- Interesting modeling from France (see Science paper):
- % of total population infected = 4.4 %
- of infected hospitalized = 3.6 %
- IFR = 0.7 %: of infected die (but 10 % in 80+)
- Effect lockdown: decrease of R0 from 2.9 to 0.67
See very nice figure p. 5 and 6
- Not based on serology, but rather an extrapolation of Diamond Princess cruise ship.
- 9000 deaths in retirement homes were excluded
A modeling exercise in UK (paper too big, will be send in a second mail) finds a similar reduction in R0 2.8 before lockdown to 0.8 after 1 month. However, they presume that unreported cases could by 200 times higher than reported ones and come up with a figure of 29 % of the population, already infected!!
- Epidemics of Kawasaki-like syndrome in children (London, Bergamo, New York….) https://www.bbc.com/news/health-52648557
Definition: Kawasaki disease is an acute and usually self-limiting vasculitis of the medium caliber vessels, which almost exclusively affects children
Symptoms: unrelenting fever (38–40°C), rash, conjunctivitis, peripheral oedema, and generalized extremity pain with significant gastrointestinal symptoms, followed by shock.
Cause: unknown, but infectious trigger suspected to elicit a hyperinflammation, macrophage
activation syndrome (MAS),…. In genetically predisposed individuals…
Treatment: hemodynamic support, intravenous Ig, aspirin, corticosteroids
Prognosis: most infants survive, but death possible.
Data from London: Children originally negative for SARS-CoV-2 PCR, but many exposed and l ater positive for SARS-CoV-2 antibodies. 6/8 were Afro-Caraibian; 5/8 boys
Bergamo: 7/10 boys, 8/10 antibodies to SARS-CoV-2; no data on ethnicity.
Nice comparison of Kawasaki before end during COVID:
- Massive increase in incidence (30X)
- Late onset of the disease compared with the primary infection, due to the host immune response.
- Older, had respiratory and gastrointestinal involvement, meningeal signs, and signs of cardiovascular involvement
- Lymphopenia, thrombocytopenia, and increased ferritin, as well as markers of myocarditis.
- More resistant to IV immunoglobulin treatment
- Diagnosis and contact tracing. See review and editorial
The review discusses the various tests and provides a good definition of what is considered a “contact”. A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case:
1. Face-to-face contact with a probable or confirmed case within 1 m and for more than 15 min.
2. Direct physical contact with a probable or confirmed case.
3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper personal protective equipment.
For confirmed asymptomatic cases, the period of contact is measured as the 2 days before through the 14 days after the date on which the sample was taken, which led to confirmation.
The Editorial stresses the importance of massive testing: they propose 2 % of population daily, with preference for high risk (HCW, elderly…). For Belgium that would mean 230,000 tests per day ! Only possible if easier sampling (e.g. saliva ?), more rapid testing (e.g. CRISPR-Cas?) and pooling is applied.
They also point to the limitations of the antibody tests and plead for the application of Apps in contact tracing…..?
18 Feb 2023 Episode 316: Under which circumstances could type I or type III IFN be a useful treatment?
> More info