Updated 26 February 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. NEJM 25 February 2021
Otolaryngologic manifestations in pediatric inflammatory multisystem syndrome temporally associated with COVID-19
Elevated rates of otolaryngology manifestations, such as dysphonia, dysphagia, and anosmia/hyposmia, persisting for longer than 6 weeks warrant otolaryngologic follow-up screening and review as required through the multidisciplinary team for all children recovering from PIMS-TS. JAMA 25 February 2021
Association of SARS-CoV-2 seropositive antibody test with risk of future infection
In this cohort study, patients with positive antibody test results were initially more likely to have positive nucleic acid amplification test (NAAT) results, consistent with prolonged RNA shedding, but became markedly less likely to have positive NAAT results over time, suggesting that seropositivity is associated with protection from infection. The duration of protection is unknown, and protection may wane over time. JAMA 24 February 2021
Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19
This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19. JAMA 24 February 2021
The Activin/Follistatin-axis is severely deregulated in COVID-19 and independently associated with in-hospital mortality
This study unravels strong link between Activin/Follistatin-axis and COVID-19 mortality and introduces FACT-CLINYCoD, a novel pathophysiology-based tool that allows dynamic prediction of disease outcome, supporting clinical decision making. Journal of infectious diseases 24 February 2021
Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries
Except in Wuhan, no increase in overall mortality was found during the three months of the covid-19 outbreak in other parts of China. The lower death rates from certain non-covid-19 related diseases might be attributable to the associated behaviour changes during lockdown. BMJ 24 February 2021
BNT162b2 mRNA Covid-19 Vaccine in a nationwide mass vaccination setting
This study in a nationwide (Israel) 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. NEJM 24 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. The authors 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. The Lancet 23 February 2021
Annals on call - Pregnancy, Lactation, and the COVID-19 Vaccines
In this episode of Annals On Call, Dr. Centor discusses the current recommendations for COVID-19 vaccination in women who are pregnant or considering pregnancy with Dr. Laura E. Riley from Weill Cornell School of Medicine. Annals of internal medicine 23 February 2021
Some practical answers to COVID-19 vaccine questions
Never before has the community been informed of every step and every result in vaccine testing, every adverse event (whether proven to be linked to the vaccine or not) and every step in approval. People who had never heard of “polymerase chain reaction” (PCR) or “messenger RNA” (mRNA) are now spouting opinions about false positives and “genetic engineering”. Those who form an obsession and read everything they can find on social media and elsewhere on the internet can feel that they have “done their research” and now know “more than my doctor”. This is when our knowledge and understanding of biochemistry, physiology and infectious diseases needs to come forward, together with our ability to recognise reputable sources of information. MJA insight 22 February 2021
Vaccines for older adults (Clinical review)
The proportion of the global population aged 65 and older is rapidly increasing. Infections in this age group, most recently with SARS-CoV-2, cause substantial morbidity and mortality. BMJ 22 February 2021
Sequelae in adults at 6 months after COVID-19 Infection
In this cohort of individuals with COVID-19 who were followed up for as long as 9 months after illness, approximately 30% reported persistent symptoms. A unique aspect of this cohort is the high proportion of outpatients with mild disease. Persistent symptoms were reported by one-third of outpatients in our study, consistent with a previously reported study, in which 36% of outpatients had not returned to baseline health by 14 to 21 days following infection. However, this has not been previously described 9 months after infection. JAMA 19 February 2021
Susceptibility and attenuated transmissibility of SARS-CoV-2 in domestic cats
Domestic cats, an important companion animal, can be infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This has aroused concern regarding the ability of domestic cats to spread the virus that causes coronavirus disease 2019. The authors systematically demonstrated the pathogenesis and transmissibility of SARS-CoV-2 in cats. Serial passaging of the virus between cats dramatically attenuated the viral transmissibility, likely owing to variations of the amino acids in the receptor-binding domain sites of angiotensin-converting enzyme 2 between humans and cats. These findings provide insight into the transmissibility of SARS-CoV-2 in cats and provide information for protecting the health of humans and cats. Journal of infectious diseases 19 February 2021
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. The Lancet 19 February 2021
Guidelines recommend measures to manage acute and chronic conditions during the COVID-19 pandemic: updated
Further guidelines have been published to inform the management of patients with coexisting conditions during the COVID-19 pandemic.
