{"id":4216,"date":"2020-02-12T15:45:22","date_gmt":"2020-02-12T23:45:22","guid":{"rendered":"https:\/\/depts.washington.edu\/pandemicalliance\/?p=4216"},"modified":"2021-02-22T12:03:54","modified_gmt":"2021-02-22T20:03:54","slug":"covid-19-literature-situation-report-february-12-2020","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/pandemicalliance\/2020\/02\/12\/covid-19-literature-situation-report-february-12-2020\/","title":{"rendered":"COVID-19 Literature Situation Report February 12, 2020"},"content":{"rendered":"<p>The scientific literature on COVID-19 is rapidly evolving and these articles were selected for review based on their relevance to Washington State decision making around COVID-19 response efforts. Included in these Lit Reps are some manuscripts that have been made available online as pre-prints but have not yet undergone peer review. Please be aware of this when reviewing articles included in the Lit Reps.<\/p>\n<h2>Key Takeaways<\/h2>\n<ul>\n<li><b>2019-nCoV Case Fatality Rates have a broad range, depending on age, severity of illness at time of diagnosis, and sex. A calculated CFR for hospitalized patients ranges from 0.7% for those presenting with mild illness 9.5% for patients with two of three risks mentioned.<\/b><\/li>\n<\/ul>\n<ul>\n<li><b>The importance of contact tracing, screening, and other public health control measures has been emphasized in recent models considering that some infected patients may infect more secondary cases than others.\u00a0<\/b><\/li>\n<\/ul>\n<ul>\n<li><b>Sputum specimens appear to be the most accurate specimen type for laboratory diagnosis of 2019-nCoV, with BALF specimens considered very accurate only for severe cases.\u00a0<\/b><\/li>\n<\/ul>\n<ul>\n<li><b>The importance of planning for limited healthcare resources during a local or regional 2019-nCoV epidemic is highlighted.<\/b><\/li>\n<\/ul>\n<div id=\"uw-accordion-shortcode\">\n<h3>Article Summaries<\/h3>\n<div class=\"js-accordion\" data-accordion-prefix-classes=\"uw-accordion-shortcode\">\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\"><span style=\"font-weight: 400\">Transmission and Global Spread<\/span><\/h2>\n<div class=\"su-posts su-posts-default-loop\">\n<div id=\"su-post-4221\" class=\"su-post\">\n<h5 class=\"su-post-title\">Ophthalmologic evidence against the interpersonal transmission of 2019 novel coronavirus through conjunctiva<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A case series of 67 2019-nCoV pneumonia patients (NCP) was evaluated to assess possible 2019-nCoV transmission from aerosol contact with the conjunctiva. A conjunctival swab sample from one patient with no ocular symptoms was RT-PCR positive; one patient with conjunctivitis was RT-PCR negative. [<\/span><i><span style=\"font-weight: 400\">Note: <\/span><\/i><span style=\"font-weight: 400\">The weak study design did not address their hypothesis, but the lab findings are potentially of interest.]<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Zhou Y, et al (Feb 12, 2020) Ophthalmologic evidence against the interpersonal transmission of 2019 novel coronavirus through conjunctiva. Pre-print accessed Feb 12 from <\/span><\/i><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20021956v1\"><span style=\"font-weight: 400\">https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20021956v1<\/span><\/a><i><span style=\"font-weight: 400\">\u00a0<\/span><\/i><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<div id=\"su-post-4219\" class=\"su-post\">\n<h5 class=\"su-post-title\">Diarrhea may be underestimated: a missing link in 2019 novel coronavirus<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A gastrointestinal route of infection is proposed by Liang, et al., based on ACE2 [host cell receptor] mRNA expression in healthy human small intestines and other molecular evidence for biologic plausibility.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">It is hypothesized that eating 2019-nCoV-infected wild animals could result in human infection; and diarrhea as a 2019-nCoV symptom could both indicate a GI route of transmission and be risk for on-going transmission.<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Liang W, et al (Feb 11, 2020) Diarrhea may be underestimated: a missing link in 2019 novel coronavirus. Pre-print accessed Feb 12 from <\/span><\/i><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.03.20020289v1\"><span style=\"font-weight: 400\">https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.03.20020289v1<\/span><\/a><i><span style=\"font-weight: 400\">\u00a0 \u00a0 <\/span><\/i><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<div id=\"su-post-4217\" class=\"su-post\">\n<h5 class=\"su-post-title\">Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A review of all 2019-nCoV patients reported to the Chinese Center for Disease Control and Prevention (Chinese CDC) up to 26 January, 2020 was undertaken to describe the affected populations and to estimate severity and transmissibility.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Of 8866 patients, 4021 (45%) were laboratory confirmed.