title: Factors Associated With Intubation and Prolonged Intubation in Hospitalized Patients With COVID-19

text: OBJECTIVE: To identify risk factors associated with intubation and time to extubation in hospitalized patients with coronavirus disease 2019 (COVID-19). STUDY DESIGN: Retrospective observational study. SETTING: Ten hospitals in the Chicago metropolitan area. SUBJECTS AND METHODS: Patients with laboratory-confirmed COVID-19 admitted between March 1 and April 8, 2020, were included. We evaluated sociodemographic and clinical characteristics associated with intubation and prolonged intubation for acute respiratory failure secondary to COVID-19 infection. RESULTS: Of the 486 hospitalized patients included in the study, the median age was 59 years (interquartile range, 47-69); 271 (55.8%) were male; and the median body mass index was 30.6 (interquartile range, 26.5-35.6). During the hospitalization, 138 (28.4%) patients were intubated; 78 (56.5%) were eventually extubated; 21 (15.2%) died; and 39 (28.3%) remained intubated at a mean ± SD follow-up of 19.6 ± 6.7 days. Intubated patients had a significantly higher median age (65 vs 57 years, P < .001) and rate of diabetes (56 [40.6%] vs 104 [29.9%], P = .031) as compared with nonintubated patients. Multivariable logistic regression analysis identified age, sex, respiratory rate, oxygen saturation, history of diabetes, and shortness of breath as factors predictive of intubation. Age and body mass index were the only factors independently associated with time to extubation. CONCLUSION: In addition to clinical signs of respiratory distress, patients with COVID-19 who are older, male, or diabetic are at higher risk of requiring intubation. Among intubated patients, older and more obese patients are at higher risk for prolonged intubation. Otolaryngologists consulted for airway management should consider these factors in their decision making.


COVID-19 in patients with HIV: clinical case series


title: A comprehensive review on drug repositioning against coronavirus disease 2019 (COVID19)

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the reason for this ongoing pandemic infection diseases termed coronavirus disease 2019 (COVID-19) that has emerged since early December 2019 in Wuhan City, Hubei Province, China. In this century, it is the worst threat to international health and the economy. After 4 months of COVID-19 outbreak, there is no certain and approved medicine against it. In this public health emergency, it makes sense to investigate the possible effects of old drugs and find drug repositioning that is efficient, economical, and riskless process. Old drugs that may be effective are from different pharmacological categories, antimalarials, anthelmintics, anti-protozoal, anti-HIVs, anti-influenza, anti-hepacivirus, antineoplastics, neutralizing antibodies, immunoglobulins, and interferons. In vitro, in vivo, or preliminary trials of these drugs in the treatment of COVID-19 have been encouraging, leading to new research projects and trials to find the best drug/s. In this review, we discuss the possible mechanisms of these drugs against COVID-19. Also, it should be mentioned that in this manuscript, we discuss preliminary rationales; however, clinical trial evidence is needed to prove them. COVID-19 therapy must be based on expert clinical experience and published literature and guidelines from major health organizations. Moreover, herein, we describe current evidence that may be changed in the future.


title: Detection of SARS-CoV-2 RNA in fecal specimens of patients with confirmed COVID-19: A meta-analysis

text: INTRODUCTION: Recent studies showed that SARS-CoV-2 RNA may be found in fecal specimens of COVID-19 patients, but the sample size is limited. This systematic review and meta-analysis examined the detection rate of SARS-CoV-2 RNA in fecal specimens of these patients according to their clinical characteristics. METHODS: MEDLINE, Embase, Scopus, and three Chinese biomedical databases were searched up to 25 March 2020 with no language restriction. We included original observational studies that reported the detection rate of SARS-CoV-2 RNA in fecal specimens of COVID-19 patients. Two separate reviewers conducted the review. Metaprop was adopted to conduct a meta-analysis of prevalence with variances stabilized by Freeman-Tukey Double Arcsine Transformation. A random-effects model was used. Heterogeneity across different studies was computed using Cochran's Q test and chi square statistics. RESULTS: From 17 studies, the pooled detection rate of fecal SARS-CoV-2 RNA was 43.7% (95% CI 32.6%-55.0%) and 33.7% (95% C.I. 33.7%, 95% C.I. 20.1%-48.8%) by patient and number of specimens as a unit count, respectively. Female individuals (59.6% vs. 53.5%), those who presented with gastrointestinal symptoms (77.1% vs. 57.7%), and patients with more severe disease (68.3% vs. 34.6%) tended to have a higher detection rate. DISCUSSION: A significant proportion of COVID-19 patients carry SARS-CoV-2 in their intestinal tract. Feces being a self-collected specimen bears a potential to improve case identification in community, especially for young children where proper respiratory sampling at home is difficult. Specific infection control strategies focusing on spread via fecal contamination and faulty toilet drainage are urgently needed.


title: Virology, Epidemiology, Pathogenesis, and Control of COVID-19

text: The outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China has been brought to global attention and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Scientific advancements since the pandemic of severe acute respiratory syndrome (SARS) in 2002~2003 and Middle East respiratory syndrome (MERS) in 2012 have accelerated our understanding of the epidemiology and pathogenesis of SARS-CoV-2 and the development of therapeutics to treat viral infection. As no specific therapeutics and vaccines are available for disease control, the epidemic of COVID-19 is posing a great threat for global public health. To provide a comprehensive summary to public health authorities and potential readers worldwide, we detail the present understanding of COVID-19 and introduce the current state of development of measures in this review.


COVID-19 Pandemic and Obstetric Anaesthesia


title: Nature and Diffusion of COVID-19-related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo

text: BACKGROUND: Social media has become increasingly important as a source of information for the public and is widely used for health-related information. The outbreak of the coronavirus disease (COVID-19) has exerted a negative impact on dental practices. OBJECTIVE: The aim of this study is to analyze the nature and diffusion of COVID-19-related oral health information on the Chinese social media site Weibo. METHODS: A total of 15,900 tweets related to oral health and dentistry information from Weibo during the COVID-19 outbreak in China (December 31, 2019, to March 16, 2020) were included in our study. Two researchers coded 1000 of the total tweets in advance, and two main thematic categories with eight subtypes were refined. The included tweets were analyzed over time and geographic region, and coded into eight thematic categories. Additionally, the time distributions of tweets containing information about dental services, needs of dental treatment, and home oral care during the COVID-19 epidemic were further analyzed. RESULTS: People reacted rapidly to the emerging severe acute respiratory syndrome coronavirus 2 threat to dental services, and a large amount of COVID-19-related oral health information was tweeted on Weibo. The time and geographic distribution of tweets shared similarities with epidemiological data of the COVID-19 outbreak in China. Tweets containing home oral care and dental services content were the most frequently exchanged information (n=4803/15,900, 30.20% and n=4478, 28.16%, respectively). Significant differences of public attention were found between various types of bloggers in dental services-related tweets (P<.001), and the tweets from the government and media engaged the most public attention. The distributions of tweets containing information about dental services, needs of dental treatment, and home oral care information dynamically changed with time. CONCLUSIONS: Our study overviewed and analyzed social media data on the dental services and oral health information during the COVID-19 epidemic, thus, providing insights for government organizations, media, and dental professionals to better facilitate oral health communication and efficiently shape public concern through social media when routine dental services are unavailable during an unprecedented event. The study of the nature and distribution of social media can serve as a useful adjunct tool to help make public health policies.


Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia


title: Telemedicine for Surgical Consultations-- Pandemic Response or Here to Stay?: A Report of Public Perceptions

text: OBJECTIVE: This study aims to determine the public's perception of telemedicine surgical consultations, during the COVID-19 pandemic and beyond. SUMMARY BACKGROUND DATA: With rapid expansion and uptake of telemedicine during the pandemic, many have posited that virtual visits will endure even as in-person visits are reinstated. The public's perception of telemedicine for an initial surgical consultation has not been previously studied. METHODS: A 43-question survey assessed respondents' attitudes toward telemedicine for initial consultations with surgeons, both in the context of COVID-19 and during "normal circumstances." Participants were recruited through Amazon Mechanical Turk, an online crowd-sourcing marketplace. RESULTS: Based on 1827 analyzable responses, we found that a majority (86%) of respondents reported being satisfied (either extremely or somewhat) with telemedicine encounters. Interestingly, preference for in-person versus virtual surgical consultation reflected access to care, with preference for telemedicine decreasing from 72% to 33% when COVID-related social distancing ends. Preferences for virtual visits decreased with increasing complexity of the surgical intervention, even during the pandemic. A majority felt that "establishing trust and comfort" was best accomplished in person, and the vast majority felt it was important to meet their surgeons prior to the day of surgery. CONCLUSIONS: The public views telemedicine as an acceptable substitute for in-person visits, especially during the pandemic. However, it appears that an in-person interaction is still preferred when possible for surgical consultations. If telemedicine services are to persist beyond social distancing, further exploration of its impact on the patient-surgeon relationship will be needed.


title: Study of the mental health status of medical personnel dealing with new coronavirus pneumonia

text: This paper studied the relationship between personality traits and mental health conditions of medical personnel to provide a basis and reference for the implementation of targeted education on mental health. A self-report inventory, the Symptom Checklist-90 (SCL-90), was used to investigate the mental health status of 548 medical personnel dealing with the new coronavirus pneumonia in eight provinces and cities of China. The overall mean SCL-90 score and mean values of factors (somatization, obsessive-compulsive, anxiety, phobic anxiety, and psychoticism) of the medical personnel were significantly higher than in the norm group (p < 0.05), while their average interpersonal sensitivity score was significantly lower (p < 0.01). In addition, personal factors affecting the mental health status of medical personnel were identified (all p < 0.05). The overall mental health status of medical personnel responding to new coronavirus pneumonia is generally higher than that of the norm group in China. The results of this study should contribute to measures to alleviate the psychological pressures on medical personnel dealing with the new coronavirus epidemic in China.