New this update:
BMJ 18 February 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. The Lancet 18 February 2021
Posttraumatic Stress Disorder in patients after severe COVID-19 infection
This cross-sectional study found a PTSD prevalence of 30.2% after acute COVID-19 infection, which is in line with findings in survivors of previous coronavirus illnesses compared with findings reported after other types of collective traumatic events. Associated characteristics were female sex, which has been extensively described as a risk factor for PTSD, history of psychiatric disorders, and delirium or agitation during acute illness. In the PTSD group, the authors also found more persistent medical symptoms, often reported by patients after recovery from severe COVID-19. JAMA 18 January 2021
Wearable technology: covid-19 and the rise of remote clinical monitoring
In the age of covid-19, digital devices worn by patients are increasingly being piloted to monitor those who might need hospital admission or who have recently been discharged. In a scheme in north west London, “wearables” collected the vital signs of people quarantining before or after travelling abroad and healthcare staff who couldn’t isolate at home. Round-the-clock data were monitored by a trained team. If the team spotted signs of deterioration, people could be transferred to hospital when necessary.1 Reducing direct contact between people in quarantine and health workers could reduce transmission of SARS-CoV-2 and reduce the use of personal protective equipment. BMJ 18 February 2021
Early high-titer plasma therapy to prevent severe Covid-19 in older adults
Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduced the progression of Covid-19. NEJM 18 February 2021
A randomized trial of convalescent plasma in Covid-19 severe pneumonia
No significant differences were observed in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo. NEJM 18 February 2021
Maintaining safety with SARS-CoV-2 vaccines
In the world of Covid-19 and vaccines, many questions remain. What are the correlates of protective immunity after natural infection or vaccination? How long will immunity last? Will widespread immunity limit the spread of the virus in the population? Which component of the vaccine is responsible for allergic reactions? Are some vaccines less likely than others to cause IgE- and non-IgE–mediated reactions? Careful vaccine-safety surveillance over time, paired with elucidation of mechanisms of adverse events across different SARS-CoV-2 vaccine platforms, will be needed to inform a strategic and systematic approach to vaccine safety. NEJM 18 February 2021
Emergency intubation in Covid-19 (video)
The video “Emergency Intubation in Covid-19” is intended for health care personnel involved in performing emergency endotracheal intubation in patients with suspected or proven infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the respiratory illness coronavirus disease 2019 (Covid-19). NEJM 18 February 2021
Should spreading anti-vaccine misinformation be criminalised?
