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Nature Medicine, Published online: 03 April 2020; doi:10.1038/d41591-020-00008-yNature Medicine summarizes all the research you need to know this week to keep on top of how science is responding to the COVID-19 pandemic.
Journal of Medical Virology, Accepted Article.
Huang J, Liu F, Teng Z, et al.
Ruan L, Wen M, Zeng Q, et al.
AbstractAs the outbreak of COVID-19 has spread globally, determining how to prevent the spread is of paramount importance. We reported the effectiveness of different responses of four affected cities in preventing the COVID-19 spread. We expect Wenzhou anti-COVID-19 measures may provide experience for cities around the world that are experiencing this epidemic.
Yuan, M., Wu, N. C., Zhu, X., Lee, C.-C. D., So, R. T. Y., Lv, H., Mok, C. K. P., Wilson, I. A.
The outbreak of COVID-19 caused by SARS-CoV-2 virus has now become a pandemic, but there is currently very little understanding of the antigenicity of the virus. We therefore determined the crystal structure of CR3022, a neutralizing antibody previously isolated from a convalescent SARS patient, in complex with the receptor-binding domain (RBD) of the SARS-CoV-2 spike (S) protein to 3.1 Å. CR3022 targets a highly conserved epitope, distal from the receptor-binding site, that enables cross-reactive binding between SARS-CoV-2 and SARS-CoV. Structural modeling further demonstrates that the binding epitope can only be accessed by CR3022 when at least two RBD on the trimeric S protein are in the "up" conformation and slightly rotated. Overall, this study provides molecular insights into antibody recognition of SARS-CoV-2.
Peter J Richardson, Mario Corbellino, Justin Stebbing
We thank Ennio Favalli and colleagues for their Correspondence regarding our suggestion to use baricitinib for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.1,2 We also appreciate their recognition that inhibition of numb-associated kinase enzymes could indeed be beneficial in preventing virus infectivity via inhibition of clathrin-mediated endocytosis.
Ennio G Favalli, Martina Biggioggero, Gabriella Maioli, Roberto Caporali
As rheumatologists used to treating rheumatoid arthritis with Janus kinase (JAK) inhibitors and working in an area (Lombardy, Italy) with a high incidence of coronavirus disease 2019 (COVID-19), we read with great interest the Comment in The Lancet Infectious Diseases by Justin Stebbing and colleagues1 about the potential use of baricitinib for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The described mechanism affecting viral endocytosis mediated by two members of the numb-associated kinase family is one of the many unfamiliar effects of a relatively recent drug class, the real safety profile of which still remains to be definitively clarified.
Dayun Kang, Hyunho Choi, Jong-Hun Kim, Jungsoon Choi
Siukan Law, Albert Wingnang Leung, Chuanshan Xu
Xiaoyang Hong, Jing Xiong, Zhichun Feng, Yuan Shi
Xun Li, Luwen Wang, Shaonan Yan, Fan Yang, Longkui Xiang, Jiling Zhu, Bo Shen, Zuojiong Gong
Zhi-Qun Mao, Ren Wan, Li-Yi He, Yue-Chun Hu, Wei Chen
The outbreak and spread of novel coronavirus (SARS-CoV-2) that began in Wuhan, China, has attracted worldwide attention (Li et al., 2020; Marc Lipsitch et al., 2020; Zou et al., 2020). As of 24:00 on February 24, 2020, a total of 77658 confirmed cases have been reported in China, and 641742 cases of close contacts were tracked, including 87902 cases under medical observation. Most close contacts are still subject to home isolation, especially in Wuhan, the center of the epidemic. Isolation at home is mainly suitable for people who are healthy in the past, have no history of basic diseases and have no symptoms or mild symptoms at present (WHO, 2020).
Xiaobing Wang, Jun Fang, Yue Zhu, Liping Chen, Feng Ding, Rui Zhou, Liuqing Ge, Fan Wang, Qian Chen, Yongxi Zhang, Qiu Zhao
Describe the clinical characteristics of patients in Fangcang Hospital.
