high risk of infectious disease transmission, and concern exists about spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Dialysis units in Wuhan, China, have reported high coronavirus disease 2019 (COVID-19) prevalence, due in part to unique exposure challenges that limit social distancing efforts, including open bay formats and rotating/multiple nursing assignments.1,2 This study describes SARS-CoV-2 seroconversion in patients and health care workers in a pediatric dialysis unit.

Emergency Use Authorization of Remdesivir

The Need for a Transparent Distribution Process

On February 4, 2020, the Secretary of the US Department of Health and Human Services (DHHS) determined that there was a public health emergency due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On March 27, 2020, the DHHS secretary declared that circumstances existed to justify the authorization of emergency use of drugs and biologics during the coronavirus disease 2019 (COVID-19) outbreak, pursuant to section 564 of the Federal Food, Drug, and Cosmetic Act

May 13, 2020

Multiorgan and Renal Tropism of SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preferentially infects cells in the respiratory tract,1,2 but its direct affinity for organs other than the lungs remains poorly defined. Here, we present data from an autopsy series of 27 patients (see the clinical data in Table S1 in the Supplementary Appendix, available with the full text of this letter at that show that SARS-CoV-2 can be detected in multiple organs, including the lungs, pharynx, heart, liver, brain, and kidneys.

Treatment of COVID-19 Patients with Convalescent Plasma in Houston, Texas

Background: COVID-19 disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally, and no proven treatments are available. Convalescent plasma therapy has been used with varying degrees of success to treat severe microbial infections for more than 100 years.

The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission

Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly considered to be a likely mode of disease transmission. Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second. In a closed, stagnant air environment, they disappear from the window of view with time constants in the range of 8 to 14 min, which corresponds to droplet nuclei of ca. 4 μm diameter, or 12- to 21-μm droplets prior to dehydration. These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.

Kawasaki-like disease: emerging complication during the COVID-19 pandemic

Children have to date borne a minimal medical burden in the global COVID-19 pandemic. Epidemiological data from many countries show that children are a small minority of those who test positive. Children younger than 18 years have made up only 1·7% of national cases in the USA, 1% of cases in the Netherlands, and 2·0% of a large observational cohort in the UK. Whether these proportions reflect lower susceptibility among children versus adults, or similar infection rates, but much higher proportions with asymptomatic disease, is unclear.

May 12, 2020

Cross-neutralization of SARS-CoV-2 by a human monoclonal SARS-CoV antibody

SARS-CoV-2 is a newly emerged coronavirus responsible for the current COVID-19 pandemic that has resulted in more than 3.7 million infections and 260,000 deaths as of 6 May 20201,2. Vaccine and therapeutic discovery efforts are paramount to curb the pandemic spread of this zoonotic virus.

High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020

The potential for superspreader events underscores the importance of physical distancing, including avoiding gathering in large groups, to control spread of COVID-19. Enhancing community awareness can encourage symptomatic persons and contacts of ill persons to isolate or self-quarantine to prevent ongoing transmission.

May 11, 2020

Real-time tracking of self-reported symptoms to predict potential COVID-19

A total of 2,618,862 participants reported their potential symptoms of COVID-19 on a smartphone-based app. Among the 18,401 who had undergone a SARS-CoV-2 test, the proportion of participants who reported loss of smell and taste was higher in those with a positive test result (4,668 of 7,178 individuals; 65.03%) than in those with a negative test result (2,436 of 11,223 participants; 21.71%) (odds ratio = 6.74; 95% confidence interval = 6.31–7.21). A model combining symptoms to predict probable infection was applied to the data from all app users who reported symptoms (805,753) and predicted that 140,312 (17.42%) participants are likely to have COVID-19.

Virus impact on Louisiana state finances pegged at $1B

Louisiana's forecasting panel Monday slashed the state's income projections by $1 billion because of the coronavirus outbreak, blowing a hole in next year's budget as the virus's economic fallout threatens deep cuts across state services.

Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

Among patients hospitalized with COVID-19, treatment with hydroxychloroquine, azithromycin, or both was not associated with significantly lower in-hospital mortality.

Identification and Monitoring of International Travelers During the Initial Phase of an Outbreak of COVID-19 — California, February 3–March 17, 2020

Monitoring travelers was labor-intensive and limited by incomplete information, volume of travelers, and potential for asymptomatic transmission. Health departments need to weigh the resources needed for monitoring against those needed for implementing mitigation activities during the COVID-19 pandemic.

Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak — New York City, March 11–May 2, 2020

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), was first identified in December 2019 in Wuhan, China, and has since spread worldwide. On March 11, 2020, the World Health Organization declared COVID-19 a pandemic (1). That same day, the first confirmed COVID-19–associated fatality occurred in New York City (NYC). To identify confirmed COVID-19–associated deaths, defined as those occurring in persons with laboratory-confirmed SARS-CoV-2 infection, on March 13, 2020, the New York City Department of Health and Mental Hygiene (DOHMH) initiated a daily match between all deaths reported to the DOHMH electronic vital registry system (eVital) (2) and laboratory-confirmed cases of COVID-19.

COVID-19 and Postinfection Immunity Limited Evidence, Many Remaining Questions

In summary, existing limited data on antibody responses to SARS-CoV-2 and related coronaviruses, as well as one small animal model study, suggest that recovery from COVID-19 might confer immunity against reinfection, at least temporarily. However, the immune response to COVID-19 is not yet fully understood and definitive data on postinfection immunity are lacking. Amidst the uncertainty of this public health crisis, thoughtful and rigorous science will be essential to inform public health policy, planning, and practice.

COVID-19 and Racial/Ethnic Disparities

The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has led to a global pandemic manifested as coronavirus disease 2019 (COVID-19), with its most severe presentation being acute respiratory distress syndrome leading to severe complications and death.

COVID-19 and Health Equity—A New Kind of “Herd Immunity”

Three articles recently published in JAMA provide insight into the large racial/ethnic differences associated with coronavirus disease 2019 (COVID-19) and highlight the need for, and potential opportunity to, redouble efforts in the US to develop strategies that would enable society to slow and ultimately eliminate the spread of inequities in health.

