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A Novel Coronavirus from Patients with Pneumonia in China, 2019

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (8)

In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.) 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.

Biliary Cast Syndrome

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (9)

A 62-year-old woman presented with a 2-month history of jaundice 3 months after undergoing orthotopic liver transplantation. Imaging revealed filling defects in the bile ducts. During repeat liver transplantation, biliary casts were found and removed (shown in a video).

SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (12)

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.

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (13)

BackgroundThe initial cases of novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. MethodsWe collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. ResultsAmong the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). ConclusionsOn the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.) 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.

Detection of Covid-19 in Children in Early January 2020 in Wuhan, China

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (14)

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.

Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (14)

Background It is recommended that patients with acute upper gastrointestinal bleeding undergo endoscopy within 24 hours after gastroenterologic consultation. The role of endoscopy performed within time frames shorter than 24 hours has not been adequately defined. Methods To evaluate whether urgent endoscopy improves outcomes in patients predicted to be at high risk for further bleeding or death, we randomly assigned patients with overt signs of acute upper gastrointestinal bleeding and a Glasgow-Blatchford score of 12 or higher (scores range from 0 to 23, with higher scores indicating a higher risk of further bleeding or death) to undergo endoscopy within 6 hours (urgent-endoscopy group) or between 6 and 24 hours (early-endoscopy group) after gastroenterologic consultation. The primary end point was death from any cause within 30 days after randomization. Results A total of 516 patients were enrolled. The 30-day mortality was 8.9% (23 of 258 patients) in the urgent-endoscopy group and 6.6% (17 of 258) in the early-endoscopy group (difference, 2.3 percentage points; 95% confidence interval [CI], -2.3 to 6.9). Further bleeding within 30 days occurred in 28 patients (10.9%) in the urgent-endoscopy group and in 20 (7.8%) in the early-endoscopy group (difference, 3.1 percentage points; 95% CI, -1.9 to 8.1). Ulcers with active bleeding or visible vessels were found on initial endoscopy in 105 of the 158 patients (66.4%) with peptic ulcers in the urgent-endoscopy group and in 76 of 159 (47.8%) in the early-endoscopy group. Endoscopic hemostatic treatment was administered at initial endoscopy for 155 patients (60.1%) in the urgent-endoscopy group and for 125 (48.4%) in the early-endoscopy group. Conclusions In patients with acute upper gastrointestinal bleeding who were at high risk for further bleeding or death, endoscopy performed within 6 hours after gastroenterologic consultation was not associated with lower 30-day mortality than endoscopy performed between 6 and 24 hours after consultation. (Funded by the Health and Medical Fund of the Food and Health Bureau, Government of Hong Kong Special Administrative Region; ClinicalTrials.gov number, NCT01675856.) Patients with acute upper gastrointestinal bleeding were assigned to receive endoscopy within 6 hours or between 6 and 24 hours after gastroenterologic consultation. Mortality at 30 days was 8.9% in the former group and 6.6% in the latter group; earlier endoscopy did not lower mortality.

Schistosomiasis and the Global Goals

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (16)

To the Editor: Deol et al. (Dec. 26 issue)(1) report that there has been progress toward the 2020 and 2025 global goals of the World Health Organization (WHO) for control of schistosomiasis. China is affected by Schistosoma japonicum more than other countries, and its contributions to global elimination programs should not be overlooked. First, the sharp decrease in the number of schistosomiasis cases in China has contributed greatly to the decline in the global burden. Second, Chinese national programs for schistosomiasis control have proved that a praziquantel-based strategy is unlikely to interrupt transmission,(2) and the success of our integrated strategy . . .

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (17)

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.

From a Sprint to a Marathon in Hong Kong

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (18)

Leung and colleagues from Hong Kong describe their actions after they were first alerted to a cluster of atypical pneumonia cases in Wuhan. A figure shows the evolution of the epidemic and the responses to date in Hong Kong.

Clinical Characteristics of Coronavirus Disease 2019 in China

期刊: NEW ENGLAND JOURNAL OF MEDICINE, 2020; 382 (18)

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. Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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