title: Eliminating COVID-19: The Impact of Travel and Timing

text: We analyze the spread of COVID-19 by considering the transmission of the disease among individuals both within and between regions. A set of regions can be defined as any partition of a population such that travel/social contact within each region far exceeds that between them. COVID-19 can be eliminated if the region-to-region reproductive number---i.e. the average number of other regions to which a single infected region will transmit the virus---is reduced to less than one. We find that this region-to-region reproductive number is proportional to the travel rate between regions and exponential in the length of the time-delay before region-level control measures are imposed. Thus, reductions in travel and the speed with which regions take action play decisive roles in whether COVID-19 is eliminated from a collection of regions. If, on average, infected regions (including those that become re-infected in the future) impose social distancing measures shortly after active spreading begins within them, the number of infected regions, and thus the number of regions in which such measures are required, will exponentially decrease over time. Elimination will in this case be a stable fixed point even after the social distancing measures have been lifted from most of the regions.


title: Clinical observation and management of COVID-19 patients

text: Three leading infectious disease experts in China were invited to share their bedside observations in the management of COVID-19 patients. Professor Taisheng Li was sent to Wuhan to provide frontline medical care. He depicts the clinical course of SARS-CoV-2 infection. Furthermore, he observes the significant abnormality of coagulation function and proposes that the early intravenous immunoglobulin and low molecular weight heparin anticoagulation therapy are very important. Professor Hongzhou Lu, a leader in China to try various anti-viral drugs, expresses concern on the quality of the ongoing clinical trials as most trials are small in scale and repetitive in nature, and emphasizes the importance of the quick publication of clinical trial results. Regarding the traditional Chinese medicine, Professor Lu suggests to develop a creative evaluation system because of the complicated chemical compositions. Professor Wenhong Zhang is responsible for Shanghai's overall clinical management of the COVID-19 cases. He introduces the team approach to manage COVID-19 patients. For severe or critically ill patients, in addition to the respiratory supportive treatment, timely multiorgan evaluation and treatment is very crucial. The medical decisions and interventions are carefully tailored to the unique characteristics of each patient.


Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19: Assessing the Risks and Identifying Needed Reforms


docid: vhrffisl

title: La Obesidad y el coronavirus 2019-nCoV. Una relación de riesgo./ [Obesity and 2019-nCoV. A risky relationship]


title: Potential interventions for novel coronavirus in China: A systematic review

text: An outbreak of a novel coronavirus (COVID-19 or 2019-CoV) infection has posed significant threats to international health and the economy. In the absence of treatment for this virus, there is an urgent need to find alternative methods to control the spread of disease. Here, we have conducted an online search for all treatment options related to coronavirus infections as well as some RNA-virus infection and we have found that general treatments, coronavirus-specific treatments, and antiviral treatments should be useful in fighting COVID-19. We suggest that the nutritional status of each infected patient should be evaluated before the administration of general treatments and the current children's RNA-virus vaccines including influenza vaccine should be immunized for uninfected people and health care workers. In addition, convalescent plasma should be given to COVID-19 patients if it is available. In conclusion, we suggest that all the potential interventions be implemented to control the emerging COVID-19 if the infection is uncontrollable.


Comment on Han et al: Analysis of heart injury laboratory parameters in 273 COVID-19 patients in one hospital in Wuhan, China


Moving biochemistry and molecular biology courses online in times of disruption: Recommended practices and resources - a collaboration with the faculty community and ASBMB


Virtual Multiple Mini-Interview during the COVID-19 Pandemic


title: Prehabilitation May Help Mitigate an Increase in COVID-19 Peripandemic Surgical Morbidity and Mortality

text: As physicians specializing in rehabilitation medicine consider sequelae from the novel coronavirus pandemic that began in 2019, one issue that should be top of mind is the physiologic effect that large-scale social distancing had on the health of patients in general but, more specifically, on preoperative patients who had their surgeries delayed or will have newly scheduled procedures during the peripandemic period. Predictably, as the virus becomes less prevalent, there will be a tremendous motivation to move forward with scheduling operations from both patient care and institutional perspectives. However, one can anticipate a pandemic-related increase in surgical morbidity and mortality above prepandemic levels, particularly in older or medically frail patients even if they did not have a novel coronavirus (i.e., COVID-19) infection. Therefore, now is the time to consider for patients awaiting surgery a wider adoption of prehabilitation-physical and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments.


What I Learned From SARS in 2003 That Will Help Me Cope With COVID-19 in 2020


title: The impact of multilateral imported cases of COVID-19 on the epidemic control in China

text: Nowadays, the epidemic of COVID-19 in China is under control. However, the epidemic are developing rapidly around the world. Due to the normal migration of population, China is facing high risk from imported cases. The potential specific medicine and vaccine is still in the process of clinical trials. Currently, controlling the impact of imported cases is the key to prevent new outbreak of COVID-19 in China. In this paper, we propose two impulsive systems to describe the impact of multilateral imported cases of COVID-19. Based on the published data, we simulate and discussed the epidemic trends under different control strategies. We compare four different scenarios and show the corresponding medical burden. The results help to design appropriate control strategy for imported cases in practice.


title: Fast reshaping of intensive care unit facilities in a large metropolitan hospital in Milan, Italy: facing the COVID-19 pandemic emergency

text: At the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak spread from China all around the world, causing thousands of deaths In Italy, the hardest hit region was Lombardy, with the first reported case on 20 February 2020 San Raffaele Scientific Institute — a large tertiary hospital and research centre in Milan, Italy — was immediately involved in the management of the public health emergency Since the beginning of the outbreak, the elective surgical activity of the hospital was rapidly reduced and large areas of the hospital were simultaneously reorganised to admit and assist patients with coronavirus disease 2019 (COVID-19) In addition, the hospital became the regional referral hub for cardiovascular emergencies in order to keep ensuring a high level of health care to non-COVID-19 patients in northern Italy In a few days, a COVID-19 emergency department was created, improving the general ward capacity to a total number of 279 beds dedicated to patients with COVID-19 Moreover, the number of intensive care unit (ICU) beds was increased from 28 to 72 (54 of them dedicated to patients with COVID-19, and 18 to cardiology and cardiac surgery hub emergencies), both converting pre-existing areas and creating new high technology spaces All the involved health care personnel were rapidly trained to use personal protection equipment and to manage this particular category of patients both in general wards and ICUs Furthermore, besides clinical activities, continuously important research projects were carried out in order to find new strategies and more effective therapies to better face an unprecedented health emergency in Italy


Approaches to global stroke care during the COVID-19 pandemic


docid: reqgnxre

title: Revisiting hydroxychloroquine and chloroquine for patients with chronic immunity-mediated inflammatory rheumatic diseases

text: Hydroxychloroquine and chloroquine, also known as antimalarial drugs, are widely used in the treatment of rheumatic diseases and have recently become the focus of attention because of the ongoing COVID-19 pandemic. Rheumatologists have been using antimalarials to manage patients with chronic immune-mediated inflammatory rheumatic diseases for decades. It is an appropriate time to review their immunomodulatory and anti-inflammatory mechanisms impact on disease activity and survival of systemic lupus erythematosus patient, including antiplatelet effect, metabolic and lipid benefits. We also discuss possible adverse effects, adding a practical and comprehensive approach to monitoring rheumatic patients during treatment with these drugs.


COVID-19 Confirms It: Paid Caregivers Are Essential Members of the Healthcare Team


title: Construct validity of the PERF-FIT, a test of motor skill-related fitness for children in low resource areas

text: BACKGROUND: Given the relationship between physical fitness and motor performance a test battery was developed that measures both components combined. AIM: Following the development of the Performance and Fitness (PERF-FIT) battery, this study investigated the construct validity with the ultimate aim of identifying attributes that discriminate between different levels of motor abilities and anaerobic or musculoskeletal fitness. METHODS: In this cross-sectional study, 34 children with developmental coordination disorder (DCD) and 34 matched typically developing children participated (7-10 years). The PERF-FIT was used to examine known group validity. The PERF-FIT items were also compared to test items of well-known standardized tests to examine concurrent validity. RESULTS: Concurrent validity was found to be of the expected low to moderate magnitude. Children with DCD were consistently found to have lower levels of motor skill-related fitness compared to typically developing children. CONCLUSION AND IMPLICATIONS: The PERF-FIT seems to be a valid test to measure movement skills, musculoskeletal fitness and agility in children between the ages of 7 and 10 years in low resourced communities. The test seems to discriminate between gross motor skills, and agility and power in children with and without DCD.


title: Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective

text: Currently, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, formerly known as 2019-nCoV, the causative pathogen of Coronavirus Disease 2019 (COVID-19)) has rapidly spread across China and around the world, causing an outbreak of acute infectious pneumonia. No specific anti-virus drugs or vaccines are available for the treatment of this sudden and lethal disease. The supportive care and non-specific treatment to ameliorate the symptoms of the patient are the only options currently. At the top of these conventional therapies, greater than 85% of SARS-CoV-2 infected patients in China are receiving Traditional Chinese Medicine (TCM) treatment. In this article, relevant published literatures are thoroughly reviewed and current applications of TCM in the treatment of COVID-19 patients are analyzed. Due to the homology in epidemiology, genomics, and pathogenesis of the SARS-CoV-2 and SARS-CoV, and the widely use of TCM in the treatment of SARS-CoV, the clinical evidence showing the beneficial effect of TCM in the treatment of patients with SARS coronaviral infections are discussed. Current experiment studies that provide an insight into the mechanism underlying the therapeutic effect of TCM, and those studies identified novel naturally occurring compounds with anti-coronaviral activity are also introduced.


