Explosive COVID-19 outbreak in a German nursing home and the possible role of the air ventilation system.

BACKGROUND: Most COVID-19 outbreaks in nursing homes are explained by transmission of SARS-CoV-2 from nurses or visitors. METHODS AND RESULTS: We describe an outbreak with 64 of the 67 residents identified as COVID-19 cases within two weeks (34 in nursing block 1, 30 in nursing block 2), at least 32 of them had relevant symptoms of COVID-19. Thirteen of the residents' deaths were associated with COVID-19. In addition, 27 of approximately 60 staff members were identified as COVID-19 cases, 23 of them had relevant symptoms. In none of the samples from residents or staff was a mutation of SARS-CoV-2 detected. Quarantine of the residents was already in force at the beginning of the outbreak. A common source among the staff was considered to be unlikely because the two nursing home blocks had no staff rotation and the staff had to wear FFP2 masks during contact with residents. Three months after the outbreak the RNA of SARS-CoV-2 was detected on 14 of 39 sampled indoor surfaces of the air ventilation system with Ct values between 34.9 and 41.9, but only at the air supply in the corridor (11 of 24 samples) and the air overflow in the door between the corridor and the residents' rooms (three of 11 samples) but not at the air exhaust in the residents' bathrooms. CONCLUSIONS: The air ventilation system and an inversion weather situation three days before the first confirmed case may have enhanced viral spread inside the nursing home assuming that a common source with a high viral load had existed at the time of outbreak.

CLINICAL OUTCOME in PEOPLE with COVID-19 by HIV-STATUS: A NATIONWIDE REGISTER STUDY

Background: It is still unclear whether people with HIV (PWH) are more likely to have severe outcome of COVID-19. We aimed to assess this association using nation-wide register data. Methods: We included all adults hospitalized with a primary diagnosis of COVID-19 (ICD-10;U07.1, U07.2) in Sweden between Feb 1, 2020, and Aug 31, 2021, identified from the National Patient Register. The study population was linked to the National HIV Quality Register (n= 8 032), the Swedish Intensive Care Register, the Swedish Cause of Death Register, and the LISA database for labour market studies. Using multivariate logistic regression models, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe COVID-19 (intensive care admission or 90-day mortality), by HIV-status. Results: We included 121 PWH and 64 764 HIV-negative individuals hospitalized with COVID-19. PWH were younger (median age 57y vs. 65y, p<0.001) and more likely to be men (68% vs. 57%, p=0.015) compared to HIV-negative. There was no difference in level of education, level of income or number of comorbidities. Most hospitalized PWH had undetectable HIV-RNA (93%) and high CD4 counts (median 560, IQR 376-780). Severe COVID-19 was identified in 17 (14%) PWH and 14 648 (23%) HIV-negative. Ten (8%) PWH and 10 217 (16%) HIV-negative died within 90 days. HIV status was not associated with higher odds of severe COVID-19 (aOR 0.88, 95% CI 0.52-1.49). Higher age was associated with severe COVID-19 in PWH (aOR 1.08, 95% CI 1.02-1.15). PWH with one or more comorbidities were four times more likely to have severe COVID-19 (aOR 4.3, 95% CI 1.1-16.7, ref PWH with no comorbidity). Neither level of income nor level of education or migrant status was associated with severe COVID-19 in PWH. Level of HIV-RNA, current CD4, nadir CD4, and mode of HIV-transmission was not associated with severe COVID-19. PWH admitted to the ICU were six times more likely treated with tocilizumab compared to HIV-negative admitted to the ICU (aOR 6.1, 95% CI 1.5-24.5), even after adjusting for regional differences in early adoption of tocilizumab use. There was no difference in the number treated with steroids (aOR 0.9, 95% CI 0.2-3.1). Conclusion: This nation-wide cohort study, including the entire Swedish adult population hospitalized with COVID-19, indicates that PWH with well-treated HIV-infection have similar odds of severe COVID-19 as HIV-negative individuals. PWH admitted to the ICU were more likely treated with tocilizumab compared to HIV-negative.

