Top 10: March 31

<<< April 2020

By Christian Hoffmann &
Bernd S. Kamps


Yu F, Yan L, Wang N, et al. Quantitative Detection and Viral Load Analysis of SARS-CoV-2 in Infected Patients. Clin Infect Dis. 2020 Mar 28. pii: 5812997. PubMed: Fulltext:

Is sputum sufficient for diagnosis? In a total of 323 samples from 76 pts, the average viral load in sputum (17429 copies/test) was significantly higher than in throat swabs (2552) and nasal swabs (651). Viral load was also higher in the early and progressive stages than in the recovery stage. If these data were confirmed, collection of specimen would be much easier.


Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020 Mar 28. pii: 5812996. PubMed: Fulltext:

More on antibody response. Among 173 patients, the seroconversion rate (median time) for Ab, IgM and IgG was 93.1% (11 days), 82.7% (12 days) and 64.7% (14 days), respectively. A higher titer of Ab was independently associated with a worse clinical classification.



Vaduganathan M, Vardeny O, Michel T, McMurray JV, Pfeffer MA, Solomon SD. Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. NEJM, March 30, 2020. DOI: 10.1056/NEJMsr2005760. Fulltext:

Phantastic review of an interdisciplinary expert panel on the use, risks and benefit of RAAS inhibitors (ACE inhibitors and sartans) in the COVID-19 era. Bottom line: We don’t know enough. Until further data are available, RAAS inhibitors should be continued.


Joob B, Wiwanitkit V. SARS-CoV-2 and HIV. J Med Virol. 2020 Mar 27. PubMed: Fulltext:

A few new thoughts on HIV infection and COVID-19.


Zhu F, Cao Y, Xu S, Zhou M. Co‐infection of SARS‐CoV‐2 and HIV in a patient in Wuhan city, China [published online ahead of print March 11, 2020]. J Med Virol.

First case report of patient with undiagnosed HIV-Infection (low CD4 counts), recovering from a coronavirus‐related pneumonia. Argues against deleterious effect of HIV.



Li Y, Zhao R, Zheng S, et al. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerg Infect Dis. 2020 Jun 17;26(6). PubMed: Fulltext:

Case report on a caesarean section, suggesting that mother-to-child transmission is unlikely.



Hellewell J, Abbott S, Gimma A, et al. Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. Lancet Glob Health. 2020 Apr;8(4):e488-e496. PubMed: Fulltext:

Excellent work with implications for future outbreaks and the time after lockdown. Using a stochastic transmission model, contact tracing and isolation of cases was sufficient to control a new outbreak.



Bhatraju PK, Ghassemieh BJ, Nichols M. Covid-19 in Critically Ill Patients in the Seattle Region — Case Series. NEJM March 30, 2020. DOI:

More than “Ok, COVID-19 has reached the US”: This paper describes in detail the demographic characteristics, coexisting conditions, imaging findings, and outcomes among 21 critically ill patients admitted at ICUs.


Nickel CH, Bingisser R. Mimics and chameleons of COVID-19. Swiss Med Wkly. 2020 Mar 23;150:w20231. PubMed:

An old patient with COVID-19 and non-specific symptoms is described, as well as another case with heart failure, mimicking COVID-19. Both cases underline the need for extensive testing.



Lurie N, Saville M, Hatchett R, Halton J. Developing Covid-19 Vaccines at Pandemic Speed. NEJM March 30, 2020. DOI:

Excellent review on vaccine development. Outlook on new platforms for RNA and DNA vaccines that can be made quickly because they require no culture or fermentation, instead using synthetic processes.  Hope and despair.