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英文版《庚子疫情述要》第二十九号

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英文版《庚子疫情述要》第二十九号

魔都晨曦来临 魔都晨曦来临 2020-07-19

Dr. Boarhead’s Summary of Global Updates on the 2019 Novel Coronavirus: 19th July 2020


1. CDC: At least 246 COVID-19 cases have been linked to nightclubs in Seoul, South Korea. During the 30 Apr.–5 May holiday, young adults from across the country who visited nightclubs in Seoul contracted COVID-19 and spread it nationally. Researchers used mobile phone location data, credit card payment records, and other information to identify more than 60,000 people who had spent time in or near Itaewon clubs.

[key info] Mobile phone and credit card data helped identify nearly 250 infections linked to a nightclub outbreak in South Korea.

[link]
https://wwwnc.cdc.gov/eid/article/26/10/20-2573_article


2. medRxiv: Researchers modelled the effect of a variety of testing strategies on the number of infections that would arise among 5,000 students during an 80-day abbreviated semester. They assumed that (1) five new cases would be imported each week; (2) R0=2.5; and (3) those who tested positive would be isolated. It was found that testing students every two days with a rapid and relatively cheap test would keep infections to around 135 over the semester and cost US$470 per student per term. However, testing only weekly would result in an explosive growth in infections.

[key info] Universities need to test their students very frequently.

[link]
https://www.medrxiv.org/content/10.1101/2020.07.06.20147702v1


3. medRxiv: A global metapopulation transmission model indicates international travel as the key driver of the introduction of SARS-CoV-2 in the West and East Coast metropolitan areas in the US. In California and New York, SARS-CoV-2 might have begun circulating as early as Dec. 2019.

[key info] SARS-CoV-2 may have invaded the US in 2019.

[link]
https://www.medrxiv.org/content/10.1101/2020.07.06.20140285v1


4. medRxiv: Blood tests revealed that while 60% of COVID-19 patients marshalled a potent antibody response at the height of their battle with SARS-CoV-2, only 17% retained the same potency three months later. Antibody levels fell as much as 23-fold over the period. In some cases, they became undetectable.

[key info] Immunity to COVID-19 could be lost in months.

[link]
https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v1


5. South China Morning Post: Prof. Gabriel Leung, dean of the University of Hong Kong’s medical school, cited an international study that suggested there was a DNA mutation in the most widely circulating strain of SARS-CoV-2, which has changed to 614G from the previous 614D, making it more infectious by about 31%. Leung said another local study confirmed this trend, as the number of people expected to be infected by each case increased in Mar. from 2.5 to 3 and has now risen to 4.

[key info] R0 of the mutated virus in HK is about 4.

[link]
https://www.scmp.com/news/hong-kong/health-environment/article/3092821/coronavirus-hong-kong-expert-warns-each-infected


6. Science: In a cohort study of 50 patients with various disease severity, a unique phenotype was observed in severe and critical patients, consisting of a highly impaired interferon (IFN) type I response, associated with a persistent blood viral load and an exacerbated inflammatory response.

[key info] Type I IFN deficiency in the blood could be a hallmark of severe COVID-19.

[link]
https://science.sciencemag.org/content/early/2020/07/10/science.abc6027


7. Nature Structural & Molecular Biology: Using a naive llama single-domain antibody library and PCR-based maturation, researchers have produced two closely related nanobodies, H11-D4 and H11-H4, which bind RBD and block its interaction with ACE2. Single-particle cryo-EM reveals that both nanobodies bind to all three RBDs in the spike trimer. Nanobody-Fc fusions show neutralizing activity against SARS-CoV-2 and additive neutralization with the SARS-CoV-1 and -2 antibody CR3022.

[key info] Llama antibodies may neutralize SARS-CoV-2.

[link]
https://www.nature.com/articles/s41594-020-0469-6


8. New English Journal of Medicine: Preliminary data from a phase 1 safety study with 45 participants showed that mRNA-1273, an mRNA vaccine, could induce anti-SARS-CoV-2 immune responses in all participants and that no trial-limiting safety concerns were identified.

[key info] Positive trial results raise hopes for a top vaccine candidate.

[link]
https://www.nejm.org/doi/10.1056/NEJMoa2022483


9. Nature: Scientists have demonstrated the transplacental transmission of SARS-CoV-2 in a neonate born to a mother infected in the last trimester and presenting with neurological compromise. The transmission is confirmed by comprehensive virological and pathological investigations. In detail, SARS-CoV-2 causes (1) maternal viremia, (2) placental infection and placental inflammation, and (3) neonatal viremia following placental infection.

[key info] The first case of a mother transmitting the virus to her unborn baby has been reported.

[link]
https://www.nature.com/articles/s41467-020-17436-6


10. Nature: Two key features of the outbreak in Wuhan could be identified: high covertness and high transmissibility. Researchers estimated that 87% of the infections before 8 Mar. were unascertained, potentially including asymptomatic and mild cases. R0 was 3.54 in the early outbreak, much higher than that of SARS and MERS. Multi-pronged interventions had considerable effect on controlling the outbreak, decreasing R0 to 0.28 and reducing the total infections in Wuhan by 96.0% as of 8 Mar.

[key info] R0 of SARS-CoV-2 in Wuhan during the early outbreak was much higher than that of SARS-CoV and MERS-CoV.

