title: Improved Molecular Diagnosis of COVID-19 by the Novel, Highly Sensitive and Specific COVID-19-RdRp/Hel Real-Time Reverse Transcription-PCR Assay Validated In Vitro and with Clinical Specimens

text: On 31 December 2019, the World Health Organization was informed of a cluster of cases of pneumonia of unknown etiology in Wuhan, China. Subsequent investigations identified a novel coronavirus, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from the affected patients. Highly sensitive and specific laboratory diagnostics are important for controlling the rapidly evolving SARS-CoV-2-associated coronavirus disease 2019 (COVID-19) epidemic. In this study, we developed and compared the performance of three novel real-time reverse transcription-PCR (RT-PCR) assays targeting the RNA-dependent RNA polymerase (RdRp)/helicase (Hel), spike (S), and nucleocapsid (N) genes of SARS-CoV-2 with that of the reported RdRp-P2 assay, which is used in >30 European laboratories. Among the three novel assays, the COVID-19-RdRp/Hel assay had the lowest limit of detection in vitro (1.8 50% tissue culture infective doses [TCID50]/ml with genomic RNA and 11.2 RNA copies/reaction with in vitro RNA transcripts). Among 273 specimens from 15 patients with laboratory-confirmed COVID-19 in Hong Kong, 77 (28.2%) were positive by both the COVID-19-RdRp/Hel and RdRp-P2 assays. The COVID-19-RdRp/Hel assay was positive for an additional 42 RdRp-P2-negative specimens (119/273 [43.6%] versus 77/273 [28.2%]; P < 0.001), including 29/120 (24.2%) respiratory tract specimens and 13/153 (8.5%) non-respiratory tract specimens. The mean viral load of these specimens was 3.21 × 104 RNA copies/ml (range, 2.21 × 102 to 4.71 × 105 RNA copies/ml). The COVID-19-RdRp/Hel assay did not cross-react with other human-pathogenic coronaviruses and respiratory pathogens in cell culture and clinical specimens, whereas the RdRp-P2 assay cross-reacted with SARS-CoV in cell culture. The highly sensitive and specific COVID-19-RdRp/Hel assay may help to improve the laboratory diagnosis of COVID-19.


Adapting to the impact of COVID-19 on mental health: an international perspective


title: Early SARS-CoV-2 outbreak detection by sewage-based epidemiology

text: Sewage can be used to determine the scale of COVID-19 outbreak. Sewage Epidemiology or Waste Based Epidemiology (WBE) approach has been successfully used to track and provide early warnings of outbreaks of pathogenic viruses such as Hepatitis A, Poliovirus and Norovirus. In untreated wastewater COVID-19 (excreted via faeces then introduced to wastewater) can survive from hours to days. Detection of COVID-19 can be carried out with nucleic acid-based polymerase chain reaction (PCR) assay, used for confirmation of COVID-19 patients around the globe. New cheaper and faster monitoring tools are being developed to detect Covid-19 in wastewater by biosensors, ELISA, or paper-based indicator methods. This will allow to reveal true scale of Covid-19 outbreak associated with population link to a specific wastewater treatment plant.


title: Prevalence and Duration of Acute Loss of Smell or Taste in COVID-19 Patients

text: Initially, acute loss of smell (anosmia) and taste (ageusia) was not considered important symptoms for coronavirus disease 2019 (COVID-19). To determine the prevalence of these symptoms and to evaluate their diagnostic significance, we (approximately 150 physicians of the Daegu Medical Association) prospectively collected data of cases of anosmia and ageusia from March 8, 2020, via telephone interview among 3,191 patients in Daegu, Korea. Acute anosmia or ageusia was observed in 15.3% (488/3,191) patients in the early stage of COVID-19 and in 15.7% (367/2,342) patients with asymptomatic-to-mild disease severity. Their prevalence was significantly more common among females and younger individuals (P = 0.01 and P < 0.001, respectively). Most patients with anosmia or ageusia recovered within 3 weeks. The median time to recovery was 7 days for both symptoms. Anosmia and ageusia seem to be part of important symptoms and clues for the diagnosis of COVID-19, particularly in the early stage of the disease.


Criterios de triaje para reanimación cardiopulmonar y soporte vital avanzado durante la epidemia COVID-19./ Criterios de triaje para reanimación cardiopulmonar y soporte vital avanzado durante la epidemia COVID-19./ Triage criteria for cardiopulmonary resuscitation and advanced life support during the COVID-19 epidemic


title: Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19

text: BACKGROUND: The pandemic coronavirus disease 2019 (COVID-19) has threaten the global health. The characteristics of laboratory findings of coronavirus are of great significance for clinical diagnosis and treatment. We found indicators that may most effectively predict a non-severe COVID-19 patient develop into a severe patient. METHODS: We conducted a meta-analysis to compare the laboratory findings of severe patients with non-severe patients with COVID-19 from searched articles. RESULTS: Through the analysis of laboratory examination information of patients with COVID-19 from 35 articles (5912 patients), we demonstrated that severe cases possessed higher levels of leukocyte (1.20-fold), neutrophil (1.33-fold), CRP (3.04-fold), PCT (2.00-fold), ESR (1.44-fold), AST (1.40-fold), ALT (1.34-fold), LDH (1.54-fold), CK (1.44-fold), CK-MB (1.39-fold), total bilirubin (1.14-fold), urea (1.28-fold), creatine (1.09-fold), PT (1.03-fold) and D-dimer (2.74-fold), as well as lower levels of lymphocytes (1.44-fold), eosinophil (2.00-fold), monocyte (1.08-fold), Hemoglobin (1.53-fold), PLT (1.15-fold), albumin (1.15-fold), and APTT (1.02-fold). Lymphocyte subsets and series of inflammatory cytokines were also different in severe cases with the non-severe ones, including lower levels of CD4 T cells (2.10-fold) and CD8 T cells (2.00-fold), higher levels of IL-1ß (1.02-fold), IL-6 (1.93-fold) and IL-10 (1.55-fold). CONCLUSIONS: Some certain laboratory inspections could predict the progress of the COVID-19 changes, especially lymphocytes, CRP, PCT, ALT, AST, LDH, D-dimer, CD4 T cells and IL6, which provide valuable signals for preventing the deterioration of the disease.


Special Issue: Digital Health in Times of COVID-19


title: Performance of urea-mediated dissociation in reducing false-positive of 2019-nCoV IgM test/ 中华检验医学杂志

text: Objective@#To investigate the interference factors causing false-positive result of novel coronavirus IgM antibody (SARS-CoV-2 IgM) detected by gold immunochromatography assay (GICA) and enzyme-linked immunosorbent assay (ELISA).@*Methods@#A total of 71 serum from different pathogen infections and related chronic diseases patients were collected from the Affiliated Hospital of North Sichuan Medical College from January 25, 2020 to February 15, 2020. GICA and ELISA were used to detect 2019-nCoV IgM in 71 serum, including 5 influenza A virus (Flu A) IgM positive serum, 5 influenza B virus (Flu B) IgM positive serum, 5 Mycoplasma pneumonia (MP) IgM positive serum, 5 Legionella pneumophila (LP) IgM positive serum, 29 rheumatoid factor (RF) IgM positive serum, 5 hypertension patients serum, 5 diabetes mellitus patients serum, 6 human immunodeficiency virus (HIV) infection patients serum and 6 Corona Virus Disease 2019 (COVID-19) patients serum. The interference factors causing false positive results of the two methods were analyzed, and urea dissociation test was employed to dissociate the 2019-nCoV IgM positive serum using the best dissociation concentration. Statistical analyses were performed by SPSS, version 19.0.@*Result@#s 2019-nCoV IgM was positive in 18 cases of middle-high level RF-IgM positive serum and 6 cases of 2019-nCoV-infected serum detected by two methods, and the other 47 serum were negative. When the dissociation concentration of urea was 6 mol/L, 2019-nCoV IgM was negative in 17 cases of middle-high level RF-IgM positive serum and positive in 6 cases of 2019-nCoV-infected serum detected by GICA. When the urea dissociation concentration was 4 mol/L, dissociation time was 10 min and the avidity index<0.46 was set as negative, 2019-nCoV IgM was negative in 15 cases of middle-high level RF-IgM positive serum and positive in 6 cases of 2019-nCoV-infected serum detected by ELISA.@*Conclusion@#The middle-high level of RF-IgM could cause false positive results of SARS-CoV-2 IgM detected by GICA and ELISA, and the urea dissociation test would be helpful for reducing the probability of false-positive results of SARS-CoV-2 IgM test.


Leader update for Heart and Lung


A Call for Addressing Barriers to Telemedicine: Health Disparities during the COVID-19 Pandemic


A model for a ventilator-weaning and early rehabilitation unit to deal with post-ICU impairments following severe COVID-19


title: Diagnostic Ultrasound Services During the Coronavirus Disease (COVID-19) Pandemic

text: OBJECTIVE. Nosocomial transmission of coronavirus disease (COVID-19) to frontline health care workers is well known, and health care workers may inadvertently become vectors for onward transmission. Ultrasound (US) service providers are at significant risk because scanning usually requires prolonged close patient contact. The bulky US equipment may also facilitate fomite transmission of disease. With increasing use of point-of-care and portable diagnostic US services, the risk is substantial. CONCLUSION. Our experience and protocols may help service providers with their own effective response against COVID-19.


docid: mfqungpo

title: Tracking the Volume of Neurosurgical Care during the COVID-19 Pandemic

text: OBJECTIVE: This study quantifies the impact of COVID-19 on the volume of adult and pediatric neurosurgical procedures, inpatient consults, and clinic visits at an academic medical center. METHODS: Neurosurgical procedures, inpatient consults, and outpatient appointments at Vanderbilt University Medical Center were identified in the time periods of March 23, 2020 through May 8, 2020 ("During COVID-19") and March 25, 2019 through May 10, 2019 ("Before COVID-19"). Neurosurgical volume was compared between these periods. RESULTS: A 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median 75 [IQR 72-80] to 45 [43-47], p<0.001). There was a 42% reduction for weekly adult procedures (62 [54-70] to 36 [34-39], p<0.001), and 31% reduction for weekly pediatric procedures (13 [12-14] to 9 [8-10], p=0.004). Among adult procedures, the most significant decreases were seen for spine (p<0.001), endovascular (p<0.001), and cranioplasty (p<0.001). There was not a significant change for adult open vascular (p=0.291), functional (p=0.263), cranial tumor (p=0.143), or hydrocephalus (p=0.173) procedural volume. Weekly inpatient consults to neurosurgery decreased by 24% (99 [94-114] to 75 [68-84], p=0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (329 [326-374] to 29 [26-39], p<0.001). Weekly telehealth encounters increased from 0 [0-0] to 151 [126-156] (p<0.001). CONCLUSION: There were significant reductions in neurosurgical operations, clinic visits, and inpatient consults during COVID-19. Telehealth was increasingly used for assessment. The long-term impacts of reduced neurosurgical volume and increased telehealth utilization on patient outcomes should be explored.