Pre-existing and post-covid-19 immune responses to sars-cov-2 in cancer patients

Cancer patients are at increased risk for critical illness upon COVID-19. We assessed antibody and T cell responses in unexposed and SARS-CoV-2 convalescent cancer patients to characterize SARS-CoV-2 immunity and to identify immunological parameters contributing to increased morbidity and mortality in COVID-19 cancer patients. Immune responses were assessed in unexposed (n = 199) and SARS-CoV-2-infected cancer patients (n = 17), comprising different hematological malignancies (HM) and solid tumor entities. T cell responses were assessed by IFN-g ELISPOT using previously defined cross-reactive and SARS-CoV-2-specific T cell epitopes (Nelde et al., Nat Immunol 2021). SARS-CoV-2 convalescents without cancer (n = 193) and unexposed healthy volunteers (HV, n = 94) served as reference groups. Whereas pre-existing SARS-CoV-2 cross-reactive CD4+ T cell responses were detectable in a high proportion of HV (78%) and solid tumor patients (77%), frequency was substantially lower in unexposed HM patients (34%). Concordantly, HM patients showed significantly higher proportions of CD4+ T cells expressing PD-1, LAG-3 and TIM-3, indicating T cell exhaustion as a potential underlying cause for the reduced T cell reactivity. In SARS-CoV-2 convalescents, no difference in antibody positivity was noted between cancer patients and HV. T cell response analyses showed comparable recognition frequencies of SARS-CoV-2-specific HLA class I and HLA-DR epitopes in both groups, whereas the frequency of HLA-DR cross-reactive T cell responses was significantly reduced in cancer patients. Again, this was attributable to a markedly reduced frequency of cross-reactive CD4+ T cell responses in HM patients. Analysis of T cell responses to single HLA-DR peptides (n = 20) after 12-day in vitro expansion further revealed reduced T cell expandability for 73% of SARS-CoV-2-derived peptides in COVID-19 cancer patients. Moreover, diversity of SARS-CoV-2 T cell responses (i.e. recognition of multiple different T cell epitopes) was significantly reduced in COVID-19 HM patients (20% recognized peptides) compared to solid tumor patients (35%) and HV (50%), and reduced T cell diversity was associated with a more severe course of COVID-19. In summary, our results identify impaired SARS-CoV-2 T cell immunity as a determinant for poor outcome of COVID-19 in cancer patients, particularly in HM. These findings guide the development of therapeutic measures and vaccines for this vulnerable patient population. Disclosure: Malte Roerden: No conflict of interest disclosed. Juliane S. Walz: Honoraria: Juliane S. Walz is listed as inventor for patents on peptides described in the research.;Expert Testimony: Bundesministerium für Bildung und Forschung (BMBF), German Cancer Consortium (DKTK), Deutsche Forschungsgemeinschaft (DFG), Wilhelm Sander Stiftung, José Carreras Leukämie-Stiftung, Fortüne-Programm der Universität Tübingen.

Tracing COVID-19 - Older Adults' Attitudes Toward Digital Contact Tracing and How to Increase Their Participation

The COVID-19 pandemic poses major challenges for health care systems. Contact tracing apps are being used around the world to help track and break the chain of infection. We conducted a qualitative study with eight older adults (65+) to find out how their lives have been affected by the pandemic. One of the topics covered was the "Stopp Corona"app, a contact tracing app by the national Red Cross and participants' attitude towards it. Despite the fact that most participants did not use the app, they expressed little concerns about the misuse of data as they have high trust in the Red Cross and the national government. Highlighting the societal benefit of contact tracing seems to be a major factor for uptake. Based on our results in comparison with recent studies on digital contact tracing, we suggest four recommendations that may support adoption of contact tracing apps by older adults. © 2021 ACM.

Covid-19, hiv/aids, and the “spanish flu”: Historical moments and social transformations

The author of this article maintains that it is not certain that COVID-19 will reach a magnitude that would justify the social significance that it has in fact been attributed to it by published opinion and government reactions in many countries. It is the lockdown, and not the virus or the infection itself, which is forcing us to imagine that there is a difference between the world before and the world after. This is what changed with the lockdown: “another world,” perhaps only temporarily, became not only possible but immediately real. The nature of the world after lockdown is the main question in the conflict between interpretations of COVID-19’s social signifi-cance. The current government discourse about a “new normal” in our future is part of that struggle. After comparing the COVID-19 pandemic with the spread of HIV/AIDS, Wagner concludes that the world is on the verge of a historical moment of the kind that opens up the possibility of large-scale social transformations comparable to the “great transformation” in the first decades of the 20th century. The virus and infection by themselves cannot reach that kind of significance. But perhaps they arrived at a moment when their emergence in combination with the lockdown as the political reaction to them will prompt a re-evaluation of our situation. The experience of lockdown has broadened social imagination and has increased the potential for positive social transformation. But we are clearly still far from any decisive collective action for solving urgent problems through free expression and democratic deliber-ation. © 2021, Gaidar Institute Press. All rights reserved.