November 20, 2020 I Blood biomarkers for detection of brain injury, MRS shows white matter changes, new multiplex SARS-CoV-2 test, diaphragmatic fibrosis associated with severe COVID-19, and high-dose anticoagulants show no clear benefits. Plus: Social isolation linked to hypertension, children mount antibodies without detection of virus, and a call for more efficient and adaptive testing measures.
Research News
Specialized scanning, sometimes referred to as virtual biopsy, was performed on the brains of three COVID-19 patients at Massachusetts General Hospital (MGH) that revealed potential effects of SARS-CoV-2 on the brain. The researchers discovered similar metabolites to patients with white matter abnormalities after hypoxia without COVID-19. One of the patients displayed severe white matter necrosis and cavitation and had particularly pronounced lactate elevation, another sign of brain injury from hypoxia. The authors of this study, published in the American Journal of Neuroradiology, now hope to find answers to explain whether these white matter changes are a result of hypoxia, or if the virus itself is attacking the white matter in the brain. DOI:10.3174/ajnr.A6877
A new paper, published in the Journal of Neurotrauma, details the risks for acute and persistent neurological deficits associated with COVID-19, and the potential for neurodegenerative diseases and psychiatric disorders. The research describes mechanisms of central nervous system penetration and action of the virus and also makes recommendations for the use of blood biomarkers to detect brain injury in combination with existing diagnostic tools to address this urgent need for rapid detection and treatment in COVID-19 patients. DOI:10.1089/neu.2020.7332
Aggressive COVID-19 testing and surveillance strategies at Duke University has been highly effective, as shown in a case study appearing in the CDC’s Morbidity and Mortality Weekly Report. The university launched their efforts prior to the start of the semester, and students were required to self-quarantine for 14 days before arriving to campus, pledge to obey mask-wearing and social distancing guidelines and have a COVID-19 test. During the semester, the university used pooled testing methods, daily symptom monitoring and contact tracing. Large outbreaks were avoided and prevalence of COVID-19 among students was lower than in the surrounding community. DOI:10.15585/mmwr.mm6946e1
A new study, published in Nature Communications, details how children in a Melbourne family developed a COVID-19 immune response after chronic exposure from their parents without ever testing positive for the virus or displaying any symptoms. Researchers at the Murdoch Children’s Research Institute followed the immune response of the two parents, both with symptomatic COVID-19, and their three school-aged children by testing samples every two to three days. All three children mounted an immune response against COVID-19 and the youngest child developed the strongest antibody response. Authors of the study suggest that the children’s immune systems effectively blocked the virus from replicating in their cells. DOI:10.1038/s41467-020-19545-8
Northwell Health Laboratories scientists have developed a new multiplex SARS-CoV-2 test that is more efficient and cost-effective than current assays. The Northwell Health Laboratories laboratory-developed test (NWHL LDT) has the capability to test 91 patients at a time for COVID-19, compared to 29 patients using the modified CDC assay, and scientists report it performs just as well. The NWHL LDT also requires only one set of primer and probe mix per specimen, compared to three sets and the use of three wells for each patient in the modified CDC assay. A full report on this new assay is published in The Journal of Molecular Diagnostics. DOI:10.1016/j.jmoldx.2020.09.004
Diaphragmatic weakness and fibrosis may be associated with severe COVID-19, a new study finds published in JAMA Internal Medicine. Researchers analyzed diaphragm muscle specimens from 26 patients who died from severe COVID-19 in three intensive care units in the Netherlands, and diaphragm specimens from eight critically ill patients who died from other causes as a control group. The team discovered angiotensin-converting enzyme 2 (ACE-2) in the specimens from both groups. Evidence of SARS-CoV-2 viral RNA was present in only four COVID-19 patient samples, however, epimysial and perimysial fibrosis was two times higher in the COVID-19 diaphragm specimens studied when compared to the control group. The authors conclude that persistent shortness of breath and fatigue may be related to a weakened diaphragm in those patients who survive severe COVID-19. DOI:10.1001/jamainternmed.2020.6278