COVID-19 current controversies


docid: veqfxptn

title: Clinical tools for cardiorespiratory assessment and rehabilitation: A primary care perspective

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide. It mainly affects the respiratory system, seen as pneumonia or acute respiratory distress syndrome. Cardiovascular manifestations have been observed in some patients. Hence, cardiorespiratory assessment is an important component of diagnosis, management and follow-up of this disease. Primary care is the first point of contact with the healthcare system for most patients. Therefore, methods for assessment and rehabilitation should be feasible in a primary care setting. This commentary aims to provide a primary care perspective on existing clinical tools for cardiorespiratory assessment and rehabilitation.


Two parts of the equation: "Flattening the curve" and "raising the line"


title: The FDA-approved gold drug auranofin inhibits novel coronavirus (SARS-COV-2) replication and attenuates inflammation in human cells

text: SARS-COV-2 has recently emerged as a new public health threat. Herein, we report that the FDA-approved drug, auranofin, inhibits SARS-COV-2 replication in human cells at low micro molar concentration. Treatment of cells with auranofin resulted in a 95% reduction in the viral RNA at 48 h after infection. Auranofin treatment dramatically reduced the expression of SARS-COV-2-induced cytokines in human cells. These data indicate that auranofin could be a useful drug to limit SARS-CoV-2 infection and associated lung injury due to its antiviral, anti-inflammatory and anti-reactive oxygen species (ROS) properties. Further animal studies are warranted to evaluate the safety and efficacy of auranofin for the management of SARS-COV-2 associated disease.


What have we learned from the covid-19 pandemic so far?


title: Development of molecular and histological methods to evaluate stress oxidative biomarkers in sea bass (Dicentrarchus labrax)

text: In aquaculture, fish species may experience stressful episodes caused by poor farming conditions. The exponential increase of global aquaculture has raised the number of research studies aimed at demonstrating the sensitivity of aquatic animals in confined environments. The development of a real-time PCR and immunohistochemistry methods were investigated to evaluate the presence, localization, and quantity of biomarkers of oxidative stress in European sea bass (Dicentrarchus labrax). In particular, stress tests such as manipulation and temperature changes were conducted through molecular methods to identify the expression level of heat shock protein 70 (HSP70) in stressed animals compared with a control group. The immunohistochemical technique was also applied to locate and study the trends-levels of nitrotyrosine (NT), heat shock protein 70 (HSP70), malondialdehyde (MDA), and 4-hydroxy-2-nonenal (HNE) in different tissues from stressed animals and control group. The presence of the rodlet cell (RCs) was evaluated by histology in both a control and stressed group. Our results show that the real-time PCR method developed is specific for the evaluated target gene and that manipulation and temperature increase are strong stressors for animals. Relative quantification data revealed a gene expression increase of HSP70 in the stressed group of animals compared to the control group. The antibodies used for the immunohistochemical staining were efficient, and it was possible to appreciate the increase of immunoprecipitates in European sea bass either manipulated or stressed by temperature increase. The present study can be a starting point to allow the quantification of HSP70 and the identification of other stress biomarkers in D. labrax.


title: Potential COVID-19 infection in patients with severe multiple sclerosis treated with alemtuzumab

text: BACKGROUND: Management of disease-modifying therapies in Multiple Sclerosis (MS) during the COVID-19 pandemic is a controversial issue. Alemtuzumab is an immunosuppressive drug that induces lymphocytes depletion. In this study, we aimed to evaluate the frequency and severity of COVID-19 in a case series of patients treated with alemtuzumab in our center. METHODS: Ten patients with a diagnosis of relapsing-remitting MS were phoned and asked about symptoms suggestive and COVID-19 using a semi-structured questionnaire. RESULTS: The mean age was 43.7 ± 9.65 years old, and 8 (80%) were females. The mean time since disease diagnosis was 17.30 ± 8.59 years, and all were patients with relapsing-remitting MS. Mean time from the last dose of Alemtuzumab was 9.80 ± 6.64 months, and last lymphocyte count was 760 ± 231 / µL. Two patients (20%) developed symptoms highly suggestive of COVID-19. Disease duration was 2 and 7 days. None patient required hospital admission. Patients with COVID-19 symptoms had longer clinical course of MS. Conversely, we did not find statistically significant differences regarding age, EDSS, last lymphocyte count, and months since the last dose of alemtuzumab administered between patients having or not symptoms of COVID-19. CONCLUSIONS: Our data suggest that patients receiving alemtuzumab showed very mild symptoms of COVID-19. We speculate that immune reconstitution induced by treatment may induce positive changes in the immune system in the defense against SARS-CoV2. Further research about alemtuzumab and their role in COVID-infection is necessary to confirm these preliminary findings.


title: Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study

text: BACKGROUND: Since the coronavirus disease 2019 outbreak began in the Chinese city of Wuhan on Dec 31, 2019, 68 imported cases and 175 locally acquired infections have been reported in Singapore. We aimed to investigate options for early intervention in Singapore should local containment (eg, preventing disease spread through contact tracing efforts) be unsuccessful. METHODS: We adapted an influenza epidemic simulation model to estimate the likelihood of human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a simulated Singaporean population. Using this model, we estimated the cumulative number of SARS-CoV-2 infections at 80 days, after detection of 100 cases of community transmission, under three infectivity scenarios (basic reproduction number [R0] of 1·5, 2·0, or 2·5) and assuming 7·5% of infections are asymptomatic. We first ran the model assuming no intervention was in place (baseline scenario), and then assessed the effect of four intervention scenarios compared with a baseline scenario on the size and progression of the outbreak for each R0 value. These scenarios included isolation measures for infected individuals and quarantining of family members (hereafter referred to as quarantine); quarantine plus school closure; quarantine plus workplace distancing; and quarantine, school closure, and workplace distancing (hereafter referred to as the combined intervention). We also did sensitivity analyses by altering the asymptomatic fraction of infections (22·7%, 30·0%, 40·0%, and 50·0%) to compare outbreak sizes under the same control measures. FINDINGS: For the baseline scenario, when R0 was 1·5, the median cumulative number of infections at day 80 was 279â000 (IQR 245â000-320â000), corresponding to 7·4% (IQR 6·5-8·5) of the resident population of Singapore. The median number of infections increased with higher infectivity: 727â000 cases (670â000-776â000) when R0 was 2·0, corresponding to 19·3% (17·8-20·6) of the Singaporean population, and 1â207â000 cases (1â164â000-1â249â000) when R0 was 2·5, corresponding to 32% (30·9-33·1) of the Singaporean population. Compared with the baseline scenario, the combined intervention was the most effective, reducing the estimated median number of infections by 99·3% (IQR 92·6-99·9) when R0 was 1·5, by 93·0% (81·5-99·7) when R0 was 2·0, and by 78·2% (59·0 -94·4) when R0 was 2·5. Assuming increasing asymptomatic fractions up to 50·0%, up to 277 000 infections were estimated to occur at day 80 with the combined intervention relative to 1800 for the baseline at R0 of 1·5. INTERPRETATION: Implementing the combined intervention of quarantining infected individuals and their family members, workplace distancing, and school closure once community transmission has been detected could substantially reduce the number of SARS-CoV-2 infections. We therefore recommend immediate deployment of this strategy if local secondary transmission is confirmed within Singapore. However, quarantine and workplace distancing should be prioritised over school closure because at this early stage, symptomatic children have higher withdrawal rates from school than do symptomatic adults from work. At higher asymptomatic proportions, intervention effectiveness might be substantially reduced requiring the need for effective case management and treatments, and preventive measures such as vaccines. FUNDING: Singapore Ministry of Health, Singapore Population Health Improvement Centre.


COVID-19: the case for health-care worker screening to prevent hospital transmission


title: COVID-19-Associated dyslipidemia: Implications for mechanism of impaired resolution and novel therapeutic approaches

text: The current coronavirus disease 2019 (COVID-19) pandemic presents a global challenge for managing acutely ill patients and complications from viral infection. Systemic inflammation accompanied by a "cytokine storm," hemostasis alterations and severe vasculitis have all been reported to occur with COVID-19, and emerging evidence suggests that dysregulation of lipid transport may contribute to some of these complications. Here, we aim to summarize the current understanding of the potential mechanisms related to COVID-19 dyslipidemia and propose possible adjunctive type therapeutic approaches that modulate lipids and lipoproteins. Specifically, we hypothesize that changes in the quantity and composition of high-density lipoprotein (HDL) that occurs with COVID-19 can significantly decrease the anti-inflammatory and anti-oxidative functions of HDL and could contribute to pulmonary inflammation. Furthermore, we propose that lipoproteins with oxidized phospholipids and fatty acids could lead to virus-associated organ damage via overactivation of innate immune scavenger receptors. Restoring lipoprotein function with ApoA-I raising agents or blocking relevant scavenger receptors with neutralizing antibodies could, therefore, be of value in the treatment of COVID-19. Finally, we discuss the role of omega-3 fatty acids transported by lipoproteins in generating specialized proresolving mediators and how together with anti-inflammatory drugs, they could decrease inflammation and thrombotic complications associated with COVID-19.


A strategic approach to COVID-19 vaccine R&D


title: The armed forces medical services response to COVID-19

text: The Indian Armed Forces have always responded to the Nation's call and the COVID-19 pandemic response has been no different. On instructions from the Government of India, the Armed Forces Medical Services (AFMS) pitched in right from the initial stages of the epidemic in India as part of a coordinated national response. Be it the execution of medical quarantine for Indian citizens evacuated from China and other COVID affected countries or establishing dedicated and mixed COVID hospitals for its own clientele as well as civilian patients, the AFMS worked in tandem with the national policies. The Armed Forces ensured force preservation and protection of its own troops and families by timely implementation of public health measures, even as it played its designated role in the national strategy. With vision, understanding and clarity, the AFMS continue to lend shoulder to India's response to this global public health challenge.


