Thank you again to everyone who attended our February Special Edition Virtual Executive Women’s Forum with Dr. Vivian Cintron. Many attendees submitted questions we were not able to cover in the allotted time. Dr. Cintron was kind enough to provide written responses!

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1.    What is the viability of dual (RNA-based and Immuno) assays for viral viability screening (not definitive/diagnostics) of large (>100) groups of people?

The rapid and accurate detection of COVID-19 is the first step for managing and controlling the spread. This is achieved by detection of SARS-CoV-2 by real- time reverse transcription polymerase chain reaction

The first step in managing COVID-19 is the rapid and accurate detection of SARS-CoV-2 enabled by real-time reverse transcription–polymerase chain reaction (RT–PCR)1.

RT–PCR detects SARS-CoV-2 nucleic acids present in nasopharyngeal fluids 2. This testing is used to prevent infectious spread between persons and communities that include asymptomatic infected persons, whose viral shedding can inadvertently spread the infection to the elderly and those with disease comorbidities 3. This specific test offers high sensitivity however it takes 4-5 to obtain the results at a laboratory setting. Other type of testing is the serological testing which can indicate a past infection based on the antibodies detected by enzyme-linked immunosorbent assay using a qualitative detection of IgG or IgM antibodies 4. Such tests determine an immune response against the viral spike (S) protein and may be helpful to assess protection against subsequent viral exposure and/or for contact tracing purposes 5. Thus, the importance of such tests cannot be overstated, however this testing setting is prone to low specificity due to the collection of samples, exposure time or incubation during the first infection phase and variations in the testing platforms. Improving this test for sensitivity and specificity are urgent matters.1

Although RT–qPCR is the current standard for detection of nucleic acids, new methods, such as pulse-controlled amplification, are being evaluated. Pulse-controlled amplification does not require RNA extraction and can be carried out in 10 min with a small device 6. In the future, S- and N-based immunodiagnostic platforms will work alongside nucleic acid amplification tests to increase detection sensitivity of COVID-19 at minimal cost 7. The aim of these dual platforms will produce results in a short time and less expensive for mass production 8. 

2.    In your opinion, when do you anticipate organizations being safely able to host in-person events?

As the COVID-19 hospitalizations are decreasing, more events will be hosted in person leaving the best practices of prevention (mask or face coverings) to the public discretion.

3.    Do you think we'll require annual Covid vaccinations, like the flu shot?

This is a topic of great discussion now that more events are face to face. As the scientist are still elucidating more data, the recommendations of a second booster will be towards the vulnerable population that has been affected during the pandemic, this will be those members of the community at age of 70 above or immunocompromised patients. Currently, several Pharmaceuticals are exploring the development of an annual dual vaccine: flu and coronavirus.

4.    What precautions/advice do you have for someone with a newborn?

Children represent about 19% of all reported COVID-19 cases in the U.S. since the pandemic began. About 7.6 million child cases have been reported since early September 2021.9

While children are as likely to get COVID-19 as adults, kids are less likely to become severely ill. Up to 50% of children and adolescents might have COVID-19 with no symptoms. However, some children with COVID-19 need to be hospitalized, treated in the intensive care unit, or placed on a ventilator to help them breathe.9

Babies under age 1 might be at higher risk of severe illness with COVID-19 than older children. Newborns can get COVID-19 during childbirth or by exposure to sick caregivers after delivery.

It is recommended If you have COVID-19 or are waiting for test results due to symptoms during your stay in the hospital after childbirth, wear a well-fitting face mask and have clean hands when caring for your newborn. Keeping your newborn's crib by your bed while you are in the hospital is fine, however it is recommended to maintain a reasonable distance from your baby when possible. When these steps are taken, the risk of a newborn getting COVID-19 is low.

