Coverage From ID Week 2020

A new podcast episode featuring Mei Mei Hu of Covaxx, whose company has made great strides toward a preventive option in mere months.

What It's Like to Make a COVID-19 Vaccine

A recent small pilot study conducted by the University of Navarra Clinic and the Barcelona Institute for Global Health as part of the SAINT project, has suggested that the early administration of the antiparasitic therapy ivermectin, has the potential to reduce viral loads and symptom duration in mild cases of the coronavirus disease 2019 (COVID-19). The study’s results were published in a journal produced by 

Ivermectin has been shown to reduce the replication of the SARS-CoV-2 virus in vitro in cell lines, although the concentrations used exceeded the dose recommended for humans. Other preliminary results from a human trial were used to initiate the study. However, the data from that study were from a suspicious origin and were never peer-reviewed.

Investigators evaluated 24 patients with a confirmed case of COVID-19 who presented mild symptoms and were given a single dose of ivermectin or a placebo within the first 72 hours of symptom onset. They collected nasal swabs and blood samples at enrollment and 1, 2 and/or 3 weeks after they received the treatment.

"Many efforts are focusing on developing treatments for COVID-19, but few are addressing how to reduce viral transmission," Carlos Chaccour, the lead author on the study said.

Findings showed that 7 days after the treatment, there was no observed difference in the percentage of PCR-positive patients, but the mean viral load in the group who received the therapy was lower overall compared to those who received a placebo. A reduced duration of symptoms, including cough and loss of smell or taste was observed in the ivermectin group, as well as a lower level of virus-specific IgG antibodies.

The team behind the study believes that since no effect on the duration of symptoms or markers associated with inflammation were seen, that the therapy may act through mechanisms that don’t involve anti-inflammatory effect and could be interfering with viral entry in cells.

"Our findings are in line with those from recent assays conducted in Bangladesh and Argentina," Chaccour said. "Although our study is small and it is too early to draw conclusions, the trends observed in viral loads, symptom duration and antibody levels are encouraging and warrant further exploration in larger clinical trials with a higher diversity of patients.”

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With vaccines being approved, less attention has been devoted to evaluating drug-based transmission blocking strategies.

Reducing Mild COVID-19 With Ivermectin

Investigators from the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust have developed a DNA test that rapidly identifies secondary infections in patients with the coronavirus disease 2019 (COVID-19). The results were published in the journal 

Patients who are hospitalized with COVID-19 and have secondary infections have double the risks of developing pneumonia while on ventilation when compared to those who do not have the virus. Mechanical ventilation is often the only way to keep those with a severe form of the disease alive, but it makes them more susceptible to other infections from bacteria and fungi.

Investigators developed the method using a high throughput DNA test that is able to give physicians information they need to start treatment in a few short hours rather than days that current tests require. The ability for quicker results offers the chance for better treatments for infections.

"Early on in the pandemic we noticed that COVID-19 patients appeared to be particularly at risk of developing secondary pneumonia, and started using a rapid diagnostic test that we had developed for just such a situation," Andrew Conway Morris, a co-author on the study said. "Using this test, we found that patients with COVID-19 were twice as likely to develop secondary pneumonia as other patients in the same intensive care unit."

The test employs a multiple polymerase chain reaction (PCR) that detects bacterial DNA which can be completed in around 4 hours, creating a shorter window for the bacteria to grow. The technology runs multiple PCR reactions in parallel, which allows the test to simultaneously detect 52 different pathogens, most importantly ones that can infect the lungs.

For the first time, the test has been used in routine clinical practice and has been approved by hospitals. The investigators believe that similar approaches can provide a benefit if applied more broadly.

"We found that although patients with COVID-19 were more likely to develop secondary pneumonia, the bacteria that caused these infections were similar to those in ICU patients without COVID-19," Mailis Maes, the lead author on the study said. "This means that standard antibiotic protocols can be applied to COVID-19 patients."

Causative organism details in patients with ICU-acquired infections has had limited reporting.

Identifying Pneumonia With DNA Test Can Aid in Faster COVID-19 Treatment 

A recent study conducted by investigators from the University of Portsmouth has found that body temperature scanners, like those used in Airports, can lead to a large number of false negatives. This can result in people being allowed to enter planes and hospitals undetected, furthering the spread of the coronavirus disease 2019 (COVID-19). The study was published in the journal 

"If scanners are not giving an accurate reading, we run the risk of falsely excluding people from places they may want, or need, to go, and we also risk allowing people with the virus to spread the undetected infection they have,” Michael J. Tipton, an author on the study said.

Investigators found that temperature alone is not a good indicator of disease, considering everyone who has the virus does not have one. Additional findings showed that skin temperature does not give an accurate estimation of someone’s deep body temperature, that a high temperature does not necessarily mean an infection with COVID-19, and that taking two temperature measurements can give a more accurate and reliable reading of a fever.

