Coronavirus (Covid-19)

More on Covid-19

• Perspective Oct 21, 2020 Covid-19 Vaccine Trials and Incarcerated People
  C. Strassle and Others

  Amid ongoing efforts to reduce the risk of Covid-19 infection in correctional facilities, researchers are considering whether incarcerated people should be included in efficacy trials of vaccine candidates after there is some evidence that such vaccines are safe.

• Perspective Oct 14, 2020 Reentry
  R.E. Leiter

  Our approach to early Covid cases was as thoughtful as it could have been, but we didn’t know enough, and many patients died. Over time, perhaps we’ll uncover the toll Covid-19 has taken on clinicians, in terms of anxiety, depression, and post-traumatic stress disorder.

• Perspective Oct 14, 2020 Holding Up
  A. Maitra

  How are you holding up? This has become my pandemic refrain, the way I begin my virtual visits. These days, the world is especially heavy. As a primary care doctor seeing patients with a range of lived experiences, I cannot know, until I ask, the burdens they carry.

• Perspective Oct 14, 2020 Supporting Clinicians during Covid-19 and Beyond
  J. Shapiro and T.B. McDonald

  Limited progress has been made in addressing some drivers of clinician well-being, including progress in improving workflow and strengthening communication with organizational leaders. Efforts often fail, however, when it comes to supporting emotional well-being.

• Perspective Oct 07, 2020 Lessons We’ve Learned
  K.R. Page and A. Flores-Miller

  In Baltimore, Covid-19 spread rapidly in the immigrant Latinx community. Transmission was fueled by poverty and economic necessity, and precarious housing arrangements and fear and mistrust of medical institutions exacerbated the situation.

• Perspective Oct 07, 2020 The Stress of Bayesian Medicine
  J.N. Rosenquist

  Changes in medical understanding or practice usually occur slowly, allowing physicians to carefully update their knowledge and retain their claim on expertise. But Covid-19 has blown a hole in that version of medicine.

• Perspective Oct 01, 2020 The Ritual of the Table
  S.R. Hata N Engl J Med 2020; 383:1301-1303

  Seeing patients in person is the lifeblood that keeps many physicians going. Being forced by the Covid-19 pandemic to overcome her hesitation about virtual care, a PCP discovers new ways of connecting with and caring for patients and families.

• Perspective Sep 30, 2020 Sewing Masks — Resilience in the Face of Covid
  E. Rittenberg

  As we weather this pandemic, we are starting to consider what recovery will look like. How can we mitigate the trauma of Covid-19 and its treatment for our patients? And how can we find meaning amid our patients’ needs and our own uncertainties?

• Perspective Sep 24, 2020 Ebola Response Priorities in the Time of Covid-19
  A. Christie and Others N Engl J Med 2020; 383:1202-1204

  Although the 10th outbreak of Ebola virus disease in the Democratic Republic of Congo was declared over in late June 2020, additional cases attributable to persistently infected survivors may occur. Therefore, surveillance and rapid-response capacity should be maintained.

• Perspective Sep 24, 2020 From Icebox to Tinderbox
  C.N. Cuneo and H. Janeway N Engl J Med 2020; 383:e81

  The situation on the U.S.–Mexico border is a public health crisis of our country’s own manufacturing, the result of a zealous effort to shirk our responsibility to people fleeing persecution, whom we have instead chosen to put directly in harm’s way.

• Perspective Sep 24, 2020 Partitioning the Curve
  D.M. Studdert, M.A. Hall, and M.M. Mello N Engl J Med 2020; 383:e83

  Many jurisdictions have responded to the unevenness of the unfolding Covid-19 pandemic by battening down their borders. But within the United States, attempts to restrict interstate travel present distinctive legal issues.

• Perspective Oct 29, 2020 Evaluating and Deploying Covid-19 Vaccines
  J.L. Schwartz N Engl J Med 2020; 383:1703-1705

  New entities and investments have aided the pursuit of Covid-19 vaccines. Moving forward, relying on time-tested mechanisms for evaluating and regulating vaccines and for developing recommendations for their use would promote transparency and scientific integrity.

• Perspective Nov 05, 2020 Community Health Workers and Covid-19
  P.J. Peretz, N. Islam, and L.A. Matiz N Engl J Med 2020; 383:e108

  Investing in community health workers and community-based organizations can help address the social determinants of poor health that disproportionately affect low-income, minority populations and that are magnified during times of crisis.

• Perspective Sep 16, 2020 A Pandemic within a Pandemic
  M.L. Evans, M. Lindauer, and M.E. Farrell

  Stay-at-home orders imposed during Covid-19 have left many victims of intimate partner violence trapped with their abusers and unable to safely connect with services. Certain steps could promote more equitable access to services as a second wave of infections looms.

• Perspective Oct 29, 2020 The Human Touch
  E.M. Cahan, L.B. Levine, and W.W. Chin N Engl J Med 2020; 383:e102

  Responses to the Covid-19 pandemic by stakeholders throughout the health care ecosystem are contributing to rapid innovation, including the development of new equipment and drugs. Less attention has been devoted to addressing important gaps in the health care workforce.

• Perspective Sep 15, 2020 Bridging the Gap at Warp Speed
  M. Slaoui, S.E. Greene, and J. Woodcock

  In addition to its goal of delivering safe and effective vaccines quickly, Operation Warp Speed aims to combat Covid-19 by improving the use of existing therapies and providing additional treatment options to ameliorate the pandemic as we await full immunization.

