Research Insights About Covid-19

We attempt to provide selected highlights in recent research findings

Last Update on 1 December 2020

A. Medicine and Health 

September 2020

September 30, 2020 (JAMA Int. Med)

Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers: A Randomized Clinical Trial

Benjamin S. Abella, Eliana L. Jolkovsky,  Barbara T. Biney et al.

This randomized clinical trial evaluates the efficacy of hydroxychloroquine to prevent transmission of SARS-CoV-2 in health care workers with exposure to patients with COVID-19 at 2 hospitals in Philadelphia, Pennsylvania. The authors found that daily hydroxychloroquine did not prevent SARS-CoV-2 infection, although the trial was terminated early and may have been underpowered to detect a clinically important difference.

September 29, 2020 (WHO Bulletin)

Fangcang shelter hospitals during the COVID-19 epidemic, Wuhan, China

Juan Li, Pei Yuan, Jane Heffernan et al

The authors designed models to test the effect of Fangcang shelter hospitals (rapidly-built temporary hospitals) on the control of the epidemic in Wuhan, China. They found that while the designated hospitals saved lives of patients  it was the increased hospital-bed capacity of the large number of Fangcang shelter hospitals that helped to eventually stop the COVID-19 epidemic. The authors recommend increasing hospital-bed capacity, especially through temporary hospitals, to isolate groups of people with mild symptoms within an affected region to help curb and eventually stop COVID-19 outbreaks in communities without effective household isolation.


September 29, 2020 (The Lancet Rheumatology)

Clinical criteria for COVID-19-associated hyperinflammatory syndrome: a cohort study

Brandon J Webb, Ithan D Peltan, Paul Jensen et al.

The authors developed and validated diagnostic criteria for COVID-19-associated hyperinflammatory syndrome (cHIS) in a cohort of inpatients with COVID-19. The cHIS scale developed might help define target populations for trials and immunomodulatory therapies, however, requires external validation.



September 28, 2020 (Virology)

Molecular and serological characterization of SARS-CoV-2 infection among COVID-19 patients

Linghua Li, Yuanhao Liang, Fengyu Hu et al.

In this study, the authors investigated the dynamics of viral load and antibodies against SARS-CoV-2 in a longitudinal cohort of COVID-19 patients with severe and mild/moderate diseases. Their findings have shed light on viral kinetics and antibody response in COVID-19 patients and provide scientific evidence for infection control and patient management.



September 28, 2020 (JAMA Int. Med)

Clinical Outcomes of In-Hospital Cardiac Arrest in COVID-19

Shrinjaya B. Thapa, Tanya S. Kakar, Corey Mayer et. al.

This case series examines the outcomes of in-hospital cardiac arrest among patients with COVID-19. Amongst the 54 patients hospitalized with COVID-19 in this study, there was a 100% mortality rate following CPR. These outcomes warrant further investigation into the risks and benefits of performing prolonged CPR in this subset of patients, especially because the resuscitation process generates aerosols that may place health care personnel at a higher risk of contracting the virus. 



September 28, 2020 (The Lancet Rheumatology)

Anti-C5a antibody IFX-1 (vilobelimab) treatment versus best supportive care for patients with severe COVID-19 (PANAMO): an exploratory, open-label, phase 2 randomised controlled trial

Alexander P J Vlaar, Sanne de Bruin, Matthias Busch et al.

In this exploratory, open-label, randomised phase 2 trial, the authors explored the potential benefit and safety of selectively blocking the anaphylatoxin and complement protein C5a with the monoclonal antibody IFX-1 (vilobelimab), in patients with severe COVID-19. The authors found that C5a inhibition with IFX-1 appears to be safe in patients with severe COVID-19.



September 28, 2020 (PNAS)

Global COVID-19 pandemic demands joint interventions for the suppression of future waves

Ruiyun Li, Bin Chen, Tao Zhang et. al.

By linking the seasonality of climate and changing human behaviour, the authors demonstrate that collaboration on global efforts for prompt and intensive intervention is fundamental to coping with future pandemic waves of COVID-19. They propose that this collaboration can be started in locations with typically high population density and international travel, followed by other high-risk locations. The authors believe that this tiered intervention strategy can greatly integrate global efforts and is effective and practical to improve the global emergency response to COVID-19 and many other infectious diseases.



