The New England Journal of Medicine (NEJM), the world’s leading medical journal, publishes an opinion piece entitled “New Coronapneumonia – Exploring the Unknown” (Covid-19-Navigating The Uncharted). Notably, the three authors of this article are Anthony S. Fauci, director of the National Institutes of Health (NIH) Institute of Allergy and Infectious Diseases (NIAID), top infectious disease specialist at the CDC, and Director of the NIAID Clinical Research and Special Program, and H. . Clifford Lane, director of the U.S. Centers for Disease Control and Prevention, Robert R. Redfield.
Fauci has been director of the U.S. National Institute of Allergy and Infectious Diseases since 1984 and is a leading figure in the U.S. scientific community, having studied the H1N1 flu, AIDS, Ebola and other infectious diseases.
The final effects of the new coronary pneumonia outbreak on humans could be similar to severe seasonal or pandemic influenza, the authors said. The death rate may be significantly lower than 1 percent in cases where the number of asymptomatic or mild cases can be several times the number of reported cases, the article said.
They conclude with the article: ‘The Covid-19 outbreak is a stark reminder of the challenges that infectious disease pathogens continue to emerge and pose, and that we need continuous surveillance, timely diagnosis, and robust research to understand the basic biological characteristics of new pathogens and human susceptibility to them. and develop effective responses.
Current research may be judged: more similar to severe seasonal influenza
As with the first two outbreaks of coronavirus disease in the past 18 years (SARS in 2002 and 2003; MERS in MERS from 2012 to the present), the Covid-19 outbreak poses a serious challenge to public health, research and the medical community.
The authors cite a study published January 29 in the New England Journal of Medicine, which included data on the dynamics of transmission in 425 cases of infection with 2019-nCoV, from the Centers for Disease Control and Prevention in China, the Hubei Provincial Center for Disease Control and Prevention, Researchers from the University of Hong Kong and other institutions gave detailed clinical and epidemiological descriptions of the initially confirmed patients from Wuhan, Hubei Province.
They note that, as noted in the paper above, while the relevant research information is critical to inform the appropriate response to an outbreak, there are limitations to the study as it reports in real time on the early stages of the evolution of emerging pathogens.
Even so, the report provides some clarity about the disease. For example, the median age of the patient was 59 years, with higher morbidity and mortality rates (similar to the flu situation) among the elderly and comorbidities;
It is worth noting that the study did not find cases of children under 15 years of age. Fauci et al. point out that this is either because children are less likely to be infected , which will have a significant epidemiological impact, or because they are infected but have so mild symptoms that they cannot be detected through detection, which will have an impact on the total number of infections in the community as a whole.
The three authors also mentioned another paper. On February 28th, local time, the “Clinical Characteristics of China 2019 New Coronary Virus Disease” research paper led by Zhong Nanshan, head of the national health and health committee’s high-level expert group and a member of the Chinese Academy of Engineering, was published in the New England Journal of Medicine, with an estimated mortality rate of 1.4% in the New England Journal of Health.
Fauci et al. say that if we assume that the number of asymptomatic or mild cases is several times the number of reported cases, the fatality rate may be significantly lower than 1 percent.
This suggests that the overall clinical results of Covid-19 may ultimately be more similar to severe seasonal influenza (about 0.1% fatality rate) or pandemic influenza (similar to 1957 and 1968) than to a disease similar to SARS or MERS, which has fatality rates of 9 to 10% and 36%, respectively.
Fauci et al. also point out that the efficiency of the transmission of any respiratory virus is important for strategic research to contain and mitigate its outbreaks. Current research shows that the basic number of infections (R0) for the new coronavirus is 2.2, which means that the average infected person will transmit the virus to two other people. The outbreak is likely to continue to spread until the R0 number drops below 1.0.
Recent reports also point out that in the early stages of the disease, the population has high levels of pharynx virus drops, which also raises concerns about increased infectiousness during the mildest periods of symptoms.
It is important to ensure that research products are evaluated where scientific and ethical are reasonable
Fauci et al. also explored the travel restrictions currently in place internationally. China, the United States and several other countries have imposed temporary travel restrictions aimed at reducing the spread of the new disease in China and other parts of the world.
They noted that the number of Chinese tourists in the United States has declined sharply, especially from Hubei province. At least for the time being, such restrictions may help slow the spread of the virus: as of February 26, 2020, there were 78,191 laboratory-confirmed cases in China, compared with a total of 2,918 cases in 37 other countries and regions around the world.
As of February 26, 2020, the United States had detected 14 cases involving travel to China or in close contact with passengers, three confirmed cases of U.S. citizens repatriated from China and 42 confirmed cases of U.S. passengers returned from an infected cruise ship (the Diamond Princess cruise ship).
However, Fauci et al. also stressed that we should be prepared for covid-19, which could include outbreaks around the world, including in the United States, given the ability of the virus to spread in the current report.
They point out that in order to reduce the spread of the virus in communities in the United States, there may be a need to shift from restrictive measures to strategies such as social isolation. Such policies include isolating patients (including voluntary isolation at home), suspension of classes, and telecommuting where possible.
The same advice comes from Vice President of the Chinese Academy of Engineering, President of the Chinese Academy of Medical Sciences, And Academician Wang Chen, Medical Expert on Respiratory and Critical Lysology. On February 24, local time, Wang Chen and others in the world’s leading medical journal, The Lancet online comment article “during the Spring FestivalChinese the new coronary pneumonia outbreak control under the big flow.” The article points out that in the course of fighting the outbreak of new coronal pneumonia, China has implemented a series of measures to increase social distance, combining “epidemic control holidays” with other measures such as home quarantine and grass-roots screening, effectively reducing the rate of disease transmission.
Wang Chen and others suggested that for countries facing the potential spread of the new coronavirus, or in the future to deal with new outbreaks of infectious diseases, we can consider using China’s “epidemic control holiday” or “epidemic control stop semester” measures.
Fauci et al. also highlight vaccines and drugs in the article. Strong research is under way on the development of the Vaccine for Covid-19. Fauci et al. expect the first drug candidates to enter Phase 1 trials in early spring.
Current treatments include supportive care, and various treatments are being studied. These include the antiviral drug Lofinavir-Litonavir, interferon-1 beta, RNA polymerase inhibitor remdesivir, chloroquine and a variety of traditional Chinese medicine products.
They also noted that intravenous hyperimmunoglobulins and monoclonal antibodies from recovering people could be attractive candidates for early intervention studies, if feasible.
While the prevention and control of new coronary pneumonia is urgent, Fauci et al. stress that even in the event of an outbreak, the key to moving the field forward is “the need to ensure that we evaluate research products scientifically and ethically.”
They also noted that a better understanding of the pathogenesis of the disease is of invaluable value to our response in this unknown area. In addition, genomic studies of viruses can also describe host factors that make people susceptible to infection and disease progression.