Corona situation is really made by china

 

oday's Headlines: February 4, 2021

COVID-19 Clinical Practice   Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19 (JAMA Otolaryngology-Head and Neck Surgery) Povidone iodine (PI) solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 in vitro with contact times as short as 15 seconds. We investigated whether nasopharyngeal application of PI could reduce the viral load of patients with nonsevere coronavirus disease 2019 (COVID-19) symptoms. Prevalence of SARS-CoV-2 in Karnataka, India (JAMA) We assessed SARS-CoV-2 prevalence among volunteers from population-representative households in urban and rural areas of the state of Karnataka (population, 67.5 million). The adjusted seroprevalence of SARS-CoV-2 across Karnataka was 46.7%, suggesting approximately 31.5 million residents were infected, far greater than the 327 076 cases reported by August 29, 2020. This discrepancy may be due to low testing rates (approximately 4000 per million population)5 and a large proportion of infections in Karnataka being asymptomatic. Public & Global Health Age Groups that Sustain Resurging COVID-19 Epidemics in the United States (Science) We analyze aggregated, age-specific mobility trends from more than 10 million individuals in the US and link these mechanistically to age-specific COVID-19 mortality data. We estimate that as of October 2020, individuals aged 20-49 are the only age groups sustaining resurgent SARS-CoV-2 transmission with reproduction numbers well above one, and that at least 65 of 100 COVID-19 infections originate from individuals aged 20-49 in the US. Malawi Setting up Field Hospitals to Cope with Virus Surge (AP) Malawi faces a resurgence of COVID-19 that is overwhelming the southern African country where a presidential residence and a national stadium have been turned into field hospitals in efforts to save lives. President Lazarus Chakwera, just six months in office, lost two Cabinet ministers to COVID-19 in January amid a surge that led him to declare a state of national disaster in all of Malawi’s 28 districts. China's Vaccine Campaign Hits A Few Bumps (NPR) China has approved one domestic coronavirus vaccine for commercial use. Four more are in late stage human trials, and a nationwide vaccination campaign is already underway. But the vaccine rollout is happening more slowly than expected. Only about 24 million doses have been administered, but those numbers represent only the first dose of a two-dose vaccine. That means at most, only 1.6% of China's population received their first shot by the end of January. Beijing's modest goal is to inoculate 50 million people — or about 3.5% of the total population — by mid-February, right before Lunar New Year. China excels at mobilizing hundreds of millions of people for home isolation or mass COVID-19 testing. So why is it struggling with vaccination?  Science & Technology  Scientists Call for Fully Open Sharing of Coronavirus Genome Data (Nature) Researchers have posted huge numbers of SARS-CoV-2 genome sequences online since January 2020. The most popular data-sharing platform, called GISAID, now hosts more than 450,000 viral genomes; Soumya Swaminathan, the chief scientist at the World Health Organization, has called it a ‘game changer’ in the pandemic. But it doesn’t allow sequences to be reshared publicly, which is hampering efforts to understand the coronavirus and the rapid rise of new variants.   Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine (NEJM) The mRNA-1273 vaccine is a lipid nanoparticle–encapsulated mRNA-based vaccine that encodes the prefusion stabilized full-length spike protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19. This phase 3 randomized, observer-blinded, placebo-controlled trial was conducted at 99 centers across the United States. The mRNA-1273 vaccine showed 94.1% efficacy at preventing Covid-19 illness, including severe disease.   Biological Agents & Infectious Diseases Multi-state Salmonella Outbreak of Unknown Origin Now up to 60 Patients (Food Safety News) Traceback efforts continue in a Salmonella Miami outbreak, but few details are available. Federal investigators report that the patient count has increased to 60. In its original outbreak notification on Jan. 13 the Food and Drug Administration’s weekly CORE investigation table listed 48 patients. The FDA has not revealed what states are involved in the outbreak. The CORE investigation table indicates that traceback is underway, but it does not provide any other information about what food or foods are part of that effort. Domestic Preparedness & Response  'Just Cruel': Digital Race For COVID-19 Vaccines Leaves Many Seniors Behind (NPR) The efforts to vaccinate people who are 65 