Recommendations for gynecologic cancer care during the COVID-19 pandemic


title: [Roles of multidisciplinary team in diagnosis and treatment of suspected cases of COVID-19]

text: OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. CONCLUSIONS: The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.


title: Kardiale Biomarker und COVID-19-Phänotypen und Interpretation./ [Cardiac biomarkers and COVID-19 - Phenotypes and Interpretation]

text: Current pandemic caused by SARS-CoV-2 inducing viral COVID-19 pneumonia, is categorized in 3 stages. Some biomarkers could be assigned to one of these stages, showing a correlation to mortality in COVID-19 patients. Laboratory findings in COVID-19, especially when serially evaluated, may represent individual disease severity and prognosis. These may help planning and controlling therapeutic interventions. Biomarkers for myocardial injury (high sensitive cardiac troponin, hsTn) or hemodynamic stress (NTproBNP) may occur in COVID-19 pneumonia such as in other pneumonias, correlating with severity and prognosis of the underlying disease. In hospitalized COVID-19 patients' mild increases of hsTn or NTproBNP may be explained by cardiovascular comorbidities and direct or indirect cardiac damage or stress caused by or during COVID-19 pneumonia. In case of suspected NSTE-ACS and COVID-19, indications for echocardiography or reperfusion strategy should be carefully considered against the risk of contamination.


Re: 'Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear'


Position paper ANMCO: Gestione delle consulenze e attività ambulatoriali cardiologiche in corso di pandemia COVID-19./ [ANMCO Position paper: Considerations on in-hospital cardiological consultations and cardiology outpatient clinics during the COVID-19 pandemic]


title: Converting Hemodialysis (HD) membranes to Extracorporeal Membrane Oxygenation (ECMO) machines

text: Crises like COVID-19 can create a massive unmet demand for rare blood oxygenation membrane machines for impaired lungs: Extracorporeal Membrane Oxygenation (ECMO) machines. Meanwhile, Hemodialysis (HD) machines, which use membranes to supplement failing kidneys, are extremely common and widespread, with orders of magnitude more available than for ECMO machines. This short study examines whether the membranes for HD can be modified for use in blood oxygenation (ECMO). To do so, it considers mass transfer at the micro-scale level, and calculations for the macro-scale level such as blood pumping rates and O2 supply pressure. Overall, while this conversion may technically be possible, poor gas transport likely requires multiple HD membranes for one patient.


title: Oseltamivir for coronavirus illness: post-hoc exploratory analysis of an open-label, pragmatic, randomised controlled trial in European primary care from 2016 to 2018

text: BACKGROUND: Patients infected with the novel coronavirus (SARS-CoV-2) are being treated empirically with oseltamivir, but there is little evidence from randomised controlled trials to support the treatment of coronavirus infections with oseltamivir. AIM: To determine whether adding oseltamivir to usual care reduces time to recovery in symptomatic patients who have tested positive for coronavirus (not including SARS-CoV-2). DESIGN AND SETTING: Exploratory analysis of data from an open-label, pragmatic, randomised controlled trial during three influenza seasons, from 2016 to 2018, in primary care research networks, in 15 European countries. METHOD: Patients aged ≥1 year presenting to primary care with influenza-like illness (ILI), and who tested positive for coronavirus (not including SARS-CoV-2), were randomised to usual care or usual care plus oseltamivir. The primary outcome was time to recovery defined as a return to usual activities, with minor or absent fever, headache, and muscle ache. RESULTS: Coronaviruses (CoV-229E, CoV-OC43, CoV-KU1 and CoV-NL63) were identified in 308 (9%) out of 3266 randomised participants in the trial; 153 of these were allocated to usual care and 155 to usual care plus oseltamivir; the primary outcome was ascertained in 136 and 147 participants, respectively. The median time to recovery was shorter in patients randomised to oseltamivir: 4 days (interquartile range [IQR] 3-6) versus 5 days (IQR 3-8; hazard ratio 1.31; 95% confidence interval = 1.03 to 1.66; P = 0.026). CONCLUSION: Primary care patients with ILI testing positive for coronavirus (not including SARS-CoV-2) recovered sooner when oseltamivir was added to usual care compared with usual care alone. This may be of relevance to the primary care management of COVID-19.


title: Case Report: The First Case of COVID-19 in Bhutan

text: The initial cases of novel coronavirus disease-19 (COVID-19) in a country are of utmost importance given their impact on healthcare providers, the country's preparedness response, and the initial molding of the public perception toward this pandemic. In Bhutan, the index case was a 76-year-old immunocompromised man who had traveled from the United States and entered Bhutan as a tourist. He presented initially with vague gastrointerestinal symptoms and later a cough. His atypical presentation led to a delay in diagnosis, but ultimately he was isolated and tested. On confirming the diagnosis of COVID-19, the patient was isolated in a separate hospital with a dedicated medical care team. All contacts were traced and quarantined. The patient's respiratory status deteriorated despite broad-spectrum antivirals, antibiotics, and intensive supportive care. He required intubation and was given a trial of intravenous immunoglobulin to modulate his likely aberrant immune response. Subsequently, the patient's clinical status improved, and after 8 days of hospitalization, he was transferred out of the country, where he recovered. This was a learning experience for the treating medical staff, the government, and the people of Bhutan.


title: The first six weeks - setting up a UK urgent dental care centre during the COVID-19 pandemic

text: Introduction The COVID-19 pandemic has posed many challenges, including provision of urgent dental care. This paper presents a prospective service evaluation during establishment of urgent dental care in the North East of England over a six-week period.Aim To monitor patient volumes, demographics and outcomes at the North East urgent dental care centre and confirm appropriate care pathways.Main outcome methods Data were collected on key characteristics of patients accessing urgent care from 23 March to 3 May 2020. Analysis was with descriptive statistics.Results There were 1,746 patient triages (1,595 telephone and 151 face-to-face), resulting in 1,322 clinical consultations. The most common diagnoses were symptomatic irreversible pulpitis or apical periodontitis. Sixty-five percent of clinical consultations resulted in extractions and 0.8% in an aerosol generating procedure. Patients travelled 25 km on average to access care; however, this reduced as more urgent care centres were established. The majority of patients were asymptomatic of COVID-19 and, to our knowledge, no staff acquired infection due to occupational exposure.Conclusion The urgent dental care centre effectively managed urgent and emergency dental care, with appropriate patient pathways established over the six-week period. Dental preparedness for future pandemic crises could be improved and informed by this data.


title: COVID 19- Clinical Profile, Radiological Presentation, Prognostic Predictors, Complications and Outcome: A Perspective from the Indian Subcontinent

text: Background: Since December 2019, we have been facing one of the worst pandemics of human history. It originated from the Hubei province in China as a case of pneumonia, later named COVID-19.1 The causative pathogen, a new enveloped betacoronavirus2 is now known as Severe acute respiratory syndrome corona virus-2 (SARS-CoV 2). India reported its first case of COVID19, on 30th January 2020. We aim to identify the defining clinical and radiological characteristics, severity and prognosis, along with impact of age on outcome. Methods: Cross sectional, observational study of patients diagnosed with COVID -19 [RT-PCR]. Results: We observed male predominance, mean age of 36 years, with less or no symptoms, majority brought in after screening and contact tracing by the screening teams. Thrombocytopenia, lymphocytosis, raised LDH was common (>35%, p<0.05). Patients over the age of 60 were the ones having severe illness and more complications (p<0.05). Radiographic abnormality was frequently associated irrespective of clinical presentation and its severity. Poor prognosis was noted in elderly, especially those with co-morbidities. Discussion: Though the disease has a relatively mild course in this part of the subcontinent, patients aged ≥60 are at significant risk for morbidity and mortality. Clinical and laboratory findings are similar to those found in viral diseases. Increased risk of cardiac involvement needs to be looked into. Chest X-ray proves sufficient for imaging, reducing the requirement of CT scans. Studies involving larger sample size and interventional trials are need of the hour.


Hyperinflammatory shock related to COVID-19 in a patient presenting with multisystem inflammatory syndrome in children: First case from Iran


Covid-19 in Immune-Mediated Inflammatory Diseases - Case Series from New York


title: Combining PCR and CT testing for COVID

text: We analyze the effect of using a screening CT-scan for evaluation of potential COVID-19 infections in order to isolate and perform contact tracing based upon a viral pneumonia diagnosis. RT-PCR is then used for continued isolation based upon a COVID diagnosis. Both the low false negative rates and rapid results of CT-scans lead to dramatically reduced transmission. The reduction in cases after 60 days with widespread use of CT-scan screening compared to PCR by itself is as high as $50\times$, and the reduction of effective reproduction rate $R(t)$ is $0.20$. Our results imply that much more rapid extinction of COVID is possible by combining social distancing with CT-scans and contact tracing.


title: Doctors in China Need More Power of Discourse

text: COVID-19 that developed in late 2019 and 2020 is a severe threat to human health. The tragedy of Dr Li Wenliang, the whistleblower, revealed a current status of doctors' insufficient power of disclosure. Therefore, prompt and effective actions warrant to be taken by the government and public to improve Chinese doctors' power of disclosure. A medical system based on the improved doctors' power of disclosure is beneficial to disease prevention in an extended period.


