Top 10: April 10

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Yuan J, Kou S, Liang Y, Zeng J, Pan Y, Liu L. PCR Assays Turned Positive in 25 Discharged COVID-19 Patients. Clin Infect Dis. 2020 Apr 8. pii: 5817588. PubMed: Full-text:

Among 172 discharged COVID-19 patients, 25 (14.5%) had positive testing again 2 to 13 days after discharge, without aggravation of symptoms. Two negative RT-PCR tests 24 hours apart may not be sufficient for viral clearance evaluation, suggesting the need for additional measures to confirm illness resolution.      


Hope MD, Raptis CA, Henry TS. Chest Computed Tomography for Detection of Coronavirus Disease 2019 (COVID-19): Don´t Rush the Science. Ann Intern Med. 2020 Apr 8. pii: 2764546. PubMed: Full-text:

Can chest CT be used as a primary tool for detecting COVID-19 in epidemic areas? Some early studies from China said so. The authors comment that this is a cautionary tale about the consequences of rushing the scientific review process: harsh criticism on faulty design, incomplete methods, biased patient cohorts, confounding and scant discussion, calling into question the broad conclusions that were made in these studies. Bottom line: CT should not be used to screen for or as a first-line test to diagnose COVID-19, all the more considering that safely CT performing is problematic.


Nair A, Rodrigues JCL, Hare S, et al. A British Society of Thoracic Imaging statement: considerations in designing local imaging diagnostic algorithms for the COVID-19 pandemic. Clin Radiol. 2020 May;75(5):329-334. PubMed: Full-text:

Same issue. The British Society of Thoracic Imaging has explored different scenarios integrating CT into a diagnostic algorithm. Of note, the clinical value, even in the absence of PCR availability, remains unclear. Again: CT can help, but probably not as a tool for diagnosing COVID-19.



Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020 Apr 8. PubMed: Full-text:

Case series on 3 patients with critical illness, developing antiphospholipid antibodies. These antibodies may rarely lead to thrombotic events that are difficult to differentiate from other causes of multifocal thrombosis in critically patients, such as disseminated intravascular coagulation, heparin-induced thrombocytopenia, and thrombotic microangiopathy.


Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020 Apr 6. pii: 10.1007/s00405-020-05965-1. PubMed: Full-text:

This important study shows that in Europe, otolaryngological symptoms are much more common than in Asia (it remains unclear whether this is a true difference). Among 417 mild-to-moderate COVID-19 patients (from 12 European hospitals), 86% and 88% reported olfactory and gustatory dysfunctions, respectively. The vast majority was anosmic (hyposmia, parosmia, phantosmia did also occur), and the early olfactory recovery rate was 44%. Females were more affected than males. Olfactory dysfunction appeared before (12%), at the same time (23%) or after (65%) the appearance of other symptoms. There is no doubt that sudden anosmia or ageusia need to be recognized as important symptoms of COVID-19.


Baig AM. Neurological manifestations in COVID-19 caused by SARS-CoV-2. CNS Neurosci Ther. 2020 Apr 7. PubMed: Full-text:

Neuroinvasive propensity has been demonstrated as a common feature of human coronaviruses. These viruses can invade brainstem via a synapse‐connected route from the lung and airways. With regard to SARS‐CoV‐2, early occurrences such as olfactory symptoms (see above) should be further evaluated for CNS involvement. Potential late neurological complications in cured COVID-19 patients are discussed. No data are available yet. However, after reading this, you will ask yourself whether herd immunity (infection of broader populations) is such a good idea.



Stafford N. Covid-19: Why Germany´s case fatality rate seems so low. BMJ. 2020 Apr 7;369:m1395. PubMed: Full-text:

Guess why? It’s probably testing and nothing else. The more people with no or mild symptoms you test, the lower the fatality rate. Reliable PCR methods have been reported by the end of January. In Germany’s public health system, testing is not restricted to a central laboratory as in many other nations but can be conducted at quality controlled laboratories throughout the country. Within a few weeks, overall capacity reached half a million PCR tests a week. The same low fatality rate is seen in South Korea, another country with high testing rates.


Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst Rev. 2020 Apr 8;4:CD013574. PubMed: Full-text:

A Word from Cochrane. Current evidence for COVID-19 “is limited”. However, findings “consistently indicate that quarantine is important in reducing incidence and mortality”. In order to maintain the best possible balance of measures, “decision makers must constantly monitor the outbreak situation and the impact of the measures implemented”. Well.



Zaigham M, Andersson O. Maternal and Perinatal Outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020 Apr 7. PubMed: Full-text:

Systematic review among 108 pregnancies published in 18 articles. 91% were delivered by cesarean section. Three maternal intensive care unit admissions were noted but no maternal deaths. One neonatal death and one intrauterine death were also reported.


Bourne T, Kyriacou C, Coomarasamy A, et al. ISUOG Consensus Statement on rationalization of early-pregnancy care and provision of ultrasonography in context of SARS-CoV-2. Ultrasound Obstet Gynecol. 2020 Apr 8. PubMed: Full-text:

Statement how to rationalize ultrasound and to manage early-pregnancy complications in this crisis.