Coronavirus (Covid-19)
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A collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary.
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Correspondence
Natural History of Asymptomatic SARS-CoV-2 Infection
A. Sakurai and Others
The outbreak on the cruise ship Diamond Princess led to the identification of 96 persons who were infected with SARS-CoV-2 but were asymptomatic. This report describes their course during isolation, with close observation and serial tests for the virus.
Jun 12 -
Correspondence
2019-nCoV Transmission from Asymptomatic Patient
C. Rothe and Others
In this report, investigators in Germany detected the spread of the novel coronavirus (2019-nCoV) from a person who had recently traveled from China to Germany for a business trip. This transmission occurred before the apparent onset of illness in the index patient and was associated with additional transmission events in Germany.
Mar 05See Also Chinese Translation in NEJM 医学前沿
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Correspondence
Natural History of Asymptomatic SARS-CoV-2 Infection
A. Sakurai and Others
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Original Article Presymptomatic SARS-CoV-2 in a Nursing Facility M.M. Arons and Others
The authors assessed transmission of SARS-CoV-2 and evaluated the adequacy of symptom-based screening in a skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission.
May 28Editorial Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19
Correspondence Screening for Covid-19 in Skilled Nursing Facilities
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Correspondence
Brain Autopsy Series in Patients with Covid-19
I.H. Solomon and Others
Eighteen brains of patients who died 0 to 32 days after the onset of symptoms of SARS-CoV-2 infection showed hypoxic–ischemic changes but no encephalitis, meningitis, strokes, or changes in olfactory bulbs or tracts. Low viral counts were detected by quantitative RT-PCR in a few brain sections, and no virus was evident on immunohistochemical analysis.
Jun 12
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Correspondence
Brain Autopsy Series in Patients with Covid-19
I.H. Solomon and Others
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Correspondence
Neurologic Features in SARS-CoV-2 Infection
J. Helms and Others
In a consecutive series of 64 patients with Covid-19 and ARDS, 58 of whom underwent neurologic examination, severe agitation and corticospinal signs were common. In 2 of 13 patients, MRI of the brain showed small acute strokes, and in 1 patient, imaging showed a subacute stroke.
Jun 04Correspondence More on Neurologic Features in Severe SARS-CoV-2 Infection
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Correspondence
Neurologic Features in SARS-CoV-2 Infection
J. Helms and Others
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Correspondence
Diabetes and Covid-19
F. Rubino and Others
Diabetes is associated with an increased risk of severe Covid-19. New-onset diabetes and metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity, for which very high doses of insulin are warranted, have been observed in patients with Covid-19. This letter discusses these issues.
Jun 12 -
Correspondence
Multiorgan and Renal Tropism of SARS-CoV-2
V.G. Puelles and Others
In this autopsy series, the authors found that SARS-CoV-2 has an organotropism beyond the respiratory tract, including the kidneys, heart, liver, and brain. They speculate that organotropism influences the course of Covid-19 disease and, possibly, aggravates preexisting conditions.
May 13
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Correspondence
Diabetes and Covid-19
F. Rubino and Others
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Original Article Angiogenesis and Covid-19 M. Ackermann and Others
Autopsy examination of lungs from seven patients who died from Covid-19 showed intussusceptive angiogenesis in greater profusion than was found in lungs from patients who died from influenza or in uninfected lungs that were rejected for transplantation.
May 21Editorial Covid-19, Angiogenesis, and ARDS Endotypes
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Correspondence
Prolonged aPTT in Patients with Covid-19
L. Bowles and Others
In this study, 20% of patients with Covid-19 had a prolonged activated partial-thromboplastin time (aPTT). In 90% of these cases, the cause was lupus anticoagulant, with no associated bleeding. Patients with Covid-19 are susceptible to thromboses. The presence of a prolonged aPTT should, in general, not be considered a contraindication to anticoagulation.
May 05 -
Correspondence
Covid-19 Notes
Cancer Management in India during Covid-19
C.S. Pramesh and R.A. Badwe
India’s largest cancer center adopts a proactive, multipronged approach to providing treatment, while facing the reality that some services must be scaled back during a nationwide lockdown. Prioritization criteria guide treatment decisions.
Apr 28
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Correspondence
Prolonged aPTT in Patients with Covid-19
L. Bowles and Others
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Correspondence
Covid-19 in Immune-Mediated Inflammatory Diseases
R. Haberman and Others
The authors describe patients in New York City with known immune-mediated inflammatory disease in whom Covid-19 developed while they were receiving biologics, other immunomodulatory therapies, or both. The incidence of hospitalization among these patients was consistent with that among patients with Covid-19 in the general population in New York City.