• Perspective Oct 29, 2020 Up Is Down
  J. Avorn and A.S. Kesselheim N Engl J Med 2020; 383:1706-1708

  The resolution of dueling perspectives from President Trump and industry leaders on Covid-19 vaccine progress will grow out of conflicting currents of clinical trial design, immunology, statistics, regulatory policy, economics, public health, and politics.

• Perspective Sep 10, 2020 Can Covid Catalyze an Educational Transformation?
  M.E.J. Goldhamer and Others N Engl J Med 2020; 383:1003-1005

  The Covid-19 pandemic presents an urgent imperative to rethink residency graduation requirements and an opportunity to implement the competency-based approach for which many educators have been calling.

• Perspective Sep 10, 2020 Covid-19 and Disparities in Nutrition and Obesity
  M.J. Belanger and Others N Engl J Med 2020; 383:e69

  Though the factors underlying racial and ethnic disparities in Covid-19 in the United States are multifaceted and complex, long-standing disparities in nutrition and obesity play a crucial role in the health inequities unfolding during the pandemic.

• Perspective Sep 10, 2020 The Climate Crisis and Covid-19
  R.N. Salas, J.M. Shultz, and C.G. Solomon N Engl J Med 2020; 383:e70

  Understanding the challenges posed by the conjunction of the rapidly emerging Covid-19 pandemic and the insidiously evolving climate crisis is essential if we are to devise effective and equitable strategies to protect and improve health in the United States.

• Perspective Sep 08, 2020 “When Will We Have a Vaccine?”
  B.R. Bloom, G.J. Nowak, and W. Orenstein

  People inquiring about Covid-19 vaccines often want to know when the public can be confident that available vaccines are safe and effective, when a vaccine will be available to people like them, and when uptake will be high enough to enable a return to prepandemic life.

• Correspondence Sep 03, 2020 Brain Autopsy Series in Patients with Covid-19
  I.H. Solomon and Others N Engl J Med 2020; 383:989-992

  Eighteen brains of patients who died 0 to 32 days after the onset of symptoms of SARS-CoV-2 infection showed hypoxic–ischemic changes but no encephalitis, meningitis, strokes, or changes in olfactory bulbs or tracts. Low viral counts were detected by quantitative RT-PCR in a few brain sections, and no virus was evident on immunohistochemical analysis.

• Perspective Sep 03, 2020 Accelerating Development of SARS-CoV-2 Vaccines
  M.E. Deming and Others N Engl J Med 2020; 383:e63

  Controlled human infection models have been proposed as a strategy for accelerating SARS-CoV-2 vaccine development. But scientific and technical factors make CHIMs unlikely to accelerate the establishment of vaccine efficacy.

• Perspective Sep 03, 2020 On Becoming a Plague Doctor
  M. Earnest N Engl J Med 2020; 383:e64

  Despite its fearsome appearance, the plague doctor’s costume — the “personal protective equipment” of the Middle Ages — had a noble purpose. It was intended to enable physicians to safely care for patients during the Black Death.

• Perspective History of Medicine Nov 05, 2020 “A Menace to the Public Health”
  G. Mooney N Engl J Med 2020; 383:1806-1808

  In the 1800s, the U.K. created a vast workforce of sanitary inspectors, part of an infectious disease surveillance system of notification, isolation, disinfection, and case finding. Its efforts suggest that Covid-19 contact tracers will require more than just persuasion.

• Correspondence Aug 20, 2020 Diabetes and Covid-19
  F. Rubino and Others N Engl J Med 2020; 383:789-790

  Diabetes is associated with an increased risk of severe Covid-19. New-onset diabetes and metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity, for which very high doses of insulin are warranted, have been observed in patients with Covid-19. This letter discusses these issues.

• Perspective Aug 20, 2020 The Death Throes of Mercy
  A.S. Kilaru and K.B. Mahoney N Engl J Med 2020; 383:706-708

  Soon after Hahnemann Hospital closed, another Philadelphia institution, Mercy Philadelphia Hospital, announced that it, too, will close. But for all the disruption they cause, hospital closures represent opportunities to develop new and robust ways to support patients.

• Perspective Aug 20, 2020 Community Health Centers and Covid-19
  S. Kishore and M. Hayden N Engl J Med 2020; 383:e54

  Community health centers have been critical to the U.S. response to Covid and key to treating other medical problems as well, but they are financially vulnerable. Congress should rescue CHCs and lay the foundation for a health system that works for everyone.

• Perspective Aug 20, 2020 Plans and Pandemics
  A. Gupta N Engl J Med 2020; 383:e53

  We had planned. Our plans had evolved, but we had still planned: for targeted pills, for early goals-of-care discussions, for radiation, for hospice, for dying at home, comfortably, with family. Yet our plans were being thrown out the window by a virus.

• Perspective Oct 22, 2020 Insurance Coverage after Job Loss
  S.D. Agarwal and B.D. Sommers N Engl J Med 2020; 383:1603-1606

  Widespread layoffs amid the Covid-19 pandemic threaten to cut off millions of people from their employer-sponsored health insurance plans at a time when insurance is especially important. The ACA will protect many of these people and their families from losing coverage.

