The New England Journal of Medicine Coronavirus (Covid-19)

Coronavirus (Covid-19) A collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary. ORIGINAL ARTICLE Oral Lopinavir–Ritonavir for Severe Covid-19 B. Cao ...

Coronavirus (Covid-19)

A collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary.

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.

MAR 18
Editorial Covid-19 — The Search for Effective Therapy

EDITORIAL
New Research on Possible Treatments for Covid-19
E.J. Rubin, L.R. Baden, and S. Morrissey
In this audio interview conducted on March 18, 2020, the editors look beyond supportive care to evaluate possible treatments for the disease.

MAR 19
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.

MAR 18
CORRESPONDENCE
Aerosol and Surface Stability of SARS-CoV-2
N. van Doremalen and Others
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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.

MAR 17
PERSPECTIVE
Covid-19 — The Law and Limits of Quarantine
W.E. Parmet and M.S. Sinha
Community transmission of the new coronavirus is occurring in several parts of the United States, and travel bans and mandatory quarantines alone cannot end the outbreak. Many public health and legal scholars believe that more constructive tools are needed.

MAR 18
PERSPECTIVE
Facing Covid-19 in Italy
L. Rosenbaum
Physicians in northern Italy have learned some painful lessons about rationing care during an epidemic. As health care systems work out ethical allocation principles, it seems clear that only with transparency and inclusivity can public trust and cooperation be achieved.

MAR 18
PERSPECTIVE
Am I Part of the Cure or Am I Part of the Disease?
C. Rose
A front-line physician wonders how he can protect a vulnerable member of his household from the pathogens he’s exposed to in the ED — especially in a rapidly spreading pandemic of a novel virus and amid so many uncertainties.

MAR 18
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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.

MAR 12
CORRESPONDENCE
Aerosol and Surface Stability of SARS-CoV-2
N. van Doremalen and Others
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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.

MAR 17
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.

MAR 12
PERSPECTIVE
Virtually Perfect? Telemedicine for Covid-19
J.E. Hollander and B.G. Carr
Telemedicine’s payment and regulatory structures, licensing, credentialing, and implementation take time to work through, but health systems that have already invested in telemedicine are well positioned to ensure that patients with Covid-19 receive the care they need.

MAR 11
PERSPECTIVE
History in a Crisis — Lessons for Covid-19
D.S. Jones
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The history of human responses to epidemics carries various lessons for our current situation. Two of the more disheartening ones are that stigmatization follows closely on the heels of pathogens and that outbreaks too often claim the lives of health care providers.

MAR 12
PERSPECTIVE
Responding to Covid-19
B. Gates
Bill Gates writes that in any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. In the case of the Covid-19 pandemic, the first point is especially pressing, but the second has crucial long-term consequences.

FEB 28
See Also Chinese Translation in NEJM 医学前沿

EDITORIAL
Covid-19 — Navigating the Uncharted
A.S. Fauci, H.C. Lane, and R.R. Redfield
The authors comment on the early clinical features and epidemiology of cases reported in Wuhan, China, along with current mortality data, noting that the outbreak is a stark reminder of the need for constant surveillance, prompt diagnosis, and robust research.

FEB 28
See Also Chinese Translation in NEJM 医学前沿

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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 28
See Also Chinese Translation in NEJM 医学前沿

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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 05
See Also Chinese Translation in NEJM 医学前沿

PERSPECTIVE
Escaping Pandora’s Box — Another Novel Coronavirus
D.M. Morens, P. Daszak, and J.K. Taubenberger
With luck, public health control measures may be able to put the Covid-19 demons back in the jar. If they do not, we face a daunting challenge equal to, or perhaps greater than, that posed by the influenza pandemic of a century ago.

FEB 26
See Also Chinese Translation in NEJM 医学前沿

CORRESPONDENCE
SARS-CoV-2 Viral Load in Upper Respiratory Specimens
L. Zou and Others
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The authors report results of an analysis of nasal and throat swabs from 17 patients in Zhuhai, China, who had received a diagnosis of Covid-19. Higher viral loads soon after symptom onset indicate the need for isolation strategies different from those used for the earlier SARS epidemic.

MAR 19
See Also Chinese Translation in NEJM 医学前沿

CORRESPONDENCE
Coronavirus in Travelers Returning from China
S. Hoehl and Others
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A group of 126 German nationals was evacuated from Wuhan to Frankfurt after screening for symptoms of Covid-19 and was to undergo a 14-day quarantine and additional screening in Frankfurt. The authors discovered evidence of SARS-CoV-2 infection in throat swabs from 2 evacuated persons who had passed the symptoms-based screening.

