Coronavirus (Covid-19)

More on Covid-19

• Perspective May 07, 2020 Abortion during the Covid-19 Pandemic
  M.J. Bayefsky, D. Bartz, and K.L. Watson N Engl J Med 2020; 382:e47

  Governors in several states have categorized abortion procedures as “elective” or “nonessential” and have ordered a halt to most surgical abortions during the Covid-19 outbreak. Such policies highlight the vulnerability of abortion care in the United States.

• Perspective May 06, 2020 Pandemic and Persona
  M.W. Kahn

  The Covid-19 pandemic offers an opportunity for doctors to recognize more readily facts that can otherwise take years to learn: that we’re no different from our patients and that interacting with them as human beings can be gratifying for them and freeing for us.

• Perspective May 06, 2020 CPR in the Covid-19 Era — An Ethical Framework
  D.B. Kramer, B. Lo, and N.W. Dickert

  Unlike ventilator allocation, provision of CPR to patients cannot be practically adjudicated by a hospital-level triage team. How does the surge of patients with Covid-19 complicate standard CPR practices, and how can we best design crisis standards for inpatient CPR?

• Perspective May 06, 2020 Once Upon a Time…the Hero Sheltered in Place
  L. Rosenbaum

  For some clinicians, the pandemic offers an opportunity to take on the hero’s role as never before. But those who can’t must confront not only shame and guilt, but also the loss of their primordial story. Who are you, if you can’t be the hero you imagined yourself to be?

• Perspective May 01, 2020 Physician Burnout, Interrupted
  P. Hartzband and J. Groopman

  The burnout problem won’t be solved without addressing the issues of autonomy, competence, and relatedness. During the Covid-19 pandemic, a sense of altruism and urgency has catalyzed restoration of these pillars of intrinsic motivation. Can these changes be sustained?

• Perspective Apr 30, 2020 Virtually Perfect? Telemedicine for Covid-19
  J.E. Hollander and B.G. Carr N Engl J Med 2020; 382:1679-1681

  Telemedicine’s payment and regulatory structures, licensing, credentialing, and implementation take time to work through, but health systems that have already invested in telemedicine are well positioned to ensure that patients with Covid-19 receive the care they need.

• Perspective Apr 30, 2020 Am I Part of the Cure or Am I Part of the Disease?
  C. Rose N Engl J Med 2020; 382:1684-1685

  A front-line physician wonders how he can protect a vulnerable member of his household from the pathogens he’s exposed to in the ED — especially in a rapidly spreading pandemic of a novel virus and amid so many uncertainties.

• Correspondence Covid-19 Cases Apr 30, 2020 Immune Thrombocytopenic Purpura and Covid-19
  A.-A. Zulfiqar and Others N Engl J Med 2020; 382:e43

  Immune thrombocytopenia with lower-extremity purpura, mucosal bleeding, and cerebral microhemorrhage developed during the clinical course in a 65-year-old woman with SARS-CoV-2 infection.

• Perspective Apr 30, 2020 History in a Crisis — Lessons for Covid-19
  D.S. Jones N Engl J Med 2020; 382:1681-1683

  The history of human responses to epidemics carries various lessons for our current situation. Two of the more disheartening ones are that stigmatization follows closely on the heels of pathogens and that outbreaks too often claim the lives of health care providers. The article is accompanied by a slide show.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Apr 30, 2020 Responding to Covid-19
  B. Gates N Engl J Med 2020; 382:1677-1679

  Bill Gates writes that in any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. In the case of the Covid-19 pandemic, the first point is especially pressing, but the second has crucial long-term consequences.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective History of Medicine Apr 29, 2020 A National Medical Response to Crisis
  J. Barr and S.H. Podolsky

  World War II’s massive casualties were mitigated by lives saved as a result of medical care. Many of the advances made would persist long after the war concluded — a silver lining that perhaps will have parallels in our current struggle with Covid-19.

• Perspective Apr 28, 2020 Covid-19 — A Reminder to Reason
  I. Zagury-Orly and R.M. Schwartzstein

  Faced with the Covid-19 pandemic, clinicians feel compelled to do something for their patients. But we need to retain a healthy skepticism and remember the principle of clinical equipoise, particularly when considering interventions that could cause harm.

• Perspective Apr 24, 2020 Rural Matters — Coronavirus and the Navajo Nation
  H. Kovich

  Reports on the severity of the Navajo Nation outbreak don’t mention the community’s diversity of talent and experience, its resourcefulness. Infections from the outside have always found their way here. It’s just infrastructure that hasn’t.