• Perspective Aug 19, 2020 Telephone
  M.B. Leick

  I had learned that communicating with patients and families is a critical part of patient care. So, facing the communication challenges brought by Covid-19, as our unit worked on technological solutions to enable widespread video calling, we learned to improvise.

• Editorial Aug 13, 2020 The United States and the WHO
  B.R. Bloom, P.E. Farmer, and E.J. Rubin N Engl J Med 2020; 383:676-677

  On July 7, 2020, the President announced that the United States will withdraw from the WHO. Barry Bloom and Paul Farmer join Eric Rubin in pointing out the particular importance of the WHO during a pandemic, comparing the withdrawal of support to firing a firefighter in the midst of a fire.

• Correspondence Aug 13, 2020 Acute Myocardial Infarction and Covid-19
  M.D. Solomon and Others N Engl J Med 2020; 383:691-693

  Data from the Kaiser Permanente Northern California health care system were used to compare rates of hospitalization for acute MI from March 4 through April 14, 2020 (the Covid-19 period) with rates from the same period in 2019 and rates from an earlier period in 2020. Rates of hospitalization for acute MI decreased by up to 48% during the Covid-19 period.

• Case Records of the Massachusetts General Hospital Aug 13, 2020 A Woman with a Lung Mass
  A. Sharma and Others N Engl J Med 2020; 383:665-674

  A 47-year-old woman presented early during the Covid-19 pandemic with cough and shortness of breath. Radiography revealed a rounded mass in the right lower lobe. Computed tomography confirmed the presence of the mass and showed ground-glass attenuation and a reversed halo sign. An oncology consultation was requested, and a diagnosis was made.

• Perspective History of Medicine Aug 13, 2020 A National Medical Response to Crisis
  J. Barr and S.H. Podolsky N Engl J Med 2020; 383:613-615

  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 Aug 13, 2020 Putting the Public Back in Public Health
  A.T. Chan and J.S. Brownstein N Engl J Med 2020; 383:e45

  There is a high unmet need for better estimates of communities’ burden of Covid-19 to guide decisions about reopening societies. Fortunately, some mobile symptom-surveillance tools can be used for predictive modeling to address this critical priority.

• Perspective Aug 13, 2020 Making the Call
  J.C. Stuart N Engl J Med 2020; 383:e46

  A fundamental aim of residency is to impart to trainees a clinical gestalt. But Covid-19 has shaken our gut instincts and thus our ability to answer family members’ simple question: Is my loved one getting better? Too often, the truthful answer would be, “I don’t know.”

• Correspondence Covid-19 Notes Aug 06, 2020 An Isolation Hotel for Homeless People
  O.W. MacKenzie, M.C. Trimbur, and R. Vanjani N Engl J Med 2020; 383:e41

  In Rhode Island, a former hotel was converted into an isolation facility. When gaps in medical care became apparent, clinicians established a system for evaluating people referred to the hotel and assessing their medical needs.

• Perspective Aug 06, 2020 Mental Health and the Covid-19 Pandemic
  B. Pfefferbaum and C.S. North N Engl J Med 2020; 383:510-512

  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 Aug 06, 2020 Preventing a Parallel Pandemic
  V.J. Dzau, D. Kirch, and T. Nasca N Engl J Med 2020; 383:513-515

  Just as the country rallied to care for September 11 first responders who suffered long-term health effects, we must take responsibility for the well-being of clinician first responders to Covid-19 — now and in the long run. Five high-priority actions can help to protect health care workers.

• Perspective Aug 06, 2020 Where Do the Children Play?
  M.I. Brener and S.R. Kaslow N Engl J Med 2020; 383:e35

  As a cardiology fellow and a surgery resident are redeployed to address the Covid-19 pandemic, one person close to them is bearing an unacknowledged burden of the crisis: their 3-year-old son. To protect him, his parents decide to send him hundreds of miles away.

• Perspective Aug 06, 2020 Of Heroes and Cowards
  S.L. Beach N Engl J Med 2020; 383:e36

  The same viral fear that has now widely metastasized throughout public life has engulfed our hospital hallways. It’s a fear that dominates my every conversation and punctuates my every professional interaction. I’m scared for my personal safety.

• Perspective Aug 06, 2020 Waiting for Certainty on Covid-19 Antibody Tests
  M.C. Weinstein and Others N Engl J Med 2020; 383:e37

  Despite our inability to guarantee the accuracy of an immunity-certification process, failing to take action to identify people who could safely return to the workplace is itself an action that carries profound costs and health consequences.

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Aug 06, 2020 Multiorgan and Renal Tropism of SARS-CoV-2
  V.G. Puelles and Others N Engl J Med 2020; 383:590-592

  In this autopsy series, the authors found that SARS-CoV-2 has an organotropism beyond the respiratory tract, including the kidneys, heart, liver, and brain. They speculate that organotropism influences the course of Covid-19 disease and, possibly, aggravates preexisting conditions.

• Correspondence Aug 06, 2020 Coronavirus in Cats
  P.J. Halfmann and Others N Engl J Med 2020; 383:592-594

  SARS-CoV-2 was detected in three cats after they were cohoused with cats that had been experimentally inoculated with the virus. Cats may be a silent intermediate host of SARS-CoV-2.

