COVID-19 Literature III

literature published 1 May 2020 – Sep 2020

1 MAY 2020: SARS-CoV-2 productively infects human gut enterocytes (Science)

2 MAY 2020: Individual variation in susceptibility or exposure to SARS-CoV-2 lowers the herd immunity threshold (medRxiv preprint)
“Although estimates vary, it is currently believed that herd immunity to SARS-CoV-2 requires 60-70% of the population to be immune. Here we show that variation in susceptibility or exposure to infection can reduce these estimates. Achieving accurate estimates of heterogeneity for SARS-CoV-2 is therefore of paramount importance in controlling the COVID-19 pandemic.”

2 MAY 2020: SARS-CoV-2 is well adapted for humans. What does this mean for re-emergence? (bioRxiv preprint)

5 MAY 2020: Acute limb ischaemia in two young, non-atherosclerotic patients with COVID-19 (Lancet)

5 MAY 2020: Blood filter may calm the cytokine storm of COVID-19 (AugustaUniversity)
“physicians are replacing the usual filter in a kidney dialysis machine with a filter known to trap these tiny proteins, with the goal of avoiding the devastation”

5 MAY 2020: COVID-19 length of hospital stay: a systematic review and data synthesis (medRxiv preprint)

5 MAY 2020: Humoral immune response and prolonged PCR positivity in a cohort of 1343 SARS-CoV 2 patients in the New York City region (medRxiv preprint)

6 MAY 2020: The disease-induced herd immunity level for Covid-19 is substantially lower than the classical herd immunity level (arXiv preprint)
“Consequently, a lower fraction infected is required for herd immunity to appear. The underlying reason is that when immunity is induced by disease spreading, the proportion infected in groups with high contact rates is greater than that in groups with low contact rates. Consequently, disease-induced immunity is stronger than when immunity is uniformly distributed in the community as in the classical herd immunity level.”

9 MAY 2020: Reductions in commuting mobility predict geographic differences in SARS-CoV-2 prevalence in New York City (HarvardLibrary)
“Population revalence was lowest in boroughs with the greatest reductions in morning commutes out of and evening commutes into the borough”

10 MAY 2020: SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19 (Journal of Hepatology)
“SARS-CoV-2 infection in the liver directly contributes to hepatic impairment in patients with COVID-19. Hence, a surveillance of viral clearance in liver and long-term outcome of COVID-19 is required.”

11 MAY 2020: The majority of male patients with COVID-19 present low testosterone levels on admission to Intensive Care in Hamburg, Germany: a retrospective cohort study (medRxiv preprint)

12 MAY 2020: Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging (JACC Cardiovascular Imaging)
“Cardiac involvement was found in a proportion of patients recovered from COVID-19. CMR manifestation included myocardial edema, fibrosis, and impaired right ventricle function. Attention should be paid to the possible myocardial involvement in patients recovered from COVID-19 with cardiac symptoms.”

“Of 5,449 patients admitted with Covid-19, AKI [acute kidney injury] developed in 1,993 (36.6%).”

13 MAY 2020: The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission (PNAS)
“These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.”

13 MAY 2020: An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study (Lancet)
“In the past month we found a 30-fold increased incidence of Kawasaki-like disease. Children diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected in countries involved in the SARS-CoV-2 epidemic.”

13 MAY 2020: Estimating the burden of SARS-CoV-2 in France (Science)
“The lockdown reduced the reproductive number from 2.90 to 0.67 (77% reduction). By 11 May 2020, when interventions are scheduled to be eased, we project 2.8 million (range: 1.8–4.7) people, or 4.4% (range: 2.8–7.2) of the population, will have been infected.”

13 MAY 2020: Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure (Annals of Internal Medicine)

13 MAY 2020: COVID-19 Virulence in Aged Patients Might Be Impacted by the Host Cellular MicroRNAs Abundance/Profile (AgingandDisease)
(Potential RNA Treatment)

14 MAY 2020: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (CDC)
“From April 16 through May 4, 2020, 15 patients aged 2-15 years were hospitalized, many requiring admission to the intensive care unit. As of May 12, 2020, the New York State Department of Health identified 102 patients (including patients from New York City) with similar presentations, many of whom tested positive for SARS-CoV-2 infection by RT-PCR or serologic assay. New York State and New York City continue to receive additional reports of suspected cases.”

14 MAY 2020: Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome: Results From a Prospective, Single-Center, Clinicopathologic Case Series (Annals of Internal Medicine)
“COVID-19 predominantly involves the lungs, causing DAD and leading to acute respiratory insufficiency. Death may be caused by the thrombosis observed in segmental and subsegmental pulmonary arterial vessels despite the use of prophylactic anticoagulation. Studies are needed to further understand the thrombotic complications of COVID-19”
article on the paper: Autopsies Indicate Blood Clots Are Lethal in COVID-19 (TheScientist) 

14 MAY 2020: Antibody study shows just 5% of Spaniards have contracted the coronavirus (ElPais)
“Only 5% of Spaniards have been infected with the coronavirus, according to the preliminary results of a study by the Carlos III public health institute, which took blood samples from nearly 70,000 participants.”

15 MAY 2020: Serology assays to manage COVID-19 (Science)
“many lateral flow assays from different companies are available, but their usefulness is questionable given the lack of official performance validation with respect to sensitivity (how many true positives are detected) and specificity (the proportion of false positives) (911). Using serological assays with validated sensitivity and specificity performance is critical for obtaining meaningful results. For some applications, such as serosurveys in high-prevalence populations, somewhat lower specificity is acceptable, whereas sensitivity should be high. For uses where a false-positive test result would be consequential, very high specificity is essential.”