Journal of Medical Virology, EarlyView.
Journal of Medical Virology, Volume 92, Issue 5, Page 464-467, May 2020.
Journal of Medical Virology, Volume 92, Issue 5, Page 468-472, May 2020.
Journal of Medical Virology, Volume 92, Issue 5, Page 479-490, May 2020.
Andrew S Azman, Francisco J Luquero
Juanjuan Zhang and colleagues1 use detailed, publicly available data to explore key epidemiological features of the coronavirus disease 2019 (COVID-19) pandemic in China. Outside the original epicentre of Hubei province, they found that the effective reproduction number dropped below the critical threshold of 1 by the end of January, 2020, for nine heavily affected Chinese provinces or cities. This finding suggests significant slowing of local transmission. Importantly, these reductions were achieved in a matter of weeks from the first signs of local transmission in most provinces.
Juanjuan Zhang, Maria Litvinova, Wei Wang, Yan Wang, Xiaowei Deng, Xinghui Chen, Mei Li, Wen Zheng, Lan Yi, Xinhua Chen, Qianhui Wu, Yuxia Liang, Xiling Wang, Juan Yang, Kaiyuan Sun, Ira M Longini, M Elizabeth Halloran, Peng Wu, Benjamin J Cowling, Stefano Merler, Cecile Viboud, Alessandro Vespignani, Marco Ajelli, Hongjie Yu
Our estimates of the incubation period and serial interval were similar, suggesting an early peak of infectiousness, with possible transmission before the onset of symptoms. Our results also indicate that, as the epidemic progressed, infectious individuals were isolated more quickly, thus shortening the window of transmission in the community. Overall, our findings indicate that strict containment measures, movement restrictions, and increased awareness of the population might have contributed to interrupt local transmission of SARS-CoV-2 outside Hubei province.
Never has the “leave no one behind” pledge felt more urgent. As nations around the world implement measures to control the spread of SARS-CoV-2, including lockdowns and restrictions on individuals’ movements, they must heed their global commitments. When member states adopted the UN 2030 Agenda for Sustainable Development, they promised to ensure no one will be left behind. Chief among the world's most vulnerable people are refugees and migrants. The COVID-19 crisis puts these groups at enormous risk.
What does it mean to be vulnerable? Vulnerable groups of people are those that are disproportionally exposed to risk, but who is included in these groups can change dynamically. A person not considered vulnerable at the outset of a pandemic can become vulnerable depending on the policy response. The risks of sudden loss of income or access to social support have consequences that are difficult to estimate and constitute a challenge in identifying all those who might become vulnerable. Certainly, amid the COVID-19 pandemic, vulnerable groups are not only elderly people, those with ill health and comorbidities, or homeless or underhoused people, but also people from a gradient of socioeconomic groups that might struggle to cope financially, mentally, or physically with the crisis.
Gerardo Chowell, Kenji Mizumoto
As of March 19, 2020, 191 127 cases of, including 7807 deaths attributed to, coronavirus disease 2019 (COVID-19) have been reported worldwide.1 The incidence of reported cases in China has dramatically reduced to tens per day as a result of strict social distancing measures; however, the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now generating sustained transmission in many countries including the USA. In The Lancet, Isaac Ghinai, Tristan D McPherson, and colleagues2 report details of the first known human-to-human transmission of SARS-CoV-2 in the USA, which was identified in late January, 2020.
