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This INSIGHTS Perspectives piece by scientist Jon J. Major highlights the societal and geologic impacts of the Mount St. Helens eruption on this day in 1980.
PERSPECTIVE VOLCANOLOGY
Mount St. Helens at 40, Jon J. Major
Science 15 May 2020:
Volume 368, Issue 6492, pp. 704-705.
doi: 10.1126/science.abb4120
Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic
AUTHORS: Eakachai Prompetchara 1,2,3 Chutitorn Ketloy 1,2 Tanapat Palaga 4,5
AUTHOR AFFILIATIONS:
1 Center of Excellence in Vaccine Research and Development (Chula Vaccine Research Center Chula VRC), Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
2 Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
3 Vaccines and Therapeutic Proteins Research Group, the Special Task Force for Activating Research (STAR), Chulalongkorn University, Bangkok 10330, Thailand
4 Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
5 Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok 10330, Thailand
ABSTRACT: As the world is witnessing the epidemic of COVID-19, a disease caused by a novel coronavirus, SARS-CoV-2, emerging genetics and clinical evidences suggest a similar path to those of SARS and MERS. The rapid genomic sequencing and open access data, together with advanced vaccine technology, are expected to give us more knowledge on the pathogen itself, including the host immune response as well as the plan for therapeutic vaccines in the near future. This review aims to provide a comparative view among SARS-CoV, MERS-CoV and the newly epidemic SARS-CoV-2, in the hope to gain a better understanding of the host-pathogen interaction, host immune responses, and the pathogen immune evasion strategies. This predictive view may help in designing an immune intervention or preventive vaccine for COVID-19 in the near future.
Dr. Michael Weekes and his colleagues at the Department of Infectious Diseases within the Cambridge University Hospitals NHS Trust identified SARS-CoV-2 positive health care workers (HCWs) in the wards in April of 2020. The overall percentage of asymptomatic positive HCWs was 5%. In one ward, identified as Ward Q, more than 25% of HCWs tested positive for SARS-CoV-2 by Real-Time RT-PCR. This study underscores the importance of regular viral surveillance screening for hospital staff and providing adequate training to prevent nosocomial spread of infectious disease pathogens including the novel coronavirus strain.
A link to the full text article e-published May 11, 2020 can be accessed here.
The authors conclude:
“Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.”
AUTHORS: Lucy Rivett, MBBS 1,2*, Sushmita Sridhar, BS 3,4,5*, Dominic Sparkes, MBBS 1,2*, Matthew Routledge, MBBS 1,2 3 *, Nick K. Jones, MBBS 1,2,4,5*, Sally Forrest, BSc 4,5, Jamie Young, BSc 6 , Joana Pereira-Dias, MSc 4,5 L. Hamilton, PhD 1,2, Mark Ferris, MSc 7, M. Estee Torok, PhD 5,8, Luke Meredith, PhD 5, The CITIID-NIHR COVID-19 BioResource Collaboration, Martin Curran, PhD 2, Stewart Fuller, MSc 10, Afzal Chaudhry, PhD 11, Ashley Shaw, MBChB 11, Prof. Richard J. Samworth, PhD 12, Prof. John R. Bradley, DM 4,13, Prof. Gordon Dougan, FRS 4,5 7, Prof. Kenneth G.C. Smith, FMedSci 4,5, Prof. Paul J. Lehner, FMedSci 1,4,5, Nicholas J. Matheson, PhD 1,4,5,8 , Giles Wright, BA 7 , Prof. Ian Goodfellow, PhD 9¶ , Prof. Stephen Baker, PhD 4,5¶, Michael P. Weekes, PhD 1,4,5¶
AFFILIATIONS:
1 Department of Infectious Diseases, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
2 Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, United Kingdom.
3 Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom.
4 Department of Occupational Health and Wellbeing, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
5 Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
6 Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom.
7 Clinical Microbiology & Public Health Laboratory, Public Health England (PHE), Cambridge, United Kingdom.
8 Clinical Research Facility, National Institutes for Health Research, Cambridge, United Kingdom.
9 Chief Medical Information Officer, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
10 Medical Director, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
11 Statistical Laboratory, Centre for Mathematical Sciences, University of Cambridge, Cambridge, United Kingdom.
12 Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom.
