Top 10: April 7

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal Masking in Hospitals in the Covid-19 Era. N Engl J Med. 2020 Apr 1. PubMed: Full-text:

Thoughts on universal masking in hospitals. Pros and cons. Bottom line: The main value is probably psychological: giving health care workers the confidence to absorb and implement prevention practices.


Tian H, Liu Y, Li Y, et al. An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China. Science. 2020 Mar 31. pii: science.abb6105. PubMed: Full-text:

“All models are wrong, but some are useful”, statistician George Box supposedly once said. This model shows how non-pharmaceutical measures have worked in China. Without the Wuhan travel ban, there would have been 744,000 cases by February 19, day 50 of the epidemic. With the Wuhan travel ban alone, the number of cases would have decreased to 202,000. Other control measures such as the national emergency response, together with the travel ban, limited the number of cases, 96 % fewer than expected in the absence of interventions.


Normile D. As normalcy returns, can China keep COVID-19 at bay? Science. 2020 Apr 3;368(6486):18-19. PubMed: Full-text:

Thoughts and opinions on how China is now addressing an issue every country and location in the world will eventually (hopefully) face: how to normalize and restore societal activities, while at the same time minimizing disease-related dangers from the outbreak.



Pan Y, Long L, Zhang D, et al. Potential false-negative nucleic acid testing results for Severe Acute Respiratory Syndrome Coronavirus 2 from thermal inactivation of samples with low viral loads. Clin Chem. 2020 Apr 4. pii: 5815979. PubMed: Full-text:

Don’t put your swabs in the sun! In this small study, all samples were inactivated by incubation in a water bath at 56˚ for 30 minutes. O note, 7/15 specimens with low virus levels converted into false negative. Longer storage also caused false-negative result in a few cases.



Monto AS, DeJonge P, Callear AP, et al. Coronavirus occurrence and transmission over 8 years in the HIVE cohort of households in Michigan. J Infect Dis. 2020 Apr 4. pii: 5815743. PubMed: Full-text:

Let’s pray that SARS-CoV-2 remembers its origins. And that it behaves like other human coronaviruses (hCoVs). A longitudinal surveillance cohort study of children and their households from Michigan found that hCoV infections were sharply seasonal, showing a peak for different HCoV types (229E, HKU1, NL63, OC43) in February. Over 8 years, almost no HCoV infections occurred after March. Will SARS-CoV-2 remember this? It’s April….


Yuan M, Wu NC, Zhu X, et al. A highly conserved cryptic epitope in the receptor-binding domains of SARS-CoV-2 and SARS-CoV. Science. 2020 Apr 3. PubMed: Full-text:

Insights into antibody recognition and how SARS-CoV-2 can be targeted by the humoral response, revealing a conserved epitope shared between SARS-CoV and SARS-CoV-2. This epitope could be used for vaccines and the development of cross-protective antibodies.



Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020 Apr 6. PubMed: Full-text:

Important work, providing sobering evidence about the burden of critical illness. Over a period of 28 days, 1,591 COVID-19 patients (88 % requiring endotracheal intubation and ventilatory support) were admitted to 72 Italian ICUs, an average of 22 patients per ICU (median length of stay was 9 days). Of note, 82 % were male and median age was only 63 years (IQR 56-70), suggesting that older age alone is not a risk factor for admission to the ICU. As of March 25, ICU mortality was 26 %. However, 58 % were still in the ICU. Scarifying study, telling us a lot about the fragility of health care systems in even the wealthiest countries.


Wunsch H. The outbreak that invented intensive care. Nature, World View, April 3, 2020. Full-text:

Interesting article on Copenhagen’s polio epidemic in 1952, when over 300 patients (see below) developed respiratory paralysis within a few weeks, completely overwhelming the ventilator facilities. Does this remind you of something?


West JB. The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology. J Appl Physiol 2005 Aug;99(2):424-32. PubMed: Full-text:

Yes, it’s old. But, please, read this incredible story on hope and despair, on enormous medical challenges and true heroes, highly topical after almost 60 years. A comprehensive review about a forgotten epidemic occurring 1952 at the Belgdam Hospital in Copenhagen, Denmark: About 3,000 polio patients were admitted between August and December, among them 1,250 with paralysis and 345 with respiratory failure – due to bulbar or bulbospinal polio affecting brainstem or nerves that control breathing. The heroic solution was to recruit 1,500 medical and dental students, providing round-the-clock manual ventilation using rubber bags, with only the patient’s appearance to guide them. For a total of 165.000 hours. Think about it. The students were flying literally by sight. Sometimes, only the patients’ rolling up eyes signalled them that more ventilation was needed. Watery eyes while reading this heart-breaking article. A perfect story for anti-vaxxers (if these damned trolls would take notice). And about how fast we forget.



Lyons C, Callaghan M. The use of high-flow nasal oxygen in COVID-19. Anaesthesia. 2020 Apr 4. PubMed: Full-text:

Careful and well-balanced review about the pros and cons of this treatment strategy.