SARS-CoV-2 likes it cool


Endothelial cells orchestrate COVID-19 coagulopathy


docid: kecxuove

title: COVID-19 safety in maternity care: lessons for the whole NHS

text: John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent reports in maternity care, which can be seen to also to have general application across all clinical specialities.


Primary Care Mock Codes During a Pandemic: Interprofessional Team-Based Emergency Education While Maintaining Social Distance


title: Prediction of numbers of the accumulative confirmed patients (NACP) and the plateau phase of 2019-nCoV in China

text: In the present study, I propose a novel fitting method to describe the outbreak of 2019-nCoV in China. The fitted data were selected carefully from the non-Hubei part and Hubei Province of China respectively. For the non-Hubei part, the time period of data collection corresponds from the beginning of the policy of isolation to present day. But for Hubei Province, the subjects of Wuhan City and Hubei Province were included from the time of admission to the Huoshenshan Hospital to present day in order to ensure that all or the majority of the confirmed and suspected patients were collected for diagnosis and treatment. The employed basic functions for fitting are the hyperbolic tangent functions tanh ( . ) since in these cases the 2019-nCoV is just an epidemic. Subsequently, the 2019-nCoV will initially expand rapidly and tend to disappear. Therefore, the numbers of the accumulative confirmed patients in different cities, provinces and geographical regions will initially increase rapidly and subsequently stabilize to a plateau phase. The selection of the basic functions for fitting is crucial. In the present study, I found that the hyperbolic tangent functions tanh ( . ) could satisfy the aforementioned properties. By this novel method, I can obtain two significant results. They base on the conditions that the rigorous isolation policy is executed continually. Initially, I can predict the numbers very accurately of the cumulative confirmed patients in different cities, provinces and parts in China, notably, in Wuhan City with the smallest relative error estimated to 0.021 % , in Hubei Province with the smallest relative error estimated to 0.012 % and in the non-Hubei part of China with the smallest relative error of - 0.195% in the short-term period of infection. In addition, perhaps I can predict the times when the plateau phases will occur respectively in different regions in the long-term period of infection. Generally for the non-Hubei part of China, the plateau phase of the outbreak of the 2019-nCoV will be expected this March or at the end of this February. In the non-Hubei region of China it is expected that the epidemic will cease on the 30th of March 2020 and following this date no new confirmed patient will be expected. The predictions of the time of Inflection Points and maximum NACP for some important regions may be also obtained. A specific plan for the prevention measures of the 2019-nCoV outbreak must be implemented. This will involve the present returning to work and resuming production in China. Based on the presented results, I suggest that the rigorous isolation policy by the government should be executed regularly during daily life and work duties. Moreover, as many as possible the confirmed and suspected cases should be collected to diagnose or treat.


Algorithm for the classification of COVID-19 rashes


title: COVID-19 in Turkey: Lessons Learned

text: Turkey reported its first COVID-19 case on March 10, 2020. We present here the mitigation efforts Turkey has undertaken so far, and also review the lessons learned for future proactive strategies. High number of intensive care unit beds and ventilators, national treatment algorithms, governmental support for free testing and medications, tedious contact-tracing with early detection and isolation of cases together with early shelter-in-place for the elderly and youngsters, and subsequent weekend curfews in selected cities have so far prevented the surge pressure on the health care system. At this phase, Turkey needs to adopt an evidence-based, proactive control system for an effective transition process to normalize the situation. Here, we underline the urgent need for detailed analysis of the national COVID-19 data and propose an epidemiologic investigation framework for better understanding, efficient control, and reliable forecasting of COVID-19 pandemic.


Plasma from donors convalescent from SARS-CoV-2 infection-A matter of priorities


title: A fractional-order compartmental model for predicting the spread of the Covid-19 pandemic

text: We propose a time-fractional compartmental model (SEI$_A$I$_S$HRD) comprising of the susceptible, exposed, infected (asymptomatic and symptomatic), hospitalized, recovered and dead population for the Covid-19 pandemic. We study the properties and dynamics of the proposed model. The conditions under which the disease-free and endemic equilibrium points are asymptotically stable are discussed. Furthermore, we study the sensitivity of the parameters and use the data from Tennessee state (as a case study) to discuss identifiability of the parameters of the model. The non-negative parameters in the model are obtained by solving inverse problems with empirical data from California, Florida, Georgia, Maryland, Tennessee, Texas, Washington and Wisconsin. The basic reproduction number is seen to be slightly above the critical value of one suggesting that stricter measures such as the use of face-masks, social distancing, contact tracing, and even longer stay-at-home orders need to be enforced in order to mitigate the spread of the virus. As stay-at-home orders are rescinded in some of these states, we see that the number of cases began to increase almost immediately and may continue to rise until the end of the year 2020 unless stricter measures are taken.


docid: qfdnysdq

title: The Impacts of Isolation Measures Against SARS-CoV-2 Infection on Sexual Health


An invited commentary on "The socio-economic implications of the coronavirus and COVID-19 pandemic: A review"


Emergency management, mitigation for COVID-19 and the importance of preparedness for future outbreaks


COVID-19 cancer conundrum-evidence driving decisions or the lack of it?


title: Fragility of an aging immune system

text: The adaptive and innate branches of the vertebrate immune system work in close collaboration to protect organisms from harmful pathogens. As an organism ages its immune system undergoes immunosenescence, characterized by declined performance or malfunction in either immune branch, which can lead to disease and death. In this study we develop a mathematical model of the immune system that incorporates both the innate and adaptive immune compartments, named the integrated immune branch (IIB) model, and investigate how immune behavior changes in response to a sequence of pathogen encounters. We find that repeated pathogen exposures induce a fragility, in which exposure to novel pathogens may cause the immune response to transition to a chronic inflammatory state. The chronic inflammatory state of the IIB model is qualitatively consistent with"inflammaging,"a clinically-observed condition in which aged individuals experience chronic low-grade inflammation even in the absence of pathogens. Thus, the IIB model quantitatively demonstrates how immunosenescence can manifest itself in the innate compartment as inflammaging. In particular, the onset of a persistent inflammatory response strongly depends on the history of encountered pathogens; the timing of its onset differs drastically when the same set of infections occurs in a different order. Lastly, the coupling between the two immune branches generates a trade-off between rapid pathogen clearance and a delayed onset of immunosenescence. By considering complex feedbacks between immune compartments, our work suggests potential mechanisms for immunosenescence and provides a theoretical framework to account for clinical observations.


Kidney transplantation trends in South Korea during the COVID-19 pandemic


title: Perception of emergent epidemic of COVID-2019 / SARS CoV-2 on the Polish Internet

text: We study the perception of COVID-2019 epidemic in Polish society using quantitative analysis of its digital footprints on the Internet (on Twitter, Google, YouTube, Wikipedia and electronic media represented by Event Registry) from January 2020 to 12.03.2020 (before and after official introduction to Poland on 04.03.2020). To this end we utilize data mining, social network analysis, natural language processing techniques. Each examined internet platform was analyzed for representativeness and composition of the target group. We identified three temporal major cluster of the interest before disease introduction on the topic COVID-2019: China- and Italy-related peaks on all platforms, as well as a peak on social media related to the recent special law on combating COVID-2019. Besides, there was a peak in interest on the day of officially confirmed introduction as well as an exponential increase of interest when the Polish government declared war against disease with a massive mitigation program. From sociolingistic perspective, we found that concepts and issues of threat, fear and prevention prevailed before introduction. After introduction, practical concepts about disease and epidemic dominate. We have found out that Twitter reflected the structural division of the Polish political sphere. We were able to identify clear communities of governing party, mainstream oppostition and protestant group and potential sources of misinformation. We have also detected bluring boundaries between comminities after disease introduction.


title: Should chest compressions be considered an aerosol-generating procedure? A literature review in response to recent guidelines on personal protective equipment for patients with suspected COVID-19

text: There is disagreement between international guidelines on the level of personal protective equipment (PPE) required for chest compressions for patients with suspected COVID-19. This discrepancy centres on whether they are considered to be an aerosol-generating procedure (AGP), thus requiring airborne protection to prevent transmission to healthcare workers (HCWs). The need to don higher-level PPE has to be weighed against the resulting delay to emergency treatment.We performed a literature search on this topic which found eight relevant studies. All were observational with low patient numbers and multiple confounding factors, but describe cases of acute respiratory infection transmission during chest compressions. One systematic review concluded that chest compressions were not an AGP. Two simulated studies (released as preprints) potentially demonstrate aerosol generation. Given that there is evidence for infection transmission during chest compressions, we conclude that a precautionary approach with appropriate PPE is necessary to protect HCW from contracting a potentially fatal infection.


