Covid-19 — Navigating the Uncharted
et al., New England Journal of Medicine, doi:10.1056/NEJMe2002387, Mar 2020
COVID-19 review noting that COVID-19's clinical consequences may ultimately resemble severe seasonal influenza (0.1% case fatality rate).
Fauci et al., 26 Mar 2020, peer-reviewed, 3 authors.
Abstract: T h e n e w e ng l a n d j o u r na l o f m e dic i n e
Edi t or i a l
Covid-19 — Navigating the Uncharted
Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.
The latest threat to global health is the ongoing
outbreak of the respiratory disease that was recently given the name Coronavirus Disease 2019
(Covid-19). Covid-19 was recognized in December 2019.1 It was rapidly shown to be caused by
a novel coronavirus that is structurally related to
the virus that causes severe acute respiratory
syndrome (SARS). As in two preceding instances
of emergence of coronavirus disease in the past
18 years2 — SARS (2002 and 2003) and Middle
East respiratory syndrome (MERS) (2012 to the
present) — the Covid-19 outbreak has posed
critical challenges for the public health, research,
and medical communities.
In their Journal article, Li and colleagues3 provide a detailed clinical and epidemiologic description of the first 425 cases reported in the
epicenter of the outbreak: the city of Wuhan in
Hubei province, China. Although this information is critical in informing the appropriate response to this outbreak, as the authors point
out, the study faces the limitation associated with
reporting in real time the evolution of an emerging pathogen in its earliest stages. Nonetheless,
a degree of clarity is emerging from this report.
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.
On the basis of a case definition requiring a
1268
n engl j med 382;13
diagnosis of pneumonia, the currently reported
case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al.5 report
mortality of 1.4% among 1099 patients with
laboratory-confirmed Covid-19; these patients had
a wide spectrum of disease severity. 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.2
The efficiency of transmission for any respiratory virus has important implications for containment and mitigation strategies. 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.
Recent reports of high titers of virus in the oropharynx early in the course of disease arouse
concern about increased infectivity during the
period of minimal symptoms.6,7
China, the United States, and several other
countries have instituted temporary..
DOI record:
{
"DOI": "10.1056/nejme2002387",
"ISSN": [
"0028-4793",
"1533-4406"
],
"URL": "http://dx.doi.org/10.1056/NEJMe2002387",
"alternative-id": [
"10.1056/NEJMe2002387"
],
"author": [
{
"affiliation": [
{
"name": "From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (A.S.F., H.C.L.); and the Centers for Disease Control and Prevention, Atlanta (R.R.R.)."
}
],
"family": "Fauci",
"given": "Anthony S.",
"sequence": "first"
},
{
"ORCID": "https://orcid.org/0000-0001-9509-1045",
"affiliation": [
{
"name": "From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (A.S.F., H.C.L.); and the Centers for Disease Control and Prevention, Atlanta (R.R.R.)."
}
],
"authenticated-orcid": false,
"family": "Lane",
"given": "H. Clifford",
"sequence": "additional"
},
{
"affiliation": [
{
"name": "From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (A.S.F., H.C.L.); and the Centers for Disease Control and Prevention, Atlanta (R.R.R.)."
}
],
"family": "Redfield",
"given": "Robert R.",
"sequence": "additional"
}
],
"container-title": "New England Journal of Medicine",
"container-title-short": "N Engl J Med",
"content-domain": {
"crossmark-restriction": false,
"domain": []
},
"created": {
"date-parts": [
[
2020,
2,
28
]
],
"date-time": "2020-02-28T17:00:24Z",
"timestamp": 1582909224000
},
"deposited": {
"date-parts": [
[
2024,
3,
27
]
],
"date-time": "2024-03-27T00:39:39Z",
"timestamp": 1711499979000
},
"indexed": {
"date-parts": [
[
2025,
10,
23
]
],
"date-time": "2025-10-23T05:36:00Z",
"timestamp": 1761197760478,
"version": "3.37.3"
},
"is-referenced-by-count": 1364,
"issue": "13",
"issued": {
"date-parts": [
[
2020,
3,
26
]
]
},
"journal-issue": {
"issue": "13",
"published-print": {
"date-parts": [
[
2020,
3,
26
]
]
}
},
"language": "en",
"link": [
{
"URL": "http://www.nejm.org/doi/pdf/10.1056/NEJMe2002387",
"content-type": "unspecified",
"content-version": "vor",
"intended-application": "similarity-checking"
}
],
"member": "150",
"original-title": [],
"page": "1268-1269",
"prefix": "10.1056",
"published": {
"date-parts": [
[
2020,
3,
26
]
]
},
"published-print": {
"date-parts": [
[
2020,
3,
26
]
]
},
"publisher": "Massachusetts Medical Society",
"reference": [
{
"key": "e_1_3_4_2_2",
"unstructured": "Pneumonia of unknown cause — China: disease outbreak news. Geneva: World Health Organization January 5 2020 (https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/)."
},
{
"DOI": "10.1038/nrmicro.2016.81",
"doi-asserted-by": "publisher",
"key": "e_1_3_4_3_2"
},
{
"DOI": "10.1056/NEJMoa2001316",
"doi-asserted-by": "publisher",
"key": "e_1_3_4_4_2"
},
{
"key": "e_1_3_4_5_2",
"unstructured": "Coronavirus disease 2019 (COVID-19): situation report — 36. Geneva: World Health Organization February 25 2020 (https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200225-sitrep-36-covid-19.pdf?sfvrsn=2791b4e0_2)."
},
{
"DOI": "10.1056/NEJMoa2002032",
"doi-asserted-by": "publisher",
"key": "e_1_3_4_6_2"
},
{
"DOI": "10.1056/NEJMoa2001191",
"doi-asserted-by": "publisher",
"key": "e_1_3_4_7_2"
},
{
"DOI": "10.1056/NEJMc2001737",
"doi-asserted-by": "publisher",
"key": "e_1_3_4_8_2"
},
{
"key": "e_1_3_4_9_2",
"unstructured": "Coronavirus disease 2019 (COVID-19) in the U.S. Atlanta: Centers for Disease Control and Prevention February 26 2020 (https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html)."
},
{
"DOI": "10.3201/eid2605.190995",
"doi-asserted-by": "publisher",
"key": "e_1_3_4_10_2"
},
{
"key": "e_1_3_4_11_2",
"unstructured": "DRAFT landscape of COVID-19 candidate vaccines — 18 February 2020. Geneva: World Health Organization (https://www.who.int/blueprint/priority-diseases/key-action/list-of-candidate-vaccines-developed-against-ncov.pdf)."
},
{
"key": "e_1_3_4_12_2",
"unstructured": "WHO R&D blueprint: informal consultation on prioritization of candidate therapeutic agents for use in novel coronavirus 2019 infection. Geneva: World Health Organization January 24 2020 (https://apps.who.int/iris/bitstream/handle/10665/330680/WHO-HEO-RDBlueprint%28nCoV%29-2020.1-eng.pdf)."
},
{
"DOI": "10.1177/1740774515618198",
"doi-asserted-by": "publisher",
"key": "e_1_3_4_13_2"
}
],
"reference-count": 12,
"references-count": 12,
"relation": {},
"resource": {
"primary": {
"URL": "http://www.nejm.org/doi/10.1056/NEJMe2002387"
}
},
"score": 1,
"short-title": [],
"source": "Crossref",
"subject": [],
"subtitle": [],
"title": "Covid-19 — Navigating the Uncharted",
"type": "journal-article",
"volume": "382"
}