15 MAY 2020: COVID-19 pipeline: spotlight on strategies to block viral entry or replication (BioCentury)

15 MAY 2020: COVID-19 update: Covid-19-associated coagulopathy (Journal of Thrombosis)

16 MAY 2020: Strong Social Distancing Measures In The United States Reduced The COVID-19 Growth Rate (Health Affairs)
“Holding the amount of voluntary social distancing constant,
these results imply 10 times greater spread by April 27 without SIPOs
(10 million cases) and more than 35 times greater spread without any of the four measures (35 million).” 

18 MAY 2020: Seroprevalence of SARS-CoV-2–Specific Antibodies Among Adults in Los Angeles County, California, on April 10-11, 2020 (JAMA)

19 MAY 2020: Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms (CDC Early Release)
“We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.”

20 MAY 2020: Viral and host factors related to the clinical outcome of COVID-19 (Nature)
“High levels of IL-6 and IL-8 during treatment were observed in patients with severe or critical disease and correlated with decreased lymphocyte count. The determinants of disease severity seemed to stem mostly from host factors such as age, lymphocytopenia, and its associated cytokine storm, whereas viral genetic variation did not significantly affect the outcomes.”

21 MAY 2020: The role of climate during the COVID‐19 epidemic in New South Wales, Australia (Wiley)
“Lower 9 a.m. relative humidity (but not rainfall or temperature) was associated with increased case occurrence; a reduction in relative humidity of 1% was predicted to be associated with an increase of COVID‐19 cases by 6.11%. During periods of low relative humidity, the public health system should anticipate an increased number of COVID‐19 cases.”

22 MAY 2020: SARS-CoV-2 RNA concentrations in primary municipal sewage sludge as a leading indicator of COVID-19 outbreak dynamics (medRxiv preprint)
“when adjusted for the time lag, the virus RNA concentrations were highly correlated with the COVID-19 epidemiological curve (R2=0.99) and local hospital admissions (R2=0.99). SARS-CoV-2 RNA concentrations were a seven-day leading indicator ahead of compiled COVID-19 testing data and led local hospital admissions data by three days.”

22 MAY 2020: The world needs Covid-19 vaccines. It may also be overestimating their power (STAT)

22 MAY 2020: Full genome viral sequences inform patterns of SARS-CoV-2 spread into and within Israel (medRxiv preprint)
“Using phylodynamic analysis, we estimated that the basic reproduction number of the virus was initially around ~2.0-2.6, dropping by two-thirds following the implementation of social distancing measures. A comparison between reported and model-estimated case numbers indicated high levels of transmission heterogeneity in SARS-CoV-2 spread, with between 1-10% of infected individuals resulting in 80% of secondary infections.” 

26 MAY 2020: U of A researchers flag similarities between COVID-19 deaths and severe rheumatic illnesses (UniversityofAlberta)

26 MAY 2020: Loss of Smell and Taste in 2013 European Patients With Mild to Moderate COVID-19 (Annals of Internal Medicine)
“The prevalence of self-reported smell and taste dysfunction in our study is higher than previously reported and may be characterized by different clinical forms. Our results suggest that anosmia may not be related to nasal obstruction or inflammation. Future studies are needed to understand the pathophysiologic mechanisms underlying loss of smell and taste in COVID-19, including potential viral spread through the olfactory neuroepithelium and invasion of the olfactory bulb and central nervous system”

26 MAY 2020: A Unique Clade of SARS-CoV-2 Viruses is Associated with Lower Viral Loads in Patient Upper Airways (medRxiv preprint)
“These results show that multiple variants of SARS-CoV-2 are circulating in the USA that differ in their relative airway viral loads and potential for expansion.”

26 MAY 2020: College Student Contribution to Local COVID-19 Spread: Evidence from University Spring Break Timing (SSRN)
“Our estimates imply that counties with more early spring break students had higher confirmed case growth rates than counties with fewer early spring break students. We find that the increase in case growth rates peaked two weeks after students returned to campus. Consistent with secondary spread to more vulnerable populations, we find an increase in mortality growth rates that peaked four to five weeks after students returned.” 

27 MAY 2020: Reducing transmission of SARS-CoV-2 (Science)
“A multidisciplinary approach is needed to address a wide range of factors that lead to the production and airborne transmission of respiratory viruses, including the minimum virus titer required to cause COVID-19; viral load emitted as a function of droplet size before, during, and after infection; viability of the virus indoors and outdoors; mechanisms of transmission; airborne concentrations; and spatial patterns. More studies of the filtering efficiency of different types of masks are also needed.”

27 MAY 2020: Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission (Lancet)
“In the best ventilated room, after 30 s the number of droplets had halved, whereas with no ventilation this took about 5 min, in agreement with the air drag calculation that shows that 5 μm drops from the average cough or speech height take 9 min to reach the ground.” 

29 MAY 2020: Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID-19) and Anosmia (JAMA)
“Based on the MRI findings … we can speculate that SARS-CoV-2 might invade the brain through the olfactory pathway and cause an olfactory dysfunction of sensorineural origin; cerebrospinal fluid and pathology studies are required to confirm this hypothesis.”

29 MAY 2020: Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019 (JAMA)
“Viral neuroinvasion may be achieved by several routes, including transsynaptic transfer across infected neurons, entry via the olfactory nerve, infection of vascular endothelium, or leukocyte migration across the blood-brain barrier. The most common neurologic complaints in COVID-19 are anosmia, ageusia, and headache, but other diseases, such as stroke, impairment of consciousness, seizure, and encephalopathy, have also been reported.”

29 MAY 2020: Introductions and early spread of SARS-CoV-2 in the New York City area (Science)
“Phylogenetic analysis of 84 distinct SARS-CoV2 genomes indicates multiple, independent but isolated introductions mainly from Europe and other parts of the United States. Moreover, we find evidence for community transmission of SARS-CoV-2 as suggested by clusters of related viruses found in patients living in different neighborhoods of the city.”

30 MAY 2020: Targeted Immunosuppression Distinguishes COVID-19 from Influenza in Moderate and Severe Disease (medRxiv preprint)
“The majority of COVID-19 patients with acute respiratory failure do not have a cytokine storm phenotype but instead exhibit profound type I and type II IFN immunosuppression when compared to patients with acute influenza. Upregulation of a small number of inflammatory mediators, including IL-6, predicts acute respiratory failure in both COVID-19 and influenza patients.”

