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3rd THREAD:

Summarising unfolding research picture on #COVID19 as the outbreak enters its 3rd month with more data being reported out of China.

This thread compiles scientific data (with direct links to papers) on what we know so far on #COVID19 #SARSCoV2

#IDTwitter
You can see the major research outputs from the 1st month of the #COVID19 outbreak in this thread (48 tweets):



or in this thread reader: threadreaderapp.com/thread/1221020…
And see the updates from the 2nd month of the #COVID19 outbreak in this thread (32 tweets):



or in this thread reader:
threadreaderapp.com/thread/1226518…
1/ A previous report of 1099 hospitalised #COVID19 patients from 52 hospitals in China now published in @NEJM

The median age=47y, 16% of hospitalised pts had severe disease, 5% were admitted to ICU, 3% had ARDS, 2.3% required ventilation & 1.4% died.

nejm.org/doi/full/10.10…
2/ In a cohort of 68 fatal #COVID19 vs 82 discharged cases, underlying CVD & secondary infection increased risk of mortality. Although the majority (53%) died of respiratory failure, some experienced cardiac injury demonstrating the severity of illness.

link.springer.com/article/10.100…
3/ A previous report of 72k cases in China now published in @JAMA_current
Among 44k lab confirmed #COVID19 ,
81% had mild disease
Mortality was higher among >60, highest in >80yo
jamanetwork.com/journals/jama/…

Details of the report can be found here:
4/ Among 25,961 lab-confirmed #COVID19 cases in China, the proportion of severe/critical cases decreased gradually over time, while the mild cases increased dramatically. The R0 dropped from 3.86 pre-interventions to 0.32 (0.28 to 0.37) post interventions

medrxiv.org/content/10.110…
5/ A descriptive case series of 18 #COVID19 patients in Singapore. 83% pts had prolonged viral shedding in nasopharynx >7d with higher Ct values after one week. In 4/8 virus was detected by PCR in stool, 1/10 detected in blood, not in urine (0/10).

jamanetwork.com/journals/jama/…
6/ In this report from Singapore, none of the 18 #COVID19 pts had ARDS. 5/18 pts who received LPV/rtv, 2 deteriorated to respiratory failure & 1 required intubation. 4/5 developed GI side effects w 3/5 hepatoxicity. In 2 pts viral shedding cleared in 2d.

jamanetwork.com/journals/jama/…
7/ Epidemiological description of the first 47 confirmed #COVID19 cases in Europe. 21 cases were infected in Europe, suggesting local transmission. Of these, 14 were linked to a cluster in Bavaria, Germany, and 7 to a cluster in Haute-Savoie, France.

eurosurveillance.org/content/10.280…
8/ A preprint on community spread based on 1286 close contacts of 319 #COVID19 cases; 20% infected contacts were asymptomatic, children as frequently infected as adults, household attack rate of 15%, surveillance + contact tracing brought R0 down to 0.4

medrxiv.org/content/10.110…
9/ First case series of 10 children with #COVID19 in Shangai:
Age 3m-10y, mostly presented with mild symptoms, 8/10 had direct contact with an adult patient. 1 possible case of transmission from infected 3m old infant to adult contacts (Patient 7)

academic.oup.com/cid/advance-ar…
10/ In this report, a well 6-month-old infant with #COVID19 had persistently positive nasopharyngeal swabs to day 16 of admission. In line with the previous report, children are less likely to have severe symptoms but continue to shed virus.

academic.oup.com/cid/advance-ar…
11/ This case report highlights the importance of clinical suspicion & importance of sample type. Diagnosis of #COVID19 was made via BAL fluid after initial negative tests from NP/OP swabs.

jcm.asm.org/content/early/…
12/ In this report, 46-year-old woman with #COVID19 had positive #SARSCoV2 on oropharyngeal swab at d17 after two consecutive negative results and clinical improvement highlighting the importance of dynamic surveillance.