Apr 29 -
Correspondence
Kidney-Transplant Recipients with Covid-19
E. Akalin and Others
A cohort of 36 consecutive kidney-transplant recipients had less fever, lower CD3, CD4, and CD8 cell counts, more rapid clinical deterioration, and a higher mortality than the general population of patients with Covid-19.
Apr 24See Also Chinese Translation in NEJM 医学前沿
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Correspondence
Covid-19 in Immune-Mediated Inflammatory Diseases
R. Haberman and Others
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Original Article
Hydroxychloroquine for Covid-19 Prophylaxis
D.R. Boulware and Others
In this double-blind, randomized trial, 821 asymptomatic persons with a high-risk or moderate-risk exposure to SARS-CoV-2 were assigned to receive hydroxychloroquine or placebo within 4 days after the exposure. No benefit in preventing illness compatible with Covid-19 was found.
Jun 03Editorial Hydroxychloroquine for the Prevention of Covid-19 — Searching for Evidence
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Original Article
Observational Study of Hydroxychloroquine in Covid-19
J. Geleris and Others
Among 1376 patients with Covid-19 admitted to a New York City hospital, 59% were treated with hydroxychloroquine. Patients selected for treatment were more severely ill. After adjustment for patients’ baseline characteristics, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04; 95% CI, 0.82 to 1.32).
May 07Editorial The Urgency of Care during the Covid-19 Pandemic — Learning as We Go
See Also Chinese Translation in NEJM 医学前沿
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Original Article
Hydroxychloroquine for Covid-19 Prophylaxis
D.R. Boulware and Others
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Original Article Remdesivir for Covid-19 — Preliminary Report J.H. Beigel and Others
In this randomized, double-blind trial in 1063 adults hospitalized with Covid-19, a 10-day course of intravenous remdesivir was superior to placebo in shortening the time to recovery. The estimates of mortality at 14 days were 7.1% in the remdesivir group and 11.9% in the placebo group.
May 22Editorial Remdesivir — An Important First Step
See Also Chinese Translation in NEJM 医学前沿
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Original Article
Compassionate-Use Remdesivir for Severe Covid-19
J. Grein and Others
A cohort of patients with severe Covid-19 received treatment with remdesivir under a compassionate-use protocol. Improvement in oxygen-support status was observed in 68% of patients, and overall mortality was 13% over a median follow-up of 18 days.
Apr 10Correspondence Compassionate Use of Remdesivir in Covid-19
See Also Chinese Translation in NEJM 医学前沿
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Original Article
Oral Lopinavir–Ritonavir for Severe Covid-19
B. Cao and Others
Investigators in China report the results of an open-label, randomized clinical trial of lopinavir–ritonavir for the treatment of Covid-19 in 199 infected adult patients. The primary end point was the time to clinical improvement.
May 07Editorial Covid-19 — The Search for Effective Therapy
Correspondence A Trial of Lopinavir–Ritonavir in Covid-19See Also Chinese Translation in NEJM 医学前沿
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Original Article
Compassionate-Use Remdesivir for Severe Covid-19
J. Grein and Others
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Original Article
Remdesivir for 5 Days or 10 Days in Covid-19
J.D. Goldman and Others
A randomized trial comparing a 5-day course of intravenous remdesivir with a 10-day course in patients with Covid-19 pneumonia and hypoxemia who were not yet receiving mechanical ventilation showed no significant differences in outcome related to the duration of treatment.
May 27Editorial Remdesivir — An Important First Step
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Clinical Implications of Basic Research
Dynamic Developments in Screening Candidate Drugs
J.M. Parks and J.C. Smith
Molecular-dynamics simulations together with virtual high-throughput screening provide a means of quick evaluation of existing drugs for antiviral activity. The authors explain how these methods serve in the quest for drugs to treat Covid-19.
May 20See Also Chinese Translation in NEJM 医学前沿
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Original Article
Remdesivir for 5 Days or 10 Days in Covid-19
J.D. Goldman and Others
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Perspective
False Negative Tests for SARS-CoV-2 Infection
S. Woloshin, N. Patel, and A.S. Kesselheim
Diagnostic testing for SARS-CoV-2 will help in safely reopening the country, but only if tests are highly accurate. Several steps need to be taken by manufacturers and the FDA to ensure that tests offer reliable guidance regarding the likelihood of spreading infection.
