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By Christian Hoffmann &
Bernd S. Kamps
Voice: Google Cloud Text-to-Speech / UK
First, investigate whether daily maximum temperature, precipitation and UV index are related to COVID-19 incidence; find out whether surgical mask partition reduces the risk of transmission in a golden Syrian hamster model; and discover that the COVID-19 incidence in January and February was too low in the US to be detected through emergency department syndromic surveillance data.
Afterwards, determine the association between acute liver injury and clinical outcome in patients with SARS-CoV-2 infection; compare the performance of four commercial ELISAs and two rapid tests; and investigate co-infections in people with COVID-19.
Finally, analyze the incidence of out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France; and present 25 patients treated with convalescent plasma and discuss with your colleagues the challenges of this treatment approach.
Voice: Google Cloud Text-to-Speech / UK
First, investigate the introduction and early spread of SARS-CoV-2 in the New York City area; analyze the stay-at-home orders in Colorado, Minnesota, Ohio, and Virginia; and characterize the nsp12-nsp7-nsp8 core polymerase complex from SARS-CoV-2.
Afterwards, examine hospitalization and mortality among black patients and white patients in a cohort of 3,481 patients in Louisiana; write a review about neuropathogenesis and neurologic manifestations of coronaviruses; present magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia; and compare the clinical characteristics of patients with asymptomatic vs symptomatic coronavirus disease.
Finally, list the risk factors associated with COVID-19 disease severity in patients with cancer; describe mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection; and discuss with your colleagues the use of anakinra for severe forms of COVID-19.
Voice: Google Cloud Text-to-Speech / US
Ball P, Maxmen A. The epic battle against coronavirus misinformation and conspiracy theories. Nature 2020, 581, 371-374. Full-text: https://doi.org/10.1038/d41586-020-01452-z
This article shows how analysts and researchers have been scrambling to track and analyse the disparate falsehoods floating around — both ‘misinformation’, which is wrong but not deliberately misleading, and ‘disinformation’, which refers to organized falsehoods that are intended to deceive. Inaccurate information doesn’t only mislead, but could be a matter of life and death if people start taking unproven drugs, ignoring public-health advice, or refusing a coronavirus vaccine if one becomes available.
Voice: Google Cloud Text-to-Speech / US
First, reduce transmission of SARS-CoV-2 as there is growing evidence that infectious aerosol particles can be released during breathing and speaking by asymptomatic infected individuals; look into super-spreading events (SSEs) in Tianjin, China, and determine the reproductive number R and the dispersion parameter k; and investigate the emergence of super-spreading events (SSEs) in Guangzhou and explore the secondary attack rate from different types of contact with 38 pre-symptomatic patients.
Afterward, counsel patients about the riskes of continuing to work in the midst of the pandemic; screen and test patients admitted for childbirth; and study emergency guidelines for radiation therapy of hematological malignancies.
Compare remdesivir 5 vs 10 days in a trial that lacked a placebo control; discuss with your colleagues five Waldenstroem macroglobulinemia patients on Bruton tyrosine kinase (BTK) inhibitor ibrutinib; and use specific human monoclonal antibody (MAbs) from a convalescent COVID-19 patient and demonstrate neutralization activity in 6 rhesus monkeys in both prophylactic and treatment settings.
No time, no summary, no audio. Our favorite article today:
Ju B, Zhang Q, Ge J, et al. Human neutralizing antibodies elicited by SARS-CoV-2 infection. Nature. 2020 May 26. PubMed: https://pubmed.gov/32454513. Full-text: https://doi.org/10.1038/s41586-020-2380-z
As long as all other therapies fail or have only modest effects, antibodies are the hope for the near future. Isolation and characterization of 206 RBD-specific monoclonal antibodies were derived from single B cells of eight SARS-CoV-2 infected individuals. Some antibodies showed potent anti-SARS-CoV-2 neutralization activity that correlates with their competitive capacity with ACE2 for RBD binding. Surprisingly, neither the anti-SARS-CoV-2 antibodies nor the infected plasma cross-reacted with SARS-CoV or MERS-CoV RBDs, although substantial plasma cross-reactivity to their trimeric Spike proteins was found.