ijidonline.com/article/S1201-…
13/ A case report of a 35w pregnant woman with confirmed #COVID19 who underwent C-section delivery of a #SARSCoV2 –ve infant. She had mild symptoms. On delivery day, her sputum was positive, but serum, amniotic fluid, placenta and breastmilk was -ve.

wwwnc.cdc.gov/eid/article/26…
14/ A case of #COVID19 in a 30w pregnant woman who underwent emergency C-section due to concerns about deterioration & delivered a healthy baby with no evidence of #SARSCoV2 in throat and stool samples and -ve amniotic fluid, placenta and breastmilk.

academic.oup.com/cid/advance-ar…
15/ Environmental screening performed in 3 isolation rooms where #COVID19 pts were admitted:

Entensive environmental contamination
Air samples were negative
Post-cleaning samples were negative
suggesting current decontamination measures are sufficient

jamanetwork.com/journals/jama/…
16/ Among medical staff directly caring for suspected #COVID19 cases, N95 respirators, disinfection and hand washing appear to help reduce the infection risk. Interestingly, departments with a high % of male docs seemed to have a higher risk of infection.

journalofhospitalinfection.com/article/S0195-…
17/ This study shows that travel restrictions even up to 90% have a modest effect unless paired w public health & behavioral change interventions that achieve the most reduction in #COVID19 transmission

@alexvespi @mattk7 @jessicadavis_ @apastorepiontti

science.sciencemag.org/content/early/…
18/ In this pre-print, based on exported cases to other countries, Italy may have had about 4000 #COVID19 cases by the end of Feb, suggesting approximately 70% of cases went undetected.

@AshTuite & co.

medrxiv.org/content/10.110…
19/ This modelling study (preprint) estimates #COVIDー19 burden in Iran & international exported cases

18,300 (3770-53,470) #coronavirus cases would have had to occur in Iran in order to observe 3 internationally exported cases reported by Feb 25th

20/ Based on the epidemiological dynamics of the first 425 cases (Li Qun et al. NEJM), this modelling study (preprint) suggests that about up to 25% of #COVID19 secondary infections may be caused during the pre-symptomatic phase of the primary cases

cmmid.github.io/topics/covid19…
21/ This prediction model (preprint) simulates #SARSCoV2 transmission through to 2025 & summarize the full range of plausible #COVID19 transmission scenarios

Many scenarios lead to recurrent outbreaks in the coming years

by @StephenKissler @mlipsitch

22/ How many #COVID19 cases can we expect when new deaths are reported in a country? @TeebzR et al. estimates (preprint) that it is likely there are already hundreds or thousands of cases in the population by the time a COVID-19 death is reported

cmmid.github.io/topics/covid19…
23/ Using transmission clusters in Singapore & Tijan, the authors estimate pre-symptomatic transmission (PREPRINT)

Results suggest that there was a substantial pre-symptomatic transmission & transmission occurred avg 2.5-2.9d before the symptom onset.

medrxiv.org/content/10.110…
24/ A new viral shedding study (PREPRINT) based on 9 mild #COVID19 cases. In this cohort, pts were already beyond the peak viral load in URT samples when first tested and shedding of infectious virus continued in sputum through the 1st week of symptoms.

medrxiv.org/content/10.110…
25/ Above results indicate more efficient transmission of #SARSCoV2 through infectious pharyngeal viral shedding during mild symptoms. In the same (PREPRINT) study, while stool samples were positive >d8 by PCR, no infectious virus was isolated. #COVID19

medrxiv.org/content/10.110…
26/ This modelling study shows that to achieve control of 90% of outbreaks, 80% of contacts needed to be traced and isolated for scenarios with R0 of 2·5 suggesting case isolation and contact tracing alone is insufficient to control #COVID19 outbreaks.

thelancet.com/journals/langl…
27/ Based on BBC Pandemic study (over 36,000 users & 378,000 contacts), this PREPRINT shows that reducing social interactions will be crucial for slowing #COVID19.
In the UK, majority interactions happen in workplace (20-50y) & outside household (>60y).
medrxiv.org/content/10.110…
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