title: [Diagnosztikus lépések és a betegség prognózisának becslése COVID19-fertozött betegeken]/ Diagnostic consideration and bedside estimation of the prognosis in COVID-19 patients

text: In December 2019, a cluster of pneumonia cases of unknown origin occured in Wuhan, China. The identified infective agent is a novel corona virus called "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) and the respiratory disease caused by this agent aquired the name "coronavirus disease 2019" (COVID-19). In March 2020, the World Health Organization (WHO) declared the novel coronavirus outbreak a pandemic. We reviewed the international literature regarding the novel coronavirus outbreak. Here below, we focus mainly on the diagnostic issues of COVID-19 and on the estimation of the prognosis. We detail the relevant anamnestic factors and initial examination results which serve as basics for the clinical suspicion of COVID-19. We also focus on the proper method of microbiological sampling and the relevant informations regarding diagnostic tests like the gold standard real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2. We also cite the current national epidemiologic regulations of testing for novel coronavirus. In the last section, we emphasize the importance and the potential way of early identification of high-risk patients. The COVID-19 pandemic may cause substantial epidemiological and healthcare burden even in Hungary. In addition to the epidemiologic interventions aiming the deceleration of the outbreak, the early identification and the correct hospital treatment remain key issues since these may influence mortality. The chances of the critically ill patients could be improved solely by a high-quality and careful critical care. It is prudent to meet the experiences of colleagues working hard with these patients in the already heavily infected countries. Orv Hetil. 2020; 161(17): 667671.


title: Combating COVID-19 and Building Immune Resilience: A Potential Role for Magnesium Nutrition?

text: BACKGROUND: In December 2019, the viral pandemic of respiratory illness caused by COVID-19 began sweeping its way across the globe. Several aspects of this infectious disease mimic metabolic events shown to occur during latent subclinical magnesium deficiency. Hypomagnesemia is a relatively common clinical occurrence that often goes unrecognized since magnesium levels are rarely monitored in the clinical setting. Magnesium is the second most abundant intracellular cation after potassium. It is involved in >600 enzymatic reactions in the body, including those contributing to the exaggerated immune and inflammatory responses exhibited by COVID-19 patients. METHODS: A summary of experimental findings and knowledge of the biochemical role magnesium may play in the pathogenesis of COVID-19 is presented in this perspective. The National Academy of Medicine's Standards for Systematic Reviews were independently employed to identify clinical and prospective cohort studies assessing the relationship of magnesium with interleukin-6, a prominent drug target for treating COVID-19. RESULTS: Clinical recommendations are given for prevention and treatment of COVID-19. Constant monitoring of ionized magnesium status with subsequent repletion, when appropriate, may be an effective strategy to influence disease contraction and progression. The peer-reviewed literature supports that several aspects of magnesium nutrition warrant clinical consideration. Mechanisms include its "calcium-channel blocking" effects that lead to downstream suppression of nuclear factor-Kß, interleukin-6, c-reactive protein, and other related endocrine disrupters; its role in regulating renal potassium loss; and its ability to activate and enhance the functionality of vitamin D, among others. CONCLUSION: As the world awaits an effective vaccine, nutrition plays an important and safe role in helping mitigate patient morbidity and mortality. Our group is working with the Academy of Nutrition and Dietetics to collect patient-level data from intensive care units across the United States to better understand nutrition care practices that lead to better outcomes.


A new normal for hypertension medicine with coronavirus disease-2019 (COVID-19): proposal from the president of the Japanese Society of Hypertension


Drone delivery of AED's and personal protective equipment in the era of SARS-CoV-2


An effective protocol for heart transplantation during COVID-19 outbreak


First organ donation in Wuhan after ending of the coronavirus lockdown


title: Antiviral Action of Tryptanthrin Isolated from Strobilanthes cusia Leaf against Human Coronavirus NL63

text: Strobilanthes cusia (Nees) Kuntze is a Chinese herbal medicine used in the treatment of respiratory virus infections. The methanol extract of S. cusia leaf contains chemical components such as ß-sitosterol, indirubin, tryptanthrin, betulin, indigodole A, and indigodole B that have diverse biological activities. However, the antiviral action of S. cusia leaf and its components against human coronavirus remains to be elucidated. Human coronavirus NL63 infection is frequent among immunocompromised individuals, young children, and in the elderly. This study investigated the anti-Human coronavirus NL63 (HCoV-NL63) activity of the methanol extract of S. cusia leaf and its major components. The methanol extract of S. cusia leaf effectively inhibited the cytopathic effect (CPE) and virus yield (IC50 = 0.64 µg/mL) in HCoV-NL63-infected cells. Moreover, this extract potently inhibited the HCoV-NL63 infection in a concentration-dependent manner. Among the six components identified in the methanol extract of S. cusia leaf, tryptanthrin and indigodole B (5aR-ethyltryptanthrin) exhibited potent antiviral activity in reducing the CPE and progeny virus production. The IC50 values against virus yield were 1.52 µM and 2.60 µM for tryptanthrin and indigodole B, respectively. Different modes of time-of-addition/removal assay indicated that tryptanthrin prevented the early and late stages of HCoV-NL63 replication, particularly by blocking viral RNA genome synthesis and papain-like protease 2 activity. Notably, tryptanthrin (IC50 = 0.06 µM) and indigodole B (IC50 = 2.09 µM) exhibited strong virucidal activity as well. This study identified tryptanthrin as the key active component of S. cusia leaf methanol extract that acted against HCoV-NL63 in a cell-type independent manner. The results specify that tryptanthrin possesses antiviral potential against HCoV-NL63 infection.


title: Coronavirus disease 2019 (COVID-19): A literature review

text: In early December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. As of February 14, 2020, 49,053 laboratory-confirmed and 1,381 deaths have been reported globally. Perceived risk of acquiring disease has led many governments to institute a variety of control measures. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, pathogenesis and immune responses, epidemiology, diagnosis, treatment and management of the disease, control and preventions strategies are all reviewed.


Recommendations for the use of vascular access in the COVID-19 patients: an Italian perspective


title: The role of pets in managing uncertainty from COVID-19

text: In an effort to manage the uncertainty brought on by the COVID-19 pandemic, many people have turned to their social support networks. With limited access to in-person human social networks, many people are turning to pets for social support. Pets may be a complementary social support to supplement virtual human-to-human interaction. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


How the andrological sector suffered from the dramatic Covid 19 outbreak in Italy: supportive initiatives of the Italian Association of Andrology (SIA)


title: Why all COVID-19 hospitals should have mental health professionals: The importance of mental health in a worldwide crisis!

text: COVID-19 pandemic has led to a worldwide crisis. At present, everyone is focusing on the prevention of COVID-19 infection, preparing and discussing issues related to physical health consequences. However, it is important to understand that the life-threatening negative physical health consequences are going to be faced by a few, but everyone is going to face the negative mental health consequences of the pandemic. At various places COVID-19 hospitals are being established, to address the physical health consequences of the pandemic. However, mental health professionals have not been very actively involved in the management of people going through this pandemic. This viewpoint discusses the mental health consequences of the pandemic for the health care workers, people who are undergoing quarantine, people who are admitted to the COVID-19 hospitals, and those who have recovered from the infection. The article also highlights the mental health needs of people at different levels and the kind of interventions, which may be carried out.


An underestimated "false negative COVID cholecystitis" in Northern Italy and the contagion of a surgical ward: it can happen everywhere


Steam inhalation and paediatric burns during the COVID-19 pandemic


title: Discrimination and Social Exclusion in the Outbreak of COVID-19

text: This paper is aimed to document the observed social exclusion and discrimination in the outbreak of COVID-19 across the world and inside of China. Discrimination and social exclusion has occurred in various forms, while 25.11% of respondents overseas experienced discrimination in the breakout of COVID-19, and 90% of respondents inside of China exhibited discriminatory attitudes. The discrimination and social exclusion also lead to a range of damaging social outcomes. Thus, this is an urgent call for the inclusiveness in policy and media in the face of this public health emergency.


title: Remdesivir for severe acute respiratory syndrome coronavirus 2 causing COVID-19: An evaluation of the evidence

text: The novel coronavirus infection that initially found at the end of 2019 has attracted great attention. So far, the number of infectious cases has increased globally to more than 100 thousand and the outbreak has been defined as a pandemic situation, but there are still no "specific drug" available. Relevant reports have pointed out the novel coronavirus has 80% homology with SARS. In the difficulty where new synthesized drug cannot be applied immediately to patients, "conventional drug in new use" becomes a feasible solution. The first medication experience of the recovered patients in the US has led remdesivir to be the "specific drug". China has also taken immediate action to put remdesivir into clinical trials with the purpose of applying it into clinical therapeutics for Corona Virus Disease 2019 (COVID-19). We started from the structure, immunogenicity, and pathogenesis of coronavirus infections of the novel coronavirus. Further, we analyzed the pharmacological actions and previous trials of remdesivir to identify the feasibility of conducting experiments on COVID-19.


