Covid-19

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RxCowboy

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Prior infection by seasonal coronaviruses does not prevent SARS-CoV-2 infection and associated Multisystem Inflammatory Syndrome in children

isabelle sermet, sarah temmam, christele huon, sylvie behillil, vincent gadjos, thomas bigot, thibaut lurier, delphine chretien, marija backovick, Agnes Moisan-Delaunay, flora donati, melanie albert, elsa foucaud, Bettina Mesplees, gregoire benoist, albert fayes, marc duval-arnould, celia cretolle, marina charbit, melodie aubart, Johanne Auriau, matthie lorrot, Dulanjalee Kariyawasam, laura fertita, Gilles Orliaguet, benedicte pigneur, Brigitte Bader-Meunier, coralie briand, julie toubiana, Tiffany Guilleminot, sylvie van der werf, marianne leruez-ville, marc eloit
doi: https://doi.org/10.1101/2020.06.29.20142596

This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Abstract
Background: Children have a lower rate of COVID-19, potentially related to cross-protective immunity conferred by seasonal coronaviruses (HCoVs). We tested if prior infections with seasonal coronaviruses impacted SARS-CoV-2 infections and related Multisystem Inflammatory Syndrome (MIS). Methods: This cross-sectional observational study in Paris hospitals enrolled 739 pauci or asymptomatic children (HOS group) plus 36 children with suspected MIS (MIS group). Prevalence, antigen specificity and neutralizing capability of SARS-CoV-2 antibodies were tested. Antibody frequency and titres against Nucleocapsid (N) and Spike (S) of the four seasonal coronaviruses (NL63, HKU1, 229E, OC43) were measured in a subset of seropositive patients (54 SARS-CoV-2 (HOS-P subgroup) and 15 MIS (MIS-P subgroup)), and in 118 matched SARS-CoV-2 seronegative patients (CTL subgroup). Findings: SARS-CoV-2 mean prevalence rate in HOSP children was 11.7% from April 1 to June 1. Neutralizing antibodies were found in 55.6% of seropositive children, and their relative frequency increased with time (up to 100 % by mid-May). A majority of MIS children (25/36) were SARS-CoV-2 seropositive, of which all tested (n=15) had neutralizing antibodies. On average, seropositive MIS children had higher N and S1 SARS-CoV-2 titres as compared to HOS children. Patients from HOS-P, MIS-P, and CTL subgroups had a similar prevalence of antibodies against the four seasonal HCoVs (66.9 -100%). The level of anti-SARS-CoV-2 antibodies was not significantly different in children who had prior seasonal coronavirus infection. Interpretation: Prior infection with HCoVs does not prevent SARS-CoV-2 infection and related MIS in children. Children develop neutralizing antibodies after SARS-CoV-2 infection.

Competing Interest Statement
The authors have declared no competing interest.

Clinical Trial
The local Ethics (CERAPHP Paris V) approved this study (IRB registration: #00011928)

Funding Statement
:.ME lab is funded by Institut Pasteur, Labex IBEID (ANR-10-LABX-62-IBEID), Reacting, EU grant Recover, ANR Ohticks. SVDW lab is funded by Institut Pasteur, CNRS, Universite de Paris, Sante publique France, Labex IBEID (ANR-10-LABX-62-IBEID), REACTing (Research & Action Emerging Infectious Diseases), EU Grant 101003589 RECoVER.

Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
 

RxCowboy

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Anti-SARS-CoV-2 IgG antibodies in adolescent students and their teachers in Saxony, Germany (SchoolCoviDD19): very low seropraevalence and transmission rates

Jakob Peter Armann, Manja Unrath, Carolin Kirsten, Christian Lueck, Alexander Dalpke, Reinhard Berner

