Since a novel coronavirus was discovered from a cluster of patients with emerging pneumonia of unknown etiology in Wuhan, China, it has spread rapidly through droplet and contact transmission. Recently, the novel coronavirus pneumonia which was named COVID-19 by the World Health Organization (WHO) has been raised as a worldwide problem. Radiological examinations were confirmed as effective methods for the screening and diagnosis of COVID-19. It is reported that some radiologists and radiological technologists were infected when giving examinations to the patients with COVID-19. In order to reduce the infection risk of medical staff in radiology department, we summarized the experience on prevention and control measures in radiology department for COVID-19, aiming to guide the prevention and practical work for radiologists and radiological technologists. KEY POINTS: â¢ The novel coronavirus spreads rapidly through droplet and contact transmission. â¢ Radiologists and radiological technologists were possibly infected by patients. â¢ Prevention and control measures in radiology department for COVID-19 are important.


docid: pnhkrgxq

title: Materials and Device Considerations in Electrophoretic Drug Delivery Devices

text: Electrophoretic drug delivery devices are able to deliver drugs with exceptional temporal and spatial precision. This technology has emerged as a promising platform for treating pathologies ranging from neuropathic pain to epilepsy. As the range of applications continues to expand, there is an urgent need to understand the underlying physics and estimate materials and device parameters for optimal performance. Here, computational modeling of the electrophoretic drug delivery device is carried out. Three critical performance indices, namely, the amount of drug transported, the pumping efficiency and the ON/OFF ratio are investigated as a function of initial drug concentration in the device and fixed charge concentration in the ion exchange membrane. The results provide guidelines for future materials and device design with an eye towards tailoring device performance to match disease-specific demands.


A letter to the flow community


title: [Management of gastrointestinal and hepatic diseases during the COVID-19 outbreak]

text: The current epidemic of SARS-CoV-2 infection poses new challenges in the management of patients with gastrointestinal or liver disease Consultations with patients with chronic diseases should ideally be done via telemedicine and treatments administered at home if possible The latter should be maintained in non-infected subjects to limit the risk of decompensation of their underlying disease In the event of proven infection, immunomodulatory or biological treatments will tend to be reduced or discontinued unless the disease is in a severely active phase Elective endoscopy should be postponed, and urgent procedures should be performed with appropriate personal protective equipment


title: Management of gastrointestinal and hepatic diseases during the COVID-19 outbreak/ Prise en charge des patients avec maladies digestives et hepatiques durant la pandemie COVID-19

text: The current epidemic of SARS-CoV-2 infection poses new challenges in the management of patients with gastrointestinal or liver disease Consultations with patients with chronic diseases should ideally be done via telemedicine and treatments administered at home if possible The latter should be maintained in non-infected subjects to limit the risk of decompensation of their underlying disease In the event of proven infection, immunomodulatory or biological treatments will tend to be reduced or discontinued unless the disease is in a severely active phase Elective endoscopy should be postponed, and urgent procedures should be performed with appropriate personal protective equipment Lepidemie actuelle dinfection par le SARS-CoV-2 pose de nouveaux defis dans la prise en charge des patients avec pathologies gastroenterologique ou hepatologique Les consultations avec les patients atteints de maladies chroniques devraient se faire idealement par telemedecine et les traitements administres a domicile si possible Ces derniers doivent etre maintenus chez les sujets non infectes pour limiter le risque de decompensation de leur maladie de base En cas dinfection averee, on aura tendance a diminuer voire interrompre les traitements immunomodulateurs ou biologiques sauf si la maladie est en phase severement active Les examens endoscopiques electifs doivent etre reportes Les interventions urgentes doivent etre effectuees en appliquant des mesures de protection adequates


title: Collaborative Multidisciplinary Incident Command at Seattle Children's Hospital for Rapid Preparatory Pediatric Surgery Countermeasures to the COVID-19 Pandemic

text: Washington was the first US state to have a patient test positive for COVID-19. Before this, our children's hospital proactively implemented an incident command structure that allowed for collaborative creation of safety measures, policies, and procedures for patients, families, staff, and providers. Although the treatment and protective standards are continuously evolving, this commentary shares our thoughts on how an institution, and specifically, surgical services, may develop collaborative process improvement to accommodate for rapid and ongoing change. Specific changes outlined include early establishment of incident command; personal protective equipment conservation; workforce safety; surgical and ambulatory patient triage; and optimization of trainee education. Please note that the contents of this manuscript are shared in the interest of providing collaborative information and are under continuous development as our regional situation changes. We recognize the limitations of this commentary and do not suggest that our approaches represent validated best practices.


title: Systematic Attack Surface Reduction For Deployed Sentiment Analysis Models

text: This work proposes a structured approach to baselining a model, identifying attack vectors, and securing the machine learning models after deployment. This method for securing each model post deployment is called the BAD (Build, Attack, and Defend) Architecture. Two implementations of the BAD architecture are evaluated to quantify the adversarial life cycle for a black box Sentiment Analysis system. As a challenging diagnostic, the Jigsaw Toxic Bias dataset is selected as the baseline in our performance tool. Each implementation of the architecture will build a baseline performance report, attack a common weakness, and defend the incoming attack. As an important note: each attack surface demonstrated in this work is detectable and preventable. The goal is to demonstrate a viable methodology for securing a machine learning model in a production setting.


Biophotonics for pandemic control: large-area infection monitoring and microbial inactivation of COVID-19


Origin and evolution of the 2019 novel coronavirus


title: COVID-19 infection may cause ketosis and ketoacidosis

text: The present study included 658 hospitalized patients with confirmed COVID-19. Forty-two (6.4%) out of 658 patients presented with ketosis on admission with no obvious fever or diarrhoea. They had a median (interquartile range [IQR]) age of 47.0 (38.0-70.3) years, and 16 (38.1%) were men. Patients with ketosis were younger (median age 47.0 vs. 58.0 years; P = 0.003) and had a greater prevalence of fatigue (31.0% vs. 10.6%; P < 0.001), diabetes (35.7% vs. 18.5%; P = 0.007) and digestive disorders (31.0% vs. 12.0%; P < 0.001). They had a longer median (IQR) length of hospital stay (19.0 [12.8-33.3] vs. 16.0 [10.0-24.0] days; P < 0.001) and a higher mortality rate (21.4% vs. 8.9%; P = 0.017). Three (20.0%) out of the 15 patients with diabetic ketosis developed acidosis, five patients (26.7%) with diabetic ketosis died, and one of these (25.0%) presented with acidosis. Two (7.4%) and four (14.3%) of the 27 non-diabetic ketotic patients developed severe acidosis and died, respectively, and one (25.0%) of these presented with acidosis. This suggests that COVID-19 infection caused ketosis or ketoacidosis, and induced diabetic ketoacidosis for those with diabetes. Ketosis increased the length of hospital stay and mortality. Meanwhile, diabetes increased the length of hospital stay for patients with ketosis but had no effect on their mortality.


COVID-19 and haemostasis: a position paper from Italian Society on Thrombosis and Haemostasis (SISET)


Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19


docid: lwcibtzz

title: Computational model on COVID-19 Pandemic using Probabilistic Cellular Automata

text: Coronavirus disease (COVID-19) which is caused by SARS-COV2 has become a pandemic. This disease is highly infectious and potentially fatal, causing a global public health concern. To contain the spread of COVID-19, governments are adopting nationwide interventions, like lockdown, containment and quarantine, restrictions on travel, cancelling social events and extensive testing. To understand the effects of these measures on the control of the epidemic in a data-driven manner, we propose a probabilistic cellular automata (PCA) based modified SEIQR model. The transitions associated with the model is driven by data available on chronology, symptoms, pathogenesis and transmissivity of the virus. By arguing that the lattice-based model captures the features of the dynamics along with the existing fluctuations, we perform rigorous computational analyses of the model to take into account of the spatial dynamics of social distancing measures imposed on the people. Considering the probabilistic behavioural aspects associated with mitigation strategies, we study the model considering factors like population density and testing efficiency. Using the model, we focus on the variability of epidemic dynamics data for different countries and point out the reasons behind these contrasting observations. To the best of our knowledge, this is the first attempt to model COVID-19 spread using PCA that gives us both spatial and temporal variations of the infection spread with the insight about the contributions of different infection parameters.


title: Human and novel coronavirus infections in children: a review

text: Coronaviruses, seven of which are known to infect humans, can cause a spectrum of clinical presentations ranging from asymptomatic infection to severe illness and death. Four human coronaviruses (hCoVs)-229E, HKU1, NL63 and OC43-circulate globally, commonly infect children and typically cause mild upper respiratory tract infections. Three novel coronaviruses of zoonotic origin have emerged during the past two decades: severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV) and the recently discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. These novel coronaviruses are known to cause severe illness and death predominantly in older adults and those with underlying comorbidities. Consistent with what has been observed during the outbreaks of SARS and MERS, children with COVID-19 are more likely to be asymptomatic or to have mild-to-moderate illness, with few deaths reported in children globally thus far. Clinical symptoms and laboratory and radiological abnormalities in children have been similar to those reported in adults but are generally less severe. A rare multisystem inflammatory syndrome in children (MIS-C) which has resulted in critical illness and some deaths has recently been described. Clinical trials for therapeutics and vaccine development should include paediatric considerations. Children may play an important role in the transmission of infection and outbreak dynamics and could be a key target population for effective measures to control outbreaks. The unintended consequences of the unprecedented scale and duration of pandemic control measures for children and families around the world should be carefully examined. ABBREVIATIONS: 2019-nCoV, 2019 novel coronavirus; ADEM, acute demyelinating encephalomyelitis; AAP, American Academy of Pediatrics; ACE-2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; BCG, bacillus Calmette-Guérin; BNP, brain natriuretic peptide; CDC, Centers for Disease Control and Prevention; CRP, C-reactive protein; CSF, cerebrospinal fluid; COVID-19, coronavirus disease 2019; CT, computed tomography; CXR, chest X-ray; DOL, day of life; hCoV, human coronavirus; ICU, intensive care unit; IL, interleukin; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; LDH, lactate dehydrogenase; MERS, Middle East respiratory syndrome; MERS-CoV, Middle East respiratory syndrome coronavirus; MEURI, monitored emergency use of unregistered and experimental interventions; MIS-C, multi-system inflammatory syndrome in children; PCR, polymerase chain reaction; PICU, paediatric intensive care unit; RNA, ribonucleic acid; RCT, randomised-controlled trial; RSV, respiratory syncytial virus; SARS, severe acute respiratory syndrome; SARS-CoV-1, severe acute respiratory syndrome coronavirus 1; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TNF-alpha, tumour necrosis factor alpha; UK United Kingdom; UNICEF, United Nations Children's Fund; USA, United States of America; WHO, World Health Organization.


