{"id":9537,"date":"2020-02-02T18:59:31","date_gmt":"2020-02-02T23:59:31","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9537"},"modified":"2020-02-04T06:15:53","modified_gmt":"2020-02-04T11:15:53","slug":"a-coronavirus-id-link-o-rama-because-im-not-watching-the-super-bowl","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/a-coronavirus-id-link-o-rama-because-im-not-watching-the-super-bowl\/2020\/02\/02\/","title":{"rendered":"A Coronavirus ID Link-o-Rama, Because I&#8217;m Not Watching the Super Bowl"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2020\/02\/Screen-Shot-2020-02-02-at-6.48.35-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-9545\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2020\/02\/Screen-Shot-2020-02-02-at-6.48.35-PM.png\" alt=\"\" width=\"301\" height=\"187\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2020\/02\/Screen-Shot-2020-02-02-at-6.48.35-PM.png 662w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2020\/02\/Screen-Shot-2020-02-02-at-6.48.35-PM-300x186.png 300w\" sizes=\"auto, (max-width: 301px) 100vw, 301px\" \/><\/a>With so much of the ID-related news out there dominated by the novel coronavirus (2019-nCoV, hard to type) outbreak, it seems appropriate to collect some of the more interesting or useful findings in this busy past week.<\/p>\n<p>Think of it as an <em>ID Link-o-Rama &#8212; Special Novel Coronavirus Edition.<\/em><\/p>\n<p>As with last week&#8217;s post, an important caveat &#8212; the outbreak continues to evolve rapidly, and data quickly become out of date. All are encouraged to check in with the excellent guidance and information on the <a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">CDC<\/a>, <a href=\"https:\/\/www.who.int\/health-topics\/coronavirus\" target=\"_blank\" rel=\"noopener noreferrer\">WHO<\/a>, and <a href=\"https:\/\/www.idsociety.org\/public-health\/Novel-Coronavirus\/\" target=\"_blank\" rel=\"noopener noreferrer\">IDSA<\/a> sites (among others), all of which are updated regularly.<\/p>\n<p>On to the links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2001316?query=featured_home\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>The mean incubation period of novel coronavirus disease after contact with an active case is around 5 days.<\/strong><\/a> The 95% confidence interval around that estimate is 4.1 to 7.0 days. Importantly, the onset of symptoms 2 weeks or more after exposure appears <em>very<\/em> unlikely. These data should dispel circulating rumors that this virus has a much longer incubation period than other coronaviruses &#8212; in fact, <strong><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.01.27.20018986v2.full.pdf+html\" target=\"_blank\" rel=\"noopener noreferrer\">it appears quite similar (Figure 3).<\/a><\/strong><\/li>\n<li><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2001468?query=featured_home\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>This case cluster demonstrates coronavirus can spread before the onset of symptoms.<\/strong><\/a> However, as in most infectious diseases, symptomatic cases are <em>probably<\/em> more contagious &#8212; usually because people with symptoms have a higher viral burden. While the findings in this report are of concern, the true contribution of asymptomatic spread of the virus in the present outbreak remains unknown. [Update:\u00a0 The &#8220;asymptomatic&#8221; person may have had symptoms after all. Additional details <strong><a href=\"https:\/\/www.sciencemag.org\/news\/2020\/02\/paper-non-symptomatic-patient-transmitting-coronavirus-wrong\" target=\"_blank\" rel=\"noopener noreferrer\">summarized here.<\/a><\/strong>]<\/li>\n<li><a href=\"https:\/\/www.nytimes.com\/interactive\/2020\/world\/asia\/china-coronavirus-contain.html#virulence\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>The <em>New York Times<\/em> has posted a widely cited figure comparing mortality and contagiousness of coronavirus with other infectious diseases.