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SmartWatch Predicts SARS-CoV-2 Infection, Skin Reveals ‘Long Haulers’, Seven Forms Identified: COVID-19 Updates

November 6, 2020 I Red marrow main target, increase in STIs amid lockdown, Dante Labs to offer Fluidigm’s saliva-based test, COVID-19 worsens tinnitus, few SNFs have fast test result turnaround time, University of Illinois creates successful test and trace program, yearlong study will determine seropositivity in frontline workers, myocarditis not as common as suspected, PerkinElmer receives EUA for pooled sample testing, and viral load determines outcomes with COVID-19 pneumonia. Plus: Twenty percent experience GI symptoms, 1.7 million New Yorkers infected, lung damage found in ‘long COVID’, unique case infectious for 70 days, and delirium early symptom in elderly.


Research News

COVID-19 may worsen tinnitus, new research has shown published in the Frontiers in Public Health. This study led by Anglia Ruskin University (ARU) researchers involved over 3,100 participants with tinnitus from 48 countries, mostly from the UK and U.S. The research team found that 40% of those displaying COVID-19 symptoms also experienced a worsening of their tinnitus. Most people had the condition prior to contracting the virus, but a small portion reported that their tinnitus was triggered with the onset of COVID-19 symptoms. The study suggests that tinnitus could be a ‘long COVID’ symptom in some cases. DOI:10.3389/fpubh.2020.592878

A new microbiologic screening program rolled out in Al Zahra Hospital in the United Arab Emirates (UAE) aimed to identify asymptomatic COVID-19 patients receiving anticancer therapy to protect this at-risk group. This program enrolled 109 asymptomatic patients with cancer who were prospectively screened for COVID-19 symptoms and underwent a nasal swab test at each screening. Additionally, patients were screened for new pulmonary infiltrates, symptoms, or at physician discretion and anticancer therapy was held until the patient had two negative test results for SARS-CoV-2. The program successfully identified nearly 1 in 10 cancer patients with COVID-19 before showing any symptoms. The team has since expanded the program across serial anticancer therapy cycles and has published this work in JAMA Oncology. DOI:10.1001/jamaoncol.2020.5745

A new case study, published in Cell, details a unique case of a 71-year-old woman with chronic lymphocytic leukemia who shed infectious SARS-CoV-2 for at least 70 days, while never showing any symptoms. An expert, and lead author, from the National Institute of Allergy and Infectious Diseases (NIAID) was contacted by a study co-author after this patient had several positive tests for the virus over several weeks. The researchers believe that this patient remained infectious for an extended period of time due to her compromised immune system that never triggered a response to the virus. Blood tests also showed that the patient never produced any antibodies. The team adds that this is the longest case of active infection with COVID while remaining asymptomatic to their knowledge. DOI:10.1016/j.cell.2020.10.049

Delirium accompanied by fever may be an early symptom of COVID-19, according to a new study published in the Journal of Clinical Immunology and Immunotherapy and conducted by researchers at the Universitat Oberta de Catalunya (OUC). The scientific research review concludes that along with loss of taste and smell and headaches, delirium or state of confusion accompanied by high fever should be considering an early marker for the disease, especially in the elderly population. The researchers attribute the cause of delirium to systemic inflammation and hypoxia, which in turn causes neuronal tissue inflammation and damage to areas such as the hippocampus. DOI:10.24966/CIIT-8844/1000039

Black and Latinx hospital workers are at the highest risk of COVID-19 infection, even those without patient care responsibilities, shows a new study led by Rutgers University and published in Open Forum Infectious Diseases. Researchers screened just over 3,900 employees and clinicians at a New Jersey hospital between April and June for the virus and SARS-CoV-2 antibodies. They found that Black and Latinx workers were twice as likely to test positive for the virus or antibodies when compared to white employees. Phlebotomists had the highest positive test rate, followed by maintenance and housekeeping staff, dining and food staff, and support roles. Surprisingly, physicians, nurses, and emergency medical technicians had much lower infection rates. The authors of the study attribute these findings to less access to PPE or less enforcement of safety protocols. DOI:10.1093/ofid/ofaa534