May 10, 2020

Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin–angiotensin–aldosterone inhibitors

In two independent cohorts of patients with heart failure, plasma concentrations of ACE2 were higher in men than in women, but use of neither an ACE inhibitor nor an ARB was associated with higher plasma ACE2 concentrations. These data might explain the higher incidence and fatality rate of COVID-19 in men, but do not support previous reports suggesting that ACE inhibitors or ARBs increase the vulnerability for COVID-19 through increased plasma ACE2 concentrations.

May 8, 2020

Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial

Effective antiviral therapy is important for tackling the coronavirus disease 2019 (COVID-19) pandemic. We  assessed  the  efficacy  and  safety  of  combined  interferon  beta-1b,  lopinavir–ritonavir, and  ribavirin  for  treating  patients with COVID-19.Methods

Changes in SARS-CoV-2 Positivity Rate in Outpatients in Seattle and Washington State, March 1-April 16, 2020

The first reported case of coronavirus disease 2019 (COVID-19) in the US occurred on January 20, 2020, in Snohomish County, Washington.1 The University of Washington (UW) Virology Division was among the first US laboratories to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and since March 1, 2020, has tested samples from more than 73 000 patients. More than 90% of the samples are from the UW health system and outpatient clinics in Washington State.

The positivity rates for SARS-CoV-2 in outpatient settings in Washington State and in emergency departments (EDs) in Seattle were analyzed to identify temporal trends that may reflect the local dynamics of the pandemic and the effect of mitigation strategies such as physical distancing.

When Should Clinicians Act on Non–Statistically Significant Results from Clinical Trials?

Understanding whether the results of a randomized clinical trial (RCT) are clinically actionable is challenging. Reporting standards adopted by JAMA and other leading journals lead to relative uniformity of presentation of RCT findings that help simplify critical appraisal.

Association between Angiotensin Blockade and Incidence of Influenza in the United Kingdom

Some researchers have hypothesized that drugs that interfere with the renin–angiotensin–aldosterone system (RAAS), including angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), may increase susceptibility to coronaviruses. This hypothesis is based on the observation that coronaviruses engage ACE2 for cell entry1 and that altered expression of ACE2 is influenced by the use of ACE inhibitors and ARBs, an action that has been shown in animal models.2 Influenza A (H7N9, H1N1, and H5N1) has been shown to use the ACE2 receptor to mediate lung damage, similar to that seen in severe acute respiratory syndrome (SARS).3 Understanding the shared mechanism between SARS and influenza may help to address the question as to how ACE inhibitors and ARBs may modulate the manifestations of certain viral respiratory infections.

Collateral Effect of Covid-19 on Stroke Evaluation in the United States

The effect of the Covid-19 pandemic on medical care for conditions other than Covid-19 has been difficult to quantify.1 Any decrease in care for patients with acute conditions such as ischemic stroke may be consequential because timely treatment may decrease the incidence of disability.

Suppressing the Epidemic in New South Wales

Facing the coronavirus pandemic, Australia has achieved national consensus on policies that were unprecedented for the past century. New South Wales (which has 8 million residents) and other jurisdictions appear to have successfully suppressed Covid-19 transmission after a rapid escalation of cases in March 2020.

May 7, 2020

Clinical Characteristics and Results of Semen Tests Among Men with Coronavirus Disease 2019

In December 2019, an outbreak of pneumonia associated with coronavirus disease 2019 (COVID-19) occurred in Wuhan, China, and rapidly spread to other parts of China and overseas.1 It has been confirmed that COVID-19 has the characteristic of human-to-human transmission, mainly through respiratory droplets and contact. Other routes require further verification. The virus responsible for COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in stool, gastrointestinal tract, saliva, and urine samples.2 However, little is known about SARS-CoV-2 in semen.

Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19

In this observational study involving patients with Covid-19 who had been admitted to the hospital, hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death. Randomized, controlled trials of hydroxychloroquine in patients with Covid-19 are needed.

The Urgency of Care during the Covid-19 Pandemic — Learning as We Go

Chloroquine and hydroxychloroquine, alone or in combination with azithromycin, have been highly touted as potential therapies for Covid-19. The claims of efficacy are based largely on anecdotes and case series that have been described as being so persuasive that it would be unethical to perform studies with placebo controls.1 On the basis of this “evidence,” these therapies have been recommended in many guidelines, including some national policies, and have been widely implemented.

May 6, 2020

Interpreting Diagnostic Tests for SARS-CoV-2

The pandemic of coronavirus disease 2019 (COVID-19) continues to affect much of the world. Knowledge of diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still evolving, and a clear understanding of the nature of the tests and interpretation of their findings is important. This Viewpoint describes how to interpret 2 types of diagnostic tests commonly in use for SARS-CoV-2 infections—reverse transcriptase–polymerase chain reaction (RT-PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over time

May 5, 2020

Adaptations and Lessons in the Province of Bergamo

Lombardy, and particularly the province of Bergamo, has been the area of Italy most affected by Covid-19. As of April 26, 2020, the province had 11,113 confirmed cases and 2932 deaths from Covid-19. Delays in recognizing SARS-CoV-2 in the few infected patients admitted to the small hospital in Alzano Lombardo — and delays in activating measures to protect other patients, hospital personnel, and visitors, as well as in implementing adequate containment measures in patients’ villages — allowed the virus to spread rapidly and into the city of Bergamo.

Lupus Anticoagulant and Abnormal Coagulation Tests in Patients with Covid-19

Patients with coronavirus disease 2019 (Covid-19) have a profound hypercoagulable state, and complicating venous thrombotic events are common.1-3 Abnormalities in coagulation screening measures, including a prolonged activated partial-thromboplastin time (aPTT), have been reported in patients with Covid-19.4 This finding could be seen as a reason to avoid the use of anticoagulation at both therapeutic and prophylactic doses.

A Trial of Lopinavir–Ritonavir in Covid-19

After a review of the findings of Cao et al. (published in the Journal online on March 18),1 many clinicians are abandoning the use of lopinavir–ritonavir for the treatment of Covid-19. We consider this action to be premature. It is crucial to realize that although this trial did not show that the time until clinical improvement was meaningfully better than standard care among patients with severe Covid-19 who received lopinavir–ritonavir, the trial was statistically underpowered to show this outcome.

