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May 22, 2020
Viewpoint

Translating Science on COVID-19 to Improve Clinical Care and Support the Public Health Response

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JAMA. Published online May 22, 2020. doi:10.1001/jama.2020.9252

This Viewpoint reviews progress to date on drug and vaccine development for COVID-19, antibody testing for demonstration of immunity and seroprevalence, and the continuing need for testing capacity to more precisely manage the public’s health as mitigation restrictions loosen during summer 2020.

Labor and Delivery Visitor Policies During the COVID-19 Pandemic: Balancing Risks and Benefits

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JAMA. Published online May 22, 2020. doi:10.1001/jama.2020.7563

This Viewpoint reviews the policies, challenges, and ethics of allowing visitors of women while laboring in a hospital from the perspective of the woman, the visitor, the hospital staff, the community, and the infant.

COVID-19: Beyond Tomorrow

Nursing Home Care in Crisis in the Wake of COVID-19

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JAMA. Published online May 22, 2020. doi:10.1001/jama.2020.8524

This Viewpoint discusses the long-standing deficiencies in nursing home financing and organization made worse by the spread of coronavirus disease 2019 (COVID-19), and proposes ways to improve testing and personal protective equipment availability, and payment reforms to incentivize quality care for residents and decrease emergency department and hospital use.

JAMA Insights

Using Insulin to Treat Poorly Controlled Type 2 Diabetes in 2020

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JAMA. Published online May 22, 2020. doi:10.1001/jama.2020.1303

This JAMA Insights Clinical Update reviews indications and timing of insulin therapy for management of type 2 diabetes, emphasizing the likely benefit of its use as first-line therapy in patients with HbA1c levels less than 9.0%.

JAMA Clinical Challenge

Chest Pain and a Cavitary Lung Mass in a Woman With Diabetes

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JAMA. Published online May 22, 2020. doi:10.1001/jama.2020.4111

A woman from the Southeastern US with a history of smoking, poorly controlled diabetes, and inhalational medical marijuana use had 4 months of productive cough, weight loss, subjective fevers, 3 days of worsening chest pain, and a large right upper lobe cavitary mass on chest CT unresponsive to antibiotics. AFB smear and GeneXpert MTB/RIF testing were negative; she developed a right-sided tension pneumothorax after intubation for hypoxemia, and chest tube placement yielded charcoal-colored pleural fluid. What is the diagnosis and what would you do next?

May 21, 2020
Research Letter

Postmortem Examination of Patients With COVID-19

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JAMA. Published online May 21, 2020. doi:10.1001/jama.2020.8907

This case series describes autopsy findings in 10 patients with proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who died at a university medical center in Germany.

Viewpoint

Innovation in Home Care: Time for a New Payment Model

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JAMA. Published online May 21, 2020. doi:10.1001/jama.2020.1036

This Viewpoint discusses the need for new payment models to incentivize innovations in personalized home care and facilitate transitions already occurring in response to the COVID-19 pandemic, and to develop lower-cost higher-quality approaches to home-based management of chronic illnesses such as heart failure and Parkinson disease.

Medical News & Perspectives

Building an “Army of Disease Detectives” to Trace COVID-19 Contacts

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JAMA. Published online May 21, 2020. doi:10.1001/jama.2020.8880

This Medical News feature discusses the role of contact tracing in containing coronavirus disease 2019.

The Arts and Medicine

Oedipus and the Coronavirus Pandemic

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JAMA. Published online May 21, 2020. doi:10.1001/jama.2020.8594

This Arts and Medicine feature draws lessons from Sophocles’ classic tragedies Oedipus Rex and Oedipus at Colonus about the limits of medicine and the importance of community in the midst of the coronavirus (COVID-19) pandemic.

Correction

Inaccurate Quote

Abstract Full Text
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JAMA. Published online May 21, 2020. doi:10.1001/jama.2020.9197
May 20, 2020
Research Letter

Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults

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JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.8707

This study compares angiotensin-converting enzyme 2 (ACE2) gene expression, which has been associated with SARS-CoV-2 cell entry, in the nasal epithelium of children vs adults.

Viewpoint

COVID-19: Beyond Tomorrow

How Academic Health Systems Can Move Forward Once COVID-19 Wanes

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JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.8002

This Viewpoint discusses the role academic health systems can play in response to public health deficiencies identified in the coronavirus disease 2019 (COVID-19) pandemic, including developing early warning systems to identify future outbreaks, addressing community mental health needs more broadly, and working to reduce structural health inequities.

Smoking Cessation—Progress, Barriers, and New Opportunities: The Surgeon General’s Report on Smoking Cessation

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JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.6647

This Viewpoint summarizes the 2020 report from the US Surgeon General, summarizing updated scientific evidence on the benefits of smoking cessation and individual, health systems, and population strategies that can facilitate smoking cessation.

