Thread by @mugecevik

THREAD
As the #nCoV2019 outbreak continues, a lot of data emerging in real-time & being rapidly disseminated.

I compiled the available data (in no particular order) to have a better understanding of #nCoV2019 & will update the list as more info become available.
#IDTwitter

Clinical features of the first 41 pts suggest that #nCoV2019 has an insidious onset with fever, cough, and myalgia +/- shortness of breath. Radiological findings of bilateral ground-glass opacities. Some with mild, but >60y with severe disease #IDTwitter

thelancet.com/journals/lance…

The majority of patients requiring ICU care are those who presented with low blood pressure and dyspnea, high neutrophil count and LDH, and more likely to have AKI, secondary infection and shock. #nCoV2019 #IDTwitter

thelancet.com/journals/lance…

Zhu et al. have identified and characterized #nCoV2019 from bronchoalveolar-lavage fluid in three patients by whole-genome sequencing, direct PCR, and culture.

Phylogenetic analysis revealed that 2019-nCoV falls into the genus betacoronavirus. #IDTwitter
nejm.org/doi/full/10.10…

This paper describes the findings of five patients in a family cluster who presented with unexplained pneumonia. This and the above reports suggest that #nCoV2019 has approx 3–6 day incubation period and confirm human-to-human transmission. #IDTwitter

thelancet.com/pb-assets/Lanc…

Key paper on the epidemiology of #nCoV2019

@Eurosurveillanc Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020 #IDTwitter

eurosurveillance.org/content/10.280…

.@ISPMBern researchers used computer simulations to analyze the early transmission pattern of the #nCoV2019 outbreak in Wuhan, China. The findings indicate the potential for sustained human-to-human transmission.

ispm.unibe.ch/about_us/news/…

Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT- RT-PCR

This paper reports the establishment and validation of #nCoV2019 RT-PCR, designed in absence of available virus isolates or original patient specimens. #IDTwitter

eurosurveillance.org/content/10.280…

Early modelling estimates of epidemiological parameters #nCoV2019 by @JonRead15

Although R0 estimates will be changing rapidly as the case data emerges, R0 currently is 2.5 95% CI 2.4 - 2.6.

R0 (basic reproduction number)

#IDTwitter

drive.google.com/file/d/1fz7Ewl…

Early estimates and explanation by @maiamajumder

Early basic reproduction number estimates for #nCoV2019 range from 2.0 to 3.3 (based off of publicly reported confirmed cases through 1/22/20)

https://twitter.com/maiamajumder/status/1220501403057229824?s=20

. @C_Althaus and colleagues analyzed the early transmission pattern of #nCoV2019 and estimated R0 around 2.2 (90% high density interval: 1.4-3.8).

github.com/jriou/wcov

. @K_G_Andersen investigated the claim about snakes being the likely reservoir for #nCoV2019. A series of analysis demonstrates that this claim is false. #IDTwitter

virological.org/t/ncov-2019-co…

Zhou et al from Wuhan, describing the initial characterisation of the #nCoV2019, demonstrating also that deeper respiratory tract samples have a higher viral load than oral/throat swabs. #IDTwitter

Great work by Wuhan virologists

biorxiv.org/content/10.110…

Excellent perspective article by Vincent Munster and colleagues in @NEJM on #nCoV2019

Currently, epidemiologic data that would allow us to draw the surveillance pyramid are largely unavailable. #IDTwitter

@DrNeeltje @DebbyvanRiel @MarionKoopmans

nejm.org/doi/full/10.10…

Continuous data sharing by the Wuhan Institute of Virology and the Thai National Institute of Health.

Genomic data of #nCoV2019 becoming more clear available on nextstrain.org/ncov

#IDTwitter

https://twitter.com/trvrb/status/1218980671885996032?s=20

Many thanks to @nicolamlow @JeremyFarrar @Laurie_Garrett @richardhorton1 @onisillos
and many others who advocated for open-access rapid data sharing, which will certainly make a difference and add to the efforts to understand this #nCoV2019 outbreak. #IDTwitter

@nicolamlow @JeremyFarrar @Laurie_Garrett @richardhorton1 @onisillos Another important feature seen in #nCoV2019 cases is that only a few patients had upper respiratory tract symptoms (rhinorrhoea or sore throat), indicating that the target cells might be located in the lower airway. #IDTwitter

thelancet.com/action/showPdf…

@nicolamlow @JeremyFarrar @Laurie_Garrett @richardhorton1 @onisillos The ct values of the sputum samples were 8–13 cycles earlier than those of throat swabs. Thus repeat testing of URT samples or testing deeper samples are warranted in clinically high suspicious cases with an initial negative result.