May 4, 2020

Obesity could shift severe COVID-19 disease to younger ages

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 was first reported in China in late December, 2019, and has since evolved into a global pandemic. As of April 29, 2020, COVID-19 has been confirmed in more than 3 million individuals in 185 countries and regions, with an overall mortality rate of more than 6%.1Severe disease involves bilateral interstitial pneumonia requiring intensive care unit (ICU) ventilatory support and can evolve into adult respiratory distress syndrome with high mortality. The largest study of 1591 ICU patients from Italy reported a median age of 63 years, with only 203 patients (13%) younger than 51 years.Common comorbidities are hypertension, cardiovascular disease, type 2 diabetes, and, more rarely (42 [4%] of 1043), obstructive pulmonary disease. Similar data have been reported from China.

Profile of a killer: the complex biology powering the coronavirus pandemic

In 1912, German veterinarians puzzled over the case of a feverish cat with an enormously swollen belly. That is now thought to be the first reported example of the debilitating power of a coronavirus. Veterinarians didn’t know it at the time, but coronaviruses were also giving chickens bronchitis, and pigs an intestinal disease that killed almost every piglet under two weeks old.

A human monoclonal antibody blocking SARS-CoV-2 infection

The emergence of the novel human coronavirus SARS-CoV-2 in Wuhan, China has caused a worldwide epidemic of respiratory disease (COVID-19). Vaccines and targeted therapeutics for treatment of this disease are currently lacking. Here we report a human monoclonal antibody that neutralizes SARS-CoV-2 (and SARS-CoV) in cell culture.

Randomized Clinical Trials and COVID-19Managing Expectations

Despite the millions of cases and hundreds of thousands of deaths that have occurred in this devastating coronavirus disease 2019 (COVID-19) pandemic, no peer-reviewed studies of specific therapies proven to be effective in reducing mortality have been published and a vaccine is many months to years away. To date, more than 1000 studies addressing various aspects of COVID-19 are registered on, including more than 600 interventional studies and randomized clinical trials (RCTs).

May 1, 2020

Contact Tracing Assessment of COVID-19 Transmission Dynamics in Taiwan and Risk at Different Exposure Periods Before and After Symptom Onset

High transmissibility of COVID-19 before and immediately after symptom onset suggests that finding and isolating symptomatic patients alone may not suffice to interrupt transmission, and that more generalized measures might be required, such as social distancing.

Production of the First Batch of Proposed COVID-19 Vaccines in the US Expected in July

Moderna, Inc. and Lonza Group AG announced a global agreement to manufacture one billion doses of Moderna's proposed vaccine every year, to be produced in the United States in July.

Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context.

Public Health Response to the Initiation and Spread of Pandemic COVID-19 in the United States, February 24–April 21, 2020

Various factors contributed to accelerated spread during February–March 2020, including continued travel-associated importations, large gatherings, introductions into high-risk workplaces and densely populated areas, and cryptic transmission resulting from limited testing and asymptomatic and presymptomatic spread. Targeted and communitywide mitigation efforts were needed to slow transmission.

COVID-19 Among Workers in Meat and Poultry Processing Facilities ― 19 States, April 2020

COVID-19 cases among U.S. workers in 115 meat and poultry processing facilities were reported by 19 states. Among approximately 130,000 workers at these facilities, 4,913 cases and 20 deaths occurred. Factors potentially affecting risk for infection include difficulties with workplace physical distancing and hygiene and crowded living and transportation conditions.

Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context.

Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19

In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.

Inhibitors of the Renin–Angiotensin–Aldosterone System and Covid-19

SARS-CoV-2, the coronavirus that causes Covid-19, enters human cells by binding of its viral spike protein to the membrane-bound form of the aminopeptidase angiotensin-converting enzyme 2 (ACE2).1

 From the viewpoint of human physiology, ACE2 plays an important regulatory role in the renin–angiotensin–aldosterone system (RAAS), metabolizing angiotensin II (a potent vasoconstrictor) to generate angiotensin-(1–7) (a vasodilator).2 Studies in animals have suggested that angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) may up-regulate ACE2 expression,3 thus increasing the availability of target molecules for SARS-CoV-2.

Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three).

COVID-19 Outbreak Among Three Affiliated Homeless Service Sites — King County, Washington, 2020

On March 30, 2020, Public Health – Seattle and King County (PHSKC) was notified of a confirmed case of coronavirus disease 2019 (COVID-19) in a resident of a homeless shelter and day center (shelter A). Residents from two other homeless shelters (B and C) used shelter A’s day center services.

April 30, 2020

A SARS-CoV-2 protein interaction map reveals targets for drug repurposing

The novel coronavirus SARS-CoV-2, the causative agent of COVID-19 respiratory disease, has infected over 2.3 million people, killed over 160,000, and caused worldwide social and economic disruption1,2. There are currently no antiviral drugs with proven clinical efficacy, nor are there vaccines for its prevention, and these efforts are hampered by limited knowledge of the molecular details of SARS-CoV-2 infection.

Clinical Characteristics of Coronavirus Disease 2019 in China

During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

Responding to Covid-19 — A Once-in-a-Century Pandemic?

In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The Covid-19 pandemic is a case in point. We need to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.

History in a Crisis — Lessons for Covid-19

Writing in the heady days of new antibiotics and immunizations, esteemed microbiologists Macfarlane Burnet and David White predicted in 1972 that “the most likely forecast about the future of infectious diseases is that it will be very dull.”1 They acknowledged that there was always a risk of “some wholly unexpected emergence of a new and dangerous infectious disease, but nothing of the sort has marked the last fifty years.” Epidemics, it seemed, were of interest only to historians.

Virtually Perfect? Telemedicine for Covid-19

Recognizing that patients prioritize convenient and inexpensive care, Duffy and Lee recently asked whether in-person visits should become the second, third, or even last option for meeting patient needs.1 Previous work has specifically described the potential for using telemedicine in disasters and public health emergencies.2 No telemedicine program can be created overnight, but U.S. health systems that have already implemented telemedical innovations can leverage them for the response to Covid-19.

Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection

No data exist regarding the effect on fetuses of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the first or second trimester of pregnancy, and data are limited regarding infections that occur during the third trimester. However, reports of newborns with fetal distress or requiring admission to the intensive care unit1,2 and a stillbirth after maternal coronavirus disease 2019 (COVID-19)3 in the third trimester suggest the possibility of COVID-19–induced placental pathology.