title: Is Inhaled Furosemide a Potential Therapeutic for COVID-19?

text: The potentially lethal infection caused by the novel Severe Acute Respiratory Disease Coronavirus-2 (SARS-CoV-2) has evolved into a global crisis. Following the initial viral infection is the host inflammatory response that frequently results in excessive secretion of inflammatory cytokines (e.g., IL-6 and TNFα), developing into a self-targeting, toxic "cytokine storm" causing critical pulmonary tissue damage. The need for a therapeutic that is available immediately is growing daily but the de novo development of a vaccine may take years. Therefore, repurposing of approved drugs offers a promising approach to address this urgent need. Inhaled furosemide, a small molecule capable of inhibiting IL-6 and TNFα, may be an agent capable of treating the Coronavirus Disease 2019 cytokine storm in both resource-rich and developing countries. Furosemide is a "repurpose-able" small molecule therapeutics, that is safe, easily synthesized, handled, and stored, and is available in reasonable quantities worldwide.


docid: rxrhhhtr

title: COVID-19: A Time for Creative Compassion


Offline: Independent science advice for COVID-19-at last


title: Fast Mass-Production of Medical Safety Shields under COVID-19 Quarantine: Optimizing the Use of University Fabrication Facilities and Volunteer Labor

text: COVID-19 pandemic provoked a number of restrictive measures, such as the closure or severe restriction of border transit for international trading traffic, quarantines and self-isolation. This caused a series of interrelated consequences that not only prevent or slow down the spread of disease, but also impact the medical systems' capability to treat the patients and help their recovery. In particular, steeply growing demand for medical safety goods cannot be satisfied by regular suppliers due to the shortage of raw materials originating from other countries or remotely located national sources, under conditions of quarantined manpower. The current context inevitably brings back memories (and records!) of the situation 80 years ago, when WWII necessitated major effort directed at the rapid build-up of low-cost mass production to satisfy all aspects of war-time need. In the present short report we document a successful case of fast mass-production of light transparent medical safety face shields (thousands per day) realized in Skolkovo Institute of Science and Technology (Skoltech) at Fablab and Machine Shop Shared Facility (Skoltech FabLab). The demand for safety face shields by tens of hospitals in Moscow and other cities rapidly ramped up due to the need to protect medical staff during patient collection and transportation to hospitals, and within both the infected ("red") and uninfected ("green") zones. Materials selection for sterilizable transparent materials was conducted based on the analysis of merit indices, namely, minimal weight at given stiffness and minimal cost at given stiffness. Due to the need for permanent wear, design was motivated by low weight and comfortable head fixation, along with high production efficiency. The selection of minimal tooling in University fabrication workshops and the use of distributed volunteer labor are discussed.


Psychological interventions for people affected by the COVID-19 epidemic


title: Recomendações da Sociedade Portuguesa de Cuidados Intensivos e Grupo de Infeção e Sépsis para a abordagem do COVID-19 em medicina intensiva./ Recomendações da Sociedade Portuguesa de Cuidados Intensivos e Grupo de Infeção e Sépsis para a abordagem do COVID-19 em medicina intensiva./ Recommendations from the Sociedade Portuguesa de Cuidados Intensivos and Infection & Sepsis Group for intensive care approach to COVID-19

text: Current COVID-19 epidemics was declared on December 31, 2019 at the Wuhan city seafood market, rapidly spreading throughout China, and later reaching several countries (mainly South Korea, Japan, Italy and Iran) and, since March 1, reaching Portugal. Most of the infected patients present with mild symptoms, not requiring hospitalization. Among those admitted to the hospital, 6% to 10% require admission to the intensive care unit. These recommendations are aimed to support the organization of intensive care services to respond COVID-19, providing optimized care to the patient and protection for healthcare professionals.


title: Palliative Care Utilization Among Patients With COVID-19 in an Underserved Population: A Single-Center Retrospective Study

text: BACKGROUND: As health-care institutions mobilize resources to address the coronavirus disease 2019 (COVID-19) pandemic, palliative care may potentially be underutilized. It is important to assess the use of palliative care in response to the COVID-19 pandemic. METHODS: This is a retrospective single-center study of patients with COVID-19 diagnosed via reverse transcriptase-polymerase chain reaction assay admitted between March 1, 2020, and April 24, 2020. An analysis of the utilization of palliative care in accordance with patient comorbidities and other characteristics was performed while considering clinical outcomes. Chi-square test was used to determine associations between categorical variables while t-tests were used to compare continuous variables. RESULTS: The overall mortality rate was 21.5% (n = 52), and in 48% (n = 25) of these patients, palliative care was not involved. Fifty-nine percent (n = 24) of those who had palliative consults eventually elected for comfort measures and transitioned to hospice care. Among those classified as having severe COVID-19, only 40% (n = 31) had palliative care involvement. Of these patients with severe COVID-19, 68% (n = 52) died. Patients who got palliative care consults were of older age, had higher rates of intubation, a need for vasopressors, and were dead. CONCLUSION: There was a low utilization rate of palliative care in patients with COVID-19. Conscious utilization of palliative care is needed at the time of COVID-19.


Considerations for transanal total mesorectal excision (TaTME) use during the COVID-19 pandemic


title: CORD19STS: COVID-19 Semantic Textual Similarity Dataset

text: In order to combat the COVID-19 pandemic, society can benefit from various natural language processing applications, such as dialog medical diagnosis systems and information retrieval engines calibrated specifically for COVID-19. These applications rely on the ability to measure semantic textual similarity (STS), making STS a fundamental task that can benefit several downstream applications. However, existing STS datasets and models fail to translate their performance to a domain-specific environment such as COVID-19. To overcome this gap, we introduce CORD19STS dataset which includes 13,710 annotated sentence pairs collected from COVID-19 open research dataset (CORD-19) challenge. To be specific, we generated one million sentence pairs using different sampling strategies. We then used a finetuned BERT-like language model, which we call Sen-SCI-CORD19-BERT, to calculate the similarity scores between sentence pairs to provide a balanced dataset with respect to the different semantic similarity levels, which gives us a total of 32K sentence pairs. Each sentence pair was annotated by five Amazon Mechanical Turk (AMT) crowd workers, where the labels represent different semantic similarity levels between the sentence pairs (i.e. related, somewhat-related, and not-related). After employing a rigorous qualification tasks to verify collected annotations, our final CORD19STS dataset includes 13,710 sentence pairs.


title: Hydroxychloroquine and chloroquine in COVID-19: should they be used as standard therapy?

text: The pandemic of the new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has urged the nations to an unprecedented world-wide reaction, including an accelerated exploration of therapeutic options. In the absence of a vaccine and specifically designed antivirals, the medical community has proposed the use of various previously available medications in order to reduce the number of patients requiring prolonged hospitalizations, oxygen therapy, and mechanical ventilation and to decrease mortality from coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine are among the proposed drugs and are the most widely used so far, despite the lack of robust evidence on their usefulness. The objective of this article is to review and discuss the possible role of these drugs in the therapy of COVID-19.


title: The biological characteristics of SARS-CoV-2 spike protein Pro330-Leu650

text: SARS-CoV-2 is the cause of the worldwide outbreak of COVID-19 that has been characterized as a pandemic by the WHO. Since the first report of COVID-19 on December 31, 2019, 179,111 cases were confirmed in 160 countries/regions with 7426 deaths as of March 17, 2020. However, there have been no vaccines approved in the world to date. In this study, we analyzed the biological characteristics of the SARS-CoV-2 Spike protein, Pro330-Leu650 (SARS-CoV-2-SPL), using biostatistical methods. SARS-CoV-2-SPL possesses a receptor-binding region (RBD) and important B (Ser438-Gln506, Thr553-Glu583, Gly404-Aps427, Thr345-Ala352, and Lys529-Lys535) and T (9 CD4 and 11 CD8 T cell antigenic determinants) cell epitopes. High homology in this region between SARS-CoV-2 and SARS-CoV amounted to 87.7%, after taking the biological similarity of the amino acids into account and eliminating the receptor-binding motif (RBM). The overall topology indicated that the complete structure of SARS-CoV-2-SPL was with RBM as the head, and RBD as the trunk and the tail region. SARS-CoV-2-SPL was found to have the potential to elicit effective B and T cell responses. Our findings may provide meaningful guidance for SARS-CoV-2 vaccine design.


title: Increased vulnerability of clinical research units during the COVID-19 crisis and their protection

text: LAY SUMMARY: Currently, the complexity of clinical trial development in oncology is being further complicated by the coronavirus disease 2019 (COVID-19) pandemic, which is reducing the resources needed to comply with protocol-specific procedures while putting patients in units, who are already vulnerable, at increased general risk not only for COVID-19 infection but also with respect to their baseline disease. Individualizing the management of patients while ensuring their safety and adherence to the study protocol, establishing specific staff contingency plans, and maintaining sponsor and contract research organization (CRO) alignment are some of the key issues for maintaining the continuity of cancer patients' investigational treatment and minimizing their infection risk as well as the risk to staff members of the unit, sponsors, and CROs while maintaining the integrity of data quality and compliance with good clinical practice.


