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COVID-19 Links To Studies on Coronavirus 2019

by NaturPro in Uncategorized Comments: 0

Updated March 18 10:18 am EST | Updated daily morning EST

NOTE: This page is for informational purposes only.   The information posted on this page has not been reviewed by independent experts, and may be incorrect or outdated. Please consult the WHO, CDC and your state and local authorities for recommendations and current information. We have not altered or changed any of the information from the sources. All information was copied and pasted directly from the cited web page.

Revisions: March 18: Added March 18 news and food safety section. March 17: Added Useful Links section, updated Johns Hopkins map. March 16: Added Johns Hopkins map @ 11:56 am EST, Wikipedia page on Coronavirus 2019 list of 143 references (Scroll to bottom)

Food Safety and Coronavirus

FDA Food Safety and Coronavirus Q&A

FDA halts food safety audits: “buy only enough food for the week ahead” (March 17)

FDA and FTC warn supplement marketers over coronavirus claims

March 18 News

U.S. Virus Plan Anticipates 18-Month Pandemic and Widespread Shortages (NY Times, March 17)

“Stealth transmission” a major driver of epidemic (LA Times, March 17)

ARS Technica comprehensive guide to coronavirus (Updated daily)

Harvard analysis of hospital bed requirements (March 17)

NIH – New coronavirus stable on surfaces for hours, similar to SARS (posted March 18)

Estimating the generation interval for COVID-19 based on symptom onset data

Nature Podcast: Coronavirus: science in the pandemic (March 17)

COVID-19 Open Research Dataset (CORD-19) announced (repository of 29,000 scientific articles)

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2) (Science, March 16)

NYT: Hundreds of scientists scramble to find a treatment (March 17)

Useful Links

added March 17

Virus Trackers

NOTE: The Johns Hopkins Map, NY Times Map and TrackCorona Maps appear to have the most updated U.S. coronavirus case information (March 17)

Johns Hopkins Coronavirus Map (United States)

COVID Tracking Project – U.S. State by State Data

New York Times Coronavirus Tracker

TrackCorona Live Map

CDC Cases in the U.S.

Info on U.S. Coronavirus

CDC Home Page

CDC Situation Summary

CDC Testing Tracker

White House Guidelines for Americans (posted March 16)

NY Times Coronavirus Updates Page

NY Governor Cuomo Interview (1-hour press conference, posted March 17)

WHO Home Page

CDC Transcript of briefing on March 10

Report on First 12 Patients in U.S. (posted March 12)

COVID-19: The Medium is the Message (The Lancet, March 11)

From Containment to Mitigation of COVID-19 in the U.S. (JAMA, March 13)

JAMA Coronavirus Page | NEJM Page | Nature Page | Elsevier Page

List of EPA-approved disinfectants for SARS-COV-2

List of Webinars and Podcasts, compiled by experts at the University of Minnesota Center for Infectious Disease Research and Policy

Development of a rapid, low-cost RT-PCR detection method for SARS-COV-2 (March 11)

What does the coronavirus mean for families? (JAMA Pediatrics, March 13)

JAMA Pediatrics, March 13, 2020

March 11: WHO characterizes COVID-19 as a pandemic

Speaking at the COVID-19 media briefing, the WHO Director-General said: 

“WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.

We have therefore made the assessment that COVID-19 can be characterized as a pandemic.

Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.

Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.

We have never before seen a pandemic sparked by a coronavirus. This is the first pandemic caused by a coronavirus.

And we have never before seen a pandemic that can be controlled, at the same time.”

COVID-19 Scientific Research Abstracts:

J. Hosp. Infect. 2020.

Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents

G. Kampfa,∗,Correspondence information about the author G. Kampf, D. Todtb, S. Pfaenderb E. Steinmannb DOI:

  • Persistence of coronavirus on inanimate surfaces  
  • Inactivation of coronaviruses by biocidal agents in suspension tests  
  • Inactivation of coronaviruses by biocidal agents in carrier tests


Currently, the emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available information about the persistence of human and veterinary coronaviruses on inanimate surfaces as well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05–0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.

Review, Published: 04 March 2020
Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)

Journal of General Internal Medicine (2020)Cite this article


In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. Previous studies have reported epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19). The purpose of this brief review is to summarize those published studies as of late February 2020 on the clinical features, symptoms, complications, and treatments of COVID-19 and help provide guidance for frontline medical staff in the clinical management of this outbreak.


In December 31, 2019, hospitals reported a cluster of cases with pneumonia of unknown cause in Wuhan, Hubei, China, attracting great attention nationally and worldwide.1 On January 1, 2020, Wuhan public health authorities shut down the Huanan Seafood Wholesale Market, where wild and live animals were sold, due to a suspected link with the outbreak. On January 7, 2020, researchers rapidly isolated a novel coronavirus (SARS-CoV-2, also referred to as 2019-nCoV) from confirmed infected pneumonia patients. Real-time reverse transcription polymerase chain reaction (RT-PCR) and next-generation sequencing were used to characterize it.2 On January 23, 2020, owing to the large flow of people during the Chinese Spring Festival, public transport was suspended in Wuhan and, eventually, in all the cities in Hubei Province to reduce the risk of further transmission.

The number of RT-PCR–confirmed cases has increased rapidly. On January 30, 2020, the World Health Organization (WHO) declared COVID-19 (as it would be officially known as of February 11) to be a Public Health Emergency of International Concern (PHEIC) and declared an epidemic. As of February 24, 2020, 80,239 cases were confirmed worldwide causing 2700 deaths. Mainland China, and especially Hubei Province, has borne the brunt of the epidemic, reporting 77,780 cases. Outside of mainland China, 33 countries have reported 2549 confirmed infections and 34 fatalities.3

We reviewed the published clinical features, symptoms, complications, and treatments of patients with COVID-19 to help health workers around the world combat the current outbreak.

We searched PubMed for all published articles regarding COVID-19 up to February 19, 2020. Keywords used were “COVID-19,” “2019 novel coronavirus,” “SARS-CoV-2,” “2019-nCoV,” “Wuhan coronavirus,” and “Wuhan seafood market pneumonia virus.” After careful screening, six published articles with confirmed cases were identified and included in this review. The summary of included clinical studies is shown in Table 1.

Huang et al.4 first reported clinical features of 41 patients confirmed to be infected with COVID-19 on January 2, 2020, which include 13 ICU cases and 28 non-ICU cases. More than half of the cases (66%) had been exposed to the Huanan Seafood Wholesale Market. Almost all the patients had bilateral lung ground glass opacity on computed tomography imaging. The initial symptoms included fever (98%), cough (76%), dyspnea (55%), myalgia or fatigue (44%), sputum production (28%), headache (8%), hemoptysis (5%), and diarrhea (3%). Only one patient did not present fever in the early stage of disease. Twelve (29%) cases progressed to acute respiratory distress syndrome (ARDS), 5 (12%) had acute cardiac injury, 3 (7%) had acute kidney injury (AKI), and 3 (7%) had shock. At the data cutoff date, 28 (68%) patients were discharged and 6 (15%) had died.

On January 20, 2020, Chen et al.5 reported 99 cases with SARS-CoV-2–infected pneumonia. This case series revealed that older males with comorbidities as a result of weaker immune function were the most susceptible to COVID-19 incidence. The symptoms, complications, and treatments in this study were similar to the previous published study by Huang and colleagues.4 At the data cutoff date, 31 (31%) were discharged and 11 (11%) died, and 57 (58%) of the patients were still hospitalized. A study of Li et al.6 reported on 425 COVID-19 cases in Wuhan confirmed between January 1 and 22, 2020. The mean incubation period was 5.2 days, with the 95th percentile of the distribution at 12.5 days, though uncertainty remains.

Two subsequent studies confirmed the pattern of signs and symptoms.78 At the time of this writing, the most recent published case series9 of 138 confirmed cases included 36 requiring intensive care by the data cutoff date of February 3, 2020. It also found the common presenting symptoms of fever (136, 99%), fatigue (96, 70%), and dry cough (82, 59%), though there were two patients who did not present any signs of fever at the onset of illness. A higher proportion of cases presented with gastrointestinal symptoms including diarrhea and nausea (14, 10%) than in previous series. Forty-seven (34%) were discharged while 6 (4%) died, while the remainder were still hospitalized. The organ failure complications were similar to the original studies.

Taken together, these studies indicate the main clinical manifestations of COVID-19 are fever (90% or more), cough (around 75%), and dyspnea (up to 50%). A small but significant subset has gastrointestinal symptoms. Preliminary estimates of case fatality, likely to fall as better early diagnostic efforts come into play, is about 2%, mostly due to ARDS, AKI, and myocardial injury.


Coronaviruses are widespread in humans and several other vertebrates and cause respiratory, enteric, hepatic, and neurologic diseases. Notably, the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 have caused human epidemics. Comparison with the current virus shows several significant differences and similarities. Both MERS-CoV and SARS-CoV have much higher case fatality rates (40% and 10%, respectively). Though the current SARS-CoV-2 shares 79% of its genome with SARS-CoV, it appears to be much more transmissible.10

Both SARS-CoVs enter the cell via the angiotensin-converting enzyme 2 (ACE2) receptor.1112The SARS-Cov-2 first predominantly infects lower airways and binds to ACE2 on alveolar epithelial cells. Both viruses are potent inducers of inflammatory cytokines. The “cytokine storm” or “cytokine cascade” is the postulated mechanism for organ damage. The virus activates immune cells and induces the secretion of inflammatory cytokines and chemokines into pulmonary vascular endothelial cells.