"Using a surface temperature scanner to obtain a single surface temperature, usually the forehead, is an unreliable method to detect the fever associated with Covid-19,” Tipton said. “Too many factors make the measurement of a skin temperature a poor surrogate for deep body temperature; skin temperature can change independently of deep body temperature for lots of reasons. Even if such a single measure did reflect deep body temperature reliably, other things, such as exercise can raise deep body temperature.”

The investigators argue that taking a temperature reading from an individual’s fingertip or eye can give a significantly more accurate reading of deep body temperature and will help to identify those with a fever. Changes in deep body temperature, even as small as 1 degree, are a key factor in diagnosing disease. The paper states that current scanners are easily able to be adapted to take the two measurements.

"We think we can improve the identification of the presence of fever using the same kit but looking at the difference between eye and finger temperature - it's not perfect, but it is potentially better and more reliable," says Tipton.

There currently remains a need to easily, accurately and rapidly assess whether an individual has a fever.

Temperature Scanners Show Limited Value in Covid-19 Detection

The interplay between type 1 interferons (IFN-I) and the HIV-1 virus is dynamic, according to new research, with IFN-I resistance highest at times of viral rebound.

, offers new insights into the role of IFN-I in HIV-1 infection, and could help pave the way for the 

 to effectively be used to help control, and possibly cure, the virus.

IFN-I are proinflammatory and immunomodulatory cytokines that have potent direct and indirect antiviral effects. However, investigators have yet to fully characterize how these interferons interact with the HIV-1 virus over time, a fact that has limited their potential use in HIV cure strategies.

Corresponding author Marcos VP Gondim, PhD, of the University of Pennsylvania, and colleagues, noted that up-regulation of IFN-I is one of the earliest innate responses to HIV-1 and its simian corollary, SIV, with high rates of the interferons detectable in the plasma prior to peak viremia. They said IFN-I, including 

 and IFNβ inferons, have been shown to help control HIV/SIV replication in CD4+ T cells and macrophages.

“Consistent with this, pretreatment of rhesus macaques with exogenous IFNα2 increased the number of intrarectal challenges required to achieve systemic SIVmac infection and vaginal administration of IFNβ protected rhesus macaques from recombinant SIV/HIV (SHIV) infection.”

The inverse also proved true–blocking IFN-I led to faster disease progression.

However, despite the benefits of IFN-I during acute infection, sustained IFN-I signalling in chronic infection appears to have a deleterious effect, correlating with higher viral load in untreated patients.

The dynamic nature of the effects of IFN-I has led to mixed results in studies aimed at evaluating the therapeutic possibilities of the interferons. Gondim and colleagues therefore sought to better understand the kinetics and magnitude of IFN-mediated pressures over time, and the degree to which such changes were uniform in individuals with different rates of disease progression.

The investigators used 500 clonally derived HIV-1 isolates from the plasma and CD4+ T cells of 26 people living with HIV, and then characterized the IFN-I sensitivity of the virus after transmission or after antiretroviral therapy (ART) and treatment interruption. They looked for IFNα2 and IFNβ concentrations to see which levels reduced viral replication, finding that the sensitivity of HIV-1 isolates to IFN-I inhibition consistently changed over time.

“Resistance of HIV-1 isolates to IFN-I was uniformly high during acute infection, decreased in all individuals in the first year after infection, was reacquired concomitant with CD4+ T cell loss, and remained elevated in individuals with accelerated disease,” they wrote.

HIV-1 isolates obtained during ART therapy were relatively IFN-I sensitive, the investigators found, but viruses that rebounded after treatment interruption had the highest degree of resistance observed at any time.

“These findings indicate a dynamic interplay between host innate responses and the evolving HIV-1 quasispecies, with the relative contribution of IFN-I to HIV-1 control affected by both ART and analytical treatment interruption,” Gondim and colleagues wrote.

The investigators said the finding that resistance is highest during viral rebound is an important factor to be considered when designing studies involving treatment interruption. They said the response will also be important as future studies attempt to use the interferons to cure the virus.

A study found patients with acute infection and those with viral rebound after antiretroviral therapy interruption had the highest viral resistance to type 1 interferons.

Interplay Between HIV-1, Type 1 Interferons is Dynamic Over Time

An observational, mathematical modeling study showed an association between 10% increases in self-reported mask-wearing and three-fold increased odds of keeping the instantaneous reproductive number (Rt) of 

Namely, this new assessment of 30,000-plus people in the US show increased mask-wearing is linked to reduced secondary cases of COVID-19 from a single infected person.

 Tuesday morning, an international team of investigators reported that localized decreased estimates of virus transmission, based on the reproductive number (R), correlated with raised survey participant reports of wearing masks in public.