title: Investigating the challenges and generalizability of deep learning brain conductivity mapping

text: PURPOSE: To investigate deep learning electrical properties tomography (EPT) for application on different simulated and in-vivo datasets including pathologies for brain conductivity reconstructions. METHODS: 3D patch-based convolutional neural networks were trained to predict conductivity maps from B1 transceive phase data. To compare the performance of DL-EPT networks on different datasets, three datasets were used throughout this work, one from simulations and two from in-vivo measurements from healthy volunteers and cancer patients, respectively. At first, networks trained on simulations were tested on all datasets with different levels of homogeneous Gaussian noise introduced in training and testing. Secondly, to investigate potential robustness towards systematical differences between simulated and measured phase maps, in-vivo data with conductivity labels from conventional EPT were used for training. RESULTS: High quality conductivity reconstructions from networks trained on simulations with and without noise confirms the potential of deep learning for EPT. However, when this network is used for in-vivo reconstructions, measurement related artifacts affect the quality of conductivity maps. Training DL-EPT networks using conductivity labels from conventional EPT improves the quality of the results. CONCLUSIONS: Networks trained on realistic simulations yield reconstruction artifacts when applied to in-vivo data. Training with realistic phase data and conductivity labels from conventional EPT allows for reducing these artifacts.


title: Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT?

text: PURPOSE: To evaluate the diagnostic value of computed tomography (CT) and real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) for COVID-19 pneumonia. METHODS: This retrospective study included all patients with COVID-19 pneumonia suspicion, who were examined by both CT and rRT-PCR at initial presentation. The sensitivities of both tests were then compared. For patients with a final confirmed diagnosis, clinical and laboratory data, in addition to CT imaging findings were evaluated. RESULTS: A total of 36 patients were finally diagnosed with COVID-19 pneumonia. Thirty-five patients had abnormal CT findings at presentation, whereas one patient had a normal CT. Using rRT-PCR, 30 patients were tested positive, with 6 cases initially missed. Amongst these 6 patients, 3 became positive in the second rRT-PCR assay(after 2 days, 2 days and 3 days respectively), and the other 3 became positive only in the third round of rRT-PCR tests(after 5 days, 6 days and 8 days respectively). At presentation, CT sensitivity was therefore 97.2%, whereas the sensitivity of initial rRT-PCR was only 83.3%. CONCLUSION: rRT-PCR may produce initial false negative results. We suggest that patients with typical CT findings but negative rRT-PCR results should be isolated, and rRT-PCR should be repeated to avoid misdiagnosis.


COVID-19 in a Kidney Transplant Patient


title: Prone positioning in conscious patients on medical wards: A review of the evidence and its relevance to patients with COVID-19 infection

text: Medical teams continue to treat many patients with COVID-19 infection. This disease can result in profound hypoxaemia that may necessitate intubation and invasive mechanical ventilation in those who are critically ill. This intervention carries risk to both patients and healthcare workers and utilises significant hospital resource for prolonged periods. Simple, safe interventions that can be used before critical deterioration are highly desirable. The prone position in conscious non-ventilated patients with COVID-19 infection may improve oxygenation in the short term and defer or prevent the need for intubation in some. However, clinicians must be aware that there is a small evidence base for this intervention currently. This review sets out evidence regarding the use of this technique to aid the decision making of frontline staff.


Call for ensuring cancer care continuity during COVID-19 pandemic


title: Two hits to the renin-angiotensin system may play a key role in severe COVID-19

text: The spike glycoprotein on the virion surface docking onto the angiotensin-converting enzyme (ACE) 2 dimer is an essential step in the process of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in human cells-involves downregulation of ACE2 expression with systemic renin-angiotensin system (RAS) imbalance and promotion of multi-organ damage. In general, the RAS induces vasoconstriction, hypertension, inflammation, fibrosis, and proliferation via the ACE/Ang II/Ang II type 1 receptor (AT1R) axis and induces the opposite effects via the ACE2/Ang (1-7)/Mas axis. The RAS may be activated by chronic inflammation in hypertension, diabetes, obesity, and cancer. SARS-CoV-2 induces the ACE2 internalization and shedding, leading to the inactivation of the ACE2/Ang (1-7)/Mas axis. Therefore, we hypothesize that two hits to the RAS drives COVID-19 progression. In brief, the first hit originates from chronic inflammation activating the ACE/Ang II/AT1R axis, and the second originates from the COVID-19 infection inactivating the ACE2/Ang (1-7)/Mas axis. Moreover, the two hits to the RAS may be the primary reason for increased mortality in patients with COVID-19 who have comorbidities and may serve as a therapeutic target for COVID-19 treatment.


Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City


SARS-CoV-2 as a protective factor for cardiovascular mortality?


title: Case Report: Diagnosis of COVID-19 versus Tropical Diseases in Pakistan

text: A 25-year-old medical student presented in Multan, Pakistan with a high fever, cough, myalgia, and diarrhea consistent with the typical signs and symptoms of novel coronavirus disease (COVID-19). The patient had traveled to high COVID-19-risk areas within Pakistan and had no significant medical and surgical history. Based on nasopharyngeal and oropharyngeal swab testing, the patient was found to be negative for COVID-19. He subsequently developed a diffuse rash and had serology consistent with dengue and measles. The patient was treated symptomatically, and his condition gradually improved over 7 days. This case highlights the high prevalence of many tropical diseases in low-income countries and the need for clinicians to consider alternate diagnoses in addition to testing for COVID-19 during the pandemic.


Self-Reported Loss of Smell and Taste in SARS-CoV-2 Patients: Primary Care Data to Guide Future Early Detection Strategies


docid: ktseqswn

title: Letter to the Editor: Safety and Efficacy of Bedside Peritoneal Dialysis Catheter Placement in the COVID-19 Era: Initial Experience at a New York City Hospital


The clinical course and short-term outcome of COVID-19 in a cohort of hemodialysis patients


title: Canonical and Noncanonical Autophagy as Potential Targets for COVID-19

text: The SARS-CoV-2 pandemic necessitates a review of the molecular mechanisms underlying cellular infection by coronaviruses, in order to identify potential therapeutic targets against the associated new disease (COVID-19). Previous studies on its counterparts prove a complex and concomitant interaction between coronaviruses and autophagy. The precise manipulation of this pathway allows these viruses to exploit the autophagy molecular machinery while avoiding its protective apoptotic drift and cellular innate immune responses. In turn, the maneuverability margins of such hijacking appear to be so narrow that the modulation of the autophagy, regardless of whether using inducers or inhibitors (many of which are FDA-approved for the treatment of other diseases), is usually detrimental to viral replication, including SARS-CoV-2. Recent discoveries indicate that these interactions stretch into the still poorly explored noncanonical autophagy pathway, which might play a substantial role in coronavirus replication. Still, some potential therapeutic targets within this pathway, such as RAB9 and its interacting proteins, look promising considering current knowledge. Thus, the combinatory treatment of COVID-19 with drugs affecting both canonical and noncanonical autophagy pathways may be a turning point in the fight against this and other viral infections, which may also imply beneficial prospects of long-term protection.


Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany


title: Development of an indirect ELISA for detecting porcine deltacoronavirus IgA antibodies

text: Porcine deltacoronavirus (PDCoV) is a novel coronavirus that can cause vomiting and watery diarrhea in pigs and death in piglets. Since PDCoV was first detected in 2009 in Hong Kong, the prevalence of PDCoV has increased in recent years, resulting in serious economic losses to the swine industry. The coronavirus spike (S) protein is an antigen that has been demonstrated to contain epitopes that induce neutralizing antibodies. The presence of serum and milk IgA antibodies against pathogens that replicate primarily on mucosal surfaces is important for mucosal immunity. Here, an indirect anti-PDCoV IgA antibody enzyme-linked immunosorbent assay (PDCoV S1 IgA ELISA) using the purified S1 portion of S protein as the coating antigen was developed to detect PDCoV IgA antibodies in serum and sow's milk. A receiver operating characteristic (ROC) curve analysis showed high specificity and sensitivity of the PDCoV-S1-IgA-ELISA based on samples confirmed by IFA. Anti-PDCoV IgA antibodies in 152 serum samples and 65 milk samples collected from six farms that had experienced diarrhea outbreaks within previous last two years were detected by this assay, and 62.5% of the serum samples and 100% of the milk samples were positive for PDCoV. The indirect ELISA method established in this study will provide a convenient tool for measurement of serum and milk IgA levels against PDCoV in pig herds, rapid detection of PDCoV infection in pigs, and evaluation of the immunogenicity of vaccines.


title: Large-scale, in-house production of viral transport media to support SARS-CoV-2 PCR testing in a multi-hospital healthcare network during the COVID-19 pandemic

text: The COVID-19 pandemic has severely disrupted worldwide supplies of viral transport media (VTM) due to widespread demand for SARS-CoV-2 RT-PCR testing. In response to this ongoing shortage, we began production of VTM in-house in support of diagnostic testing in our hospital network. As our diagnostic laboratory was not equipped for reagent production, we took advantage of space and personnel that became available due to closure of the research division of our medical center. We utilized a formulation of VTM described by the CDC that was simple to produce, did not require filtration for sterilization, and used reagents that were available from commercial suppliers. Performance of VTM was evaluated by several quality assurance measures. Based on Ct values of spiking experiments, we found that our VTM supported highly consistent amplification of the SARS-CoV-2 target (coefficient of variation = 2.95%) using the Abbott RealTime SARS-CoV-2 EUA assay on the Abbott m2000 platform. VTM was also found to be compatible with multiple swab types and, based on accelerated stability studies, able to maintain functionality for at least four months at room temperature. We further discuss how we met logistical challenges associated with large-scale VTM production in a crisis setting including use of staged, assembly line for VTM transport tube production.