[link]
https://www.nature.com/articles/s41586-020-2554-8


11. Lancet: Post-mortem examinations were done on 14 people who died with COVID-19. All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organizing phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, the kidneys, and the gastrointestinal tract.

[key info] Autopsies in dead cases found that the primary pathology was diffuse alveolar damage.

[link]
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31305-2/fulltext


12. Science: Aging is associated with increased morbidity arising from a range of tissue dysfunctions. A common denominator of age-associated frailty is increased baseline inflammation, called inflammaging. The presence of excessive inflammation can inhibit immunity in both animals and humans. Older individuals infected with pathogens such as SARS-CoV-2 may induce overwhelming inflammation, which can be fatal. Reducing inflammation may be a therapeutic strategy for enhancing immunity in older people.

[key info] Excessive inflammation in older people may reduce their immunity to SARS-CoV-2.

[link]
https://science.sciencemag.org/content/369/6501/256


13. medRxiv: Symptoms of COVID-19 appear to fall into six groupings: (1) mainly upper respiratory tract symptoms, such as a persistent cough, with muscle pain; (2) mainly upper respiratory tract symptoms with a greater frequency of skipped meals and fever; (3) gastrointestinal symptoms such as diarrhoea, but few other symptoms; (4) early signs of severe fatigue, continuous chest pain, and cough; (5) confusion, skipped meals, and severe fatigue; and (6) marked respiratory distress including early onset of breathlessness and chest pain, as well as confusion, fatigue, and gastrointestinal symptoms.

[key info] Six groupings of symptoms may help predict whether a patient will end up needing a ventilator or other breathing support.

[link]
https://www.medrxiv.org/content/10.1101/2020.06.12.20129056v1.full.pdf


14. New England Journal of Medicine: A total of 2,104 patients were assigned to receive dexamethasone and 4,321 to receive usual care. 482 patients in the dexamethasone group and 1,110 patients in the usual care group died within 28 days after randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation and among those receiving oxygen without invasive mechanical ventilation, but not among those who were receiving no respiratory support at randomization.

[key info] The use of dexamethasone results in lower 28-day mortality among those who receive either invasive mechanical ventilation or oxygen alone.

[link]
https://www.nejm.org/doi/full/10.1056/NEJMoa2021436?query=featured_home


15. South China Morning Post: Variations of the SARS-CoV-2 pathogen circulating in Europe and the US could be causing serial infections in some people, confusing the immune system and triggering an overreaction or even death. In Britain, for instance, the American strain was present in only 6.4% of its samples, but the actual number of people being infected serially could be high, and it helped push the British death rate to 14%, one of the highest in the world.

[key info] Different strains of SARS-CoV-2 may cause serial infection and lead to higher death rates.

[link]
https://www.scmp.com/news/world/article/3093690/coronavirus-are-two-strains-together-deadlier-one


16. Cell: Researchers investigated 80 variants of the spike protein of SARS-CoV-2 and 26 glycosylation site modifications for the infectivity and reactivity to a panel of neutralizing antibodies and sera from convalescent patients. D614G, along with several variants containing both D614G and another amino acid change, was significantly more infectious. The majority of glycosylation deletions were less infectious, while deletion of both N331 and N343 glycosylation drastically reduced infectivity. N234Q was markedly resistant to neutralizing antibodies, whereas N165Q became more sensitive.

[key info] D614G is more infectious, and N234Q is more resistant to antibodies.

[link]
https://www.cell.com/cell/pdf/S0092-8674(20)30877-1.pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867420308771%3Fshowall%3Dtrue


17. Science: A major virulence factor of SARS-CoVs is the nonstructural protein 1 (Nsp1) which suppresses host gene expression by ribosome association. Nsp1 from SARS-CoV-2 binds to the 40S ribosomal subunit, resulting in the shutdown of mRNA translation both in vitro and in cells. It effectively blocks RIG-I-dependent innate immune responses that would otherwise facilitate clearance of the infection. The structural characterization of the inhibitory mechanism of Nsp1 may aid structure-based drug design against SARS-CoV-2.

[key info] Nsp1 may be a target for drug design.

[link]
https://science.sciencemag.org/content/early/2020/07/16/science.abc8665


18. Science: A resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. However, appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe means half as many lockdown periods are required to end community transmission continent-wide.

[key info] International coordination helps reduce community transmission across Europe.

[link]
https://science.sciencemag.org/content/early/2020/07/16/science.abc5096


19. Scientific Reports: Three widely distributed species of mosquito, Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus, representing the two most significant genera of arbovirus vectors that infect people, were tested. Researchers demonstrate that even under extreme conditions, SARS-CoV-2 is unable to replicate in these mosquitoes and therefore cannot be transmitted to people even in the unlikely event that a mosquito feeds on a viremic host.

[key info] Mosquitoes do not transmit SARS-CoV-2.

[link]
https://www.nature.com/articles/s41598-020-68882-7

* * *

This is issue twenty-night, edited on the basis of information from the official websites including but not limited to those of

The World Health Organization,

The European Centre for Disease Prevention and Control,

The Centers for Disease Control and Prevention of the United States of America, &

The Center for Infectious Disease Research and Policy of the University of Minnesota


and from the forums of FluTrackers.com.

This issue is edited by Alex Sun, Fred Wong, Dorothy Fang, and Dora Zhang under the supervision of Dr. Jason Chu and Conch Zhang.

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