COVID-19 in Children: Initial Characterization of the Pediatric Disease


docid: eieidtwg

title: Therapeutic targets and computational approaches on drug development for COVID-19

text: World Health Organization declared coronavirus disease (COVID-19) caused by SARS coronavirus-2 (SARSCoV-2) as pandemic. Its outbreak started in China in Dec 2019 and rapidly spread across all over the world. SARS-CoV-2 infected more than 800,000 people and caused about 35,000 deaths so far and no approved drugs are available to treat COVID-19. Several investigations have been carried out to identify potent drugs to COVID-19 based on drug repurposing, potential novel compounds from ligand libraries, natural products, short peptides, and RNAseq analysis. This review is focused on three different aspects such as (i) targets for drug design (ii) computational methods to identify lead compounds and (iii) drugs for COVID-19. It also covers the latest literature on various hit molecules proposed by computational methods and experimental techniques.


title: Duties toward Patients with Psychiatric Illness

text: Patients with psychiatric illness feel the brunt of the intersection of many of our society's and our health care system's disparities, and the vulnerability of this population during the Covid-19 pandemic cannot be overstated. Patients with psychiatric illness often suffer from the stigma of mental illness and receive poor medical care. Many patients with severe and persistent mental illness face additional barriers, including poverty, marginal housing, and food insecurity. Patients who require psychiatric hospitalization now face the risk of transmission of Covid-19 due to the inherent difficulties of social distancing within a psychiatric hospital. Patients whose freedom and self-determination have been temporarily overruled as they receive involuntary psychiatric treatment deserve a setting that maintains their health and safety. While tele-mental health has been rapidly expanded to provide new ways to access psychiatric treatment, some patients may have limitations in technological literacy or access to devices. The social isolation, economic fallout, and potential traumatization related to the current pandemic will disproportionately affect this vulnerable population, and society's duties to them must be considered.


title: Acute Pulmonary Embolism in SARS-CoV-2 Infection Treated with Surgical Embolectomy

text: A cluster of pneumonia cases caused by the novel SARS-CoV-2 has spread rapidly throughout China, Europe and USA. The pneumonia might evolve in ARDS requiring assisted mechanical-ventilation. The prolonged immobilization combined with respiratory failure, sepsis and dehydration might expose SARS-CoV-2/patients to increased risk of complication including pulmonary embolism. We report the first case of SARS-CoV-2 complicated by massive pulmonary embolism underwent successfully surgical embolectomy. We believe that maintaining the same pro-active attitude suggested by current Guidelines might help in reducing morality and improving survival in SARS-COV-2/patients.


Securing the Safety Net and Protecting Public Health During a Pandemic: Medicaid's Response to COVID-19


title: COVID-19 and psoriasis: Should we fear for patients treated with biologics?

text: The new coronavirus pandemic poses question and challenges for dermatologists. One of question is if psoriasis patients treated with immunomodulating and immunosuppressive drugs have to discontinue their treatment in the midst of fears for the infection and its consequences. One of the challenges is how can we support our patients in this critical time. Previous coronaviruses outbreaks reports, current published evidences on pathogenesis and on clinical reports of COVID infection in immunosuppressed patients are used to make a scientifically based decision.


The first Vietnamese case of COVID-19 acquired from China


title: Clinical Pathway for Early Diagnosis of COVID-19: Updates from Experience to Evidence-Based Practice

text: The COVID-19 pandemic is a significant global event in the history of infectious diseases. The SARS-CoV-2 appears to have originated from bats but is now easily transmissible among humans, primarily through droplet or direct contact. Clinical features of COVID-19 include high fever, cough, and fatigue which may progress to ARDS. Respiratory failure can occur rapidly after this. The primary laboratory findings include lymphopenia and eosinopenia. Elevated D-dimer, procalcitonin, and CRP levels may correlate with disease severity. Imaging findings include ground-glass opacities and patchy consolidation on CT scan. Mortality is higher in patients with hypertension, cardiac disease, diabetes mellitus, cancer, and COPD. Elderly patients are more susceptible to severe disease and death, while children seem to have lower rates of infection and lower mortality. Diagnostic criteria and the identification of persons under investigation have evolved as more data has emerged. However, the approach to diagnosis is still very variable from region to region, country to country, and even among different hospitals in the same city. The importance of a clinical pathway to implement the most effective and relevant diagnostic strategy is of critical importance to establish the control of this virus that is responsible for more and more deaths each day.


What can COVID-19 teach us about responding to climate change?


title: Impact of Covid-19 epidemics in Pediatric Morbidity and utilization of Hospital Pediatric Services in Italy

text: we read with great interest the article by Pata et al. published online on June 2nd in the Journal (1). Indeed, the current Covid-19 epidemic in Italy and the associated, two months (March-April) strict lockdown have impacted on the overall epidemiology and use of adult and pediatric medical resources -also due to dramatic changes in lifestyle.


title: Evidence for Limited Early Spread of COVID-19 Within the United States, January-February 2020

text: From January 21 through February 23, 2020, public health agencies detected 14 U.S. cases of coronavirus disease 2019 (COVID-19), all related to travel from China (1,2). The first nontravel-related U.S. case was confirmed on February 26 in a California resident who had become ill on February 13 (3). Two days later, on February 28, a second nontravel-related case was confirmed in the state of Washington (4,5). Examination of four lines of evidence provides insight into the timing of introduction and early transmission of SARS-CoV-2, the virus that causes COVID-19, into the United States before the detection of these two cases. First, syndromic surveillance based on emergency department records from counties affected early by the pandemic did not show an increase in visits for COVID-19-like illness before February 28. Second, retrospective SARS-CoV-2 testing of approximately 11,000 respiratory specimens from several U.S. locations beginning January 1 identified no positive results before February 20. Third, analysis of viral RNA sequences from early cases suggested that a single lineage of virus imported directly or indirectly from China began circulating in the United States between January 18 and February 9, followed by several SARS-CoV-2 importations from Europe. Finally, the occurrence of three cases, one in a California resident who died on February 6, a second in another resident of the same county who died February 17, and a third in an unidentified passenger or crew member aboard a Pacific cruise ship that left San Francisco on February 11, confirms cryptic circulation of the virus by early February. These data indicate that sustained, community transmission had begun before detection of the first two nontravel-related U.S. cases, likely resulting from the importation of a single lineage of virus from China in late January or early February, followed by several importations from Europe. The widespread emergence of COVID-19 throughout the United States after February highlights the importance of robust public health systems to respond rapidly to emerging infectious threats.


docid: zvqbntye

title: Response to "The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs"


Visualization of SARS-CoV-2 virus invading the human placenta using electron microscopy


title: [Epidemiological analysis on a family cluster of COVID-19]

text: Objective: To understand the possible transmission route of a family cluster of COVID-19 in Zhengzhou and the potential infectivity of COVID-19 in incubation period, and provide scientific evidence for the timely control of infectious source and curb the spread of the epidemic. Methods: Epidemiological investigation was conducted for a family cluster of COVID-19 (8 cases) with descriptive epidemiological method, and respiratory tract samples of the cases were collected for the nucleic acid detection of virus by RT-PCR. Results: Two primary cases, which occurred on 31 January and 1 February, 2020, respectively, had a common exposure history in Wuhan. The other six family members had onsets on 30 January, 31 January, 1 February (three cases) and 3 February, 2020. Conclusions: In this family cluster of COVID-19, six family members were infected through common family exposure to the 2 primary cases. Five secondary cases had onsets earlier than or on the same day as the primary cases, indicating that COVID-19 is contagious in incubation period, and the home isolation in the early phase of the epidemic might lead to the risk of family cluster of COVID-19.


title: Epidemiological analysis on a family cluster of COVID-19/ 中华流行病学杂志

text: Objective@#To understand the possible transmission route of a family cluster of COVID-19 in Zhengzhou and the potential infectivity of COVID-19 in incubation period, and provide scientific evidence for the timely control of infectious source and curb the spread of the epidemic.@*Methods@#Epidemiological investigation was conducted for a family cluster of COVID-19 (8 cases) with descriptive epidemiological method, and respiratory tract samples of the cases were collected for the nucleic acid detection of 2019-nCoV by RT-PCR.@*Results@#Two primary cases, which occurred on 31 January and 1 February, 2020, respectively, had a common exposure history in Wuhan. The other six family members had onsets on 30 January, 31 January, 1 February (three cases) and 3 February, 2020.@*Conclusions@#In this family cluster of COVID-19, six family members were infected through common family exposure to the 2 primary cases. Five secondary cases had onsets earlier than or on the same day as the primary cases, indicating that COVID-19 is contagious in incubation period, and the home isolation in the early phase of the epidemic might lead to the risk of family cluster of COVID-19.