title: Covid-19 and the digestive system

text: The novel coronavirus disease is currently causing a major pandemic. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the Betacoronavirus genus that also includes the SARS-CoV and Middle East respiratory syndrome coronavirus. While patients typically present with fever and a respiratory illness, some patients also report gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. Studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and its viral receptor angiotensin converting enzyme 2 was found to be highly expressed in gastrointestinal epithelial cells. These suggest that SARS-CoV-2 can actively infect and replicate in the gastrointestinal tract. This has important implications to the disease management, transmission, and infection control. In this article, we review the important gastrointestinal aspects of the disease.


docid: baujkbnz

title: Impact of the COVID-19 pandemic on the management of patients with end-stage renal disease

text: A novel infectious disease, coronavirus disease-2019 (COVID-19), spread globally since December 2019. Without effective treatment and vaccination, the strategies to restrain this disease are only keeping social distance, maintaining personal hygiene, quarantine, and isolation. However, thrice-a-week treatment is inevitable for all hemodialysis patients. In addition to the high risk of cluster infection and compromised immunity in patients with end-stage renal disease (ESRD), an atypical disease presentation could also make the medial system neglect these patients during CVOID-19 pandemic. To avoid COVID-19 transmission among patients on dialysis, the major societies of nephrology around the world have provided their guidelines for screening, dialysis facilities adjustment, and health education, respectively. In this review, we summarized the main contents and differences of these guidelines and addressed the prompt management for patients with ESRD to reduce the risk of infection during COVID-19 pandemic.


title: Impact of the COVID-19 Pandemic on the Management of End-Stage Renal Disease Patients

text: A novel infectious disease, Coronavirus disease -2019 (COVID-19), spread globally since Dec. 2019. Without effective treatment and vaccination, the strategies to restrain this disease is only keeping social distance, maintaining personal hygiene, quarantine and isolation. However, thrice-a-week treatment is inevitable for all hemodialysis patients. In addition to the high risk of cluster infection and compromised immunity in patients with end-stage renal disease (ESRD), an atypical disease presentation could also make the medial system neglect these patients during CVOID-19 pandemic. To avoid COVID-19 transmission among dialysis patients, the major societies of nephrology around the world have provided their guidelines of screening, dialysis facilities adjustment, and health education, respectively. In this review, we summarized the main contents and difference of these guidelines and addressed the prompt management for ESRD patients to reduce the risk of infection during COVID-19 pandemic.


title: In vivo effect of UV-photofunctionalization of CoCrMo in processes of guided bone regeneration and tissue engineering

text: Photofunctionalization of implant materials with ultraviolet radiation (UV) have been subject of study in the last two decades, and previous research on CoCrMo discs have showed good results in terms of bioactivity and the findings of apatite-like crystals in vitro. In the current study, CoCrMo domes were photofunctionalized with UV radiation of 254 nm on their internal faces during 24 hours; they were implanted in rabbit tibia and remained for 3, 4 and 6 weeks. The potential to induce bone formation beneath the dome-shaped membranes was evaluated through morphometric, histologic and density measurements; and the results were compared with those obtained under control untreated domes. Higher density values were observed for irradiated domes at 3 weeks, while higher volumes were obtained under photofunctionalized domes for longer periods (4 and 6 weeks). Histologically, woven bone was formed by endochondral ossification in all cases; differences in the architecture and size of the trabeculae and in the number of osteoblasts were noted between irradiated and non-irradiated samples. The UV radiation of 254 nm generated a larger bone volume fraction compared to that found in the absence of UVC radiation, and induced an increase of density in the early stages of healing, leading to a better initial bone quality and improved osseointegration.


title: COVID-19 pandemic: overview of protective-ventilation strategy in ARDS patients

text: Objectives: In the context of COVID-19 pandemic, the aim of this manuscript is to provide a standard of care of patients with ARDS for non-emergency medicine trained physicians who are not customary with mechanical ventilation.Methods: We conducted a systematic review of the literature to investigate the best practice recommendations regarding the mechanical ventilation of patients with ARDS.Conclusion: We summarized the principal strategies for lung-protective ventilation of patients with ARDS. This focus is particularly addressed to physicians who are not experienced in the invasive respiratory management of ARDS patients. Nevertheless, it remains fundamental to acknowledge that new insights concerning this quickly spreading illness become available on a regular base.


Baricitinib for COVID-19: a suitable treatment? - Authors' reply


Covid-19: Confidentiality agreements allow antibody test manufacturers to withhold evaluation results


title: COVID-19, Australia: Epidemiology Report 5 (Reporting week ending 19:00 AEDT 29 February 2020)

text: This is the fifth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 19:00 Australian Eastern Daylight Time [AEDT] 29 February 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.


title: Pandemic Risks and Equilibrium Social Distancing in Heterogeneous Networks

text: We study a SIRD epidemic process among a heterogeneous population that interacts through a network. We give general upper bounds for the size of the epidemic starting from a (small) set of initially infected individuals. Moreover, we characterize the epidemic reproduction numbers in terms of the spectral properties of a relevant matrix based on the network adjacency matrix and the infection rates. We suggest that this can be used to identify sub-networks that have high reproduction numbers before the epidemic reaches and picks up in them. When we base social contact on a random graph with given vertex degrees, we give limit theorems on the fraction of infected individuals. For a given social distancing individual strategies, we establish the epidemic reproduction number $\mathfrak{R}_0$ which can be used to identify network vulnerability and inform vaccination policies. In the second part of the paper we study the equilibrium of the social distancing game and we show that voluntary social distancing will always be socially sub-optimal. Our numerical study using Covid-19 data serves to quantify the absolute and relative utility gaps across age cohorts.


title: Experiencing the Surge: Report from a Large New York Radiation Oncology Department During the COVID-19 Pandemic

text: Purpose/Objective(s): The COVID-19 pandemic is impacting all aspects of life and changing the practice of medicine. Multiple recommendations exist on how radiation oncology practices should deal with this crisis, but little information is available on what actually happens when the COVID-19 surge arrives. New York City experienced the first surge of COVID-19 in the United States and is now the epicenter of the global pandemic. This study reviews the impact of COVID-19 on a hospital system in New York on aspects of medicine, nursing, radiation therapy, and administration.Materials/Methods: A retrospective review was conducted of the department of radiation oncology in a single health system in New York from 3/1/20 to 4/1/20. Collaboration was obtained from physicians, nursing, radiation therapy, and administration to recall their policies and impact on specific duties. A timeline was reconstructed to chronicle significant events. Numbers were obtained for patients on treatment, treatments breaks, and COVID-19 infections amongst staff and patients. Results: The COVID-19 surge had a tremendous impact on the health system including cessation of all of surgeries, including oncologic surgery, as well as transfer of all inpatient oncology services to makeshift outpatient facilities. Radiation Oncology made aggressive efforts to reduce patients on treatment to protect patients and staff as well reallocate staff and space for more acute clinical needs. Patients on-beam were reduced by 27% from 172 to 125 by 4/1/20. Almost all visits were changed to telemedicine within 2 weeks. Infection rates and quarantine were quite low amongst staff and patients. The majority of residents were deployed into COVID-19 clinical settings. Conclusion: While "planning for the worst", our health system was able to make necessary changes to still function at a reduced capacity. Our experience will give other departments a concrete experience to help them make their own policies and manage expectations.


How the Lives of Neuroradiologists and Neurosurgeons Have Been Changed by COVID-19


title: Estimation and prediction of COVID-19 cases in Brazilian metropolises

text: OBJECTIVE: to estimate the transmission rate, the epidemiological peak, and the number of deaths by the new coronavirus. METHOD: a mathematical and epidemiological model of susceptible, infected, and recovered cases was applied to the nine Brazilian capitals with the highest number of cases of the infection. The number of cases for the 80 days following the first case was estimated by solving the differential equations. The results were logarithmized and compared with the actual values to observe the model fit. In all scenarios, it was considered that no preventive measures had been taken. RESULTS: the nine metropolises studied showed an upward curve of confirmed cases of COVID-19. The prediction data point to the peak of the infection between late April and early May. Fortaleza and Manaus had the highest transmission rates (≥2·0 and ≥1·8, respectively). Rio de Janeiro may have the largest number of infected people (692,957) and Florianópolis the smallest (24,750). CONCLUSION: the estimates of the transmission rate, epidemiological peak, and number of deaths from coronavirus in Brazilian metropolises presented expressive and important numbers the Brazilian Ministry of Health needs to consider. The results confirm the rapid spread of the virus and its high mortality in the country.


title: Liver injury in COVID-19: The current evidence

text: Patients with novel coronavirus disease 2019 (COVID-19) experience various degrees of liver function abnormalities. Liver injury requires extensive work-up and continuous surveillance and can be multifactorial and heterogeneous in nature. In the context of COVID-19, clinicians will have to determine whether liver injury is related to an underlying liver disease, drugs used for the treatment of COVID-19, direct effect of the virus, or a complicated disease course. Recent studies proposed several theories on potential mechanisms of liver injury in these patients. This review summarizes current evidence related to hepatobiliary complications in COVID-19, provides an overview of the available case series and critically elucidates the proposed mechanisms and provides recommendations for clinicians.


title: Degenerate Fermion Dark Matter from a Broken $U(1)_{\rm B-L}$ Gauge Symmetry

text: The extension of the Standard model by assuming $U(1)_{\rm B-L}$ gauge symmetry is very well-motivated since it naturally explains the presence of heavy right-handed neutrinos required to account for the small active neutrino masses via the seesaw mechanism and thermal leptogenesis. Traditionally, we introduce three right handed neutrinos to cancel the $[U(1)_{\rm B-L}]^3$ anomaly. However, it suffices to introduce two heavy right-handed neutrinos for these purposes and therefore we can replace one right-handed neutrino by new chiral fermions to cancel the $U(1)_{\rm B-L}$ gauge anomaly. Then, one of the chiral fermions can naturally play a role of a dark matter candidate. In this paper, we demonstrate how this framework produces a dark matter candidate which can address the so-called"core-cusp problem". As one of the small scale problems that $\Lambda$CDM paradigm encounters, it may imply an important clue for a nature of dark matter. One of resolutions among many is hypothesizing that sub-keV fermion dark matter halos in dwarf spheroidal galaxies are in (quasi) degenerate configuration. We show how the degenerate sub-keV fermion dark matter candidate can be non-thermally originated in our model and thus can be consistent with Lyman-$\alpha$ forest observation. Thereby, the small neutrino mass, baryon asymmetry, and the sub-keV dark matter become consequences of the broken B-L gauge symmetry.


