title: Ocular manifestations and clinical characteristics of 534 cases of COVID-19 in China: A cross-sectional study

text: Objective: The novel coronavirus disease (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. Previous study has reported several COVID-19 cases with conjunctivitis. However, the complete profiling of COVID-19 related ocular symptoms and diseases are still missing. We aim to investigate the ocular manifestations and clinical characteristics of COVID-19 patients. Methods: A total of five hundred and thirty-four patients were recruited at Mobile Cabin Hospital and Tongji Hospital. We collected information on demographic characteristics, exposure history, ocular symptoms, systemic concomitant symptoms, eye drop medication, eye protections, radiologic findings, and SARS-CoV-2 detection in nasopharyngeal swabs by RT-PCR from questionnaires and electronic medical records. Results: The median age of patients was 40 and 50 years at Mobile Cabin Hospital and Tongji Hospital, respectively. Of 534 COVID-19 patients, 25 patients (4.68%) presented with conjunctival congestion and 3 patients had conjunctival congestion as the initial symptom. The average duration of conjunctival congestion was 4.9 {+/-} 2.6 days (mean [SD]), ranging from 2 to 10 days. Dry eye (112, 20.97%), blurred vision (68, 12.73%), and foreign body sensation (63, 11.80%) ranked as the top three COVID-19 related ocular symptoms. Notably, a total of 332 COVID-19 patients (62%) had a hand-eye contact history. We also found that some COVID-19 patients had a history of eye disease, including conjunctivitis (33, 6.18%), dry eye (24, 4.49%), keratitis (14, 2.62%), cataract (9, 1.69%), and diabetic retinopathy (5, 0.94%). In consistent with previous studies, the most common clinical symptoms were fever, cough, and fatigue. Patients, 60.5% in Mobile Cabin Hospital and 67.5% in Tongji Hospital, respectively were confirmed with positive SARS-CoV-2 detection. Conclusions: Conjunctival congestion was one of the COVID-19 related ocular symptoms, which may have clinical diagnostic significance. It is essential to provide eye-care equipment and strengthen education on eye protection, as dirty hand-eye contact might be a high risk factor of COVID-19. Further detailed and comprehensive ophthalmological guidance is needed for COVID-19 control.


title: ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China

text: Background: Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) outbreaks in Wuhan, China, healthcare systems capacities in highly endemic areas have been overwhelmed. Approaches to efficient management are urgently needed and key to a quicker control of the outbreaks and casualties. We aimed to characterize the clinical features of hospitalized patients with confirmed or suspected COVID-19, and develop a mortality risk index for COVID-19 patients. Methods: In this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports. Results: Of 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44.0%) were men; 22.8% (100/438) were severe pneumonia on admission, and 37.7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8.4 days (IQR, 5.8 - 12.0), 39 patients died with a 12-day cumulative mortality of 8.7% (95% CI, 5.9% to 11.5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age ≥ 60 years and CRP ≥ 34 mg/L) was 33.2% (95% CI, 19.8% to 44.3%), which was significantly higher than those of grade two (age ≥ 60 years and CRP < 34 mg/L; age < 60 years and CRP ≥ 34 mg/L; 5.6% [95% CI, 0 to 11.3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0.001), respectively. Conclusion: The ACP index can predict COVID-19 related short-term mortality, which may be a useful and convenient tool for quickly establishing a COVID-19 hierarchical management system that can greatly reduce the medical burden and therefore mortality in highly endemic areas.