Jun 05 -
Perspective
Waiting for Certainty on Covid-19 Antibody Tests
M.C. Weinstein and Others
Despite our inability to guarantee the accuracy of an immunity-certification process, failing to take action to identify people who could safely return to the workplace is itself an action that carries profound costs and health consequences.
Jun 05
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Perspective
False Negative Tests for SARS-CoV-2 Infection
S. Woloshin, N. Patel, and A.S. Kesselheim
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Correspondence Patient-Collected Swabs for SARS-CoV-2 Testing Y.-P. Tu and Others
Tongue, nasal, and mid-turbinate swabs to detect SARS-CoV-2 were collected by 530 outpatients before a health care worker collected nasopharyngeal swabs from these patients. Both the mid-turbinate and nasal samples collected by the patients themselves may be clinically acceptable, with estimated sensitivities above 90%.
Jun 03
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Videos in Clinical Medicine
How to Obtain a Nasopharyngeal Swab Specimen
F.M. Marty, K. Chen, and K.A. Verrill
Collecting specimens from the surface of the respiratory mucosa with nasopharyngeal swabs is a procedure used to diagnose Covid-19 as well as other respiratory viral infections and certain bacterial infections in adults and children. This video describes the collection of specimens for detection of Covid-19.
May 28Correspondence How to Obtain a Nasopharyngeal Swab Specimen
See Also Chinese Translation in NEJM 医学前沿
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Perspective
Putting the Public Back in Public Health
A.T. Chan and J.S. Brownstein
There is a high unmet need for better estimates of communities’ burden of Covid-19 to guide decisions about reopening societies. Fortunately, some mobile symptom-surveillance tools can be used for predictive modeling to address this critical priority.
Jun 05
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Videos in Clinical Medicine
How to Obtain a Nasopharyngeal Swab Specimen
F.M. Marty, K. Chen, and K.A. Verrill
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Perspective
“Is It Safe for Me to Go to Work?”
M.R. Larochelle
A strategy to protect at-risk workers requires a framework for counseling patients about the risks posed by continuing to work, policy changes to ensure financial protections for people kept out of work, and a data-driven plan for safe reentry into the workforce.
May 26 -
Perspective
Legal Authority for States’ Stay-at-Home Orders
M.A. Hall, M.M. Mello, and D.M. Studdert
To prevent officials from trampling civil liberties during emergencies, some checks on their power are essential, but in striking down the state’s renewed stay-at-home order, the Wisconsin Supreme Court misapprehended how such checks ought to function.
Jun 03
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Perspective
“Is It Safe for Me to Go to Work?”
M.R. Larochelle
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Correspondence
Universal Masking in the Covid-19 Era
M. Klompas, C.A. Morris, and E.S. Shenoy
Klompas and colleagues write that they understand that some people are citing their Perspective article (published on April 1) as support for discrediting widespread masking. In truth, the intent of their article was to push for more masking, not less.
Jun 03Perspective Universal Masking in the Covid-19 Era
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Sounding Board
Allocating Scarce Medical Resources for Covid-19
E.J. Emanuel and Others
The Covid-19 pandemic has already stressed health care systems throughout the world, requiring rationing of medical equipment and care. The authors discuss the ethical values relevant to health care rationing and provide six recommendations to guide fair allocation of scarce medical resources during the pandemic.
May 21Correspondence Allocating Medical Resources in the Time of Covid-19
Perspective The Toughest Triage — Allocating Ventilators in a Pandemic
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Correspondence
Universal Masking in the Covid-19 Era
M. Klompas, C.A. Morris, and E.S. Shenoy
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Videos in Clinical Medicine Personal Protective Equipment and Covid-19 R. Ortega and Others
This video demonstrates a procedure for donning and doffing one type of PPE recommended by the CDC for use in hospitals to minimize the risk of exposure to infectious material during the care of patients with Covid-19.
May 19
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Correspondence
Covid-19 Notes
Transforming ORs into ICUs
A.W. Peters, K.S. Chawla, and Z.A. Turnbull
In the epicenter of New York City, a medical center rapidly transforms unused facilities to increase its critical care capacity. In the process, it repurposes equipment, retrains staff, modifies ventilation systems, and constructs new walls.
May 07 -
Correspondence
Covid-19 Notes
Repurposing a Pediatric ICU for Adults
P.H. Yager, K.A. Whalen, and B.M. Cummings
A Boston hospital transformed its pediatric ICU to treat adult patients. Preserving the original PICU team minimized unnecessary changes to personnel and the environment and helped with a rapid transition.
