Weekly Coronavirus Update: Tuesday, August 25, 2020

Hello, friends! Here is the latest research and news regarding Coronavirus. Bear with me on the first point; it’s a long one, but an important one. I hope you find all of this information to be useful.

1) You’ve probably seen the news that the US Food and Drug Administration (FDA) issued an emergency use authorization for the use of convalescent plasma from Coronavirus survivors as a treatment for Covid-19. Unfortunately, though, there is very little scientific evidence about this treatment’s effectiveness yet. And, somewhat frighteningly, Dr. Walid Gellad, part of the research team who conducted a study cited by the FDA, said that the agency “grossly misrepresented data” from their study to make the treatment look more promising than what their results showed. Here is some of what we know about convalescent plasma thus far:
-An article on the website Nature summarized a study that has yet to undergo peer review (a very important asterisk to consider when you read these findings!) It involved 35,322 patients who all received plasma with varying levels of antibodies. No control group was used, but among the patients receiving convalescent plasma, “participants who received transfusions soon after their diagnosis and got high concentrations of antibodies showed more improvement and were less likely to die in the study period than were those who received later transfusions with lower antibody concentrations.”
-Another study published in the peer-reviewed journal JAMA used a much smaller sample size, with just 102 patients, who were divided into an experimental group (those who received the plasma) and a control group (those who did not). In this study, the authors concluded, “Among patients with severe or life-threatening COVID-19, convalescent plasma therapy added to standard treatment did not significantly improve the time to clinical improvement within 28 days.” We will have to wait and see what happens now that the treatment has been authorized for use outside of such studies.
NYTimes article with Dr. Walid Gellad: https://www.nytimes.com/2020/08/24/health/fda-blood-plasma.html?action=click&module=Top%20Stories&pgtype=Homepage
Nature article: https://www.nature.com/articles/d41586-020-02324-2#ref-CR2
Not-yet-peer reviewed study: https://www.medrxiv.org/content/10.1101/2020.08.12.20169359v1
JAMA study: https://jamanetwork.com/journals/jama/article-abstract/2766943

2) Yesterday it was revealed that a man in Hong Kong was the first known person to be reinfected with Coronavirus. A paper accepted for publication in the medical journal Clinical Infectious Diseases details the case of a 33-year-old man who was first treated for Coronavirus in March, and when tested 4.5 months later, he once again tested positive, though his second infection was asymptomatic. Researchers were able to compare the virus from his first and second infections, and found that there were differences between the two, meaning he was infected with a different strain of the virus the second time. The authors stated that the case shows that lifelong immunity may not be possible from antibodies or a vaccine, and that the possibility for herd immunity is unlikely. Other scientists who were not part of this study differed in their interpretation of the results, stating that this could be a rare example of reinfection (not the norm), and that it is good news that the second case of the man’s Coronavirus was asymptomatic. Although it has been accepted for publication, the paper is not yet available on the journal’s website. Here is an article from Science that summarizes the findings: https://www.sciencemag.org/news/2020/08/some-people-can-get-pandemic-virus-twice-study-suggests-no-reason-panic

3) Speaking of different strains of the virus, new peer-reviewed research published in The Lancet found that a strain of Coronavirus carrying a mutation in which a chunk of DNA was missing was associated with less severe infections. Of the 29 people studied who had the mutated virus, none of them needed supplemental oxygen. Of those who did not have the mutation, 28% DID need supplemental oxygen. Unfortunately, scientists have not detected the mutated virus in patients since March. Still, the researchers stated that studying the more severe strain of the virus “could have implications for the development of treatments and vaccines”, and that’s a good thing. You can read the full study here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31757-8/fulltext

4) A study examined Covid-19 patients with a rheumatic autoimmune disease, including chronic inflammatory arthritis (including rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis) or connective tissue diseases (including systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, polymyalgia rheumatica, and vasculitides). The rheumatic patients were compared to those without a rheumatic disease, and 456 patients were included in each group. The risk of developing severe Covid-19 was 31.6% in the rheumatic group and 28.1% in the non-rheumatic group. Those with a connective tissue disease were at significantly greater risk of poor outcomes than those with inflammatory arthritis. Additional risk factors included those who were older, male, and had a comorbidity such as obesity, diabetes, hypertension, or cardiovascular or lung disease. You can read the full peer-reviewed study, published in Annals of the Rheumatic Diseases, here: https://ard.bmj.com/content/early/2020/08/12/annrheumdis-2020-218296

5) In other autoimmune disease news relating to Covid-19, a new study (also published in Annals of the Rheumatic Diseases) found that the much talked about drug hydroxychloroquine did not prevent those with autoimmune diseases from contracting Covid-19. Drawing on data from 36 different healthcare facilities, 159 patients with either lupus or rheumatoid arthritis were analyzed. The findings showed difference between those who were taking hydroxychloroquine as treatment for their autoimmune disease and those who were not taking the drug. The lead author, Dr. Mendel Singer, said of the findings, ““This likely means that hydroxychloroquine is not active against the SARS-CoV-2 virus in humans versus in the lab, and is unlikely to be an effective preventive antiviral for anyone.” The research can be read here: https://ard.bmj.com/content/early/2020/08/19/annrheumdis-2020-218500.full and a news article about it can be found here: https://www.mcknights.com/news/clinical-news/hydroxychloroquine-does-not-prevent-covid-19-in-autoimmune-disease-patients-new-study-finds/

