Active Monitoring of Persons Exposed to Patients with Confirmed COVID-19 — United States, January–February 2020

Burke, Rachel M; Midgley, Claire M; Dratch, Alissa; Fenstersheib, Martin; Haupt, Thomas; Holshue, Michelle; Ghinai, Isaac; Jarashow, M. Claire; Lo, Jennifer; McPherson, Tristan D; Rudman, Sara; Scott, Sarah E.; Hall, Aron J.; Fry, Alicia M.; Rolfes, Melissa A.

doi:10.15585/mmwr.mm6909e1

Cited by 451 publications

(432 citation statements)

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“…25%) estimates of efficacy are modelled. For example, the proposed clinical trial was designed with a projected attack rate of 20% (10.5-35%) (47,48); a high proportion of those who are infected will go on to severe disease including death (~1-4%) (2). By contrast, a total of 41 transfusion-associated fatalities (1 in 414,634 blood products) were reported to the FDA in 2015 (49).…”

Section: Risk Benefit Analysis (Figure 2)mentioning

confidence: 99%

Deployment of convalescent plasma for the prevention and treatment of COVID-19

Bloch

Shoham

Casadevall

et al. 2020

Journal of Clinical Investigation

702

764

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Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease , has spurred a global health crisis. To date, there are no proven options for prophylaxis for those who have been exposed to SARS-CoV-2, nor therapy for those who develop COVID-19. Immune (i.e. "convalescent") plasma refers to plasma that is collected from individuals, following resolution of infection and development of antibodies. Passive antibody administration through transfusion of convalescent plasma may offer the only short-term strategy to confer immediate immunity to susceptible individuals. There are numerous examples, where convalescent plasma has been used successfully as post-exposure prophylaxis and/or treatment of infectious diseases, including other outbreaks of coronaviruses (e.g. SARS-1, Middle East Respiratory Syndrome [MERS]). Convalescent plasma has also been used in the COVID-19 pandemic; limited data from China suggest clinical benefit, including radiological resolution, reduction in viral loads and improved survival. Globally, blood centers have robust infrastructure to undertake collections and construct inventories of convalescent plasma to meet the growing demand. Nonetheless, there are nuanced challenges, both regulatory and logistical, spanning donor eligibility, donor recruitment, collections and transfusion itself. Data from rigorously controlled clinical trials of convalescent plasma are also few, underscoring the need to evaluate its use objectively for a range of indications (e.g. prevention vs treatment) and patient populations (e.g. age, comorbid disease). We provide an overview of convalescent plasma, from evidence of benefit, regulatory considerations, logistical work flow and proposed clinical trials, as scale up is brought underway to mobilize this critical resource.

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Section: Risk Benefit Analysis (Figure 2)mentioning

confidence: 99%

Deployment of convalescent plasma for the prevention and treatment of COVID-19

Bloch

Shoham

Casadevall

et al. 2020

Journal of Clinical Investigation

702

764

View full text Add to dashboard Cite

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“…Transmission via aerosols (< 5 μm) is mediated by expelled particles that are smaller in size than respiratory droplets and can remain suspended in the air for prolonged periods of time, allowing infection of susceptible individuals at a greater distance from the site of expulsion 13 . Current epidemiological data suggest that SARS-CoV-2 is transmitted primarily via respiratory droplets and contact 8–10,14,15 , which is used as the basis for mitigation of spread through physical and social distancing measures. However, scientific evidence that SARS-CoV-2 can be efficiently transmitted via the air is weak.…”

Section: Figurementioning

confidence: 99%

SARS-CoV-2 is transmitted via contact and via the air between ferrets

Richard

Kok

Meulder

et al. 2020

Preprint

127

189

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bioRxiv preprint SARS-CoV-2, a coronavirus that newly emerged in China in late 2019 1,2 and spread rapidly 12 worldwide, caused the first witnessed pandemic sparked by a coronavirus. As the pandemic 13 progresses, information about the modes of transmission of SARS-CoV-2 among humans is critical 14 to apply appropriate infection control measures and to slow its spread. Here we show that SARS-15 CoV-2 is transmitted efficiently via direct contact and via the air (via respiratory droplets and/or 16 aerosols) between ferrets. Intranasal inoculation of donor ferrets resulted in a productive upper 17 respiratory tract infection and long-term shedding, up to 11 to 19 days post-inoculation. SARS-18 CoV-2 transmitted to four out of four direct contact ferrets between 1 and 3 days after exposure 19 and via the air to three out of four independent indirect recipient ferrets between 3 and 7 days 20 after exposure. The pattern of virus shedding in the direct contact and indirect recipient ferrets 21 was similar to that of the inoculated ferrets and infectious virus was isolated from all positive 22 animals, showing that ferrets were productively infected via either route. This study provides 23 experimental evidence of robust transmission of SARS-CoV-2 via the air, supporting the 24 implementation of community-level social distancing measures currently applied in many 25 countries in the world and informing decisions on infection control measures in healthcare 26 settings 3 . In late December 2019, clusters of patients in China presenting with pneumonia of unknown etiology 29 were reported to the World Health Organization (WHO) 1 . The causative agent was rapidly identified 30 as being a virus from the Coronaviridae family, closely related to the severe acute respiratory 31 syndrome coronavirus (SARS-CoV) 2,4,5 . The SARS-CoV epidemic affected 26 countries and resulted in 32 more than 8000 cases in 2003. The newly emerging coronavirus, named SARS-CoV-2 6 , rapidly spread 33 worldwide and was declared pandemic by the WHO on March 11, 2020 7 . The first evidence 34 suggesting human-to-human transmission came from the descriptions of clusters among the early 35 cases 8,9 . Based on epidemiological data from China before measures were taken to control the 36 spread of the virus, the reproductive number R0 (the number of secondary cases directly generated 37 from each case) was estimated to be between 2 and 3 10-12 . In order to apply appropriate infection 38 control measures to reduce the R0, the modes of transmission of SARS-CoV-2 need to be elucidated.39 Respiratory viruses can be transmitted via direct and indirect contact (via fomites), and through the 40 air via respiratory droplets and/or aerosols. Transmission via respiratory droplets (> 5 μm) is 41 mediated by expelled particles that have a propensity to settle quickly and is therefore reliant on 42 close proximity between infected and susceptible individuals, usually within 1 m of the site of 43 expulsion. Transmission via aerosols (< 5 μm) is mediated by expelled parti...

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“…In February 2020, a funeral was held for a decedent with a non-COVID-19, nonrespiratory cause of death. A close friend of the bereaved family (patient A1.1) attended the funeral; patients in this investigation were referred to by their family cluster letter (A or B), then by the assumed transmission generation (1)(2)(3)(4), and finally, in sequence order within each generation (1-7) † (Figure 1). Patient A1.1 had recently traveled out of state and was experiencing mild respiratory symptoms; he was only tested later as part of the epidemiologic investigation and received a diagnosis of confirmed COVID-19.…”

mentioning

confidence: 99%