1 JUN 2020: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review (Lancet)
“Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m … Face mask use could result in a large reduction in risk of infection … with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar . Eye protection also was associated with less infection”

4 JUN 2020: Autoimmune and inflammatory diseases following COVID-19 (NatRevRheum)
“Emerging reports show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection precedes the appearance of various autoimmune and autoinflammatory diseases, including paediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C)”

8 JUN 2020: Neurobiology of COVID-19 (Journal of Alzheimer’s Disease)
“Anosmia, stroke, paralysis, cranial nerve deficits, encephalopathy, delirium, meningitis, and seizures are some of the neurological complications in patients with coronavirus disease-19 (COVID-19)“

9 JUNE 2020: SARS-CoV-2 Infections and Serologic Responses from a Sample of U.S. Navy Service Members (CDC Early Release)
“Service members who reported taking preventive measures had a lower infection rate than did those who did not report taking these measures (e.g., wearing a face covering, 55.8% versus 80.8%; avoiding common areas, 53.8% versus 67.5%; and observing social distancing, 54.7% versus 70.0%, respectively). The presence of neutralizing antibodies, which represent antibodies that inhibit SARS-CoV-2, among the majority (59.2%) of those with antibody responses is a promising indicator of at least short-term immunity.” 

9 JUN 2020: Dynamics of IgG seroconversion and pathophysiology of COVID-19 infections (medRxiv preprint)

12 JUN 2020: New-Onset Diabetes in Covid-19 (NEJM)
“There is a bidirectional relationship between Covid-19 and diabetes. On the one hand, diabetes is associated with an increased risk of severe Covid-19. On the other hand, new-onset diabetes and severe metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity for which exceptionally high doses of insulin are warranted, have been observed in patients with Covid-19”

15 JUN 2020: Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020 (CDC Early Release)
“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.”

15 JUN 2020: The First Covid Vaccines May Not Prevent Covid Infection (Bloomberg)

15 JUN 2020: Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study (Lancet)
“We estimated that 1·7 billion (UI 1·0–2·4) people, comprising 22% (UI 15–28) of the global population, have at least one underlying condition that puts them at increased risk of severe COVID-19 if infected”

16 JUN 2020: Erythropoietin as candidate for supportive treatment of severe COVID-19 (Molecular Medicine)
“We recap here evidence that supports the use of human recombinant erythropoietin (EPO) for ameliorating course and outcome of seriously ill COVID-19 patients.” 

18 JUN 2020: Global evaluation of echocardiography in patients with COVID-19 (European Hearth Journal)
“In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe”

18 JUN 2020: Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections (Nature)
“The asymptomatic group had a significantly longer duration of viral shedding than the symptomatic group” & “These data suggest that asymptomatic individuals had a weaker immune response to SARS-CoV-2 infection.” & “Upon admission, chest computed tomography (CT) scans showed focal ground-glass opacities in 11 asymptomatic individuals (11/37, 29.7%) and stripe shadows and/or diffuse consolidation in ten individuals (10/37, 27.0%), whereas 16 individuals (16/37, 43.2%) had no abnormalities” & “In this study, we observed that IgG levels and neutralizing antibodies in a high proportion of individuals who recovered from SARS-CoV-2 infection start to decrease within 2–3 months after infection.”

22 JUN 2020: Mini organs reveal how the coronavirus ravages the body (Nature Article)
“The virus can damage lung, liver and kidney tissue grown in the lab”

23 JUN 2020: Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions (CDC Early Release)
“our findings suggest retained infectivity and virion integrity for up to 16 hours in respirable-sized aerosols.”

24 JUN 2020: Mounting clues suggest the coronavirus might trigger diabetes (Nature Article)
“Evidence from tissue studies and some people with COVID-19 shows that the virus damages insulin-producing cells.”

24 JUN 2020: Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients (CDC Early Release)
“In our study, the neutralizing antibody titer correlated with the severity of the disease. This result suggests that patients with more severe disease might be more protected against reinfection and those with asymptomatic or mild disease could be more vulnerable to waning immunity over time because the initial immune response was not as strong as in patients with more severe disease.”

25 JUN 2020: COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study (Lancet)
“The study has several key findings. First, the data show that COVID-19 is generally a mild disease in children, including infants. Second, the study found that a substantial proportion (8%) of children develop severe disease, requiring intensive care support and prolonged ventilation. Several predisposing factors for requiring intensive care support were identified.”

25 JUN 2020: Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series (Lancet)
“In this series of seven COVID-19 autopsies, thrombosis was a prominent feature in multiple organs, in some cases despite full anticoagulation and regardless of timing of the disease course, suggesting that thrombosis plays a role very early in the disease process. The finding of megakaryocytes and platelet-rich thrombi in the lungs, heart and kidneys suggests a role in thrombosis.”

26 JUN 2020: Seroprevalence of Antibodies to SARS-CoV-2 in Six Sites in the United States, March 23-May 3, 2020 (medRxiv preprint)
“Results: We tested sera from 11,933 persons. Adjusted estimates of the proportion of persons seroreactive to the SARS-CoV-2 spike protein ranged from 1.13% (95% confidence interval [CI] 0.70-1.94) in WA to 6.93% (95% CI 5.02-8.92) in NYC (collected March 23-April 1). For sites with later collection dates, estimates ranged from 1.85% (95% CI 1.00-3.23, collected April 6-10) for FL to 4.94% (95% CI 3.61-6.52) for CT (April 26-May 3). The estimated number of infections ranged from 6 to 24 times the number of reported cases in each site.”