• Perspective Apr 23, 2020 The Invisible Hand
  M.M. Kittleson N Engl J Med 2020; 382:1586-1587

  The patient’s wife had insisted that he get an angiogram, but by the time it came due, the country was in the throes of the Covid-19 pandemic. Suddenly, the benefits of continuing medical therapy seemed greater, and he was spared an unnecessary procedure.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Apr 22, 2020 Waiting for Something Positive
  A. Jayawardena

  Those of us who have found our role diminished as our elective cases have been canceled are being redeployed to the areas of the hospital with the greatest need. I want to help fight the battle against this invisible enemy, but I wonder: How do I not catch this disease?

• Perspective Apr 17, 2020 Africa in the Path of Covid-19
  W.M. El-Sadr and J. Justman

  Despite intensive preparations by African countries that are no strangers to epidemics, we should have no illusions that Africa can confront the Covid-19 threat alone. Coordinated global support is essential in the face of the pandemic, and the time to act is now.

• Perspective Apr 17, 2020 Covid-19 and Immunity in Aging Populations
  W.C. Koff and M.A. Williams

  As billions of dollars flow into research and development efforts aimed at controlling SARS-CoV-2, the pandemic response remains hamstrung by our limited understanding of how to generate effective immunity, particularly in aging populations.

• Perspective Apr 17, 2020 Covid-19 and the Need for Health Care Reform
  J.S. King

  The patchwork way we govern and pay for health care in the United States is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.

• Medicine and Society Apr 17, 2020 The Untold Toll
  L. Rosenbaum

  As the pandemic focuses medical attention on treating affected patients and protecting others from infection, how do we best care for people with non-Covid disease? Some physicians predict that “the toll on non-Covid patients will be much greater than Covid deaths.”

• Perspective Apr 16, 2020 Covid-19 and the Stiff Upper Lip
  D.J. Hunter N Engl J Med 2020; 382:e31

  Throughout the past few weeks, the U.K. mantra regarding Covid-19 has been “we will act at the appropriate time according to the science.” Though experts have been pushing the panic button, the alarm, if heard, was not acted on publicly until the third week of March.

• Perspective Apr 13, 2020 Mental Health and the Covid-19 Pandemic
  B. Pfefferbaum and C.S. North

  Many aspects of the Covid-19 pandemic and the public health response to it will undoubtedly contribute to widespread emotional distress and increased risk for psychiatric illness. Health care providers have an important role in addressing these emotional outcomes.

• Perspective Apr 13, 2020 They Call Us and We Go
  S. Koven

  In medical school, we learn that physicians do not turn away from human suffering: when we’re called, we go. So though a PCP initially ignored a call for volunteer staff for a Covid-19 screening clinic, she soon decided that she couldn’t live with herself if she didn’t go.

• Perspective Apr 13, 2020 Waiting
  E.J. Rourke

  In January, reported events in China seem remote to a U.S. physician. In February, the new coronavirus spreads to other countries, seemingly selected at random. The physician’s life goes on as usual. Then suddenly, on March 13, everything changes — and all she can do is wait.

• Perspective Apr 09, 2020 A Shift on the Front Line
  S. Castelletti

  Dressed in the protective gear, you feel like a soldier about to jump from a plane, hoping your parachute will open. As the hours go by, made longer by thirst, hunger, and the need to relieve yourself, you can’t wait to take it off and breathe. We all just want to breathe.

• Perspective Apr 09, 2020 Covid-19 — The Law and Limits of Quarantine
  W.E. Parmet and M.S. Sinha N Engl J Med 2020; 382:e28

  Community transmission of the new coronavirus is occurring in several parts of the United States, and travel bans and mandatory quarantines alone cannot end the outbreak. Many public health and legal scholars believe that more constructive tools are needed.

• Perspective Apr 09, 2020 Disease Control, Civil Liberties, and Mass Testing
  D.M. Studdert and M.A. Hall

  There is emerging consensus that a graduated approach to Covid-19–related restrictive measures will be needed. Decisions to continue, modify, or lift restrictions — particularly bans on movement and gathering — could be tailored using individualized risk assessment.

• Perspective Apr 08, 2020 Ensuring and Sustaining a Pandemic Workforce
  E.P. Fraher and Others

  It seems clear that health care delivery organizations, educators, and government leaders all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand our health care workforce and sustain it for the duration of the pandemic.

• Perspective Apr 08, 2020 “We Signed Up for This!”
  T.H. Gallagher and A.M. Schleyer

  Students and trainees are experiencing intense anxiety, uncertainty, and anticipatory loss during the Covid-19 pandemic. Many are facing new ethical dilemmas and practical challenges. Such feelings compete internally with a desire and commitment to serve the sick.

