January 26th, 2020

Uncertainties Notwithstanding, Pace of Scientific Discovery in Coronavirus Outbreak Is Breathtakingly, Impressively Fast

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!

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?

4 Responses to “Uncertainties Notwithstanding, Pace of Scientific Discovery in Coronavirus Outbreak Is Breathtakingly, Impressively Fast”

  1. JOHN MCKENNA says:

    Social media being used for society’s benefit.
    Mr. Zuckerberg please make note; that’s what you’re supposed to be doing!

  2. omar sued says:

    Impressive!!!
    Nice summary of the incredible change in our world. Make us more connected, more responsive, but also more vulnerable!.
    I really liked the JHU real time data at> https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

  3. Double says:

    Does this mean that this or an HIV drug combo, like PreP, could be use as preventative for coronavirus ? I’m obviously not a scientist here just curious how they relate ELI5, someone 😉

    https://www.aidsmap.com/news/mar-2014/lopinavirritonavir-or-3tc-prep-equally-protective-against-infant-hiv-infection-during

  4. Ray Sullivan MD says:

    Letters to the Editor in newspapers are replete with concerns about our VP, Mr Mike Pence being the point man for information about the current corona virus pandemic. It could be argued that the WH is the last stop in the chain and it is perfectly acceptable for the VP to coordinate official statements in an effort to diminish “fake news” or otherwise inaccurate information flooding the internet and mainstream media sources. What do the ID experts opine? Is a non-medical person like the VP of the US not qualified in any sense of the word?

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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.