27 JUN 2020: Myocarditis in a 16-year-old boy positive for SARS-CoV-2 (Lancet)
“Paediatric patients reporting chest pain and other features suggestive of acute myocarditis—with or without respiratory symptoms—should, we believe, also be tested for SARS-CoV-2” 

29 JUN 2020: Multisystem Inflammatory Syndrome in Children in New York State (NEJM) 
“These findings support that MIS-C is probably a postinfectious, inflammatory process related to Covid-19.”

29 JUN 2020: Childhood Multisystem Inflammatory Syndrome — A New Challenge in the Pandemic (NEJM Editorial)
“Because MIS-C generally occurs late after SARS-CoV-2 infection, after antibody has developed, aberrant cellular or humoral adaptive immune responses may be involved. … One might speculate that the clinical similarity between Kawasaki’s disease and MIS-C implies a related underlying genetic architecture, supporting the hypothesis that the new disorder arises from aberrant T- or B-cell responses to SARS-CoV-2. Given such hypotheses, might an understanding of MIS-C illuminate the elusive pathogenesis of Kawasaki’s disease? Furthermore, would it have implications for the development of a safe vaccine against SARS-CoV-2”

29 JUN 2020: Seroconversion of a city: Longitudinal monitoring of SARS-CoV-2 seroprevalence in New York City (medRxiv preprint)
using >5,000 plasma samples from patients at Mount Sinai Hospital in New York City (NYC), we identified seropositive samples as early as in the week ending February 23, 2020. A stark increase in seropositivity in the sentinel group started the week ending March 22 and in the screening group in the week ending March 29. By the week ending April 19, the seroprevalence in the screening group reached 19.3%”

30 JUN 2020: A focused review on the genital and sexual affection of COVID-19 patients (Journal of Gynecology Obstetrics and Human Reproduction)
“The pandemic of coronavirus disease-2019 (COVID-19) could harm the reproductive and sexual health of both males and females. This could be through psychological, immunological, or systemic effects. In this article, we tried to elucidate the mechanisms that could explain the current and future genital affection of COVID-19 patients.”

1 JUL 2020: Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children (JAMA Neurology)
“Of the 27 children with COVID-19 pediatric multisystem inflammatory syndrome, 4 patients (14.8%) who were previously healthy had new-onset neurological symptoms. Symptoms included encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness, and reduced reflexes … all 4 patients had signal changes in the splenium of the corpus callosum on neuroimaging and required intensive care admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome.”

1 JUL 2020: How important is obesity as a risk factor for respiratory failure, intensive care admission and death in hospitalized COVID-19 patients (European Journal of Endocrinology)
“Obesity is a strong, independent risk factor for respiratory failure, admission to the ICU and death among COVID-19 patients. Whereas a BMI ≥ 30 kg/m2 identifies a population of patients at high risk for severe illness, a BMI ≥ 35 kg/m2 dramatically increases the risk of death.” 
Press Release Link 16 Jul (MedicalExpress)

1 JUL 2020: Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020 (JAMA Internal Medicine)
“In this cohort study, the number of deaths due to any cause increased by approximately 122 000 from March 1 to May 30, 2020, which is 28% higher than the reported number of COVID-19 deaths.”

1 JUL 2020: Association between mobility patterns and COVID-19 transmission in the USA: a mathematical modelling study (Lancet)
“Our analysis revealed that mobility patterns are strongly correlated with decreased COVID-19 case growth rates for the most affected counties in the USA … Additionally, the effect of changes in mobility patterns, which dropped by 35–63% relative to the normal conditions, on COVID-19 transmission are not likely to be perceptible for 9–12 days, and potentially up to 3 weeks, which is consistent with the incubation time of severe acute respiratory syndrome coronavirus 2 plus additional time for reporting. We also show evidence that behavioural changes were already underway in many US counties days to weeks before state-level or local-level stay-at-home policies were implemented”

1 JUL 2020: Large SARS-CoV-2 Outbreak Caused by Asymptomatic Traveler, China (CDC Early Release)
“An asymptomatic person infected with severe acute respiratory syndrome coronavirus 2 returned to Heilongjiang Province, China, after international travel. The traveler’s neighbor became infected and generated a cluster of >71 cases, including cases in 2 hospitals.”

2 JUL 2020: Neurological associations of COVID-19 (Lancet Neurology)
“We summarise the evidence to date for COVID-19, examine putative disease mechanisms, and finally suggest a framework for investigating patients with suspected COVID-19-associated neurological disease to support clinico-epidemiological, disease mechanism, and treatment studies.”

3 JUL 2020: Characteristics of Adult Outpatients and Inpatients with COVID-19 — 11 Academic Medical Centers, United States, March–May 2020 (CDC Early Release)
“In a multistate telephone survey of 350 adult inpatients and outpatients who tested positive for SARS-CoV-2 infection, only 46% reported recent contact with a COVID-19 patient. Most participants’ contacts were a family member (45%) or a work colleague (34%).”

3 JUL 2020: The major genetic risk factor for severe COVID-19 is inherited from Neandertals (bioRxiv preprint)
“Here, we show that the risk is conferred by a genomic segment of ~50 kb that is inherited from Neandertals and occurs at a frequency of ~30% in south Asia and ~8% in Europe.” 

3 JUL 2020: Complications from COVID-19 may depend on von Willebrand factor in the blood (EurekaAlert Press Release)
“As the researcher suggests, the replication of the virus stimulates the development of microdamage on vessel walls. In its response to this, the body releases von Willebrand factor into the blood, trying to ‘patch’ possible holes. As a result, the risk of thromboses increases. It is with this clotting that a significant part of the deaths from COVID-19 is associated.”

4 JUL 2020: Tissue-specific tolerance in fatal Covid-19 (medRxiv preprint)
“Our results support virus-independent immunopathology being one of the primary mechanisms underlying fatal Covid-19. This supports prioritising pathogen tolerance as a therapeutic strategy in Covid-19, by better understanding non-injurious organ-specific viral tolerance mechanisms and targeting aberrant macrophage and plasma cell responses.”