• Correspondence Jul 30, 2020 Out-of-Hospital Cardiac Arrest and Covid-19
  E. Baldi and Others N Engl J Med 2020; 383:496-498

  From February 21 through April 1, 2019, a total of 229 cases of out-of-hospital cardiac arrest were reported in four provinces of Lombardy, Italy. During the same period in 2020 (the first 40 days of the Covid-19 epidemic), 362 cases were reported — a 58% increase. Of the additional 133 cases in 2020, a total of 103 involved suspected or diagnosed Covid-19.

• Perspective Jul 30, 2020 Respecting Disability Rights
  M.M. Mello, G. Persad, and D.B. White N Engl J Med 2020; 383:e26

  Disability rights advocates have filed complaints regarding crisis standards of care put forth by several U.S. states. Policymakers and hospitals can take key steps to honor commitments to antidiscrimination principles while appropriately stewarding scarce resources.

• Perspective Jul 30, 2020 Covid-19 Crisis Triage
  M.Z. Solomon, M.K. Wynia, and L.O. Gostin N Engl J Med 2020; 383:e27

  Crisis triage protocols should seek to optimize health outcomes, but doing so requires explicit protection of core values, such as the equal moral worth of all people, including those with disabilities. Some thoughtful policies are capable of meeting both goals.

• Perspective Jul 30, 2020 “Is It Safe for Me to Go to Work?”
  M.R. Larochelle N Engl J Med 2020; 383:e28

  A strategy to protect at-risk workers requires a framework for counseling patients about the risks posed by continuing to work, policy changes to ensure financial protections for people kept out of work, and a data-driven plan for safe reentry into the workforce.

• Perspective Jul 30, 2020 Legal Authority for States’ Stay-at-Home Orders
  M.A. Hall, M.M. Mello, and D.M. Studdert N Engl J Med 2020; 383:e29

  To prevent officials from trampling civil liberties during emergencies, some checks on their power are essential, but in striking down the state’s renewed stay-at-home order, the Wisconsin Supreme Court misapprehended how such checks ought to function.

• Perspective Jul 23, 2020 Failing the Test
  E.C. Schneider N Engl J Med 2020; 383:299-302

  Tragically, the United States, unable to match other countries’ pandemic response, has tallied the most Covid-19 cases and deaths in the world. Why has the U.S. response been so ineffectual? A key answer is testing, which has been slow to start and difficult to ramp up.

• Correspondence Jul 23, 2020 Use of Stroke Imaging during the Covid-19 Pandemic
  A.P. Kansagra and Others N Engl J Med 2020; 383:400-401

  The authors reviewed an imaging database used to determine whether patients with acute stroke were eligible to undergo endovascular thrombectomy. They found a 39% decrease in daily use of this imaging from a 29-day prepandemic period in February 2020 to a 14-day early-pandemic period from late March through early April.

• Perspective Jul 23, 2020 Wrong but Useful
  I. Holmdahl and C. Buckee N Engl J Med 2020; 383:303-305

  Mechanistic epidemiologic models are designed to help us systematically examine the implications of various assumptions about a highly nonlinear process that is hard to predict using only intuition. Used appropriately, they can help guide us through this pandemic.

• Perspective Jul 23, 2020 Pandemic as Teacher
  J. deLima Thomas N Engl J Med 2020; 383:306-307

  As a palliative care leader plans for a Covid surge, she sees that planning for the worst isn’t as simple as she imagined when she asked patients to do it. In many ways, the pandemic is forcing clinicians to gain insight into the experience of seriously ill patients.

• Perspective Jul 23, 2020 Inequity in Crisis Standards of Care
  E. Cleveland Manchanda, C. Couillard, and K. Sivashanker N Engl J Med 2020; 383:e16

  Recent state-based crisis standards of care that provide a color-blind process for determining whether a patient with Covid-19 respiratory failure lives or dies are alarming, since color-blind policies result in discrimination against communities of color.

• Perspective Jul 23, 2020 The Liminal Space
  R.L.A. Awdish N Engl J Med 2020; 383:e17

  There is so much talk of “endings” and “after this” and even of “returning” to some way that we used to be. None of those imagined times and places feel real to me. Only this timeless space feels real. This is the pause before a new beginning.

• Sounding Board Oct 08, 2020 Covid-19 — Implications for the Health Care System
  D. Blumenthal and Others N Engl J Med 2020; 383:1483-1488

  The Covid-19 pandemic has exposed and exacerbated weaknesses in the U.S. health care system. Many patients are losing their health insurance when they lose their jobs. Declining revenues are threatening the financial viability of some hospitals and medical practices. The authors propose policy solutions to address these challenges.

• Perspective Oct 29, 2020 The New Stability
  A. DeForest N Engl J Med 2020; 383:1708-1709

  The morning you die, I don’t want to be there — like most mornings now, when I rise against my will and crawl dejectedly into scrubs. I don’t want to be a plague doctor or a hero on TV. I look for hope and find none, but I’m not allowed to admit to total free fall.

• Correspondence Jul 16, 2020 Prolonged aPTT in Patients with Covid-19
  L. Bowles and Others N Engl J Med 2020; 383:288-290

  In this study, 20% of patients with Covid-19 had a prolonged activated partial-thromboplastin time. In 90% of these cases, the cause was lupus anticoagulant, with no associated bleeding. Patients with Covid-19 are susceptible to thromboses. The presence of a prolonged aPTT should, in general, not be considered a contraindication to anticoagulation.