Early Lessons on the Importance of Lung Imaging in Novel Coronavirus Disease (COVID-19)


title: Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients

text: BACKGROUND: Although the detection of SARS-CoV-2 viral load in respiratory specimens has been widely used to diagnose coronavirus disease-19 (COVID-19), it is undeniable that serum SARS-CoV-2 nucleic acid (RNAaemia) could be detected in a fraction of COVID-19 patients. However, it is not clear whether testing for RNAaemia is correlated with the occurrence of cytokine storms or with the specific class of patients. METHODS: This study enrolled 48 patients with COVID-19 admitted to the General Hospital of Central Theater Command, PLA, a designated hospital in Wuhan, China. The patients were divided into three groups according to the "Diagnosis and Treatment of New Coronavirus Pneumonia (6th edition)" issued by the National Health Commission of China. The clinical and laboratory data were collected. The serum viral load and IL-6 levels were determined. . RESULTS: Clinical characteristics analysis of 48 cases of COVID-19 showed that RNAaemia was diagnosed only in the critically ill group and seemed to reflect the severity of the disease. Furthermore, the level of inflammatory cytokine IL-6 in critically ill patients increased significantly, almost 10 times that in other patients. More importantly, the extremely high IL-6 level was closely correlated with the detection of RNAaemia (R = 0.902). CONCLUSIONS: Detectable serum SARS-Cov-2 RNA(RNAaemia) in COVID-19 patients was associated with elevated IL-6 concentration and poor prognosis. Because the elevated IL-6 may be part of a larger cytokine storm which could worsen outcome, IL-6 could be a potential therapeutic target for critically ill patients with an excessive inflammatory response.


Reinventing Behavioral Health During the COVID-19 Pandemic


Providing cancer surgery in the COVID-19 crisis


title: Reaping the Informational Surplus in Bayesian Persuasion

text: The Bayesian persuasion model studies communication between an informed sender and a receiver with a payoff-relevant action, emphasizing the ability of a sender to extract maximal surplus from his informational advantage. In this paper we study a setting with multiple senders, but in which the receiver interacts with only one sender of his choice: senders commit to signals and the receiver then chooses, at the interim stage, with which sender to interact. Our main result is that whenever senders are even slightly uncertain about each other's preferences, the receiver receives all the informational surplus in all equilibria of this game.


The COVID-19 outbreak in Iran


title: Montreal AI Ethics Institute's Response to Scotland's AI Strategy

text: In January and February 2020, the Scottish Government released two documents for review by the public regarding their artificial intelligence (AI) strategy. The Montreal AI Ethics Institute (MAIEI) reviewed these documents and published a response on 4 June 2020. MAIEI's response examines several questions that touch on the proposed definition of AI; the people-centered nature of the strategy; considerations to ensure that everyone benefits from AI; the strategy's overarching vision; Scotland's AI ecosystem; the proposed strategic themes; and how to grow public confidence in AI by building responsible and ethical systems. In addition to examining the points above, MAIEI suggests that the strategy be extended to include considerations on biometric data and how that will be processed and used in the context of AI. It also highlights the importance of tackling head-on the inherently stochastic nature of deep learning systems and developing concrete guidelines to ensure that these systems are built responsibly and ethically, particularly as machine learning becomes more accessible. Finally, it concludes that any national AI strategy must clearly address the measurements of success in regards to the strategy's stated goals and vision to ensure that they are interpreted and applied consistently. To do this, there must be inclusion and transparency between those building the systems and those using them in their work.


title: Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: Part I: Innovations in Pain Fellows' Education, Research, Applicant Selection Process, Wellness, and ACGME Implementation During the COVID-19 Pandemic

text: BACKGROUND: Pain fellowship programs are facing unique challenges during the COVID-19 pandemic. Restrictions from state governments and the Centers for Disease Control and Prevention have resulted in a rapidly changing and evolving learning environment for todays' fellows. Innovative solutions must be sought to guarantee that proper education is maintained and to ensure the well-being of our trainees. METHODS: We assembled a panel of pain program directors who serve as officers/board members of the Association of Pain Program Directors to provide guidance and formulate recommendations to pain fellowship directors nationally. This guidance is based on reviewing current changes to the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Anesthesiology policies and best available evidence and expert opinion on the use of remote educational activities, research endeavors, and trainee wellness. CONCLUSIONS: The country is in the midst of an unprecedented pandemic. The impact on pain management fellowships has been severe and will likely last for months, resulting in extraordinary challenges to the administration of pain fellowship programs and the education of our fellows. Understanding revisions to ACGME policies, using technology to promote remote learning opportunities, and providing trainees with opportunities to alleviate their anxiety and encourage mental health are beneficial strategies to implement. Together, we can implement innovative solutions to help overcome these challenges.


title: How the COVID-19 pandemic may impact public support for clinical xenotransplantation in the United States?

text: Many patients who would undergo organ transplantation cannot proceed due to the inability of human organ donation to satisfy medical needs. Xenotransplantation has the potential to offer unlimited availability of pig organs for transplantation, and pig-to-non-human primate models have demonstrated outcomes that may soon justify clinical trials. However, one of the unique ethical challenges faced by xenotransplantation is that the risk of introducing potential zoonotic disease into the community must be weighed along with the benefit to the patient. While most experts believe that zoonosis is manageable, apprehension over disease transmission from animal donors to human recipients remains a frequent concern of many who are undecided or opposed to clinical xenotransplantation. The COVID-19 pandemic represents a scenario (rapid worldwide spread of a highly contagious novel zoonotic disease with no natural defense in humans) that would seem to justify apprehension, especially in the United States, which has largely avoided previous pandemic outbreaks. However, there are many differences between zoonosis found in the wild or after xenotransplantation that favor the safety of the latter. Still, these differences, as well as the benefits of xenotransplantation, are not widely understood outside of the field. We must therefore ask what impact the COVID-19 pandemic will have on attitudes toward xenotransplantation.


title: Understanding the renin-angiotensin-aldosterone-SARS-CoV axis: a comprehensive review

text: IMPORTANCE: Coronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared a global pandemic with significant morbidity and mortality since first appearing in Wuhan, China, in late 2019. As many countries are grappling with the onset of their epidemics, pharmacotherapeutics remain lacking. The window of opportunity to mitigate downstream morbidity and mortality is narrow but remains open. The renin-angiotensin-aldosterone system (RAAS) is crucial to the homeostasis of both the cardiovascular and respiratory systems. Importantly, SARS-CoV-2 utilises and interrupts this pathway directly, which could be described as the renin-angiotensin-aldosterone-SARS-CoV (RAAS-SCoV) axis. There exists significant controversy and confusion surrounding how anti-hypertensive agents might function along this pathway. This review explores the current state of knowledge regarding the RAAS-SCoV axis (informed by prior studies of SARS-CoV), how this relates to our currently evolving pandemic, and how these insights might guide our next steps in an evidence-based manner. OBSERVATIONS: This review discusses the role of the RAAS-SCoV axis in acute lung injury and the effects, risks and benefits of pharmacological modification of this axis. There may be an opportunity to leverage the different aspects of RAAS inhibitors to mitigate indirect viral-induced lung injury. Concerns have been raised that such modulation might exacerbate the disease. While relevant preclinical, experimental models to date favour a protective effect of RAAS-SCoV axis inhibition on both lung injury and survival, clinical data related to the role of RAAS modulation in the setting of SARS-CoV-2 remain limited. CONCLUSION: Proposed interventions for SARS-CoV-2 predominantly focus on viral microbiology and aim to inhibit viral cellular injury. While these therapies are promising, immediate use may not be feasible, and the time window of their efficacy remains a major unanswered question. An alternative approach is the modulation of the specific downstream pathophysiological effects caused by the virus that lead to morbidity and mortality. We propose a preponderance of evidence that supports clinical equipoise regarding the efficacy of RAAS-based interventions, and the imminent need for a multisite randomised controlled clinical trial to evaluate the inhibition of the RAAS-SCoV axis on acute lung injury in COVID-19.


title: Structural basis for the inhibition of SARS-CoV-2 main protease by antineoplastic drug carmofur

text: The antineoplastic drug carmofur is shown to inhibit the SARS-CoV-2 main protease (Mpro). Here, the X-ray crystal structure of Mpro in complex with carmofur reveals that the carbonyl reactive group of carmofur is covalently bound to catalytic Cys145, whereas its fatty acid tail occupies the hydrophobic S2 subsite. Carmofur inhibits viral replication in cells (EC50 = 24.30 µM) and is a promising lead compound to develop new antiviral treatment for COVID-19.


title: Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: A systematic review and Meta-analysis

text: BACKGROUND: The rate of ICU admission among patients with coronavirus varied from 3% to 100% and the mortality was as high as 86% of admitted patients. The objective of the systematic review was to investigate the rate of ICU admission, mortality, morbidity, and complications among patients with coronavirus. METHODS: A comprehensive strategy was conducted in PubMed/Medline; Science direct and LILACS from December 2002 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting rate of ICU admission, the prevalence of mortality and its determinants among ICU admitted patients with coronavirus were included and the rest were excluded. RESULT: A total of 646 articles were identified from different databases and 50 articles were selected for evaluation. Thirty-seven Articles with 24983 participants were included. The rate of ICU admission was 32% (95% CI: 26 to 38, 37 studies and 32, 741 participants). The Meta-Analysis revealed that the pooled prevalence of mortality in patients with coronavirus disease in ICU was 39% (95% CI: 34 to 43, 37 studies and 24, 983 participants). CONCLUSION: The Meta-Analysis revealed that approximately one-third of patients admitted to ICU with severe Coronavirus disease and more than thirty percent of patients admitted to ICU with a severe form of COVID-19 for better care died which warns the health care stakeholders to give attention to intensive care patients. REGISTRATION: This Systematic review and Meta-Analysis was registered in Prospero international prospective register of systemic reviews (CRD42020177095) on April 9/2020.