Clinical analysis of sinus bradycardia in patients with severe COVID-19 pneumonia


Coronavirus Lockdown: Forced Inactivity for the Oldest Old?


docid: sdjndyqo

title: Maintaining safety and service provision in human milk banking: a call to action in response to the COVID-19 pandemic


Cardiac Troponin I is an Independent Predictor for Mortality in Hospitalized Patients with Coronavirus Disease 2019


title: COVID-19 in rheumatic disease patients on immunosuppressive agents

text: OBJECTIVE: To analyze clinical characteristics and outcome of COVID-19 patients with underlying rheumatic diseases (RD) on immunosuppressive agents. METHOD: A case series of COVID-19 patients with RD on disease modifying anti-rheumatic drugs (DMARDs) were studied by a retrospective chart review. A literature search identified 9 similar studies of single cases and case series, which were also included. RESULTS: There were 4 COVID-19 inpatients with RD from our hospital, and the mean age was 57 ± 21 years. Two patients had a mild infection, and 2 developed severe COVID-19 related respiratory complications, including 1 patient on secukinumab requiring mechanical ventilation and 1 patient on rituximab developing viral pneumonia requiring supplemental oxygenation. All 4 patients had elevated acute phase reactants, 2 patients had mild COVID-19 with lymphopenia, and 2 patients had severe COVID-19 with normal lymphocyte counts, and high levels of IL-6. None of the patients exhibited an exacerbation of their underlying RD. In the literature, there were 9 studies of COVID-19 involving 197 cases of various inflammatory RD. Most patients were on DMARDs or biologics, of which TNFα inhibitors were most frequently used. Two tocilizumab users had a mild infection. Two patients were on rituximab with 1 severe COVID-19 requiring mechanical ventilation. Six patients were on secukinumab with 1 hospitalization. Of the total 201 cases, 12 died, with an estimated mortality of 5.9% CONCLUSION: Patients with RD are susceptible to COVID-19. Various DMARDs or biologics may affect the viral disease course differently. Patients on hydroxychloroquine, TNFα antagonists or tocilizumab may have a mild viral illness. Rituximab or secukinumab could worsen the viral disease. Further study is warranted.


Hygiene at home: A bulwark against COVID-19 to be protect from SARS-CoV-2


title: Access to evidence-based care for eating disorders during the COVID-19 crisis

text: The COVID-19 pandemic has forced an abrupt change in the delivery of clinical services, including for individuals with an eating disorder. We present this Virtual Issue as a resource for the eating disorder community to showcase research published in the International Journal of Eating Disorders that provides information on effective strategies to help address the challenges arising from COVID-19-related disruptions. Articles included describe original research or systematic reviews on obstacles to health services use and strategies to improve access to care; technological tools to provide or enhance interventions; patients' and clinicians' attitudes or perspectives on using digital tools for clinical care; factors influencing therapeutic alliance; and ideas for improving reach and uptake of digital interventions. We hope that readers will find ways to observe and record their own experiences during this global crisis; the experiences of people at risk for developing or exhibiting an eating disorder; and the experiences of those who care for people with an eating disorder. These lived experiences will be invaluable in formulating hypotheses for future studies in service of advancing the understanding of eating disorders and improving interventions and policies for reducing the burden of suffering attributable to eating disorders.


title: Informal motorbike taxi drivers and mobility injustice on Hanoi's streets. Negotiating the curve of a new narrative

text: The central government of the Socialist Republic of Vietnam and Hanoi's municipal authorities are enthusiastically embracing a series of plans and policies for the capital city to create a sustainable mega-city. This state imaginary privileges 'modern' mobilities, championing highways, a bus rapid transport system, and an elevated metro, while so called 'traditional' means of moving around the city such as motorbikes, bicycles, or cyclos are being strongly discouraged and increasingly marginalised. For example, Hanoi officials are implementing a step-wise ban on motorbikes from downtown streets by 2030, while the majority of the urban population travels by motorbike, with about five million motorbikes plying the city's streets. While such an approach not only creates mobility injustice for lower socio-economic residents of the city as a whole, it threatens to undermine the livelihoods of thousands of informal motorbike taxi drivers (locally known as xe ôm). In this article I engage with the emerging mobility injustice literature to explore how state discourses regarding urban modernisation are impacting the possibilities for Hanoi's xe ôm drivers to maintain access to city streets and viable livelihoods. These drivers must negotiate emerging and often conflicting state policies, their enforcement, as well as new app-based competitors, all of which challenge the equitable distribution of motility and produce important frictions. Nonetheless, xe ôm drivers draw on their agency and creativity during their daily routines to push back, while also creating new narratives regarding their vital role in maintaining neighbourhood security. We thus see how marginalised individuals are counteracting policies they consider unjust, even when this urban agenda is embedded in a politically socialist context.


Focus on the Crosstalk between COVID-19 and Urogenital Systems


COVID-19 lockdown dropped the rate of paediatric asthma admissions


High-flow nasal-oxygenation-assisted fibreoptic tracheal intubation in critically ill patients with COVID-19 pneumonia: a prospective randomised controlled trial


docid: thtnihyg

title: Asthmatic patients in COVID-19 outbreak: Few cases despite many cases


docid: lvpsfdbm

title: Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19


title: COVID-19 vulnerability: the potential impact of genetic susceptibility and airborne transmission

text: The recent coronavirus disease (COVID-19), caused by SARS-CoV-2, is inarguably the most challenging coronavirus outbreak relative to the previous outbreaks involving SARS-CoV and MERS-CoV. With the number of COVID-19 cases now exceeding 2 million worldwide, it is apparent that (i) transmission of SARS-CoV-2 is very high and (ii) there are large variations in disease severity, one component of which may be genetic variability in the response to the virus. Controlling current rates of infection and combating future waves require a better understanding of the routes of exposure to SARS-CoV-2 and the underlying genomic susceptibility to this disease. In this mini-review, we highlight possible genetic determinants of COVID-19 and the contribution of aerosol exposure as a potentially important transmission route of SARS-CoV-2.


title: Clinical Best Practice Advice for Hepatology and Liver Transplant Providers During the COVID-19 Pandemic: AASLD Expert Panel Consensus Statement

text: Coronavirus disease 2019 (COVID-19), the illness caused by the SARS-CoV-2 virus, is rapidly spreading throughout the world. Hospitals and healthcare providers are preparing for the anticipated surge in critically ill patients but few are wholly equipped to manage this new disease. We all must do our part to prepare our patients, clinics, and hospitals for the drastic changes necessary to mitigate the spread of SARS-CoV-2 or we risk overwhelming the capacity of our healthcare system. The goals of this document are to provide data on what is currently known about COVID-19, and how it may impact hepatologists and liver transplant providers and their patients. Our aim is to provide a template for the development of clinical recommendations and policies to mitigate the impact of the COVID-19 pandemic on liver patients and healthcare providers.


The Spread of COVID-19 in the Italian Population: Anxiety, Depression, and Post-traumatic Stress Symptoms


title: Shining a light on the pathogenicity of health care providers' mobile phones: Use of a novel ultraviolet-C wave disinfection device

text: BACKGROUND: Mobile phones are known to carry pathogenic bacteria and viruses on their surfaces, posing a risk to healthcare providers (HCPs) and hospital infection prevention efforts. We utilize an Ultraviolet-C (UV-C) device to provide an effective method for mobile phone disinfection and survey HCPs about infection risk. METHODS: Environmental swabs were used to culture HCPs' personal mobile phone surfaces. Four cultures were obtained per phone: before and after the UV-C device's 30-second disinfecting cycle, at the beginning and end of a 12-hour shift. Surveys were administered to participants pre- and poststudy. RESULTS: Total bacterial colony forming units were reduced by 90.5% (Pâ¯=â¯.006) after one UV-C disinfection cycle, and by 99.9% (Pâ¯=â¯.004) after 2 cycles. Total pathogenic bacterial colony forming units were decreased by 98.2% (Pâ¯=â¯.038) after one and >99.99% (Pâ¯=â¯.037) after 2 disinfection cycles. All survey respondents were willing to use the UV-C device daily to weekly, finding it convenient and beneficial. DISCUSSION: This novel UV-C disinfecting device is effective in reducing pathogenic bacteria on mobile phones. HCPs would frequently use a phone disinfecting device to reduce infection risk. CONCLUSIONS: In light of the ongoing coronavirus (COVID-19) pandemic, a standardized approach to phone disinfection may be valuable in preventing healthcare-associated infections.


title: Attending to the Emotional Well-Being of the Health Care Workforce in a New York City Health System During the COVID-19 Pandemic

text: The COVID-19 pandemic has placed an enormous strain on health care workers, and its potential impact has implications for the physical and emotional well-being of the work force. As hospital systems run far over capacity, facing possible shortages of critical care medical resources and personal protective equipment as well as clinician deaths, the psychological stressors necessitate a strong well-being support model for staff. At the Mount Sinai Health System (MSHS) in New York City, health care workers have been heroically providing front-line care to COVID-19 patients while facing their own appropriate fears for their personal safety in the setting of contagion. This moral obligation cannot be burdened by unacceptable risks; the health system's full support is required to address the needs of its workforce.In this Invited Commentary, the authors describe how an MSHS Employee, Faculty, and Trainee Crisis Support Task Force-created in early March 2020 and composed of behavioral health, human resources, and well-being leaders from across the health system-used a rapid needs assessment model to capture the concerns of the workforce related to the COVID-19 pandemic. The task force identified 3 priority areas central to promoting and maintaining the well-being of the entire MSHS workforce during the pandemic: meeting basic daily needs; enhancing communications for delivery of current, reliable, and reassuring messages; and developing robust psychosocial and mental health support options. Using a work group strategy, the task force operationalized the roll-out of support initiatives for each priority area. Attending to the emotional well-being of health care workers has emerged as a central element in the MSHS COVID-19 response, which continues to be committed to the physical and emotional needs of a workforce that courageously faces this crisis.


title: Mitigating the impact of COVID-19 on oncology: Clinical and operational lessons from a prospective radiation oncology cohort tested for COVID-19

text: BACKGROUND AND PURPOSE: The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures, and quarantines. MATERIALS AND METHODS: Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020-04/22/2020). RESULTS: A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (4 warranting intensive care), and 2 died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1-4) to ≤1-day (P < 0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75-5) to 1 business day (IQR: 1-2) [P < 0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3-6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2-11), with a peak of 17 employees simultaneously quarantined. Following implementation of a "dual PPE policy," newly quarantined employees decreased from 2.9 to 0.5 per day. CONCLUSION: The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes.