September 25, 2020 (JAMA Netw. Open)

Association of Race and Ethnicity with Comorbidities and Survival Among Patients with COVID-19 at an Urban Medical Center in New York

Rafi Kabarriti, N. Patrik Brodin,  Maxim I. Maron et al.

This cohort study investigates whether presenting comorbidities in patients with coronavirus disease (COVID-19) in New York City differed by race/ethnicity and whether case fatality rates varied among different ethnic and racial groups controlling for presenting comorbidities and other risk factors.



September 25, 2020 (The Lancet)

Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study

Shuchi Anand, Maria Montez-Rath, Jialin Han et al.

Many patients receiving dialysis in the USA share the socioeconomic characteristics of underserved communities. In this cross-sectional study, the authors tested plasma of  28 503 randomly selected adult patients receiving dialysis in July 2020, using a spike protein receptor-binding domain total antibody chemiluminescence assay (100% sensitivity, 99·8% specificity). They found that during the first wave of the COVID-19 pandemic, fewer than 10% of the US adult population formed antibodies against SARS-CoV-2, and fewer than 10% of those with antibodies were diagnosed to have the disease. Public health efforts to limit SARS-CoV-2 spread need to especially target racial and ethnic minority and densely populated communities.



September 25, 2020 (The Lancet Microbe)

Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study

Bernadette Schurink, Eva Roos, Teodora Radonik et al.

This prospective cohort study performed in the Netherlands aimed to assess the duration of viral presence, identify the extent of an inflammatory response, and investigate the underlying cause of coagulopathy in patients who succumbed to COVD-19. The authors performed autopsies on 21 patients and found that in patients with lethal COVID-19, an extensive systemic inflammatory response was present, with a continued presence of neutrophils and NETs. However, SARS-CoV-2-infected cells were only sporadically present at late stages of COVID-19. This suggests a maladaptive immune response and substantiates the evidence for immunomodulation as a target in the treatment of severe COVID-19.



September 25, 2020 (Science)

Distinct conformational States of SARS-CoV-2 spike protein

Yongfei Cai, Jun Zhang, Tianshu Xiao et al.

Efforts to protect human cells against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have focused on the trimeric spike (S) protein. Several structures have shown a stabilized ectodomain of the spike in its prefusion conformation. Cai et al. now provide insight into the structural changes in the S protein that result in the fusion of the viral and host cell membranes. They purified full-length S protein and determined cryo–electron microscopy structures of both the prefusion and postfusion conformations. These structures add to our understanding of S protein function and could inform vaccine design.


September 24, 2020 (Virol J)

Favipiravir versus other antiviral or standard of care for COVID-19 treatment: a rapid systematic review and meta-analysis

Shrestha, D.B., Budhathoki, P., Khadka, S. et al.

 The authors conduct a systematic review and meta-analysis on efficacy and safety of the drug Favipravir as a treatment for COVID-19. They analysed 9 qualitative and 4 quantitative studies. They found that there is a significant clinical and radiological improvement following treatment with favipravir in comparison to the standard of care with no significant differences on viral clearance, oxygen support requirement and side effect profiles.



September 24, 2020 (JAMA)

Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Mohamad El Moheb, Leon, Naar, Mathias A. Christensen et. al.

This study compares the incidence of gastrointestinal complications of critically ill patients with COVID-19–induced acute respiratory distress syndrome (ARDS) vs comparably ill patients with non–COVID-19 ARDS using propensity score analysis.



September 23, 2020 (JAMA Netw. Open)

Association of Red Blood Cell Distribution Width With Mortality Risk in Hospitalized Adults With SARS-CoV-2 Infection

Brody H. Foy, Jonathan C. T. Carlson, Erik Reinertsen et. al.

This cohort study assesses the potential use of red blood cell distribution width for risk stratification of patients with coronavirus disease in 2019. The authors studied 1641 adult patients with SARS-CoV-2 infection who were hospitalized and found that elevated red blood cell distribution width (RDW) at admission and increasing RDW during hospitalization were associated with statistically significant increases in mortality risk. They postulate that RDW may be helpful for patient risk stratification.


September 20, 2020 (EClinicalMedicine)

An open-label, randomized trial of the combination of IFN-κ plus TFF2 with standard care in the treatment of patients with moderate COVID-19

Weihui Fu, Yan Liu, Li Liu et al.

