The Friday Report – Issue 12
By Matt Fletcher and Nicola Oliver
COVID-19 Actuaries Response Group – Learn. Share. Educate. Influence.
Every week, more is written on COVID-19 than any individual could possibly read. Collectively, the COVID-19 Actuaries Response Group read more about the outbreak than most, so we’ve decided each Friday to provide you with a curated list of the key papers and articles that we’ve looked at recently.
Modelling – reports
Test, trace and isolation
Modelling the health and economic impacts of Population-wide Testing, contact Tracing and Isolation (PTTI) strategies for COVID-19 in the UK (Colbourn et al, June 2020)
This paper uses mathematical and economic modelling to look at the benefits, costs and impacts of different strategies on testing, tracing and isolation.
31 scenarios are modelled in total, with different approaches to tracing, testing, and any subsequent lockdowns. They conclude that a scenario with targeted testing of symptomatic people only, with a mandatory face coverings policy and subsequent lockdown triggered to enable PTTI to suppress the epidemic will result in the fewest deaths and the lowest intervention costs.
Children and COVID-19
The role of children in the transmission of SARS-CoV-2 (van de Hoek et al, June 2020)
This paper looks at various aspects of transmission of the disease in the Netherlands, with a particular focus on children. Based on serology studies, they found that young children were around 50% as likely to get infected as older members of the household.
They also investigated ‘infection pairs’ to find out transmission by age bands, finding that most transmission was adult to adult with minimal transmission between children and adults or vice versa.
This is one of a number of studies on children and COVID-19 summarised by Alasdair Monroe and others on the website for the “Don’t forget the bubbles” group – this group aims to make sense of information in paediatric medicine for clinicians (link).
Clinical and Medical News
Dexamethasone
The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial was set up in order to study the effectiveness of a number of therapies that may be beneficial for people hospitalised with suspected or confirmed COVID-19 .
The treatments under investigation include Lopinavir-Ritonavir, (antivirals), low dose Dexamethasone, (steroid, therefore has anti-inflammatory effects), Azithromycin, (an
antibiotic), Tocilizumab (a type of antibody that has an anti-inflammatory action), and Convalescentplasma (collected from donors who have recovered from COVID-19 and contains antibodies against the SARS-CoV-2 virus).
Latest analysis suggests that low dose dexamethasone given to patients hospitalised with COVID-19 can reduce deaths by 35% in ventilated patients and by 20% in patients receiving oxygen only
The advantages of using dexamethasone are that it is a well-established, cheap drug whose safetyprofile is good when used in a hospital setting. Do note, however, that it was not shown to be effective in less severely ill patients, nor was it shown to have preventive properties.
At this stage the Dexamethasone results, while promising, have only been shared in the form of a press release. Without a paper (even a pre-print) setting out more details of the approach used and any limitations, it is worth being cautious about the results.
Genetic association with severity of COVID-19
The variation in severity of symptoms in COVID-19 patients may be related to genetic variations.
Genome wide association analysis, which is a way of studying the entire genome to identify key variants, has been undertaken in order to identify potential genetic factors involved in the development of COVID-19 . This study which analysed the DNA of 1980 patients with COVID-19 and severe disease was able to identify two novel DNA variations that appeared to be common amongst the sickest patients.
Also, these variants were found to be linked to determination of blood type so that blood-group–specific analysis showed a higher risk in blood group A than in other blood
groups, and a protective effect in blood group O compared with other blood groups.
It may be that blood type does indeed play some sort of role in disease severity, but the overall effect is small.
Age and disease susceptibility
It was established early in the coronavirus pandemic that young people are less affected than adults, but it hasn’t been understood whether fewer individuals are infected or whether they are less likely to show symptoms.
Seroprevalence studies have recently reported that children aged 5–9 years have
significantly lower seroprevalence compared with those aged 10–64 years .
(Interestingly, this study also reported that older people (≥65 years) also had significantly lower seroprevalence than the other age groups.)
Antibodies
The dynamics of seroconversion, i.e. the period during which a specific antibody develops and becomes detectable in the blood, are of key interest in order to establish whether previous exposure to SARS-CoV-2 results in some degree of lasting immunity.
Here , researchers examined the demographics associated with antibody responses and found that 2-8.5% of individuals do not seroconvert, even weeks after infection. Seroconverters were found to be older than nonseroconverters, more likely to have one or more comorbidities, and higher antibody responses were associated with non-white ethnicity. In up to two months of follow-up, antibody responses persisted.
Data
COVID-19 SOLES project
COVID-19-SOLES (“Specialist Online Living Evidence Summary”) have developed a series of tools to assess COVID-19 evidence from primary research studies. They have categorised over 3,500 papersand displayed them in an interesting infographic .
This may be useful when looking for specific types of research or evidence on COVID-19.
COVID-19-SOLES are looking for reviewers who can contribute from anywhere around the world. Details of how to get involved are set out here .
ONS – Coronavirus (COVID-19) related deaths by disability status, England and Wales: 2 March to 15 May 2020
This report looks at various aspects of deaths related to COVID-19 by disability status. It finds that mortality for males whose activities were “limited a lot” at the 2011 Census had the highest age-standardised rate of death involving COVID-19.
After adjusting for other characteristics, the relative difference in mortality rates between those “limited a lot” and those not disabled was 2.5 times higher
for females and 1.9x times higher for males. ONS note that the reasons for this remaining increased risk cannot currently be explained by their data.
Other material
We couldn’t let an appearance from one of our number on BBC’s “More or Less” radio show pass unnoticed – you can find it here (Stuart McDonald’s section, on whether individuals dying of COVID19 are likely to have died of other causes in the near future, starts at about 6:30).
And finally…..
What will happen to pets after lockdown?
Many people brought pets into their lives during lockdown. A pet behaviourist explains how animals will react to their owners’ return to work and how promoting distance in the home now can be beneficial in the long run. Pets may find the reduction in owner (or in the case of cats, ‘staff’) interaction, a challenge .
19 June 2020
