Everything we know about COVID-19

(Image: US National Institute of Allergy and Infectious Diseases (NIAID))

This document is almost complete. My strategy here was every medical journal I’ve read or information from a health authority or medical professional working with COVID-19 patients. Sorted by category.

Last Update: 05-15-2020 12:15AM

Duration

• There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. (Sources: Annals of Internal Medicine, ScienceDaily)
• Patients with the new coronavirus keep the pathogen in their respiratory tract for as long as 37 days, a new study found, suggesting they could remain infectious for many weeks.In yet another sign of how difficult the pandemic may be to contain, doctors in China detected the virus’s RNA in respiratory samples from survivors for a median of 20 days after they became infected, they wrote in an article published in the Lancet medical journal. (Sources: Lancet Medical Journal, Bloomberg)
• A new report from the Centers for Disease Control and Prevention (CDC) indicates that traces of the coronavirus were found on cruise ship surfaces after more than two weeks.The study, published on the CDC’s website, found that COVID-19 RNA traces were found on surfaces throughout the Diamond Princess cruise ship as long as 17 days after passengers and crew had disembarked from the voyage. (Sources: CDC.gov, The Hill, Bloomberg)

Origins

• Strong evidence suggests the Wuhan marketplace played an early role in spreading 2019-nCoV, but whether it was the origin of the outbreak remains uncertain. Many of the initially confirmed 2019-nCoV cases—27 of the first 41 in one report, 26 of 47 in another—were connected to the Wuhan market, but up to 45%, including the earliest handful, were not. This raises the possibility that the initial jump into people happened elsewhere. (Sources: Lancet Medical Journal, ScienceMag)
• “If you look at the evolution of the virus in bats and what’s out there now, [the scientific evidence] is very, very strongly leaning toward this could not have been artificially or deliberately manipulated … Everything about the stepwise evolution over time strongly indicates that [this virus] evolved in nature and then jumped species,” Dr. Anthony Fauci, Director of US NIAID says. Based on the scientific evidence, he also doesn’t entertain an alternate theory—that someone found the coronavirus in the wild, brought it to a lab, and then it accidentally escaped. – (Sources: National Geographic, Futurism)
• The coronavirus outbreak in France was not caused by cases imported from China, but from a locally circulating strain of unknown origin, according to a new study by French scientists at the Institut Pasteur in Paris .. Genetic analysis showed that the dominant types of the viral strains in France belonged to a clade – or group with a common ancestor – that did not come from China or Italy .. The Pasteur institute collected samples from more than 90 other patients across France and found the strains all came from one genetic line. Strains following this unique path of evolution had so far only been detected in Europe and the Americas. (Sources: BioRXiv, SCMP)
• One persistent myth is that this virus, called SARS-CoV-2, was made by scientists and escaped from a lab in Wuhan, China, where the outbreak began.A new analysis of SARS-CoV-2 may finally put that latter idea to bed. A group of researchers compared the genome of this novel coronavirus with the seven other coronaviruses known to infect humans: SARS, MERS and SARS-CoV-2, which can cause severe disease; along with HKU1, NL63, OC43 and 229E, which typically cause just mild symptoms, the researchers wrote March 17 in the journal Nature Medicine.“Our analyses clearly show that SARS-CoV-2 is not a laboratory construct or a purposefully manipulated virus,” they write in the journal article. (Sources: Nature Medicine Journal, LiveScience)
• So far, the Mount Sinai researchers have identified seven separate lineages of viruses that entered New York and began circulating. “We will probably find more,” Dr. van Bakel said.The coronavirus genomes are also revealing hints of early cross-country travel. Dr. van Bakel and his colleagues found one New York virus that was identical to one of the Washington viruses found by Dr. Bedford and his colleagues. In a separate study, researchers at Yale found another Washington-related virus. Combined, the two studies hint that the coronavirus has been moving from coast to coast in the US for several weeks. (Sources: MedRXiv, New York Times)
• Scientists are now keen to identify the so-called patient zero, which could help them to trace the source of the coronavirus, which is generally thought to have jumped to humans from a wild animal, possibly a bat. Of the first nine cases to be reported in November – four men and five women – none has been confirmed as being “patient zero”. They were all aged between 39 and 79, but it is unknown how many were residents of Wuhan, the capital of Hubei and the epicentre of the outbreak. (Sources: SCMP)