title: Inhaled biguanides and mTOR inhibition for influenza and coronavirus (Review)

text: The mammalian target of rapamycin (mTOR) signaling pathway senses and responds to nutrient availability, energy sufficiency, stress, hormones and mitogens to modulate protein synthesis. Rapamycin is a bacterial product that can inhibit mTOR via the PI3K/AKT/mTOR pathway. mTOR signaling is necessary for the development of influenza and modulates the antibody response to provide cross-protective immunity to lethal infection with influenza virus. In one human study, it was found that the treatment of severe H1N1 influenza‑related pneumonia with rapamycin and steroids improved the outcome. However, in other studies, immunosuppression with systemic steroids, and possibly rapamycin as well, was associated with an increased morbidity/mortality and a prolonged viral replication. In order to avoid the systemic side-effects, some investigators have postulated that the inhalation of rapamycin would be desirable. However, the inhalation of rapamycin, with its well-documented lung toxicity, could be contraindicated. Another class of drug, biguanides, can also inhibit mTOR, but have no lung toxicity. Biguanides are widely used small molecule drugs prescribed as oral anti-diabetics that have exhibited considerable promise in oncology. During the 1971 outbreak of influenza, diabetic patients treated with the biguanides, phenformin and buformin, had a lower incidence of infection than diabetics treated with sulfonylureas or insulin. Both buformin and phenformin reduce the mortality of influenza in mice; phenformin is less effective than buformin. The inhalation of buformin or phenformin for influenza may be an effective novel treatment strategy that would limit the risk of systemic side-effects associated with biguanides due to the low inhaled dose. Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2, a virus closely related to the SARS virus. The disease is the cause of the 2019–2020 coronavirus outbreak. It is primarily spread between individuals via small droplets emitted from infected individuals when breathing or coughing. PI3K/AKT/mTOR signaling responses play important roles in MERS-CoV infection and may represent a novel drug target for therapeutic intervention strategies. The present review article discusses the effects of biguanides on influenza and coronavirus.


title: How Previous Epidemics Enable Timelier COVID-19 Responses: A Cross-Sectional Study Using Organizational Memory Theory

text: Introduction: There has been little systematic exploration of what affects timeliness of epidemic response, despite the potential for earlier responses to be more effective. Speculations have circulated that exposure to major epidemics helped health systems respond more quickly to COVID-19. This study leverages organizational memory theory to test whether health systems with any, more severe, more recent exposure to major epidemics enacted timelier COVID-19 policy responses. Methods: A dataset was constructed cataloguing 719 policies across 177 health systems in total, 12 of which had major epidemics within the last twenty years. Hypotheses testing used cluster robust regressions with WHO region fixed effects, controlling for several health system expenditure and political variables. Results: Results show that exposure to any major epidemics was nearly significant (p = 0.07) with approximately 20 days earlier response. As the number of total cases from major epidemics increase by one, this was associated with 0.0028 day earlier response (p < 0.001). A decrease of one year from last major epidemics was also associated with 0.4020 day earlier response (p < 0.001). Conclusion: This study suggests that health systems do learn from past major epidemics. Policymakers ought to institutionalize lessons from COVID-19 to prevent erosion of organizational memory, and learn from other more severely affected health systems. Future studies can examine specific generalizable lessons and whether timelier responses correlated with lower health and economic impacts.


title: ICON (Ivermectin in COvid Nineteen) study: Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID19