IFN-κ inhibits the replication of SARS-CoV-2, and TFF2 is a small secreted polypeptide that promotes the repair of mucosal injury and reduces the inflammatory responses. Here, the authors conducted an open-label, randomized, clinical trial involving patients with moderate COVID-19 testing this aerosol inhalation treatment and report their findings here.

September 18, 2020 (Biosensors and Bioelectronics)

Array-based analysis of SARS-CoV-2, other coronaviruses, and influenza antibodies in convalescent COVID-19 patients

Daniel J. Steiner, John S. Cognetti, Ethan P. Luta et al.

Detection of antibodies to COVID-19 is critical to surveillance, assessment of the immune status of individuals, vaccine development, and basic biology. The authors report a multiplex label-free antigen microarray on the Arrayed Imaging Reflectometry (AIR) platform for detection of antibodies to SARS-CoV-2, SARS-CoV-1, MERS, three circulating coronavirus strains (HKU1, 229E, OC43) and three strains of influenza. They found that the array is readily able to distinguish the uninfected from convalescent COVID-19 subjects, and provides quantitative information about total Ig, as well as IgG- and IgM-specific responses.



September 18, 2020 (Science)

Structural basis for neutralization of SARS-CoV-2 and SARS-CoV by a potent therapeutic antibody

Zhe Lv, Yong-Qiang Deng, Qing Ye et al.
Lv et al. report a humanized monoclonal antibody that protected against SARS-CoV2 in a mouse model. The cryo-electron microscopy structure, together with biochemical, cellular, and virological studies, showed that the antibody acts by binding to the receptor-binding domain of the spike and blocking its attachment to the host receptor.



September 17, 2020 (The Lancet)

Assessing a novel, lab-free, point-of-care test for SARS-CoV2 (CovidNudge): a diagnostic accuracy study

Malick M Gibani, Christofer TOumazou, Mohammadreza Sohbati et al.

The authors performed a diagnostic accuracy assessment of a novel, rapid point-of-care real-time RT-PCR CovidNudge test, which requires no laboratory handling or sample pre-processing. They found the test to be sensitive and specific in diagnosing SARS-CoV2. 



September 17, 2020 (The Lancet Psychiatry)

Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study

Seung Won Lee, Jee Myung Yang, Sung Yong Moon et al.

The authors performed a nationwide cohort study with propensity score matching to investigate the associations between mental illness, the likelihood of a positive SARS-CoV2 test result and the clinical outcomes of COVID-19. They found that a diagnosis of mental illness was not associated with an increased likelihood of testing positive for SARS-CoV-2. However, patients with a severe mental illness had a slightly higher risk for severe clinical outcomes of COVID-19 than patients without a history of mental illness.



September 16, 2020 (EBioMedicine by The Lancet)

Impact of interleukin-6 blockade with tocilizumab on SARS-CoV2 viral kinetics and antibody responses in patients with COVID-19: A prospective cohort study

Mar Masia, Marta Fernandez-Gonzalex, Sergio Padilla et al.

In this prospective cohort study, the authors evaluated the impact of interleukin (IL)-6 blockade with tocilizumab on SARS-CoV-2 viral kinetics and the antibody response in patients with COVID-19. They found that in patients infected with SARS-CoV-2, IL-6 blockade does not impair the viral-specific antibody responses, supporting the safety of Tocilizumab for COVID-19.



September 15, 2020 (JAMA)

Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial

Christoph D. Spinner, Robert L. Gottlieb, Gerard J. Criner et al.

This open-label randomized trial compares the effect of remdesivir (5 or 10 days) vs standard care on clinical status 11 days after treatment initiation among patients with confirmed SARS-CoV-2 infection hospitalized with moderate pneumonia (room air oxygen saturation >94%).


September 15, 2020 (BMJ)

Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and metaanalysis

Preeti Malik, Urvish Patel, Deep Mehta et al.

In this meta-analysis of 32 studies reflective of 10491 confirmed COVID-19 patients across different geographic locations, the authors found that decreased lymphocyte count, a decreased platelet count and elevated C reactive protein, creatine kinase, procalcitonin, D-dimer, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase and creatinine were associated with poor outcomes in COVID-19 hospitalised patients. The results show that there is clear evidence of an association between different biomarkers and COVID-19 disease severity. This can be used as an adjunct in clinical practice to guide treatment and admission, helps improve prognosis and decrease mortality rates.