Ramadan and COVID-19: A Challenge amongst Challenges


title: Fisioterapia na recuperação funcional e qualidade de vida de cães paraplégicos por doença do disco intervertebral (Hansen tipo I) toracolombar submetidos à cirurgia descompressiva/ Physiotherapy in functional recovery and quality of life of paraplegic dogs due to thoracolumbar intervertebral disc disease (Hansen type I) submitted to decompressive surgery

text: Este estudo retrospectivo incluiu cães paraplégicos com ausência de percepção a dor profunda secundário a doença do disco intervertebral toracolombar e submetidos à cirurgia descompressiva. Teve como objetivo comparar a recuperação funcional e a qualidade de vida (QV) quando submetidos a um protocolo em um centro especializado ou a domicílio realizado pelo tutor. Vinte e oito cães foram distribuídos no grupo A (GA) e submetidos ao protocolo domiciliar e 38 denominados grupo B (GB) em um centro especializado. Recuperaram a habilidade de caminhar 43% dos cães em uma média de 40 dias de pós-operatório (PO) no GA e 42% em uma média de 36 dias no GB. Em 53% dos casos (35/66) os cães permaneceram paraplégicos sem percepção a dor profunda ao final do período de 90 dias de PO. Vinte e cinco tutores do GA e 26 do GB responderam um questionário sobre a QV, com no mínimo seis meses de PO. A avaliação do tempo de sobrevida dos animais, realização de eutanásia e nota atribuída a QV demonstraram que os cães do GB provavelmente foram beneficiados pelo estreito acompanhamento e orientação aos tutores até 90 dias PO.(AU)


Re: Delayed Radical Prostatectomy is not Associated with Adverse Oncological Outcomes: Implications for Men Experiencing Surgical Delay due to the COVID-19 Pandemic


title: COVID-19, Australia: Epidemiology Report 8 (Reporting period from 19:00 AEDT 14 March to 23:59 AEDT 22 March 2020)

text: This is the eighth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 23:59 Australian Eastern Daylight Time [AEDT] 22 March 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.


title: Aerosolization of COVID-19 and Contamination Risks During Respiratory Treatments

text: Background: Aerosolized medications are frequently administered across the health care continuum to acutely ill patients During viral pandemics, the World Health Organization and the Centers for Disease Control and Prevention advise the application of airborne precautions when performing aerosol-generating medical procedures, such as aerosolized medications Observations: Appropriate personal protective equipment (PPE), including fit-tested particulate respirators should be worn when administering nebulized medications to patients These PPEs have been in short supply in the US during early phases of the COVID-19 pandemic, which is increasing the risk faced by health care workers (HCWs) who are treating patients using aerosolized medications Despite taking appropriate precautions, HCWs are becoming infected with COVID-19 This may be related to secondary exposure related to viral longevity in fugitive emissions and viability on fomites Conclusions: We have expanded on non-US public health recommendations to provide guidance to frontline HCWs to enhance collaboration between clinicians, who are often siloed in their clinical practices, and ultimately to protect the federal workforce, which cannot sustain a significant loss of frontline HCWs


docid: pthocnzv

title: A Simple Three-Tier Classification System for Triage, Communication, and Resource Utilization by Patients Afflicted with COVID-19 Disease


title: Ayurveda and COVID-19: Where psychoneuroimmunology and the meaning response meet

text: The COVID-19 pandemic has led to high levels of psychological distress in the general public, including symptoms of anxiety and depression. Such distress is associated with alterations in immune function, including an elevated risk of viral respiratory tract infections. In this light, the possible effects of Ayurveda, a traditional system of medicine promoted by the Indian government as an "immune booster", are examined from the point of view of psychoneuroimmune mechanisms as well as the "meaning response" described by Moerman. It was found that many of the measures advocated in their guidelines could positively influence immunity either by direct effects on symptoms of depression or anxiety, or through their symbolic significance. Therefore, it is possible that such traditional practices could be beneficial both in terms of psychological quality of life, and in terms of moderating the risk of infection.


title: Anxiety and Depression Scores in Maternity Healthcare Workers during the Covid-19 Pandemic

text: While Severe-Acute-Respiratory-Syndrome-CoronaVirus-2 (SARSCoV-2/Covid-19) causes physical morbidity for healthcare workers (HCWs), Covid-19 also carries psychological morbidity for HCWs. This morbidity translates to anxiety and depressive symptomatology. To this end, we assessed anxiety and depression among HCWs during Covid-19 pandemic.


title: Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study

text: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its caused coronavirus disease 2019 (COVID-19) has been reported in China since December 2019. More than 16% of patients developed acute respiratory distress syndrome, and the fatality ratio was about 1%-2%. No specific treatment has been reported. Herein, we examine the effects of Favipiravir (FPV) versus Lopinavir (LPV)/ritonavir (RTV) for the treatment of COVID-19. Patients with laboratory-confirmed COVID-19 who received oral FPV (Day 1: 1600 mg twice daily; Days 2-14: 600 mg twice daily) plus interferon (IFN)-α by aerosol inhalation (5 million U twice daily) were included in the FPV arm of this study, whereas patients who were treated with LPV/RTV (Days 1-14: 400 mg/100 mg twice daily) plus IFN-α by aerosol inhalation (5 million U twice daily) were included in the control arm. Changes in chest computed tomography (CT), viral clearance, and drug safety were compared between the two groups. For the 35 patients enrolled in the FPV arm and the 45 patients in the control arm, all baseline characteristics were comparable between the two arms. A shorter viral clearance time was found for the FPV arm versus the control arm (median (interquartile range, IQR), 4 (2.5-9) d versus 11 (8-13) d, P < 0.001). The FPV arm also showed significant improvement in chest imaging compared with the control arm, with an improvement rate of 91.43% versus 62.22% (P = 0.004). After adjustment for potential confounders, the FPV arm also showed a significantly higher improvement rate in chest imaging. Multivariable Cox regression showed that FPV was independently associated with faster viral clearance. In addition, fewer adverse reactions were found in the FPV arm than in the control arm. In this open-label nonrandomized control study, FPV showed significantly better treatment effects on COVID-19 in terms of disease progression and viral clearance; if causal, these results should be important information for establishing standard treatment guidelines to combat the SARS-CoV-2 infection.


title: Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak - New York City, March 11-May 2, 2020

text: SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), was first identified in December 2019 in Wuhan, China, and has since spread worldwide. On March 11, 2020, the World Health Organization declared COVID-19 a pandemic (1). That same day, the first confirmed COVID-19-associated fatality occurred in New York City (NYC). To identify confirmed COVID-19-associated deaths, defined as those occurring in persons with laboratory-confirmed SARS-CoV-2 infection, on March 13, 2020, the New York City Department of Health and Mental Hygiene (DOHMH) initiated a daily match between all deaths reported to the DOHMH electronic vital registry system (eVital) (2) and laboratory-confirmed cases of COVID-19. Deaths for which COVID-19, SARS-CoV-2, or an equivalent term is listed on the death certificate as an immediate, underlying, or contributing cause of death, but that do not have laboratory-confirmation of COVID-19 are classified as probable COVID-19-associated deaths. As of May 2, a total of 13,831 laboratory-confirmed COVID-19-associated deaths, and 5,048 probable COVID-19-associated deaths were recorded in NYC (3). Counting only confirmed or probable COVID-19-associated deaths, however, likely underestimates the number of deaths attributable to the pandemic. The counting of confirmed and probable COVID-19-associated deaths might not include deaths among persons with SARS-CoV-2 infection who did not access diagnostic testing, tested falsely negative, or became infected after testing negative, died outside of a health care setting, or for whom COVID-19 was not suspected by a health care provider as a cause of death. The counting of confirmed and probable COVID-19-associated deaths also does not include deaths that are not directly associated with SARS-CoV-2 infection. The objective of this report is to provide an estimate of all-cause excess deaths that have occurred in NYC in the setting of widespread community transmission of SARS-CoV-2. Excess deaths refer to the number of deaths above expected seasonal baseline levels, regardless of the reported cause of death. Estimation of all-cause excess deaths is used as a nonspecific measure of the severity or impact of pandemics (4) and public health emergencies (5). Reporting of excess deaths might provide a more accurate measure of the impact of the pandemic.


title: Spatiotemporal pattern of COVID-19 and government response in South Korea (as of May 31, 2020)

text: OBJECTIVES: The aim of this study is to assess how COVID-19 clustered across districts in South Korea and to assess whether the pattern and duration of clusters changed following the country's containment strategy. METHODS: We conducted spatiotemporal analysis of COVID-19 daily confirmed cases by 250 districts in South Korea from January 20 to May 31, 2020, obtained from the Korea Centers for Disease Control and Prevention and each provincial website. Global Moran's I statistic was used for spatial autocorrelation analysis and retrospective space-time scan statistic was used to analyze spatiotemporal clusters of COVID-19. RESULTS: The geographical distribution showed strong spatial autocorrelation, with a global Moran's I coefficient of 0.784 (p = 0.0001). Twelve statistically significant spatiotemporal clusters were identified by space-time scan statistic using a discrete Poisson model. The spatial pattern of clusters changed and the duration of clusters became shorter over time. CONCLUSIONS: Results indicate that South Korea's containment strategy of COVID-19 was highly effective in both early detection and mitigation, with recent clusters being small in size and duration. Lessons from South Korea should spark a discussion on epidemic response.


