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	<title>Collection : COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv</title>
	<link>https://biorxiv.org</link>
	<description>
	This feed contains articles for Collection "COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv"
	</description>

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	<title>bioRxiv/medRxiv</title>
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	<link>https://biorxiv.org</link>
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	<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.05.05.722935v1?rss=1">
<title>
<![CDATA[
Targeted metagenomic recovery of coronaviruses from wildlife samples 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.05.05.722935v1?rss=1"
</link>
<dc:creator>Johnston, C. M.</dc:creator>
<dc:creator>Gunalan, V.</dc:creator>
<dc:creator>Baagoe, H. J.</dc:creator>
<dc:creator>Elmeros, M.</dc:creator>
<dc:creator>Fjederholt, E. T.</dc:creator>
<dc:creator>Quaade, M. L.</dc:creator>
<dc:creator>Hansen, M. J. S.</dc:creator>
<dc:creator>Lohse, L.</dc:creator>
<dc:creator>Rasmussen, T. B.</dc:creator>
<dc:date>2026-05-05</dc:date>
<dc:identifier>doi:10.64898/2026.05.05.722935</dc:identifier>
<dc:title><![CDATA[Targeted metagenomic recovery of coronaviruses from wildlife samples]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-05</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Coronaviruses (CoVs) are diverse RNA viruses infecting a wide range of hosts, with significant implications for public health, animal production and welfare. Bats are key reservoirs of mammalian CoVs and have contributed to the emergence and circulation of several zoonotic viruses in a wildlife context, while mustelids represent important hosts at the human-animal interface, as highlighted by SARS-CoV-2 outbreaks in farmed mink. Using metagenomic next-generation sequencing, we screened bats and wild mustelids and recovered and characterized full-length CoV genomes. Building on previous findings in Danish wildlife, including alpha-CoVs and a MERS-related beta-CoV in bats, this study expands current knowledge of coronavirus diversity and evolution in wildlife, emphasizing their relevance for zoonotic emergence.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.30.721971v1?rss=1">
<title>
<![CDATA[
Condensate-Like Organization in Respiratory Aerosols Modulates the Dynamics of an Airborne Virus 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.30.721971v1?rss=1"
</link>
<dc:creator>Wauer, N.</dc:creator>
<dc:creator>Calvo-Tusell, C.</dc:creator>
<dc:creator>Dommer, A.</dc:creator>
<dc:creator>Casalino, L.</dc:creator>
<dc:creator>Kearns, F.</dc:creator>
<dc:creator>Caparotta, M.</dc:creator>
<dc:creator>Rosenfeld, M.</dc:creator>
<dc:creator>Morris, C.</dc:creator>
<dc:creator>Amaro, R. E.</dc:creator>
<dc:date>2026-05-04</dc:date>
<dc:identifier>doi:10.64898/2026.04.30.721971</dc:identifier>
<dc:title><![CDATA[Condensate-Like Organization in Respiratory Aerosols Modulates the Dynamics of an Airborne Virus]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The molecular behavior of viruses within respiratory aerosols plays a critical role in airborne disease transmission yet remains largely inaccessible to experimental characterization. Here, we use a billion-atom all-atom molecular dynamics simulation of a virus-laden respiratory aerosol to uncover how respiratory proteins, lipids, ions, and water collectively assemble around SARS-CoV-2, giving rise to structured microenvironments that influence viral stability and spike dynamics. We find that respiratory components rapidly evolve into heterogeneous networks characterized by protein-rich aggregates, patchy lipid assemblies, and spatially structured ion and water dynamics. These features create distinct microenvironments that constrain molecular transport and stabilize regions surrounding the virion. Within this crowded aerosol context, we observe sustained and selective interactions between aerosol components and the viral spike protein, including preferential recruitment of surfactant lipids and persistent coordination by divalent cations. These interactions modulate spike conformational dynamics, enhancing domain breathing motions and flexibility at key hinge regions while preserving a stable membrane anchor. Together, these observations reveal a condensate-like physical regime in which multivalent aerosol components coalesce into a soft, heterogeneous matrix that selectively modulates viral protein dynamics under extreme crowding. By framing virus-laden respiratory aerosols within this physical context, this work establishes an in situ molecular framework for understanding how aerosols influence viral persistence and offers a platform for exploring mechanisms relevant to airborne disease transmission and mitigation strategies.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.05.02.722415v1?rss=1">
<title>
<![CDATA[
Connecting Cryo-EM and Crystallographic Views of RNA Folding through Ionic Conditions and Structural Flexibility 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.05.02.722415v1?rss=1"
</link>
<dc:creator>Mainan, A.</dc:creator>
<dc:creator>Roy, S.</dc:creator>
<dc:creator>Kirmizialtin, S.</dc:creator>
<dc:date>2026-05-04</dc:date>
<dc:identifier>doi:10.64898/2026.05.02.722415</dc:identifier>
<dc:title><![CDATA[Connecting Cryo-EM and Crystallographic Views of RNA Folding through Ionic Conditions and Structural Flexibility]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Discrepancies between biomolecular structures resolved by cryo-electron microscopy (cryo-EM) and X-ray crystallography (XRD) often arise from differences in ionic conditions and construct design, yet their mechanistic impact on RNA folding remains unclear. In the SARS-CoV-2 frameshifting stimulatory element, cryo-EM and XRD structures reveal distinct pseudoknot conformations: a bent and a coaxially stacked state, complicating its structure-function relationship. Here, combining all-atom explicit-solvent simulation results with a structure-based electrostatic model, we show that Mg2+; ions drive transitions between these states by stabilizing long-range tertiary interactions and modulating local dynamical coupling involving the slippery site and stem3. Energy landscape analysis reveals distinct folding pathways, while deletion of the slippery segment in crystallographic constructs alters intermediates and produces pathways inconsistent with single-molecule optical tweezer experiments. This study demonstrates how condition-dependent experiments encode complementary interaction-level information and how physics-based computational approaches integrate these to yield a coherent, mechanistic picture of RNA folding.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.05.03.722459v1?rss=1">
<title>
<![CDATA[
SARS-CoV-2 (E)-protein induces rapid TLR2-mediated T cell activation in mouse lungs revealed by intravital lung microscopy 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.05.03.722459v1?rss=1"
</link>
<dc:creator>Shaalan, Y.</dc:creator>
<dc:creator>Kuruppu, N.</dc:creator>
<dc:creator>Orinska, Z.</dc:creator>
<dc:creator>Li, C.</dc:creator>
<dc:creator>Koops, F.</dc:creator>
<dc:creator>Wasnick, R.</dc:creator>
<dc:creator>Noessner, E.</dc:creator>
<dc:creator>Stoeger, T.</dc:creator>
<dc:creator>Meiners, S.</dc:creator>
<dc:creator>Rehberg, M.</dc:creator>
<dc:date>2026-05-04</dc:date>
<dc:identifier>doi:10.64898/2026.05.03.722459</dc:identifier>
<dc:title><![CDATA[SARS-CoV-2 (E)-protein induces rapid TLR2-mediated T cell activation in mouse lungs revealed by intravital lung microscopy]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Mounting evidence indicates that T cells can operate in an innate-like mode challenging the classical description of T cells as strictly adaptive immune effectors. T cells can engage innate pattern recognition receptors to mount rapid but antigen-nonspecific responses to infection or cellular stress. This study observed that CD8+ T cells, and to a lesser extent also CD4+ T cells, responded to viral proteins in the mouse lung quickly in an innate-like fashion. We employed intravital lung microscopy to visualize infiltration of CD8+ T cells into the lung following intratracheal instillation of the SARS-CoV-2 envelope (E)-protein. Here, we demonstrate acute recruitment of CD8+ from the pulmonary microcirculation into the lung as early as 4 and 24 hours after (E)-protein instillation. The acute infiltration of CD8+ T cells was not observed in Tlr2-/- mice. Immunohistochemistry analysis of mouse lungs revealed T cell accumulation in nodular inflammatory foci (NIF) of the lung at perivascular regions and around large airways. Stimulating spleen-derived CD8+ T cells from wild-type mice with (E)-protein ex vivo in combination with cytokines or TCR agonists significantly upregulated CD69 and activated secretion of interferon (IFN){gamma} which was not observed with CD8+ T cells isolated from Tlr2-/- mice. These findings indicate rapid bystander activation of CD8+ T cells by the SARS-CoV-2 envelope (E)-protein that depends on (E)-protein sensing by TLR2. This innate-like CD8+ T cell response to SARS-CoV-2 (E)-protein may offer novel opportunities for diagnostic and therapeutic development, warranting further investigation.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.30.721889v1?rss=1">
<title>
<![CDATA[
Single-cell atlas of transcript usage remodelling in antiviral immune responses across human populations 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.30.721889v1?rss=1"
</link>
<dc:creator>Chazarra-Gil, R.</dc:creator>
<dc:creator>Ripoll-Cladellas, A. R.-C.</dc:creator>
<dc:creator>Sopena-Rios, M.</dc:creator>
<dc:creator>Mestres-Pascual, I.</dc:creator>
<dc:creator>Calvo, M.</dc:creator>
<dc:creator>Reverter, F.</dc:creator>
<dc:creator>Garrido-Martin, D.</dc:creator>
<dc:creator>Mele, M.</dc:creator>
<dc:date>2026-05-04</dc:date>
<dc:identifier>doi:10.64898/2026.04.30.721889</dc:identifier>
<dc:title><![CDATA[Single-cell atlas of transcript usage remodelling in antiviral immune responses across human populations]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Humans exhibit substantial interindividual variation in their immune esponses to infection, yet the contribution of transcript usage -the relative abundance of gene isoforms- to this variation remains poorly understood. Here, we generate the first single-cell atlas of transcript usage variation during early responses to influenza A virus and SARS-CoV-2 across 160 individuals of African and European ancestry. We show that viral stimulation induces widespread remodelling of transcript usage across all major immune lineages, with changes that are largely lineage-restricted and frequently undetected at the gene expression level. We further find that ancestry-associated effects on transcript usage are redominantly cell type-specific and contribute to population differences in antiviral responses. In addition, the genetic regulation of transcript usage during stimulation differs between influenza A and SARS-CoV-2, pointing to virus-dependent regulatory architectures. Together, our findings establish transcript usage as a dynamic regulatory layer shaping responses to viral infection across immune cell types and human populations, providing new insights into the molecular basis of variation in human antiviral immunity.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.30.26352163v1?rss=1">
<title>
<![CDATA[
Early functional maturation of anti-Spike antibodies predicts SARS-CoV-2 RNA clearance in mild infection 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.30.26352163v1?rss=1"
</link>
<dc:creator>Rodrigues, D.</dc:creator>
<dc:creator>Araujo, B.</dc:creator>
<dc:creator>Pestana, J.</dc:creator>
<dc:creator>da Costa, L.</dc:creator>
<dc:creator>Andrade, M.</dc:creator>
<dc:creator>de Freitas, L.</dc:creator>
<dc:creator>Nery, B.</dc:creator>
<dc:creator>Bozza, V.</dc:creator>
<dc:creator>Conde, L.</dc:creator>
<dc:creator>Raposo, L.</dc:creator>
<dc:creator>Gama, A.</dc:creator>
<dc:creator>Mendes, V.</dc:creator>
<dc:creator>Cobos, E.</dc:creator>
<dc:creator>Higa, L.</dc:creator>
<dc:creator>Galliez, R.</dc:creator>
<dc:creator>Tanuri, A.</dc:creator>
<dc:creator>Ferreira, O.</dc:creator>
<dc:creator>Castilho, L.</dc:creator>
<dc:creator>Castineiras, T.</dc:creator>
<dc:creator>Echevarria, J.</dc:creator>
<dc:creator>Bozza, M.</dc:creator>
<dc:creator>Vale, A. M.</dc:creator>
<dc:date>2026-05-03</dc:date>
<dc:identifier>doi:10.64898/2026.04.30.26352163</dc:identifier>
<dc:title><![CDATA[Early functional maturation of anti-Spike antibodies predicts SARS-CoV-2 RNA clearance in mild infection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-03</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
SARS-CoV-2 infection exhibits heterogeneous viral clearance kinetics even in individuals with mild disease. The immunological determinants underlying rapid versus prolonged viral RNA detection remain incompletely defined. Here, we performed a three-year longitudinal analysis of 77 healthcare professionals infected with the ancestral Wuhan strain. Participants were stratified according to viral RNA clearance kinetics into non-persistent ([&le;]21 days) and persistent (>21 days) groups. Non-persistent individuals exhibited accelerated seroconversion to Spike and receptor-binding domain (RBD) antigens during the first 11 days after symptom onset. Early antibody responses were characterized by higher functional activity, including significantly greater neutralizing activity against the ancestral strain. In contrast, persistent individuals displayed delayed seroconversion, prolonged IgM responses, and weaker coordination among IgG subclasses, with less synchronized subclass responses, during early infection. Importantly, total immunoglobulin levels did not distinguish the groups. Cross-variant antibody recognition during acute infection was limited and largely strain-focused in both groups. During convalescence, durable anti-Spike IgG responses were maintained independently of persistence status, without significant differences in cross-variant breadth. Vaccination robustly amplified antibody titers, enhanced variant recognition, and sustained high-affinity responses in both groups. Together, our findings demonstrate that the timing and functional quality of early humoral maturation, reflected by neutralizing antibody activity, rather than antibody magnitude or breadth, are key determinants of SARS-CoV-2 RNA clearance in mild infection. These results highlight the importance of early neutralizing antibody generation in shaping acute viral control and the long-term immune architecture.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.30.722013v1?rss=1">
<title>
<![CDATA[
Modeling healthy proteomic profiles for anomaly detection using subspace learning based one-class classification 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.30.722013v1?rss=1"
</link>
<dc:creator>Sohrab, F.</dc:creator>
<dc:creator>Kumar, A.</dc:creator>
<dc:creator>Ahola, V.</dc:creator>
<dc:creator>Magis, A.</dc:creator>
<dc:creator>Hautamaki, V.</dc:creator>
<dc:creator>Heinaniemi, M.</dc:creator>
<dc:creator>Huang, S.</dc:creator>
<dc:date>2026-05-01</dc:date>
<dc:identifier>doi:10.64898/2026.04.30.722013</dc:identifier>
<dc:title><![CDATA[Modeling healthy proteomic profiles for anomaly detection using subspace learning based one-class classification]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
High-throughput plasma proteomics provides sensitive and scalable measurements of thousands of systemic protein profiles from minimally invasive blood samples, creating new opportunities for disease detection and population-scale health monitoring. However, robust statistical modeling remains challenging due to high dimensionality, limited availability and high diversity of diseased samples, resulting in class imbalance in clinical cohorts. Here, we present a subspace One-Class Classification (OCC) framework for proteomics-driven anomaly detection that models healthy proteomic profiles as a reference distribution. To address the limitations of conventional hyperparameter tuning in severely imbalanced data settings, we introduce a fully data-driven parameter estimation strategy that infers all model parameters directly from intrinsic properties of the healthy training data, without using any disease labels. Using plasma proteomics data generated with Olink, we evaluate a family of subspace and graph-embedded subspace extensions of Support Vector Data Description, in which all models operate on learned low-dimensional representations rather than the original feature space. Models are trained exclusively on a healthy reference cohort and evaluated on heterogeneous disease conditions, including multiple cancer types and an independent COVID-19 cohort, with all disease samples withheld from training to enable unbiased assessment of cross-disease generalization. Across disease contexts, the evaluated one-class models yield stable and balanced detection performance, demonstrating that learning structured low-dimensional representations of healthy proteomic variation captures intrinsic biological organization that generalizes across disease-specific perturbations. These results establish healthy-profile-based, subspace one-class learning as a robust and disease-agnostic framework for screening in high-dimensional plasma proteomics.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.29.26352072v1?rss=1">
<title>
<![CDATA[
Global burden of foreign bodies and impact of COVID-19 pandemic 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.29.26352072v1?rss=1"
</link>
<dc:creator>Simayi, F.</dc:creator>
<dc:date>2026-04-30</dc:date>
<dc:identifier>doi:10.64898/2026.04.29.26352072</dc:identifier>
<dc:title><![CDATA[Global burden of foreign bodies and impact of COVID-19 pandemic]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-30</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundForeign bodies (FBs) can cause obstruction, infection, or injury, yet comprehensive global assessments remain limited. This study evaluated the burden of FBs from 1990-2021, projected trends to 2050, and identified high-risk populations.

MethodsUsing Global Burden of Disease 2021 data, we estimated age-standardized incidence ratio (ASIR), death ratio (ASDR), and disability-adjusted life years (DALYs) by age, sex, and region. Temporal trends were assessed with estimated annual percentage change (EAPC) and Joinpoint regression; projections applied Bayesian age-period-cohort models; decomposition quantified the effects of aging, population, and epidemiological change.

ResultsFrom 1990-2021, global ASIR declined from 660.75 to 561.16 per 100,000 (EAPC: -0.84), ASDR from 2.11 to 1.41 (-1.47), and DALYs from 145.14 to 77.87 (- 2.13). Males had consistently higher burden (2021: 725.96 versus 394.11 per 100,000 in females). Children under 5 and adults over 80 bore the highest risks, with intraocular FBs dominating incidence and pulmonary aspiration/airway FBs driving mortality. Western Europe had the highest ASIR, Andean Latin America the highest ASDR. Since 2019, the onset of the COVID-19 pandemic, intraocular FBs incidence has surged in East Asia, mainly China. Projections suggest ASIR will continue to rise through 2050, while ASDR and DALYs continue to decline, driven by global population growth (187.27%) and aging (46.82%) but offset by epidemiological improvements (-134.09%).

ConclusionsDespite long-term declines, FB incidence is rebounding, with marked disparities across sex, age, and region. Targeted interventions, including workplace safety, pediatric and geriatric care, and region-specific policies, are needed to mitigate risks and reduce inequalities.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.29.721712v1?rss=1">
<title>
<![CDATA[
Proof-of-concept of targeted degradation of p38α/β MAPK host-kinase as a potent inhibitor of coronaviruses. 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.29.721712v1?rss=1"
</link>
<dc:creator>Cooper, G.</dc:creator>
<dc:creator>Snape, T. J.</dc:creator>
<dc:creator>Shivkumar, M.</dc:creator>
<dc:date>2026-04-30</dc:date>
<dc:identifier>doi:10.64898/2026.04.29.721712</dc:identifier>
<dc:title><![CDATA[Proof-of-concept of targeted degradation of p38α/β MAPK host-kinase as a potent inhibitor of coronaviruses.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-30</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Host-targeting antivirals offer a promising strategy for combating emerging viral threats by targeting cellular pathways required for infection. The p38 mitogen-activated protein kinase (MAPK) pathway has been implicated as a host dependency factor exploited by multiple viruses, including coronaviruses, making it an attractive antiviral target. Here, we show for the first time that targeted degradation of p38 using the proteolysis-targeting chimera (PROTAC) NR-7h potently inhibits coronavirus infection. NR-7h induced substantial degradation of p38 in multiple cell lines and inhibited infection of two seasonal coronaviruses OC43 and 229E, providing broad pan-coronavirus activity. Infectious viral titres and viral RNA levels were significantly reduced without any detectable cytotoxicity. NR-7h exhibited greater antiviral potency than conventional p38 small-molecule inhibitors, with an IC50 of 1.0 nM compared with 648.4 nM for LY2228820, while the parent kinase inhibitor PH-797804 did not achieve 50% inhibition at the highest concentration tested. Pseudovirus and time-of-addition studies indicated that antiviral activity occurred at a post-entry stage of infection. Importantly, antiviral activity was eliminated by inhibition of proteasome function or E3 ligase activity, demonstrating dependence on PROTAC-mediated degradation. Our findings provide a proof-of-concept that targeted degradation of host kinase p38 can function as an antiviral modality and suggest PROTAC-based host-directed therapeutics may offer advantages over conventional kinase inhibition for broad-spectrum antiviral development.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.27.26351870v1?rss=1">
<title>
<![CDATA[
Changing COVID-19 vaccine eligibility could reshape disease burden for all 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.27.26351870v1?rss=1"
</link>
<dc:creator>Larsen, S. L.</dc:creator>
<dc:creator>Martinez, P. P.</dc:creator>
<dc:creator>Mahmud, A.</dc:creator>
<dc:date>2026-04-29</dc:date>
<dc:identifier>doi:10.64898/2026.04.27.26351870</dc:identifier>
<dc:title><![CDATA[Changing COVID-19 vaccine eligibility could reshape disease burden for all]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-29</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
COVID-19 vaccine recommendations are evolving in the United States. While older adults are most at risk of severe COVID-19 outcomes and therefore experience the greatest direct benefits of vaccination, limiting vaccination to only this age group could worsen outcomes in this higher-risk population. Here, we leveraged data from a statewide survey in Illinois to inform transmission models accounting for contact and vaccination rates across age. Simulating a single season of COVID-19 transmission, we compared deaths under existing vaccination coverage against counterfactual scenarios where individuals under 5 or under 65 were never vaccinated. We find substantial indirect vaccine impacts for older adults. Our results suggest that existing vaccination coverage among younger people is mitigating COVID-19 mortality for older populations. These findings can provide insights into the long-term consequences of deprioritizing young adults and children from vaccination campaigns, and suggest that a lack of vaccine-induced immunity may impact outcomes in other age groups. This underscores the importance of considering indirect vaccine impacts when developing policy.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.28.26351941v1?rss=1">
<title>
<![CDATA[
Detection and characterization of single SARS-CoV-2 viral particles by flow virometry 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.28.26351941v1?rss=1"
</link>
<dc:creator>Jungbauer-Groznica, M.</dc:creator>
<dc:creator>Commere, P.-H.</dc:creator>
<dc:creator>Cottignies-Calamarte, A.</dc:creator>
<dc:creator>De Cruz, A.</dc:creator>
<dc:creator>Fantin, A.</dc:creator>
<dc:creator>Planchais, C.</dc:creator>
<dc:creator>Guivel-Benhassine, F.</dc:creator>
<dc:creator>Staropoli, I.</dc:creator>
<dc:creator>Schmutz, S.</dc:creator>
<dc:creator>Novault, S.</dc:creator>
<dc:creator>Veyer, D.</dc:creator>
<dc:creator>Pere, H.</dc:creator>
<dc:creator>Mouquet, H.</dc:creator>
<dc:creator>Schwartz, O.</dc:creator>
<dc:creator>Bruel, T.</dc:creator>
<dc:date>2026-04-29</dc:date>
<dc:identifier>doi:10.64898/2026.04.28.26351941</dc:identifier>
<dc:title><![CDATA[Detection and characterization of single SARS-CoV-2 viral particles by flow virometry]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-29</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Virus infected cells release viral particles, which have variable protein content and are functionally diverse. Deciphering this heterogeneity remains a challenge. Here, we adapt flow virometry to detect and phenotype severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) particles. In supernatants of infected cells, we observe particles measuring 70-100 nm. The appearance of these particles is associated to the increase in viral RNA and infectivity. Sample inactivation using temperature or detergent leads to the disappearance of these particles. Using antibodies and dyes for lipid membranes and nucleic acids, we detect the spike protein, the lipid envelope and the RNA genome. We further confirm the presence of viral particles by electron microscopy. Analyzing different viral preparations demonstrate that spike detection in particles outcompetes particle concentration to predict infectivity. Antibodies against different spike epitopes enable probing of spike conformation changes in the presence of soluble ACE2. Lastly, we detect SARS-CoV-2 particles in PCR-confirmed patient nasal swabs without prior purification steps. In summary, we developed an efficient framework to detect and characterize single SARS-CoV-2 particles.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.28.26351994v1?rss=1">
<title>
<![CDATA[
COVID-19 onset, stay-at-home orders, and racialized inequities in homicide mortality across the US 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.28.26351994v1?rss=1"
</link>
<dc:creator>Tanveer, M.</dc:creator>
<dc:creator>Santaularia Gomez, N. J.</dc:creator>
<dc:creator>Vinita Fitch, K.</dc:creator>
<dc:creator>Holmes, M.</dc:creator>
<dc:creator>Moracco, K. E.</dc:creator>
<dc:creator>Dolan, M.</dc:creator>
<dc:creator>Fulcher, N.</dc:creator>
<dc:creator>Ranapurwala, S. I.</dc:creator>
<dc:date>2026-04-29</dc:date>
<dc:identifier>doi:10.64898/2026.04.28.26351994</dc:identifier>
<dc:title><![CDATA[COVID-19 onset, stay-at-home orders, and racialized inequities in homicide mortality across the US]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-29</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
We examined the impact of COVID-19 pandemic onset (2020 April) on homicide mortality in the United States.

We conducted a single interrupted time series analysis using homicide events from the National Vital Statistics System that occurred over six years (2017-2022), with COVID-19 onset as an interruption. Monthly homicide deaths rates were calculated per 100,000 person-years to create a monthly time series. We used autoregressive integrated moving average regression, adjusted for seasonality, to model the immediate and sustained trend changes in the homicide mortality rate ratios due to the pandemic. We stratified models by length of stay-at-home order, race and ethnicity, sex, age, and weapon used to examine effect measure modification.

In Jan 2017, the US homicide mortality rate was 5.9/100,000 PY. While there were annual seasonal changes, the overall time trend before April 2020 was stable. However, with COVID-19 onset, the overall homicide mortality rate ratio increased by 32% (95% CI: 0.23, 0.41), which persisted through 2022 without additional trend changes, but with seasonal variations. Immediate increases with stable sustained trends in homicide rates were also observed in most stratified analyses.

COVID-19 pandemic onset is associated with US homicide mortality rates immediately increasing and remaining stable and higher afterwards.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.27.721131v1?rss=1">
<title>
<![CDATA[
Naturally occurring ACE2 stalk variants are differentially released from the cell. 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.27.721131v1?rss=1"
</link>
<dc:creator>Wiersch, F.</dc:creator>
<dc:creator>Lux, C.</dc:creator>
<dc:creator>Vanderliek-Kox, J.</dc:creator>
<dc:creator>Schun, K.</dc:creator>
<dc:creator>Ludwig, A.</dc:creator>
<dc:creator>Dusterhoft, S.</dc:creator>
<dc:date>2026-04-29</dc:date>
<dc:identifier>doi:10.64898/2026.04.27.721131</dc:identifier>
<dc:title><![CDATA[Naturally occurring ACE2 stalk variants are differentially released from the cell.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-29</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Angiotensin-converting enzyme 2 (ACE2) is a key regulator of the renin-angiotensin-aldosterone system (RAAS). It also acts as a receptor for SARS-CoV-2 and stabilises the B0AT1 amino acid transporter at the cell surface. Therefore, surface expression of ACE2 is crucial for these physiological processes. ACE2 is released as a soluble, catalytically active form, partly through ectodomain shedding. This process mainly involves the sheddases ADAM10 and ADAM17, but the exact regulatory mechanisms remain unclear.

We assessed 11 naturally occurring single-point mutations in the ACE2 stalk region. Most variants showed significantly reduced release compared to wild-type (WT) ACE2; however, the single point mutations P734L and G726R significantly increased their release. ACE2_P734L also exhibits higher surface expression, directly increasing the surface levels of B0AT1. Despite B0AT1 and ACE2 forming a tight tetrameric complex, this did not affect ACE2 shedding. This suggests that complex formation does not restrict sheddase access.

Overall, these data identify the ACE2 stalk region as a major determinant of shedding efficiency. Naturally occurring variants in this region can substantially affect the release of soluble ACE2, potentially contributing to interindividual differences that are relevant for pathophysiological processes.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.27.721205v1?rss=1">
<title>
<![CDATA[
T-cell repertoire response in individuals with post-acute sequelae of COVID-19 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.27.721205v1?rss=1"
</link>
<dc:creator>Montague, Z.</dc:creator>
<dc:creator>Grover, R. M.</dc:creator>
<dc:creator>Baumgartner, A.</dc:creator>
<dc:creator>Trofimov, A.</dc:creator>
<dc:creator>Hadlock, J.</dc:creator>
<dc:creator>Nourmohammad, A.</dc:creator>
<dc:date>2026-04-29</dc:date>
<dc:identifier>doi:10.64898/2026.04.27.721205</dc:identifier>
<dc:title><![CDATA[T-cell repertoire response in individuals with post-acute sequelae of COVID-19]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-29</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
T-cells are central to SARS-CoV-2 clearance and immunological memory, yet their contribution to the persistence of post-acute sequelae of COVID-19 (PASC) remains poorly understood. The immunological features that distinguish individuals who develop PASC from those who recover fully are unresolved, in part due to the phenotypic heterogeneity of the condition and the likely multiplicity of its underlying mechanisms. Here, we profiled longitudinal bulk TCR{beta} repertoires from 120 individuals in the INCOV cohort-71 with PASC and 49 without-sampled at two to three time points spanning the acute and post-acute phases of infection. Using robust statistical modeling of repertoire composition and clonal dynamics, we found that global statistics such as V, J gene usage and CDR3 length do not differ between groups, but that locally enriched sequence motifs and differentially dynamic clones reveal distinct T-cell signatures associated with PASC status. Clones contracting following the peak of the acute response were significantly enriched for SARS-CoV-2 specificity in both groups. Interestingly, Influenza A-specific TCRs were disproportionately enriched among contracting clones in PASC+ repertoires, implicating viral co-infection as a potential contributor to early disease severity and, possibly, PASC pathogenesis. Rare public TCR clones were markedly enriched for SARS-CoV-2 specificity, with PASC+ individuals harboring a modestly but significantly higher proportion than PASC- individuals. Together, we identified over 1,000 candidate TCR{beta} receptors potentially discriminating PASC+ from PASC- immune responses, opening a path toward the identification of disease-relevant T-cell specificities and the development of T-cell-based immunological biomarkers for long COVID.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.27.26351858v1?rss=1">
<title>
<![CDATA[
A Deterministic-Stochastic Model for COVID-19 and Malaria Co-Infection with Malaria-Acquired Partial Immunity 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.27.26351858v1?rss=1"
</link>
<dc:creator>Idowu, K. O.</dc:creator>
<dc:creator>Lin, G.</dc:creator>
<dc:date>2026-04-28</dc:date>
<dc:identifier>doi:10.64898/2026.04.27.26351858</dc:identifier>
<dc:title><![CDATA[A Deterministic-Stochastic Model for COVID-19 and Malaria Co-Infection with Malaria-Acquired Partial Immunity]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-28</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Coinfection of COVID-19 and malaria in endemic regions may generate complex epidemiological interactions that influence susceptibility patterns, disease burden, and outbreak risk. Although malaria-acquired immunity has been hypothesized to modulate host responses to other infections, its population-level implications for COVID-19 transmission under uncertainty remain insufficiently understood. In this study, we develop a deterministic-stochastic compartmental model for the coupled dynamics of COVID-19, malaria, and their co-infection. Malaria-acquired partial immunity is incorporated through a relative susceptibility parameter that reduces the risk of COVID-19 infection among malaria-recovered individuals.

For the deterministic system, we establish positivity, boundedness, an invariant feasible region, and basic reproduction numbers for the COVID-19-only and malaria-only subsystems. We then use numerical simulations to examine how immunity-mediated reductions in susceptibility may influence COVID-19 incidence, peak burden, hospitalization, and cumulative mortality. To account for environmental and transmission variability, we extend the deterministic model to an Ito stochastic differential equation framework and use repeated realizations to characterize uncertainty in epidemic trajectories, peak distributions, and outbreak risk. In addition, global sensitivity analysis based on partial rank correlation coefficients (PRCCs) is performed to identify the parameters with the greatest influence on COVID-19 outcomes.

Our results suggest that, under the assumed modeling framework, malaria-acquired partial immunity may reduce the peak infectious burden and cumulative mortality associated with COVID-19. The stochastic simulations further show substantial variability around deterministic trajectories and indicate a non-negligible probability of large outbreak events that are not fully captured by mean-field predictions alone. Overall, the proposed framework provides an uncertainty-aware, mechanistic basis for studying COVID-19-malaria co-dynamics and for assessing how interacting disease processes may shape epidemic outcomes in endemic settings.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.28.721328v1?rss=1">
<title>
<![CDATA[
Distinct virus-derived circular RNA molecule influences host response during SARS-CoV-2 infection 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.28.721328v1?rss=1"
</link>
<dc:creator>Grossi-Soyster, E. N.</dc:creator>
<dc:creator>Gullberg, R. C.</dc:creator>
<dc:creator>Rustagi, A.</dc:creator>
<dc:creator>Lee, J. S.</dc:creator>
<dc:creator>Blish, C. A.</dc:creator>
<dc:creator>Cherry, S.</dc:creator>
<dc:creator>Salzman, J.</dc:creator>
<dc:creator>Sarnow, P.</dc:creator>
<dc:date>2026-04-28</dc:date>
<dc:identifier>doi:10.64898/2026.04.28.721328</dc:identifier>
<dc:title><![CDATA[Distinct virus-derived circular RNA molecule influences host response during SARS-CoV-2 infection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-28</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Virus-derived circular RNA molecules (VcircRNAs) are expressed by many RNA viruses during infection. Putative functions include modulating viral replication and interacting with the host immune response. Some function as non-coding RNA fragments that regulate gene expression through binding to complementary RNA sequences, whereas others contain internal ribosomal entry site (IRES) sequences or non-canonical modifications that allow them to be translated. Here, we confirm the expression of a distinct SARS-CoV-2 VcircRNA molecule, circ7b8N, that has not been previously identified. We found that circ7b8N is expressed and detectable in cell culture infections and in acute infections across SARS-CoV-2 variants and shows promise for detection in post-acute clinical samples. Conservation of circ7b8N junctions is limited to the nearest phylogenetic relatives within the betacoronavirus genus but are present in other human and bat-infecting coronaviruses. Host cell gene expression is modulated by the treatment with circ7b8N agnostic of viral infection. The discovery and subsequent confirmation of circ7b8N expressed by SARS-CoV-2 provides a new biomarker for infection, and its conservation across variants suggests functional importance.