Mental Health in the Coronavirus Disease 2019 Emergency—The Italian Response

This article briefly reports the experience of mental health services and the lessons learned during the coronavirus disease 2019 (COVID-19) crisis. In particular, this report offers opportunities to build on experience gained in managing the COVID-19 emergency in the Departments of Mental Health and Addiction (DMHAs) in Lombardy, the wealthiest Italian region, which has approximately 10 million inhabitants.

Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection

The coronavirus disease 2019 (COVID-19) pandemic is filling the headlines these days. Although it is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be associated with skin manifestations, a limited number of images are available in the literature at this time. This observation reports dermatologic findings associated with a confirmed case of COVID-19.

April 29, 2020

Responding to the hidden pandemic for healthcare workers: stress

Healthcare workers are having to work under incredibly stressful conditions. Videoconferencing can be harnessed to provide mental-health support, but some report ‘tele-health’ fatigue. To protect public health, prepare for the mental-health surge among healthcare workers.

Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York

Data on Covid-19 in patients with immune-mediated inflammatory disease who have received anticytokine biologics, other immunomodulatory therapies, or both on a long-term basis are scarce. Trials to assess the efficacy of antirheumatic therapies such as hydroxychloroquine1 and anticytokine therapies such as interleukin-6 inhibitors2 to improve outcomes in patients with Covid-19 are ongoing.

Characteristics and Clinical Outcomes of Adult Patients Hospitalized with COVID-19 — Georgia, March 2020

In a cohort of 305 hospitalized adults with COVID-19 in Georgia (primarily metropolitan Atlanta), black patients were overrepresented, and their clinical outcomes were similar to those of nonblack patients. One in four hospitalized patients had no recognized risk factors for severe COVID-19.

April 28, 2020

The race for coronavirus vaccines: a graphical guide

More than 90 vaccines are being developed against SARS-CoV-2 by research teams in companies and universities across the world. Researchers are trialling different technologies, some of which haven’t been used in a licensed vaccine before.

Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young

We report five cases of large-vessel stroke in patients younger than 50 years of age who presented to our health system in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all five patients.

Negative-Pressure Aerosol Cover for COVID-19 Tracheostomy

Because of the high virulence of the novel coronavirus responsible for causing COVID-19, many patients infected with the virus become critically ill, requiring prolonged intubation, and may ultimately require tracheostomy. Mucosal surfaces have been shown to be reservoirs for high concentrations of the virus, which can become aerosolized for up to 3 hours following manipulation.1,2 Surgeons performing tracheostomies are at high risk for exposure, and recently published guidelines recommend against elective, non–time-sensitive procedures.3 In the event that a tracheostomy is indicated in a patient with confirmed or suspected COVID-19, interventions that limit the spread of aerosols are critical to reducing exposure.4,5 Here we present the creation of a novel negative-pressure aerosol cover made out of readily available operating room materials as an additional barrier to limit the spread of aerosols during tracheostomy.

April 27, 2020

Epidemiological characteristics and incubation period of 7,015 confirmed cases with Coronavirus Disease 2019 outside Hubei Province in China

Rapidly transmitting COVID-19 has a short incubation period. The onset mainly occurs among young to middle-aged adults. Traffic restrictions played an important role in the decreased number of imported cases outside Hubei.

Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals

Our results indicate that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols. Future work should explore the infectivity of aerosolized virus.

Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study

Rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, prompted heightened surveillance in Shenzhen, China. The resulting data provide a rare opportunity to measure key metrics of disease course, transmission, and the impact of control measures.

Q&A: AAP president concerned about pandemic-related drop in vaccination rates

According to data from PCC, an independent firm that provides pediatric electronic health records software, pediatric vaccinations are down as a result of the COVID-19 pandemic.

Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment

Despite personal protective equipment, fluorescent markers were found on the uncovered skin, hair, and shoes of participants after simulations of emergency department management of patients experiencing respiratory distress. The findings suggest that the current recommendations for personal protective equipment may not fully prevent exposures in emergency department settings. Clothing that covers all skin may further diminish exposure risk.

COVID-19 and Risks Posed to Personnel During Endotracheal Intubation

Fundamental research is needed to better inform PPE recommendations. For example, it would be useful to know how long SARS-CoV-2 can remain infective on surfaces such as the skin, hair, and clothing, and the potential for contact transmission from those sites to guide recommendations for barrier protection. A better understanding of the duration of infectivity and level of risk posed by airborne SARS-CoV-2 would help to guide recommendations for respiratory protection. Much can be done to protect health care personnel performing endotracheal intubations from procedure-related transmission of COVID-19. Individuals who perform this life-saving procedure must be able to do it as safely as possible.

Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston

Universal SARS-CoV-2 PCR testing of an adult homeless shelter population in Boston shortly after the identification of a COVID-19 case cluster yielded a 36% positivity rate. The majority of individuals with newly identified infections had no symptoms and no fever at the time of diagnosis, suggesting that symptom screening in homeless shelters2 may not adequately capture the extent of disease transmission in this high-risk setting.

The Potential Effects of Coronavirus on National Health Expenditures

The first step in projecting how COVID-19 may affect the health share of the GDP is to estimate how COVID-19 will affect health care spending. This will depend on the future extent, timing, and composition of the pandemic, so it is highly uncertain.

April 25, 2020

Travel restrictions hampering COVID-19 response

The coronavirus disease 2019 (COVID-19) pandemic has sparked an unprecedented shutdown of borders and airlines, which is severely restricting the movement of essential medical personnel and supplies that are vital to stem the spread of the virus and save lives.

April 24, 2020

"Immunity passports" in the context of COVID-19

WHO has published guidance on adjusting public health and social measures for the next phase of the COVID-19 response.1 Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an “immunity passport” or “risk-free certificate” that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.

Clarification of Mortality Rate and Data in Abstract, Results, and Table 2

In the Original Investigation titled “Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area” published online April 22, 2020, in JAMA,1 clarification and correction of data were required.

Mild or Moderate Covid-19

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations.

Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California

Coronavirus disease 2019 (COVID-19) has resulted in increased hospital and intensive care unit (ICU) use. In the United States, few reports have characterized patients treated outside of the ICU.1 Northern California was an early epicenter of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community transmission in the United States. We report hospitalization and ICU admissions from Kaiser Permanente Northern California (KPNC), a regional integrated health care system serving 4.4 million members, constituting 30% of the area’s insured population.