Voice: Google Cloud Text-to-Speech / Australia
First, investigate if social connectedness is a risk factor for the spreading of COVID-19 among older adults; analyze a South African outbreak involving 39 patients and 80 staff; and detect SARS-CoV-2 in human breastmilk.
Afterwards, examine factors associated with hospital admission and critical illness among 5279 people in New York; manage different cases of STEMI/NSTEMI ACS with potential or known COVID-19 infection; evaluate if CRP performs better than other parameters (age, neutrophil count, platelet count) in predicting adverse outcome; and discuss with your colleagues if we should one day measure the “viral load”?
Finally, apply past lessons learned from sepsis to immunotherapies for COVID-19; explain why lopinavir concentrations in 12 COVID-19 patients are higher than in HIV-infected patients; and compare individual quarantine with active monitoring targeted by contact tracing.
Voice: Google Cloud Text-to-Speech / US
A brief (and probably the last) review on hydroxychloroquine and chloroquine
A few months ago, lab experiments suggested that hydroxychloroquine (HCQ) and chloroquine (CQ) might have some antiviral effects against SARS-CoV-2 due to an increase in the endosomal pH value which disrupts the virus-cell fusion and some post-entry steps (Wang 2020, Yao 2020). An early enthusiastic mini-review stated “results from more than 100 patients” showed that chloroquine phosphate would be able to alleviate the course of the disease (Gao 2020). Continue >>>
Voice: Google Cloud Text-to-Speech / UK
First, take notice of the probable COVID-19 career end of two improbable drugs, cloroquine and hydroxychloroquine. The short message: Don’t use them anymore, alone or in combination, for the prophylaxis or treatment of SARS-CoV-2 infection. This recommendation stems from a large multinational registry analysis from 671 hospitals on six continents, 14,888 patients treated with these drugs were compared with 81,444 control patients. Each cloroquine or hydroxychloroquine regimen was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias.
Update 3 June 2020: The previous study by Mehra et al. is like to be retracted soon.
Afterwards, discover seeding patterns of SARS-CoV-2 in Saudi Arabia; quantify the reduction in daily global CO2 emissions during the early COVID-19 pandemic; administer an adenovirus type-5 vectored COVID-19 vaccine to 108 healthy adults, measure neutralizing antibodies and determine the frequency of fever, fatigue, and headache; try and understand which healthcare workers in Tongji hospital, Wuhan, were more likely to be infected with SARS-CoV-2: HCWs in fever clinics or wards or HCWs in other clinical departments; and discuss with your friends that there is no direct evidence indicates that public mask wearing protects either the wearer or others, but that the possible benefit of a modest reduction in transmission likely outweighs the possibility of harm.
Finally, review evidence regarding the benefits and harms of ventilation techniques; discuss with your colleagues the role of systemic inflammation and vascular endothelial damage in the development of fatal organ failure; assess endothelial cell dysfunction which might explain the vascular microcirculatory complications seen in different organs in patients with COVID-19; and discover that 6% of 1, 353 health-care workers reporting fever or respiratory symptoms were found to be infected with SARS-CoV-2. How many of the 86 infected HCWs continued working while symptomatic?
Voice: Google Cloud Text-to-Speech / UK
First, continue following the antiviral saga. You’ll finally read the ‘preliminary report’ of a study that randomized 1,063 COVID-19 patients to receive remdesivir or placebo. (Remember: the data were pre-announced three weeks ago during a hastily arranged press conference in the wake of the publication of a study by Wang and collaborators who found no clinical benefit for remdesivir in a randomised, double-blind, placebo-controlled, multicentre trial (The Lancet: Wang 2020)). The preliminary report, now published in the New England Journal of Medicine, suggests that remdesivir may shorten the time to recovery in hospitalized adults by a few days. Mortality was somewhat but not significantly lower in patients who received remdesivir.
