Top 10: April 1

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Ceraolo C, Giorgi FM. Genomic variance of the 2019-nCoV coronavirus. J Med Virol. 2020 May;92(5):522-528. PubMed: Full-text:

Analysis of 56 genomic sequences from distinct patients, showing high sequence similarity (>99%).  A few variable genomic regions exist, mainly at the ORF8 locus (coding for accessory proteins).


Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020 Apr;5(4):536-544. PubMed: Full-text:

Consensus statement (a little bit wordiness), defining the place of SARS-CoV-2 (provisionally named 2019-nCoV) within the Coronaviridae.


Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat Microbiol. 2020 Apr;5(4):562-569. PubMed: Full-text:

Important work on viral entry, using a rapid and cost-effective platform with allows to functionally test large groups of viruses for zoonotic potential. Host protease processing during viral entry is a significant barrier for several lineage B viruses. However, bypassing this barrier allows several coronaviruses to enter human cells through an unknown receptor.



Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020; (published online March 30.) Full-text:

Defining the case fatality rate (CFR) remains challenging and simply dividing the number of deaths by the number of cases can be misleading. Using individual-case data and after careful modelling, CFR was 1.38% (95% CI, 1.23–1.53) in this analysis. The mean duration from symptom onset to death was 17.8 days (95% 16.9–19.2).



Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020 Apr;7(4):e21. Full-text:

Don’t forget people with mental health conditions! A few thoughts on these patients who could be more substantially affected, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population.


Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Apr;7(4):e15-e16. PubMed: Full-text:

And don’t forget the staff! Some thoughts on how to maintain staff mental health during such a crisis.


Jin XH, Zheng KI, Pan KH, Xie YP, Zheng MH. COVID-19 in a patient with chronic lymphocytic leukaemia. Lancet Haematol. 2020 Apr;7(4):e351-e352. Full-text:

Interesting case report on a patient with CLL. Clinical and biochemical features of COVID-19 might be partly masked by coexisting CLL. Longer incubation period was presumed.



Chen C, Gao G, Xu Y, et al. SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19. Ann Intern Med. 2020, March 30. DOI: 10.7326/M20-0991. Full-text:

Among 133 patients, 22 patients who had positive RT-qPCR results for SARS–CoV-2 in the sputum or feces (up to 39 and 13 days, respectively) after pharyngeal swabs became negative. Although uncontrolled, this study raises concern about whether patients with negative pharyngeal swabs are truly virus-free, or sampling of additional body sites is needed.


Therapy and Procedures

Kim AH, Sparks JA, Liew JW. A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19. Ann Intern Med 2020. DOI:

Harsh criticism at the Gautret-Study (on a potential benefit of hydroxychloroquine), making clear that essential standards of data generation and interpretation were lacking, leading to undesirable downstream effects.


Yazdany J, Kim AH. Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know. Ann Intern Med. 2020. DOI: 10.7326/M20-1334. Full-text:

Extensive comment on someone’s swanky twitter claiming that the combination of HCQ and azithromycin has “a real chance to be one of the biggest game changers in the history of medicine” (March 21). Careful review about the risks of HCQ and how pretentious dissemination of overpromised data may cause severe harm.