Jigang Wang, Chengchao Xu, Yin Kwan Wong, Yingke He, Ayôla A Adegnika, Peter G Kremsner, Selidji T Agnandji, Amadou A Sall, Zhen Liang, Chen Qiu, Fu Long Liao, Tingliang Jiang, Sanjeev Krishna, Youyou Tu
The coronavirus disease 2019 (COVID-19) pandemic that first emerged in Wuhan in China's Hubei province1 has quickly spread to the rest of China and many other countries. Within 3 months, more than 125 000 people have been infected and the death toll had reached over 4600 worldwide on March 12, 2020.2 In an attempt to contain the virus, the Chinese Government has made unprecedented efforts and invested enormous resources and these containment efforts have stemmed the spread of the disease.3 As of March 12, 2020, malaria-endemic regions in Africa have reported a few imported COVID-19 cases including in Nigeria, Senegal, and the Democratic Republic of the Congo.
Brian McCloskey, Alimuddin Zumla, Giuseppe Ippolito, Lucille Blumberg, Paul Arbon, Anita Cicero, Tina Endericks, Poh Lian Lim, Maya Borodina, WHO Novel Coronavirus-19 Mass Gatherings Expert Group
The coronavirus disease 2019 (COVID-19) pandemic1 presents countries with major political, scientific, and public health challenges. Pandemic preparedness and reducing risk of global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are key concerns. Mass gathering (MG) events2 pose considerable public health challenges to health authorities and governments. Historically, sporting, religious, music, and other MGs have been the source of infectious diseases that have spread globally.
Alastair Brown, Richard Horton
It is natural during the unfolding coronavirus disease 2019 (COVID-19) pandemic to focus on emergency response planning, including containment, treatment procedures, and vaccine development, and nobody would doubt the need for these measures. However, an emergency can also open a window of opportunity for reflection and learning. We live in increasingly global, interdependent, and environmentally constrained societies and the COVID-19 pandemic exemplifies these aspects of our world. We would therefore be wise to take a broad integrated perspective on this disease, the impacts of which are already spilling over into the realms of economics, international trade, politics, and inequality.
How should countries plan for the approaching health crisis caused by coronavirus disease 2019 (COVID-19)? In the UK, Prime Minister Boris Johnson, himself struck down with infection, has written to every household warning that, “we know things will get worse before they get better”. The UK Government is right to prepare the public for the coming human catastrophe. All governments have a responsibility to do the same. But this advice does not go far enough. Here are five critical actions that need to be considered immediately.
Laboratories and diagnostic companies are racing to produce antibody tests, a key part of the response to the COVID-19 pandemic. Anna Petherick reports.
Dale Fisher, Annelies Wilder-Smith
“Much of the global community is not yet ready for COVID-19 [coronavirus disease 2019]”.1 This is arguably one of the most resonating phrases in the Report of the WHO-China Joint Mission on Coronavirus Disease 2019,1 released publicly on Feb 28, 2020. Major transmission hotspots were brought under control in China, but subsequently others sprouted across the globe. Since late February, 2020, the daily number of new cases has been higher in other parts of the world. New major epicentres have established in South Korea, Japan, Iran, and Italy.
Andrea Saglietto, Fabrizio D’Ascenzo, Giuseppe Biondi Zoccai, Gaetano Maria De Ferrari
Severe acute respiratory syndrome coronavirus 2 is rapidly spreading worldwide,1 and WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic on March 11, 2020.2
Andrew I Ritchie, Aran Singanayagam
Mehta and colleagues1 postulate that hyperinflammation in coronavirus disease 2019 (COVID-19) could be a driver of severity that is amenable to therapeutic targeting since retro-spective data have shown that systemic inflammation is associated with adverse outcome. However, correlation does not equal causation, and it is equally plausible that increased virus burden (secondary to failure of the immune response to control infection) drives inflammation and consequent severity (as shown for other viruses2) rather than augmented inflammation being an inappropriate host response that requires correction.
Isaac Ghinai, Tristan D McPherson, Jennifer C Hunter, Hannah L Kirking, Demian Christiansen, Kiran Joshi, Rachel Rubin, Shirley Morales-Estrada, Stephanie R Black, Massimo Pacilli, Marielle J Fricchione, Rashmi K Chugh, Kelly A Walblay, N Seema Ahmed, William C Stoecker, Nausheen F Hasan, Deborah P Burdsall, Heather E Reese, Megan Wallace, Chen Wang, Darcie Moeller, Jacqueline Korpics, Shannon A Novosad, Isaac Benowitz, Max W Jacobs, Vishal S Dasari, Megan T Patel, Judy Kauerauf, E Matt Charles, Ngozi O Ezi
Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected.