A new saliva-based antibody test for SARS-CoV-2 developed by a team at John Hopkins Bloomberg School of Public Health has been found to be highly accurate in a study published in the Journal of Clinical Microbiology. The researchers found that their test detected antibodies to several antigens in saliva samples from all 24 participants who had confirmed exposure to COVID-19 and had symptoms that began at least two weeks prior to testing. The test also accurately provided negative results for saliva samples that were collected from individuals prior to the pandemic. The team hopes that this noninvasive approach will help with easier identification of those people who have had SARS-CoV-2 exposure at a population level and show where gaps in seropositivity remain. DOI:10.1128/JCM.02204-20
High-doses of blood thinners in COVID-19 patients may be ineffective and potentially harmful, according to a new study by George Washington University researchers. The research team evaluated 402 hospitalized patients diagnosed with COVID-19 and clinical outcomes were compared between 152 patients treated with high-dose blood thinners and 250 patients treated with the standard low dose. They found that higher doses of blood thinners were potentially harmful and had no clear benefits in those patients. The authors caution against an aggressive blood thinner regimen unless there is clear clinical evidence to do so, and they add that the benefits remain unknown. This study is published in Thrombosis Research. DOI:10.1016/j.thromres.2020.10.031
A new paper, published in JAMA, calls for more efficient and adaptive testing measures for COVID-19, however, the authors of this paper explain that this alone will not prevent the spread of the virus. The researchers state that testing alone is not enough in a clinical setting, given that even the most sensitive tests available may provide false-negative test results due to timing during infection and sampling, and clinicians should continue isolation for patients with a clinical presentation consistent with COVID-19. In the public health setting, rapid antigen tests may be more beneficial in reducing the spread within a household or within the community. They also note the importance of a broad testing strategy across all settings that allows for easily obtained specimens, such as self-collected nasal swabs and salivary samples, and emphasize that social distancing and mask wearing will remain important even with improved testing strategies. DOI:10.1001/jama.2020.21694
Industry News
New research presented at the 46th Argentine Congress of Cardiology (SAC) links social isolation during the pandemic to increased incidence of high blood pressure among patients admitted to the emergency department. The study compared patients admitted to the Favaloro Foundation University Hospital ED during the three-month social isolation period beginning in March to patients admitted during the same timeframe in 2019 and the three months prior to the pandemic lockdown. Researchers found a 37 percent increase in the likelihood of having elevated blood pressure, even after accounting for several factors such as age and gender. Authors of the study, led by the European Society of Cardiology, explained numerous reasons for these findings, but one emphasized the psychological stress inevitably caused by the pandemic has led to lasting effects on mental and physical health. Press Release
Siemens Healthineers announced that its SARS-CoV-2 IgG Antibody Test (COV2G) has proven to measure neutralizing antibodies and has received FDA Emergency Use Authorization (EUA). This is the first antibody test authorized with semi-quantitative detection claim and the fifth test from the company to receive EUA that offers sensitivity and specificity greater than 99 percent. The COV2G antibody test has also received the CE Mark and is now available globally. Press Release
The December issue of SLAS Technology will feature a special collection of articles addressing COVID-19 and focuses on the advancing technological innovations being used to address the novel coronavirus. The special collection includes seven articles of original research, in addition to two reviews and the featured cover article, “Advances in Technology to Address COVID-19”. Press Release
The Governance Lab (GovLab) at the NYU Tandon School of Engineering has released recommendations for the re-use of data in response to the COVID-19 crisis. The guidance and a new Responsible Data Re-Use framework stem from The Data Assembly initiative in New York City. The GovLab co-hosted four months of remote deliberations with civil rights organizations, key data holders, and policymakers and this newly published release is the product of this combined effort to guide New York decision-makers on potential costs and benefits of re-using data while considering the sometimes contradictory needs of various stakeholders. Press Release
The University of Arizona Health Sciences is developing a lung ultrasound education program to enable rural emergency departments (EDs) to better diagnose and treat COVID-19 patients. The project, called CLUE Study: A Tele-ultrasound Pilot Study in Rural Emergency Departments, is funded by a research grant from the National Foundation of Emergency Medicine (NFoEM). With many rural EDs lacking CT scan capabilities or limited COVID-19 testing access, lung ultrasounds may be particularly useful with mounting evidence of its effectiveness to diagnose and assess severity of COVID-19. Press Release