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

In this phase IIb randomized clinical trial of 81 patients with COVID-19, an unplanned interim analysis recommended by an independent data safety and monitoring board found that a higher dosage of chloroquine diphosphate for 10 days was associated with more toxic effects and lethality, particularly affecting QTc interval prolongation. The limited sample size did not allow the study to show any benefit overall regarding treatment efficacy.

A real-time dashboard of clinical trials for COVID-19

As trial findings are communicated, these data must be centralised and meta-analysed in real-time. Syntheses of these trials are urgently needed to assist clinicians, researchers, and policy makers to make evidence-informed decisions to minimise the morbidity and mortality due to COVID-19.

April 23, 2020

Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19

The renin–angiotensin–aldosterone system (RAAS) is an elegant cascade of vasoactive peptides that orchestrate key processes in human physiology. Severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and SARS-CoV-2, which have been responsible for the SARS epidemic in 2002 to 2004 and for the more recent coronavirus disease 2019 (Covid-19) pandemic, respectively, interface with the RAAS through angiotensin-converting enzyme 2 (ACE2), an enzyme that physiologically counters RAAS activation but also functions as a receptor for both SARS viruses.

Epidemiological Assessment of Imported Coronavirus Disease 2019 (COVID-19) Cases in the Most Affected City Outside of Hubei Province, Wenzhou, China

The coronavirus disease 2019 (COVID-19) outbreak was first identified in Wuhan, the capital of Hubei Province, China, in December 2019.1 The disease spread rapidly from Wuhan to other cities. To contain this epidemic, Wuhan was locked down on January 23, 2020. Wenzhou, which has a population of 9.3 million and is located in southeastern China approximately 600 miles from Wuhan, is the most affected Chinese city outside of Hubei.

Information Technology–Based Tracing Strategy in Response to COVID-19 in South Korea—Privacy Controversies

South Korea extensively utilized the country’s advanced information technology (IT) system for tracing individuals suspected to be infected or who had been in contact with an infected person. Such measures helped flatten the curve of newly confirmed cases and deaths around mid-March.1,2(pp4-5) As of April 21, 2020, there had been 10 683 confirmed cases of COVID-19 in South Korea, with a total of 2233 patients who are in isolation because of hospitalization or quarantine, and a total of 237 deaths.3 However, important concerns have been raised over privacy involving the tracing strategy.

April 22, 2020

Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs

When we compared SARS-CoV-2 detection from patient-matched nasopharyngeal and saliva samples, we found that saliva yielded greater detection sensitivity and consistency throughout the course of infection. Furthermore, we report less variability in self-sample collection of saliva. Taken together, our findings demonstrate that saliva is a viable and more sensitive alternative to nasopharyngeal swabs and could enable at-home self-administered sample collection for accurate large-scale SARS-CoV-2 testing.

Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection

Since December 2019, a pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally.1 A spectrum of disease severity has been reported, with main symptoms that include fever, fatigue, dry cough, myalgia, and dyspnea.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and AdolescentsA Systematic Review

In this systematic review of 18 studies with 1065 participants, most pediatric patients with SARS-CoV-2 infection presented with fever, dry cough, and fatigue or were asymptomatic; 1 infant presented with pneumonia, complicated by shock and kidney failure, and was successfully treated with intensive care. Most pediatric patients were hospitalized, and symptomatic children received mainly supportive care; no deaths were reported in the age range of 0 to 9 years.

Timely antiviral therapy may slow COVID-19 progression; more study needed

Researchers in China found that hospitalized patients with milder cases of COVID-19 were treated earlier with an assortment of antivirals compared with patients who experienced more severe disease, suggesting that the timing of antiviral therapy may significantly slow COVID-19 progression.

Timeline reset: CDC confirms weeks-earlier California deaths

Health officials say two people died with the coronavirus in California weeks before the first reported death from the disease.

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

In this case series that included 5700 patients hospitalized with COVID-19 in the New York City area, the most common comorbidities were hypertension, obesity, and diabetes. Among patients who were discharged or died (n = 2634), 14.2% were treated in the intensive care unit, 12.2% received invasive mechanical ventilation, 3.2% were treated with kidney replacement therapy, and 21% died.

April 21, 2020

Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study

Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed.

Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study

Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed.

April 20, 2020

Health Care Heroes of the COVID-19 Pandemic

The COVID-19 pandemic has accounted for tens of thousands of deaths and ultimately will affect millions more people who will survive. There will be time to mourn the victims and care for the survivors. But it is also time to recognize and thank some of the heroes who have emerged so far.

Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 — National Poison Data System, United States, January 1, 2020–March 31, 2020

On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2 (1). As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3).

April 19,2020

Profile of RT-PCR for SARS-CoV-2: a preliminary study from 56 COVID-19 patients

A novel coronavirus (COVID-19) pandemic threatens the world. Here, we first studied the dynamics profile of SARS-CoV-2 from 56 recovered COVID-19 patients. We found virus shedding was up to 6 weeks after onset of symptoms. Prolonged observation period is necessary for older patients.

April 18, 2020

Will antibody tests for the coronavirus really change everything?

British Prime Minister Boris Johnson called them a ‘game changer’. Antibody tests have captured the world’s attention for their potential to help life return to normal by revealing who has been exposed, and might now be immune, to the new coronavirus.

Will antibody tests for the coronavirus really change everything?

Dozens of biotech companies and research laboratories have rushed to produce the blood tests. And governments around the world have bought millions of kits, in the hope that they could guide decisions on when to relax social-distancing measures and get people back to work. Some have even suggested that the tests could be used as an ‘immunity passport’, giving the owner clearance to interact with others again.

Flooded by the torrent: the COVID-19 drug pipeline

The coronavirus disease 2019 (COVID-19) drug pipeline is not growing at quite the same speed as the pandemic. But its rate of expansion is nevertheless cause for pause. In the months since COVID-19 has spread, researchers have launched more than 180 clinical trials of everything from repurposed antivirals and immunomodulators to unproven cell therapies and vitamin C. A further 150 trials are preparing to recruit patients.

COVID-19 exacerbating inequalities in the US

COVID-19 does not affect everyone equally. In the US, it is exposing inequities in the health system. Aaron van Dorn, Rebecca E Cooney, and Miriam L Sabin report from New York.

