Top 10

Home | TOP 10 BOOK (PDF) | April | May | June | July | August

By Christian Hoffmann &
Bernd S. Kamps



Daily Science
The Top 10 Book
Update 9 October
Volume 1: Jan-Sep
720 pages, PDF
Volume 2:
November – April 2021

CR Twitter

16 October

This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing the text to give it early visibility.

Special Paper

WHO Solidarity Trial Consortium, Pan, H, Peto R, et al. Repurposed antiviral drugs for COVID-19; interim WHO SOLIDARITY trial results. medRxiv 2020, posted 15 October. Full-text:

Will remdesivir soon join the hydroxychloroquine and lopinavir graveyard? Interim results from the Solidarity Therapeutics Trial, coordinated by the World Health Organization, indicate that remdesivir, hydroxychloroquine, lopinavir and interferon regimens appear to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay. This paper is currently being peer-reviewed.

Figure 2. Effect of remdesivir and hydroxychloroquine on 28-day mortality. Copyright: WHO. Reproduced with permission.


See also the press articles in

English: Boseley S. Remdesivir has very little effect on Covid-19 mortality, WHO finds. The Guardian 2020, published 16 October. Full-text:

Results from gold-standard trial described as sobering, as drug found not to improve survival rates

Spanish: Domínguez N. La OMS confirma que ninguno de los fármacos contra la covid que estaba probando salva vidas. El País 2020, published 16 October. Full-text:

Los datos del ensayo Solidarity confirman que ni la cloroquina ni el remdesivir ni otros dos tratamientos reducen la mortalidad.


Top 10 Special: Transmission

The 5th COVID Reference Edition will be published this month.


These are 13 among the important papers we will include in the Transmission chapter.  The topics:

  1. Review
  2. Super-spreading
  3. Transmission terminology
  4. Spit happens
  5. Aerosolized fomites
  6. Fecal aerosol transmission
  7. Fomites
  8. Bus
  9. Restaurant
  10. Leisure
  11. Workplace: Meat-processing plant
  12. Workplace: Musician
  13. Choir



Meyerowitz EA, Richterman A, Gandhi RT, Sax PE. Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors. Ann Intern Med 2020, published 17 September. Full-text:

  1. Eric Meyerowitz et al. present a comprehensive review of the evidence of human SARS-CoV-2 transmission (Meyerowitz 2020). Their key points:
  2. Respiratory transmission is the dominant mode of transmission.
  3. Vertical transmission occurs rarely; transplacental transmission has been documented.
  4. Cats and ferrets can be infected and transmit to each other, but there are no reported cases to date of transmission to humans; minks transmit to each other and to humans.
  5. Direct contact and fomite transmission are presumed but are likely only an unusual mode of transmission.
  6. Although live virus has been isolated from saliva and stool and viral RNA has been isolated from semen and blood donations, there are no reported cases of SARS-CoV-2 transmission via fecal–oral, sexual, or bloodborne routes. To date, there is 1 cluster of possible fecal–respiratory transmission.



Adam DC, Wu P, Wong JY, et al. Clustering and superspreading potential of SARS-CoV-2 infections in Hong Kong. Nat Med (2020). Full-text:

Dillon Adam, Peng Wu and colleagues identified 4–7 superspreading events (SSEs) across 51 clusters (n = 309 cases) and estimate that 19% (95% confidence interval, 15–24%) of cases seeded 80% of all local transmissions (Adam 2020). After controlling for age, transmission in social settings was associated with more secondary cases than households when controlling for age. Social settings are likely to become major battle grounds of coming SARS-CoV-2 waves.


Transmission terminology

Prather KA, Marr LC, Schooley RT, et al. Airborne transmission of SARS-CoV-2. Science 05 Oct 2020: eabf0521. Full-text:

According to Kimberly Prather and colleagues, we should clarify the terminology to distinguish between aerosols and droplets using a size threshold of 100 μm, not the historical 5 μm (Prather 2020). This size more effectively separates their aerodynamic behavior, ability to be inhaled, and efficacy of interventions. Viruses in droplets (larger than 100 μm) typically fall to the ground in seconds within 2 m of the source and can be sprayed like tiny cannonballs onto nearby individuals.


Spit happens

Bax A, Bax CE, Stadnytskyi V, Anfinrud P. SARS-CoV-2 transmission via speech-generated respiratory droplets. Lancet Inf Dis September 11, 2020. Full-text:

Spit happens. This group published the impressive NEJM video, visualizing speech-generated oral fluid droplets and suggesting that normal speaking might be an important mode of transmission (Bax 2020). Here, the four authors vigorously resist the criticism of other authors who argued that the video experiments were unrealistic. They also provide nice new videos showing speech droplets emitted by four people, when speaking the phrase “spit happens” with the face positioned about 10–15 cm behind a thin sheet of intense green laser light.