May 28
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Correspondence
Covid-19 Notes
Transforming ORs into ICUs
A.W. Peters, K.S. Chawla, and Z.A. Turnbull
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Correspondence
Covid-19 Notes
Surgery Scheduling in a Crisis
M. Argenziano, K. Fischkoff, and C.R. Smith
After a New York medical center converted most ORs into ICUs and cut operative time by 90%, clinicians developed a triage system to guide scheduling decisions. Their approach considered both clinical urgency and expected intensity of resource utilization.
May 22 -
Correspondence
Covid-19 Notes
In Pursuit of PPE
A.W. Artenstein
A chief physician executive finds himself involved in the complexities of trying to secure a shipment of much-needed personal protective equipment for his hospital. In the end, it seemed like a scene from a gangster movie.
Apr 30
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Correspondence
Covid-19 Notes
Surgery Scheduling in a Crisis
M. Argenziano, K. Fischkoff, and C.R. Smith
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Correspondence Protective Shield for Intubation R. Canelli and Others
A four-sided plexiglass box with access holes for an operator was used to provide additional protection for an operator performing intubation. The box reduced the amount of material expelled from a simulated patient cough that ended up on the operator. This letter is accompanied by a video showing the simulation.
Apr 03Correspondence More on Barrier Enclosure during Endotracheal Intubation
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Correspondence
Covid-19 Notes
Staying Ahead of the Wave
A.J. Singer, E.J. Morley, and M.C. Henry
This report from a hard-hit hospital on Long Island, New York, explains how the local coronavirus epidemic led to rapid innovation. The ED set up a forward-triage and treatment unit and a split-flow process to expedite care. Ways were found to produce face shields and hand sanitizer and to sterilize used N95 respirators.
Apr 30 -
Correspondence
Covid-19 Notes
Opening Up New Supply Chains
M.L. Zeidel, C. Kirk, and B. Linville-Engler
A Massachusetts economic-development agency assembled a diverse team to help manufacturers open up new supply chains and start producing materials needed to alleviate critical shortages and fight the epidemic.
May 21
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Correspondence
Covid-19 Notes
Staying Ahead of the Wave
A.J. Singer, E.J. Morley, and M.C. Henry
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Special Article
Black Patients and White Patients with Covid-19
E.G. Price-Haywood and Others
A retrospective cohort study analyzed data from a Louisiana health system whose population is 31% black non-Hispanic. A total of 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died from the disease were black. Black race was not associated with higher in-hospital mortality after adjustment for patients’ baseline characteristics.
May 27
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Special Article
Black Patients and White Patients with Covid-19
E.G. Price-Haywood and Others
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Perspective
Racial Health Disparities and Covid-19
M. Chowkwanyun and A.L. Reed, Jr.
In documenting Covid-19 racial disparities, we must contextualize such data with adequate analysis. Disparity figures without explanatory context can perpetuate harmful myths and misunderstandings that actually undermine the goal of eliminating health inequities.
May 06
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Perspective
Racial Health Disparities and Covid-19
M. Chowkwanyun and A.L. Reed, Jr.
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Original Article
RAAS Inhibitors and Risk of Covid-19
H.R. Reynolds and Others
There is concern that patients taking renin–angiotensin–aldosterone system blockers have an increased risk of Covid-19, because angiotensin-converting enzyme 2 is a receptor for the virus. This study showed no increase in likelihood of a positive Covid-19 test or severe Covid-19 in patients taking any of five common classes of antihypertensive drugs.
May 01Editorial Inhibitors of the Renin–Angiotensin–Aldosterone System and Covid-19
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Original Article
Renin–Angiotensin–Aldosterone System Blockers and Covid-19
G. Mancia and Others
This population-based case–control study from northern Italy shows that the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 because of a higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors and ARBs affected the risk of Covid-19.
May 01
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Original Article
RAAS Inhibitors and Risk of Covid-19
H.R. Reynolds and Others
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Special Report RAAS Inhibitors in Patients with Covid-19 M. Vaduganathan and Others
The effects of renin–angiotensin–aldosterone system blockers on angiotensin-converting enzyme 2 levels and activity in humans are uncertain. The authors hypothesize that ACE2 may be beneficial rather than harmful during lung injury and suggest that RAAS-inhibitor withdrawal may be harmful in some high-risk patients with known or suspected Covid-19.