6 JUL 2020: Prevalence of SARS-CoV-2 in Spain (ENE-COVID) (Lancet)
Seroprevalence was 5·0% (Ranging from 1.4 to 14.4 in different regions). “Around a third of seropositive participants were asymptomatic. … the seroprevalence was 16·9% in those who reported a history of symptoms compatible with COVID-19” 

6 JUL 2020: High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms (medRxiv preprint)
“We report [anti-neuronal] autoantibody findings in eleven critically ill COVID-19 patients presenting with a variety of neurological symptoms with unexplained etiology.” 

JUL 2020: SARS-CoV2 induced respiratory distress: Can cannabinoids be added to anti-viral therapies to reduce lung inflammation? (Brain, Behavior, and Immunity)

7 JUL 2020: Pre-existing immunity to SARS-CoV-2: the knowns and unknowns (Nature Reviews Immunology)
“In conclusion, it is now established that SARS-CoV-2 pre-existing immune reactivity exists to some degree in the general population. It is hypothesized, but not yet proven, that this might be due to immunity to CCCs (common cold coronaviruses). This might have implications for COVID-19 disease severity, herd immunity and vaccine development, which still await to be addressed with actual data.”

8 JUL 2020: Cannabidiol Modulates Cytokine Storm in Acute Respiratory Distress Syndrome Induced by Simulated Viral Infection Using Synthetic RNA (Cannabis and Cannabinoid Research)
“Our results suggest a potential protective role for CBD during ARDS that may extend CBD as part of the treatment of COVID-19 by reducing the cytokine storm, protecting pulmonary tissues, and re-establishing inflammatory homeostasis.”

8 JUL 2020: The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings (Brain)
“Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness…”
Article on paper: Dozens More Cases of Neurological Problems in COVID-19 Reported (The Scientist)

9 JUL 2020: Persistent Symptoms in Patients After Acute COVID-19 (JAMA Research Letter) 
“Patients were assessed a mean of 60.3 (SD, 13.6) days after onset of the first COVID-19 symptom; at the time of the evaluation, only 18 (12.6%) were completely free of any COVID-19–related symptom, while 32% had 1 or 2 symptoms and 55% had 3 or more. None of the patients had fever or any signs or symptoms of acute illness. Worsened quality of life was observed among 44.1% of patients.” 

9 JUL 2020: Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK (Lancet Children)
“During the study period, the rate of PICU admissions for PIMS-TS was at least 11-fold higher than historical trends for similar inflammatory conditions. Clinical presentations and treatments varied. Coronary artery aneurysms appear to be an important complication. Although immediate survival is high, the long-term outcomes of children with PIMS-TS are unknown.”

9 JUL 2020: Association of neuronal injury blood marker neurofilament light chain with mild-to-moderate COVID-19 (Journal of Neurology)
“Our results indicate for the first time that COVID-19 may affect the neuro-axonal integrity also in adults with a mild-to-moderate course of the disease. This new evidence for a more general neuro-destructive capability of SARS-CoV-2 also in mild-to-moderate COVID-19 patients should raise awareness for potential long-term neurologic sequelae following COVID-19.”

9 JUL 2020: Nutrition, immunity and COVID-19 (BMJ Nutrition)

10 JUL 2020: Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities ― United States, April–May 2020 (CDC Early Release)
“Among 23 states reporting COVID-19 outbreaks in meat and poultry processing facilities, 16,233 cases in 239 facilities occurred, including 86 (0.5%) COVID-19–related deaths. Among cases with race/ethnicity reported, 87% occurred among racial or ethnic minorities.”

10 JUL 2020: An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 (Lancet)
“Here we describe the case of an adult male who presented to NYU Langone Health in New York City, NY, USA, with a Kawasaki-like multisystem inflammatory syndrome in the setting of SARS-CoV-2 infection, similar to what has been reported in children.”

10 JUL 2020: SARS-CoV-2 Seroprevalence Among Parturient Women (medRxiv preprint)
“Our finding that Black/non-Hispanic and Hispanic/Latino women have higher SARS-CoV-2 seroprevalence rates relative to women of other races suggest that there are race/ethnicity differences in SARS-CoV-2 exposures in Philadelphia and surrounding areas.” 

10 JUL 2020: Extrapulmonary manifestations of COVID-19 (Nature Medicine)
“Some examples of areas that require further attention include elucidation of the mechanism by which SARS-CoV-2 is disseminated to extrapulmonary tissues, understanding of the viral properties that may enhance extrapulmonary spread, the contribution of immunopathology and effect of anti-inflammatory therapies, anticipation of the long-term effects of multi-organ injury, the identification of factors that account for the variability in presentation and severity of illness, and the biological and social mechanisms that underlie disparities in outcomes.” 

11 JUL 2020: Longitudinal evaluation and decline of antibody responses in SARS-CoV-2 infection (medRxiv preprint)
“In summary, using sequential samples from SARS-CoV-2 infected individuals collected up to 94 days POS, we demonstrate declining nAb titres in the majority of individuals. For those with a low nAb response, titres can return to base line over a relatively short period. Further studies using sequential samples from these individuals is required to fully determine the longevity of the nAb response and studies determining the nAb threshold for protection from re-infection are needed.” 

14 JUL 2020: U of T tests show Canadian-made mask deactivates 99% of SARS-CoV-2 virus (University of Toronto News)
“An antimicrobial coating developed by Quebec company I3 BioMedical Inc. can deactivate more than 99 per cent of SARS-CoV-2 – the virus that causes COVID-19 – on the outer surface of medical masks, tests carried out by University of Toronto scientists have shown.”

14 JUL 2020: Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers (JAMA)

14 JUL 2020: Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy (CDC Early Release)
“Among 139 clients exposed to two symptomatic hair stylists with confirmed COVID-19 while both the stylists and the clients wore face masks, no symptomatic secondary cases were reported; among 67 clients tested for SARS-CoV-2, all test results were negative.” 