Author SummaryCircular RNAs are a well-documented class of molecules expressed by mammalian cells. However, circular RNA molecules expressed by RNA viruses remain largely uncharacterized regarding their generation, specific functions, and roles in host-pathogen interactions. Our computational predictions discovered thousands of distinct circular RNA molecules expressed by SARS-CoV-2. Among these, we confirmed the presence of circ7b8N, the most abundant SARS-CoV-2-derived circular RNA identified in our sequencing data. We found that circ7b8N localizes outside the nucleus and is detectable in clinical samples collected both during and after acute SARS-CoV-2 infection. Although overexpression of circ7b8N was not found to alter viral titers, it modulated the expression of host genes related to immune response activation and membrane remodeling. This suggests that circ7b8N may simultaneously provide pro- and anti-viral functions independent of influencing viral replication. Phylogenetic analyses of coronaviruses suggest that the expression of circ7b8N is a relatively recent evolutionary event, and it is conserved across SARS-CoV-2 variants from the first five years of the pandemic. The abundant presence of circ7b8N across variants in both sequencing data and clinical samples implies it plays a multifaceted role in SARS-CoV-2 pathogenesis.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.24.26351694v1?rss=1">
<title>
<![CDATA[
Disentangling Fatigue from Depression among Survivors of Severe COVID-19 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.24.26351694v1?rss=1"
</link>
<dc:creator>Cabrera, J. R.</dc:creator>
<dc:creator>Pham, P.</dc:creator>
<dc:creator>Boscardin, W. J.</dc:creator>
<dc:creator>Makam, A. N.</dc:creator>
<dc:date>2026-04-27</dc:date>
<dc:identifier>doi:10.64898/2026.04.24.26351694</dc:identifier>
<dc:title><![CDATA[Disentangling Fatigue from Depression among Survivors of Severe COVID-19]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-27</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
PurposeSurvivors of severe COVID-19 commonly experience post-intensive care syndrome (PICS), which includes depression and fatigue. Fatigue is far more common and may inflate depression severity given overlapping symptoms. We sought to disentangle fatigue from depression in PICS.

MethodsWe conducted a cross-sectional analysis of the RAFT COVID study, a national multicenter longitudinal cohort of severe prolonged COVID-19 survivors. We included participants who completed validated surveys at 1-year from hospitalization for depression (PHQ-9) and fatigue (FACIT-Fatigue). We described correlation of FACIT-fatigue with the PHQ9, and separately with PHQ-2 and PHQ-7, which both omit the two items we hypothesized are influenced by fatigue--tiredness and sleeping. Using a MIMIC model, we performed differential item functioning to evaluate the impact of fatigue on depression directly through these two questions and indirectly with the latent depression construct. We then compared PHQ-7 to PHQ-9 scores by fatigue status.

ResultsAmong 82 participants, 61.0% reported fatigue (reverse-scored FACIT-Fatigue [&ge;]9), and 15.9% moderately severe depression (PHQ-9 [&ge;]10). FACIT-fatigue was strongly correlated with PHQ-9 (r=.87, p<.001), but less so for PHQ-2 (r=.76, p<.001) and PHQ-7 (r=.82, p<.001). The MIMIC model identified significant direct effects on tiredness ({lambda}=.89, p<.001) and sleep ({lambda}=.52, p<.001). Among fatigued participants, the rescaled PHQ-7 was lower than the PHQ-9 (median of 4.5, IQR 1.50-9.75, vs 7, IQR 4-9.75).

ConclusionsFatigue significantly inflated depression symptoms in severe COVID-19 survivors through tiredness and sleeping PHQ-9 items. PHQ-2 may better screen for true depressive symptoms in PICS, minimizing the risk of misdiagnosis and overtreatment.

PLAIN ENGLISH SUMMARYSurvivors of severe COVID-19 illness commonly experience post-intensive care syndrome (PICS), which includes depression and fatigue. Fatigue is far more common and may inflate depression severity given overlapping symptoms. We sought to disentangle fatigue from depression in PICS. We found that the presence of fatigue inflated depression severity through symptoms of tiredness and difficulty sleeping, which are two of the nine items of a commonly used depression screening tool, known as the Patient Health Questionnaire-9 (PHQ-9). Depression screening tools that omit these two items, such as the PHQ-2, may better screen for depressive symptoms in PICS, minimizing the risk of overestimating depression symptoms and potentially misdiagnosis.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.27.721040v1?rss=1">
<title>
<![CDATA[
Inhibiting the interaction between the mitochondrial receptor Tom70 and SARS CoV 2 Orf9b with small molecules 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.27.721040v1?rss=1"
</link>
<dc:creator>San Felipe, C.</dc:creator>
<dc:creator>Verba, K. A.</dc:creator>
<dc:creator>Krogan, N. J.</dc:creator>
<dc:creator>Grabe, M.</dc:creator>
<dc:creator>Fraser, J. S.</dc:creator>
<dc:date>2026-04-27</dc:date>
<dc:identifier>doi:10.64898/2026.04.27.721040</dc:identifier>
<dc:title><![CDATA[Inhibiting the interaction between the mitochondrial receptor Tom70 and SARS CoV 2 Orf9b with small molecules]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-27</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The SARS CoV 2 accessory protein Orf9b is in a complex monomer-dimer equilibrium that influences its interactions with the host mitochondrial receptor Tom70. This interaction is critical for viral suppression of a Type-1 interferon response during infection. Modulating this equilibrium with a small molecule, either by stabilizing the Orf9b dimer or blocking its interaction with Tom70, represents a promising strategy for restoring interferon signaling and the antiviral response. To build tool molecules that could test this concept, we performed two screens: a crystallographic fragment screen against the Orf9b homodimer and a high-throughput fluorescence polarization screen for competitors of an Orf9b-derived peptide binding to Tom70. Fragment screening revealed two binding sites with potential to be developed into an inhibitor: one located at the peripheral dimer interface and the other just outside the lipid-binding channel that defines the central dimer interface. Functionalization of the fragments outside of the lipid-binding channel with hydrophobic moieties stabilized the Orf9b dimer thereby indirectly inhibiting association with Tom70. In parallel, the high throughput screen for competitive inhibitors of the Tom70:Orf9b interaction discovered a separate series of molecules. These molecules display dynamic structure activity relationship (SAR) and could be improved in the future to modulate the interaction between Tom70 and potentially a wide range of substrates. Collectively, these results demonstrate the feasibility of two distinct strategies to manipulate the Orf9b-Tom70 equilibrium, which is critical to the host response to SARS CoV 2 infection.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.21.26350610v1?rss=1">
<title>
<![CDATA[
Identifying clinician perceived priorities for a real-time wearable system for in-hospital monitoring: findings and evolutions following the COVID-19 pandemic 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.21.26350610v1?rss=1"
</link>
<dc:creator>Vollam, S.</dc:creator>
<dc:creator>Roman, C.</dc:creator>
<dc:creator>King, E.</dc:creator>
<dc:creator>Tarassenko, L.</dc:creator>
<dc:date>2026-04-24</dc:date>
<dc:identifier>doi:10.64898/2026.04.21.26350610</dc:identifier>
<dc:title><![CDATA[Identifying clinician perceived priorities for a real-time wearable system for in-hospital monitoring: findings and evolutions following the COVID-19 pandemic]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-24</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
A Wearable Monitoring System (WMS), comprising a chest patch, wrist-worn pulse oximeter, and arm-worn blood pressure device, was developed in preparation for a pilot Randomised Controlled Trial (RCT) on a UK surgical ward. The system was designed to support continuous physiological monitoring and early detection of deterioration.

An initial prototype user interface was developed by the research team based on prior clinical experience and engineering knowledge. To ensure suitability for clinical practice, iterative user-centred refinement was undertaken through a series of clinician focus groups and wearability assessments. Six focus groups were conducted between November 2019 and May 2021 involving multidisciplinary healthcare professionals. Feedback from these sessions informed successive interface and system modifications.

System development spanned the COVID-19 pandemic, during which the WMS was rapidly adapted and deployed to support clinical care on isolation wards. Feedback obtained during this period was incorporated into later versions of the system and provided a unique opportunity to examine changes in clinician priorities under pandemic conditions.

Clinicians consistently prioritised alert visibility, alarm fatigue mitigation, parameter flexibility, and centralised monitoring. Notably, preferences regarding alert modality and access mechanisms evolved over time: early enthusiasm for mobile or smartphone-type devices shifted towards a preference for fixed, ward-based displays and audible alerts at the nurses station following pandemic deployment.

Building on previous wearability testing in healthy volunteers, wearability testing using a validated questionnaire was completed by 169 patient participants during the RCT. The chest patch and pulse oximeter demonstrated high tolerability, whereas the blood pressure cuff showed poor wearability and was removed from the final system.

These findings demonstrate the importance of iterative, clinician-led design for wearable WMS and highlight how extreme clinical contexts such as the COVID-19 pandemic can significantly reshape perceived requirements for safety-critical monitoring technologies.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.22.26351531v1?rss=1">
<title>
<![CDATA[
Identifying SARS-CoV-2 Lineages that Share the Same Relative Effective Reproduction Numbers 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.22.26351531v1?rss=1"
</link>
<dc:creator>Musonda, R.</dc:creator>
<dc:creator>Ito, K.</dc:creator>
<dc:creator>Omori, R.</dc:creator>
<dc:creator>Ito, K.</dc:creator>
<dc:date>2026-04-24</dc:date>
<dc:identifier>doi:10.64898/2026.04.22.26351531</dc:identifier>
<dc:title><![CDATA[Identifying SARS-CoV-2 Lineages that Share the Same Relative Effective Reproduction Numbers]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-24</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continuously evolved since its emergence in the human population in 2019. As of 1st August 2025, more than 1,700 Omicron subvariants have been designated by the Pango nomenclature system. The Pango nomenclature system designates a new lineage based on genetic and epidemiological information of SARS-CoV-2 strains. However, there is a possibility that strains that have similar genetic backgrounds and the same phenotype are given different Pango lineage names. In this paper, we propose a new algorithm, called FindPart-w, which can identify groups of viral lineages that share the same relative effective reproduction numbers. We introduced a new lineage replacement model, called the constrained RelRe model, which constrains groups of lineages to have the same relative effective reproduction numbers. The FindPart-w algorithm searches the equality constraints that minimise the Akaike Information Criterion of constrained RelRe models. Using hypothetical observation count data created by simulation, we found that the FindPart-w algorithm can identify groups of lineages having the same relative effective reproduction number in a practical computational time. Applying FindPart-w to actual real-world data of time-stamped lineage counts from the United States, we found that the Pango lineage nomenclature system may have given different lineage names to SARS-CoV-2 strains even if they have the same relative effective reproduction number and similar genetic backgrounds. In conclusion, this study showed that viruses that had the same relative effective reproduction number were identifiable from temporal count data of viral sequences. These findings will contribute to the future development of lineage designation systems that consider both genetic backgrounds and transmissibilities of lineages.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.22.720035v1?rss=1">
<title>
<![CDATA[
Bacteriocin Diversity and Antiviral Potential of Lactiplantibacillus pentosus from Fermented Rice. 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.22.720035v1?rss=1"
</link>
<dc:creator>Cheruvari, A.</dc:creator>
<dc:creator>kammara, R.</dc:creator>
<dc:date>2026-04-24</dc:date>
<dc:identifier>doi:10.64898/2026.04.22.720035</dc:identifier>
<dc:title><![CDATA[Bacteriocin Diversity and Antiviral Potential of Lactiplantibacillus pentosus from Fermented Rice.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-24</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Fermentation is a long-standing tradition on the Indian subcontinent, shaped by local cultures and resources. Regional ingredients create a variety of fermented foods rich in probiotics. Lactiplantibacillus pentosus, found in foods like olives, grains, and vegetables, is a key strain. We studied the genome of L. pentosus from traditional fermented rice in Himachal Pradesh, India, and compared it to 95 global genomes. Our focus was on antimicrobial compounds, especially bacteriocins, which improve food safety. KEGG analysis revealed important metabolic proteins, while BPGA showed genome sizes of 3.4-4 Mb and GC content of 45.5-46%. The Indian L. pentosus strain (krglsrbmofpi2) uniquely contains three bacteriocins: Pentoplantaricin-EF, Pentobovicin, and Pentopediocin. Docking studies assessed their antiviral potential. Pentoplantaricin-EF showed the strongest binding to the prefusion 2019-nCoV spike glycoprotein (PDB 6VSB), while Pentobovicin had the highest affinity for the Omicron spike protein (PDB 7T9J) and the Hepatitis E virus E2 domain (PDB 3RKC).
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.22.720112v1?rss=1">
<title>
<![CDATA[
Proximity proteomics reveals a role for IFI16 during human coronavirus infection 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.22.720112v1?rss=1"
</link>
<dc:creator>Languon, S.</dc:creator>
<dc:creator>Bailey, I.</dc:creator>
<dc:creator>Sorensen, M.</dc:creator>
<dc:creator>Miller, Z. D.</dc:creator>
<dc:creator>Sha, J.</dc:creator>
<dc:creator>Dearborn, J.</dc:creator>
<dc:creator>Dowell, W.</dc:creator>
<dc:creator>Kirch, T.</dc:creator>
<dc:creator>Wohlschlegel, J.</dc:creator>
<dc:creator>MAJUMDAR, D.</dc:creator>
<dc:date>2026-04-23</dc:date>
<dc:identifier>doi:10.64898/2026.04.22.720112</dc:identifier>
<dc:title><![CDATA[Proximity proteomics reveals a role for IFI16 during human coronavirus infection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-23</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Viruses rely on the infected host cell to ensure successful replication and propagation of infection. This is achieved through interactions between virus-encoded proteins and proteins expressed in infected cells. All human coronaviruses (HCoVs) encode 16 non-structural proteins (NSPs) which exhibit some level of similarity in identity and function among the HCoVs. To identify host proteins that are potential interacting partners of HCoV NSPs, we utilized split-TurboID along with mass spectrometry and identified IFN-{gamma}-inducible protein-16 (IFI16) as a proximal partner of SARS-CoV-2 NSP8 and NSP10. To investigate the significance of the association between the NSP8/NSP10 complex and IFI16, we utilized CRISPR-Cas9 to knockout and CRISPRi to knockdown IFI16 in A549 cells and demonstrated that loss or reduced expression of IFI16 leads to a decrease in human coronavirus infection. We further demonstrated that there is reduced viral RNA replication and viral protein synthesis upon loss of IFI16. Interestingly, the loss of IFI16 results in reduced expression of type I IFNs. Taken together, these data suggests that IFI16 promotes human coronavirus infection, and the role IFI16 plays in coronavirus replication is independent of its role as a regulator of type I IFN gene expression.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.21.26351402v1?rss=1">
<title>
<![CDATA[
Diagnostic Classification for Long Covid Patients identifying Persistent Virus and Hyperimmune Pathophysiologies 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.21.26351402v1?rss=1"
</link>
<dc:creator>James-Pemberton, P.</dc:creator>
<dc:creator>Harper, D.</dc:creator>
<dc:creator>Wagerfield, P.</dc:creator>
<dc:creator>Watson, C.</dc:creator>
<dc:creator>Hervada, L.</dc:creator>
<dc:creator>Kohli, S.</dc:creator>
<dc:creator>Alder, S.</dc:creator>
<dc:creator>Shaw, A.</dc:creator>
<dc:date>2026-04-22</dc:date>
<dc:identifier>doi:10.64898/2026.04.21.26351402</dc:identifier>
<dc:title><![CDATA[Diagnostic Classification for Long Covid Patients identifying Persistent Virus and Hyperimmune Pathophysiologies]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
A multiplex diagnostic test is evaluated for self-reported long COVID associated persistent symptoms and a poor recovery from a SARS-CoV-2 infection. A mass-standardised concentration of total antibodies (AC), high-quality (HQ) antibodies and percentage of HQ antibodies (HQ%) is assessed against a spectrum of spike proteins to the SARS-CoV-2 variants: Wuhan, , {delta}, and the Omicron variants BA.1, BA.2, BA.2.12.1, BA.2.75, BA.5, CH.1.1, BQ.1.1 and XBB.1.5 in three cohorts. A cohort of control patients (n = 46) recovered (CC) and a cohort of self-declared long COVID patients (n = 113) (LCC). A nested Receiver Operating Characteristic (ROC) analysis, performed for the variant with lowest HQ concentration in the spectrum, produced an area under the curve and AUC = 0.61 (0.53-0.70) for the CC vs LCC cohorts. For the LCC cohort, the cut-off thresholds for AC = 0.8 mg/L, HQ = 1.5 mg/L and HQ% of 34% were determined, leading to a 71% sensitivity and 66% specificity derived by the Youden metric. The cohorts may be fully classified based on ROC and outlier analysis to give an incidence of persistent virus 62% (95% CI 52% - 71%), hyperimmune 12% (95% CI 7% - 20%) and unclassified, 26% (95% CI 18% - 35%). The overall diagnostic accuracy for both the hyper and hypo immune is 69%. All clinical interventions can now be tailored for the heterogenous long COVID patient cohort.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.20.719671v1?rss=1">
<title>
<![CDATA[
Unique nasal cell states induced by common pediatric respiratory viruses 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.20.719671v1?rss=1"
</link>
<dc:creator>Walsh, J. M. L.</dc:creator>
<dc:creator>Juttukonda, L. J.</dc:creator>
<dc:creator>Tang, Y.</dc:creator>
<dc:creator>Chatterjee, A.</dc:creator>
<dc:creator>Elosua-Bayes, M.</dc:creator>
<dc:creator>Langan, E.</dc:creator>
<dc:creator>Frischmann, A.</dc:creator>
<dc:creator>Taliaferro, F.</dc:creator>
<dc:creator>Matthews, H. R.</dc:creator>
<dc:creator>Kimler, K.</dc:creator>
<dc:creator>Lent, C. M.</dc:creator>
<dc:creator>Purna Keya, D.</dc:creator>
<dc:creator>Chondrow Dev, P.</dc:creator>
<dc:creator>Rajib Malaker, A.</dc:creator>
<dc:creator>Tanvia, L.</dc:creator>
<dc:creator>Mohammad Tanmoy, A.</dc:creator>
<dc:creator>Ghosh, S.</dc:creator>
<dc:creator>Maitra, A.</dc:creator>
<dc:creator>Ghosh, A.</dc:creator>
<dc:creator>Basu, S.</dc:creator>
<dc:creator>Kane, A. S.</dc:creator>
<dc:creator>Coomer, C. A.</dc:creator>
<dc:creator>Shalek, A. K.</dc:creator>
<dc:creator>de Silva, T. I.</dc:creator>
<dc:creator>Sesay, A. K.</dc:creator>
<dc:creator>Edwards, J.</dc:creator>
<dc:creator>Sin Quee, C.</dc:creator>
<dc:creator>Gonzalez, W. I.</dc:creator>
<dc:creator>Yonker, L. M.</dc:creator>
<dc:creator>Glover, S. C.</dc:creator>
<dc:creator>Majumder, P.</dc:creator>
<dc:creator>Hooda, Y.</dc:creator>
<dc:creator>Saha, S.</dc:creator>
<dc:creator>Ordovas-Montanes, J.</dc:creator>
<dc:creator>Horwitz, B. H.</dc:creator>
<dc:date>2026-04-22</dc:date>
<dc:identifier>doi:10.64898/2026.04.20.719671</dc:identifier>
<dc:title><![CDATA[Unique nasal cell states induced by common pediatric respiratory viruses]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Respiratory viral infections in early childhood are major drivers of acute morbidity and long-term airway disease, yet how distinct viruses remodel the pediatric nasal mucosa at cellular resolution remains unresolved. Here, we generated a single-cell RNA sequencing atlas of 335,174 nasal epithelial and immune cells from 132 children under five years of age with SARS-CoV-2, rhinovirus, or respiratory syncytial virus (RSV) infection, alongside uninfected controls. Mapping viral transcripts to individual cells revealed virus-specific infected epithelial states: an NF-kB-responsive ciliated subset in SARS-CoV-2 and a previously undescribed KRT17+ squamous-like subset in RSV. We delineated divergent mucosal response programs, including a robust interferon (IFN) response in SARS-CoV-2, an IL-13-responsive secretory program in rhinovirus, and heightened inflammatory and cytotoxic immune activation in RSV. In RSV, specific immune subsets and elevated IFN-response signatures were associated with disease severity, whereas rhinovirus-induced wheeze was marked by expansion of a CST1+ goblet cell subset. Integration of asthma genome-wide association data with our atlas revealed a KRT13+ hillock-like squamous epithelial subset enriched for expression of childhood-onset asthma risk loci. Finally, we demonstrate that this resource enables high-resolution annotation of independent pediatric cohorts in Kolkata, India and rural Bangladesh. Together, this atlas establishes a comprehensive view of antiviral immunity in the pediatric nasal mucosa and defines virus-specific mucosal immune programs relevant to disease severity and asthma risk in early life.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.20.719543v1?rss=1">
<title>
<![CDATA[
Long-range allosteric communication, double mutant cycles, and energetic coupling in SARS-CoV-2 spike protein 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.20.719543v1?rss=1"
</link>
<dc:creator>Lucas, A.</dc:creator>
<dc:creator>Rayaprolu, V.</dc:creator>
<dc:creator>Mallela, K.</dc:creator>
<dc:date>2026-04-22</dc:date>
<dc:identifier>doi:10.64898/2026.04.20.719543</dc:identifier>
<dc:title><![CDATA[Long-range allosteric communication, double mutant cycles, and energetic coupling in SARS-CoV-2 spike protein]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
SARS-CoV-2 spike protein is continuously evolving, leading to new variants. While mutations in the receptor-binding domain (RBD) enhance binding to the ACE2 receptor and evade neutralizing antibodies, the function of mutations in the N-terminal domain (NTD) remains poorly understood. Using two independent methods, surface plasmon resonance (SPR) and cryo-EM, we show that NTD mutations increase the population of spike protein with the RBD in the "up" conformational state. SPR association and dissociation kinetics of spike binding to ACE2 and antibodies, analyzed using a coupled equilibrium model, determined the relative populations and indicated that the RBD-up-to-down transition is rate-limiting relative to the RBD-down-to-up transition. Advanced model fitting of cryo-EM Coulomb potential maps confirmed the populations. The combined effect of NTD and RBD mutations exceeds the sum of their individual effects, indicating long-range allosteric communication and energetic coupling within the spike protein.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.21.719937v1?rss=1">
<title>
<![CDATA[
A High-Throughput Platform for Rapidly Adapting DNA Aptamers to SARS-CoV-2 Evolution 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.21.719937v1?rss=1"
</link>
<dc:creator>He, Y.</dc:creator>
<dc:creator>Yang, Z.</dc:creator>
<dc:creator>Kuo, Y.-A.</dc:creator>
<dc:creator>Wu, Y.</dc:creator>
<dc:creator>Fonseca-Albert, D.</dc:creator>
<dc:creator>Le, K. K.</dc:creator>
<dc:creator>Guo, J. G.</dc:creator>
<dc:creator>Wang, Y.</dc:creator>
<dc:creator>Nguyen, A.-T.</dc:creator>
<dc:creator>Chen, Y.-I.</dc:creator>
<dc:creator>Kim, S.</dc:creator>
<dc:creator>Chen, W.-R.</dc:creator>
<dc:creator>Seifi, S.</dc:creator>
<dc:creator>Hong, S.</dc:creator>
<dc:creator>Nguyen, T. D.</dc:creator>
<dc:creator>Chen, Y.</dc:creator>
<dc:creator>Ren, P.</dc:creator>
<dc:creator>Lu, Y.</dc:creator>
<dc:creator>Yeh, H.-C.</dc:creator>
<dc:date>2026-04-22</dc:date>
<dc:identifier>doi:10.64898/2026.04.21.719937</dc:identifier>
<dc:title><![CDATA[A High-Throughput Platform for Rapidly Adapting DNA Aptamers to SARS-CoV-2 Evolution]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Rapid pathogen evolution threatens public health by eroding the effectiveness of vaccines, therapeutics, and diagnostic tools. Although spike protein targeting monoclonal antibodies (mAbs) were developed within 10-12 months of the initial outbreak to serve as key theranostic agents, their redesign has struggled to keep pace with viral evolution, rendering many neutralizing antibodies ineffective. Here we demonstrate a novel platform that combines a random-rational hybrid library diversification with high-throughput MiSeq screening to rapidly reprogram aptamers against emerging SARS-CoV-2 spike variants. Interactions between 3 different spike proteins and 11,806 unique aptamer variant designs were profiled within a few days. Starting from a 40-nt aptamer originally selected against wild-type (WT) spike protein, our screen identified a Delta-binding mutant with a 4-fold affinity improvement and an Omicron-binding mutant that converted undetectable binding into nanomolar affinity. We also identified a WT-selective mutant with substantially reduced affinity for Delta, as well as previously unrecognized bases that critically contribute to spike recognition. Integrating high-throughput binding data with molecular dynamics simulations further revealed sequence-dependent structural features underlying variant-specific aptamer-spike interactions. Finally, we developed a sensor based on the identified WT-selective aptamer mutant, enabling highly specific detection of the WT spike protein with robust performance. Together, this work establishes a rapid and adaptable aptamer engineering platform for rapid adaptation of aptamers to evolving pathogens in future pandemics.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.14.26350639v1?rss=1">
<title>
<![CDATA[
Modeling the impact of adherence to U.S. isolation and masking guidance on SARS-CoV-2 transmission in office workplaces in 2021-2022 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.14.26350639v1?rss=1"
</link>
<dc:creator>Garcia Quesada, M.</dc:creator>
<dc:creator>Wallrafen-Sam, K.</dc:creator>
<dc:creator>Kiti, M. C.</dc:creator>
<dc:creator>Ahmed, F.</dc:creator>
<dc:creator>Aguolu, O. G.</dc:creator>
<dc:creator>Ahmed, N.</dc:creator>
<dc:creator>Omer, S. B.</dc:creator>
<dc:creator>Lopman, B. A.</dc:creator>
<dc:creator>Jenness, S. M.</dc:creator>
<dc:date>2026-04-21</dc:date>
<dc:identifier>doi:10.64898/2026.04.14.26350639</dc:identifier>
<dc:title><![CDATA[Modeling the impact of adherence to U.S. isolation and masking guidance on SARS-CoV-2 transmission in office workplaces in 2021-2022]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-21</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Non-pharmaceutical interventions (NPIs) have been important for controlling SARS-CoV-2 transmission, particularly before and during initial vaccine rollout. During the pandemic, the US Centers for Disease Control and Prevention issued isolation and masking guidance in case of COVID-19-like illness, a positive SARS-CoV-2 test, or known exposure to SARS-CoV-2. However, the impact of this guidance on mitigating transmission in office workplaces is unclear. We used a network-based mathematical model to estimate the impact of this guidance on SARS-CoV-2 transmission among office workers and their communities. The model represented social contacts in the home, office, and community. We used data from the CorporateMix study to parametrize social contacts among office workers and calibrated the model to represent the COVID-19 epidemic in Georgia, USA from January 2021 through August 2022. In the reference scenario (58% adherence to guidance among office workers and the broader population), workplace transmission accounted for a small fraction of total infections. Reducing adherence among office workers to 0% increased workplace transmissions by 27.1% and increasing adherence to 75% reduced workplace transmission by 7.0%. Increasing adherence to 75% among office workers had minimal impact on symptomatic cases and deaths; increasing it among the broader population was more effective in reducing office worker cases and deaths. In our model, moderate adherence to recommended NPIs in workplaces was effective in reducing transmission, but increasing adherence had limited benefit given workplaces that have low contact intensity and hybrid work arrangements. These results underscore the public health benefits of community-wide adoption of recommended NPIs.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.19.719510v1?rss=1">
<title>
<![CDATA[
SARS-CoV-2 spike protein-associated sialoglycoconjugates induce nanoscale filipodia to facilitate micro-size platelet clotting 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.19.719510v1?rss=1"
</link>
<dc:creator>Bake, A.</dc:creator>
<dc:creator>Sanaubarova, A.</dc:creator>
<dc:creator>Spillings, B. L.</dc:creator>
<dc:creator>Bremaud, E.</dc:creator>
<dc:creator>Masic, V.</dc:creator>
<dc:creator>Dirr, L.</dc:creator>
<dc:creator>von Itzstein, M.</dc:creator>
<dc:creator>Mak, J.</dc:creator>
<dc:date>2026-04-20</dc:date>
<dc:identifier>doi:10.64898/2026.04.19.719510</dc:identifier>
<dc:title><![CDATA[SARS-CoV-2 spike protein-associated sialoglycoconjugates induce nanoscale filipodia to facilitate micro-size platelet clotting]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-20</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
COVID-19 disease is associated with thrombosis, but the pathogenic mechanism remains unclear. Here, we investigate how SARS-CoV-2 spike protein causes platelet activation and aggregation. Our three-dimensional ultrastructural analyses showed that invaginated platelet structures, open canalicular system (OCS), expanded upon activation, trapping viral particles in the process. Binding with platelet OCS concealed SAR-CoV-2 spike-coated particles from virion detection in platelet-depleted blood plasma. Both SARS-CoV-2 spike coated-particles and recombinant spikes specifically induced platelet aggregation with nanoscale filipodia extensions, with the terminal sialic acids of the SARS-CoV-2 spike protein-associated sialoglycoconjugates being the key determinant in platelet activation. Our work illustrates that virus-associated sialic acids, not proteins, are functionally responsible for SARS-CoV-2 induced thrombotic events, providing a mechanistic insight on how glycosylation contributes to disease severity in COVID-19. This study lays the foundation for the development of glycan-modified vaccines with reduced risks of thrombosis.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.17.716662v1?rss=1">
<title>
<![CDATA[
Conserved metabolic vulnerabilities across pathogenic coronaviruses nominate host-directed therapeutic targets 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.17.716662v1?rss=1"
</link>
<dc:creator>Dohai, B.</dc:creator>
<dc:creator>El Assal, D. C.</dc:creator>
<dc:creator>Kang, M.</dc:creator>
<dc:creator>Jaiswal, A.</dc:creator>
<dc:creator>Poulet, C.</dc:creator>
<dc:creator>Daakour, S.</dc:creator>
<dc:creator>Nelson, D. R.</dc:creator>
<dc:creator>Falter-Braun, P.</dc:creator>
<dc:creator>Twizere, J.-C.</dc:creator>
<dc:creator>Salehi-Ashtiani, K.</dc:creator>
<dc:date>2026-04-20</dc:date>
<dc:identifier>doi:10.64898/2026.04.17.716662</dc:identifier>
<dc:title><![CDATA[Conserved metabolic vulnerabilities across pathogenic coronaviruses nominate host-directed therapeutic targets]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-20</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Pathogenic coronaviruses profoundly rewire host cell metabolism to support viral replication, yet whether these metabolic alterations expose shared and actionable vulnerabilities remains unclear. By integrating transcriptomic profiles from cells infected with SARS-CoV, SARS-CoV-2, and MERS-CoV with genome-scale metabolic models, we identify conserved and virus-specific metabolic perturbations affecting mitochondrial transport, nucleotide biosynthesis, fatty acid metabolism, and redox balance. Despite distinct transcriptional responses, all three viruses converge on a limited set of metabolic reactions whose flux ranges deviate strongly from healthy states. Using a network-based predictive framework, we systematically identify gene-pair perturbations that restore perturbed reaction fluxes toward non-infected metabolic states. Predicted rescue mechanisms reveal shared metabolic dependencies across coronaviruses, as well as time-dependent virus-specific vulnerabilities, and nominate druggable host targets. Notably, several top predictions align with independent experimental and clinical evidence, including metabolic interventions shown to reduce viral replication or disease severity in COVID-19 patients. Together, our results define conserved metabolic rescue pathways in coronavirus infection and provide a general strategy for identifying host-directed therapeutic opportunities from transcriptomic data.