April 17, 2020

SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection

We found that ocular fluids from SARS-CoV-2-infected patients may contain infectious virus, and hence may be a potential source of infection. These findings highlight the importance of control measures, such as avoiding touching the nose, mouth, and eyes and frequent hand washing. A related implication is the importance of appropriate use of personal protective equipment for ophthalmologists during clinical examination, because ocular mucosa may be not only a site of virus entry but also a source of contagion. Furthermore, we observed that ocular involvement of SARS-CoV-2 may occur early in the COVID-19 course, suggesting that measures to prevent transmission via this route must be implemented as early as possible.

Masks and Coronavirus Disease 2019 (COVID-19)

Recent studies suggest that coronavirus disease 2019 (COVID-19) may be transmitted by infected persons even in the absence of symptoms of disease. While social distancing and good hand hygiene are the most important methods to prevent virus transmission, new guidelines state that healthy individuals can consider wearing masks in public settings, particularly when physical distancing is difficult (like in grocery stores or pharmacies). Primary benefits of wearing a mask include limiting the spread of the virus from someone who knows or does not know they have an infection to others.

Symptom Screening at Illness Onset of Health Care Personnel With SARS-CoV-2 Infection in King County, Washington

In this cohort, screening only for fever, cough, shortness of breath, or sore throat might have missed 17% of symptomatic HCP at the time of illness onset; expanding criteria for symptoms screening to include myalgias and chills may still have missed 10%. The data indicate that HCP worked for several days while symptomatic, when, according to a growing body of evidence, they may transmit SARS-CoV-2 to vulnerable patients and other HCP.1 Interventions to prevent transmission from HCP include expanding symptoms-based screening criteria,2 furloughing symptomatic HCP,2 facilitating testing of symptomatic HCP,4 and creating sick leave policies that are nonpunitive, flexible, and consistent with public health guidance.5

From Mitigation to Containment of the COVID-19 Pandemic

Putting the SARS-CoV-2 Genie Back in the Bottle

The COVID-19 pandemic will one day be in the rearview mirror. US history will inevitably recount an early phase of the crisis plagued with denial, flawed testing, a patchwork response, and inadequate supplies that resulted in thousands of excess infections and deaths. Therefore, before the US “reopens,” the country must ensure that this chapter will end with a course-corrected public health strategy that promises widespread testing, resources for those affected, and a profound appreciation for an impressive, inspired, and tireless health care workforce that helped the US deal with this pandemic.

COVID-19—Looking Beyond Tomorrow for Health Care and Society

While acknowledging that there will be uncertainty in addressing the topics in the “COVID-19: Beyond Tomorrow” series, the insights from these Viewpoints should serve to help inform physicians, other health care professionals, administrators, and policy makers about what the future may hold with COVID-19 for health care and society. Perhaps these Viewpoints could also serve to provide suggestions to galvanize efforts about what will need to be done beyond tomorrow.

April 16, 2020

Project IDentif.AI: Harnessing Artificial Intelligence to Rapidly Optimize Combination Therapy Development for Infectious Disease Intervention

This platform is disease indication and disease mechanism‐agnostic, and potentially applicable to the systematic N‐of‐1 and population‐wide design of highly efficacious and tolerable clinical regimens. This work also discusses key factors ranging from healthcare economics to global health policy that may serve to drive the broader deployment of this platform to address COVID‐19 and future pandemics.

April 15, 2020

COVID-19 and African Americans

Public health is complicated and social reengineering is complex, but change of this magnitude does not happen without a new resolve. The US has needed a trigger to fully address health care disparities; COVID-19 may be that bellwether event. Certainly, within the broad and powerful economic and legislative engines of the US, there is room to definitively address a scourge even worse than COVID-19: health care disparities. It only takes will. It is time to end the refrain.

Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens

These results suggest higher rates of co-infection between SARS-CoV-2 and other respiratory pathogens than previously reported, with no significant difference in rates of SARS-CoV-2 infection in patients with and without other pathogens. The presence of a non–SARS-CoV-2 pathogen may not provide reassurance that a patient does not also have SARS-CoV-2.

April 14, 2020

Stay 6 Feet Apart, We’re Told. But How Far Can Air Carry Coronavirus?

And scientists agree that six feet is a sensible and useful minimum distance, but, some say, farther away would be better.

FDA authorizes process it says could decontaminate 4 million masks daily

Amid widespread shortages of personal protective equipment and masks during the COVID-19 pandemic, the FDA has granted several emergency use authorizations, or EUAs, for the decontamination and reuse of N95 or N95-equivilent masks.

IDSA publishes ‘living guidelines’ on treatment of COVID-19

The Infectious Diseases Society of America published rapid guidelines on the treatment and management of patients with COVID-19 that mostly recommend recruiting patients into ongoing trials for investigational therapies.

CMS waiver on telehealth amid COVID-19 represents a ‘sea change’

CMS recently announced that video and chat apps that normally do not comply with HIPAA security and privacy regulations can be used to facilitate patient care during the COVID-19 public health emergency.

Weathering the cytokine storm in COVID-19: Telltale signs, therapeutic hope on the horizon

Good news about COVID-19 is at a premium these days. Encouraging reports about therapeutic options or vaccine development usually are either overly optimistic or entirely spurious. But scientific advancement is as relentless as the virus itself, and this is exemplified by a growing body of research into a potential association between cytokine storm syndrome and COVID-19.

Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient — Solano County, California, February 2020

Health care personnel (HCP) are at heightened risk of acquiring COVID-19 infection, but limited information exists about transmission in health care settings.

Spread of SARS-CoV-2 in the Icelandic Population

In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males. The proportion of infected persons identified through population screening did not change substantially during the screening period, which was consistent with a beneficial effect of containment efforts.

Drug Evaluation during the Covid-19 Pandemic

The pandemic will inevitably leave considerable morbidity, mortality, and loss in its wake. Damage to the country’s medication-assessment process — and the public’s respect for it — should not be part of its legacy.

Not Dying Alone — Modern Compassionate Care in the Covid-19 Pandemic

There may be no way for families to hold patients’ hands or hug them while they’re dying, but with the care and compassion of frontline health care workers, maybe we can harness creative solutions to help them feel some connection, while still keeping everyone safe.