17 JUL 2020: SARS-CoV-2 RNAemia in a Healthy Blood Donor 40 Days After Respiratory Illness Resolution (Annals of Internal Medicine)
“The confirmation of donor RNAemia more than 1 month after symptom resolution is concerning in light of current guidelines, which do not recommend SARS-CoV-2 screening in the general allogeneic donor population (5). In this case, plasma viral RNA was reproducibly detected at a time point that exceeded recommendations for deferral based on time since symptom resolution (14 days).

20 JUL 2020: Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System (JAMA Research Letter)
“Among 829 ICU patients, 29.4% had a thrombotic event (13.6% venous and 18.6% arterial). Among 2505 non-ICU patients, 11.5% had a thrombotic event (3.6% venous and 8.4% arterial).”

21 JUL 2020: The Infectious Nature of Patient-Generated SARS-CoV-2 Aerosol (medRxiv preprint)
“Our results demonstrate that SARS-CoV-2 RNA exists in respired aerosols less than 5 μm in diameter; that aerosols containing SARS-CoV-2 RNA exist in particle modes that are produced during respiration, vocalization, and coughing; and that some fraction of the RNA-containing aerosols contain infectious virions” 

21 JUL 2020: Unexpected Features of Cardiac Pathology in COVID-19 Infection (Circulation Letter)
“We identify key gross and microscopic changes that challenge the notion that typical myocarditis is present in severe SARS-CoV-2 infection. We speculate on alternative mechanisms for cardiac injury that should be investigated to provide a better understanding of the cardiac manifestations of COVID-19.” 

21 JUL 2020: COVID-19 worse in colder weather (King’s College London press release)
“Comparing outcomes from more than 40,000 COVID-19 patients over the course of the pandemic suggests that the disease is more severe in colder months than warmer ones, and that dry indoor air may encourage the spread of the disease.”

23 JUL 2020: Forecasts of Total Deaths (CDC)
“This week’s national ensemble forecast predicts there will likely be between 160,000 and 175,000 total reported COVID-19 deaths by August 15th.”

23 JUL 2020: Pre-existing and de novo humoral immunity to SARS-CoV-2 in humans (bioRxiv)
“A possible modification of COVID-19 severity by prior HCoV infection might account for the age distribution of COVID-19 susceptibility, where higher HCoV infection rates in children than in adults correlates with relative protection from COVID-19, and might also shape seasonal and geographical patterns of transmission.” 

23 JUL 2020: Investigation of a superspreading event preceding the largest meat processing plant-related SARS-Coronavirus 2 outbreak in Germany (SSRN)
“Our results indicate climate conditions and airflow as factors that can promote efficient spread of SARS- CoV-2 via distances of more than 8 meters and provide insights into possible requirements for pandemic mitigation strategies in industrial workplace settings.” 

“The only striking positive comorbidity was obesity. However,
in NYC, obesity is also much more prevalent among low-income groups who are more likely to live in densely populated neighborhoods and to work in high-exposure jobs. Thus, it is quite possible that NYC’s obese population has a higher infection rate”

24 JUL 2020: Excess Weight and COVID-19: Insights from new evidence (Public Health England)

24 JUL 2020: Particle sizes of infectious aerosols: implications for infection control (Lancet Respiratory Medicine)
“These data support calls for the recognition of aerosol (ie, traditional airborne) transmission of SARS-CoV-2.144 This could facilitate the use of enhanced dilution and directional ventilation and other environmental control options—eg, air disinfection with ultraviolet germicidal irradiation”

25 JUL 2020: Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study (Lancet Psychiatry)
“Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.”

25 JUL 2020: High Rate of SARS-CoV-2 Transmission due to Choir Practice in France at the Beginning of the COVID-19 Pandemic (medRxiv preprint)
“The secondary rate attack (70%) was much higher than it is described within households (10-20%) and among close contacts made outside households (0-5%). … 36% of the cases needed a hospitalization (7/19), and 21% (4/19) were admitted to an ICU.”

26 JUL 2020: The protein expression profile of ACE2 in human tissues (Molecular Systems Biology)
“ACE2 is suggested to be the key protein involved in SARS‐CoV‐2 host cell entry. … Using an integrated omics approach, we here analyzed the spatial localization of ACE2 on the protein level in > 150 different cell types corresponding to all major human tissues and organs” 

27 JUL 2020: Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (JAMA Cardiology)

29 JUL 2020: Cardiac Endotheliitis and Multisystem Inflammatory Syndrome After COVID-19 (Annals of Internal Medicine)
“The autopsy was also significant for the presence of new pulmonary thrombi in a background of otherwise reparative changes in the lungs. These thrombi indicate a potential for hypercoagulability affecting the pulmonary vasculature beyond the initial course of COVID-19, as well as the need for continued monitoring of laboratory markers and possible anticoagulation. 

Our report highlights the potential for serious complications due to endothelial damage and describes potential pathologic characteristics of MIS after COVID-19, a possible mimicker of true myocarditis.”

29 JUL 2020: SARS-CoV-2, SARS-CoV-1 and MERS-CoV viral load dynamics, duration of viral shedding and infectiousness: a living systematic review and meta-analysis (medRxiv preprint)
“Although SARS-CoV-2 RNA shedding in respiratory and stool can be prolonged, duration of viable virus is relatively short-lived. Thus, detection of viral RNA cannot be used to infer infectiousness. High SARS-CoV-2 titres are detectable in the first week of illness with an early peak observed at symptom onset to day 5 of illness.” 

