Coronavirus Files: Smell Tests, Convalescent Plasma & Cases of Reinfection

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September 1, 2020

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Since April, The Center for Health Journalism has been publishing a special newsletter geared to journalists as they report on one of the biggest and most complex stories of our times. Each Monday, while the pandemic runs its course, The Coronavirus Files will provide tips and resources and highlight exemplary work to help you with your coverage. This week, The Center for Health Journalism’s Coronavirus Files Monday newsletter is curated and reported by science writer Ula Chrobak. Have a suggestion or a request? Write us at editor@centerforhealthjournalism.org.
 
The Health Divide: The Inequity of Evacuating 
 
Hurricane Laura made landfall in Louisiana early Thursday morning, bringing Category 4 winds and a storm surge of over 9 feet in some coastal areas. Amid a pandemic, this storm was especially poised to disproportionately impact low income and communities of color in the region.
 
Officials had to rush to rewrite evacuation guidelines to reduce the spread of COVID-19 this hurricane season, which the National Oceanic and Atmospheric Administration forecasted to be “extremely active,” Sarah Gibbens reports for National Geographic. People living in the path of the hurricane were encouraged to find hotel rooms away from harm, but the state’s usual hurricane shelters remained closed due to COVID-19 precautions.
 
In a blog post for the Union of Concerned Scientists, climate vulnerability social scientist Juan Declet-Barret lays out the problem in detail. To safely evacuate, you need a place to go, money, a mode of transit, and—when information isn’t distributed in multiple languages—the ability to read in English to stay updated. “As it turns out,” writes Declet-Barreto, “many U.S. coastal counties at risk of flooding from a Category 5 storm have large populations that lack many of these key resources.” Many of the communities lacking these resources are Black and Latino.
 
Although Laura ultimately dealt less damage than predicted, thousands evacuated ahead of the storm, hundreds of thousands lost power and at least six people died.
 
CDC Changes Its Testing Guidance—To Make the US Look Better?
 
Until last week, the Centers for Disease Control and Prevention’s  website recommended that everyone who had been in close contact with a person infected with the coronavirus get tested, symptoms or not. Now, that same page says someone who’s been exposed but is symptomless doesn’t need a test, unless that person is a “vulnerable individual.”
 
Disease experts are baffled by the change, reports Katherine J. Wu for The New York Times. It’s estimated that about one-half of COVID-19 transmission occurs before individuals feel symptoms. Those quietly carrying the virus in this stage have been found to harbor higher loads of the virus than people further along in an infection. On top of that, people are probably more likely to socialize when they don't have symptoms, increasing the opportunity for the pathogen to spread. According to another New York Times report, the change was influenced by pressure from senior officials at the White House and the Department of Health and Human Services.
 
President Trump has repeatedly called to reduce testing, saying things like “when you do testing to that extent, you’re going to find more people — you’re going to find more cases,” reports German Lopez for Vox. “The implication is that testing makes the US look bad, since it will have more confirmed coronavirus cases," Lopez writes.
 
Smell Tests, Convalescent Plasma & Cases of Reinfection
 
Move Over Thermometers—Smell Tests Might Be a Good Diagnostic for COVID-19
 
At Penn State University, faculty are promoting a new test to sniff out COVID-19 infections on campus. The school’s department of food science sent scratch-and-sniff postcards to students, and also have plans to include flower bouquets and other reminders to check their sense of smell. “Our message is, ‘If you have sudden-onset smell loss, in the absence of other explanatory history like a head injury, the chance of you being infected is high,’” John Hayes, a Penn State sensory science researcher overseeing the project told Kaiser Health News.
 
Loss of smell in COVID-19 patients is "swift and utter” and not accompanied by a stuffy nose, writes Ann Bauer for Kaiser Health News. Penn State is not alone in hoping smell tests will supplement efforts to wrangle the virus. In the SmellTracker project led by the Edith Wolfson Medical Center and the Weizmann Institute of Science, both based in Israel, researchers are enlisting participants to chart their smell using five items in their household. The goal is for the program's algorithm to use the aggregated data to inform officials about new potential outbreaks, allowing them to focus on where further PCR testing may be needed.
 
