Thread by @GertrudRey

UPDATE ON SARS-COV-2 (3/22/20)

Summary of #twiv with guest Daniel Griffin, MD, PhD. Dr. Griffin is an infectious disease specialist who is affiliated with multiple hospitals in the NYC area. He’s a regular co-host on TWiV’s sister show #twip. (1/n) microbe.tv/twiv/twiv-593/

[Note from me: I don’t watch the news. I rely on scientific data. The best resource for reliable scientific information can be found in the primary biomedical literature at PubMed, a search engine maintained by the United States National Library of Medicine at the NIH. (2/n)

The group of doctors and scientists on today’s episode of TWiV have devised a system of sifting through the vast amount of SARS-CoV-2 literature that is readily pouring out on PubMed these days. (3/n)

The PhDs in this group do the reading and analyzing and report back to Daniel Griffin, MD, PhD, who is busy in trenches, treating patients. They report back to him with information from the most critical papers to find a consensus to help guide doctors.] (4/n)

What are the numbers from NYC hospitals? Of all the people tested that were suspected to be positive in a number of NYC area hospitals, about 40% turned out to be positive for SARS-CoV-2. 19% of patients diagnosed end up in the hospital. (5/n)

5% end up in the ICU requiring intubation. Keep in mind that these percentages result from people who are actually TESTED. Unfortunately right now the only people being tested are the ones that are the sickest. (6/n)

It is very likely that the vast majority of infected people are not sick enough to seek medical care or are asymptomatic, so they don’t get tested. Once testing is ramped up in the coming weeks, you will see thousands and thousands of more positive tests. (7/n)

That does not mean that we have an explosion of new cases, it just means that more people are being tested, which is good, because now we know who is infected and can implement more realistic quarantine strategies. (8/n)

Are there long-term consequences to being infected? Based on the limited data we have so far, most patients seem to do well after they recover. (9/n)

What’s the deal with ibuprofen? The hysteria is based on a single letter to the Lancet. It is not based on a scientific study and there are currently no data that substantiate that it can’t be used in COVID-19 patients. (10/n)

Is it possible to become re-infected after you recover? Based on the data we have so far, the vast majority of people should be immune once they have been infected once. (11/n)

After infection, one develops neutralizing antibodies (antibodies that inactivate the virus) that should last at least a year. Hopefully by then we’ll have a vaccine. (12/n)

Are co-infections with other pathogens possible? Co-infection with influenza has been observed, and those individuals usually have a worse outcome. Infection with SARS-CoV-2 does not magically protect one against infection with flu or with other viruses, and vice versa. (13/n)

Secondary bacterial infections can also occur. What about pregnant women? Right now there are no data suggest that pregnant women are a higher-risk group than non-pregnant women of the same age. (14/n)

At this point, there is no evidence for transmission of the virus from mother to child during pregnancy or breast feeding (known as vertical transmission). (15/n)

What’s up with Italy? A yet-to-be-published study done in a village in Italy by the University of Padua suggests that 75% of people that tested positive for SARS-CoV-2 were asymptomatic. (16/n)

Why are there so many deaths in Italy? The numbers in Italy are high compared to other countries because they’re only testing people who are actually sick. If these numbers were divided by all the people who are actually infected, the death rate would decrease. (17/n)

Also, a majority of the Italian population is elderly. According to an Italian website, the “Integrated surveillance of COVID-19 in Italy” site, the originally published numbers that indicated that the case fatality rate increases with age seems to hold true. (18/n)

Here's a table from this website. (19/n)

What is going to happen with this virus in the long term? There are many other coronaviruses that circulate among the human population that only cause mild colds. (20/n)

A plausible hypothesis is that these viruses spilled over from animal hosts many years ago and caused very serious disease, comparable to what we are observing now with SARS-CoV-2. However, because of general lack of surveillance at the time, we weren’t aware of it. (21/n)

Over time, the population became immune and now those viruses only cause mild disease. Based on this, and based on our knowledge about how other viruses adapt in humans, it is reasonable to assume that SARS-CoV-2 will probably follow the same pattern over time. (end)