• Perspective Apr 07, 2020 Between Scylla and Charybdis
  M.A. Lewis

  As the deaths from Covid-19 have mounted, many patients with cancer struggle to process the case fatality rate in the context of all the other statistics their oncologists cite. Chemotherapy, hardly desirable at the best of times, may never have been less appealing.

• Perspective Apr 07, 2020 Age, Complexity, and Crisis
  L. Aronson

  The outsized impact of Covid-19 on elders has laid bare medicine’s outdated, frequently ineffective or injurious approach to the care of patients who are the planet’s fastest-growing age group and the generations most often requiring health care.

• Sounding Board Apr 02, 2020 Responding to Global Infectious Disease Outbreaks
  N.E. Dean and Others N Engl J Med 2020; 382:1366-1369

  As in the ongoing Covid-19 pandemic, global outbreaks of infectious illnesses often develop quickly and resolve in unpredictable ways. In this report, strategies to develop high-quality evidence to guide the development of new therapies are proposed.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Apr 02, 2020 Thinking Globally, Acting Locally
  R.L. Haffajee and M.M. Mello

  The defining feature of the U.S. response to Covid-19 has been localized action against a global threat. Under our federalist system, what more can the federal government do to promote a unified response, particularly as regards community mitigation approaches?

• Perspective Apr 02, 2020 Covid-19 and Health Care’s Digital Revolution
  S. Keesara, A. Jonas, and K. Schulman

  In the face of the Covid-19 pandemic, Americans are waking up to the limitations of their analogue health care system. It seems clear that we need an immediate digital revolution, pursued on several fronts, to address this crisis.

• Perspective Apr 02, 2020 Flattening the Curve for Incarcerated Populations
  M.J. Akiyama, A.C. Spaulding, and J.D. Rich

  People caught up in the U.S. justice system have already been affected by SARS-CoV-2, and improved preparation is essential to minimizing the impact of this pandemic on incarcerated persons, correctional staff, and surrounding communities.

• Perspective Apr 02, 2020 Escaping Pandora’s Box — Another Novel Coronavirus
  D.M. Morens, P. Daszak, and J.K. Taubenberger N Engl J Med 2020; 382:1293-1295

  With luck, public health control measures may be able to put the Covid-19 demons back in the jar. If they do not, we face a daunting challenge equal to, or perhaps greater than, that posed by the influenza pandemic of a century ago.

  See Also Chinese Translation in NEJM 医学前沿

• Sounding Board Apr 02, 2020 Responding to Global Infectious Disease Outbreaks
  N.E. Dean and Others N Engl J Med 2020; 382:1366-1369

  As in the ongoing Covid-19 pandemic, global outbreaks of infectious illnesses often develop quickly and resolve in unpredictable ways. In this report, strategies to develop high-quality evidence to guide the development of new therapies are proposed.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Apr 01, 2020 Universal Masking in Hospitals in the Covid-19 Era
  M. Klompas and Others

  The extent of the marginal benefit of universal masking over and above foundational personal protection measures is debatable. But there may be additional benefits to broad masking policies that extend beyond their technical contribution to reducing pathogen transmission.

• Perspective Mar 31, 2020 Paying for Medicaid
  J. Gruber and B.D. Sommers

  In the face of the Covid-19 pandemic, expanding Medicaid would rapidly bring needed resources into the health care system and infuse federal dollars into state economies. It requires no new infrastructure or federal oversight, and it can save lives.

• Perspective Mar 30, 2020 Developing Covid-19 Vaccines at Pandemic Speed
  N. Lurie and Others

  An ideal vaccine platform would support development from viral sequencing to clinical trials in less than 16 weeks, demonstrate elicitation of consistent immune responses across pathogens, and be suitable for large-scale manufacturing using a pathogen-agnostic platform.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Mar 27, 2020 Undocumented U.S. Immigrants and Covid-19
  K.R. Page and Others

  Years of anti-immigrant policies and rhetoric will be difficult to reverse, but it’s essential that the Trump administration address the needs of undocumented immigrants in its response to the Covid-19 pandemic.

• Editorial Mar 26, 2020 Covid-19 — Navigating the Uncharted
  A.S. Fauci, H.C. Lane, and R.R. Redfield N Engl J Med 2020; 382:1268-1269

  Fauci, Lane, and Redfield comment on the early clinical features and epidemiology of cases reported in Wuhan, China, along with current mortality data, noting that the outbreak is a stark reminder of the need for constant surveillance, prompt diagnosis, and robust research.