Editorial

Nasal ACE2 Levels and COVID-19 in Children

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JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.8946
JAMA Insights

Clinical Update

Olfactory Dysfunction in COVID-19: Diagnosis and Management

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JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.8391

This JAMA Insights Clinical Update discusses the presumed mechanism of COVID-19–related olfactory dysfunction and proposes assessment and management strategies, including olfactory training and adjuvant medication treatments.

Medical News & Perspectives

Prioritizing Physician Mental Health as COVID-19 Marches On

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JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.5205

This Medical News article is an interview with the University of New Mexico’s Eileen Barrett, MD, MPH, about the pandemic’s mental toll on health care workers—and how they and their employers can safeguard their emotional well-being.

May 18, 2020
Research Letter

Seroprevalence of SARS-CoV-2–Specific Antibodies Among Adults in Los Angeles County, California, on April 10-11, 2020

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JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.8279

This population epidemiology study investigates the prevalence of IgG and IgM antibodies to SARS-CoV-2 in Los Angeles County, California, as a marker of both active and past infections.

Viewpoint

COVID-19: Beyond Tomorrow

Planning for a COVID-19 Vaccination Program

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JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.8711

This Viewpoint describes the categories of concerns underlying vaccine hesitancy (necessity, safety, and freedom of choice), and proposes ways to educate the public now about the public health and individual benefits of a COVID-19 vaccine to enhance its rapid, widespread uptake when it becomes available.

Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV): An Unprecedented Partnership for Unprecedented Times

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JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.8920

This Viewpoint describes how the National Institutes of Health is partnering with more than a dozen biopharmaceutical companies and multiple other agencies to develop an international strategy for a coordinated research response to the COVID-19 pandemic, including prioritizing vaccine and drug candidates.

COVID-19: Beyond Tomorrow

Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues

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JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.7943

This Viewpoint describes changes in reimbursement standards, patient privacy (HIPAA) regulations, and licensing requirements that have occurred around provision of telehealth in the US in response to the COVID-19 pandemic and highlights opportunities to further standardize regulations and facilitate use of telehealth after the pandemic.

COVID-19: Beyond Tomorrow

COVID-19 and the Need for a National Health Information Technology Infrastructure

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JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.7239

This Viewpoint emphasizes the need for efficient and accurate data collection, aggregation, and analysis at the national level to properly manage the coronavirus pandemic, and proposes responses to the legal, ethical, and financial barriers that have historically delayed development of a national HIT infrastructure.

May 15, 2020
Research Letter

Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit

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JAMA. Published online May 15, 2020. doi:10.1001/jama.2020.7861

This study measured respiratory parameters of 15 non-ICU patients before, during, and after receiving noninvasive ventilation in the prone position.

Use of Prone Positioning in Nonintubated Patients With COVID-19 and Hypoxemic Acute Respiratory Failure

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JAMA. Published online May 15, 2020. doi:10.1001/jama.2020.8255

This case series describes the proportion of awake, nonintubated inpatients with COVID-19 and hypoxemic respiratory failure requiring oxygen supplementation whose Pao2 increased ≥20% with prone positioning, and their respiratory status after resuming supine positioning.

Viewpoint

COVID-19: Beyond Tomorrow

Reopening Society and the Need for Real-Time Assessment of COVID-19 at the Community Level

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JAMA. Published online May 15, 2020. doi:10.1001/jama.2020.7872

This Viewpoint discusses the need for population COVID-19 PCR and antibody surveys to better understand where communities are on the continuum of COVID-19 incidence and prevalence, to determine the effectiveness of mitigation strategies, and to plan for future mitigation strategies and development of vaccines and therapeutics.

An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US

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JAMA. Published online May 15, 2020. doi:10.1001/jama.2020.8914

This Viewpoint proposes ethical principles to guide allocation of scarce inpatient therapies for hospitalized COVID-19 patients to maximize patient benefit, mitigate disparities, and minimize clinician burden.

Editorial

Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?

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JAMA. Published online May 15, 2020. doi:10.1001/jama.2020.8539
May 14, 2020
Research Letter

Asymptomatic Seroconversion of Immunoglobulins to SARS-CoV-2 in a Pediatric Dialysis Unit

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JAMA. Published online May 14, 2020. doi:10.1001/jama.2020.8438

This case series describes subclinical development of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in some patients and health care workers in a pediatric dialysis unit after contact with a seropositive patient.

Viewpoint

Emergency Use Authorization of Remdesivir: The Need for a Transparent Distribution Process

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JAMA. Published online May 14, 2020. doi:10.1001/jama.2020.8863

This Viewpoint reviews the FDA’s May 2020 Emergency Use Authorization of the antiviral drug remdesivir for treatment of COVID-19 and discusses the need for a transparent distribution plan of a drug not otherwise available in the US and for which demand will likely exceed supply.

