Coronavirus (Covid-19)

A collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary.

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All Journal content related to the Covid-19 pandemic is freely available.

ORIGINAL ARTICLE Convalescent Plasma for High-Risk Covid-19F.K. Korley and OthersPatients who were seen in emergency departments within 7 days after the onset of Covid-19 symptoms and were considered appropriate for discharge were randomly assigned to receive either convalescent plasma or placebo. Convalescent plasma did not prevent disease progression.AUG 18

ORIGINAL ARTICLE Bamlanivimab plus Etesevimab for Covid-19M. Dougan and OthersIn a phase 3 trial involving 1035 outpatients who were at increased risk for severe Covid-19, those who received two monoclonal antibodies targeting SARS-CoV-2 had a significant reduction in the viral load and a significantly lower incidence of progression to severe illness than those who received placebo.JUL 14

ORIGINAL ARTICLEBRIEF REPORTBroadly Neutralizing Antibodies against All CoronavirusesC.-W. Tan and OthersPeople who recovered from SARS-CoV-1 infection in 2002–2003 have neutralizing antibodies documented for up to 17 years. Vaccinating such people with the BNT162b2 SARS-CoV-2 vaccine elicited high titers of antibodies capable of neutralizing not only all SARS-CoV-2 variants of concern but also coronavirus types found in bats and pangolins. Immunity against all beta-coronaviruses may be achievable.AUG 18

CORRESPONDENCE Cross-Reactive Antibody Responses Elicited by the 501Y.V2 VariantT. Moyo-Gwete and OthersConvalescent serum from persons who had recovered from infection with 501Y.V2 (B.1.351), a SARS-CoV-2 variant first identified in South Africa, showed potent neutralization of the original variant (D614G), the 501Y.V2 variant, and the P.1 variant first identified in Brazil. These results suggest that vaccines based on the 501Y.V2 spike protein may be broadly effective against two common variants of SARS-CoV-2.JUN 03

ORIGINAL ARTICLE Breakthrough Covid-19 in Health Care WorkersM. Bergwerk and OthersAmong 1497 health care workers who were fully vaccinated against Covid-19 and had full testing results, 39 breakthrough infections were detected between January 20 and April 28, 2021. The infected workers had mild symptoms or were asymptomatic and had lower titers of peri-infection neutralizing antibody than coworkers who were not infected.JUL 28

ORIGINAL ARTICLEBRIEF REPORTVariant SARS-CoV-2 Infection after VaccinationE. Hacisuleyman and OthersMild Covid-19 symptoms developed in two fully vaccinated persons. Serum tests showed high titers of antibodies capable of neutralizing the wild-type strain of SARS-CoV-2 first identified in Wuhan, China, but sequencing of the virus isolates revealed novel variants. Some mutations in the receptor-binding domain of the spike protein were shared by the two variant strains.JUN 10 Correspondence Vaccine Breakthrough Infections with SARS-CoV-2 Variants

ORIGINAL ARTICLE Vaccine-Induced Thrombocytopenia and ThrombosisS. Pavord and OthersThe phenotypes of VITT were defined in 220 patients in the United Kingdom who presented a median of 14 days after the first ChAdOx1 nCoV-19 vaccination. Half had cerebral venous sinus thrombosis, a third of whom also had intracranial hemorrhage. Mortality was 22%. Intravenous immune globulin may reverse VITT.AUG 11

ORIGINAL ARTICLE Thrombotic Thrombocytopenia after ChAdOx1 nCoV-19 VaccinationM. Scully and OthersScully and colleagues report 23 cases of abnormal clotting, primarily involving the cerebral veins, 6 to 24 days after the first dose of the ChAdOx1 nCoV-19 vaccine. The syndrome was incited by antibodies to platelet factor 4, independent of heparin therapy. Early recognition and avoidance of platelet transfusion are key.JUN 10 Editorial SARS-CoV-2 Vaccine–Induced Immune Thrombotic Thrombocytopenia

CORRESPONDENCE Rare Thromboembolic Events among Vaccinated South AfricansS. Takuva and OthersAmong 288,368 South African health care workers who received the Ad26.COV2.S vaccine, no cases of vaccine-induced immune thrombotic thrombocytopenia have been observed, and the small number of thromboembolic events that have been noted occurred in persons with risk factors for thromboses other than vaccination.AUG 05