Lockdowns due to COVID-19 threaten PhD students' and early-career researchers' careers


title: The Epidemiology of SARS-CoV-2 in a Pediatric Healthcare Network in the United States

text: BACKGROUND: Understanding the prevalence and clinical presentation of COVID-19 in pediatric patients can help healthcare providers and systems prepare and respond to this emerging pandemic. METHODS: Retrospective case series of patients tested for SARS-CoV-2 across a pediatric healthcare network, including the clinical features and outcomes of those with positive test results. RESULTS: Of 7,256 unique children tested for SARS-CoV-2, 424 (5.8%) tested positive. Patients 18-21 years of age had the highest test positive rate (11.2%) while those 1-5 years of age had the lowest (3.9%). By race, 10.6% (226/2132) of Black children tested positive vs. 3.3% (117/3592) of White children. Of those with an indication for testing, 21.1% (371/1756) of patients with reported exposures or clinical symptoms tested positive vs. 3.8% (53/1410) of those undergoing pre-procedural or pre-admission testing. Of the 424 patients who tested positive for SARS-CoV-2, 182 (42.9%) had no comorbid medical conditions, 87 (20.5%) had asthma, 55 (13.0% had obesity, and 38 (9.0%) had mental health disorders. Overall, 52.1% had cough, 51.2% fever, and 14.6% shortness of breath. Seventy-seven (18.2%) SARS-CoV-2 positive patients were hospitalized, of which 24 (31.2%) required any respiratory support. SARS-CoV-2-targeted antiviral therapy was given to 9 patients, and immunomodulatory therapy to 18 patients. Twelve (2.8%) SARS-CoV-2 positive patients developed critical illness requiring mechanical ventilation and 2 patients required extracorporeal membrane oxygenation. Two patients died. CONCLUSIONS: In this large cohort of pediatric patients tested for SARS-CoV-2, the rate of infection was low, but varied by testing indication. The majority of cases were mild, few children had critical illness, and two patients died.


Pearls and Oy-sters: Facial nerve palsy as a neurological manifestation of Covid-19 infection


title: Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes

text: Aerosolization procedures during the COVID-19 pandemic place all operating room personnel at risk for exposure. We offer detailed perioperative management strategies and present a specific protocol designed to improve safety during pediatric laryngoscopy and bronchoscopy. Several methods of using disposable drapes for various procedures are described, with the goal of constructing a tent around the patient to decrease widespread contamination of dispersed droplets and generated aerosol. The concepts presented herein are translatable to future situations where aerosol generating procedures increase risk for any pathogenic exposure. This protocol is a collaborative effort based on knowledge gleaned from clinical and simulation experience from Children's Hospital Colorado, Children's Hospital of Philadelphia, The Hospital for Sick Children in Toronto, and Boston Children's Hospital.


title: Navigating the Ethics of COVID-19 in Otolaryngology

text: The COVID-19 pandemic has dramatically altered how otolaryngologists contemplate and assume their roles in health care delivery. The ethical implications of this pandemic upon our practice are formidable and distinct from other surgical fields. The salient ethical issues of public health stewardship and safety, distributive justice, and nonabandonment are distilled for the practicing otolaryngologist.


title: Analysis of the Hosts and Transmission Paths of SARS-CoV-2 in the COVID-19 Outbreak

text: The severe respiratory disease COVID-19 was initially reported in Wuhan, China, in December 2019, and spread into many provinces from Wuhan. The corresponding pathogen was soon identified as a novel coronavirus named SARS-CoV-2 (formerly, 2019-nCoV). As of 2 May, 2020, over 3 million COVID-19 cases had been confirmed, and 235,290 deaths had been reported globally, and the numbers are still increasing. It is important to understand the phylogenetic relationship between SARS-CoV-2 and known coronaviruses, and to identify its hosts for preventing the next round of emergency outbreak. In this study, we employ an effective alignment-free approach, the Natural Vector method, to analyze the phylogeny and classify the coronaviruses based on genomic and protein data. Our results show that SARS-CoV-2 is closely related to, but distinct from the SARS-CoV branch. By analyzing the genetic distances from the SARS-CoV-2 strain to the coronaviruses residing in animal hosts, we establish that the most possible transmission path originates from bats to pangolins to humans.


title: Stable Backward Diffusion Models that Minimise Convex Energies

text: The inverse problem of backward diffusion is known to be ill-posed and highly unstable. Backward diffusion processes appear naturally in image enhancement and deblurring applications. It is therefore greatly desirable to establish a backward diffusion model which implements a smart stabilisation approach that can be used in combination with an easy to handle numerical scheme. So far, existing stabilisation strategies in literature require sophisticated numerics to solve the underlying initial value problem. We derive a class of space-discrete one-dimensional backward diffusion as gradient descent of energies where we gain stability by imposing range constraints. Interestingly, these energies are even convex. Furthermore, we establish a comprehensive theory for the time-continuous evolution and we show that stability carries over to a simple explicit time discretisation of our model. Finally, we confirm the stability and usefulness of our technique in experiments in which we enhance the contrast of digital greyscale and colour images.


title: Preferential placement for community structure formation

text: Various models have been recently proposed to reflect and predict different properties of complex networks. However, the community structure, which is one of the most important properties, is not well studied and modeled. In this paper, we suggest a principle called"preferential placement", which allows to model a realistic community structure. We provide an extensive empirical analysis of the obtained structure as well as some theoretical results.


docid: xpbeuoqm

title: Prejudice in science - Lessons from the coronavirus story

text: In the current pandemic times, medical physicists may not be aware that there is an interesting story on two significant discoveries related to the coronavirus. One is the invention of the polymerase chain reaction (PCR) and the other is the first electron microscopic observation and identification of the coronavirus. Both of them were disregarded by the reviewers and major journals declined to publish these discoveries. These days, PCR, for example, is a widespread method for analyzing DNA, having a profound effect on healthcare, especially now during the Covid-19 pandemic. Prejudice or perhaps ignorance prevail in every aspect of our society, and there is no exception in scientific research. We need to, however, learn from these two stories and be open-minded about novel discoveries and findings - as they may be just disruptive in the "right" way to lead to an unexpected breakthrough.


Treating patients with multiple sclerosis during the COVID-19 pandemic: Assessing the expert recommendations


How diabetes management is adapting amid the COVID-19 pandemic


title: Blurring Boundaries: Toward the Collective Empathic Understanding of Product Requirements

text: Within the agile paradigm, many software product companies create cross-functional product development teams that own their product or a defined set of product features. In contrast to development teams operating within a heavily-disciplined software development process, these product teams often require a deeper and, importantly, a collective understanding of the product domain to serve as a rich context within which to understand the product requirements. Little is known about the factors that support or impede these teams in collectively achieving this deep understanding of the product domain. Using Constructivist Grounded Theory method, we study individuals and teams across seven software companies that create products for a diverse range of markets. The study found that certain organisational and planning process factors play a significant role in whether product development teams have the potential to collectively develop deep domain understanding. These factors also impact individual and development team dynamics. We identify two essential metaphorical dynamics of broadening the lens and blurring boundaries that cross-functional product teams employ in order to fully embrace product ownership, visioning, and planning towards achieving a deep collective domain understanding, creating a richer context in which to understand product requirements. We also conclude that the highly specialised nature of many organisational models and development processes is contraindicated for cross-functional product development teams in achieving this deep collective understanding and we call for a rethinking of conventional organisational and product planning practices for software product development.


Love in the Time of Corona


Acute Cor Pulmonale in Critically Ill Patients with Covid-19


title: A Note on UK Covid19 death rates by religion: which groups are most at risk?

text: There has been great concern in the UK that people from the BAME (Black And Minority Ethnic) community have a far higher risk of dying from Covid19 than those of other ethnicities. However, the overall fatalities data from the Government's ONS (Office of National Statistics) most recent report on deaths by religion shows that Jews (very few of whom are classified as BAME) have a much higher risk than those of religions (Hindu, Sikh, Muslim) with predominantly BAME people. This apparently contradictory result is, according to the ONS statistical analysis, implicitly explained by age as the report claims that, when 'adjusted for age' Muslims have the highest fatality risk. However, the report fails to provide the raw data to support this. There are many factors other than just age that must be incorporated into any analysis of the observed data before making definitive conclusions about risk based on religion/ethnicity. We propose the need for a causal model for this. If we discount unknown genetic factors, then religion and ethnicity have NO impact at all on a person's Covid19 death risk once we know their age, underlying medical conditions, work/living conditions, and extent of social distancing.


title: The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro

text: Although several clinical trials are now underway to test possible therapies, the worldwide response to the COVID-19 outbreak has been largely limited to monitoring/containment. We report here that Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 h post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48 h. Ivermectin therefore warrants further investigation for possible benefits in humans.