text: Abstract Importance: No therapy to date has been shown to improve survival for patients infected with SARS-CoV-2. Ivermectin has been shown to inhibit the replication of SARS-CoV-2 in vitro but clinical response has not been previously evaluated. Objective: To determine whether Ivermectin is associated with lower mortality rate in patients hospitalized with COVID-19. Design and Setting: Retrospective cohort study of consecutive patients hospitalized at four Broward Health hospitals in South Florida with confirmed SARS-CoV-2. Enrollment dates were March 15, 2020 through May 11, 2020. Follow up data for all outcomes was May 19, 2020. Participants: 280 patients with confirmed SARS-CoV-2 infection (mean age 59.6 years [standard deviation 17.9], 45.4% female), of whom 173 were treated with ivermectin and 107 were usual care were reviewed. 27 identified patients were not reviewed due to multiple admissions, lack of confirmed COVID results during hospitalization, age less than 18, pregnancy, or incarceration. Exposure: Patients were categorized into two treatment groups based on whether they received at least one dose of ivermectin at any time during the hospitalization. Treatment decisions were at the discretion of the treating physicians. Severe pulmonary involvement at study entry was characterized as need for either FiO2 [≥]50%, or noninvasive or invasive mechanical ventilation. Main Outcomes and Measures: The primary outcome was all-cause in-hospital mortality. Secondary outcomes included subgroup mortality in patients with severe pulmonary involvement and extubation rates for patients requiring invasive ventilation. Results: Univariate analysis showed lower mortality in the ivermectin group (25.2% versus 15.0%, OR 0.52, 95% CI 0.29-0.96, P=.03). Mortality was also lower among 75 patients with severe pulmonary disease treated with ivermectin (38.8% vs 80.7%, OR 0.15, CI 0.05-0.47, P=.001), but there was no significant difference in successful extubation rates (36.1% vs 15.4%, OR 3.11 (0.88-11.00), p=.07). After adjustment for between-group differences and mortality risks, the mortality difference remained significant for the entire cohort (OR 0.27, CI 0.09-0.85, p=.03; HR 0.37, CI 0.19-0.71, p=.03). Conclusions and Relevance: Ivermectin was associated with lower mortality during treatment of COVID-19, especially in patients who required higher inspired oxygen or ventilatory support. These findings require randomized controlled trials for confirmation.


title: Perceived Challenges of COVID-19 Infection Prevention and Control Preparedness: A Multinational Survey

text: Objectives Implementation of effective infection prevention and control (IPC) measures is needed to support global capacity building to limit transmission of coronavirus disease 2019 (COVID-19) and mitigate its impact on health systems. We assessed the perceptions of healthcare workers on the current global IPC preparedness measures for COVID-19. Methods A cross-sectional survey using an electronic survey was circulated between February 26, 2020, and March 20, 2020, to IPC professionals during COVID-19 pandemic. The survey addressed the presence of COVID-19 guidelines as well as specific IPC preparedness activities in response to the outbreak. Findings In total, 339 IPC professionals spanning 63 countries in all 6 World Health Organization (WHO) regions, mostly from tertiary care centres participated. Of all participants, 66{middle dot}6% were aware of the existence of national guidelines to prevent COVID-19. A shortage of PPE supplies was reported by 48% (ranging from 64{middle dot}2% in low-income countries to 27{middle dot}4% in high-income countries); 41{middle dot}5% of respondents considered that the media had an impact on guideline development and 63{middle dot}6% believed that guidelines were based on maximum security rather than on evidence-based analyses. 58{middle dot}5% and 72{middle dot}7% of participants believed that healthcare facilities and community settings respectively were not sufficiently prepared. Conclusion Results revealed lack of guidelines and concerns over insufficient PPE supply in both high- and low-income countries. Our findings should alert national health authorities to ramp up the implementation of IPC measures and focus on long-term preparedness and readiness for future pandemics, likely requiring government funds rather than reliance on healthcare institutions.


title: The Evaluation of Deep Neural Networks and X-Ray as a Practical Alternative for Diagnosis and Management of COVID-19

text: High-resolution computed tomography radiology is a critical tool in the diagnosis and management of COVID-19 infection; however, in smaller clinics around the world, there is a shortage of radiologists available to analyze these images. In this paper, we compare the performance of 16 available deep learning algorithms to help identify COVID19. We utilize an already existing diagnostic technology (X-ray) and an already existing neural network (ResNet-50) to diagnose COVID-19. Our approach eliminates the extra time and resources needed to develop new technology and associated algorithm, thus aiding the front-line in the race against the COVID-19 pandemic. Results show that ResNet-50 is the optimal pretrained neural network for the detection of COVID-19, using three different cross-validation ratios, based on training time, accuracy, and network size. We also present a custom visualization of the results that can be used to highlight important visual biomarkers of the disease and disease progression.