HighlightsO_LICoronaviruses converge on shared metabolic vulnerabilities in host cells
C_LIO_LINiTRO predicts gene pairs that rescue viral-induced metabolic states
C_LIO_LIMitochondrial transport emerges as a key pan-coronavirus target
C_LIO_LITop predictions validated by clinical trials and in vitro evidence
C_LI

eTOC BlurbDohai et al. develop NiTRO, a network-based algorithm that integrates coronavirus-induced transcriptomic changes with genome-scale metabolic models to identify gene-pair perturbations capable of rescuing infected metabolic states. The approach reveals shared and virus-specific druggable metabolic vulnerabilities, with top predictions corroborated by clinical evidence.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.16.719115v1?rss=1">
<title>
<![CDATA[
Systematic evaluation of 24 extraction and library preparation combinations for metagenomic sequencing of SARS-CoV-2 in saliva 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.16.719115v1?rss=1"
</link>
<dc:creator>Qian, K.</dc:creator>
<dc:creator>Abhyankar, V.</dc:creator>
<dc:creator>Keo, D.</dc:creator>
<dc:creator>Zarceno, P.</dc:creator>
<dc:creator>Toy, T.</dc:creator>
<dc:creator>Eskin, E.</dc:creator>
<dc:creator>Arboleda, V. A.</dc:creator>
<dc:date>2026-04-20</dc:date>
<dc:identifier>doi:10.64898/2026.04.16.719115</dc:identifier>
<dc:title><![CDATA[Systematic evaluation of 24 extraction and library preparation combinations for metagenomic sequencing of SARS-CoV-2 in saliva]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-20</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Sequencing the respiratory tract transcriptome has the potential to provide insights into infectious pathogens and the hosts immune response. While DNA-based sequencing is more standard in clinical laboratories due to its stability, RNA assays offer unique advantages. RNA reflects dynamic physiological changes, and for RNA viruses, viral RNA particles directly represent copies of the viral genome, enabling greater diagnostic sensitivity. However, RNAs susceptibility to degradation remains a significant challenge, particularly in RNase-rich specimens like saliva. To address this, we conducted a systematic, combinatorial evaluation of 24 distinct mNGS workflows, crossing eight nucleic acid extraction methods with three RNA-Seq library preparation protocols. Remnant saliva samples (n = 6) were pooled and spiked with MS2 phage as a control. The SARS-CoV-2 virus was spiked into half of the samples, which were extracted using the eight different extraction methods (n = 3) and compared using RNA Integrity Number equivalent (RINe) scores and RNA concentration. The extracted RNA was then processed across the three library construction methods and subjected to short-read sequencing to assess all 24 combinations head-to-head. We compared methods based on viral read recovery and found that RINe and concentration did not correlate with viral detection. The Zymo Quick-RNA Magbead kit and the Tecan Revelo RNA-Seq High-Sensitivity RNA library kit were the extraction and library-preparation kits that yielded the most SARS-CoV-2 reads, respectively. Importantly, our combinatorial analysis revealed that any small variability attributable to different nucleic acid extraction methods was heavily overshadowed by differences in quality attributable to the RNA-Seq library preparation methods. These findings challenge the reliance on conventional RNA quality metrics for clinical metagenomics and underscore the need to redefine extraction quality standards for mNGS applications.

IMPORTANCEmNGS is a powerful and unbiased approach towards pathogen detection that has mostly been applied to blood and cerebrospinal fluid samples. However mNGS has recently been applied to more areas including the respiratory pathogen detection space, with potential applications in both in-patient diagnostics and public health surveillance. Saliva samples are an ideal sample type for these use cases since they can be collected non-invasively. However, saliva is also a challenging sample type due to its high RNase activity and often yields low-quality nucleic acid. This study explores the feasibility of using saliva specimens in mNGS with contrived SARS-CoV-2 samples to optimize the combination of two factors: nucleic acid extraction and RNA-seq library preparation. Exploration in this area could enhance the sensitivity of saliva-based mNGS assays, with the goal of future expansion of this specimen type in clinical diagnostics and public health surveillance.

Key PointsO_LIThe choice of RNA-Seq library preparation kit has a greater impact on pathogen detection than the nucleic acid extraction method.
C_LIO_LIThe combination of Zymo Quick-RNA Magbead extraction kit and TECAN Revelo RNA-Seq High Sensitivity RNA library kit recovered the highest percentage of total SARS-CoV-2 reads.
C_LIO_LIRNA quantity and RINe score do not correlate with viral read capture, indicating a need for an alternative metric to assess RNA quality for downstream mNGS clinical diagnostics.
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.16.26351013v1?rss=1">
<title>
<![CDATA[
Evolving concerns about the COVID-19 pandemic: A content analysis of free-text reports from the UK COVID-19 Public Experiences (COPE) study cohort over a two-year period 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.16.26351013v1?rss=1"
</link>
<dc:creator>Phillips, R.</dc:creator>
<dc:creator>Wood, F.</dc:creator>
<dc:creator>Torrens-Burton, A.</dc:creator>
<dc:creator>Glennan, C.</dc:creator>
<dc:creator>Sellars, P.</dc:creator>
<dc:creator>Lowe, S.</dc:creator>
<dc:creator>Caffoor, A.</dc:creator>
<dc:creator>Hallingberg, B.</dc:creator>
<dc:creator>Gillespie, D.</dc:creator>
<dc:creator>Shepherd, V.</dc:creator>
<dc:creator>Poortinga, W.</dc:creator>
<dc:creator>Wahl-Jorgensen, K.</dc:creator>
<dc:creator>Williams, D.</dc:creator>
<dc:date>2026-04-19</dc:date>
<dc:identifier>doi:10.64898/2026.04.16.26351013</dc:identifier>
<dc:title><![CDATA[Evolving concerns about the COVID-19 pandemic: A content analysis of free-text reports from the UK COVID-19 Public Experiences (COPE) study cohort over a two-year period]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-19</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ObjectivesConcerns about COVID-19 were a key driver of infection-prevention behaviour during the pandemic. The aim of this study was to gain an in-depth longitudinal understanding of the type and frequency of concerns experienced throughout the first two years of the COVID-19 pandemic.

DesignContent analysis of qualitative descriptions provided in a prospective longitudinal online survey as part of the COVID-19 UK Public Experiences (COPE) Study.

MethodAt baseline (March/April 2020), when the UK entered its first national lockdown, 11,113 adults completed the COPE survey. Follow-up surveys were conducted at 3, 12, 18 and 24 months. Participants were recruited via the HealthWise Wales research registry and social media. Baseline surveys collected demographic and health data, and all waves included an open-ended question about COVID-19 concerns. Content analysis was used to identify the type and frequency of concerns at each time point.

ResultsA total of 41,564 open-text responses were coded into six categories: personal harm (n=16,353), harm to others (n=11,464), social/economic impact (n=6,433), preventing transmission (n=4,843), government/media (n=1,048), and general concerns (n=1,423). The proportion of respondents reporting any concern declined from 75.3% at baseline to 65.8% at 24 months. Over time, concerns about personal harm increased (baseline 41.8% vs. 24-months 52.7%) whereas concerns about harm to others decreased (baseline 48.5% vs. 24-months 28.6%). Concerns about harm were also expressed in relation to clinical vulnerability, lack of trust in government/media, and perceived lack of adherence by others. These were balanced against concerns about wider social and economic impacts of restrictions.

ConclusionsPublic concerns about COVID-19 evolved substantially over the first two years of the pandemic, reflecting changing perceptions of risk and responsibility. Monitoring concerns longitudinally is vital to help guide effective communication and behavioural interventions during future pandemics.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.16.26350989v1?rss=1">
<title>
<![CDATA[
Impact of COVID-19 pandemic on childhood immunization coverage in Indonesia: lesson learned from a nationwide analysis of the Expanded Programme on Immunization 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.16.26350989v1?rss=1"
</link>
<dc:creator>Nurina, A.</dc:creator>
<dc:creator>Puspaningrum, E.</dc:creator>
<dc:creator>Tandy, G.</dc:creator>
<dc:creator>Pattilima, D.</dc:creator>
<dc:creator>Hegar, B.</dc:creator>
<dc:creator>Wangge, G.</dc:creator>
<dc:creator>Hamers, R.</dc:creator>
<dc:creator>Elyazar, I.</dc:creator>
<dc:creator>Surendra, H.</dc:creator>
<dc:date>2026-04-18</dc:date>
<dc:identifier>doi:10.64898/2026.04.16.26350989</dc:identifier>
<dc:title><![CDATA[Impact of COVID-19 pandemic on childhood immunization coverage in Indonesia: lesson learned from a nationwide analysis of the Expanded Programme on Immunization]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-18</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe COVID-19 pandemic disrupted childhood immunization programmes in many countries worldwide. However, evidence on its impact in low and middle-income countries remains limited. This study examined the impact of the COVID-19 pandemic on childhood immunization coverage across 514 districts in Indonesia and identified district-level associated factors.

MethodsWe conducted a nationwide longitudinal analysis of the Expanded Programme on Immunization to compare immunization coverage before and after the pandemic. The outcome variable was the annual childhood immunization coverage (proportion of children aged 0-12 months who have received all recommended doses of childhood immunization as per the national immunization schedule). The explanatory variables include COVID-19 burden and vaccination rates, health system and human development indicators. Mixed-effect logistic regression was done to assess association between the explanatory and outcome variables.

ResultsAt the national level, the coverage was 83.2% in pre-pandemic, 75.0% in the first year of pandemic, and 88.6%, in the second. In the first year, 69.3% of districts experienced significant decline, with a lower national coverage ratio of 0.92 (95% confidence interval 0.89-0.94). In the second year, 36.2% districts were still affected. The multivariable analysis showed that a significant decline in coverage during the first pandemic year was associated with high COVID-19 incidence (adjusted odds ratio 2.19, 95%CI 1.01-4.73 for the highest vs. lowest group), low midwife adequacy (5.84, 2.40-14.16 for the lowest vs. the highest group, 2.61, 1.26-5.40 for low-middle vs. the highest group), and a high proportion of health facility-based births (2.98, 1.49-5.98 for middle-high vs. the lowest group).

ConclusionsThe COVID-19 pandemic negatively and unevenly impacted childhood immunization in Indonesia, with greatest impacts in districts facing a higher COVID-19 burden and weaker health system capacity. These findings underscore the need for targeted efforts to strengthen the local health system for future health crises.

Summary boxO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIAccording to the WHO Pulse Survey, routine immunizations were the most disrupted essential health services during the COVID-19 pandemic, reported by 70% of countries. Southeast Asia experienced the steepest drop in childhood immunization coverage compared to the other regions.
C_LIO_LIIndonesia had the highest number of COVID-19 cases and related mortality in Southeast Asia. However, the magnitude and heterogeneity of the impact of COVID-19 pandemic on childhood immunization coverage across all 514 districts in Indonesia has not been evaluated.
C_LI

What this study addsO_LIThis study affirmed that the COVID-19 pandemic greatly impacted childhood immunization coverage, disproportionately impacting district with vulnerable health systems capacity.
C_LI

How this study might affect research, practice, or policyO_LIThis study highlights the critical need of addressing health inequity to strengthen health system resilience for future global health crises.
C_LIO_LIIn the context of a decentralised health system such as in Indonesia, coordination and prioritisation of available resources and public health intervention will be critical to ensure optimal health outcomes for children living in districts with weak health systems.
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.14.26350918v1?rss=1">
<title>
<![CDATA[
Combined Effects of Severe Immunocompromise and Prolonged Virus Shedding on Within-Host SARS-CoV-2 Evolution in COVID-19 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.14.26350918v1?rss=1"
</link>
<dc:creator>Hirata, Y.</dc:creator>
<dc:creator>Takahashi, K.</dc:creator>
<dc:creator>Iwamoto, N.</dc:creator>
<dc:creator>Dam Jeong, Y.</dc:creator>
<dc:creator>Miyamoto, S.</dc:creator>
<dc:creator>Kawasaki, J.</dc:creator>
<dc:creator>Mine, S.</dc:creator>
<dc:creator>Iida, S.</dc:creator>
<dc:creator>Saito, S.</dc:creator>
<dc:creator>Ainai, A.</dc:creator>
<dc:creator>Kanno, T.</dc:creator>
<dc:creator>Katano, H.</dc:creator>
<dc:creator>Sasaki, N.</dc:creator>
<dc:creator>Horiba, K.</dc:creator>
<dc:creator>Ishikane, M.</dc:creator>
<dc:creator>Kamegai, K.</dc:creator>
<dc:creator>Harrison, M. T.</dc:creator>
<dc:creator>Itoh, N.</dc:creator>
<dc:creator>Akazawa, N.</dc:creator>
<dc:creator>Okumura, N.</dc:creator>
<dc:creator>Haraguchi, M.</dc:creator>
<dc:creator>Sakoh, T.</dc:creator>
<dc:creator>Morishima, M.</dc:creator>
<dc:creator>Araoka, H.</dc:creator>
<dc:creator>Uchida, N.</dc:creator>
<dc:creator>Hase, R.</dc:creator>
<dc:creator>Marumo, Y.</dc:creator>
<dc:creator>Adachi, T.</dc:creator>
<dc:creator>Matsue, K.</dc:creator>
<dc:creator>Saito, T.</dc:creator>
<dc:creator>Ohmagari, N.</dc:creator>
<dc:creator>Iwami, S.</dc:creator>
<dc:creator>Suzuki, T.</dc:creator>
<dc:date>2026-04-17</dc:date>
<dc:identifier>doi:10.64898/2026.04.14.26350918</dc:identifier>
<dc:title><![CDATA[Combined Effects of Severe Immunocompromise and Prolonged Virus Shedding on Within-Host SARS-CoV-2 Evolution in COVID-19]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-17</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundProlonged SARS-CoV-2 infection in immunocompromised individuals may accelerate virus evolution within the host, raising concerns about the virus evading immunity, developing resistance, and forming novel variants of concern. However, the determinants and public health implications of within-host viral evolution in this population remain incompletely understood.

MethodsWe performed longitudinal analyses of SARS-CoV-2 genomes from 91 patients with COVID-19 who were classified as being severely or moderately immunocompromised. Using serial measurements of viral RNA loads and infectious titers, we modeled the shedding dynamics of the virus and stratified the infected cases by upper respiratory virus shedding duration to assess associations with within-host evolutionary dynamics.

ResultsShedding modeling identified two profiles of shedding duration: intermediate and long. The long shedding profile (shedding lasting >21 days) was found in 14.8% of moderately immunocompromised cases and 72.1% of severely immunocompromised cases. Frequent single-nucleotide variants accumulated specifically in severely immunocompromised individuals with the long shedding phenotype, correlating positively with shedding duration. By contrast, mutations remained limited in moderately immunocompromised individuals with the long shedding phenotype and in severely immunocompromised individuals with the intermediate shedding phenotype. We identified mutations in the spike receptor-binding domain associated with monoclonal antibody resistance; however, we found no fitness-enhancing mutations for inter-host transmission, and antiviral drug resistance mutations were rare. Instead, mutations were introduced frequently and randomly across the entire viral genome.

ConclusionsProlonged upper respiratory virus shedding exceeding 21 days combined with severe immunocompromise is a risk factor of the accumulation of within-host SARS-CoV-2 mutations. Although no variants of concern emerged, the introduction of genome-wide random mutations suggests that the risk for novel variant generation cannot be excluded. These findings highlight the need for intensive antiviral strategies to limit shedding duration to less than 21 days in severely immunocompromised patients, and for immunological investigations to elucidate the host factors underlying residual shedding control in those who achieve clearance within this threshold.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.15.26350844v1?rss=1">
<title>
<![CDATA[
Understanding inequalities in COVID-19 vaccination between migrants and non-migrants in Germany: The role of psychological factors of vaccine behaviour 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.15.26350844v1?rss=1"
</link>
<dc:creator>Bartig, S.</dc:creator>
<dc:creator>Siegert, M.</dc:creator>
<dc:creator>Hoevener, C.</dc:creator>
<dc:creator>Michalski, N.</dc:creator>
<dc:date>2026-04-17</dc:date>
<dc:identifier>doi:10.64898/2026.04.15.26350844</dc:identifier>
<dc:title><![CDATA[Understanding inequalities in COVID-19 vaccination between migrants and non-migrants in Germany: The role of psychological factors of vaccine behaviour]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-17</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundUnderstanding the underlying mechanisms for differences in vaccine uptake between migrants and non-migrants is crucial in order to design targeted interventions encouraging vaccination and to ensure vaccine-related equity. Therefore, this study examined to what extent migration-related disparities in COVID-19 vaccination were associated with psychological factors, based on the established 5C model of vaccine behaviour (Confidence, Complacency, Constraints, Calculation, Collective Responsibility).

MethodsData were obtained from the German study "Corona Monitoring Nationwide - Wave 2" (RKI-SOEP-2 study), which was carried out between November 2021 and March 2022. The association between COVID-19 vaccination and migration status, while considering the psychological factors, was investigated using multivariable binary logistic regressions. A decomposition analysis (Karlson-Holm-Breen method) was conducted to examine the extent to which migration-related disparities in vaccine uptake were associated with the psychological factors of the 5C framework.

ResultsMigrants were less likely to be vaccinated against COVID-19 compared to non-migrants, especially participants from the Middle East and North Africa (MENA) region. Our decomposition showed that almost two-thirds of the disparities in COVID-19 vaccine uptake between migrants and non-migrants were associated with the psychological factors (first-generation: 61.2%, second-generation: 64.2%). Confidence in safety of the vaccine was the most relevant factor in the 5C framework. Furthermore, the results highlighted the importance of a differentiated analysis regarding country of origin: While the 5C model accounted for only 19.4% of the difference between participants from the MENA region and non-migrants, the proportion for participants from Eastern Europe was 73.5%, suggesting that the underlying mechanisms for the lower uptake in the MENA group need further investigation.

ConclusionsOverall, migration-related disparities in COVID-19 vaccination were significantly associated with differences in psychological factors of vaccine behaviour. To increase vaccine acceptance within the heterogeneous group of migrants in general, tailored and proactive health communication interventions are needed.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.16.26351004v1?rss=1">
<title>
<![CDATA[
Transmission dynamics of the COVID-19 pandemic across the emerging variants in mainland China: a hypergraph-based spatiotemporal modeling study 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.16.26351004v1?rss=1"
</link>
<dc:creator>Wang, Y.</dc:creator>
<dc:creator>WANG, D.</dc:creator>
<dc:creator>Lau, Y. C.</dc:creator>
<dc:creator>Du, Z.</dc:creator>
<dc:creator>Cowling, B. J.</dc:creator>
<dc:creator>Zhao, Y.</dc:creator>
<dc:creator>Ali, S. T.</dc:creator>
<dc:date>2026-04-17</dc:date>
<dc:identifier>doi:10.64898/2026.04.16.26351004</dc:identifier>
<dc:title><![CDATA[Transmission dynamics of the COVID-19 pandemic across the emerging variants in mainland China: a hypergraph-based spatiotemporal modeling study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-17</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Mainland China experienced multiple waves of COVID-19 pandemic during 2020-2022, driven by emerging variants and changes in public health and social measures (PHSMs). We developed a hypergraph-based Susceptible-Vaccinated-Exposed-Infectious-Recovered-Susceptible (SVEIRS) model to reconstruct epidemic dynamics across 31 provinces, capturing transmission heterogeneity associated with clustered contacts. We assessed key characteristics of transmission at national and provincial levels during four outbreak periods: initial, localized pre-delta, Delta, and widespread Omicron, which accounted for 96.7% of all infections. We found significant diversity in transmission contributions across cluster sizes, with a small fraction of larger clusters responsible for a disproportionate share of infections. Counterfactual analyses showed that reducing cluster-size heterogeneity, while holding overall exposure constant, could have lowered national infections by 11.70-30.79%, with the largest effects during Omicron period. Ascertainment rates increased over time but remained spatially heterogeneous with a range: (14.40, 71.93)%. Population susceptibility declined following mass vaccination (to 42.49% in Aug 2021, nationally) and rebounded (to 89.89% in Nov 2022) due to waning immunity with variations across the provinces. Effective reproduction numbers displayed marked temporal and spatial variability, with higher estimates during Omicron. Overall, these results highlight critical role of group contact heterogeneity in shaping epidemic dynamics.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.16.26351029v1?rss=1">
<title>
<![CDATA[
SARS-CoV-2 neutralising antibody profiles reveal variant specific antibody dynamics and regional differences in infection histories in Malawi 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.16.26351029v1?rss=1"
</link>
<dc:creator>McCormack, M. J.</dc:creator>
<dc:creator>Banda, L.</dc:creator>
<dc:creator>Kasenda, S.</dc:creator>
<dc:creator>Hughes, E. C.</dc:creator>
<dc:creator>Crampin, A. C.</dc:creator>
<dc:creator>Amoah, A. S.</dc:creator>
<dc:creator>Read, J. M.</dc:creator>
<dc:creator>Ho, A.</dc:creator>
<dc:creator>Willett, B. J.</dc:creator>
<dc:creator>Hay, J. A.</dc:creator>
<dc:date>2026-04-17</dc:date>
<dc:identifier>doi:10.64898/2026.04.16.26351029</dc:identifier>
<dc:title><![CDATA[SARS-CoV-2 neutralising antibody profiles reveal variant specific antibody dynamics and regional differences in infection histories in Malawi]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-17</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Serological data provide important insights into SARS-CoV-2 transmission and immunity, particularly in regions with limited routine surveillance such as sub-Saharan Africa. However, antibody waning and boosting following reinfection or vaccination remain poorly characterised, complicating interpretation of serological measurements. Improved understanding of these dynamics is critical for accurate epidemiological inference. Modelling longitudinal serological data provides a means to quantify antibody kinetics and reconstruct infection histories. We analysed 15,679 neutralising antibody (nAb) titres from 1,675 unvaccinated, HIV-uninfected participants in urban (Lilongwe) and rural (Karonga) Malawi (February 2021 - April 2022). NAb titres against ancestral B.1, Beta, Delta, and Omicron (BA.1/BA.2) viruses were measured using an HIV-based SARS-CoV-2 pseudotyped virus neutralisation assay. A multi-level Bayesian model was used to reconstruct infection histories and antibody kinetics. The model identified 429 infections (95% credible interval 417-441), including 39 (9{middle dot}1%) that had not been identified by traditional seroconversion-based thresholds. Antibody levels waned rapidly, with 48% (0{middle dot}403-0{middle dot}560) of the acute boost remaining after three months and only 5% (0{middle dot}027-0{middle dot}098) after one year. Pre-Omicron infections generated stronger antibody boosts than Omicron infections. Responses varied, with individuals clustering into low and high responders. Cross-reactive responses extended across substantial antigenic distances - Omicron infections induced broader immunity. Seroincidence was higher in Lilongwe than in Karonga (0{middle dot}41 vs. 0{middle dot}27 infections per person per three months), driven by the early 2022 Omicron wave. Reinfections were common, particularly among adults and urban residents. SARS-CoV-2 nAb responses following infection were heterogeneous and declined rapidly. This rapid waning underscores the importance of vaccination for sustained protection, while cross-reactivity suggests only partial immunity from prior variants. Identifying reinfections is essential for understanding transmission and finding populations at higher repeat infection risk, particularly where routine surveillance is limited.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.12.26350701v1?rss=1">
<title>
<![CDATA[
SPLIT: Safety Prioritization for Long COVID Drug Repurposing via a Causal Integrated Targeting Framework 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.12.26350701v1?rss=1"
</link>
<dc:creator>Pinero, S. L.</dc:creator>
<dc:creator>Li, X.</dc:creator>
<dc:creator>Lee, S. H.</dc:creator>
<dc:creator>Liu, L.</dc:creator>
<dc:creator>Li, J.</dc:creator>
<dc:creator>Le, T. D.</dc:creator>
<dc:date>2026-04-16</dc:date>
<dc:identifier>doi:10.64898/2026.04.12.26350701</dc:identifier>
<dc:title><![CDATA[SPLIT: Safety Prioritization for Long COVID Drug Repurposing via a Causal Integrated Targeting Framework]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Long COVID affects millions of people worldwide, yet no disease-modifying treatment has been approved, and existing interventions have shown only modest and inconsistent benefits. A key reason for this limited progress is that current computational drug repurposing pipelines do not match well with the clinical reality of Long COVID. These patients often have persistent, multi-systemic symptoms and may already be taking multiple medications, making treatment safety a primary concern. However, most repurposing workflows still treat safety as a downstream filter and rely on disease-associated targets rather than causal drivers. They also assume that the findings of one analysis would generalize across the diverse presentations of Long COVID. We introduce SPLIT, a safety-first repurposing framework that addresses these limitations. SPLIT prioritizes safety at the start of the candidate evaluation, integrates complementary causal inference strategies to identify likely driver genes, and uses a counterfactual substitution design to compare drugs within specific cohort contexts. When applied to cognitive and respiratory Long COVID cohorts, SPLIT revealed three main findings. First, drugs with similar predicted efficacy could have very different predicted safety profiles. Second, the drugs flagged as unfavorable were often different between the two cohorts, showing that drug prioritization is phenotype-specific. Third, SPLIT flagged 18 drugs currently under active investigation in Long COVID trials as having unfavorable predicted profiles. SPLIT provides a practical framework to identify safer, more context-appropriate candidates earlier in the process, supporting more targeted and better-tolerated treatment strategies for Long COVID.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.13.26350772v1?rss=1">
<title>
<![CDATA[
Effectiveness of 2025-2026 mRNA-1283 and BNT162b2 COVID-19 Vaccines Against COVID-19 Related Hospitalizations and Medically-Attended COVID-19 Among Adults Aged >= 65 years in the United States 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.13.26350772v1?rss=1"
</link>
<dc:creator>Vicic, N.</dc:creator>
<dc:creator>Bogdanov, A.</dc:creator>
<dc:creator>Hensler, H.</dc:creator>
<dc:creator>Ryan, T.</dc:creator>
<dc:creator>Zeng, N.</dc:creator>
<dc:creator>Beck, E.</dc:creator>
<dc:creator>Patry, E.</dc:creator>
<dc:creator>Bonafede, M.</dc:creator>
<dc:creator>Araujo, A. B.</dc:creator>
<dc:creator>Wilson, A.</dc:creator>
<dc:date>2026-04-16</dc:date>
<dc:identifier>doi:10.64898/2026.04.13.26350772</dc:identifier>
<dc:title><![CDATA[Effectiveness of 2025-2026 mRNA-1283 and BNT162b2 COVID-19 Vaccines Against COVID-19 Related Hospitalizations and Medically-Attended COVID-19 Among Adults Aged >= 65 years in the United States]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe 2025-2026 COVID-19 vaccine season introduced updated formulations targeting the LP.8.1 lineage. This study assessed the absolute vaccine effectiveness (aVE) of mRNA-1283 and BNT162b2 on COVID-19 outcomes in adults aged [&ge;]65 years.

MethodsThis retrospective study used linked electronic health record and administrative claims data through Jan 31, 2026. Adults [&ge;]65 years who received the mRNA-1283 or BNT162b2 2025-2026 COVID-19 vaccine were matched to unvaccinated individuals. Inverse probability of treatment weighting was applied to each vaccines matched cohorts to balance covariates. Each vaccine was evaluated independently against its own unvaccinated comparator group. aVE against COVID-19 related hospitalization and medically-attended COVID-19 was estimated using Cox proportional hazards models; aVE = 100 x (1 - hazard ratio [HR]).

ResultsWe identified 233,072 mRNA-1283 recipients and 422,610 BNT162b2 recipients [&ge;]65 years. The aVE (95% confidence interval) of mRNA-1283 against COVID-19 related hospitalization and medically-attended COVID-19 was 59.3% (39.0%, 72.9%) and 42.0% (35.0%, 48.3%) among adults [&ge;]65 years and 66.9% (45.9 %, 79.8%) and 50.2% (42.1%, 57.2%) in [&ge;]75 years, respectively. The aVE of BNT162b2 against COVID-19 related hospitalization and medically-attended COVID-19 was 48.3% (32.4%, 60.5%) and 41.2% (36.2%, 45.8%) in [&ge;]65 years and 45.9% (26.0%, 60.4%) and 44.0% (37.8%, 49.6%) in [&ge;]75 years, respectively.

ConclusionsThis is the first real-world evidence showing that mRNA-1283 prevents COVID-19-related hospitalizations and medically attended events in vulnerable older adults at highest risk of severe disease. These findings support mRNA-1283 as an important public health tool for reducing the ongoing burden of COVID-19.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.14.26350862v1?rss=1">
<title>
<![CDATA[
Cognitive Profiling and Validation of a Digital Cognitive Assessment Tool in Post-COVID-19 Condition: Protocol for a Single-Center, Cross-Sectional Study (DigiCog Study) 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.14.26350862v1?rss=1"
</link>
<dc:creator>Lacomba-Arnau, E.</dc:creator>
<dc:creator>Da Rocha Oliveira, R.</dc:creator>
<dc:creator>Monteiro, S.</dc:creator>
<dc:creator>Pauly, C.</dc:creator>
<dc:creator>Vaillant, M.</dc:creator>
<dc:creator>Celebic, A.</dc:creator>
<dc:creator>Bulaev, D.</dc:creator>
<dc:creator>Fischer, A.</dc:creator>
<dc:creator>Fagherazzi, G.</dc:creator>
<dc:creator>Fernandez, G.</dc:creator>
<dc:creator>Shulz, M.</dc:creator>
<dc:creator>Perquin, M.</dc:creator>
<dc:date>2026-04-16</dc:date>
<dc:identifier>doi:10.64898/2026.04.14.26350862</dc:identifier>
<dc:title><![CDATA[Cognitive Profiling and Validation of a Digital Cognitive Assessment Tool in Post-COVID-19 Condition: Protocol for a Single-Center, Cross-Sectional Study (DigiCog Study)]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundCognitive impairment is among the most frequently reported and disabling persistent symptoms following SARS-CoV-2 infection. Despite growing evidence of its prevalence, the characterization of domain-specific cognitive profiles and the identification of modifiable factors influencing cognitive outcomes in post-COVID-19 condition (PCC) remains scarce. Digital cognitive assessment tools have emerged as scalable and examiner-independent alternatives to traditional neuropsychological testing, but their validation in post-infectious contexts is still limited.

ObjectiveThe DigiCog study aims to characterize cognitive profiles associated with PCC, to evaluate a novel digital cognitive assessment technology (ViewMind, VMTech) against standardized neuropsychological measures, and to explore the potential role of cognitive reserve (CR) proxies in shaping cognitive outcomes following SARS-CoV-2 infection.

MethodsDigiCog is a single-center cross-sectional study conducted within the Luxembourgish Predi-COVID cohort (NCT04380987). Participants aged 25-65 years, with and without persistent COVID-19 symptoms, are invited to participate. Cognitive assessments are performed during face-to-face sessions by trained nurses and neuropsychologists using both the VMTech device and standardized neuropsychological tests. Additional data on PCC symptom status, CR, sociodemographic characteristics, fatigue, and psychological factors are also collected. Agreement between digital and standard cognitive assessments will be evaluated using Cohens kappa coefficient, with sensitivity, specificity, and receiver operating characteristic analyses as secondary measures. Cognitive performance will be compared between participants with and without PCC, and associations with CR proxies will be explored.

ResultsParticipant recruitment began in May 2023. As of March 2025, 199 participants had been enrolled. Data collection has been completed. Data processing and statistical analyses are ongoing.

ConclusionsThe DigiCog study will provide new insights into cognitive functioning in PCC and evaluate the validity of a novel digital cognitive assessment approach. By integrating neuropsychological testing, digital assessment, and cognitive reserve, the study may inform scalable and more personalized approaches to cognitive screening and monitoring in post-infectious conditions.

Study registrationClinicalTrials.gov NCT06391970; Luxembourg National Research Ethics Committee approval No. 202208/05.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.15.718804v1?rss=1">
<title>
<![CDATA[
Repeated SARS-CoV-2 Antigenic Exposures from Prior Vaccinations and Infections Demonstrate Limits of Antibody Durability and Breadth Against Newer Variants 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.15.718804v1?rss=1"
</link>
<dc:creator>WANG, W.</dc:creator>
<dc:creator>Goguet, e.</dc:creator>
<dc:creator>Lusvarghi, S.</dc:creator>
<dc:creator>Paz, S.</dc:creator>
<dc:creator>Shrestha, L.</dc:creator>
<dc:creator>Vassell, R.</dc:creator>
<dc:creator>Pollett, S.</dc:creator>
<dc:creator>Mitre, E.</dc:creator>
<dc:creator>Weiss, C. D.</dc:creator>
<dc:date>2026-04-16</dc:date>
<dc:identifier>doi:10.64898/2026.04.15.718804</dc:identifier>
<dc:title><![CDATA[Repeated SARS-CoV-2 Antigenic Exposures from Prior Vaccinations and Infections Demonstrate Limits of Antibody Durability and Breadth Against Newer Variants]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundWidespread immunity from vaccination and infection has reduced COVID-19 morbidity and mortality, but this immunity varies across the population. Understanding how repeated antigenic exposures influence antibody responses helps to inform future vaccination strategies.