May 13, 2020
Research Letter

SARS-CoV-2 Rates in BCG-Vaccinated and Unvaccinated Young Adults

Abstract Full Text
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JAMA. Published online May 13, 2020. doi:10.1001/jama.2020.8189

This cohort study compares rates of coronavirus PCR test positivity among Israelis with symptoms suspicious for COVID-19 who did and did not receive BCG vaccination as part of routine childhood immunization in the early 1980s.

Medical News & Perspectives

Global Effort to Collect Data on Ventilated Patients With COVID-19

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JAMA. Published online May 13, 2020. doi:10.1001/jama.2020.8341

This Medical News feature describes an international effort to compile data about ventilated patients with COVID-19.

May 11, 2020
Original Investigation

Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

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JAMA. Published online May 11, 2020. doi:10.1001/jama.2020.8630

This study examines associations between use of hydroxychloroquine, azithromycin, or both and in-hospital mortality, ECG changes, and cardiac arrest among patients with COVID-19 hospitalized in the metropolitan New York area in March 2020.

Viewpoint

COVID-19: Beyond Tomorrow

COVID-19 and Postinfection Immunity: Limited Evidence, Many Remaining Questions

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JAMA. Published online May 11, 2020. doi:10.1001/jama.2020.7869

This Viewpoint describes what is currently known about the immune response to coronavirus disease 2019 (COVID-19), highlights important gaps in knowledge, and identifies opportunities for future research.

COVID-19 and Racial/Ethnic Disparities

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JAMA. Published online May 11, 2020. doi:10.1001/jama.2020.8598

This Viewpoint reviews possible reasons for reported excess mortality and poor outcomes in racial/ethnic minority populations with COVID-19 and proposes research, public health, and clinical interventions to decrease health inequities in and beyond the pandemic.

Editorial

COVID-19 and Health Equity—A New Kind of “Herd Immunity”

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JAMA. Published online May 11, 2020. doi:10.1001/jama.2020.8051
May 8, 2020
Research Letter

Changes in SARS-CoV-2 Positivity Rate in Outpatients in Seattle and Washington State, March 1-April 16, 2020

Abstract Full Text
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JAMA. Published online May 8, 2020. doi:10.1001/jama.2020.8097

This population epidemiology study characterizes trends in polymerase chain reaction (PCR) test positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Washington State and the Seattle area between March 1 and April 16, 2020, before and after statewide physical distancing guidelines and stay-at-home orders.

Viewpoint

When Should Clinicians Act on Non–Statistically Significant Results From Clinical Trials?

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JAMA. Published online May 8, 2020. doi:10.1001/jama.2020.3508

This Viewpoint discusses considerations that might lead physicians to change their practice based on RCTs reporting non–statistically significant differences in primary outcomes, including trial methodology, totality of evidence, cost, invasiveness, and labor-intensiveness of the interventions being compared.

May 7, 2020
Viewpoint

Surgery in a Time of Uncertainty: A Need for Universal Respiratory Precautions in the Operating Room

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JAMA. Published online May 7, 2020. doi:10.1001/jama.2020.7903

This Viewpoint proposes that universal respiratory precautions in the operating room—use of respirators with face masks and eye protection—could protect staff from possible coronavirus disease 2019 (COVID-19) infection and facilitate resumption of elective surgeries canceled during the first wave of the pandemic.

COVID-19: Beyond Tomorrow

The Equitable Distribution of COVID-19 Therapeutics and Vaccines

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JAMA. Published online May 7, 2020. doi:10.1001/jama.2020.6641

This Viewpoint proposes a framework for international cooperation among governments and organizations to replace competition and hoarding with equitable global distribution of COVID-19 therapeutics and vaccines as they are developed.

Scientific Discovery and the Future of Medicine

Progress in Multiple Sclerosis Research: An Example of Bedside to Bench

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JAMA. Published online May 7, 2020. doi:10.1001/jama.2020.1522

This Viewpoint attributes improved understanding of the role of autoantibodies and B-cell activity in MS pathogenesis and the development of effective therapies to the ability of physician-scientists to bring clinical insights to laboratory research and it emphasizes the importance of supporting and encouraging these investigators to reinvigorate science at the bedside.

JAMA Clinical Guidelines Synopsis

Initial Management of Acute Pancreatitis

Abstract Full Text
JAMA. Published online May 7, 2020. doi:10.1001/jama.2020.2177

This JAMA Clinical Guidelines Synopsis summarizes the American Gastroenterological Association Institute’s 2018 guideline on initial management of acute pancreatitis.