Researchers have identified unique characteristics in the lungs of those suffering from ‘long COVID’. The study, published in eBioMedicine, analyzed the organs of 41 patients who died from COVID-19 at the University Hospital of Trieste, Italy from February to April 2020, examining lung, heart, liver, and kidney samples. The research team, led by King’s College London, found extensive lung damage in most cases and profound disruption of the normal lung structure. Nearly 90% of the patient lung samples showed extensive blood clotting in the lung arteries and veins and several lung cells were abnormally large. Additionally, the samples showed persistence of the viral genome in respiratory cells and in cells lining the blood vessels that persisted for several weeks or months. They believe these findings could explain ‘long COVID’. The study found no obvious signs of SARS-CoV-2 infection or prolonged inflammation in other organs. DOI:10.1016/j.ebiom.2020.103104

More than 1.7 million New Yorkers have been infected with SARs-CoV-2 and the infection fatality rate of the virus is close to 1%, making it ten times deadlier than the flu, according to new research from the Icahn School of Medicine at Mount Sinai. The study, published in Nature, looked at a dataset of over 10,000 plasma samples from Mount Sinai Health System patients between February and July 2020 who were seen in the emergency department and urgent care and also from patients seen for routine care. Researchers tested for SARS-CoV-2 antibodies weekly and determined seroprevalence to be roughly 22% after the first wave subsided by the end of May. They also noted that seropositive samples were found as early as mid-February, before the first cases had been reported. DOI:10.1038/s41586-020-2912-6

A rapid CRISPR-based testing method has been developed by Stanford University researchers through combining microfluidics and on-chip electric field control. Current CRISPR testing methods require up-front nucleic acid extraction, large reagent volumes, and several manual steps that are time consuming and not feasible in low resource settings. This new method takes roughly 35 minutes from sample to test results. This is a significant improvement over existing nucleic acid-based testing methods for COVID-19, according to the authors of this study published in PNAS. DOI:10.1073/pnas.2010254117

Nearly 20% of COVID-19 patients present with gastrointestinal symptoms, according to a new study published in Abdominal Radiology. The researchers reviewed 36 studies published through July to determine these findings. GI symptoms varied widely but researchers found that 18% of COVID-19 patients presented with these symptoms and 16% of cases only showed gastrointestinal symptoms with the virus. Researchers also determined potential signs for radiologists to look for which included inflammation of the small and large bowel, air within the bowl wall and bowel perforation. They noted that these signs are quite rare and would indicate advanced disease. DOI:10.1007/s00261-020-02739-5

Seven different “forms of disease” have been identified in mild COVID-19 cases, finds a team of Medical University of Vienna scientists. The study, published in Allergy, involved 109 convalescent individuals and 98 health individuals for their control group. Researchers were able to determine seven different groups of symptoms, which distinguished systemic from organ-specific forms of disease. The scientists also found that the virus leaves behind detectable changes in the blood that is similar to a fingerprint. The number of granulocytes were significantly lower in the COVID-19 group and regulatory cells were greatly diminished, which the study emphasizes could lead to autoimmunity. Essentially, their findings show that the immune system “doubles up” when fighting COVID-19 even several weeks after infection. They hope to implement these findings for development of a highly effective vaccine. DOI:10.1111/all.14647

The main target for SARS-CoV-2 may be red marrow, leading to damage of erythrocytes and blocking the formation of new ones, according to new research published in Archiv EuroMedica. The study analyzed lung samples from 79 COVID-19 patients who died from the virus. They found damage to the endothelium of red marrow, which normally regulates the migration of maturing blood cells, and these damaged red blood cells led to ischemia and anemia with cell death of various organ systems. The researchers suggest erythrocyte mass and vitamin B12 as effective treatment options and note that mechanical ventilation is ineffective when there are not enough red blood cells to transport oxygen throughout the body. The mechanism of recovery of damaged erythrocytes remains unknown. DOI:10.35630/2199-885X/2020/10/3.1