September 14, 2020 (The Lancet)

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

The Lancet COVID-19 Commissioners, Task Force Chairs, and Commission Secretariat

The Lancet COVID-19 Commission, launched on July 9, 2020 aims to offer practical solutions to the four main global challenges posed by the pandemic: suppressing the pandemic by means of pharmaceutical and non-pharmaceutical interventions, overcoming humanitarian emergencies, restructuring public and private finances in the wake of the pandemic, and rebuilding the world economy in an inclusive, resilient, and sustainable way. This initial Statement of the Commission marks the occasion of the opening of the 75th Session of the UN General Assembly on Sept 15, 2020.


September 14, 2020 (JAMA Pediatrics)

Frequency of Children vs Adults Carrying Severe Acute Respiratory Syndrome Coronavirus 2 Asymptomatically

Gregorio P. Milani, Ilaria Bottino, Alessia Rocchi et al.

This case-control study compares the rates of test results indicating SARS-CoV-2 infection among children and adults admitted to a single hospital in Milan, Italy, for noninfectious reasons and without COVID-19 symptoms.


September 11, 2020 (Annals of Int. Medicine)

Every Body Counts: Measuring Mortality From the COVID-19 pandemic

Mathew V. Kiang, Rafael A. Irazarry, Caroline O. Buckee et. al.

This article discusses the current difficulties of disaster death attribution and describes the strengths and limitations of relying on death counts form death certificates, estimations of indirect deaths and estimations of excess mortality.


September 11, 2020 (JAMA Cardiol.)

Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection

Saurabh Rajpal, Matthew S. Tong, James Borchers et. al.

This study investigates the use of cardiac magnetic resonance imaging in competitive athletes who recovered from coronavirus disease 2019 (COVID-10) to detect myocardial inflammation that would identify high-risk athletes for return to competitive play.



September 11, 2020 (JAMA)

COVID-19 and the Path to Immunity

David S. Stephens, Juliana McElrath

This Viewpoint reviews what is known about acute and long-term B-cell, antibody, and T-cell responses to SARS-CoV-2 infection and explains how each is implicated in vaccine candidates likely to be effective and durably protective against COVID-19.



September 10, 2020 (JAMA Int. Med)

Effect of Recombinant Human Granulocyte Colony–Stimulating Factor for Patients With Coronavirus Disease 2019 (COVID-19) and Lymphopenia: A Randomized Clinical Trial

Lin-ling Cheng, Wei-jie Guan, Chong-yang Duan et al.

This randomized clinical trial examines the effect of recombinant human granulocyte colony-stimulating factor on peripheral blood leukocyte and lymphocyte cell counts and clinical improvement in Chinese patients with COVID-19.


September 9, 2020 (BMJ)

Risk stratification of patients admitted to hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score 

This prospective observational cohort study was carried out to develop and validate a pragmatic risk score to predict mortality in patients admitted to hospital with COVID-19. The 4C Mortality Score developed by the authors outperformed existing scores, showed utility to directly inform clinical decision making and can be used to stratify patients admitted to hospital with COVID-19 into different management groups. The authors recommend that the score be further validated to determine its applicability in other populations.

September 9, 2020 (JAMA Int. Med)

Clinical Outcomes in Young US Adults Hospitalized With COVID-19

Jonathan W. Cunningham, Muthiah Vaduganathan, Brian L. Claggett et al.

This case series examines the clinical outcomes for young adults hospitalized with COVID-19.



September 9, 2020 (JAMA Net. Open)

Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large US Academic Medical Center

Chanu Rhee, Meghan Baker, Vineeta Vaidya et al.

This cohort study evaluates the incidence of nosocomial coronavirus disease 2019 (COVID-19) among patients admitted to a US medical centre in the context of a comprehensive and progressive infection control program.



September 8, 2020 (JAMA)

Effect of an Inactivated Vaccine Against SARS-CoV-2 on Safety and Immunogenicity Outcomes: Interim Analysis of 2 Randomized Clinical Trials

Shengli Xia, Kai Duan, Yuntao Zhang et al.

This interim analysis of 2 randomized trials compares adverse reactions and neutralizing antibody responses to inactivated coronavirus disease 2019 (COVID-19) vs adjuvant-only control vaccination, and compares the outcomes at varying vaccine doses among healthy adults in China.

September 5, 2020 (BMJ)

Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?

