Age dependence of the natural history of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): An analysis of Diamond Princess data

Abstract Background Little is known about the natural history of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods We conducted a prospective study at a quarantine center for coronavirus disease 2019 in Ho Chi Minh City, Vietnam. We enrolled quarantined people with reverse-transcription polymerase chain reaction (RT-PCR)–confirmed SARS-CoV-2 infection, collecting clinical data, travel and contact history, and saliva at enrollment and daily nasopharyngeal/throat swabs (NTSs) for RT-PCR testing. We compared the natural history and transmission potential of asymptomatic and symptomatic individuals. Results Between 10 March and 4 April 2020, 14 000 quarantined people were tested for SARS-CoV-2; 49 were positive. Of these, 30 participated in the study: 13 (43%) never had symptoms and 17 (57%) were symptomatic. Seventeen (57%) participants imported cases. Compared with symptomatic individuals, asymptomatic people were less likely to have detectable SARS-CoV-2 in NTS collected at enrollment (8/13 [62%] vs 17/17 [100%]; P = .02). SARS-CoV-2 RNA was detected in 20 of 27 (74%) available saliva samples (7 of 11 [64%] in the asymptomatic group and 13 of 16 [81%] in the symptomatic group; P = .56). Analysis of RT-PCR positivity probability showed that asymptomatic participants had faster viral clearance than symptomatic participants (P < .001 for difference over the first 19 days). This difference was most pronounced during the first week of follow-up. Two of the asymptomatic individuals appeared to transmit SARS-CoV-2 to 4 contacts. Conclusions Asymptomatic SARS-CoV-2 infection is common and can be detected by analysis of saliva or NTSs. The NTS viral loads fall faster in asymptomatic individuals, but these individuals appear able to transmit the virus to others.

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The Natural History of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Composite But Incomplete Picture

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1413 ◽

2020 ◽

Author(s):

Jaiprasath Sachithanandham ◽

Chloe L Thio ◽

Ashwin Balagopal

Keyword(s):

Natural History ◽

Severe Acute Respiratory Syndrome ◽

History Of ◽

Incomplete Picture

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Post-COVID-19 Pulmonary Fibrosis: An Update

Journal of Advanced Research in Medicine ◽

10.24321/2349.7181.202109 ◽

2021 ◽

Vol 08 (02) ◽

pp. 16-26

Author(s):

Naresh Kumar ◽

Keyword(s):

Natural History ◽

Severe Acute Respiratory Syndrome ◽

Pulmonary Fibrosis ◽

Severity Of Illness ◽

Pulmonary Vascular Disease ◽

History Of ◽

Prolonged Icu Stay

Coronavirus disease 2019 (COVID-19) is caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most common cause of hospitalisation for COVID-19 is interstitial pneumonia that may be complicated by Acute Respiratory Distress Syndrome (ARDS). With an increasing magnitude of COVID-19 survivors, post-COVID interstitial lung disease and pulmonary vascular disease are likely to be the most important long term respiratory complications. Data from previous coronavirus infections such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), as well as emerging data from the COVID-19 pandemic, suggest that there could be substantial pulmonary fibrotic consequences following SARS-CoV-2 infection. Thus, the long-term consequences of COVID-19 appear crucial. Here, we have discussed the pathogenesis, natural history, and radiological aspects of such patients and the possible predictors which might lead to the development of lung fibrosis. Older age, severity of illness, prolonged ICU stay, history of smoking and alcoholism are few of the risk factors for the development of post-COVID-19 pulmonary fibrosis. Therapeutic options like antifibrotic drugs such as pirfenidone, nintedanib, pulmonary rehabilitation, SARS-COV-2 vaccine etc. have been described. The role of steroids and antifibrotics in the prevention of post-COVID fibrosis is still controversial. Careful longitudinal follow-up of multiple cohorts of post-COVID-19 survivors with serial lung function testing and imaging is required to complete the knowledge about natural history of the disease and the response to various therapies.

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The Natural History of Severe Acute Respiratory Syndrome Coronavirus 2–Related Multisystem Inflammatory Syndrome in Children: A Systematic Review

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa112 ◽

2020 ◽

Cited By ~ 3

Author(s):

Stephen C Aronoff ◽

Ashleigh Hall ◽

Michael T Del Vecchio

Keyword(s):

Systematic Review ◽

Natural History ◽

Severe Acute Respiratory Syndrome ◽

Myocardial Dysfunction ◽

Case Reports ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Case Series ◽

History Of ◽

Inflammatory Syndrome

Abstract Background The clinical manifestations and natural history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related multisystem inflammatory syndrome in children (MIS-C) are poorly defined. Using a systematic review of individual cases and case series and collating elements of the clinical course, the objective of this study was to provide a detailed clinical description and natural history of MIS-C. Methods Case reports and series of MIS-C were recovered from repeated MEDLINE searches, a single EMBASE search, and table of contents reviews of major general medicine and pediatric journals performed between June 3 and July 23, 2020. Fever, evidence of inflammation, and evidence of organ dysfunction were required for inclusion. Results MEDLINE and EMBASE searches produced 129 articles, and 10 articles were identified from journal contents or article bibliographies; 16 reports describing 505 children with MIS-C comprise this review. Thirty-two children (14.7%) had negative results for SARS-CoV-2 by nucleic acid and/or antibody testing. The weighted median age was 9 years (6 months to 20 years). Clinical findings included fever (100%), gastrointestinal symptoms (88.0%), rash (59.2%), conjunctivitis (50.0%), cheilitis/ “strawberry tongue” (55.7%), or extremity edema/erythema (47.5%). Median serum C-reactive protein, ferritin, fibrinogen, and D-dimer concentrations were above the normal range. Intravenous gammaglobulin (78.1%) and methylprednisolone/prednisone (57.6%) were the most common therapeutic interventions; immunomodulation was used in 24.3% of cases. Myocardial dysfunction requiring ionotropic support (57.4%) plus extracorporeal membrane oxygenation (5.3%), respiratory distress requiring mechanical ventilation (26.1%), and acute kidney injury (11.9%) were the major complications; anticoagulation was used commonly (54.4%), but thrombotic events occurred rarely (3.5%). Seven (1.4%) children died. Conclusions MIS-C following SARS-CoV-2 infection frequently presents with gastrointestinal complaints and/or rash; conjunctivitis, cheilitis, and/or extremity changes also occur frequently. Serious complications occur frequently and respond to aggressive supportive therapy.

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How is the moral stance related to the intentional stance and group thinking?

Behavioral and Brain Sciences ◽

10.1017/s0140525x19002413 ◽

2020 ◽

Vol 43 ◽

Author(s):

Hannes Rakoczy

Keyword(s):

Natural History ◽

Social Cognitive ◽

Intentional Stance ◽

Cognitive Capacities ◽

Shared Intentionality ◽

History Of ◽

Group Thinking ◽

Moral Stance

Abstract The natural history of our moral stance told here in this commentary reveals the close nexus of morality and basic social-cognitive capacities. Big mysteries about morality thus transform into smaller and more manageable ones. Here, I raise questions regarding the conceptual, ontogenetic, and evolutionary relations of the moral stance to the intentional and group stances and to shared intentionality.

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