doi: https://doi.org/10.1101/2020.07.16.20155143
This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Abstract
Background: School closures are part of the SARS-CoV-2 pandemic control measures in many countries, based on the assumption that children play a similar role in transmitting SARS-CoV-2 as they do in transmitting influenza. We therefore performed a SARS-CoV-2 seropraevalence-study in students and teachers to assess their role in the SARS-CoV-2 transmission. Methods: Students grade 8-11 and their teachers in 13 secondary schools in eastern Saxony, Germany, were invited to participate in the SchoolCoviDD19 study. Blood samples were collected between May 25th and June 30th, 2020. Anti-SARS-CoV-2 IgG were assed using chemiluminescence immunoassay technology and all samples with a positive or equivocal test result were re-tested with two additional serological tests. Findings: 1538 students and 507 teachers participated in this study. The seropraevalence for SARS-CoV-2 was 0.6%. Even in schools with reported Covid-19 cases before the Lockdown of March 13th no clusters could be identified. 23/24 participants with a household history of COVID-91 were seronegative. By using a combination of three different immunoassays we could exclude 16 participants with a positive or equivocal results after initial testing. Interpretation: Students and teachers do not play a crucial role in driving the SARS-CoV-2 pandemic in a low prevalence setting. Transmission in families occurs very infrequently, and the number of unreported cases is low in this age group, making school closures not appear appropriate as a strategy in this low prevalence settings. Funding: This study was supported by a grant from the state of Saxony
 

RxCowboy

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Park YJ, Choe YJ, Park O, Park SY, Kim YM, Kim J, et al. Contact tracing during coronavirus disease outbreak, South Korea, 2020. Emerg Infect Dis. 2020 Oct [date cited]. https://doi.org/10.3201/eid2610.201315

Abstract
We analyzed reports for 59,073 contacts of 5,706 coronavirus disease (COVID-19) index patients reported in South Korea during January 20–March 27, 2020. Of 10,592 household contacts, 11.8% had COVID-19. Of 48,481 nonhousehold contacts, 1.9% had COVID-19. Use of personal protective measures and social distancing reduces the likelihood of transmission.

Effective contact tracing is critical to controlling the spread of coronavirus disease (COVID-19) (1). South Korea adopted a rigorous contact-tracing program comprising traditional shoe-leather epidemiology and new methods to track contacts by linking large databases (global positioning system, credit card transactions, and closed-circuit television). We describe a nationwide COVID-19 contact tracing program in South Korea to guide evidence-based policy to mitigate the pandemic (2).

The Study
South Korea’s public health system comprises a national-level governance (Korea Centers for Disease Control and Prevention), 17 regional governments, and 254 local public health centers. The first case of COVID-19 was identified on January 20, 2020; by May 13, a total of 10,962 cases had been reported. All reported COVID-19 patients were tested using reverse transcription PCR, and case information was sent to Korea Centers for Disease Control and Prevention.

We defined an index case as the first identified laboratory-confirmed case or the first documented case in an epidemiologic investigation within a cluster. Contacts in high-risk groups (household contacts of COVID-19 patients, healthcare personnel) were routinely tested; in non–high-risk groups, only symptomatic persons were tested. Non–high-risk asymptomatic contacts had to self-quarantine for 14 days and were placed under twice-daily active surveillance by public health workers. We defined a household contact as a person who lived in the household of a COVID-19 patient and a nonhousehold contact as a person who did not reside in the same household as a confirmed COVID-19 patient. All index patients were eligible for inclusion in this analysis if we identified >1 contact. We defined a detected case as a contact with symptom onset after that of a confirmed COVID-19 index patient.

We grouped index patients by age: 0–9, 10–19, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and >80 years. Because we could not determine direction of transmission, we calculated the proportion of detected cases by the equation [number of detected cases/number of contacts traced] × 100, excluding the index patient; we also calculated 95% CIs. We compared the difference in detected cases between household and nonhousehold contacts across the stratified age groups.

We conducted statistical analyses using RStudio (https://rstudio.comExternal Link). We conducted this study as a legally mandated public health investigation under the authority of the Korean Infectious Diseases Control and Prevention Act (nos. 12444 and 13392).

We monitored 59,073 contacts of 5,706 COVID-19 index patients for an average of 9.9 (range 8.2–12.5) days after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was detected (Table 1). Of 10,592 household contacts, index patients of 3,417 (32.3%) were 20–29 years of age, followed by those 50–59 (19.3%) and 40–49 (16.5%) years of age (Table 2). A total of 11.8% (95% CI 11.2%–12.4%) household contacts of index patients had COVID-19; in households with an index patient 10–19 years of age, 18.6% (95% CI 14.0%–24.0%) of contacts had COVID-19. For 48,481 nonhousehold contacts, the detection rate was 1.9% (95% CI 1.8%–2.0%) (Table 2). With index patients 30–39 years of age as reference, detection of COVID-19 contacts was significantly higher for index patients >40 years of age in nonhousehold settings. For most age groups, COVID-19 was detected in significantly more household than nonhousehold contacts (Table 2).