MethodsSerum samples collected one and six months after XBB.1.5 vaccination from 25 generally healthy healthcare workers with varying exposure histories were assessed for neutralizing activity against a range of variants, from pre-Omicron variants to latest Omicron JN.1 sublineage variants and divergent BA.3.2 variants, using lentiviral pseudoviruses. Participants were stratified by vaccination and infection history.

ResultsXBB.1.5 vaccination elicited broad neutralizing responses, with strong boosting against previously encountered antigens relative to vaccine-matched XBB.1.5 and newer variants. Geometric mean neutralization titers were generally comparable across exposure groups, indicating limited influence of prior Omicron infection or bivalent vaccination, though intra-group heterogeneity was observed. At six months, overall titers declined by 36-62%. Titers remained highest against the pre-Omicron and lowest against JN.1 sublineage variants. N-terminal glycosylation (DelS31, T22N) modestly affected neutralization.

ConclusionsXBB.1.5 vaccination elicited broad neutralizing antibody responses against previously encountered and vaccine-matched antigens regardless of exposure history, but titers waned after six months. This waning, compounded by continued emergence of immune-evasive variants and heterogenous population immunity, underscores the need for continually monitoring neutralizing antibody durability and breadth to guide evidence-based COVID-19 vaccine formulation updates.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.15.718757v1?rss=1">
<title>
<![CDATA[
Mechanistic insights into the association and activation of the SARS-CoV-2 2'-O-Methyltransferase (NSP16) 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.15.718757v1?rss=1"
</link>
<dc:creator>Ma, H.</dc:creator>
<dc:creator>Brace, A.</dc:creator>
<dc:creator>Lemus, M. R.</dc:creator>
<dc:creator>Chennubhotla, S. C.</dc:creator>
<dc:creator>Satchell, K. J.</dc:creator>
<dc:creator>Ramanathan, A.</dc:creator>
<dc:date>2026-04-16</dc:date>
<dc:identifier>doi:10.64898/2026.04.15.718757</dc:identifier>
<dc:title><![CDATA[Mechanistic insights into the association and activation of the SARS-CoV-2 2'-O-Methyltransferase (NSP16)]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The nsp16 2-O-Methyltransferase is an essential non-structural protein of SARS-CoV-2, which methylates the viral mRNA cap structure, enabling it to evade the host immune response for higher translation efficiency. However, nsp16 is only active when it is bound to its cofactor, namely the non-structural protein-10 (nsp10). Understanding how nsp10 binds to and activates nsp16 function can help to develop targeted inhibitors; however, given the varying degree of disorder in both nsp10 and nsp16, characterizing this interaction has been challenging. Using long-timescale molecular dynamics simulations and AI/ML methods, we posit that the nsp16/nsp10 binding process is mediated by a hydrophobic latch formed with Leu4298 from nsp10 and a hydrophobic concave on the nsp16 protein surface. Our study highlights how the nsp16 S-adenosyl-L-methionine (SAM) pocket closes in its monomer state, which in turn deactivates the MTase function. We also observe that the nsp16/nsp10 complex allows for the RNA binding site to open with the empty SAM pocket. The results reveal how the SAM pocket loops facilitate SAM binding while allowing for the by-product S-adenosyl-L-homocysteine (SAH) to exit. Our study thus provides valuable atomistic-level mechanistic insights into understanding the activation of nsp16 MTase function while highlighting the challenges of studying protein-protein interactions mediated by largely flexible/disordered regions.

SIGNIFICANCENsp16 carries out the methylation of the viral mRNA to gain immune evasion and translation efficiency. Understanding its complex molecular machinery can help us develop better therapeutic treatments. Here, we explore the key activation conditions for the SARS-CoV-2 nsp16 function via molecular dynamics simulation and AI/ML methods. The results demonstrate the role of nsp16 loops in different stages preparing for the methylation reaction from nsp16/nsp10 binding, (de)activation of nsp16 function and how the nsp16 SAM binding pocket can affect the RNA binding loops. This research explains the role of the nsp16 loops, which orchestrate its molecular function, and provides valuable insight to develop more targeted therapeutic approaches to disrupt viral immune evasion activity.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.14.718551v1?rss=1">
<title>
<![CDATA[
Tracing cell communication programs across conditions at single cell resolution with CCC-RISE 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.14.718551v1?rss=1"
</link>
<dc:creator>Ramirez, A.</dc:creator>
<dc:creator>Thomas, N.</dc:creator>
<dc:creator>Calabrese, D. R.</dc:creator>
<dc:creator>Greenland, J. R.</dc:creator>
<dc:creator>Meyer, A. S.</dc:creator>
<dc:date>2026-04-15</dc:date>
<dc:identifier>doi:10.64898/2026.04.14.718551</dc:identifier>
<dc:title><![CDATA[Tracing cell communication programs across conditions at single cell resolution with CCC-RISE]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-15</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Cell-cell communication (CCC) mediates coordinated cellular activities that vary dynamically across time, location, and biological context. While various tools exist to infer CCC, they typically aggregate data according to pre-defined cell types, obscuring critical single-cell heterogeneity. Furthermore, because signaling pathways and cell populations operate in a coordinated manner, an integrative analytical approach is essential. To address these challenges, we developed CCC-RISE, an extension of the tensor-based method Reduction and Insight in Single-cell Exploration (RISE). CCC-RISE identifies integrative patterns of single-cell variation by deconvolving communication into interpretable modules defined by unique sender cells, receiver cells, ligands, and condition associations. We applied this framework to a COVID-19 cohort with varying disease severity and a lung transplant cohort with acute allograft dysfunction. In both contexts, CCC-RISE successfully identified disease-relevant communication programs and traced them to specific cellular subpopulations, often crossing conventional cell-type boundaries. This approach offers a robust pipeline enabling the identification of disease-relevant signaling subpopulations that are invisible to aggregate methods.

HighlightsO_LICCC-RISE enables integrative analysis of cell-cell communication across multiple conditions at single-cell resolution
C_LIO_LICCC-RISE deconvolves signaling patterns into modules defined by their sender cells, receiver cells, LR pairs, and experimental conditions/samples
C_LIO_LIAnalysis at single-cell resolution uncovers signaling activity within and across conventional cell types
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.11.26350682v1?rss=1">
<title>
<![CDATA[
Risk of Post-acute Symptoms and Conditions After SARS-CoV-2 Compared to Other Respiratory Viral Infections: A Systematic Review and Meta-Analysis 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.11.26350682v1?rss=1"
</link>
<dc:creator>Pinto, T. F.</dc:creator>
<dc:creator>Santoro, A.</dc:creator>
<dc:creator>Oliveira, A. L. G.</dc:creator>
<dc:creator>Tavares, T. S.</dc:creator>
<dc:creator>Almeida, A.</dc:creator>
<dc:creator>Incardona, F.</dc:creator>
<dc:creator>Marchetti, G.</dc:creator>
<dc:creator>Cozzi-Lepri, A.</dc:creator>
<dc:creator>Pinto, J.</dc:creator>
<dc:creator>Caporali, J. F. M.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.11.26350682</dc:identifier>
<dc:title><![CDATA[Risk of Post-acute Symptoms and Conditions After SARS-CoV-2 Compared to Other Respiratory Viral Infections: A Systematic Review and Meta-Analysis]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundHow post-COVID-19 condition (PCC) differs from post-acute infection syndromes (PAIS) caused by other respiratory viruses remains uncertain. Comparing these conditions may clarify whether post-acute symptoms reflect specific consequences of SARS-CoV-2 infection or broader post-viral mechanisms.

MethodsWe conducted a systematic review and meta-analysis of cohort studies comparing persistent symptoms or conditions in adults after SARS-CoV-2 infection with those following other acute respiratory viral infections. PubMed, Embase, and Scopus were searched. Random-effects models were used to estimate pooled risks.

ResultsAmong 9,371 records screened, 22 studies were included and 14 contributed to the meta-analysis. Increased risk after SARS-CoV-2 infection was observed for pulmonary embolism, abnormal breathing, fatigue, hemorrhagic stroke, memory loss/brain fog, and palpitations; heart rate abnormalities showed borderline significance. For most other outcomes pooled estimates were inconclusive.

ConclusionsOnly a subset of outcomes appears more frequent after SARS-CoV-2 infection, suggesting many symptoms attributed to PCC may reflect broader post-viral syndromes.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.09.26350495v1?rss=1">
<title>
<![CDATA[
Classifying and Differentiating Individuals with Respiratory Syncytial Virus, Influenza, and COVID-19 Cases in OpenSAFELY 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.09.26350495v1?rss=1"
</link>
<dc:creator>Prestige, E.</dc:creator>
<dc:creator>Warren-Gash, C.</dc:creator>
<dc:creator>Quint, J. K.</dc:creator>
<dc:creator>Evans, D.</dc:creator>
<dc:creator>Costello, R. E.</dc:creator>
<dc:creator>Mehrkar, A.</dc:creator>
<dc:creator>Bacon, S.</dc:creator>
<dc:creator>Goldacre, B.</dc:creator>
<dc:creator>Barley-McMullen, S.</dc:creator>
<dc:creator>Yameen, F.</dc:creator>
<dc:creator>Shah, P.</dc:creator>
<dc:creator>Natt, M.</dc:creator>
<dc:creator>Alder, Y.</dc:creator>
<dc:creator>Hulme, W.</dc:creator>
<dc:creator>Parker, E. P. K.</dc:creator>
<dc:creator>Eggo, R. M.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.09.26350495</dc:identifier>
<dc:title><![CDATA[Classifying and Differentiating Individuals with Respiratory Syncytial Virus, Influenza, and COVID-19 Cases in OpenSAFELY]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Electronic health records (EHRs) are a rich source of data which can be used to analyse health outcomes using computable phenotypes. With the approval of NHS England we used the OpenSAFELY secure analytics platform to design and assess phenotypes to classify three key respiratory viruses - respiratory syncytial virus (RSV), influenza, and COVID-19 - in English coded health data between September 2016 and August 2024. We compared specific and sensitive phenotypes to one another and to publicly available surveillance data. Cases from both phenotypes showed similar seasonal patterns to surveillance data. Sensitive phenotypes led to increased risk of misclassification than specific phenotypes for mild cases. For severe cases the risk of misclassification was higher in infants than for older adults, irrespective of the phenotype used. The phenotypes presented here offer a solution to classifying respiratory viruses from coded health records in the absence of testing information.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.09.26349480v1?rss=1">
<title>
<![CDATA[
SARS-CoV-2 Introductions into Lao PDR Revealed by Genomic Surveillance, 2021-2024 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.09.26349480v1?rss=1"
</link>
<dc:creator>Panapruksachat, S.</dc:creator>
<dc:creator>Troupin, C.</dc:creator>
<dc:creator>Souksavanh, M.</dc:creator>
<dc:creator>Keeratipusana, C.</dc:creator>
<dc:creator>Vongsouvath, M.</dc:creator>
<dc:creator>Vongphachanh, S.</dc:creator>
<dc:creator>Vongsouvath, M.</dc:creator>
<dc:creator>Phommasone, K.</dc:creator>
<dc:creator>Somlor, S.</dc:creator>
<dc:creator>Robinson, M. T.</dc:creator>
<dc:creator>Chookajorn, T.</dc:creator>
<dc:creator>Kochakarn, T.</dc:creator>
<dc:creator>Day, N. P.</dc:creator>
<dc:creator>Mayxay, M.</dc:creator>
<dc:creator>Letizia, A. G.</dc:creator>
<dc:creator>Dubot-Peres, A.</dc:creator>
<dc:creator>Ashley, E. A.</dc:creator>
<dc:creator>Buchy, P.</dc:creator>
<dc:creator>Xangsayarath, P.</dc:creator>
<dc:creator>Batty, E. M.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.09.26349480</dc:identifier>
<dc:title><![CDATA[SARS-CoV-2 Introductions into Lao PDR Revealed by Genomic Surveillance, 2021-2024]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
We used 2492 whole genome sequences from Laos to investigate the molecular epidemiology of SARS-CoV-2 from 2021 through 2024, covering the major waves of COVID-19 disease in Laos including time periods of travel restrictions and after relaxation of travel across international borders. We identify successive waves of COVID-19 caused by shifts in the dominant lineage, beginning with the Alpha variant in April 2021 and continuing through the Delta and Omicron variants. We quantify a shift from a small number of viral introductions responsible for widespread transmission in early waves to a larger number of introductions for each variant after travel restrictions were lifted, and identify potential routes of introduction into the country. Our study underscores the importance of genomic surveillance to public health responses to characterize viral transmission dynamics during pandemics.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.10.26350587v1?rss=1">
<title>
<![CDATA[
Comparative LUSZ Therapeutic Study (LUSZ_AVIST) of Antiviral, Antiretroviral, and Immunosuppressive Treatments in Hospitalized COVID-19 Patients with High-Risk Factors, Biomarkers, and Disease Progression. 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.10.26350587v1?rss=1"
</link>
<dc:creator>Makdissy, N.</dc:creator>
<dc:creator>Makdessi, E. W.</dc:creator>
<dc:creator>Fenianos, F.</dc:creator>
<dc:creator>Nasreddine, N.</dc:creator>
<dc:creator>Daher, W.</dc:creator>
<dc:creator>El Hamoui, S.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.10.26350587</dc:identifier>
<dc:title><![CDATA[Comparative LUSZ Therapeutic Study (LUSZ_AVIST) of Antiviral, Antiretroviral, and Immunosuppressive Treatments in Hospitalized COVID-19 Patients with High-Risk Factors, Biomarkers, and Disease Progression.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
COVID-19 has spread rapidly and caused a global pandemic making it one of the deadliest in history. Early identification of patients with coronavirus disease 2019 who may develop critical illness is of immense importance. Therefore, novel biomarkers were needed to identify patients who will suffer rapid disease progression to severe complications and death. Many treatments were adopted including the antiviral Remdesivir, the antiretroviral Lopinavir /Ritonavir and Tocilizumab. Our study aimed not only to specify high-risk factors and biomarkers of fatal outcome in hospitalized subjects with coronavirus but also to compare the efficacy of the three considered treatments to help clinicians better choose a therapeutic strategy and reduce mortality. We divided the population (n=711) into four main groups based according to the WHO ordinal severity scale. The percentage of mortality, in and out the hospital, the length of stay in the hospital, the pulmonary inflammatory lesion and its distribution, the SARS-CoV-2 IgM and IgG variations at admission, the inflammatory markers, the complete blood count, the coagulation factors and enzymes, proteins and electrolytes profile, glucose and lipid profile, and other relevant markers were measured. The significance of the observed variation was assessed by multivariate and ANOVA analyses. We succeeded to establish a novel predictive scoring model of disease progression based on a cohort of Lebanese hospitalized patients relying on the pulmonary inflammatory lesions, inflammation biomarkers such as LDH, D-Dimer, CRP, IL-6 and the lymphocyte count, the number of comorbidities and the age of the patient which all were significantly correlated with the illness severity showing best outcomes with immunomodulatory and anticoagulant treatments by the results. As top tier, Tocilizumab was more efficient than the two other treatments in non-severe cases but none of the used treatments was insanely effective alone to reduce mortality in severe cases.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.10.717462v1?rss=1">
<title>
<![CDATA[
Loss of host factor-mediated m6Am methylation of the viral RNA cap impairs SARS CoV-2 replication 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.10.717462v1?rss=1"
</link>
<dc:creator>Pandey, R. R.</dc:creator>
<dc:creator>Ebert, N.</dc:creator>
<dc:creator>Homolka, D.</dc:creator>
<dc:creator>Barut, T.</dc:creator>
<dc:creator>Trueeb, B.</dc:creator>
<dc:creator>Stalder, H.</dc:creator>
<dc:creator>Delfino, E.</dc:creator>
<dc:creator>Vagbo, C.</dc:creator>
<dc:creator>Veiga, I.</dc:creator>
<dc:creator>Leidel, S.</dc:creator>
<dc:creator>Thiel, V.</dc:creator>
<dc:creator>Pillai, R.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.10.717462</dc:identifier>
<dc:title><![CDATA[Loss of host factor-mediated m6Am methylation of the viral RNA cap impairs SARS CoV-2 replication]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Eukaryotic mRNAs are co-transcriptionally capped at the 5' end with a methylated m7G moiety (cap0)1, which in higher eukaryotes is further methylated on the ribose (Nm) of the transcription start site (TSS) nucleotide to create the cap1 structure (m7GpppNm). Coronaviruses that replicate in the cytoplasm encode their own capping enzymes to acquire this cap1 structure which facilitates translation and shields them from the host innate immune system2-5. Here we report the identification of an additional N6-methyladenosine (m6A) methylation on the 5' cap (m7Gpppm6Am) of the human coronavirus SARS-CoV-2 RNA. It is catalysed by the host m6A methylase PCIF16-9 following capping by virus-encoded non-structural protein NSP 14 and NSP1610. Human cell cultures lacking PCIF1 accumulate reduced levels of the viral RNA and support reduced viral replication. Furthermore, Pcif1 mutant mice infected with SARS CoV-2 display milder symptoms. We identify the host RNA methyltransferase PCIF1 as a critical ally of SARS CoV-2 for viral replication.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.10.717575v1?rss=1">
<title>
<![CDATA[
Integrated Computational and Experimental Evaluation of selected Flavonoids as a Multi-Target Modulator of Viral Entry and Protease Activity. 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.10.717575v1?rss=1"
</link>
<dc:creator>Mohseni-Motlagh, A.</dc:creator>
<dc:creator>Alereza, T.</dc:creator>
<dc:creator>Mozaffari, L.</dc:creator>
<dc:creator>Rozbeh, M.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.10.717575</dc:identifier>
<dc:title><![CDATA[Integrated Computational and Experimental Evaluation of selected Flavonoids as a Multi-Target Modulator of Viral Entry and Protease Activity.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Flavonoids have been widely investigated for their antiviral and anti-inflammatory properties, but their mechanisms of action often remain insufficiently defined. In the present study, high-purity flavonoids were evaluated using an integrated workflow combining molecular docking, LigPlot+ interaction mapping, surface plasmon resonance (SPR), fluorescence-based TMPRSS2 inhibition assays, and cell-based viability studies. Docking with AutoDock Vina identified Hesperidin as the strongest overall candidate among the compounds evaluated. Hesperidin showed strong active-site engagement with TMPRSS2, including interactions with catalytic residues His296, Asp345, and Ser441, and stable binding within the SARS-CoV-2 main protease (Mpro) pocket. Comparative docking showed weaker or more peripheral interaction patterns for Rutin and moderate Spike binding for Hesperidin and Rutin. Experimental validation demonstrated dose-dependent inhibition of TMPRSS2 activity with an IC50 of 79.1 {micro}M for Hesperidin and 43.5 {micro}M for Hesperetin, while Rutin showed partial inhibition without a defined IC50 in the tested range. In Calu-3 cells, pre-treatment with Hesperidin or Rutin reduced SARS-CoV-2 Spike-induced cytotoxicity by approximately 30% without detectable intrinsic toxicity at the concentrations tested Docking analysis of Hesperidin and Rutin with the SARS-CoV-2 Spike protein revealed moderate interaction patterns involving residues such as Asn343, Ser371, and Val367. Hydrogen bond distances were generally in the range of approximately 2.9-3.3 [A], indicating moderate stabilization compared with the stronger active-site interactions observed for Hesperidin in TMPRSS2. The resulting binding poses suggest that these flavonoids can associate with structurally relevant regions of the Spike receptor-binding domain; however, they do not strongly overlap with the key residues required for ACE2 interaction. Rutin, in particular, exhibited a more peripheral and distributed binding mode within the Spike-ACE2 complex, indicating limited potential for direct disruption of the binding interface. In addition to SARS-CoV-2 targets, docking analysis extended to influenza viral proteins revealed moderate interaction of Hesperidin with hemagglutinin (HA) and strong catalytic-pocket binding of Rutin to neuraminidase (NA), involving key residues associated with enzymatic activity. These findings broaden the scope of the study to include influenza viral entry and release mechanisms, supporting a multi-virus, multi-target framework.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.11.716570v1?rss=1">
<title>
<![CDATA[
Serial vaccination expands and refines human CD4+ T cell memory 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.11.716570v1?rss=1"
</link>
<dc:creator>Lai, Y.-H.</dc:creator>
<dc:creator>Su, X.</dc:creator>
<dc:creator>Awad, S.</dc:creator>
<dc:creator>Ansari, A.</dc:creator>
<dc:creator>Jang, J.</dc:creator>
<dc:creator>Saber, A. O.</dc:creator>
<dc:creator>Chen, H.-W.</dc:creator>
<dc:creator>Jung, H.</dc:creator>
<dc:creator>Sarkar, A.</dc:creator>
<dc:creator>Drapeau, E. M.</dc:creator>
<dc:creator>Bilker, W. B.</dc:creator>
<dc:creator>Hensley, S. E.</dc:creator>
<dc:creator>Su, L. F.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.11.716570</dc:identifier>
<dc:title><![CDATA[Serial vaccination expands and refines human CD4+ T cell memory]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
CD4+ T cells coordinate protective immunity against pathogens. However, a major unresolved question is how human CD4+ T cell memory is established and evolves following primary and repeated vaccination. Using COVID-19 mRNA vaccination as a model, we tracked 50 distinct antigen-specific populations directly ex vivo with peptide-MHC class II tetramers in eight SARS-CoV-2-naive individuals from pre-vaccine baseline through memory time points after three mRNA doses. Our findings identify the primary vaccine series as the main driver of memory pool size. It leverages pre-existing memory while preferentially recruiting high-avidity T cells, establishing an immunodominance hierarchy dominated by a small subset of precursors. Booster vaccination refines both the magnitude and quality of T cell memory. It increases select populations and enhances differentiation of subdominant CD4+ T cells. Populations that did not become more abundant after boosting retained their polyfunctional potential. Beyond establishing memory to the ancestral spike, vaccinations broadened responses by recruiting cross-reactive T cells recognizing viral variants. Collectively, these findings reveal how human CD4+ T cell memory evolves through sequential immunizations to generate a functionally diverse and broadly responsive memory repertoire against future viral challenges.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.10.717770v1?rss=1">
<title>
<![CDATA[
MIMIQ: Fast mutual information calculation and significance testing for single-cell RNA sequencing analysis 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.10.717770v1?rss=1"
</link>
<dc:creator>O'Hanlon, D.</dc:creator>
<dc:creator>Garcia Busto, S.</dc:creator>
<dc:creator>Perez Carrasco, R.</dc:creator>
<dc:date>2026-04-13</dc:date>
<dc:identifier>doi:10.64898/2026.04.10.717770</dc:identifier>
<dc:title><![CDATA[MIMIQ: Fast mutual information calculation and significance testing for single-cell RNA sequencing analysis]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Mutual information is a fundamental quantity in information theory that describes the non-linear dependency between two variables, and has numerous applications within bioinformatics and beyond. However, its exploitation is hampered by a trade-off between computational intensity and accuracy. Here we present an adaptive binning approach to computing the pairwise mutual information, optimized for small integer counts such as those observed in single-cell RNA sequencing. By assuming a sampling distribution such as the negative binomial, a {chi}2 test statistic for hypothesis testing can be computed simultaneously via a copula transformation. Using these quantities, we show how gene rewiring of CD4+ naive T-cells during SARS-CoV-2 infection can be studied using a single-cell sequencing dataset of healthy and COVID-19 donors.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.10.26350613v1?rss=1">
<title>
<![CDATA[
Comprehensive Immunophenotyping of Monocytes and Dendritic Cells Suggests Distinct Pathophysiology in Chronic Fatigue Syndrome and Long COVID 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.10.26350613v1?rss=1"
</link>
<dc:creator>Petrov, S. I.</dc:creator>
<dc:creator>Bozhkova, M.</dc:creator>
<dc:creator>Ivanovska, M.</dc:creator>
<dc:creator>Kalfova, T.</dc:creator>
<dc:creator>Dudova, D.</dc:creator>
<dc:creator>Todorova, Y.</dc:creator>
<dc:creator>Dimitrova, R.</dc:creator>
<dc:creator>Murdjeva, M.</dc:creator>
<dc:creator>Taskov, H.</dc:creator>
<dc:creator>Nikolova, M.</dc:creator>
<dc:creator>Maes, M.</dc:creator>
<dc:date>2026-04-12</dc:date>
<dc:identifier>doi:10.64898/2026.04.10.26350613</dc:identifier>
<dc:title><![CDATA[Comprehensive Immunophenotyping of Monocytes and Dendritic Cells Suggests Distinct Pathophysiology in Chronic Fatigue Syndrome and Long COVID]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-12</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID are complex chronic conditions that often follow infectious triggers with overlapping clinical features but poorly defined pathophysiological relationships. This study aimed to identify disease-specific immune signatures through multiparameter immunophenotyping of monocytes, dendritic cells, and T-cell subsets. A total of 207 participants were included (ME/CFS: n = 103; long COVID: n = 63; healthy controls: n = 41). Peripheral blood mononuclear cells were analyzed using multiparameter flow cytometry. Statistical analyses included non-parametric testing, age-adjusted ANCOVA, correlation network analysis, and principal component analysis (PCA). Long COVID was characterized by increased M2-like monocyte polarization, elevated CD80 expression across monocyte subsets, expansion of dendritic cells, and reduced expression of activation markers, indicating persistent immune activation with features of immune exhaustion. In contrast, ME/CFS exhibited reduced costimulatory molecule expression, impaired CCR7-mediated immune cell trafficking, and less coordinated activation patterns, consistent with a state of immune suppression. Correlation network analysis revealed more extensive and integrated immune interactions in long COVID, while PCA identified distinct immunophenotypic components and enabled moderate discrimination between the two conditions. These findings demonstrate that ME/CFS and long COVID are characterized by distinct immune profiles, supporting the concept of divergent immunopathological mechanisms. The identified signatures may contribute to biomarker development and guide targeted therapeutic approaches.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.10.26350608v1?rss=1">
<title>
<![CDATA[
Minor Consent state policies and COVID-19 vaccination in adolescents 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.10.26350608v1?rss=1"
</link>
<dc:creator>Litchy, C.</dc:creator>
<dc:creator>Semprini, J.</dc:creator>
<dc:date>2026-04-11</dc:date>
<dc:identifier>doi:10.64898/2026.04.10.26350608</dc:identifier>
<dc:title><![CDATA[Minor Consent state policies and COVID-19 vaccination in adolescents]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundEver since the COVID-19 vaccine became available, vaccinations in adolescents lagged behind adults. Whether adolescent vaccination rates were higher in states with "Minor Consent" policies remains unknown.

MethodsWe accessed adolescent (aged 12-17) county-level vaccine administration data from the CDC (12/2020-05/2023) Our outcomes were COVID-19 vaccination counts for 1) initial dose, 2) completed series doses, 3) booster doses. Panel Poisson regression models with state and time random effects, seasonal fixed-effects, log-population offsets, and adult vaccination rates were estimated to calculate incidence rate ratios (IRR), testing the association between residing in a state with a Minor Consent policy and COVID-19 vaccine uptake.

ResultsOverall, for the initial dose and complete series, there was no difference in adolescent COVID-19 vaccination between states with or without Minor Consent policies. However, we found that Minor Consent policies were associated with lower COVID-19 booster doses (IRR = 0.582; 95% CI: 0.409, 0.828; p=0.0026). This association was not found in urban (IRR = 0.867; CI = 0.722, 1.043; p = 0.1295), but only in rural counties (IRR 0.541; CI 0.401, 0.730; p<0.0001).

ConclusionsMinor Consent policies were not associated with higher adolescent COVID-19 vaccination. Rather, we found that Minor Consent policies were associated with lower adolescent vaccination for booster doses in rural counties. Despite minimal evidence of impact, states continue to implement Minor Consent vaccination policies. Future research on the topic should investigate, not just other vaccines, but how Minor Consent policies impact parental trust in public health more broadly.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.09.717495v1?rss=1">
<title>
<![CDATA[
Phagocytic Clearance of SARS-CoV-2 Nucleocapsid- and RNA-Containing Immune Complexes Drives Inflammatory Cytokine Production and Endothelial Dysfunction 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.09.717495v1?rss=1"
</link>
<dc:creator>Gach, J. S.</dc:creator>
<dc:creator>Kim, D.</dc:creator>
<dc:creator>Vu, K.</dc:creator>
<dc:creator>Marshall, M. E.</dc:creator>
<dc:creator>Cachay, C.</dc:creator>
<dc:creator>Rangwala, A. A.</dc:creator>
<dc:creator>Kerster, G.</dc:creator>
<dc:creator>Tifrea, D.</dc:creator>
<dc:creator>Pearlman, E.</dc:creator>
<dc:creator>van Gils, M.</dc:creator>
<dc:creator>Hughes, C. C.</dc:creator>
<dc:creator>Forthal, D. N.</dc:creator>
<dc:date>2026-04-10</dc:date>
<dc:identifier>doi:10.64898/2026.04.09.717495</dc:identifier>
<dc:title><![CDATA[Phagocytic Clearance of SARS-CoV-2 Nucleocapsid- and RNA-Containing Immune Complexes Drives Inflammatory Cytokine Production and Endothelial Dysfunction]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The aberrant inflammation that characterizes severe COVID-19 is incompletely understood. Given the persistence of SARS-Cov-2 RNA and nucleocapsid protein (N) and the presence of anti-N antibody during the course of severe infection, we investigated the role of RNA-containing immune complexes (ICs) in driving inflammation. We found that ICs consisting of SARS-CoV-2 RNA, N, and anti-N IgG1 stimulate primary human monocytes in vitro to produce inflammatory cytokines and chemokines in a manner dependent on Fc{gamma} receptors and partially dependent on toll-like receptor-8. In addition, the inflammatory response induced in monocytes by RNA-containing ICs caused endothelial dysfunction in vascularized micro-organs. Using nasopharyngeal samples from SARS-CoV-2-infected individuals, SARS-CoV-2 RNA and N were captured by anti-N monoclonal antibody in the absence of lysing reagents, indicating that SARS-CoV-2 RNA and N complexes are present outside of virions and cells. Finally, we found that during an early wave of COVID-19, the anti-N IgG:IgM ratio predicted severe clinical outcomes, consistent with a role for inflammatory, IgG-mediated phagocytic clearance of nucleic acid-containing ICs in SARS-CoV-2 pathogenesis, perhaps mitigated by non-inflammatory, IgM-mediated clearance. We conclude that RNA-containing ICs may play a role in the pathogenesis of severe COVID-19. Since all pathogenic viruses encode nucleic acid-binding proteins, such as N, and these proteins often elicit an antibody response, inflammatory clearance of nucleic acid-containing ICs may also contribute to disease severity in other viral infections.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.08.717316v1?rss=1">
<title>
<![CDATA[
Role of Nonneutralizing Antibodies and Fc Effector Functions in Inhibiting SARS-CoV-2 Infection 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.08.717316v1?rss=1"
</link>
<dc:creator>Sun, H.</dc:creator>
<dc:creator>Esqueda, A.</dc:creator>
<dc:creator>Steinkellner, H.</dc:creator>
<dc:creator>Chen, Q.</dc:creator>
<dc:date>2026-04-09</dc:date>
<dc:identifier>doi:10.64898/2026.04.08.717316</dc:identifier>
<dc:title><![CDATA[Role of Nonneutralizing Antibodies and Fc Effector Functions in Inhibiting SARS-CoV-2 Infection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Neutralizing monoclonal antibodies (mAbs) are a key component of antiviral therapeutics against SARS-CoV-2; however, the contribution of Fc-mediated effector functions remains underexplored. Here, we compare the antiviral activities of the neutralizing and non-neutralizing mAbs CB6 and CR3022, respectively. The Fc regions of both plant-produced mAbs carried nonfucosylated, non-galactosylated complex glycans (pCB6 and pCR3022), and CR3022 was also produced with mammalian-typical galactosylated, fucosylated glycans (mCR3022). pCR3022 exhibited markedly enhanced antibody-dependent cellular cytotoxicity (ADCC) and antibody-dependent cell-mediated virus inhibition (ADCVI) compared to mCR3022, indicating a significant impact of Fc glycosylation on antiviral activity despite the lack of neutralization. pCB6 exhibited potent neutralization while further enhancing virus clearance through synergistic Fc effector activity. Our findings suggest that Fc-mediated mechanisms, especially ADCC and ADCVI, can contribute substantially to viral control and may be particularly valuable against immune-evasive variants. These results advance our understanding of the functional roles that non-neutralizing antibodies can play in SARS-CoV-2 infection and highlight the potential of Fc glycoengineering to modulate the antiviral efficacy of both neutralizing and non-neutralizing mAbs.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.09.717442v1?rss=1">
<title>
<![CDATA[
An imaging flow cytometry method to study platelet-monocyte aggregates using Long COVID as a model 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.09.717442v1?rss=1"
</link>
<dc:creator>Thompon, A.</dc:creator>
<dc:creator>Venter, C.</dc:creator>
<dc:creator>de Villiers, W. J.</dc:creator>
<dc:creator>De Swardt, D.</dc:creator>
<dc:creator>Laubscher, G. J.</dc:creator>
<dc:creator>Kell, D. B.</dc:creator>
<dc:creator>Pretorius, E.</dc:creator>
<dc:date>2026-04-09</dc:date>
<dc:identifier>doi:10.64898/2026.04.09.717442</dc:identifier>
<dc:title><![CDATA[An imaging flow cytometry method to study platelet-monocyte aggregates using Long COVID as a model]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundLong COVID is characterised by persistent systemic inflammation and endothelial dysfunction, with increasing evidence implicating thromboinflammatory mechanisms. Platelet-monocyte aggregates (PMA) represent a sensitive marker of platelet activation and immune-vascular interactions, but their role in Long COVID remains incompletely defined.

