A brief Coronavirus update

A guestblogger at Watts Up With That, who himself survived the infection, has a news-packed update. Read the whole thing, but perhaps the most important paragraphs are:

Transmission route is either contact or inhalation […] The significant inhalation route is now shown by both the Diamond Princess cruise ship experiment (more below) and by the fact that ordinary surgical masks proved ineffective in the Wuhan hospital setting (JAMA, previous post).

Incubation period is 7-10 days from initial infection. The good news is that the 14-day quarantine adopted pretty much universally last week should therefore be effective […] Wuhan then makes a now well-established clinical bifurcation. In 75-80% of cases, by symptom day 10 there is a normal ‘corona cold’ recovery lasting a few days. (In my own case last week, 3 recovery days in total, days 9-12 from symptom onset.) In 20-25% of cases, by symptom day 10 Wuhan progresses to lower respiratory tract pneumonia, where death may occur with or without ICU intervention. The percentage of these deep pneumonias that are viral as opposed to a secondary bacteria infection is not known, but the NEJM clinical case report from Washington State discussed in the following paragraph strongly suggests viral (like SARS), not secondary [opportunistic] bacterial [infection] treatable with antibiotics.

The bad news is that Wuhan IS transmissible during some later part of the symptomless incubation period. […]

And here is some good news:

The new NEJM [New England Journal of Medicine] case report is so important it is summarized here because it leads to a hopeful culminating section below. The Seattle Wuhan case evidenced x-ray diagnosed lower respiratory tract pneumonia from days 9-11 from symptom onset. Supplemental oxygen was started day 9. IV antibiotics were started day 10 to no effect, so discontinued after one day. Importantly (more below), experimental antiviral remdesivir started day 11 by IV under a compassionate use exception, and the deep viral pneumonia fully resolved (per x-ray diagnosis) within 24 hours!

Remdesivir was developed by Gilead Scientific as an antiviral for Ebola and Marburg viruses, but was subsequently found to be active against other single-stranded RNA viruses.

Based on this, China has announced a full-scale random double blind placebo controlled trial in 761 patients. As of this writing China reports successful synthesis of sufficient remdesivir active, so human testing begins today.

PS: A friendly writer sent me this rather more worrying analysis arriving at a comparatively high basic reproduction number R0 of the virus: https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1

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