Administration of end-of-life drugs by family caregivers during covid-19: opportunity for future home prescribing plans


First case of acute pancreatitis related to SARS-CoV-2 infection


title: Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal

text: OBJECTIVE: To review and critically appraise published and preprint reports of prediction models for diagnosing coronavirus disease 2019 (covid-19) in patients with suspected infection, for prognosis of patients with covid-19, and for detecting people in the general population at increased risk of becoming infected with covid-19 or being admitted to hospital with the disease. DESIGN: Living systematic review and critical appraisal. DATA SOURCES: PubMed and Embase through Ovid, Arxiv, medRxiv, and bioRxiv up to 7 April 2020. STUDY SELECTION: Studies that developed or validated a multivariable covid-19 related prediction model. DATA EXTRACTION: At least two authors independently extracted data using the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist; risk of bias was assessed using PROBAST (prediction model risk of bias assessment tool). RESULTS: 4909 titles were screened, and 51 studies describing 66 prediction models were included. The review identified three models for predicting hospital admission from pneumonia and other events (as proxy outcomes for covid-19 pneumonia) in the general population; 47 diagnostic models for detecting covid-19 (34 were based on medical imaging); and 16 prognostic models for predicting mortality risk, progression to severe disease, or length of hospital stay. The most frequently reported predictors of presence of covid-19 included age, body temperature, signs and symptoms, sex, blood pressure, and creatinine. The most frequently reported predictors of severe prognosis in patients with covid-19 included age and features derived from computed tomography scans. C index estimates ranged from 0.73 to 0.81 in prediction models for the general population, from 0.65 to more than 0.99 in diagnostic models, and from 0.85 to 0.99 in prognostic models. All models were rated at high or unclear risk of bias, mostly because of non representative selection of control patients, exclusion of patients who had not experienced the event of interest by the end of the study, high risk of model overfitting, and vague reporting. Most reports did not include any description of the study population or intended use of the models, and calibration of the model predictions was rarely assessed. CONCLUSION: Prediction models for covid-19 are quickly entering the academic literature to support medical decision making at a time when they are urgently needed. This review indicates that proposed models are poorly reported, at high risk of bias, and their reported performance is probably optimistic. Hence, we do not recommend any of these reported prediction models to be used in current practice. Immediate sharing of well documented individual participant data from covid-19 studies and collaboration are urgently needed to develop more rigorous prediction models, and validate promising ones. The predictors identified in included models should be considered as candidate predictors for new models. Methodological guidance should be followed because unreliable predictions could cause more harm than benefit in guiding clinical decisions. Finally, studies should adhere to the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) reporting guideline. SYSTEMATIC REVIEW REGISTRATION: Protocol https://osf.io/ehc47/, registration https://osf.io/wy245. READERS' NOTE: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 7 April 2020 (BMJ 2020;369:m1328), and previous updates can be found as data supplements (https://www.bmj.com/content/369/bmj.m1328/related#datasupp).


title: The Role of YouTube and the Entertainment Industry in Saving Lives by Educating and Mobilizing the Public to Adopt Behaviors for Community Mitigation of COVID-19: Successive Sampling Design Study

text: BACKGROUND: Effective community mitigation through voluntary behavior change is currently the best way to reduce mortality caused by coronavirus disease (COVID-19). This study builds on our prior study based on the scientific premise that YouTube is one of the most effective ways to communicate and mobilize the public in community mitigation to reduce exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE: Because of the rapidly changing nature of YouTube in the context of the COVID-19 pandemic, we conducted a follow-up study to document how coverage of preventive behaviors for effective community mitigation has changed. METHODS: A successive sampling design was used to compare coverage of behaviors to mitigate community transmission of COVID-19 in the 100 most widely viewed YouTube videos in January 2020 and March 2020. RESULTS: Videos in the January and March samples were viewed >125 million times and >355 million times, respectively. Fewer than half of the videos in either sample covered any of the prevention behaviors recommended by the US Centers for Disease Control and Prevention, but many covered key prevention behaviors and were very widely viewed. There were no videos uploaded by entertainment television in the January sample, but this source comprised the majority of videos and garnered the majority of cumulative views in the March sample. CONCLUSIONS: This study demonstrates the incredible reach of YouTube and the potential value of partnership with the entertainment industry for communicating and mobilizing the public about community mitigation to reduce mortality from the COVID-19 viral pandemic.


title: Dynamic profile and clinical implications of hematological parameters in hospitalized patients with coronavirus disease 2019

text: Objectives As people across the world suffer from coronavirus disease 2019 (COVID-19), further studies are needed to facilitate evaluating the severity and prognosis of COVID-19 patients. In the study, we aimed to dissect the dynamic profile and clinical implications of hematological findings in hospitalized patients with COVID-19. Methods We retrospectively analyzed the hematological findings of 72 patients with COVID-19 admitted from January 21 to February 17, 2020. The final date of follow-up was March 20, 2020. Dynamic profile of vital hematological parameters in severe and non-severe patients was presented at different time points (day 1, 5, 7, 9, 11, 13, 15 after admission), and the correlation of hematological parameters with hospitalization time was indicated. Results Of 72 patients with COVID-19, lymphopenia and leukopenia occurred in 39 (54.2%) and 20 (27.8%) patients with COVID-19, respectively. Fifteen (20.8%) patients were defined as severe cases and 57 (79.2%) were non-severe cases. Compared to non-severe patients, leukocyte count, neutrophil count and neutrophil-to-lymphocyte ratio (NLR) were significantly higher, whereas lymphocyte count was declined in severe patients at each time point. A growing trend in platelet count was found in non-severe patients over the follow-up period. In addition, a positive correlation of NLR with hospitalization time was detected from day 5 after admission. Conclusions Dynamic changes in vital hematological parameters from severe and non-severe patients had been characterized in the course of hospitalization. During hospitalization, NLR was found to have certain relevance to the hospitalization days and a role in forecasting disease prognosis for patients with COVID-19.


Upsurge of deep venous thrombosis in patients affected by COVID-19: Preliminary data and possible explanations


title: A Rapid Advice Guideline for the Prevention of Novel Coronavirus Through Nutritional Intervention

text: PURPOSE OF REVIEW: An unexpected and sudden outbreak of a novel infection known as a coronavirus (COVID-19) has imposed important problems to global well-being and economy. Based upon current researches, this virus is spreading from one human to another through respiratory droplets, i.e. cough and sneeze. Till now, there has not been any specific treatment found for this virus. Hence, there is a critical need to discover alternative techniques to cope with the current scenario. RECENT FINDINGS: This review conducted an online search for prevention of coronavirus infection with the help of nutritional interventions. It has been observed that the effect of the virus is mostly on the individual with low immunity, individual affected with diseases like diabetes, and individual using any immune-suppressed drug or having past history of major surgeries or severe medical conditions. Therefore, consuming foods which boost immunity helps in preventing respiratory-related disorder or suppressing diseases-related problems, which could be helpful in controlling the spread of this virus. In conclusion, it has been suggested that before the beginning of generalised treatments and interventions in each infected patient, nutritional status should be evaluated, as it can help in creating a specific nutrition intervention for the infected individual.


A protocol for central venous access in patients with coronavirus disease 2019 (COVID-19)


title: OpenSAFELY: factors associated with COVID-19 death in 17 million patients

text: COVID-19 has rapidly affected mortality worldwide1. There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England, here we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people with white ethnicity, Black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.30-1.69 and 1.44, 1.32-1.58, respectively). We have quantified a range of clinical risk factors for COVID-19-related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients' records; we will update and extend results regularly.


SARS-CoV-2: Herausforderung für alle./ [SARS-CoV-2-a challenge for all of us]


docid: yopgzfyq

title: Epidemics with containment measures

text: We propose a Susceptible-Infected (SI) epidemic spreading model including containment measures. In absence of containment measures the epidemics spreads exponentially fast for any value of the infectivity $\lambda>0$. The containment measures are modeled by considering a time-dependent modulation of the bare infectivity $\lambda$ leading to an effective infectivity that decays in time for each infected individual, mimicking for instance the combined effect of asymptomatic onset of the disease, testing policies and quarantine. We consider a wide range of temporal kernels for the effective infectivity and we investigate the effect of the considered containment measures. We find that not all kernels are able to push the epidemic dynamics below the epidemic threshold, with some containment measures only able to reduce the rate of the exponential growth of new infected individuals. We also propose a model with pandemic caused by a growing number of new separated foci. This model provides a stylized mathematical framework that can shed light on the role of different containment measures in mitigating and suppressing the spread of an epidemics such as COVID-19.


title: Remdesivir for 5 or 10 Days in Patients with Severe Covid-19

text: BACKGROUND: Remdesivir is an RNA polymerase inhibitor with potent antiviral activity in vitro and efficacy in animal models of coronavirus disease 2019 (Covid-19). METHODS: We conducted a randomized, open-label, phase 3 trial involving hospitalized patients with confirmed SARS-CoV-2 infection, oxygen saturation of 94% or less while they were breathing ambient air, and radiologic evidence of pneumonia. Patients were randomly assigned in a 1:1 ratio to receive intravenous remdesivir for either 5 days or 10 days. All patients received 200 mg of remdesivir on day 1 and 100 mg once daily on subsequent days. The primary end point was clinical status on day 14, assessed on a 7-point ordinal scale. RESULTS: In total, 397 patients underwent randomization and began treatment (200 patients for 5 days and 197 for 10 days). The median duration of treatment was 5 days (interquartile range, 5 to 5) in the 5-day group and 9 days (interquartile range, 5 to 10) in the 10-day group. At baseline, patients randomly assigned to the 10-day group had significantly worse clinical status than those assigned to the 5-day group (P = 0.02). By day 14, a clinical improvement of 2 points or more on the ordinal scale occurred in 64% of patients in the 5-day group and in 54% in the 10-day group. After adjustment for baseline clinical status, patients in the 10-day group had a distribution in clinical status at day 14 that was similar to that among patients in the 5-day group (P = 0.14). The most common adverse events were nausea (9% of patients), worsening respiratory failure (8%), elevated alanine aminotransferase level (7%), and constipation (7%). CONCLUSIONS: In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 ClinicalTrials.gov number, NCT04292899.).


title: Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis

text: BACKGROUND: Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients. METHODS: From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores. RESULTS: Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation. CONCLUSIONS: LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.