German researchers have developed a two-step antibody testing approach that provides more accurate results, close to 100% specificity and more than 95% sensitivity, and utilized these tests to detect antibody frequency in Bavaria children. The study, published in Med, screened 12,000 children (1-18 years old) for SARS-CoV-2 antibody positivity and detected a frequency of 0.87% . When compared to the incidence of COVID-19 positive cases in children reported by the Bavarian Health and Food Safety Authority, the antibody positive frequency found by researchers was six times higher. These findings indicate the importance of large-scale antibody testing for SARS-CoV-2. The study also showed 47% of the antibody-positive children were asymptomatic and in children with virus-positive family members, 35% had antibodies. DOI:10.1016/j.medj.2020.10.003

A new study, published in Nature Medicine, reveals that sensor data from wearable devices may predict COVID-19 infection along with self-reported symptoms. Scripps Research Institute examined data from the first six weeks of the DETECT study, which launched in March and uses a mobile app to collect smartwatch and activity tracker data from participants, and also collects self-reported symptoms and diagnostic test results. The research team reviewed sensor data from those who reported COVID-19 symptoms and tested positive for the virus to pinpoint specific changes in heart rate, sleep and activity levels. Using this health data from wearable devices, the study showed approximately 80% accuracy in predicting whether a person who reported symptoms was likely to have COVID-19. DOI:10.1038/s41591-020-1123-x

The SARS-CoV-2 viral load detected in hospitalized patients with COVID-19 associated pneumonia predicts risk of adverse outcomes, finds a new study published in the Annals of the American Thoracic Society. Researchers looked at medical records from 314 patients who came to the NYU Langone Health emergency department and were diagnosed with COVID-19 and viral pneumonia requiring hospitalization. They found that high viral load was a strong predictor of poor outcomes, even after considering the patients’ underlying conditions. They also determined that patients with comorbidities were more likely to have a high SARS-CoV-2 load upon admission, and therefore experience increased risk for poor outcomes. DOI:10.1513/AnnalsATS.202008-931RL  

New research shows that myocarditis caused by COVID-19 may not be as common as suspected. The study, published in Cardiovascular Pathology, collected data from 277 autopsies to analyze cardiovascular pathology findings from COVID-19 deaths in nine countries. Researchers of this analysis determined that the rate of myocarditis in these patients was between 1.4 and 7.2%, compared to previously reported rates of COVID-19 myocarditis ranging from 60% among middle-aged and elderly recovered patients to 14% among recovered athletes. The authors pointed out that these findings do not mean that SARS-CoV-2 does not have a significant impact on cardiovascular health, explaining that these complications are likely due to endothelial cell activation, cytokine storms, or electrolyte imbalances. DOI:10.1016/j.carpath.2020.107300

A study, published in JAMA Internal Medicine, examines COVID-19 test result turnaround time for resident and staff in U.S. skilled nursing facilities (SNFs) to determine if these facilities were achieving the less than one day turnaround time recommended to effectively guide infection control. Researchers performed a cross-sectional study using the Medicare COVID-19 Nursing Home Database, a mandatory weekly survey of all Medicare-certified SNFs that collects facility-reported test result turnaround time, combined with SNF characteristics from the National Institute on Aging databases and the 2020 Medicare Nursing Home Compare database. They found that only a small percentage of SNFs had less than one day turnaround time for test results and even in hot spot counties less than 17% of SNFs had a turnaround time of less than 1 day. Authors of this study note that conflicting regulations and testing supply shortages may have caused these delayed testing times. DOI:10.1001/jamainternmed.2020.7330

Industry News

The University of Illinois at Urbana-Champaign (UIUC) has developed a campus-wide testing and tracing program, called Shield, which aims to screen students, faculty, and staff for SARS-CoV-2 and help prevent the spread of the virus. Shield now processes over 10,000 saliva-based tests each day with undergraduate students getting tested two to three times each week. The program has seen success in controlling infection with UIUC case positivity rate declining to 0.47% by the end of October with over 600,000 completed tests. Students must have negative results to access campus facilities, which has led to good compliance. Due to their success with the Shield program, the state of Illinois has adapted the program statewide with Shield-Illinois. Press Release

