Top 10: April 9

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Kim YI, Kim SG, Kim SM, et al. Infection and Rapid Transmission of SARS-CoV-2 in Ferrets. Cell Host Microbe. 2020 Apr 5.. PubMed: . Full-text:

Ferrets shed the virus in nasal washes, saliva, urine, and feces up to 8 days post-infection. They may represent an infection and transmission animal model of COVID-19 that may facilitate development of SARS-CoV-2 therapeutics and vaccines.



Miller DG, Pierson L, Doernberg S. The Role of Medical Students During the COVID-19 Pandemic. Ann Intern Med. 2020 Apr 7. pii: 2764413. PubMed: . Full-text:

The American Association of Medical Colleges (AAMC) recommended that “unless there is a critical health care workforce need locally, we strongly suggest that medical students not be involved in any direct patient care activities”. The authors disagree (for good reasons).


Cheung KS, Hung IF, Chan PP, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis. Gastroenterology. 2020 Apr 3. pii: S0016-5085(20)30448-0. PubMed: . Full-text:

In a meta-analysis of 60 studies, comprising 4,243 patients, the pooled prevalence of gastrointestinal symptoms was 17.6% (95% CI, 12.3%-24.5%). Prevalence was lower in studies from China than other countries. Pooled prevalence of stool samples that were positive for virus RNA was 48.1% and could persist for up to ≥33 days from illness onset even after viral RNA negativity in respiratory specimens. Stool viral RNA was detected at higher frequency among those with diarrhea.


Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020 Apr 7. pii: 2764380. PubMed: . Full-text:

This viewpoint summarizes key considerations for supporting the health care workforce.



Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet. 2020 Apr 3. pii: S0140-6736(20)30806-0. PubMed: . Full-text:

Don’t forget the dentists! And test them with the same high priority as that of medical health­care workers in hospitals!


Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver Int. 2020 Apr 6. doi: . [Epub ahead of print]

“Since December 2019, patients with unexplained pneumonia have been found in Wuhan, Hubei Province, China, which was caused by a novel coronavirus that had not been previously identified (1). Tentatively defined as 2019 novel coronavirus (2019-nCoV), the pathogen has now been named Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (2), while the disease termed Coronavirus Disease 2019 (COVID-19).” This abstract was published on April 6, with references. In all seriousness. Come on guys, we all know that! It is to be feared that nobody will read your interesting mini-review on mechanisms and clinical implications of liver injury, unmet clinical needs and main research questions.



Praveen D, Chowdary PR, Aanandhi MV. Baricitinib – a januase kinase inhibitor – not an ideal option for management of COVID-19. Int J Antimicrob Agents. 2020 Apr 4:105967. PubMed: . Full-text:

Several studies have speculated that baricitinib could act on AT2 cells and AAK1 mediated endocytosis. The authors argue that the drug would not be an ideal option, due to the fact that baricitinib causes lymphocytopenia, neutropenia and viral reactivation. Sounds reasonable.


Perinel S, Launay M, Botelho-Nevers E, et al. Towards Optimization of Hydroxychloroquine Dosing in Intensive Care Unit COVID-19 Patients. Clin Infect Dis. 2020 Apr 7. pii: 5816960. PubMed: . Full-text:

Ongoing clinical trials with HCQ use different dosing regimens. In this PK study on 13 patients critically ill with COVID-19, 200 mg three times daily dosing regimen were  inappropriate  to reach a supposed target  blood level of 1-2 mg/L. Authors proposed 800 mg once daily on day 1, followed by 200 mg twice daily for 7 days. However, further PK studies are needed.


Bloch EM, Shoham S, Casadevall A, et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest. 2020 Apr 7. pii: 138745. PubMed: . Full-text:

An overview of treatment with convalescent plasma on current evidence of benefit, regulatory considerations, logistical work flow (recruitment of donors etc.) and proposed clinical trials.



Loftus RW, Dexter F, Parra MC, Brown JR. Importance of oral and nasal decontamination for patients undergoing anesthetics during the COVID-19 era. Anesth Analg. 2020 Apr 3. PubMed: . Full-text:

According to authors, the evidence shows a favourable risk/benefit profile for patient decolonization with nasal povidone and oral chlorhexidine rinse to help mitigate the perioperative spread.