COVID-19 Update: Vaccine Has Immune Response, CDC on Masks

July 15, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today.

A messenger RNA vaccine for COVID-19 that was developed by Moderna, known as mRNA-1273, has elicited an immune response among all 45 people who received it in a phase 1 study. There were some side effects, but no significant safety problems.

The study results were published in The New England Journal of Medicine. The principal investigator, Evan Anderson, MD, of Emory University, Atlanta, Georgia, called the results encouraging. "Importantly, the vaccine resulted in a robust immune response," he said in a news release issued by Emory.

Moderna is already testing the vaccine in a phase 2 trial and plans to begin phase 3 trials in late July.

CDC: Wear a Mask

Centers for Disease Control and Prevention (CDC) Director Robert Redfield, MD, says that if all Americans wear a mask, the rising cases of COVID-19 could be under control within a month or two.

Speaking in an online interview with The Journal of the American Medical Association, he stressed: "I think if we can get everyone to wear masks right now, we can bring this under control within 4, 6, 8 weeks."

The CDC director also says wearing a mask is a public health issue and that he is "sad" to see it become so politicized.

Some Patients Test Positive After Recovery

Researchers in Wuhan, China, say some COVID-19 patients have tested positive for the SARS-CoV-2 virus after they had recovered, raising the risk for further spread of the virus.

To prevent a second wave of SARS-CoV-2 infections, they recommend that patients undergo clinical observation for a minimum 14 days in medical "shelters" following recovery from COVID-19.

In a comment in The Lancet Infectious Diseases, they report on 651 patients who were classified as having recovered from COVID-19 and were discharged into intermediary shelter hospitals or other healthcare centers for 14 days of clinical monitoring.

During a median follow-up of 48 days, 23 (3%) of the patients tested positive on a retest for SARS-CoV-2. Fifteen retest-positive patients (65%) had no symptoms at the time of the retest, and eight (35%) had at least one symptom associated with active COVID-19.

"Although a positive PCR test in asymptomatic patients who were retested might only reflect residual non-pathogenic viral components, the positive retest in symptomatic patients suggests the potential for recurrence of active disease and its transmission," note Xianglin Yuan, of Wuhan's Tongji Hospital, and colleagues in their article.

Lung Damage Linked to Ventilation

In a new study, radiologists have found evidence of lung damage more often among COVID-19 patients who had received invasive mechanical ventilation than among those with acute respiratory distress syndrome who were treated under similar ventilation protocols.

The barotrauma (including pneumothorax and pneumomediastinum) they discovered was an independent risk factor for death in COVID-19 and was also associated with a longer length of hospital stay, report Georgeann McGuinness, MD, of NYU Grossman School of Medicine, New York City, and colleagues in Radiology.

Such lung damage was also more likely to occur in younger patients with COVID-19, the researchers say.

"The real thrust of this paper is to bring to light a serious potential complication in patients with severe respiratory failure related to SARS-CoV-2 infection and to make sure that the clinicians in emerging hot spots are aware that in NYC during the height of the pandemic, we saw elevated rates of barotrauma," McGuinness told Medscape Medical News.

The US a Long Way From Herd Immunity

In a perspective for WebMD, F. Perry Wilson, MD, and John Whyte, MD, slice and dice the numbers needed to help understand the pandemic.

"An important number to know is the positivity rate, or the percentage of COVID-19 tests that are positive," they say. According to the World Health Organization, "if an area is testing enough, the positivity rate should be below 10%. A positivity rate of less than 5% is recommended before an area reopens."

There may be a gap between an initial reopening and death rates, because of rolling waves of people who continue to infect others over the next few weeks, they explain.

They caution that the United States "is a long way from herd immunity." On average, each person with COVID-19 infects two to three people. The herd immunity goal is 50% to 75%, and our country is only at 5% at most, Wilson cautions.

Protecting Kidney Patients, Nephrologists in COVID-19

Those with advanced kidney disease are at high risk from COVID-19, and such patients often present with atypical symptoms, often not displaying fever, for example, says Michal Melamed, MD, MHS, of Albert Einstein College of Medicine at Montefiore Medical Center in the Bronx, New York City, in an editorial in The Clinical Journal of the American Society of Nephrology.

Nephrologists need to be aware of these issues and to be cognizant of other important issues, such as how to safely manage kidney patients who undergo dialysis during the pandemic and knowing when it is safe to monitor those with renal disease infected with SARS-CoV-2 at home, she adds.

Also important to figure out is when it is safe to resume low-risk kidney transplants.

Adding a patient voice, Nieltje Gedney, of West Virginia, says in an article accompanying Melamed’s editorial: "The world has become terrifying for those with chronic kidney disease, on dialysis, or with a transplanted kidney in light of COVID-19."

Lastly, the issue of acute kidney injury in those with COVID-19 who have no prior renal disease is of key importance, says Melamed. Hospitals need to take proactive measures and to stock up on potassium binders and peritoneal dialysis solutions, among other supplies.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 1700 throughout the world have died.

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

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