#nCoV2019 #IDTwitter

thelancet.com/pdfs/journals/…

@nicolamlow @JeremyFarrar @Laurie_Garrett @richardhorton1 @onisillos Early estimation and modelling by @MRC_Outbreak suggests that R0 of #nCoV2019 is 2.6 ( 1.5-3.5) #IDTwitter

imperial.ac.uk/mrc-global-inf…

@neil_ferguson @dr_anne_cori @SRileyIDD @MarcBaguelin
@IlariaDorigatti

A further summary:

https://twitter.com/MRC_Outbreak/status/1221032729971773440?s=20

@nicolamlow @JeremyFarrar @Laurie_Garrett @richardhorton1 @onisillos @MRC_Outbreak @neil_ferguson @dr_anne_cori @SRileyIDD @MarcBaguelin @IlariaDorigatti Links in this thread can take you to full papers with much more details!

i.e, Zhou et al. showed that #nCoV2019 could be cross-neutralized by horse anti-SARS-CoV serum at dilutions 1:80, further confirming the relationship of the two viruses.

#IDTwitter
biorxiv.org/content/10.110…

The same paper shows that Angiotensin converting enzyme II (ACE2), which is known as cell receptor for SARS-CoV, is likely the cell receptor of #nCoV2019 #IDTwitter

biorxiv.org/content/10.110…

Phylogenetic analysis demonstrates that #nCoV2019 falls into the genus betacoronavirus, that includes #coronaviruses such as SARS-CoV, bat SARS-like CoV discovered in humans, bats, and other wild animals.

#IDTwitter @NEJM

nejm.org/doi/full/10.10…

@NEJM Functional assessment of cell entry and receptor usage for lineage B β- #coronaviruses

This paper demonstrates that different lineage B viruses can recombine to gain entry into human cells and human ACE2 is likely the receptor of #nCoV2019 #IDTwitter

biorxiv.org/content/10.110…

@NEJM Based on 164 confirmed #nCoV2019 cases, Guangdong Provincial CDC reports the first detailed epidemic curve & estimated R0 =2.9, consistent with previous reports. The average incubation period (exposure to symptom onset) is reported as 4.8 days #IDTwitter

biorxiv.org/content/10.110…

@NEJM This data is generated to inform public health planning and some estimates may change over time, thus should not be viewed as a reason to panic.

eg. this paper shows how R0 had a downward trend for SARS as the data became available #IDTwitter #nCoV2019

biorxiv.org/content/10.110…

@NEJM The crystal structure of the #nCoV2019 coronavirus 3CL hydrolase (Mpro) has been determined by Rao Zihe / Yang Haitao's team at ShanghaiTech Uni. Being processed by PDB, (6LU7) #IDTwitter @tsrabbit3

Press release in Chinese:
shanghaitech.edu.cn/2020/0126/c100…

@NEJM @tsrabbit3 Chen et al. based on data as of Jan 23, built a logistical model to predict future trends of #2019nCoV. Cumulative cases are *estimated* approx 2-3 times the total number of SARS, and the peak incidence is predicted to be in early or mid-Feb. #IDTwitter

biorxiv.org/content/10.110…

@NEJM @tsrabbit3 In this paper, Zang and Wang modelling the phylogeny, divergence times and epidemic dynamics of #2019nCoV suggest that the origin time of the outbreak is estimated to be December 17, 2019 (95% 19 CI: December 5 - 23, 2019). #IDTwitter

biorxiv.org/content/10.110…

@NEJM @tsrabbit3 Lots of discussion about whether the virus can spread during the incubation period. Although this is an important question, there is no solid scientific evidence yet to suggest asymptomatic shedding contributes to significant transmission. #2019nCoV #IDTwitter #nCoV19

@NEJM @tsrabbit3 Based on 34 confirmed #2019nCoV cases that were detected outside Wuhan, Backer et al. estimate the mean incubation period to be 5.8 (4.6 - 7.9, 95% CI) days, ranging from 1.3 to 11.3 days (2.5th to 97.5th percentile). #IDTwitter

medrxiv.org/content/10.110…

@NEJM @tsrabbit3 Estimated incubation periods are quite consistent across all #coronaviruses

Although based on 34 confirmed cases, this study debunks the unverified news that #2019nCoV might have an unusually long incubation period. #IDTwitter

medrxiv.org/content/10.110…

@NEJM @tsrabbit3 A family cluster of #2019nCoV in Vietnam confirming human-to-human transmission and a short incubation period (3 days).

28 close contacts including wife were subsequently tested negative.