Strains & Mutations

• At least eight strains of the coronavirus are making their way around the globe, creating a trail of death and disease that scientists are tracking by their genetic footprints.While much is unknown, hidden in the virus’s unique microscopic fragments are clues to the origins of its original strain, how it behaves as it mutates and which strains are turning into conflagrations while others are dying out thanks to quarantine measures.Huddled in once bustling and now almost empty labs, researchers who oversaw dozens of projects are instead focused on one goal: tracking the current strains of the SARS-CoV-2 virus that cause the illness COVID-19. (Sources: NextStrain, USAToday)
• Scientists in Iceland found 40 mutations of the coronavirus among people with the deadly bug in the country — and that seven infections came from people who attended the same soccer match in the UK, according to a report.The researchers discovered the mutations — or small changes in the genome of the virus — by analyzing swabs of COVID-19 patients in the country, where nearly 648 cases had been reported as of Tuesday afternoon, according to the Iceland outlet Information. (Sources: Iceland Ministry of Health, NYPost)
• As of 4 March 2020, the cutoff point for our phylogenetic analysis, the GISAID database had compiled 254 coronavirus genomes, isolated from 244 humans .. The 160 human coronavirus sequences comprised exactly 100 different types. (Sources: National Academy of Sciences (PNAS))
• A new strain of the novel coronavirus appears to be more contagious than the version that gained footing at the beginning of the COVID-19 pandemic, according to a new study led by scientists at Los Alamos National Laboratory (LANL). The new strain, dubbed D614G, surfaced in Europe in February before appearing in the east coast of the United States. It has been the dominant strain across the world since mid-March (Sources: BioRxiv, Salon)
• A new study by one of China’s top scientists has found the ability of the new coronavirus to mutate has been vastly underestimated .. They also confirmed for the first time with laboratory evidence that certain mutations could create strains deadlier than others. “Sars-CoV-2 has acquired mutations capable of substantially changing its pathogenicity,” Li and her collaborators wrote (Sources: MedRXiv, SCMP)
• A coronavirus strain isolated in India carried a mutation that could upend vaccine development around the globe, according to researchers from Australia and Taiwan. .. The study said the change had occurred in part of the spike protein that allows the virus to bind with certain human cells. This structure targets cells containing ACE2, an enzyme found in the lungs which also allowed the severe acute respiratory syndrome (Sars) virus to infect people.Scientists know more about this receptor than any other so had been working on antibodies that target it, but an unexpected structural change could render them useless. .. “[This] means current vaccine development against Sars-CoV-2 is at great risk of becoming futile.” (Sources: ScienceTimes, SCMP)