6) In vaccine news, a new peer-reviewed study published in the journal Cell showed that vaccines given through the nose were found to be more effective than injected forms of the vaccine in mice. The group of mice who were given an injected vaccine and were then exposed to Covid-19 showed small amounts of viral RNA in their lungs. The group that received the nasal insertion of the vaccine did not show any viral RNA in their lungs, suggesting the nasal vaccine warded off infection entirely. A similar study published in Nature Communications tested nasal vs. injected vaccines in monkeys, and found both to be effective. The authors concluded that a potential benefit to the nasal vaccines is that “the administration of Ad5 vectored vaccines through nostrils may make self-vaccination possible, thus reducing the burden of healthcare workers and enabling more people to receive a vaccine within a short timeframe.”
The Cell study can be found here: https://www.cell.com/cell/pdf/S0092-8674(20)31068-0.pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867420310680%3Fshowall%3Dtrue
The Nature Communications study can be found here: https://www.nature.com/articles/s41467-020-18077-5

7) A new study examining the drug remdesivir as a treatment for Coronavirus showed mixed results. Published last week in peer-reviewed journal JAMA, a total of 600 patients were randomly assigned to one of three groups — one group received remdesivir over 5 days, one group received it over 10 days, and one group did not receive it at all. Findings showed that the 5-day group had a significantly better clinical status than those who did not receive the drug, but the 10-day group did not show any differences compared to the non-drug group. Of the 5-day group, the authors concluded “the difference was of uncertain clinical importance.” It is also important to note that the research was funded by Gilead Sciences, the maker of remdesivir. More research is certainly necessary on this drug, and ideally research conducted without any conflicts of interest. The full study can be read here: https://jamanetwork.com/journals/jama/fullarticle/2769871

8) Study after study has shown that Covid-19 can affect different parts of the body, such as the lungs, heart, kidneys, and more. New research shows that it can also affect our thyroid. A study published in the Lancet Diabetes & Endocrinology found that out of 85 critical care patients in Milan, Italy, none of whom had previous thyroid conditions, 15% experienced thyrotoxicosis, which means there is an excess of thyroid hormone in the blood. Comparing the data to 78 patients who were admitted to the same unit in 2019 (before Covid), only one of those patients experienced thyrotoxicosis. Researchers followed-up with eight of those who experienced thyrotoxicosis nearly three months after they were discharged from the hospital. Two of those had hypothyroidism, and all eight showed signs of abnormalities in ultrasounds of their thyroid glands. A similar study published in the European Journal of Endocrinology found that 20.2% of patients from a cohort of 287 were also found to have this condition. You can read the first study here: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30266-7/fulltext and the second study here: https://eje.bioscientifica.com/view/journals/eje/183/4/EJE-20-0335.xml This article on Medium also explains the findings pretty well: https://elemental.medium.com/the-coronavirus-may-mess-with-thyroid-levels-too-87f94e45c5c9

9) New research published in the journal JAMA examined the breast milk of 18 women infected with Covid-19 (all were symptomatic except for one) to determine whether the virus could be transmitted to infants through breastfeeding. After collecting a total of 64 samples from the women, only one sample was found to contain detectable RNA from the virus. The sample was collected on the day of symptom onset. Later samples from the same woman did not contain the viral RNA. Control samples were spiked with replication-competent SARS-CoV-2 virus, and these did not have detectable RNA either. The authors concluded that “these data suggest that SARS-CoV-2 RNA does not represent replication-competent virus and that breast milk may not be a source of infection for the infant.” As this was a very small sample size, more research is necessary to confirm these findings. The study can be read here: https://jamanetwork.com/journals/jama/fullarticle/2769825

10) Finally, your US and world update. The current 7-day average of new cases in the US is down to 42,710, compared to a 7-day average of 48,777 last week. Nine states and two US territories are increasing in cases, including many states in the Midwest such as both North and South Dakota, Iowa, Kansas, and Illinois. The 7-day death average in the US is 964 per day, compared to 1,046 last week. In Europe, cases continue to rise in Spain, which logged 78,000 new cases over the past two weeks. Numbers in France are also on the rise, and last Thursday the country recorded its highest daily number of post-lockdown cases with 4,700. According to an article published in The Guardian, “Health experts say the increase in the number of new cases cannot be explained by the widespread testing being carried out as the rise in new cases is significantly higher than the rise in the number of tests.” In the UK, numbers are remaining pretty steady, with 853 new cases reported on Monday. India has now surpassed the 3 million mark in terms of its total number of cases.
US numbers: https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html?name=styln-coronavirus-national&region=TOP_BANNER&variant=1_Show&block=storyline_menu_recirc&action=click&pgtype=Article&impression_id=22fe7801-e6b6-11ea-8032-0776c1061742
Spain numbers: https://www.theguardian.com/world/2020/aug/25/spain-warned-of-dire-impact-of-second-coronavirus-lockdown
The Guardian article: https://www.theguardian.com/world/2020/aug/21/coronavirus-iurope-dozens-schools-report-infections-berlin-germany-spain
UK numbers: https://coronavirus.data.gov.uk/
India numbers: https://www.theguardian.com/world/2020/aug/23/global-report-india-passes-3m-cases-as-south-korea-sees-biggest-daily-surge-since-march

That’s all for this week. Please stay safe, socially distance yourself whenever possible, and remember to wear your mask!