Anfinrud P, Stadnytskyi V, Bax CE, Bax A. Visualizing Speech-Generated Oral Fluid Droplets with Laser Light Scattering. N Engl J Med. 2020 May 21;382(21):2061-2063. PubMed: Full-text:

New video:


Aerosolized fomites

Asadi S, Gaaloul ben Hnia N, Barre RS, et al. Influenza A virus is transmissible via aerosolized fomites. Nat Commun 11, 4062 (2020). Full-text:

SARS-CoV-2 can be transmitted via droplets, fomites and possibly aerosol. Will we need to get accustomed to a fourth transmission route, aerosolized fomites? That’s what Nicole Bouvier and colleagues suggest, although for now only for influenza A virus. They show that dried influenza virus remains viable in the environment, on materials like paper tissues and on the bodies of living animals, long enough to be aerosolized on non-respiratory dust particles that can transmit infection through the air to new mammalian hosts (Asadi 2020). Will we soon see a paper about SARS-CoV-2 transmission via aerosolized fomites?


Fecal aerosol transmission

Kang M, Wi J, Yuan J, et al. Probable Evidence of Fecal Aerosol Transmission of SARS-CoV-2 in a High-Rise Building. Ann Intern Med 2020, published 1 September. Full-text:

Nanshan Zhong, Min Kang and colleagues report 9 infected patients in 3 families. While the first family had a history of travel to the coronavirus disease 2019 (COVID-19) epicenter Wuhan, the other 2 families had no travel history and a later onset of symptoms. The families lived in 3 vertically aligned flats connected by drainage pipes in the master bathrooms. The authors suggest that virus-containing fecal aerosols may have been produced in the associated vertical stack during toilet flushing after use by the index patients (Kang M 2020). This report reminds us of a SARS-1 outbreak in March 2003 among residents of Amoy Gardens, Hong Kong, with a total of 320 SARS cases in less than three weeks (see, page 65).

Copyright: Annals of Internal Medicine. Reproduced with permission.

See also the comment by Michael Gormley [Gormley M. SARS-CoV-2: The Growing Case for Potential Transmission in a Building via Wastewater Plumbing Systems. Ann Intern Med 2020, published 1 September. Full-text:] concludes that that wastewater plumbing systems, particularly those in high-rise buildings, deserve closer investigation, both immediately in the context of SARS-CoV-2 and in the long term, because they may be a reservoir for other harmful pathogens.



Mondelli MU, Colaneri M, Seminari E, et al. Low risk of SARS-CoV-2 transmission by fomites in real-life conditions. Lancet Infect Dis September 29, 2020. Full-text:

Some arguments that environmental contamination leading to SARS-CoV-2 transmission is unlikely to occur in real-life conditions, provided that standard cleaning procedures and precautions are enforced. The chance of transmission through inanimate surfaces is likely less frequent than hitherto recognized (Mondelli 2020).



Shen Y, Li C, Dong H. Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China. JAMA Intern Med, September 1, 2020. Full-text:

If you take the bus, choose seats near a window (and open it). On January 19, 2020, 68 individuals (including the source patient) took a bus on a 100-minute round trip to attend a worship event. In total, 24 (35%) received a diagnosis of COVID-19 after the event. The authors were able to identify seats for each passenger and divided bus seats into high-risk and low-risk zones (Shen Y 2020). Passengers in the high-risk zones had moderately but non-significantly higher risk of getting COVID-19 than those in the low-risk zones. On the 3-seat side of the bus, except for the passenger sitting next to the index patient, none of the passengers sitting in seats close to the bus window developed infection. In addition, the driver and passengers sitting close to the bus door also did not develop infection, and only 1 passenger sitting by an operable window developed infection. The absence of a significantly increased risk in the part of the bus closer to the index case suggested that airborne spread of the virus may at least partially explain the markedly high attack rate observed.



Fisher KA, Tenforde MW, Feldstein LR, et al. Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults ≥18 Years in 11 Outpatient Health Care Facilities — United States, July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1258–1264. Full-text:

Eating and drinking and socializing? Everything may well return to normal in a few years. In the meantime, note that adults with a positive SARS-CoV-2 test result were found to be twice as likely to have had dinner at a restaurant than those with negative test results (Fisher 2020). Kiva Fisher and colleagues conclude that eating and drinking on-site at locations that offer such options might be important risk factors associated with SARS-CoV-2 infection. Bars and restaurants are in for a rough autumn and winter season.