Rael D. Strous, Tami Karni

In this article, the authors discuss the role of the physician in sharing medical knowledge to the public during an epidemic. Citing the effects of COVID-19 on the Chareidi community in Israel, the authors advocate that the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, nonmaleficence, utilitarian ethics as well as social, procedural and distributive justice.

September 4, 2020 (The Lancet)

Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II): a randomised clinical trial

Remo H M Furtado, Otavio Berwanger, Henrique A Fonseca et al.

The authors performed an open-label multicentre randomised control trial to assess whether adding azithromycin to the standard of care, which included hydroxychloroquine, would improve clinical outcomes of patients admitted to the hospital with severe COVID-19. They found that the addition of azithromycin did not improve clinical outcomes. 


September 4, 2020 (The Lancet)

Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: two open, non-randomised phase 1/2 studies from Russia

Denis Y Logunov, Inna V Dolzhikova, Olga V Zubkova et al.

Logunov and his team assessed the safety and immunogenicity of a heterologous COVID-19 vaccine that they had developed. The vaccine consists of two components, a recombinant adenovirus type 26 (rAd26) vector and a recombinant adenovirus type 5 (rAd5) vector, both carrying the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAd26-S and rAd5-S). They assessed the safety and immunogenicity of two formulations (frozen and lyophilised) of this vaccine and found that the vaccine not only has a good safety profile but also induced strong humoral and cellular immune responses in participants.



September 4, 2020 (Nature Reviews Immunology)

Immunological considerations for COVID-19 vaccine strategies

Jeyanathan, M., Afkhami, S., Smaill, F. et al.

Jeyanathan et al. discuss the immunological principles that need to be taken into consideration in the development of COVID-19 vaccine strategies. Based on these principles, they examine the current COVID-19 vaccine candidates, their strengths and potential shortfalls, and make inferences about their chances of success. Finally, they discuss the scientific and practical challenges that will be faced in the process of developing a successful vaccine and how COVID-19 vaccine strategies may evolve over the next few years.


September 3, 2020 (PNAS)

Reduced development of COVID-19 in children reveals molecular checkpoints gating pathogenesis illuminating potential therapeutics

Jonathan Baruch Steinman, Fook Mun Lum, Peggy Pui-Kay Ho et al.

The reduced development of COVID-19 amongst children compared to adults provides some tantalizing clues on the pathogenesis and transmissibility of this pandemic virus. Here, the authors discuss the pathogenesis of COVID-19 and how it affects children and adults differently. This may guide our understanding of susceptibility to infection and may provide further clues for therapeutics.


September 2, 2020 (NEJM)

Phase 1–2 Trial of a SARS-CoV-2 Recombinant Spike Protein Nanoparticle Vaccine

Cheryl Keech, Gary Albert, Iksung Cho et al.

This randomized, placebo-controlled, phase 1–2 trial was carried out to evaluate the safety and immunogenicity of the SARS-CoV-2 vaccine. A recombinant SARS-CoV-2 spike protein nanoparticle vaccine delivered in the deltoid muscle on days 0 and 21 was found to be immunogenic at both 5 μg and 25 μg doses. When given with a saponin-based adjuvant, both doses were equally immunogenic, with little or no reactogenicity, and elicited neutralizing antibody titers higher than those in convalescent serum.



September 2, 2020 (JAMA)

Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis

The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group

In this prospective meta-analysis of 7 randomized trials that included 1703 patients of whom 647 died, 28-day all-cause mortality was lower among patients who received corticosteroids compared with those who received usual care or placebo showing that administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality in critically ill patients with COVID-19.


September 1, 2020 (NEJM)

Humoral Immune Response to SARS-CoV-2 in Iceland

Daniel F. Gudbjartsson, Gudmundur L. Norddahl, Pall Melsted et al.

This large comparative study of the Icelandic population showed that the humoral response did not decline within 4 months after infection, that 44% of persons who had been infected had not been diagnosed with qPCR, and that the infection fatality risk was 0.3%.



September 1, 2020 (The Lancet Inf. Diseases)

Long-term consequences of COVID-19: research needs

Dana Yelin, Eytan Wirtheim, Pauline Vetter et al.

In this commentary, Yelin et al. emphasize the need to perform research assessing the long-term sequelae of COVID-19. They also raise questions that need to be answered to provide patients and health-care workers with a better understanding of the course and prognosis of this disease.