FEB 18
See Also Chinese Translation in NEJM 医学前沿

PERSPECTIVE
Defining the Epidemiology of Covid-19
M. Lipsitch, D.L. Swerdlow, and L. Finelli
Experience with MERS, pandemic influenza, and other outbreaks has shown that as an epidemic evolves, we face an urgent need to expand public health activities in order to elucidate the epidemiology of the novel virus and characterize its potential impact.

FEB 19
See Also Chinese Translation in NEJM 医学前沿

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CORRESPONDENCE
A Case of Locally Transmitted SARS-CoV-2 in Taiwan
Y.-C. Liu and Others
The authors describe transmission of the novel coronavirus from a woman who had been living for several months in Wuhan, China, to her husband, after her return to their home in Taiwan in January 2020. No secondary case from this couple has been identified.

MAR 12
See 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 20
See Also Chinese Translation in NEJM 医学前沿

CORRESPONDENCE
A Thai Taxi Driver with Covid-19
W.A. Pongpirul and Others
The authors describe a taxi driver in Thailand who was infected with the novel coronavirus, potentially from passengers who were tourists from China, in January 2020. The infection appeared not to have spread to the taxi driver’s family or other close contacts.

MAR 12
See Also Chinese Translation in NEJM 医学前沿

CORRESPONDENCE
2019-nCoV Transmission from Asymptomatic Patient
C. Rothe and Others
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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 05
See Also Chinese Translation in NEJM 医学前沿

EDITORIAL
Medical Journals and the Coronavirus Outbreak
E.J. Rubin and Others
The editors announce expedited handling for submitted manuscripts describing the 2019-nCoV outbreak and make broad recommendations for speed, transparency, and data sharing.

FEB 27
See Also Chinese Translation in NEJM 医学前沿

EDITORIAL
Another Decade, Another Coronavirus
S. Perlman
For the third time in as many decades, a zoonotic coronavirus has crossed species to infect human populations. The genome of the virus, provisionally called 2019-nCoV, has now been sequenced.

FEB 20
See Also Chinese Translation in NEJM 医学前沿

CORRESPONDENCE
Human-to-Human Coronavirus Transmission in Vietnam
L.T. Phan and Others
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The authors describe transmission of 2019-nCoV from a father, who had flown with his wife from Wuhan to Hanoi, to the son, who met his father and mother in central Vietnam and shared a hotel room with them for 3 days. The findings suggest that the incubation period in the son may have been 3 days or less.

FEB 27
See Also Chinese Translation in NEJM 医学前沿

PERSPECTIVE
A Novel Coronavirus Emerging in China
V.J. Munster and Others
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A novel coronavirus, designated as 2019-nCoV, emerged in Wuhan, China, at the end of 2019. Although many details of the emergence of this virus remain unknown, it has put global public health institutions on high alert.

FEB 20
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.

JAN 29
See Also Chinese Translation in NEJM 医学前沿

NEJM Coronavirus Update
Listen to conversations with editors Eric Rubin and Lindsey Baden on the current coronavirus outbreak.
CLINICAL CONVERSATIONS
Dr. Anthony Fauci on Covid-19publication image
Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, on talking with patients about Covid-19.

MAR 10
Link to HealthMap of Coronavirus OutbreakHealthMap of the Coronavirus Outbreak
The HealthMap team from Boston Children’s Hospital tracks publicly reported confirmed and suspected cases of Covid-19 throughout the world. The map is automatically updated to show current data.
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Panel Members - Epidemics Going ViralEpidemics Going Viral: Innovation vs. Nature
In April 2018, a group of renowned researchers, clinicians, public health officials, and others with first-hand experience dealing with epidemics explored the complex challenges of global health emergencies, as well as potential solutions. Watch the video.
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Resources

World Health Organization
Coronavirus Disease (COVID-19) Outbreak
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Centers for Disease Control and Prevention
Coronavirus Disease 2019 (COVID-19)
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Chinese Centers for Disease Control
Tracking the Epidemic
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University of Washington HGIS Lab
Novel Coronavirus Infection Map — Global Trend
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Journal Watch Summaries

