There is a dire need for personal protective equipment (PPE) within healthcare settings during the COVID-19 pandemic. In particular, single use disposable N95 face masks have been limited in supply. We have developed an Injection Molded Autoclavable, Scalable, Conformable (iMASC) system for aerosol-based protection. The iMASC system was designed as a reusable liquid silicone rubber mask with disposable N95 filter cartridges that can fit most face sizes and shapes. This system reduced the amount of N95 filter while preserving breathability and fit. Using finite element analysis, we demonstrated mask deformation and reaction forces from facial scans of twenty different wearers. In addition, we validated these findings by succesful fit testing in twenty participants in a prospective clinical trial. The iMASC system has the potential to protect our healthcare workers with a reusable N95-comparable face mask that is rapidly scalable.


title: Comparison of throat swabs and sputum specimens for viral nucleic acid detection in 52 cases of novel coronavirus (SARS-Cov-2) infected pneumonia (COVID-19)

text: Abstract Background: In December 2019, a novel coronavirus (SARS-CoV-2) infected pneumonia (COVID-19) occurred in Wuhan, China. Diagnostic test based on real-time reverse transcription polymerase chain reaction assay (qRT-PCR) was the main means of confirmation, and sample collection was mostly throat swabs, which was easy to miss the diagnosis. It is necessary to seek specimen types with higher detection efficiency and accuracy. Methods: Paired specimens of throat swabs and sputum were obtained from 54 cases, and RNA was extracted and tested for 2019-nCoV (equated with SARS-CoV-2) by qRT-PCR assay. Results: The positive rates of 2019-nCoV from sputum specimens and throat swabs were 76.9% and 44.2%, respectively. Sputum specimens showed a significantly higher positive rate than throat swabs in detecting viral nucleic acid using qRT-PCR assay (P=0.001). Conclusions: The detection rates of 2019-nCoV from sputum specimens are significantly higher than throat swabs. We suggest that sputum would benefit for the detection of 2019-nCoV in patients who produce sputum. The results can facilitate the selection of specimens and increase the accuracy of diagnosis.


title: The Approved Dose of Ivermectin Alone is not the Ideal Dose for the Treatment of COVID-19

text: Introduction: Caly, Druce (1) reported that ivermectin inhibited SARS-CoV-2 in vitro for up to 48 h using ivermectin at 5 uM. The concentration resulting in 50% inhibition (IC50, 2 uM) was >35x higher than the maximum plasma concentration (Cmax) after oral administration of the approved dose of ivermectin when given fasted. Method: Simulations were conducted using an available population pharmacokinetic model to predict total (bound and unbound) and unbound plasma concentration-time profiles after a single and repeat fasted administration of the approved dose of ivermectin (200 ug/kg), 60 mg, and 120 mg. Plasma total Cmax was determined and then multiplied by the lung:plasma ratio reported in cattle to predict the lung Cmax after administration of each single dose. Results: Plasma ivermectin concentrations of total (bound and unbound) and unbound concentrations do not reach the IC50, even for a dose level 10x higher than the approved dose. Even with higher exposure in lungs than plasma, ivermectin is unlikely to reach the IC50 in lungs after single oral administration of the approved dose (predicted lung: 0.0857 uM) or at doses 10x higher that the approved dose administered orally (predicted lung: 0.817 uM). Conclusions: The likelihood of a successful clinical trial using the approved dose of ivermectin is low. Combination therapy should be evaluated in vitro. Re-purposing drugs for use in COVID-19 treatment is an ideal strategy but is only feasible when product safety has been established and experiments of re-purposed drugs are conducted at clinically relevant concentrations.


title: Modeling the Post-Containment Elimination of Transmission of COVID-19

text: Roughly six months into the COVID-19 pandemic, many countries have managed to contain the spread of the virus by means of strict containment measures including quarantine, tracing and isolation of patients as well strong restrictions on population mobility. Here we propose an extended SEIR model to explore the dynamics of containment and then explore scenarios for the local extinction of the disease. We present both the deterministic and stochastic version fo the model and derive the R0 and the probability of local extinction after relaxation (elimination of transmission) of containment, P0. We show that local extinctions are possible without further interventions, with reasonable probability, as long as the number of active cases is driven to single digits and strict control of case importation is maintained. The maintenance of defensive behaviors, such as using masks and avoiding agglomerations are also important factors. We also explore the importance of population immunity even when above the herd immunity threshold.


title: Robust three-dimensional expansion of human adult alveolar stem cells and SARS-CoV-2 infection

text: Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), which is the cause of a present global pandemic, infects human lung alveolar cells (hACs). Characterising the pathogenesis is crucial for developing vaccines and therapeutics. However, the lack of models mirroring the cellular physiology and pathology of hACs limits the study. Here, we develop a feeder-free, long-term three-dimensional (3D) culture technique for human alveolar type 2 (hAT2) cells, and investigate infection response to SARS-CoV-2. By imaging-based analysis and single-cell transcriptome profiling, we reveal rapid viral replication and the increased expression of interferon-associated genes and pro-inflammatory genes in infected hAT2 cells, indicating robust endogenous innate immune response. Further tracing of viral mutations acquired during transmission identifies full infection of individual cells effectively from a single viral entry. Our study provides deep insights into the pathogenesis of SARS-CoV-2, and the application of long-term 3D hAT2 cultures as models for respiratory diseases.


title: A Combined approach of MALDI-TOF Mass Spectrometry and multivariate analysis as a potential tool for the detection of SARS-CoV-2 virus in nasopharyngeal swabs

text: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The rapid, sensitive and specific diagnosis of SARS-CoV-2 by fast and unambiguous testing is widely recognized to be critical in responding to the ongoing outbreak. Since the current testing capacity of RT-PCR-based methods is being challenged due to the extraordinary demand of supplies, such as RNA extraction kits and PCR reagents worldwide, alternative and/or complementary testing assays should be developed. Here, we exploit the potential of mass spectrometry technology combined with machine learning algorithms as an alternative fast tool for SARS-CoV-2 detection from nasopharyngeal swabs samples. According to our preliminary results, mass spectrometry-based methods combined with multivariate analysis showed an interesting potential as a complementary diagnostic tool and further steps should be focused on sample preparation protocols and the improvement of the technology applied.


title: Characteristics and application of immune-regulating and antiviral Chinese materia medica/ 免疫调节抗病毒中药的特性与应用

text: Recently, the epidemic of novel coronavirus pneumonia (COVID-19) in China and other countries in the world is serious. There are at present no effective treatments for COVID-19. The safety and effectiveness of western anti-coronavirus drugs are under investigation. In many places in China, traditional Chinese medicine (TCM) has been used to treat COVID-19 with a high clinical cure rate. The treatment economics of TCM is good. The immune-regulating and antiviral TCM can enhance human immunity and exert an antiviral effect. They have been widely used in the anti-COVID-19 treatment. We consulted the database of CNKI, Wanfang, VIP and PubMed for screening the immune-regulating and antiviral TCMs (Glycyrrhizae Radix et Rhizoma, Pogostemonis Herba, Lonicerae Japonicae Flos, Scutellariae Radix, Forsythiae Fructus, Magnoliae Officinalis Cortex, Bupleuri Radix, Isatidis Radix, Rhei Radix et Rhizoma, Astragali Radix, and Houttuyniae Herba). This article summarizes the physicochemical and pharmacokinetic characteristics, and the clinical application of the effective components of immune-regulating and antiviral TCM in the prescriptions and Chinese patent medicines, in order to provide a better reference for the clinical application of TCM.


title: Quality Prediction of Drilled and Reamed Bores Based on Torque Measurements and the Machine Learning Method of Random Forest

text: Abstract Increasing amount of available process data in the manufacturing industry together with analysis methods like machine learning provides new possibilities to increase the manufacturing efficiency and to rethink existing process structures. For example, assessing the workpiece quality in an early machining stage can be used to alter the quality control strategy, to increase the product quality, and to reduce the number of scrap parts which leads to savings in terms of time, resources, and cost. In this work, torque measurements obtained from the numerical control of a milling-machine in the serial production of hydraulic valves are used to predict the concentricity as well as the diameter of drilled and reamed bores of the valves. Statistical features are determined out of the torque measurements, which are presented as time series. The prediction of the quality is achieved with the machine learning method of random forest (RF) on the basis of the extracted features. The Pearson correlation between the features and the quality characteristics as well as the learning curves of the RF method are studied. It turns out, that a strong correlation comes along with a fast decreasing learning curve of the RF but gives no information over the achievable prediction accuracy with the RF. The obtained predictions are very precise and evaluated with four statistical criteria. A mean absolute error of 17.1 µm for the concentricity and only 0.27 µm for the diameter is achieved. In addition, the coefficients of determination of the concentricity and the diameter are 96.3% and 94.1% respectively, very high. It can be stated, that for the considered use case in this paper, a precise quality prediction on the basis of torque measurements and RF could be implemented which would make a much faster and efficient quality control possible.


docid: mcpibnkj

title: A geotemporal survey of hospital bed saturation across England during the first wave of the COVID-19 Pandemic

text: Background: Non-pharmacological interventions were introduced based on modelling studies which suggested that the English National Health Service (NHS) would be overwhelmed by the COVID-19 pandemic. In this study, we describe the pattern of bed occupancy across England during the first wave of the pandemic, January 31st to June 5th 2020. Methods: Bed availability and occupancy data was extracted from daily reports submitted by all English secondary care providers, between 27-Mar and 5-June. Two thresholds (85% as per Royal College of Emergency Medicine and 92% as per NHS Improvement) were applied as thresholds for safe occupancy. Findings: At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough, there were 8.7% (8,508) fewer general and acute (G&A) beds across England, but occupancy never exceeded 72%. The closest to (surge) capacity that any trust in England reached was 99.8% for general and acute beds. For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity, and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust = 1 [range: 1 to 17]). However, only 3 STPs (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds. Interpretation: Throughout the first wave of the pandemic, an adequate supply of all bed-types existed at a national level. Due to an unequal distribution of bed utilization, many trusts spent a significant period operating above safe occupancy thresholds, despite substantial capacity in geographically co-located trusts; a key operational issue to address in preparing for a potential second wave. Funding: This study received no funding.