April 13, 2020

Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19)A Review

The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection.

Who Is Immune to the Coronavirus?

Among the many uncertainties that remain about Covid-19 is how the human immune system responds to infection and what that means for the spread of the disease. Immunity after any infection can range from lifelong and complete to nearly nonexistent. So far, however, only the first glimmers of data are available about immunity to SARS-CoV-2, the coronavirus that causes Covid-19.

Universal Screening for SARS-CoV-2 in Women Admitted for Delivery

The potential benefits of a universal testing approach include the ability to use Covid-19 status to determine hospital isolation practices and bed assignments, inform neonatal care, and guide the use of personal protective equipment. Access to such clinical data provides an important opportunity to protect mothers, babies, and health care teams during these challenging times.

Mental Health and the Covid-19 Pandemic

The Covid-19 pandemic has alarming implications for individual and collective health and emotional and social functioning. In addition to providing medical care, already stretched health care providers have an important role in monitoring psychosocial needs and delivering psychosocial support to their patients, health care providers, and the public — activities that should be integrated into general pandemic health care.

They Call Us and We Go

And I also know something about myself that I didn’t know even a few weeks ago: that as averse to risk as I am by nature, I would take on more if called to do so. The sentiments expressed by a character in The Plague, a novel by Albert Camus that I first read in high school, are no longer abstract to me: “I have no idea what’s awaiting me, or what will happen when this all ends,” says Dr. Rieux. “For the moment I know this: there are sick people and they need curing.”

Staying Ahead of the Wave

For clinicians in areas that have not yet been hard hit, the pandemic wave will surely come. Persons under investigation for Covid-19 should be treated as if they are infected. These patients often have a progression of disease severity, with approximately 15% of admitted patients requiring upgrades in care. We hope that lessons from our center will help prepare other physicians and hospitals for what is likely to come so they can stay ahead of the wave.

April 6, 2020

Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients

In conclusion, both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface.

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.

Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020

Pediatric COVID-19 patients might not have fever or cough. Social distancing and everyday preventive behaviors remain important for all age groups because patients with less serious illness and those without symptoms likely play an important role in disease transmission.

Sample Pooling as a Strategy to Detect Community Transmission of SARS-CoV-2

Strategies such as pooled screening may facilitate detection of early community transmission of SARS-CoV-2 and enable timely implementation of appropriate infection control measures to reduce spread.

April 3, 2020

Detection of SARS-CoV-2 Among Residents and Staff Members of an Independent and Assisted Living Community for Older Adults — Seattle, Washington, 2020

Following identification of two COVID-19 cases in a Seattle independent and assisted living facility, stringent preventive measures were implemented. Testing of all residents and staff members found few cases of COVID-19. Three of four residents who had positive test results were asymptomatic.

Lessons from Covid-19 Hotspots
Eric J. Rubin, Lindsey R. Baden, and Stephen Morrissey

In this audio interview conducted April 1, the editors draw lessons from the early Covid-19 outbreak in Seattle and the growing crisis in New York City. Listen to the interview.

Barrier Enclosure during Endotracheal Intubation

Clinicians with inadequate access to standard personal protective equipment (PPE) have been compelled to improvise protective barrier enclosures for use during endotracheal intubation. We describe one such barrier that is easily fabricated and may help protect clinicians during this procedure.

Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness

The coronavirus disease 2019 (COVID-19) pandemic will present an unprecedented stressor to patients and health care systems across the globe. Because there is currently no vaccine or treatment for the underlying infection, current health efforts are focused on providing prevention and screening, maintaining continuity of treatment for other chronic conditions, and ensuring access to appropriately intensive services for those with the most severe symptoms.

April 2, 2020

Audio Interview: Lessons from Covid-19 Hotspots

The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission, diagnosis, and treatment is the subject of ongoing updates from infectious disease experts at the Journal.

Governmental Public Health Powers During the COVID-19 Pandemic

The president and all 50 governors have declared health emergencies to counteract the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). While researchers race to develop vaccines, officials are implementing physical distancing, including orders to stay at home, restricting travel, and closing nonessential businesses.

April 1, 2020

Virological assessment of hospitalized patients with COVID-2019

Altogether, this suggests active virus replication in upper respiratory tract tissues, where SARS-CoV is not thought to replicate in spite of detectable ACE-2 expression19,20 . At the same time, the concurrent use of ACE-2 as a receptor by SARS-CoV and SARS-CoV-2 corresponds to a highly similar excretion kinetic in sputum, with active replication in the lung.

An Uncomplicated Delivery in a Patient with Covid-19 in the United States

This case describes uncomplicated labor and vaginal delivery in a woman with Covid-19. Care was taken to avoid infecting hospital staff, and 7 days after the delivery, no caregivers appeared to be infected.

Detection of Covid-19 in Children in Early January 2020 in Wuhan, China

A small number of cases of coronavirus disease 2019 (Covid-19) have been described in children,1,2 and our understanding of the spectrum of illness is limited.3 We conducted a retrospective analysis involving hospitalized children in Wuhan, China.

Ten Weeks to Crush the Curve

Rather than stumble through a series of starts and stops and half-measures on both the health and the economic fronts, we should forge a strategy to defeat the coronavirus and open the way to economic revival. If we act immediately, we can make the anniversary of D-Day on June 6, 2020, the day America declares victory over the coronavirus.

Universal Masking in Hospitals in the Covid-19 Era

As the SARS-CoV-2 pandemic continues to explode, hospital systems are scrambling to intensify their measures for protecting patients and health care workers from the virus. An increasing number of frontline providers are wondering whether this effort should include universal use of masks by all health care workers. Universal masking is already standard practice in Hong Kong, Singapore, and other parts of Asia and has recently been adopted by a handful of U.S. hospitals.

March 31, 2020

Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020

Based on preliminary U.S. data, persons with underlying health conditions such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions.

Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

Health care workers who come in close contact with a patient’s head and neck are particularly at risk for developing coronavirus disease 2019 (COVID-19) because of the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) through respiratory droplets. This article provides safety recommendations for these health care workers regarding exams and surgical procedures based on a review of the literature and the experiences of physicians with firsthand knowledge of safety procedures during this pandemic.