Afterwards, simulate three transmission modes including close contact, respiratory droplets and aerosol routes in naive h ACE2 mice; publish the cryo-electron microscopic structure of the SARS-CoV-2 RdRp in its active form; evaluate different DNA vaccine candidates expressing different forms of the spike protein in 35 rhesus macaques in regard to neutralizing antibody titers; discuss with your colleagues the administration of thymosin alpha 1 (subcutaneous injections of 10 mg) to 76 patients with severe COVID-19; describe clinical characteristics, imaging findings, and outcomes among 24 patients who presented with acute hypoxemic respiratory failure; explore why immunity passports are a bad idea; present clinical data from 20,133 patients, admitted to (or diagnosed in) 208 acute care hospitals in the UK until April 19, and discuss overall mortality (26%) and mortality of patients admitted to high-dependency or intensive care units (32%) and of those who received mechanical ventilation (37%).
Finally, investigate viral and host factors related to the clinical outcome of COVID-19. You’ll find that up to now, different viral clades did not exhibit significant difference in clinical features, mutation rate or transmissibility. However, lymphocytopenia, especially reduced CD4+ and CD8+ T cell counts, was predictive of disease progression. High levels of IL-6 and IL-8 during treatment were observed in patients with severe or critical disease and correlated with decreased lymphocyte count. The determinants of disease severity seemed to stem mostly from host factors such as age, lymphocytopenia, and its associated cytokine storm.
Voice: Google Cloud Text-to-Speech / US
First, design natural sunlight representing a clear day at sea level during summer solstice at 40oN latitude and determine the time needed to inactivate 90% percentage of infectious virus; investigate the potential of UVB radiation from sunlight as a potential virucide; and re-challenge 9 rhesus macaques 35 days after initial infection with SARS-CoV-2.
Afterwards, find out that a positive RT-qPCR result may not necessarily mean the person is still infectious or that they still have any meaningful disease; compare daily incidence in 8 Iowa counties bordering Illinois with those in the 7 Illinois counties bordering Iowa; and evaluate the expression of ACE in nasal epithelial samples in children 4 to 9 years old and discuss the implications.
Finally, discuss with your colleagues why the 4.65% prevalence of SARS-CoV-2-specific antibodies found in Los Angeles may be biased; discuss with your patients why hydroxychloroquine doses tolerable for humans are too low to have any effect on SARS-CoV-2 in vivo; and examine lungs from 7 deceased COVID-19 patients with lungs from 7 patients who died from ARDS secondary to influenza A and 10 age-matched, uninfected control lungs. What will you discover?
An update on HIV infection in the current crisis
HIV infection is of particular interest in the current crisis. First, many patients take antiretroviral therapies that are thought to have some effects against SARS-CoV-2. Second, HIV serves as a model of cellular immune deficiency. Third and by the far most important point, the collateral damage caused by COVID-19 in the HIV population may be much higher than that of COVID-19 itself.
Inexplicably, information on the HIV population is still scarce. More >>>
First, investigate high SARS-CoV-2 attack rates at church events; show competency in putting on and removing personal protective equipment (PPE); and edit consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.
Afterwards, build multiple monoclonal antibodies targeting SARS-CoV-2 S identified from memory B cells; establish whether blood 25-hydroxyvitamin D (25(OH)D) concentration was associated with COVID-19 risk; calculate the incidence of deep vein thrombosis in 143 patients from Wuhan; and describe the dynamic relationship between D‐dimer level and the progression of COVID‐19 in 279 patients.
Finally, explain the decline in acute myocardial infarction in California after March 4; analyze 525 patients with inflammatory bowel disease from 33 countries and search for risk factors for severe COVID-19; and discuss available antifibrotic therapies with your colleagues for fibrotic lung disease following SARS-CoV-2 infection.
First, travel to Nembro in the Northern Italian Province of Bergamo, a city of 11,500. Discover that from January 1 until April 4, 2020, 175 people older than 64 died. For comparison: over the same time period in the years 2015 to 2019, a mean of 36 individuals of the same age died (see Table 1). Most deaths in 2020 occurred between March 1 and April 4. From the outbreak onset until 11 April 2020, only 85 confirmed deaths from COVID-19 were recorded. The authors conclude that the full impact of the COVID-19 pandemic can only be assessed after careful comparison of all-cause mortality in 2020 vs the preceding years.