title: On Data-Driven Management of the COVID-19 Outbreak in South Africa

text: The rapid spread of the novel coronavirus (SARS-CoV-2) has highlighted the need for the development of rapid mitigating responses under conditions of extreme uncertainty. While numerous works have provided projections of the progression of the pandemic, very little work has been focused on its progression in Africa and South Africa, in particular. In this work, we calibrate the susceptible-infected-recovered (SIR) compartmental model to South African data using initial conditions inferred from progression in Hubei, China and Lombardy, Italy. The results suggest two plausible hypotheses - either the COVID-19 pandemic is still at very early stages of progression in South Africa or a combination of prompt mitigating measures, demographics and social factors have resulted in a slowdown in its spread and severity. We further propose pandemic monitoring and health system capacity metrics for assisting decision-makers in evaluating which of the two hypotheses is most probable.


docid: mskkahwi

title: SARS-CoV-2 detection using digital PCR for COVID-19 diagnosis, treatment monitoring and criteria for discharge

text: Background: SARS-CoV-2 nucleic acid detection by RT-PCR is one of the criteria approved by China FDA for diagnosis of COVID-19. However, inaccurate test results (for example, high false negative rate and some false positive rate) were reported in both China and US CDC using the RT-PCR method. Inaccurate results are caused by inadequate detection sensitivity of RT-PCR, low viral load in some patients, difficulty to collect samples from COVID-19 patients, insufficient sample loading during RT-PCR tests, and RNA degradation during sample handling process. False negative detection could subject patients to multiple tests before diagnosis can be made, which burdens health care system. Delayed diagnosis could cause infected patients to miss the best treatment time window. False negative detection could also lead to prematurely releasing infected patients who still carry residual SARS-CoV-2 virus. In this case, these patients could infect many others. A high sensitivity RNA detection method to resolve the existing issues of RT-PCR is in need for more accurate COVID-19 diagnosis. Methods: Digital PCR (dPCR) instrument DropX-2000 and assay kits were used to detect SARS-CoV-2 from 108 clinical specimens from 36 patients including pharyngeal swab, stool and blood from different days during hospitalization. Double-blinded experiment data of 108 clinical specimens by dPCR methods were compared with results from officially approved RT-PCR assay. A total of 109 samples including 108 clinical specimens and 1 negative control sample were tested in this study. All of 109 samples, 26 were from 21patients reported as positive by officially approved clinical RT-PCR detection in local CDC and then hospitalized in Nantong Third Hospital. Among the 109 samples, dPCR detected 30 positive samples on ORFA1ab gene, 47 samples with N gene positive, and 30 samples with double positive on ORFA1ab and N genes. Results: The lower limit of detection of the optimize dPCR is at least 10-fold lower than that of RT-PCR. The overall accuracy of dPCR for clinical detection is 96.3%. 4 out 4 of (100 %) negative pharyngeal swab samples checked by RT-PCR were positive judged by dPCR based on the follow-up investigation. 2 of 2 samples in the RT-PCR grey area (Ct value > 37) were confirmed by dPCR with positive results. 1 patient being tested positive by RT-PCR was confirmed to be negative by dPCR. The dPCR results show clear viral loading decrease in 12 patients as treatment proceed, which can be a useful tool for monitoring COVID-19 treatment. Conclusions: Digital PCR shows improved lower limit of detection, sensitivity and accuracy, enabling COVID-19 detection with less false negative and false positive results comparing with RT-PCR, especially for the tests with low viral load specimens. We showed evidences that dPCR is powerful in detecting asymptomatic patients and suspected patients. Digital PCR is capable of checking the negative results caused by insufficient sample loading by quantifying internal reference gene from human RNA in the PCR reactions. Multi-channel fluorescence dPCR system (FAM/HEX/CY5/ROX) is able to detect more target genes in a single multiplex assay, providing quantitative count of viral load in specimens, which is a powerful tool for monitoring COVID-19 treatment.


title: COVID-19 is rapidly changing: Examining public perceptions and behaviors in response to this evolving pandemic

text: Background: Since the emergence of SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) in late 2019, communities have been required to rapidly adopt community mitigation strategies rarely used before, or only in limited settings. This study aimed to examine the attitudes and beliefs of Australian adults towards the COVID-19 pandemic, and willingness and capacity to engage with these mitigation measures. In addition, we aimed to explore the psychosocial and demographic factors that are associated with adoption of recommended hygiene-related and avoidance-related behaviors. Methods: A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between the 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis. Results: The survey of 1420 respondents found 50% (710) of respondents felt COVID-19 would somewhat affect their health if infected and 19% perceived their level of risk as high or very high. 84.9% had performed [≥]1 of the three recommended hygiene-related behaviors and 93.4% performed [≥]1 of six avoidance-related behaviors over the last one month. Adopting avoidance behaviors was associated with trust in government/authorities (aOR: 5.5, 95% CI 3-9.0), higher perceived rating of effectiveness of behaviors (aOR: 4.3, 95% CI: 2.8-6.9) and higher levels of perceived ability to adopt social distancing strategies (aOR: 1.8, 95% CI 1.1-3.0). Interpretation: In the last two months, members of the public have been inundated with messages about hygiene and social (physical) distancing. However, our results indicate that a continued focus on supporting community understanding of the rationale for these strategies, as well as instilling community confidence in their ability to adopt or sustain the recommendations is needed.


title: Effect of various treatment modalities on the novel coronavirus (nCOV-2019) infection in humans: a systematic review & meta-analysis

text: Background and aim: Several therapeutic agents have been investigated for the treatment of novel Coronavirus-2019 (nCOV-2019). We aimed to conduct a systematic review and meta-analysis to assess the effect of various treatment modalities in nCOV-2019 patients. Methods: An extensive literature search was conducted before 22 May 2020 in PubMed, Google Scholar, Cochrane library databases. Quality assessment was performed using Newcastle Ottawa Scale. A fixed-effect model was applied if I2 <50%, else the results were combined using random-effect model. Risk Ratio (RR) or Standardized Mean Difference (SMD) along-with 95% Confidence Interval (95%CI) were used to pool the results. Between study heterogeneity was explored using influence and sensitivity analyses & publication bias was assessed using funnel plots. Entire statistical analysis was conducted in R version 3.6.2. Results: Eighty-one studies involving 44 in vitro and 37 clinical studies including 8662 nCOV-2019 patients were included in the review. Lopinavir-Ritonavir compared to controls was significantly associated with shorter mean time to clinical improvement (SMD -0.32; 95%CI -0.57 to -0.06) and Remdesivir compared to placebo was significantly associated with better overall clinical improvement (RR 1.17; 95%CI 1.07 to 1.29). Hydroxychloroquine was associated with less overall clinical improvement (RR 0.88; 95%CI 0.79 to 0.98) and longer time to clinical improvement (SMD 0.64; 95%CI 0.33 to 0.94). It additionally had higher all-cause mortality (RR 1.6; 95%CI 1.26 to 2.03) and more total adverse events (RR 1.84; 95% CI 1.58 to 2.13). Conclusion: Our meta-analysis suggests that except in vitro studies, no treatment till now has shown clear-cut benefit on nCOV-2019 patients. Lopinavir-Ritonavir and Remdesivir have shown some benefits in terms less time to clinical improvement and better overall clinical improvement. Hydroxychloroquine use has a risk of higher mortality and adverse events. Results from upcoming large clinical trials must be awaited to draw any profound conclusions.


title: Predictive accuracy of a hierarchical logistic model of cumulative SARS-CoV-2 case growth

text: Background: Infectious disease predictions models, including virtually all epidemiological models describing the spread of the SARS-CoV-2 pandemic up to June 2020, are rarely evaluated. The aim of the present study was to investigate the predictive accuracy of a prognostic model for forecasting the development of the cumulative number of reported SARS-CoV-2 cases in countries and administrative regions worldwide. Methods: The cumulative number of reported SARS-CoV-2 cases was forecasted in 251 regions with a horizon of two weeks, one month, and two months using a previously described hierarchical logistic model at the end of March 2020. Forecasts were compared to actual observations by using a series of evaluation metrics. Results: On average, predictive accuracy was very high in nearly all regions at the two weeks forecast, high in most regions at the one month forecast, and notable in the majority of the regions at the two months forecast. Higher accuracy was associated with the availability of more data for estimation and with a more pronounced cumulative case growth from the first case to the date of estimation. In some strongly affected regions, cumulative case counts were considerably underestimated. Conclusions: With keeping its limitations in mind, the investigated model can be used for the preparation and distribution of resources during the SARS-CoV-2 pandemic. Future research should primarily address the model's assumptions and its scope of applicability. In addition, establishing a relationship with known mechanisms and traditional epidemiological models of disease transmission would be desirable.


title: Discovery of baicalin and baicalein as novel, natural product inhibitors of SARS-CoV-2 3CL protease in vitro

text: Human infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause coronavirus disease 19 (COVID-19) and there is currently no cure. The 3C-like protease (3CLpro), a highly conserved protease indispensable for replication of coronaviruses, is a promising target for development of broad-spectrum antiviral drugs. To advance the speed of drug discovery and development, we investigated the inhibition of SARS-CoV-2 3CLpro by natural products derived from Chinese traditional medicines. Baicalin and baicalein were identified as the first non-covalent, non-peptidomimetic inhibitors of SARS-CoV-2 3CLpro and exhibited potent antiviral activities in a cell-based system. Remarkably, the binding mode of baicalein with SARS-CoV-2 3CLpro determined by X-ray protein crystallography is distinctly different from those of known inhibitors. Baicalein is perfectly ensconced in the core of the substrate-binding pocket by interacting with two catalytic residues, the crucial S1/S2 subsites and the oxyanion loop, acting as a “shield” in front of the catalytic dyad to prevent the peptide substrate approaching the active site. The simple chemical structure, unique mode of action, and potent antiviral activities in vitro, coupled with the favorable safety data from clinical trials, emphasize that baicalein provides a great opportunity for the development of critically needed anti-coronaviral drugs.