Szablewski CM, Chang KT, Brown MM, et al. SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020. MMWR Morb Mortal Wkly Rep. ePub: 31 July 2020. Full-text:

Mid-June 2020. An overnight camp in Georgia (camp A) with trainees, staff members and campers. Wearing cloth masks for campers and opening windows and doors for increased ventilation in buildings were not required. (Cloth masks were required only for staff members.) Camp attendees engaged in a variety of indoor and outdoor activities, including daily vigorous singing and cheering. Of a total of 597 Georgia residents attendending camp A, test results were available for 344 (58%) attendees; among these 260 (76%) were positive. The overall attack rate was 44% (260 of 597), 51% among those aged 6–10 years, 44% among those aged 11–17 years, and 33% among those aged 18–21 years (Szablewski 2020). Attack rates increased with increasing length of time spent at the camp, with staff members having the highest attack rate (56%).


Workplace: Meat-processing plant

Günther T, Czech-Sioli M, Indenbirken D, et al. SARS-CoV-2 outbreak investigation in a German meat processing plant. EMBO Mol Med. 2020 Oct 4:e202013296. PubMed: Full-text:

In June, more than 1,400 employees at a meat-processing plant (MPP) in Germany were infected with SARS-CoV-2. Now a research group led by virologist Melanie Brinkmann (Helmholtz Center for Infection Research, Braunschweig) reconstructed how the virus was transmitted in the company. The first employees who became infected worked the early shift (147 workers), mostly in a fixed position on the conveyor belt. The evaluation of these positions showed that the risk of infection was greatest within a distance of eight meters from the first infected individual (Günther 2020). In order words: a distance of 1.5 or two meters, which is currently thought (and instituted!) as relatively safe in most situations, was far from sufficient. The authors conclude that climate conditions (10° C ambient air temperature) and airflow are important factors that can promote spread of SARS-CoV-2 via distances of more than 8 meters. These findings may have far-reaching implications for pandemic mitigation strategies in industrial workplace settings.


Workplace: Musician

Plautz J. Is it safe to strike up the band in a time of coronavirus? Science, 17 July 2020. Full-text:

Is keeping 2 meters away enough to stay safe from a trumpet at full blast? Try it, find out! Introduce five student musicians – a soprano singer and clarinet, flute, French horn, and trumpet players — in a clean room one at a time and let them perform a short solo piece (Plautz 2020).



An outbreak in Sallent (72 km from Barcelona) with 30 SARS-CoV-2-infected people demonstrates the risk posed by choirs and karaoke in poorly ventilated places. See the video: Do not sing and jump around in enclosed spaces!

If you read Spanish, read Salas J. El peligro de cantar en interiores en tiempos de covid. El País 2020, published 26 September. Full-text: See also the City Hall announcement (in Catalan): Comunicat de l’Ajuntament de Sallent en relació als casos positius per COVID-19 de la coral The River Troupe Gospel.


15 October


Walsh EE, Frenck RW, Falsey AR, et al. Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates. N Engl J Med 2020, published 15 October. Full-text:

Safety and immunogenicity data from a phase 1 trial of RNA-based Pfizer/BioNTech vaccines. In both younger (18 to 55 years of age) and older adults (65 to 85 years of age), the two vaccine candidates elicited similar dose-dependent SARS-CoV-2–neutralizing geometric mean titers, comparable or higher than the geometric mean titer of a panel of SARS-CoV-2 convalescent serum samples. The data presented here by Judith Absalon, Edward Walsh and colleagues include those that guided the companies’ decision to advance BNT162b2 at the 30-μg dose level to the phase 2–3, international trial to evaluate its safety and efficacy in participants 18 to 85 years of age.



Alwan NA, Burgess RA, Ashworth S, et al. Scientific consensus on the COVID-19 pandemic: we need to act now. Lancet 2020, published 15 October. Full-text:

Herd immunity against SARS-CoV-2? Allowing large uncontrolled outbreaks in the low-risk population while protecting the vulnerable? Developing population immunity in the low-risk population, which will eventually protect the vulnerable? The authors don’t beat about the bush: “Dangerous fallacy unsupported by scientific evidence.” Their conclusion: “Japan, Vietnam, and New Zealand, to name a few countries, have shown that robust public health responses can control transmission, allowing life to return to near-normal, and there are many such success stories. The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months. We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.”