and older have strained under the enormous demand that has overwhelmed cumbersome, inconsistent scheduling systems. The struggle represents a shift from the first wave of vaccinations — health care workers in health care settings — which went comparatively smoothly. Now, in most places, elderly people are pitted against each other competing on an unstable technological playing field for limited shots. Global Health Security The Five Things to Get Right Before the Next Pandemic (Bloomberg Businessweek) As depressing as the current situation is, though, the next one—and there will be a next one—doesn’t have to be this bad. Shortly before his inauguration, President Biden proposed spending $20 billion to speed up vaccination rollouts. That’s a start. But a complete plan—one that can protect the U.S. from mass death, catastrophic economic damage, and (let’s hope) incompetent political leaders who squander the public’s trust—will have to be more comprehensive. It will likely involve at least five separate areas of research and investment. Science & Technology Vaccine Innovations — Past and Future (NEJM) Vaccination is a powerful method of disease prevention that is relevant to people of all ages and in all countries, as the Covid-19 pandemic illustrates. Vaccination can improve people’s chances of survival, protect communities from new and reemerging health threats, and enhance societal productivity. But achieving the promise of vaccination requires much more than the vaccines themselves. Texas A&M Researchers Show Water Treatment Removes Enveloped Viruses (Outbreak News Today) Using a surrogate of the coronavirus that only infects bacteria, researchers at Texas A&M University have now presented strong evidence that existing water purification plants can easily reduce vast quantities of the virus thereby protecting our household water from such contagions. In particular, the researchers showed that the water purification step called coagulation could alone get rid of 99.999% of the virus, markedly decontaminating water for consumption. A Replication Competent Adenovirus-vectored Influenza Vaccine Induces Durable Systemic and Mucosal Immunity (Journal of Clinical Investigation) Immunization with replication-competent recombinant vectors provides exposure to transgene-encoded antigens in the context of inflammation that may drive more potent and durable immunity compared to non-replicating vaccines. To understand the features of a replicating vaccine that drive such responses we tested a replication-competent adenovirus type 4 encoding influenza virus H5 hemagglutinin (Ad4-H5-Vtn) administered by an oral capsule or via a tonsillar swab or nasal spray. Ad4-H5-Vtn DNA was shed from most upper respiratory tract (URT)-immunized volunteers for 2-4 weeks, but cultured from only 60% of participants with a median duration of one day. Ad4-H5-Vtn vaccination induced increases in H5-specific CD4+ and CD8+ T cells in the peripheral blood and IgG and IgA in nasal, cervical and rectal secretions. URT immunizations induced high levels of serum neutralizing antibodies (NAb) to H5 which remained stable at week 26. Other 21st Century Threats United States Extends Nuclear Treaty with Russia for Five Years (Washington Post) The United States formally extended a critical nuclear accord with Russia on Wednesday for five years, opting to prolong limits on the arsenals of both nations two days before the treaty’s expiration date and bringing a measure of stability to U.S.-Russia relations on nuclear matters. Secretary of State Antony Blinken said in a statement that the extension of the New START accord ensures verifiable limits will remain on Russian intercontinental ballistic missiles, submarine launch ballistic missiles and heavy bombers until 2026, and keeps in place a mutual verification regime that gives the United States greater insight into Russia’s nuclear posture.  Public Health & Healthcare Preparedness RESEARCH Addressing COVID-19 Misinformation on Social Media Preemptively and Responsively Efforts to address misinformation on social media have special urgency with the emergence of coronavirus disease (COVID-19). In one effort, the World Health Organization designed and publicized shareable infographics to debunk coronavirus myths. We used an experiment to test the efficacy of these infographics, depending on placement and source. Researchers found that exposure to a corrective graphic on social media reduced misperceptions about the science of 1 false COVID-19 prevention strategy but did not affect misperceptions about prevention of COVID-19. Lowered misperceptions about the science persisted >1 week later. These effects were consistent when the graphic was shared by the World Health Organization