docid: ytsqfqvh

title: Impact assessment of non-pharmaceutical interventions against COVID-19 and influenza in Hong Kong: an observational study

text: Background: A range of public health measures have been implemented to delay and reduce local transmission of COVID-19 in Hong Kong, and there have been major changes in behaviours of the general public. We examined the effect of these interventions and behavioral changes on the incidence of COVID-19 as well as on influenza virus infections which may share some aspects of transmission dynamics with COVID-19. Methods: We reviewed policy interventions and measured changes in population behaviours through two telephone surveys, on January 20-23 and February 11-14. We analysed data on laboratory-confirmed COVID-19 cases, influenza surveillance data in outpatients of all ages, and influenza hospitalisations in children. We estimated the daily effective reproduction number (R_t), for COVID-19 and influenza A(H1N1). Findings: COVID-19 transmissibility has remained at or below 1, indicating successful containment to date. Influenza transmission declined substantially after the implementation of social distancing measures and changes in population behaviours in late January, with a 44% (95% confidence interval, CI: 34% to 53%) reduction in transmissibility in the community, and a 33% (95% CI: 24% to 43%) reduction in transmissibility based on paediatric hospitalization rates. In the two surveys we estimated that 74.5% and 97.5% of the general adult population wore masks when going out, and 61.3% and 90.2% avoided going to crowded places, respectively. Implications: Containment measures, social distancing measures and changes in population behaviour have successfully prevented spread of COVID-19. The social distancing measures and behavioural changes led to a substantial reduction in influenza transmission in early February 2020. However, it may be challenging to avoid fatigue and sustain these measures and population behaviours as COVID-19 continues to spread globally. Funding: Health and Medical Research Fund, Hong Kong


title: Clinical Efficacy of Chloroquine derivatives in COVID-19 Infection: Comparative meta-analysis between the Big data and the real world

text: In the context of the current COVID-19 pandemic, we conducted a meta-analysis on the effects of chloroquine derivatives in patients, based on unpublished and published reports available publicly on the internet as of May, 27, 2020 The keywords “hydroxychloroquine”, “chloroquine”, “coronavirus”, “COVID-19” and “SARS-Cov-2” were used in the PubMed, Google Scholar and Google search engines without any restrictions as to date or language Twenty studies were identified involving 105,040 patients (19,270 treated patients) from nine countries (Brazil, China, France, Iran, Saudi Arabia, South Korea, Spain, and USA) Big data observational studies were associated with conflict of interest, lack of treatment dosage and duration, and absence of favorable outcome Clinical studies were associated with favorable outcomes and details on therapy Among clinical studies, three of four randomized controlled trials reported a significant favorable effect Among clinical studies, a significant favorable summary effect was observed for duration of cough (Odds ratio (OR), 0 19, p = 00003), duration of fever (0 11, p = 039), clinical cure (0 21, p = 0495), death (0 32, p = 4 1x10-6) and viral shedding (0 43, p = 031) A trend for a favorable effect was noted for the outcome “death and/or ICU transfer” (0 29, p = 069) with a point estimate remarkably similar to that observed for death (∼0 3) In conclusion, a meta-analysis of publicly available clinical reports demonstrates that chloroquine derivatives are effective to improve clinical and virological outcomes but, more importantly, it reduces mortality by a factor 3 in patients infected with COVID-19 Big data are lacking basic treatment definitions and are linked to conflict of interest


title: Hoe blijf je mentaal overeind?

text: Als verpleegkundige ben je gewend aan stressvolle, emotioneel belastende omstandigheden op je werk De coronacrisis doet daar echter nog een schepje bovenop Hoe zorg je dat je in deze tijden psychisch gezond blijft?


title: Potential impacts of COVID-19 on Canadian farmland markets

text: Evidence from the past 50 years suggests that changes in Canadian farmland values are influenced by farming returns, real interest rates, and exchange rates. Residential and commercial development also affects the value of farmland close to major urban centers. The COVID-19 economic shutdown is expected to reduce crop and livestock returns, which will put downward pressure on farmland values. The magnitude of this downward pressure will depend on the extent and the length of the recession. The evolution of interest rates over the next months and years could have a significant impact on farmland values. Historically, low real interest rates have coincided with higher farmland values, whereas high real interest rates have caused significant reductions in farmland values. The development value of farmland close to major cities could be negatively impacted by a sharp downturn in residential and commercial property markets.


title: Lack of coordination and medical disinformation in Canadian self-assessment tools for COVID-19

text: As SARS-CoV-2 threatens to overwhelm health systems in Canada, it is imperative that provinces are able to plan and manage an effective and reduced risk response. For this response to be most effective, it must reflect an evidence-based, pan-Canadian response. We designed four different prototypical patients with a combination of common COVID-19 symptoms and opportunities for exposure who were made to self-assess using the 10 provincial COVID-19 self-assessment tools on 1 April. These tools were developed to allow individuals to self-triage, allowing health systems direct capacity to testing and care. We assessed the consistency of the self-assessment tools and of the guidance provided to the patients. While the tools generally screen in three areas, the scope of included COVID-19 associated symptoms as well as the opportunities for exposure, and therefore transmission, vary between provinces such that no two provinces screened in the same way. This was, in turn, reflected in the inconsistency in guidance found. A patient with cough who had travelled abroad or had close contact with a confirmed case within 14 days received the most consistent guidance, with remaining patients receiving guidance ranging from mandatory quarantine or self-isolation to being told they did not have COVID-19 symptoms, guidance at odds with medical evidence. Thus, there is not a single, evidence-based Canadian standard of care simply for self-assessment. Without consistency in public health guidance, Canadians cannot appropriately self-isolate to mitigate community transmission, nor can the necessary valid and reliable data be collected to inform critical epidemiological models that help guide pandemic response. If federal and provincial governments are unable to coordinate a response, Parliament must use its available jurisdiction to legislate a duty on both to follow national standards, so as to improve coordination on COVID-19 in coming months.


title: A Review of Salivary Diagnostics and Its Potential Implication in Detection of Covid-19

text: Saliva is an exocrine secretion produced from the salivary glands and has numerous functions, such as cleansing and protection of the oral cavity, antimicrobial effects and aids in digestion. Due to the speedy development in the field of salivaomics, saliva is now well accepted as a pool of biological markers that vary from changes in biochemicals, nucleic acids and proteins to the microflora. Saliva has an immense potential as a diagnostic fluid and offers an edge over other biological fluids as its collection method does not require invasive procedure, economical and is useful for monitoring systemic health. Development of sensitive and precise salivary diagnostic tools and the formulation of defined guidelines following meticulous testing will allow salivary diagnostics to be utilised as chair side tests for various oral and systemic diseases in the near future. The coronavirus disease (Covid-19) pandemic is the biggest challenge and global health crisis for the world since World War Two. Rapid and accurate diagnosis of Covid-19 is crucial in controlling the outbreak in the community and in hospitals. Nasopharyngeal and oropharyngeal swabs are the recommended specimen types for Covid-19 diagnostic testing. The collection of these specimen types requires close contact between healthcare workers and patients and poses a risk of transmission of the virus, causes discomfort and may cause bleeding, especially in patients with condition such as thrombocytopenia. Hence, nasopharyngeal or oropharyngeal swabs are not desirable for sequential monitoring of viral load. Saliva specimens can be obtained easily as the patient is asked to spit into a sterile bottle. The collection of saliva is non-invasive and greatly minimizes the exposure of healthcare workers to Covid-19. Saliva has a high consistency rate of greater than 90% with nasopharyngeal specimens in the detection of respiratory viruses, including coronaviruses. Saliva has also been used in screening respiratory viruses among hospitalized patients without pyrexia or respiratory symptoms. SARS-CoV can be detected in saliva at high titers. Salivary diagnostics is a dynamic field that is being incorporated as part of disease diagnosis, clinical monitoring of systemic health and to make significant clinical decisions for patient care. More research is required to analyze the potential diagnostic of Covid-19 in saliva to develop rapid chair side tests for the detection of Covid-19 and it is also pivotal to improve and develop successful strategies for prevention, especially for dentists and healthcare professionals who are involved in performing aerosol-generating procedures.


title: Sanofi adds new virus to vaccine pact

text: Sanofi's vaccine business Translate Bio will work together to develop an mRNA vaccine for the novel coronavirus The collaboration will build on a 2018 pact in which Sanofi paid Translate $45 million to develop up to five mRNA vaccines for infectious diseases For Sanofi, one of the world’s leading vaccine makers, the agreement complements a collaboration it formed in February with the US Biomedical Advanced Research and Development Authority to develop a cell-based vaccine against the virus


title: Modelling the impact of control measures against the COVID-19 pandemic in Viet Nam

text: Objectives: Health care system of many countries are facing a surging burden of COVID-19. Although Vietnam has successfully controlled the COVID-19 pandemic to date, there is a sign of initial community transmission. An estimate of possible scenarios to prepare health resources in the future is needed. We used modelling methods to estimate impacts of mitigation measures on the COVID-19 pandemic in Vietnam. Methods: SEIR model built in the COVIDSIM1.1 tool was adopted using available data for estimation. The herd immunization scenario was with no intervention implemented. Other scenarios consisted of isolation and social distancing at different levels (25%, 50%, 75% and 10%, 20%, 30%, respectively). Outcomes include epidemic apex, daily new and cumulative cases, deaths, hospitalized patients and ICU beds needed. Results: By April 8, 2020, there would be 465 infected cases with COVID-19 in Viet Nam, of those 50% were detected. Cumulatively, there would be 1,400 cases and 30 deaths by end of 2020, if 75% of cases was detected and isolated, and 30% of social distancing could be maintained. The most effective intervention scenario is the detection and isolation of 75% infected cases and reduction of 10% social contacts. This will require an expansion of testing capacity at health facilities and in the community, posing a challenge to identify high-risk groups to prioritized testing. Conclusions: In a localized epidemic setting, the expansion of testing should be the key measure to control the epidemic. Social distancing plays a significant role to prevent further transmission to the community.