  Correspondence Lupus Anticoagulant in Patients with Covid-19

• Perspective Jul 16, 2020 Racial Health Disparities and Covid-19
  M. Chowkwanyun and A.L. Reed, Jr. N Engl J Med 2020; 383:201-203

  In documenting Covid-19 racial disparities, we must contextualize such data with adequate analysis. Disparity figures without explanatory context can perpetuate harmful myths and misunderstandings that actually undermine the goal of eliminating health inequities.

• Perspective Jul 16, 2020 Africa in the Path of Covid-19
  W.M. El-Sadr and J. Justman N Engl J Med 2020; 383:e11

  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 Jul 16, 2020 Covid-19 — A Reminder to Reason
  I. Zagury-Orly and R.M. Schwartzstein N Engl J Med 2020; 383:e12

  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 Oct 08, 2020 Improving Clinical Trial Enrollment
  C.M. North, M.L. Dougan, and C.A. Sacks N Engl J Med 2020; 383:1406-1408

  Despite formidable barriers to designing, implementing, and completing clinical trials in the midst of a pandemic, there are ways to ensure that the selected trials are structured to maximize the chance that the key research questions will be definitively answered.

• Perspective Jul 09, 2020 Disease Control, Civil Liberties, and Mass Testing
  D.M. Studdert and M.A. Hall N Engl J Med 2020; 383:102-104

  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 Jul 09, 2020 Rural Matters — Coronavirus and the Navajo Nation
  H. Kovich N Engl J Med 2020; 383:105-107

  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 Jul 09, 2020 Once Upon a Time…the Hero Sheltered in Place
  L. Rosenbaum N Engl J Med 2020; 383:e5

  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 Jul 09, 2020 CPR in the Covid-19 Era — An Ethical Framework
  D.B. Kramer, B. Lo, and N.W. Dickert N Engl J Med 2020; 383:e6

  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?

• Correspondence Jul 02, 2020 Covid-19 in Immune-Mediated Inflammatory Diseases
  R. Haberman and Others N Engl J Med 2020; 383:85-88

  The authors describe patients in New York City with known immune-mediated inflammatory disease in whom Covid-19 developed while they were receiving biologics, other immunomodulatory therapies, or both. The incidence of hospitalization among these patients was consistent with that among patients with Covid-19 in the general population in New York City.

  Correspondence More on Covid-19 in Immune-Mediated Inflammatory Diseases

• Correspondence Jul 02, 2020 Acute Coronary Syndrome during Covid-19 Outbreak
  O. De Filippo and Others N Engl J Med 2020; 383:88-89

  During the Covid-19 outbreak in northern Italy, the daily rate of admissions for acute coronary syndrome at 15 hospitals was significantly lower than the rate during two control intervals (13.3 admissions vs. 18.0 and 18.9 admissions for the two control periods).

• Perspective Jul 02, 2020 Age, Complexity, and Crisis
  L. Aronson N Engl J Med 2020; 383:4-6

  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.

• Perspective Jul 02, 2020 Pandemic and Persona
  M.W. Kahn N Engl J Med 2020; 383:e1

  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 Sep 24, 2020 Are U.S. Hospitals Still “Recession-proof”?
  B. Teasdale and K.A. Schulman N Engl J Med 2020; 383:e82

  Key changes within hospitals’ cost structures have led them to an economic precipice. Hospitals were vulnerable to economic downturns before the first Covid-19 cases were detected and, barring a correction, will remain so long after the epidemic runs its course.

• Perspective Oct 01, 2020 Ensuring Uptake of Vaccines against SARS-CoV-2
  M.M. Mello, R.D. Silverman, and S.B. Omer N Engl J Med 2020; 383:1296-1299

  Although a SARS-CoV-2 vaccine remains months to years away, now is the time to develop a policy strategy to ensure vaccine uptake — including consideration of key criteria for determining when a vaccination mandate is appropriate.

• Correspondence Jun 25, 2020 Guillain–Barré Syndrome with Covid-19
  G. Toscano and Others N Engl J Med 2020; 382:2574-2576

  Five patients who had Guillain–Barré syndrome 5 to 10 days after the onset of Covid-19 are described. Three had severe weakness and an axonal pattern on electrophysiological studies, and two had normal protein levels in the cerebrospinal fluid. The virus was not found in CSF.

• Perspective Jun 25, 2020 Physician Burnout, Interrupted
  P. Hartzband and J. Groopman N Engl J Med 2020; 382:2485-2487

  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 Jun 25, 2020 Covid-19 and the Need for Health Care Reform
  J.S. King N Engl J Med 2020; 382:e104

  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.

• Clinical Implications of Basic Research Jun 18, 2020 A New Twist on RNA Vaccines
  D.H. Fuller and P. Berglund N Engl J Med 2020; 382:2469-2471

  There are several strategies to elicit immunity with an RNA vaccine; they all involve coaxing the host cell to replicate and translate an exogenous RNA encoding the vaccine antigen. A recent study describes a new, versatile approach.

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Jun 18, 2020 ST-Segment Elevation in Covid-19
  S. Bangalore and Others N Engl J Med 2020; 382:2478-2480

  Eighteen patients with Covid-19 presented with ST-segment elevation on ECG or had it develop during hospitalization. Eight patients received a diagnosis of acute myocardial infarction, and 10 had noncoronary myocardial injury. Thirteen patients died in the hospital.