13 Department of Pathology, University of Cambridge, Cambridge, United Kingdom.
ABSTRACT: Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3-week period (April 2020), 1,032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19) >7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.
PMID: 32392129
doi: 10.7554/eLife.58728
© 2020, Rivett et al.
Emerging Infectious Diseases Volume 26, Number 7—July 2020
Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released. Accessed online: May 10, 2020
This article shows the data from Wuhan and 26 provinces. Described in Figure 3C, from January 18th to 26th, the growth of new cases in areas outside of Hubei, grew rapidly (over only 8 days) and exponentially. These data further support the public health imperative of limiting social interactions in areas of high SARS-CoV-2 transmission and discouraging travel from these areas to areas of no or low transmission.
The authors also underscore that while they have calculated an R0 , they have made a series of assumptions that may or may not prove correct. They summarize:
“The values estimated have important implications for predicting the effects of pharmaceutical and nonpharmaceutical interventions. For example, the threshold for combined vaccine efficacy and herd immunity needed for disease extinction is calculated as 1 – 1/R0 . At R0 = 2.2, this threshold is only 55%. But at R0 = 5.7, this threshold rises to 82% (i.e., >82% of the population has to be immune, through either vaccination or prior infection, to achieve herd immunity to stop transmission).”
“We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus.”
Figure 3. Estimates of the exponential growth rate and the date of exponential growth initiation of the 2019 novel coronavirus disease outbreak in China based on 2 different approaches. A) Schematic illustrating the export of infected persons from Wuhan. Travelers (dots) are assumed to be random samples from the total population (whole pie). Because of the growth of the infected population (orange pie) and the shrinking size of the total population in Wuhan over time, probability of infected persons traveling to other provinces increases (orange dots). B) The dates of documented first arrivals of infected persons in 26 provinces. C) Best fit of the case count model to daily counts of new cases (including only imported cases) in provinces other than Hubei. Error bars indicate SDs.
AUTHORS: Steven Sanche1, Yen Ting Lin1, Chonggang Xu, Ethan Romero-Severson, Nick Hengartner, and
Ruian Ke
Author affiliations: Los Alamos National Laboratory, Los Alamos, New Mexico, USA
1 These authors contributed equally to this work
ABSTRACT: Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R0) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period. We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R0 value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus.
Rapid implementation of mobile technology for real-time epidemiology of COVID-19
A friend and colleague Dr. Long H. Nguyen of the Harvard Medical School and the Clinical & Translational Epidemiology Unit at Massachusetts General Hospital has written about the new COronavirus Pandemic Epidemiology (COPE) consortium. As of May 2, 2020 2.8 million users have used the mobile application for symptom tracking. Also, as a side note, Dr. Long Nguyen knows the best vegan restaurants around any town he visits.
ABSTRACT: The rapid pace of the Severe Acute Respiratory Syndrome COronaVirus 2 (SARS-CoV-2) pandemic presents challenges to the robust collection of population-scale data to address this global health crisis. We established the COronavirus Pandemic Epidemiology (COPE) consortium to bring together scientists with expertise in big data research and epidemiology to develop a COVID-19 Symptom Tracker mobile application that we launched in the UK on March 24, 2020 and the US on March 29, 2020 garnering more than 2.8 million users as of May 2, 2020. This mobile application offers data on risk factors, herald symptoms, clinical outcomes, and geographical hot spots. This initiative offers critical proof-of-concept for the repurposing of existing approaches to enable rapidly scalable epidemiologic data collection and analysis which is critical for a data-driven response to this public health challenge.
David A. Drew1,*, Long H. Nguyen1,*, Claire J. Steves2,3, Cristina Menni2, Maxim Freydin2, Thomas Varsavsky4, Carole H. Sudre4, M. Jorge Cardoso4, Sebastien Ourselin4, Jonathan Wolf5, Tim D. Spector2,5,†, Andrew T. Chan1,6,†,‡, COPE Consortium§
Corresponding author. Email: achan@mgh.harvard.edu
Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA.