Several efforts to develop vaccines are underway, but the WHO estimates it will take 18 months for the COVID-19 vaccines to be available.21 At present, most treatment is symptomatic and supportive, though anti-inflammatory and antiviral treatments have been employed. Supportive treatment for complicated patients has included continuous renal replacement therapy (CRRT), invasive mechanical ventilation, and even extracorporeal membrane oxygenation (ECMO). No specific antiviral drugs have been confirmed effective. The first reported patient with 2019-nCoV infection in the USA was treated with remdesivir,13and others have used antiretrovirals like ritonavir, with trials of both in progress.22 A recent study conducted by the “front-line” health care providers combating COVID-19 in Wuhan indicated that systemic corticosteroid treatment did not show significant benefit.23 Baricitinib has been suggested as a potential drug for the treatment in the hope that it might reduce the process of both virus invasion and inflammation.24


Despite some diversity in initial symptoms, most COVID-19 patients have fever and respiratory symptoms. For now, travel history to epidemic areas is important to the diagnosis and should be obtained on all patients with flu-like syndromes. If positive, timely referral to the public health authorities for testing is crucial. Frontline medical staff are at risk and should employ protective measures. Treatment is mainly supportive and symptomatic, though trials of vaccines and antivirals are underway. Healthcare providers should follow subsequent reports as the situation will likely change rapidly.

Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 17;41(2):145-151. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003. [Epub ahead of print]

[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China].

[Article in Chinese; Abstract available in Chinese from the publisher]

Novel Coronavirus Pneumonia Emergency Response Epidemiology Team1.

in EnglishChinese

Objective: An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020. Methods: All COVID-19 cases reported through February 11, 2020 were extracted from China’s Infectious Disease Information System. Analyses included: 1) summary of patient characteristics; 2) examination of age distributions and sex ratios; 3) calculation of case fatality and mortality rates; 4) geo-temporal analysis of viral spread; 5) epidemiological curve construction; and 6) subgroup analysis. Results: A total of 72 314 patient records-44 672 (61.8%) confirmed cases, 16 186 (22.4%) suspected cases, 10567 (14.6%) clinical diagnosed cases (Hubei only), and 889 asymptomatic cases (1.2%)-contributed data for the analysis. Among confirmed cases, most were aged 30-79 years (86.6%), diagnosed in Hubei (74.7%), and considered mild (80.9%). A total of 1 023 deaths occurred among confirmed cases for an overall case-fatality rate of 2.3%. The COVID-19 spread outward from Hubei sometime after December 2019 and by February 11, 2020, 1 386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked in January 23-26, then began to decline leading up to February 11. A total of 1 716 health workers have become infected and 5 have died (0.3%). Conclusions: The COVID-19 epidemic has spread very quickly. It only took 30 days to expand from Hubei to the rest of Mainland China. With many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.

Coronavirus Clinical China COVID-19 SARS-COV-2
Coronavirus Clinical studies from China Dec-Feb 2020, COVID-19 SARS-COV-2

Coronavirus Disease 2019 (COVID-19): A Perspective from China

Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China (Z.Y.Z., M.D.J., P.P.X., Q.Q.N., G.M.L., L.J.Z); Department of Medical Imaging, Taihe Hospital, Shiyan, Hubei, 442000, China (W.C).

Published Online: Feb 21 2020

In December 2019, an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection occurred in Wuhan, Hubei Province, China and spread across China and beyond. On February 12, 2020, WHO officially named the disease caused by the novel coronavirus as Coronavirus Disease 2019 (COVID-19). Since most COVID-19 infected patients were diagnosed with pneumonia and characteristic CT imaging patterns, radiological examinations have become vital in early diagnosis and assessment of disease course. To date, CT findings have been recommended as major evidence for clinical diagnosis of COVID-19 in Hubei, China. This review focuses on the etiology, epidemiology, and clinical symptoms of COVID-19, while highlighting the role of chest CT in prevention and disease control.

Covid-19 — Navigating the Uncharted

Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.

February 28, 2020
DOI: 10.1056/NEJMe2002387

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…

….China, the United States, and several other countries have instituted temporary restrictions on travel with an eye toward slowing the spread of this new disease within China and throughout the rest of the world. The United States has seen a dramatic reduction in the number of travelers from China, especially from Hubei province. At least on a temporary basis, such restrictions may have helped slow the spread of the virus: whereas 78,191 laboratory-confirmed cases had been identified in China as of February 26, 2020, a total of 2918 cases had been confirmed in 37 other countries or territories.4 As of February 26, 2020, there had been 14 cases detected in the United States involving travel to China or close contacts with travelers, 3 cases among U.S. citizens repatriated from China, and 42 cases among U.S. passengers repatriated from a cruise ship where the infection had spread.8 However, given the efficiency of transmission as indicated in the current report, we should be prepared for Covid-19 to gain a foothold throughout the world, including in the United States. Community spread in the United States could require a shift from containment to mitigation strategies such as social distancing in order to reduce transmission. Such strategies could include isolating ill persons (including voluntary isolation at home), school closures, and telecommuting where possible.9

A robust research effort is currently under way to develop a vaccine against Covid-19.10 We anticipate that the first candidates will enter phase 1 trials by early spring. Therapy currently consists of supportive care while a variety of investigational approaches are being explored.11 Among these are the antiviral medication lopinavir–ritonavir, interferon-1β, the RNA polymerase inhibitor remdesivir, chloroquine, and a variety of traditional Chinese medicine products.11 Once available, intravenous hyperimmune globulin from recovered persons and monoclonal antibodies may be attractive candidates to study in early intervention. Critical to moving the field forward, even in the context of an outbreak, is ensuring that investigational products are evaluated in scientifically and ethically sound studies.12

Every outbreak provides an opportunity to gain important information, some of which is associated with a limited window of opportunity. For example, Li et al. report a mean interval of 9.1 to 12.5 days between the onset of illness and hospitalization. This finding of a delay in the progression to serious disease may be telling us something important about the pathogenesis of this new virus and may provide a unique window of opportunity for intervention. Achieving a better understanding of the pathogenesis of this disease will be invaluable in navigating our responses in this uncharted arena. Furthermore, genomic studies could delineate host factors that predispose persons to acquisition of infection and disease progression.

The Covid-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging infectious pathogens and the need for constant surveillance, prompt diagnosis, and robust research to understand the basic biology of new organisms and our susceptibilities to them, as well as to develop effective countermeasures.


The role of absolute humidity on transmission rates of the COVID-19 outbreak

Wei Luo, Maimuna S Majumder, Dianbo Liu, Canelle Poirier, Kenneth D Mandl,  Marc Lipsitch,  Mauricio Santillana


This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.


A novel coronavirus (COVID-19) was identified in Wuhan, Hubei Province, China, in December 2019 and has caused over 40,000 cases worldwide to date. Previous studies have supported an epidemiological hypothesis that cold and dry (low absolute humidity) environments facilitate the survival and spread of droplet-mediated viral diseases, and warm and humid (high absolute humidity) environments see attenuated viral transmission (i.e., influenza). However, the role of absolute humidity in transmission of COVID-19 has not yet been established. Here, we examine province-level variability of the basic reproductive numbers of COVID-19 across China and find that changes in weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in COVID-19 case counts without the implementation of extensive public health interventions.



The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak


Motivated by the rapid spread of COVID-19 in Mainland China, we use a global metapopulation disease transmission model to project the impact of travel limitations on the national and international spread of the epidemic. The model is calibrated based on internationally reported cases, and shows that at the start of the travel ban from Wuhan on 23 January 2020, most Chinese cities had already received many infected travelers. The travel quarantine of Wuhan delayed the overall epidemic progression by only 3 to 5 days in Mainland China, but has a more marked effect at the international scale, where case importations were reduced by nearly 80% until mid February. Modeling results also indicate that sustained 90% travel restrictions to and from Mainland China only modestly affect the epidemic trajectory unless combined with a 50% or higher reduction of transmission in the community.

Defining the Epidemiology of Covid-19 — Studies Needed

Marc Lipsitch, D.Phil., David L. Swerdlow, M.D., and Lyn Finelli, Dr.P.H.

February 19, 2020
DOI: 10.1056/NEJMp2002125


Types of Evidence Needed for Controlling an Epidemic.

several questions are especially critical. First, what is the full spectrum of disease severity (which can range from asymptomatic, to symptomatic-but-mild, to severe, to requiring hospitalization, to fatal)?

Second, how transmissible is the virus?

Third, who are the infectors — how do the infected person’s age, the severity of illness, and other characteristics of a case affect the risk of transmitting the infection to others? Of vital interest is the role that asymptomatic or presymptomatic infected persons play in transmission. When and for how long is the virus present in respiratory secretions?

And fourth, what are the risk factors for severe illness or death? And how can we identify groups most likely to have poor outcomes so that we can focus prevention and treatment efforts?

The table lists approaches to answering these questions, each of which has shown success in prior disease outbreaks, especially MERS and pandemic H1N1 influenza.1

Counting the number of cases, including mild cases, is necessary to calibrate the epidemic response. Conventional wisdom dictates that the sickest people seek care and undergo testing; early in an epidemic, case fatality and hospitalization ratios are often used to assess impact. These measures should be interpreted with caution, since it may take time for cases to become severe, or for infected persons to die, and it may not be possible to accurately estimate the denominator of infected people in order to calculate those ratios.2 As in past epidemics, the first cases of Covid-19 to be observed in China were severe enough to come to medical attention and result in testing, but the total number of people infected has been elusive. The estimated case fatality ratio among medically attended patients thus far is approximately 2%, but the true ratio may not be known for some time.2

Simple counts of the number of confirmed cases can be misleading indicators of the epidemic’s trajectory if these counts are limited by problems in access to care or bottlenecks in laboratory testing, or if only patients with severe cases are tested. During the 2009 influenza pandemic, an approach was described for maintaining surveillance when cases become too numerous to count. This approach, which can be adapted to Covid-19, involves using existing surveillance systems or designing surveys to ascertain each week the number of persons with a highly sensitive but nonspecific syndrome (for example, acute respiratory infection) and testing a subset of these persons for the novel coronavirus. The product of the incidence of acute respiratory infection (for example) and the percent testing positive provides an estimate of the burden of cases in a given jurisdiction.3 Now is the time to put in place the infrastructure to accomplish such surveillance. Electronic laboratory reporting will dramatically improve the efficiency of this and other public health studies involving viral testing……

Bull World Health Organ. 2020 Mar 1; 98(3): 150. 