title: Prevalence Threshold and Temporal Interpretation of Screening Tests: The Example of the SARS-CoV-2 (COVID-19) Pandemic

text: The curvilinear relationship between a screening test's positive predictive value (PPV) and its target disease prevalence is proportional. In consequence, there is an inflection point of maximum curvature in the screening curve defined as a function of the sensitivity and specificity beyond which the rate of change of a test's PPV declines sharply relative to disease prevalence. Herein, we demonstrate a mathematical model exploring this phenomenon and define the prevalence threshold point where this change occurs. Understanding where this prevalence point lies in the curve has important implications for the interpretation of test results, the administration of healthcare systems, the implementation of public health measures, and in cases of pandemics like SARS-CoV-2, the functioning of society at large. To illustrate the methods herein described, we provide the example of the screening strategies used in the SARS-CoV-2 (COVID-19) pandemic, and calculate the prevalence threshold statistic of different tests available today. This concept can help contextualize the validity of a screening test in real time, thereby enhancing our understanding of the dynamics of the current pandemic.


title: Exuberant elevation of IP-10, MCP-3 and IL-1ra during SARS-CoV-2 infection is associated with disease severity and fatal outcome

text: The outbreak of Coronavirus Disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, December 2019, and continuously poses a serious threat to public health. Our previous study has shown that cytokine storm occurred during SARS-CoV-2 infection, while the detailed role of cytokines in the disease severity and progression remained unclear due to the limited case number. In this study, we examined 48 cytokines in the plasma samples from 53 COVID-19 cases, among whom 34 were severe cases, and the others moderate. Results showed that 14 cytokines were significantly elevated upon admission in COVID-19 cases. Moreover, IP-10, MCP-3, and IL-1ra were significantly higher in severe cases, and highly associated with the PaO2/FaO2 and Murray score. Furthermore, the three cytokines were independent predictors for the progression of COVID-19, and the combination of IP-10, MCP-3 and IL-1ra showed the biggest area under the curve (AUC) of the receiver-operating characteristics (ROC) calculations. Serial detection of IP-10, MCP-3 and IL-1ra in 14 severe cases showed that the continuous high levels of these cytokines were associated with disease deterioration and fatal outcome. In conclusion, we report three cytokines that closely associated with disease severity and outcome of COVID-19. These findings add to our understanding of the immunopathologic mechanisms of SARS-CoV-2 infection, which suggested novel therapeutic targets and strategy.


title: SARS-CoV-2 pandemic in Italy: ethical and organizational considerations

text: The current SARS-CoV-2 pandemic is still raging in Italy. The country is currently plagued by a huge burden of virusrelated cases and deaths. So far, the disease has highlighted a number of problems, some in common with other Countries and others peculiar to Italy which has suffered from a mortality rate higher than that observed in China and in most Countries in the world. The causes must be sought not only in the average age of the population (one of the oldest in the world), but also in the inconsistencies of the regional health systems (into which the National Health System is divided) and their delayed response, at least in some areas. Ethical issues emerged from the beginning, ranging from restrictions on freedom of movements and restrictions on personal privacy due to the lockdown, further to the dilemma for healthcare professionals to select people for ICU hospitalization in a shortage of beds in Intensive Care Unit (ICU). Organizational problems also emerged, although an official 2007 document from the Ministry of Health had planned not only what measures had to be taken during an epidemic caused by respiratory viruses, but also what had to be done in the inter-epidemic period (including the establishment of DPIs stocks and ventilators), vast areas of Italy were totally unprepared to cope with the disease, as a line of that document was not implemented. Since organizational problems can worsen (and even cause) ethical dilemmas, every effort should be made in the near future to prepare the health system to respond to a similar emergency in a joint, coherent, and homogeneous way across the Country, as planned in the 2007 document. In this perspective, Pulmonary Units and specialists can play a fundamental role in coping with the disease not only in hospitals, as intermediate care units, but also at a territorial level in an integrated network with GPs.