Musculoskeletal symptoms in SARS-CoV-2 (COVID-19) patients


title: [Emergency surgery during COVID-19 pandemia.]

text: INTRODUCTION: The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation Furthermore, we propose a general action protocol for these patients MATERIAL AND METHODS: The document is based ont he scarce evidence on SARS / Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery" and "emergency care" A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria Finally, a definitive version was made, agreed by all the authors on May 12, 2020 RESULTS: General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures CONCLUSIONS: Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology The information is changing, as the epidemiological knowledge of the disease advances The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with protective measures for the patient and other healthcare personnel


title: COVID-19: Regulatory Landscape of Medicinal and Medical Device Products for Human Use

text: Against the backdrop of the COVID pandemic, the scientific and medical communities are working with all deliberate speed with state-of-the-art technologies to develop diagnostic and therapeutic products that can identify, treat, and prevent infection with SARS-CoV-2. These activities may only be legally conducted with the necessary statutes and regulations in place to facilitate the timely development, manufacturing, evaluation, and distribution of products that meet quality standards. The present regulatory landscape for medicinal and medical products for human use has been shaped by nearly 12 decades of statutory history that followed in reaction to disasters and tragedies. Five distinct, closely woven threads of statutory history have led to the regulatory infrastructure we have in place: (1) standardized processes for routine development of medicinal and medical device products for human use; (2) processes for expedited development to shorten time frames and expand patient populations; (3) mechanisms of Expanded Access to make medicinal products available to patients prior to approval of the US Food and Drug Administration; (4) Emergency Use Authorization during public health emergencies; and (5) the development of pathways for bringing generic drugs and biosimilar biologics to market. These mechanisms are being brought to bear to facilitate the defeat of infection with SARS-CoV-2.


Peripheral nerve blocks in a patient with suspected COVID-19 infection


Highlights of the May issue


title: Earliest cases of coronavirus disease 2019 (COVID-19) identified in solid organ transplant recipients in the United States

text: With the rapidly expanding pandemic of SARS-CoV-2, there is concern that solid organ transplant recipients will be particularly vulnerable to infection and may experience a more severe clinical course. We report four cases of COVID-19 in solid organ transplant recipients including recipients of kidney, liver, lung, and heart transplants. We describe each patient's medical history including transplantation history, their clinical presentation and workup, and their course from diagnosis to either hospital discharge or to improvement in symptoms. These reports demonstrate a range of symptoms, clinical severity, and disease course in solid organ transplant recipients with COVID-19, including two hospitalized patients and two patients managed entirely in the outpatient setting.


title: The Psychological Impacts of a COVID-19 Outbreak on College Students in China: A Longitudinal Study

text: An outbreak in Wuhan, China in late 2019 of a highly infectious new coronary pneumonia (COVID-19) led to the imposition of countrywide confinement measures from January to March 2020. This is a longitudinal study on changes in the mental health status of a college population before and after their COVID-19 confinement for the first two weeks, focusing on states of psychological distress, depression, anxiety and affectivity. The influence of possible stressors on their mental health were investigated, including inadequate supplies and fears of infection. Five hundred and fifty-five undergraduate students were recruited from Hebei Agricultural University in Baoding, China. The participants completed two online surveys-on anxiety and depression, and on positive and negative affect. One survey was conducted before the confinement and the other was conducted 15-17 days after the start of the confinement. Increases in negative affect and symptoms of anxiety and depression (p-values < 0.001) were observed after 2 weeks of confinement. Inadequate supplies of hand sanitizers, a higher year of study, and higher scores on anxiety and depression were common predictors of increased negative affect, anxiety, and depression across the confinement period. The results suggest that healthcare policymakers should carefully consider the appropriate confinement duration, and ensure adequate supplies of basic infection-control materials.


title: Longitudinal study of interventional radiology activity in a large metropolitan Italian tertiary care hospital: how the COVID-19 pandemic emergency has changed our activity

text: OBJECTIVES: To retrospectively analyze interventional radiology (IR) activity changes in the COVID-19 era and to describe how to safely and effectively reorganize IR activity. METHODS: All IR procedures performed between January 30 and April 8, 2020 (COVID-era group) and the same 2019 period (non-COVID-era group) were retrospectively included and compared. A sub-analysis for the lockdown period (LDP: 11 March-8 April) was also conducted. Demographic, hospitalization, clinical, and procedural data were obtained for both groups and statistically compared with univariable analysis. RESULTS: A total of 1496 procedures (non-COVID era, 825; COVID era, 671) performed in 1226 patients (64.9 ± 15.1 years, 618 women) were included. The number of procedures decreased by 18.6% between 2019 and 2020 (825 vs 671, p < .001), with a reduction by 48.2% in LDP (188 vs 363, p < .0001). In the LDP COVID era, bedside procedures were preferred (p = .013), with an increase in procedures from the intensive care unit compared with the emergency department and outpatients (p = .048), and an increased activity for oncological patients (p = .003). No incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of healthcare workers in the IR service was registered. CONCLUSIONS: Coronavirus disease outbreak changed the interventional radiology activity with an overall reduction in the number of procedures. However, this study confirms that interventional radiology continuum of care can be safely performed also during the pandemic, following defined measures and protocols, taking care of all patients. KEY POINTS: â¢ Coronavirus disease pandemic determined a reduction of interventional radiology activity as compared to the same period of the previous year. â¢ Interventional radiology procedures for life-threatening conditions and non-deferrable oncologic treatments were prioritized as opposed to elective procedures. â¢ Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service.


Thousands of people will help scientists to track the long-term health effects of the coronavirus crisis


COVID-19 diagnostic process in mainland China: The math beyond pneumonia


title: Guidelines and Recommendations for Patient Management, Surgical Activities, and Safety in the Maxillofacial Unit and Head and Neck Department During COVID-19 Pandemic

text: The recent pandemic has led to an unprecedented overload of sanitary systems around the world. Despite that a maxillofacial department is not a frontline specialty in the treatment of coronavirus disease 2019 infections, our department has found itself faced with numerous problems in keeping the care system active and efficient while ensuring safety for patients and healthcare professionals. Massive redistribution of health personnel was needed to improve prevention and personal safety measures. The education and training system has been kept active, giving residents a decisive role in managing the state of emergency response. This article outlines new guidelines for infection prevention: from clinical control, treatment processes, clinical management, protection, and disinfection of healthcare professionals.


COVID-19 Health Technology Governance, Epistemic Competence, and the Future of Knowledge in an Uncertain World


title: Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available. OBJECTIVE: We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation. METHODS: Patients with COVID-19 who were hospitalized from February 29 to April 9, 2020, were analyzed for baseline clinical and laboratory findings at admission and during the disease. Data from 89 evaluable patients were available for the purpose of analysis comprising an initial evaluation cohort (n = 40) followed by a temporally separated validation cohort (n = 49). RESULTS: We identified markers of inflammation, lactate dehydrogenase, and creatinine as the variables most predictive of respiratory failure in the evaluation cohort. Maximal IL-6 level before intubation showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. The respective AUC values for IL-6 and CRP levels in the evaluation cohort were 0.97 and 0.86, and they were similar in the validation cohort (0.90 and 0.83, respectively). The calculated optimal cutoff values during the course of disease from the evaluation cohort (IL-6 level > 80 pg/mL and CRP level > 97 mg/L) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure. CONCLUSION: The maximal level of IL-6, followed by CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP level to guide escalation of treatment in patients with COVID-19-related hyperinflammatory syndrome.


Convalescent plasma for COVID-19: Back to the future


title: COVID-19 and pregnancy - where are we now? A review

text: The new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.


title: The potential of putative zinc-binding motifs of haemagglutinin (HA) protein for categorization and prediction of pathogenicity of H5 subtypes of avian influenza virus

text: In the present study, we used the potential of bioinformatics and computational analysis to predict the existence and biological relevance of zinc finger (ZF) motifs in heamagglutinin (HA) protein of Avian Influenza (AI) virus. Sequence data of Avian Influenza (AI) viruses were retrieved from accessible databases (GenBank, GISAID, IRD) and analyzed for the existence, as well as functional prediction of the putative zinc finger or ''zinc-binding'' motif(s) of HA protein. It is hypothesized that the ZF motif(s) in HA of AI virus can be used as a ''novel'' biomarker for categorization of the virus and/or its virulence. As a model for analysis, we used the H5 subtypes of highly pathogenic, non-pathogenic and low pathogenic avian influenza (HPAI, NPAI and LPAI) viruses of H5N1 and H5N2 of avian and human origins. Interestingly, our method of characterization using the zinc-finger agrees with the existing classification in distinguishing between highly pathogenic and non-pathogenic or low pathogenic subtypes. The new method also clearly distinguished between low and non-pathogenic strains of H5N2 and H5N1 which are indistinguishable by the existing method that utilizes the sequence of the polybasic amino acids of the proteolytic cleavage site for pathogenicity. It is hypothesized that zinc through the activities of zinc-binding proteins modulates the virulence property of the viral subtypes. Our observation further revealed that only the HA protein among the eight encoded proteins of influenza viruses contain high numbers of Cys-His residues. It is expected that the information gathered from the analysis of the data will be useful to generate more research hypotheses/designs that will give further insight towards the identification and control of avian influenza virus through the molecular manipulation of zinc finger motifs present in viral HA protein.