• Correspondence Jun 18, 2020 Pregnant Women with Covid-19 in Wuhan, China
  L. Chen and Others N Engl J Med 2020; 382:e100

  Among 118 pregnant women with Covid-19 in Wuhan, China, the vast majority had a mild course of disease.

  Correspondence More on Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Jun 18, 2020 Kidney-Transplant Recipients with Covid-19
  E. Akalin and Others N Engl J Med 2020; 382:2475-2477

  A cohort of 36 consecutive kidney-transplant recipients had less fever, lower CD3, CD4, and CD8 cell counts, more rapid clinical deterioration, and a higher mortality than the general population of patients with Covid-19.

  See Also Chinese Translation in NEJM 医学前沿

• Perspective Jun 18, 2020 “We Signed Up for This!”
  T.H. Gallagher and A.M. Schleyer N Engl J Med 2020; 382:e96

  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.

• Correspondence Jun 11, 2020 Covid-19 in New York City
  P. Goyal and Others N Engl J Med 2020; 382:2372-2374

  In this series of 393 consecutive patients admitted with Covid-19 to two New York City hospitals from March 3 to March 27, a third of patients received invasive mechanical ventilation, 10% of patients died, and 24% were still hospitalized as of April 10.

• Correspondence Covid-19 Notes Jun 11, 2020 The South African Response to the Pandemic
  S.S. Abdool Karim N Engl J Med 2020; 382:e95

  South Africa’s early interventions have delayed the peak of Covid-19 cases. The author describes the eight stages of the national response and ongoing challenges.

• Medicine and Society Jun 11, 2020 The Untold Toll
  L. Rosenbaum N Engl J Med 2020; 382:2368-2371

  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 Jun 11, 2020 Paying for Medicaid
  J. Gruber and B.D. Sommers N Engl J Med 2020; 382:2280-2282

  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 Jun 11, 2020 Drug Evaluation during the Covid-19 Pandemic
  B.N. Rome and J. Avorn N Engl J Med 2020; 382:2282-2284

  The search for a treatment for Covid-19 is testing our country’s ability to quickly develop, test, and deploy medications, and several aspects of the U.S. response highlight how the processes for evaluating and approving drugs can go awry during a public health crisis.

• Perspective Jun 11, 2020 Between Scylla and Charybdis
  M.A. Lewis N Engl J Med 2020; 382:2285-2287

  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 Jun 11, 2020 Not Dying Alone
  G.K. Wakam and Others N Engl J Med 2020; 382:e88

  When the wife of a severely ill patient with Covid-19 is told she can’t visit him, her anger quickly gives way to pleading — “What if I only spent 5 minutes and left?” How can we harness creative solutions during this pandemic so that people don’t have to die alone?

• Perspective Jun 11, 2020 Waiting for Something Positive
  A. Jayawardena N Engl J Med 2020; 382:e89

  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?

• Correspondence Jun 04, 2020 Neurologic Features in SARS-CoV-2 Infection
  J. Helms and Others N Engl J Med 2020; 382:2268-2270

  In a consecutive series of 64 patients with Covid-19 and ARDS, 58 of whom underwent neurologic examination, severe agitation and corticospinal signs were common. In 2 of 13 patients, MRI of the brain showed small acute strokes, and in 1 patient, imaging showed a subacute stroke.

  Correspondence More on Neurologic Features in Severe SARS-CoV-2 Infection

• Correspondence Jun 04, 2020 Death from Covid-19 of Health Workers in China
  M. Zhan and Others N Engl J Med 2020; 382:2267-2268

  This report describes the deaths from Covid-19 of 23 health care workers, including physicians, surgeons, a nurse, and an electrocardiography technician. Only 2 of the health care workers were physicians in respiratory medicine who had been specifically assigned to treat patients with Covid-19. Eleven had come out of retirement to serve as clinicians.

• Perspective Jun 04, 2020 A Shift on the Front Line
  S. Castelletti N Engl J Med 2020; 382:e83

  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 Jun 04, 2020 Waiting
  E.J. Rourke N Engl J Med 2020; 382:2184-2185

  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 Jun 04, 2020 Ensuring and Sustaining a Pandemic Workforce
  E.P. Fraher and Others N Engl J Med 2020; 382:2181-2183

  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 Jun 04, 2020 Covid-19 and Health Care’s Digital Revolution
  S. Keesara, A. Jonas, and K. Schulman N Engl J Med 2020; 382:e82

  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.

• Correspondence Covid-19 Notes Jun 04, 2020 Surgery Scheduling in a Crisis
  M. Argenziano, K. Fischkoff, and C.R. Smith N Engl J Med 2020; 382:e87

  After a New York medical center converted most ORs into ICUs and cut operative time by 90%, clinicians developed a triage system to guide scheduling decisions. Their approach considered both clinical urgency and expected intensity of resource utilization.

• Correspondence Covid-19 Notes May 28, 2020 Repurposing a Pediatric ICU for Adults
  P.H. Yager, K.A. Whalen, and B.M. Cummings N Engl J Med 2020; 382:e80

  A Boston hospital transformed its pediatric ICU to treat adult patients. Preserving the original PICU team minimized unnecessary changes to personnel and the environment and helped with a rapid transition.