Published online 2020 Mar 1. doi: 10.2471/BLT.20.251561

PMCID: PMC7047033

PMID: 32132744

Data sharing for novel coronavirus (COVID-19)

corresponding author

Vasee Moorthy,a Ana Maria Henao Restrepo,b Marie-Pierre Preziosi,c and  Soumya Swaminathana

Author information Copyright and License information Disclaimer

corresponding author

Corresponding author.

Correspondence to Vasee Moorthy (email: tni.ohw@vyhtroom).

Rapid data sharing is the basis for public health action. The report from the 30 January 2020 International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (COVID-19) stressed the importance of the continued sharing of full data with the World Health Organization (WHO). The information disseminated through peer-reviewed journals and accompanying online data sets is vital for decision-makers.13 For example, the release of full viral genome sequences through a public access platform and the polymerase chain reaction assay protocols that were developed as a result made it possible to accurately diagnose infections early in the current emergency.

Deficiencies in data-sharing mechanisms – highlighted during the 2013–2016 Ebola virus disease outbreak in west Africa – brought the question of data access to the forefront of the global health agenda.2 In September 2015, agreement was reached on the need for open sharing of data and results, especially in public health emergencies.2 Subsequently, the International Committee of Medical Journal Editors confirmed that pre-publication dissemination of information critical to public health will not prejudice journal publication in the context of health emergencies declared by WHO.4Furthermore the committee stated that information critical for public health is to be shared with WHO before publication5 – a commitment echoed by several leading journals in the context of the COVID-19 response.

Efforts for expedited data and results reporting should not be limited to clinical trials, but should include observational studies, operational research, routine surveillance and information on the virus and its genetic sequences, as well as the monitoring of disease control programmes.

To improve timely access to data in the context of the COVID-19 emergency the Bulletin of the World Health Organization will implement an “COVID-19 Open” data sharing and reporting protocol, which will apply during the current COVID-19 emergency.

On submission to the Bulletin, all research manuscripts relevant to the coronavirus emergency will be assigned a digital object identifier and posted online in the “COVID-19 Open” collection within 24 hours while undergoing peer review. The data in these papers will thus be attributed to the authors while being freely available for unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited as indicated by the Creative Commons Attribution 3.0 Intergovernmental Organizations license (CC BY IGO 3.0). Should a paper be accepted by the Bulletin following peer review, this open access review period will be reported in the final publication. If a paper does not meet the journal’s requirements after peer review, authors will be free to seek publication elsewhere. If the authors of any paper posted with the Bulletin in this context are unable to obtain acceptance with a suitable journal, WHO undertakes to publish these papers in its institutional repository as citable working papers, independently of the Bulletin. The choice of a pre-print platform remains the sole discretion of the author. This early access to research manuscripts at WHO builds on examples of other rapid information access platforms such as PROMED and F1000Research.5,6

Given the many unanswered questions on the reservoir, transmission, consequences and manifestations of COVID-19 infection and associated disease, our goal is to encourage all researchers to share their data as quickly and widely as possible. With this protocol for immediate online posting, we are providing another means to achieve immediate global access to relevant data. By submitting their studies to “COVID-19 Open,” researchers can share their data while meeting their need to retain authorship, document precedence and facilitate international scientific cooperation in the response to this emergency.

J Hosp Infect. 2006 Feb;62(2):195-9. Epub 2005 Sep 8.

Using an integrated infection control strategy during outbreak control to minimize nosocomial infection of severe acute respiratory syndrome among healthcare workers.

Yen MY1Lin YESu IJHuang FYHuang FYHo MSChang SCTan KHChen KTChang HLiu YCLoh CHWang LSLee CH.

Healthcare workers (HCWs) are at risk of acquiring severe acute respiratory syndrome (SARS) while caring for SARS patients. Personal protective equipment and negative pressure isolation rooms (NPIRs) have not been completely successful in protecting HCWs. We introduced an innovative, integrated infection control strategy involving triaging patients using barriers, zones of risk, and extensive installation of alcohol dispensers for glove-on hand rubbing. This integrated infection control approach was implemented at a SARS designated hospital (‘study hospital’) where NPIRs were not available. The number of HCWs who contracted SARS in the study hospital was compared with the number of HCWs who contracted SARS in 86 Taiwan hospitals that did not use the integrated infection control strategy. Two HCWs contracted SARS in the study hospital (0.03 cases/bed) compared with 93 HCWs in the other hospitals (0.13 cases/bed) during the same three-week period. Our strategy appeared to be effective in reducing the incidence of HCWs contracting SARS. The advantages included rapid implementation without NPIRs, flexibility to transfer patients, and re-inforcement for HCWs to comply with infection control procedures, especially handwashing. The efficacy and low cost are major advantages, especially in countries with large populations at risk and fewer economic resources.



Am J Infect Control. 2011 Jun;39(5):401-407. doi: 10.1016/j.ajic.2010.08.011. Epub 2011 Jan 22.

Inactivation of surrogate coronaviruses on hard surfaces by health care germicides.

Hulkower RL1Casanova LM2Rutala WA3Weber DJ3Sobsey MD4.

Author information



In the 2003 severe acute respiratory syndrome outbreak, finding viral nucleic acids on hospital surfaces suggested surfaces could play a role in spread in health care environments. Surface disinfection may interrupt transmission, but few data exist on the effectiveness of health care germicides against coronaviruses on surfaces.


The efficacy of health care germicides against 2 surrogate coronaviruses, mouse hepatitis virus (MHV) and transmissible gastroenteritis virus (TGEV), was tested using the quantitative carrier method on stainless steel surfaces. Germicides were o-phenylphenol/p-tertiary amylphenol) (a phenolic), 70% ethanol, 1:100 sodium hypochlorite, ortho-phthalaldehyde (OPA), instant hand sanitizer (62% ethanol), and hand sanitizing spray (71% ethanol).


After 1-minute contact time, for TGEV, there was a log(10) reduction factor of 3.2 for 70% ethanol, 2.0 for phenolic, 2.3 for OPA, 0.35 for 1:100 hypochlorite, 4.0 for 62% ethanol, and 3.5 for 71% ethanol. For MHV, log(10) reduction factors were 3.9 for 70% ethanol, 1.3 for phenolic, 1.7 for OPA, 0.62 for 1:100 hypochlorite, 2.7 for 62% ethanol, and 2.0 for 71% ethanol.


Only ethanol reduced infectivity of the 2 coronaviruses by >3-log(10) after 1 minute. Germicides must be chosen carefully to ensure they are effective against viruses such as severe acute respiratory syndrome coronavirus.

J Occup Environ Hyg. 2020 Jan;17(1):30-37. doi: 10.1080/15459624.2019.1691219. Epub 2019 Dec 19.

Assessing virus infection probability in an office setting using stochastic simulation.

Contreras RD1Wilson AM1Garavito F1Sexton JD1Reynolds KA1Canales RA2.

Author information


Viral infections are an occupational health concern for office workers and employers. The objectives of this study were to estimate rotavirus, rhinovirus, and influenza A virus infection risks in an office setting and quantify infection risk reductions for two hygiene interventions. In the first intervention, research staff used an ethanol-based spray disinfectant to clean high-touch non-porous surfaces in a shared office space. The second intervention included surface disinfection and also provided workers with alcohol-based hand sanitizer gel and hand sanitizing wipes to promote hand hygiene. Expected changes in surface concentrations due to these interventions were calculated. Human exposure and dose were simulated using a validated, steady-state model incorporated into a Monte Carlo framework. Stochastic inputs representing human behavior, pathogen transfer efficiency, and pathogen fate were utilized, in addition to a mixed distribution that accounted for surface concentrations above and below a limit of detection. Dose-response curves were then used to estimate infection risk. Estimates of percent risk reduction using mean values from baseline and surface disinfection simulations for rotavirus, rhinovirus, and influenza A infection risk were 14.5%, 16.1%, and 32.9%, respectively. For interventions with both surface disinfection and the promotion of personal hand hygiene, reductions based on mean values of infection risk were 58.9%, 60.8%, and 87.8%, respectively. This study demonstrated that surface disinfection and the use of personal hand hygiene products can help decrease virus infection risk in communal offices. Additionally, a variance-based sensitivity analysis revealed a greater relative importance of surface concentrations, assumptions of relevant exposure routes, and inputs representing human behavior in estimating risk reductions.


Communal workspaces; exposure science; hygiene intervention; micro-activity; risk analysis; workplace wellness

J Hosp Infect. 2016 Mar;92(3):235-50. doi: 10.1016/j.jhin.2015.08.027. Epub 2015 Oct 3.

Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination.

Otter JA1Donskey C2Yezli S3Douthwaite S4Goldenberg SD4Weber DJ5.

Viruses with pandemic potential including H1N1, H5N1, and H5N7 influenza viruses, and severe acute respiratory syndrome (SARS)/Middle East respiratory syndrome (MERS) coronaviruses (CoV) have emerged in recent years. SARS-CoV, MERS-CoV, and influenza virus can survive on surfaces for extended periods, sometimes up to months. Factors influencing the survival of these viruses on surfaces include: strain variation, titre, surface type, suspending medium, mode of deposition, temperature and relative humidity, and the method used to determine the viability of the virus. Environmental sampling has identified contamination in field-settings with SARS-CoV and influenza virus, although the frequent use of molecular detection methods may not necessarily represent the presence of viable virus. The importance of indirect contact transmission (involving contamination of inanimate surfaces) is uncertain compared with other transmission routes, principally direct contact transmission (independent of surface contamination), droplet, and airborne routes. However, influenza virus and SARS-CoV may be shed into the environment and be transferred from environmental surfaces to hands of patients and healthcare providers. Emerging data suggest that MERS-CoV also shares these properties. Once contaminated from the environment, hands can then initiate self-inoculation of mucous membranes of the nose, eyes or mouth. Mathematical and animal models, and intervention studies suggest that contact transmission is the most important route in some scenarios. Infection prevention and control implications include the need for hand hygiene and personal protective equipment to minimize self-contamination and to protect against inoculation of mucosal surfaces and the respiratory tract, and enhanced surface cleaning and disinfection in healthcare settings.

Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.


Healthcare-associated infection; Influenza virus; MERS-CoV; SARS-CoV; Surface contamination; Transmission

COVID-19: the gendered impacts of the outbreak 

Published Online March 6, 2020 S0140-6736(20)30526-2 

*Clare Wenham, Julia Smith, Rosemary Morgan, on behalf of the Gender and COVID-19 Working Group† 

Policies and public health efforts have not addressed the gendered impacts of disease outbreaks.

1 The response to coronavirus disease 2019 (COVID-19) appears no different. We are not aware of any gender analysis of the outbreak by global health institutions or governments in affected countries or in preparedness phases. Recognising the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions.

Although sex-disaggregated data for COVID-19 show equal numbers of cases between men and women so far, there seem to be sex differences in mortality and vulnerability to the disease.

2 Emerging evidence suggests that more men than women are dying, potentially due to sex-based immunological

3 or gendered differences, such as patterns and prevalence of smoking.

4 However, current sex-disaggregated data are incomplete, cautioning against early assumptions. Simultaneously, data from the State Council Information Office in China suggest that more than 90% of health-care workers in Hubei province are women, emphasising the gendered nature of the health workforce and the risk that predominantly female health workers incur.


COVID-19 and the anti-lessons of history 

ROBERT PECKHAM, | VOLUME 395, ISSUE 10227, P850-852, MARCH 14, 2020 Published Online March 2, 2020 S0140-6736(20)30468-2 

As the outbreak of coronavirus disease 2019 (COVID-19) in China’s Hubei province continues and new cases of the disease increase globally,

1 there is pressure on historians to show the value of history for policy. How can the past assist in the real-time management of the crisis? What insights can be gleaned from the ongoing epidemic for future disease preparedness and prevention? Lurking in the background of these interrogatives is a more or less explicit accusation: why haven’t past lessons been learned? The gist of some commentaries seems to be: “there is almost nothing surprising about this pandemic”.

2 The history-as-lessons approach pivots on the assumption that epidemics are structurally comparable events, wherever and whenever they take place. The COVID-19 outbreak “creates a sense of déjà vu” with the 2003 outbreak of severe acute respiratory syndrome (SARS).

3 Citing early estimates of the disease’s infectiousness, based on an analysis of the first 425 confirmed cases in Wuhan,

4 comparisons have been drawn with the 1918–19 influenza pandemic.


Although in some respects the outbreak of COVID-19 presents a compelling argument for why history matters, there are problems with analogical views of the past because they constrain our ability to grasp the complex place-and-time-specific variables that drive contemporary disease emergence. A lessons approach to epidemics produces what Kenneth Burke, borrowing from the economist and sociologist Thorstein Veblen, called “trained incapacity”—“that state of affairs whereby one’s very abilities can function as blindnesses”.

6Habitual modes of thinking can diminish our capacity to make lateral connections. When the present is viewed through the lens of former disease outbreaks, we typically focus on similitudes and overlook important differences. In other words, analogies create blind spots. As Burke commented, “a way of seeing is also a way of not seeing—a focus on object A involves a neglect of object B”….


A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations

  1. Jianyin Qiu1
  2. Bin Shen2
  3. Min Zhao1
  4. Zhen Wang1
  5. Bin Xie1 and 
  6. Yifeng Xu1


The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people’s lives. It has also triggered a wide variety of psychological problems, such as panic disorder, anxiety and depression. This study is the first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic.


Medical procedures, health, medicine, handwashing, PPE, 

Am J Infect Control. 2005 Dec;33(10):580-6.

Handwashing practice and the use of personal protective equipment among medical students after the SARS epidemic in Hong Kong.

Wong TW1Tam WW.



Hand hygiene is an important element of infection control. We conducted 2 surveys on hand hygiene practices and use of personal protective equipment among medical students during and after the outbreak of severe acute respiratory syndrome (SARS) to study its impact on their personal hygiene practice when they contacted patients.


Two cross-sectional surveys were conducted among medical students in their clinical training years (years 3-5) in a teaching hospital (at which the first and major SARS outbreak occurred) in March 2003 and August 2004, respectively.


Prior to the recognition of the SARS outbreak in March 2003, 35.2% of the students washed their hands before and 72.5% after they physically examined patients in the wards. None of the students wore masks during history taking and physical examination. In the 2004 survey, the corresponding proportions were 60.3% and 100%, respectively, and 86.1% and 93.8% of students wore masks during history taking and physical examination, respectively. Attitudes to handwashing and perception of infection risk were not significantly associated with handwashing practice, whereas peer behavior might be a significant influencing factor.


A significant improvement in compliance with hand hygiene practice was found after the SARS outbreak.





Public Health. 2006 Jan;120(1):8-14. Epub 2005 Nov 16.

The 2003 SARS outbreak and its impact on infection control practices.

Shaw K1.


Severe Acute Respiratory Syndrome (SARS) emerged recently as a new infectious disease that was transmitted efficiently in the healthcare setting and particularly affected healthcare workers (HCWs), patients and visitors. The efficiency of transmission within healthcare facilities was recognised following significant hospital outbreaks of SARS in Canada, China, Hong Kong, Singapore, Taiwan and Vietnam. The causative agent of SARS was identified as a novel coronavirus, the SARS coronavirus. This was largely spread by direct or indirect contact with large respiratory droplets, although airborne transmission has also been reported. High infection rates among HCWs led initially to the theory that SARS was highly contagious and the concept of ‘super-spreading events’. Such events illustrated that lack of infection control (IC) measures or failure to comply with IC precautions could lead to large-scale hospital outbreaks. SARS was eventually contained by the stringent application of IC measures that limited exposure of HCWs to potentially infectious individuals. As the ‘global village’ becomes smaller and other microbial threats to health emerge, or re-emerge, there is an urgent need to develop a global strategy for infection control in hospitals. This paper provides an overview of the main IC practices employed during the 2003 SARS outbreak, including management measures, dedicated SARS hospitals, personal protective equipment, isolation, handwashing, environmental decontamination, education and training. The psychological and psychosocial impact on HCWs during the outbreak are also discussed. Requirements for IC programmes in the post-SARS period are proposed based on the major lessons learnt from the SARS outbreak.


Canine coronavirus (CCoV), a member of the family Coronaviridae, is an enveloped, positive-stranded RNA virus, clustered into antigenic group I. CCoV is responsi- ble for mild enteric disease in pups. In young pups, or when mixed infections occur, the clinical signs may be severe and include diarrhoea, vomiting, dehydration and occasional death. CCoV is highly contagious and once the virus has become established in the environment, the spread of infection is difficult to control (Pratelli, 2006). Avoiding contact with infected dogs and their excretions is the only way to ensure disease prevention. Crowded, unsanitary conditions, stress during training and other factors appear to favour the development of clinical dis- ease. The virus is acid stable and was not inactivated at pH 3.0 and +20–22°C (Binn et al., 1974; Appel, 1987). Canine coronavirus is relatively heat stable and can be a permanent loss disinfection tests.


Human Coronaviruses: Insights into Environmental Resistance and Its Influence on the Development of New Antiseptic Strategies

by Chloé Geller,  Mihayl Varbanov and Raphaël E. Duval *

UMR 7565, SRSMC, Université de Lorraine – CNRS, Faculty of Pharmacy, 5 rue Albert Lebrun, BP 80403, 54001 Nancy Cedex, France


The Coronaviridae family, an enveloped RNA virus family, and, more particularly, human coronaviruses (HCoV), were historically known to be responsible for a large portion of common colds and other upper respiratory tract infections. HCoV are now known to be involved in more serious respiratory diseases, i.e. bronchitis, bronchiolitis or pneumonia, especially in young children and neonates, elderly people and immunosuppressed patients. They have also been involved in nosocomial viral infections. In 2002–2003, the outbreak of severe acute respiratory syndrome (SARS), due to a newly discovered coronavirus, the SARS-associated coronavirus (SARS-CoV); led to a new awareness of the medical importance of the Coronaviridae family. This pathogen, responsible for an emerging disease in humans, with high risk of fatal outcome; underline the pressing need for new approaches to the management of the infection, and primarily to its prevention. Another interesting feature of coronaviruses is their potential environmental resistance, despite the accepted fragility of enveloped viruses. Indeed, several studies have described the ability of HCoVs (i.e. HCoV 229E, HCoV OC43 (also known as betacoronavirus 1), NL63, HKU1 or SARS-CoV) to survive in different environmental conditions (e.g. temperature and humidity), on different supports found in hospital settings such as aluminum, sterile sponges or latex surgical gloves or in biological fluids. Finally, taking into account the persisting lack of specific antiviral treatments (there is, in fact, no specific treatment available to fight coronaviruses infections), the Coronaviridae specificities (i.e. pathogenicity, potential environmental resistance) make them a challenging model for the development of efficient means of prevention, as an adapted antisepsis-disinfection, to prevent the environmental spread of such infective agents. This review will summarize current knowledge on the capacity of human coronaviruses to survive in the environment and the efficacy of well-known antiseptic-disinfectants against them, with particular focus on the development of new methodologies to evaluate the activity of new antiseptic-disinfectants on viruses.


 human coronaviruses; environmental survival; antiseptics-disinfectants


History of Human Coronaviruses

2.1.1. Respiratory Diseases

The HCoV 229E and the HCoV OC43, now called betacoronavirus 1 [1], were the first human coronaviruses to be identified. Since the late sixties, they were recognized as being responsible for upper and mild respiratory tract infections such as the common cold [2,3,4,5,6].

