Revealing the extent of the first wave of the COVID-19 pandemic in Kenya based on serological and PCR-test data

Policymakers in Africa need robust estimates of the current and future spread of SARS-CoV-2. We used national surveillance PCR test, serological survey and mobility data to develop and fit a county-specific transmission model for Kenya up to the end of September 2020, which encompasses the first wave of SARS-CoV-2 transmission in the country. We estimate that the first wave of the SARS-CoV-2 pandemic peaked before the end of July 2020 in the major urban counties, with 30-50% of residents infected. Our analysis suggests, first, that the reported low COVID-19 disease burden in Kenya cannot be explained solely by limited spread of the virus, and second, that a 30-50% attack rate was not sufficient to avoid a further wave of transmission.

Acute Hemorrhagic Leukoencephalitis as a Primary Presentation in an Immunocompromised Patient With Cerebral Toxoplasmosis

Objective: To draw attention towards a devastating presentation of Acute Hemorrhagic Leukoencephalitis (AHLE) in an immunocompromised patient with cerebral toxoplasmosis. Background: AHLE is a rare, hyper-acute variant of Acute Disseminated Encephalomyelitis (ADEM). It is often preceded by an upper respiratory infection, and associated pathogens include influenza, Epstein Barr Virus (EBV), mycoplasma pneumonia, and SARS-CoV-2. Design/Methods: NA Results: A 27-year-old man presented to our hospital with a three day history of headaches and altered mental status. He was having seizures on arrival. He had a Glasgow Coma Scale (GCS) of 4 upon arrival. His pupils were anisocoric and sluggish to light. His brainstem reflexes were intact. Motor exam revealed extensor posturing in bilateral upper extremities and triple flexion in bilateral lower extremities in response to noxious stimuli. He received lorazepam in the emergency room with minimal improvement and was ultimately intubated for airway protection. Computed tomography (CT) head showed regions of hypoattenuation involving bilateral basal ganglia and thalami with superimposed acute hemorrhage, significant mass effect, and patchy regions of acute hemorrhage in the cerebellum. Magnetic resonance imaging (MRI) brain revealed areas of confluent FLAIR signal abnormality in the deep white matter, bilateral basal ganglia and thalami, brainstem, and throughout the cerebellum. He had a hypercellular cerebral spinal fluid (CSF) analysis that showed white blood cell count of 218 with lymphocytic predominance. Protein was elevated to 412 mg/dl and glucose was 17 mg/dl. He was found to be HIV-1 positive with a CD4 count of 6 cells per cubic centimeter. CSF specific toxoplasmosis PCR showed 730,000 copies/milliliter. He was treated with solumedrol and broad-spectrum antimicrobials with minimal improvement in his clinical picture and ultimately succumbed to his disease. Conclusions: This report highlights AHLE as a rapidly progressive hemorrhagic demyelination of white matter. It is imperative to recognize it to implement life saving therapies earlier in the course.

The effectiveness of social bubbles as part of a Covid-19 lockdown exit strategy, a modelling study

Background: ​ During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: ​ We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results:  Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: ​ If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.