Covid-19: Delays in attending emergency departments may have contributed to deaths of nine children


title: The Virtual Neurologic Exam: Instructional Videos and Guidance for the COVID-19 Era

text: OBJECTIVE: To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond. METHODS: The full neurologic examination is described with attention to components that can be performed virtually. RESULTS: A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations). CONCLUSIONS: During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.


The Adaptation of Management of Chronic Migraine Patients With Medication Overuse to the Suspension of Treatment Protocols During the COVID-19 Pandemic: Lessons From a Tertiary Headache Center in Milan, Italy


Refugee and migrant health in the COVID-19 response


Mass intake of hydroxychloroquine or chloroquine in the present context of the Covid-19 outbreak: Possible consequences in endemic malaria settings


title: In-silico approaches to detect inhibitors of the human severe acute respiratory syndrome coronavirus envelope protein ion channel

text: Recent outbreak of Coronavirus disease (COVID-19) pandemic around the world is associated with 'severe acute respiratory syndrome' (SARS-CoV2) in humans. SARS-CoV2 is an enveloped virus and E proteins present in them are reported to form ion channels, which is mainly associated with pathogenesis. Thus, there is always a quest to inhibit these ion channels, which in turn may help in controlling diseases caused by SARS-CoV2 in humans. Considering this, in the present study, authors employed computational approaches for studying the structure as well as function of the human 'SARS-CoV2 E' protein as well as its interaction with various phytochemicals. Result obtained revealed that α-helix and loops present in this protein experience random movement under optimal condition, which in turn modulate ion channel activity; thereby aiding the pathogenesis caused via SARS-CoV2 in human and other vertebrates. However, after binding with Belachinal, Macaflavanone E, and Vibsanol B, the random motion of the human 'SARS-CoV2 E' protein gets reduced, this, in turn, inhibits the function of the 'SARS-CoV2 E' protein. It is pertinent to note that two amino acids, namely VAL25 and PHE26, play a key role while interacting with these three phytochemicals. As these three phytochemicals, namely, Belachinal, Macaflavanone E & Vibsanol B, have passed the ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) property as well as 'Lipinski's Rule of 5s', they may be utilized as drugs in controlling disease caused via SARS-COV2, after further investigation.Communicated by Ramaswamy H. Sarma.


Challenges and Responsibilities in Caring for the Most Vulnerable During the COVID-19 Pandemic


Acute Respiratory Failure in COVID-19 Pneumoniae: The Best Interface for an Optimal Management. A South Italian Experience


title: High-flow cannulas will be required with current COVID-19 crisis, not only mechanical ventilators

text: COVID-19 is characterized by acute respiratory distress syndrome progression, which ranges from mild to severe. A percentage of critically ill patients will require endotracheal intubation and mechanical ventilation; therefore, Mexican engineers from different places have had the initiative of creating mechanical ventilators. Although artificial ventilator is one of the last resources for the most severely ill patients, there are patients who are on the verge of not meeting the criteria for intubation; if they are directly intubated, the opportunity for them to overcome the severe phase with high concentration supplemental oxygen would be be missed. Intubation per se induces lung damage, increases the risk of superinfection, and the number of days of ICU stay. Furthermore, non-selective use of artificial ventilators decreases the opportunity for patients who require a ventilator to survive and increases institutional care costs of both human and material resources.


The use of aspirated consonants during speech may increase the transmission of COVID-19


title: Construction of 5G intelligent medical service system in novel coronavirus pneumonia prevention and control/ 中华急诊医学杂志

text: Objective@#To analyze application fields of 5G communication technology in Corona Virus Disease 2019 (COVID-19) epidemic prevention and control, and build a 5G intelligent medical service system for COVID-19 epidemic prevention and control in China.@*Methods@#We collected and analyzed 5G technology application cases used in the fight against COVID-19 from December 2019 to February 2020: 5G + telemedicine application cases, 5G + negative pressure ambulance cases, 5G + remote monitoring cases, 5G + artificial intelligence cases, 5G + infrared thermography temperature detection cases, 5G + big data analysis cases for epidemic prevention and control.@*Results@#Through the analysis of 5G application cases in COVID-19 epidemic prevention and control, we found out the key elements of 5G intelligent medical service system in COVID-19 epidemic prevention and control. By optimizing and upgrading the internal service mode of the hospital, breaking the internal and external barriers, integrating internal and external resources, and strengthening 5G intelligent medical security, we can form a 5G intelligent medical service system for COVID-19 epidemic prevention and control, including application layer, technical service layer, network support layer and security system layer.@*Conclusion@#5G communication technology has the characteristics of faster speed, shorter time delay and denser capacity. In COVID-19 epidemic prevention and control work, it can further improve the efficiency of doctors' diagnosis, improve patients' medical experience, realize the remote sharing of high-quality medical resources and real-time information exchange, effectively block the spread of epidemic, alleviate the shortage of medical resources and medical staff, and make the epidemic prevention and control more efficient.


Call for Papers: The Pathophysiology of COVID-19 and SARS-CoV-2 Infection


title: Rapid implementation of virtual neurology in response to the COVID-19 pandemic

text: The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.


Decreased Mortality of COVID-19 With Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients With Hypertension: A Meta-Analysis


David Oliver: Covid-19 highlights the need for effective government communications


title: Evidence for host-dependent RNA editing in the transcriptome of SARS-CoV-2

text: The COVID-19 outbreak has become a global health risk, and understanding the response of the host to the SARS-CoV-2 virus will help to combat the disease. RNA editing by host deaminases is an innate restriction process to counter virus infection, but it is not yet known whether this process operates against coronaviruses. Here, we analyze RNA sequences from bronchoalveolar lavage fluids obtained from coronavirus-infected patients. We identify nucleotide changes that may be signatures of RNA editing: adenosine-to-inosine changes from ADAR deaminases and cytosine-to-uracil changes from APOBEC deaminases. Mutational analysis of genomes from different strains of Coronaviridae from human hosts reveals mutational patterns consistent with those observed in the transcriptomic data. However, the reduced ADAR signature in these data raises the possibility that ADARs might be more effective than APOBECs in restricting viral propagation. Our results thus suggest that both APOBECs and ADARs are involved in coronavirus genome editing, a process that may shape the fate of both virus and patient.


Single ventilator for multiple patients during COVID19 surge: matching and balancing patients


title: Gender equity and public health outcomes: The COVID-19 experience

text: This paper extends the growing research on the impact of gender equity on public health outcomes using the ongoing Covid-19 pandemic as its research setting. Specifically, it introduces a conceptual model incorporating the impact of gender equity and human development on women's representation in legislature and public health expenditure, and their combined impact with human environment (population density, aging population and urban population) on important public health outcomes in the Covid-19 context, including the total number of tests, diagnosed, active and critical cases, and deaths. Data from 210 countries shows support for many of the hypothesized relationships in the conceptual model. The results provide useful insights about the factors that influence the representation of women in political systems around the world and its impact on public health outcomes. The authors also discuss implications for public health policy-makers to ensure efficient and effective delivery of public health services in future.


COVID-19 convalescent plasma donor recruitment: beware the Faustian bargains


Elevated serum levels of S100A8/A9 and HMGB1 at hospital admission are correlated with inferior clinical outcomes in COVID-19 patients


title: A mechanistic model and therapeutic interventions for COVID-19 involving a RAS-mediated bradykinin storm

text: Neither the disease mechanism nor treatments for COVID-19 are currently known. Here we present a novel molecular mechanism for COVID-19 that provides therapeutic intervention points that can be addressed with existing FDA-approved pharmaceuticals. The entry point for the virus is ACE2, which is a component of the counteracting hypotensive axis of RAS, that produces the nonapeptide angiotensin1-9 from angiotensin I. Bradykinin is a potent, but often forgotten, part of the vasopressor system that induces hypotension and vasodilation 1, and is regulated by ACE and enhanced by angiotensin1-9 2. Here we perform a completely new analysis on gene expression data from cells of bronchoalveolar lavage samples from COVID-19 patients that were used to sequence the virus, but the host information was discarded 3. Comparison with lavage samples from controls identify a critical imbalance in RAS represented by decreased expression of ACE in combination with increases in ACE2, renin (REN) , angiotensin (AGT), key RAS receptors (AGTR2, AGTR1), kinogen (KNG) and the kallikrein enzymes (KLKB1, many of KLK-1-15) that activate it, and both bradykinin receptors (BDKRB1, BDKRB2). This very atypical pattern of the RAS is predicted to elevate bradykinin levels in multiple tissues and systems that will likely cause increases in vascular dilation, vascular permeability and hypotension. These bradykinin-driven outcomes explain many of the symptoms being observed in COVID-19.


title: Orchiepididymitis in a Boy with Covid-19

text: Coronavirus disease 2019 (COVID-19) symptoms in children are incompletely described. We present the first case of orchiepididymitis associated with COVID-19 in a boy and discuss pathways of testicular involvement by SARS-CoV2 virus. This case underlines the need for further study of the clinical presentation of pediatric COVID-19 and the potential association with nonrespiratory symptoms.