Following the identification of new members of coronaviruses that infect humans, the NL63 in 2004 [7,8,9] and the HKU1 in 2005 [10] and, of course, the SARS-CoV in 2003 [11,12,13,14], new studies have been conducted on the clinical features of HCoVs infections. Indeed, before 2003, very few studies and routine monitoring dealt with the role of coronaviruses in humans. Thus, epidemiological data were rare and it is likely that, as a result, the precise role that HCoVs played in respiratory tract infections was greatly underestimated.

It is important to note that these viruses have been identified worldwide [15,16,17,18,19,20,21,22]. Human coronavirus infections occur mainly in winter, with a short incubation time [19,23,24]. They are recovered in 3 to 11% of patients sampled with a respiratory tract infection, depending on the studied population and the HCoV strain [19,21,23,24,25]. Coronaviruses occupy the fourth or fifth place, behind influenzaviruses, respiratory syncytial virus, adenoviruses and rhinoviruses and their proportion is generally equivalent to the ones of metapneumovirus and parainfluenzaviruses [23,24].

They have since been implicated in more serious diseases of the lower respiratory tract as bronchitis, bronchiolitis or pneumonia [10,26,27,28,29,30,31] or croup in the case of the HCoV NL63 [18,30]. These infections concern predominantly weak patients such as newborns or infants [23,24,26,30,32,33], elderly people [34,35] or immunosuppressed patients [23,36,37]. They have also been implicated in nosocomial infections notably in neonatal care unit [32,33].

2.1.2. Involvement of Coronaviruses in Other Human Diseases

HCoVs are suspected to cause digestive dysfunctions. First, they have been associated with necrotizing enterocolitis in newborns [38], and diarrhea or other gastrointestinal symptoms have been shown to accompany coronavirus infections [17,24,27,30,39]. Then, other findings such as the detection of viral particles and coronavirus RNA in stool samples [39,40], or the presence of HCoV OC43 antibodies in children with gastroenteritis, support this idea. However, despite these arguments, their implication in human intestinal infections is still controversial but should be considered to evaluate the potential routes of HCoVs spread.

Another debate is the potential involvement of HCoVs in central nervous system diseases such as multiple sclerosis. This is supported by a body of evidence, e.g. neurological symptoms in some HCoV OC43 infected patients [29], experimental infection of neural cells with HCoV 229E and OC43 [41,42,43], detection of HCoV 229E and OC43 RNAs and antigens in brain of multiple sclerosis patients [44,45,46], or, more recently, neuroinvasive properties of HCoV OC43 after intranasal inoculation in mice [47]. However, the precise and real implication of HCoVs in neural diseases has not yet been clearly demonstrated.

Furthermore, some studies reported also some heart troubles associated with HCoVs infections [29,48].

2.2. A Highly Pathogenic Coronavirus: the SARS-Associated Coronavirus

The epidemic outbreak due to the SARS-CoV was the first worldwide epidemic of the 21st century. It began in Guangdong province of China in November 2002 and spread all over the world within just a few months. This new coronavirus was quickly identified thanks to a concerted international effort [12,13,14,49,50]. 

From November 2002 to July 2003, SARS-CoV affected more than 8000 people in all five continents and caused about 800 deaths [51]. One of the striking features of this epidemic was its nosocomial propagation and the heavy burden of the health care workers [49,52,53,54]. Moreover, the mortality rate was higher than 50% in aged (>60-year-old) populations [55,56,57].

SARS-CoV infection in humans typically causes an influenza-like syndrome such as malaise, rigors, tiredness and high fevers. In one-third of the infected patients, the clinical symptoms regress and patients recover, with, for some of them, persistent pulmonary lesions. In the remaining two-thirds of the infected patients, the disease progresses to an atypical pneumonia. Respiratory insufficiency leading to respiratory failure is the most common cause of death among those infected with SARS-CoV [52,54,58,59]. Many of these patients also develop watery diarrhea with active virus shedding (until several weeks), which might increase the transmissibility of the virus and add another evidence of gastrointestinal tropism of HCoVs [57]. Moreover, the SARS-CoV receptor, the angiotensin-converting enzyme 2 ACE-2, is present in lungs but also in the gastrointestinal tract [60,61].

SARS-CoV seemed predominantly transmitted by respiratory droplets over a relatively close distance [62]. However, direct and indirect contact with respiratory secretions, feces or animal vectors could also lead to transmission, at least under some circumstances [59,63]. 

2.3. Evolutionary Ability of Coronaviruses

Besides these pathogenic properties, coronaviruses represent another risk for human population through their interspecies jumping capacity. This is suspected for the HCoV OC43 that may have evolved from the bovine coronavirus, which is responsible for gastrointestinal infections in cattle [64]. Similarly, the SARS-CoV is a zoonotic virus that crossed the species barrier. Phylogenetic analysis of SARS-CoV isolates from animals and humans strongly suggest that the virus originated from animals, most likely bats [65,66,67,68], was amplified in palm civets, and transmitted to human population vialive animal markets [69].

This potency of coronaviruses may be responsible for new disastrous outbreaks and therefore should be kept in mind.

2.4. Vaccines and Therapy

No treatment or vaccine is available to fight HCoVs infections. In the case of SARS-CoV, various approaches were used during the epidemic, but none was really successful and targeted. Treatment was essentially empiric and symptomatic and depended upon the severity of the illness. 

Since then, studies have been conducted to identify potent anti-SARS-CoV treatment. Standard molecules used in viral infections such as ribavirine, interferon or hydrocortisone, were used, leading to diverging, and not so conclusive, results as they were tested in vivo or in vitro [57,70,71,72,73]. Development of strategies with monoclonal antibodies, siRNAs or molecules such as glycyrrhizin or nelfinavir, have been conducted in vitro but still need to be improved [71,74,75,76].

The emergence of the SARS-CoV has also led to the development of new vaccine strategies, including expression of SARS-CoV spike protein in other viruses [77,78,79,80,81,82,83,84,85], inactivated SARS-CoV particles [82,86,87,88,89,90,91] or DNA vaccines [92,93,94,95]. However, an early concern for application of a SARS-CoV vaccine was the experience with animal coronavirus vaccines, which induced enhanced disease and immunopathology in animals when challenged with infectious virus [96]. Indeed, a similar immunopathologic reaction has been described in mice vaccinated with a SARS-CoV vaccine and subsequently challenged with SARS-CoV [97,98,99,100,101]. Thus, safety concerns related to effectiveness and safety for vaccinated persons, especially if exposed to other coronaviruses, should be carefully examined.


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Dietary Supplement Recall

January 17, 2020 — Dietary Supplement Recall announced for 1,200 products from 850 supplement distributors made between January 2013 and November 2019.

FDA Supplement Recall
FDA Supplement Recall on 1200 product from 850 companies made from 2013-2019

ABH NATURE’S PRODUCTS, INC, ABH PHARMA, INC., and STOCKNUTRA.COM, INC. (the “COMPANIES”) is conducting a nationwide recall of ALL lots of its dietary supplement products pursuant to a Consent Decree entered by the U.S. District Court for the Eastern District of New York. This recall applies to all dietary supplement products manufactured and sold between January 2013 – November 2019 and all lots of products are included in this recall.

These products are being recalled after an FDA inspection found significant violations of current good manufacturing practice regulations. Manufacturing practices that are not in adequate control represent the possibility of risk being introduced into the manufacturing process resulting in finished supplement products with decreased identity, purity, strength and composition.

To date, there have been no reported illnesses or injuries as a result of this situation.

The COMPANIES contract manufactured dietary supplements for other firms and did not sell products directly to consumers. Link to Press Release

Contract Manufacturing Advocacy and Recall Prevention

It’s important to recognize the differences between GMP certification and GMP verification.

If you own a supplement brand, and are not 100% sure whether your supplement contract manufacturer is meeting FDA requirements, contact us.

Here is the list of supplement brands and own-label distributors affected by the recall:

