COVID-19: Antibodies & Immunity / 6 Symptoms Added / Presymptomatic Transmission in SNFs

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Have a look at some of the latest developments on novel coronavirus disease (COVID-19):

"Immunity passports": The World Health Organization has emphasized possible concern about the risk for no immunity against a second infection. The WHO was responding to the idea that "immunity passports" could be given to people who have recovered from COVID-19 and have antibodies. The passport could theoretically allow someone to travel or return to work. In a statement, the WHO says, "People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission."

6 new symptoms: The CDC has added chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell to its list of possible COVID-19 symptoms. These join fever, shortness of breath or difficulty breathing, and cough on the list.

Presymptomatic transmission in skilled nursing facility: Of 89 residents in a skilled nursing facility in Washington State, 64% had tested positive for SARS-CoV-2 by March 26 — 23 days after the first positive result in a resident — according to results published in the New England Journal of Medicine. Of those who tested positive through point-prevalence surveys, 56% were essentially asymptomatic at testing, but most developed symptoms later. The case fatality rate was 26%. Editorialists write: "A new approach that expands Covid-19 testing to include asymptomatic persons residing or working in skilled nursing facilities needs to be implemented now."

Chloroquine/hydroxychloroquine warning: The FDA is warning the public that chloroquine and hydroxychloroquine should not be taken for COVID-19 outside a hospital or clinical trial setting, as the drugs confer potentially life-threatening cardiac risks. A Nature Medicine study published on Friday found that a cohort of 84 COVID-19 patients given the combination of hydroxychloroquine plus azithromycin had their average QTc interval increase from 435 ms at baseline to a maximal average value of 463 ms. Roughly 11% had a QTC interval above 500 ms, "a known marker of high risk of malignant arrhythmia and sudden cardiac death."

Kidney-transplant recipients: A New York hospital reports on 36 adult kidney-transplant recipients who tested positive for COVID-19. Only 58% had fever as an initial symptom. They had lower CD3, CD4, and CD8 counts than COVID-19 patients in the general population, which the authors say "indirectly supports the need to decrease doses of immunosuppressive agents" in these patients. Transplant recipients also had faster clinical progression, and at 3 weeks, 28% had died, they report in NEJM.

Kids' mental health: An estimated 23% of primary school children surveyed in China's Hubei province while they were under home confinement reported feeling depressive symptoms, and 19% said they had symptoms of anxiety, according to a study in JAMA Pediatrics.