Poirier C, Luo W, Majumder MS, et al. The role of environmental factors on transmission rates of the COVID-19 outbreak: an initial assessment in two spatial scales. Sci Rep 10, 17002 (2020). Full-text:

Bad news for CCOs (‘Coronavirus Climate Optimists’): changes in weather (i.e., increase of temperature and humidity as spring and summer months arrive in the Northern Hemisphere) may not necessarily lead to declines in case counts without the implementation of drastic public health interventions. Only absolute humidity might play a role.



Oltermann P. Berlin gives middle finger to anti-maskers in tourism agency ad. The Guardian 2020, published 14 October. Full-text:

An ad placed in local papers by the German capital’s senate as part of a public information campaign shows an elderly woman presenting her outstretched middle finger to the camera, next to the words: “A finger-wag for all those without a mask: we stick to corona rules.” John F. Kennedy would add: “Ich bin ein Berliner.

“A finger wag for all those without a mask. We respect the corona rules.” Picture: Berlin Senate.



Gordon DE, Hiatt J, Bouhaddou M, et al. (Total: 200 authors) Comparative host-coronavirus protein interaction networks reveal pan-viral disease mechanisms. Science 2020, published 15 October. Full-text:

Nevan Krogan, David Gordon and colleagues – a group of 200 researchers –uncovered molecular processes used by coronaviruses MERS, SARS-CoV1 and SARS-CoV2 to manipulate host cells. The researchers from six countries found 73 human proteins with which components of all three types of the virus enter into bonds and thus influence the survival of infected cells in culture. Host factors that functionally impinge on coronavirus proliferation include Tom70, a mitochondrial chaperone protein that interacts with both SARS-CoV-1 and SARS-CoV-2 Orf9b. The consortium also discovered cell surface molecules that are influenced by all three coronaviruses and that bind to already approved drugs, for example an antipsychotic and an anti-inflammatory drug.

Nevan Krogan


Prevention (2)

Yesterday evening, the French President Emmanuel Macron ordered a curfew for 20 million people for at least four weeks. At 9 p.m., everybody at home. This move was inspired by the results of a paper by Andronico A, Kiem CT, Paireaux J, et al. (Evaluating the impact of curfews and other measures on SARS-CoV-2 transmission in French Guiana. medRxiv 2020, posted 12 October. Full-text: However, nobody knows if curfews can be successfully adapted to other areas than French Guaiana. French Guaiana is a young territory with a median age is 25 years and the risk of hospitalisation following infection was only 30% that of France. About 20% of the population had been infected with SARS-CoV-2 by July 2020 (Andronico 2020). Expect more countries to adopt curfews over the coming weeks and be prepared for curfews lasting considerably longer than one month. If you read French, read one or more of the following articles.


Marot L. En Guyane, un couvre-feu évolutif efficace contre la première vague de l’épidémie de Covid-19. Le Monde 2020, published 15 October. Full-text:

Instauré après le confinement, le couvre-feu a été renforcé avec l’augmentation du nombre de cas, puis allégé, évitant une asphyxie totale de l’économie locale.


Covid-19 en France : forte hausse du nombre de cas déclarés et des admissions en réanimation. Le Monde 2020, published 15 October. Full-text :

Les nouvelles admissions dans les services de réanimation des hôpitaux marquent une nette hausse depuis plusieurs jours : 171 patients lundi, 226 mardi, 193 mercredi et 219 jeudi, selon Santé publique France.


Couvre-feu, fêtes privées, télétravail… Ce qu’il faut retenir de l’intervention de Jean Castex et des ministres. Le Monde 2020, published 15 October. Full-text:

« A 21 heures, chacun devra être chez soi. (…) Sauf exception, tous les commerces, services et lieux recevant du public seront fermés », a notamment annoncé le premier ministre.


Durand AA, Parienté J, Audureau W, Aubert R. Covid-19: peut-on prendre le train ? Faut-il une attestation ? 24 questions sur le couvre-feu et l’état d’urgence sanitaire. Le Monde 2020, published 15 October. Full-text:

Le gouvernement a précisé, jeudi, les modalités pratiques des mesures exceptionnelles annoncées mercredi soir par le président Emmanuel Macron.


Szadkowski M, Leloup D. Couvre-feu, privations de liberté, surveillance de masse… Ce que George Orwell n’avait pas prévu. Le Monde 2020, published 15 October. Full-text:

Après les dernières annonces d’Emmanuel Macron sur le couvre-feu, plusieurs personnalités politiques ont à nouveau convoqué le roman « 1984 » de l’écrivain britannique. Parfois avec erreur.