title: El SARS-CoV-2, una nueva zoonosis pandémica que amenaza al mundo

text: On December 31, 2019, an outbreak of pneumonia of unknown etiology was detected in the city of Wuhan (China). A week later, a new coronavirus was isolated in these patients, initially designated as 2019-nCoV and subsequently SARS-CoV-2. This is a new virus that is much closer genetically to the coronavirus of bats than to human SARS. The new virus infects and replicates in the lung parenchyma pneumocytes and macrophages in which the ACE-2 cell receptor resides. He has now infected many more people than his predecessors (> 85,000). From the clinical point of view, those infected have an average age of 55 years; the main symptoms are fever, dry cough, lymphopenia, dyspnea, and pneumonia in its severe form. The overall lethality rate is 2-3% in China and 0.1% in cases detected outside of this country. The incubation period has been set at about 3 days (0-24 days). There are no specific antivirals or vaccines.


title: Blood biomarker score identifies individuals at high risk for severe COVID-19 a decade prior to diagnosis: metabolic profiling of 105,000 adults in the UK Biobank

text: Background: Identification of healthy people at high risk for severe COVID-19 is a global health priority. We investigated whether blood biomarkers measured by high-throughput metabolomics could be predictive of severe pneumonia and COVID-19 hospitalisation years after the blood sampling. Methods: Nuclear magnetic resonance metabolomics was used to quantify a comprehensive biomarker profile in 105,146 plasma samples collected in the UK Biobank during 2007-2010 (age range 39-70). The biomarkers were tested for association with severe pneumonia (2507 cases, defined as diagnosis in hospital or death record occurring during a median of 8.1-year follow-up) and with severe COVID-19 (195 cases, defined as diagnosis in hospital between mid-March to mid-June 2020). A multi-biomarker score was derived for prediction of severe pneumonia based on half of the study population and validated in the other half. We explored how this biomarker score relates to the risk of severe COVID-19. Findings: The biomarker associations with risk of severe COVID-19 followed an overall pattern similar to associations with risk of severe pneumonia (correlation 0.83). The multi-biomarker score, comprised of 25 blood biomarkers including inflammatory proteins, fatty acids, amino acids and advanced lipid measures, was strongly associated with risk of severe pneumonia (odds ratio 1.67 per standard deviation [95% confidence interval 1.59-1.76]; 3.8-fold risk increase for individuals in upper vs lower quintile). The multi-biomarker score was also associated with risk of severe COVID-19 (odds ratio 1.33 [1.17-1.53]; 2.5-fold risk for upper vs lower quintile) and remained significant when adjusting for body mass index, smoking, and existing respiratory and cardiometabolic diseases. Mimicking the decade lag from blood sampling to COVID-19, severe pneumonia events occurring after 7-11 years associated with the multi-biomarker score to a similar magnitude (odds ratio 1.43 [1.29-1.59]; 2.6-fold risk for upper vs lower quintile) as for severe COVID-19. However, the short-term risk of severe pneumonia events associated to the multi-biomarker score at even 3 times higher magnitude (odds ratio 2.21 [1.95-2.50]; 8.0-fold risk for upper vs lower quintile in analysis of the first 2 years after blood sampling). Interpretation: In decade-old blood samples from the UK Biobank, a biomarker score measured by high-throughput metabolomics is indicative of the risk for severe COVID-19. The molecular signature of biomarker changes reflective of risk for severe COVID-19 is similar to that for severe pneumonia, in particular when accounting for the time lag to the COVID-19 pandemic. The even stronger association of the biomarker score with 2-year risk for severe pneumonia lends support to promising screening possibilities for identifying people at high risk for severe COVID-19.


title: COVID-19, wall building, and the effects on Migrant Protection Protocols by the Trump administration: the spectacle of the worsening human rights disaster on the Mexico-U.S. border

text: The COVID-19 pandemic has repercussions well beyond the confines of borders. National border policies can thwart international efforts to combat the spread of infectious diseases. These problems are especially relevant for the United States with the spectacle of President Trump’s “big, beautiful border wall” used as leverage to maintain political and economic power domestically and globally while confronting the coronavirus pandemic. The focus of this paper is the implementation of Trump’s Zero Tolerance Policy, Migrant Protection Protocols, and the Asylum Cooperation Agreement, all aimed primarily at migrants and refugees, the homo sacer, from Central America to prevent entrance into the U.S. using the border security apparatus. These policies have adverse consequences for people dwelling throughout the hemisphere, particularly borderlanders, as the COVID-19 pandemic spreads into the Americas.


title: Covid-19 trajectories: Monitoring pandemic in the worldwide context

text: Background: Covid-19 pandemic is developing worldwide with common dynamics but also with partly marked differences between regions and countries. They are not completely understood, but presumably, provide one clue to find ways to mitigate epidemics until exit strategies to its eradication become available. Method: We provide a monitoring tool available at www.izbi.de. It enables inspection of the dynamic state of the epidemic in 187 countries using trajectories. They visualize transmission and removal rates of the epidemic and this way bridge epi-curve tracking with modelling approaches. Results: Examples were provided which characterize state of epidemic in different regions of the world in terms of fast and slow growing and decaying regimes and estimate associated rate factors. Basic spread of the disease associates with transmission between two individuals every two-three days on the average. Non-pharmaceutical interventions decrease this value to up to ten days where complete lock down measures are required to stop the epidemic. Comparison of trajectories revealed marked differences between the countries regarding efficiency of measures taken against the epidemic. Trajectories also reveal marked country-specific dynamics of recovery and death rates. Conclusions: The results presented refer to the pandemic state in May 2020 and can serve as working instruction for timely monitoring using the interactive monitoring tool as a sort of seismometer for the evaluation of the state of epidemic, e.g., the possible effect of measures taken in both, lock-down and lock-up directions. Comparison of trajectories between countries and regions will support developing hypotheses and models to better understand regional differences of dynamics of Covid-19.


title: 2020PMD, 30-years of Translational Mobility Medicine at the time of COVID-19 outbreak: Last-minute forewords from the editor

text: In the autumn of 2019, the organizers of the 2020 Padua Muscle Days planned an intense program, which was to be held from March 18 to March 21, 2020. The program included eight Scientific Sessions to occur over three full days at either Padova University or the Hotel Augustus on Euganei Hills (Padova), Italy. Abruptly, however, in early January the Coronavirus COVID-19 outbreak started in China and changed the world perspectives and expectations. In Italy, it started in Lombardy and Veneto, two main industrial areas of the country with intense connections and interchanges of people and commercial activities with China. Indeed, the virus was first isolated from a couple of Chinese tourists, who inadvertently incubated the infection during their visit to many towns in Italy. Within the following two weeks, the epidemic had the first Italian cases and victims in an area south of Milan and in a Village of the Euganei Hills (Vo Euganeo, Padova). The village was immediately quarantined, but it was too late. The virus had escaped the area. Thus, it was a mandatory, though difficult decision (made even before the Italian National Government posted rules to be followed to decrease spread of the infection), to post-pone the Padua Muscle Days meeting from 18-21 March, 2020 to 25-28 November, 2020. Luckily, the vast majority of organizers, chairs, speakers, and attendees accepted the decision and have assured their presence in late November, despite the coincidence with the Thanksgiving holiday in the US. Currently, the only changes in the program are the new dates; however, it is difficult to forecast the future. Anyhow, the rationale of the decision to post-pone 2020PMD was reinforced by the actions of many organizers of international events. One of the most recent examples is the March 6, 2020 decision of the leaders of the Experimental Biology Host Societies to cancel Experimental Biology (EB) 2020, set to take place April 4–7 in San Diego, California, USA. All these active civil responses to world dangers are mandatory to avoid those military responses that are easy to start, but provide the worst results. How do we not lose half of the 2020 year? The option is to try to achieve some of the goals of the meeting by long-distance communications. Thus, the Collection of Abstracts will be, as originally planned, e-published in this 30(1) 2020 Issue of the European Journal of Translational Myology (EJTM) together with the many EJTM Communications submitted by speakers and attendees of the 2020PMD. We may also start the process that will implement EMMA, the European Mobility Medicine Association, by circulating a proposal and inviting comments.


title: Current State and Predicting Future Scenario of Highly Infected Nations for COVID-19 Pandemic

text: Since the first report of COVID-19 from Wuhan China, the virus has rapidly spread across the globe now presently reported in 177 countries with positive cases crossing 400 thousand and rising. In the current study, prediction is made for highly infected countries by a simple and novel method using only cumulative positive cases reported. The rate of infection per week (R_w) coefficient delineated three phases for the current COVID-19 pandemic. All the countries under study have passed Phase 1 and are currently in Phase 2 except for South Korea which is in Phase 3. Early detection with rapid and large-scale testing helps in controlling the COVID-19 pandemic. Staying in Phase 2 for longer period would lead to increase in COVID-19 positive cases.


title: Super spreader cohorts and covid-19

text: A simple two-cohort SIR like model can explain the qualitative behaviour of the logarithmic derivative estimations of the covid-19 epidemic evolution as observed in several countries. The model consists of a general population in which the R_0 value is slightly below 1, but in which a super-spreading small subgroup with high R_0, coupled to the general population, is contaminating a significant fraction of the population. The epidemic starts to slow down when herd immunity is reached in this subgroup. The dynamics of this system is quite robust against non-pharmaceutical measures.


title: Estimating the distribution of the incubation period of 2019 novel coronavirus (COVID-19) infection between travelers to Hubei, China and non-travelers

text: Objectives: Amid the continuing spread of the novel coronavirus (COVID-19), the incubation period of COVID-19 should be regularly re-assessed as more information is available upon the increase in reported cases. The present work estimated the distribution of incubation periods of patients infected in and outside Hubei province of China. Methods: Clinical data were collected from the individual cases reported by the media as they were not fully available on the official pages of the Chinese health authorities. MLE was used to estimate the distributions of the incubation period. Results: It was found that the incubation period of patients with no travel history to Hubei was longer and more volatile. Conclusion: It is recommended that the duration of quarantine should be extended to at least 3 weeks.