Anesthesia and infection control in cesarean section of pregnant women with COVID-19 infection: A descriptive study


Coronavirus Pandemic: What Nuclear Medicine Departments Should Know


COVID19: Why justice and transparency in hospital triage policies are paramount


title: Stacked Convolutional Neural Network for Diagnosis of COVID-19 Disease from X-ray Images

text: Automatic and rapid screening of COVID-19 from the chest X-ray images has become an urgent need in this pandemic situation of SARS-CoV-2 worldwide in 2020. However, accurate and reliable screening of patients is a massive challenge due to the discrepancy between COVID-19 and other viral pneumonia in X-ray images. In this paper, we design a new stacked convolutional neural network model for the automatic diagnosis of COVID-19 disease from the chest X-ray images. We obtain different sub-models from the VGG19 and developed a 30-layered CNN model (named as CovNet30) during the training, and obtained sub-models are stacked together using logistic regression. The proposed CNN model combines the discriminating power of the different CNN`s sub-models and classifies chest X-ray images into COVID-19, Normal, and Pneumonia classes. In addition, we generate X-ray images dataset referred to as COVID19CXr, which includes 2764 chest x-ray images of 1768 patients from the three publicly available data repositories. The proposed stacked CNN achieves an accuracy of 92.74%, the sensitivity of 93.33%, PPV of 92.13%, and F1-score of 0.93 for the classification of X-ray images. Our proposed approach shows its superiority over the existing methods for the diagnosis of the COVID-19 from the X-ray images.


title: Psychological status of surgical staff during the COVID-19 outbreak

text: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared in early December 2019, had an atypical viral pneumonia outbreak in Wuhan, Hubei, China. And there is a high risk of global proliferation and impact. The sudden increase in confirmed cases has brought tremendous stress and anxiety to frontline surgical staff. The results showed that the anxiety and depression of surgical staff during the outbreak period were significantly higher and mental health problems appeared, so psychological interventions are essential.


Strategic plan for management of COVID-19 in paediatric haematology and oncology departments


docid: owkrqlhm

title: Harnessing Our Humanity - How Washington's Health Care Workers Have Risen to the Pandemic Challenge


docid: djzevyuz

title: Ethical guidelines for COVID-19 tracing apps


docid: enxvgadl

title: Sick time


title: New-onset anosmia and ageusia in adult patients diagnosed with SARS-CoV-2 infection

text: OBJECTIVES: We investigated the prevalence of anosmia and ageusia in adult patients with a laboratory-confirmed diagnosis of infection with severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). METHODS: This was a retrospective observational analysis of patients infected with SARS-CoV-2 admitted to hospital or managed in the community and their household contacts across a London population during the period March 1st to April 1st, 2020. Symptomatology and duration were extracted from routinely collected clinical data and follow-up telephone consultations. Descriptive statistics were used. RESULTS: Of 386 patients, 141 (92 community patients, 49 discharged inpatients) were included for analysis; 77/141 (55%) reported anosmia and ageusia, nine reported only ageusia and three only anosmia. The median onset of anosmia in relation to onset of SARS-CoV-2 disease (COVID-19) symptoms (as defined by the Public Health England case definition) was 4 days (interquartile range (IQR) 5). Median duration of anosmia was 8 days (IQR 16). Median duration of COVID-19 symptoms in community patients was 10 days (IQR 8) versus 18 days (IQR 13.5) in admitted patients. As of April 1, 45 patients had ongoing COVID-19 symptoms and/or anosmia; 107/141 (76%) patients had household contacts, and of 185 non-tested household contacts 79 (43%) had COVID-19 symptoms with 46/79 (58%) reporting anosmia. Six household contacts had anosmia only. CONCLUSIONS: Over half of the positive patients reported anosmia and ageusia, suggesting that these should be added to the case definition and used to guide self-isolation protocols. This adaptation may be integral to case findings in the absence of population-level testing. Until we have successful population-level vaccination coverage, these steps remain critical in the current and future waves of this pandemic.


title: COVID-19 Community Stabilization and Sustainability Framework: An Integration of the Maslow Hierarchy of Needs and Social Determinants of Health

text: All levels of government are authorized to apply coronavirus disease 2019 (COVID-19) protection measures; however, they must consider how and when to ease lockdown restrictions to limit long-term societal harm and societal instability. Leaders that use a well-considered framework with an incremental approach will be able to gradually restart society while simultaneously maintaining the public health benefits achieved through lockdown measures. Economically vulnerable populations cannot endure long-term lockdown, and most countries lack the ability to maintain a full nationwide relief operation. Decision-makers need to understand this risk and how the Maslow hierarchy of needs and the social determinants of health can guide whole of society policies. Aligning decisions with societal needs will help ensure all segments of society are catered to and met while managing the crisis. This must inform the process of incremental easing of lockdowns to facilitate the resumption of community foundations, such as commerce, education, and employment in a manner that protects those most vulnerable to COVID-19. This study proposes a framework for identifying a path forward. It reflects on baseline requirements, regulations and recommendations, triggers, and implementation. Those desiring a successful recovery from the COVID-19 pandemic need to adopt an evidence-based framework now to ensure community stabilization and sustainability.


title: Radiological approach to COVID-19 pneumonia with an emphasis on chest CT

text: Coronavirus disease 2019 (COVID-19) has recently become a worldwide outbreak with several millions of people infected and more than 160.000 deaths. A fast and accurate diagnosis in this outbreak is critical to isolate and treat patients. Radiology plays an important role in the diagnosis and management of the patients. Among various imaging modalities, chest CT has received attention with its higher sensitivity and specificity rates. Shortcomings of the real-time reverse transcriptase-polymerase chain reaction test, including inappropriate sample collection and analysis methods, initial false negative results, and limited availability has led to widespread use of chest CT in the diagnostic algorithm. This review summarizes the role of radiology in COVID-19 pneumonia, diagnostic accuracy of imaging, and chest CT findings of the disease.


docid: dhjoratu

title: The Plight of Patients with Lupus Nephritis during the Outbreak of COVID-19 in Wuhan, China

text: The number of cases of SARS-CoV-2 infection is rising rapidly globally. Severe disease and high fatality are observed in older patients and those with comorbid conditions1 However, little is known about patients with rheumatic disease in the epidemic areas.


title: Processing by RNase 1 forms tRNA halves and distinct Y RNA fragments in the extracellular environment

text: Extracellular RNAs participate in intercellular communication, and are being studied as promising minimally invasive diagnostic markers. Several studies in recent years showed that tRNA halves and distinct Y RNA fragments are abundant in the extracellular space, including in biofluids. While their regulatory and diagnostic potential has gained a substantial amount of attention, the biogenesis of these extracellular RNA fragments remains largely unexplored. Here, we demonstrate that these fragments are produced by RNase 1, a highly active secreted nuclease. We use RNA sequencing to investigate the effect of a null mutation of RNase 1 on the levels of tRNA halves and Y RNA fragments in the extracellular environment of cultured human cells. We complement and extend our RNA sequencing results with northern blots, showing that tRNAs and Y RNAs in the non-vesicular extracellular compartment are released from cells as full-length precursors and are subsequently cleaved to distinct fragments. In support of these results, formation of tRNA halves is recapitulated by recombinant human RNase 1 in our in vitro assay. These findings assign a novel function for RNase 1, and position it as a strong candidate for generation of tRNA halves and Y RNA fragments in biofluids.


Expansion of COVID-19 within Brazil: the importance of highways


title: COVID-19: A Window of Opportunity for Positive Healthcare Reforms

text: The current coronavirus disease 2019 (COVID-19) pandemic is testing healthcare systems like never before and all efforts are now being put into controlling the COVID-19 crisis. We witness increasing morbidity, delivery systems that sometimes are on the brink of collapse, and some shameless rent seeking. However, besides all the challenges, there are also possibilities that are opening up. In this perspective, we focus on lessons from COVID-19 to increase the sustainability of health systems. If we catch the opportunities, the crisis might very well be a policy window for positive reforms. We describe the positive opportunities that the COVID-19 crisis has opened to reduce the sources of waste for our health systems: failures of care delivery, failures of care coordination, overtreatment or low-value care, administrative complexity, pricing failures and fraud and abuse. We argue that current events can canalize some very needy reforms to make our systems more sustainable. As always, political policy windows are temporarily open, and so swift action is needed, otherwise the opportunity will pass and the vested interests will come back to pursue their own agendas. Professionals can play a key role in this as well.


Should Schools Reopen Early or Late? - Transmission Dynamics of COVID-19 in Children


title: Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis

text: BACKGROUND: The rapid global spread of the coronavirus disease (COVID-19) has compelled national governments to issue guidance on the use of face masks for members of the general public. To date, no work has assessed how this guidance differs across governments. OBJECTIVE: This study seeks to contribute to a rational and consistent global response to infectious disease by determining how guidelines differ across nations and regions. METHODS: A content analysis of health agency mask guidelines on agency websites was performed in late March 2020 among 25 countries and regions with large numbers of COVID-19 cases. Countries and regions were assigned across the coding team by language proficiency, with Google Translate used as needed. When available, both the original and English language version of guidance were reviewed. RESULTS: All examined countries and regions had some form of guidance online, although detail and clarity differed. Although 9 countries and regions recommended surgical, medical, or unspecified masks in public and poorly ventilated places, 16 recommended against people wearing masks in public. There were 2 countries that explicitly recommended against fabric masks. In addition, 12 failed to outline the minimum basic World Health Organization guidance for masks. CONCLUSIONS: Online guidelines for face mask use to prevent COVID-19 in the general public are currently inconsistent across nations and regions, and have been changing often. Efforts to create greater standardization and clarity should be explored in light of the status of COVID-19 as a global pandemic.