<\/strong><\/a> Current estimates are 3% mortality and transmission number (R0) between 1.5 and 3.5. It&#8217;s an impressive graphic (modeled on <strong><a href=\"https:\/\/informationisbeautiful.net\/visualizations\/the-microbescope-infectious-diseases-in-context\/\" target=\"_blank\" rel=\"noopener noreferrer\">this one<\/a><\/strong>) that puts the infection into perspective. Importantly, note the log scale of the vertical axis in the <em>Times<\/em> figure, which prompted this revision:<\/li>\n<\/ul>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">This is one of those \u201cplease don\u2019t judge me for making this horror\u201d graphs that I\u2019ve just thrown together with possibly the least reliable underlying data (hence extensive caveats in caption). All available on github, please scrutinise and send improvements <a href=\"https:\/\/t.co\/vtU3bUFDzH\">pic.twitter.com\/vtU3bUFDzH<\/a><\/p>\n<p>&mdash; Isaac Florence (@IsaacATFlorence) <a href=\"https:\/\/twitter.com\/IsaacATFlorence\/status\/1223255052242038784?ref_src=twsrc%5Etfw\">January 31, 2020<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<ul>\n<li><a href=\"https:\/\/issues.org\/clarity-please-on-the-coronavirus-statistics\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Here&#8217;s a clear explanation why the estimated mortality will likely change &#8212; for the better &#8212; as we gain greater understanding of the disease.<\/strong> <\/a>Severe cases tend to dominate reports early in an outbreak; only later, when diagnostic tests and surveillance improves, will we understand how many mild (and even asymptomatic) cases occur. Remember when West Nile virus first appeared in North America? It was initially terrifying &#8212; yet we now know that 80% of people who acquire this infection do so without any symptoms whatsoever, and fewer than 1% develop encephalitis.<\/li>\n<li><a href=\"https:\/\/www.nytimes.com\/2020\/01\/28\/opinion\/coronavirus-prevention-tips.html?searchResultPosition=1\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Wonderful perspective from Dr. Elizabeth Rosenthal offering her advice on how to avoid coronavirus.<\/strong><\/a> <em>Wash your hands frequently.<\/em> Yep, that&#8217;s it &#8212; plus a few other things that fall squarely into the &#8220;common sense&#8221; category. The piece includes interesting anecdotes from when she covered SARS in 2002-3 as a journalist, living in China with her family.<\/li>\n<li><strong><a href=\"https:\/\/lloyd-smithlab.shinyapps.io\/travelScreeningModel\/\" target=\"_blank\" rel=\"noopener noreferrer\">This online calculator estimates the effectiveness of screening travelers to detect people who have 2019-nCoV.<\/a><\/strong> You can move the sliders around on parameters such as incubation period, proportion who have fever, and R0 (transmissibility), among others. Not surprisingly, those most likely to be detected have both fever and a reported epidemiologic risk.<\/li>\n<li><strong><a href=\"https:\/\/www.nature.com\/articles\/s41467-019-13940-6\" target=\"_blank\" rel=\"noopener noreferrer\">Some patients with coronavirus disease have already received antiviral therapy with drugs demonstrating in vitro activity against the virus.\u00a0<\/a><\/strong> In <a href=\"https:\/\/www.dawn.com\/news\/1532081\/?fbclid=IwAR2ZOv3YLnAbwFWhYRcNIKK74Z-fzLWszkvgLm1S8gXl3Za3c68Tjfw7gU0\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>this report<\/strong><\/a>, a woman received lopinavir\/ritonavir (along with oseltamivir). In <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2001191\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>another case<\/strong><\/a>, doctors received permission for compassionate use of the experimental drug remdesivir. Both patients improved &#8212; but obviously in these anecdotal cases, we don&#8217;t know if they would have improved anyway. A Chinese clinical trials registry <strong><a href=\"http:\/\/www.chictr.org.cn\/showprojen.aspx?proj=48684\" target=\"_blank\" rel=\"noopener noreferrer\">cites at least one planned study.<\/a> <\/strong>My virologist colleague Dr Jonathan Li summarized some of the background data in <strong><a href=\"https:\/\/twitter.com\/dskinfdis\/status\/1222596981618405376?s=20\" target=\"_blank\" rel=\"noopener noreferrer\">this thread.<\/a><\/strong><\/li>\n<li><a href=\"https:\/\/www.sciencemag.org\/news\/2020\/01\/mining-coronavirus-genomes-clues-outbreak-s-origins\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>How did this novel coronavirus first spread to humans?<\/strong><\/a> This is critical information &#8212; not only for this outbreak, but also for prevention of future zoonotic infections. Excellent summary of ongoing work in this area.