title: Novel rapid identification of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by real-time RT-PCR using BD Max Open System in Taiwan

text: Coronavirus disease 2019 has become a worldwide pandemic. By April 7, 2020, approximately 1,279,722 confirmed cases were reported worldwide including those in Asia, European Region, African Region and Region of the Americas. Rapid and accurate detection of Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) is critical for patient care and implementing public health measures to control the spread of infection. In this study, we developed and validated a rapid total nucleic acid extraction method based on real‐time RT-PCR for reliable, high‐throughput identification of SARS-CoV-2 using the BD MAX platform. For clinical validation, 300 throat swab and 100 sputum clinical samples were examined by both the BD MAX platform and in-house real-time RT-PCR methods, which showed 100% concordant results. This BD MAX protocol is fully automated and the turnaround time from sample to results is approximately 2.5 h for 24 samples compared to 4.8 h by in-house real-time RT-PCR. Our developed BD MAX RT-PCR assay can accurately identify SARS-CoV-2 infection and shorten the turnaround time to increase the effectiveness of control and prevention measures for this emerging infectious disease.


title: Aligning SARS-CoV-2 Indicators via an Epidemic Model: Application to Hospital Admissions and RNA Detection in Sewage Sludge

text: Ascertaining the state of coronavirus outbreaks is crucial for public health decision-making. Absent repeated representative viral test samples in the population, public health officials and researchers alike have relied on lagging indicators of infection to make inferences about the direction of the outbreak and attendant policy decisions. Recently researchers have shown that SARS-CoV-2 RNA can be detected in municipal sewage sludge with measured RNA concentrations rising and falling suggestively in the shape of an epidemic curve while providing an earlier signal of infection than hospital admissions data. The present paper presents a SARS-CoV-2 epidemic model to serve as a basis for estimating the incidence of infection, and shows mathematically how modeled transmission dynamics translate into infection indicators by incorporating probability distributions for indicator-specific time lags from infection. Hospital admissions and SARS-CoV-2 RNA in municipal sewage sludge are simultaneously modeled via maximum likelihood scaling to the underlying transmission model. The results demonstrate that both data series plausibly follow from the transmission model specified, and suggest that the detection of viral RNA in sewage sludge leads hospital admissions by 4.6 days on average.


title: Reducing visible aerosol generation during phacoemulsification in the era of Covid-19

text: Objective: To assess potential methods of reducing visible aerosol generation during clear corneal phacoemulsification surgery in the era of Covid-19. Methods: Aerosol generation during phacoemulsification was assessed using a model comprising a human cadaveric corneoscleral rim mounted on an artificial anterior chamber. Typical phacoemulsification settings were used and visible aerosol production was recorded using high speed 4K camera. Aerosolisation was evaluated under various experimental settings: Two different phacoemulsification tip sizes (2.2mm, 2.75mm), varying levels of corneal moisture, the use of suction and blowing air in the surgical field, the use of hydroxypropyl methylcellulose (HPMC) coating of the cornea with a static and moving tip. Results: This model demonstrates visible aerosol generation during phacoemulsification with a 2.75mm phacoemulsification tip. No visible aerosol was noted with a 2.2mm tip. The presence of visible aerosol is unrelated to corneal wetting. Suction in close proximity to the aerosol plume did not impact on its dispersion. Blowing air redirected the aerosol plume towards the ocular surface. Visible aerosol production was abolished when HPMC was used to coat the cornea. This effect lasted for an average of 67{+/-}8 seconds in the static model. Visible aerosol generation was discerned during movement of the 2.2mm tip towards the corneal wound. Conclusions: We demonstrate visible aerosol production in the setting of a model of a clear cornea phacoemulsification. Visible aerosol can be reduced using a 2.2mm phacoemulsification tip and reapplying HPMC every minute during phacoemulsification.