Communication, transparency key as Canada faces new coronavirus threat


title: Inbetweening auto-animation via Fokker-Planck dynamics and thresholding

text: We propose an equilibrium-driven deformation algorithm (EDDA) to simulate the inbetweening transformations starting from an initial image to an equilibrium image, which covers images varying from a greyscale type to a colorful type on plane or manifold. The algorithm is based on Fokker-Planck dynamics on manifold, which automatically cooperates positivity, unconditional stability, mass conservation law, exponentially convergence and also the manifold structure suggested by dataset. The thresholding scheme is adapted for the sharp interface dynamics and is used to achieve the finite time convergence. Using EDDA, three challenging examples, (I) facial aging process, (II) coronavirus disease 2019 (COVID-19) invading/treatment process, and (III) continental evolution process are conducted efficiently.


Interleukin-17A (IL-17A), a key molecule of innate and adaptive immunity, and its potential involvement in COVID-19-related thrombotic and vascular mechanisms


title: Deep-CAPTCHA: a deep learning based CAPTCHA solver for vulnerability assessment

text: CAPTCHA is a human-centred test to distinguish a human operator from bots, attacking programs, or other computerised agents that tries to imitate human intelligence. In this research, we investigate a way to crack visual CAPTCHA tests by an automated deep learning based solution. The goal of this research is to investigate the weaknesses and vulnerabilities of the CAPTCHA generator systems; hence, developing more robust CAPTCHAs, without taking the risks of manual try and fail efforts. We develop a Convolutional Neural Network called Deep-CAPTCHA to achieve this goal. The proposed platform is able to investigate both numerical and alphanumerical CAPTCHAs. To train and develop an efficient model, we have generated a dataset of 500,000 CAPTCHAs to train our model. In this paper, we present our customised deep neural network model, we review the research gaps, the existing challenges, and the solutions to cope with the issues. Our network's cracking accuracy leads to a high rate of 98.94% and 98.31% for the numerical and the alpha-numerical test datasets, respectively. That means more works is required to develop robust CAPTCHAs, to be non-crackable against automated artificial agents. As the outcome of this research, we identify some efficient techniques to improve the security of the CAPTCHAs, based on the performance analysis conducted on the Deep-CAPTCHA model.


title: A feedback SIR (fSIR) model highlights advantages and limitations of infection-based social distancing

text: Transmission rates in epidemic outbreaks vary over time depending on the societal and government response to infections and mortality data, as evidenced in the course of the COVID-19 pandemic. Following a mean field approach that models individuals like molecules in a well-mixed solution, I derive a modified SIR model in which the average daily contacts between susceptible and infected population are reduced based on the known infection levels, capturing the effects of social distancing policies. This approach yields a time-varying reproduction number that is continuously adjusted based on infection information through a negative-feedback term that is equivalent to Holling type II functions in ecology and Hill functions in chemistry and molecular biology. This feedback-adjustment of the transmission rate causes a structural reduction in infection peak, and simulations indicate that such reduction persists even in the presence of information delays. Simulations also show that a distancing policy based on infection data may substantially extend the duration of an epidemic. If the distancing rate is linearly proportional to infections, this model adds a single parameter to the original SIR, making it useful to illustrate the effects of social distancing enforced based on awareness of infections.


title: Stochastic modeling and estimation of COVID-19 population dynamics

text: The aim of the paper is to describe a model of the development of the Covid-19 contamination of the population of a country or a region. For this purpose a special branching process with two types of individuals is considered. This model is intended to use only the observed daily statistics to estimate the main parameter of the contamination and to give a prediction of the mean value of the non-observed population of the contaminated individuals. This is a serious advantage in comparison with other more complicated models where the observed official statistics are not sufficient. In this way the specific development of the Covid-19 epidemics is considered for different countries.


Novel coronavirus is putting the whole world on alert


docid: zmiyseqv

title: Vascular Life During the COVID-19 Pandemic Reminds Us to Prepare for the Unexpected


title: Impacts of State-Level Policies on Social Distancing in the United States Using Aggregated Mobility Data during the COVID-19 Pandemic

text: Social distancing has emerged as the primary mitigation strategy to combat the COVID-19 pandemic in the United States. However, large-scale evaluation of the public's response to social distancing campaigns has been lacking. We used anonymized and aggregated mobility data from Google Location History users to estimate the impact of social distancing recommendations on bulk mobility among users who have opted into this service. We found that state-of-emergency declarations resulted in approximately a 10% reduction in time spent away from places of residence. Implementation of one or more social distancing policies resulted in an additional 25% reduction in mobility the following week. Subsequent shelter-in-place mandates provided an additional 29% reduction. Our findings provide evidence that state-wide mandates are effective in promoting social distancing within this study group.


title: Digital habits of PR service-users: Implications for home-based interventions during the COVID-19 pandemic

text: Remote models of pulmonary rehabilitation (PR) are vital with suspension of face-to-face activity during the COVID-19 pandemic. We surveyed digital access and behaviours and PR delivery preferences of current PR service users. There was significant heterogeneity in access to and confidence in using the Internet with 31% having never previously accessed the Internet, 48% confident using the Internet and 29% reporting no interest in accessing any component of PR through a Web-based app. These data have implications for the remote delivery of PR during the COVID-19 pandemic and raise questions about the current readiness of service users to adopt Web-based delivered models of PR.


title: Correction: Cuscuta seeds: Diversity and evolution, value for systematics/identification and exploration of allometric relationships

text: [This corrects the article DOI: 10.1371/journal.pone.0234627.].


title: Evaluation of an electrostatic spray disinfectant technology for rapid decontamination of portable equipment and large open areas in the era of SARS-CoV-2

text: In the setting of the coronavirus disease 2019 pandemic, efficient methods are needed to decontaminate shared portable devices and large open areas such as waiting rooms. We found that wheelchairs, portable equipment, and waiting room chairs were frequently contaminated with potential pathogens. After minimal manual precleaning of areas with visible soiling, application of a dilute sodium hypochlorite disinfectant using an electrostatic sprayer provided rapid and effective decontamination and eliminated the benign virus bacteriophage MS2 from inoculated surfaces.


docid: wjxtebla

title: Survival regression with accelerated failure time model in XGBoost

text: Survival regression is used to estimate the relation between time-to-event and feature variables, and is important in application domains such as medicine, marketing, risk management and sales management. Nonlinear tree based machine learning algorithms as implemented in libraries such as XGBoost, scikit-learn, LightGBM, and CatBoost are often more accurate in practice than linear models. However, existing implementations of tree-based models have offered limited support for survival regression. In this work, we propose and implement loss functions for learning accelerated failure time (AFT) models in XGBoost, to increase the support for survival modeling for different kinds of label censoring. The AFT model assumes effects that directly accelerate or decelerate the survival time for different kinds of censored data sets. We demonstrate with real and simulated experiments the effectiveness of AFT in XGBoost with respect to a number of baselines, in two respects: generalization performance and training speed. Furthermore, we take advantage of the support for NVIDIA GPUs in XGBoost to achieve substantial speedup over multi-coreCPUs. To our knowledge, our work is the first implementation of AFT that utilizes the processing power of NVIDIA GPUs.


title: Transitioning a Surgery Practice to Telehealth During COVID-19

text: : The spread of COVID-19 has challenged practices across the United States to dramatically change inpatient and outpatient practices to focus on containing spread of the virus and accommodate the anticipated increase in volume of acute illness. Despite this transition, practices will need to continue to accommodate evaluation of newly diagnosed malignancies, routine postoperative visits, and acute postoperative issues. Building on an existing telemedicine framework, we aim to describe rapid transition in our outpatient care to a telehealth model in a general thoracic surgery practice during COVID-19.