#IDTwitter

nejm.org/doi/full/10.10…

@NEJM @tsrabbit3 In this family cluster, initial #2019nCoV case was a 65y man with hypertension, diabetes, heart disease, and lung ca. He had fever & fatigue, subsequently developed shortness of breath, consistent with clinical course reported previously. #IDTwitter

nejm.org/doi/full/10.10…

@NEJM @tsrabbit3 New study by Lu et al. published in the @TheLancet confirms that #2019nCoV is closely related to bat-derived SARS-like coronaviruses. Although, it is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. #IDTwitter

marlin-prod.literatumonline.com/pb-assets/Lanc…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos New in @TheLancet: Chen et al. report 99 patients with #2019nCoV pneumonia. The median age was 55y, >60% over the age of 50y, and over half with a comorbid disease. The majority (80%) presented with fever and cough, +/- shortness of breath. #IDTwitter
thelancet.com/pb-assets/Lanc…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos In this cohort, 75% of patients with #2019nCoV had bilateral pneumonia; 20% with ARDS, 4% required invasive ventilation. The majority received antivirals and antimicrobials + those with ARDS were given IV immunoglobulin and corticosteroids. #IDTwitter

thelancet.com/pb-assets/Lanc…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos Despite the severity of presentation, 89% had good prognosis. 11 of whom died of multiorgan failure had underlying conditions. (Pls note this is a cohort of hospitalised patients, so the mortality rate doesn't reflect the overall figures) #IDTwitter #2019nCoV

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos Early transmission dynamics of the first 425 confirmed #2019nCoV cases in Wuhan @NEJM

Earliest cases were linked to seafood market
Median age 59y, 56% were male.
No cases below age 15.
The mean incubation period was 5.2 days (4.1 to 7.0). #IDTwitter

nejm.org/doi/full/10.10…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos It is becoming clear that there is a population at risk of #2019nCoV; older (>60y) men with underlying conditions. Children are likely either asymptomatic or have milder symptoms. Little transmission among HCW, suggesting good IPC measures. #IDTwitter

nejm.org/doi/full/10.10…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos Based on the data on exposures among 10 confirmed #2019nCoV cases, the mean incubation period was 5.2d, the 95th percentile of the distribution was 12.5 days (9.2 to 18), supporting 14d medical observation recommendation for exposed persons. #IDTwitter

nejm.org/doi/full/10.10…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos In this new modelling study, using ground, rail and air travel data, Simon Cauchemez @institutpasteur & colleagues *estimate* the probability of 2019 novel coronavirus importations throughout China prior to the Wuhan quarantine. #IDTwitter #2019nCoV

medrxiv.org/content/10.110…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos @institutpasteur Second peer-reviewed basic reproduction number (R_0) estimate for #nCoV2019 in IJID @ISID_org , consistent with previous reports by @maiamajumder @JonRead15 @neil_ferguson

This team finds mean R0 ranging from 2.24-3.5 pre-intervention. #IDTwitter

sciencedirect.com/science/articl…

@NEJM @tsrabbit3 @TheLancet @TheLancetInfDis @onisillos @institutpasteur @ISID_org @maiamajumder @JonRead15 @neil_ferguson Just a reminder to readers:

1- Higher R0 doesn’t necessarily mean a worse disease
2- R0 is not intrinsic to the virus, it depends on the context
3- R0 is not a destiny, all preventative measures could lower R0 and the spread #2019nCoV

by @maiamajumder
theatlantic.com/science/archiv…

New in @NEJM : Transmission of #2019nCoV Infection from an Asymptomatic Contact

Timeline of Exposure to Index Patient suggests transmission 1-2d before symptom onset

To note: this is a very close contact, they spent 2d in several meetings

#IDTwitter

nejm.org/doi/full/10.10…

@NEJM First UK #2019nCoV cases confirmed. Based on this modelling study published in @Eurosurveillanc , the importation risk of #coronavirus was highest for the UK (25%), followed by Germany (16%), France (13%), Italy (11%) and Spain (9.5%). #IDTwitter

eurosurveillance.org/content/10.280…

@NEJM @Eurosurveillanc New modelling study in @TheLancet estimates potential spread of #2019nCoV

"Precisely what and how much should be done is highly context-specific and there is no one-size-fits-all set of prescriptive interventions that would be appropriate in all settings"
thelancet.com/lancet/article…

@NEJM @Eurosurveillanc @TheLancet First Case of #2019nCoV #Coronavirus in the United States

35y man who travelled back from Wuhan initially presented with mild cough and fevers. Pneumonia developed by day 9. His clinical condition improved by d12 with mainly supportive care. #IDTwitter

nejm.org/doi/full/10.10…

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