Surgical Considerations for Tracheostomy During COVID-19 Pandemic

Lessons learned from the 2003 severe acute respiratory syndrome (SARS) epidemic may help reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), the cause of coronavirus disease 2019 (COVID-19), to health care workers performing open tracheostomies, a surgical procedure to open an airway that may be required for many patients with COVID-19.

Ocular Findings of Patients With COVID-19

One-third of COVID-19 patients from Hubei, China, had ocular manifestations, occurring frequently in patients with more severe physical conditions.

Measures for Care of Cancer Patients During COVID-19 Outbreak in China

The authors describe measures taken to reduce the risk of transmitting severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) to medical staff and cancer patients seeking treatment during the COVID-19 outbreak in China.

Perspectives on COVID-19 Control Measures for Ophthalmology Clinics

This article describes treatment initiatives being undertaken for novel coronavirus 2019 at an ophthalmology center in Singapore.

WHO advises that ivermectin only be used to treat COVID-19 within clinical trials

The current evidence on the use of ivermectin to treat COVID-19 patients is inconclusive. Until more data is available, WHO recommends that the drug only be used within clinical trials.

March 30, 2020

SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19

Pharyngeal swabs are widely used to determine the appropriateness of a patient's discharge from the hospital and whether isolation continues to be required. We observed 22 patients who had positive RT-qPCR results for SARS–CoV-2 in the sputum or feces after pharyngeal swabs became negative. These finding raise concern about whether patients with negative pharyngeal swabs are truly virus-free, or sampling of additional body sites is needed.

Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high.

Older Clinicians and the Surge in Novel Coronavirus Disease 2019 (COVID-19)

The recent report of 2 critically ill emergency physicians infected by the novel coronavirus disease 2019 (COVID-19) is a sobering reminder of the vulnerability of the nation’s health care workforce.1 While all members of the health care workforce are vital as the health care system faces perhaps its greatest challenge in memory, physicians and nurses are the caregivers who typically have the most direct contact with patients, whether through advising, triaging, or treating those who require hospitalization.

Optimizing the Trade-off Between Learning and Doing in a Pandemic

The world is united regarding the goal of ending the coronavirus disease 2019 (COVID-19) pandemic but not the strategy to achieve that goal. One stark example is the debate over whether to prescribe available therapies, such as quinine-based antimalarial drugs (eg, chloroquine or hydroxychloroquine), or test these drugs in randomized clinical trials (RCTs). At the heart of the problem is one of the oldest dilemmas in human organizations: the “exploitation-exploration” trade-off.

March 27, 2020

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

In this uncontrolled case series of 5 critically ill patients with COVID-19 and acute respiratory distress syndrome (ARDS), administration of convalescent plasma containing neutralizing antibody was followed by an improvement in clinical status.

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

March 26, 2020

Cutaneous manifestations in COVID‐19: a first perspective

From the collected data (88 patients), 18 patients (20.4%) developed cutaneous manifestations. 8 patients developed cutaneous involvement at the onset, 10 patients after the hospitalization. Cutaneous manifestations were erythematous rash (14 patients), widespread urticaria (3 patients) and chickenpox-like vesicles (1 patient). Trunk was the main involved region. Itching was low or absent and usually lesions healed in few days. Apparently there was not any correlation with disease’s severity.

Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China

Although 2 recent studies1,2 have shown that there were no clinical findings or investigations suggestive of COVID-19 in neonates born to affected mothers, and all samples, including amniotic fluid, cord blood, and breast milk, were negative for SARS-CoV-2, the vertical maternal-fetal transmission cannot be ruled out in the current cohort. Therefore, it is crucial to screen pregnant women and implement strict infection control measures, quarantine of infected mothers, and close monitoring of neonates at risk of COVID-19.

Tracking COVID-19 responsibly

As of  March  25,  2020, WHO’s  online  coronavirus  disease  2019  (COVID-19)  situation  dashboard  reveals  that  the  pandemic  spans  195  countries  and  territories with 375 498 cases. With this rapid expansion of the pandemic comes a growing need to ensure that accurate and credible information is accessible to public  health  authorities,  researchers,  and the wider public.

March 25, 2020

The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study

Our projections show that physical distancing measures were most effective if the staggered return to work was at the beginning of April; this reduced the median number of infections by more than 92% (IQR 66–97) and 24% (13–90) in mid-2020 and end-2020, respectively.

Novel Coronavirus and Old Lessons — Preparing the Health System for the Pandemic

How sad that the people who remember the last major pandemic — influenza in 1968 — are the primary victims of today’s. How sad that despite the many medical advances that have been made since then — critical care, extracorporeal membrane oxygenation (ECMO), emergency medicine, and emergency medical services, to name a few — the treatments offered to many patients in areas where Covid-19 has exploded are the same ones they might have received in that era. Perhaps the lessons they remember, those of quarantine, isolation, and social distancing, are the ones that will save us again.

March 24, 2020

Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics

Although many drugs have in vitro activity against different coronaviruses, no clinical evidence currently supports the efficacy and safety of any drug against any coronavirus in humans, including SARS-CoV-2. Numerous drugs that have been highly promising in vitro for other infectious diseases have failed in clinical studies.

Novel 2019 coronavirus SARS-CoV-2 (COVID-19): An updated overview for emergency clinicians

This overview analyzes the best information from the early research, including epidemiologic and demographic features from SARS-CoV-1 and MERS-CoV viruses; lessons learned from the experience of an emergency physician in Northern Italy, where the outbreak has devastated the healthcare system

Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease

Among those with COVID-19, there is a higher prevalence of cardiovascular disease and more than 7% of patients suffer myocardial injury from the infection (22% of the critically ill). 

COVID-19: Abnormal Clotting Common in More Severe Disease

Endothelial damage and subsequent clotting is common in severe and critical COVID-19 coronavirus, which may have implications for treatment, Chinese clinicians said at a webinar co-sponsored by the Chinese Cardiovascular Association and American College of Cardiology.

Psychiatrists Anticipate Mental Health Needs With COVID-19

Psychiatric appointments across the country have been going virtual as mental health professionals try to limit potential exposures by moving to home offices and keeping outpatient visits to a minimum.

COVID-19 Update: 17 Days on Surfaces; U.S. 'New Epicenter'? Fatal Chloroquine

March 23, 2020

COVID-19: Melatonin as a potential adjuvant treatment.

This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology.

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.

Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study

Implementing the combined interven