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Viewpoint
February 28, 2020

COVID-19—New Insights on a Rapidly Changing Epidemic

Author Affiliations
  • 1Department of Internal Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
  • 2Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor
  • 3Associate Editor, JAMA
JAMA. 2020;323(14):1339-1340. doi:10.1001/jama.2020.3072

Since first reported in Wuhan, China, in late December 2019, the outbreak of the novel coronavirus now known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has spread globally. As of February 27, 2020, more than 82 000 cases of coronavirus disease 2019 (COVID-19) (the disease caused by SARS-CoV-2) and 2800 deaths have been reported, of which approximately 95% of cases and 97% of deaths are in China.1 Cases have now been reported in 49 other countries. A particularly large outbreak occurred among the passengers and crew of the Diamond Princess cruise ship, where more than 700 infections are reported.

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    4 Comments for this article
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    Coronavirus is a Known Human Pathogen
    Giuliano Ramadori, Professor of Medicine | Univeristy Clinic, Göttingen,Germany
    I am grateful to the authors for the comprehensive review of the events of the last three months concerning COVID-19 first described in China.I would like however to add the information that the "new" virus belongs to a group of viruses which have been endemic in humans for long time (1) and are responsible for a significant number of pneumonia cases as reported by prospective investigations (2) which demonstrate that this testing for coronavirus is not part of the routine search causes of pulmonary disease. Every year we have to deal with mutated influenza viruses, which are considered to be responsible for influenza symptoms even in those persons who were vaccinated against the most common strains. As the first case of the Italian COVID-19-epidemic does not seem to be of Chinese origin, the question arises whether a mutated CoV have been already circulating around the world for a longer time.

    References

    1.Jonsdottir HR, Dijkman R.Coronaviruses and the human airway:a universal system for virus-host interaction studies.Virological Journal,2016. https://creativecommons.org/licences/by4.0/)
    2.Iven M et al. Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries. Clin Microbiol and Infect,2018;24:1158-1163
    CONFLICT OF INTEREST: None Reported
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    Screening and Testing
    Kyriakos Zaragkoulias, Medical Doctor | HNT Hospital of Levanger, Norway
    Great article and a very good summary regarding SARS-CoV-2!

    I would suggest a small correction in the paragraph for screening and testing. It is mentioned that the specimen submitted for PCR testing "be a nasopharyngeal and not a throat swab and, ideally, a lower respiratory tract sample such as induced sputum or bronchoalveolar lavage." However regarding sampling from the low respiratory tract, induced sputum is not recommended according both to CDC and ECDC recommendations. It has to be expectorated sputum instead in case there is a productive cough, or alternatively a bronchoalveolar lavage or tracheal aspirate (depending on the
    patient).

    With kind regards,
    Kyriakos Zaragkoulias, MD, MSc

    CONFLICT OF INTEREST: Consultant in Medical Microbiology
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    Re-Infection or Biphasic Course?
    Edward Lynam, MD | Private Practice
    I'm curious about the unknowns that are presented by the several cases in which individuals appeared to fully recover, test negative, and were sent home to isolation. Two or three weeks later they become symptomatic and test positive again. Could this be like syphilis, with a primary, secondary, or chronic infectious state? Do we know why the lymphopenia occurs and could the virus hide in immune cells?
    CONFLICT OF INTEREST: None Reported
    Known Unknowns of COVID-19
    Michael McAleer, PhD (Econometrics),Queen's | Asia University, Taiwan
    The informative Viewpoint provides topical and insightful discussion of some "known knowns" of the COVID-19 epidemic.

    Some "known unknowns" of COVID-19 would seem to include:

    (1) Rate of false positive diagnoses;

    (2) Rate of false negative diagnoses, including screening at airports;

    (3) Infection period before symptoms appear;

    (4) Mode and ease of transmission to and from humans;

    (5) Mode and ease of transmission to and from animals;

    (6) Optimal isolation / quarantine period;

    (7) Best and worst isolation / quarantine methods;

    (8) Frequency of reinfection after discharge;

    (9) Relationship of
    COVID-19 to SARS and HIV;

    (10) Protection against COVID-19 using existing flu vaccines;

    (11) Risk factors, including existing illnesses, age, gender, tobacco, and alcohol;

    (12) Seasonal, weather and temperature effects.
    CONFLICT OF INTEREST: None Reported
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