or by an anonymous Facebook user and when the graphics were shared preemptively or in response to misinformation. (CDC EID, 2/2021) RESEARCH Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020 An epidemic of dengue virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infections occurred in Argentina during 2020. Researchers describe the clinical characteristics and outcomes in a cohort of patients hospitalized because of co-infection. They retrospectively identified 13 patients from different hospitals in Buenos Aires who had confirmed infection with SARS-CoV-2 and dengue virus and obtained clinical and laboratory data from clinical records. All patients had febrile disease when hospitalized. The outcome of these patients did not seem to be worse than those having either SARS-CoV-2 or dengue infection alone. (CDC EID, 2/2021) RESEARCH Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program — United States, December 14, 2020–January 14, 2021 During the first month of the US COVID-19 vaccination program, approximately 13,000,000 persons received ≥1 dose of vaccine. Among persons with demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White. As the vaccination program expands, it is critical to ensure efficient and equitable administration to persons in each successive vaccine priority category, especially those at highest risk for infection and severe health outcomes. (CDC MMWR, 2/1/2021) PRESS RELEASE FEMA Obligates $2.6 Million to South Carolina for COVID-19 Vaccination Costs The Federal Emergency Management Agency has obligated $2.6 million to the State of South Carolina for costs for the COVID-19 vaccine mission. The award provides expedited federal funding to reimburse 100% of costs related to the State’s vaccination program for a 90-day period. These costs can include: equipment and supplies needed for storing, handling, and distributing vaccines, personal protective equipment (PPE) for staff and patients, leasing facilities for storing and administering vaccines, additional medical and support staff, including facility infection control measures, emergency medical care, equipment for the safe disposal of medical waste, communications to disseminate public information. (FEMA, 2/1/2021) PRESS RELEASE Acting Secretary Pekoske Directs TSA to Mitigate Spread of COVID-19 Through the Transportation System Acting Secretary of Homeland Security announced the issuance of a National Emergency Determination to mitigate the spread of COVID-19. This determination enables TSA to implement President Biden’s Executive Order on Promoting COVID-19 Safety in Domestic and International Travel. TSA will require individuals to wear a mask at TSA screening checkpoints and throughout the commercial and public transportation system. (DHS, 1/31/2021) PRESS RELEASE CDC Requires Wearing of Face Masks While on Public Transportation and at Transportation Hubs As the COVID-19 pandemic continues to surge in the United States, CDC is implementing provisions of President Biden’s Executive Order on Promoting COVID-19 Safety in Domestic and International Travel and will require the wearing of masks by all travelers into, within, or out of the United States, e.g., on airplanes, ships, ferries, trains, subways, buses, taxis, and ride-shares. The mask requirement also applies to travelers in US transportation hubs such as airports and seaports; train, bus, and subway stations; and any other areas that provide transportation. (CDC, 1/30/2021) PRESS RELEASE USAID Recognizes World Neglected Tropical Diseases Day and A New Global Strategy The US Agency for International Development is proud to join governments around the world in celebrating World Neglected Tropical Diseases (NTD) Day and the launch of a new global strategy for NTDs. This week, the World Health Organization publicly launched a new strategy: Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021–2030. The launch coincides with the second annual World NTD Day on January 30, which acknowledges progress and partnerships helping to end NTDs. The US Government, through USAID, has provided more than $1 billion to eliminate NTDs since 2006, contributing to tremendous progress against these diseases. (USAID, 1/30/2021) RESEARCH Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, December 21, 2020–January 10, 2021 During December 21, 2020–January 10, 2021, monitoring by the Vaccine Adverse Event Reporting System detected 10 cases of anaphylaxis after administration of a reported 4,041,396 first doses of Moderna COVID-19 vaccine (2.5 cases per million doses administered). In nine cases, onset occurred within 15 minutes of vaccination. No anaphylaxis-related deaths were reported. (CDC MMWR, 1/29/2021) RESEARCH Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, August 