Acute Care Surgeons' Response to the COVID-19 Pandemic: Observations and Strategies from the Epicenter of the American Crisis


Secure the availability of labor: Extension of annual paid leave settlement between healthcare workers and employers is good for post COVID-19 recovery


title: Epidemiologic Features of 135 Patients With Coronavirus Disease (COVID-19) in Tianjin, China

text: OBJECTIVE: This study describes the epidemiologic features of an outbreak of the coronavirus disease (COVID-19) in Tianjin caused by a novel coronavirus and provides the scientific basis for prevention and control measures. METHODS: Data from COVID-19 cases were collected from daily notifications given to the National Health Commission of the People's Republic of China and Tianjin Health Committee. All of the data were analyzed with SPSS, version 24.0 software (IBM Corp, Armonk, NY). RESULTS: As of February 24, 2020, there have been 135 confirmed cases, 3 deaths, and 87 recoveries in Tianjin, China. The incidence of COVID-19 was 8.65/1 000 000 with a 2.22% case fatality rate. Regarding geographic distribution, the incidence was 8.82 per 1 000 000 in urban areas and 8.00 per 1 000 000 in suburbs. During the early stage of the epidemic, most cases came from urban areas and in patients with a history of sojourning in Hubei Province. The majority of patients were 31-70 years old (75.97%). A familial clustering was the most important characteristic of COVID-19 (accounting for 74.81%). CONCLUSIONS: Current information suggests that people are generally susceptible to COVID-19, which has shown a familial clustering in Tianjin.


title: Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein

text: The emergence of SARS-CoV-2 has resulted in >90,000 infections and >3,000 deaths. Coronavirus spike (S) glycoproteins promote entry into cells and are the main target of antibodies. We show that SARS-CoV-2 S uses ACE2 to enter cells and that the receptor-binding domains of SARS-CoV-2 S and SARS-CoV S bind with similar affinities to human ACE2, correlating with the efficient spread of SARS-CoV-2 among humans. We found that the SARS-CoV-2 S glycoprotein harbors a furin cleavage site at the boundary between the S1/S2 subunits, which is processed during biogenesis and sets this virus apart from SARS-CoV and SARS-related CoVs. We determined cryo-EM structures of the SARS-CoV-2 S ectodomain trimer, providing a blueprint for the design of vaccines and inhibitors of viral entry. Finally, we demonstrate that SARS-CoV S murine polyclonal antibodies potently inhibited SARS-CoV-2 S mediated entry into cells, indicating that cross-neutralizing antibodies targeting conserved S epitopes can be elicited upon vaccination.


title: Clinical features and high resolutionCT imaging findings of preliminary diagnosis novel coronavirus pneumonia/ 中华放射学杂志

text: Objective@#To summarize the clinical characteristics of 141 patients with novel coronavirus pneumonia (NCP) and the imaging characteristics of High Resolution CT(HRCT) in the chest.@*Methods@#From January 20, 2020 to 28, 141 NCP patients, 77 males and 64 females, with a median age of 49 (9,87), were retrospectively analyzed. The clinical features, laboratory examination indexes and HRCT findings of 141 NCP patients were analyzed.@*Results@#In 141 NCP patients, 38 (26.95%) had a decrease in leukocyte count and 71 (50.35%) had a decrease in lymphocyte ratio. Among 141 NCP patients, 139 (98.58%) had fever (over 37.5 ° C), 106 (75.18%) coughed, 11 (7.80%) had headache, 41 (29.08%) coughed up sputum, 93 (65.96%) had chest distress, and 4 (2.84%) had diarrhea. HRCT of 141 NCP patients were abnormal, 52 (36.88%) showed ground glass shadow (GGO) and patchy shadow, mainly subpleural distribution; 23 (16.31%) showed GGO with focal consolidation; 27 (19.15%) had small patchy blur; 20 (14.18%) had large patchy consolidation; 48 (34.04%) had bronchovascular bundle thickening and vascular perforator sign; 5 (3.55%) had Air bronchus sign; small nodule shadow in 7 cases (4.96%); fibrosis, grid shadow or strip shadow in 5 cases (3.55%); bilateral pleural effusion in 7 cases (4.96%); mediastinal or bilateral hilar lymphadenopathy in 4 cases (2.84%).@*Conclusions@#The clinical features and HRCT images of NCP are various. Under the specific epidemiological background of NCP, HRCT scan of chest should be carried out in time to make early warning of disease.


Appropriate terms for chest CT features in COVID-19 infection


title: A Proposed Process for Risk Mitigation During the COVID-19 Pandemic

text: Recent executive orders have led some applied behavior analysis (ABA) providers to interpret themselves as "essential personnel" during the COVID-19 pandemic. In this article, we argue against a blanket interpretation that being labeled "essential personnel" means that all in-person ABA services for all clients should continue during the COVID-19 pandemic. We believe this argument holds even if ABA providers are not in a jurisdiction currently under an active shelter-at-home or related order. First, we provide a brief description of risks associated with continued in-person ABA service delivery, as well as risks associated with the temporary suspension of services or the transition to remote ABA service delivery. For many clients, continued in-person service delivery carries a significant risk of severe harm to the client, family and caregivers, staff, and a currently overburdened health care system. In these situations, ABA providers should temporarily suspend services or transition to telehealth or other forms of remote service delivery until information from federal, state, and local health care experts deems in-person contact safe. In rare cases, temporary suspension of services or a transition to remote service delivery may place the client or others at risk of significant harm. In these situations, in-person services should likely continue, and ongoing assessment and risk mitigation are essential.


title: Early National and Center-level Changes to Kidney Transplantation in the United States During COVID-19 Epidemic

text: In March 2020, COVID-19 spread rapidly nationally, causing widespread emergent changes to the health system. Our goal was to understand the impact of the epidemic on kidney transplantation (KT), at both the national and center-levels, accounting statistically for waitlist composition. Using SRTR data, we compared data on observed waitlist registrations, waitlist mortality, living-donor and deceased-donor kidney transplants (LDKT/DDKT) March 15-April 30, 2020 to expected events calculated from pre-epidemic data January 2016-February 2020. There were few changes before March 15, at which point the number of new listings/DDKT/LDKT dropped to 18%/24%/87% below the expected value (all p<0.001). Only 12 centers performed LDKT March 15-31; by April 30, 40 centers had resumed LDKT. The decline in new listings and DDKT was greater among states with higher per capita confirmed COVID-19 cases. The number of waitlist deaths was 2.2-fold higher than expected in the five states with highest COVID-19 burden (p<0.001). DCD DDKT and regional/national imports declined nationwide, but most steeply in states with the highest COVID-19 burden. The COVID-19 epidemic has resulted in substantial changes to KT; we must adapt and learn rapidly to continue provide safe access to transplantation and limit the growing indirect toll of an already deadly disease.


Inverse association between chronic hepatitis B infection and COVID-19: immune-exhaustion or coincidence?


South Africa's COVID-19 Alcohol Sales Ban: The Potential for Better Policy-Making


Back to Basics: Improving Care for Psychosis


Reply by Xu et al: Haouzi et al


docid: mniaeoop

title: I am having trouble keeping up with virtual teaching activities: Reflections in the COVID-19 era


Mask is the possible key for self-isolation in COVID-19 pandemic


COVID-19 and dengue, co-epidemics in Ecuador and other countries in Latin America: Pushing strained health care systems over the edge


title: Performing Bronchoscopy in Times of the COVID-19 Pandemic: Practice Statement from an International Expert Panel

text: These recommendations for physicians who perform bronchoscopy will help to protect those patients (un)-affected by the current COVID-19 pandemic, minimize the risk of transmission, and maintain clinical care for all patients.


Letter: Approaches to Mitigate Impact of COVID-19 Pandemic on Neurosurgical Residency Application Cycle


Where are the women? Gender inequalities in COVID-19 research authorship


Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage


title: Robot art, in the eye of the beholder?: Personalization through self-disclosure facilitates visual communication of emotions in representational art

text: Socially assistive robots could help to support people's well-being in contexts such as art therapy where human therapists are scarce, by making art such as paintings together with people in a way that is emotionally contingent and creative. However, current art-making robots are typically either contingent, controlled as a tool by a human artist, or creative, programmed to paint independently, possibly because some complex and idiosyncratic concepts related to art, such as emotion and creativity, are not yet well understood. For example, the role of personalized taste in forming beauty evaluations has been studied in empirical aesthetics, but how to generate art that appears to an individual to express certain emotions such as happiness or sadness is less clear. In the current article, a collaborative prototyping/Wizard of Oz approach was used to explore generic robot art-making strategies and personalization of art via an open-ended emotion profile intended to identify tricky concepts. As a result of conducting an exploratory user study, participants indicated some preference for a robot art-making strategy involving"visual metaphors"to balance exogenous and endogenous components, and personalized representational sketches were reported to convey emotion more clearly than generic sketches. The article closes by discussing personalized abstract art as well as suggestions for richer art-making strategies and user models. Thus, the main conceptual advance of the current work lies in suggesting how an interactive robot can visually express emotions through personalized art; the general aim is that this could help to inform next steps in this promising area and facilitate technological acceptance of robots in everyday human environments.


title: Power of Artificial Intelligence to Diagnose and Prevent Further COVID-19 Outbreak: A Short Communication

text: Novel coronavirus-19 (2019-nCoV or COVID-19) is by far the most dangerous coronavirus ever identified for the third time in the three decades capable of infecting not only the animals but also the humans across the globe. Nearly 6000 deaths have been recorded due mainly to COVID-19 outbreak worldwide and more than 50% of these deaths appeared to have evolved from China where the virus was thought to originate. The endemicity of COVID-19 dramatically surpassed severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) that were so far discovered in 2003 and 2012 respectively. Thus, the World Health Organization (WHO) has declared the 2019-nCoV outbreak not only a public health emergency but also pandemic in nature. Currently, over 120 countries including Nigeria were reported to have more than 157,844 confirmed cases and 5,846 deaths due mainly to COVID-19 outbreak as of March 15, 2020, 10:55 GMT. Artificial Intelligence (AI) is widely used to aid in the prediction, detection, response, recovery of disease and making clinical diagnosis. In this study, we highlighted the power of AI in the containment and mitigation of the spread of COVID-19 outbreak in African countries such as Nigeria where human to human contact is apparently inevitable.