Department of Twin Research and Genetic Epidemiology, King’s College London, Westminster Bridge Road, London SE17EH, UK.
Department of Ageing and Health, Guys and St. Thomas’s NHS Foundation Trust, Lambeth Palace Road, London SE17EHIL, UK.
School of Biomedical Engineering & Imaging Sciences, King’s College London, 1 Lambeth Palace Road, London SE1 7EU, UK.
Zoe Global Limited, 164 Westminster Bridge Road, London SE17RW, UK.
Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02114, USA.
↵* These authors contributed equally to this work.
↵† These authors contributed equally to this work.
↵§ COPE Consortium members and affiliations are listed in the supplementary materials.
Science 05 May 2020: eabc0473
DOI: 10.1126/science.abc0473
Prevention of Cervical Cancer in Sub-Saharan Africa: The Advantages and Challenges of HPV Vaccination
HPV vaccination campaigns and medical affairs support to provide evidence describing HPV strain prevalence were areas of work I did in Kenya, Tanzania, Uganda, Zambia, and Ethiopia. Rwanda had implemented government-sponsored HPV and Rotavirus vaccination, yet I worked there too as new scientific research emerged. While there are now government-sponsored HPV vaccination programs in Kenya, Tanzania, Uganda, Zambia, and Ethiopia, due in part to the teams and individuals I coordinated and the support of the Global Alliance for Vaccinations and Immunization, there are many obstacles still to reckon with. This review highlights a lot of the challenges our teams faced and my teams and colleagues continue to face in their work in sub-Saharan Africa.
AUTHORS: Eleanor Black * and Robyn Richmond
School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia;
*Correspondence: ellie.black@gmail.com; Tel.: +61-413-037-188, R.Richmond@unsw.edu.au
ABSTRACT: Cervical cancer is a critical public health issue in sub-Saharan Africa (SSA), where it is the second leading cause of cancer among women and the leading cause of female cancer deaths. Incidence and mortality rates are substantially higher than in high-income countries with population-based screening programs, yet implementing screening programs in SSA has so far proven to be challenging due to financial, logistical, and sociocultural factors. Human Papillomavirus (HPV) vaccination is an effective approach for primary prevention of cervical cancer and presents an opportunity to reduce the burden from cervical cancer in SSA. With a number of SSA countries now eligible for Global Alliance for Vaccines and Immunization (GAVI) support for vaccine introduction, it is timely to consider the factors that impede and facilitate implementation of vaccine programs in SSA. This article describes epidemiological features of cervical cancer in SSA and the current status of HPV vaccine implementation in SSA countries. Rwanda’s experience of achieving high vaccination coverage in their national HPV immunization program is used as a case study to explore effective approaches to the design and implementation of HPV vaccination programs in SSA. Key factors in Rwanda’s successful implementation included government ownership and support for the program, school-based delivery, social mobilization, and strategies for reaching out-of-school girls. These findings might usefully be applied to other SSA countries planning for HPV vaccination.
Dr. Jonathan O’B Hourihane and his research group with the Irish Centre for Fetal and Neonatal Translational Research (INFANT) conducted the FIRST longitudinal study of insect stings and characterized allergies and adverse outcomes in children. 2137 children completed the 5 year study.
A longitudinal study of hymenoptera stings in preschool children
AUTHORS: Danielle Clifford, Carol Ni Chaoimh, Eve Stanley, Jonathan O’B Hourihane
BACKGROUND: Insect venom is the second most common cause of anaphylaxis outside of medical encounters. Stings cause over 20% of all anaphylactic deaths and 7% of anaphylaxis in children. To date, there have been no longitudinal studies of insect sting events or allergy in preschool children.
METHODS: A prospective longitudinal nested observational study in the BASELINE Birth Cohort Study (n = 2137). Sting‐related questions were asked at 6 and 12 months and 2 and 5 years. Skin prick testing (SPT) was performed at 2 and 5 years. SpIgE testing was performed on selected cases at 2 years.