The spread of false health information casts a shadow over required vaccine coverage. Melinda Mills says that we must, reluctantly, consider criminalising people who deliberately spread false information—but Jonas Sivelä argues that the definitions are too murky and that criminalisation may do more harm than good BMJ 17 February 2021
Effect of a single high dose of vitamin D3 on hospital length of stay in patients with moderate to severe COVID-19 : A randomized clinical trial
Among hospitalized patients with COVID-19, a single high dose of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay. The findings do not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19. JAMA 17 February 2021
Discriminant accuracy of the SOFA Score for determining the probable mortality of patients with COVID-19 pneumonia requiring mechanical ventilation
The Sequential Organ Failure Assessment (SOFA) score possesses inadequate discriminant accuracy to be used for ventilator triage of COVID-19 patients. A better option is needed that incorporates variables specifically related to mortality in patients with COVID-19 pneumonia requiring mechanical ventilation. JAMA 17 February 2021
Delayed second dose versus standard regimen for Covid-19 vaccination
This interactive feature about administration of the second dose Covid-19 vaccine either according to the standard schedule or delayed offers a case vignette accompanied y two essays, each of which recommends a different approach. NEJM 17 February 2021
What makes new variants of SARS-CoV-2 concerning is not where they come from, but the mutations they contain
The world now seems obsessed with SARS-CoV-2 variants and designating them with a place of origin. This is an unfortunate stigma that should be avoided at all costs given that where a virus is first detected is not necessarily where it originate BMJ 16 February 2021
Covid-19: How the lessons of HIV can help end the pandemic
Harm reduction, which proved its worth with HIV/AIDS, can help stem the covid-19 pandemic by helping people change their behaviour. BMJ 16 February 2021
Patient factors and temporal trends associated with COVID-19 in-hospital mortality in England: an observational study using administrative data
Reductions in the adjusted probability of in-hospital mortality for COVID-19 patients over time might reflect the impact of changes in hospital strategy and clinical processes. The reasons for the observed improvements in mortality should be thoroughly investigated to inform the response to future outbreaks. The higher mortality rate reported for certain ethnic minority groups in community-based studies compared with our hospital-based analysis might partly reflect differential infection rates in those at greatest risk, propensity to become severely ill once infected, and health-seeking behaviours. The Lancet 15 February 2021
Covid-19: Are cloth masks still effective? And other questions answered
In light of new, more transmissible variants of SARS-CoV-2, Elisabeth Mahase examines what kinds of mask the public should be wearing, and where they should be worn. BMJ 15 February 2021
A Phase II safety and efficacy study on prognosis of moderate pneumonia in COVID-19 patients with regular intravenous immunoglobulin therapy
IVIG was safe and efficacious as an adjuvant with other antiviral drugs in the treatment of COVID-19.
Journal of infectious diseases 15 February 2021
Viral load of SARS-CoV-2 in adults during the first and second wave of COVID-19 pandemic in Houston, TX: the potential of the super-spreader
The author’s detected a small group of individuals with extremely high SARS-CoV-2 viral load with mild illness. They believe that these individuals’ characteristics could be consistent with the super-spreader phenomenon and that greater awareness of the social dynamics of these individuals is needed to understand the spread of SARS-CoV-2. Journal of infectious diseases 15 February 2021
S-variant SARS-CoV-2 lineage B1.1.7 is associated with significantly higher viral loads in samples tested by ThermoFisher TaqPath RT-qPCR
A SARS-CoV-2 variant B1.1.7 containing a mutation Δ69/70 has spread rapidly in the UK and shows an identifiable profile in ThermoFisher TaqPath RTqPCR (S-gene target failure; SGTF). We analysed recent test data for trends and significance. Linked Ct values for respiratory samples showed that a low Ct for ORF1ab and N were clearly associated with SGTF. Significantly more SGTF samples had higher inferred viral loads between 1x10 7 and 1x10 8. Our conclusion is that patients whose samples exhibit the SGTF profile are more likely to have high viral loads, which may explain higher infectivity and rapidity of spread. Journal of infectious diseases 13 February 2021
High amounts of SARS-CoV-2 precede sickness among asymptomatic healthcare workers
High amounts of SARS-CoV-2 virus, as determined using PCR Ct values, associates with development of sickness in the next few weeks. The results support the concept that PCR Ct may be informative when testing for SARS-CoV-2 is performed. Journal of infectious diseases 13 February 2021
Reports of Anaphylaxis after receipt of mRNA COVID-19 Vaccines in the US—December 14, 2020-January 18, 2021