\u00a0<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Ages were similar between confirmed and suspect cases (49 years; SD, <\/span><span style=\"font-weight: 400\">+<\/span><span style=\"font-weight: 400\">16 yrs). Fourteen of the 4021 confirmed cases were in children &lt;10 years old. Most confirmed cases were 30-65 years of age.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Wuhan patients were on average older and more likely to be male compared to elsewhere in China.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Among confirmed cases, median time from symptom onset to diagnosis was 5 days. Mild pneumonia (70%) was most often seen at time of diagnosis, with about 26% diagnosed with severe pneumonia and 5% with no evidence of pneumonia.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Incidence shifted from sporadic to exponential on 1 January. Starting 17 January, more confirmed patients were reported outside of Wuhan than in Wuhan.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Bias-adjusted Case Fatality Rate (CFR) estimates:\u00a0<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Among confirmed cases, calculated CFRs were higher than observed CFRs (3.1% and 1.4%, respectively).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Ranged from 0.7% for those with mild disease at time of diagnosis to 9.5% for patients with two of three risks (male, <\/span><span style=\"font-weight: 400\">&gt;<\/span><span style=\"font-weight: 400\">60 years of age, or severe disease at diagnosis)\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Were higher in patients <\/span><span style=\"font-weight: 400\">&gt;<\/span><span style=\"font-weight: 400\">60 years of age (5.3% vs. 1.4% &lt;60 yrs), patients with longer time from onset to diagnosis (3.1%, &gt;5 days vs. 1.3%, <\/span><span style=\"font-weight: 400\">&lt;<\/span><span style=\"font-weight: 400\">5), and among males (4.5% vs. 1.3%)<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">R<\/span><span style=\"font-weight: 400\">0<\/span><span style=\"font-weight: 400\"> estimates were highest (R<\/span><span style=\"font-weight: 400\">0<\/span><span style=\"font-weight: 400\">, 3.2-4.8) for long incubation (6.4 days) and infectious (9.2 days) periods; and lowest (R<\/span><span style=\"font-weight: 400\">0<\/span><span style=\"font-weight: 400\">, 2.2-2.8) for short incubation (3.8 days) and infectious (5.2 days) periods, with added variability due to reporting rate(30%-100%).<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Yang Y, et al (Feb 11, 2020) Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China. Pre-print accessed Feb 12 from <\/span><\/i><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.10.20021675v1\"><span style=\"font-weight: 400\">https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.10.20021675v1<\/span><\/a><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\">Modeling and Prediction<\/h2>\n<div class=\"su-posts su-posts-default-loop\">\n<div id=\"su-post-4225\" class=\"su-post\">\n<h5 class=\"su-post-title\">Assessing the plausibility of subcritical transmission of 2019-nCoV in the United States<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The upper bound for basic reproduction number, R, in the current US context is estimated based on the number of imported primary cases and secondary cases, and using a maximum likelihood technique. R is found to be less than 1 (subcritical) at this time. Depending on the value of a dispersion parameter reflecting heterogeneity of spread [see above], 2-9 secondary cases from 10 imported cases would be required for R to exceed 1.<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Blumberg S, et al (Feb 11, 2020) Assessing the plausibility of subcritical transmission of 2019-nCoV in the United States. Pre-print. Accessed Feb 12 from<\/span><\/i><span style=\"font-weight: 400\"> https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.08.20021311v1<\/span><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<div id=\"su-post-4223\" class=\"su-post\">\n<h5 class=\"su-post-title\">Beyond R0: the importance of contact tracing when predicting epidemics<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Hebert-Dufrense, <\/span><i><span style=\"font-weight: 400\">et al.<\/span><\/i><span style=\"font-weight: 400\"> apply network theory to improve basic estimates of R<\/span><span style=\"font-weight: 400\">0<\/span><span style=\"font-weight: 400\">, using added information from the <\/span><i><span style=\"font-weight: 400\">numeric heterogeneity of secondary infections <\/span><\/i><span style=\"font-weight: 400\">\u2013 that is, the fact that some individuals create more secondary infections then others.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A range of predictions for the final size of the Wuhan 2019-nCoV epidemic is provided, using R<\/span><span style=\"font-weight: 400\">0<\/span><span style=\"font-weight: 400\"> estimates from early cases and SARS data for the underlying distribution of secondary cases. The resulting range, as a fraction of the total susceptible population, is 5%-40%.