Apr 23Correspondence Renin–Angiotensin–Aldosterone System Inhibitors in Covid-19
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Correspondence
ACE Inhibitors or ARBs and Incident Influenza
S.-C. Chung, R. Providencia, and R. Sofat
Certain influenza strains and SARS-CoV-2 gain access to cells by means of the ACE2 receptor. In this database study in the United Kingdom, investigators observed a null-to-protective effect on influenza susceptibility among those taking ACE inhibitors or angiotensin-receptor blockers, possibly owing to mechanisms relevant to infection with coronaviruses, including SARS-CoV-2.
May 08
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Correspondence
ACE Inhibitors or ARBs and Incident Influenza
S.-C. Chung, R. Providencia, and R. Sofat
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Correspondence
Retraction
Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19
M.R. Mehra and Others
In this letter, Mehra and colleagues request retraction of their article, “Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19,” because they were unable to validate the primary data sources underlying the article.
Jun 04Original Article Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19
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Correspondence
Retraction
Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19
M.R. Mehra and Others
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Correspondence
Covid-19 Notes
The South African Response to the Pandemic
S.S. Abdool Karim
South Africa’s early interventions have delayed the peak of Covid-19 cases. The author describes the eight stages of the national response and ongoing challenges.
May 29 -
Perspective
Africa in the Path of Covid-19
W.M. El-Sadr and J. Justman
Despite intensive preparations by African countries that are no strangers to epidemics, we should have no illusions that Africa can confront the Covid-19 threat alone. Coordinated global support is essential in the face of the pandemic, and the time to act is now.
Apr 17
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Correspondence
Covid-19 Notes
The South African Response to the Pandemic
S.S. Abdool Karim
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Original Article SARS-CoV-2 in Iceland D.F. Gudbjartsson and Others
Despite timely implementation of testing for SARS-CoV-2 virus, a contact-tracing scheme, and social-distancing measures, infection has spread in Iceland. However, there was no detected increase in the proportion of infected persons between March 13 and April 4, 2020.
Apr 14
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Correspondence
Covid-19 Notes
Suppressing the Epidemic in New South Wales
J.M. McAnulty and K. Ward
Australia appears to have largely suppressed the first wave of Covid-19 infections. The authors describe key responses, including travel restrictions, effective identification and isolation of infected people, and quarantine of those who have been exposed.
May 21
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Correspondence
Covid-19 Notes
Suppressing the Epidemic in New South Wales
J.M. McAnulty and K. Ward
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Correspondence
Covid-19 Notes
Adaptations and Lessons in the Province of Bergamo
S. Fagiuoli, F.L. Lorini, and G. Remuzzi
A referral hospital in the hardest-hit region of Italy had to manage a continuously increasing number of daily admissions for Covid-19 after delayed responses in the province allowed for rapid spread of the virus. Nineteen physicians in the province died.
May 21
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Correspondence
Covid-19 Notes
Adaptations and Lessons in the Province of Bergamo
S. Fagiuoli, F.L. Lorini, and G. Remuzzi
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Correspondence
Covid-19 Notes
French Pandemic Resistance
C. Haug
Just over 4 years after its ED faced a flood of patients severely wounded in a terrorist attack, a Paris hospital makes large-scale changes to care for people with Covid-19 while preserving access for others needing urgent treatment.
May 07
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Correspondence
Covid-19 Notes
French Pandemic Resistance
C. Haug
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Correspondence
Covid-19 in New York City
P. Goyal and Others
In this series of 393 consecutive patients admitted with Covid-19 to two New York City hospitals from March 3 to March 27, a third of patients received invasive mechanical ventilation, 10% of patients died, and 24% were still hospitalized as of April 10.
Apr 17
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Correspondence
Covid-19 in New York City
P. Goyal and Others
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Perspective
Long-Term Care Policy after Covid-19
R.M. Werner, A.K. Hoffman, and N.B. Coe
Covid-19 has exposed the cracks in the U.S. system of providing and funding long-term care, and there are no easy fixes. We need comprehensive policies that take the care of aging Americans seriously and fund it accordingly and in a wider range of settings.
May 27
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Perspective
Long-Term Care Policy after Covid-19
R.M. Werner, A.K. Hoffman, and N.B. Coe
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Original Article
Covid-19 Outbreak at a Long-Term Care Facility
T.M. McMichael and Others
On February 28, 2020, public health officials in the Seattle area were informed of a Covid-19 infection at a long-term care facility. An investigation identified 167 infected persons associated with the facility, including residents, health care personnel, and visitors; more than a third of the 101 residents identified died.