9–November 21, 2020 The National Football League observed SARS-CoV-2 transmission after <15 minutes of cumulative interaction, leading to a revised definition of a high-risk contact that evaluated mask use and ventilation in addition to duration and proximity of interaction. Intensive mitigation protocols effectively reduced close interactions. (CDC MMWR, 1/29/2021) PRESS RELEASE South Carolina Detects First US Cases Associated with Variant First Detected in South Africa CDC is aware that the first US documented cases of the B 1.351 variant of SARS-CoV-2, which was first detected in South Africa, have been identified in South Carolina. At this time, we have no evidence that infections by this variant cause more severe disease. Like the UK and Brazilian variants, preliminary data suggests this variant may spread more easily and quickly than other variants. CDC will continue communicating with international, state, and local partners to monitor the presence and impact of variants in the United States and around the world. Monitoring variants is why CDC has expanded National SARS-CoV-2 Strain Surveillance (NS3). We continue working with national reference laboratories, state health departments and researchers from around the country to gather sequence data and increase use of genomic sequencing data in response to this pandemic. (CDC, 1/29/2021) PRESS RELEASE HHS Amends PREP Act Declaration to Increase Workforce Authorized to Administer COVID-19 Vaccines The US Department of Health and Human Services issued a fifth amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) to add additional categories of qualified persons authorized to prescribe, dispense, and administer COVID-19 vaccines authorized by the US Food and Drug Administration. (HHS, 1/28/2021) REPORT Tracking COVID-19 Vaccines: US Data Systems and Related Issues The US Food and Drug Administration has granted Emergency Use Authorizations (EUAs) for two Coronavirus Disease 2019 (COVID-19) vaccines, sponsored by Pfizer-BioNTech and Moderna, and millions of vaccine doses are being distributed nationwide. Both vaccines require two doses, which are generally not interchangeable. Key to this effort, several existing and new data systems are in use to track, specifically, where the vaccines supply is through the Vaccine Tracking System (VTrckS); who has received a vaccine through jurisdiction-based Immunization Information Systems (IIS); and if any new safety issues occur. (CRS, 1/28/2021) Homeland Security & Disaster Preparedness REPORT The Apollo Program for Biodefense – Winning the Race Against Biological Threats The risks of future pandemics increase as technological progress eases barriers to modifying pathogens, raising the specter of novel biological agents causing diseases much worse than humanity has ever faced. Meanwhile, US vulnerabilities to biological attacks have never been clearer to our adversaries. The Apollo Program for Biodefense would provide the United States the opportunity to mobilize the nation and lead the world to meet these challenges: a world where we detect and continually trace any new pathogen from the source; where we can distribute rapid point-of-person tests to every household in the country within days of that detection; where effective treatments are already in-hand; where vaccine development and rollout occur in weeks rather than years; and where pandemics will never again threaten the lives and livelihoods of Americans and people around the world. (Bipartisan Commission on Biodefense, January 2021) REPORT COVID-19 International Responses: Resources for the 117th Congress Numerous international organizations, educational institutions, and private research firms have compiled information and are tracking international responses to the Coronavirus Disease 2019 (COVID-19). This Insight presents selected resources and CRS products that may be useful for Congress in tracking and understanding different countries’ approaches to addressing the effects of the COVID-19 pandemic. Some of these resources are listed below in alphabetical order by organization, along with brief notes on the type of information provided. (CRS, 1/28/2021) REPORT Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal Attention This review of the federal response to the COVID-19 pandemic is GAO's fifth comprehensive report since June 2020 about the implementation of the CARES Act. As of January, 27 of our 31 previous recommendations had not been implemented. This report makes 13 new recommendations to improve agencies' public health and economic recovery efforts, including the development of a national testing strategy. (GAO, 1/28/2021) BLOG Places Please: Get Better Prepared by Getting Organized A new