Top 10: April 13

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Gao Y, Yan L, Huang Y, et al. Structure of the RNA-dependent RNA polymerase from COVID-19 virus. Science. 2020 Apr 10. pii: science.abb7498. PubMed: Full-text:

Using cryogenic electron microscopy, authors describe the structure of the RNA-dependent RNA polymerase, another central enzyme of the viral replication machinery. It is also shown how remdesivir and sofosbuvir bind to this polymerase.



Danis K, Epaulard O, Benet T, et al. Cluster of coronavirus disease 2019 (Covid-19) in the French Alps, 2020. Clin Infect Dis. 2020 Apr 11. pii: 5819060. PubMed: Full-text:

Some clusters are described, including a 9-yr-old child who attended three different schools (why 3 is not described) and one ski class while symptomatic. Coinfected with both picornavirus + influenza A(H1N1), child transmitted only these viruses to others but not SARS-CoV-2, suggesting that these viruses are more easily transmitted than SARS-CoV-2.


Asadi S, Bouvier N, Wexler AS, et al. The coronavirus pandemic and aerosols: Does COVID-19 transmit via expiratory particles? Aerosol Sci Technol 2020, April 3. DOI: 10.1080/02786826.2020.1749229. Full-text:

Why is SARS-CoV-2 so highly transmissible? This interesting overview describes current knowledge of airborne transmission. It’s not only the “droplet spray”, typically greater than 5 µm in diameter. Alternatively, a susceptible person can inhale microscopic aerosol particles consisting of the residual solid components of evaporated respiratory droplets, which are tiny enough to remain airborne for hours. Authors conclude that speech plausibly serves as an underrecognized transmission mechanism: “it is up to ‘aerosol scientists’ to provide the technology and hard data to either corroborate or reject that.” So please, get on the scene, aerosol scientists on this planet!



Yousefzadegan S, Rezaei N. Case Report: Death Due to Novel Coronavirus Disease (COVID-19) in Three Brothers. Am J Trop Med Hyg. 2020 Apr 10. PubMed: Full-text:

Is there a genetic predisposition for severe diseases? This report from Iran describes three brothers aged 54-66 years, all dying from COVID-19 with a relatively similar pattern after less than 2 weeks of illness. All were previously healthy, without histories of underlying diseases.


Casini A, Alberio L, Angelillo-Scherrer A, et al. Thromboprophylaxis and laboratory monitoring for in-hospital patients with Covid-19 – a Swiss consensus statement by the Working Party Hemostasis. Swiss Med Wkly. 2020 Apr 11;150:w20247. PubMed: Full-text:

All in-hospital COVID-19 patients should receive pharmacological thromboprophylaxis according to a risk stratification score, unless contraindicated. In patients with creatinine clearance >30 ml/min, low molecular weight heparin (LMWH) should be administered according to the prescribing information. These guidelines also suggest regularly monitoring prothrombin time, D-dimers, fibrinogen, platelet count, LDH, creatinine and ALT daily or at least 2-3 times per week.


Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol. 2020 Apr 12. PubMed: Full-text:

“Flu plus ‘loss of smell’ means COVID-19”. Among 263 patients presenting during March (single center in San Diego) with flu-like-symptoms, loss of smell was found in 68 % of COVID-19 patients (n=59), compared to only 16 % in negative patients (n=203). Smell and taste impairment were independently and strongly associated with positivity (anosmia: adjusted odds ratio 11, 95%CI: 5‐24). Conversely, sore throat was independently associated with negativity.



Torres T, Puig L. Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic. Am J Clin Dermatol. 2020 Apr 10. PubMed: Full-text:

Patients with cutaneous immune-mediated diseases (including psoriasis, atopic dermatitis, and hidradenitis suppurativa) may continue their treatment even during the COVID-19 outbreak, preventing disease flares. However, in patients with active COVID-19 infection, it is generally recommended to withhold immunosuppressive or biologic treatment.


Coles CE, Aristei C, Bliss J, et al. International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol). 2020 May;32(5):279-281. PubMed: Full-text:

In order to reduce hospital visits to a minimum and to ease pressure on workforce, detailed guidelines on radiation therapy for breast cancer are given, mainly focussing on hypofractionation.


Treatment, procedures

Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology. 2020 Apr 11. PubMed: Full-text:

In whom to perform bronchoscopy and how to perform it safely? This paper describes different guidelines (based on expert opinions).


Grant WB, Lahore H, McDonnell SL, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020 Apr 2;12(4). pii: nu12040988. PubMed: Full-text:

Evidence? Well. Serum 25(OH)D concentrations tend to decrease with age, which may be important for COVID-19 because case-fatality rates increase with age. That’s the whole story. After all, the ”hypothesis that vitamin D supplementation can reduce the risk of influenza and COVID-19Â incidence and death should be investigated in trials”.