docid: tukeofwh

title: The Emotional Toll: How These Neurology Departments Are Getting Through COVID-19


Prognosticating COVID-19: A need for Africa-specific laboratory predictors


docid: swrbafwq

title: COVID 19: An SEIR model predicting disease progression and healthcare outcomes for Pakistan

text: Background Recent pandemic of the Noval Coronal Virus (COVID 19) has claimed more than 200000 lives and about 3.8 million infected worldwide. Countries are being gradually exposed to its devastating threat without being properly prepared and with inadequate response. COVID 19 first two cases were reported in Pakistan on February 26, 2020. We present a model depicting progression of epidemiology curve for Pakistan with and without interventions in view of its health system response capacity in near future. Methodology We used a modified compartmental epidemiological SEIR model to describe the outbreak of COVID-19 in Pakistan including the possibility of asymptomatic infection and presymptomatic transmission. The behavior of the dynamic model is determined by a set of clinical parameters and transmission rate. Results We estimated that in the absence of a set of proven interventions, the total susceptible population would be 43.24 million, exposed individuals would be almost 32 million, asymptomatic cases would be 13.13 million, mildly infected 30.64 million, severely infected slightly more than 6 million and critical cases would be around 967,000 in number. By that time, almost 760,000 fatalities of infected critical would have taken place. Comparing with the healthcare capacity of Pakistan, if we could flatten the curve to a level below the dashed grey line, the healthcare system will be capable of managing the cases with ideal healthcare facilities, where the grey line representing the healthcare capacity of Pakistan. With the intervention in place, the number of symptomatic infected individuals is expected to be almost 20 million. Conclusion We consider the impact of intervention and control measures on the spread of COVID-19 with 30% reduction in transmission from mild cases in case a set of interventions are judiciously in place to mitigate its impact.


title: A Fractal kinetics SI model can explain the dynamics of COVID-19 epidemics

text: The COVID-19 pandemic has already had a shocking impact on the lives of everybody on the planet. Here, we present a modification of the classical SI model, the Fractal Kinetics SI model which is in excellent agreement with the disease outbreak data available from the World Health Organization. The fractal kinetic approach that we propose here originates from chemical kinetics and has successfully been used in the past to describe reaction dynamics when imperfect mixing and segregation of the reactants is important and affects the dynamics of the reaction. The model introduces a novel epidemiological parameter, the "fractal" exponent h which is introduced in order to account for the self-organization of the societies against the pandemic through social distancing, lockdowns and flight restrictions.


New Zealand and Covid-19: a swift and firm response


title: SARS-CoV-2 Spike S1 Receptor Binding Domain undergoes Conformational Change upon Interaction with Low Molecular Weight Heparins

text: The dependence of the host on the interaction of hundreds of extracellular proteins with the cell surface glycosaminoglycan heparan sulphate (HS) for the regulation of homeostasis is exploited by many microbial pathogens as a means of adherence and invasion. The closely related polysaccharide heparin, the widely used anticoagulant drug, which is structurally similar to HS and is a common experimental proxy, can be expected to mimic the properties of HS. Heparin prevents infection by a range of viruses when added exogenously, including S-associated coronavirus strain HSR1 and inhibits cellular invasion by SARS-CoV-2. We have previously demonstrated that unfractionated heparin binds to the Spike (S1) protein receptor binding domain, induces a conformational change and have reported the structural features of heparin on which this interaction depends. Furthermore, we have demonstrated that enoxaparin, a low molecular weight clinical anticoagulant, also binds the S1 RBD protein and induces conformational change. Here we expand upon these studies, to a wide range of low molecular weight heparins and demonstrate that they induce a variety of conformational changes in the SARS-CoV-2 RBD. These findings may have further implications for the rapid development of a first-line therapeutic by repurposing low molecular weight heparins, as well as for next-generation, tailor-made, GAG-based antiviral agents, against SARS-CoV-2 and other members of the Coronaviridae.


title: Design of a Novel Multiplex Real Time RT-PCR Assay for SARS-CoV-2 Detection

text: Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than 386,000 deaths globally as of June 4, 2020. In this study, we developed a novel multiplex real time reverse transcription (RT)-PCR test for detection of SARS-CoV-2, with primers designed to amplify a 108 bp target on the spike surface glycoprotein (S gene) of SARS-CoV-2 and a hydrolysis Taqman probe designed to specifically detect SARS-CoV-2. Following our design, we evaluated the Limit of detection (LOD) and clinical performance of this laboratory-developed test (LDT). A LOD study with inactivated whole virus exhibited equal performance to that seen in the modified CDC assay with a final LOD of 1,301 ± 13 genome equivalents/ml for our assay vs 1,249 ± 14 genome equivalents/ml for the modified CDC assay. In addition, a clinical evaluation with 270 nasopharyngeal (NP) swab specimens exhibited 98.5% positive percent agreement and 99.3% negative percent agreement with the modified CDC assay. The multiplex design of this assay allows the testing of 91 patients per plate, versus a maximum of 29 patients per plate on the modified CDC assay, providing the benefit of testing significantly more patients per run and saving reagents during a time when both of these parameters have been critical. Our results demonstrate that our multiplex assay performs as well as the modified CDC assay, but is more efficient and cost effective and is therefore adequate for use as a diagnostic assay and for epidemiological surveillance and clinical management of SARS-CoV-2.


title: The disease-induced herd immunity level for Covid-19 is substantially lower than the classical herd immunity level

text: Most countries are suffering severely from the ongoing covid-19 pandemic despite various levels of preventive measures. A common question is if and when a country or region will reach herd immunity h. The classical herd immunity level hC is defined as hC=1-1/R0, where R0 is the basic reproduction number, for covid-19 estimated to lie somewhere in the range 2.2-3.5 depending on country and region. It is shown here that the disease-induced herd immunity level hD, after an outbreak has taken place in a country/region with a set of preventive measures put in place, is actually substantially smaller than hC. As an illustration we show that if R0=2.5 in an age-structured community with mixing rates fitted to social activity studies, and also categorizing individuals into three categories: low active, average active and high active, and where preventive measures affect all mixing rates proportionally, then the disease-induced herd immunity level is hD=43% rather than hC=1-1/2.5=60%. Consequently, a lower fraction infected is required for herd immunity to appear. The underlying reason is that when immunity is induced by disease spreading, the proportion infected in groups with high contact rates is greater than that in groups with low contact rates. Consequently, disease-induced immunity is stronger than when immunity is uniformly distributed in the community as in the classical herd immunity level.


title: Recent update on COVID-19 in India: Is locking down the country enough?

text: Abstract Background: India is the second-largest population in the world, and it is not well equipped, hitherto, in the scenario of the global pandemic, SARS-CoV-2 could impart a devastating impact on the Indian population. Only way to respond against this critical condition is by practicing large-scale social distancing. India lock down for 21 days, however, till 7 April 2020, SARS-CoV-2 positive cases were growing exponentially, which raises the concerns if the number of reported and actual cases are similar. Methods: We use Lasso Regression with α=0.12 and Polynomial features of degree 2 to predict the growth factor. Also, we predicted Logistic curve using the Prophet Python. Further, using the growth rate to logistic, and carrying capacity is 20000 allowed us to calculate the maximum cases and new cases per day. Results: We found the predicted growth factor with a standard deviation of 0.3443 for the upcoming days. When the growth factor becomes 1.0, which is known as Inflection point, it will be safe to state that the rate is no longer exponential. The estimated time to reach the inflection point is between 15-20 April. At that time, the estimated number of total positive cases will be over 12500, if lockdown remains continue. Conclusions: Our analysis suggests that there is an urgent need to take action to extend the period of lockdown and allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. Otherwise, the outbreak in India can reach the level of the USA or Italy or could be worse than these countries within a few days or weeks, given the size of the population and lack of resources.


title: Two distinct immunopathological profiles in lungs of lethal COVID-19

text: Immune responses in lungs of Coronavirus Disease 2019 (COVID-19) are poorly characterized. We conducted transcriptomic, histologic and cellular profiling of post mortem COVID-19 and normal lung tissues. Two distinct immunopathological reaction patterns were identified. One pattern showed high expression of interferon stimulated genes (ISGs) and cytokines, high viral loads and limited pulmonary damage, the other pattern showed severely damaged lungs, low ISGs, low viral loads and abundant immune infiltrates. Distinct patterns of pulmonary COVID-19 immune responses correlated to hospitalization time and may guide treatment and vaccination approaches.


title: Extracorporeal Membrane Oxygenation Support in a Young Patient With COVID-19 Infection

text: Critically ill patients with coronavirus disease 2019 (COVID-19) infection often require mechanical ventilation, and still many of them will progress to worsening hypoxia and death Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in some centers, but its role in the setting of COVID-19 infection is still unclear to date We describe a case of a young female patient with obesity but otherwise no other underlying medical conditions who was admitted with respiratory failure secondary to COVID-19 Given her severe acute respiratory distress syndrome (ARDS) with refractory hypoxemia, she was treated with VV-ECMO After a prolonged hospital course, she improved clinically and was able to have VV-ECMO explanted, after 18 days of extracorporeal therapy The complexity of ECMO therapy requires a well-trained multidisciplinary team present only at expert centers The high resource cost is a challenge to the health care system in times of a global pandemic Considering the limitations of this resource-intensive therapy, clinical judgment is crucial to decide whether ECMO is an appropriate option for the patient However, for young patients with no underlying conditions who are critically ill despite optimized mechanical ventilation, we believe that extracorporeal therapy represents a reasonable option when available


title: Management of the first severe case of COVID19 in the small islands of Maldives

text: The first cases of COVID19 in the Maldives was reported on 7th March 2020 with a total of 13 cases by 27th March from number of resort islands and were confined to the islands in which the cases were detected. This report describes the clinical course and management of the first severe case that required intensive care. Treatment strategy adopted was supportive and patient improved wit timely symptomatic management. This case highlights the importance of epidemiological surveillance and active case finding to detect and diagnose the case at an early stage for appropriate clinical management for positive outcomes in high risk groups.