  Original Article Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Mar 26, 2020 Coronavirus in Travelers Returning from China
  S. Hoehl and Others N Engl J Med 2020; 382:1278-1280

  A group of 126 German nationals was evacuated from Wuhan to Frankfurt after screening for symptoms of Covid-19 and was to undergo a 14-day quarantine and additional screening in Frankfurt. The authors discovered evidence of SARS-CoV-2 infection in throat swabs from 2 evacuated persons who had passed the symptoms-based screening.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Mar 26, 2020 Defining the Epidemiology of Covid-19
  M. Lipsitch, D.L. Swerdlow, and L. Finelli N Engl J Med 2020; 382:1194-1196

  Experience with MERS, pandemic influenza, and other outbreaks has shown that as an epidemic evolves, we face an urgent need to expand public health activities in order to elucidate the epidemiology of the novel virus and characterize its potential impact.

  Correspondence Epidemiology of Covid-19

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Mar 25, 2020 Novel Coronavirus and Old Lessons
  J.L. Hick and P.D. Biddinger N Engl J Med 2020; 382:e55

  Bolstering our health system for the Covid-19 pandemic requires several critical moves, from expanding testing to protecting and expanding the health care workforce. Along the way, we must learn the lessons of this crisis so we can apply them to the next one.

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Mar 19, 2020 SARS-CoV-2 Viral Load in Upper Respiratory Specimens
  L. Zou and Others N Engl J Med 2020; 382:1177-1179

  The authors report results of an analysis of nasal and throat swabs from 17 patients in Zhuhai, China, who had received a diagnosis of Covid-19. Higher viral loads soon after symptom onset indicate the need for isolation strategies different from those used for the earlier SARS epidemic.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Mar 18, 2020 Facing Covid-19 in Italy
  L. Rosenbaum N Engl J Med 2020; 382:1873-1875

  Physicians in northern Italy have learned some painful lessons about rationing care during an epidemic. As health care systems work out ethical allocation principles, it seems clear that only with transparency and inclusivity can public trust and cooperation be achieved.

• Correspondence Mar 12, 2020 A Thai Taxi Driver with Covid-19
  W.A. Pongpirul and Others N Engl J Med 2020; 382:1067-1068

  The authors describe a taxi driver in Thailand who was infected with the novel coronavirus, potentially from passengers who were tourists from China, in January 2020. The infection appeared not to have spread to the taxi driver’s family or other close contacts.

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Mar 12, 2020 A Case of Locally Transmitted SARS-CoV-2 in Taiwan
  Y.-C. Liu and Others N Engl J Med 2020; 382:1070-1072

  The authors describe transmission of the novel coronavirus from a woman who had been living for several months in Wuhan, China, to her husband, after her return to their home in Taiwan in January 2020. No secondary case from this couple has been identified.

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Feb 27, 2020 Human-to-Human Coronavirus Transmission in Vietnam
  L.T. Phan and Others N Engl J Med 2020; 382:872-874

  The authors describe transmission of 2019-nCoV from a father, who had flown with his wife from Wuhan to Hanoi, to the son, who met his father and mother in central Vietnam and shared a hotel room with them for 3 days. The findings suggest that the incubation period in the son may have been 3 days or less.

  See Also Chinese Translation in NEJM 医学前沿

• Editorial Feb 27, 2020 Medical Journals and the Coronavirus
  E.J. Rubin and Others N Engl J Med 2020; 382:866

  The editors announce expedited handling for submitted manuscripts describing the 2019-nCoV outbreak and make broad recommendations for speed, transparency, and data sharing.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Feb 20, 2020 A Novel Coronavirus Emerging in China
  V.J. Munster and Others N Engl J Med 2020; 382:692-694

  A novel coronavirus, designated as 2019-nCoV, emerged in Wuhan, China, at the end of 2019. Although many details of the emergence of this virus remain unknown, it has put global public health institutions on high alert.

  See Also Chinese Translation in NEJM 医学前沿

More on Coronaviruses

• Original Article Aug 28, 2014 Transmission of MERS-Coronavirus in Household Contacts
  C. Drosten and Others N Engl J Med 2014; 371:828-835

  Defining transmission dynamics of the Middle East respiratory syndrome coronavirus (MERS-CoV) is important for public health measures. In this report, potential transmission to household contacts of 26 index patients with MERS-CoV infection is investigated.