29 JUL 2020: SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19 (Nature)
“Our study demonstrates the presence of S-reactive CD4+ T cells in COVID-19 patients, and in a considerable proportion of SARS-CoV-2 unexposed HD. In light of the recent emergence of SARS-CoV-2, our data raise the intriguing possibility that such pre-existing S-reactive T cells represent cross-reactive clones, probably acquired in previous infections with endemic” 

30 JUL 2020: Children and COVID-19: State Data Report (American Academy of Pediatrics)
“97,078 new child cases reported from 7/16-7/30 (241,904 to 338,982), a 40% increase in child cases” 

30 JUL 2020: AstraZeneca to be exempt from coronavirus vaccine liability claims in most countries (Reuters)

3 AUG 2020: Cerebral Micro-Structural Changes in COVID-19 Patients – An MRI-based 3-month Follow-up Study (Lancet)
“COVID-19 patients had statistically significantly higher bilateral gray matter volumes (GMV) in olfactory cortices, hippocampi, insulas, left Rolandic operculum, left Heschl’s gyrus and right cingulate gyrus and a general decline of MD, AD, RD accompanied with an increase of FA in white matter, especially AD in the right CR, EC and SFF, and MD in SFF compared with non-COVID-19 volunteers” 

4 AUG 2020: Selective and cross-reactive SARS-CoV-2 T cell epitopes in unexposed humans (Science)
“We demonstrate a range of pre-existing memory CD4+ T cells that are cross-reactive with comparable affinity to SARS-CoV-2 and the common cold coronaviruses HCoV-OC43, HCoV-229E, HCoV-NL63, or HCoV-HKU1. Thus, variegated T cell memory to coronaviruses that cause the common cold may underlie at least some of the extensive heterogeneity observed in COVID-19 disease.”

4 AUG 2020: Boosting immune system a potential treatment strategy for COVID-19 (Washington University School of Medicine in St. Louis press release)
“They found that the COVID-19 patients often had far fewer circulating immune cells than is typical. … We think if we can make our immune systems stronger, we’ll be better able to fight off this coronavirus, as well as other viral and bacterial pathogens that may be unleashed in the future.”

4 AUG 2020: SARS-CoV-2 infects human neural progenitor cells and brain organoids (Nature Letter to the Editor)
“The finding that SARS-CoV-2 can productively infect human brain organoids highlights the potential of direct viral involvement in neurological symptoms in COVID-19 patients. These results provided insight on the pathognomonic symptoms of anosmia (loss of smell) and ageusia (loss of taste) as well as other neurological manifestations of COVID-19 including seizure, encephalopathy, encephalitis, Guillain-Barre syndrome, and Miller Fisher syndrome.” 

8 AUG 2020: Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis (Journal of Neurology)
“In meta-analysis, COVID-19 patient with pre-existing CeVD had 2.67-fold (1.75–4.06) higher odds of poor outcomes.”

11 AUG 2020: Management of post-acute covid-19 in primary care (BMJ)
“Post-acute covid-19 (“long covid”) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness.1 Clinical management requires a whole-patient perspective.2 This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital ward.” 

11 AUG 2020: Study reveals immune-system deviations in severe COVID-19 cases (Stanford Medicine News Center)
“A Stanford study shows that in severely ill COVID-19 patients, “first-responder” immune cells, which should react immediately to signs of viruses or bacteria in the body, instead respond sluggishly.”

11 AUG 2020: Overweight, obesity, and risk of hospitalization for COVID-19: A community-based cohort study of adults in the United Kingdom (PNAS)
“In summary, overall and central obesity are risk factors for COVID-19 hospital admission. Elevated risk was apparent even at modest weight gain. The mechanisms may involve impaired glucose and lipid metabolism.” 

11 AUG 2020: Study reveals immune-system deviations in severe COVID-19 cases (Stanford Medicine News Center)
“A Stanford study shows that in severely ill COVID-19 patients, “first-responder” immune cells, which should react immediately to signs of viruses or bacteria in the body, instead respond sluggishly.”

12 AUG 2020: Might SARS‐CoV‐2 Have Arisen via Serial Passage through an Animal Host or Cell Culture? (Bioessays)
“Unless the intermediate host necessary for completing a natural zoonotic jump is identified, the dual‐use gain‐of‐function research practice of viral serial passage should be considered a viable route by which the novel coronavirus arose. The practice of serial passage mimics a natural zoonotic jump, and offers explanations for SARS‐CoV‐2’s distinctive spike‐protein region and its unexpectedly high affinity for angiotensin converting enzyme (ACE2), as well as the notable polybasic furin cleavage site within it. Additional molecular clues raise further questions, all of which warrant full investigation into the novel coronavirus’s origins and a re‐examination of the risks and rewards of dual‐use gain‐of‐function research.”

12 AUG 2020: SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group (medRxiv preprint)
“We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients.”

12 AUG 2020: Obesity and Mortality Among Patients Diagnosed With COVID-19 (Annals of Internal Medicine)
“Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations.”

14 AUG 2020: Neutralizing antibodies correlate with protection from SARS-CoV-2 in humans during a fishery vessel outbreak with high attack rate (medRxiv preprint)
Fishing vessel experienced 85% attack rate & “None of these crewmembers with neutralizing antibody titers showed evidence of bona fide viral infection or experienced any symptoms during the viral outbreak. Therefore, the presence of neutralizing antibodies from prior infection was significantly associated with protection against re-infection”

14 AUG 2020: Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 (CDC Early Release)
“This study, along with other studies of hospitalized children with COVID-19, found that obesity was the most prevalent underlying medical condition. Childhood obesity affects almost one in five U.S. children and is more prevalent in black and Hispanic children” 

15 AUG 2020: Twitter Thread on COVID Toes by Dr Zoe Hyde (ThreadReaderApp).
“In this case series of 7 children aged 11-17 years, all who were tested for #SARSCoV2by RT-PCR (n=6) were negative. But monoclonal antibody tests of biopsies were positive for all 7 children.

