HIV and ID Observations

The 2019-nCoV, transmission electron microscopy. From The New England Journal of Medicine, January 24, 2020.

The current novel coronavirus outbreak due to 2019-nCoV and SARS from 2002–3 share many features, including:

• Both are coronaviruses, genetically distinct from those that had caused infection in humans previously (most of which led to cold-like illnesses)
• First cases recognized in China, with subsequent international spread
• Source an animal reservoir — likely bats for both of them
• Both cause severe lower respiratory illness
• Documented person-to-person spread, including nosocomial transmission to healthcare workers

What direction 2019-nCoV goes from here remains uncertain, as the current outbreak is rapidly evolving. Despite the extensive press conferences and commentaries from public health officials, microbiologists, and specialists in Infectious Disease — most of them quite thoughtful — the uncertainty will no doubt lead to isolated overstatements of both alarm at one extreme and reassurance at the other.

For a good primer on the current situation, The New England Journal of Medicine and JAMA both weighed in with last week with excellent perspectives.

Uncertainties notwithstanding, I can assuredly say one thing is vastly different this time compared with SARS — the pace of scientific discovery and communication, especially on the molecular level, is breathtakingly fast.

Think about it — less than 2 weeks after the first reported cases (December 31), researchers released the genetic sequence of the virus in its entirety. It’s now available in GenBank.

We already have a diagnostic test being used by our CDC and, internationally, other public health laboratories; this paper describes how such a test might work.

After isolation of the virus, a pre-print demonstrated its affinity for the human ACE2 receptor, which is present predominantly in lower respiratory tract cells. A second scientific group confirmed this finding.

A description of the clinical syndrome can be found here; the incubation period in this family cluster was 3–6 days, though may average 10–14 days; and investigators estimate its contagiousness (R0) — always a dynamic number, especially early in an outbreak — in this report.

Several mention ongoing plans to test drugs with in vitro activity, including approved (lopinavir/ritonavir, interferon) and investigational (remdesivir) agents. Tony Fauci says time from virus discovery to a vaccine in Phase 1 studies could be 3 months — fast!

All of this is quite amazing — and would not have been possible during the SARS outbreak.

Another thing different from 2002 is this was pre-Social Media — which, for all the bad things associated with the specific platform of Twitter, on the plus side it remains an extraordinarily efficient way to transmit and summarize data, at least when it’s done by a thoughtful individual.

Here’s Exhibit A, a must-read thread from Dr. Muge Cevik, an ID doctor in Britain. Thank you!

THREAD
As the #nCoV2019 outbreak continues, a lot of data emerging in real-time & being rapidly disseminated.

I compiled the available data (in no particular order) to have a better understanding of #nCoV2019 & will update the list as more info become available. #IDTwitter

— dr muge cevik (@mugecevik) January 25, 2020

Meanwhile, a plea to our media outlets — can we get expert opinion from true experts on viral infections, public health, and policy? Good grief, will Dr. Gwyneth Paltrow be next?