CORRESPONDENCE A Third Vaccine Dose in Organ-Transplant RecipientsV.G. Hall and OthersIt is known that people receiving immune suppressive therapy, such as recipients of solid-organ transplants, have a suboptimal response to SARS-CoV-2 vaccination. In a randomized, double-blind trial, a third dose of the mRNA-1273 vaccine was compared with placebo. The third dose of vaccine produced a significant boost in neutralizing antibodies.AUG 11 Editorial Third Time’s a Charm — Covid-19 Vaccine Hope for Solid-Organ Transplant Recipients

ORIGINAL ARTICLE The mRNA-1273 Vaccine in AdolescentsK. Ali and OthersIn a trial of mRNA-1273 or placebo involving 3700 adolescents 12 to 17 years of age, two doses of vaccine stimulated high levels of neutralizing antibodies, with a side-effect profile similar to that seen in other age groups. The incidence of Covid-19 in the unvaccinated group was too low to gauge protection, but Covid-19 did not develop in any vaccinated participants.AUG 11

ORIGINAL ARTICLE Treatment of MIS-CA.J. McArdle and OthersAn observational cohort study evaluated immunomodulatory therapy of multisystem inflammatory syndrome in children by comparing IVIG, IVIG plus glucocorticoids, or glucocorticoids alone. The investigators found no evidence of the superiority of any of the three therapies, although significant differences may emerge as more data accrue.JUN 16 Editorial Immunotherapy for MIS-C — IVIG, Glucocorticoids, and Biologics Letters responding to this article are now published: Therapy for Multisystem Inflammatory Syndrome in Children

ORIGINAL ARTICLE Vaccine Effectiveness against Delta Covid-19 VariantJ. Lopez Bernal and OthersThe B.1.617.2 (delta) Covid-19 variant has surged in India and spread worldwide. In a test-negative case–control study, the effectiveness of two doses of BNT162b2 was 94% against the B.1.1.7 (alpha) variant and 88% against delta; with the ChAdOx1 nCoV-19 vaccine, effectiveness was 74% and 67%, respectively. Protection after a single vaccine injection was low; two doses are needed.JUL 21 Editorial Vaccine Effectiveness Studies in the Field

CORRESPONDENCE Durability of Response after Ad26.COV2.S VaccinationD.H. Barouch and OthersIn this study, investigators measured immune responses in 20 participants who had received either one or two doses of the Ad26.COV2.S vaccine and in 5 who had received placebo. A high level of neutralizing antibodies against SARS-CoV-2 was maintained for at least 8 months after single-dose injection, with a median decrease by a factor of 1.8 in the titer.JUL 14

ORIGINAL ARTICLE Inactivated SARS-CoV-2 Vaccine in ChileA. Jara and OthersIn a national prospective cohort study involving 10.2 million participants in Chile, the effectiveness of an inactivated SARS-CoV-2 vaccine, which had been developed in China and administered in two doses 28 days apart, was estimated. Effectiveness among fully immunized persons was estimated at 65.9% for Covid-19 and at 87.5% for hospitalization, 90.3% for ICU admission, and 86.3% for death.JUL 07

CORRESPONDENCE Local Covid-19 Vaccine Reactions in Non-White PersonsU. Samarakoon, S. Alvarez-Arango, and K.G. BlumenthalPrevious reports document a small risk of delayed large local reactions to Covid-19 vaccines; however, clinical photos most often show White persons. Reactions have also been noted in vaccine recipients who are Black, Indigenous, or People of Color (BIPOC). Photos of eight such delayed reactions are shown.AUG 12

CLINICAL PRACTICE Mild or Moderate Covid-19R.T. Gandhi, J.B. Lynch, and C. del RioThe diagnosis of Covid-19 is usually based on SARS-CoV-2 PCR testing of a nasopharyngeal swab or other specimen. Remdesivir and dexamethasone have benefits in hospitalized patients with severe Covid-19, but in patients with moderate disease, dexamethasone is not efficacious and data are insufficient to recommend for or against routine use of remdesivir.OCT 29

CLINICAL DECISIONS Doctor, How Long Should I Isolate?S.R. Kadire, V. Fabre, and R.P. WenzelThis interactive feature about isolation for Covid-19 offers a case vignette accompanied by two essays with differing viewpoints on the length of isolation.MAR 25 Polling Results View the interim analysis.