Conclusions
We detected COVID-19 in 11.8% of household contacts; rates were higher for contacts of children than adults. These risks largely reflected transmission in the middle of mitigation and therefore might characterize transmission dynamics during school closure (3). Higher household than nonhousehold detection might partly reflect transmission during social distancing, when family members largely stayed home except to perform essential tasks, possibly creating spread within the household. Clarifying the dynamics of SARS-CoV-2 transmission will help in determining control strategies at the individual and population levels. Studies have increasingly examined transmission within households. Earlier studies on the infection rate for symptomatic household contacts in the United States reported 10.5% (95% CI 2.9%–31.4%), significantly higher than for nonhousehold contacts (4). Recent reports on COVID-19 transmission have estimated higher secondary attack rates among household than nonhousehold contacts. Compiled reports from China, France, and Hong Kong estimated the secondary attack rates for close contacts to be 35% (95% CI 27%–44%) (5). The difference in attack rates for household contacts in different parts of the world may reflect variation in households and country-specific strategies on COVID-19 containment and mitigation. Given the high infection rate within families, personal protective measures should be used at home to reduce the risk for transmission (6). If feasible, cohort isolation outside of hospitals, such as in a Community Treatment Center, might be a viable option for managing household transmission (7).

We also found the highest COVID-19 rate (18.6% [95% CI 14.0%–24.0%]) for household contacts of school-aged children and the lowest (5.3% [95% CI 1.3%–13.7%]) for household contacts of children 0–9 years in the middle of school closure. Despite closure of their schools, these children might have interacted with each other, although we do not have data to support that hypothesis. A contact survey in Wuhan and Shanghai, China, showed that school closure and social distancing significantly reduced the rate of COVID-19 among contacts of school-aged children (8). In the case of seasonal influenza epidemics, the highest secondary attack rate occurs among young children (9). Children who attend day care or school also are at high risk for transmitting respiratory viruses to household members (10). The low detection rate for household contacts of preschool-aged children in South Korea might be attributable to social distancing during these periods. Yet, a recent report from Shenzhen, China, showed that the proportion of infected children increased during the outbreak from 2% to 13%, suggesting the importance of school closure (11). Further evidence, including serologic studies, is needed to evaluate the public health benefit of school closure as part of mitigation strategies.

Our observation has several limitations. First, the number of cases might have been underestimated because all asymptomatic patients might not have been identified. In addition, detected cases could have resulted from exposure outside the household. Second, given the different thresholds for testing policy between households and nonhousehold contacts, we cannot assess the true difference in transmissibility between households and nonhouseholds. Comparing symptomatic COVID-19 patients of both groups would be more accurate. Despite these limitations, the sample size was large and representative of most COVID-19 patients early during the outbreak in South Korea. Our large-scale investigation showed that pattern of transmission was similar to those of other respiratory viruses (12). Although the detection rate for contacts of preschool-aged children was lower, young children may show higher attack rates when the school closure ends, contributing to community transmission of COVID-19.

The role of household transmission of SARS-CoV-2 amid reopening of schools and loosening of social distancing underscores the need for a time-sensitive epidemiologic study to guide public health policy. Contact tracing is especially important in light of upcoming future SARS-CoV-2 waves, for which social distancing and personal hygiene will remain the most viable options for prevention. Understanding the role of hygiene and infection control measures is critical to reducing household spread, and the role of masking within the home, especially if any family members are at high risk, needs to be studied.

We showed that household transmission of SARS-CoV-2 was high if the index patient was 10–19 years of age. In the current mitigation strategy that includes physical distancing, optimizing the likelihood of reducing individual, family, and community disease is important. Implementation of public health recommendations, including hand and respiratory hygiene, should be encouraged to reduce transmission of SARS-CoV-2 within affected households.

Dr. Young Joon Park is the preventive medicine physician leading the Epidemiology and Case Management Team for the COVID-19 National Emergency Response Center, Korea Centers for Disease Control and Prevention. His primary research interests include epidemiologic investigation of infectious disease outbreaks. Dr. Choe is an assistant professor at Hallym University College of Medicine. Her research focuses on infectious diseases epidemiology.
 