A new system development, led by the National University of Singapore (NUS), wirelessly collects pulse oximeter data to monitor oxygen levels. Supported by the Temasek Foundation and the National Research Foundation, this new technology will help address the challenge of monitoring migrant workers health during the pandemic. The NUS team conducted a two-month pilot test within a dormitory that house these workers and results showed that the workers could be reliably monitored four times a day with a more than 85% compliance rate and minimal intervention by dormitory operators. Developers add that this system would also be suitable for deployment in community care facilities. Press Release

Elsevier and Canadian Association of Pathologists (CAP) have announced a partnership to provide ExpertPath to resident members of CAP as they prepare for Royal College examinations. ExpertPath is an anatomic and clinical pathology online decision support solution that gives pathologists instant access to the collective clinical experience and knowledge of sub-specialists in every field of anatomic and clinical pathology. Due to the pandemic, many face-to-face educational activities and exams have been canceled for students and residents are working more frontline shifts to meet growing demands for testing. Access to this platform will allow residents to use it as a primary study reference while continuing to work amidst the COVID-19 pandemic. Press Release

Fluidigm has announced that Dante Labs will be offering the company’s saliva-based COVID-19 test in local communities across seven countries in Europe. The lab will be utilizing Fluidigm’s assay and reagents designed to be run on the Fluidigm Biomark HD system and plan to process 30,000 tests per day to meet growing demands. This extraction free and scalable test has a 24-hour turnaround time for results and is 100% agreeable with nasal swab tests. Press Release

Despite COVID-19 lockdown restrictions, diagnoses of sexually transmitted infections (STIs) have increased in Milan, Italy, according to new research presented at the 29th European Academy of Dermatology and Venereology (EADV) Congress, EADV Virtual. The study was conducted in two STI centers in Milan and compared the number of confirmed diagnoses of the most common STIs in patients with symptoms during the March and April lockdown of this year to the same time period in 2019. Specifically, gonorrhea, secondary syphilis and mycoplasma genitalium (MG) increased while non-acute cases, such as genital warts and Molluscum Contagiosum, fell. The researchers note that these findings show the importance of ongoing screening for STIs throughout the pandemic. Press Release

A new analysis of skin symptoms related to COVID-19 reveals a subset of patients, called ‘long-haulers’, who experience prolonged symptoms (more than 60 days). This research, presented at the EADV Virtual, analyzed data from 990 cases from 39 countries that showed patients presenting with a broad range of dermatologic manifestations, but most notable was pernio/chilblains (“COVID toes”). COVID toes often appeared one to four weeks after initial infection and persisted for as long as 150 days. These findings reveal the multi-organ inflammation that can occur with COVID-19 and demonstrate the importance of further research into dermatological symptoms related to the virus. Press Release

A yearlong study, conducted by the Medical College of Georgia (MCG), aims to determine the percentage of frontline workers positive for COVID-19 and whether the antibodies produced by those SARS-CoV-2 positive workers are protective against reinfection. This study is among four others funded by the National Institute of Allergy and Infectious Disease (NIAID), totaling $1.9 million, called the SARS2 SeroPrevalance and Respiratory Tract Assessment (SPARTA) study. MCG researchers hope to find which specific antibodies produced by these frontline workers are the most effective at neutralizing the virus and identify variants that may explain the wide range of immune responses. Press Release

The U.S. Food and Drug Administration (FDA) has issued Emergency Use Authorization (EUA) to allow pooling with PerkinElmer’s New Coronavirus Nucleic Acid Detection Kit to increase testing without increasing resources. Laboratories can now use this real-time RT-PCR in vitro diagnostic test for COVID-19 to pool multiple samples together for a single test. Based on comparative data released by the FDA, the PerkinElmer test kit has the lowest Limit of Detection (LoD) among the authorized COVID-19 molecular diagnostic tests reported. Press Release

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