Symptoms

• The Centers for Disease Control and Prevention just added six new symptoms to its list of known COVID-19 symptoms, including chills, repeated shaking with chills, muscle pain, headaches, and a sore throat.The original list included known symptoms such as fever, cough, and shortness of breath. (Sources: CDC.gov, Futurism)
• [May 4] The World Health Organization added “loss of taste or smell” to its list of “What are the symptoms of COVID-19?” on its Q&A page.
  [April 17] The Centers for Disease Control and Prevention added “new loss of taste or smell” to the list of symptoms that may appear 2-14 days after exposure to the virus on its Symptoms page (Sources: CDC, WHO, American Academy of Otolaryngology, NYT)
• On rounds in a 20-bed intensive care unit one recent day, physician Joshua Denson assessed two patients with seizures, many with respiratory failure and others whose kidneys were on a dangerous downhill slide. Days earlier, his rounds had been interrupted as his team tried, and failed, to resuscitate a young woman whose heart had stopped. All shared one thing, says Denson, a pulmonary and critical care physician at the Tulane University School of Medicine. “They are all COVID positive.” .. “[The disease] can attack almost anything in the body with devastating consequences,” says cardiologist Harlan Krumholz of Yale University and Yale-New Haven Hospital, who is leading multiple efforts to gather clinical data on COVID-19. “Its ferocity is breathtaking and humbling.” .. the virus acts like no pathogen humanity has ever seen. (Sources: ScienceMag, Dozens of primary sources in OP)
• In a study posted this week, scientists in China examined the blood test results of 34 COVID-19 patients over the course of their hospitalization. In those who survived mild and severe disease alike, the researchers found that many of the biological measures had “failed to return to normal.” Chief among the worrisome test results were readings that suggested these apparently recovered patients continued to have impaired liver function. That was the case even after two tests for the live virus had come back negative and the patients were cleared to be discharged. At the same time, as cardiologists are contending with the immediate effects of COVID-19 on the heart, they’re asking how much of the damage could be long-lasting. In an early study of COVID-19 patients in China, heart failure was seen in nearly 12% of those who survived, including in some who had shown no signs of respiratory distress .. “COVID-19 is not just a respiratory disorder,” said Dr. Harlan Krumholz, a cardiologist at Yale University. “It can affect the heart, the liver, the kidneys, the brain, the endocrine system and the blood system.” (Sources: MedRXiv, NIH.gov, LA Times)
• Chinese doctors have proved for the first time that the novel coronavirus can cause damage to patients’ central nervous system.Doctors from Beijing Ditan Hospital affiliated to Capital Medical University, a designated institution treating the novel coronavirus disease (COVID-19), announced Thursday that they have cured a male patient whose cerebrospinal fluid had the virus.Previous studies show that COVID-19 may attack multiple organs, including kidneys, livers and heart (Sources: Xinhuanet, Beijing Ditan Hospital, Capital Medical University)
• People who recover after being infected with the novel coronavirus can still be left with substantially weakened lung capacity, with some left gasping for air when walking quickly, doctors in Hong Kong have found.
  The Hong Kong Hospital Authority made the findings after studying the first wave of patients who were discharged from the hospital and had fully recovered from COVID-19. (Sources: BusinessInsider, SCMP, Hong Kong Hospital Authority)

Transmission

• While food hasn’t been shown to be a transmission entry point for the coronavirus, surfaces can be. A research letter study published in The New England Journal of Medicine in March indicated that the coronavirus was detectable for up to four hours on copper, up to 24 hours on cardboard and up to three days on plastic and stainless steel. (Sources: New England Journal of Medicine (NEJM), NPR)
• Sixty singers showed up. A greeter offered hand sanitizer at the door, and members refrained from the usual hugs and handshakes. “It seemed like a normal rehearsal, except that choirs are huggy places,” Burdick recalled. “We were making music and trying to keep a certain distance between each other.” .. Nearly three weeks later, 45 have been diagnosed with COVID-19 or ill with the symptoms, at least three have been hospitalized, and two are dead. The outbreak has stunned county health officials, who have concluded that the virus was almost certainly transmitted through the air from one or more people without symptoms .. One of the authors of that study, Jamie Lloyd-Smith, a UCLA infectious disease researcher, said it’s possible that the forceful breathing action of singing dispersed viral particles in the church room that were widely inhaled .. With three-quarters of the choir members testing positive for the virus or showing symptoms of infection, the outbreak would be considered a “super-spreading event,” he said. (Sources: New England Journal of Medicine (NEJM), LA Times)
• The novel coronavirus is shed in the feces of infected people, which may help explain why it’s spread so fast, according to Chinese researchers.The finding of live virus particles in stool specimens indicates a fecal-oral route for coronavirus, which may be why it’s caused outbreaks on cruise ships with an intensity often seen with gastro-causing norovirus, which also spreads along that pathway .. “This virus has many routes of transmission, which can partially explain” its rapid spread, the Chinese Center for Disease Control and Prevention said in a report Saturday .. “The virus can also be transmitted through the potential fecal-oral route,” the Chinese CDC said. “This means that stool samples may contaminate hands, food, water” and cause infection when the microbes enter the mouth or eyes, or are inhaled, they said (Sources: China Centers for Disease Control (CCDC), Fortune)
• People with blood type A may be more vulnerable to infection by the new coronavirus, while those with type O seem more resistant, according to a preliminary study of patients in China who contracted the disease known as Covid-19.Medical researchers in China took blood group patterns of more than 2,000 patients infected with the virus in Wuhan and Shenzhen and compared them to local healthy populations. They found that blood type A patients showed a higher rate of infection and they tended to develop more severe symptoms. (Sources: SCMP, Centre for Evidence-Based and Translational Medicine at Zhongnan Hospital)
• There are also reports in other countries of significant transmission by people who are asymptomatic or only mildly symptomatic. On Tuesday, Dr. Sandra Ciesek, director of the Institute of Medical Virology in Frankfurt, Germany, tested 24 passengers who had just flown in from Israel. Seven of the 24 passengers tested positive for coronavirus. Four of those had no symptoms, and Ciesek was surprised to find that the viral load of the specimens from the asymptomatic patients was higher than the viral load of the specimens from the three patients who did have symptoms. A higher load means that someone is more likely to spread the infection to other people. (Sources: New England Journal of Medicine (NEJM), CNN)

