C19 Notes

Quick summary of covid literature so far by two HIV clinical fellows at Boston

Author Topic: Quick summary of covid literature so far by two HIV clinical fellows at Boston  (Read 538 times)

stog

  • Administrator
  • Full Member
  • *****
  • Posts: 192
    • soul-trade.com
 a Quick summary of covid literature so far by two HIV clinical fellows at Boston hospitals have recorded a biweekly deep dive into the most compelling COVID-19 data. this is snapshot as at may 18 2020 this is page 3 so there is more -- move left at bottom of page

https://www.medscape.com/viewarticle/930588#vp_3

stog

  • Administrator
  • Full Member
  • *****
  • Posts: 192
    • soul-trade.com
Here are some key points from our first three presentations that are still valid.Viral Shedding: Key Points
  • Nasopharyngeal viral load peaks around 1 day prior to symptom onset, correlating to peak time of infectiousness.
  • Saliva may become an important sampling site for diagnosis.
  • SARS-CoV-2 is a descending infection; in later disease, viral loads are higher in the lower respiratory tract (especially in severe/critical illness).
  • In mild cases, live virus is isolated up to day 8 after symptom onset.
  • There can be prolonged shedding of viral RNA lasting many weeks, particularly after critical illness. Correlation with infectiousness is unknown.
  • Studies differ on whether severity of illness correlates with viral load.
  • In some cases, viral RNA has also been identified in the stool, blood, conjunctiva, urine, cerebrospinal fluid, and pleural fluid.
SARS-CoV-2 Seroprevalence
  • Studies with (near) universal screening of various populations are increasingly available, finding a wide range of asymptomatic people with positive RT-PCR tests.
     
  • Varying rates relate to local stage of epidemic, population and sampling, and mitigation strategies in place.
  • Some asymptomatic people are likely to be presymptomatic given the variable and sometimes lengthy incubation period.
Viral Entry: Key Points
  • ACE2 is an important receptor for viral cellular entry.
  • TMPRSS2 primes the S protein and allows for efficient cellular entry.
  • An interaction between SARS-CoV-2 and CD147 may facilitate invasion.
  • Many unresolved questions remain regarding the exact role of CD147 in viral entry. Does it directly interact with the S protein or is the interaction mediated by CypA and the N protein, as was found for SARS-CoV?
What Else Have We Learned?Key observations from our first three updates that are still relevant:
  • Peak infectiousness is probably 1 day prior to symptom onset.
  • In the absence of therapy/vaccine, intermittent social distancing is likely to be needed for years to avoid overwhelming critical care capacity.
  • Emerging pathologic correlates of clinical presentations:
     
    • Multiple mechanisms of cardiac injury
    • Virus can cause systemic infection
    • Viral endotheliitis and possible complement activation as cause of micro/macro thromboses
  • Obesity is a risk factor for severity of disease.
  • Hypercoagulability is a key feature of the disease.
  • Age-based sheltering is unlikely to be effective without social distancing.
  • Epidemic control is feasible with contact tracing if minimal delay is achieved.
  • Asymptomatic/presymptomatic transmission is substantial.
  • The incubation period is highly variable (median, 5 days).
« Last Edit: June 05, 2020, 09:22:37 AM by stog »

stog

  • Administrator
  • Full Member
  • *****
  • Posts: 192
    • soul-trade.com
here is the table key findings in mode of transport, and the clinical course

all taken from the summary link in main post