May 21
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Original Article
Covid-19 Outbreak at a Long-Term Care Facility
T.M. McMichael and Others
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Clinical Practice
Mild or Moderate Covid-19
R.T. Gandhi, J.B. Lynch, and C. del Rio
The diagnosis of Covid-19 is usually based on detection of SARS-CoV-2 by PCR testing (most commonly of a nasopharyngeal swab); false negatives may occur. Available data to guide treatment have substantial limitations; randomized trials of several treatments (e.g., hydroxychloroquine, remdesivir, and favipiravir) are ongoing.
Apr 24 -
Case Records of the Massachusetts General Hospital
A Man with Acute Respiratory Failure and Unclear Goals of Care
J.C. Jacobsen and Others
A 74-year-old man with lymphoma was admitted to the hospital during the Covid-19 pandemic because of rapidly progressive respiratory failure. Several years earlier, when he had been critically ill, he had expressed a desire for “do not resuscitate” status. More recently, he had indicated that he would try all therapies that may be helpful. A consultation was requested.
May 27
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Clinical Practice
Mild or Moderate Covid-19
R.T. Gandhi, J.B. Lynch, and C. del Rio
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Clinical Practice Severe Covid-19 D.A. Berlin, R.M. Gulick, and F.J. Martinez
Patients with severe Covid-19 should be closely monitored regarding the need for endotracheal intubation; intubated patients should receive lung-protective ventilation. Data from randomized, controlled trials are awaited to inform the use of antiviral and immunomodulatory therapies; preliminary data support benefits of remdesivir in this population.
May 15See Also Chinese Translation in NEJM 医学前沿
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Case Records of the Massachusetts General Hospital
A Man with Covid-19 and Acute Kidney Injury
M.E. Sise and Others
A 68-year-old man was admitted to the hospital with fever, shortness of breath, and acute kidney injury. Testing of a nasopharyngeal swab for SARS-CoV-2 RNA was positive. Respiratory failure and hypotension developed. The creatinine level was 6.9 mg per deciliter (normal range, 0.6 to 1.5), and the urea nitrogen level 111 mg per deciliter (normal range, 8 to 25). Management decisions were made.
May 28
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Case Records of the Massachusetts General Hospital
A Man with Covid-19 and Acute Kidney Injury
M.E. Sise and Others
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Perspective
A Shift on the Front Line
S. Castelletti
Dressed in the protective gear, you feel like a soldier about to jump from a plane, hoping your parachute will open. As the hours go by, made longer by thirst, hunger, and the need to relieve yourself, you can’t wait to take it off and breathe. We all just want to breathe.
Jun 04
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Perspective
A Shift on the Front Line
S. Castelletti
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Correspondence Acute Myocardial Infarction and Covid-19 M.D. Solomon and Others
Data from the Kaiser Permanente Northern California health care system were used to compare rates of hospitalization for acute MI from March 4 through April 14, 2020 (the Covid-19 period) with rates from the same period in 2019 and rates from an earlier period in 2020. Rates of hospitalization for acute MI decreased by up to 48% during the Covid-19 period.
May 19
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Correspondence
Use of Stroke Imaging during the Covid-19 Pandemic
A.P. Kansagra and Others
The authors reviewed an imaging database used to determine whether patients with acute stroke were eligible to undergo endovascular thrombectomy. They found a 39% decrease in the use of this imaging from a 29-day prepandemic period in February 2020 to a 14-day early-pandemic period from late March through early April.
May 08 -
Correspondence
Covid-19 Cases
Stroke in Young Patients with Covid-19
T.J. Oxley and Others
Five patients younger than 50 years of age with large-vessel stroke and Covid-19 infection presented to a health system in New York City over a 2-week period. The authors report the patients’ clinical characteristics, including the presence or absence of symptoms of Covid-19.
Apr 28
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Correspondence
Use of Stroke Imaging during the Covid-19 Pandemic
A.P. Kansagra and Others
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Correspondence
Neurologic Features in SARS-CoV-2 Infection
J. Helms and Others
In a consecutive series of 64 patients with Covid-19 and ARDS, 58 of whom underwent neurologic examination, severe agitation and corticospinal signs were common. In 2 of 13 patients, MRI of the brain showed small acute strokes, and in 1 patient, imaging showed a subacute stroke.
Apr 15Correspondence More on Neurological Features in Severe Covid-19 Infection
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Correspondence
Neurologic Features in SARS-CoV-2 Infection
J. Helms and Others
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Correspondence
ST-Segment Elevation in Covid-19
S. Bangalore and Others
Eighteen patients with Covid-19 presented with ST-segment elevation on ECG or had it develop during hospitalization. Eight patients received a diagnosis of acute myocardial infarction, and 10 had noncoronary myocardial injury. Thirteen patients died in the hospital.