ICU beds: less is more? Not sure


docid: uxiranke

title: More than smell - COVID-19 is associated with severe impairment of smell, taste, and chemesthesis

text: Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation and initial results of a multi-lingual, international questionnaire to assess self-reported quantity and quality of perception in three distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, 8 other, ages 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change ±100) revealed a mean reduction of smell (-79.7 ± 28.7, mean ± SD), taste (-69.0 ± 32.6), and chemesthetic (-37.3 ± 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell, but also affects taste and chemesthesis. The multimodal impact of COVID-19 and lack of perceived nasal obstruction suggest that SARS-CoV-2 infection may disrupt sensory-neural mechanisms.


Subcutaneous terbutaline as an alternative to aerosolized albuterol


Beta-thalassemia may protect against COVID 19


title: Spatiotemporal fluctuation scaling law and metapopulation modeling of the novel coronavirus (COVID-19) and SARS outbreaks

text: We comparatively analyzed the spatiotemporal fluctuations of the 2019-novel coronavirus (COVID-19) and SARS outbreaks to understand their epidemiological characteristics. Methodologically, we introduced TPL (Taylor power law) to characterize their spatiotemporal heterogeneity/stability and Hubbell (2001) unified neutral theory of biodiversity (UNTB) [specifically Harris et al. (2015) HDP-MSN model (hierarchical Dirichlet process multi-site neutral model)] to approximate the metapopulation of coronavirus infections. First, TPL analysis suggested that the coronaviruses appear to have a specific heterogeneity/stability scaling parameter (TPL-b) slightly exceeding 2 for cumulative infections or exceeding 1 for daily incremental infections, suggesting their potentially chaotic, unstable outbreaks. Another TPL parameter (M0) (i.e., infection critical threshold) depends on virus kinds (COVID-19/SARS), time (disease-stages), space (regions) and public-health interventions (e.g., quarantines and mobility control). M0 measures the infection level, at which infections are random (Poisson distribution) and below which infections follow uniform distribution and may die off if M0 coincides or below the level of Allee effects. It was found that COVID-19 outbreak seems nearly twice more risky than SARS, and the lower infection threshold may be due to its lower lethality than SARS since lower fatality rates can facilitate the survival and spread of pathogen. Second, metacommunity UNTB neutrality testing seems appropriate for approximating metapopulation of coronavirus infections. Specifically, two parameters {\theta} and M, borrowed from neutral theory, may be used to assess the relative significance of infection through local contagion vs. infection through migration, both of which may depend on time, space, virus kinds, and particularly public-health interventions.


The influence of corticosteroid on patients with COVID-19 infection: A meta-analysis


Cyclosporine as a preferred calcineurin inhibitor in renal allograft recipients with COVID-19 infection


docid: nndvunvp

title: Cats under the shadow of the SARS-CoV-2 pandemic


title: Retest positive for SARS-CoV-2 RNA of "recovered" patients with COVID-19: Persistence, sampling issues, or re-infection?

text: "Retest Positive" for severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) from "recovered" coronavirus disease-19 (COVID-19) has been reported and raised several important questions for this novel coronavirus and COVID-19 disease. In this commentary, we discussed several questions: (a) Can SARS-CoV-2 re-infect the individuals who recovered from COVID-19? This question is also associated with other questions: whether or not SARS-CoV-2 infection induces protective reaction or neutralized antibody? Will SARS-CoV-2 vaccines work? (b) Why could some recovered patients with COVID-19 be re-tested positive for SARS-CoV-2 RNA? (c) Are some recovered pwith atients COVID-19 with re-testing positive for SARS-CoV-2 RNA infectious? and (d) How should the COVID-19 patients with retest positive for SARS-CoV-2 be managed?


title: Möglichkeiten der Beschäftigung von schwangeren Mitarbeiterinnen im Gesundheitssystem in Zusammenhang mit SARS-CoV-2./ [Possibilities of employment of pregnant women in the health care system in association with SARS-CoV-2]

text: Continued employment of pregnant women related to COVID (Corona Virus Disease) should only be considered if the risk of infection in the workplace is not higher than that of the general population. This option should therefore be carried out after an individual risk assessment with a precise description of the patient clientele and definition of the activities to be performed.


The Eclipse of Degenerative Spine Pathology During COVID-19 Pandemic


docid: ztieexdu

title: Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a "Red Zone" Area in Northern Italy


Management of patients with autoimmune liver disease during COVID-19 pandemic


Maintenance of ophthalmic specialist out-patient service during the COVID-19 outbreak: The University of Hong Kong experience


title: Calcineurin inhibitors revisited: A new paradigm for COVID-19?

text: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can cause mild, moderate or severe disease (COVID-19). In severe disease, there is hyperinflammation causing severe symptoms. Severe COVID-19 is an immunological phenomenon, rather than a direct viral damage disease. Therapies for COVID-19 are all investigational therapies. In case of severe disease, treatment with a calcineurin inhibitor could be promising. In this article we explain the mechanisms of calcineurin inhibitor treatment for COVID-19, based on experiences seen in solid organ transplant recipients who suffered from COVID-19.


title: Clinical Outcomes of COVID-19 with Evidence-Based Supportive Care

text: Calls for adherence to evidence-based medicine have emerged during the initial wave of the COVID-19 pandemic but reports of outcomes are lacking. This retrospective study of a single-institution cohort including 135 patients with confirmed COVID-19 demonstrates positive outcomes when institutional standards of care consist of evidence-based supportive therapies.


title: Association Between COVID-19 and Kawasaki Disease: Vigilance Required From Otolaryngologists

text: With the onset of the COVID-19 pandemic, many novel presentations of known conditions are occurring. In the pediatric population, new instances of Kawasaki disease have recently been singled out as presenting in conjunction with or soon after diagnosis of COVID-19. This poses a novel situation, particularly for otolaryngologists, who may be the first to encounter these patients. Otolaryngologists should be cognizant of the coexistence of conditions to allow for timely recognition and optimal management.


SARS-CoV-2: What is known and what there is to know-Focus on coagulation and lipids


Pertinent roles of African higher institutions in the COVID-19 pandemic response: The University of Ilorin, Ilorin, Nigeria; An African Model


COVID 19 and the Patient with Obesity - The Editors Speak Out


title: Tobacco smoking and COVID-19 pandemic: old and new issues. A summary of the evidence from the scientific literature

text: INTRODUCTION: COVID-19 pandemic burst onto the international scene as a new disease not affecting patients uniformly; hence it has risen many questions yet to be clarified. The aim of this study was to outline the main issues that led tobacco smoking being discussed as a potential risk factor associated with COVID-19. METHODS: articles from MEDLINE and pre-prints published from January to April 2020 were identified. RESULTS: data from China showed that men had more severe outcomes of COVID-19 than women. Since smoking prevalence is very high among Chinese men in comparison to women, it was hypothesized that smoking could be a risk factor for poor prognosis. This was also supported by the higher prevalence of comorbidities, many of which are tobacco-related diseases, in patients with severe COVID-19, who were also more likely to have a smoking history. A meta-analysis confirmed these results reporting an OR=2.25 (95% CI: 1.49-3.39) for developing severe Covid-19 among patients with a smoking history. Some authors, noticing that reported smoking prevalence among hospitalized patients was substantially below smoking prevalence in the corresponding populations, speculated a protective role of nicotine. However, it is likely that low prevalence among hospitalized patients are partially due to many smokers misclassified as nonsmokers. Tobacco smoking seems to cause a dose-dependent upregulation of the angiotensin-converting- enzyme-2 (ACE2), the virus cellular entry receptor, which could explain the higher risk of severe COVID-19 in smokers. CONCLUSIONS: There is need for further independent studies to clarify the role of smoking on COVID-19 incidence, progression and mortality.


docid: jcshqkaa

title: Table-top exercises to prepare for neonatal resuscitation in the Era of COVID-19


docid: qbwpwvwy

title: The public health response to COVID-19: balancing precaution and unintended consequences


The Moral Obligation of Nurse Leaders: COVID-19


title: Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN)

text: Patients with multiple myeloma (MM) seem to be at increased risk for more severe COVID-19 infection and associated complications due to their immunocompromised state, the older age and comorbidities. The European Myeloma Network has provided an expert consensus statement in order to guide therapeutic decisions in the era of the COVID-19 pandemic. Patient education for personal hygiene and social distancing measures, along with treatment individualization, telemedicine and continuous surveillance for early diagnosis of COVID-19 are essential. In countries or local communities where COVID-19 infection is widely spread, MM patients should have a PCR test of nasopharyngeal swab for SARS-CoV-2 before hospital admission, starting a new treatment line, cell apheresis or ASCT in order to avoid ward or community spread and infections. Oral agent-based regimens should be considered, especially for the elderly and frail patients with standard risk disease, whereas de-intensified regimens for dexamethasone, bortezomib, carfilzomib and daratumumab should be used based on patient risk and response. Treatment initiation should not be postponed for patients with end organ damage, myeloma emergencies and aggressive relapses. Autologous (and especially allogeneic) transplantation should be delayed and extended induction should be administered, especially in standard risk patients and those with adequate MM response to induction. Watchful waiting should be considered for standard risk relapsed patients with low tumor burden, and slow biochemical relapses. The conduction of clinical trials should continue with appropriate adaptations to the current circumstances. Patients with MM and symptomatic COVID-19 disease should interrupt anti-myeloma treatment until recovery. For patients with positive PCR test for SARS-CoV-2, but with no symptoms for COVID-19, a 14-day quarantine should be considered if myeloma-related events allow the delay of treatment. The need for surveillance for drug interactions due to polypharmacy is highlighted. The participation in international COVID-19 cancer registries is greatly encouraged.