• Perspective May 28, 2020 Harnessing Our Humanity
  L. Rosenbaum N Engl J Med 2020; 382:2069-2071

  As the Covid-19 pandemic spreads, we’ll continue to be plagued by resource constraints that will compromise our ability to protect ourselves, our patients, and our communities. But as Washington’s response reminds us, the professional spirit marches on, unconstrained.

• Perspective May 28, 2020 Thinking Globally, Acting Locally
  R.L. Haffajee and M.M. Mello N Engl J Med 2020; 382:e75

  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 May 28, 2020 Flattening the Curve for Incarcerated Populations
  M.J. Akiyama, A.C. Spaulding, and J.D. Rich N Engl J Med 2020; 382:2075-2077

  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.

• Original Article May 21, 2020 Covid-19 — Early ICU Experience, Seattle
  P.K. Bhatraju and Others N Engl J Med 2020; 382:2012-2022

  Clinicians and investigators report on the first 24 patients admitted to ICUs from nine Seattle area hospitals. Key aspects of the clinical presentation, treatment, and outcomes are described.

• Correspondence May 21, 2020 Oral Fluid Droplets Generated during Speech
  P. Anfinrud and Others N Engl J Med 2020; 382:2061-2063

  In this experiment, investigators used a laser in a darkened box to visualize droplets that were generated during speech. The droplets decreased in number with lower-amplitude speech and were almost eliminated when the speaker’s mouth was covered with a damp cloth (shown in a video).

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence May 21, 2020 Aerosols and Transmission of SARS-CoV-2
  M. Meselson N Engl J Med 2020; 382:2063

  With reference to a letter about the use of laser light scattering to visualize droplets that emanate during speech, this author describes the nature of aerosols and their potential for transmission of SARS-CoV-2.

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Covid-19 Notes May 21, 2020 Adaptations and Lessons in the Province of Bergamo
  S. Fagiuoli, F.L. Lorini, and G. Remuzzi N Engl J Med 2020; 382:e71

  A referral hospital in the hardest-hit region of Italy had to manage a continuously increasing number of daily admissions for Covid-19 after delayed responses in the province allowed for rapid spread of the virus. Nineteen physicians in the province died.

• Perspective May 21, 2020 Developing Covid-19 Vaccines at Pandemic Speed
  N. Lurie and Others N Engl J Med 2020; 382:1969-1973

  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 May 21, 2020 The Toughest Triage
  R.D. Truog, C. Mitchell, and G.Q. Daley N Engl J Med 2020; 382:1973-1975

  Of all the medical care that will have to be rationed during the Covid-19 pandemic, the most problematic will be mechanical ventilation. One strategy for avoiding debilitating distress over these decisions is to use a triage committee to buffer bedside clinicians.

  Sounding Board Fair Allocation of Scarce Medical Resources in the Time of Covid-19Correspondence Allocating Medical Resources in the Time of Covid-19

• Perspective May 21, 2020 Undocumented U.S. Immigrants and Covid-19
  K.R. Page and Others N Engl J Med 2020; 382:e62

  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.

• Correspondence Covid-19 Cases May 21, 2020 Acute Cor Pulmonale in Covid-19
  C. Creel-Bulos and Others N Engl J Med 2020; 382:e70

  Five cases of acute cor pulmonale in patients with Covid-19 are described. Although acute pulmonary thromboembolism was the most likely cause of right ventricular failure, it was not definitively confirmed in all cases. Acute cor pulmonale causing obstructive shock should be included in the differential diagnosis in critically ill patients with Covid-19. A video shows echocardiographic findings in one of the patients.

• Correspondence Covid-19 Notes May 21, 2020 Suppressing the Epidemic in New South Wales
  J.M. McAnulty and K. Ward N Engl J Med 2020; 382:e74

  Australia appears to have largely suppressed the first wave of Covid-19 infections. The authors describe key responses, including travel restrictions, effective identification and isolation of infected people, and quarantine of those who have been exposed.

• Original Article May 07, 2020 Oral Lopinavir–Ritonavir for Severe Covid-19
  B. Cao and Others N Engl J Med 2020; 382:1787-1799

  Investigators in China report the results of an open-label, randomized clinical trial of lopinavir–ritonavir for the treatment of Covid-19 in 199 infected adult patients. The primary end point was the time to clinical improvement.

  Editorial Covid-19 — The Search for Effective TherapyCorrespondence A Trial of Lopinavir–Ritonavir in Covid-19See Also Chinese Translation in NEJM 医学前沿

• 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.

• Correspondence Covid-19 Notes May 07, 2020 French Pandemic Resistance
  C. Haug N Engl J Med 2020; 382:e51

  Just over 4 years after its ED faced a flood of patients severely wounded in a terrorist attack, a Paris hospital makes large-scale changes to care for people with Covid-19 while preserving access for others needing urgent treatment.

• Original Article Apr 30, 2020 Characteristics of Covid-19 in China
  W.-j. Guan and Others N Engl J Med 2020; 382:1708-1720

  In this study, researchers describe the clinical characteristics of coronavirus disease 2019 in a selected cohort of 1099 patients with laboratory-confirmed disease throughout mainland China during the first 2 months of the current outbreak.

