Worth reading: Covid-19 — Navigating the Uncharted

Just published today (February 28, 2020) in the New England Journal of Medicine, from Anthony Fauci and Clifford Lane (director and deputy director, respectively, of the NIH’s National Institute of Allergy & Infectious Disease) and Robert Redfield (director of the CDC). A clear, concise report on what is currently known about the SARS-CoV-2 outbreak from some of the foremost public health officials in the United States.


Some especially relevant excerpts from the NEJM paper:

(regarding an epidemiological report on the first 425 confirmed cases in Wuhan) “The median age of the patients was 59 years, with higher morbidity and mortality among the elderly and among those with coexisting conditions (similar to the situation with influenza); 56% of the patients were male. Of note, there were no cases in children younger than 15 years of age. Either children are less likely to become infected, which would have important epidemiologic implications, or their symptoms were so mild that their infection escaped detection, which has implications for the size of the denominator of total community infections.”

“If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

“The current study indicates an estimated basic reproduction number (R0) of 2.2, which means that, on average, each infected person spreads the infection to an additional two persons. As the authors note, until this number falls below 1.0, it is likely that the outbreak will continue to spread.”

“Community spread in the United States could require a shift from containment to mitigation strategies such as social distancing in order to reduce transmission. Such strategies could include isolating ill persons (including voluntary isolation at home), school closures, and telecommuting where possible.”