MARCH 17, 2020
Pharyngeal and Nasal Swabs May Not Have Adequate Sensitivity for SARS-CoV-2
MARCH 13, 2020
COVID-19 Incubation Period: An Update
MARCH 12, 2020
Psychological Effects of Quarantine: A Qualitative “Rapid Review”
MARCH 9, 2020
Preventing Nosocomial Spread of SARS-CoV-2: Wash Your Hands and Clean the Room
MARCH 6, 2020
Detection of SARS-CoV-2 Nucleic Acid in Throat Swabs After Clinical Recovery
View more Journal Watch summaries »

More on Coronaviruses
ORIGINAL ARTICLEAUG 28, 2014
Transmission of MERS-Coronavirus in Household Contacts
C. Drosten and Others
N Engl J Med 2014; 371:828-835
Defining transmission dynamics of the Middle East respiratory syndrome coronavirus (MERS-CoV) is important for public health measures. In this report, potential transmission to household contacts of 26 index patients with MERS-CoV infection is investigated.

ORIGINAL ARTICLE
BRIEF REPORT
JUN 26, 2014
Evidence for Camel-to-Human Transmission of MERS Coronavirus
E.I. Azhar and Others
N Engl J Med 2014; 370:2499-2505
The source of Middle East respiratory syndrome coronavirus infection in humans is unclear, although bats and camels are suspected animal reservoirs. In this report, direct transmission of a fatal human case is tightly linked to a camel by epidemiologic, serologic, and virologic data.

ORIGINAL ARTICLEAUG 01, 2013
Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus
A. Assiri and Others
N Engl J Med 2013; 369:407-416
A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases and evidence of person-to-person transmission were identified. The median incubation period was 5.2 days.

Editorial Person-to-Person Spread of the MERS Coronavirus — An Evolving Picture

ORIGINAL ARTICLE
BRIEF REPORT
JUN 27, 2013
Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections
Z.A. Memish and Others
N Engl J Med 2013; 368:2487-2494
A novel coronavirus (MERS-CoV) was recently identified as the cause of severe respiratory disease. In this report from Saudi Arabia, a family cluster of infection over a 6-week period is described, suggesting possible limited person-to-person transmission.

ORIGINAL ARTICLE
BRIEF REPORT
NOV 08, 2012
Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia
A.M. Zaki and Others
N Engl J Med 2012; 367:1814-1820
On June 24, 2012, a 60-year-old man died of progressive respiratory infection in Saudi Arabia. A novel coronavirus was identified as a potential cause of this severe illness. Subsequently, a second patient was reported to have severe illness associated with this coronavirus.

Editorial Emerging Human Coronaviruses — Disease Potential and Preparedness

ORIGINAL ARTICLEMAY 15, 2003
A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome
T.G. Ksiazek and Others
N Engl J Med 2003; 348:1953-1966
This report summarizes the laboratory studies undertaken to identify the etiologic agent of the worldwide outbreak of the severe acute respiratory syndrome (SARS). In specimens from patients from seven countries, a coronavirus was identified by electron microscopy. The virus is only distantly related to previously sequenced coronaviruses. From serologic studies it appears that this virus has not previously circulated in humans.

Perspective SARS-Associated Coronavirus
Perspective Managing SARS amidst Uncertainty

ORIGINAL ARTICLEMAY 15, 2003
Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome
C. Drosten and Others
N Engl J Med 2003; 348:1967-1976
This study used cell culture and molecular techniques to identify the infectious agent associated with SARS. A novel coronavirus was found in multiple samples from 18 patients but in no specimens from control subjects. In the patients there were high concentrations of viral RNA in sputum, a finding consistent with a highly infectious agent. Low concentrations of viral RNA were also detected in stool.

ORIGINAL ARTICLEMAY 15, 2003
A Cluster of Cases of Severe Acute Respiratory Syndrome in Hong Kong
K.W. Tsang and Others
N Engl J Med 2003; 348:1977-1985
This report describes 10 epidemiologically linked patients in Hong Kong in whom SARS was diagnosed between late February and late March. They presented with fever, cough, malaise, dyspnea, and hypoxemia. Chest radiographs showed progressive airway disease. In the two patients who died, examination of the lungs showed diffuse alveolar damage.

Editorial Case Clusters of the Severe Acute Respiratory Syndrome

ORIGINAL ARTICLEMAY 15, 2003
A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong
N. Lee and Others
N Engl J Med 2003; 348:1986-1994
Over a period of two weeks at a hospital in Hong Kong 69 patients and 69 health care workers were admitted to isolation wards because of SARS. Thirty-two of those with SARS required intensive care, and five died. This report describes the clinical and radiologic features of SARS, and it analyzes the predictors of a poor outcome.

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