In a not-yet-peer-reviewed study of more than 4,000 patients, smell was among the most predictive symptoms for COVID-19 infection, and was better associated with positive tests than fever or cough.
 
In another take on smell tests, researchers in Israel say they’ve created a device that “smells” your breath and provides an electronic reading of your COVID-19 infection status within 30 seconds. It's fast and inexpensive to run, though less accurate than PCR tests, reports Helen Albert for Forbes. Still others want dog noses on the case, she writes.
 
Convalescent Plasma OK’d for Treatment—Too Soon?
 
Last week, the Food and Drug Administration issued an emergency order allowing the use of convalescent blood plasma for treating COVID-19 patients. The treatment involves injecting patients with the plasma—the liquid part of blood—of those who recovered from the virus and have protective antibodies.
 
While there’s some evidence that plasma could help survival, especially if administered early in an infection, no randomized controlled trials have shown convalescent plasma can be effective against COVID-19, Jonathan Lambert and Tina Hesman Saey report for Science News. And the move “has some experts worried that an unproven treatment may interfere with other more promising therapies, and may make it harder to find out if convalescent plasma really can help against COVID-19,” they write.
 
The FDA’s declaration appears to be influenced by a recent, preliminary study, which found that patients who received plasma earlier in their infection had lower mortality rates than those who had the treatment later. But many worry that political pressure pushed the agency to accept a lower bar for evidence than they normally would have. The authorization came only a day after President Donald Trump “tweeted dissatisfaction with the pace of FDA approval for new vaccines and therapies to fight COVID-19” and “less than a week after The New York Times reported that top National Institutes of Health officials were trying to stop an emergency use authorization for plasma, citing concerns about lack of sufficient data,” Lambert and Hesman Saey write.
 
COVID-19 Reinfection Might Not Be Cause For Worry
 
Researchers in Hong Kong, Europe and Nevada all reported cases of COVID-19 reinfection last week. Although anecdotal reports have raised the possibility that reinfection might be possible, these cases are the first confirmed reports. In Hong Kong, for example, researchers used a genetic analysis to distinguish one infection from the other in a 33-year-old man, showing he had picked up the virus a second time (as opposed to having one, drawn out case).
 
But medical experts still believe it's unlikely you'll catch the virus twice in a short time frame, as The New York Times reported in July. Many anecdotal cases might actually just be prolonged primary infections.
 
And the cases are not necessarily bad news for immunity, writes Brian Resnick for Vox. In the Hong Kong case, for example, the patient felt ill during his first infection but had no symptoms during the second—a sign that the immune system recognized the pathogen and worked to suppress it. “You can be reinfected with the virus but still have some protective immunity to it,” writes Resnick. “Why? There are many, many components of our immune system that are working together to fight the virus.”
 
Antibodies get a lot of hype, but there are numerous other tools our bodies use to remember how to defend themselves from familiar attackers. Once the pathogen has invaded cells, other functions are more active. Killer T cells, for example, seek out invading pathogens and—you guessed it—try to kill them.
 
The Nevada case was more disconcerting. The first time around the patient had many classic COVID-19 symptoms, but it wasn’t until his second bout with the disease that he was hospitalized. His first illness did not appear to lend protection.
 
“Still, despite what happened to the man in Nevada, researchers are stressing this is not a sky-is-falling situation or one that should result in firm conclusions,” Andrew Joseph writes for STAT. “They always presumed people would become vulnerable to COVID-19 again some time after recovering from an initial case, based on how our immune systems respond to other respiratory viruses, including other coronaviruses. It’s possible that these early cases of reinfection are outliers and have features that won’t apply to the tens of millions of other people who have already shaken off COVID-19.”
 
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