title: Managing the coronavirus pandemic in Portugal: A step-by-step adjustment of health and social services

text: This article presents an overview of what has been done in Portugal to curb the spread of coronavirus disease 2019 (COVID-19), regarding public health actions, mental health implications, and measures taken or recommended to prevent the harmful effects of the pandemic. Because Portugal has been pointed out as a case of success in managing the COVID-19 pandemic, this report offers opportunities to build on the experience gained, which may positively influence other countries, especially those that are still deeply affected by the COVID-19 pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Clinical trials and the COVID-19 pandemic

text: "...but why think? Why not try the experiment?..." John Hunter (1728-1793), in a letter to Edward Jenner. August 2nd, 1775. When Galen of Pergamum (2nd c. A.D.), physician, philosopher and experimentalist, sought to ascertain the therapeutic properties of Theriac, an antidote of repute against poisons, he resorted to an experiment. Theriac or Theriaca was a compound drug, containing in some versions used in antiquity numerous components; Galen's own composition included over 70 ingredients! One of its uses was as an antidote against snakebites, a frequent peril for the Roman armies marching on in sandals. Galen spent most of his life in Rome and was elevated to Imperial Physician at the court of Marcus Aurelius, who apparently took daily doses of Theriac, which among other components included opium. Describing the experiment to his friend Pison, Galen wrote, "as I could not possibly conduct a trial on humans, I experimented on roosters" For his experiment, Galen, studied two groups of roosters, but he doesn't tell us how many animals he included in each category. Both groups were exposed to poisonous snakebites. All roosters who were fed with theriac prior to exposure to viper bites survived, whereas in the second group that had not received prophylactic Theriac, all roosters died. Not only is Galen's methodology remarkable, preceding the modern randomised trial by eighteen centuries, but more importantly, it is notable for his ethical stance at a time when sensitivities about human rights, prevalent in our times, were largely absent in societies of widespread slavery. For example, Mithridates VI (132-63 BC), the King of Pontus who is credited with the first use of Theriac, tested its efficacy on criminals and slaves. For his experiment Galen used the random allocation of treatment, today's prospective randomised clinical trial, implemented in the evaluation of novel therapies, widely used internationally, particularly in cancer research! This experimental method used for ascertaining the efficacy of new drugs became established after the second half of the 20th century and is now firmly entrenched as a research tool. On the other hand, the retrieval of information from observational studies or non-randomised series is considered scientifically inferior and is often dismissed or ignored as irrelevant or anecdotal. Such is the compulsion for the randomised study that in the midst of the COVID-19 pandemic, respected physicians and scientists appeared in the media hesitant to recommend the use of protective facial masks, as there was no evidence of benefit for their use from prospective randomised studies in the general population! Logic had no place in the argument! COVID-19, caused by the SARS-CoV-2 new corona virus, brought to the fore the randomised trial, as well as, the ethical dilemmas that surround the allocation of treatment at random, in the face of a devastating pandemic. Anthony Fauci, distinguished infectious diseases expert and an adviser to the President of the USA, at a recent briefing from the Situation Room of the White House, endorsed categorically and unreservedly the randomised trial for the evaluation of drugs potentially effective against SARS-CoV-2, in patients afflicted with COVID-19. A few days later on April 8th, 2020, Professor Sotiris Tsiodras, scientific advisor to the Greek Government for COVID-19 and an expert on infectious diseases, when asked by a journalist about chloroquine, he responded, "Antony Fauci is correct. Nevertheless, we give the drug to everyone, that is, not half of the patients will receive it, and the other half will not". If we accept that the randomised trial represents the unique, impregnable method of evaluating new treatments-several clinicians dispute this dogma. -the question arises how will treatments be allocated to patients? According to the Declaration of Helsinki participation of a subject in a clinical trial requires their explicit written consent. Will, a potentially hypoxic patient rapidly deteriorating, be able to understand what is being asked of them, and will that patient be in a position to provide consent? And if that patient refuses to be randomised, what are the options? Is it his/her right to request the active treatment that a fellow patient is receiving in the next bed? Although the Declaration of Helsinki allows the option of no treatment or even placebo, where no known treatment is available for a certain condition, such as COVID-19, it also emphasizes that "while the primary purpose of medical research is to generate new knowledge, this goal can never take precedence over the rights and interests of individual research subjects". Consider now the physicians and nurses on the first line of the battle against the pandemic; to the enormous pressures and risks that they experience daily, they may have to endure the added psychological burden of the randomised trial, knowing that half of their patients are receiving the promising drug, whilst the other half are denied the chance of potential benefit. When during the Medical Research Council's randomized trial of streptomycin, one senior physician contracted tuberculosis, the Medical Research Council obtained supplies for him outside the trial. In this brief instance of medical history, the equipoise, the scientific imperative, all arguments and other justifications for providing treatment at random, were thrown out of the window in favour of the human factor! Why is randomization necessary? Because-it is presumed-the process of randomising subjects, protects the study from the selective inclusion of patients with favourable characteristics, thus inadvertently allowing or facilitating a falsely favourable result for the drug or treatment under investigation. However, the process of randomising patients does not necessarily result in the randomisation of the characteristics of their disease. Exactly because of this, at the end of a randomised study, even if the prognostic variables are evenly represented and balanced in the strata, further confirmation of the result is sought with a statistical multifactorial analysis. Such multifactorial analyses can also be applied to a non-randomised group of patients engaged in the trial of a new drug. Since the middle of the 20th century a generation of physicians have been trained to dismiss, or are incapable of evaluating the validity of a treatment beyond the established etiquette of the randomised study. This, some have argued, constitutes intellectual indolence, it is not scientific robustness. Pandits foresee that the world will be different after the end of this pandemic. Perhaps human ingenuity will seek new investigative methods that will render the randomised clinical trial obsolete, both, on methodological and ethical grounds. Until then and even if we have to accept the scientific supremacy of the randomised study in the evaluation of novel therapies, the ethical considerations in the unprecedented circumstances of a relentless pandemic demand a more humane approach, befitting the beneficent precepts of the Hippocratic tradition.


COVID-19 needs a big science approach


title: Avaliação microbiológica de hambúrgueres industrializados congelados comercializados na cidade de Maceió, AL

text: O hambúrguer é um produto industrializado de origem animal, extremamente utilizado pela população principalmente pela sua praticidade no consumo. Esse trabalho teve como objetivo realizar a análise microbiológica de hambúrgueres congelados comercializados em Maceió-AL. Foram selecionadas nove marcas comerciais de hambúrgueres dos tipos: bovino, frango e misto (bovino e frango), foram pesquisados os seguintes micro-organismos: bactérias do grupo coliformes, Estafilococos coagulase positiva e Salmonella sp. As amostras das marcas comerciais B (misto), E (frango), F (misto), H (bovino) apresentaram contaminação por coliformes a 35 ºC e 45 ºC, porém dentro dos padrões da legislação brasileira. Para inibir o crescimento de micro-organismos nos alimentos cárneos é necessário manter a temperatura de armazenamento e distribuição a -18 ºC, além da conservação destes em equipamentos adequadamente higienizados, de forma a garantir a qualidade sanitária do produto. De acordo com os resultados encontrados, todos os hambúrgueres congelados industrializados avaliados estavam aptos para consumo.(AU)


title: Perspectives on challenges and opportunities for birth defects surveillance programs during and after the COVID-19 era

text: In recent months, various public health measures have been implemented throughout the world in response to the coronavirus disease 2019 (COVID-19) pandemic. This outbreak, and the subsequent containment policies, may have a range of potential short- and long-term impacts on the monitoring and surveillance of other conditions, such as birth defects. In this commentary, we provide a perspective on these potential impacts on birth defects surveillance and analysis. We discuss possible effects on clinical birth defect diagnoses, routine birth defects surveillance system activities, and epidemiologic considerations, as well as opportunities for mitigating the impact of COVID-19. Like many other sectors of public health and medicine, birth defects surveillance programs may be faced with organizational and methodological obstacles in the wake of a changing landscape. A better understanding of these potential challenges faced by birth defects surveillance programs could facilitate better planning and collaboration across programs to overcome barriers to core activities and to prepare for novel opportunities for research and prevention.


Professional identity formation in disorienting times


title: Online behavioural patterns for Coronavirus disease 2019 (COVID-19) in the United Kingdom

text: The current coronavirus (COVID-19) pandemic offers a unique opportunity to conduct an infodemiological study examining patterns in online searching activity about a specific disease and how this relates to news media within a specific country. Google Trends quantifies volumes of online activity. The relative search volume was obtained for 'Coronavirus', 'handwashing', 'face mask' and symptom related keywords, for the United Kingdom, from the date of the first confirmed case until numbers peaked in April. The relationship between online search traffic and confirmed case numbers was examined. Search volumes varied over time; peaks appear related to events in the progression of the epidemic which were reported in the media. Search activity on 'Coronavirus' correlated well against confirmed case number as did 'face mask' and symptom-related keywords. User-generated online data sources such as Google Trends may aid disease surveillance, being more responsive to changes in disease occurrence than traditional disease reporting. The relationship between media coverage and online searching activity is rarely examined, but may be driving online behavioural patterns.


Reply to Facing COVID-19 in Ophthalmology Department


title: 2019 novel coronavirus disease (COVID-19) in patients with inflammatory bowel diseases

text: BACKGROUND: Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are needed. AIMS: To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD. METHODS: This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region. RESULTS: Through April 8, 12 of 1918 IBD patients were diagnosed with COVID-19. The average age was 52 years, 75% of the patients were female and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these four with combined therapy (33%). Eight patients (66%) required hospitalisation (one intensive care unit admission, and two deaths), and four patients were isolated at home. Nine patients had diarrhoea ranging between 4 and 10 loose stools per day (mean 5.4, SD 1.6). In five patients (42%) diarrhoea was a presenting symptom. In two patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.2 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70-0.77; P < 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI: 0.84-1.06; P = 0.36), compared with the general population. CONCLUSIONS: IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients, diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19.


title: Responding to COVID-19: What's the Problem?

text: This commentary argues that the coronavirus SARS-CoV-2 pandemic should be considered as a transdisciplinary societal challenge that requires coordinated systemic thinking and actions in the context of uncertainty. Responses to the propagation of the coronavirus SARS-CoV-2 and the health, economic and social impacts of Covid-19 are complex, emergent and unpredictable. We describe the virtuous relations between three prerequisite conditions-multilevel governance, knowledge and types of resources and individual and collective behaviours-that should be combined in transdisciplinary responses.