Challenges posed by COVID-19 to children with cancer


docid: yphmntoc

title: [Genomic analysis of a 2019-novel coronavirus (2019-nCoV) strain in the first COVID-19 patient found in Hangzhou]

text: Objective: To understand the viral genomic characteristics of a 2019-novel coronavirus (2019-nCoV) strain in the first COVID-19 patient found in Hangzhou, China. Methods: Viral RNA was extracted in throat swab and sputum sample of the patient and was performed real-time reverse transcription PCR detection and obtained viral genome by high-throughput sequencing method. Phylogenetic analysis was conducted using 29 2019-nCoV genomes and 30 ß-coronavirus genomes deposited in NCBI GenBank. Fifteen genomes from Wuhan were grouped by mutation sites and others were identified by Wuhan's or specific mutation sites. Results: A 29 833 bp length genome of the first 2019-nCoV strain in Hangzhou was obtained, covering full length of the coding regions of coronavirus. Phylogenetic analysis showed that the genome was closest to the genome of a bat SARS-like coronavirus strain RaTG13 with an identity of 96.11% (28 666/29 826). Among the genes between two genomes, E genes were highly conserved (99.56%), while S genes had lowest identity (92.87%). The genome sequence similarities among 29 strains from China (Hangzhou, Wuhan, and Shenzhen), Japan, USA, and Finland, were all more than 99.9%; however, some single nucleotide polymorphisms were identified in some strains. Conclusion: The genome of Hangzhou 2019-nCoV strain was very close to the genomes of strains from other cities in China and overseas collected at early epidemic phase. The 2019-nCoV genome sequencing method used in this paper provides an useful tool for monitoring variation of viral genes.


Africa's response to COVID-19


title: Microwave-Generated Steam Decontamination of N95 Respirators Utilizing Universally Accessible Materials

text: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused a severe, international shortage of N95 respirators, which are essential to protect health care providers from infection. Given the contemporary limitations of the supply chain, it is imperative to identify effective means of decontaminating, reusing, and thereby conserving N95 respirator stockpiles. To be effective, decontamination must result in sterilization of the N95 respirator without impairment of respirator filtration or user fit. Although numerous methods of N95 decontamination exist, none are universally accessible. In this work, we describe a microwave-generated steam decontamination protocol for N95 respirators for use in health care systems of all sizes, geographies, and means. Using widely available glass containers, mesh from commercial produce bags, a rubber band, and a 1,100-W commercially available microwave, we constructed an effective, standardized, and reproducible means of decontaminating N95 respirators. Employing this methodology against MS2 phage, a highly conservative surrogate for SARS-CoV-2 contamination, we report an average 6-log10 plaque-forming unit (PFU) (99.9999%) and a minimum 5-log10 PFU (99.999%) reduction after a single 3-min microwave treatment. Notably, quantified respirator fit and function were preserved, even after 20 sequential cycles of microwave steam decontamination. This method provides a valuable means of effective decontamination and reuse of N95 respirators by frontline providers facing urgent need.IMPORTANCE Due to the rapid spread of coronavirus disease 2019 (COVID-19), there is an increasing shortage of protective gear necessary to keep health care providers safe from infection. As of 9 April 2020, the CDC reported 9,282 cumulative cases of COVID-19 among U.S. health care workers (CDC COVID-19 Response Team, MMWR Morb Mortal Wkly Rep 69:477-481, 2020, https://doi.org/10.15585/mmwr.mm6915e6). N95 respirators are recommended by the CDC as the ideal method of protection from COVID-19. Although N95 respirators are traditionally single use, the shortages have necessitated the need for reuse. Effective methods of N95 decontamination that do not affect the fit or filtration ability of N95 respirators are essential. Numerous methods of N95 decontamination exist; however, none are universally accessible. In this study, we describe an effective, standardized, and reproducible means of decontaminating N95 respirators using widely available materials. The N95 decontamination method described in this work will provide a valuable resource for hospitals, health care centers, and outpatient practices that are experiencing increasing shortages of N95 respirators due to the COVID-19 pandemic.


title: Video Visits as a Substitute for Urological Clinic Visits

text: OBJECTIVE: To evaluate whether video visits were being used as substitutes to clinic visits prior to COVID-19 at our institution's outpatient urology centers. METHODS: We reviewed 600 established patient video visits completed by 13 urology providers at a tertiary academic center in southeast Michigan. We compared these visits to a random, stratified sample of established patient clinic visits. We assessed baseline demographics and visit characteristics for both groups. We defined our primary outcome ("revisit rate") as the proportion of additional healthcare evaluation (i.e., office, emergency room, hospitalization) by a urology provider within 30 days of the initial encounter. RESULTS: Patients seen by video visit tended to be younger (51 vs 61 years, p<0.001), would have to travel further for a clinic appointment (82 vs 68 miles, p<0.001), and were more likely to be female (36 vs 28%, p=0.001). The most common diagnostic groups evaluated through video visits were nephrolithiasis (40%), oncology (18%) and andrology (14.3%). While the 30-day revisit rates were higher for clinic visits (4.3% vs 7.5%, p=0.01) primarily due to previously scheduled appointments, revisits due to medical concerns were similar across both groups (0.5% vs 0.67%; p=0.60). CONCLUSIONS: Video visits can be used to deliver care across a broad range of urologic diagnoses and can serve as a substitute for clinic visits.


Covid-19: Johnson is on back foot over next steps to control pandemic


title: IEEE 7010: A New Standard for Assessing the Well-being Implications of Artificial Intelligence

text: Artificial intelligence (AI) enabled products and services are becoming a staple of everyday life. While governments and businesses are eager to enjoy the benefits of AI innovations, the mixed impact of these autonomous and intelligent systems on human well-being has become a pressing issue. This article introduces one of the first international standards focused on the social and ethical implications of AI: The Institute of Electrical and Electronics Engineering (IEEE) Standard (Std) 7010-2020 Recommended Practice for Assessing the Impact of Autonomous and Intelligent Systems on Human Well-being. Incorporating well-being factors throughout the lifecycle of AI is both challenging and urgent and IEEE 7010 provides key guidance for those who design, deploy, and procure these technologies. We begin by articulating the benefits of an approach for AI centered around well-being and the measurement of well-being data. Next, we provide an overview of IEEE 7010, including its key principles and how the standard relates to approaches and perspectives in place in the AI community. Finally, we indicate where future efforts are needed.


Revisiting the organ procurement organization-based organ procurement center in the COVID era


title: Cutaneous manifestations of COVID-19: A review of the published literature

text: COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID-19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020. The infection has been reported to demonstrate different types of cutaneous manifestations including urticarial, maculopapular, papulovesicular, purpuric, livedoid, and thrombotic-ischemic lesions. Given the high mortality rate of the infection, timely and accurate identification of relevant cutaneous manifestations may play a key role in the early diagnosis and management. In this study, we provide a review with a focus on the reported cutaneous manifestations of COVID-19.


Surgeons, plague, and leadership: A historical mantle to carry forward


docid: pprzpzrs

title: Anemia hemolítica em bovinos de corte em sistema de criação extensiva em Mato Grosso e Rondônia/ Hemolytic anemia in beef cattle in extensive system farming in Mato Grosso and Rondônia

text: Casos de anemia hemolítica em bovinos de corte em sistema de criação extensiva em Mato Grosso e Rondônia são acompanhados desde 2008. Os animais acometidos apresentam fraqueza, mucosas pálidas ou ictéricas, urina enegrecida, depressão e anorexia. Esse quadro muitas vezes evolui para morte, principalmente quando os animais são movimentados. Durante esse período aproximadamente 429 bovinos morreram em diferentes surtos eem alguns casos a mortalidade chegou a 50%. Foi realizada investigação para as principais causas infecciosas como leptospirose, babesiose, tripanossomíase, anaplasmose e hemoglobinúria bacilar, bem como para as possíveis causas toxicas relatadas como etiologia de anemia hemolítica em bovinos por meio de exames hematológicos, bioquímica sanguínea, moleculares e histopatológicos. Não se observou nas propriedades acometidas, nenhuma das plantas já descritas no Brasil como causadora de anemia hemolítica em animais de interesse pecuário no momento das investigações dos surtos. Apesar da etiologia desses casos ainda não ser conhecida, as evidências epidemiológicas, clínicas e patológicas da doença sugerem que a mesma seja causada por uma planta tóxica de ação hemolítica, presente nas propriedades acometidas, mas que ainda não foi confirmada experimentalmente.(AU)


Intrauterine vertical transmission of SARS-CoV-2: what we know so far


title: Viral Infections in Burns

text: Background: Viral infections after burns are less common than bacterial infections but usually occur in the more severely burned patients and have been associated with poor outcomes. Methods: Retrospective reviews and case series were examined to provide an overview of the management of viral infections in the burn patient. Results: The most common viral pathogens in these patients are the herpesviruses, which include herpes simplex, varicella zoster, cytomegalovirus, and human herpesvirus 6. Established viral infections that may complicate patient management include human immunodeficiency virus, hepatitis B and C, and, more recently, the novel coronavirus SARS-CoV-2. Herpesvirus infections can occur as primary or nosocomial pathogens but clinical manifestations most commonly are re-activation of latent viral infection. Because of the paucity of data in the burn population, much of the evidence for specific treatments is extrapolated from patients with severe immunosuppression or critical illness. Antiviral therapy is employed for the burn patient with herpesvirus infections. This is an area of active study, and further research is needed to better understand the risks, clinical manifestations, and attributable morbidity and mortality of viral infections. Conclusions: Major burn injury results in immunosuppression and viral infection in a small number of patients. Recognition and antiviral therapy are employed, but additional studies are necessary to improve outcomes in these patients.


