February 2nd, 2020

A Coronavirus ID Link-o-Rama, Because I’m Not Watching the Super Bowl

With so much of the ID-related news out there dominated by the novel coronavirus (2019-nCoV, hard to type) outbreak, it seems appropriate to collect some of the more interesting or useful findings in this busy past week.

Think of it as an ID Link-o-Rama — Special Novel Coronavirus Edition.

As with last week’s post, an important caveat — the outbreak continues to evolve rapidly, and data quickly become out of date. All are encouraged to check in with the excellent guidance and information on the CDC, WHO, and IDSA sites (among others), all of which are updated regularly.

On to the links:

The rapidly spreading virus has closed schools in Knoxville, Tenn., cut blood donations to dangerous levels in Cleveland and prompted limits on hospital visitors in Wilson, N.C. More ominously, it has infected as many as 26 million people in the United States in just four months, killing up to 25,000 so far.
In other words, a difficult but not extraordinary flu season in the United States …

So yes — get your flu shot! Listen to Dr. Stephenson!

As for the title of this post …

12 Responses to “A Coronavirus ID Link-o-Rama, Because I’m Not Watching the Super Bowl”

  1. Ivica Čabraja says:

    Thank you for this.


    I am wondering what else has to go. Hockey and rugby certainly. This is not a race thing sorry. Hockey is a white sport and rugby too. You cannot get anywhere by banning this or that.

    we have to offer and LIONIZE better sports. I live on running and jogging and cross country skiiing. soccer needs work–no headers. Volleyball should have male and female and co-ed leagues. Is baseball beaten? Is Swimming too boring? Skaters need helmets but the ABATE fiasco shows the culture must change and not merely from top down.

    You are in a hurry, understandably. But nature and human nature are miserably slow. Keep trying but don’t put your efforts on Prohibition. it makes danger more attractive.

  3. John Brooks says:

    Hi Paul! Hey, please note that the report in NEJM of the cluster of cases from Germany alleged to have occurred during the index patient’s period of asymptomatic infection has been thrown into question because the investigators never actually interviewed the index case: https://www.sciencemag.org/news/2020/02/paper-non-symptomatic-patient-transmitting-coronavirus-wrong. Although the data for transmission form Patient #1 to Patients #3 and #4 seems compelling for asymptomatic spread, the sloppy work of these investigators raises general concerns about the overall accuracy of the report, sadly. BTW I can’t find the letter from Robert-Koch Institut on the NEJM website yet but hope they will link it to the report itself post haste since the webpage with the original report is approaching 300,00 page views.

    • Paul Sax says:

      Thanks for this comment, John. I’ve updated the post with the bracketed material so people are aware.

      My gut feeling is that there will be ***some*** pre-symptomatic spread, as there is with many viral infections, but the likelihood is lower due to the reasons I mentioned.


  4. Justin Moore says:

    This is so, so helpful. Many thanks for posting it.

  5. K Y Lee says:

    Dr Sax, thank you for hard data putting the novel Corona virus outbreak in perspective. Perhaps an article in the traditional International lay press as well to allay the hysterical reports evident so far?

  6. Sandeep Saluja says:

    Your views on doubts being put forward that it could actually have been designed to be a tool for bioterrorism

  7. Babak says:

    Hi everybody.
    As a pathologist, I have a question regarding the possible animal source of the new coronavirus.

    I think there is an usual emphasis on genetics these days, rather than microbiology or epidemiology. Pangolins are the newest culprit said to spread coronavirus to humans.

    Can genetic analysis identify what animal species the coronavirus jumped from into humans?


    I am Biochemist specializing in translating research into Pathways, Diagnoses and Treatments.This approach is common with Human Gene Variants/SNP’s and there are databases to search on.My search shows this new Coronavirus is in the RNAS-L Pathway like HepC,HIV-1-all RNA viruses, and including Asian Flu, Epstein Barr,and Herpes vIruses.I do not feel it came from animals recently as HIV-1 cane from green Monkey,Millions of years ago.So these “newer” viruses do not always trigger the immune system RNASE-L Pathway as it is TLR triggered by Interferon-usually Interferon 1,or Alpha.I feel best treatment is an antiviral Protease Inhibitor along with Interferon or an Interferon activator to activate RNASE-L and induce Auyophagy virus killing by Macrophages,which is more natural and better than Antigens used by Vaccines.So,my biggest fear is Vaccine will take too long to test and make,and,it may not work.So,least risk and fasted,most certain approach is ARV Therapy+Interferon.A small number of patients were treated this way in 2003 with SARS and again with this new virus,and I understand the results were favorable.I would treat patients with minor.early symptoms with Interferon,and more serious patients with appropriate antiviral drug which prevents viral entry into cell to form RNA a sit is a retrovirus and next boost immune with Interferon.Time is of the essence so this is Plan B,except I would go down parallel path with 2 approaches to get maximum success. Interferon will lower TNF Alpha and IL-6, improving cell signaling.High dose Green Tea in a Gelcap with Olive Oil and some Chinese Herbs+Caffeine will slow down viral entry and enter the brain, minimizing Encephalitis,so this is really needed.Ask Jarrow,they know.Both ERK 1/2 and GP 129 will be inhibited.

  9. Gerald says:

    Very good summary brings some sanity and perspective to this whole situation, thank you.

  10. Bryan s says:

    Nine years ago, movie about the coronavirus epidemic came out.
    Name: Cantagion (2011) – Link bellow:

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.