RESULTS: Seventy‐seven children (6.8%) were stung by the age of 2. Of these, 25 (32.5%) reported adverse reactions (four systemic). Eleven (0.9%) had positive SPT at 2 years (eight bee, two wasp, one both). Four stung children had: positive SPT. Two (one stung, one never stung) had positive spIgE to a venom component at 2 years. A total of 268 children (21.9%) were stung by 5 years, 144 (52.1%) reporting local reactions but none systemic. Four children (0.4%) had positive SPT at 5 years: one bee and three wasp. Of the 11 SPT‐positive children at 2 years, none were still positive at 5 years.
CONCLUSION: This is the first longitudinal study of the natural history of hymenoptera stings and allergy in preschool children. Hymenoptera venom allergy is less common in this cohort than in adults. Systemic reactions were not medically documented in this population, in keeping with previous literature. This study confirms the poor correlation of IgE sensitization to venom with sting allergy and does not support the common parental request to screen children for sting allergy.
AUTHOR AFFILIATIONS:
-Paediatrics and Child Health, University College Cork, Cork, Ireland
-Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
CORRESPONDENCE:
Jonathan O’B Hourihane, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland Email: j.hourihane@ucc.ie
First published: 08 October 2018 https://doi.org/10.1111/pai.12987
Treatment with convalescent plasma for COVID-19 patients in Wuhan, China.
Mingxiang Ye and colleagues published this paper on April 15, 2020. Six laboratory-confirmed COVID-19 patients admitted to Wuhan Huoshenshan Hospital from February 11th to March 12th, 2020 received transfusions of ABO-compatible convalescent plasma. The clinicians then monitored for alleviation of symptoms, changes in radiologic abnormalities, and laboratory test outcomes.
These researchers also described a post-discharge asymptomatic “walking COVID-19” case in one of their patients. These “walking COVID-19” cases may be able to infect additional people.
The researchers measured the efficacy of convalescent plasma therapy in three SARS patients by measuring viral load. Their results revealed viral load dropped from 495×10*3, 76×10*3, or 650×10*3 copies/mL to zero or 1 copy/mL one day after transfusion.
AUTHORS : Ye M, Fu D, Ren Y, Wang F, Wang D, Zhang F, Xia X, Lv T
ABSTRACT : The discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the outbreak of coronavirus disease 2019 (COVID-19) are causing public health emergency. A handful of literatures have summarized its clinical and radiologic features, whereas therapies for COVID-19 are rather limited. In order to evaluate the efficacy of convalescent plasma therapy in COVID-19 patients, we did this timely descriptive study. 6 laboratory confirmed COVID-19 patients were enrolled and received the transfusion of ABO-compatible convalescent plasma. The efficacy of this intervention was determined by the alleviation of symptoms, changes in radiologic abnormalities and laboratory tests. No obvious adverse effect observed during the treatment. Transfusion of convalescent plasma led to a resolution of ground glass opacities (GGOs) and consolidation in patient #1, #2, #3, #4 and #6. In patient #1 and #5 who presented with SARS-CoV-2 in throat swab, convalescent plasma therapy elicited an elimination of virus. Serologic analysis indicated an immediate increase in anti-SARS-CoV-2 antibody titers in patient #2 and #3, but not in patient #1. This study indicates that convalescent plasma therapy is effective and specific for COVID-19. This intervention has a special significance for eliminating SARS-CoV-2 and is believed to be a promising state-of-art therapy during COVID-19 pandemic crisis.
This article is protected by copyright. All rights reserved.
Please cite this article as doi: 10.1002/jmv.25882
Cryptic transmission of SARS-CoV-2 in Washington State
Dr. Keith R. Jerome and Dr. Trevor Bedford describe the silent spread of the novel coronavirus, SARS-CoV-2 in Washington state in January and February of 2020. While the first death in the United States was thought to be in Washington state, the viral evolution and results to date (April 25, 2020) have shown deaths in California prior to the case in Washington. The analysis described in this publication reveals that the exponential doubling and spread to be as short as 2 days. It also underscores the importance of early detection and surveillance sampling for respiratory pathogens.