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">With a <\/span><b>high heterogeneity (<\/b><span style=\"font-weight: 400\">e.g., transmission mostly maintained by \u201csuper-spreading\u201d events), the epidemic is less likely to spread extensively and be easier to manage with contact tracing, screening and infection control\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">With <\/span><b>low heterogeneity<\/b><span style=\"font-weight: 400\">, containment strategies will likely fail, and pandemic of 2019-nCoV is likely.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Overall, this network modeling approach highlights the need for contact tracing during emerging infectious disease outbreaks; and the need to look beyond R<\/span><span style=\"font-weight: 400\">0<\/span><span style=\"font-weight: 400\"> when predicting epidemic size.<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Hebert-Dufrense L, et al. (Feb 11, 2020) Beyond R0: the importance of contact tracing when predicting epidemics. Pre-print. Accessed Feb 12 from<\/span><\/i><span style=\"font-weight: 400\"> https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.10.20021725v1<\/span><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\"><span style=\"font-weight: 400\">Clinical Outcomes and Access to Care<\/span><\/h2>\n<div class=\"su-posts su-posts-default-loop\">\n<div id=\"su-post-4231\" class=\"su-post\">\n<h5 class=\"su-post-title\">Epidemiological and Clinical Characteristics of 17 Hospitalized Patients with 2019 Novel Coronavirus Infections Outside Wuhan, China<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A case series of 17 COVID-2019 cases from Dazhou, China is described. In comparing discharged and non-discharged patients, the authors find that younger age and higher lymphocytes and monocyte levels may be factors in faster recover.<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Li J, et al (Feb 12, 2020) Epidemiological and Clinical Characteristics of 17 Hospitalized Patients with 2019 Novel Coronavirus Infections Outside Wuhan, China. Pre-print. Accessed Feb 12 from <\/span><\/i><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20022053v1\"><span style=\"font-weight: 400\">https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20022053v1<\/span><\/a><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<div id=\"su-post-4229\" class=\"su-post\">\n<h5 class=\"su-post-title\">On the use of corticosteroids for 2019-nCoV pneumonia<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Shang, <\/span><i><span style=\"font-weight: 400\">et al.<\/span><\/i><span style=\"font-weight: 400\"> respond to an earlier article by Russell, <\/span><i><span style=\"font-weight: 400\">et al.<\/span><\/i><span style=\"font-weight: 400\"> on clinical evidence of corticosteroid therapy in severe coronavirus infections. Shang, <\/span><i><span style=\"font-weight: 400\">et al.<\/span><\/i><span style=\"font-weight: 400\"> describe the potential for selection bias and confounding in observational studies, given that usually only critically ill patients are treated with corticosteroid therapy. They further note that four references in the original articles cited as having \u201cconclusive data\u2026indicating harm\u201d were not definitive, and that Russell, <\/span><i><span style=\"font-weight: 400\">et al.<\/span><\/i><span style=\"font-weight: 400\"> did not address 25 other inconclusive studies. Additional studies supporting low-moderate dose corticosteroid therapy for severely ill coronavirus and influenza patients are cited.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">An expert consensus statement from the Chinese Thoracic Society identifies basic principles for corticosteroids use, including that corticosteroids can be used prudently in critically ill COVID-2019 patients, with special caution for patients with hypoxemia due to underlying diseases or who regularly use corticosteroids for chronic diseases; that dosage should be low-to-moderate (\u22640\u00b75\u20131 mg\/kg per day methylprednisolone or equivalent); and that duration should be short (\u22647 days).<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Shang L, et al. (Feb 11, 2020) On the use of corticosteroids for 2019-nCoV pneumonia. The Lancet. <\/span><\/i><a href=\"https:\/\/doi.org\/10.1016\/S0140-6736(20)30361-5\"><span style=\"font-weight: 400\">https:\/\/doi.org\/10.1016\/S0140-6736(20)30361-5<\/span><\/a><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<div id=\"su-post-4227\" class=\"su-post\">\n<h5 class=\"su-post-title\">Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A case series of nine pregnant women with COVID-2019 provides a description of clinical characteristics and initial information on risk of vertical transmission.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020.\u00a0<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Seven patients presented with a fever; four, with cough; three, myalgia; and two, sore throat or malaise. Five had lymphopenia (&lt;1\u00b70 \u00d7 10\u2079 cells per L); three, increased aminotransferase concentrations. Fetal distress was monitored in two cases.