move SARS/MERS containment to pharma

content/09.evolution.md

@@ -31,29 +31,6 @@ CoV-HKU1 was identified in samples collected from a 71-year-old pneumonia patien
 These viruses are associated with respiratory diseases of varying severity, ranging from common cold to severe pneumonia, with severe symptoms mostly observed in immunocompromised individuals [@doi:10.1086/377612].
 In addition to these relatively mild HCoV, however, highly pathogenic human coronaviruses have been identified, including _Severe acute respiratory syndrome-related coronavirus_ (SARS-CoV or SARS-CoV-1) and _Middle East respiratory syndrome-related coronavirus_ (MERS-CoV) [@doi:10.1038/nrmicro.2016.81; @doi:10.1038/s41579-018-0118-9; @doi:10.1016/bs.aivir.2018.01.001].
 
-At the time that SARS-CoV-1 emerged in the early 2000s, no HCoV had been identified in almost 40 years [@doi:10.1038/nrmicro.2016.81].
-The first case of SARS was reported in November 2002 in the Guangdong Province of China, and over the following month, the disease spread more widely within China and then into several countries across multiple continents [@doi:10.1093/ajcp/aqaa029; @doi:10.1038/nrmicro.2016.81].
-Unlike previously identified HCoV, SARS was much more severe, with an estimated death rate of 9.5% [@doi:10.1093/ajcp/aqaa029].
-It was also highly contagious via droplet transmission, with a basic reproduction number (R~0~) of 4 (i.e., each person infected was estimated to infect four other people) [@doi:10.1093/ajcp/aqaa029].
-However, the identity of the virus behind the infection remained unknown until April of 2003, when the SARS-CoV-1 virus was identified through a worldwide scientific effort spearheaded by the WHO [@doi:10.1038/nrmicro.2016.81].
-SARS-CoV-1 belonged to a distinct lineage from the two other HCoV known at the time [@doi:10.1093/ajcp/aqaa029].
-By July 2003, the SARS outbreak was officially determined to be under control, with the success credited to infection management practices [@doi:10.1038/nrmicro.2016.81].
-A decade later, a second outbreak of severe respiratory illness associated with a coronavirus emerged, this time in the Arabian Peninsula.
-This disease, known as Middle East respiratory syndrome (MERS), was linked to another novel coronavirus, MERS-CoV.
-The fatality rate associated with MERS is much higher than that of SARS, at almost 35%, but the disease is much less easily transmitted, with an R~0~ of 1 [@doi:10.1093/ajcp/aqaa029].
-Although MERS is still circulating, its low reproduction number has allowed for its spread to be contained [@doi:10.1093/ajcp/aqaa029].
-The COVID-19 pandemic is thus associated with the seventh HCoV to be identified and the fifth since the turn of the millennium, though additional HCoVs may be in circulation but remain undetected.
-
-SARS-CoV-1 and MERS-CoV were ultimately managed largely through infection management practices (e.g., mask wearing) and properties of the virus itself (i.e., low rate of transmission), respectively [@doi:10.1038/nrmicro.2016.81; @doi:10.1093/ajcp/aqaa029].
-Vaccines were not used to control either virus, although vaccine development programs were established for SARS-CoV-1 [@doi:10.3390/v11010059].
-In general, care for SARS and MERS patients focuses on supportive care and symptom management [@doi:10.1093/ajcp/aqaa029].
-Clinical treatments for SARS and MERS developed during the outbreaks generally do not have strong evidence supporting their use.
-Common treatments included Ribavirin, an antiviral, often in combination with corticosteroids or sometimes interferon (IFN) medications, which would both be expected to have immunomodulatory effects [@doi:10.1038/nrmicro.2016.81].
-However, retrospective and _in vitro_ analyses have reported inconclusive results of these treatments on SARS and the SARS-CoV-1 virus, respectively [@doi:10.1038/nrmicro.2016.81].
-IFNs and Ribavirin have shown promise in _in vitro_ analyses of MERS, but their clinical effectiveness remains unknown [@doi:10.1038/nrmicro.2016.81].
-Therefore, only limited strategy for the pharmaceutical management of COVID-19 can be adopted from previous severe HCoV infections.
-Research in response to prior outbreaks of HCoV-borne infections, such as SARS and MERS, have, however, provided a strong foundation for hypotheses about the pathogenesis of SARS-CoV-2 as well as potential diagnostic and therapeutic approaches.
-
 ### Conclusions
 
