Matt and Nicola

General

On 23 April, the European Centre for Disease Prevention and Control (ECDC) issued their ninth “rapid risk assessment” report on COVID-19 . As with previous ECDC reports, this is a very detailed and informative summary of all aspects of the outbreak in EU/EEA countries and the UK.

They note that the interventions put in place to combat the outbreak have collectively reduced transmission, and that it appears that the initial wave of transmission has now passed its peak in 20 EU/EEA countries.

Modelling – reports

COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study (Hanlon P, Chadwick F, Shah A et al., 23 April 2020).

This paper sets out analysis of the number of years of life lost on average for each COVID-19 death, using mortality data from Italy and routine UK healthcare data. Their conclusion was that, even after allowing for multimorbidity, each COVID-19 death represented on average over a decade of life lost.
COVID-19 Antibody Seroprevalence in Santa Clara County, California (Bendavid et al (16 April 2020))

This paper, based on antibody testing in California, suggests that the prevalence of SARS-CoV-2antibodies was, by early April, between 50 and 85 times as high as the number of confirmed cases.

This paper and a follow-up got a lot of press coverage – however, doubt has been cast on its conclusions – see for example here (quoting “angry statisticians”).

News Coverage

The Wall Street Journal article “Mortality rates tell true tale of Coronavirus’s effect” explains how overall death totals are now being used to determine when governments can ease lockdown measures.

Stuart McDonald (on behalf of the COVID-19 Actuaries Response Group) provided comments for the article.

Clinical and Medical News

Hydroxychloroquine
There has been a lot of attention on the anti-malarial drug hydroxychloroquine and the potential for use in patients with COVID-19. This drug is approved for use to prevent malaria, though in recent years resistant strains of malaria have emerged. Its antimalarial properties are thought to involve stimulation of a process that creates a toxic environment within the parasite.

Hydroxychloroquine is also indicated for use to treat rheumatoid arthritis and lupus. In these conditions, hydroxychloroquine interferes with the inflammatory response.

The study here , which was a retrospective analysis of data from patients hospitalized with confirmed SARSCoV-2 infection in all United States Veterans Health Administration medical centres until April 11, 2020, reports no evidence of benefit, and, alarmingly, more deaths among those given hydroxychloroquine versus standard care.

Nicotine
In addition, it has been widely reported that nicotine may play a protective role in developing COVID-19.  Indeed, studies have been planned in which nicotine patches will be used to test for any protective effect. This is potentially linked to the relationship between nicotine and ACE2, an enzyme known to be the principal receptor molecule for SARS-CoV-2. The hypothesis is presented in detail here .

However, smokers also develop more severe disease once they have COVID-19 (link), therefore, media reporting needs to reinforce that the message is not to take up smoking, or indeed to initiate use of nicotine patches in a non-smoking population.
Comorbidities
Many studies have already indicated that those with comorbidities are at much greater risk of severe outcomes from COVID-19. This analysis from New York  provides characteristics and early outcomes of patients hospitalized with COVID-19 in the New York City area.

As previously observed, common comorbidities included hypertension (57%), obesity (42%) and diabetes (34%). This study adds additional detail in regard to presenting characteristics and reports that only 31% of patients were febrile and 17% had an increased respiratory rate. Significant media attention was given to the finding in the report that mortality in those requiring mechanical ventilation was 88% although this
figure excludes those who were still on ventilators after a five-day period, so may over- or (possibly) under-state the true rates.
Understanding and tracking mutations 

A key feature of coronaviruses is that compared with other RNA viruses, such as influenza, they do not mutate as readily.

However, mutations do still occur and it is important to track these, to better
understand the spread of the virus and also the protective value of current immunity against future infections. Nextstrain.org provides an invaluable resource to virologists, epidemiologists, public health official and community scientists (which is now almost all of us) to look at how different variants are emerging.

So far 8 different strains have been identified based on thousands of genome
sequences, and their site provides a fascinating insight on how the virus has changed during its journeys around the world. The good news is that it hasn’t changed much – but the vigil must continue.

Data

The EuroMOMO network (“European Mortality Monitoring”) publish weekly data on excess mortality in 24 participating countries, including the UK. Within the last week, they have updated the way in which they present their data, with a much more user-friendly set of charts than the previous version.

From the EuroMomo report

And finally…

Wildlife

Videos abound on the internet seemingly showing us the return of nature during the period of lockdown (though many clearly predate it). But it is a wonderful fact that many animals are finding the lack of human activity a great opportunity to explore urban spaces (link).
Pour a coffee, sit back, and admire the mountain goats of Orme in Llandudno

and / or the flamingos near Mumbai

.
24 April 2020