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">All nine patients had a caesarean section (third trimester) leading to a livebirth.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">All nine newborns had a 1-min Apgar score of 8\u20139 and a 5-min Apgar score of 9\u201310.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Six patients had amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples tested for SARS-CoV-2. All samples tested negative for the virus.<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Chen H, et al. (Feb 12, 2020) Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. <\/span><\/i><a href=\"https:\/\/doi.org\/10.1016\/S0140-6736(20)30360-3\"><i><span style=\"font-weight: 400\">https:\/\/doi.org\/10.1016\/S0140-6736(20)30360-3<\/span><\/i><\/a><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\"><span style=\"font-weight: 400\">Testing and Treatment<\/span><\/h2>\n<div class=\"su-posts su-posts-default-loop\">\n<div id=\"su-post-4233\" class=\"su-post\">\n<h5 class=\"su-post-title\">Laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The diagnostic accuracy of different respiratory specimens for 2019-nCoV detection is assessed by Yang, <\/span><i><span style=\"font-weight: 400\">et al<\/span><\/i><span style=\"font-weight: 400\">.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Specimens were collected from confirmed novel coronavirus pneumonia (NCP; severe or mild) patients in a Guangdong, China hospital; and tested using the Qiagen QIAamp RNA Viral Kit and a Chinese Food &amp; Drug Administration-approved, quantitative RT-PCR 2019-nCoV detection kit.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">866 specimens from 213 hospitalized patients were tested, including nasal swabs (n=490), throat swabs (n=205), sputum (n=142) and bronchoalveolar lavage fluid (BALF; n=29). Sample collection was grouped by days after symptom onset (0-7 days, 8-14 days, and &gt;14 days).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Overall, sputum was found to be the most accurate specimen type for laboratory diagnosis of NCP<\/span><span style=\"font-weight: 400\">.\u00a0<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Sputum specimens taken with 14 days after onset were positive in 74-89% of cases (mild and severe). From 15 days onward, 43-61% continued to test positive.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Nasal swab specimens taken within 14 days after onset were positive in 54-73% of cases, dropping to 50-55% after 14 days.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Throat specimens taken within 7 days were positive in 60-61% of cases. From 8 days onward, this dropped to 37%-50% of severe cases and 11%-30% of mild cases.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Among 10 severe cases, positive BALF specimens were found from 6-23 days after onset; and 100% tested BALF-positive at 8-14 days after symptom onset. Three mild cases were BALF-negative.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Among 13 NCP cases with specimens from upper (throat, nasal, sputum) and lower respiratory (BALF) samples across multiple time periods, viral RNA was reliably detected in the lower respiratory tract of cases of severe NCP cases, but not in upper respiratory samples.\u00a0<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Yang Y, et al (Feb 12, 2020) Laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. Pre-print. Accessed Feb 12 from <\/span><\/i><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20021493v1\"><span style=\"font-weight: 400\">https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20021493v1<\/span><\/a><i><span style=\"font-weight: 400\">\u00a0<\/span><\/i><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\"><span style=\"font-weight: 400\">Policy and Prevention<\/span><\/h2>\n<div class=\"su-posts su-posts-default-loop\">\n<div id=\"su-post-4239\" class=\"su-post\">\n<h5 class=\"su-post-title\">Healthcare-resource-adjusted vulnerabilities towards the 2019-nCoV epidemic across China<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Given that limited healthcare resources have become a serious bottleneck to the Wuhan epidemic response, an SEIR modeling approach was combined with a healthcare-resource-adjusted vulnerability index to inform public health planning for constrained healthcare resources in this epidemic response.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">In addition to identifying vulnerabilities across 100 cities in China, the framework provided integrates human movements and healthcare resources data in a way that could also be more generally useful.