MethodsThis study quantified circulating PMA in 20 Long COVID patients and 20 healthy controls using a two-colour imaging flow cytometry assay targeting CD14 (a monocyte receptor for pathogen-associated molecular patterns, PAMPs) and CD62P (P-selectin). PMA were expressed as a percentage of total monocytes, and platelet attachment patterns were classified into single versus multiple platelet binding. Statistical analyses included Shapiro-Wilk normality testing, unpaired t-tests, Mann-Whitney U tests or two-way ANOVA as appropriate, and linear regression for correlation analysis.

ResultsCirculating PMA were significantly elevated in Long COVID patients compared with controls (29.19 [20.02-37.26] vs 4.59 [2.67-7.16], p < 0.0001). Long COVID samples showed a reduced proportion of monocytes with single platelet attachment and a corresponding increase in multiple platelet binding (p < 0.0001). In controls, %PMA increased with age (p < 0.01), whereas no age association was observed in Long COVID, indicating an elevated baseline independent of age.

ConclusionsLong COVID is associated with markedly increased platelet-monocyte aggregation and altered platelet attachment dynamics, consistent with sustained thromboinflammatory activity. PMA represent a sensitive cellular marker of platelet-driven immune activation and may have utility as an accessible biomarker for stratifying thromboinflammatory burden in Long COVID.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.08.717307v1?rss=1">
<title>
<![CDATA[
Myeloma and therapy reshape the bone marrow niche to durably constrain immune reconstitution and vaccine responsiveness 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.08.717307v1?rss=1"
</link>
<dc:creator>Chander, A.</dc:creator>
<dc:creator>Rachid Zaim, S.</dc:creator>
<dc:creator>Dillon, M. A.</dc:creator>
<dc:creator>Genge, P. C.</dc:creator>
<dc:creator>Moss, N.</dc:creator>
<dc:creator>McGrath, P. I.</dc:creator>
<dc:creator>Kopp, M. S.</dc:creator>
<dc:creator>Lee, K. J.</dc:creator>
<dc:creator>Kuan, E. L.</dc:creator>
<dc:creator>Reading, J.</dc:creator>
<dc:creator>Hernandez, V.</dc:creator>
<dc:creator>Song, X.</dc:creator>
<dc:creator>Singh, M.</dc:creator>
<dc:creator>Garber, J.</dc:creator>
<dc:creator>LaFrance, C. M.</dc:creator>
<dc:creator>Kong, G. L.</dc:creator>
<dc:creator>Glass, M. C.</dc:creator>
<dc:creator>Davis, E. L. W.</dc:creator>
<dc:creator>Glass, D.</dc:creator>
<dc:creator>He, Y. D.</dc:creator>
<dc:creator>Heubeck, A. T.</dc:creator>
<dc:creator>Kawelo, E. K.</dc:creator>
<dc:creator>Krishnan, U.</dc:creator>
<dc:creator>Lord, C.</dc:creator>
<dc:creator>Meijer, P.</dc:creator>
<dc:creator>Mettey, R. R.</dc:creator>
<dc:creator>Musgrove, B.</dc:creator>
<dc:creator>Okada, L. Y.</dc:creator>
<dc:creator>Parthasarathy, V.</dc:creator>
<dc:creator>Peng, T.</dc:creator>
<dc:creator>Phalen, C. G.</dc:creator>
<dc:creator>Riddell, S.</dc:creator>
<dc:creator>Roll, C. R.</dc:creator>
<dc:creator>Stuckey, T. J.</dc:creator>
<dc:creator>Swanson, E. G.</dc:creator>
<dc:creator>Thomson, Z. J.</dc:creator>
<dc:creator>Weiss, M. D. A.</dc:creator>
<dc:creator>Wittig, P. J.</dc:creator>
<dc:creator>Anover-Sombke, S. D.</dc:creator>
<dc:creator>Coffey, E. M.</dc:creator>
<dc:creator>Becker, L. A.</dc:creator>
<dc:creator>Bumol, T. F.</dc:creator>
<dc:creator>Goldrath, A. W.</dc:creator>
<dc:creator>Newell, E. W.</dc:creator>
<dc:creator>Greenberg, P. D.</dc:creator>
<dc:creator>Li, X.-j.</dc:creator>
<dc:creator>Kaech, S. M.</dc:creator>
<dc:creator>Skene, P. J.</dc:creator>
<dc:creator>Graybuck, L. T.</dc:creator>
<dc:creator>Tatting, L.</dc:creator>
<dc:creator>Sigvardsson, M.</dc:creator>
<dc:creator>Kwok, M.</dc:creator>
<dc:creator>Green, D. J.</dc:creator>
<dc:creator>Torgerson, T. R.</dc:creator>
<dc:creator>Angus-Hill, M. L.</dc:creator>
<dc:date>2026-04-09</dc:date>
<dc:identifier>doi:10.64898/2026.04.08.717307</dc:identifier>
<dc:title><![CDATA[Myeloma and therapy reshape the bone marrow niche to durably constrain immune reconstitution and vaccine responsiveness]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Infections are the most common cause of non-relapse mortality in multiple myeloma (MM), but the basis of persistent immune dysfunction is obscured by patient heterogeneity and complex treatment regimens, including autologous stem cell transplant (ASCT). We performed longitudinal multi-omic profiling of matched bone marrow and peripheral blood from MM patients across diagnosis, induction, ASCT, and recovery. We found the tumor imposes a compartment-specific immune program where the marrow exhibits metabolic and inflammatory changes that bias hematopoiesis and alter cytotoxic effector programs not mirrored in blood. Adaptive immune reconstitution is impaired up to two years post-ASCT. Half of patients fail to mount IgG responses to high-dose non-adjuvanted influenza vaccine, a defect overcome by the lipid nanoparticle (LNP) adjuvanted COVID mRNA vaccine, which elicited responses in all patients, supporting adjuvanted influenza vaccine strategies in MM. Together these findings define how myeloma and its treatment durably reshape immunity from the marrow outward.

HighlightsO_LIMultiple Myeloma marrow and blood show opposing metabolic and inflammatory states
C_LIO_LIInduction therapy selects durable myeloma plasma-cell transcriptional states
C_LIO_LIB cell and follicular helper T deficits blunt antigen responses after transplant
C_LIO_LICOVID-19 vaccination builds immune memory with variable responses to flu vaccination
C_LI

eTOCMultiple myeloma and its treatment leave a lasting imprint on the bone marrow niche. By profiling bone marrow and blood longitudinally at diagnosis, through induction, autologous transplant, and recovery, we show that marrow-local metabolic and inflammatory constraints persist and help explain why influenza vaccination often fails while mRNA vaccination succeeds.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.04.07.26349269v1?rss=1">
<title>
<![CDATA[
Assessing the Impact of Timing and Coverage of United States COVID-19 Vaccination Campaigns: A Multi-Model Approach 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.04.07.26349269v1?rss=1"
</link>
<dc:creator>Nande, A.</dc:creator>
<dc:creator>Larsen, S. L.</dc:creator>
<dc:creator>Turtle, J.</dc:creator>
<dc:creator>Davis, J. T.</dc:creator>
<dc:creator>Bandekar, S. R.</dc:creator>
<dc:creator>Lewis, B.</dc:creator>
<dc:creator>Chen, S.</dc:creator>
<dc:creator>Contamin, L.</dc:creator>
<dc:creator>Jung, S.-m.</dc:creator>
<dc:creator>Howerton, E.</dc:creator>
<dc:creator>Shea, K.</dc:creator>
<dc:creator>Bay, C.</dc:creator>
<dc:creator>Ben-Nun, M.</dc:creator>
<dc:creator>Bi, K.</dc:creator>
<dc:creator>Bouchnita, A.</dc:creator>
<dc:creator>Chen, J.</dc:creator>
<dc:creator>Chinazzi, M.</dc:creator>
<dc:creator>Fox, S. J.</dc:creator>
<dc:creator>Hill, A. L.</dc:creator>
<dc:creator>Hochheiser, H.</dc:creator>
<dc:creator>Lemaitre, J. C.</dc:creator>
<dc:creator>Loo, S. L.</dc:creator>
<dc:creator>Marathe, M.</dc:creator>
<dc:creator>Meyers, L. A.</dc:creator>
<dc:creator>Pearson, C. A. B.</dc:creator>
<dc:creator>Porebski, P.</dc:creator>
<dc:creator>Przykucki, E.</dc:creator>
<dc:creator>Smith, C. P.</dc:creator>
<dc:creator>Venkatramanan, S.</dc:creator>
<dc:creator>Vespignani, A.</dc:creator>
<dc:creator>Willard, T. C.</dc:creator>
<dc:creator>Yan, K.</dc:creator>
<dc:creator>Viboud, C.</dc:creator>
<dc:creator>Lessler, J.</dc:creator>
<dc:creator>Truelove, S.</dc:creator>
<dc:date>2026-04-08</dc:date>
<dc:identifier>doi:10.64898/2026.04.07.26349269</dc:identifier>
<dc:title><![CDATA[Assessing the Impact of Timing and Coverage of United States COVID-19 Vaccination Campaigns: A Multi-Model Approach]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Six years after its emergence, SARS-CoV-2 continues to have a substantial burden, however, the impact of vaccination and the optimal timing of its rollout remain uncertain. To explore these uncertainties, the US Scenario Modeling Hub convened its 19th round of ensemble projections for COVID-19 hospitalizations and deaths in the United States. Eight teams provided outcomes for each US state and nationally from April 2025 to April 2026 under five scenarios regarding vaccine recommendations and timing. We assessed recommendations with two eligibility scenarios (high-risk individuals only and all-eligible) and two timing scenarios (classic start: mid-August, earlier start: late June). These were crossed to create four scenarios and were compared against a counterfactual scenario with no vaccination. We found that compared to no vaccination, our ensemble projections estimated 90,000 (95% PI 53,000-126,000) hospitalizations averted in the high-risk and classic timing scenario across the US. Expanding coverage averted an additional 26,000 (95% PI 14,000-39,000) hospitalizations, which when coupled with earlier vaccination timing further reduced national hospitalizations by 15,000 (95% PI -3,000-33,000). These findings estimate significant benefits from a broad all-eligible vaccination recommendation, and suggest an additional benefit is likely to be gained from an earlier vaccination campaign.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.07.716934v1?rss=1">
<title>
<![CDATA[
Intranasal Anti-CD3 Antibody Treatment Attenuates Post-COVID Neuroinflammation and Enhances Hippocampal Neurogenesis and Cognitive Function in Mice 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.07.716934v1?rss=1"
</link>
<dc:creator>Lu, P.</dc:creator>
<dc:creator>Izzy, S.</dc:creator>
<dc:creator>Da Silva, P.</dc:creator>
<dc:creator>Imkamp, H. T.</dc:creator>
<dc:creator>Christenson, J. R.</dc:creator>
<dc:creator>Yahya, T.</dc:creator>
<dc:creator>Mansi, M. H. A.</dc:creator>
<dc:creator>Alawi, A.</dc:creator>
<dc:creator>Moreira, T. G.</dc:creator>
<dc:creator>Monje, M.</dc:creator>
<dc:creator>Weiner, H. L.</dc:creator>
<dc:creator>Iwasaki, A.</dc:creator>
<dc:date>2026-04-08</dc:date>
<dc:identifier>doi:10.64898/2026.04.07.716934</dc:identifier>
<dc:title><![CDATA[Intranasal Anti-CD3 Antibody Treatment Attenuates Post-COVID Neuroinflammation and Enhances Hippocampal Neurogenesis and Cognitive Function in Mice]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Cognitive impairment is a disabling feature of Long COVID, with data supporting neuroinflammation and maladaptive glial responses as primary drivers. Nasal administration of an anti-CD3 monoclonal antibody (aCD3 mAb) has shown therapeutic benefits in autoimmune and CNS disease models. Using a respiratory-restricted mild SARS-CoV-2 mouse model of Long COVID, we show that nasal anti-CD3 mAb, administered shortly after infection or during chronic neuroinflammation, increased brain FoxP3+ IL-10+ Tregs, reduced microglial and astrocytic gliosis in the white matter and hippocampus, restored neurogenesis, and improved short-term memory. Nasal aCD3 mAb reprogrammed microglia from an antigen-presenting, NF-{kappa}B-driven inflammatory state toward chemokine signaling, phagosome, and TGF {beta}-related regulatory phenotype. Patients with Long COVID with neurological symptoms had lower circulating Treg populations. These findings identify nasal administration of aCD3 mAb as a noninvasive strategy to control neuroinflammation, restore the neurogenic niche, and offer a novel approach to treating cognitive impairment in Long COVID.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.07.717019v1?rss=1">
<title>
<![CDATA[
SKIN AS A POTENTIAL ENTRY POINT FOR SARS-COV-2 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.07.717019v1?rss=1"
</link>
<dc:creator>Trubestskoy, D.</dc:creator>
<dc:creator>Grudzien, P.</dc:creator>
<dc:creator>Chudakova, D.</dc:creator>
<dc:creator>Klopot, A.</dc:creator>
<dc:creator>Bhalla, P.</dc:creator>
<dc:creator>Perez-White, B.</dc:creator>
<dc:creator>Budunova, I.</dc:creator>
<dc:date>2026-04-08</dc:date>
<dc:identifier>doi:10.64898/2026.04.07.717019</dc:identifier>
<dc:title><![CDATA[SKIN AS A POTENTIAL ENTRY POINT FOR SARS-COV-2]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The primary route of SARS-CoV-2 entry is via respiratory epithelium. However, many COVID-19 patients developed dermatological lesions, and SARS-CoV-2 RNA has been detected in the patients skin. Inflammatory skin diseases, psoriasis and atopic dermatitis (AD), significantly increased the risk of COVID-19. To evaluate the potential role of skin in SARS-CoV-2 host interactions, we utilized 3D human skin organoids (HSO) generated from human epidermal keratinocytes, as well as neonatal skin explants. HSO were treated with cytokines involved in acute and chronic skin inflammation and cytokine storm in severe COVID-19 disease, TNF-, IL-6, IL-1{beta}, and IFN-{gamma}, individually and in combination. HSO were also treated with Th1 (TNF- + IL-17) and Th2 (IL-4 + IL-13) cocktails inducing pro-psoriasis and pro-AD HSO changes, respectively. All individual cytokines, and especially their combinations, elevated the expression of ACE2 and TMPRSS2 at mRNA/protein levels. The Th2 induced only TMPRSS2, the Th1 predominantly induced ACE2. Topically applied Spike-pseudotyped lentiviral Tomato reporter, which binds ACE2 similarly to SARS-CoV-2, successfully infected control and cytokine-treated HSO as well as neonatal skin explants. Cytokine treatment, especially TNF- + IL-6 + IL-1{beta} + IFN-{gamma} and the Th1, significantly increased viral entry. Transcriptomic analysis further revealed partial overlap between gene expression signatures induced by Spike-mediated entry in inflamed HSO and those observed in lung tissue from COVID-19 patients, supporting the biological relevance of skin models. Together, these findings demonstrate that inflammation enhances the permissiveness of human skin to SARS-CoV-2 entry, suggesting that the skin may represent a previously underappreciated interface in viral host interactions.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.03.716319v1?rss=1">
<title>
<![CDATA[
High-speed 3D single-virus tracking reveals actin-aided viral trafficking of SARS-CoV-2 on the plasma membrane 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.03.716319v1?rss=1"
</link>
<dc:creator>Lin, Y.</dc:creator>
<dc:creator>Lu, X.</dc:creator>
<dc:creator>Exell, J.</dc:creator>
<dc:creator>Lin, H.</dc:creator>
<dc:creator>Johnson, C.</dc:creator>
<dc:creator>Welsher, K.</dc:creator>
<dc:date>2026-04-06</dc:date>
<dc:identifier>doi:10.64898/2026.04.03.716319</dc:identifier>
<dc:title><![CDATA[High-speed 3D single-virus tracking reveals actin-aided viral trafficking of SARS-CoV-2 on the plasma membrane]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-06</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Early interactions between viruses and live cells are difficult to resolve due to rapid extracellular motion, 3D nature of the cell membrane, and the fast, nanoscale interactions involved. While actin is a central regulator of viral entry, direct observations of actin-aided trafficking have been restricted to membrane protrusions on glass surfaces given the limitations of conventional methods. Here, high-speed 3D Tracking and Imaging microscopy (3D-TrIm) is integrated with highly photostable StayGold-labeled SARS-CoV-2 virus-like particles to capture long-term, high-resolution single-virus trajectories in live cells. This approach revealed distinct regimes of viral dynamics, including extracellular diffusion, protrusion-based surfing, and an unreported linear trafficking mode along the plasma membrane that precedes viral internalization. This work demonstrates that this membrane trafficking is actin-driven and positively correlated with ACE2 expression. These findings reveal new actin exploitation by viruses and demonstrate the utility of 3D-TrIm for dissecting dynamic virus-cell interactions at high spatiotemporal resolution.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.02.716254v1?rss=1">
<title>
<![CDATA[
Frustration Landscapes of Broadly Neutralizing SARS-CoV-2 Spike Antibodies Targeting Conserved Epitopes Reveal Energetic Logic of Escape-Proof and Escape-Prone Mechanisms 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.02.716254v1?rss=1"
</link>
<dc:creator>Alshahrani, M.</dc:creator>
<dc:creator>Gatlin, W.</dc:creator>
<dc:creator>Ludwick, M.</dc:creator>
<dc:creator>Turano, L.</dc:creator>
<dc:creator>Foley, B.</dc:creator>
<dc:creator>Verkhivker, G.</dc:creator>
<dc:date>2026-04-03</dc:date>
<dc:identifier>doi:10.64898/2026.04.02.716254</dc:identifier>
<dc:title><![CDATA[Frustration Landscapes of Broadly Neutralizing SARS-CoV-2 Spike Antibodies Targeting Conserved Epitopes Reveal Energetic Logic of Escape-Proof and Escape-Prone Mechanisms]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-03</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The continued evolution of SARS-CoV-2 has enabled escape from most monoclonal antibodies, yet a subset of broadly neutralizing antibodies targeting three newly identified super-conserved RBD epitopes--SCORE-A, SCORE-B, and SCORE-C--retains remarkable activity against even the most recent JN.1-derived sublineages. Here we employed an integrated computational framework combining conformational dynamics, mutational scanning, MM-GBSA binding energetics, and frustration profiling to dissect the molecular mechanisms by which XGI antibodies achieve broad neutralization and resistance to immune escape. Structural analysis revealed that all three SCORE epitopes share a common architecture: a highly conserved, minimally frustrated core that provides stable anchoring, flanked by peripheral regions that accommodate antibody-specific variations. Conformational dynamics showed that SCORE-A antibodies (XGI-183) rigidify the lateral epitope while leaving the RBM partially mobile; SCORE-B antibodies (XGI-198, XGI-203) clamp the RBM apex, directly blocking ACE2; and SCORE-C antibodies (XGI-171) allosterically loosen the RBM loop, impairing receptor engagement indirectly. Mutational scanning identified a hierarchical hotspot organization where primary hotspots (e.g., K356, T500, Y380, T385) are evolutionarily constrained and minimally frustrated, while secondary hotspots (e.g., V503, Y508, S383) are neutrally frustrated and represent the principal sites of immune-driven mutations. MM-GBSA decomposition revealed that van der Waals-driven hydrophobic packing dominates binding, with electrostatic interactions providing auxiliary stabilization. Critically, frustration analysis demonstrated that immune escape hotspots reside precisely in zones of neutral frustration--"energetic playgrounds" that permit mutational exploration without destabilizing the RBD--while minimally frustrated cores are evolutionarily locked. The comparative analysis of conformational versus mutational frustration distributions revealed a unifying principle: aligned neutral frustration yields permissive, escape-prone interfaces; decoupling enables targeting of constrained cores; and convergence of minimal frustration in both distributions creates invulnerable interfaces. These findings establish that broad neutralization arises not from ultra-high-affinity anchors but from strategic energy distribution across rigid, evolutionarily informed interfaces, providing a roadmap for designing next-generation therapeutics that target the invulnerable cores of viral surface proteins.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.03.716256v1?rss=1">
<title>
<![CDATA[
The transmembrane domain regulates the kinetics of the SARS-CoV-2 spike conformational transition 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.03.716256v1?rss=1"
</link>
<dc:creator>Kulshrestha, A.</dc:creator>
<dc:creator>Banerjee, A.</dc:creator>
<dc:creator>Lall, S.</dc:creator>
<dc:creator>Gosavi, S.</dc:creator>
<dc:date>2026-04-03</dc:date>
<dc:identifier>doi:10.64898/2026.04.03.716256</dc:identifier>
<dc:title><![CDATA[The transmembrane domain regulates the kinetics of the SARS-CoV-2 spike conformational transition]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-03</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ABSTRACTThe homotrimeric SARS-CoV-2 spike glycoprotein comprises two subunits: S1, which recognizes host-receptors through its receptor-binding domains (RBDs), and S2, anchored to the viral membrane through its transmembrane domain (TMD), which facilitates the fusion of the viral envelope with the host cell membrane. Upon host-receptor engagement and proteolytic activation, S1 dissociates and triggers a large conformational transition in S2, involving structural rearrangements in the S2 ectomembrane-domains and the TMD. While studies have focused on the ectomembrane-domain dynamics, the TMD has typically been modeled as being in a trimeric state. Here, we use molecular dynamics simulations of a coarse-grained structure-based model (SBM) with an implicit membrane to investigate the role of TMD dynamics in modulating S2 conformational conversion. We first recapitulate previous results from an all-atom SBM with a trimeric TMD and re-emphasize that the extended pre-hairpin intermediate state of S2, which brings the two membranes into apposition, is a byproduct of the prefusion-to-postfusion transition. Next, by introducing dynamics into the TMD, we find a late fusion intermediate structurally similar to a recent cryo-EM structure. A dynamic TMD also makes the conformational transition faster. Simulations including the S1/S2 complex reveal coupled RBD-TMD dynamics: when all three RBDs are in the closed state, they can stabilize the TMD in a trimeric configuration, whereas the opening of a single RBD can trigger a transition to a dynamic TMD. So, the dynamics and the conformational preferences of the TMD can be tuned by the presence and conformation of S1. There is some evidence that the TMDs of class I viral fusion proteins, such as spike, contribute to viral fusion by modulating membrane properties. Our simulations indicate an expanded role for the function of the TMD, where it can directly regulate the kinetics of S2 conformational transitions.

SIGNIFICANCE STATEMENTThe SARS-CoV-2 fusion protein, spike, undergoes a large conformational transition, which facilitates the fusion of the viral and host-cell membranes and the delivery of the viral genome into the host cell. Despite extensive studies of the spike conformational conversion, its transmembrane domain (TMD) has largely been viewed as a viral membrane anchor. Using coarse-grained structure-based model simulations, we show that TMD dynamics can modulate the timing of the spike-S2 (fusion subunit) prefusion-to-postfusion conformational conversion. The presence of spike-S1 (receptor-recognition subunit) can suppress TMD dynamics, potentially reducing the rate of spike conformational conversion and viral fusion. Thus, the spike TMD regulates the kinetics of spike-mediated membrane fusion, and TMD-targeting strategies can be an additional avenue for antiviral intervention.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.02.716054v1?rss=1">
<title>
<![CDATA[
Machine Learning-Driven Antigen Selection Reveals Conserved T-Cell Targets for Broad Coronavirus Vaccination 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.02.716054v1?rss=1"
</link>
<dc:creator>Federico, L.</dc:creator>
<dc:creator>Odainic, A.</dc:creator>
<dc:creator>Lund, K. P.</dc:creator>
<dc:creator>Egner, I. M.</dc:creator>
<dc:creator>Wiese, K. E.</dc:creator>
<dc:creator>Cornelissen, L. A. H. M.</dc:creator>
<dc:creator>Kared, H.</dc:creator>
<dc:creator>Stratford, R.</dc:creator>
<dc:creator>Kapell, S.</dc:creator>
<dc:creator>Malone, B.</dc:creator>
<dc:creator>Gheorghe, M.</dc:creator>
<dc:creator>Machart, P.</dc:creator>
<dc:creator>Siarheyeu, R.</dc:creator>
<dc:creator>Tanaka, Y.</dc:creator>
<dc:creator>Clancy, T.</dc:creator>
<dc:creator>Bendjama, K.</dc:creator>
<dc:creator>Munthe, L. A.</dc:creator>
<dc:date>2026-04-03</dc:date>
<dc:identifier>doi:10.64898/2026.04.02.716054</dc:identifier>
<dc:title><![CDATA[Machine Learning-Driven Antigen Selection Reveals Conserved T-Cell Targets for Broad Coronavirus Vaccination]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-03</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundCoronavirus outbreaks remain a persistent threat to global health, and vaccines based primarily on spike-specific immune responses are susceptible to antigenic variation. T-cell immunity directed against conserved internal viral proteins may provide a complementary and more variant-tolerant strategy for next-generation coronavirus vaccines.

MethodsWe combined machine learning-guided antigen prioritization with ex vivo functional immunological validation to identify conserved non-spike T-cell targets across betacoronaviruses. Candidate sequences were screened for immunogenicity using primary human peripheral blood mononuclear cells from healthy donors using intracellular cytokine staining and activation-induced marker assays. Top-ranked conserved regions were incorporated into multiepitope mRNA constructs, and their intracellular expression and HLA class I presentation were confirmed by immunopeptidomics. Immunogenicity was further evaluated ex vivo and in vivo using mRNA immunization of mice and T-cell FluoroSpot assays.

FindingsAcross a panel of 97 peptides derived from 19 viral proteins, evolutionary conservation across distinct betacoronavirus taxa was strongly associated with functional T-cell immunogenicity in human donors. Highly conserved peptides elicited significantly stronger and more frequent CD4 and CD8 T-cell responses than taxon-restricted peptides. Multiepitope mRNA constructs encoding conserved regions were efficiently expressed and presented on HLA class I molecules and induced T-cell responses in human PBMCs. In mice, mRNA immunization with conserved multiepitope constructs generated robust interferon-{gamma}- and interleukin-2-producing T-cell responses that exceeded those induced by unconserved control constructs.

InterpretationThese results link evolutionary conservation to functional cellular immunogenicity and demonstrate the feasibility of multiepitope mRNA delivery for inducing conserved coronavirus-directed T-cell responses. Although protective efficacy remains to be established, conservation-guided antigen selection represents a scalable strategy for developing T-cell-focused vaccines with broad lineage coverage, supporting pandemic preparedness beyond spike-centered immunity.

FundingThe research was supported by CEPI, NEC, University of Oslo and Oslo university hospital.

Research in contextO_ST_ABSEvidence before this studyC_ST_ABSPrior coronavirus vaccine development has focused predominantly on spike protein-directed neutralizing antibodies. While highly effective against matched strains, spike-centered immunity is vulnerable to antigenic drift and lineage-specific escape. Multiple observational and experimental studies have shown that T-cell responses, particularly against internal viral proteins, are more conserved and correlate with reduced disease severity and cross-variant recognition. Epitope prediction algorithms and immunoinformatics approaches have been widely used to nominate candidate T-cell targets; however, systematic functional validation of conserved non-spike antigens across betacoronaviruses in primary human immune systems, combined with antigen presentation data and in vivo vaccine testing, has remained limited. Searches of PubMed and bioRxiv up to December 2025 using terms including "coronavirus T-cell vaccine," "conserved coronavirus epitopes," "betacoronavirus cross-reactive T cells," and "mRNA T-cell vaccine" identified studies demonstrating cross-reactive T-cell immunity and computational epitope selection, but few integrated machine-learning-guided antigen prioritization with ex vivo human functional screening, immunopeptidomics, and in vivo mRNA immunization in a unified workflow.

Added value of this studyThis study provides an integrated experimental and computational framework for identifying and validating conserved non-spike T-cell antigens across betacoronaviruses. We functionally screened a panel of candidate peptides derived from multiple viral proteins and demonstrated that evolutionary conservation across species is strongly associated with T-cell immunogenicity. We further demonstrate that multiepitope mRNA constructs encoding these top-ranked conserved regions can be intracellularly expressed, presented on HLA class I molecules to induce polyfunctional T-cell responses in primary human PBMCs. Finally, in vivo mRNA immunization in mice induces robust interferon-{gamma} and interleukin-2 T-cell responses exceeding those induced by unconserved control constructs. Together, these findings link evolutionary conservation to functional cellular immunogenicity and extend beyond in silico prediction by demonstrating antigen processing, presentation, and immunogenicity across human and murine systems.

