Coronavirus (COVID-19) Q&A

Infectious epidemics have always driven change and triggered discrimination in human societies. Frank Snowden, DPhil, Professor Emeritus of History and History of Medicine at Yale University and author of Epidemics and Society: From the Black Death to the Present (Yale University Press, 2019), puts the COVID-19 pandemic in historical context.

Food and medicine shopping is essential during the COVID-19 pandemic, but requires getting out and standing close to strangers at a time when social distancing and sheltering-in-place are recommended to slow spread of disease. David Aronoff, MD, director of the Division of Infectious Diseases at Vanderbilt University in Nashville, explains how to minimize COVID-19 risk while shopping.

Noninvasive ventilation (NIV), working with dying patients' families, use of experimental therapies, and more. JAMA Associate Editor Derek Angus, MD, MPH, Distinguished Professor and Chair of Critical Care Medicine at the University of Pittsburgh, provides a COVID-19 ICU management update. Watch the recording of this livestream

How does the current pandemic compare to historical infectious outbreaks and what can we expect in summer and fall of 2020? Nicholas Christakis, MD, PhD, MPH, director of the Human Nature Lab, Co-director of the Institute of Network Science, and Sterling Professor of Social and Natural Science at Yale University, discusses the epidemiology of COVID-19.

Interview with Joshua K Tay, author of Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak, and Babak Givi, MD, author of Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

Interview with Alfred Sommer, MD, author of Humans, Viruses, and the Eye—An Early Report From the COVID-19 Front Line

Hospitals need ways to make rational, fair decisions about who gets ICU beds and ventilators if COVID-19 patients overwhelm capacity. Douglas B. White, MD, MAS, Director of the Program on Ethics and Decision Making in Critical Illness at the University of Pittsburgh, discusses a framework for those decisions and a guideline he helped develop for allocation of scarce resources in public health emergencies.

The lack of availability of COVID-19 testing has interfered with the ability to contain the spread of disease. Omai Garner, PhD, laboratory director for Clinical Microbiology in the UCLA health system, explains how PCR testing for COVID-19 works and why testing is in short supply.

Interview with Robert O. Bonow, MD, Patrick T. O'Gara, MD, Clyde W. Yancy, MD, and Gregg C. Fonarow, MD, authors of Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality and Ajay J. Kirtane, MD

As COVID-19 spreads globally, populations who survive their illness will become immune. Mayo Vaccine Research Group Director Gregory Poland, MD, discusses antibody responses, duration of immunity, vaccine safety, and the prospects for using convalescent serum to passively immunize people unexposed to SARS-CoV-2.

As COVID-19 spreads, clinicians and health systems are struggling to prepare for a surge of patients. Richard Stone, MD, the US Veterans Health Administration's Executive in Charge, spoke with JAMA about how the VA health system is preparing for this public health emergency.

In 2003, Toronto was the North American center for Severe Acute Respiratory Syndrome (SARS). The disease spread through the city's hospitals before anyone knew what was happening. Dr Allison McGeer was a clinician caring for SARS patients and ultimately was infected herself. She describes her experience as a patient and provider and reviews lessons learned that might help others manage their regional COVID-19 outbreaks. Related: Supporting the Health Care Workforce During the COVID-19 Global Epidemic

The ARDS in COVID-19 patients appears more responsive to PEEP and prone ventilation, but seems to require prolonged ventilation and may be associated with myocardial injury. Michelle N. Gong, MD, MS, Chief of Critical Care Medicine at Montefiore Medical Center in the Bronx, discusses her department's experience managing critically ill coronavirus patients, procuring diagnostic tests and personal protective equipment (PPE) for her staff, and more.

Chloroquine was shown in 2004 to be active in vitro against SARS coronavirus but is of unproven efficacy and safety in patients infected with SARS-CoV-2. The drug's potential benefits and risks for COVID-19 patients, without and with azithromycin, is discussed by Dr. David Juurlink, head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto.