Ophthalmology in the time of corona: Measures taken in a tertiary eye care hospital in Rajasthan against COVID-19 spread


title: May patients receiving 5-alpha-reductase inhibitors be in higher risk of COVID-19 complications?

text: COVID-19 pandemic is a major challenge for global and national healthcare providers. Number of new cases is continuously increasing with an emerging trend showing worse prognosis in males in comparison to females. Based on this observation, our proposed hypothesis is that 5-alpha-reductase inhibitors, that are commonly used for BPH treatment, may be one of the factors contributing to poorer prognosis in males.


title: The 21-item Barratt Impulsiveness Scale Revised (BIS-R-21): An alternative three-factor model

text: Background and aims: Due to its important role in both healthy groups and those with physical, mental and behavioral disorders, impulsivity is a widely researched construct. Among various self-report questionnaires of impulsivity, the Barratt Impulsiveness Scale is arguably the most frequently used measure. Despite its international use, inconsistencies in the suggested factor structure of its latest version, the BIS-11, have been observed repeatedly in different samples. The goal of the present study was therefore to test the factor structure of the BIS-11 in several samples. Methods: Exploratory and confirmatory factor analyses were conducted on two representative samples of Hungarian adults (N = 2,457; N = 2,040) and a college sample (N = 765). Results: Analyses did not confirm the original model of the measure in any of the samples. Based on explorative factor analyses, an alternative three-factor model (cognitive impulsivity; behavioral impulsivity; and impatience/restlessness) of the Barratt Impulsiveness Scale is suggested. The pattern of the associations between the three factors and aggression, exercise, smoking, alcohol use, and psychological distress supports the construct validity of this new model. Discussion: The new measurement model of impulsivity was confirmed in two independent samples. However, it requires further cross-cultural validation to clarify the content of self-reported impulsivity in both clinical and nonclinical samples.


Non-invasive respiratory support for patients with novel coronavirus pneumonia: clinical efficacy and reduction in risk of infection transmission


The detrimental effect of COVID-19 on subspecialty medical education


Preventing the dysfunction of public health centres responding to COVID-19 by focusing on public health nurses in Japan


title: Establishment and clinical performance evaluation of 2019 novel coronavirus antibody colloidal gold detection method/ 中华传染病杂志

text: Objective@#To establish a colloidal gold technique assay for the rapid detection of immunoglobulin(Ig) M and IgG antibodies against 2019 novel coronavirus (2019-nCoV) and to evaluate its clinical performance.@*Methods@#A total of 278 patients who were treated at Wuhan Hankou Hospital and the People's Hospital of Honghu from February 12, 2020 to February 20, 2020 were collected. According to the diagnostic criteria, 89 patients were confirmed with 2019-nCoV nucleic acid positive diagnosis, and 189 were 2019-nCoV nucleic acid-negative suspected patients. A total of 273 medical examiners from Nanfang Hospital, Southern Medical University from 2015 to 2018 were selected as controls. The serum samples of patients were collected. 2019-nCoV nucleic proteins were obtained from prokaryotic expression vectors. Indirect IgM and IgG colloidal gold techniques were established by using recombinant N protein. 2019-nCoV nucleic acid detection by reverse transcription-polymerase chain reaction (RT-PCR) was used as control. Serum specimens were tested for 2019-nCoV IgM and IgG. The specificity and sensitivity of colloidal gold assay were analyzed.@*Results@#The sensitivity and specificity of IgM detection reagents were 78.7% and 98.2%, respectively, those of IgG detection reagents were 73.0% and 99.3%, respectively, and those of IgM combined with IgG detection were 87.6% and 98.2%, respectively. For suspected patients with negative 2019-nCoV nucleic acid, the positive rates of IgM and IgG were 59.8% (113/189) and 52.9% (100/189), respectively, and the positive rate of IgM combined with IgG detection was 66.1% (125/189).@*Conclusion@#This reagent of 2019-nCoV antibodies detection (colloidal gold technique) fulfills the requirement for clinical application with high specificity and sensitivity, which can be served as a supplementary detection method for 2019-nCoV nucleic acid detection by RT-PCR.


"I have beard permission for all the patients!"


On the death of 100 + Italian doctors from COVID-19


This Time Must Be Different: Disparities During the COVID-19 Pandemic


title: The impact of 2019 novel coronavirus on heart injury: A Systematic review and Meta-analysis

text: BACKGROUND: Evidence about COVID-19 on cardiac injury is inconsistent. OBJECTIVES: We aimed to summarize available data on severity differences in acute cardiac injury and acute cardiac injury with mortality during the COVID-19 outbreak. METHODS: We performed a systematic literature search across Pubmed, Embase and pre-print from December 1, 2019 to March 27, 2020, to identify all observational studies that reported cardiac specific biomarkers (troponin, creatine kinase-MB fraction, myoglobin, or NT-proBNP) during COVID-19 infection. We extracted data on patient demographics, infection severity, comorbidity history, and biomarkers during COVID-19 infection. Where possible, data were pooled for meta-analysis with standard (SMD) or weighted (WMD) mean difference and corresponding 95% confidence intervals (CI). RESULTS: We included 4189 confirmed COVID-19 infected patients from 28 studies. More severe COVID-19 infection is associated with higher mean troponin (SMD 0.53, 95% CI 0.30 to 0.75, p < 0.001), with a similar trend for creatine kinase-MB, myoglobin, and NT-proBNP. Acute cardiac injury was more frequent in those with severe, compared to milder, disease (risk ratio 5.99, 3.04 to 11.80; p < 0.001). Meta regression suggested that cardiac injury biomarker differences of severity are related to history of hypertension (p = 0.030). Also COVID19-related cardiac injury is associated with higher mortality (summary risk ratio 3.85, 2.13 to 6.96; p < 0.001). hsTnI and NT-proBNP levels increased during the course of hospitalization only in non-survivors. CONCLUSION: The severity of COVID-19 is associated with acute cardiac injury, and acute cardiac injury is associated with death. Cardiac injury biomarkers mainly increase in non-survivors. This highlights the need to effectively monitor heart health to prevent myocarditis in patients infected with COVID-19.


title: Idle medical students review emerging COVID-19 research

text: The coronavirus disease (COVID-19) pandemic is causing wide-spread interruptions in medical education. With little warning, clinical rotations were cancelled and medical students were sent home. While pre-clinical students transitioned to online curricula, clinical students were left without discreet educational goals. Simultaneously, medical doctors were scrambling to maintain competence in the face of rapidly evolving COVID-19 information. Here, we describe an education program that integrates medical students into interdisciplinary teams to review emerging COVID-19 research that directly answers questions sent in by medical doctors.


title: Clinical Presentation of COVID-19: A Systematic Review Focusing on Upper Airway Symptoms

text: AIM: Pharyngodynia, nasal congestion, rhinorrhea, smell, and taste dysfunctions could be the presenting symptoms of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2. The aim was to perform a systematic review of current evidences on clinical presentation of COVID-19, focusing on upper airway symptoms in order to help otolaryngologists identifying suspected cases. METHODS: We searched PubMed and Web of Science electronic databases. RESULTS: We included 5 retrospective clinical studies for a total of 1556 hospitalized patients with COVID-19, 57.5% were male and mean age was 49.1 years. Pooled data revealed that pharyngodynia was present in 12.4% of patients, nasal congestion in 3.7%, and rhinorrhea was rare. No reports on COVID-19 and olfactory/gustative disorders matched inclusion criteria but preliminary evidences suggested they could be present. Common symptoms were fever (85.6%), cough (68.7%), and fatigue (39.4%). Frequent comorbidities were hypertension (17.4%), diabetes (3.8%), and coronary heart disease (3.8%); 83% of patients had alterations on chest computed tomography that were bilateral in 89.5% of cases. Ground-glass opacity was the most common finding (50%). Lymphopenia (77.2%) and leucopenia (30.1%) were common. Critical cases with complications were 9%, intensive care unit admission was required in 7.3%, invasive ventilation in 3.4%, and mortality was 2.4%. CONCLUSION: Otolaryngologists should know that pharyngodynia, nasal congestion, olfactory, and gustative disorders could be the presenting symptoms of COVID-19. Clinical presentation together with radiological and laboratory findings could help to identify suspected cases.


title: COVID-19: Lessons From the Disaster That Can Improve Health Professions Education

text: COVID-19 has disrupted every aspect of the U.S. health care and health professions education systems, creating anxiety, suffering, and chaos and exposing many of the flaws in the nation's public health, medical education, and political systems. The pandemic has starkly revealed the need for a better public health infrastructure and a health system with incentives for population health and prevention of disease as well as outstanding personalized curative health. It has also provided opportunities for innovations in health care and has inspired courageous actions of residents, who have responded to the needs of their patients despite risk to themselves.In this Invited Commentary, the author shares lessons he learned from three earlier disasters and discusses needed changes in medical education, health care, and health policy that the COVID-19 pandemic has revealed. He encourages health professions educators to use the experiences of this pandemic to reexamine the current curricular emphasis on the bioscientific model of health and to broaden the educational approach to incorporate the behavioral, social, and environmental factors that influence health. Surveillance for disease, investment in disease and injury prevention, and disaster planning should be basic elements of health professions education. Incorporating innovations such as telemedicine, used under duress during the pandemic, could alter educational and clinical approaches to create something better for students, residents, and patients. He explains that journals such as Academic Medicine can provide rapid, curated, expert advice that can be an important counterweight to the misinformation that circulates during disasters. Such journals can also inform their readers about new training in skills needed to mitigate the ongoing effects of the disaster and prepare the workforce for future disasters.