title: Monitoring the post-containment COVID-19 crisis in Guadeloupe: Early-warning signals of destabilisation through bootstrapped probability density functions

text: We propose a method to detect early-warning information in relation with subtle changes occurring in the trend of evolution in data time series of the COVID-19 epidemic spread (e.g. daily new cases). The method is simple and easy to implement on laptop computers. It is designed to be able to provide reliable results even with very small amounts of data (i.e. {approx} 10 - 20). The results are given as compact graphics easy to interpret. The data are separated into two subsets: the old data used as control points to statistically define a "trend" and the recent data that are tested to evaluate their conformity with this trend. The trend is characterised by bootstrapping in order to obtain probability density functions of the expected misfit of each data point. The probability densities are used to compute distance matrices where data clusters and outliers are easily visually recognised. In addition to be able to detect very subtle changes in trend, the method is also able to detect outliers. A simulated case is analysed where R0 is slowly augmented (i.e. from 1.5 to 2.0 in 20 days) to pass from a stable damped control of the epidemic spread to an exponentially diverging situation. The method is able to give an early warning signal as soon as the very beginning of the R0 variation. Application to the data of Guadeloupe shows that a small destabilising event occurred in the data near April 30, 2020. This may be due to an increase of R0 {approx} 0.7 around April 13-15, 2020.


title: Latent Blowout of COVID-19 Globally: An Effort to Healthcare Alertness via Medical GIS Approach

text: Since January 2020, the COVID-19 pandemic has been escalating from North America to Asia. Various studies projected the spread of pandemic globally, using air passenger data from an infected area. But there could be various parameters that can be the basis for the forecasting of the pandemic. Current research adopts the Medical GIS approach and incorporates critical parameters from various domains to create a global alertness scale to combat the pandemic. The finding of the study ranks the countries on a 1 to 9 scale based on the spatial alertness In this context, the study focuses on the role of GIS techniques as an enabler to fight against the global pandemic and could be beneficial for the authorities to adopt timely preventive actions.


title: Kaleidoscope: A New Bioinformatics Pipeline Web Application for In Silico Hypothesis Exploration of Omics Signatures

text: Background In silico data exploration is a key first step of exploring a research question. There are many publicly available databases and tools that offer appealing features to help with such a task. However, many applications lack exposure or are constrained with unfriendly or outdated user interfaces. Thus, it follows that there are many resources that are relevant to investigation of medical disorders that are underutilized. Results We developed an R Shiny web application, called Kaleidoscope, to address this challenge. The application offers access to several omics databases and tools to let users explore research questions in silico. The application is designed to be user- friendly with a unified user interface, while also scalable by offering the option of uploading user-defined datasets. We demonstrate the application features with a starting query of a single gene (Disrupted in schizophrenia 1, DISC1) to assess its protein-protein interactions network. We then explore expression levels of the gene network across tissues and cell types in the brain, as well as across 34 schizophrenia versus control differential gene expression datasets. Conclusion Kaleidoscope provides easy access to several databases and tools under a unified user interface to explore research questions in silico. The web application is open-source and freely available at https://kalganem.shinyapps.io/Kaleidoscope/. This application streamlines the process of in silico data exploration for users and expands the efficient use of these tools to stakeholders without specific bioinformatics expertise.


title: Risk factors for critical-ill events of patients with COVID-19 in Wuhan, China: a retrospective cohort study

text: Background Little is known about the risk factors for critical-ill events (intensive care, invasive ventilation, or death) in patients with COVID-19. Methods Patients with laboratory-confirmed COVID-19 admitted to the Wuhan Leishenshan Hospital from February 13 to March 14 was retrospectively analyzed. Demographic data, symptoms, laboratory values at baseline, comorbidities, treatments and clinical outcomes were extracted from electronic medical records and compared between patients with and without critical-ill events. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression models were developed to explore the risk factors for critical-ill events. A risk nomogram was established to predict the probability for the critical-ill events. Survival analysis of patients with critical-ill events was performed by the Kaplan-Meier method. Results 463 COVID-19 patients were included in this study, of whom 397 were non-critically ill and 66 were critically ill (all from the intensive care unit). The LASSO regression identified four variables (hypersensitive cardiac troponin I, blood urea nitrogen , haemoglobin, and interleukin-6) contributing to the critical-ill events. Multivariable regression showed increasing odds of in-hospital critical-ill events associated with hypersensitive cTnI greater than 0.04 ng/mL (OR 20.98,95% CI 3.51-125.31), blood urea nitrogen greater than 7.6 mmol/L (OR 5.22, 95% CI 1.52-17.81, decreased haemoglobin (OR 1.06, 95% CI 1.04-1.10), and higher interleukin-6 (OR 1.05, 95% CI 1.02-1.08) on admission. Conclusions Hypersensitive cTnI greater than 0.04 ng/mL, blood urea nitrogen greater than 7.6 mmol/L, decreased haemoglobin, and high IL-6 were risk factors of critical-ill events in patients with COVID-19.


Coronavirus and environmental engineering science


Shutting Down the Postindustrial Shop Floor: The High Line and Biopolitical Production in Pandemic Time


title: Amid coronavirus shutdowns, some grad students feel pressure to report to their labs

text: As the coronavirus outbreak roils university campuses across the world, early-career scientists are facing several dilemmas Many are worrying about the survival of cell cultures, laboratory animals, and other projects critical to their career success And some are reporting feeling unwelcome pressure to report to their laboratories—even if they don’t think it’s a good idea, given that any gathering can increase the risk of spreading the virus It’s unclear exactly how common these concerns are, but social media posts reveal numerous graduate students expressing stress and frustration at requests to come to work “Just emailed advisor to say I am not comfortable breaking self isolation to come to lab this week They emailed … saying I have to come in What do I do?” tweeted an anonymous Ph D student on 16 March who doesn’t have essential lab work scheduled “My health & safety should NOT be subject to the whims of 1 person It should NOT be this scary/hard to stand up for myself ”


title: Can we trust the prediction model? Demonstrating the importance of external validation by investigating the COVID-19 Vulnerability (C-19) Index across an international network of observational healthcare datasets

text: Background: SARS-CoV-2 is straining healthcare systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate between patients requiring hospitalization and those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital for treatment of pneumonia or pneumonia proxies, has been developed and proposed as a valuable tool for decision making during the pandemic. However, the model is at high risk of bias according to the Prediction model Risk Of Bias ASsessment Tool and has not been externally validated. Methods: We followed the OHDSI framework for external validation to assess the reliability of the C-19 model. We evaluated the model on two different target populations: i) 41,381 patients that have SARS-CoV-2 at an outpatient or emergency room visit and ii) 9,429,285 patients that have influenza or related symptoms during an outpatient or emergency room visit, to predict their risk of hospitalization with pneumonia during the following 0 to 30 days. In total we validated the model across a network of 14 databases spanning the US, Europe, Australia and Asia. Findings: The internal validation performance of the C-19 index was a c-statistic of 0.73 and calibration was not reported by the authors. When we externally validated it by transporting it to SARS-CoV-2 data the model obtained c-statistics of 0.36, 0.53 (0.473-0.584) and 0.56 (0.488-0.636) on Spanish, US and South Korean datasets respectively. The calibration was poor with the model under-estimating risk. When validated on 12 datasets containing influenza patients across the OHDSI network the c-statistics ranged between 0.40-0.68. Interpretation: The results show that the discriminative performance of the C-19 model is low for influenza cohorts, and even worse amongst COVID-19 patients in the US, Spain and South Korea. These results suggest that C-19 should not be used to aid decision making during the COVID-19 pandemic. Our findings highlight the importance of performing external validation across a range of settings, especially when a prediction model is being extrapolated to a different population. In the field of prediction, extensive validation is required to create appropriate trust in a model.


title: Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study

text: Since SARS-CoV-2 infection was first identified in December 2019, it spread rapidly and a global pandemic of COVID-19 has occurred. ACE2, the receptor for entry into the target cells by SARS-CoV-2, was found to abundantly express in testes, including spermatogonia, Leydig and Sertoli cells. However, there is no clinical evidence about whether SARS-CoV-2 infection can affect male gonadal function so far. In this study, we compared the sex-related hormones between 81 reproductive-aged men with SARS-CoV-2 infection and 100 age-matched healthy men, and found that serum luteinizing hormone (LH) was significantly increased, but the ratio of testosterone (T) to LH and the ratio of follicle stimulating hormone (FSH) to LH were dramatically decreased in males with COVID-19. Besides, multivariable regression analysis indicated that c-reactive protein (CRP) level was significantly associated with serum T:LH ratio in COVID-19 patients. This study provides the first direct evidence about the influence of medical condition of COVID-19 on male sex hormones, alerting more attention to gonadal function evaluation among patients recovered from SARS-CoV-2 infection, especially the reproductive-aged men.


title: PROGNOSTIC VALUE OF COMORMIDITY FOR SEVERITY OF COVID-19: A SYSTEMATIC REVIEW AND META-ANALYSIS STUDY

text: Abstract: Background and Aim: With the increase in the number of COVID-19 infections, global health is facing insufficient sources; this study aimed to provide additional data regarding the clinical characteristics of patients diagnosed with COVID-19 and in particular to analyze the factors associated with disease severity, unimprovement and mortality. Methods: 82 studies were included in the present meta-analysis that all of them have been published before May 1, 2020 and were found by searching through the databases Scopus and MEDLINE. The selected papers were studied and analyzed by employing the version 14 of stata software. It should be noted that, we employed I2 statistics for testing and verifying heterogeneity. Results: 82 papers were finally chosen for this meta- analysis, including 74855 infected patients (35673 men, 31140 women). The mean age of the patients was 56.49. The results indicate the prevalence of fever 79.84 (95% CI: 75.22-84.13), cough 59.53 (95% CI: 55.35-63.65), fatigue or myalgia 33.46 (95% CI: 28.68-38.40), dyspnea 31.48 (95% CI: 25.75-37.49) and diarrhea 10.71 (95% CI: 8.20-13.49). The prevalence of the most common comorbidities were hypertension 25.10 (95% CI: 19.91-30.64), diabetes 13.48 (95% CI: 10.61-16.62), cardiovascular diseases 8.94 (95% CI: 6.99-11.10), and chronic kidney disease 3.27 (95% CI: 2.22-4.47). Conclusion: The results of this study are seriously needed to effectively monitor the health of people with comorbidities (hypertension, diabetes, cardiovascular and cerebrovascular disease, coronary heart disease, and chronic kidney disease) to prevent the development of COVID-19 infection.