Implementing Telemedicine in Response to the COVID-19 Pandemic


An unusual collateral damage of COVID-19 pandemic


Caring of cancer patients during COVID-19: A real-life challenge


title: [Epidemic characteristics and trend analysis of the COVID-19 in Hubei province]

text: Objective: By describing and analyzing the epidemic characteristics and trends of the attack rate, the crude mortality and relevant indexes in Hubei province during the pandemic of COVID-19 to provide comprehensive evaluations of the epidemic trends and the effects of intervention measures. Methods: Based on the case data reported in Hubei province during the COVID-19 epidemic, combined with the important time of major interventions and event, the cumulative attack rate, the sequential increase rate of new cases, baseline increase rate of new cases, the observation- confirmed case conversion rate, the cumulative crude mortality, the daily severe case rate, and the ratio of death to severe were used to describe and analyze the epidemic characteristics in different phases of the COVID-19 epidemic. Results: The epidemic experienced an outbreak phase from January 10 to February 3 with large amount of case reported, a peak phase from February 4 to February 19 with continuous increasing number of new cases and deaths, a platform phase from February 20 to March 3 with balanced diagnosis and treatment number, and a descending phase from March 4 to March 18 with decreased diagnosis and increased treatment number. Up to March 18, the cumulative attack rate of the COVID-19 epidemic in Hubei province increased from 0.03/10 000 on January 19 to 11.46/10 000, from 0.04/10 000 on January 10 to 45.13/10 000 in Wuhan city, and from 0.002/ 10 000 on January 20 to 3.70/ 10 000 in other areas of Hubei province other than Wuhan city. The increase rate of new cases fluctuated during the epidemic period and reached the highest at February 12 in Hubei province. The cumulative crude mortality in Hubei Province increased rapidly from 1.01% on January 19 to 5.13% on January 26, then decreased to 2.54% on February 13, and then slowly increased to 4.62% on March 18, and similar trend was also observed in Wuhan city. The daily severe rate in Hubei Province increased from 26.88% on January 27 to 34.27% on March 18. The ratio of death to severe decreased from 7.37% on January 23 to 0.35% on March 18. Conclusions: The epidemic cycle of COVID-19 in Hubei province proposed to be 60 days, which was about 1.76 times of the combination of the longest incubation period or isolation period (14 d) and the average hospitalization time of confirmed patients in Hubei province (20 d). It suggested that the major anti-epidemic decisions made in China were effective.


title: Strong Social Distancing Measures In The United States Reduced The COVID-19 Growth Rate

text: State and local governments imposed social distancing measures in March and April of 2020 to contain the spread of novel coronavirus disease 2019 (COVID-19). These included large event bans, school closures, closures of entertainment venues, gyms, bars, and restaurant dining areas, and shelter-in-place orders (SIPOs). We evaluated the impact of these measures on the growth rate of confirmed COVID-19 cases across US counties between March 1, 2020 and April 27, 2020. An event-study design allowed each policy's impact on COVID-19 case growth to evolve over time. Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1-5 days, 6.8 after 6-10 days, 8.2 after 11-15 days, and 9.1 after 16-20 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million). Our paper illustrates the potential danger of exponential spread in the absence of interventions, providing relevant information to strategies for restarting economic activity. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].


text: State and local governments imposed social distancing measures in March and April 2020 to contain the spread of the novel coronavirus disease (COVID-19). These measures included bans on large social gatherings; school closures; closures of entertainment venues, gyms, bars, and restaurant dining areas; and shelter-in-place orders. We evaluated the impact of these measures on the growth rate of confirmed COVID-19 cases across US counties between March 1, 2020, and April 27, 2020. An event study design allowed each policy's impact on COVID-19 case growth to evolve over time. Adoption of government-imposed social distancing measures reduced the daily growth rate of confirmed COVID-19 cases by 5.4 percentage points after one to five days, 6.8 percentage points after six to ten days, 8.2 percentage points after eleven to fifteen days, and 9.1 percentage points after sixteen to twenty days. Holding the amount of voluntary social distancing constant, these results imply that there would have been ten times greater spread of COVID-19 by April 27 without shelter-in-place orders (ten million cases) and more than thirty-five times greater spread without any of the four measures (thirty-five million cases). Our article illustrates the potential danger of exponential spread in the absence of interventions, providing information relevant to strategies for restarting economic activity.


title: Kallikrein-kinin blockade in patients with COVID-19 to prevent acute respiratory distress syndrome

text: COVID-19 patients can present with pulmonary edema early in disease. We propose that this is due to a local vascular problem because of activation of bradykinin 1 receptor (B1R) and B2R on endothelial cells in the lungs. SARS-CoV-2 enters the cell via ACE2 that next to its role in RAAS is needed to inactivate des-Arg9 bradykinin, the potent ligand of the B1R. Without ACE2 acting as a guardian to inactivate the ligands of B1R, the lung environment is prone for local vascular leakage leading to angioedema. Here, we hypothesize that a kinin-dependent local lung angioedema via B1R and eventually B2R is an important feature of COVID-19. We propose that blocking the B2R and inhibiting plasma kallikrein activity might have an ameliorating effect on early disease caused by COVID-19 and might prevent acute respiratory distress syndrome (ARDS). In addition, this pathway might indirectly be responsive to anti-inflammatory agents.


title: ESMO Management and treatment adapted recommendations in the COVID-19 era: Lung cancer

text: The COVID-19 pandemic, characterised by a fast and global spread during the first months of 2020, has prompted the development of a structured set of recommendations for cancer care management, to maintain the highest possible standards. Within this framework, it is crucial to ensure no disruption to essential oncological services and guarantee the optimal care.This is a structured proposal for the management of lung cancer, comprising three levels of priorities, namely: tier 1 (high priority), tier 2 (medium priority) and tier 3 (low priority)-defined according to the criteria of the Cancer Care Ontario, Huntsman Cancer Institute and Magnitude of Clinical Benefit Scale.The manuscript emphasises the impact of the COVID-19 pandemic on lung cancer care and reconsiders all steps from diagnosis, staging and treatment.These recommendations should, therefore, serve as guidance for prioritising the different aspects of cancer care to mitigate the possible negative impact of the COVID-19 pandemic on the management of our patients.As the situation is rapidly evolving, practical actions are required to guarantee the best patients' treatment while protecting and respecting their rights, safety and well-being. In this environment, cancer practitioners have great responsibilities: provide timely, appropriate, compassionate and justified cancer care, while protecting themselves and their patients from being infected with COVID-19. In case of shortages, resources must be distributed fairly. Consequently, the following recommendations can be applied with significant nuances, depending on the time and location for their use, considering variable constraints imposed to the health systems. An exceptional flexibility is required from cancer caregivers.


title: The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing

text: The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.


title: Outbreak Trends of Coronavirus Disease-2019 in India: A Prediction

text: OBJECTIVE: The objective of this paper is to prepare the government and citizens of India to take or implement the control measures proactively to reduce the impact of coronavirus disease 2019 (COVID-19). METHOD: In this work, the COVID-19 outbreak in India has been predicted based on the pattern of China using a machine learning approach. The model is built to predict the number of confirmed cases, recovered cases, and death cases based on the data available between January 22, 2020, and April 3, 2020. The time series forecasting method is used for prediction models. RESULTS: The COVID-19 effects are predicted to be at peak between the third and fourth weeks of April 2020 in India. This outbreak is predicted to be controlled around the end of May 2020. The total number of predicted confirmed cases of COVID-19 might reach around 68 978, and the number of deaths due to COVID-19 are predicted to be 1557 around April 25, 2020, in India. If this outbreak is not controlled by the end of May 2020, then India will face a severe shortage of hospitals, and it will make this outbreak even worse. CONCLUSION: The COVID-19 pandemic may be controlled if the Government of India takes proactive steps to aggressively implement a lockdown in the country and extend it further. This presented epidemiological model is an effort to predict the future forecast of COVID-19 spread, based on the present scenario, so that the government can frame policy decisions, and necessary actions can be initiated.


Doctors in Pakistan denounce opening of mosques for congregational prayers during Ramadan amid the COVID-19 pandemic: Correspondence


Changes of CT findings in a 2019 novel coronavirus (2019-nCoV) pneumonia patient


Recommendations for Essential Esophageal Physiologic Testing During the COVID-19 Pandemic


title: Trying to make sense out of chaos: science, politics and the COVID-19 pandemic

text: This essay discusses the proliferation of discourses about the COVID-19 pandemic, presenting the challenges both to science and public policies that such an information overload present, having Collins' sociology of expertise as a theoretical framework.