title: Rapid Direct Nucleic Acid Amplification Test without RNA Extraction for SARS-CoV-2 Using a Portable PCR Thermocycler

text: There is an ongoing worldwide coronavirus disease 2019 (Covid-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, confirmatory diagnosis is by reverse transcription polymerase chain reaction (RT-PCR), typically taking several hours and requiring a molecular laboratory to perform. There is an urgent need for rapid, simplified, and cost-effective detection methods. We have developed and analytically validated a protocol for direct rapid extraction-free PCR (DIRECT-PCR) detection of SARS-CoV-2 without the need for nucleic acid purification. As few as six RNA copies per reaction of viral nucleocapsid (N) gene from respiratory samples such as sputum and nasal exudate can be detected directly using our one-step inhibitor-resistant assay. The performance of this assay was validated on a commercially available portable PCR thermocycler. Viral lysis, reverse transcription, amplification, and detection are achieved in a single-tube homogeneous reaction within 36 min. This minimizes hands-on time, reduces turnaround-time for sample-to-result, and obviates the need for RNA purification reagents. It could enable wider use of Covid-19 testing for diagnosis, screening, and research in countries and regions where laboratory capabilities are limiting.


title: Lessons learned from the 2019-nCoV epidemic on prevention of future infectious diseases

text: Only a month after the outbreak of pneumonia caused by 2019-nCoV, more than forty-thousand people were infected. This put enormous pressure on the Chinese government, medical healthcare provider, and the general public, but also made the international community deeply nervous. On the 25th day after the outbreak, the Chinese government implemented strict traffic restrictions on the area where the 2019-nCoV had originated-Hubei province, whose capital city is Wuhan. Ten days later, the rate of increase of cases in Hubei showed a significant difference (p = 0.0001) compared with the total rate of increase in other provinces of China. These preliminary data suggest the effectiveness of a traffic restriction policy for this pandemic thus far. At the same time, solid financial support and improved research ability, along with network communication technology, also greatly facilitated the application of epidemic prevention measures. These measures were motivated by the need to provide effective treatment of patients, and involved consultation with three major groups in policy formulation-public health experts, the government, and the general public. It was also aided by media and information technology, as well as international cooperation. This experience will provide China and other countries with valuable lessons for quickly coordinating and coping with future public health emergencies.


title: COVID-19 Twitter Dataset with Latent Topics, Sentiments and Emotions Attributes

text: This resource paper describes a large dataset covering over 63 million coronavirus-related Twitter posts from more than 13 million unique users since 28 January to 1 July 2020. As strong concerns and emotions are expressed in the tweets, we analyzed the tweets content using natural language processing techniques and machine-learning based algorithms, and inferred seventeen latent semantic attributes associated with each tweet, including 1) ten attributes indicating the tweet's relevance to ten detected topics, 2) five quantitative attributes indicating the degree of intensity in the valence (i.e., unpleasantness/pleasantness) and emotional intensities across four primary emotions of fear, anger, sadness and joy, and 3) two qualitative attributes indicating the sentiment category and the most dominant emotion category, respectively. To illustrate how the dataset can be used, we present descriptive statistics around the topics, sentiments and emotions attributes and their temporal distributions, and discuss possible applications in communication, psychology, public health, economics and epidemiology.


How to Rapidly Determine First-in-Children Dosing for COVID-19 Therapeutics


Comment on Matricardi PM et al: The first, holistic immunological model of COVID-19: Implications for prevention, diagnosis, and public health measures


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title: Mass masking in the COVID-19 epidemic: people need guidance


COVID-19 research: toxicological input urgently needed!


Pharmacological characteristics of patients infected with SARS-Cov-2 admitted to Intensive Care Unit in South of France


title: Description of a new species of Moenkhausia (Characiformes: Characidae) from the upper Paraguay basin, Central Brazil, with comments on its phylogenetic relationships

text: A new species of Moenkhausia is described from tributaries of the upper rio Sepotuba, Paraguay basin, Brazil. The new species is distinguished from its congeners by a combination of characters, including an inconspicuous oval-shaped vertically elongated humeral blotch, extending horizontally from third through five lateral-line scales, and vertically from third row above lateral line to first row below it, followed by a diffuse field of dark chromatophores in the flank, combined with a well-defined dark line at the base of the anal fin. Furthermore, the phylogenetic position of the new species is presented based on molecular data, showing a close relationship among species of Moenkhausia and Hemigrammus that have a well-defined dark line at the base of the anal fin. Until this moment, this species is only known from in the upper rio Sepotuba basin.(AU)


Viral infection-induced thrombosis, novel coronavirus


Urinalysis parameters for predicting severity in coronavirus disease 2019 (COVID-19)


COVID-19: A relationship to climate and environmental conditions?


title: Fitting and forecasting the trend of COVID-19 by SEIR + CAQ dynamic model

text: Objectives Fitting and forecasting the trend of COVID-19 epidemics Methods Based on SEIR dynamic model, considering the COVID-19 transmission mechanism, infection spectrum and prevention and control procedures, we developed SEIR + CAQ dynamic model to fit the frequencies of laboratory confirmed cases obtained from the government official websites The data from January 20, 2020 to February 7, 2020 were used to fit the model, while the left data between February 8-12 were used to evaluate the quality of forecasting Results According to the cumulative number of confirmed cases between January 29 to February 7, the fitting bias of SEIR + CAQ model for overall China (except for cases of Hubei province), Hubei province (except for cases of Wuhan city) and Wuhan city was less than 5% For the data of subsequent 5 days between February 8 to 12, which were not included in the model fitting, the prediction biases were less than 10% Regardless of the cases diagnosed by clinical examines, the numbers of daily emerging cases of China (Hubei province not included), Hubei Province (Wuhan city not included) and Wuhan city reached the peak in the early February Under the current strength of prevention and control, the total number of laboratory- confirmed cases in overall China will reach 80 417 till February 29, 2020, respectively Conclusions The proposed SEIR + CAQ dynamic model fits and forecasts the trend of novel coronavirus pneumonia well and provides evidence for decision making


title: Fitting and forecasting the trend of COVID-19 by SEIR+ CAQ dynamic model

text: Objectives;Fitting and forecasting the trend of COVID-19 epidemics ;;Methods;Based on SEIR dynamic model, considering the COVID-19 transmission mechanism, infection spectrum and prevention and control procedures, we developed SEIR+ CAQdynamic model to fit the frequencies of laboratory confirmed cases obtained from the government official websites The data from January 20, 2020 to February 7, 2020 were used to fit the model, while the left data between February 8-12 were used to evaluate the quality of forecasting ;;Results;According to the cumulative number of confirmed cases between January 29 to February 7, the fitting bias of SEIR+ CAQmodel for overall China (except for cases of Hubei province), Hubei province (except for cases of Wuhan city) and Wuhan city was less than 5% For the data of subsequent 5 days between February 8 to 12, which were not included in the model fitting, the prediction biases were less than 10% Regardless of the cases diagnosed by clinical examines, the numbers of daily emerging cases of China (Hubei province not included), Hubei Province (Wuhan city not included) and Wuhan city reached the peak in the early February Under the current strength of prevention and control, the total number of laboratory- confirmed cases in overall China will reach 80 417 till February 29, 2020, respectively ;;Conclusions;The proposed SEIR+ CAQdynamic model fits and forecasts the trend of novel coronavirus pneumonia well and provides evidence for decision making ;


Six months of coronavirus: the mysteries scientists are still racing to solve


Impact of a nationwide COVID-19 lockdown on acute coronary syndrome referrals


title: COVID_MTNet: COVID-19 Detection with Multi-Task Deep Learning Approaches

text: COVID-19 is currently one the most life-threatening problems around the world. The fast and accurate detection of the COVID-19 infection is essential to identify, take better decisions and ensure treatment for the patients which will help save their lives. In this paper, we propose a fast and efficient way to identify COVID-19 patients with multi-task deep learning (DL) methods. Both X-ray and CT scan images are considered to evaluate the proposed technique. We employ our Inception Residual Recurrent Convolutional Neural Network with Transfer Learning (TL) approach for COVID-19 detection and our NABLA-N network model for segmenting the regions infected by COVID-19. The detection model shows around 84.67% testing accuracy from X-ray images and 98.78% accuracy in CT-images. A novel quantitative analysis strategy is also proposed in this paper to determine the percentage of infected regions in X-ray and CT images. The qualitative and quantitative results demonstrate promising results for COVID-19 detection and infected region localization.


docid: uieoyjoz

title: Masques contre le COVID : une evidence


docid: mhbqnujn

title: Nigeria responds to COVID-19; first case detected in sub-Saharan Africa


title: Forecasting spatial, socioeconomic and demographic variation in COVID-19 health care demand in England and Wales

text: BACKGROUND: COVID-19 poses one of the most profound public health crises for a hundred years. As of mid-May 2020, across the world, almost 300,000 deaths and over 4 million confirmed cases were registered. Reaching over 30,000 deaths by early May, the UK had the highest number of recorded deaths in Europe, second in the world only to the USA. Hospitalization and death from COVID-19 have been linked to demographic and socioeconomic variation. Since this varies strongly by location, there is an urgent need to analyse the mismatch between health care demand and supply at the local level. As lockdown measures ease, reinfection may vary by area, necessitating a real-time tool for local and regional authorities to anticipate demand. METHODS: Combining census estimates and hospital capacity data from ONS and NHS at the Administrative Region, Ceremonial County (CC), Clinical Commissioning Group (CCG) and Lower Layer Super Output Area (LSOA) level from England and Wales, we calculate the number of individuals at risk of COVID-19 hospitalization. Combining multiple sources, we produce geospatial risk maps on an online dashboard that dynamically illustrate how the pre-crisis health system capacity matches local variations in hospitalization risk related to age, social deprivation, population density and ethnicity, also adjusting for the overall infection rate and hospital capacity. RESULTS: By providing fine-grained estimates of expected hospitalization, we identify areas that face higher disproportionate health care burdens due to COVID-19, with respect to pre-crisis levels of hospital bed capacity. Including additional risks beyond age-composition of the area such as social deprivation, race/ethnic composition and population density offers a further nuanced identification of areas with disproportionate health care demands. CONCLUSIONS: Areas face disproportionate risks for COVID-19 hospitalization pressures due to their socioeconomic differences and the demographic composition of their populations. Our flexible online dashboard allows policy-makers and health officials to monitor and evaluate potential health care demand at a granular level as the infection rate and hospital capacity changes throughout the course of this pandemic. This agile knowledge is invaluable to tackle the enormous logistical challenges to re-allocate resources and target susceptible areas for aggressive testing and tracing to mitigate transmission.