Rubin EJ, Baden LR, Morrissey S. Vaccinology and Covid-19. Audio interview (32:26). N Engl J Med 2020; 383: e109. Access: 10.1056/NEJMe2031646

The editors discuss discuss the fundamental concepts behind candidate vaccines against SARS-CoV-2 and the status of ongoing clinical trials.



14 October

The Top 10 >>>

  • Curfew in France
  • SARS-CoV-2 immunity: review and applications to phase 3 vaccine candidates
  • How anti-ageing drugs could boost COVID vaccines in older people

and more >>>

13 October

The Top 10 >>>

  • Evaluating the impact of curfews and other measures on SARS-CoV-2 transmission in French Guiana
  • The effect of temperature on persistence of SARS-CoV-2 on common surfaces
  • Absence of SARS-CoV-2 neutralizing activity in pre-pandemic sera from individuals with recent seasonal coronavirus infection

and more >>>

12 October

The Top 10 >>>

The 5th COVID Reference Edition will be published this month. These are 10 among the important papers we will include in the Epidemiology chapter.

and more >>>

11 October

The Top 10 >>>

  • Vascular Disease and Thrombosis in SARS-CoV-2 Infected Rhesus Macaques
  • Convalescent plasma for patients with severe COVID-19: a matched cohort study
  • Rapid, sensitive and specific SARS coronavirus-2 detection: a multi-center comparison between standard qRT-PCR and CRISPR based DETECTR

and more >>>

10 October

The Top 10 >>>

  • Remdesivir for the Treatment of Covid-19 – Final Report.
  • REGN-COV2 antibodies prevent and treat SARS-CoV-2 infection in rhesus macaques and hamsters.
  • Imperfect storm: is interleukin-33 the Achilles heel of COVID-19?

and more >>>

9 October

The Top 10 >>>

  • SARS-CoV-2 exposure, symptoms and seroprevalence in healthcare workers in Sweden
  • Recent endemic coronavirus infection is associated with less severe COVID-19.
  • Metallodrug ranitidine bismuth citrate suppresses SARS-CoV-2 replication and relieves virus-associated pneumonia in Syrian hamsters

and more >>>

8 October

The Top 10 >>>

  • Dying in a Leadership Vacuum
  • Face masks: what the data say
  • Cross-reactive memory T cells and herd immunity to SARS-CoV-2

and more >>>

7 October

The Top 10 >>>

  • Airborne transmission of SARS-CoV-2
  • A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
  • A quantitative evaluation of aerosol generation during tracheal intubation and extubation.

and more >>>

6 October

The Top 10 >>>

  • Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy
  • Adolescent with COVID-19 as the Source of an Outbreak at a 3-Week Family Gathering
  • Imbalance of regulatory and cytotoxic SARS-CoV-2-reactive CD4+ T cells in COVID-19

and more >>>

5 October

The Top 10 >>>

Trump is still receiving remdesivir, famotidine and dexamethasone. All relevant data on these compounds can be found in our COVID Reference book (for dexa, which was added on Saturday to his therapy, see also the WHO statement below). However, the most interesting treatment he has received is 8 g IV of REGN-CoV-2, a pair of two new monoclonal antibodies, named REGN10987 and REGN10933. Here we summarize the data published to date, based on key publications.

more >>>

4 October

Top 10 Long Covid Special >>>

The profound physical impairments associated with critical COVID-19 illness are well known. Many patients with severe COVID-19, especially older patients and those with ARDS, will suffer long-term complications from an intensive care unit stay and from the effects of the virus on multiple body systems such has the lung, heart, blood vessels and the CNS.  more >>>

3 October

The Top 10 >>>

  • ACTIVating Resources for the COVID-19 Pandemic: In vivo Models for Vaccines and Therapeutics
  • Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection
  • Kidney function indicators predict adverse outcomes of COVID-19

and more >>>

2 October

The Top 10 >>>

  • Superantigenic character of an insert unique to SARS-CoV-2 spike supported by skewed TCR repertoire in patients with hyperinflammation
  • The major genetic risk factor for severe COVID-19 is inherited from Neanderthals
  • In-flight Transmission of SARS-CoV-2: a review of the attack rates and available data on the efficacy of face masks

and more >>>

1 October

The Top 10 >>>

  • Rethinking Covid-19 Test Sensitivity — A Strategy for Containment
  • Dangerous to claim “no clear association” between intergenerational relationships and COVID-19
  • Association of a Prior Psychiatric Diagnosis With Mortality Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Infection

and more >>>

If you understand French, listen to Duval K. Nouvelle religion : le covidisme. YouTube 2020, published 29 September. Video (4:44):