Bienvenue sur le front de l'Est : l'épidémie du Covid-19 à Mulhouse./ Welcome to the Eastern Front: the VIDOC-19 outbreak in Mulhouse


docid: umkiplrg

title: Current safety preferences for intravitreal injection during COVID-19 pandemic


title: The Limits to Learning an SIR Process: Granular Forecasting for Covid-19

text: A multitude of forecasting efforts have arisen to support management of the ongoing COVID-19 epidemic. These efforts typically rely on a variant of the SIR process and have illustrated that building effective forecasts for an epidemic in its early stages is challenging. This is perhaps surprising since these models rely on a small number of parameters and typically provide an excellent retrospective fit to the evolution of a disease. So motivated, we provide an analysis of the limits to estimating an SIR process. We show that no unbiased estimator can hope to learn this process until observing enough of the epidemic so that one is approximately two-thirds of the way to reaching the peak for new infections. Our analysis provides insight into a regularization strategy that permits effective learning across simultaneously and asynchronously evolving epidemics. This strategy has been used to produce accurate, granular predictions for the COVID-19 epidemic that has found large-scale practical application in a large US state.


title: A Novel Machine Learning-derived Radiomic Signature of the Whole Lung Differentiates Stable From Progressive COVID-19 Infection: A Retrospective Cohort Study

text: OBJECTIVE: This study aimed to use the radiomics signatures of a machine learning-based tool to evaluate the prognosis of patients with coronavirus disease 2019 (COVID-19) infection. METHODS: The clinical and imaging data of 64 patients with confirmed diagnoses of COVID-19 were retrospectively selected and divided into a stable group and a progressive group according to the data obtained from the ongoing treatment process. Imaging features from whole-lung images from baseline computed tomography (CT) scans were extracted and dimensionality reduction was performed. Support vector machines were used to construct radiomics signatures and to compare differences between the 2 groups. We also compared the differences of signature scores in the clinical, laboratory, and CT image feature subgroups and finally analyzed the correlation between the radiomics features of the constructed signature and the other features including clinical, laboratory, and CT imaging features. RESULTS: The signature has a good classification effect for the stable group and the progressive group, with area under curve, sensitivity, and specificity of 0.833, 80.95%, and 74.42%, respectively. Signature score differences in laboratory and CT imaging features between subgroups were not statistically significant (P>0.05); cough was negatively correlated with GLCM Entropy_angle 90_offset4 (r=-0.578), but was positively correlated with ShortRunEmphhasis_AllDirect_offset4_SD (r=0.454); C-reactive protein was positively correlated with Cluster Prominence_ AllDirect_offset 4_ SD (r=0.47). CONCLUSION: The radiomics signature of the whole lung based on machine learning may reveal the changes of lung microstructure in the early stage and help to indicate the progression of the disease.


title: A combination regimen by lopinave/litonawe (LPV/r), emtricitabine and tenofovir alafenamide fumarate (FTC/TAF) for treatment of novel coronavirus pneumonia (TARCoV)/ 中华急诊医学杂志

text: Objective@#To explore the efficacy of a combination regimen by Lopinave/Litonawe (LPV/r), emtricitabine and tenofovir alafenamide fumarate (FTC/TAF) for the treatment of novel coronavirus pneumonia (NCP).@*Methods@#We design the protocol as a real world study, which includes two groups: prospective intervention cohort (T1) and historical control group (T2). For T1 group, ninety patients will be enrolled who are diagnosed as NCP. All patients in T1 group will receive standard therapies following the recommendation in the guidelines of National Commission of Health, and they will be administered an anti-virus regimen includes LPV/r and FTC/TAF. The T2 group will enroll patients who have received single regimen includes LPV/r. The major outcome is the survival rate of patients. Secondary outcomes are the time of seroconversion of RNA, ARDS progression rate and length of hospital stay.@*Conclusions@#The results of this real world study might provide clinical practitioners a high efficiency and fast antivirus regimen for NCP. In addition, the conduction of this study will accelerate screening for other new effective therapeutic method.


The HAREM (Had Appendicitis and Resolved/Recurred Emergency Morbidity/Mortality) Study


docid: vnqvfygw

title: COVID-19 and Inequities in Oral Health Care for Older People: An Opportunity for Emerging Paradigms

text: Severe restrictions have been imposed in most countries for oral health care to the general population, allowing treatment only for emergencies, because of the generation of aerosols during clinical procedures and to ration personal protective equipment (PPE) during the pandemic. This article stresses the critical situation that affects oral health for older persons in the complex times of the COVID-19 pandemic. Older adults are at high risk for the viral infection, but neglected dental conditions may worsen their health, triggering infections that can lead to local and systemic complications, compromising general health. We propose that under current and possibly future scenarios, teledentistry and the minimal intervention dentistry approach may play a pivotal role in reshaping the profession. The already existent inequities in oral health care may be exacerbated due to the pandemic, especially in the developing world. More research along with a strong educational component in the dental curriculum must be emphasized. COVID-19 may be an opportunity to change canonical paradigms. The dental profession must reflect and take action to face future challenges. Knowledge Transfer Statement: This article provides an overview of the oral health situation imposed by COVID-19 and the minimal intervention alternatives to provide care to older people who are at risk and have reduced access to care.


title: Phylogenetic relationships of the family Tarumaniidae (Characiformes) based on nuclear and mitochondrial data

text: Characiformes is an order of freshwater fishes that includes many commercially important and emblematic species from South America and Africa, such as the popular piranhas, hatchetfishes, African tiger fishes and tetras. The order is split into two suborders with a total of 24 families, 282 genera and ca. 2,100 species. Here, we present an expanded phylogeny of characiform fishes, including data for 520 species and three genes (12S, 16S and RAG1), and the recently described family Tarumaniidae, which has not been examined by previous molecular analysis. Although our genetic coverage is limited to three gene fragments, the tree inferred based on maximum likelihood and Bayesian inference supports the monophyly of all characiform families and is largely congruent with results from recent studies that sampled less taxa but more genes. Also in agreement with a morphological hypothesis, our results strongly support the sister-group relationships between the family Tarumaniidae and Erythrinidae. Based on our results and that of the other molecular analyses, we propose a revised circumscription of the superfamily Erythrinoidea to include the families Tarumaniidae and Erythrinidae only.(AU)


Serving meals and mopping floors: the consultant psychiatrist working differently during the covid-19 pandemic


'Masking' of the mental state: Unintended consequences of personal protective equipment (PPE) on psychiatric clinical practice


title: Absence of Skin of Colour Images in Publications of COVID-19 Skin Manifestations

text: There are now over 1 million confirmed cases of COVID-19 globally with more than 270,000 recorded deaths to date. COVID-19 has been shown to disproportionately impact people of colour both in the United Kingdom and in the United States where blacks make up 13.4% of the population but 30% of COVID-19 cases. Mounting evidence shows that COVID-19 impacts several organ systems, including the skin.


SARS-CoV-2/COVID-19: Empfehlungen für die Radiologische Versorgung - Eine Stellungnahme der Deutschen Röntgengesellschaft (DRG), der Deutschen Gesellschaft für Neuroradiologie (DGNR), der Gesellschaft für Pädiatrische Radiologie (GPR), der Deutschen Gesellschaft für Interventionelle Radiologie (DeGIR), des Berufsverbands der Neuroradiologen (BDNR) und des Berufsverbands der Radiologen (BDR)


title: Effects of pyrolysis temperature on soil-plant-microbe responses to Solidago canadensis L.-derived biochar in coastal saline-alkali soil

text: Because salinity of coastal soils is drastically increasing, the application of biochars to saline-alkali soil amendments has attracted considerable attention. Various Solidago-canadensis-L.-derived biochars prepared through pyrolysis from 400 to 600 °C were applied to coastal saline-alkali soil samples to optimise the biochar pyrolysis temperature and investigate its actual ecological responses. All biochars reduced the soil bulk density and exchangeable sodium stress and increased soil water-holding capacity, cation exchange capacity, and organic matter content. Principal-component-analysis results showed that pyrolysis temperature played an important role in the potential application of biochars to improve the coastal saline-alkali soil, mainly contributed to ameliorating exchangeable sodium stress and decreasing biochar-soluble toxic compounds. Furthermore, soil bulk density and organic matter, as well as carboxylic acids, phenolic acids and amines of biochar were major driving factors for bacterial community composition. Compared to low-temperature biochar (pyrolyzed below 550 °C), which showed higher toxicity for Brassica chinensis L. growth due to the higher content of carboxylic acids, phenols and amines, high-temperature biochar (pyrolyzed at or above 550 °C) possessed less amounts of these toxic functional groups, more beneficial soil bacteria and healthier for plant growth. Therefore, high-temperature biochar could be applied as an effective soil amendment to ameliorate the coastal saline-alkali soil with acceptable environmental risk.


The COVID-19 outbreak and implications for the Tokyo 2020 Summer Olympic Games


title: Logistic approximations used to describe new outbreaks in the 2020 COVID-19 pandemic

text: In this investigation I used the Logistic Model to fit the COVID-19 pandemic data for some countries. The data modeled is the death numbers per day in China, Iran, Italy, South Korea, Spain and United States. Considering the current growth rate of the pandemic, it was possible to show that the death toll should be between 3,277-3,327 deaths in China, 2,035-2,107 in Iran, 120-134 in South Korea, 11,227-12,793 in Italy and 6,217-7,405 in Spain. Also, with this toy model it was possible to show a clear emergence of a new outbreak within the same country (Iran, China and the United States). The growth rate of deaths found for South Korea was the lowest among the countries studied ($0.14701\pm0.00923$) and for China ($0.16667\pm0.00284$). Italy ($0.22594\pm0.00599$) and Spain ($0.31213\pm0.02337$) had the highest rates and in the second wave in Iran ($0.37893\pm0.02712$).


title: ACE2 Expression in Pancreas May Cause Pancreatic Damage After SARS-CoV-2 Infection

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that causes coronavirus disease 2019 (COVID-19) in human beings, has caused a serious public health issue.1 Attention to pancreatic injury is lacking, which may impact patients' prognosis. In this study, we explored the expression and distribution of angiotensin-converting enzyme 2 (ACE2), the receptor of SARS-CoV-2, in the pancreas. Combined with clinical data, we showed that pancreatic injury can occur in some COVID-19 patients.


title: Role of Porcine Aminopeptidase N and Sialic Acids in Porcine Coronavirus Infections in Primary Porcine Enterocytes

text: Porcine epidemic diarrhea virus (PEDV) and transmissible gastroenteritis virus (TGEV) have been reported to use aminopeptidase N (APN) as a cellular receptor. Recently, the role of APN as a receptor for PEDV has been questioned. In our study, the role of APN in PEDV and TGEV infections was studied in primary porcine enterocytes. After seven days of cultivation, 89% of enterocytes presented microvilli and showed a two- to five-fold higher susceptibility to PEDV and TGEV. A significant increase of PEDV and TGEV infection was correlated with a higher expression of APN, which was indicative that APN plays an important role in porcine coronavirus infections. However, PEDV and TGEV infected both APN positive and negative enterocytes. PEDV and TGEV Miller showed a higher infectivity in APN positive cells than in APN negative cells. In contrast, TGEV Purdue replicated better in APN negative cells. These results show that an additional receptor exists, different from APN for porcine coronaviruses. Subsequently, treatment of enterocytes with neuraminidase (NA) had no effect on infection efficiency of TGEV, implying that terminal cellular sialic acids (SAs) are no receptor determinants for TGEV. Treatment of TGEV with NA significantly enhanced the infection which shows that TGEV is masked by SAs.


