Coronavirus COVID-19 Update for January 25, 2021

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Clinical Reports

COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings
The objective of this study is to describe COVID-19 symptom evolution and persistence in an outpatient setting in Geneva, Switzerland, from day 1 through day 30 to 45 after diagnosis. From 18 March to 15 May 2020, the Geneva University Hospitals was 1 of 5 available testing centers and served more than 50% of patients with COVID-19 in the Geneva canton. Only symptomatic persons were tested during that period. Because many practices were closed, persons who were not hospitalized at baseline could benefit from remote follow-up with an ambulatory care center (a process called COVICARE) in case their primary care physician was unavailable for follow-up care. Exclusion criteria were refusal to provide consent and administrative reasons (living outside the Geneva canton). Most patients were called every 48 hours for the first 10 days with a standardized interview inquiring about self-reported symptoms. Follow-up during the 10 days was suspended if patients declined follow-up, clinically recovered, or were hospitalized. Participants were called every 24 hours if they reported deteriorating clinical symptoms; those who were unreachable (eligible minus reached) were called again the next day. All patients were then contacted again 30 to 45 days after diagnosis. Results of this study show that patients with COVID-19 develop an array of symptoms that evolve over time. Recognizing the persistence of symptoms could legitimize patients' concerns in an unknown and new disease. Adequate communication can provide reassurance, reduce anxiety, and potentially optimize recovery.

The impact of Spike mutations on SARS-CoV-2 neutralization
As new SARS-CoV-2 variants are rapidly emerging, exemplified by the B.1.1.7, 501Y.V2 and P.1 lineages, it is critical to understand if antibody responses induced by infection with the original SARS-CoV-2 virus or the current vaccines will remain effective against virus variants. In this study, authors evaluate neutralization of a series of altered Spike pseudotypes including a B.1.1.7 Spike pseudotype. The analyses of a panel of Spike-specific monoclonal antibodies revealed that the neutralizing activity of some antibodies was dramatically reduced by Spike amino acid changes. In contrast, polyclonal antibodies in the serum of patients infected in early 2020 remained active against most mutated Spike pseudotypes. The majority of serum samples were equally able to neutralize the B.1.1.7 Spike pseudotype, however, potency was reduced in a small number of samples (3 of 36) by 5–10-fold. This work highlights that changes in the SARS-CoV-2 Spike can alter neutralization sensitivity and underlines the need for effective real-time monitoring of emerging mutations and their impact on vaccine efficacy.

Antiviral Therapeutics and Vaccines

Vitamin D Status is Associated With In-hospital Mortality and Mechanical Ventilation: A Cohort of COVID-19 Hospitalized Patients
To explore the possible associations of serum 25-hydroxyvitamin D concentration [25(OH)D] with COVID-19 in-hospital mortality and need for invasive mechanical ventilation, a retrospective, observational, cohort study was conducted at two tertiary academic medical centers in Boston and New York. Eligible participants were hospitalized adult patients with laboratory-confirmed COVID-19 between 1 February 2020 and 15 May 2020. Demographic, clinical characteristics, comorbidities, medications, and disease-related outcomes were extracted from electronic medical records. The final analysis included 144 patients with confirmed COVID-19 (median age: 66 years, 44.4% male). Overall mortality was 18%, while patients with 25(OH)D levels ≥30 ng/mL had lower rates of mortality compared to those with 25(OH)D levels <30 ng/mL (9.2% vs. 25.3%, P=.02). In the adjusted multivariable analyses, 25(OH)D as a continuous variable was independently significantly associated with lower in-hospital mortality (OR, 0.94; 95% CI, 0.90-0.98; P=.007) and need for invasive mechanical ventilation (OR, 0.96; 95% CI, 0.93-0.99; P=.01). Similar data were obtained when 25(OH)D was studied as a continuous variable after logarithm transformation and as a dichotomous (<30ng/mL vs. ≥30ng/mL) or ordinal variable (quintiles), in the multivariable analyses. Among patients admitted with laboratory-confirmed COVID-19, 25(OH)D levels were inversely associated with in-hospital mortality and the need for invasive mechanical ventilation. Further observational studies are needed to confirm these findings and randomized clinical trials to assess the role of vitamin D administration in improving the morbidity and mortality of COVID-19.

Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis
Thrombotic complications occur at high rates in hospitalized patients with COVID-19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. This study was done to address the question, how does in-hospital mortality compare with intermediate-versus prophylactic-dose anticoagulation, and separately with in-hospital aspirin versus no antiplatelet therapy, in treatment of COVID-19. Using data from 2785 hospitalized adult COVID-19 patients, two separate, nested cohorts of patients were established who received intermediate- or prophylactic-dose anticoagulation (“anticoagulation cohort”, N = 1624), or who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy (“aspirin cohort”, N = 1956). Propensity score matching utilizing various markers of illness severity and other patient-specific covariates yielded treatment groups with well-balanced covariates in each cohort. The primary outcome was cumulative incidence of in-hospital death. Among propensity score-matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate-compared to prophylactic-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.518 [0.308-0.872]). Among propensity-score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in-hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.522 [0.336-0.812]). In this propensity score-matched, observational study of COVID-19, intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death.

Diagnostics

Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites — Pima County, Arizona, November 3–17, 2020
The BinaxNOW rapid antigen test received Emergency Use Authorization by the Food and Drug Administration for testing specimens from symptomatic persons; performance among asymptomatic persons is not well characterized. Sensitivity of the BinaxNOW antigen test, compared with polymerase chain reaction testing, was lower when used to test specimens from asymptomatic (35.8%) than from symptomatic (64.2%) persons, but specificity was high. Sensitivity was higher for culture-positive specimens (92.6% and 78.6% for those from symptomatic and asymptomatic persons, respectively); however, some antigen test-negative specimens had culturable virus. The high specificity and rapid BinaxNOW antigen test turnaround time facilitate earlier isolation of infectious persons. Antigen tests can be an important tool in an overall community testing strategy to reduce transmission.