The research team conducted an online survey across the US, asking participants to rate their likelihood of wearing a mask while grocery shopping or visiting family and friends on a four-point scale.

At the same time, investigators estimated levels of physical distancing within each state based on residents’ frequency to stay home—which they found by anonymized data from Google users who consented to sharing location history on mobile devices.

The team compared the Google-collected data from June 3 – July 27, 2020 versus a baseline, pre-pandemic period of January 3 – February 6, 2020.

Estimated levels of virus transmission over time in each state were comprised of daily estimated Rt numbers from the database Rt.live, and fitted to case data from The COVID-19 Tracking Project and the COVID-19 data working group.

In the 378,207 responses to the online survey, nearly 85% stated they were “very likely” to wear a face mask to the grocery story. Just 42% stated they would do so to visit family or friends, and just 4.7% stated they were “not likely at all” to wear a mask.


People 65 years and older were the most likely age group to report mask-wearing (48%), while minority groups including Black (62%) and Hispanic (57%) respondents more frequently reported mask-wearing than White respondents.

Investigators also observed an association between mask-wearing and respondent location; regions among the coasts and southern border of the US, as well as large urban areas, reported the greatest proportion of mask-wearing.

Though the findings do not prove the actual scientific value of mask-wearing in limiting COVID-19 transmission—and may actually just better indicate mask-wearers who are also more likely to practice social distancing during the pandemic—they do evidence the understood benefit of such a practice mandated by health agencies and legislators worldwide.

Study senior author John Brownstein, PhD, of the Boston Children’s Hospital, stressed that the aim of mask-wearing remains to be a physical barrier that stops the spread of COVID-19 droplets.

“However, past evidence on the effectiveness of mask use against COVID-19 transmission is mixed and setting up randomized controlled trials to investigate this is challenging,” Brownstein said in a statement. “Our findings, based on observational data, suggest a community benefit for wearing face masks for slowing the transmission of COVID-19; however, mandates alone may not be enough to increase mask use.”

Brownstein advised that legislators and policy-makers continue to consider additional means of mask usage evaluation and implementation to reduce COVID-19 spread—at a time when new daily cases have again spiked in the US.

Study co-author Christina M. Astley, MD, ScD, a clinician and epidemiologist at Boston Children’s Hospital and Harvard Medical School, echoed her colleague’s call for improved mask-wearing at crucial time in the pandemic.

“The world is facing a more transmissible coronavirus strain, hospitals are struggling with new cases, and vaccination programs are still being rolled out,” Astley said. “Interventions are needed now to lower the burden on our healthcare systems.”

An online survey-based assessment showed older adults and minorities have been more likely to wear masks in public.

Mask-Wearing Linked to Reduced Regional COVID-19 Transmissions

State and federal officials confirmed Friday that promise for a reserve supply of vaccines meant for second doses is actually unavailable.

Report: No COVID-19 Vaccine Federal Reserve Exists

Emotional and health behavior can potentially alter the body’s ability to develop an immune response.

Depression and Stress Could Impact COVID-19 Vaccine Efficacy 

The American College of Physicians offered recommendations on the distribution and administration of vaccines.

Physician Organization Provides Statement on COVID-19 Vaccines

The bowel resting strategy might reduce switching from metronidazole to vancomycin among patients with Clostridioides difficile infection, but it might not reduce mortality or recurrence, a new study found.

Bowel Resting Strategy May Not Reduce Mortality, Recurrence Among CDI Patients

The first two weeks of instruction present a high-risk period for outbreaks.

College Campuses Found to be COVID-19 Superspreaders

Frontline workers are a critical aspect to a community's ability to manage crises and disasters.

COVID-19 Health Care Workers at High Risk for Mental Health Issues

Passive immunotherapy has been used since the late 19th century and has since been evaluated for various diseases.

 Convalescent Plasma Antibody Levels Associated With Risk of Death in COVID-19

This vaccine is meant to be delivered as a single dose administration as compared to other vaccines that have been authorized and in development that require a booster shot.

J&J COVID-19 Vaccine Shows a 90% Immune Response in Interim Data

A new study of COVID-19 interventions in the 2 countries shows how lockdowns and public recommendations are associated with reductions in the mobility of visitors to public spaces. 

Denmark, Sweden Reduced Mobility With Different COVID-19 Interventions

Understanding the full extent of viral invasion is crucial to treating patients and figuring out potential long-term consequences of COVID-19.

Top Medical News

Reducing Mild COVID-19 With Ivermectin

Identifying Pneumonia With DNA Test Can Aid in Faster COVID-19 Treatment

Temperature Scanners Show Limited Value in Covid-19 Detection

Interplay Between HIV-1, Type 1 Interferons is Dynamic Over Time

Mask-Wearing Linked to Reduced Regional COVID-19 Transmissions

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