 As of October 2020 the SARS-CoV-2 virus remains a serious worldwide threat.

content/20.pharmaceuticals.md

@@ -36,6 +36,29 @@ These differences are present when comparing both between institutions in simila
 For example, even within New York City, one study [@doi:10.1001/jama.2020.6775] identified low oxygen saturation (<90% without the use of supplemental oxygen or ventilation support) in a significant percentage of patients upon presentation, while another study [@doi:10.1056/NEJMc2010419] reported cough, fever, and dyspnea as the most common presenting symptoms.
 The variability of both which symptoms present and their severity makes it difficult for public health agencies to provide clear recommendations for citizens regarding what symptoms indicate SARS-CoV-2 infection and should prompt isolation.
 
+At the time that SARS-CoV-1 emerged in the early 2000s, no HCoV had been identified in almost 40 years [@doi:10.1038/nrmicro.2016.81].
+The first case of SARS was reported in November 2002 in the Guangdong Province of China, and over the following month, the disease spread more widely within China and then into several countries across multiple continents [@doi:10.1093/ajcp/aqaa029; @doi:10.1038/nrmicro.2016.81].
+Unlike previously identified HCoV, SARS was much more severe, with an estimated death rate of 9.5% [@doi:10.1093/ajcp/aqaa029].
+It was also highly contagious via droplet transmission, with a basic reproduction number (R~0~) of 4 (i.e., each person infected was estimated to infect four other people) [@doi:10.1093/ajcp/aqaa029].
+However, the identity of the virus behind the infection remained unknown until April of 2003, when the SARS-CoV-1 virus was identified through a worldwide scientific effort spearheaded by the WHO [@doi:10.1038/nrmicro.2016.81].
+SARS-CoV-1 belonged to a distinct lineage from the two other HCoV known at the time [@doi:10.1093/ajcp/aqaa029].
+By July 2003, the SARS outbreak was officially determined to be under control, with the success credited to infection management practices [@doi:10.1038/nrmicro.2016.81].
+A decade later, a second outbreak of severe respiratory illness associated with a coronavirus emerged, this time in the Arabian Peninsula.
+This disease, known as Middle East respiratory syndrome (MERS), was linked to another novel coronavirus, MERS-CoV.
+The fatality rate associated with MERS is much higher than that of SARS, at almost 35%, but the disease is much less easily transmitted, with an R~0~ of 1 [@doi:10.1093/ajcp/aqaa029].
+Although MERS is still circulating, its low reproduction number has allowed for its spread to be contained [@doi:10.1093/ajcp/aqaa029].
+The COVID-19 pandemic is thus associated with the seventh HCoV to be identified and the fifth since the turn of the millennium, though additional HCoVs may be in circulation but remain undetected.
+
+SARS-CoV-1 and MERS-CoV were ultimately managed largely through infection management practices (e.g., mask wearing) and properties of the virus itself (i.e., low rate of transmission), respectively [@doi:10.1038/nrmicro.2016.81; @doi:10.1093/ajcp/aqaa029].
+Vaccines were not used to control either virus, although vaccine development programs were established for SARS-CoV-1 [@doi:10.3390/v11010059].
+In general, care for SARS and MERS patients focuses on supportive care and symptom management [@doi:10.1093/ajcp/aqaa029].
+Clinical treatments for SARS and MERS developed during the outbreaks generally do not have strong evidence supporting their use.
+Common treatments included Ribavirin, an antiviral, often in combination with corticosteroids or sometimes interferon (IFN) medications, which would both be expected to have immunomodulatory effects [@doi:10.1038/nrmicro.2016.81].
+However, retrospective and _in vitro_ analyses have reported inconclusive results of these treatments on SARS and the SARS-CoV-1 virus, respectively [@doi:10.1038/nrmicro.2016.81].
+IFNs and Ribavirin have shown promise in _in vitro_ analyses of MERS, but their clinical effectiveness remains unknown [@doi:10.1038/nrmicro.2016.81].
+Therefore, only limited strategy for the pharmaceutical management of COVID-19 can be adopted from previous severe HCoV infections.
+Research in response to prior outbreaks of HCoV-borne infections, such as SARS and MERS, have, however, provided a strong foundation for hypotheses about the pathogenesis of SARS-CoV-2 as well as potential diagnostic and therapeutic approaches.
+
 ### Small Molecule Drugs
 
 #### Small Molecule Drugs Targeting SARS-CoV-2