Virological assessment of hospitalized patients with COVID-2019.
Roman Wölfel,Victor M. Corman,Wolfgang Guggemos,M Seilmaier,Sabine Zange,Marcel A. Müller,Daniela Niemeyer,Terry Jones,Terry Jones,Patrick Vollmar,Camilla Rothe,Michael Hoelscher,Tobias Bleicker,Sebastian Brünink,Julia Schneider,Rosina Ehmann,Katrin Zwirglmaier,Christian Drosten,Clemens M. Wendtner +18 more
TLDR
Detailed virological analysis of nine cases of coronavirus disease 2019 (COVID-19) provides proof of active replication of the SARS-CoV-2 virus in tissues of the upper respiratory tract.Abstract:
Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity—but also aided in the control—of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6–8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples—in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19. Detailed virological analysis of nine cases of coronavirus disease 2019 (COVID-19) provides proof of active replication of the SARS-CoV-2 virus in tissues of the upper respiratory tract.read more
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Dexamethasone in Hospitalized Patients with Covid-19
Peter Horby,Wei Shen Lim,Jonathan Emberson,M Mafham,Jennifer L Bell,Louise Linsell,Natalie Staplin,Christopher E. Brightling,Andrew Ustianowski,E Elmahi,B Prudon,Christopher A Green,Timothy Felton,David Chadwick,K Rege,C Fegan,Lucy C Chappell,Saul N. Faust,Thomas Jaki,Katie Jeffery,Alan A Montgomery,Kathryn M Rowan,Edmund Juszczak,J K Baillie,Richard Haynes,Martin J Landray +25 more
TL;DR: In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
Journal ArticleDOI
Temporal dynamics in viral shedding and transmissibility of COVID-19.
Xi He,Eric H. Y. Lau,Peng Wu,Xilong Deng,Jian Wang,Xinxin Hao,Yiu Chung Lau,Jessica Y. Wong,Yujuan Guan,Xinghua Tan,Xiaoneng Mo,Yanqing Chen,Baolin Liao,Weilie Chen,Fengyu Hu,Qing Zhang,Mingqiu Zhong,Yanrong Wu,Lingzhai Zhao,Fuchun Zhang,Benjamin J. Cowling,Fang Li,Gabriel M. Leung +22 more
TL;DR: It is estimated that 44% (95% confidence interval, 25–69%) of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home.
Journal ArticleDOI
Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.
W. Joost Wiersinga,Andrew Rhodes,Allen C. Cheng,Sharon J. Peacock,Sharon J. Peacock,Hallie C. Prescott +5 more
TL;DR: This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19, the novel severe acute respiratory syndrome coronavirus 2 pandemic that has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease.
Journal ArticleDOI
Imbalanced Host Response to SARS-CoV-2 Drives Development of COVID-19.
Daniel Blanco-Melo,Benjamin E. Nilsson-Payant,Wen-Chun Liu,Skyler Uhl,Daisy A. Hoagland,Rasmus Møller,Tristan X. Jordan,Kohei Oishi,Maryline Panis,David H. Sachs,Taia T. Wang,Robert E. Schwartz,Jean K. Lim,Randy A. Albrecht,Benjamin R. tenOever +14 more
TL;DR: It is proposed that reduced innate antiviral defenses coupled with exuberant inflammatory cytokine production are the defining and driving features of COVID-19.
Journal ArticleDOI
Characteristics of SARS-CoV-2 and COVID-19
TL;DR: The basic virology of SARS-CoV-2 is described, including genomic characteristics and receptor use, highlighting its key difference from previously known coronaviruses.
References
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Victor M. Corman,Olfert Landt,Marco Kaiser,Richard Molenkamp,Adam Meijer,Daniel K.W. Chu,Tobias Bleicker,Sebastian Brünink,Julia Schneider,Marie Luisa Schmidt,Daphne G.J.C. Mulders,Bart L. Haagmans,Bas van der Veer,Sharon van den Brink,Lisa Wijsman,Gabriel Goderski,Jean Louis Romette,Joanna Ellis,Maria Zambon,Malik Peiris,Herman Goossens,Chantal B.E.M. Reusken,Marion Koopmans,Christian Drosten +23 more
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TL;DR: The independent zoonotic transmission of SARS-CoV and SARS -CoV-2 highlights the need for studying viruses at the species level to complement research focused on individual pathogenic viruses of immediate significance.
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