Apr 17
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Correspondence
ST-Segment Elevation in Covid-19
S. Bangalore and Others
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Correspondence
Out-of-Hospital Cardiac Arrest and Covid-19
E. Baldi and Others
From February 21 through April 1, 2019, a total of 229 cases of out-of-hospital cardiac arrest were reported in four provinces of Lombardy, Italy. During the same period in 2020 (the first 40 days of the Covid-19 epidemic), 362 cases were reported — a 58% increase. Of the additional 133 cases in 2020, a total of 103 involved suspected or diagnosed Covid-19.
Apr 29
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Correspondence
Out-of-Hospital Cardiac Arrest and Covid-19
E. Baldi and Others
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Correspondence
Acute Coronary Syndrome during Covid-19 Outbreak
O. De Filippo and Others
During the Covid-19 outbreak in northern Italy, the daily rate of admissions for acute coronary syndrome at 15 hospitals was significantly lower than the rate during two control intervals (13.3 admissions vs. 18.0 and 18.9 admissions for the two control periods).
Apr 28
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Correspondence
Acute Coronary Syndrome during Covid-19 Outbreak
O. De Filippo and Others
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Correspondence Aerosol and Surface Stability of SARS-CoV-2 N. van Doremalen and Others
In this research letter, investigators report on the stability of SARS-CoV-2 and SARS-CoV-1 under experimental conditions. The viability of the two viruses was assessed in aerosols and on plastic, stainless steel, copper, and cardboard.
Apr 16Correspondence Stability and Viability of SARS-CoV-2
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Correspondence
Oral Fluid Droplets Generated during Speech
P. Anfinrud and Others
In this experiment, investigators used a laser in a darkened box to visualize droplets that were generated during speech. The droplets decreased in number with lower-amplitude speech and were almost eliminated when the speaker’s mouth was covered with a damp cloth (shown in a video).
Apr 15See Also Chinese Translation in NEJM 医学前沿
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Correspondence
Aerosols and Transmission of SARS-CoV-2
M. Meselson
With reference to a letter about the use of laser light scattering to visualize droplets that emanate during speech, this author describes the nature of aerosols and their potential for transmission of SARS-CoV-2.
Apr 15See Also Chinese Translation in NEJM 医学前沿
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Correspondence
Oral Fluid Droplets Generated during Speech
P. Anfinrud and Others
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Correspondence
Children with Covid-19 in Italy
N. Parri, M. Lenge, and D. Buonsenso
This letter describes a cohort of 100 children younger than 18 years of age with RT-PCR–confirmed Covid-19 who were assessed in 17 pediatric emergency departments in Italy. The descriptive results are compared with previously published results involving children in China and the United States.
May 01 -
Correspondence
SARS-CoV-2 Infection in Children
X. Lu and Others
In this report, investigators in Wuhan, China, describe the spectrum of Covid-19 illness in children under the age of 16 years. Of 1391 children assessed and tested over a period of 4 weeks, 171 (12.3%) were confirmed to have SARS-CoV-2 infection.
Apr 23See Also Chinese Translation in NEJM 医学前沿
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Correspondence
Children with Covid-19 in Italy
N. Parri, M. Lenge, and D. Buonsenso
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Correspondence
Children with Covid-19 in Wuhan, China
W. Liu and Others
A retrospective analysis of routine surveillance data involving children hospitalized in central Wuhan, China, for acute lower respiratory infection in early January 2020 revealed six cases of Covid-19. The authors report clinical characteristics of the children and laboratory data.
Apr 02See Also Chinese Translation in NEJM 医学前沿
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Perspective
Feeding Low-Income Children during the Pandemic
C.G. Dunn and Others
U.S. government programs serve nearly 35 million children daily, delivering vital nutrition and financial assistance to families in need. With such programs interrupted, an essential element of the Covid-19 response will be feeding children from low-income families.
Apr 30
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Correspondence
Children with Covid-19 in Wuhan, China
W. Liu and Others
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Original Article
Brief Report
First U.S. Confirmed Case of 2019-nCoV Infection
M.L. Holshue and Others
A healthy 35-year-old man who had visited Wuhan, China, presented with cough and fever that progressed to pneumonia. This report describes the diagnosis, clinical course, and management of the condition. The case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels.