title: Initial Model for Impact of Social Distancing on CoVID-19 Spread

text: The initial stages of the CoVID-19 coronavirus pandemic all around the world exhibit a nearly exponential rise in the number of infections with time. Planners, governments, and agencies are scrambling to figure out "How much? How bad?" and how to effectively treat the potentially large numbers of simultaneously sick people. Modeling the CoVID-19 pandemic using an exponential rise implicitly assumes a nearly unlimited population of uninfected persons ("dilute pandemic"). Once a significant fraction of the population is infected ("saturated pandemic"), an exponential growth no longer applies. A new model is developed here, which modifies the standard exponential growth function to account for factors such as Social Distancing. A Social Mitigation Parameter [SMP] /s is introduced to account for these types of society-wide changes, which can modify the standard exponential growth function, as follows: N(t)= No exp[ +Ko t/(1 + /s t)] . The doubling-time t/dbl=(ln2)/Ko can also be used to substitute for Ko, giving a {t/dbl, /s} parameter pair for comparing to actual CoVID-19 data. This model shows how the number of CoVID-19 infections can self-limit before reaching a saturated pandemic level. It also provides estimates for: (a) the timing of the pandemic peak, (b) the maximum number of new daily cases that would be expected, and (c) the expected total number of CoVID-19 cases. This model shows fairly good agreement with the presently available CoVID-19 pandemic data for several individual States, and the for the USA as a whole (6 Figures), as well as for various countries around the World (9 Figures). An augmented model with two Mitigation Parameters, /s and {beta}/s, is also developed, which can give better agreement with the daily new CoVID-19 data. Data-to-model comparisons also indicate that using /s by itself likely provides a worst-case estimate, while using both /s and {beta}/s likely provides a best-case estimate for the CoVID-19 spread.


title: Fear, anxiety and health-related consequences after the COVID-19 epidemic

text: The current COVID-19 pandemic is causing direct and indirect effects in the global population. In this paper, fear and its possible forthcoming consequences on health will be investigated and discussed. Fear is an innate reactive emotion to the immediate threats produced by danger. It is hardwired within subcortical survival circuits and originally had to defend the organism from predators. Besides, fear is a cognitive emotional process mediated by the cortical structures, and implies a subjective evaluation both at implicit (subsymbolic, unconscious) and explicit (symbolic, conscious) levels. Within a defensive taxonomy framework, fear can be defined as a reflex triggering a prompt behavior aimed at surviving from predating attacks (freezing), whereas anxiety as a deliberate pattern aimed at planning behaviors for anticipating and avoiding future harm. Fear and anxiety overlap at a subjective level, but are generated by different neurobiological networks and serve different evolutionary goals. The current viral danger and the need for social distancing worsen the sense of loneliness. A wide body of experimental and epidemiological literature evidence that psychological stress, social isolation, and loneliness have a detrimental effect on multiple health-related outcomes including comorbidity, multimorbidity, and mortality. The negative effects can be even higher for people currently living a massive limitation of physical and interpersonal contacts. A strong effort to integrate psychological and medical care is needed to face post-pandemic health issues.


title: La certificacion de la defuncion de casos de covid-19 en españa

text: Abstract La certificación de la defunción es un acto médico en el que el profesional debe poner el mismo esfuerzo y dedicación que en el resto de los informes elaborados en vida del paciente. Para su correcta cumplimentación el facultativo debe seguir las instrucciones básicas, poniendo especial cuidado en rellenar adecuadamente la secuencia de causas de muerte. En casos de pandemia, la cumplimentación del certificado de defunción corresponde a la medicina asistencial y para poder hacerlo, los organismos oficiales deben publicar instrucciones basadas en recomendaciones internacionales. Debe establecerse, cuanto antes, la posibilidad de comunicación telemática de las defunciones. Mientras eso no sea posible tienen que establecerse procedimientos que permitan en situación de pandemia, comunicar de forma inmediata la mortalidad a las autoridades sanitarias. Abstract Death certification requires the same effort and dedication as all reports by doctors during their patients’ lifetimes. The physician must follow the basic instructions to complete a death certificate correctly, taking special care to fill in the sequence of causes of death. In the case of a pandemic, completion of the death certificate falls to the primary care physician and therefore the official bodies must publish instructions based on international recommendations. It should be established as soon as possible whether it is possible to report deaths telematically. While this is not possible, in a pandemic procedures should be put in place to enable the immediate reporting of deaths to the health authorities.