Implications of all the available evidenceCollectively, the available evidence indicates that T-cell immunity directed toward conserved internal coronavirus proteins represents a complementary and potentially more variant-tolerant axis of vaccine design than spike-only strategies. Our findings suggest that evolutionary conservation can serve as a practical selection principle for prioritizing T-cell antigens with broad lineage coverage and that multiepitope mRNA delivery is a feasible platform for inducing such responses. While direct protection and heterologous challenge studies will be required to establish clinical efficacy, the integration of computational prioritization with functional validation supports a scalable approach to pandemic preparedness that may be applicable to other rapidly evolving viral families.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.02.716024v1?rss=1">
<title>
<![CDATA[
TF-IDF k-mer-based Classical and Hybrid Machine Learning Models for SARS-CoV-2 Variant Classification under Imbalanced Genomic Data 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.02.716024v1?rss=1"
</link>
<dc:creator>Haque, N.</dc:creator>
<dc:creator>Mazed, A.</dc:creator>
<dc:creator>Ankhi, J. N.</dc:creator>
<dc:creator>Uddin, M. J.</dc:creator>
<dc:date>2026-04-02</dc:date>
<dc:identifier>doi:10.64898/2026.04.02.716024</dc:identifier>
<dc:title><![CDATA[TF-IDF k-mer-based Classical and Hybrid Machine Learning Models for SARS-CoV-2 Variant Classification under Imbalanced Genomic Data]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-02</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Accurate classification of SARS-CoV-2 genomic variants is essential for effective genomic surveillance, yet it is challenged by extreme class imbalance, limited representation of rare variants, and distribution shifts in real-world sequencing data. In this study, we employed hybrid RF-SVM framework designed for robust detection of rare SARS-CoV-2 variants. It integrates a random forest and a polynomial-kernel based support vector machine to enhance sensitivity to minority classes while maintaining overall predictive stability. We systematically compared classical machine learning models, deep learning approaches, and hybrid strategies under both standard and distribution-shifted evaluation settings. Our results show that classical models using TF-IDF-based k-mer features outperform deep learning methods on macro-averaged performance metrics. The Random Forest classifier using TF-IDF Feature achieved the best overall performance, with a macro-averaged F1-score of 0.8894 and an accuracy of 96.3%. The model also demonstrated strong generalization ability, as evidenced by stable cross-validation performance (CV accuracy = 0.9637). Hybrid RF-SVM model further improves rare variant detection under severe class imbalance. Calibration analysis indicates reliable probability estimates for common variants, although challenges persist for minority classes. Overall, this study highlights the limitations of deep learning in highly imbalanced genomic settings and demonstrates that carefully designed hybrid machine learning approaches provide an effective and interpretable solution for rare SARS-CoV-2 variant detection.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.04.01.715984v1?rss=1">
<title>
<![CDATA[
Conserved stem-loops of the SARS-CoV-2 5'-UTR activate OAS1 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.04.01.715984v1?rss=1"
</link>
<dc:creator>Oviedo, A.</dc:creator>
<dc:creator>Bair, C. R.</dc:creator>
<dc:creator>Vasilakopoulos, A. P.</dc:creator>
<dc:creator>Regis, K.</dc:creator>
<dc:creator>VanInsberghe, D.</dc:creator>
<dc:creator>Lowen, A. C.</dc:creator>
<dc:creator>Conn, G. L.</dc:creator>
<dc:date>2026-04-02</dc:date>
<dc:identifier>doi:10.64898/2026.04.01.715984</dc:identifier>
<dc:title><![CDATA[Conserved stem-loops of the SARS-CoV-2 5'-UTR activate OAS1]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-02</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The innate immune system relies on pathogen recognition receptors, such as the 2,5-oligoadenylate synthetase (OAS) proteins, to detect pathogen-associated molecular patterns like viral doublestranded (ds)RNA. A specific splicing variant of OAS1 (OAS1-p46) has been implicated in initiating an immune response that leads to decreased disease severity during SARS-CoV-2 infection. OAS1-p46 has a C-terminal lipid modification motif that allows for anchoring of the protein to intracellular membranes and thus potential colocalization with immunogenic viral RNA regions such as the SARS-CoV-2 5-untranslated region (5-UTR). Here, we show that OAS proteins can detect the 5-structured elements (5-SE)-comprising the 5-UTR and three additional stem-loop structures-and activate the cellular RNase L pathway. Through systematic 3-end truncations of the 5-SE, we show that the smallest 5-SE fragment capable of potently activating OAS1 is the conserved and highly structured SL1-4b region, containing the first four stem-loop structures and their intervening linking sequences (SL1-4), as well as an unstructured region ("SL4b") to the 3-side of SL4. Analyses of OAS1 activation and RNA secondary structure probing using selective 2-hydroxyl acylation analyzed by primer extension and mutational profiling (SHAPE-MaP) of additional SL1-4b RNA variants suggests a model in which SL4 acts as the primary OAS1 interaction site, while the unstructured SL4b region and two other stem-loops (SL1 and SL3) are necessary for optimal presentation of this region for OAS1 activation. Our findings reveal a structurally complex viral RNA region that potently activates OAS1, underscoring the potential complexity of RNAs that can strongly activate this innate immune sensor.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.31.715419v1?rss=1">
<title>
<![CDATA[
VYD2311 is a promising candidate for passive immunization against COVID-19 in immunocompromised individuals 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.31.715419v1?rss=1"
</link>
<dc:creator>Mellis, I. A.</dc:creator>
<dc:creator>Wu, M.</dc:creator>
<dc:creator>Daniel, K.</dc:creator>
<dc:creator>Hong, H.</dc:creator>
<dc:creator>Guo, Y.</dc:creator>
<dc:creator>Ho, D. D.</dc:creator>
<dc:date>2026-04-01</dc:date>
<dc:identifier>doi:10.64898/2026.03.31.715419</dc:identifier>
<dc:title><![CDATA[VYD2311 is a promising candidate for passive immunization against COVID-19 in immunocompromised individuals]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
For millions of immunocompromised individuals, vaccines may not elicit adequate protection from infections, so alternative strategies for pre-exposure prophylaxis are essential. There is only one non-vaccine product authorized in the U.S. as pre-exposure prophylaxis against COVID-19: the monoclonal antibody pemivibart. We previously showed that pemivibart had lower neutralizing activity in vitro against many recent dominant SARS-CoV-2 variants, such as KP.3.1.1, NB.1.8.1, and LP.8.1.1, than it had against JN.1, which was dominant when the antibody was first authorized. The manufacturer of pemivibart (Invivyd) recently initated clinical testing of a new monoclonal antibody derived from pemivibart, VYD2311, but there are no available studies of the activity of VYD2311 against dominant and emerging SARS-CoV-2 variants. Here, using pseudovirus neutralization assays, we measured the neutralizing activity of laboratory-synthesized VYD2311 and pemivibart against dominant and emerging SARS-CoV-2 variants, including XFG, NB.1.8.1, and the genetically distant BA.3.2.2. We found that VYD2311 potently neutralized all tested variants in vitro, dramatically more so than pemivibart. Combined with interpretation of earlier clinical trials of a parental antibody product, we conclude that VYD2311 is a promising candidate for passive immunoprophylaxis against COVID-19, particularly for those who do not respond well to vaccination.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.31.715496v1?rss=1">
<title>
<![CDATA[
Omicron-Enhanced Immunosuppressive Effects of SARS-CoV-2 ORF3a and ORF9b Accessory Proteins on Monocytic Inflammatory Response 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.31.715496v1?rss=1"
</link>
<dc:creator>Grigas, J.</dc:creator>
<dc:creator>Padilla-Blanco, M.</dc:creator>
<dc:creator>Herran, U. M.</dc:creator>
<dc:creator>Lopez-Ayllon, B. D.</dc:creator>
<dc:creator>Rius, A. d. L.</dc:creator>
<dc:creator>Mendoza Garcia, L.</dc:creator>
<dc:creator>Fernandez Rodriguez, R.</dc:creator>
<dc:creator>Garcia Garcia, T.</dc:creator>
<dc:creator>Garrido, J. J.</dc:creator>
<dc:creator>Pautienius, A.</dc:creator>
<dc:creator>Stankevicius, A.</dc:creator>
<dc:creator>Kucinskaite-Kodze, I.</dc:creator>
<dc:creator>Montoya, M.</dc:creator>
<dc:date>2026-04-01</dc:date>
<dc:identifier>doi:10.64898/2026.03.31.715496</dc:identifier>
<dc:title><![CDATA[Omicron-Enhanced Immunosuppressive Effects of SARS-CoV-2 ORF3a and ORF9b Accessory Proteins on Monocytic Inflammatory Response]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-04-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
This study investigates the poorly understood roles of SARS-CoV-2 accessory proteins using monocytic THP-1 cells expressing individual viral ORFs. ORF3a, ORF7b, and ORF9b were identified as major immunomodulators that suppress host inflammatory signaling. Specifically, cells expressing ORF3a or ORF9b exhibited reduced Toll-like receptor 4 (TLR4)-mediated production of key proinflammatory molecules--CCL2, CCL4, and IL-1{beta}--resulting in diminished immune cell recruitment. Importantly, Omicron-associated mutations in ORF3a (T223I) and ORF9b (P10S+{Delta}E27N28A29) amplified this immunosuppressive effect, leading to stronger transcriptomic suppression consistent with Omicrons reduced pathogenicity and clinical outcomes. These findings suggest that SARS-CoV-2 accessory proteins, particularly ORF3a and ORF9b, play pivotal roles in modulating monocytic immune responses. Enhanced suppression in Omicron variants highlights an evolutionary adaptation contributing to immune evasion and milder disease manifestations.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.30.715311v1?rss=1">
<title>
<![CDATA[
Intranasal immunization with live-attenuated RSV-vectored SARS-CoV-2 vaccines elicits antigen-specific systemic and mucosal immunity and protects against viral challenge and natural infection 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.30.715311v1?rss=1"
</link>
<dc:creator>Botta, D.</dc:creator>
<dc:creator>Schultz, M. D.</dc:creator>
<dc:creator>Silva-Sanchez, A.</dc:creator>
<dc:creator>Kalange, D.</dc:creator>
<dc:creator>Akther, J.</dc:creator>
<dc:creator>Zhou, F.</dc:creator>
<dc:creator>Tipper, J. L.</dc:creator>
<dc:creator>Yang, G.</dc:creator>
<dc:creator>Schaefers, L. T.</dc:creator>
<dc:creator>Barkley, C. A.</dc:creator>
<dc:creator>Qiu, S.</dc:creator>
<dc:creator>Foote, J. B.</dc:creator>
<dc:creator>Tioni, M. F.</dc:creator>
<dc:creator>Weiss, C. M.</dc:creator>
<dc:creator>Phan, S. I.</dc:creator>
<dc:creator>Green, T. J.</dc:creator>
<dc:creator>Leal, S. M.</dc:creator>
<dc:creator>Harrod, K. S.</dc:creator>
<dc:creator>King, R. G.</dc:creator>
<dc:creator>Moore, M. L.</dc:creator>
<dc:creator>Randall, T. D.</dc:creator>
<dc:creator>Tang, R. S.</dc:creator>
<dc:creator>Lund, F. E.</dc:creator>
<dc:date>2026-03-31</dc:date>
<dc:identifier>doi:10.64898/2026.03.30.715311</dc:identifier>
<dc:title><![CDATA[Intranasal immunization with live-attenuated RSV-vectored SARS-CoV-2 vaccines elicits antigen-specific systemic and mucosal immunity and protects against viral challenge and natural infection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-31</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The emergence of new SARS-CoV-2 variants and breakthrough infections underscores the need for next-generation vaccines capable of protecting from natural infection and/or preventing virus transmission to others. Intranasal vaccination offers a promising approach by eliciting local immune responses in the nasal mucosa, the primary site of infection and reservoir for transmissible virus. We evaluated two live-attenuated, respiratory syncytial virus vectored vaccines in which the RSV F and G surface glycoproteins were replaced with a chimeric SARS-CoV-2 Spike protein from either the ancestral USA/WA-1/2020 strain (MV-014-212) or the Delta variant (MV-014-212-delta). A single intranasal dose of either vaccine elicited systemic and mucosal immunity in K18-hACE2 mice, including serum neutralizing antibodies, Spike-specific memory B cells and plasmablasts, and Spike-specific CD8 lung-resident memory T cells. Although MV-014-212-delta vaccination provided the best protection against Delta variant virus challenge, both vaccines decreased viral loads in nasal discharge, lung and brain, and reduced weight loss and mortality. In naturally acquired infection studies, vaccinated hamsters exposed to infected cagemates exhibited minimal weight loss, limited viral replication within the nasal mucosa, and attenuated lung pathology. Therefore, intranasal RSV-vectored vaccines can elicit broad protective respiratory immunity, suggesting that this platform could be leveraged for other respiratory pathogens.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.27.26349516v1?rss=1">
<title>
<![CDATA[
Increased Risk of Pulmonary Embolism Following SARS-CoV-2 Activity in Ontario, Canada 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.27.26349516v1?rss=1"
</link>
<dc:creator>Lee, C. E.</dc:creator>
<dc:creator>Wilson, N. J.</dc:creator>
<dc:creator>Fisman, D.</dc:creator>
<dc:date>2026-03-30</dc:date>
<dc:identifier>doi:10.64898/2026.03.27.26349516</dc:identifier>
<dc:title><![CDATA[Increased Risk of Pulmonary Embolism Following SARS-CoV-2 Activity in Ontario, Canada]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-30</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundSARS-CoV-2 infection is an established prothrombotic trigger, yet the population-level temporal relationship between circulating viral activity and pulmonary embolism (PE) remains poorly characterized. We aimed to evaluate the short-term association between respiratory viral activity and PE hospitalizations, accounting for specific temporal lags.

MethodsWe conducted a population-level time-series analysis of incident PE hospitalizations in Ontario, Canada, from 2011 to 2024. Using distributed lag non-linear models, we assessed the association between standardized weekly activity levels of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV) and PE risk over a 5-week lag period. Relative risks (RR) per standard deviation (SD) increase in viral activity were estimated via negative binomial regression using cross-basis terms to account for both exposure-response and lag-response non-linearities. Models were adjusted for Fourier seasonal terms and secular trends.

FindingsAmong 70,670 incident PE cases identified between 2011 and 2024, SARS-CoV-2 activity demonstrated a significant temporal association with PE. A cumulative RR increase of 20% per SD in SARS-CoV-2 activity was observed over the five weeks following exposure (RR 1.20; 95% CI 1.05-1.37). The risk followed a distinct delay trajectory: weekly cumulative RRs peaked at week 3 (RR 1.21; 95% CI 1.01-1.45). For the 2020-2024 period, influenza A also showed an association peaking at week 3 without statistical significance (RR 1.17; 95% CI 0.95-1.45).

InterpretationIncreased population-level SARS-CoV-2 activity is associated with a heightened risk of PE, peaking at approximately the third week. This delayed peak suggests a protracted thrombo-inflammatory window, likely driven by sustained endothelial injury. These findings highlight the vascular burden of COVID-19 and suggest that infection prevention measures, including vaccination, may provide significant downstream protection against thromboembolic disease.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.27.26349524v1?rss=1">
<title>
<![CDATA[
Twelve Distinct Laboratory Methods Used to Measure SARS-CoV-2 in Wastewaters throughout a Three-Year Ontario-Wide, Canada Study: Impact on Public Health Interpretation of Disease Incidence 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.27.26349524v1?rss=1"
</link>
<dc:creator>Hegazy, N.</dc:creator>
<dc:creator>Peng, K. K.</dc:creator>
<dc:creator>de Haan-Ward, J.</dc:creator>
<dc:creator>Renouf, E.</dc:creator>
<dc:creator>Mercier, E.</dc:creator>
<dc:creator>Wan, S.</dc:creator>
<dc:creator>Hu, X. J.</dc:creator>
<dc:creator>Dean, C.</dc:creator>
<dc:creator>Servos, M.</dc:creator>
<dc:creator>Edwards, E.</dc:creator>
<dc:creator>Ybazeta, G.</dc:creator>
<dc:creator>Habash, M.</dc:creator>
<dc:creator>Goodridge, L.</dc:creator>
<dc:creator>Brown, R. S.</dc:creator>
<dc:creator>Payne, S. J.</dc:creator>
<dc:creator>Kirkwood, A.</dc:creator>
<dc:creator>Kyle, C.</dc:creator>
<dc:creator>McKay, R. M.</dc:creator>
<dc:creator>Gilbride, K.</dc:creator>
<dc:creator>DeGroot, C.</dc:creator>
<dc:creator>Delatolla, R.</dc:creator>
<dc:date>2026-03-30</dc:date>
<dc:identifier>doi:10.64898/2026.03.27.26349524</dc:identifier>
<dc:title><![CDATA[Twelve Distinct Laboratory Methods Used to Measure SARS-CoV-2 in Wastewaters throughout a Three-Year Ontario-Wide, Canada Study: Impact on Public Health Interpretation of Disease Incidence]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-30</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Wastewater and environmental monitoring (WEM) was a critical public health surveillance tool for SARS-CoV-2 surveillance during the COVID-19 Pandemic. However, substantial methodological heterogeneity across laboratories continues to challenge the interpretation and thus compromise the actionability of resulting WEM measurements. This study quantifies interlaboratory concordance in SARS-CoV-2 WEM measurements using influent wastewater samples collected between September 2021 and January 2024 at a single wastewater treatment facility within the Ontario Wastewater Surveillance Initiative, analyzed independently by 12 laboratories using their routine methods. In the absence of a known true viral concentration, interlaboratory WEM measurements were evaluated against a facility-specific longitudinal benchmark derived from routine surveillance at the source facility and correlated to clinical surveillance metrics. Concordance was assessed across four WEM measurement units commonly used in practice: SARS-CoV-2 copies/mL, SARS-CoV-2 copies/copies of PMMoV, and their standardized counterpart wastewater viral activity level (WVAL) units of WVAL-standardized SARS-CoV-2 copies/mL and WVAL-standardized SARS-CoV-2 copies/copies of PMMoV. Measurements in each unit were analyzed using complementary analytical frameworks, including categorical concordance metrics, principal component analysis, and linear mixed-effects modelling. Across the study period, interlaboratory measurements consistently captured benchmark temporal dynamics, including major peaks and periods of low activity, but showed substantial variation in magnitude and public-health interpretation across laboratory methods. Concordance was strongest during epidemiological extremes and deteriorated during transitional periods, increasing the risk of misclassification with potentially implications for public health decision-making. To explore potential laboratory methodological drivers of agreement, associations between the benchmark concordance and the laboratory-specific concentration, extraction, and RT-qPCR analytical steps were assessed using Fishers exact tests, alongside extracted-mass threshold analyses. No single methodological factor showed a statistically significant association with benchmark concordance in this study; however, several parameters, including RNA template volume, total RT-qPCR reaction volume, and extracted mass of analyzed settled solids, may warrant further investigation in future studies.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.29.711974v1?rss=1">
<title>
<![CDATA[
Panmap: Scalable phylogeny-guided alignment, genotyping, and placement on pangenomes 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.29.711974v1?rss=1"
</link>
<dc:creator>Kramer, A. M.</dc:creator>
<dc:creator>Zhang, A.</dc:creator>
<dc:creator>Ayala, N.</dc:creator>
<dc:creator>de Sanctis, B.</dc:creator>
<dc:creator>Karim, L. M.</dc:creator>
<dc:creator>Hinrichs, A. S.</dc:creator>
<dc:creator>Walia, S.</dc:creator>
<dc:creator>Turakhia, Y.</dc:creator>
<dc:creator>Corbett-Detig, R.</dc:creator>
<dc:date>2026-03-30</dc:date>
<dc:identifier>doi:10.64898/2026.03.29.711974</dc:identifier>
<dc:title><![CDATA[Panmap: Scalable phylogeny-guided alignment, genotyping, and placement on pangenomes]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-30</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Pangenomes capture population-level variation but remain computationally challenging at scale. We present Panmap, a tool that leverages evolutionary structure to place, align, and genotype sequencing reads against mutation-annotated pangenomes containing up to millions of genomes. Panmap introduces a phylogenetically compressed k-mer index that stores only sequence differences along branches, enabling efficient comparison of reads to both sampled genomes and inferred ancestors. This approach reduces index size by up to 600-fold and construction time by over three orders of magnitude relative to existing tools. Panmap places a 100x coverage SARS-CoV-2 sample onto 20,000 genomes in 0.4 seconds and onto 8 million genomes in under two minutes. Furthermore, it enables accurate haplotype identification and abundance estimation in metagenomic samples and sensitive placement of ancient environmental DNA without prior alignment. Our approach makes large-scale pangenomes directly amenable to read mapping, genome assembly, alignment-free phylogenetic placement, and metagenomic analysis.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.28.714969v1?rss=1">
<title>
<![CDATA[
Structure of SARS-CoV-2 spike in complex with its co-receptor the neuronal cell adhesion protein contactin 1 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.28.714969v1?rss=1"
</link>
<dc:creator>Krepel, S. T.</dc:creator>
<dc:creator>Hurdiss, D. L.</dc:creator>
<dc:creator>Bosch, B. J.</dc:creator>
<dc:creator>Snijder, J.</dc:creator>
<dc:creator>Janssen, B. J. C.</dc:creator>
<dc:date>2026-03-29</dc:date>
<dc:identifier>doi:10.64898/2026.03.28.714969</dc:identifier>
<dc:title><![CDATA[Structure of SARS-CoV-2 spike in complex with its co-receptor the neuronal cell adhesion protein contactin 1]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-29</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The emergence of SARS-CoV-2 has caused millions of deaths and excess morbidity in the worldwide population. In addition to its respiratory symptoms, SARS-CoV-2 has become known for its neurotropism and long-term neurological sequelae, with a post-acute infection syndrome commonly referred to as long-COVID. Next to the host receptor angiotensin-converting enzyme 2 (ACE2) additional interactions of the SARS-CoV-2 spike (S) protein have been described for neuronal co-receptors specific to the nervous system including cell adhesion protein contactin 1 (CNTN1). Details of the spike-CNTN1 interaction have remained elusive. Here, we quantified the spike-CNTN1 interaction by surface plasmon resonance and resolved the structure of the complex by single particle cryo-electron microscopy (cryo-EM). Spike and CNTN1 interact with nanomolar affinity, driven by an avidity effect and mediated by the horseshoe moiety of CNTN1. The cryo-EM structure reveals that the CNTN1 Ig1-4 horseshoe is wedged in between two receptor binding domains (RBDs) and interacts, through Ig3, with a unique receptor interface at the base of the RBD in the up-conformation. This receptor interface is not previously described for other spike receptors but overlaps with the epitopes of several neutralizing monoclonal antibodies. Comparison of our data with available spike structures suggests one spike trimer can bind three CNTN1 molecules, or alternatively, different co-receptors such as ACE2 and CNTN1, simultaneously. These findings shed new light on the molecular determinants of SARS-CoV-2 neurotropism.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.25.714316v1?rss=1">
<title>
<![CDATA[
Characterization of Self-Incompatibility Genes in Brassica rapa var. Toria and Yellow sarson 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.25.714316v1?rss=1"
</link>
<dc:creator>Bhalla, H.</dc:creator>
<dc:creator>Ankita, K.</dc:creator>
<dc:creator>Ahlawat, A.</dc:creator>
<dc:creator>Rode, S. S.</dc:creator>
<dc:creator>Singh, K. H.</dc:creator>
<dc:creator>Sankaranarayanan, S.</dc:creator>
<dc:date>2026-03-28</dc:date>
<dc:identifier>doi:10.64898/2026.03.25.714316</dc:identifier>
<dc:title><![CDATA[Characterization of Self-Incompatibility Genes in Brassica rapa var. Toria and Yellow sarson]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-28</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Self-incompatibility (SI), a reproductive mechanism that prevents self-pollen from fertilizing the ovule, is widespread in flowering plants, including the Brassicaceae family, where it promotes outcrossing, genetic diversity, and hybrid vigor. Although prevalent in Brassica rapa, an economically vital crop, it remains poorly characterized in widely grown varieties, such as toria and yellow sarson, with prior studies primarily focused on Brassica napus. Given its potential for hybrid breeding and crop improvement in rapeseed (B. rapa), we characterized key SI-regulatory genes, analyzing their phylogenetic relationships, structure-function dynamics, and expression patterns. Our results indicate sequence, structural, and functional homology as well as conservation with previously known candidates. This study identifies SRK, FER, and ARC1 as essential, while MLPK plays a minor role in SI for the varieties under study. Furthermore, we identified that SRK, FER, and MLPK activate ROS during the SI response, while ARC1 does not. Our findings establish a foundation for harnessing this natural system to integrate agriculturally important traits and sustain them across generations via outcrossing.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.26.26347671v1?rss=1">
<title>
<![CDATA[
A protocol for assessment of interventions using a computational phenotype for Long COVID 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.26.26347671v1?rss=1"
</link>
<dc:creator>Amitabh Gunjan, A.</dc:creator>
<dc:creator>Huang, L.</dc:creator>
<dc:creator>Appe, A.</dc:creator>
<dc:creator>McKelvey, P. A.</dc:creator>
<dc:creator>Algren, H. A.</dc:creator>
<dc:creator>Berry, M.</dc:creator>
<dc:creator>Mozaffari, E.</dc:creator>
<dc:creator>Wright, B. J.</dc:creator>
<dc:creator>Hadlock, J. J.</dc:creator>
<dc:creator>Goldman, J. D.</dc:creator>
<dc:date>2026-03-27</dc:date>
<dc:identifier>doi:10.64898/2026.03.26.26347671</dc:identifier>
<dc:title><![CDATA[A protocol for assessment of interventions using a computational phenotype for Long COVID]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-27</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundLong COVID presents with one or multiple symptoms or diagnosable conditions after SARS-CoV-2 infection. To study whether use of the antiviral remdesivir in persons hospitalized with acute COVID-19 is associated with reduced Long COVID, we created a computational phenotype for Long COVID.

MethodsIn electronic health records (EHR) from a multistate healthcare system (US), hospital admissions from 5/1/20 - 9/30/22 were reviewed. The study group was hospitalized with acute COVID-19 and the control group was hospitalized for other reasons without prior SARS-CoV-2 infection. The populations were balanced with overlap weights based on a high-dimensional propensity score of pre-specified variables and the top 100 comorbidities differing between the groups. Hazard ratios (HR) were calculated for the combined primary outcome: U09.9 (Post-Covid Conditions) or any incident secondary outcome from 90 to 365 days after admission. Secondary outcomes included 27 individual incident diagnoses, corrected for multiplicity with Holm-Bonferroni.

ResultsAdmissions included 45,540 with, and 409,186 without COVID-19 during the study period, evaluable for the primary outcome. After weighting, standardized difference was < 0.01 for all measured confounders including demographic and clinical features. In the COVID+ and non-COVID groups 38.0% and 29.3% met the combined primary outcome, respectively. Weighted HR (95%CI) for the primary outcome was 1.37 (1.35, 1.40), p < 0.0001. All secondary outcomes were associated with the COVID+ group, when adjusted for multiplicity. Incident diagnoses with strong associations (HR > 2) included thromboembolism, hair loss, diabetes mellitus, obesity, and hypoxia. Anosmia/dysgeusia was associated with COVID, but wide confidence intervals reflected few charted diagnoses.

ConclusionsManifestations of Long COVID at population scale are detectable as part of routine symptoms and clinical diagnoses in the EHR after admissions for COVID-19, compared with all other hospital admissions. This a prior computational phenotype for Long COVID will be used to assess whether remdesivir use is associated with decreased Long COVID.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.27.714475v1?rss=1">
<title>
<![CDATA[
Impact of viral membrane oxidation on SARS-CoV-2 spike protein transmembrane anchoring stability 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.27.714475v1?rss=1"
</link>
<dc:creator>Ghasemitarei, M.</dc:creator>
<dc:creator>Gyursanszky, C.</dc:creator>
<dc:creator>Karttunen, M.</dc:creator>
<dc:creator>Ala-Nissila, T.</dc:creator>
<dc:date>2026-03-27</dc:date>
<dc:identifier>doi:10.64898/2026.03.27.714475</dc:identifier>
<dc:title><![CDATA[Impact of viral membrane oxidation on SARS-CoV-2 spike protein transmembrane anchoring stability]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-27</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Reactive oxygen species generated during inflammation can oxidize viral envelope lipids, with outcomes ranging from modulated infectivity to viral inactivation. For SARS-CoV-2, the molecular mechanisms by which membrane lipid oxidation influences spike protein anchoring remain poorly understood. We use all-atom molecular dynamics (MD) simulations to quantify how graded oxidation of 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC) affects the anchoring of the SARS-CoV-2 spike transmembrane (TM) region in an endoplasmic-reticulum-Golgi intermediate compartment (ERGIC)-like multicomponent membrane. Viral envelopes containing 0, 25, 50, 75, and 100% oxidized POPC (PoxnoPC) corresponding to 0 - 55% oxidation of all PO-type phospholipids were simulated with the spike TM helix and cytoplasmic tail embedded in a POPC/POPE/POPI/POPS/cholesterol mixture. Steered MD and umbrella sampling were used to calculate the potential of mean force (PMF) for extracting the TM+CT region along the membrane normal. Partial oxidation (25 - 75% POPC) produced reductions in the detachment barrier that were not statistically distinguishable from the native system within the sampling uncertainty, whereas full POPC oxidation lowered the anchoring free energy by about 23% (from 606 {+/-} 39 to 464 {+/-} 38 kJ mol-1), indicating that oxidation of roughly half of the glycerophospholipids can measurably weaken spike-membrane coupling. Despite this reduction, the remaining barrier (about 180kBT ) is still large, suggesting that oxidation alone may be insufficient for spontaneous spike detachment and likely acts synergistically with mechanical forces during fusion or immune engagement. Analysis of acyl-chain order parameters, area per lipid, membrane thickness, number-density profiles, and lateral lipid clustering reveals that POPC peroxidation decreases lipid order, thins and softens the bilayer, and disrupts cholesterol-stabilized clusters that refer to large cooperative lipid assemblies (>10 lipids) identified via RDF-based clustering. These oxidation-induced changes reduce hydrophobic matching around the TM helix and facilitate its extraction from the viral envelope. Our results provide a mechanistic link between lipid peroxidation, membrane nanostructure, and spike anchoring, supporting lipid oxidation for example during cold atmospheric plasma or ozone treatment as a physically grounded contributing antiviral mechanism against SARS-CoV-2.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.24.26349101v1?rss=1">
<title>
<![CDATA[
An Assessment of Correctional Officer's Health Beliefs in Relationship to COVID-19 Vaccine Uptake and Hesitancy. 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.24.26349101v1?rss=1"
</link>
<dc:creator>Hedden-Clayton, B.</dc:creator>
<dc:creator>Roddy, A. L.</dc:creator>
<dc:creator>Roddy, J. K.</dc:creator>
<dc:creator>Ngassa, Y.</dc:creator>
<dc:creator>Pickard, B.</dc:creator>
<dc:creator>Tam, R. A.</dc:creator>
<dc:creator>Wurcel, A. G.</dc:creator>
<dc:date>2026-03-26</dc:date>
<dc:identifier>doi:10.64898/2026.03.24.26349101</dc:identifier>
<dc:title><![CDATA[An Assessment of Correctional Officer's Health Beliefs in Relationship to COVID-19 Vaccine Uptake and Hesitancy.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
IntroductionDuring the COVID-19 pandemic, incarcerated populations faced heightened risk of exposure due to healthcare barriers, restrictive environments, and pre-existing health conditions. Consequently, Correctional Officers (COs) faced increased risk of COVID-19 exposure. Given the health benefits of COVID-19 vaccination and the rise in vaccine hesitancy, this study examined the relationship between COs health beliefs and COVID-19 vaccine uptake.

MethodsA health beliefs survey was administered to Massachusetts-based COs (n=118). Chi-squared Automatic Interaction Detection modeling and logistic regression was utilized to analyze the survey data.

ResultsCOs with higher trust in vaccines and a prior positive COVID-19 test were most likely to get vaccinated voluntarily. Those with low trust in vaccines and no previous positive COVID-19 test were least likely to receive the vaccine.

ConclusionDespite the severe impact of COVID-19 in correctional settings, and the evidence of vaccine efficacy against hospitalization and death, vaccine uptake among COs remains low.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.21.26348591v1?rss=1">
<title>
<![CDATA[
Disentangling the Shared and Differential Genetic Architecture Between COVID-19 and Other Respiratory Disorders: A Multi-Omics Genome-Wide Analysis 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.21.26348591v1?rss=1"
</link>
<dc:creator>Xue, X.</dc:creator>
<dc:creator>LIN, Y.-P.</dc:creator>
<dc:creator>FENG, Y.</dc:creator>
<dc:creator>SO, H.-C.</dc:creator>
<dc:date>2026-03-26</dc:date>
<dc:identifier>doi:10.64898/2026.03.21.26348591</dc:identifier>
<dc:title><![CDATA[Disentangling the Shared and Differential Genetic Architecture Between COVID-19 and Other Respiratory Disorders: A Multi-Omics Genome-Wide Analysis]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundA bidirectional relationship has been observed between COVID-19 and respiratory disorders, where respiratory comorbidities increase severity and COVID-19 induces respiratory sequelae. The underlying biological and genetic mechanisms remain unclear. While previous studies have identified overlapping genetic loci, few have systematically disentangled the genetic factors shared between these conditions versus those specific to COVID-19, particularly at a multi-omics level.

MethodsWe developed and applied a unified analytical framework to compare three COVID-19 phenotypes with eight respiratory disorders (including asthma, COPD, IPF, and pneumonia). Utilizing the cofdr method for shared genetic signal analysis and DDx/mtCOJO for differentiation, we integrated genome-wide association statistics with multi-omics data (transcriptome, splicing, and proteome). This approach allowed for the simultaneous identification of shared genetic signals (concordant or discordant) and disease-specific variants across expression (TWAS), alternative splicing (spTWAS), and protein abundance (PWAS).

ResultsWe delineated a comprehensive atlas of 214 differential and numerous shared loci across 24 pairwise comparisons. The shared genetic architecture was characterized by pleiotropic effects in genes such as ATP11A (exhibiting opposing effects in COVID-19 vs. IPF) and GSDMB (shared with COPD). Crucially, differentiation analysis revealed that severe COVID-19 is genetically distinct from other respiratory infections (e.g., pneumonia and influenza) through dysregulated Type I/III interferon signaling and specific defects in alveolar epithelial and macrophage function, as well as GM-CSF/surfactant metabolism pathways. These findings provide direct genetic evidence supporting the use of GM-CSF modulators and interferon-lambda for COVID-19 treatment, therapies that have already entered clinical trials. Furthermore, multi-trait conditional analysis prioritized FYCO1 and HCN3 as potential COVID-19-specific risk genes. Splicing analysis underscored the critical role of alternative splicing in both shared and differential architectures, highlighting IFNAR2 isoform regulation as a key discriminator between COVID-19 and other respiratory traits.

ConclusionThis study provides the first genome-wide, multi-omics map revealing the shared and differential genetic landscapes of COVID-19 and other respiratory phenotypes. By uncovering specific molecular mechanisms that distinguish COVID-19 pathology, specifically involving surfactant homeostasis and interferon pathways, our findings offer novel insights for targeted drug repurposing and precision risk stratification.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.24.26349229v1?rss=1">
<title>
<![CDATA[
A Demographic Look at Cancer Treatment Behaviors during the COVID-19 Pandemic 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.24.26349229v1?rss=1"
</link>
<dc:creator>Acosta Morales, J. M.</dc:creator>
<dc:date>2026-03-26</dc:date>
<dc:identifier>doi:10.64898/2026.03.24.26349229</dc:identifier>
<dc:title><![CDATA[A Demographic Look at Cancer Treatment Behaviors during the COVID-19 Pandemic]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Abstract/SummaryO_ST_ABSBackgroundC_ST_ABSWhile numerous studies have explored the relationship between COVID-19 and cancer, few have specifically examined the significant impact of the pandemic on cancer patients, particularly concerning their treatments and appointments.