VIDEOS IN CLINICAL MEDICINE Emergency Intubation in Covid-19G.S. Shrestha and OthersThis video demonstrates the procedure for emergency endotracheal intubation in patients with suspected or proven Covid-19. Endotracheal intubation in such patients poses a risk of infection for the health care personnel involved. Meticulous planning and preparation and the use of practice drills can minimize this risk.FEB 18 Letters responding to this article are now published: Emergency Intubation in Covid-19

CORRESPONDENCE Patient-Collected Swabs for SARS-CoV-2 TestingY.-P. Tu and OthersTongue, nasal, and mid-turbinate swabs to detect SARS-CoV-2 were collected by 530 outpatients before a health care worker collected nasopharyngeal swabs from these patients. Both the mid-turbinate and the nasal samples collected by the patients themselves may be clinically acceptable, with estimated sensitivities above 90%.JUL 30

ORIGINAL ARTICLE Baricitinib plus Remdesivir for Adults with Covid-19A.C. Kalil and OthersIn a trial involving 1033 patients hospitalized with Covid-19, the addition of baricitinib to remdesivir was associated with shorter recovery time, particularly among patients receiving high-flow oxygen, and with a 30% higher odds of improvement at day 15 than remdesivir alone. Adverse events were less frequent with the combination therapy.DEC 11

ORIGINAL ARTICLE Remdesivir for 5 Days or 10 Days in Covid-19J.D. Goldman and OthersA randomized trial comparing a 5-day course of intravenous remdesivir with a 10-day course in patients with Covid-19 pneumonia and hypoxemia who were not yet receiving mechanical ventilation showed no significant differences in outcome related to the duration of treatment.NOV 05 Editorial Remdesivir — An Important First Step

CORRESPONDENCE Type I Interferonopathy in Muscle in a Man with Covid-19G.S. Manzano, J.K. Woods, and A.A. AmatoGeneralized, predominantly proximal weakness and a greatly elevated creatine kinase level developed in a man with Covid-19. Immunohistochemical analysis of a muscle-biopsy specimen revealed abnormal expression of MHC-1 and myxovirus resistance protein A on muscle fibers, suggesting type I interferonopathy.DEC 10

CORRESPONDENCE Universal Masking in the Covid-19 EraM. Klompas, C.A. Morris, and E.S. ShenoyKlompas and colleagues write that they understand that some people are citing their Perspective article (published on April 1) as support for discrediting widespread masking. In truth, the intent of their article was to push for more masking, not less. JUL 09Perspective Universal Masking in Hospitals in the Covid-19 Era

NEJM Covid-19 UpdateListen to conversations with editors Eric Rubin and Lindsey Baden on the current coronavirus outbreak.

Covid-19 Rx — Treatment SimulationsThe spectrum of Covid-19 presentations ranges from a mild self-limited flulike illness to life-threatening multiorgan failure. While hoping for the best, prepare for the worst by engaging in these five treatment simulations that mimic the real-life, unforgiving uncertainty of medicine.

HealthMap of the Coronavirus OutbreakThe HealthMap team from Boston Children’s Hospital tracks publicly reported confirmed and suspected cases of Covid-19 throughout the world. The map is automatically updated to show current data.

A SneezeThis video captures the emission of a sneeze cloud. The largest droplets rapidly settle within 1 to 2 m away from the person. The smaller and evaporating droplets can travel the dimensions of a room and land up to 6 to 8 m away.

Coughing and AerosolsSequential schlieren images during a cough, shown in a video, were recorded at 3000 frames per second. A maximum airspeed of 8 m per second (18 mph) was observed, averaged during the half-second cough.

COVID-19: Where Do We Go From Here?This symposium, held on April 21, 2020, with the Harvard T.H. Chan School of Public Health and NEJM, presents a timely conversation with public health leaders on Covid-19 and collective next steps, from securing crucial supplies to hopes for treatments and vaccines and the lifting of restrictions.

For More Information: https://www.nejm.org/coronavirus

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