17 AUG 2020: Integrative Modelling of Quantitative Plasma Lipoprotein, Metabolic and Amino Acid Data Reveals a Multi-organ Pathological Signature of SARS-CoV-2 Infection (Journal of Proteome Research)
“The breadth of the disturbed pathways indicates a systemic signature of SARS-CoV-2 positivity that includes elements of liver dysfunction, dyslipidaemia, diabetes, and coronary heart disease risk that are consistent with recent reports that COVID-19 is a systemic disease affecting multiple organs and systems.”
Press Release (Murdoch University)

18 AUG 2020: Assessment of SARS-CoV-2 Transmission on an International Flight and Among a Tourist Group (JAMA Research Letter)
“The risk of transmission of droplet-mediated infections on an aircraft depends on proximity to an index case and on other factors, such as movement of passengers and crew, fomites, and contact among passengers in the departure gate. In our study, both passengers with likely onboard transmission were seated within 2 rows of an index case. 

The airflow in the cabin from the ceiling to the floor and from the front to the rear may have been associated with a reduced transmission rate. It could be speculated that the rate may have been reduced further had the passengers worn masks.”

18 AUG 2020: Peripheral immunophenotypes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection (Nature Medicine)
“In conclusion, based on our cohort characteristics and the immune cell changes we observed, MIS-C is likely to be a distinct immunopathogenic illness associated with SARS-CoV-2, with more severe illness in seropositive children.” 

18 AUG 2020: Seeding of outbreaks of COVID-19 by contaminated fresh and frozen food (BioRxiv)
“Our laboratory work has shown that SARS-CoV-2 can survive the time and temperatures associated with transportation and storage conditions associated with international food trade. When adding SARS-CoV-2 to chicken, salmon and pork pieces there was no decline in infectious virus after 21 days at 4°C (standard refrigeration) and –20°C (standard freezing).” 
Article on study (Forbes) 

19 AUG 2020: Loss of Bcl-6-expressing T follicular helper cells and germinal centers in COVID-19 (Cell)
“These data identify defective Bcl-6+ TFH cell generation and dysregulated humoral immune induction early in COVID-19 disease, providing a mechanistic explanation for the limited durability of antibody responses in coronavirus infections and suggest that achieving herd immunity through natural infection may be difficult.”

25 AUG 2020: SARS-CoV-2 infection of human iPSC-derived cardiac cells predicts novel cytopathic features in hearts of COVID-19 patients (bioRxiv preprint)
“…these results suggest that a majority of patients could suffer long-term consequences of COVID-19 on cardiac function, and that even the mildest cases could cause permanent heart damage.”
Press Release (Gladstone Institutes)

26 AUG 2020: Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships (Obesity Reviews)
Press Release (University of North Carolina at Chapel Hill)
“Researchers examined the available published literature on individuals infected with the virus and found that those with obesity (BMI over 30) were at a greatly increased risk for hospitalization (113%), more likely to be admitted to the intensive care unit (74%), and had a higher risk of death (48%) from the virus.”

27 AUG 2020: Genomic Evidence for a Case of Reinfection with SARS-CoV-2 (Lancet preprint by SSRN)
“Herein, we describe the data from an investigation of two instances of SARS-CoV-2 infection in the same individual … An implication of this finding is that initial exposure to the SARS-CoV-2 virus may not result in a level of immunity that is 100% protective for all individuals.” 

Summary: 25 yr old tested positive 4/18/2020. Symptom onset was 3/25/20 and symptoms resolved 4/27/20. Patient tested negative 5/9/20 and 5/26/20. Patient sought care 5/31/20 for self-reported fevers, headache, dizziness, cough, nausea, and diarrhea, and was discharged home. Patient was found to be hypoxic 6/5/20 and hospitalized – requiring ongoing oxygen support. Patient tested positive again.

1 SEP 2020: Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China (JAMA)
“In this cohort study and case investigation of a community outbreak of COVID-19 in Zhejiang province, individuals who rode a bus to a worship event with a patient with COVID-19 had a higher risk of SARS-CoV-2 infection than individuals who rode another bus to the same event. Airborne spread of SARS-CoV-2 seems likely to have contributed to the high attack rate in the exposed bus.” 

2 SEP 2020: Twitter Thread by Prof Peter Hotez MD PhD on concerns over possible Emergency Use Authorization for COVID vaccine (Threader)

3 SEP 2020: Questions concerning the proximal origin of SARS‐CoV‐2 (Journal of Medical Virology – Letter to the Editor)
“There is a consensus that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) originated naturally from Bat coronaviruses (CoVs), in particular RaTG13. However, the SARS‐CoV‐2 host tropism/adaptation pattern has significant discrepancies compared to other CoVs, raising questions concerning the proximal origin of SARS‐CoV‐2.”

3 SEP 2020: Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States (CDC)
“As of 9/3/2020, CDC has received reports of 792 confirmed cases of MIS-C and 16 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation. Most cases are in children between the ages of 1 and 14 years, with an average age of 8 years.”

8 SEP 2020: Comparison of Clinical Features of COVID-19 vs Seasonal Influenza A and B in US Children (JAMA)
“This study found that patients with COVID-19 and those with seasonal influenza had similar hospitalization rates, ICU admission rates, and mechanical ventilator use. Compared with patients hospitalized with seasonal influenza, a greater proportion of patients hospitalized with COVID-19 had underlying medical conditions and reported fever, diarrhea or vomiting, headache, body ache or myalgia, or chest pain.”

11 SEP 2020: Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection (JAMA Cardiology)
“Of 26 competitive athletes, 4 (15%) had CMR findings suggestive of myocarditis and 8 additional athletes (30.8%) exhibited LGE without T2 elevation suggestive of prior myocardial injury. COVID-19–related myocardial injury in competitive athletes and sports participation remains unclear. Cardiac magnetic resonance imaging has the potential to identify a high-risk cohort for adverse outcomes”

28 SEP 2020: Superantigenic character of an insert unique to SARS-CoV-2 spike supported by skewed TCR repertoire in patients with hyperinflammation (Immunology and Inflammation)
”the superantigen-like motif is not present in other SARS family coronaviruses, which may explain the unique potential for SARS-CoV-2 to cause both MIS-C and the cytokine storm observed in adult COVID-19.”