The burden of thrombotic complications in critically ill patients with COVID-19: charting the uncharted


Cultivating Deliberate Resilience During the Coronavirus Disease 2019 Pandemic


Public-private partnership: strategies for continuing urgent elective operative care during the COVID-19 pandemic


Prevention and Control of COVID-19 in Chronic Kidney Disease: Correspondence


title: Coronavirus Disease 2019 Pandemic Measures: Reports From a National Survey of 9,120 ICU Clinicians

text: IMPORTANCE: Recent reports identify that among hospitalized coronavirus disease 2019 patients, 30% require ICU care. Understanding ICU resource needs remains an essential component of meeting current and projected needs of critically ill coronavirus disease 2019 patients. OBJECTIVES: This study queried U.S. ICU clinician perspectives on challenging aspects of care in managing coronavirus disease 2019 patients, current and anticipated resource demands, and personal stress. DESIGN, SETTING, AND PARTICIPANTS: Using a descriptive survey methodology, an anonymous web-based survey was administered from April 7, 2020, to April 22, 2020 (email and newsletter) to query members of U.S. national critical care organizations. MEASUREMENTS AND MAIN RESULTS: Through a 16-item descriptive questionnaire, ICU clinician perceptions were assessed regarding current and emerging critical ICU needs in managing the severe acute respiratory syndrome coronavirus 2 infected patients, resource levels, concerns about being exposed to severe acute respiratory syndrome coronavirus 2, and perceived level of personal stress. A total of 9,120 ICU clinicians responded to the survey, representing all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more coronavirus disease 2019 cases. The 7,317 respondents who indicated their profession included ICU nurses (n = 6,731, 91.3%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 4.5%), physicians (n = 212, 2.9%), respiratory therapists (n = 31, 0.4%), and pharmacists (n = 30, 0.4%). A majority (n = 6,510, 88%) reported having cared for a patient with presumed or confirmed coronavirus disease 2019. The most critical ICU needs identified were personal protective equipment, specifically N95 respirator availability, and ICU staffing. Minimizing healthcare worker virus exposure during care was believed to be the most challenging aspect of coronavirus disease 2019 patient care (n = 2,323, 30.9%). Nurses report a high level of concern about exposing family members to severe acute respiratory syndrome coronavirus 2 (median score of 10 on 0-10 scale). Similarly, the level of concern reached the maximum score of 10 in ICU clinicians who had provided care to coronavirus disease 2019 patients. CONCLUSIONS: This national ICU clinician survey identifies continued concerns regarding personal protective equipment supplies with the chief issue being N95 respirator availability. As the pandemic continues, ICU clinicians anticipate a number of limited resources that may impact ICU care including personnel, capacity, and surge potential, as well as staff and subsequent family members exposure to severe acute respiratory syndrome coronavirus 2. These persistent concerns greatly magnify personal stress, offering a therapeutic target for professional organization and facility intervention efforts.


Reply: The Optimal Management of Electrodiagnostic Studies during COVID-19 Outbreak


Infection control protocol inside computed tomography suites during COVID-19 outbreak


title: Impact of the COVID-19 pandemic on interventional cardiology fellowship training in the New York metropolitan area: A perspective from the United States epicenter

text: BACKGROUND: The healthcare burden posed by the coronavirus disease 2019 (COVID-19) pandemic in the New York Metropolitan area has necessitated the postponement of elective procedures resulting in a marked reduction in cardiac catheterization laboratory (CCL) volumes with a potential to impact interventional cardiology (IC) fellowship training. METHODS: We conducted a web-based survey sent electronically to 21 Accreditation Council for Graduate Medical Education accredited IC fellowship program directors (PDs) and their respective fellows. RESULTS: Fourteen programs (67%) responded to the survey and all acknowledged a significant decrease in CCL procedural volumes. More than half of the PDs reported part of their CCL being converted to inpatient units and IC fellows being redeployed to COVID-19 related duties. More than two-thirds of PDs believed that the COVID-19 pandemic would have a moderate (57%) or severe (14%) adverse impact on IC fellowship training, and 21% of the PDs expected their current fellows' average percutaneous coronary intervention (PCI) volume to be below 250. Of 25 IC fellow respondents, 95% expressed concern that the pandemic would have a moderate (72%) or severe (24%) adverse impact on their fellowship training, and nearly one-fourth of fellows reported performing fewer than 250 PCIs as of March 1st. Finally, roughly one-third of PDs and IC fellows felt that there should be consideration of an extension of fellowship training or a period of early career mentorship after fellowship. CONCLUSIONS: The COVID-19 pandemic has caused a significant reduction in CCL procedural volumes that is impacting IC fellowship training in the NY metropolitan area. These results should inform professional societies and accreditation bodies to offer tailored opportunities for remediation of affected trainees.


title: Taking control amidst the chaos: Emotion regulation during the COVID-19 pandemic

text: The COVID-19 pandemic represents a major global health crisis that continues to threaten public health and safety. Although the pandemic is still unfolding, measures to reduce the spread of the virus have spawned significant challenges to people's current work as well as their careers more generally. In this commentary, we discuss the implications of COVID-19 for maintaining one's psychological well-being and employment security, and also managing family and work responsibilities. We also bring forth evidence from the emotion regulation literature to help mitigate the downstream negative consequences of COVID-19 on people's work lives. Finally, we offer several suggestions for future scholarly investigation into how this pandemic impacts vocational behavior.


Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic


title: What lies ahead: Elevated concerns for the ongoing suicide pandemic

text: The genesis and global spread of coronavirus disease 2019 (COVID-19) has resulted in significant health concerns amid societies that were ill-equipped for such a formidable opponent. The COVID-19 pandemic has illuminated systemic health disparities and weaknesses within our health care and political systems. With aggressive but necessary interventions to thwart the instantaneous reproduction number, we have simultaneously introduced risk factors for new and exacerbated mental health concerns. Suicide, an ongoing pandemic whose rates are higher than they have been in the past 50 years, is one of these concerns as we navigate COVID-19 deaths and fears surrounding its spread. This article aims to briefly describe in retrospect some of the historical pandemics and their downstream consequences as well as present what may lie ahead in terms of anxiety, depression, and suicidal behaviors. This applies not only to frontline health care workers but also the public at large, who may very well experience long-term stressor- and trauma-related consequences through ongoing exposure to a virus that is not only potentially fatal but may have taken the lives of loved ones. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: The hidden side of COVID-19 spread in Italy

text: Background. The paper concerns the SARS-CoV2 (COVID-19) pandemic that, starting from the end of February 2020, began spreading along the Italian peninsula, by first attacking small communities in north regions, and then extending to the center and south of Italy, including the two main islands. Objective. The creation of a forecast model that manages to alert the decision-making bodies and, in particular, the healthcare system, to hinder the emergence of any other pandemic outbreaks, or the arrival of subsequent pandemic waves. Methods. A new mathematical model to describe the pandemic is given. The model includes the class of undiagnosed infected people, and has a multi-region extension, to cope with the in-time and in-space heterogeneity of the epidemic. Results. We obtain a robust and reliable tool for the forecast of the total and active cases, which can be also used to simulate different scenarios. Conclusions. We are able to address a number of issues, such as assessing the adoption of the lockdown in Italy, started from 11 March 2020, and how to employ a rapid screening test campaign for containing the epidemic.


Latest updates on COVID-2019: A changing paradigm shift


title: Transcatheter mitral valve repair with MitraClip for severe mitral regurgitation and cardiogenic shock during the COVID-19 pandemic

text: Transcatheter mitral valve repair with MitraClip (Abbott) is largely an elective procedure. The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed challenges to health care systems; in many cases elective interventions have been curtailed. Patients with severe mitral regurgitation (MR) and cardiogenic shock are high-risk surgical candidates and at risk of a poor outcome without intervention. The American College of Cardiology (ACC) and the Society of Coronary Angiography and Interventions (SCAI) recently proposed joint guidance on triage of structural heart disease (SHD) interventions during the COVID-19 pandemic. We present two illustrative cases of severe MR and cardiogenic shock that were successfully treated with MitraClip amidst the COVID-19 pandemic with good outcomes at short term follow-up.