Innovative technologies for hand hygiene monitoring are urgently needed in the fight against COVID-19


title: The Impact of COVID-19 on the Orthopaedic Surgery Residency Application Process

text: Over recent months, coronavirus disease 2019 (COVID-19) has swept the world as a global pandemic, largely changing the practice of medicine as it was previously known. Physician trainees have not been immune to these changes - uncertainty during this time is undeniable for medical students at all levels of training. Of particular importance is the potential impact of COVID-19 on the upcoming residency application process for rising fourth year students; a further source of added complexity in light of the newly integrated allopathic and osteopathic match in the 2020-2021 cycle. Due to the impact COVID-19 could have on the residency match, insight regarding inevitable alterations to the application process and how medical students can adapt is in high demand. Further, it is very possible that programs will inquire about how applicants spent their time while not in the hospital due to COVID-19, and applicants should be prepared to provide a meaningful answer. While competitive at a basal level, the complexity of COVID-19 now presents an unforeseen, superimposed development in the quest to match. In this article, we aim to discuss and provide potential strategies for navigating the impact of COVID-19 on the residency application process for orthopaedic surgery.


Recurrent Positive Reverse Transcriptase-Polymerase Chain Reaction Results for Coronavirus Disease 2019 in Patients Discharged From a Hospital in China


title: COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury

text: An outbreak of a novel coronavirus disease (COVID-19) that emerged in the Chinese city of Wuhan has rapidly become a global public health pandemic. As of March 2020, the Centers for Disease Control and Prevention (CDC) has described priority levels for testing patients with suspected COVID-19 and information on when to seek medical attention. However, there is a paucity of further guidance for people with spinal cord injury (SCI) who may not present with typical symptoms of COVID-19 due to altered physiology. This may pose challenges with surveillance, risk stratification, and initial management of this vulnerable population. In this point-counterpoint discussion, we outline important differences in presentation along with COVID-19 cases co-morbid with SCI.


title: AI4COVID-19: AI Enabled Preliminary Diagnosis for COVID-19 from Cough Samples via an App

text: Inability to test at scale has become Achille's heel in humanity's ongoing war against COVID-19 pandemic. An agile, scalable and cost-effective testing, deployable at a global scale, can act as a game changer in this war. To address this challenge, building on the promising results of our prior work on cough-based diagnosis of a motley of respiratory diseases, we develop an Artificial Intelligence (AI)-based test for COVID-19 preliminary diagnosis. The test is deployable at scale through a mobile app named AI4COVID-19. The AI4COVID-19 app requires 2-second cough recordings of the subject. By analyzing the cough samples through an AI engine running in the cloud, the app returns a preliminary diagnosis within a minute. Unfortunately, cough is common symptom of over two dozen non-COVID-19 related medical conditions. This makes the COVID-19 diagnosis from cough alone an extremely challenging problem. We solve this problem by developing a novel multi-pronged mediator centered risk-averse AI architecture that minimizes misdiagnosis. At the time of writing, our AI engine can distinguish between COVID-19 patient coughs and several types of non-COVID-19 coughs with over 90% accuracy. AI4COVID-19's performance is likely to improve as more and better data becomes available. This paper presents a proof of concept to encourage controlled clinical trials and serves as a call for labeled cough data. AI4COVID-19 is not designed to compete with clinical testing. Instead, it offers a complementing tele-testing tool deployable anytime, anywhere, by anyone, so clinical-testing and treatment can be channeled to those who need it the most, thereby saving more lives.


title: Epidemiological and clinical characteristics of discharged patients infected with SARS-CoV-2 on the Qinghai plateau

text: Since the outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, a series of confirmed cases of COVID-19 were found on the Qinghai-Tibet plateau. We aimed to describe the epidemiological, clinical characteristics, and outcomes of all confirmed cases in Qinghai, a province at high altitude. The region had no sustained local transmission. Of all 18 patients with confirmed SARS-CoV-2 infection, 15 patients comprising 4 transmission clusters were identified. Three patients were infected by direct contact without travel history to Wuhan. Of 18 patients, 10 patients showed bilateral pneumonia and 2 patients showed no abnormalities. Three patients with comorbidities such as hypertension, liver diseases or diabetes developed severe illness. High C-reactive protein levels and elevations of both ALT and AST were observed in 3 severely ill patients on admission. All 18 patients were eventually discharged, including the 3 severe patients who recovered after treatment with non-invasive mechanical ventilation, convalescent plasma and other therapies. Our findings confirmed human-to-human transmission of SARS-CoV-2 in clusters. Patients with comorbidities are more likely to develop severe illness. This article is protected by copyright. All rights reserved.


Maps, masks and media - Traveller and practitioner resources for 2019 novel coronavirus (2019-nCoV) acute respiratory virus


COVID19 meets the antivaccine movement


title: Remdesivir for Treatment of COVID-19: Combination of Pulmonary and IV Administration May Offer Aditional Benefit

text: Remdesivir is one of the most promising drugs to treat COVID-19 based on the following facts: remdesivir has a broad-spectrum antiviral mechanism of action; it demonstrated in vitro activity against SARS-CoV-2 and in vivo efficacy in animal models against the similar coronavirus MERS-CoV; its safety profile has been tested in Ebola patients and in compassionate use in COVID-19 patients. Currently, remdesivir is being investigated in ten randomized controlled trials against COVID-19. The dose regimen of remdesivir is an IV loading dose of 200 mg on day 1 followed by daily IV maintenance doses of 100 mg for 5-9 days. Based on our data analysis, however, remdesivir with IV administration alone is unlikely to achieve excellent clinical efficacy. This analysis is based on the following observations: plasma exposures of remdesivir and its active metabolite are unlikely to be correlated with its clinical efficacy; remdesivir and its active metabolites are unlikely to be adequate in the lung to kill the SARS-CoV-2 virus. Even if remdesivir demonstrates benefits in the current randomized controlled trials, its efficacy may be limited. We suggest that a combination of an IV and pulmonary delivery dose regimen should be studied immediately to realize a potentially more effective antiviral therapy against COVID-19. Graphical abstract.


Commentary: Cardiac surgery during the coronavirus disease 2019 (COVID-19) pandemic: Feeling our way in the dark


docid: vayqcwqm

title: SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria

text: PURPOSE: Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18th, 2020. METHODS: We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in April 6th, 2020. Mortality was assessed in those who completed 15-days of ICU stay. RESULTS: We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51-75] years. Symptoms began a median of 7 [5-12] days before ICU admission. The most common comorbidities identified were obesity (48%), arterial hypertension (44%) and chronic lung disease (37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 (6%) high flow nasal therapy (HFNT), 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (46%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10/45 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented super-infection. Procalcitonin plasma above 0.5µg/L was associated with 16% vs. 19% (p=0.78) risk of death after 7 days. CONCLUSION: This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died.


docid: zubsyqag

title: Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

text: OBJECTIVE: To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units. DESIGN: Retrospective manual medical record review. SETTING: NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City. PARTICIPANTS: The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records. MAIN OUTCOME MEASURES: Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. RESULTS: Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital. CONCLUSIONS: Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.


Update on COVID-19 From the Journal


Public health and local emergency ethics: vulnerability in Eastern Samar, Philippines


title: COVID-19 related depression and anxiety among quarantined respondents

text: Objective: The outbreak of the coronavirus disease (COVID-19) poses an unprecedented threat to public health. Current measures to control the spread include social distancing and quarantine, which may trigger mental health problems.Design and Main Outcome Measures: The sample (N = 1160) constituted three groups: people quarantined in an affected area, unaffected areas, and people not in quarantine. The Center for Epidemiological Studies Depression Scale (CES-D-20) and the Goldberg Depression and Anxiety Scale (GAD-7) were administered as measures of depression and anxiety, respectively. The multi-variant logistic and multiple linear regression identified factors associated with depression and anxiety.Results: Probable depression and anxiety were reported by 26.47% and 70.78% of all respondents, respectively. After adjusting for demographic and community variables, quarantined respondents reported a higher likelihood to exhibit symptoms of depression and anxiety than those not quarantined. Respondents living in communities where screening for COVID-19 was required were less likely to report depression and anxiety symptoms.Conclusion: The incidence of depression and anxiety among quarantined respondents was significantly higher than that of respondents not quarantined, and twice as common among quarantined respondents in unaffected areas as those in affected areas. Appropriate community screening may reduce the risk of depression and anxiety during an epidemic.


title: Phylogenetic study of 2019-nCoV by using alignment-free method

text: The origin and early spread of 2019-nCoV is studied by phylogenetic analysis using IC-PIC alignment-free method based on DNA/RNA sequence information correlation (IC) and partial information correlation (PIC). The topology of phylogenetic tree of Betacoronavirus is remarkably consistent with biologist's systematics, classifies 2019-nCoV as Sarbecovirus of Betacoronavirus and supports the assumption that these novel viruses are of bat origin with pangolin as one of the possible intermediate hosts. The novel virus branch of phylogenetic tree shows location-virus linkage. The placement of root of the early 2019-nCoV tree is studied carefully in Neighbor Joining consensus algorithm by introducing different out-groups (Bat-related coronaviruses, Pangolin coronaviruses and HIV viruses etc.) and comparing with UPGMA consensus trees. Several oldest branches (lineages) of the 2019-nCoV tree are deduced that means the COVID-19 may begin to spread in several regions in the world before its outbreak in Wuhan.


Covid-19: All essential workers in England can now be tested


title: Health Systems' Resilience: COVID-19 Response in Trinidad and Tobago

text: Trinidad and Tobago, a small island developing state, has been ranked as number one in a report published by the University of Oxford that assessed responses to COVID-19 based on four of the six WHO criteria for rolling back COVID-19 "lockdown" measures. The key mitigation and containment strategies implemented by the country were evidence-informed and demonstrated an "all-of-government" approach. The COVID-19 health system response of this country demonstrates that although developing countries face many health system challenges, political will, evidence-informed decision-making, respect for science, and timely, coordinated, collaborative actions can strengthen the resilience and response of the health system during a health emergency.


Evaluation of Potential Therapeutic Options for COVID-19