If you are severely ill with COVID-19, you might need to be temporarily separated from your newborn. It is also recommended that the baby's caregivers wear face masks and wash their hands to protect themselves. Frequent follow-up with the baby's doctor is needed by phone, virtual visits, or in-office visits for 14 days. Infants who test negative for COVID-19 can be sent home from the hospital.9

5.    For in-person gatherings (bridal shower, team potluck, etc.) how do you recommend the food to be served?  Individually wrapped portions or is a self serve buffet ok?

For in person events, food should be serve taking all potential precautions avoiding handling the food without sanitation measures. If there is an event with few participants having a small unit desk with hand sanitizer prior to the line up for food banquets might be a favorable practice.

6.    How safe is it to travel abroad?

Traveling measures will soon start changing regarding mask or face coverings at the onboarding stage of the airplane. Be alert for those announcements.

Traveling abroad is fine, however knowing the cases of COVID-19 infections prior to the country visit is recommended in addition to be cognizant of mass gatherings that could be a place of spreading in case of an infection. Utilization of appropriate reasonable face covering could be a good practice.

7.    What is the Stealth variant?

BA.2, or known as the “stealth omicron,” is one of three known sublineages of Omicron. BA.2 differs from the omicron in mutations in the spike protein and other areas according to the World Health Organization. While this mutation makes it more difficult to identify as Omicron on some tests, it does not make the virus more difficult to detect.

BA.2 is more transmissible than the original Omicron variant (BA.1), though exactly how much more is still unknown. In February 2022, early studies from the UK and Denmark found BA.2 was 30% more transmissible.10 The risk of hospitalization is the same in BA.1 and BA.2 based on reviews from Denmark, India, South Africa and the United Kingdom.11 Vaccinated people are still less likely to get infected by either variant compared to non-vaccinated people.

As of March 2022, BA.2 has become the dominant variant globally, according to the World Health Organization.12

In the United States, BA.2 accounted for over a third of new cases, according to the CDC. While a new surge is not expected, health officials have warned that overall COVID-19 infections could rise across the US, parallel to trends in the UK and Europe.12

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References

1. Liu, R. et al. Positive rate of RT–PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin. Chim. Acta 505, 172–175 (2020).

2. Research Use Only 2019-Novel Coronavirus (2019-nCoV) Real-time RT-PCR Primers and Probes (Centers for Disease Control and Prevention, 2020); https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-primer-probes.html

3. Wang, B., Li, R., Lu, Z. & Huang, Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging 12, 6049–6057 (2020).

4. Pan, Y. et al. Serological immunochromatographic approach in diagnosis with SARS-CoV-2 infected COVID-19 patients. J. Infect. 81, e28–e32 (2020).

5. Lin, D. et al. Evaluations of the serological test in the diagnosis of 2019 novel coronavirus (SARS-CoV-2) infections during the COVID-19 outbreak. Eur. J. Clin. Microbiol. Infect. Dis. 39, 2271–2277 (2020).

6. Zwirglmaier, K. et al. Rapid detection of SARS-CoV-2 by pulse-controlled amplification (PCA). Preprint at medRxiv https://doi.org/10.1101/2020.07.29.20154104 (2020).

7. Infantino, M. et al. Serological assays for SARS-CoV-2 infectious disease: benefits, limitations, and perspectives. Isr. Med. Assoc. J. 22, 203–210 (2020).

8. Wang, D. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J. Am. Med. Assoc. 323, 1061–1069 (2020).

9. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-in-babies-and-children/art-20484405

10. https://edition.cnn.com/2022/02/23/health/covid-ba2-omicron-studies-explainer/index.html

11. https://en.wikipedia.org/wiki/SARS-CoV-2_Omicron_variant#Severity_and_immunity

12. https://www.msn.com/en-us/health/medical/ba2-covid-subvariant-now-dominant-worldwide/ar-AAVjtOU

13. https://covid.cdc.gov/covid-data-tracker/#variant-proportions

Fig 1Ref: Dreamtime.com

Fig 2 https://covid.cdc.gov/covid-data-tracker/#variant-proportions