Feng Ye, Shicai Xu, Zhihua Rong, Ronghua Xu, Xiaowei Liu, Pingfu Deng, Hai Liu, Xuejun Xu
On Dec 31, 2019, the government of Hubei Province, China, first reported a group of confused patients with pneumonia (The Central Government of the People’s Republic of China, 2020). Metagenomics sequencing analysis revealed a novel coronavirus, which was officially named SARS-CoV-2 and is the cause of the disease named COVID-19 (World health Organization, 2020). The National Health Commission (NHC) set COVID-19 as a category B infectious disease with A-class management on Jan 20 (The Central Government of the People’s Republic of China, 2020).
J. Lu et al.
Nature Medicine, Published online: 02 April 2020; doi:10.1038/s41591-020-0852-1As the COVID-19 pandemic shuts down labs across the globe, funders and institutions must step up to support scientists and ensure the healthy future of research.
Cao J, Tu W, Cheng W, et al.
AbstractObjectiveIn December, 2019, a series of pneumonia cases of unknown cause emerged in Wuhan, Hubei, China. In this study, we investigate clinical and laboratory features and short-term outcomes of patients with Corona Virus Disease 2019(COVID-19).MethodsAll patients with COVID-19 admitted to Wuhan University Zhongnan Hospital in Wuhan, China, between January 3 and February 1, 2020 were included. All those patients were with laboratory-confirmed infection. Epidemiological, clinical, radiological characteristics, underlying diseases, laboratory tests treatment, complications and outcomes data were collected. Outcomes were followed up at discharge until Feb 15, 2020.ResultsThe study cohort included 102 adult patients. The median (IQR) age was 54 years (37-67years) and 48.0% were female. A total of 34 patients (33.3%) were exposed to source of transmission in the hospital setting (as health care workers, patients, or visitors) and 10 patients (9.8%) had a familial cluster. Eighteen patients (17.6%) were admitted to the ICU, and 17 patients died (mortality, 16.7%; 95% confidence interval [CI], 9.4%-23.9%). Among patients who survived, they were younger, more likely were health care workers and less likely suffered from comorbidities. They were also less likely suffered from complications. There was no difference in drug treatment rates between the survival and non-survival groups. Patients who survived less likely required admission to the intensive care unit (14.1% vs. 35.3%). Chest imaging examination showed that death patients more likely had ground-glass opacity (41.2% vs. 12.9%).ConclusionsThe mortality rate was high among the COVID-19 patients described in our cohort who met our criteria for inclusion in this analysis. Patient characteristics seen more frequently in those who died were development of systemic complications following onset of the illness and the severity of disease requiring admission to the ICU. Our data support those described by others that COVID-19 infection results from human-to-human transmission, including familial clustering of cases, and nosocomial transmission. There were no differences in mortality among those who did or did not receive antimicrobial or glucocorticoid drug treatment.
The Lancet Respiratory Medicine
On March 11, 2020, WHO declared COVID-19 a pandemic and has called for governments to take “urgent and aggressive action” to change the course of the outbreak. As of March 12, 2020, the USA has suspended all travel from 26 European countries, and Italy is the latest country to enforce widespread lockdown measures to curb the spread of the virus. Robust plans and policies to avoid the disease trajectories seen in the worst-hit countries are urgently needed. These responses must be proportionate to each country's situation and communicated in a clear and balanced way to avoid spreading fear and panic.