• Original Article Brief Report Jun 26, 2014 Evidence for Camel-to-Human Transmission of MERS Coronavirus
  E.I. Azhar and Others N Engl J Med 2014; 370:2499-2505

  The source of Middle East respiratory syndrome coronavirus infection in humans is unclear, although bats and camels are suspected animal reservoirs. In this report, direct transmission of a fatal human case is tightly linked to a camel by epidemiologic, serologic, and virologic data.

• Original Article Aug 01, 2013 Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus
  A. Assiri and Others N Engl J Med 2013; 369:407-416

  A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases and evidence of person-to-person transmission were identified. The median incubation period was 5.2 days.

  Editorial Person-to-Person Spread of the MERS Coronavirus — An Evolving Picture

• Original Article Brief Report Jun 27, 2013 Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections
  Z.A. Memish and Others N Engl J Med 2013; 368:2487-2494

  A novel coronavirus (MERS-CoV) was recently identified as the cause of severe respiratory disease. In this report from Saudi Arabia, a family cluster of infection over a 6-week period is described, suggesting possible limited person-to-person transmission.

• Original Article Brief Report Nov 08, 2012 Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia
  A.M. Zaki and Others N Engl J Med 2012; 367:1814-1820

  On June 24, 2012, a 60-year-old man died of progressive respiratory infection in Saudi Arabia. A novel coronavirus was identified as a potential cause of this severe illness. Subsequently, a second patient was reported to have severe illness associated with this coronavirus.

  Editorial Emerging Human Coronaviruses — Disease Potential and Preparedness

• Case Records of the Massachusetts General Hospital Mar 24, 2005 Case 9-2005 — A 67-Year-Old Man with Acute Respiratory Failure
  D.M. Systrom and C. Wittram N Engl J Med 2005; 352:1238-1246

  A 67-year-old man was admitted to the hospital with acute respiratory failure. He had never smoked, had not traveled, but had recently been exposed to bird droppings. Cultures and serologic test results were negative. With antibiotic therapy and respiratory support, his symptoms rapidly improved over 48 hours. Three days after discharge, his symptoms returned shortly after using his hot tub, and again abated rapidly after admission to his local hospital.

• Review Article Current Concepts Dec 18, 2003 The Severe Acute Respiratory Syndrome
  J.S.M. Peiris and Others N Engl J Med 2003; 349:2431-2441

  Within months after SARS emergence in Guangdong Province, it had affected more than 8000 patients and caused 774 deaths in 26 countries on five continents. It illustrated dramatically the potential of air travel and globalization for the dissemination of an emerging infectious disease and highlighted the need for a coordinated global response to contain such disease threats.

• Original Article May 15, 2003 A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome
  T.G. Ksiazek and Others N Engl J Med 2003; 348:1953-1966

  This report summarizes the laboratory studies undertaken to identify the etiologic agent of the worldwide outbreak of the severe acute respiratory syndrome (SARS). In specimens from patients from seven countries, a coronavirus was identified by electron microscopy. The virus is only distantly related to previously sequenced coronaviruses. From serologic studies it appears that this virus has not previously circulated in humans.

  Perspective SARS-Associated CoronavirusPerspective Managing SARS amidst Uncertainty

• Original Article May 15, 2003 Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome
  C. Drosten and Others N Engl J Med 2003; 348:1967-1976

  This study used cell culture and molecular techniques to identify the infectious agent associated with SARS. A novel coronavirus was found in multiple samples from 18 patients but in no specimens from control subjects. In the patients there were high concentrations of viral RNA in sputum, a finding consistent with a highly infectious agent. Low concentrations of viral RNA were also detected in stool.

• Original Article May 15, 2003 A Cluster of Cases of Severe Acute Respiratory Syndrome in Hong Kong
  K.W. Tsang and Others N Engl J Med 2003; 348:1977-1985

  This report describes 10 epidemiologically linked patients in Hong Kong in whom SARS was diagnosed between late February and late March. They presented with fever, cough, malaise, dyspnea, and hypoxemia. Chest radiographs showed progressive airway disease. In the two patients who died, examination of the lungs showed diffuse alveolar damage.

  Editorial Case Clusters of the Severe Acute Respiratory Syndrome

• Original Article May 15, 2003 A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong
  N. Lee and Others N Engl J Med 2003; 348:1986-1994

  Over a period of two weeks at a hospital in Hong Kong 69 patients and 69 health care workers were admitted to isolation wards because of SARS. Thirty-two of those with SARS required intensive care, and five died. This report describes the clinical and radiologic features of SARS, and it analyzes the predictors of a poor outcome.