9Round LLC
A & E Medical Supply
A Ham
A Twin
Abacus Pills
Abigon-Wilde Research LLC
Abulon Ltd
Accelerated Intelligence
Active Beauty
Active Remedy
Adapt Sport Supplements
Adnanbadnan Industries DBA Love Mom
Advanced Blend Inc.
Advantage Wellness
Akta Innovations
Alcyon Health LLC
Alhambra Group Inc
All By Usa LLC
All Star Health
Allied Bait, Beverage, and Yarn
Aloha Turmeric
Alpha Formula Labs
Alpha Wolf Nutrition LLC
Alternative Laboratories
Altius Nutraceuticals
Always Plug LLC
America Medic & Science LLC
American  Health Formulations
Ames United Pte Ltd
Amz Sales
Antiaging Institute of California Inc.
Apothoes LLC
Apricot Power
Arem Nutritionals
Art is Hearted
Athlete Elite
Athletic Elite 10
Atronarch Media Solutions Inc.
Awakened Alchemy
Axis Labs
AZOE Enterptises
Azoth LLC
B2 Industries
Barrientos Inc
BarSpout, LLC
Basic Organics, Inc
Bauman Medical Group
Beautiful Once Again
Beauty Group LLC
Bee Nutritional & Packaging LLC
Bee Xtreme LLC
BelloHoldings LLC
Bergen Bulldog Supplements
Best  Vite
Best Nutritionals LLC
Binh Nghia MST. CO.LTD
Bio-Energy System
Biotech Factory
BJKB Inc. Pain & Stress Center
Black Doctor LLC
Black Edged LLC
Bluvos Energy LTD
BMO Nutrition
Bobby Buka MD Dermatology
Body Nutriceuticals LLC
Bona Dea Boric
BonCalme LLC
Boost Beauty LLC
Borlan Industries
Boston Functional Nutrition
Botanycl Ltd
Boyett LLC
BR International
Brain Mind Body L.L.C.
Brainvincible GmbH
Break Ventures
Brilliant Ways
Buddah Brain
Busy Life Brands Inc.
Cambridge Institute for Better Vision
Campanella Holdings LLC
Caraway Vitamins
Carecam International
Catalyst Nutraceuticals
Catalytic Edge Lifestyle
Cellreon Corporation
Centurion Sellers LLC 
Century IQ
Certified Nutraceuticals
Charcohol LLC
Chengdu Nutri-Packs Health Technology Co.
Chews-4-Health, Inc.
Chic Shakes
Chiral Balance LLC
Chiropractor Future, inc.
Chosen Pro Fit LLC
Claudia Berciotti
CLC Nutracuticals
Clean Tribe Co. LLC
Clean Victory LLC
Coaches Nutrtion LTD
Cognitune LLC
Coinfort LLC
CoreIngredients Vietnam Company
Creating Health Nutrition
Cyber Group USA
Cyrene LLC
Damage Control
David Agudelo
David Parker Ventures
DC Stewart Nutrition Labs
De Lune Inc
Dee Cee Lab
DEMD 860
Derivative Nutrition
Deswill integrated services INC
Diet Standards LLC
Dishes for Dogs LLC
DN Global Trading
Doctor Jess MD LLC
Dom Medical
Download Apps Services, Inc
Dr. Boz LLC
Dr. Ernesto Herger
Dr. Moritz Inc
Dr. Olivia Naturals Inc
Dr. Owusu Skincare & Wellness, LLC
dr. russell imboden pc
Dr. Scott’s
Du Soleil Noir
East Coast Group NY LTD
Eastward Brands LLC
Edible Health Ltd
Elements First
Elmira Imports LLC
Elysium Health
Emperor International Network FZ LLC
Empire Koz LLC
Energy By Science
Eniva USA, Inc.
ENZO Nutrition LLC
Enzymotec Ltd
Eurark LLC
Everlife LLC
EVL Nutrition
EZ Commence In
Faris Bros, LLC
Fayza Rhaimi AB
Feed Me More Nutrition
Femelabs LLC
Fight Brands LLC
First Opps
Fit and Focused Supplements
Fitness Innovative Technologies LLC
Fitness One Formulas LLC
Flex Fit Lives
Flora Optima
FMDK Consulting Ltd
FROMM Carolina
Furst Place Nutrition
G & L Medical Company Limited
Gainzville Athletics
GameChanger Nutrition
GearBox Rx, Inc
Gentech Nutrition
Ghayal Global
Ghost Nutrition
Gives Health
Global Health and Wellness Group
Gloryfeel Global GmbH
GnuPharma Corp
Go Pure Labs
Golden Life Blends
Golden Protein
Golgotha pharma  LLC
Goliath Marketing Services LLC
Good Brands
Grateful Health
Graystone LLC
Green Bracket LLC
green fettle
Green Wood Biotech LLC
Greenpoint Nutrition Labs LLC
Gro Hair Vitamin
Gussy Proteins LLC
Habit Hair Hearts
Hair369 LLC
Harvest Trading Group
Hatfield Holdings Company, Inc.
Health Management Group
Health Support
Healthy and Beauty Group Inc
Healthy Belly Company LLC
Healthy Healing Enterprises, LLC
Healthy Life Creations
Healthy Living Proteins
Helios Healthcare Consultants
her fit club
Herbalists Best
Hercules Laboratory Group
HeyMate Health
Highland Laboratories
Highmark Nutrition
Hillside Naturals
Holiday Cove LLC
Holistic Health Center
Holistic Media Inc
HolyLand Botanicals
HormoneSynergy Inc
HP Ingredients, Inc
Ievgen Barskyi
Ignite Media LLC
iHeart Nature
Infinities Life 101 LLC
Infinity Maximus
Ingredient Evolution
Ingredient Evolution Customer
Inner Armour Sports Nutrition
Intelligent Holdings, Inc
Intellivite, Inc.
Isolator Fitness
Jackson Raider Consulting, LLC
JMH Capital, LLC.
Joie Organics
JPK Nutri
Juniper Mountain LLC
Kamire Nutrition LLC
Kaori Rodman
Kapsulations LLC
Karmin Professional
Kelker Pharma
Kelsey Park Limited
Kennedy Wellness Labs
Kessep Dermaceuticals
Key to Youth LLC
Kilburn Industries
Kings Best Nutrition
Komodo Pharmaceuticals Inc.
Labrada Nutriton
Lacehold Limited
Lazarus Enterprises Inc
Leaf Biome, LLC
Leaner Living
Lemon Box
Lexington International LLC
LFI Labs, Inc
Life Botanica
Life Pharmacy
Life Pulse Inc
Lifebrook, LLC
Limitless venture Group, Inc.
Lingroup Global LLC
Liquid Assets
Lisanne Wellness Center, LLC
Liv Body LLC
Living Essentials Inc
Living Health Care
Loan from -jahirul
Local Rewards
Loocid Labs
Lubbock Sports Medicine
Lucky Nature Inc.
Luna Pharmaceuticals Inc.
Lycol Pharma
Made Nutrients LLC
Mademoiselle Hair Vitamins
Mahima For Life
Maine Natural Health
Maju Superfoods LLC
Makers Nutrition
Maks Ventures LLC
Mammoth Fuel
Manikinn Group Pty Ltd.
Marina Naturals
Mashay Inc
Masta Corporation
Mat Rat Supplements
MAV Nutrition
MaxFire LLC
McPherson Labs, Inc.
MDR Fitness Corp
Me By Kiki
Me Power LLC
Me Professional BV
Medza llc
MetaFormula International
Metrosel Inc.
MHNY Global
Michigan Cherry LLC
Mighty Ant Nutrition
Millenium Natural Health Products
Mind Body & Coal
Modexus LLC
Monarca Marketing LLC
Moon Oral Care
Moringa Source LLC
MTC Industries Inc.
Muhammad Qureshi
Muriello Muscle Products, LLC
Muscle Feast
N & S Supply INC
Natura Lifestyle Produce Inc
Natural Health Corner
Natural Health Corp
Natural Products Corp
naturals food 360 LLC
Nature’s Beneficials Inc.
Nature’s Boost
Nature’s Love
Nature Smart
NatureALL Inc.
NatureLab Corp.
Natures Cures
Natures MD
Naxos Nutrition LLC
Necessity Nutrition
Neff’s Naturals
Neoblends LLC
New Beginnings Nutritionals
New Pharma Inc.
next generation supplement
nextPHARM sp. z o.o. Sp.k
NHS Gold Corp
No Jitter Caffeine
Nolies Naturals
NomNom Now Inc.
Nootrous Supplements LLC
North East Development Commision Billing
Nova Medical Health Care Trade LLC
Nuevo Nutrition
Nugru Inc.
Nutrend Products, LLC.
Nutri trade llc
NutriMarket S.A.
NutriMedika Corp.
Nutrition For Healing
Nutrition Mode
Nutritional Resources,Inc
OAT Organization
Ocean Blue Life
Omega Health Products LLC
Omnite LLC
Oneword, Inc
Optimal Health Systems
Optimal Lifestyle LLC
Organax Ltd
Organic Benefit
Organs Life Sciences
OSL Labs
Osyris Nutrition Lab
Over Powered Energy
Oz Detox LLC
Palm Beach Nutra, LLC
Pangea Biomedical Ltd
Paradise Supplement
Paragon Fruits
Paul’s Family Store LLC
Peachy Lazuli
Perfect Supplements LLC
Persimmon Health, LLC
Personal Care Healthy Living
Pharma Cap Labs
Pharmatech USA LLC
Pinnacle of Wellness
Pivot Labs LLC
Positive Naturals LLC
Potent Supplements LLC
Power Co. Nutrition LLC
Powerful LLC
Primal Life Organics LLC
Prime Business Group, Inc
Prime Vitamina
Primerose Hill Inc
Primeval Labs
Private Label Supplements
Proactive Sciences LLC
Products Development LLC
Progene Healthcare Inc
Prospera Supplements LLC
ProX Formulas
Pure Health Naturals
Pure Life Keto Inc
Pure Life LLC
Pure Naturals LLC
Pure science supplements
Python Holdings
Quick Weight Loss Centers, LLC
Rask Health LLC
Raw 1 Nutrition
Raw Complexions
Raw Purities
Real Health Products
Real Herbs Limited
Reda Saad Medical
Rediston LTD
RegenaLife, LLC
Regora Pharmaceuticals Inc.
Rejuvenation Technologies Inc.
Relay Peak Research LLC
Restore Hair Restoration
Revive Naturals
Ricolife, LLC
Rizie De La Nawa
RM Discounts Direct, LLC
RMM Trading CO LLC
RNC Limited
Rokeda LLC
RSP Nutrition
RTG Commerce
SalesVenue Inc
Salt Supplement Co.
Saving Dinner
Schizandu Organics
Science Backed Naturals
Script Essentials
Secucom, LLC.
SFK Discount Properties
Shanab Pharma E.U
Shefinity Inc
SilverOnyx LLC
Sirin Sports LLC
Skyview Naturals LLC
Smart Fitness Products
Smash Bid LLC
Smoky Mountain Naturals LLC
SoCal Herbal Remedies LLC
Soflete LLC
Source Omega
Spark Punch LLC
Squad Tour Pty
Summit Rx, Inc.
Sunup Nutritionals LLC
Sunvita Health
Superior Supplement Manufacturing
Supernatural Man LLC
Supernova PTE
SuperNutrient Corp.
Swan Trading Corp, Inc.
Targe LLC
Tea of Life Health Inc.
Teami LLC
Teaveli Inc
TechWorld Corporation Inc.
Tennessee Scientific, Inc.
The Coveterie Showroom Inc.
The Creative Hub LLC
The International Eye Wellness Institute
The Prostate King
Three Peaks Direct LLC
Thrival Nutrition
ThrivePlus LLC
Thrivr LLC
Time Pioneer Limited
Total Tonic
Transparent Supplements Co LLC
Treadcorp, LTD
Treasure Holdings
Tres Chique
True Compare LLC
TruePeak Supplements
Turmeripure, LLC
Typhoon Sales
U.S. 2015, INC.
Uhlmann Packaging Systems L.P.
Ultimate Life LTD
Ultra Life
Ultra Life Inc.
Union Springs
University of Nevada, Las Vegas
Unkown Customer
Unwindly LLC
USA Supplements LLC
Various customers
Vergence Naturals
Vibrant Health
Vida Essentials, LLC
Vida Glow Pty Ltd
Vigorocity/ Anti Aging Central
Vinkem Pharma LLC
ViSalus, Inc.
Vita-Gen Labs
Vita Health Essentials
Vitadocs, Inc
VitaGen Laboratories
Vitalchemy, LLC
Vitalitus LLC
Vitality Max Labs
Vitamin Makers USA
Vitarim, Inc.
Viva Deo, LLC
Water Divine
Wealth Nutrition
Wellness and Vitality
White Label Cosmetics LLC
Wildflower Nutrients
Willhaven Group
Wisnewski Enterprise
Wonder Active LLC
WPN Supplements
Xeco Limited
Young Life Research, Inc.
Younger Tomorrow
yours2u Limited
Zach Attack Supplements LLC
Zammex Nutrition
Zanimo Inc
Zenarco LLC
Zenith Herbal
Zint LLC
Zongle Therapeutics
Zulu Heritage Corporation

Contract Supplement Manufacturer Advocates

Behind every successful product is a great contract supplement manufacturer.