  Correspondence Clinical Characteristics of Covid-19 in China

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Covid-19 Notes Apr 30, 2020 Staying Ahead of the Wave
  A.J. Singer, E.J. Morley, and M.C. Henry N Engl J Med 2020; 382:e44

  This report from a hard-hit hospital on Long Island, New York, explains how the local coronavirus epidemic led to rapid innovation. The ED set up a forward-triage and treatment unit and a split-flow process to expedite care. Ways were found to produce face shields and hand sanitizer and to sterilize used N95 respirators.

• 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 Apr 30, 2020 Feeding Low-Income Children during the Pandemic
  C.G. Dunn and Others N Engl J Med 2020; 382:e40

  U.S. government programs serve nearly 35 million children daily, delivering vital nutrition and financial assistance to families in need. With such programs interrupted, an essential element of the Covid-19 response will be feeding children from low-income families.

• Correspondence Covid-19 Notes Apr 30, 2020 In Pursuit of PPE
  A.W. Artenstein N Engl J Med 2020; 382:e46

  A chief physician executive finds himself involved in the complexities of trying to secure a shipment of much-needed personal protective equipment for his hospital. In the end, it seemed like a scene from a gangster movie.

• Correspondence Covid-19 Cases Apr 28, 2020 Stroke in Young Patients with Covid-19
  T.J. Oxley and Others N Engl J Med 2020; 382:e60

  Five patients younger than 50 years of age with large-vessel stroke and Covid-19 infection presented to a health system in New York City over a 2-week period. The authors report the patients’ clinical characteristics, including the presence or absence of symptoms of Covid-19.

• Correspondence Covid-19 Notes Apr 28, 2020 Cancer Management in India during Covid-19
  C.S. Pramesh and R.A. Badwe N Engl J Med 2020; 382:e61

  India’s largest cancer center adopts a proactive, multipronged approach to providing treatment, while facing the reality that some services must be scaled back during a nationwide lockdown. Prioritization criteria guide treatment decisions.

• Perspective Aug 27, 2020 Covid-19 and Immunity in Aging Populations
  W.C. Koff and M.A. Williams N Engl J Med 2020; 383:804-805

  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.

• Editorial Apr 23, 2020 Ten Weeks to Crush the Curve
  H.V. Fineberg N Engl J Med 2020; 382:e37

  Harvey Fineberg calls for a forceful, focused campaign to eradicate Covid-19 and outlines six steps to mobilize and organize the nation to crush the curve by early June.

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Covid-19 Cases Apr 23, 2020 Coagulopathy in Critical Illness with Covid-19
  Y. Zhang and Others N Engl J Med 2020; 382:e38

  The authors describe a 69-year-old man with Covid-19 diagnosed in January 2020 in Wuhan, China, along with two other critically ill patients with Covid-19 who were also seen in the same intensive care unit. Coagulopathy and antiphospholipid antibodies were seen in all three patients.

  See Also Chinese Translation in NEJM 医学前沿

• 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

• Correspondence Apr 16, 2020 Aerosol and Surface Stability of SARS-CoV-2
  N. van Doremalen and Others N Engl J Med 2020; 382:1564-1567

  In this research letter, investigators report on the stability of SARS-CoV-2 and SARS-CoV-1 under experimental conditions. The viability of the two viruses was assessed in aerosols and on plastic, stainless steel, copper, and cardboard.

  Correspondence Stability and Viability of SARS-CoV-2

• 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 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.

• Correspondence Apr 02, 2020 Children with Covid-19 in Wuhan, China
  W. Liu and Others N Engl J Med 2020; 382:1370-1371

  A retrospective analysis of routine surveillance data involving children hospitalized in central Wuhan, China, for acute lower respiratory infection in early January 2020 revealed six cases of Covid-19. The authors report clinical characteristics of the children and laboratory data.

  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 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

• Original Article Mar 26, 2020 Early Transmission Dynamics of 2019-nCoV
  Q. Li and Others N Engl J Med 2020; 382:1199-1207 The authors provide an epidemiologic analysis of the first 425 confirmed cases of infection with the novel coronavirus in Wuhan, China. This analysis provides estimates of the epidemic doubling time and the basic reproductive number and shows clear evidence of sustained human-to-human transmission.

  See Also Chinese Translation in NEJM 医学前沿

• 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

• Original Article Brief Report Mar 05, 2020 First U.S. Confirmed Case of 2019-nCoV Infection
  M.L. Holshue and Others N Engl J Med 2020; 382:929-936

  A healthy 35-year-old man who had visited Wuhan, China, presented with cough and fever that progressed to pneumonia. This report describes the diagnosis, clinical course, and management of the condition. The case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels.

  Correspondence First Case of Covid-19 in the United States

  See Also Chinese Translation in NEJM 医学前沿

• Correspondence Mar 05, 2020 2019-nCoV Transmission from Asymptomatic Patient
  C. Rothe and Others N Engl J Med 2020; 382:970-971

  In this report, investigators in Germany detected the spread of the novel coronavirus (2019-nCoV) from a person who had recently traveled from China to Germany for a business trip. This transmission occurred before the apparent onset of illness in the index patient and was associated with additional transmission events in Germany.

  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

• Original Article Brief Report Feb 20, 2020 A Novel Coronavirus in China
  N. Zhu and Others N Engl J Med 2020; 382:727-733 The authors report the emergence and isolation of a previously unknown betacoronavirus, the seventh member of the family of coronaviruses that infect humans, in Wuhan, China. Findings in three patients are described.

• 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.