Excellent paper jamanetwork.com/journals/jama/… from @CarlosdelRio7 and @PreetiNMalani about insights into the novel coronavirus. Please follow then for updates. I spoke to the authors, updated the data and created a twitter thread to explain the findings. #coronavirus 1/22
Since first reported in Wuhan China, in late Dec 2019, the outbreak of novel coronavirus, known as COVID – 19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has spread to more than 145 countries/regions. +160K cases confirmed, and +6k have died #coronavirus 2/22
The virus likely originated in chrysanthemum bats. #CoronavirusOutbreak 3/22 
The virus uses a spike protein (S) to enter cells and bind to the angiotensin-converting enzyme 2 (ACE2) receptor. The ACE2 enzyme is expressed in type II alveolar cells, which produce surfactant and allows normal lung function. #coronavirus 4/22
Inadequate surfactant leads to acute respiratory distress syndrome, known as ARDS. #COVID19 5/22
Early data shows that Asian males have a large number of ACE2-expressing cells in the lung, which may explain the male predominance of coronavirus infection and disease. Men are more likely to become infected and ill from the coronavirus. 6/22
It could also be that there is a higher prevalence of smoking among men in China, as compared to women #CoronavirusOutbreak 7/22
Worth remembering China is a fairly homogenous population. As the virus spreads to countries with more diverse populations, such as the United States, we may see different patterns of disease, such as more severe illness in younger people. #CoronaVirus 8/22
It is surprising this hasn't yet spread more widely in India, Africa or Latin America. That is worth noting and following. Some have said it is “warm weather” but would not count on that. #CoronavirusOutbreak 9/22
There is quite possibly an intermediate host between bats and humans. Early evidence has pointed to the pangolin, one of the most illegally traded animal in the world #CoronavirusPandemic 10/22
The best estimates are an incubation period between 2 and 14 days, with a median of 5 to 6 days. We recently interviewed a patient who is still carrying virus after a month. @cnn 11/22
If the incubation is much longer than 14 days, that would have serious implications for quarantine practices #Quarantine 12/22
The virus appears to be transmitted through large respiratory droplets and fomites (infected surfaces). Although viral material has been found in stool there is no live virus there so unlikely that there is fecal transmission. #CoronaVirusUpdates 13/22
The reproductive number (Ro) is estimated to be between 2 and 3. That means a single infected person can spread the infection to 2 to 3 people. For reference: flu (Ro) is 1.28 #CoronavirusUSA 14/22
From China data: The clinical presentation – fever in 83%-98% of patients. Dry cough (76%-82%) and fatigue/myalgias (11%-44%) of patients. Less common symptoms have been headache, sore throat, abdominal pain and diarrhea @CarlosdelRio7 @PreetiNMalani 15/22
Patients with COVID-19 receive care similar to other viral pneumonias. Typically supportive care and oxygen. Steroids are not generally recommended. Anecdotal evidence that remdesivir, an antiviral drug may help. Clinical trials are underway. #COVID19 16/22
China recently approved the use of favilavir, an antiviral drug used for flu, as an investigational therapy. There are more than 100 clinical trials to test new and repurposed drugs against the novel #coronavirus. 17/22
Here is a look at the case fatality ratio in China by age. Again, that data may look different in other countries. #wuhan 18/22
This is the case fatality ratio in China based on pre-existing conditions. Heart disease was the biggest risk factor, followed by diabetes, lung disease and hypertension. #coronavirus 19/22
Men have a higher case fatality ratio as compared to women. 20/22
In the United States, as of today, there have been +3800 confirmed cases and 68 deaths. Of course, we have had limited testing so the number of people infected could be much higher, which would bring down the fatality ratio. #cornoavirususa 21/22
