COVID-19 Alaska Clinical Update, Oct. 17

 

State case update

Cases are not just increasing but accelerating across Alaska. Cases in Alaska residents now total 10,760, with 361 cumulative hospitalizations and 67 deaths. In the US, 8 million have been infected, with more than 219,000 reported deaths. Worldwide, more than 39 million infections and 1.1 million deaths have been reported

 

Alcohol use increases in the pandemic

A two-part survey of 1,540 US adults compared reported alcohol consumption in spring 2019 to that in spring 2020, finding substantial increases in reported alcohol use particularly among women. Overall, respondents reported consuming alcohol 14% more often than the previous year. Women also reported a 41% increase in days of heavy drinking (defined for women as 4 or more drinks within a couple of hours). Nearly one in ten women reported an increase in alcohol-related problems independent of consumption level. Adults aged 30-59 reported a 19% average increase in frequency of consumption, while non-Hispanic White individuals reported a 10% increase in frequency. 

Heparin to block viral entry into cells?

In a paper in Cell, heparan sulfate, a carbohydrate on the surface of human cells, was identified as a binding site and ‘necessary co-factor’ with ACE2 for the entry of SARS-CoV-2 into cells. Specifically, heparan sulfate seems to interact with a key part of the spike protein, the receptor binding domain, and triggers a change in the spike protein that allows it to better bind to ACE2. Scientists found that heparin bound the same site. In lab-grown cells, heparin binding the virus prevented entry, as did using enzymes to remove heparan sulfate from the surface of cells. The graphical abstract from the manuscript, below, shows the interaction of heparan sulfate and ACE2 with SARS-CoV-2 spike proteins. More studies are needed to see if heparin or therapeutics targeting heparan sulfate will be useful to prevent viral replication in humans.

 

Preconception counseling in a pandemic

A NEJM perspective article notes that the bar to recommend women avoid becoming pregnant because of potential risks to themselves and their newborns should be set quite high and examines the ethics of public health guidelines around preconception counseling. Authors note that an initial CDC recommendation early in the HIV epidemic that women with HIV postpone pregnancy raised significant ethical concerns, ultimately resulting in a recommendation to contextualize preconception counseling with the then-unknown risks of untreated HIV. Similar issues were raised during H1N1 and Zika outbreaks, with similar recommendations made. Authors outline criteria that should be met to issue a broad recommendation to avoid pregnancy during a public health emergency, namely that the pregnancy-related risks are well understood and well in excess of other common conditions, that pregnancy-related risks cannot be mitigated, that effective contraception should be readily available and that education on risks and benefits should be widely available and accessible to all. Authors conclude that the risks associated with COVID-19 do not meet these criteria. 

 

In brief

Monoclonal antibody seems safe in phase 2 trial

A small randomized phase 2 trial of the monoclonal antibody IFX-1, which blocks the complement protein C5a, was conducted in 30 adults with severe COVID-19 (15 intervention, 15 controls). The frequency of serious adverse events were similar between groups and no deaths were considered related to treatment assignment, so authors concluded the therapy seems to be safe and recommended proceeding to a phase 3 trial to investigate efficacy. This study was not powered to show efficacy, although 28-day mortality was somewhat lower in the intervention group than control group. 

Another reason to wash your hands

A paper accepted for publication by Clinical Infectious Diseases examined the longevity of active SARS-CoV-2 on human cadaver skin, finding that it remained active for an average of 9 hours, longer if mixed with mucus, compared to influenza A virus, which survived an average of 1.8 hours. Both were inactivated within 15 seconds of ethanol application. This study was not designed to determine whether the amount of virus on skin is sufficient to cause infection, however.

Horror films and pandemic resilience

In a survey of 310 people conducted early in the pandemic, respondents who reported enjoying zombie, apocalyptic/post-apocalyptic and alien invasion genres of movies and TV shows also reported less anxiety and psychological distress on average than those who reported enjoying other genres.

 

How to set up testing in your office
DHSS wants to help every clinical setting in Alaska have access to COVID-19 testing. This can be as simple as collecting samples in the office and sending them to a local, commercial or state laboratory. Swabs and media can be requested from the state through your local Emergency Operations Center. For more information, contact covidquestions@alaska.gov.