ObjectivesThis study aims to investigate cancer treatment behaviors during the COVID-19 pandemic.

MethodsThis retrospective quantitative study utilized data from the Centers for Disease Control and Preventions National Health Interview Survey of 2020. The inclusion criteria were as follows: studies conducted within the United States; patients diagnosed with COVID-19 since the pandemic began; patients diagnosed with cancer within the United States; patients undergoing cancer treatment or in remission since the start of the pandemic; patients who experienced a change, delay, or cancellation of treatment due to the COVID-19 pandemic; patients who experienced a change or delay in cancer care due to the COVID-19 pandemic; patients with a weakened immune system due to prescriptions; and patients who took prescription medication within the past 12 months. The variables were analyzed against population characteristics, including age, race, gender, cancer type, and COVID-19 status. Python Jupyter Notebook (packaged by Anaconda Navigator in R Studio, version 6.4.8), Microsoft Excel for data cleaning and assessment, and SPSS were used for statistical analyses.

ResultsChi-Square Analysis (p<.05) revealed significant associations between cancer treatment and gender (p=0.009), other cancer treatments and age (p<.001) and education (p<.001), changes in other cancer treatments and gender (p=0.045), race (p<.001), age (p<.001), and education (p=.013), and prescribed medication and gender (p=.009), family income (p<.001), and age (p<.001).

ConclusionThe COVID-19 pandemic has significantly impacted cancer care in the U.S., affecting the delivery of treatments. Additional government funding is necessary to help medical facilities develop programs for off-site treatment delivery, to better prepare for future pandemics, and avoid repeating past challenges.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.23.26349092v1?rss=1">
<title>
<![CDATA[
Higher SARS-CoV-2 Transmission Burden Among Racialized Individuals: Evidence from Canadian Serology Data 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.23.26349092v1?rss=1"
</link>
<dc:creator>Mann, S. K.</dc:creator>
<dc:creator>Wilson, N. J.</dc:creator>
<dc:creator>Lee, C. E.</dc:creator>
<dc:creator>Fisman, D.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.23.26349092</dc:identifier>
<dc:title><![CDATA[Higher SARS-CoV-2 Transmission Burden Among Racialized Individuals: Evidence from Canadian Serology Data]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
IntroductionCOVID-19 transmission has not been evenly distributed across racial groups, with exposure being shaped by social and structural factors. The emergence of highly transmissible variants (i.e., Omicron) dramatically increased infection rates. However, it remains unclear whether racial disparities in transmission disappeared or persisted over the course of the pandemic.

ObjectiveTo understand how SARS-CoV-2 transmission differed by race in Canada and whether those disparities changed with the Omicron variant.

MethodsWe analyzed cross-sectional SARS-CoV-2 seroprevalence data from the Canadian Blood Services serosurveillance program (June 2020 to April 2023) using a previously described dynamic susceptible-infection model, while accounting for seroreversion. Race-specific force of infection was estimated for the pre-Omicron and Omicron periods (with the emergence of Omicron defined as beginning December 26, 2021).

ResultsPrior to Omicron, racialized individuals had a 74% higher force of infection (IRR = 2.205; 95% CI: 2.115-2.299). During the Omicron period, infection rates rose significantly within each racial group relative to the pre-Omicron period, with a 55.52-fold increase among White individuals and a 31.27-fold increase among racialized individuals. Despite this, racialized individuals remained disproportionately affected following the emergence of Omicron, with 24% higher infection rates than those of their White counterparts (IRR = 1.242; 95% CI: 1.231-1.253).

ConclusionWidespread transmission during Omicron did not result in epidemiologic equity, as racialized populations continued to experience higher infection risk despite crude seroprevalence depicting convergence.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.23.26349084v1?rss=1">
<title>
<![CDATA[
Beyond COVID-19 Deaths: Cause-Specific Analysis of Excess Mortality in Russia 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.23.26349084v1?rss=1"
</link>
<dc:creator>Degtiareva, E.</dc:creator>
<dc:creator>Timonin, S.</dc:creator>
<dc:creator>Tilstra, A.</dc:creator>
<dc:creator>Aburto, J. M.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.23.26349084</dc:identifier>
<dc:title><![CDATA[Beyond COVID-19 Deaths: Cause-Specific Analysis of Excess Mortality in Russia]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
During the COVID-19 pandemic, European mortality exhibited a marked East-West divide in both timing and magnitude, echoing longstanding longevity disparities in this region. Russia sits on the Eastern side: early restrictions were short-lived, and vaccine uptake remained low amid historically limited trust in government and science. Using weekly national and monthly regional mortality data disaggregated by age, sex, and cause of death, we estimated excess mortality from March 2020 to December 2021 using generalised additive models. We identify two major mortality peaks (late 2020-early 2021 and late 2021) and estimate 1,044,914 excess deaths, well above the 595,815 officially registered COVID-19 deaths. Non-COVID-19 excess was larger during the first peak, especially at ages 15-44. Cardiovascular diseases accounted for roughly 60% of the non-COVID-19 excess and we find no evidence of excess mortality from cancer or external causes. Among women, excess deaths were concentrated at older ages, whereas among men they clustered at working and older working ages, only partly reflecting differences in age structure. The highest excess mortality was found in the most populous regions, particularly the Central European and Volga parts. Temporal and spatial inconsistencies in cause-of-death coding may obscure indirect mortality burden and hinder the associated policy response.

Highlights- Russia had 1,044,914 excess deaths in 2020-21, about twice official COVID-19 deaths.
- These discrepancies varied over time and across regions.
- Cardiovascular deaths drove most non-COVID excess mortality.
- We find no evidence of excess mortality from external causes of death.
- Autopsy-based COVID-19 assignment may have increased misclassification
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.23.26349096v1?rss=1">
<title>
<![CDATA[
Wastewater-Based Genomic Surveillance of SARS-CoV-2 Variant Circulation in Two Informal Urban Settlements in Nairobi, Kenya 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.23.26349096v1?rss=1"
</link>
<dc:creator>Kingwara, L.</dc:creator>
<dc:creator>Madada, R. S.</dc:creator>
<dc:creator>Morangi, V.</dc:creator>
<dc:creator>Akasa, S.</dc:creator>
<dc:creator>Kiprutto, V.</dc:creator>
<dc:creator>Julie, O.</dc:creator>
<dc:creator>Muthoka, R.</dc:creator>
<dc:creator>Rombo, C.</dc:creator>
<dc:creator>Kimonye, K.</dc:creator>
<dc:creator>Okunga, E.</dc:creator>
<dc:creator>Masika, M.</dc:creator>
<dc:creator>Ochieng, E.</dc:creator>
<dc:creator>Nyaga, R.</dc:creator>
<dc:creator>Otieno, O.</dc:creator>
<dc:creator>Cham, F.</dc:creator>
<dc:creator>Hull, N.</dc:creator>
<dc:creator>Kimenye, K.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.23.26349096</dc:identifier>
<dc:title><![CDATA[Wastewater-Based Genomic Surveillance of SARS-CoV-2 Variant Circulation in Two Informal Urban Settlements in Nairobi, Kenya]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundSARS-CoV-2 genomic surveillance data remain limited in most low and middle-income countries (LMICs), resulting in significant gaps in the understanding of variant circulation and evolution. Wastewater-based epidemiology (WBE) presents a non-invasive, cost-effective, and population-representative surveillance approach that can complement clinical testing, particularly in densely populated urban informal settlements with limited healthcare access. This study aimed to pilot wastewater-based genomic surveillance as a multifaceted public health tool in Kenya.

MethodsA prospective study was conducted using wastewater samples collected from two WHO-validated environmental surveillance sites -- Eastleigh A (Kamukunji sub-county) and Mathare (Starehe sub-county) -- in Nairobi, Kenya, between December 2022 and October 2023. A total of 272 samples were collected using Moore swabs at a frequency of two to three times per week. Samples were concentrated using Nanotrap(R) Magnetic Virus Particles, and nucleic acid was extracted using the Qiagen QIAamp Viral RNA Mini Kit. SARS-CoV-2 was detected using RT-PCR (TaqPath COVID-19 CE-IVD RT-PCR Kit). Library preparation for whole-genome sequencing was performed using the Illumina COVIDSeq kit, and sequencing was conducted on the Illumina MiSeq platform. Bioinformatic analysis was performed using Terra.bio and RStudio, and phylogenetic analysis included sequences abstracted from GISAID.

ResultsOf 272 samples, 238 (87.5%) tested positive with a cycle threshold (Ct) value of less than 36. Genomic analysis of 181 sequences identified Omicron as the predominant circulating variant, detected in 59% of samples. Other variants included XBB (16%), XBB.2.3(10%), XBB.1.9.X (5%), and additional minor variants. These findings were concordant with clinical sequencing data from Kenya over the same period.

ConclusionsWastewater-based genomic surveillance reliably reflected SARS-CoV-2 variant trends observed in clinical data. This approach provides early signals of variant emergence and evolution, offering a cost-effective complement to clinical surveillance in resource-limited settings.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.23.26349117v1?rss=1">
<title>
<![CDATA[
Household Size and Age as Primary Drivers of COVID-19 Infection Among Priority Populations in Australia 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.23.26349117v1?rss=1"
</link>
<dc:creator>Narayanasamy, S.</dc:creator>
<dc:creator>Altermatt, A.</dc:creator>
<dc:creator>Tse, W. C.</dc:creator>
<dc:creator>Gibbs, L.</dc:creator>
<dc:creator>Wilkinson, A.</dc:creator>
<dc:creator>Heath, K.</dc:creator>
<dc:creator>Stoove, M.</dc:creator>
<dc:creator>Scott, N.</dc:creator>
<dc:creator>Gibney, K.</dc:creator>
<dc:creator>Hellard, M.</dc:creator>
<dc:creator>Pedrana, A.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.23.26349117</dc:identifier>
<dc:title><![CDATA[Household Size and Age as Primary Drivers of COVID-19 Infection Among Priority Populations in Australia]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe COVID-19 pandemic exacerbated health disparities globally, with certain populations experiencing disproportionate disease burdens. In Australia, COVID-19 deaths occurred disproportionately among first-generation migrants. This study examined risk factors for COVID-19 infection in a Victorian cohort recruited from priority populations, including healthcare workers, people with chronic health conditions, and culturally and linguistically diverse (CALD) communities.

MethodsWe conducted a cross-sectional analysis of participants from the Optimise longitudinal cohort study (September 2020-December 2023). The primary outcome was the self-reported count of confirmed COVID-19 infections (PCR or rapid antigen test positive) from December 2019 to December 2023. We used Poisson regression to examine associations between baseline sociodemographic characteristics and infection count, calculating unadjusted and adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

ResultsOf 433 participants (median age 51 years, 75% female), 25% reported no infections, 48% reported one infection, and 27% reported two or more infections. In univariate analysis, CALD status (IRR=1.24,95%CI:1.02-1.50) and larger household size (2-5 people, IRR=1.71,95%CI:1.14-2.50) were associated with higher infection rates, while chronic health conditions (IRR=0.73, 95%CI:0.61-0.88) and older age (IRR=0.54, 95%CI:0.43-0.67) were associated with lower infection rates. In adjusted analysis, younger age (18-34 years vs [&ge;]55 years: aIRR=0.63,95%CI:0.48-0.82) and medium household size (living alone vs 2-5 person household: aIRR=1.42, 95%CI:1.11-1.83) remained significant predictors. CALD status and socioeconomic status showed no independent association with infection risk after adjustment for household size and age.

ConclusionCOVID-19 infection risk in this Victorian cohort was driven by younger age and larger household size rather than CALD status or socioeconomic status, suggesting that housing density and age, rather than cultural or socioeconomic characteristics, determined infection patterns. Future pandemic preparedness should prioritise policies enabling safe quarantine and isolation for individuals in larger households and workplace protections and economic security for younger essential workers.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.23.26349139v1?rss=1">
<title>
<![CDATA[
Phylogenetic Insights into SARS-CoV-2 Introductions and Spread in Georgia 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.23.26349139v1?rss=1"
</link>
<dc:creator>Veytsel, G. E.</dc:creator>
<dc:creator>Lyu, L.</dc:creator>
<dc:creator>Stott, G.</dc:creator>
<dc:creator>Carmola, L.</dc:creator>
<dc:creator>Dishman, H.</dc:creator>
<dc:creator>Bahl, J.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.23.26349139</dc:identifier>
<dc:title><![CDATA[Phylogenetic Insights into SARS-CoV-2 Introductions and Spread in Georgia]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The spread of successive novel COVID-19 variants presented a challenge for outbreak surveillance, epidemiology, and emergency responses. Monitoring the emergence and spread of SARS-CoV-2 variants is essential to allocate limited public health resources and optimize control efforts. Global collaboration among the scientific community enabled large-scale viral surveillance and sequencing efforts. However, translating these vast datasets into actionable public health inferences requires rapid statistical methodologies, scalable workflows, and robust frameworks.

In this study, we focused on the Delta epidemic wave in Georgia by applying a hybrid maximum likelihood (ML) and Bayesian phylodynamic approach. We characterized the Delta variant introduction to Georgia and its subsequent local spread. Our analysis of 9,783 Delta sequences collected between August 1, 2020 and January 25, 2022 detected at least 344 introductions into Georgia, resulting in 34 highly-supported local clusters. On average, clusters circulated for one month before the earliest detected sequence, highlighting critical delays in detection. While most clusters remained small, a few introduction events led to large, sustained outbreaks. We jointly inferred the statewide transmission network, estimated from all locally circulating clusters with a modified Bayesian discrete trait phylogeographic reconstruction of statewide health districts. We showed that South Central, Georgia was a major source of transmission, despite having smaller numbers of infected people, compared to major metropolitan areas.

Our study addresses the urgent need for methodologies and data-driven recommendations for public health practice, particularly given large, dynamic, and integrated datasets. By identifying key geographic sources and sinks of transmission, our findings can guide resource allocation and prepare for future epidemics among high-risk populations. Additionally, by characterizing introduction events, local circulation, and detection lags, we highlight critical gaps in surveillance. These gaps can inform outbreak investigation and response, such as targeted contact tracing and testing.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.24.713966v1?rss=1">
<title>
<![CDATA[
SARS-CoV-2 PLpro Drives Epithelial Barrier Disruption Across Drosophila and Mammalian Epithelia 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.24.713966v1?rss=1"
</link>
<dc:creator>Ahmad, Q. T.</dc:creator>
<dc:creator>Banerjee, S.</dc:creator>
<dc:creator>Anerao, I. M.</dc:creator>
<dc:creator>Tripathi, J.</dc:creator>
<dc:creator>Parihar, S. S.</dc:creator>
<dc:creator>Bajpai, A.</dc:creator>
<dc:creator>Rizvi, M. S.</dc:creator>
<dc:creator>SINHA, P.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.24.713966</dc:identifier>
<dc:title><![CDATA[SARS-CoV-2 PLpro Drives Epithelial Barrier Disruption Across Drosophila and Mammalian Epithelia]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Disruption of epithelial homeostasis and barrier integrity, compounded by maladaptive inflammation, is central to SARS-CoV-2 pathogenesis. Prior reductionist studies relying on mammalian cell lines, which lack the capacity to form architecturally faithful epithelium in vitro, were ill-suited to identify the viral proteins that proximally underpin these epithelial perturbations. We therefore screened all SARS-CoV-2 NSPs and ORFs in the Drosophila larval imaginal disc--an intact epithelium whose conserved junctional architecture and stress signaling circuits closely recapitulate those of human epithelium. This systemic filter identified the papain-like protease (PLpro) of NSP3 as a primary driver of junctional disruption. In imaginal disc epithelium, PLpro expression induced elevated oxidative stress (ROS) and hyperactivation of Akt, JNK, and JAK-STAT pathways--a self-amplifying pathological network that acts as a  cog-in-the-wheel to derail tissue homeostasis. PLpro further induced organ-specific junctional perturbations and dysregulation of stress signaling in the larval tracheal system and the adult midgut, extending its epithelial-disrupting role across three morphologically distinct organs. Targeted genetic suppression of this network restored integrity, establishing these pathways as causal drivers. Critically, PLpro expression in mammalian MDCK epithelium recapitulated these defects, revealing cross-species conservation. These findings redefine PLpro as a  dual-threat pathogen--not merely an immune-evasion factor, but a direct  architect of injury and a previously unrecognized determinant of COVID-19 pathogenesis.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.24.713916v1?rss=1">
<title>
<![CDATA[
Coronavirus envelope protein drives iron sensing disorder by hijacking the TAp73-FDXR axis 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.24.713916v1?rss=1"
</link>
<dc:creator>Zhu, M.</dc:creator>
<dc:creator>Hu, L.</dc:creator>
<dc:creator>Fu, X.</dc:creator>
<dc:creator>Yuan, B.</dc:creator>
<dc:creator>Guan, G.</dc:creator>
<dc:creator>Han, L.</dc:creator>
<dc:creator>Rong, Z.</dc:creator>
<dc:creator>Tian, R.</dc:creator>
<dc:creator>Li, G.</dc:creator>
<dc:creator>Du, M.</dc:creator>
<dc:creator>Ma, Y.</dc:creator>
<dc:creator>Xu, N.</dc:creator>
<dc:creator>Liu, H.</dc:creator>
<dc:creator>Tian, H.</dc:creator>
<dc:creator>Yin, X.</dc:creator>
<dc:creator>Zhong, J.</dc:creator>
<dc:creator>Sun, M.</dc:creator>
<dc:creator>Yang, S.</dc:creator>
<dc:creator>Liu, S.</dc:creator>
<dc:creator>Liu, Q.</dc:creator>
<dc:creator>Li, J.</dc:creator>
<dc:creator>Fan, B.</dc:creator>
<dc:creator>Chen, Y.</dc:creator>
<dc:creator>Zhao, Q.</dc:creator>
<dc:creator>Zhou, T.</dc:creator>
<dc:creator>Chang, L.</dc:creator>
<dc:creator>Zhao, X.</dc:creator>
<dc:creator>Ran, X.</dc:creator>
<dc:creator>Du, Q.</dc:creator>
<dc:creator>Ding, S.</dc:creator>
<dc:creator>Li, B.</dc:creator>
<dc:creator>Huang, Y.</dc:creator>
<dc:creator>Tong, D.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.24.713916</dc:identifier>
<dc:title><![CDATA[Coronavirus envelope protein drives iron sensing disorder by hijacking the TAp73-FDXR axis]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Iron overload is increasingly recognized as a critical contributor to coronavirus pathogenesis1, yet the underlying induction mechanisms remain unclear. Here, we uncover a fundamental pathway by which coronavirus drives IRP1 RNA-binding activity to induce iron accumulation2 via targeting the TAp73-FDXR axis. Specifically, coronavirus infection represses transcription of FDXR (encoding the key rate-limiting enzyme in host iron-sulfur cluster synthesis3), thereby impairing host iron-sulfur cluster generation to trigger the functional conversion of the cytosolic aconitase 1 (ACO1) into iron-regulatory protein 1 (IRP1)4, ultimately leading to the hosts persistently false perception of iron deficiency. We identify TAp73 as the primary transcription factor governing FDXR expression, and demonstrate that the coronavirus envelope protein (CoV-E) orchestrates TAp73 nuclear export. Subsequently, CoV-E binds TAp73 through a critical valine residue within its C-terminal PBM domain, inducing the K48-linked ubiquitination and proteasomal degradation of TAp73. Furthermore, we developed a CoV-E-targeting molecule, DPTP-FC, which blocks CoV-E-TAp73 interaction via forming steric hindrance and effectively alleviates iron accumulation and tissue damage caused by PEDV, PDCoV, and SARS-CoV-2 infection. Our study reveals the central role of the TAp73-FDXR axis in CoV-induced iron accumulation, highlighting CoV-E as an attractive antiviral target and DPTP-FC as a promising therapeutic candidate.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.20.713312v1?rss=1">
<title>
<![CDATA[
Somatic evolution of a cross-reactive germline antibody that expands its breadth to neutralize new SARS-CoV-2 variants 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.20.713312v1?rss=1"
</link>
<dc:creator>Lv, H.</dc:creator>
<dc:creator>Feng, Z.</dc:creator>
<dc:creator>Teo, Q. W.</dc:creator>
<dc:creator>Chen, C.</dc:creator>
<dc:creator>Gopal, A. B.</dc:creator>
<dc:creator>Choi, D.</dc:creator>
<dc:creator>Tan, T. J. C.</dc:creator>
<dc:creator>Tang, Y. S.</dc:creator>
<dc:creator>Siu, L.</dc:creator>
<dc:creator>Nourmohammad, A.</dc:creator>
<dc:creator>Bruzzone, R.</dc:creator>
<dc:creator>Wilson, I. A.</dc:creator>
<dc:creator>Yuan, M.</dc:creator>
<dc:creator>Wu, N. C.</dc:creator>
<dc:creator>Mok, C. K.-P.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.20.713312</dc:identifier>
<dc:title><![CDATA[Somatic evolution of a cross-reactive germline antibody that expands its breadth to neutralize new SARS-CoV-2 variants]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Rapid antigenic drift of the SARS-CoV-2 receptor-binding domain (RBD) underlies immune escape and continues to challenge the durability of antibody-mediated protection. Among the major classes of RBD-directed antibodies, germline-encoded IGHV3-53 responses are highly potent against early SARS-CoV-2 variants but are generally compromised by Omicron-associated mutations. Here, we identify an intrinsically cross-reactive IGHV3-53 germline antibody that recognizes multiple pre-Omicron variants, including SARS-CoV-2 wild-type, Alpha, and Delta. Notably, we demonstrate that targeted somatic evolution can further expand this breadth to overcome the immune escape of different Omicron variants. Guided by integrated structural and sequence analyses, we introduce four somatic mutations (G26E, T28I, S53P, and Y58F) into the germline antibody, resulting in markedly enhanced binding and neutralization of Omicron BA.1, BA.2, and BA.4/5. High-resolution crystal structures reveal that these mutations re-establish critical interactions disrupted by substitutions on Omicron RBD and optimize affinity at a remodeled epitope interface. Collectively, our findings delineate a structural and mechanistic pathway through which an inherently cross-reactive germline antibody lineage can be adaptively refined to counter highly divergent SARS-CoV-2 variants. This work highlights the underappreciated breadth encoded within the naive B-cell repertoire and provides a conceptual framework for engineering and eliciting antibody responses resilient to future antigenic drift.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.23.713574v1?rss=1">
<title>
<![CDATA[
Modulation of liposome membranes by the C-terminal domain of the coronavirus envelope protein 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.23.713574v1?rss=1"
</link>
<dc:creator>Alag, R.</dc:creator>
<dc:creator>Bui, M. H.</dc:creator>
<dc:creator>Miserez, A.</dc:creator>
<dc:creator>Torres, J.</dc:creator>
<dc:creator>Pervushin, K.</dc:creator>
<dc:creator>Sharma, B.</dc:creator>
<dc:date>2026-03-25</dc:date>
<dc:identifier>doi:10.64898/2026.03.23.713574</dc:identifier>
<dc:title><![CDATA[Modulation of liposome membranes by the C-terminal domain of the coronavirus envelope protein]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The coronavirus envelope (E) protein is a viroporin that plays a key role in viral assembly, release, budding and pathogenesis. E protein forms oligomeric ion channels that can activate immune responses. However, high-resolution structural data for its extramembrane domains is limited. The C-terminal domain of SARS-CoV has been shown previously to form amyloid fibers, and here we show that these fibers can modulate the shape of liposomes. The propensity to form fibrils, and their effect on liposomes, was examined for sequences belonging to the four clades of coronaviruses. Electron microscopy data shows that the C-terminal domain in E protein adopts a filamentous structure. These findings demonstrate the potential of these peptides to modulate membranes, providing a possible mechanism by which E protein interacts with membranes in the host cell.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.20.26348947v1?rss=1">
<title>
<![CDATA[
Shifts in the pathogen spectrum and epidemiology of respiratory tract infections in the post-COVID-19 era: A study from Quzhou, Eastern China 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.20.26348947v1?rss=1"
</link>
<dc:creator>Yang, R.</dc:creator>
<dc:creator>Wang, M.</dc:creator>
<dc:creator>Lyu, L.</dc:creator>
<dc:creator>You, J.</dc:creator>
<dc:creator>Huang, S.</dc:creator>
<dc:creator>Zhan, B.</dc:creator>
<dc:date>2026-03-24</dc:date>
<dc:identifier>doi:10.64898/2026.03.20.26348947</dc:identifier>
<dc:title><![CDATA[Shifts in the pathogen spectrum and epidemiology of respiratory tract infections in the post-COVID-19 era: A study from Quzhou, Eastern China]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-24</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundAlthough the relaxation of COVID-19 containment measures in China has altered the transmission dynamics of respiratory pathogens, regional data on post-pandemic epidemiological characteristics remain limited.

ObjectiveThis study aimed to investigate the pathogen spectrum and epidemiological characteristics of acute respiratory infections (ARIs) in Quzhou City from 2023 to 2024, providing a scientific basis for local prevention and control strategies.

MethodsA total of 2,800 respiratory specimens were collected from November 2023 to July 2024, comprising 1,960 influenza-like illness (ILI) cases from outpatient/emergency departments and 840 severe acute respiratory infection (SARI) cases from inpatient departments. All samples were tested for 13 common respiratory pathogens using multiplex fluorescence quantitative PCR. Etiological and epidemiological analyses were performed based on detection results and case information.

ResultsThe overall ARI positivity rate was 59.28% (1,660/2,800), with a male-to-female ratio of 1.07:1 (1,447/1,353). The three most prevalent pathogens were influenza virus (Flu, 23.21%, 650/2,800), Streptococcus pneumoniae (SP, 13.14%, 368/2,800), and adenovirus (ADV, 8.39%, 235/2,800). Single pathogen infections accounted for 73.55% (1,221/1,660) of positive cases, while co-infections with two or more pathogens accounted for 26.45% (439/1,660), yielding an overall co-infection rate of 15.68% (439/2,800). No significant gender difference was observed in detection rates. However, significant differences were found across case types, temporal periods, age groups, and geographic regions (P < 0.01). Children aged [&le;]5 years exhibited the highest positivity rate (78.00%, 378/525), while adults aged [&ge;]65 years showed the lowest (34.53%, 144/417). Among surveillance regions, Kaihua County had the highest positivity rate (72.47%), and Changshan County the lowest (40.55%).

ConclusionsMultiple respiratory pathogens and co-infections are prevalent in Quzhou City, with distinct age-specific and seasonal patterns. These findings underscore the need for continuous multi-pathogen surveillance and integrated prevention strategies for influenza and other respiratory infectious diseases in the post-pandemic era.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.18.26348530v1?rss=1">
<title>
<![CDATA[
Microtesla Magnetic Therapy for cognitive impairment in post-acute sequelae of SARS CoV-2: A randomized controlled feasibility study 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.18.26348530v1?rss=1"
</link>
<dc:creator>Canori, A.</dc:creator>
<dc:creator>Watson, E.</dc:creator>
<dc:creator>Patel, D.</dc:creator>
<dc:creator>Fiorentino, A.</dc:creator>
<dc:creator>Santiago, C.</dc:creator>
<dc:creator>Maltz, D.</dc:creator>
<dc:creator>Gurfein, B.</dc:creator>
<dc:creator>Putrino, D.</dc:creator>
<dc:creator>Becker, J.</dc:creator>
<dc:date>2026-03-23</dc:date>
<dc:identifier>doi:10.64898/2026.03.18.26348530</dc:identifier>
<dc:title><![CDATA[Microtesla Magnetic Therapy for cognitive impairment in post-acute sequelae of SARS CoV-2: A randomized controlled feasibility study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-23</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundCognitive impairment has significant implications for function and quality of life and is common in individuals with post-acute sequelae of SARS CoV-2, also known as long COVID (LC). Emerging evidence suggests that sustained neuroinflammation, cerebrovascular dysfunction, and mitochondrial impairment are contributors to cognitive symptoms. Microtesla Magnetic Therapy (MMT) is a low-amplitude radiofrequency magnetic field intervention that has demonstrated anti-inflammatory and neuroprotective effects in preclinical models, suggesting it may be valuable in the management of cognitive impairment from LC and other neurological disorders. This study is the first randomized controlled trial to evaluate MMT for LC-related cognitive impairment.

ObjectiveTo evaluate the feasibility, safety, and preliminary efficacy of an at-home MMT intervention in individuals with moderate-to-severe cognitive impairment from LC.

MethodsIn this prospective feasibility study, 30 participants with LC-related cognitive impairment were randomized (2:1) to receive active or sham MMT. Participants self-administered 15-minute treatments at home with remote monitoring twice weekly for 4 weeks using a head-worn device that delivered a nonthermal radiofrequency magnetic field to the whole brain. Feasibility was defined as completion of at least 80% of prescribed treatments and all study visits. Secondary outcomes included safety, cognitive function, and self-reported mood and quality of life assessed at baseline, post-treatment (Week 4), and follow-up (Week 8).

ResultsFeasibility was high, with 100% treatment adherence among participants who completed the study and strong usability ratings for at-home administration. There were no device-related adverse events. Compared with sham, participants receiving active MMT showed significantly greater improvements from baseline to Week 8 in WAIS-IV Digit Span Sequencing (p= 0.026), HVLT-R Recall (p= 0.044), and D-KEFS Color Naming (p= 0.049). Additional measures of attention, processing speed, and executive function demonstrated favorable trends in the active group. Emotional well-being, assessed by the SF-36, improved significantly in the active group at Week 8 compared with sham (p= 0.017), and mood symptoms showed clinically meaningful improvement.

ConclusionsAdministration of the MMT intervention at home was feasible, safe, and well tolerated in individuals with cognitive impairment from LC. Preliminary findings suggest sustained clinically meaningful improvements in multiple cognitive domains and mood following treatment.

Trial RegistrationClinicalTrials.gov NCT06739668, https://clinicaltrials.gov/study/NCT06739668, 2024-12-17
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.16.26348020v1?rss=1">
<title>
<![CDATA[
Feasibility, Acceptability, and Cost of Community-Based Self-monitoring among Sex Workers Testing Positive for COVID-19 in Zimbabwe: A Mixed-methods Study. 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.16.26348020v1?rss=1"
</link>
<dc:creator>Kabonga, I.</dc:creator>
<dc:creator>Mangenah, C.</dc:creator>
<dc:creator>Watadzaushe, C.</dc:creator>
<dc:creator>Madanhire, C.</dc:creator>
<dc:creator>Ruhode, N.</dc:creator>
<dc:creator>Dunkley, Y.</dc:creator>
<dc:creator>Karin, H.</dc:creator>
<dc:creator>Corbett, E. L.</dc:creator>
<dc:creator>Cowan, F. M.</dc:creator>
<dc:creator>Sibanda, E. L.</dc:creator>
<dc:date>2026-03-23</dc:date>
<dc:identifier>doi:10.64898/2026.03.16.26348020</dc:identifier>
<dc:title><![CDATA[Feasibility, Acceptability, and Cost of Community-Based Self-monitoring among Sex Workers Testing Positive for COVID-19 in Zimbabwe: A Mixed-methods Study.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-23</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundSex workers struggled to adhere to isolation guidelines following COVID-19 diagnosis because of financial pressure to keep working. We co-developed and evaluated for feasibility, acceptability, and cost an intervention for promoting isolation and community-based self-monitoring for COVID-19.

MethodsSex workers testing positive for COVID-19 received the following co-developed intervention: i) risk-differentiated support, including immediate hospitalization and/or treatment for serious illness, and community-based self-monitoring for those at risk of progressing to severe illness, ii) food packs lasting two weeks. Using Proctors Framework, we interviewed purposively selected health-workers and sex workers before intervention implementation (26 sex workers and 24 health workers) and during implementation (8 sex workers of whom 5 tested positive, and 5 health workers) to evaluate the intervention. We determined intervention development and implementation costs using program data.

ResultsThe intervention was implemented between March-June 2023. Sex workers and health workers reported that the intervention was highly acceptable and was implemented with fidelity. Food packs were highly appreciated; participants said they promoted isolation although vulnerability to non-food financial pressures persisted. Unanticipated impacts were increased testing uptake following introduction of food packs. Self-monitoring at home was acceptable although fear of stigma prevented some participants from seeking the needed support. The cost per sex worker testing positive was $49 and $54 respectively excluding/including intervention co-development costs.