year is a popular time to make resolutions, like to get more exercise or quit tobacco. Another common one is to get organized. Getting organized can help you prepare for emergencies and stay calm in stressful and time-sensitive situations, like an evacuation. Here are a few ways to get organized and improve your emergency preparedness at the same time. (CDC Public Health Matters, 1/26/2021) Radiological & Nuclear Disaster Preparedness MEETING NRC Atomic Safety and Licensing Board to Hold Oral Argument on North Anna Subsequent License Renewal A Nuclear Regulatory Commission Atomic Safety and Licensing Board will conduct an oral argument via WebEx on Feb. 4, regarding a petition to hold an adjudicatory hearing. The hearing will concern Virginia Electric Power Company’s application to renew the operating licenses of North Anna Units 1 and 2, near Mineral, Va., for an additional 20 years. (NRC, 2/4/2021) PRESS RELEASE NRC Names New Resident Inspector at Byron Nuclear Power Plant The US Nuclear Regulatory Commission has selected Jamie Weigandt as the new resident inspector at the Byron nuclear power plant. The plant is operated by Exelon Generation Co., LLC., and is located in Byron, Ill., 17 miles southwest of Rockford. Each commercial nuclear power plant site in the United States has at least two resident inspectors who monitor day-to-day operations at the plant. (NRC, 2/1/2021) Science & Technology Policy NEWS RELEASE Janssen Investigational COVID-19 Vaccine: Interim Analysis of Phase 3 Clinical Data Released An investigational COVID-19 vaccine developed by Janssen Pharmaceuticals appears to be safe and effective at preventing moderate and severe COVID-19 in adults, according to an interim analysis of Phase 3 clinical data conducted Jan. 21. The vaccine, called Ad.26.COV2.S or JNJ-78436725, requires only a single injection and can be stored in a refrigerator for months. The interim analysis assessed 468 cases of symptomatic COVID-19 among 44,325 adult volunteers in Argentina, Brazil, Chile, Colombia, Mexico, Peru, South Africa, and the United States. The investigational vaccine was reportedly 66% effective at preventing the study’s combined endpoints of moderate and severe COVID-19 at 28 days post-vaccination among all volunteers, including those infected with an emerging viral variant. (NIH, 1/29/2021) NEWS DHS S&T Initiates Funding Opportunity for New Center of Excellence The Department of Homeland Security (DHS) Science and Technology Directorate (S&T) has announced a $36.5 million funding opportunity for a new DHS Center of Excellence (COE). The COE’s focus would be Engineering Secure Environments from Targeted Attacks (ESE). DHS is soliciting center lead proposals from accredited United States colleges and universities. (Homeland Preparedness News, 1/27/2021) NEWS RELEASE NIH Launches Database to Track Neurological Symptoms Associated with COVID-19 A new database will collect information from clinicians about COVID-19-related neurological symptoms, complications, and outcomes as well as COVID-19 effects on pre-existing neurological conditions. The COVID-19 Neuro Databank/Biobank (NeuroCOVID), which was created and will be maintained by NYU Langone Health, New York City, will be a resource of clinical information as well as biospecimens from people of all ages who have experienced neurological problems associated with SARS-CoV-2 infection. The database is supported by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS). (NIH, 1/26/2021)

Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020 On This Page Lucila M. Carosella, Daniel Pryluka, Aldo Maranzana, Laura Barcan, Rosana Cuini, Cristina Freuler, Alfredo Martinez, Tomás Rivero Equiza, Carolina Rodriguez Peria, Diego Yahni, Martin E. Stryjewski , and for the COVIDENGUE Study Group1 Author affiliations: Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina (L.M. Carosella, A. Martinez, T. Rivero Equiza, M.E. Stryjewski); Sanatorio Otamendi, Buenos Aires (D. Pryluka); General Hospital de Agudos Parmenio Piñero Gobierno de la Ciudad, Buenos Aires (A. Maranzana); Hospital Italiano de Buenos Aires, Buenos Aires (L. Barcan); Hospital de Agudos Dr. Teodoro Álvarez, Buenos Aires (R. Cuini); Hospital Alemán, Buenos Aires (C. Freuler); Sanatorio de Los Arcos, Buenos Aires (C. Rodriguez Peria),; Sanatorio Mutual del Transporte Automotor, Buenos Aires (D. Yahni) Cite This Article Abstract An epidemic of dengue virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infections occurred in Argentina during 2020. We describe the clinical characteristics and outcomes in a cohort of patients hospitalized because of co-infection. We retrospectively identified 13 patients from different hospitals in Buenos Aires who had confirmed infection with SARS-CoV-2 and dengue virus and obtained clinical and laboratory data from clinical records. All patients had febrile disease when hospitalized. Headache was a common symptom. A total of 8 patients had respiratory symptoms, 5 had pneumonia, and 3 had rash. Nearly all patients had lymphopenia when hospitalized. No patients were admitted to an intensive care unit or died during follow up. Co-infection with SARS-CoV-2 and dengue virus can occur in patients living in areas in which both viruses are epidemic. The outcome of these patients did not seem to be worse than those having either SARS-CoV-2 or dengue infection alone. