December 30, 2020

In today's episode we discuss: —Climate: The US Centers for Disease Control COVID-19 Response Team used data from three online CARAVAN omnibus surveys (n=858) conducted to assess parental attitudes and concerns about schools reopening during the COVID-19 pandemic and found more white families were in favor of in-person school (62.3%) compared to Hispanic families (50.2%, p=0.014) and Black families (46.0%, p=0.007), while non-white parents were more concerned about schools opening safely (98.8% very or somewhat concerned) than were white families (86.0%, p=0.012). Authors suggest socioeconomic differences and structural inequities may drive these differing attitudes and recommend school districts consider each community's unique needs when devising school reopening plans. —Epidemiology: In a retrospective cohort study evaluating albumin levels in correlation with disease severity and inflammatory markers (CRP, d-dimer, and IL-6), investigators in Milan, Italy analyzed data from 207 COVID-19 patients admitted to Fatebenefratelli-Sacco Hospital and found 50.7% patients had hypoalbuminemia (serum albumin <30 g/L), and that albumin levels were significantly inversely correlated with increased severity of disease and worse outcomes at day 30, as well as inversely correlated with inflammatory markers. The results suggest hypoalbuminemia and urinary protein wasting may be useful biomarkers on admission to determine disease severity. —Understanding the Pathology: Microbiologists and infectious disease specialists from Anhui Medical University and the Anhui and Fuyang Centers for Disease Control in China analyzed SARS-CoV-2 IgM and IgG antibody responses using indirect ELISA in serum from 165 patients and found spike protein IgM and IgG was detectable in 12.5% of hospitalized patients on day 1 of infection, IgM peaked at 22-28 days and was undetectable in 30% and 79% of patients at three and seven months, respectively, and IgG peaked at four months and declined rapidly at seven months. Authors suggest their analysis can help guide SARS-CoV-2 diagnosis and vaccine development via an improved understanding of the human humoral response in COVID-19. —Transmission & Prevention: A review of current data on COVID-19 transmission and vaccine efficacy by otolaryngologists from Harvard Medical School and Johns Hopkins School of Medicine illustrates how COVID-19 mRNA vaccines generate immunogenicity by creating IgG antibodies against the SARS-CoV-2 virus, however IgG antibodies, while preventing patients from clinically getting sick with COVID-19, do not stop the virus from replicating in the upper airway -- as this requires secretory IgA antibodies -- suggesting that transmission precautions should still be widely practiced even after vaccination. —Management: A multicenter retrospective study conducted by French physicians at the Cochin Hospital utilized demographic data, clinical symptomatology, and results of lab tests from 605 patients with clinical suspicion of COVID-19 to create a pre-test probability score of SARS-CoV-2 infection (the PARIS score) and found that fever, myalgias, lymphopenia, and elevated CRP had the highest positive predictive value, though no clinical variable was individually significant. The high-probability PARIS score had a positive predictive value of 93%, while the low-probability score had a negative predictive value of 98%.