Afterwards, go to Lyon and determine the prevalence of obesity among adult inpatients with COVID-19; present a detailed description of existing SARS-CoV-2 serology assays at your weekly journal club; analyze 26 studies to learn more about the duration of fecal viral shedding after a negative nasopharyngeal swab; and test 290 serum samples from patients with rheumatoid arthritis, systemic lupus erythematosus, and Sjogren’s syndrome, for cross-reactivity against SARS-CoV-2 IgG and IgM antibodies.
Finally, describe neurologically devastating intra-parenchymal hemorrhage in two patients on extracorporeal membrane oxygenation; discuss with your colleagues a review about psychiatric and neuropsychiatric presentations associated with severe COVID-19; write a review of the literature on thromboembolic events associated with COVID-19; and while awaiting the results of several ongoing randomized controlled trials, present the possible role of favipiravir in the treatment of SARS-CoV-2 infection.
First, identify 14 potent neutralizing antibodies by high-throughput single B-cell RNA- sequencing; investigate the transmission rate from households with confirmed COVID-19 cases to their dogs; and tell your friends to stop making assumptions on the effect of sunlight on SARS-CoV-2 transmission.
Afterwards, design a rhesus macaque model that recapitulates COVID-19 in humans; transmit SARS-CoV-2 from inoculated Golden Syrian hamsters to naïve hamsters by direct contact and via aerosols; and determine changes in host-cell pathways upon SARS-CoV-2 infection.
Finally, make an in-depth enquiry of COVID-19-associated headache; discuss with your colleagues the hypothetical use of alisporivir; follow 21 transplanted patients (10 kidney, 5 liver, 1 pancreas, 1 lung, 1 heart and 3 combined transplantations); and describe a cohort of 168 children and adolescents with laboratory-confirmed COVID-19.
We have published the third French Edition. A great thanks to Bruno Giroux and Georges Mion.
First, investigate a 2.5 hour choir practice involving a 61 person choir with 32 confirmed and 20 probable secondary cases of SARS-CoV-2 infection. Transmission was likely facilitated by close proximity (within 6 feet) during practice and augmented by the act of singing. The superspreading event underscores the importance of physical distancing, including avoiding gathering in large groups, to control the spread of COVID-19.
Afterwards, build an online tool for understanding excess mortality in the UK; determine infectiousness before or on the day of symptom onset in a German outbreak; use cryoelectron microscopy to determine a 2.9 angstrom resolution structure of the virus’s RNA synthesizing machine; and show the total excess of all cause deaths in New York by COVID-19.
Finally, analyze the host response to SARS-CoV-2 and other human respiratory viruses in cell lines, primary cell cultures, ferrets, and… COVID-19 patients! In particular measure type I and III interferons as well as chemokines and IL-6; demonstrate that the overabundance of ACE2 in the lungs of smokers may partially explain why smokers are significantly more likely to develop severe COVID-19; propose prone positioning to non-intubated patients with hypoxemic acute respiratory failure requiring oxygen supplementation; and discuss with your colleagues an editorial which summarizes the current knowledge on the prone position.
First, acknowledge that health care workers on the frontline are facing a substantial risk of infection during the COVID-19 outbreak. Discover that among 2,457 SARS-CoV-2-infected health care workers in Wuhan, China, more than half were nurses, while 33% were doctors. Importantly, most infected cases among health care workers were female: 72%. It is essential to improve protective measures for HCWs. Ensuring an adequate supply of PPE is just the first step. Other measures should be considered, including a nutritious food supply, adequate rest time, and societal, familial, and psychological support.
Afterwards, discuss with your colleagues a comprehensive overview about current knowledge (and knowledge gaps) about treatment of patients who develop severe disease; grant an FDA emergency use authorization for a clustered regularly interspaced short palindromic repeats (CRISPR)-based SARS-CoV-2 fluorescent assay; and use data from Germany to build a model that detects change points in the effective epidemic growth rate that correlate with the times of publicly announced interventions (including kind regards to Boris et al.).
Finally, evaluate anakinra in 29 patients with moderate-to-severe ARDS and hyperinflammation (serum C-reactive protein, CRP ≥100 mg/L) and in 8 patients with secondary hemophagocytic lymphohistocytosis (sHLH) characterized by pancytopenia, hypercoagulation, acute kidney injury and hepatobiliary dysfunction; discover that pulmonary arterial thrombosis in COVID-19 may occur despite the use of prophylactic anticoagulation; read a well-balanced editorial on the same subject; and read four critical letters about the remdesivir compassionate use program.