<\/li>\n<li><strong><a href=\"https:\/\/www.biorxiv.org\/content\/10.1101\/2020.01.30.927871v1\" target=\"_blank\" rel=\"noopener noreferrer\">A pre-print reported that the novel coronavirus had insertions that bore an &#8220;uncanny&#8221; resemblance to HIV gp120 and Gag.<\/a><\/strong> This finding (later withdrawn) triggered <a href=\"https:\/\/massivesci.com\/notes\/wuhan-coronavirus-ncov-sars-mers-hiv-human-immunodeficiency-virus\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>a momentary spike in conspiracy theories<\/strong><\/a> that would be excellent evidence for the benefits of scientific peer review &#8212; which happened in this case anyway, only not in the usual way. For a good takedown, read <strong><a href=\"https:\/\/twitter.com\/trvrb\/status\/1223666856923291648?s=20\" target=\"_blank\" rel=\"noopener noreferrer\">this analysis<\/a><\/strong>.<\/li>\n<li><a href=\"https:\/\/www.washingtonpost.com\/health\/time-for-a-reality-check-america-the-flu-is-a-much-bigger-threat-than-coronavirus-for-now\/2020\/01\/31\/46a15166-4444-11ea-b5fc-eefa848cde99_story.html\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Many have tried to put the coronavirus outbreak in perspective by citing this year&#8217;s flu season.<\/strong><\/a>\u00a0 Here&#8217;s the brilliant opening from the linked piece:<\/li>\n<\/ul>\n<blockquote><p>The rapidly spreading virus has closed schools in Knoxville, Tenn., cut blood donations to dangerous levels in Cleveland and prompted limits on hospital visitors in Wilson, N.C. More ominously, <a href=\"https:\/\/www.cdc.gov\/flu\/about\/burden\/preliminary-in-season-estimates.htm\" target=\"_blank\" rel=\"noopener noreferrer\">it has infected as many as 26\u00a0million people in the United States in just four months<\/a>, killing up to 25,000 so far.<br \/>\nIn other words, a difficult but not extraordinary flu season in the United States &#8230;<\/p><\/blockquote>\n<p>So yes &#8212; get your flu shot! Listen to Dr. Stephenson!<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\"><a href=\"https:\/\/twitter.com\/hashtag\/Influenza?src=hash&amp;ref_src=twsrc%5Etfw\">#Influenza<\/a> and <a href=\"https:\/\/twitter.com\/hashtag\/coronavirus?src=hash&amp;ref_src=twsrc%5Etfw\">#coronavirus<\/a> are the same problem. It\u2019s not a competition over which virus is the scariest. They are circulating at the same time which complicates diagnosis and treatment and add together to stress our health care systems. Flu <a href=\"https:\/\/twitter.com\/hashtag\/vaccine?src=hash&amp;ref_src=twsrc%5Etfw\">#vaccine<\/a> helps *both* outbreaks.<\/p>\n<p>&mdash; Katy Stephenson, MD, MPH (@k_stephensonMD) <a href=\"https:\/\/twitter.com\/k_stephensonMD\/status\/1223623614769106945?ref_src=twsrc%5Etfw\">February 1, 2020<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<p>As for the title of this post &#8230;<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">Nope.<a href=\"https:\/\/t.co\/ElJH4KIpvp\">https:\/\/t.co\/ElJH4KIpvp<\/a> via <a href=\"https:\/\/twitter.com\/sciam?ref_src=twsrc%5Etfw\">@sciam<\/a><\/p>\n<p>&mdash; Paul Sax (@PaulSaxMD) <a href=\"https:\/\/twitter.com\/PaulSaxMD\/status\/1224005497596059649?ref_src=twsrc%5Etfw\">February 2, 2020<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>With so much of the ID-related news out there dominated by the novel coronavirus (2019-nCoV, hard to type) outbreak, it seems appropriate to collect some of the more interesting or useful findings in this busy past week. Think of it as an ID Link-o-Rama &#8212; Special Novel Coronavirus Edition. As with last week&#8217;s post, an [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8,10],"tags":[4449,4472],"class_list":["post-9537","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","category-research","tag-2019-ncov","tag-coronavirus"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9537","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=9537"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9537\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=9537"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=9537"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=9537"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}