May 6, 2020
Viewpoint

COVID-19: Beyond Tomorrow

Privileges and Immunity Certification During the COVID-19 Pandemic

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JAMA. Published online May 6, 2020. doi:10.1001/jama.2020.7712

This Viewpoint explains the ethics of implementing licensing or certification of coronavirus immunity as basis for permitting public activities, anticipates challenges to effectively implementing such a system, and proposes potential policy solutions.

COVID-19: Beyond Tomorrow

The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”)

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JAMA. Published online May 6, 2020. doi:10.1001/jama.2020.8102

This Viewpoint explains the ethical basis for implementing immunity-based licensing—certification of coronavirus immunity as a basis for permitting public activities—and anticipates challenges to effective implementing such a system, and potential solutions.

Interpreting Diagnostic Tests for SARS-CoV-2

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JAMA. Published online May 6, 2020. doi:10.1001/jama.2020.8259

This Viewpoint discusses the 2 most common categories of testing to diagnose SARS-CoV-2—real-time PCR to identify viral RNA and serological diagnosis of IgG and IgM antibodies to assess immune response—and estimates time intervals for test positivity by specimen source to help clinicians interpret results relative to symptom onset.

May 5, 2020
Research Letter

Case Series of Transcutaneous Magnetic Stimulation for Ventricular Tachycardia Storm

Abstract Full Text
JAMA. Published online May 5, 2020. doi:10.1001/jama.2020.3833

This case series describes outcomes for 5 patients with VT storm refractory to drug therapy treated with left stellate ganglion transcutaneous magnetic stimulation (TCMS) to reduce cardiac sympathetic input.

JAMA Guide to Statistics and Methods

Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial

Abstract Full Text
JAMA. Published online May 5, 2020. doi:10.1001/jama.2020.7819

This JAMA Guide to Statistics and Methods reviews overlap weighting, a technique to reduce the influence of patients who are nearly always treated or never treated on propensity score estimates, when attempting to reduce bias associated with nonrandomized treatment in observational study populations.

May 4, 2020
Viewpoint

COVID-19: Beyond Tomorrow

COVID-19 and the Financial Health of US Hospitals

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JAMA. Published online May 4, 2020. doi:10.1001/jama.2020.6269

This Viewpoint reviews the revenue sources and financial liquidity of nonfederal US general hospitals to estimate the economic effects pandemic-related reductions in elective procedures and outpatient revenues might have, and argues for targeted government financial support for smaller, independent, and more rural institutions.

COVID-19: Beyond Tomorrow

Choices for the “New Normal”

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JAMA. Published online May 4, 2020. doi:10.1001/jama.2020.6949

In this Viewpoint, Donald Berwick summarizes the rapid changes the COVID-19 pandemic has wrought on the pace, scientific standards, delivery mechanisms, and working conditions of health care and how it has sharply increased awareness of the societal costs of poor public health preparedness and health inequities.

Editorial

Randomized Clinical Trials and COVID-19: Managing Expectations

Abstract Full Text
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JAMA. Published online May 4, 2020. doi:10.1001/jama.2020.8115
JAMA Patient Page

Keeping Medicine Away From Children

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JAMA. Published online May 4, 2020. doi:10.1001/jama.2020.7206

This JAMA Patient Page describes practices for keeping household medicine safely stored away from children and what to do if an unintentional medicine exposure happens.

May 1, 2020
Viewpoint

COVID-19: Beyond Tomorrow

The Business of Medicine in the Era of COVID-19

Abstract Full Text
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JAMA. Published online May 1, 2020. doi:10.1001/jama.2020.7242

This Viewpoint discusses the shifting landscape of health care financing, regulation, and delivery as a result of the coronavirus pandemic, and discusses regulatory and other changes that need to be in place if telehealth and physician practice and hospital mergers become the “new normal” once the pandemic is controlled.

Understanding Brain Death

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JAMA. Published online May 1, 2020. doi:10.1001/jama.2020.3593

This Viewpoint examines the need to reconcile discrepancies between the definition of brain death in the 1981 Uniform Determination of Death Act and current diagnostic standards in the US given legal challenges arising from the differences.

Action-Informed Artificial Intelligence—Matching the Algorithm to the Problem

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JAMA. Published online May 1, 2020. doi:10.1001/jama.2020.5035

This Viewpoint discusses ways in which artificial intelligence (AI) methods can enhance the use of health care data in detection, prognostication, and prediction; suggests ways in which AI tools might be better developed and deployed; and calls for increased focus on anticipated changes that will be made in the health care system to better benefit from the use of AI.

JAMA Insights

Public Health Measures and the Reproduction Number of SARS-CoV-2

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JAMA. Published online May 1, 2020. doi:10.1001/jama.2020.7878

This JAMA Insights review explains the use of the effective reproduction number (Rt) as a measure of the number of secondary infectious disease cases spread from an initial case, and how this number is used to assess the effects of public containment and mitigation efforts to control SARS-CoV-2 transmission.

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