Silvio A Ñamendys-Silva
As of Feb 27, 2020, coronavirus disease 2019 (COVID-19) has affected 47 countries and territories around the world.1 Xiaobo Yang and colleagues2 described 52 of 710 patients with confirmed COVID-19 admitted to an intensive care unit (ICU) in Wuhan, China. 29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.
Jonathan Chun-Hei Cheung, Lap Tin Ho, Justin Vincent Cheng, Esther Yin Kwan Cham, Koon Ngai Lam
Medical professionals caring for patients with coronavirus disease 2019 (COVID-19) are at high risk of contracting the infection.1 Aerosol-generating procedures, such as non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), bag-mask ventilation, and intubation are of particularly high risk.2 We hereby describe the approach of our local intensive care unit (North District Hospital, Sheung Shui, Hong Kong) to managing the risks to health-care staff, while maintaining optimal and high-quality care.
The outbreak of novel coronavirus disease 2019 (COVID-19) is quickly turning into a pandemic. Although the disease is now better contained in China, 32 702 cases remain as of March 2, 2020. 10 566 cases and 166 deaths outside of China had been reported as of March 3 (WHO situation report 43), which is a large increase from the 2918 cases and 44 deaths reported on Feb 26 (WHO situation report 37). Rapid progress has been made with diagnostic reagents (eg, nucleic acid detection and detection of IgM or IgG, or both), drug repurposing (eg, remdesivir and chloroquine), and vaccine production.
Lei Fang, George Karakiulakis, Michael Roth
The most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study by Xiaobo Yang and colleagues1 were cerebrovascular diseases (22%) and diabetes (22%). Another study2 included 1099 patients with confirmed COVID-19, of whom 173 had severe disease with comorbidities of hypertension (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), and cerebrovascular disease (2·3%). In a third study,3 of 140 patients who were admitted to hospital with COVID-19, 30% had hypertension and 12% had diabetes.
Rodgers R Ayebare, Robert Flick, Solome Okware, Bongomin Bodo, Mohammed Lamorde
Despite major advances in epidemic preparedness, Africa remains uniquely susceptible to novel coronavirus disease 2019 (COVID-19). According to the Infectious Disease Vulnerability Index,1 22 of the 25 countries most susceptible to an infectious disease outbreak are in Africa. The high prevalence of HIV, tuberculosis, and other pathogens might potentiate the severity of COVID-19 and contribute to diagnostic uncertainty. Health-care systems and human resources are already spread thin. And although the young age of the population (with more than half aged younger than 20 years) might prove protective, it also means that Africa has much to lose in terms of disability-adjusted life years.
Li Li, Qianghong Xv, Jing Yan
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) moved rapidly through China, and the virus had spread to more than 60 countries and infected nearly 90 000 patients by March 5, 2020. Based on data for 72 314 cases of coronavirus disease 2019 (COVID-19), 14% of people have severe disease, 5% have critical illness, and 2·3% die.1 COVID-19 is not a conventional disease, and rapid changes in the provision of critical care have been needed to meet the needs of patients. Health emergencies such as the COVID-19 outbreak can be a huge challenge for critical-care physicians, who need strong comprehensive skills to respond effectively.
Brandon Michael Henry
Extracorporeal membrane oxygenation (ECMO) can serve as life-saving rescue therapy for refractory respiratory failure in the setting of acute respiratory distress syndrome, such as that induced by coronavirus disease 2019 (COVID-19). In the study by Yang and colleagues,1 who compared clinical characteristics and outcomes in patients with severe COVID-19, five (83%) of six patients receiving ECMO died. Although this sample was small, and specific baseline characteristics and disease courses were almost unknown, it raises concerns about potential harms of ECMO therapy for COVID-19.
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centred, retrospective, observational study. Lancet Respir Med 2020; published online Feb 21. https://doi.org/10.1016/S2213-2600(20)30079-5—In this Article, Tables 1, 2, and 3 have been updated. These corrections have been made to the online version as of Feb 28, 2020, and will be made to the printed version.
Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8: 420–22—In this Case Report “by obtaining biopsy samples at autopsy” has been replaced with “by postmortem biopsies” in paragraph 1, “microvascular” has been replaced with “microvesicular” in two incidences in paragraph 5, and “(B) Frequency of Th17 (CD4+ CCR6+CCR4+) subset” has been changed to “(B) Frequency of Th17 (CD4+ CCR6+) subset” on page 3 of the appendix.
Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med 2020; 8: e20—In this Correspondence, the author's affiliation has been corrected and the following sentence has been corrected: “A trend towards an association was seen between smoking and severity of COVID-19 in the study by Guan and colleagues4 (11·8% of patients with non-severe disease were smokers vs 16·9% who had severe disease)…”. These corrections have been made to the online version as of April 1, 2020, and the printed version is correct.
Zhe Xu, Lei Shi, Yijin Wang, Jiyuan Zhang, Lei Huang, Chao Zhang, Shuhong Liu, Peng Zhao, Hongxia Liu, Li Zhu, Yanhong Tai, Changqing Bai, Tingting Gao, Jinwen Song, Peng Xia, Jinghui Dong, Jingmin Zhao, Fu-Sheng Wang
Since late December, 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV)1,2 was reported in Wuhan, China,2 which has subsequently affected 26 countries worldwide. In general, COVID-19 is an acute resolved disease but it can also be deadly, with a 2% case fatality rate. Severe disease onset might result in death due to massive alveolar damage and progressive respiratory failure.2,3 As of Feb 15, about 66 580 cases have been confirmed and over 1524 deaths. However, no pathology has been reported due to barely accessible autopsy or biopsy.
Zhongwei Jia, Zuhong Lu
The speed and scope of detection of an infectious disease, in particular, timely identification and reporting of a new pathogen, is a major indicator of a country's ability to control infectious diseases. Findings of the Global Health Security (GHS) index1 suggest that only 19% of countries have the ability to quickly detect and report epidemics of potential international concern, fewer than 5% of countries can rapidly respond to and mitigate the spread of an epidemic, and no country is fully prepared for epidemics or pandemics.
Rene Niehus, Pablo M De Salazar, Aimee R Taylor, Marc Lipsitch
Estimates of case counts in Wuhan based on assumptions of 100% detection in travellers could have been underestimated by several fold. Furthermore, severity estimates will be inflated several fold since they also rely on case count estimates. Finally, our model supports evidence that underdetected cases of COVID-19 have probably spread in most locations around the world, with greatest risk in locations of low detection capacity and high connectivity to the epicentre of the outbreak.
Mingxuan Xie, Qiong Chen
In late December 2019, a pneumonia outbreak of unknown etiology took place in Wuhan, Hubei province, China, and spread quickly nationwide. Chinese Center for Disease Control and Prevention (CCDC) identified a novel beta-coronavirus called 2019-nCoV, now officially known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Gorbalenya et al., 2020), that responsible for the pandemic. This was the third zoonotic coronavirus breakout in the first two decades of 21st century that allowing human-to-human transmission and raising global health concerns.
International Liver Congress (ILC) 2020
15.04.2020 - 19.04.2020
European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2020
18.04.2020 - 21.04.2020
DSI årsmøde 2020 (aflyst)
Hindsgavl Slot, Middelfart
1.05.2020 - 2.05.2020
Kursus i rejsemedicin 2020
Statens Serum Institut
4.05.2020 - 6.05.2020
5.05.2020 - 7.05.2020
COVID-19 retningslinje (2020)
National handlingsplan for antibiotika til mennesker (2017)
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
A real-world evaluation of a Case-Based Reasoning algorithm to support antimicrobial prescribing decisions in acute care
4.04.2020Clinical Infectious Diseases Advance Access
Open versus endovascular repair of aortic aneurysms
COVID-19 will not leave behind refugees and migrants
Redefining vulnerability in the era of COVID-19
The COVID-19 pandemic in the USA: what might we expect?
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