title: Epidemic prevention and control measures in China significantly curbed the epidemic of COVID-19 and influenza

text: At the end of 2019, an outbreak of unknown pathogen pneumonia occurred in China, then it was named corona virus disease 2019 (COVID-19). With the rapid spread of COVID-19, a series of strict prevention and control measures were implemented to cut the spread of the epidemic. Influenza as a respiratory tract infection disease as COVID-19 might also be controlled. To assess the effects, we used the total passenger numbers sent in mainland China from 2018 to 2020 and the daily number of railway passenger (DNRP) flow in 2020 during Spring Festival travel rush to reflect the population movement and further to analyze newly and cumulative confirmed COVID-19 and influenza. We found that with implementing the series measures on COVID-19, not only COVID-19, but also influenza mitigated in China. The prevention and control measures for COVID-19 might be used in controlling respiratory tract diseases, and reducing the national health economic burden. When other countries issue measures on COVID-19 and influenza, they should consider adopting more aggressive epidemic prevention and control strategies.


title: Structural basis for neutralization of SARS-CoV-2 and SARS-CoV by a potent therapeutic antibody

text: The COVID-19 pandemic caused by the SARS-CoV-2 virus has resulted in an unprecedented public health crisis. There are no approved vaccines or therapeutics for treating COVID-19. Here we reported a humanized monoclonal antibody, H014, efficiently neutralizes SARS-CoV-2 and SARS-CoV pseudoviruses as well as authentic SARS-CoV-2 at nM level by engaging the S receptor binding domain (RBD). Importantly, H014 administration reduced SARS-CoV-2 titers in the infected lungs and prevented pulmonary pathology in hACE2 mouse model. Cryo-EM characterization of the SARS-CoV-2 S trimer in complex with the H014 Fab fragment unveiled a novel conformational epitope, which is only accessible when the RBD is in open conformation. Biochemical, cellular, virological and structural studies demonstrated that H014 prevents attachment of SARS-CoV-2 to its host cell receptors. Epitope analysis of available neutralizing antibodies against SARS-CoV and SARS-CoV-2 uncover broad cross-protective epitopes. Our results highlight a key role for antibody-based therapeutic interventions in the treatment of COVID-19. One sentence summary A potent neutralizing antibody conferred protection against SARS-CoV-2 in an hACE2 humanized mouse model by sterically blocking the interaction of the virus with its receptor.


title: The UCSC SARS-CoV-2 Genome Browser

text: Background Researchers are generating molecular data pertaining to the SARS-CoV-2 RNA genome and its proteins at an unprecedented rate during the COVID-19 pandemic. As a result, there is a critical need for rapid and continuously updated access to the latest molecular data in a format in which all data can be quickly cross-referenced and compared. We adapted our genome browser visualization tool to the viral genome for this purpose. Molecular data, curated from published studies or from database submissions, are mapped to the viral genome and grouped together into “annotation tracks” where they can be visualized along the linear map of the viral genome sequence and programmatically downloaded in standard format for analysis. Results The UCSC Genome Browser for SARS-CoV-2 (https://genome.ucsc.edu/covid19.html) provides continuously updated access to the mutations in the many thousands of SARS-CoV-2 genomes deposited in GISAID and the international nucleotide sequencing databases, displayed alongside phylogenetic trees. These data are augmented with alignments of bat, pangolin, and other animal and human coronavirus genomes, including per-base evolutionary rate analysis. All available annotations are cross-referenced on the virus genome, including those from major databases (PDB, RFAM, IEDB, UniProt) as well as up-to-date individual results from preprints. Annotated data include predicted and validated immune epitopes, promising antibodies, RT-PCR and sequencing primers, CRISPR guides (from research, diagnostics, vaccines, and therapies), and points of interaction between human and viral genes. As a community resource, any user can add manual annotations which are quality checked and shared publicly on the browser the next day. Conclusions We invite all investigators to contribute additional data and annotations to this resource to accelerate research and development activities globally. Contact us at genome-www@soe.ucsc.edu with data suggestions or requests for support for adding data. Rapid sharing of data will accelerate SARS-CoV-2 research, especially when researchers take time to integrate their data with those from other labs on a widely-used community browser platform with standardized machine-readable data formats, such as the SARS-CoV-2 Genome Browser.


title: Predicting the Growth and Trend of COVID-19 Pandemic using Machine Learning and Cloud Computing

text: The outbreak of COVID-19 Coronavirus, namely SARS-CoV-2, has created a calamitous situation throughout the world. The cumulative incidence of COVID-19 is rapidly increasing day by day. Machine Learning (ML) and Cloud Computing can be deployed very effectively to track the disease, predict growth of the epidemic and design strategies and policy to manage its spread. This study applies an improved mathematical model to analyse and predict the growth of the epidemic. An ML-based improved model has been applied to predict the potential threat of COVID-19 in countries worldwide. We show that using iterative weighting for fitting Generalized Inverse Weibull distribution, a better fit can be obtained to develop a prediction framework. This can be deployed on a cloud computing platform for more accurate and real-time prediction of the growth behavior of the epidemic. A data driven approach with higher accuracy as here can be very useful for a proactive response from the government and citizens. Finally, we propose a set of research opportunities and setup grounds for further practical applications.


docid: wqxpdaaq

title: From Threat to Risk? Exceptionalism and Logics of Health Security

text: The logic of "risk" is increasingly important in the study of global health politics. One recent contribution has even argued that risk is beginning to replace security as the defining logic of health governance and policy. Others dispute this on the basis that risk and security have always operated together in the "securitization" of disease. This article constitutes a theoretical intervention into this burgeoning debate. Does a stronger appreciation of risk warrant the diminishment of security? Are we looking at the "riskification" of health rather than "securitization"? Or would this miss the way these two logics might be complimentary or intertwined in ways that we are yet to theorize? I argue that the global health and securitization literatures are better served by an explicit consideration of risk and security logics in interplay, or never entirely encompassed by the other, nor in complete alignment, yet never truly separate. To do this, I propose a reconceptualization of the central problem-exceptionalism-that allows for risk to be understood as a form of exceptionalist politics. I demonstrate the validity of this approach through an otherwise "easy case" of securitization: the US response to the 2014-2016 Ebola outbreak in West Africa.


title: The impact of contact tracing and household bubbles on deconfinement strategies for COVID-19: an individual-based modelling study

text: Background. The rising COVID-19 pandemic caused many governments to impose policies restricting social interactions. These policies have slowed down the spread of the SARS-CoV-2 virus to the extent that restric- tions can be gradually lifted. Models can be useful to assess the consequences of deconfinement strategies with respect to business, school and leisure activities. Methods. We adapted the individual-based model "STRIDE" to simulate interactions between the 11 million inhabitants of Belgium at the levels of households, workplaces, schools and communities. We calibrated our model to observed hospital incidence and seroprevalence data. STRIDE can explore contact tracing options and account for repetitive leisure contacts in extended household settings (so called "household bubbles") with varying levels of connectivity. Findings. Household bubbles have the potential to reduce the number of COVID-19 hospital admissions by up to 90%. The effectiveness of contact tracing depends on its timing, as it becomes futile more than 4 days after the index case developed symptoms. Assuming that children have a lower level of susceptibility and lower probability to experience symptomatic SARS-CoV-2 infection, (partial) school closure options have relatively little impact on COVID-19 burden. Interpretation. Not only the absolute number and intensity of physical contacts drive the transmission dynamics and COVID-19 burden, also their repetitiveness is influential. Contact tracing seems essential for a controlled and persistent release of lockdown measures, but requires timely compliance to testing, reporting and self-isolation. Rapid tracing and testing, and communication ensuring continued involvement of the population are therefore essential.


title: A systematic review and meta-analysis reveals long and dispersive incubation period of COVID-19

text: Background: The incubation period of SARS-CoV-2 remains uncertain, which has important implications for estimating transmission potential, forecasting epidemic trends, and decision-making in prevention and control. Purpose: To estimate the central tendency and dispersion for incubation period of COVID-19 and, in turn, assess the effect of a certain length of quarantine for close contacts in active monitoring. Data Sources: PubMed, Embase, medRxiv, bioRxiv, and arXiv, searched up to April 26, 2020 Study Selection: COVID-19 studies that described either individual-level incubation period data or summarized statistics for central tendency and dispersion measures of incubation period were recruited. Data Extraction: From each recruited study, either individual-level incubation period data or summarized statistics for central tendency and dispersion measures were extracted, as well as population characteristics including sample size, average age, and male proportion. Data Synthesis: Fifty-six studies encompassing 4 095 cases were included in this meta-analysis. The estimated median incubation period for general transmissions was 5.8 days [95% confidence interval (95%CI), 5.3 to 6.2 d]. Median and dispersion were higher for SARS-CoV-2 incubation compared to other viral respiratory infections. Furthermore, about 20 in 10 000 contacts in active monitoring would develop symptoms after 14 days, or below 1 in 10 000 for young-age infections or asymptomatic transmissions. Limitation: Small sample sizes for subgroups; some data were possibly used repeatedly in different studies; limited studies for outside mainland China; non-negligible intra-study heterogeneity. Conclusion: The long, dispersive incubation period of SARS-CoV-2 contributes to the global spread of COVID-19. Yet, a 14-day quarantine period is sufficient to trace and identify symptomatic infections, which while could be justified according to a better understanding of the crucial parameters.


