This week brings more scientific publications about immunity, interesting findings about COVID prevalence in children and the homeless, and updates to CDC recommendations. Meanwhile, case counts continue to fall nationally and we are finally seeing death counts begin to decline. It is welcome news.
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1) CDC Mask Recommendations
The CDC conducted studies on two mask options that both “substantially improved source control and reduced wearer exposure”. They studied placement of a “fitter” or tight outer cloth layer on top of a surgical mask. They also studied an alternate method of applying a surgical mask alone by knotting the ear loops in order to make the fit tighter. Both methods reduced exposure by more than 95% when both parties were wearing tightly fitted masks. This is another reminder that a well fitted mask is more important than the material.
2) Daycare And COVID-19
A French study of children in daycare centers and COVID-19 was recently published. The study examined 327 children across 22 daycare centers, age 5 months to 4 years. All participants had blood tested for antibodies to SARS-CoV-2 and PCR testing of either nasal swabs or stool. No children had positive PCR tests, but 14 were positive for antibodies (4.3%) compared to the calculated community rate of 10% at the time of the study. Of those 14 cases, more than half had a parent who also tested positive for antibodies. In addition, the cases among children were spread out among the daycare centers with no clusters of cases in classrooms or schools. They concluded that transmission among children in this age group is extremely low, and primarily due to exposure from family members. This is similar to findings published by the European CDC in August, 2020. This article adds to the growing body of evidence that in-person education is safe and not a large contributor to community spread of COVID-19. It is important to note that both of these publications relied on data from early last year, prior to the discovery of COVID variants.
3) COVID-19 And Homelessness
Another French study published in the journal Lancet studied homeless people in France during a COVID-19 lockdown from June-July, 2020. They studied people at food distribution sites, emergency shelters, and worker’s residences for the presence of antibodies against SARS-CoV-2. Out of 818 recruits, 426 (52%) tested positive at 14 different sites. There was considerable variation based on location, with the highest prevalence among those living in worker’s residences (88.7%), followed by shelters (50%), and lastly food distribution centers (27%). More than two thirds of the people who had antibodies reported no symptoms of prior infection. They concluded that living in crowded conditions was the strongest factor associated with exposure level.
4) Antibodies From Recovered Patients Against Variants
A pre-peer review article published online studied the antibodies from patients who recovered from COVID against the B1351 variant. They then compared the same patients after a single dose of the Pfizer or Moderna vaccination. Interestingly, they found all 10 samples displayed weak neutralizing antibodies against the original Wuhan strain, and only half demonstrated weak neutralizing activity against the B1351 (South Africa) variant. However, after a single dose of vaccine, there was a 1000 fold increase in neutralizing IgG and IgA antibodies, with a less robust (2-3 fold lower) but still improved response against the B1351 variant. This very small study suggests that patients who have recovered form infection would still benefit from one vaccine dose.
5) Exposure For Vaccinated People
The CDC published new guidelines regarding COVID exposure in people who have been vaccinated. They suggest that people do not need to quarantine after exposure if they meet all 3 criteria listed:
- Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine)
- Are within 3 months following receipt of the last dose in the series
- Have remained asymptomatic since the current COVID-19 exposure
The 3 month stipulation is expected to increase as more data is published regarding vaccine immunity.
6) Dementia And COVID-19
A study published in Alzheimer’s & Dementia studied patients in the U.S. with varying types of dementia and their risk of contracting COVID-19. The study examined the electronic health records of over 61 million adult patients. 1,064,960 patients with dementia, 15,770 with COVID‐19, and 810 with both dementia and COVID‐19. They found the following risks over a 6 month period:
- Adults (>18yo) with COVID has a 25% chance of hospitalization
- Adults with dementia and COVID had a 59% chance of hospitalization
- Adult Blacks with dementia and COVID had a 73% chance of hospitalization
- Adults (>18yo) with COVID had a 5.6% risk of death
- Adults with dementia and COVID had a 20% risk of death
- Adult Blacks with dementia and COVID had a 23% risk of death
The study highlights the significant increased risk of death and hospitalization for patients with dementia and COVID-19.
7) FDA Authorizes Dual Antibody Treatment
The FDA provided emergency authorization to Eli Lilly for use of its combination antibody therapy against COVID-19. The authorization allows a combination of 700 mg bamlanivimab and 1400 milligrams etesevimab to be infused as a single dose for mild to moderate COVID in high risk patients 12 years of age and older, weighing at least 40 kg.
8) WHO Finds COVID-19 Not Leaked From Chinese Lab
A team of investigators from the World Health Organization concluded an investigation into the origins of the virus that causes COVID-19. In a press conference, the team stated that the the virus most likely appeared in humans after jumping from an animal. They note “the findings suggest that the laboratory incident hypothesis is extremely unlikely to explain introduction of the virus into the human population and therefore is not a hypothesis that will imply to suggest future studies…”
9) Florida Leads Nation In B117 Variant Cases
The CDC COVID-19 variant tracker shows that Florida has the most B1117 (U.K.) cases in the country so far. Over 300 cases have been reported. California has the second highest number with over 150 cases reported. B1351 (South Africa) and P1 (Brazil) variant activity remains low in the U.S.