First, determine the false-negative rate of RT-PCR on the day of symptom onset and three days later; discuss with your colleagues if antibody testing for SARS-CoV-2 can be used in low prevalence areas; and detect SARS-CoV-2−reactive CD4 T cells in unexposed individuals.
Afterwards, use optical coherence tomography (OCT) in patients with COVID-19 and describe retinal changes; and correlate perforin+ NK cell number to disease severity in COVID-19 patients.
Finally, randomize patients with mild to moderate COVID-19 to receive lopinavir/r, arbidol (200 mg TID) or no antiviral medication as control; find out why the treatment of COVID-19 with lopinavir/r at the currently used dose is unlikely to be effective; and analyze a group of 177 pediatric patients and find out how many were hospitalized and/or critically ill.
Today, we have published theTurkish Edition of COVID Reference. A great thanks to Zekeriya Temircan and Füsun Ferda Erdoğan.
First, inoculate three domestic cats with SARS-CoV-2. One day later, cohouse an uninfected cat with each of the inoculated cats. Find out how many cats become infected, measure antibody titers on day 24 and count the number of infected cats that show symptoms. If cats are silent intermediate carriers of SARS-CoV-2, what would we recommend to cat owners?
Afterward, describe a scalable serological enzyme-linked immunosorbent assay (ELISA) for the screening and identification of human SARS-CoV-2 seroconverters; build a model to estimate the percentage of infected individuals who were hospitalized in France and how many died; establish an expandable organoid culture system of bat intestinal epithelium; and quantify SARS-CoV-2 viral load in autopsy tissue samples from 22 patients. You will detect the highest levels in the respiratory tract. Where will you find the lowest viral loads?
Finally, discuss with your colleagues what we know about SARS-CoV-2 infection in children; find out that BCG vaccination does not protect against SARS-CoV-2 infection; isolate human-origin monoclonal antibodies from a convalescent patient that show neutralization abilities; and develop and validate a clinical risk score to predict the risk of critical illness in hospitalized patients with COVID-19.
First, put 8 dermatologists and 6 scientists (index patient + n=13) into an advisory board meeting (a conference room of about 70 m2 with a U-shaped set-up of tables separated by a central aisle >1 m wide); serve refreshments buffet style in the same room 4 times during a 9.5 hour meeting; let all participants have dinner in a nearby restaurant; let them shake hands during farewell with a few short hugs (no kisses); and let the index patient share a taxi with three colleagues for about 45 min. How many of the 13 individuals were infected by the asymptomatic index patient?
Afterwards, take a random sample of 7914 COVID-19 patients admitted to New York metropolitan hospitals and investigate if treatment with hydroxychloroquine or azithromycin or both drugs combined is associated with significantly lower in-hospital mortality (you probably know the answer); learn how many of 48 children with COVID-19 admitted to ICUs had significant preexisting comorbidities; read a retrospective review of 22 children and adolescents with acute chilblain-like lesions; and discuss with experts a critical review of the evidence for low-dose radiation treatment of COVID-19 pneumopathy.
Finally, investigate knowledge gaps on postinfection immunity and possible inaccuracies of “COVID passports”; calculate the transmission rate between 35 index cases and 148 household contacts in Zhuhai, China; optimize leukemia management in COVID-19 times; and perform a meta-analysis of 15 studies to assess the severity and mortality associated with COPD and smoking in patients with COVID-19.
First, randomize 127 patients with mild-to-moderate COVID-19 to receive lopinavir/r only or a triple combination of interferon beta-1b, lopinavir–ritonavir (lopinavir/r), and ribavirin; build a smartphone app and test if a combination of symptoms, including anosmia, fatigue, persistent cough and loss of appetite is appropriate to identify individuals with COVID-19; and measure hydroxychloroquine concentrations in 57 patients.