Continued safety monitoring of mRNA COVID-19 vaccines in the US has confirmed that anaphylaxis following vaccination is a rare event, with rates of 4.7 cases/million Pfizer-BioNTech vaccine doses administered and 2.5 cases/million Moderna vaccine doses administered, based on information through January 18, 2021. When considered in the context of morbidity and mortality from COVID-19,9 the benefits of vaccination far outweigh the risk of anaphylaxis, which is treatable. Because of the acute, life-threatening nature of anaphylaxis, immediate epinephrine administration is indicated for all cases. CDC guidance on use of mRNA COVID-19 vaccines8 and management of anaphylaxis is available. All facilities administering COVID-19 vaccines should have the necessary supplies and trained medical personnel available to manage anaphylaxis. JAMA 12 February 2021
Effect of high-dose zinc and ascorbic acid supplementation vs usual care on symptom length and reduction among ambulatory patients with SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial
In this randomized clinical trial of ambulatory patients diagnosed with SARS-CoV-2 infection, treatment with high-dose zinc gluconate, ascorbic acid, or a combination of the 2 supplements did not significantly decrease the duration of symptoms compared with standard of care. JAMA 12 February 2021
Age- and sex-associated variations in the sensitivity of serological tests among individuals infected with SARS-CoV-2
The findings of this cohort study suggest that measuring serological levels too soon after SARS-CoV-2 infection might lead to an incorrect assessment of immune response. The sensitivity of antibody testing was higher in males and patients aged 40 to 59 years, but our subset cohort sizes are small. If these findings are validated, then accounting for differences in sex and age in interpreting serological levels may be warranted. Antibody test sensitivity was stable at 112 days and beyond after a known positive RT-PCR result, suggesting a detectable antibody response long after infection. This study has some limitations. The study was performed in a limited-size convenience cohort of patients. Preexisting conditions, clinical severity of disease, and unobserved clinical factors may confound estimated sensitivity. Treatment centers were all in California, which may limit generalizability of the findings. Additionally, serological results were treated as binary observations; specific titer levels were not available. The results of this cohort study suggest that while it was possible to conduct serological tests too soon after SARS-CoV-2 infection, a detectable antibody response was clinically detectable many months after an infection. JAMA 12 February 2021
Why did a German newspaper insist the Oxford AstraZeneca vaccine was inefficacious for older people—without evidence?
Reporting information from single anonymous sources that turns out to be false could erode public confidence in the vaccines that are crucial to controlling the covid-19 pandemic. BMJ 12 February 2021
Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study
Early initiation of prophylactic anticoagulation compared with no anticoagulation among patients admitted to hospital with covid-19 was associated with a decreased risk of 30 day mortality and no increased risk of serious bleeding events. These findings provide strong real world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial treatment for patients with covid-19 on hospital admission. BMJ 11 February 2021
Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey
Half of LTCFs had no cases of SARS-CoV-2 infection in the first wave of the pandemic. Reduced transmission from staff is associated with adequate sick pay, minimal use of agency staff, an increased staff-to-bed ratio, and staff cohorting with either infected or uninfected residents. Increased transmission from residents is associated with an increased number of new admissions to the facility and poor compliance with isolation procedures. The Lancet 11 February 2021
The Coronavirus Pandemic 1 year on—What went wrong?
January 30, 2021, marked the first anniversary of the declaration by the World Health Organization (WHO) of coronavirus disease 2019 (COVID-19) as a public health emergency of international concern (PHEIC). Thus far, the world has been no match for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with more than 100 million cases and 2 million deaths—both rising quickly. JAMA 11 February 2021
Repurposed antiviral drugs for Covid-19 — Interim WHO solidarity trial results
These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. NEJM 11 February 2021
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. NEJM 11 February 2021
Effectiveness of mask wearing to control community spread of SARS-CoV-2
When masks are worn and combined with other recommended mitigation measures, they protect not only the wearer but also the greater community. Recommendations for masks will likely change as more is learned about various mask types and as the pandemic evolves. With the emergence of more transmissible SARS-CoV-2 variants, it is even more important to adopt widespread mask wearing as well as to redouble efforts with use of all other nonpharmaceutical prevention measures until effective levels of vaccination are achieved nationally. JAMA 10 February 2021
Guidelines recommend measures to manage acute and chronic conditions during the COVID-19 pandemic: updated
Further guidelines have been published to inform the management of patients with coexisting conditions during the COVID-19 pandemic.
New this update:
BMJ 10 February 2021
