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27 maart 2020

How does the Coronavirus behave inside a patient? - The New Yorker

Bron: 26-03-2020: https://www.newyorker.com/magazine/2020/04/06/how-does-the-coronavirus-behave-inside-a-patient
By S. Mukherjee

Aim
Answer to the following questions:

  1. dose-response curve for the initial infection
  2. relationship between initial doses of the virus and severity of the disease
  3. are there quantitative measures of how the virus behaves in infected patients

Key findings

  • For Covid-19, studies are ongoing to investigate the relationship between viral load and severity of the disease. The relationship between initial viral dose and severity remains to be seen
  • As the virus continues to spread over the world → we will begin to find quantitative answers to these questions of how exposure intensity and subsequent viral loads relate to clinical course of covid-19
  • To win the fight against covid-19, it’s essential to trace the course of virus as it moves through populations. But it’s equally essential to measure its course within a single patient

Summary

  • Every virus has its own personality. The viral load -  a continuum, not a binary value, helps to predict the nature, course and transmissibility of the disease
  • The host immune response forms the other aspect of transmission and disease
  • The relation between severity of the disease and amount of virus initially exposed to:
    • Reports from China an Italy show that front-line health-care workers are at a great risk for serious illness despite their younger age
    • A study from 2004  investigating the SARS-virus found that a higher initial load of the virus was correlated with a more severe respiratory illness → this pattern held true regardless of a patient’s age or underlying conditions
    • The interaction between the virus and the immune system is a race in time → if you give the virus a head start with a large doses, you get higher viremia, more dissemination, higher infection and worse disease
    • For Covid-19, studies are ongoing to investigate the relationship between viral load and severity of the disease. The relationship between initial viral dose and severity remains to be seen
  • Quantitative measures to track Covid-19 in infected patients:
    • A study from China reported that the viral loads in nasopharyngeal swabs from a group of patients with severe covid-19 were six times higher, on average, than the loads among patients with a mild form of the disease
    • As the virus continues to spread over the world → we will begin to find quantitative answers to these questions of how exposure intensity and subsequent viral loads relate to clinical course of covid-19
  • To win the fight against covid-19, it’s essential to trace the course of virus as it moves through populations. But it’s equally essential to measure its course within a single patient