RxCowboy

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Spread of SARS-CoV-2 in the Icelandic Population
Daniel F. Gudbjartsson, Ph.D., Agnar Helgason, Ph.D., Hakon Jonsson, Ph.D., Olafur T. Magnusson, Ph.D., Pall Melsted, Ph.D., Gudmundur L. Norddahl, Ph.D., Jona Saemundsdottir, B.Sc., Asgeir Sigurdsson, B.Sc., Patrick Sulem, M.D., Arna B. Agustsdottir, M.Sc., Berglind Eiriksdottir, Run Fridriksdottir, M.Sc., et al.

N Engl J Med 2020; 382:2302-2315
DOI: 10.1056/NEJMoa2006100

Abstract
BACKGROUND
During the current worldwide pandemic, coronavirus disease 2019 (Covid-19) was first diagnosed in Iceland at the end of February. However, data are limited on how SARS-CoV-2, the virus that causes Covid-19, enters and spreads in a population.

METHODS
We targeted testing to persons living in Iceland who were at high risk for infection (mainly those who were symptomatic, had recently traveled to high-risk countries, or had contact with infected persons). We also carried out population screening using two strategies: issuing an open invitation to 10,797 persons and sending random invitations to 2283 persons. We sequenced SARS-CoV-2 from 643 samples.

RESULTS
As of April 4, a total of 1221 of 9199 persons (13.3%) who were recruited for targeted testing had positive results for infection with SARS-CoV-2. Of those tested in the general population, 87 (0.8%) in the open-invitation screening and 13 (0.6%) in the random-population screening tested positive for the virus. In total, 6% of the population was screened. Most persons in the targeted-testing group who received positive tests early in the study had recently traveled internationally, in contrast to those who tested positive later in the study. Children under 10 years of age were less likely to receive a positive result than were persons 10 years of age or older, with percentages of 6.7% and 13.7%, respectively, for targeted testing; in the population screening, no child under 10 years of age had a positive result, as compared with 0.8% of those 10 years of age or older. Fewer females than males received positive results both in targeted testing (11.0% vs. 16.7%) and in population screening (0.6% vs. 0.9%). The haplotypes of the sequenced SARS-CoV-2 viruses were diverse and changed over time. The percentage of infected participants that was determined through population screening remained stable for the 20-day duration of screening.

CONCLUSIONS
In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males. The proportion of infected persons identified through population screening did not change substantially during the screening period, which was consistent with a beneficial effect of containment efforts. (Funded by deCODE Genetics–Amgen.)
 

Boomer.....

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1,117 new cases
13 new deaths (0 occurred within the past 24-hours) 13 - 65+
1,025 newly recovered
647 currently hospitalized
244 Covid-19 patients in ICU
205 ICU beds available (21%)
5.749% positive test rate
7/31/20

747 new cases
5 new deaths (0 occurred within the past 24-hours)
776 newly recovered
621 currently hospitalized
253 Covid-19 patients in ICU
208 ICU beds available (22%)
 

Deere Poke

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But you just posted a graph showing how great it was going in South Africa because of HCQ. Did this happen overnight?
Posted today's numbers with no BS media hype for you on another thread. They are doing far better than nations that have far fewer cases. Here it is again for ya. I didn't say anything I posted and article put out by medical doctors that have been battling in the trenches. Even the honest non HCQ crowd admits the research done to discredit it was utter crap.

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Deere Poke

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Which is better, my attempt to show some knowledge or your attempt to show ignorance? I'll take the former any day.
Great Knowledge.

This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.
 

sc5mu93

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@RxCowboy Chief Sofa Stuffer. We flattened the curve!

https://twitter.com/IngrahamAngle/status/1288633962370342912?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1288633962370342912%7Ctwgr%5E&ref_url=https%3A%2F%2Fsecondnexus.com%2Flaura-ingraham-texas-virus-cases
Da Fuq? is she looking at the huge penis like mountain? that aint good. it looks to be trending down - but still - da fuq?
 

TheMonkey

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Da Fuq? is she looking at the huge penis like mountain? that aint good. it looks to be trending down - but still - da fuq?
I know, right? I live in Texas. What is she smoking? Deaths just spiked. Hopefully they’ll start trending down soon, but this is hardly the time for a victory lap.
 

RxCowboy

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Great Knowledge.

This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.
When Trump declared that HCQ could be a "game changer" the French study he was talking about had not yet been peer-reviewed.

Sometimes all we have to guide clinical practice is all we have to guide clinical practice. Declaring that something should or should not be used out of hand is to misunderstand the nature of the literature. There are times when we appropriately base clinical decisions on anecdotes because anecdotes are all we have.