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which produces coronavirus disease (COVID-19), and dengue caused an epidemic in Argentina during 2020. During March 3–October 25, 2020, a total of 1,090,589 confirmed cases of infection with SARS-CoV-2 were reported in this country. Of these cases, 143,990 were reported in Ciudad Autónoma de Buenos Aires (1). During January 4–June 13, 2020, there were ≈7,300 confirmed cases of dengue virus infection in this city (2). Although co-infection with these 2 virus is a major concern, it has only been reported in individual patients (3–5). Information from cohorts of co-infected patients is still lacking. We describe the clinical characteristics and outcomes in a cohort of patients co-infected with SARS-CoV-2 and dengue virus in Buenos Aires. Methods Using a network of colleagues (COVIDENGUE Study Group), we retrospectively identified patients co-infected with SARS-CoV-2 and dengue virus during March–June 2020. Seven sites were in Buenos Aires, and an additional site was in the surrounding area. Through June 30, 2020, healthcare admission was mandated in Argentina for any patient with confirmed COVID-19. Therefore, all patients had complete information regarding signs and symptoms at hospitalization, as well as their hospital course. Clinical data were obtained in a predesigned clinical report form by reviewing medical records. Infection with SARS-CoV-2 was diagnosed by using real-time PCR of nasopharyngeal swab specimens, as approved by the Ministry of Health in reference laboratories. Dengue was diagnosed by either detection of nonstructural protein 1 (NS1), real-time PCR, or serologic conversion. Severe dengue was defined by presence of respiratory distress, severe bleeding, or organ impairment. Mild COVID-19 was defined by absence of pneumonia or pneumonia without impairment in oxygenation for otherwise stable patients. Patients requiring supplemental oxygen were considered to have moderate-to-severe COVID-19. Patients were followed up for 4 weeks from their initial hospitalizations. Descriptive statistics were used. This study was approved by the Ethic Committee of Centro de Educación Médica e Investigaciones Clínicas (Buenos Aires, Argentina). Top Results A total of 13 patients who had co-infections with SARS-CoV-2 and dengue virus were identified. Most patients were relatively young (median age 37 years), 46% were female, and 54% reported >1 concurrent condition. All patients had febrile disease at hospitalization (Table). The median duration of fever was 7 days; 9 (69%) patients had fever for >5 days. Headache was a common symptom among co-infected patients. A total of 8 patients (62%) had respiratory symptoms. Symptoms of lower respiratory tract infection were present in 4 (31%) patients; 5 (38%) patients had ground glass opacities consistent with viral pneumonia on computed tomography (CT) scans. Two patients had bilateral infiltrates on a chest radiograph or computed tomography. Rash appeared in 3 patients early in the course of the disease and before resolution of fever. Two of these patients had concomitant pneumonia and rash. Lymphopenia was observed in all but 1 patient (92%), and thrombocytopenia was observed in 46%. Among patients with fever <5 days, suspicion of dengue was based on a history of recent mosquito bite (2 patients), frontal headache (3 patients), intense myalgia (3 patients), or thrombocytopenia (2 patients). All patients had a diagnosis of COVID-19 by real-time PCR of nasopharyngeal swabs specimens. Dengue was diagnosed by detection of NS1 in >50% of co-infected patients; 4 cases were diagnosed by real-time PCR of serum and 1 by serologic conversion. The patient who had serologic conversion had a first serum sample negative for IgM and IgG. One week later, a second serum sample was positive for both antibodies. All but 1 patient (92%) had mild COVID-19. No patients had severe dengue infection, required admission to an intensive care unit, or died during follow up. All patients fully recovered from their symptoms after 4 weeks. Top Discussion This report of patients co-infected with