COVID-19: Depression / Time to Viral Clearance / Nanoparticle Vaccine / NIH & Convalescent Plasma

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Here are some of the most recent developments in COVID-19:

Depression: The prevalence of depression in the U.S. is three times higher during the pandemic than a few years before, a JAMA Network Open study finds. Roughly 1400 adults were surveyed about depressive symptoms in March and April. Their results were compared with 5000 who completed the National Health and Nutrition Examination Survey in 2017–2018. Overall, 9% of participants had depression symptoms pre-pandemic, and 28% had such symptoms during the pandemic. The prevalence of all levels of depression were higher during the pandemic (e.g., severe depression: 5.1% vs. 0.7% pre-pandemic). Among those with the lowest incomes, nearly half had depressive symptoms during the pandemic. The authors conclude: "Post-COVID plans should account for the probable increase in mental illness to come, particularly among at-risk populations."

Time to viral clearance: The median time from the first positive SARS-CoV-2 test to viral clearance was 30 days in a study in BMJ Open. Italian researchers examined reverse transcription polymerase chain reaction results from the nasopharyngeal swabs of roughly 1200 patients with COVID-19. Each patient submitted an average of three swabs during the study. The median time from symptom onset to viral clearance (first negative swab) was 36 days. Clearance was slower in more severe cases. The authors recommend that patients be retested at least 4 weeks after symptoms resolve to reduce transmission risk, but they say it is not yet known how infectious patients are during the recovery phase.

Vaccine results: Novavax has published results of a phase I trial on its rSARS-COV-2 full-length spike protein nanoparticle vaccine in the New England Journal of Medicine. Over 130 healthy adults were randomized to receive two doses of the vaccine — with or without adjuvant — or placebo, 21 days apart. Most adverse events were mild or moderate. By day 35, vaccine with adjuvant produced an immune response that exceeded that observed in convalescent plasma of hospitalized COVID-19 patients.

NIH panel & convalescent plasma: The National Institutes of Health's COVID-19 Treatment Guidelines Panel says there is currently not enough evidence to recommend for or against use of convalescent plasma for treating COVID-19, and the treatment should not be considered the standard of care. The FDA granted emergency use authorization for the treatment last week. "There are currently no data from well-controlled, adequately powered randomized clinical trials that demonstrate the efficacy and safety of convalescent plasma for the treatment of COVID-19," the panel said in a statement. A Mayo Clinic study found a 7-day survival benefit in nonintubated patients who received convalescent plasma with high antibody titers compared with those who received plasma with low levels. There was no survival benefit for intubated patients. The study lacked a randomized control group.