Interview with Jason Ying Kuen Chan, MBBS, author of Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus Epidemic: An Experience in Hong Kong

The strategy for managing the COVID-19 pandemic has shifted from containment to mitigation. What does that mean for US hospitals and health systems? Kaiser Permanente Executive Vice President Stephen M. Parodi, MD, discusses telemedicine, protecting health care workers, equipment allocation planning, and more.

Emerging information about how SARS-CoV-2 virus infects cells has led to speculation that NSAIDs and ACE inhibitors/angiotensin receptor blockers (ARBs) may worsen clinical disease. Infectious disease physician Carlos del Rio, MD, of Emory University explains the concerns and their clinical implications.

Diagnostic testing, NSAIDs, ACE Inhibitors, antivirals, and more. Anthony Fauci, MD from NIAID discusses latest developments in the spread and clinical management of COVID-19 and the SARS-CoV-2 virus with JAMA Editor Howard Bauchner, MD. JAMA Coronavirus Resource Center

Coronavirus testing will help countries manage coronavirus disease 2019 (COVID-19) but will raise questions about how to counsel patients about their test results. The CDC's Deputy Director for Infectious Diseases Jay C. Butler, MD, talks with JAMA Editor Howard Bauchner about what to advise healthy patients with positive PCR results, sick patients with negative test results, exposed health care workers, and more.

Seattle has been a focal point for the US in the coronavirus pandemic. Doug Paauw, MD, professor of medicine at the University of Washington, in Seattle, describes the UW primary care clinic experience as this pandemic evolved. Major lessons learned included accommodating for significant numbers of staff not available to work in the clinic because of school closures, change in workflow because of shortages of personal protective equipment, physicians having to accommodate very large numbers of patient queries via telephone, email, or electronic health record, and the importance of the rapid development of local ability to test for SARS-CoV-2 independent of public health agencies.

Seattle has been a focal point for the US in the coronavirus pandemic. Doug Paauw, MD, professor of medicine at the University of Washington, in Seattle, describes the UW primary care clinic experience as this pandemic evolved. Major lessons learned included accommodating for significant numbers of staff not available to work in the clinic because of school closures, change in workflow because of shortages of personal protective equipment, physicians having to accommodate very large numbers of patient queries via telephone, email, or electronic health record, and the importance of the rapid development of local ability to test for SARS-CoV-2 independent of public health agencies.

Physicians in Lombardy, Italy, have been overwhelmed by COVID-19 patients requiring critical care. Based on an existing ECMO center network they developed an ICU network to rapidly identify, triage, and manage patients infected with SARS-2-CoV. Maurizio Cecconi, MD, of Humanitas University in Milan discusses the region's approach to the surge, including clinical and supply management, health care worker training and protection, and ventilation strategies, with JAMA Editor Howard Bauchner. Read the article: Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response

Coronavirus testing, mortality, vaccine development, containment vs mitigation, and more. JAMA Editor Howard Bauchner, MD, interviews US NIAID Director Anthony Fauci, MD, about the latest developments in SARS-CoV-2 science and global spread of infection. JAMA Coronavirus Resource Page

By mid-February 2020 there were 60,000 confirmed cases of COVID-19, the vast majority diagnosed in Hubei Province (including Wuhan city) in mainland China. China CDC Chief Epidemiologist Zunyou Wu, MD, PhD discusses the latest COVID-19 developments in the country with JAMA Editor in Chief Howard Bauchner, MD.

In February 2020 the nature of the 2019-nCoV outbreak is still slowly coming into focus but it appears to be acting more like bad pandemic influenza (efficient spread, overall lower mortality) than like SARS (less efficient spread, overall higher mortality). Anthony Fauci, MD, of the US National Institute of Allergy and Infectious Diseases (NIAID) discusses the latest developments with JAMA Editor in Chief Howard Bauchner. Coronavirus Resource Center

The 2019 novel coronavirus (2019-nCoV) outbreak exemplifies ongoing biothreats to global security, as each new threat tests principles of preparation and response at national, regional, and clinical levels. Tom Inglesby, MD, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, discusses biosecurity with Angel Desai, MD, JAMA Fishbein fellow.

Interview with Anthony S. Fauci, MD, author of Coronavirus Infections—More Than Just the Common Cold