Afterwards, discuss an unprecedented cluster of eight children (all previously fit and well) with hyperinflammatory shock, showing features similar to atypical Kawasaki disease, Kawasaki disease shock syndrome, or toxic shock syndrome; show how SARS-CoV-2 infects epithelial cells and alters the immune landscape in patients with severe disease; evaluate tissue and cellular tropism of SARS-CoV-2 in the human respiratory tract and conjunctiva; and demonstrate what happens during the second week, when resident macrophages initiating lung inflammatory responses are unable to contain SARS-CoV-2.
Finally, appreciate that not all world leaders use Twitter in response to the COVID-19 pandemic (…); find out that it is difficult to establish a clear cause-effect relationship between COVID-19 infection and MRI findings; and develop a pathway for an effective vaccine with Anthony Fauci.
First, collect samples from 227 bats in Yunnan and find a close relative of SARS-CoV-2; determine the crystal structure of CR3022, a neutralizing antibody previously isolated from a convalescent SARS patient; and revisit closing citywide public transport and entertainment venues as well as banning public gatherings.
Afterwards, pool the data of 3,428 COVID-19 infected patients (1,455 severe cases and 1,973 mild cases) and correlate serum levels of ALT, AST, bilirubin and albumin with severity of COVID-19; find out that there is no excess COVID-19 morbidity and mortality among HIV-infected patients; dissect conspiracy theories and the “infodemic” (WHO) of incorrect information about SARS-CoV-2 (or not if you have no time to waste); and measure ACE2 concentrations in 1485 men and 537 women with heart failure.
Finally, confront 16 recommendations for acute management of COVID-19 with your own experience; analyze 131 patients undergoing maintenance hemodialysis with a mean age of 63 years; discuss JAK kinase inhibitors as a way of managing the cytokine storm in severe COVID-19 patients and possible side effects; and listen to Peter Piot (71), one of the discoverers of the Ebola virus in 1976 and former UNAIDS director, discussing a severe case of COVID-19: his own.
First, develop ‘shield immunity’ at the population scale; savor a review on current knowledge of innate and adaptive immune responses elicited by SARS-CoV-2 infection; and establish correlation between neutralization antibody titers and the numbers of virus-specific T cells.
Afterwards, present autopsy findings where 7/12 patients with COVID-19 had venous thromboembolism; investigate five cases of cor pulmonale; and determine the incidence of influenza among adults who received a prescription for an ACE inhibitor from 1998 through 2016.
Finally, analyze the association of higher body mass index (BMI) with severe COVID in younger patients; participate in the race for antibodies that might stop the new coronavirus; and identify neutralizing cross-reactive VHH camelid antibodies, which may serve as potential therapeutic candidates.
Kawasaki-like syndrome in children – A new twist in this new pandemic: at the end of March 2020, Jones et al. described the case of a six-month-old baby girl with fever, rash and swelling characteristic of a rare pediatric inflammatory condition, Kawasaki syndrome (Jones 2020). >>> Read more
First, savor an observational study of hydroxychloroquine in 1,376 hospitalized patients; investigate COVID-19 on the African continent; and explain why 95/100 of deceased Italian doctors were men.
Afterwards, discover the pathogenicity of SARS-CoV-2 in transgenic mice bearing human ACE2; isolate SARS-CoV-2-related coronavirus from 25 Malayan pangolins; and use T cell subset counts in peripheral blood as biomarkers for diagnosis and severity prediction of COVID-19.
Finally, rehabilitate COVID-19 patients after intensive care; learn about the number of cases and deaths among detained persons and staff members in correctional and detention facilities in the US; and discuss with your colleagues off-the-shelf SARS-COV-2-specific HLA-matched cytotoxic T cells prepared from convalescent COVID-19 patients.
First, test how often you can heat N95 respirators at 85°C; explain the problems of immunity passports (“COVID passports”); and describe how to interpret RT-PCR and IgM and IgG ELISAs and how the results may vary over time.
Afterwards, determine the incidence of venous thromboembolism in 198 hospitalized patients at 7, 14, and 21 days; examine three patients with ulcers in the oral cavity; and discover thrombocytopenia as an initial manifestation of COVID-19.
Finally, reveal glycan structures of the SARS-CoV-2 spike that facilitate immune evasion; check mAb 47D11, a human monoclonal antibody that neutralizes SARS-CoV-2; and discuss why lopinavir/r may still be a potential therapeutic agent against COVID-19, especially when given earlier.