We’ve audited and worked together with a lot of contract manufacturers.

That means we know how to get the best value, at the best quality, from supplement contract manufacturer partners.

NaturPro Verified Supply™

by NaturPro in Uncategorized Comments: 0

As consultants for a diversity of supplement and food firms, NaturPro Scientific has qualified numerous ingredients, suppliers and products.

So, we decided to share some of the products and ingredients that we have verified, within a curated supply catalog: NaturPro Verified Supply™

What’s different about NaturPro Verified Supply compared to other suppliers and manufacturers?

  1. Suppliers cannot pay to be listed. Unlike most suppliers, NaturPro does not accept fees or commissions to represent or promote any specific ingredients or products. Our core business is in vetting the best ingredients and products — not selling them.
  2. We are not tied or committed to any one ingredient or supplier, so we can keep our standards high.
  3. Our vetting process goes beyond FDA regulatory requirements. NaturPro standards include our intimate understanding of supplier practices, supply chain quality, sustainability, GMP’s, best practices, traceability to source, a track record of integrity, and a demonstrated commitment to quality and research.

Connect to NaturPro Verified Supply™ Portal

Contact us with questions or comments!

Ethical Sourcing Assessments for Ingredients, Supplements and Foods

by NaturPro in Uncategorized Comments: 0

NaturPro has served an essential role in helping our clients source and evaluate ethically sourced ingredients. 

Our Ethical Sourcing Assessments include elements from many recognized programs such as Fairtrade(R), and uses one of the most comprehensive set of standards guiding the evaluation of the social and environmental impact of natural products and foods.

Ethical Sourcing Assessments are Key to Understanding Social, Environmental and Product Sustainability

Ethical Sourcing of Ingredients for Supplements and Foods
Ethical Sourcing of Ingredients for Supplements and Food is used to benchmark sustainability and identify ways to improve supply chains.

The following outline covers subject matter covered in our evaluation protocol, which is derived from multiple sources, including the International Labour Organization Labour Principles of the United Nations Global Compact, the UN Forum on Sustainability Standards, Fairtrade,, WHO GAP, Global G.A.P., and NOP Organic.

General Guidelines for Ethical Sourcing: The Human Element


  1. Contact information
  2. Product name
  3. Specifications, nomenclature
  4. Sourcing origin
  5. Land use and inputs
  6. Harvest practices
  7. Plant population care
  8. Raw material processing and labeling


  1. Type and controls
  2. Prices and wages
  3. Non-discrimination
  4. Reciprocity
  5. Communications


  1. Labor practices
  2. Fair wages and prices
  3. Child labor
  4. Harrassment
  5. Working conditions
  6. Worker safety


  1. Legal requirements
  2. Policies and communications
  3. Management responsibilities
  4. Waste management
  5. Emissions
  6. Energy usage

Management and Supply Chain

  1. Written policies
  2. Training
  3. Supplier management
  4. Dealing with non-compliances
  5. Audit program
  6. Geographic risk
  7. Community improvements

NaturPro fits our review protocol and minimum standards according to your practices currently in place, and we also evaluate according to the ‘stretch goal’ standards our clients are working to achieve, and set a clear path towards improved social and environmental impact.

Global Herb Producer Cooperative
Reviewing your ‘people practices’ helps our clients to better understand and support their supply chain.

Here are a couple examples of case studies we have performed for clients:

1. “Seed-to-Shelf Independent Audit” — A comprehensive, umbrella independent review of all quality and ethical procedures, relating to both farm-level and manufacturing practices.

We review all documentation, audit reports and other information, provide a list of opportunities to improve quality, identify gaps that minimize business, regulatory and product quality risk, help our clients meet the minimum level of regulatory compliance, and identify ‘best practices’ that are either already in place, or can be implemented. 

2. “Human Impact Audit” – A third-party independent review of the “human element” of an agricultural or wild-collected product, focusing in particular on staff training, farming practices and GAP, worker health and safety, and cultural preservation.   This includes a review of personnel SOP, safety, fair trade, farm practices, environmental impact estimates, ethical sourcing & organic practices.

The above 2 programs could be done separately or combined, and are typically performed in 2 phases: 

Phase 1: Document Audit
Phase 2: In-person/field Audits

3. Program marketing and communications – A comprehensive review paper that describes in detail all the elements of the program, references to the standards applied, and images or video footage. This comprehensive review can then be broken down into separate stories, that can become webpages, Youtube videos and social media posts that educate your audience.

Contact us for more information on NaturPro Scientific’s ingredient traceability and ethical sourcing programs. 

Pilot and Benchtop Prototype Capsules & Powders for Dietary Supplements

by Morgan Settle in Uncategorized Comments: 0

Creating a successful pilot and bench top prototype capsule is a lot more than creating a list of ingredients that mix well together.

NaturPro has a broad base of knowledge in capsule development and prototype formulation as well as healthy foods and natural products, spanning from raw material to finished consumer product.

We guide our clients in the right direction, by helping to manage all or parts of the process for natural product formulation and development — from seed to shelf — for dietary supplement and health food products.

NaturPro offers supplement prototypes, R&D pilot production for capsules and powders

Product Prototypes and Samples

Our client list includes folks of all shapes and sizes, from startup to large corporation. Many of them need small runs of new or custom products for stability and human survey trials.

No two clients or projects are the same, but there are some common approaches found in our Development Toolbox:

Imagine the Possibilities…

Supplement Custom Packaging Copacker Manufacturing
We do supplement Custom Packaging, because your Copacker or Contract Manufacturer is probably not thinking about creative ways to package your product..

Product Development Toolbox: Top 10 Developer’s Tools:

Product development for dietary supplement capsules requires a ‘toolbox’ of analysis including the following

  • Market Analysis, Competitive Analysis and Positioning
Brain Supplement Nootropic Food Beverage Drink
Where is your concept in the mindshare of your target customer?
  • Regulatory Status / Safety Assessment — GRAS | ODI | NDI
Regulatory compliance quality supplements food
Regulatory compliance and quality assurance for supplements and food ingredients
Supplement Product Claims Science Clinicals
Supplement Product Claims Depends on Your Science and Clinicals — In Writing.
Supplement Product Financials Costs Margins
It’s critical to know your product and ingredient financials, including costs and margins.
Supplier Qualification Ingredients
Supplier qualification and ingredients vetting are key functions of all new product development.
Ingredient Specifications Specs Verification
Ingredient specifications and verification of specs are central parts of the process

Contact Us

Product Strategy Consultants for Dietary Supplements

by NaturPro in Uncategorized Comments: 0

Product strategy for health products like supplements requires extensive knowledge of consumer trends, marketing, consumer behavior, food science, regulatory requirements and technical and scientific affairs.

NaturPro Scientific combines expertise in a wide array of product types and disciplines, offering clients a way to maximize chances for consumer product success in the market.

Product Strategy – Cores of Discipline 

A product may be determined as safe and effective, and also legal and kosher — but still not be positioned for success.  For example, it may be undifferentiated in a crowded market, or not provide a meaningful benefit that is valued by the consumer. A great product may find itself swimming in infested waters filled with competitors.

Supplement capsules prototype pilot samples
NaturPro offers seed-to-shelf strategy and execution for supplement product development

 Our in-depth analysis and advisory process helps to guide our clients in the right direction.

Some main considerations for any supplement product design consultants includes the following:

  1. Target Health Category(s) and subcategories, including potential niche markets
  2. Market Opportunity Analysis
  3. Market Size & Market Leaders
  4. Key Competitor Analysis
  5. Pricing Sensitivity
  6. Consumer Preference Analysis, including consumner surveys and focus groups
  7. Key Product Benefit
  8. Regulatory Review
  9. Customer Demographics
  10. Differentiation, Positioning and Competitive Analysis
  11. Innovation Strategy
  12. SWOT Analaysis
  13. Marketing and Distribution Channel Analysis

Healthy Food and Supplement Beverage Formulators

by Morgan Settle in Uncategorized Comments: 0

Creating a successful healthy food or beverage is a lot more than selecting a list of ingredients that mix well together.

NaturPro has a broad base of knowledge in product development and production of dietary supplements, healthy foods and healthy beverages, spanning from raw material to finished functional food or beverage.

We guide our clients in the right direction, by helping to manage all or parts of the process for healthy food and beverage formulation and development — from seed to shelf — for dietary supplement and health food products.

NaturPro offers beverage formulation support for healthy drinks

Functional Food and Drink Development

Our client list includes folks of all shapes and sizes, from startup to large corporation.

