Top Infectious Disease News of the Week—March 29, 2020

#5: New Guidance on COVID-19 Issued to Long-Term Care Facilities

New guidelines on COVID-19 for long-term care facilities (LTCFs) have been issued by the World Health Organization, as well as by organizations in the US including the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), that provide best practices to protect the elderly, vulnerable populations and staff.

In the CMS investigation of the outbreak in a skilled nursing facility in February in Kirkland, Washington, inspectors found 3 failings principally responsible for patients being in "imminent danger". These included failure to rapidly identify and manage ill residents, failure to notify the state department of health about the increasing rate of respiratory infection among residents, and failure to possess a sufficient backup plan following the absence of the facility's primary clinician who fell ill.

The demonstrated vulnerability of this population is not unique to the state of Washington, as the CMS relates in the investigation report that the CDC had notified them of 147 facilities across 27 states reporting at least 1 resident with COVID-19. Similar circumstances occurring across the globe prompted the WHO to issue an interim guidance on infection prevention and control for LTCFs.

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#4: Coronavirus Lingers After Symptoms Resolve in Some Patients

Coronavirus disease 2019 (COVID-19) patients can still spread the virus after their infection and even once their symptoms clear up, according to a paper published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Investigators from China and the United States tracked COVID-19 in 16 patients in order to determine how long a patient may still have coronavirus despite being asymptomatic post-infection. The patients were treated in Beijing between Jan. 28 and Feb. 9, 2020. After 2 negative PCR tests, done through throat swabs collective on alternative days, the patients were discharged from the hospital. The median age was 35.5 years but ranged from 3 to 68 years, the study authors added. Most of the patients’ symptoms were fever (in 14 of 16 patients), cough (11/16), pharyngula (5/16), and dyspnea (2/16).

Some of the patients had comorbidities, including diabetes (2/16) and tuberculosis (1/16); the study authors wrote that these comorbidities did not affect the time course of the disease. The 3-year-old patient did not have significantly different clinical course for the disease either compared to the rest of the patients, the study authors added.

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#3: COVID-19 Vaccine Candidate Shows Immune Response in Early Testing

A coronavirus disease 2019 (COVID-19) vaccine candidate has shown promise in early testing, according to a paper published by investigators from the University of Pittsburgh School of Medicine in EBioMedicine. In mouse models, the vaccine produced antibodies which may offer sufficient protection against SARS-CoV-2.

The investigational vaccine, PittCoVacc, led to a surge of antibody production within 2 weeks of administration.

The vaccine is delivered through a novel approach, known as a microneedle array. The microneedle array is a fingertip-sized patch of 400 small needles. The patch is placed like a bandage and the needles, made of protein pieces and sugar, dissolve into the skin.

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#2: Preparing for Patients to Recover from COVID-19

Patients testing positive for the SARS-CoV-2 virus after receiving ostensibly successful treatment of their acute coronavirus disease 2019 (COVID-19) has prompted their clinicians to question the present standards for patient discharge, and others to call for greater preparedness for post acute care of patients recovering from COVID-19.

"Previous studies on COVID-19 mainly focused on epidemiological, clinical, and radiological features of patients with confirmed infection. Little attention has been paid to the follow-up of recovered patients," observed Haibo Xu, MD, PhD, of the Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China and colleagues.

Xu and colleagues reported on 4 patients, all medical professionals, experiencing mild to moderate symptoms who were treated after reverse transcription polymerase chain reaction (RT-PCR) tests were positive for SARS-CoV-2 and CT imaging showed ground-glass opacification or mixed ground-glass opacification and consolidation. The time to recovery ranged from 12 to 32 days, and all 4 patients had 2 consecutive negative RT-PCR tests before discharge.

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#1: Case Study Shows Asymptomatic Transmission of COVID-19 in China

A case study of a family in Zhejiang province, China, shows how coronavirus disease 2019 (COVID-19) can spread before symptoms of the disease emerge, and symptoms can vary widely even in a close family cluster.

The study, published in Clinical Infectious Diseases, details how SARS-CoV-2 spread from a presymptomatic carrier to infect 8 of 9 family members from 3 households after a 58-year-old woman (index 1) and 60-year-old man (index 2) attended a Chinese Spring Festival temple activity on January 19.

Investigators at Ningbo First Hospital and the University of Nottingham Ningbo China in Zhejiang province examined case for the study, which was funded by the Natural Science Foundation of Zhejiang province.

Among the patients who contracted the disease, 2 remained asymptomatic and 1 was placed under intensive care with severe pneumonia.

The index couple’s daughter (case 1), son-in-law (case 2) and 2 grandchildren, ages 6 (case 3) and 13 months (case 4), visited the couple after the festival but before the emergence of symptoms, from January 20-23. On January 23, the young family (cases 1-4) visited the mother (case 5), father (case 6) and grandmother (case 7) of case 2.

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