COVID-19: Reality and Misinformation John McConnell Editor-in-Chief, The Lancet Infectious Diseases
COVID-19 Management WHO guidelines: https://www.who.int/publications/i/item/clinical-management-of-severe-acute-respiratory-infection- when-novel-coronavirus-(ncov)-infection-is-suspected NIH guidelines: https://www.covid19treatmentguidelines.nih.gov/introduction/
Outcome of disease https://ourworldindata.org/mortality-risk-covid#case-fatality-rate-of-covid-19-by-age
Infection fatality ratio of COVID-19 vs Seasonal Influenza https://github.com/mbevand/covid19-age-stratified-ifr
COVID-19 rank as a leading cause of death https://www.thinkglobalhealth.org/article/just-how-do-deaths-due-covid-19-stack
Current situation: cases and deaths https://covid19.who.int/ https://covid19.who.int/table https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html
Timeline of early emergence of COVID-19: Report of three cases in France, the first in Europe, in travellers from Wuhan: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30200-0/fulltext First report from Wuhan of clinical features of the disease: https://www.thelancet.com/journals/lancet/article/PIIaS0140-6736(20)30183-5/fulltext Report of a cluster of cases in Shenzhen involving family who had travelled to Wuhan, showing human-to-human transmission: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext Animated map of confirmed COVID-19 cases spreading from 2020-01-12: https://commons.wikimedia.org/w/index.php?curid=86472036 Genetic epidemiology of SARS-CoV-2 show how COVID-19 spread worldwide: https://nextstrain.org/ncov/global?r=region Evolutionary origins of the SARS-CoV-2 sarbecovirus lineage responsible for COVID-19 pandemic: https://www.nature.com/articles/s41564-020-0771-4 Treatments for COVID-19: RECOVERY Randomized Controlled Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2022926 SOLIDARITY Randomized Controlled Trial: https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1.full.pdf Cloroquine/hydroxychloroquine: • no reduction in disease post https://www.nejm.org/doi/full/10.1056/NEJMoa2016638( ) or pre (https://www.medrxiv.org/content/10.1101/2020.09.18.20197327v1) exposure prophylaxis • no beneficial effect of addition of azithromycin: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31862-6/fulltext Remdesivir • Some evidence of better clinical status vs control:https://jamanetwork.com/journals/jama/fullarticle/2769871 • Shorter recovery time vs placebo: https://www.nejm.org/doi/full/10.1056/NEJMoa2007764 • No reduction in mortality:https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1.full.pdf Tocilizumab • Roche announcement drug does not improve clinical status: https://www.roche.com/media/releases/med-cor-2020-07-29.htm • Reduced need for mechanical ventilation: https://www.roche.com/media/releases/med-cor-2020-09-18.htm Convalescent plasma • No definitive evidence of beneficial effect: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013600.pub3/full • NIH panel review, insufficient data to recommend for or against:https://www.acpjournals.org/doi/10.7326/M20-6448 Dexamethasone • Death reduced by 35% in ventilated patients (RECOVERY RCT): https://www.nejm.org/doi/full/10.1056/NEJMoa2021436 • Brazil CoDEX Randomized Controlled Trial shows significant increase in the number of days alive and free from medical ventilation:https://jamanetwork.com/journals/jama/fullarticle/2770277 Thousands of clinical trials for COVID-19 therapies undergoind worldwide, some examples: https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-therapeutics-tracker and https://www.pharmaceutical-journal.com/news-and-analysis/features/everything-you-need-to-know-about-the-covid-19- therapy-trials/20208126.article
Vaccines against SARS-CoV-2 As of 22 October 2020: • 248 vaccines candidates: https://vac-lshtm.shinyapps.io/ncov_vaccine_landscape/ • 46 vaccines at some stage of clinical testing: https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html Some leading candidates: CanSino Biologics, China • https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31208-3/fulltext • https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31605-6/fulltext Gamaleya Research Institute, Russia • https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31866-3/fulltext AstraZeneca/University of Oxford, UK • https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31604-4/fulltext Moderna/NIH, USA • https://www.nejm.org/doi/10.1056/NEJMoa2022483 BioNTech/Pfizer/Fosun Pharma, Germany/USA/China • https://www.medrxiv.org/content/10.1101/2020.08.17.20176651v2 Sinopharm, China (2 vaccines) • https://jamanetwork.com/journals/jama/fullarticle/2769612 • https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30831-8/fulltext J&J/Beth Israel Deaconess Medical Center, USA • https://www.medrxiv.org/content/10.1101/2020.09.23.20199604v1 Novavax, USA • https://www.nejm.org/doi/full/10.1056/NEJMoa2026920
Vaccine policy issues COVID-19 vaccine online survey: https://www.ipsos.com/en-us/news-polls/WEF-covid-vaccine-global Operation Warp Speed: https://www.scientificamerican.com/article/warp-speed-covid-19-vaccine-efforts-aim-for-diverse- volunteers-and-long-lasting-protection/ https://foreignpolicy.com/2020/09/03/trumps-vaccine-cant-be-trusted/ Two doses of vaccine likely to be needed: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31604-4/fulltext Immunity passport: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30766-0/fulltext Weakly protective vaccine worse than no vaccine: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31821-3/fulltext COVID-19 Vaccines Global Access Facility: https://www.who.int/news-room/detail/24-08-2020-172-countries-and-multiple- candidate-vaccines-engaged-in-covid-19-vaccine-global-access-facility
Effects of the pandemic on health-care delivery Disruption to care for non-communicable diseases: https://www.who.int/news-room/detail/01-06-2020-covid-19-significantly-impacts-health-services-for-noncommunicable- diseases https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31356-8/fulltext Disruption of immunization services: https://www.who.int/immunization/monitoring_surveillance/immunization-and-covid-19/en/ https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.19.2000848 Disruption to care for HIV, tuberculosis and malaria in high-burden countries: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30288-6/fulltext Longer waiting times for care: https://www.nhsconfed.org/news/2020/08/grim-picture-of-covid19-ripple-effect-highlighted-by-nhs-performance-figures https://www.cancerresearchuk.org/about-us/cancer-news/news-report/2020-09-17-lung-cancer-risks-becoming-forgotten- disease-of-the-coronavirus-pandemic Cost of response: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30383-1/fulltext
Elsevier’s response to the pandemic Coronavirus Research Directory: https://www.elsevier.com/novel-coronavirus-covid-19 COVID-19 Healthcare Hub: https://covid-19.elsevier.health/ The Lancet COVID-19 Resource Center: https://www.thelancet.com/coronavirus
Access to related journal articles and books in Science Direct WHO-Elsevier collaboration: https://search.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/
What might the future hold? New confirmed cases and deaths, 7 day rolling average: https://ig.ft.com/coronavirus-chart/ New confirmed cases and deaths in France: https://www.nytimes.com/interactive/2020/world/europe/france-coronavirus-cases.html Cases, deaths, and hospitalizations in Switzerland: https://www.bag.admin.ch/bag/fr/home/krankheiten/ausbrueche- epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/situation-schweiz-und-international.html UK cases by specimen date and patients admitted to hospital https://coronavirus.data.gov.uk Hospital admissions. Czech health ministry https://onemocneni-aktualne.mzcr.cz/covid-19/prehled-hospitalizaci Greater share of cases now in young people: https://www.gov.uk/government/publications/national-covid-19-surveillance-reports Projected cases globally: https://covid19.healthdata.org/global Projected cases US: https://covid19.healthdata.org/united-states-of-america Hospital resource use—UK https://covid19.healthdata.org/united-kingdom and India https://covid19.healthdata.org/india