No two clients or products are the same, but there are some common approaches found in our Product Development Toolbox:

Product Development Toolbox: Top 5 Product Development Tools:

Product development requires a ‘toolbox’ of analysis including the following

  1. Market Analysis, Competitive Analysis and Positioning
  2. Regulatory Status / Safety Assessment
  3. Claims Development and Substantiation
  4. Product Costing and Financials
  5. Ingredient Readiness, Supplier Qualification

Contact Us

Dietary Supplement Formulation

by Morgan Settle in Uncategorized Comments: 0

As Dietary Supplement Formulators we often are asked what we think of a product concept. The thought process to develop an answer is generally similar, regardless of the type of product, and whether its finished product, or an ingredient or raw material.

A number of considerations go into formulating successful, effective, safe and compliant dietary supplements, foods, and food and dietary ingredients.  These include:

  • What does the supplement or food do?
  • What can be claimed about the product?
  • Is the evidence supporting the claims sufficient?
  • How safe is the product?
  • Who will benefit from the product?
  • How is the ingredient dosage determined?
  • Are the ingredients available at an acceptable quality, cost and volume?

The 4 Initial Steps to Dietary Supplement Formulation

There are seven basic elements to formulating a groundbreaking product:

  1. Begin with the finished product in mind. Determine in full detail how the product will be marketed, what the desired product claims will be, and how the product will address an unmet market need.
  2. Intimately understand the product value and market positioning compared to the competition. How will the product address an unmet need, or be different than what is already found on the market?  How will the product be priced compared to the competition? A full competitive analysis is important to determine positioning.
  3. What language will be used to describe the product? (This language, found on product labels and on webpages, is considered to be part of product claims.)
  4. In what country(s) will the product be marketed?  Regulations in different countries vary, and it is important to understand the unique requirements of each location.

Sufficient time spent in the planning phase is the difference between success and failure.

Product formulating plans often coordinate the knowledge of supplement consultants and experts, review regulatory status of the product and evaluate the available scientific evidence.  A good formulating plan will identify not only opportunities, but also gaps and risks that may prevent success.

Contact us for more information on our Dietary Supplement Formulation and Development

Additional Reading:

Food and Supplement Claims with Confidence

Dietary Supplement Formula Development

Dietary Supplement Ingredient Regulatory Status

Supplement Manufacturing Consulting

Creating Natural Product Intellectual Property

Dietary Supplement Facts and Label Review

There’s a lot of detail required for dietary supplement labels. Between supplement facts, structure-function health claims, content claims, and required formatting, it’s easy to overlook some of the FDA requirements for labeling.

Supplement Label Review Nutrition Facts

Supplement Label Review for Supplement Facts, Nutrition Labeling and Claims

Dietary Supplement Facts and Label Review

As part of our Label Review services, NaturPro helps clients develop, review and suggest improvements to dietary supplement labels, to ensure compliance with FDA regulatory requirements

Our clients enjoy the following benefits:

  1. Reliability: 100% accuracy and FDA compliance
  2. Experience: 15+ years of experience reviewing supplement labels
  3. Science-driven: Our reviews are based on the most current, reliable information, techniques and evidence
  4. Perspective: We have experience on the business side of the industry, so we know what the law is, whether it’s followed, and what is likely to happen if you don’t.

Updated Pricing:

Label Review (Basic): $350-550  — review only label — for “red flags” and suggested improvements

Label Review (Complete): $550-850 – review of label for red flags and suggested improvements, and matching finished product specifications

Label and Marketing Review: $800-1500 per label – web page / sales sheet

 (Volume discounts may apply for similarly labeled products — Contact for Pricing

FDA Dietary Supplement Labeling Guidelines

See our Dietary Supplement Label Review Checklist.

The following outlines some of the most frequently asked questions (FAQ) for dietary supplement labels:

  1. How are dietary supplements defined?Dietary supplements are defined, in part, as products (other than tobacco) intended to supplement the diet that bear or contain one or more of the following dietary ingredients:
    1. A vitamin;
    2. A mineral;
    3. An herb or other botanical;
    4. An amino acid;
    5. A dietary substance for use by man to supplement the diet by increasing the total dietary intake; or
    6. A concentrate, metabolite, constituent, extract, or a combination of any ingredient mentioned above.Further, dietary supplements are products intended for ingestion, are not represented for use as a conventional food or as a sole item of a meal or the diet, and are labeled as dietary supplements.
  2.  What label statements are required on the containers and packages of dietary supplements?Five statements are required: 1) the statement of identity (name of the dietary supplement), 2) the net quantity of contents statement (amount of the dietary supplement), 3) the nutrition labeling, 4) the ingredient list, and 5) the name and place of business of the manufacturer, packer, or distributor.
  3.  Where do I place the required label statements?You must place all required label statements either on the front label panel (the principal display panel) or on the information panel (usually the label panel immediately to the right of the principal display panel, as seen by the consumer when facing the product), unless otherwise specified by regulation (i.e., exemptions).
  4.  What label statements must I place on the principal display panel?You must place the statement of identity and the net quantity of contents statement on the principal display panel. Where packages bear alternate principal display panels, you must place this information on each alternate principal display panel.
  5.  How do I locate the principal display panel?The principal display panel of the label is the portion of the package that is most likely to be seen by the consumer at the time of display for retail purchase. Many containers are designed with two or more different surfaces that are suitable for use as the principal display panel. These are alternate principal display panels.
  6.  What label statements must I place on the information panel?You must place the “Supplement Facts” panel, the ingredient list, and the name and place of business of the manufacturer, packer, or distributor on the information panel if such information does not appear on the principal display panel, except that if space is insufficient, you may use the special provisions on the “Supplement Facts” panel in 21 CFR 101.36(i)(2)(iii) and (i)(5). See questions 46 and 56 in Chapter IV for more details.
  7.  Where is the information panel?The information panel is located immediately to the right of the principal display panel as the product is displayed to the consumer. If this panel is not usable, due to package design and construction (e.g. folded flaps), the panel immediately contiguous and to the right of this part may be used for the information panel. The information panel may be any adjacent panel when the top of a container is the principal display panel.
  8.  What name and address must I list on the label of my product?You must list the street address if it is not listed in a current city directory or telephone book, the city or town, the state, and zip code. You may list the address of the principal place of business in lieu of the actual address.
  9.  May I place intervening material on the information panel?No. You may not place intervening material, which is defined as label information that is not required (e.g., UPC bar code), between label information that is required on the information panel.
  10.  What type size, prominence and conspicuousness am I required to use on the principal display panel and the information panel?You are required to use a print or type size that is prominent, conspicuous and easy to read. The letters must be at least one-sixteenth (1/16) inch in height based on the lower case letter “o,” and not be more than three times as high as they are wide, unless you petition for an exemption in accordance with 21 CFR 101.2(f). The lettering must contrast sufficiently (it does not need to be black and white) with the background so as to be easy to read. See Chapter IV for the type size requirements for the nutrition label.
  11.  Do I need to specify the country of origin if my product, or the ingredients in my product, is not from the United States?Yes. Unless excepted by law, the Tariff Act requires that every article of foreign origin (or its container) imported into the United States conspicuously indicate the English name of the country of origin of the article.
  12. What is the nutrition label for a dietary supplement called?The nutrition label for a dietary supplement is called a “Supplement Facts” panel.
    1. You must list dietary ingredients without RDIs or DRVs in the “Supplement Facts” panel for dietary supplements. You are not permitted to list these ingredients in the “Nutrition Facts” panel for foods.
    2. You may list the source of a dietary ingredient in the “Supplement Facts” panel for dietary supplements. You cannot list the source of a dietary ingredient in the “Nutrition Facts” panel for foods.
    3. You are not required to list the source of a dietary ingredient in the ingredient statement for dietary supplements if it is listed in the “Supplement Facts” panel.
    4. You must include the part of the plant from which a dietary ingredient is derived in the “Supplement Facts” panel for dietary supplements. You are not permitted to list the part of a plant in the “Nutrition Facts” panel for foods.
    5. You are not permitted to list “zero” amounts of nutrients in the “Supplement Facts” panel for dietary supplements. You are required to list “zero” amounts of nutrients in the “Nutrition Facts” panel for food.How does “Supplement Facts” differ from “nutrition facts?”The major differences between “Supplement Facts” panel and “Nutrition Facts” panel are as follows:
  13. What information must I list in the “Supplement Facts” panel?You must list the names and quantities of dietary ingredients present in your product, the “Serving Size” and the “Servings Per Container.” However, the listing of “Servings Per Container” is not required when it is the same information as in the net quantity of contents statement. For example, when the net quantity of contents statement is 100 tablets and the “Serving Size” is one tablet, the “Serving Per Container” also would be 100 tablets and would not need to be listed.
  14. How must I display the “Supplement Facts” panel?The “Supplement Facts” nutrition information (referred to as a panel) must be enclosed in a box by using hairlines. The title, “Supplement Facts,” must be larger than all other print in the panel and, unless impractical, must be set full width of the panel. The title and all headings must be bolded to distinguish them from other information.
  15. How must I present the information in the “Supplement Facts” panel?You must present all information using the following:
    1. A single easy-to-read type style;
    2. All black or one color type, printed on a white or neutral contrasting background, whenever practical;
    3. Upper- and lowercase letters, except that you may use all uppercase lettering on small packages (i.e., packages having a total surface area available to bear labeling of less than 12 square inches);
    4. At least one point leading (i.e., space between lines of text); and
    5. Letters that do not touch.

  16. What are the type size requirements for the “Supplement Facts” panel?Except as provided for small and intermediate-sized packages, you must set information other than the title, headings, and footnotes in uniform type size no smaller than 8 point. You also must use a type size larger than all other print size in the nutrition label for the title “Supplement Facts.” You may set the column headings and footnotes in type no smaller than 6 point type. See the section on “Special Labeling Provisions” for the exceptions for small and intermediate-sized packages.
    For more information, visit FDA Dietary Supplement Labeling Guide