Top 10: April 8

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Ghinai I, McPherson TD, Hunter JC, et al. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet. 2020 Apr 4;395(10230):1137-1144. PubMed: . Full-text:

Infection of health-care workers (HCWs) is not inevitable. A female in her 60s who travelled to Wuhan on Dec 25, 2019, and returned to Illinois on Jan 13, 2020, transmitted infection to her husband.  Although both were hospitalised in the same facility and shared hundreds (n=348) of contacts with HCWs, nobody else became infected, supporting recommendations regarding appropriate infection control.


Bae S, Kim MC, Kim JY, et al. Effectiveness of Surgical and Cotton Masks in Blocking SARS-CoV-2: A Controlled Comparison in 4 Patients. Ann Intern Med. 2020 Apr 6. pii: 2764367. PubMed: . Full-text:

Very small study, but both surgical and cotton masks appeared to be ineffective in preventing the virus dissemination from the coughs of patients with COVID-19 to the environment and external mask surface.



Chapman AR, Bularga A, Mills NL. High-Sensitivity Cardiac Troponin Can Be An Ally in the Fight Against COVID-19. Circulation. 2020 Apr 6. PubMed: . Full-text:

Nice review on how to use and interpret troponin results in COVID-19 patients. According to the authors, clinicians must recognize that troponin is not a test for myocardial infarction, and it never was. No biomarker has ever had the ability to detect acute atherothrombotic occlusion in a coronary artery. Elevations of cardiac troponin can inform the diagnosis of a number of cardiac conditions related to COVID-19.



Omer SB, Malani P, Del Rio C. The COVID-19 Pandemic in the US: A Clinical Update. JAMA. 2020 Apr 6. pii: 2764366. PubMed: Full-text:

Short but interesting viewpoint on current clinical insights and key questions. Is PCR always positive? What about reinfection, immunity? What do we know about transmission?



Schiffrin EL, Flack J, Ito S, Muntner P, Webb C. Hypertension and COVID-19. Am J Hypertens. 2020 Apr 6. pii: 5816609. PubMed: . Full-text:

Is hypertension a true risk factor for severe COVID-19 courses? According to the authors,  there  is  as  yet (March 29) “no  evidence”  that  hypertension  is  related  to  outcomes  of COVID-19, or that ACE inhibitor or ARB use is harmful, or for that matter beneficial.


Pasha SB, Fatima H, Ghouri YA. Management of Inflammatory Bowel Diseases in the Wake of COVID-19 Pandemic. J Gastroenterol Hepatol. 2020 Apr 4. PubMed: . Full-text:

Some thoughts on how to manage patients suffering from Inflammatory Bowel Diseases, regarding their ongoing immunosuppressive therapies which could render them more susceptible to acquire COVID-19 infection and develop severe courses.



Duan K, Liu B, Li C, et al. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. PNAS 2020, April 6.

A single dose (200 mL) of convalescent plasma was given to 10 patients (9 treated with umifenovir, 6 with methylprednisolone, 1 with remdesivir). In all 7 patients with viremia, serum SARS-CoV-2 RNA decreased to an undetectable level within 2-6 days. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within three days. Using antibodies from convalescents could be an option in severe cases. It’s now time for larger studies.


Du YX, Chen XP. Favipiravir: pharmacokinetics and concerns about clinical trials for 2019-nCoV infection. Clin Pharmacol Ther. 2020 Apr 4. PubMed: . Full-text:

This mini-review (not free accessible, unfortunately) focusses on the pharmacokinetics of favipiravir and potential drug-drug interactions (DDIs). As the parent drug undergoes metabolism in the liver mainly by aldehyde oxidase (AO), potent AO inhibitors such as cimetidine, amlodipine, or amitriptyline are expected to cause relevant DDIs.


Pregnancy, pediatrics

Choi SH, Kim HW, Kang JM, Kim DH, Cho EY. Epidemiology and Clinical Features of Coronavirus disease 2019 in Children. Clin Exp Pediatr. 2020 Apr 6. pii: cep.2020.00535. PubMed: . Full-text:

In this nice review published on April 6, it is summarized “what is known about COVID-19 in children and adolescents until now”. No, not until now. Until March 12, 2020 (a far-off age).  What has happened since then?


Poon LC, Yang H, Kapur A, et al. Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals. Int J Gynaecol Obstet. 2020 Apr 4. PubMed: . Full-text:

For those of you who are not gynaecologists: No, it’s not Luís Figo. It’s FIGO, the International Federation of Gynaecology and Obstetrics which gives “interim” recommendations about how to deal with pregnant women: 46 pages on ambulatory antenatal care, management in the setting of the obstetrical triage, intra/postpartum management and neonatal care. Among others, IRCCS, PAHO, ECDC, SIN, SEGO, RCOG, SOGC, SOAP, ISUOG and RANZCOG have also contributed.