Treatment

• In the context of the coronavirus crisis, researchers at the Israel Institute of Technology are testing the therapeutic potential of cannabis terpenes. During previous severe coronavirus outbreaks, such as those caused by the SARS coronavirus in 2002-2003, researchers found that cannabis terpenes reduced disease severity and impact in both in-vitro and in-vivo. In a 2007 study published in the Journal of Medical Chemistry, Chinese scientists concluded that the terpenes blocked a certain protein that allows the virus to replicate its genetic material. (Sources: NIH.gov, ZME Science)
• Researchers at the University of Lethbridge in Alberta, Canada, found that certain Cannabis sativa extracts could be used in treatments to prevent infection with SARS-CoV-2, the virus that causes COVID-19. (Sources: Preprints, ZME Science)

Vaccination & Immunity

• In a scientific brief dated Friday, the United Nations agency said the idea that one-time infection can lead to immunity remains unproven and is thus unreliable as a foundation for the next phase of the world’s response to the pandemic.”Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an ‘immunity passport’ or ‘risk-free certificate’ that would enable individuals to travel or to return to work assuming that they are protected against re-infection,” the WHO wrote. “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.” (Sources: World Health Organization, NPR)
• South Korean officials on Friday reported 91 patients thought cleared of the new coronavirus had tested positive again. Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention (KCDC), told a briefing that the virus may have been “reactivated” rather than the patients being re-infected.South Korean health officials said it remains unclear what is behind the trend, with epidemiological investigations still under way. The prospect of people being re-infected with the virus is of international concern, as many countries are hoping that infected populations will develop sufficient immunity to prevent a resurgence of the pandemic. (Sources: Reuters, Korea Centers for Disease Control (KCDC))
• World Health Organization officials said Monday not all people who recover from the coronavirus have the antibodies to fight a second infection, raising concern that patients may not develop immunity after surviving Covid-19.”With regards to recovery and then reinfection, I believe we do not have the answers to that. That is an unknown,” Dr. Mike Ryan, executive director of WHO’s emergencies program, said at a press conference at the organization’s Geneva headquarters on Monday. A preliminary study of patients in Shanghai found that some patients had “no detectable antibody response”, said Dr. Maria Van Kerkhove, WHO’s Lead Scientist on COVID-19. (Sources: NBC, World Health Organization)
• A team from Fudan University analysed blood samples from 175 patients discharged from the Shanghai Public Health Clinical Centre and found that nearly a third had unexpectedly low levels of antibodies. In some cases, antibodies could not be detected at all .. The coronavirus antibody intercepts the spike protein on the viral envelope to prevent it from binding with human cells .. “Vaccine developers may need to pay particular attention to these patients,” Huang said. If the real virus could not induce antibody response, the weakened version in the vaccine might not work in these patients either. (Sources: MedRXiv, SCMP)