\u00a0<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Zhou H, et al (Feb 12, 2020) Healthcare-resource-adjusted vulnerabilities towards the 2019-nCoV epidemic across China. PRE-PRINT. Accessed Feb 12 from <\/span><\/i><span style=\"font-weight: 400\">https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20022111v1<\/span><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<div id=\"su-post-4237\" class=\"su-post\">\n<h5 class=\"su-post-title\">Early lessons from the frontline of the 2019-nCoV outbreak<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Zhang describes the challenges early in the Wuhan 2019-nCoV outbreak. Areas mentioned with implications for policy include transparency of information, including timely public information; provider awareness of atypical presentations, potentially affecting spread across provider settings and insufficient use of respiratory precautions by providers; appreciation of alternate, non-respiratory routes of transmission; availability of personal protective equipment; assuring therapeutic drug supply; and implications of insufficient hospital beds and cancellation of outpatient services, ultimately impacting disease spread, morbidity, and mortality.<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Zhang H (Feb 11, 2020) Early lessons from the frontline of the 2019-nCoV outbreak. The Lancet. <\/span><\/i><a href=\"https:\/\/doi.org\/10.1016\/S0140-6736(20)30356-1\"><span style=\"font-weight: 400\">https:\/\/doi.org\/10.1016\/S0140-6736(20)30356-1<\/span><\/a><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<div id=\"su-post-4235\" class=\"su-post\">\n<h5 class=\"su-post-title\">Primary Care Practitioners&#8217; Response to 2019 Novel Coronavirus Outbreak in China<\/h5>\n<p>\t\t\t\t<!-- \n\n\n\n\n\n\n\n\n\n\n\n<div class=\"su-post-meta\">\n\t\t\t\t\t: \t\t\t\t<\/div>\n\n\n\n\n\n\n\n\n\n\n\n --><\/p>\n<div class=\"su-post-excerpt\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A national survey of primary care providers in China to assess 2019-nCoV prevention practices had a 62% response rate. Most respondents were proactively studying 2019-nCoV (99%); and guiding patients on preventive measures (94%). While only 48% were referring patients meeting a suspect case definition [undefined here] to hospitals for further diagnosis and treatment, this response varied significantly by geographic region, specialty, and practice setting.\u00a0<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\">Xu Z, et al (Feb 12, 2020) Primary Care Practitioners&#8217; Response to 2019 Novel Coronavirus Outbreak in China. Pre-print access Feb 12 from <\/span><\/i><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20022095v1\"><span style=\"font-weight: 400\">https:\/\/www.medrxiv.org\/content\/10.1101\/2020.02.11.20022095v1<\/span><\/a><i><span style=\"font-weight: 400\">\u00a0\u00a0<\/span><\/i><\/p>\n<\/p>\n<\/div>\n<p>\t\t\t\t\t\t\t\t\t<!-- <a href=\"\" class=\"su-post-comments-link\"><\/a> --><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h3>Other Resources<\/h3>\n<ul>\n<li style=\"font-weight: 400\"><a href=\"https:\/\/clinicaltrials.gov\/ct2\/results?cond=%22wuhan+coronavirus%22\"><span style=\"font-weight: 400\">ClinicalTrials.gov has a list of 23 trials related to 2019-nCoV.<\/span><\/a><\/li>\n<li style=\"font-weight: 400\"><a href=\"https:\/\/disasterinfo.nlm.nih.gov\/search\/?q=(coronavirus%20AND%20novel)%20OR%20(Wuhan%20OR%20ncov)\"><span style=\"font-weight: 400\">Repository of disaster management recommendations and guidance from PH agencies.<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><a href=\"https:\/\/redbook.solutions.aap.org\/chapter.aspx?sectionid=189640073&amp;bookid=2205\"><span style=\"font-weight: 400\">Red Book chapter on coronaviruses which covers SARS and MERS. Source is American Academy of Pediatrics<\/span><\/a><\/li>\n<li style=\"font-weight: 400\"><a href=\"https:\/\/www.genomedetective.com\/app\/typingtool\/cov\/\"><span style=\"font-weight: 400\">Genome Typing Tool \u2013 Genome Detective<\/span><\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>2019-nCoV Case Fatality Rates have a broad range, depending on age, severity of illness at time of diagnosis, and sex. A calculated CFR for hospitalized patients ranges from 0.7% for those presenting with mild illness 9.5% for patients with two of three risks mentioned.<\/p>\n<div><a class=\"more\" href=\"https:\/\/depts.washington.edu\/pandemicalliance\/2020\/02\/12\/primary-care-practitioners-response-to-2019-novel-coronavirus-outbreak-in-china\/\">Read more<\/a><\/div>\n","protected":false},"author":8,"featured_media":1713,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"categories":[5],"tags":[],"topic":[],"class_list":["post-4216","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-covid-19-literature-situation-report"],"_links":{"self":[{"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/posts\/4216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/comments?post=4216"}],"version-history":[{"count":4,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/posts\/4216\/revisions"}],"predecessor-version":[{"id":4500,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/posts\/4216\/revisions\/4500"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/media\/1713"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/media?parent=4216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/categories?post=4216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/tags?post=4216"},{"taxonomy":"topic","embeddable":true,"href":"https:\/\/depts.washington.edu\/pandemicalliance\/wp-json\/wp\/v2\/topic?post=4216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}