Coronavirus disease 2019 (COVID-19) and cardiovascular events


title: Structural basis for the neutralization of SARS-CoV-2 by an antibody from a convalescent patient

text: The COVID-19 pandemic has had unprecedented health and economic impact, but currently there are no approved therapies. We have isolated an antibody, EY6A, from a late-stage COVID-19 patient and show it neutralises SARS-CoV-2 and cross-reacts with SARS-CoV-1. EY6A Fab binds tightly (KD of 2 nM) the receptor binding domain (RBD) of the viral Spike glycoprotein and a 2.6Å crystal structure of an RBD/EY6A Fab complex identifies the highly conserved epitope, away from the ACE2 receptor binding site. Residues of this epitope are key to stabilising the pre-fusion Spike. Cryo-EM analyses of the pre-fusion Spike incubated with EY6A Fab reveal a complex of the intact trimer with three Fabs bound and two further multimeric forms comprising destabilized Spike attached to Fab. EY6A binds what is probably a major neutralising epitope, making it a candidate therapeutic for COVID-19.


title: COVID-19 Mobility Data Collection of Seoul, South Korea

text: The relationship between pandemic and human mobility has received considerable attention from scholars, as investigating such relationship can provide an indication of how human mobility changes in response to a public health crisis or whether reduced mobility contributes to preventing the spread of an infectious disease. While several studies attempted to unveil this relationship, no studies have focused on changes in mobility pattern at a finer scale utilizing high-resolution datasets. To address the complex association between pandemic's spread and human mobility, this paper presents two categories of mobility datasets-trip mode and trip purpose-that concern nearly 10 million citizens' movements during the first 100 days of COVID-19 in Seoul, South Korea, where no major lockdown has been imposed. We curate hourly data of subway ridership, traffic volume and population present count at selected points of interests. The results to be derived from the presented datasets can be used as an important reference for public health decision making in the post COVID-19 era.


title: Dynamics of Transmission and Control of COVID-19: A Real-time Estimation Using the Kalman Filter

text: The COVID-19 pandemic has become the center of attention for both researchers and authorities. In this paper, we propose and test a methodology to estimate the daily effective reproduction number (Rt) through the lens of the Kalman Filter and Bayesian estimation. Moreover, we apply our method to data from the current COVID-19 pandemic in China, Italy, Japan, and South Korea. We correlate our findings with the implementation of control measures in each of these countries. Our results show that China, Italy, and South Korea have been able to reduce Rt over time. We find significant heterogeneity in the way Rt decreases across countries. For instance, China reduced Rt from its peak to below one in 19 days, while South Korea achieved the same reduction in 12 days. In contrast, it has taken Italy almost a month to reach similar levels. We hypothesize this is related to how strict, enforceable, and comprehensive are the implemented policies.


title: Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study

text: OBJECTIVE: To study the neurological manifestations of patients with coronavirus disease 2019 (COVID-19). DESIGN: Retrospective case series SETTING: Three designated COVID-19 care hospitals of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China. PARTICIPANTS: Two hundred fourteen hospitalized patients with laboratory confirmed diagnosis of severe acute respiratory syndrome from coronavirus 2 (SARS-CoV-2) infection. Data were collected from 16 January 2020 to 19 February 2020. MAIN OUTCOME MEASURES: Clinical data were extracted from electronic medical records and reviewed by a trained team of physicians. Neurological symptoms fall into three categories: central nervous system (CNS) symptoms or diseases (headache, dizziness, impaired consciousness, ataxia, acute cerebrovascular disease, and epilepsy), peripheral nervous system (PNS) symptoms (hypogeusia, hyposmia, hypopsia, and neuralgia), and skeletal muscular symptoms. Data of all neurological symptoms were checked by two trained neurologists. RESULTS: Of 214 patients studied, 88 (41.1%) were severe and 126 (58.9%) were non-severe patients. Compared with non-severe patients, severe patients were older (58.7 ± 15.0 years vs 48.9 ± 14.7 years), had more underlying disorders (42 [47.7%] vs 41 [32.5%]), especially hypertension (32 [36.4%] vs 19 [15.1%]), and showed less typical symptoms such as fever (40 [45.5%] vs 92 [73%]) and cough (30 [34.1%] vs 77 [61.1%]). Seventy-eight (36.4%) patients had neurologic manifestations. More severe patients were likely to have neurologic symptoms (40 [45.5%] vs 38 [30.2%]), such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]) and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]). CONCLUSION: Compared with non-severe patients with COVID-19, severe patients commonly had neurologic symptoms manifested as acute cerebrovascular diseases, consciousness impairment and skeletal muscle symptoms.


title: Updated thoughts on SARS-CoV-2 and coronavirus therapies, fighting and surviving

text: From late December 2019 a new human-adapted coronavirus, SARS-CoV-2, was observed and isolated in clustered patients in Wuhan, China. It has been proved to be able to transmit human-to-human and cause pneumonia, leading to about 2% fatality. Its genome characteristics, immune responses and related potential treatments, such as chemical drugs, serum transfusion and vaccines including DNA vaccines, are discussed in this review for a brief summary.


title: Variation in COVID-19 Outbreaks at U.S. State and County Levels

text: Background. The COVID-19 pandemic poses an unprecedented threat to the health and economic prosperity of the world's population. Yet, some countries or regions within a country appear to be affected in different ways. Objectives. This research aims to understand whether the outbreak varies significantly between U.S. states and counties. Methods. A statistical model is estimated using publicly available outbreak data in the U.S., and regional differences are statistically analyzed. Results. There is significant variance in outbreak data between U.S. states and counties. At the state level, the outbreak rate follows a normal distribution with an average relative growth rate of 0.197 (doubling time 3.518 days). But there is a low degree of reliability between state-wide and county-specific data reported (ICC = 0.169, p < 0.001), with a bias of 0.070 (standard deviation 0.062) as shown with a Bland-Altman plot. Conclusions. The results emphasize the need for policy makers to look at the pandemic from the smallest population subdivision possible, so that countermeasures can be implemented, and critical resources provided effectively. Further research is needed to understand the reasons for these regional differences.


Social work’s role during and after the pandemic: Keeping vigilant and hopeful on human rights


title: Coronavirus puts drug chemical industry on alert

text: Major drug companies have issued statements in recent days assuring the public that their inventories are adequate in the face of supply chain threats stemming from the novel coronavirus Suppliers of active pharmaceutical ingredients (APIs) are also assuring customers that they are prepared for temporary interruption in the supply of key ingredients from firms in China, where the outbreak originated API makers in Europe and the US warn, however, that supply disruptions could result from a protracted delay in restarting production at plants closed in recent weeks by the Chinese government or from prolonged transportation restrictions James Bruno, president of the consulting firm Chemical and Pharmaceutical Solutions, says travel restrictions are already interrupting business with Chinese suppliers “First of all, nobody is going to be able to get to China,” he says, “so all the audits are going to be canceled ” Bruno adds that the restrictions will prolong plant closures


title: High-Accuracy Multiplexed SARS-CoV-2 Antibody Assay with Avidity and Saliva Capability on a Nano-Plasmonic Platform

text: The outbreak and rapid spread of SARS-CoV-2 virus has led to a dire global pandemic with millions of people infected and ~ 400,000 deaths thus far. Highly accurate detection of antibodies for COVID-19 is an indispensable part of the effort to combat the pandemic1,2. Here we developed two-plex antibody detection against SARS-CoV-2 spike proteins3 (the S1 subunit and receptor binding domain RBD) in human serum and saliva on a near-infrared nano-plasmonic gold (pGOLD) platform4–8. By testing nearly 600 serum samples, pGOLD COVID-19 assay achieved ~ 99.78 % specificity for detecting both IgG and IgM with 100 % sensitivity in sera collected > 14 days post disease symptom onset, with zero cross-reactivity to other diseases. Two-plex correlation analysis revealed higher binding of serum IgM to RBD than to S1. IgG antibody avidity toward multiple antigens were measured, shedding light on antibody maturation in COVID-19 patients and affording a powerful tool for differentiating recent from remote infections and identifying re-infection by SARS-CoV-2. Just as important, due to high analytical sensitivity, the pGOLD COVID-19 assay detected minute amounts of antibodies in human saliva, offering the first non-invasive detection of SARS-CoV-2 antibodies.


title: COVID-19: Modelling Local Transmission and Morbidity effects to provide an estimate of overall Relative Healthcare Resource Impact by General Practice Granularity

text: Introduction Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the name given to the 2019 novel coronavirus. COVID-19 is the name given to the disease associated with the virus. SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. Methods Two key factors were analysed which when multiplied together would give an estimate of relative demand on healthcare utilisation. These factors were case incidence and case morbidity. GP Practice data was used as this provided the most geographically granular source of published public population data. To analyse case incidence, the latest values for indicators that could be associated with infection transmission rates were collected from the Office of National Statistics (ONS) and Quality Outcome Framework (QOF) sources. These included population density, % age >16 at fulltime work/education, % age over 60, % BME ethnicity, social deprivation as IMD 2019, Location as latitude/longitude, and patient engagement as % self-confident in their own long term condition management. Average case morbidity was calculated by applying the international mortality Odds Ratio to the local population relevant age and disease prevalences and then summing and dividing by the equivalent national figure. To provide a comparative measure of overall healthcare resource impact, individual GP practice impact scores were compared against the median practice. Results The case incidence regression is a dynamic situation with the significance of specific factors moderating over time as the balance between external infection, community transmission and impact of mitigation measures feeds through to the number of cases. It showed that currently Urban, % Working and age >60 were the strongest determinants of case incidence. The local population comorbidity remains unchanged. The range of relative HC impact was wide with 80% of practices falling between 20%-250% of the national median. Once practice population numbers were included it showed that the top 33% of GP practices supporting 45% of the patient population would require 68% of COVID-19 healthcare resources. The model provides useful information about the relative impact of Covid-19 on healthcare workload at GP practice granularity in all parts of England. Conclusion Covid-19 is impacting on the utilisation of health and social care resources across the country. This model provides a method for predicting relative local levels of disease burden based on defined criteria and thereby providing a method for targeting limited (and perhaps soon to be scarce) care resources to optimise national, regional and local responses to the COVID-19 outbreak.