COVID-19 Updates – a Potpourri of what we learned over the past 2 weeks
We write today after a two-week hiatus and we wish we had brighter news of an effective vaccine ready for approval or effective treatment for COVID-19. While we don’t have anything groundbreaking to share we do feel there is some light at the end of the tunnel.
U.S. Case Counts – on the decline?
To start, it appears that the number of new reported cases per day in the U.S. has started to level off since the surge of cases seen in June and July, which is encouraging despite the U.S. continuing to have one of the highest infection rates in the world. Interestingly, the states with the steepest decrease in cases appear to be states that were hit hardest in the previous two months, including Arizona and Florida. As expected, the decrease correlates with mask mandates, pausing or reversing reopening policies, bar closures, curfews, etc. While this is a positive sign, it in no way means that our case numbers are low, but we expect we will see a continued decline in case numbers (and hospitalizations and deaths) if everyone maintains mask wearing and social distancing.
Speaking of protective measures, our institution (Cleveland Clinic) added a required additional layer of protection for all persons working in patient facing areas – a plastic face shield. An study reported in a JAMA research letter last week suggested that wearing a face shield on top of a surgical mask may reduce community health care workers’ risk of acquiring COVID-19 (https://jamanetwork.com/journals/jama/fullarticle/2769693). Community workers in India conducting home visits to asymptomatic COVID-19 positive patients were examined before and after face shields were recommended to be worn on top of surgical masks. Twelve of 62 workers tested positive before face shields were implemented, and no workers tested positive afterwards. While the eye protection piece is important, we feel that their efficacy comes from being an added barrier over the mouth and nose. While a little steamy at times, we feel very safe in our face shields.
Back to school
Given that the brunt of increased case counts, especially in states like Florida and Arizona, were attributed to younger people getting infected, the idea of going back to school during a pandemic is troublesome for all ages. We are sure you have read or seen on the news the trials and tribulations of high school and college students’ returns to campus (think dorm life, crowded halls, and parties), however younger children and daycare age children may fare better during this portion of re-opening. The American Academy of Pediatrics has issued guidance calling for cloth face coverings for all children over the age of 2 in school settings (https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/). A reassuring report in MMWR about childcare programs in Rhode Island was published online last week, detailing their experience with re-opening after three months of closure, while implementing mandated changes including reduced enrollment, stable groups in physically separated spaces, universal masking, daily symptom screening of adults and children and enhanced disinfection (https://www.cdc.gov/mmwr/volumes/69/wr/mm6934e2.htm). With these precautions in place, possible secondary transmission was identified in only 4 of the 666 programs that reopened. We found this report reassuring that if best practices are followed, daycare can be a safe place.
At present, both the Moderna and Pfizer/BioNtech vaccines are currently enrolling subjects in large phase III studies (goal is n = 30,000). While their efforts have moved at a pace never before seen, everyone is wondering what the odds are of an effective vaccine being approved by the end of this year. Each of the above mentioned trials is currently only 1/3 enrolled, and the Pfizer/BioNtech vaccine will include two doses, 21 days apart. So, you do the math. Regardless, we are still very hopeful on this front.
SARS-CoV-2 antibody testing
Last, week, the Infectious Disease Society of America released Guidelines for serologic testing in COVID-19 and the consensus is that we still have a lot to learn about antibody testing . What we do know is that NAAT/PCR remains the diagnostic test of choice during acute infection, and the IDSA recommends against using antibody testing during the first 2 weeks of infection. But, antibody testing may be useful as an adjunct at later time points, for example three-to-four weeks after symptom onset, which may maximize sensitivity and specificity of antibody testing. In general, testing for IgM and IgA are discouraged, and no antibody test should be used to determine immunity or risk of re-infection. All recommendations are supported by very low certainty of evidence. What I think we can say with certainty is, getting an antibody test to see if you had COVID-19 three months ago is probably not going to be helpful.
In other news, Cassie started reading “The Great Influenza” by John M. Barry, an excellent perspective on leadership in a pandemic – strongly recommended!
We come to have some positive news to share with you in two weeks from now, but until then please give us a shout out with thoughts or questions!
Please follow us on Twitter (It’s the only way to keep up with #COVID19)