Top 10: April 20

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Normile D. ‘Suppress and lift’: Hong Kong and Singapore say they have a coronavirus strategy that works. Science Mag Apr 13, 2020. Full-text

Bottom line: The tighter you control the infected, the less restriction you have to impose on the uninfected. With this strategy, Hong Kong and Singapure are very successful. But look at the controls: Hospitalizing all those who test positive, regardless of whether they have symptoms, two weeks of self-quarantine to all close contacts, electronic wristbands etc. You want to see were infected people in Hong Kong are? You’ll find them here:


Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet. 2020 Apr 16. pii: S0140-6736(20)30918-1. PubMed: Full-text:

Authors review current recommendations and conclude that mass masking  for  source  control  is  a  useful  and   low-cost   adjunct   to   social   distancing   and   hand   hygiene, shifting the  focus  from  self-protection  to  altruism, actively involves every citizen, and is a symbol of social solidarity in the global response to the pandemic.



Rockx B, Kuiken T, Herfst S, et al. Comparative pathogenesis of COVID-19, MERS, and SARS in a nonhuman primate model. Science  17 Apr 2020: eabb7314. Full text:

This animal study was performed to understand pathogenesis, showing SARS-CoV-2-infected macaques provide a new model to test therapeutic strategies. Virus was excreted from nose and throat in the absence of clinical signs, and detected in type I and II pneumocytes in foci of diffuse alveolar damage and in ciliated epithelial cells of nasal, bronchial, and bronchiolar mucosae. In SARS-CoV-infection, lung lesions were typically more severe, while they were milder in MERS-CoV infection, where virus was detected mainly in type II pneumocytes.



Atkinson B, Petersen E. SARS-CoV-2 shedding and infectivity. Lancet. 2020 Apr 15. pii: S0140-6736(20)30868-0. PubMed: Full-text:

Brief but important comment on several papers reporting on prolonged viral shedding. PCR  does  not distinguish between infectious virus and non-infectious nucleic acid. This is well-known from many viral infections such as Ebola or Measles.



Toscano G, Palmerini F, Ravaglia S, et al. Guillain-Barre Syndrome Associated with SARS-CoV-2. N Engl J Med. 2020 Apr 17. PubMed: Full-text:

Observational series from Italy, involving five patients with COVID-19–associated Guillain–Barré syndrome which probably should be distinguished from critical illness neuropathy and myopathy, which tend to appear later in the course of critical COVID-19 illness.


Gutierrez-Ortiz C, Mendez A, Rodrigo-Rey S, et al. Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology. 2020 Apr 17. pii: WNL.0000000000009619. PubMed: Full-text:

The next paper on neurological complications seen with COVID-19, which are probably due to an aberrant immune response.


Chen R, Liang W, Jiang M, et al. Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest. 2020 Apr 15. pii: S0012-3692(20)30710-8. PubMed: Full-text:

It’s only age. Multivariate analysis of a retrospective cohort of 1590 hospitalized subjects with COVID-19 throughout China revealed the following factors associated with mortality: Age 75 or older (HR: 7.86, 95% CI: 2.44-25.35), Age 65-74 years (HR: 3.43, 95% CI: 1.24-9.5), coronary heart disease (HR: 4.28, 95% CI: 1.14-16.13), cerebrovascular disease(HR: 3.1, 95% CI: 1.07-8.94), dyspnea (HR: 3.96, 95% CI:1.42-11), procalcitonin>0.5ng/ml (HR: 8.72, 95% CI:3.42-22.28), AST>40 U/L (HR: 2.2, 95% CI: 1.1- 6.73). Not very new, but by now the largest cohort with detailed informations.



Brojakowska A, Narula J, Shimony R, Bander J. Clinical Implications of SARS-Cov2 Interaction with Renin Angiotensin System. J Am Coll Cardiol. 2020 Apr 14. pii: S0735-1097(20)35001-4. PubMed: Full-text:

Don’t stop your sartans or ACE inhibitors! Authors hypothesize that the benefits of treatment with renin-angiotensin system inhibitors in SARS-COV2 may outweigh the risks and at the very least should not be withheld.


Kennedy NA, Jones GR, Lamb CA, et al. British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic. Gut. 2020 Apr 17. pii: gutjnl-2020-321244. PubMed: Full-text:

Making recommendation in the absence of data is not that easy. Authors have made heroic attempts to balance the risk of immune modifying drugs with the risk associated with active disease.


Severe COVID-19

Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science  17 Apr 2020: eabb8925. Full-text: /2020/04/16/science.abb8925

Brief but phantastic overview about current knowledge and the pathways leading to cytokine release syndrome.