SARS-CoV-2 and dengue virus provides several useful observations. First, in geographic areas in which both viruses are circulating, co-infections can occur. This concerning possibility, which might impose an additional burden on healthcare systems, has been reported previously (6). In Latin America, >3 million cases of dengue were reported during 2019 (7). Dengue virus circulates epidemically in Argentina, particularly in the northeastern region of this country (8). The most recent epidemic occurred in 2016 (2). In Buenos Aires, the number of cases reported during 2017–2019 was relatively low. For example, during 2018 only 151 cases were reported and during 2019 only 51 cases in this city. However, during 2020, the magnitude of the dengue epidemic in Buenos Aires surpassed case counts for the preceding 10 years. Therefore, given the current circulation of SARS-CoV-2 at high levels, a new epidemic of dengue virus during early 2021 (warm months) could substantially increase the risk for co-infections. Second, in this scenario of concomitant circulation of SARS-CoV-2 and dengue virus, the distinction between clinical diseases among febrile patients is crucial. Certain clinical characteristics among these co-infected patients are relevant. All patients who had co-infections had fever at hospitalization, and most had fever duration for ≥5 days. Also, >50% of patients with COVID-19 did not have fever at admission (9). Prolonged fever has been associated with more severe disease in patients with COVID-19 (10). Therefore, for most patients with mild COVID-19 in this study, prolonged fever was a clinical clue for suspecting co-infection. Other than fever, headache was the most common symptom in patients with co-infection. Although headache is common in patients who have dengue infection (>90%) (11) it is less commonly observed in patients with COVID-19 (≈13%) (9). For some co-infected patients, a clinical overlap based on hallmarks of both diseases was also noted. For example, 2 patients had pneumonia, suggesting COVID-19, as well as a rash, which can be a hallmark of dengue virus infection. The duration of fever longer than expected for mild COVID-19, headache, rash, or absence of respiratory symptoms should raise the suspicion of a concomitant infection with dengue virus. Therefore, clinical suspicion based on epidemiologic grounds might alert clinicians to order tests for both viruses. Third, all patients had favorable outcomes for both COVID-19 and dengue virus infections. There is conflictive data on the clinical outcome of co-infection with dengue and other viruses (12–14). All but 1 of our patients had mild COVID-19, and none had severe dengue. Our preliminary findings, based on limited data, do not suggest that co-infection with dengue and SARS-CoV-2 viruses worsens clinical outcomes. Our study had several limitations. False-positive IgM results for dengue have been described for 2 patients who had COVID-19 (15). However, only 1 of our patients had a serologic diagnosis of dengue, and this diagnosis was based on serologic conversion for IgM and IgG. Almost all our patients had positive results for virus NS1 tests or real-time PCR of serum for dengue. Because these tests for dengue have high specificity for acute infection (16), a false-positive diagnosis is unlikely (17). Immune response was not evaluated in our study. Analyzing the immune activation for these co-infected patients would help to clarify the clinical outcomes of these patients who have simultaneous viral infections. Finally, our data are limited by a small sample size. Our observation on the unaltered clinical course of COVID-19 concomitant with dengue infection needs to be confirmed in larger cohorts of patients, including a comparative analysis of persons infected only with SARS-CoV-2 or dengue virus, and patients who are co-infected with both viruses. In conclusion, co-infection with SARS-CoV-2 and dengue virus can occur in patients living in areas in which both viruses are epidemic. Some clinical clues can orient physicians to suspect both diseases. Based on limited data, our study suggests that the clinical outcome of these co-infected patients may not be worse than for patients who have either SARS-CoV-2 or dengue infection alone. Top Dr. Carosella is a chief resident of internal medicine at the Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina. Her primary research interests are cardiology and COVID-19. Top Acknowledgments Members of the COVIDENGUE Study Group: Claudio Basile, Pablo Bonvehi, Patricia Chabay, Mariana De Paz, Cecilia Ezcurra, Diana Ferreño, Margarita Gaset, Daniel Lopez, Cecilia Losada, Veronica Paz, Sandra Paz, and Pedro Wainer. M.E.S. is a consultant to Basilea and a speaker for Pfeizer.