ConclusionA co-developed intervention for promoting isolation and community-based self-monitoring for COVID-19 was feasible and acceptable, with costs comparing favorably with similar interventions. Addressing stigma could optimise implementation and potential for future pandemics.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.03.22.712163v1?rss=1">
<title>
<![CDATA[
Resistome, Virulome, Mobilome, And Biosynthetic Gene Clusters Adaptations of Acinetobacter Baumannii Mexican Strains Across the Pre- and of the COVID-19 Period: Insights from Whole-Genome Sequencing 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.03.22.712163v1?rss=1"
</link>
<dc:creator>Alejo, M. A.</dc:creator>
<dc:creator>Lozano Gamboa, M. S.</dc:creator>
<dc:creator>Munoz Gomez, B. E.</dc:creator>
<dc:creator>Hernandez Magro Gil, K. G.</dc:creator>
<dc:creator>Garcia Contreras, R.</dc:creator>
<dc:creator>Whitaker, R.</dc:creator>
<dc:creator>Palacios Marmolejo, A.</dc:creator>
<dc:creator>Ceapa, C. D.</dc:creator>
<dc:date>2026-03-23</dc:date>
<dc:identifier>doi:10.64898/2026.03.22.712163</dc:identifier>
<dc:title><![CDATA[Resistome, Virulome, Mobilome, And Biosynthetic Gene Clusters Adaptations of Acinetobacter Baumannii Mexican Strains Across the Pre- and of the COVID-19 Period: Insights from Whole-Genome Sequencing]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-23</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundAcinetobacter baumannii is a critical multidrug-resistant pathogen whose genomic landscape in Mexico has been reshaped by the COVID-19 pandemic. While global studies have highlighted distinctive sequence type distributions, systematic analyses in Mexico remain limited.

MethodsWe analyzed 194 genomes, including 47 newly sequenced post-COVID isolates (MIQ), alongside 147 publicly available genomes (HPG). Whole-genome sequencing was combined with phylogenetic reconstruction, resistome and virulome profiling based on gene presence and absence, mobilome analysis, and biosynthetic gene cluster (BGC) characterization.

ResultsTwo major clades dominated by Oxford STs 758, 208, 417, and 369 were identified. Resistome profiling uncovered 128 distinct resistome profiles (combinations of genes) and 44 emerging antimicrobial resistance genes (ARGs), with an increased number of resistance genes in the strains obtained during the pandemic. Virulome analysis revealed enrichment of metabolic adaptation genes (argG, carA, ilvC) in MIQ strains. Mobilome profiling demonstrated enrichment of ISAbA1 and ISAbA3 elements, known to mobilize carbapenemase genes. BGC analysis showed conserved siderophores involved in virulence, alongside diversification of the secondary metabolite repertoires in MIQ genomes. Additional observations included geographic mixing of clades across Jalisco, Aguascalientes, and Mexico City and referral bias toward carbapenemase-positive isolates.

ConclusionThe genomic landscape of A. baumannii in Mexico has diversified post-COVID, with evidence of inter-regional transmission, referral bias, virulome expansion, mobilome-driven ARG dissemination, and metabolic adaptation. These findings underscore the urgent need for coordinated genomic surveillance, functional and clinical validation of adaptation signals, and regionally integrated infection control strategies to mitigate resistance trajectories.

Graphical abstractIntegrative genomic profiling of A. baumannii isolates from Mexico. Workflow summarizing the analysis of 194 genomes (147 historic public genomes, 47 novel MIQ strains). Clinical isolates were identified by MALDI Biotyper and tested with BD Phoenix M50. Whole genome sequencing enabled phylogenetic and MLST analyses, resistome and virulome profiling, mobilome characterization, and BGC identification using BIGSCAPE and antiSMASH. Outputs include phylogenetic clustering, resistance/virulence gene distributions, and biosynthetic potential across Mexican regions.



O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=84 SRC="FIGDIR/small/712163v1_ufig1.gif" ALT="Figure 1">
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org.highwire.dtl.DTLVardef@74c87borg.highwire.dtl.DTLVardef@1160aa7org.highwire.dtl.DTLVardef@1564c1org.highwire.dtl.DTLVardef@89e91b_HPS_FORMAT_FIGEXP  M_FIG C_FIG
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.19.26348776v1?rss=1">
<title>
<![CDATA[
Physiotherapy service during the COVID-19 pandemic in Nepal: An onsite survey and the lived experience among clinicians 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.19.26348776v1?rss=1"
</link>
<dc:creator>Shakya, N. R.</dc:creator>
<dc:creator>Dahal, S.</dc:creator>
<dc:creator>Shrestha, N.</dc:creator>
<dc:creator>Webb, G.</dc:creator>
<dc:creator>Stensdotter, A.-K.</dc:creator>
<dc:date>2026-03-22</dc:date>
<dc:identifier>doi:10.64898/2026.03.19.26348776</dc:identifier>
<dc:title><![CDATA[Physiotherapy service during the COVID-19 pandemic in Nepal: An onsite survey and the lived experience among clinicians]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe COVID-19 pandemic significantly disrupted healthcare services globally, particularly in low-resource settings. This study explores the impact of the pandemic on physiotherapy services in Nepal.

MethodsA cross-sectional study was conducted. Qualitative data were collected through semi-structured interviews with 12 physiotherapists, while quantitative data were gathered from an onsite survey of 29 health facilities at six different districts of Province III of Nepal. Inductive thematic analysis approach was used to analyze the qualitative data, and descriptive statistics were used for the closed ended questions.

ResultsThe findings were categorized into sub-themes under two major themes: i) Pandemic effect on physiotherapy services and patient care and ii) Adaptation, innovation and collaboration. The study revealed a significant disruption in physiotherapy services with a notable decline in patient flow and service availability. Most patients, especially those with disabilities and post-operative needs, experienced worsening conditions due to limited access to care. There was an increased recognition of the role of physiotherapy in acute respiratory care and post-COVID-19 recovery. Tele-rehabilitation was explored as an alternative care method but faced challenges in implementation. More than half (62.07%) of the centers reported uninterrupted physiotherapy services, whereas almost one third (31.03%) experienced service suspension. Most centers (89.7%) had personal protective equipment available, and majority (86.2%) of the physiotherapists worked in multidisciplinary team: fever clinics, triage, emergency care, respiratory physical therapy, and nursing and administrative support were among the expanded roles. Several centers (37.9%) used virtual care with telephone consultation serving as the primary modality. Virtual service was mostly absent in centers where in-person services persisted.

ConclusionThe COVID-19 pandemic significantly impacted physiotherapy services in Nepal, leading to service disruptions and compromised patient care. It highlighted the need to further incorporate physiotherapy into the healthcare system and enhance rehabilitation services to improve continued patient care.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.19.26348823v1?rss=1">
<title>
<![CDATA[
SARS-CoV-2 and the Pandemic Surge in Invasive Group A Streptococcal Disease 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.19.26348823v1?rss=1"
</link>
<dc:creator>Fisman, D.</dc:creator>
<dc:creator>Lee, C. E.</dc:creator>
<dc:creator>Wilson, N.</dc:creator>
<dc:creator>Barton, M.</dc:creator>
<dc:creator>Mann, S. K.</dc:creator>
<dc:creator>Tuite, A.</dc:creator>
<dc:date>2026-03-22</dc:date>
<dc:identifier>doi:10.64898/2026.03.19.26348823</dc:identifier>
<dc:title><![CDATA[SARS-CoV-2 and the Pandemic Surge in Invasive Group A Streptococcal Disease]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundMultiple countries reported unprecedented increases in invasive group A streptococcal (iGAS) disease following widespread SARS-CoV-2 circulation. Whether this surge reflects reduced pathogen exposure during non-pharmaceutical interventions ("immunity debt") or effects of SARS-CoV-2 infection on host immunity remains unresolved.

MethodsWe conducted a population-based time-series analysis of weekly iGAS incidence in central Ontario, Canada (population {approx}11 million) from March 2011 through March 2024 (676 weeks). Using negative binomial panel regression, we modeled acute (2-week lagged) and cumulative SARS-CoV-2 exposure while adjusting for seasonality, secular trends, age, and sex. Population attributable fractions (PAFs) were estimated by counterfactual prediction. Specificity was assessed through negative control analyses (influenza, RSV). The immunity debt hypothesis was evaluated using cumulative streptococcal exposure as a predictor of iGAS.

ResultsAmong 2,906 iGAS episodes, 34.3% during the pandemic period were associated with acute SARS-CoV-2 effects (range by age group: 16.5-39.1%). Models incorporating cumulative SARS-CoV-2 burden showed markedly better fit ({Delta}AIC=-157.5); cumulative exposure was strongly associated with iGAS (IRR 1.193, 95% CI 1.151-1.235), increasing the estimated PAF to 66.7%. Cumulative effects were strongest in children (IRR 1.309). SARS-CoV-2 was comparably associated with non-invasive streptococcal disease, with no increase in invasion propensity. Cumulative streptococcal exposure was not protective (overall IRR 1.000, p=0.730); where significant, the association was positive, opposite to immunity debt predictions.

ConclusionsCumulative SARS-CoV-2 burden was strongly associated with pandemic-era iGAS incidence. Cumulative streptococcal exposure did not support the immunity debt hypothesis. These ecological findings are consistent with SARS-CoV-2-associated immune dysregulation and warrant individual-level confirmation.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.19.26348833v1?rss=1">
<title>
<![CDATA[
Autoantibody landscapes in neurological Long COVID and post-COVID cognitive impairment show heterogeneity without a shared disease signature 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.19.26348833v1?rss=1"
</link>
<dc:creator>Chakravarty, D.</dc:creator>
<dc:creator>Dandekar, R.</dc:creator>
<dc:creator>Lashkari, V. D.</dc:creator>
<dc:creator>Tilton, I.</dc:creator>
<dc:creator>McAlpine, L.</dc:creator>
<dc:creator>Chiarella, J.</dc:creator>
<dc:creator>Nelson, A.</dc:creator>
<dc:creator>Ngo, T.</dc:creator>
<dc:creator>Chen, P.</dc:creator>
<dc:creator>Wang, G.</dc:creator>
<dc:creator>Saxena, A.</dc:creator>
<dc:creator>Castillo-Rojas, B.</dc:creator>
<dc:creator>Zorn, K.</dc:creator>
<dc:creator>Tribble, D. R.</dc:creator>
<dc:creator>Burgess, T. H.</dc:creator>
<dc:creator>Rubin, L. H.</dc:creator>
<dc:creator>Richard, S. A.</dc:creator>
<dc:creator>Agan, B. K.</dc:creator>
<dc:creator>Pollett, S. D.</dc:creator>
<dc:creator>Farhadian, S.</dc:creator>
<dc:creator>Spudich, S.</dc:creator>
<dc:creator>Pleasure, S. J.</dc:creator>
<dc:creator>Wilson, M. R.</dc:creator>
<dc:date>2026-03-22</dc:date>
<dc:identifier>doi:10.64898/2026.03.19.26348833</dc:identifier>
<dc:title><![CDATA[Autoantibody landscapes in neurological Long COVID and post-COVID cognitive impairment show heterogeneity without a shared disease signature]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundNeurological Long COVID (n-LC) includes persistent cognitive and autonomic symptoms after SARS-CoV-2 infection. Prior studies of post-COVID conditions have described diverse humoral autoreactivity, but findings are heterogeneous, and it remains unclear whether n-LC is associated with a consistent CNS-directed humoral signature.

MethodsWe performed a cross-cohort case-control analysis to detect autoantibodies in cerebrospinal fluid (CSF) and serum from n-LC participants. In the Yale COVID Mind Study cohort, CSF from n-LC participants and from pre-pandemic and post-COVID asymptomatic controls was assessed by mouse brain immunofluorescence and proteome-wide phage immunoprecipitation sequencing (PhIP-Seq), with candidate reactivities evaluated by orthogonal assays and supervised modeling. In the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (IDCRP EPICC) cohort, post-COVID sera collected prior to iPhone- or iPad-based cognitive screening were profiled by PhIP-Seq and compared between participants with and without cognitive impairment.

ResultsCSF immunoreactivity on mouse brain tissue was observed in both n-LC and controls, with similar overall frequencies, although n-LC participants more often showed nuclear-predominant staining patterns. PhIP-Seq identified sparse, largely patient-specific peptide reactivities to nuclear and neuronal proteins in CSF and serum. Supervised models provided limited discrimination between cases and controls. Candidate autoantigens had limited disease specificity on orthogonal testing. EPICC serum autoantibody profiling similarly failed to distinguish individuals with and without cognitive impairment.

ConclusionsAcross cohorts and compartments, n-LC did not exhibit a shared autoantibody signature. These findings support the absence of a dominant, common CNS autoantibody-mediated mechanism in n-LC.

FundingGrants HU00012020067, HU00012120103, HU00011920111, R01NS125693, R01MH125737, R01AI157488 from Defense health program and NIH.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.18.26348767v1?rss=1">
<title>
<![CDATA[
Prediction of confirmed, hospitalized, and severe COVID-19 cases and mechanistic insights from viral concentrations and variant dynamics in wastewater 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.18.26348767v1?rss=1"
</link>
<dc:creator>Murakami, M.</dc:creator>
<dc:creator>Watanabe, R.</dc:creator>
<dc:creator>Iwamoto, R.</dc:creator>
<dc:creator>Chung, U.-i.</dc:creator>
<dc:creator>Kitajima, M.</dc:creator>
<dc:creator>Yoo, B.-K.</dc:creator>
<dc:date>2026-03-20</dc:date>
<dc:identifier>doi:10.64898/2026.03.18.26348767</dc:identifier>
<dc:title><![CDATA[Prediction of confirmed, hospitalized, and severe COVID-19 cases and mechanistic insights from viral concentrations and variant dynamics in wastewater]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-20</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundFollowing the end of a public health emergency of international concern, divergence emerged between reported coronavirus disease 2019 (COVID-19) cases and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in wastewater. Exploring viral, clinical, patient, and surveillance-related factors underlying this divergence, we developed models to predict clinically confirmed infections, hospitalizations, and severe cases.

MethodsIn this observational study, we analyzed [~]2 years of data from January 2022 in Kanagawa Prefecture, Japan, assessing associations between wastewater SARS-CoV-2 RNA concentrations and confirmed, hospitalized, and severe cases, adjusting for wave and variant effects.

FindingsOur models based on wastewater viral RNA concentrations showed high predictive accuracy (R{superscript 2} = 0.8199-0.9961), closely tracking confirmed, hospitalized, and severe cases. Models derived from earlier waves were applied to subsequent waves with residual correction based on prior prediction errors and maintained good predictive performance (root mean square error = 0.0665-0.2065). Divergence between wastewater viral RNA concentrations and reported cases was not explained by changes in viral shedding. Declines in patients healthcare-seeking behavior and testing were associated with trends in confirmed cases, whereas milder clinical presentation was associated with severe case trends. The lineages XBB.1.9.2 and BA.2.86 were identified as candidates associated with reduced virulence.

InterpretationBy incorporating understanding of viral, clinical, and surveillance-related mechanisms, wastewater surveillance may enable prediction of case trends approximately one week earlier than official reporting and inform healthcare capacity planning.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.12.26346895v1?rss=1">
<title>
<![CDATA[
Prenatal exposure to SARS-CoV-2, early relational health, and child socio-emotional functioning in the first 6 months 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.12.26346895v1?rss=1"
</link>
<dc:creator>Lavallee, A.</dc:creator>
<dc:creator>Warmingham, J. M.</dc:creator>
<dc:creator>Owens, J. B.</dc:creator>
<dc:creator>Xu, R. L.</dc:creator>
<dc:creator>Ahmed, I.</dc:creator>
<dc:creator>Atwood, G. D.</dc:creator>
<dc:creator>Kyle, M. H.</dc:creator>
<dc:creator>Hussain, M.</dc:creator>
<dc:creator>Chaves, V.</dc:creator>
<dc:creator>Arduin, E.</dc:creator>
<dc:creator>Lanoff, M. R.</dc:creator>
<dc:creator>Hyman, S. P.</dc:creator>
<dc:creator>Coskun, L. Z.</dc:creator>
<dc:creator>Shearman, N. D.</dc:creator>
<dc:creator>Russo, J. E.</dc:creator>
<dc:creator>Ettinger, S.</dc:creator>
<dc:creator>Greenman, E. A.</dc:creator>
<dc:creator>Serota, D. E.</dc:creator>
<dc:creator>Bence, M. L.</dc:creator>
<dc:creator>Hott, V.</dc:creator>
<dc:creator>Hu, Y.</dc:creator>
<dc:creator>Kurman, G.</dc:creator>
<dc:creator>Lara, M.</dc:creator>
<dc:creator>Tzul Lopez, H.</dc:creator>
<dc:creator>Mollicone, I.</dc:creator>
<dc:creator>Ravi, R.</dc:creator>
<dc:creator>Rodriguez, C.</dc:creator>
<dc:creator>Smotrich, G. C.</dc:creator>
<dc:creator>Lawless, A.</dc:creator>
<dc:creator>Ontiveros-Angel, P.</dc:creator>
<dc:creator>Curtin, A.</dc:creator>
<dc:creator>Austin, J.</dc:creator>
<dc:creator>Firestein, M. R.</dc:creator>
<dc:creator>Shuffery, L. C.</dc:creator>
<dc:creator>Fernandez, C. R.</dc:creator>
<dc:creator>Battarbee, A. N.</dc:creator>
<dc:creator>Bruno, A.</dc:creator>
<dc:creator>Dawood, F. S.</dc:creator>
<dc:creator>Maniatis, P.</dc:creator>
<dc:creator>Morrill, T. C.</dc:creator>
<dc:creator>Newes-Adeyi, G.</dc:creator>
<dc:creator>Reichle, L.</dc:creator>
<dc:creator>Sem</dc:creator>
<dc:date>2026-03-19</dc:date>
<dc:identifier>doi:10.64898/2026.03.12.26346895</dc:identifier>
<dc:title><![CDATA[Prenatal exposure to SARS-CoV-2, early relational health, and child socio-emotional functioning in the first 6 months]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-19</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ImportanceParent/caregiver-infant early relational health (ERH) is known to play a critical role in the promotion of socio-emotional functioning and wellbeing across the life course. The negative impact of the COVID-19 pandemic on maternal mental health and secondarily on ERH and child socio-emotional functioning is clear. However, the direct impact of maternal viral exposure during pregnancy on ERH has not been investigated.

ObjectiveThe goal of this study was to determine the impact of prenatal SARS-CoV-2 exposure on ERH and infant socio-emotional functioning in the first 6 months of life.

DesignMothers with and without SARS-CoV-2 exposure during pregnancy who gave birth from 02/2020 to 09/2021 were enrolled from 05/2020 to 09/2021 in one of two parallel prospective studies (the COVID-19 Mother Baby Outcomes [COMBO] Initiative or the Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI] COMBO sub-study). Mothers reported on their health and the socioemotional functioning of their infant via online surveys (REDCap) at enrollment, 1, 2, 4, and 6 months. At 4 to 6 months, dyads were invited to participate in a video-based, remote assessment of ERH.

Participants884 mother-infant dyads from three U.S. States (Alabama, New York, and Utah).

ExposurePrenatal SARS-CoV-2.

Main Outcomes and MeasuresMaternal-reported ERH (parental stress, parenting confidence and bonding) and observer-based ERH (video-coded quality of maternal caregiving behaviors and mother-infant emotional connection). Infant socio-emotional development assessed using the 6-month Ages and Stages Questionnaire: Socio-Emotional 2nd Edition (ASQ:SE-2).

Results316 (36%) mothers had a positive prenatal SARS-CoV-2 exposure. Prenatal SARS-CoV-2 exposure was associated with an adjusted estimate of [~]5% reduction (incidence rate ratio=0.95, 95% confidence interval [0.90, 1.00], p=0.03) in observed maternal caregiving quality, after accounting for postnatal maternal mental health and sociodemographic factors. We found no evidence of effect on other ERH constructs or infant socio-emotional functioning.

Conclusions and RelevanceIn this large prospective cohort study, prenatal SARS-CoV-2 was associated with a small decrement in caregiving quality, but not other ERH constructs or infant socioemotional functioning. These findings should be interpreted as hypothesis generating and will require replication in independent studies.

Key PointsO_LIQuestion: Is SARS-CoV-2 exposure during pregnancy associated with maternal-reported and observer-based measures of early relational health (ERH) and infant socio-emotional functioning at 4-6 months postpartum?
C_LIO_LIFindings: Prenatal SARS-CoV-2 exposure was associated with a [~]5% reduction in observed quality of maternal caregiving after accounting for postnatal mental health symptomatology and sociodemographic factors.
C_LIO_LIMeaning: A small reduction in maternal caregiving quality, but not other ERH constructs (parental stress, parenting confidence, bonding and emotional connection) or infant socio-emotional functioning, was associated with prenatal SARS-CoV-2 exposure. Results should be interpreted as hypothesis generating and will require replication in independent studies.
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.06.26347822v1?rss=1">
<title>
<![CDATA[
Predictors of COVID-19 hospital outcomes: a machine learning analysis of the National COVID Cohort Collaborative 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.06.26347822v1?rss=1"
</link>
<dc:creator>Vazquez, J.</dc:creator>
<dc:creator>Taylor, L.</dc:creator>
<dc:creator>Chen, Y.-Y. K.</dc:creator>
<dc:creator>Araya, K.</dc:creator>
<dc:creator>Farnsworth, M. G.</dc:creator>
<dc:creator>Xue, X.</dc:creator>
<dc:creator>Hasan, M.</dc:creator>
<dc:creator>N3C Consortium,</dc:creator>
<dc:date>2026-03-09</dc:date>
<dc:identifier>doi:10.64898/2026.03.06.26347822</dc:identifier>
<dc:title><![CDATA[Predictors of COVID-19 hospital outcomes: a machine learning analysis of the National COVID Cohort Collaborative]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Predicting hospital outcomes for patients with severe acute respiratory infections is critical for risk stratification and resource planning, yet heterogeneous electronic health record (EHR) data, class imbalance, and evolving clinical practice present persistent methodological challenges for machine learning (ML) approaches.

We conducted a retrospective cohort study using EHR data harmonized to the OMOP common data model from the National COVID Cohort Collaborative (N3C; May 2020-June 2025), including 263,619 adults hospitalized with COVID-19 across 51 contributing sites. We developed penalized linear regression (elastic net), random forest, XGBoost, and multilayer perceptron (MLP) models to predict hospital length of stay (LOS) and mortality (in-hospital and 60-day), using demographics, comorbidities, prior healthcare utilization, COVID-19 vaccination status, and hospital site as predictors. Missing data were handled via multiple imputation by chained equations (MICE) and class imbalance was addressed using SMOTE. Model performance was evaluated using area under the ROC curve (AUROC), Brier score, calibration plots, and decision curve analysis, following the TRIPOD reporting framework.

Mortality prediction achieved moderate discrimination across all models (test AUROC = 0.71-0.73 for in-hospital mortality; 0.72-0.73 for 60-day all-cause mortality). Models trained without SMOTE achieved the highest AUROCs but assigned virtually no patients to the mortality class at the default 0.5 threshold. SMOTE improved recall and F-1 score at the cost of reduced AUROC and precision. LOS was poorly explained by available structured predictors (best R2 = 0.059). Remdesivir-treated patients (n = 103,536; 39.3%) were older, had higher comorbidity burden, and had higher unadjusted mortality than untreated patients.

Common structured EHR features offer moderate utility for mortality risk stratification in hospitalized COVID-19 patients but are insufficient for LOS prediction. The consistent SMOTE-related tradeoff between discrimination and calibration underscores the need to report threshold-dependent metrics alongside AUROC in clinical ML studies, with implications for operational planning during future respiratory disease emergencies.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.06.26347802v1?rss=1">
<title>
<![CDATA[
Would Lifting Versus Maintaining COVID-19 Containment Policies Have Reduced Psychological Distress in the US? 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.06.26347802v1?rss=1"
</link>
<dc:creator>Cudic, M.</dc:creator>
<dc:creator>de la Hoz, J. F.</dc:creator>
<dc:creator>Dall'Aglio, L.</dc:creator>
<dc:creator>Tubbs, J. D.</dc:creator>
<dc:creator>Ebrahimi, O. V.</dc:creator>
<dc:creator>Madsen, E. M.</dc:creator>
<dc:creator>Fatori, D.</dc:creator>
<dc:creator>Zuccolo, P. F.</dc:creator>
<dc:creator>Lian, J.</dc:creator>
<dc:creator>Kabir, D. K.</dc:creator>
<dc:creator>Zhou, Y.</dc:creator>
<dc:creator>Watts, D.</dc:creator>
<dc:creator>Choi, K. W.</dc:creator>
<dc:creator>Manfro, G. G.</dc:creator>
<dc:creator>Sweeney, E.</dc:creator>
<dc:creator>Lin, Y.-F.</dc:creator>
<dc:creator>Fancourt, D.</dc:creator>
<dc:creator>COVID-19 Global Mental Health Consortium (CGMHC),</dc:creator>
<dc:creator>Patel, V.</dc:creator>
<dc:creator>Kessler, R. C.</dc:creator>
<dc:creator>Bauermeister, S.</dc:creator>
<dc:creator>Brunoni, A. R.</dc:creator>
<dc:creator>Lee, Y. H.</dc:creator>
<dc:creator>Smoller, J. W.</dc:creator>
<dc:date>2026-03-09</dc:date>
<dc:identifier>doi:10.64898/2026.03.06.26347802</dc:identifier>
<dc:title><![CDATA[Would Lifting Versus Maintaining COVID-19 Containment Policies Have Reduced Psychological Distress in the US?]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundBoth the COVID-19 pandemic and containment policies caused widespread psychological distress, yet their independent effects remain unclear. Disentangling these effects could inform future responses that balance physical and mental health. This study sought to estimate the effect of lifting versus maintaining containment policies on psychological distress, independent of pandemic severity.

MethodsWe conducted a state-level longitudinal analysis using the Behavioral Risk Factor Surveillance System (BRFSS), a representative survey of US adults, restricted to the pandemic period preceding widespread vaccine availability (April 2020 to April 2021). The exposure was lifting versus maintaining containment policies (school closures, workplace closures, event cancellations, and full lockdown) from the Oxford COVID-19 Government Response Tracker. Exposure was measured during periods of low (<25/100,000 new cases) or declining (>14 days) pandemic severity. The primary outcome was prevalence of psychological distress, derived from a BRFSS survey item corresponding to a PHQ-4 score [&ge;]6.

FindingsThree causal inference approaches yielded consistent evidence of transient policy-lifting effects: (1) synthetic control analysis of Maine showed a temporary 5.5 percentage-point reduction in psychological distress lasting three months before returning to counterfactual levels; (2) within-state fixed effects found immediately after lifting full lockdown, distress decreased by 5.68 [-8.67, -2.69] percentage points, declining by 30 days (-3.24 [-6.88, 0.39]) and negligible at 60 days (-0.94 [-3.77, 1.89]); (3) target trial emulation detected no significant effects from lifting versus maintaining policies for 90 days.

InterpretationLifting containment policies in the first year of the pandemic produced immediate but transient reductions in psychological distress. These results suggest that extended containment policies were unlikely to account for persistent increases in distress during this period.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.03.04.26347661v1?rss=1">
<title>
<![CDATA[
Chronic absenteeism in Canadian kindergarten classes, pre- and post-COVID-19, and its association with concurrent developmental vulnerability 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.03.04.26347661v1?rss=1"
</link>
<dc:creator>Reid-Westoby, C.</dc:creator>
<dc:creator>Duku, E.</dc:creator>
<dc:creator>Gaskin, A.</dc:creator>
<dc:creator>Janus, M.</dc:creator>
<dc:date>2026-03-05</dc:date>
<dc:identifier>doi:10.64898/2026.03.04.26347661</dc:identifier>
<dc:title><![CDATA[Chronic absenteeism in Canadian kindergarten classes, pre- and post-COVID-19, and its association with concurrent developmental vulnerability]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-05</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Students who frequently miss school are at greater risk for academic difficulty. High levels of absenteeism as early as kindergarten have been associated with long-term consequences, such as low reading proficiency in Grade 3 and low academic achievement in Grade 5, both of which have been associated with lower rates of high school graduation and enrollment in post-secondary education. The prevalence of school absenteeism has increased significantly since the COVID-19 pandemic and there have been sustained shifts in student attendance rates from kindergarten to Grade 12 since 2020. The goals of this population-level, repeated cross-sectional cohort study were to compare rates of chronic absenteeism, defined as being absent from school at least 10% of the time, in kindergarten in Canada before and after the onset of the COVID-19 pandemic, and examine the association between childrens chronic absenteeism and their concurrent developmental vulnerability. A total of 513,159 kindergarten children participated in the study, with 284,712 (55.5%) being in the pre-COVID-19 cohort (2017-2020) and 228,447 (44.5%) in the post-COVID-19 cohort (2020-2023). Across Canada, rates of chronic absenteeism increased from pre- to post-COVID-19, from 17.7% to 41.3%, with differences by jurisdiction. The greatest increase was seen in Ontario, while the smallest increase was seen in British Columbia. Children attending kindergarten in the post-COVID-19 cohort were three times more likely to be chronically absent compared to their peers attending kindergarten before the onset of the pandemic. Despite this, chronic absenteeism in the post-COVID-19 period was associated with reduced odds of overall developmental vulnerability, a pattern that is likely attributable to shifts in the composition of chronically absent children. In the post-COVID-19 cohort, a greater percentage of children who were chronically absent resided in higher SES neighbourhoods compared to their chronically absent peers attending school before the onset of the pandemic. While increasing rates of school absenteeism should not be ignored, our results suggest that chronic absenteeism following COVID-19 might be more nuanced than before. The jurisdictional differences in rates of chronic absenteeism observed in this study could be due to the various public health measures put in place by the various provincial and territorial governments. It is also possible that the children from higher SES neighbourhoods missed more school after the onset of the COVID-19 pandemic because their parents had the capability to work from home, making it easier to keep their child(ren) home from school. The decreased association between chronic absenteeism and developmental vulnerability post-COVID-19 may reflect improved access to online resources, which enables students to stay on track academically from home. Gaining a better understanding of the reasons behind missing school and the relation between absenteeism and academic achievement at various developmental stages is crucial to support successful learning trajectories.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.02.27.26346872v1?rss=1">
<title>
<![CDATA[
Outburst of serotype 4 IPD after COVID-19 is driven by ST15063/GPSC162 lineage associated with high-risk behaviors and greater virulence linked to influenza H3N2 virus coinfection and cigarette smoke 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.02.27.26346872v1?rss=1"
</link>
<dc:creator>Perez-Garcia, C.</dc:creator>
<dc:creator>Llorente, J.</dc:creator>
<dc:creator>Aguirre Alustuey, M. E.</dc:creator>
<dc:creator>Llamosi, M.</dc:creator>
<dc:creator>Gil, R.</dc:creator>
<dc:creator>Lahlali, G.</dc:creator>
<dc:creator>El-Ayache, F.</dc:creator>
<dc:creator>Yan, V.</dc:creator>
<dc:creator>Schotsaert, M.</dc:creator>
<dc:creator>Del Diego, J.</dc:creator>
<dc:creator>Cisneros, J. M.</dc:creator>
<dc:creator>Garcia-Sastre, A.</dc:creator>
<dc:creator>Domenech, M.</dc:creator>
<dc:creator>Sempere, J.</dc:creator>
<dc:creator>Yuste, J.</dc:creator>
<dc:date>2026-03-04</dc:date>
<dc:identifier>doi:10.64898/2026.02.27.26346872</dc:identifier>
<dc:title><![CDATA[Outburst of serotype 4 IPD after COVID-19 is driven by ST15063/GPSC162 lineage associated with high-risk behaviors and greater virulence linked to influenza H3N2 virus coinfection and cigarette smoke]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-03-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The emergence of vaccine covered serotypes causing invasive pneumococcal disease (IPD) is a serious concern worldwide. We investigated the unexpected rise of serotype 4 causing IPD primarily in non-vaccinated young adults after the COVID-19 pandemic that further spread to adults [&ge;] 65 years in recent years. For this purpose, we conducted a retrospective study of serotype 4 IPD cases (n=827) reported in Spain between 2009 and 2024. Whole-genome sequencing was performed to assess clonal lineages and phylogenetic relationships. Clinical and epidemiological data were compared between serotype 4 and all other serotypes causing IPD. Epidemiological and genomic analysis confirmed that the rise started as an abrupt cluster of IPD cases in Seville (Andalusia) in the year 2022 due to the ST15063 within GPSC12 lineage. This outbreak initially caused pneumonia episodes that required hospitalization in young individuals associated with high rates of tobacco smoking, alcohol, and inhaled drugs such as cannabis and cocaine, followed by a general distribution pattern throughout the country in the following years, affecting the elderly population. Experimental studies to evaluate potential underlying mechanisms confirmed that ST15063 serotype 4 strains displayed enhanced infection rates of human lung cells that significantly increased in the presence of cigarette smoke exposure and by influenza H3N2 virus coinfection, but not with H1N1. These findings highlight the need for targeted vaccination strategies not only against pneumococcus but also against respiratory viruses such as influenza, RSV and COVID-19 and demonstrate the importance of molecular surveillance to establish effective interventions in high-risk populations.
]]></description>
</item>
</rdf:RDF>
