Top news, reports and insights for today:
- Daily headline summaries for Sunday:
- New study from the South Korean CDC finds no evidence that “re-infection” cases resulted in a new secondary case. Crucially, they also did viral cell culturing in 108 such cases finding that all were negative. Taken together, this is the strongest evidence yet that getting infected a second time is not happening and that those who re-test positive are not passing the disease to others. The vast majority of these cases are test errors or a period of prolonged recycling of viral waste that cause a positive test result, not a true second infection in the same person (KCDC)
- Social distancing measures aimed at COVID-19 have stopped influenza in its tracks 6 weeks early (Nature)
- New study from China (not yet peer reviewed) examined 319 outbreaks in detail finding most occurred at home and on transportation. Importantly, they find evidence of only 1 outbreak that occurred outdoors. Study may provide important evidence of substantially lower risk of transmission outside (medRxiv)
- CBS News and others have reported that CDC guidance has been updated to say that COVID-19 is “…not caught easily” from touching surfaces and that “…40% of transmission occurs before people feel sick”. I can’t find either of those statements on the CDC website (CBS News)
- Map check, 4 weeks later: the epidemic has shifted to places nobody notices or wants to talk about
I am a map fanatic. I enjoy staring at them. It actually is a pretty useful fetish if you are a disease detective because the spatial patterning of disease is often among our most vital clues. I last showed you a U.S. map of incidence (confirmed COVID-19 cases per 100,000 residents) back on April 30, just under 4 weeks ago. I grabbed a picture from a similar map today from my colleagues at coronashutdown. Comparing the 2 maps tells us where we have been in recent weeks. Here are my take-home messages from this comparison:
- The epidemic has shifted from the east coast to the midwest, south and southwest.
- Epidemic radiation from last month’s hotspots can be seen from southwest Georgia all the way to Eastern Texas and Northern Florida, Southern New Jersey into Delaware and eastern Maryland, southern Utah and western New Mexico, the Texas panhandle, and Ford county in southern Kansas.
- New hotspot counties include (marked on map) Franklin Parish in Louisiana (1433), Liberty County Florida (2442), Duplin County North Carolina (927), Buckingham Co. Virginia (2560).
- Continuous corridors of higher infection can be seen along major transportation routes. Compare for example the area from New Orleans all the way to Chicago. Or note the increasing connection of high incidence counties going west from Chicago into parts Illinois, Wisconsin, Iowa, Minnesota and South Dakota.
- Ford County Kansas was a hotspot on April 30 at 2,088 per 100,000. That county has now more than doubled to 4,634, which is twice the rate of infection in the county containing part of New York City. The rates have gone to more than 1,000 in 5 surrounding counties.
- The bottom line: while many congratulate themselves on winning the battle against COVID-19, these maps tell us that what has really happened is that the epidemic has shifted to places nobody notices or wants to talk about.
- Severe illness similar to Kawasaki disease impacting children
Recent articles in Science, the Lancet, and Nature have drawn attention to a rare and severe post-infection syndrome associated with coronavirus that is occurring in children. While children are at lower risk of severe illness during the pandemic, it now appears that a small number are becoming very sick with a condition that looks similar to Kawasaki disease – a rare condition affecting about 1 in 10,000 children in Western countries, characterized by a hyperactive immune response to viral infection leading to rash, fever, and dangerous inflammation in blood vessels (also called vasculitis). The disease named after a Japanese physician who was the first to describe it is associated with dangerous heart complications, most notably aneurisms. Hot spots for this newly recognized Kawasaki-like illness have been noted in Bergamo Italy and New York city. A study in the Lancet found a 30-fold increase in the incidence of Kawasaki-like illness in one region of Italy. New York state is investigating about 157 cases. Outbreaks have also been noted in the UK (where it was first noticed) and Los Angeles. Kawasaki disease is not new. It is generally assumed to be a post-viral syndrome involving an immune system “overshoot”. Currently, experts are not certain whether the outbreak of cases is Kawasaki disease or something similar. In Europe they are using the term paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), or multisystem inflammatory syndrome (MIS-C) at the CDC. So far, children treated for MIS-C have had good survival, but when it occurs, it requires urgent and comprehensive medical intervention. The condition has been seen mostly in children under age 18 but is increasingly appearing in somewhat older ages. There is no certain diagnostic test for Kawasaki or MIS-C and more will be learned in the coming weeks.
What this means? While it’s scary to think that we have to add very sick kids to the list of things to worry about, the disease detective in me believes at this point that the emergence of super-rare autoimmune reactions to a novel virus is an inevitable development in a disease impacting almost 5.5 million people. At this time, I do not believe this is cause for concern. Having said that, it is urgent that experts determine whether children and young adults with a previous history of Kawasaki disease should be considered at elevated risk for MIS-C.