Mar 05Correspondence First Case of Covid-19 in the United States
See Also Chinese Translation in NEJM 医学前沿
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Correspondence
Detection of Covid-19 through a Citywide Surveillance Platform
H.Y. Chu and Others
The Seattle Flu study, initiated in 2018, mailed kits for home collection of midnasal swabs to people reporting respiratory symptoms. From January 1 through March 9, 2020, specimens from 2,353 people were also tested for SARS-CoV-2; 25 (1.1%) tested positive. A specimen collected on February 24, 2020, was the first documented U.S. case of community transmission at the time.
May 01
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Original Article
Brief Report
First U.S. Confirmed Case of 2019-nCoV Infection
M.L. Holshue and Others
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Correspondence
SARS-CoV-2 Testing in Obstetrical Patients
D. Sutton and Others
Among 215 pregnant women who were admitted to a New York hospital for delivery and who underwent universal testing for SARS-CoV-2, more than one of eight asymptomatic women had positive results, and most of the women with Covid-19 were asymptomatic.
Apr 13See Also Chinese Translation in NEJM 医学前沿
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Correspondence
Pregnant Women with Covid-19 in Wuhan, China
L. Chen and Others
Among 118 pregnant women with Covid-19 in Wuhan, China, the vast majority had a mild course of disease.
Apr 17See Also Chinese Translation in NEJM 医学前沿
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Correspondence
SARS-CoV-2 Testing in Obstetrical Patients
D. Sutton and Others
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Correspondence
Covid-19 Cases
Late-Onset Neonatal Sepsis with Covid-19
A. Coronado Munoz and Others
The condition of a 3-week-old boy with nasal congestion, tachypnea, and reduced feeding deteriorated, and he underwent intubation and received hemodynamic support in the pediatric intensive care unit. Chest radiography showed bilateral linear opacities, and a nasal swab was positive for SARS-CoV-2.
Apr 22 -
Correspondence
Covid-19 Cases
Uncomplicated Delivery in a Patient with Covid-19
S.N. Iqbal and Others
The peripartum care of a woman with Covid-19 at 39 weeks of gestation is described. The woman and the neonate were discharged home on hospital day 6. Care was taken to avoid infecting hospital staff, and 7 days after the delivery, no caregivers appeared to be infected.
Apr 16
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Correspondence
Covid-19 Cases
Late-Onset Neonatal Sepsis with Covid-19
A. Coronado Munoz and Others
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Original Article Characteristics of Covid-19 in China W. Guan and Others
In this study, researchers describe the clinical characteristics of coronavirus disease 2019 in a selected cohort of 1099 patients with laboratory-confirmed disease throughout mainland China during the first 2 months of the current outbreak.
Feb 28Correspondence Clinical Characteristics of Covid-19 in China
See Also Chinese Translation in NEJM 医学前沿
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Original Article
Early Transmission Dynamics of 2019-nCoV
Q. Li and Others
The authors provide an epidemiologic analysis of the first 425 confirmed cases of infection with the novel coronavirus in Wuhan, China. This analysis provides estimates of the epidemic doubling time and the basic reproductive number and shows clear evidence of sustained human-to-human transmission.
Mar 26See Also Chinese Translation in NEJM 医学前沿
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Original Article
Brief Report
A Novel Coronavirus in China
N. Zhu and Others
The authors report the emergence and isolation of a previously unknown betacoronavirus, the seventh member of the family of coronaviruses that infect humans, in Wuhan, China. Findings in three patients are described.
Feb 20Editorial Another Decade, Another Coronavirus
See Also Chinese Translation in NEJM 医学前沿
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Original Article
Early Transmission Dynamics of 2019-nCoV
Q. Li and Others
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Correspondence
SARS-CoV-2 Infection in Travelers Returning from Wuhan
O.-T. Ng and Others
Data on travelers returning from areas with many cases of Covid-19 may be useful in estimating incidence. The authors report follow-up data on 94 persons who boarded an evacuation flight from Wuhan, China, to Singapore on January 30, 2020.
Apr 09See Also Chinese Translation in NEJM 医学前沿
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Correspondence
SARS-CoV-2 Infection in Travelers Returning from Wuhan
O.-T. Ng and Others
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Correspondence
Death from Covid-19 of Health Workers in China
M. Zhan and Others
This report describes the deaths from Covid-19 of 23 health care workers, including physicians, surgeons, a nurse, and an electrocardiography technician. Only 2 of the health care workers were physicians in respiratory medicine who had been specifically assigned to treat patients with Covid-19. Eleven had come out of retirement to serve as clinicians.
Apr 15
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Correspondence
Death from Covid-19 of Health Workers in China
M. Zhan and Others