title: Coronavirus and interpersonal violence: A need for digital mental health resources

text: Since the declaration of COVID-19 restrictions and lockdowns, countries across the world have seen an increase in reports of interpersonal violence. During these trying times, digital mental health resources tailored to interpersonal violence are needed. Through the use of online platforms such as websites, mobile applications, and social media, survivors and perpetrators alike can access tools that help them manage stressors induced by the coronavirus as well as practice emotional regulation techniques and communication strategies at home. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Natural small molecules as inhibitors of coronavirus lipid-dependent attachment to host cells: a possible strategy for reducing SARS-COV-2 infectivity?

text: BACKGROUND: Viral infectivity depends on interactions between components of the host cell plasma membrane and the virus envelope. Here we review strategies that could help stem the advance of the SARS-COV-2 epidemic. METHODS AND RESULTS: We focus on the role of lipid structures, such as lipid rafts and cholesterol, involved in the process, mediated by endocytosis, by which viruses attach to and infect cells. Previous studies have shown that many naturally derived substances, such as cyclodextrin and sterols, could reduce the infectivity of many types of viruses, including the coronavirus family, through interference with lipid-dependent attachment to human host cells. CONCLUSIONS: Certain molecules prove able to reduce the infectivity of some coronaviruses, possibly by inhibiting viral lipid-dependent attachment to host cells. More research into these molecules and methods would be worthwhile as it could provide insights the mechanism of transmission of SARS-COV-2 and, into how they could become a basis for new antiviral strategies.


title: The role of afferent pulmonary innervation in poor prognosis of acute respiratory distress syndrome in COVID-19 patients and proposed use of resiniferatoxin (RTX) to improve patient outcomes in advanced disease state: A review

text: Acute respiratory distress is one of the major causes of mortality associated with COVID-19 disease. Many patients will require intensive care with ventilatory support. Despite progress and best efforts, the mortality rates projected remain high. Historical data outlook points towards 80% expected fatality for patients progressing to advanced pulmonary disease, even when hospitalized in the intensive care unit. This is particularly true among the patient population over 65. Novel life-saving strategies are desperately needed to mitigate the high mortality that will be associated with the late stage SARS-CoV-2 viral infection associated with the fatal respiratory distress. We hypothesize that the morbidity, severity of the disease, and underlying physiological events leading to mortality are closely linked to the TRPV1 expressing neuronal system (afferent/efferent neurons) in the lungs. TRPV1 expressing cells are responsible for pain transmission, inflammation and immunomodulation throughout the entire pulmonary system and are modulating the processes associated with localized cytokine release (storm) and overall rapid disease progression. We suggest that therapeutic approaches targeting TRPV1 containing nerve fibers in the lungs will modulate the inflammatory and immune signal activity, leading to reduced mortality and better overall outcomes. We also propose to further explore the use of resiniferatoxin (RTX), an ultra-potent TRPV1 agonist currently in clinical trials for cancer and osteoarthritis pain, as a possible ablating agent of TRPV1 positive pulmonary pathways in patients with advanced COVID-19 disease.


title: Patients asymptomatiques du SARS-CoV-2 et transmission du virus : Où en sont nos connaissances?/ Asymptomatic carriage and transmission of SARS-CoV-2: What do we know?

text: PURPOSE: Risk to healthcare workers treating asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the operating room depends on multiple factors. This review examines the evidence for asymptomatic or pre-symptomatic carriage of SARS-CoV-2, the risk of transmission from asymptomatic patients, and the specific risks associated with aerosol-generating procedures. Protective measures, such as minimization of aerosols and use of personal protective equipment in the setting of treating asymptomatic patients, are also reviewed. SOURCE: We examined the published literature as well as Societal guidelines. PRINCIPAL FINDINGS: There is evidence that a proportion of those infected with SARS-CoV-2 have detectable viral loads prior to exhibiting symptoms, or without ever developing symptoms. The degree of risk of transmission from asymptomatic patients to healthcare providers will depend on the prevalence of disease in the population, which is difficult to assess without widespread population screening. Aerosol-generating procedures increase the odds of viral transmission from infected symptomatic patients to healthcare providers, but transmission from asymptomatic patients has not been reported. Techniques to minimize aerosolization and appropriate personal protective equipment may help reduce the risk to healthcare workers in the operating room. Some societal guidelines recommend the use of airborne precautions during aerosol-generating procedures on asymptomatic patients during the coronavirus disease pandemic, although evidence supporting this practice is limited. CONCLUSION: Viral transmission from patients exhibiting no symptoms in the operating room is plausible and efforts to reduce risk to healthcare providers include reducing aerosolization and wearing appropriate personal protective equipment, the feasibility of which will vary based on geographic risk and equipment availability.


Signs of an increase in suicides due to the effects of COVID-19


COVID-19: thoughts at sunrise


Reply to Rheumatologists' perspective on coronavirus disease 19: is heparin the dark horse for COVID-19?


title: Working in the dark: Interaction with a sub clinical COVID-19 subject and lessons learned

text: Subclinical COVID-19 subjects pose a significant challenge. We present a very close clinical interaction with a subclinical COVID-19 subject that met the "standard screening criteria" and is unique in several ways. Learning from our experience, we suggest close attention should be paid to any unexpected findings such as groundglass opacity on CT as it could help early identification of subclinical COVID-19 infection.


docid: ockpdxgo

title: Deeply reconsidering elective surgery: worldwide concerns regarding colorectal surgery in a COVID-19 pandemic and a Singapore perspective


Organ donation during the coronavirus pandemic: an evolving saga in uncharted waters


title: Nursing in the COVID-19 pandemic and beyond: protecting, saving, supporting and honouring nurses

text: As the world tackles the largest public health event in more than a century, the COVID-19 pandemic, the true value of nursing is being seen by politicians and the public. But while nurses are being praised for the vital work they do, many are being put into high-risk situations, and some have died, because of a shortage of appropriate, high-quality personal protective equipment. The International Council of Nurses has called for governments to make the provision of such equipment their number one priority to prevent further loss of life among the nurses caring for the world's most vulnerable patients.


title: Managing hand and reconstructive microsurgery service during COVID-19 pandemic: Singapore experience

text: INTRODUCTION: Managing healthcare service during pandemics and outbreaks is a challenging process. The aim is to keep patient safety as the priority, besides, continuing to provide essential healthcare services. METHODS: Situational audit was performed for the services rendered before and during COVID-19 pandemic and the elevation of the disease alert status, and a retrospective analysis of the attendance and procedures performed in the service. RESULTS: We present a methodology for performing a situational audit and generating service modification for hand and reconstructive microsurgery unit in a pandemic. There was no significant difference between the number of patients seen at outpatient clinics. However, there was a reduction in the numbers of total surgeries performed, with a 40% drop in the number of elective surgeries performed. There was also a reduction of cases seen in the emergency department hand clinic. DISCUSSION: COVID-19 pandemic is currently affecting not only the health service but also, other vital services all over the world. The pandemic puts significant challenges to acute surgical services in a hospital system involved in the management of the pandemic. Surgeons need to take proactive and a systematic approach in managing the available resources while maintaining essential surgical services. This paper provides the tools and methodology for doctors to plan their services in a pandemic situation. CONCLUSIONS: It is possible to maintain essential surgical services in a pandemic situation through rapid situational audits and generating localised strategies while considering the constraints imposed during the pandemics while maintaining patient and staff safety.


title: Pediatric ophthalmology, strabismus and neuro-ophthalmology practice in the COVID-19 era: All India Ophthalmological Society guidelines

text: The COVID-19 Pandemic has prompted substantial changes in the way ophthalmology is practiced globally. General guidelines on safe ophthalmic practice have been issued by various bodies across the globe including the All India Ophthalmological Society. While these are suitable to ophthalmology overall, they are not entirely suitable to a subspecialty practice, particularly pediatric ophthalmology, strabismus and neuro-ophthalmology, which entails dealing with children, surgery under general anesthesia and managing possible life threatening situations. A group of sub-specialists and anesthetists met virtually and arrived at a consensus with regard to practice and general anesthesia protocols pertaining to these subspecialties of ophthalmology. The recommendations made by the expert group are specific yet can be universally followed to ensure the best and safest outcome for the practitioner and patient alike. The recommendations pertain to listing conditions which need emergency or urgent care in the fields of pediatric ophthalmology and neuro-ophthalmology, precautions and technique of pediatric and neuro-ophthalmic eye examination and a protocol for delivering a safe general anesthesia for a pediatriceye surgery.


COVID-19 laboratory testing issues and capacities as we transition to surveillance testing and contact tracing


title: Fear, anger, and media-induced trauma during the outbreak of COVID-19 in the Czech Republic

text: Fear, anger and hopelessness were the most frequent traumatic emotional responses in the general public during the first stage of outbreak of the COVID-19 epidemic in the Czech Republic (N = 1,000). The four most frequent categories of fear were determined: (a) fear of the negative impact on household finances, (b) fear of the negative impact on the household finances of significant others, (c) fear of the unavailability of health care, and (d) fear of an insufficient food supply. The pessimistic communications used by the Czech mass media contributed to intensifying traumatic feelings, fears and psychological distress in the general public during the outbreak of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


COVID-19 leading to acute encephalopathy in a patient with heart transplant