First, write a thrilling feature on what you know about SARS-CoV-2; then, discover a summary of what you always knew about risk factors for coronavirus infections in HCWs; and revisit the power of early detection and isolation of cases.
Afterwards, build a yeast-based synthetic genomics platform to genetically reconstruct RNA viruses; and use a hamster model to create less pathogenic SARS-CoV-2 variants.
Finally, assess the impact of the insomnia drug dexzopiclone on survival in hospitalized patients; present a predictive model for in-hospital mortality; analyze 100 children with COVID-19; and discuss with your colleagues how to interpret a Swiss study where two thirds of 21 autopsied patients had blood group A.
Top 10 Special on Remdesivir
Get it done!
On remdesivir, rumors of recovery, rolling reviews, and random noise
“That’s very exciting. Get it done, Daniel.” If you want to get an idea about the incredible pressure on and expectations from researchers, then please read the protocol from the White House (Trump 2020). NIAID’s Anthony Fauci and Gilead’s CEO Daniel O’Day make heroic attempts to explain the situation to decision makers. This pressure has its consequences. >>> Read more
Top Ten Special on
ACE inhibitors/ARBs – continue them (or start them up again)!
There has hardly been a topic in the last weeks of this pandemic that has kept doctors (mainly internists) and their patients as busy as the question of whether ACE inhibitors or angiotensin-receptor blockers (ARBs) can cause harm to patients. Early observations of an increased risk for mortality or severe COVID-19 in patients with hypertension, cardiovascular diseases and diabetes (Guan 2020) raised concerns.
First of all, create a group of more than 100 colleagues and map the interaction landscape between SARS-CoV-2 proteins and human proteins; express more than 20 of the 29 SARS-CoV-2 proteins in human cells and identify at least 300 high-confidence SARS-CoV-2-human PPIs; and identify pharmacological agents that display antiviral activity. (We give you a hint: inhibitors of mRNA translation and predicted regulators of the Sigma1 and Sigma2 receptors.)
Thereafter, using contact survey data for Wuhan and Shanghai, build a model that predicts the impact of lockdown and show that daily contacts were reduced 7-8-fold during the social distancing period; generate 53 genomes from infected individuals in Guangdong to deduce where the first infections came from; and show how remdesivir might inhibit SARS-CoV-2 RdRp activity.
Finally, feed >300,000 CT images into an AI system and test if it does better than junior radiologists; check HbA1c because it might lower mortality; learn that the COVID-19 outbreak led to a 32% decline in percutaneous coronary interventions for acute coronary syndromes; and discuss with your colleagues a review on current immunotherapies.
Dermatology Special Issue
This has been the week of the dermatologists: numerous studies reported on cutaneous manifestations seen in the context of COVID-19. The most prominent phenomenon, the so-called “COVID toes”, are chilblain-like lesions which mainly occur at acral areas [chilblain: Frostbeule (de), engelure (fr), sabañón (es), gelone (it), frieira (pt), 冻疮 (cn)]. These lesions can be painful (sometimes itchy, sometimes asymptomatic) and may represent the only symptom or late manifestations of SARS-CoV-2 infection. Of note, in most patients with “COVID toes”, the disease is only mild to moderate. It is speculated that the lesions are caused by inflammation in the walls of blood vessels, or by small micro clots in the blood. However, whether “COVID toes” represent a coagulation disorder or a hypersensitivity reaction is yet to be known. In addition, in many patients, SARS-CoV-2 PCR was negative (or not done) and serology tests (to proof the relationship) are still pending.
First, question a previous publication about a more aggressive and more quickly spreading SARS-CoV-2 subtype and demonstrate that the authors were wrong; then use mobile phone geolocation data to compute aggregate population movements in China.
Thereafter, savor a brilliant overview of SARS-CoV-2 pathophysiology; investigate if heart fatty acid-binding protein (HFABP) can be an indicator of severe COVID-19; and search for genetic variants which might indicate a predisposition for severe COVID-19 disease.
Finally, analyze sex-specific clinical characteristics and prognosis of COVID-19 in Wuhan; don’t use convalescent plasma too late; and develop a diagnostic pathway for COVID-19 patients with STEMI aimed at protecting healthcare providers.