More information on Dr. Jerome’s research focus can be found here.
AUTHORS: Bedford T, Greninger AL, Roychoudhury P, Lea M Starita, Famulare M, Huang M, Nalla A, Pepper G, Reinhardt A, Xie H, Shrestha L, Nguyen TN, Adler A, Brandstetter E, Cho S, Giroux D, Peter D Han, Fay K, Frazar CD, Ilcisin M, Lacombe K, Lee J, Kiavand A, Richardson M, Sibley TR, Truong M, Wolf CR, Nickerson DA, Rieder MJ, Englund JA, Hadfield J, Hodcroft EB, Huddleston J, Moncla LH, Müller NF, Neher RA, Deng X, Gu W, Federman S, Chiu C, Duchin J, Gautom R, Melly G, Hiatt B, Dykema P, Lindquist S, Queen K, Tao Y, Uehara A, Tong S, MacCannell D, Armstrong GL, Baird GS, Chu HY, Shendure J, Jerome KR.
2020. medRxiv: 2020.04.02.20051417.
ABSTRACT: Following its emergence in Wuhan, China, in late November or early December 2019, the SARS-CoV-2 virus has rapidly spread throughout the world. On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Genome sequencing of SARS-CoV-2 strains allows for the reconstruction of transmission history connecting these infections. Here, we analyze 346 SARS-CoV-2 genomes from samples collected between 20 February and 15 March 2020 from infected patients in Washington State, USA. We found that the large majority of SARS-CoV-2 infections sampled during this time frame appeared to have derived from a single introduction event into the state in late January or early February 2020 and subsequent local spread, strongly suggesting cryptic spread of COVID-19 during the months of January and February 2020, before active community surveillance was implemented. We estimate a common ancestor of this outbreak clade as occurring between 18 January and 9 February 2020. From genomic data, we estimate an exponential doubling between 2.4 and 5.1 days. These results highlight the need for large-scale community surveillance for SARS-CoV-2 introductions and spread and the power of pathogen genomics to inform epidemiological understanding.
Dr. Johanna Lindahl and I met in 2015 and have shared a lot of wonderful scientific discussions since. I was happy to learn she is currently working in Sweden again after our time together in Kenya.
Dr. Lindahl and her colleagues have described rapid IgG and IgM antibody testing using samples from individuals with previous exposure to SARS-CoV-2.
AUTHORS: Tove Hoffman, Karolina Nissen, Janina Krambrich, Bengt Rönnberg, Dario Akaberi, Mouna Esmaeilzadeh, Erik Salaneck, Johanna Lindahl, & Åke Lundkvist
ABSTRACT: COVID-19 is the most rapidly growing pandemic in modern time, and the need for serological testing is most urgent. Although the diagnostics of acute patients by RT-PCR is both efficient and specific, we are also crucially in need of serological tools for investigating antibody responses and assessing individual and potential herd immunity. We evaluated a commercially available test developed for rapid (within 15 minutes) detection of SARS-CoV-2-specific IgM and IgG by 29 PCR-confirmed COVID-19 cases and 124 negative controls. The results revealed a sensitivity of 69% and 93.1% for IgM and IgG, respectively, based solely on PCR-positivity due to the absence of a serological gold standard. The assay specificities were shown to be 100% for IgM and 99.2% for IgG. This indicates that the test is suitable for assessing previous virus exposure, although negative results may be unreliable during the first weeks after infection. More detailed studies on antibody responses during and post infection are urgently needed.
Infection Ecology & Epidemiology Volume 10, 2020 - Issue 1
UW team illustrates the adverse impact of visiting ‘just one friend’ during COVID-19 lockdown
Dr. James Urton and I are colleagues from graduate school. Dr. Urton now writes scientific content for the University of Washington highlighting relevant research conducted by Seattle scientists and their collaborators.
In this article Dr. Urton highlights the risks and consequences inherent to having even brief interactions with people beyond your family unit and breaking social distancing recommendations.