title: Stress, burnout and depression in women in health care during COVID-19 Pandemic: Rapid Scoping Review

text: ABSTRACT Objectives The overall objectives of this rapid scoping review are to (a) synthesize the common triggers of stress, burnout, and depression faced by women in health care during the COVID-19 pandemic, and (b) identify individual-, organizational-, and systems-level interventions that can support the well-being of women HCWs during a pandemic. Design This scoping review is registered on Open Science Framework (OSF) and was guided by the JBI guide to scoping reviews and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping reviews. A systematic search of literature databases (Medline, EMBASE, CINAHL, PsycInfo and ERIC) was conducted from 2003 until June 12, 2020. Two reviewers independently assessed full-text articles according to predefined criteria. Interventions We included review articles and primary studies that reported on stress, burnout, and depression in HCWs; that primarily focused on women; and that included the percentage or number of women included. All English language studies from any geographical setting where COVID-19 has affected the population were reviewed. Primary and secondary outcome measures Studies reporting on mental health outcomes (e.g., stress, burnout, and depression in HCWs), interventions to support mental health well-being were included. Results Of the 2,803 papers found, 31 were included. The triggers of stress, burnout and depression are grouped under individual-, organizational-, and systems-level factors. There is a limited amount of evidence on effective interventions that prevents anxiety, stress, burnout and depression during a pandemic. Conclusions Our preliminary findings show that women HCWs are at increased risk for stress, burnout, and depression during the COVID-19 pandemic. These negative outcomes are triggered by individual level factors such as lack of social support; family status; organizational factors such as access to personal protective equipment or high workload; and systems-level factors such as prevalence of COVID-19, rapidly changing public health guidelines, and a lack of recognition at work. Keywords Coronavirus, COVID-19, women in health care, stress, burnout, depression


title: Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

text: The recent outbreak of COVID-19 has been rapidly spreading on a global scale. To date, there is no specific vaccine against the causative virus, SARS-CoV-2, nor is there an effective medicine for treating COVID-19, thus raising concerns with respect to the effect of risk factors such as clinical course and pathophysiological parameters on disease severity and outcome in patients with COVID-19. By extracting and analyzing all available published clinical data, we identified several major clinical characteristics associated with increased disease severity and mortality among patients with COVID-19. Specifically, preexisting chronic conditions such as hypertension, cardiovascular disease, chronic kidney disease, and diabetes are strongly associated with an increased risk of developing severe COVID-19; surprisingly, however, we found no correlation between chronic liver disease and increased disease severity. In addition, we found that both acute cardiac injury and acute kidney injury are highly correlated with an increased risk of COVID-19-related mortality. Given the high risk of comorbidity and the high mortality rate associated with tissue damage, organ function should be monitored closely in patients diagnosed with COVID-19, and this approach should be included when establishing new guidelines for managing these high-risk patients. Moreover, additional clinical data are needed in order to determine whether a supportive therapy can help mitigate the development of severe, potentially fatal complications, and further studies are needed to identify the pathophysiology and the mechanism underlying this novel coronavirus-associated infectious disease. Taken together, these findings provide new insights regarding clinical strategies for improving the management and outcome of patients with COVID-19.


title: Fusing a Bayesian case velocity model with random forest for predicting COVID-19 in the U.S.

text: Predictions of COVID-19 case growth and mortality are critical to the decisions of political leaders, businesses, and individuals grappling with the pandemic. This predictive task is challenging due to the novelty of the virus, limited data, and dynamic political and societal responses. We embed a Bayesian nonlinear mixed model and a random forest algorithm within an epidemiological compartmental model for empirically grounded COVID-19 predictions. The Bayesian case model fits a location-specific curve to the velocity (first derivative) of the transformed cumulative case count, borrowing strength across geographic locations and incorporating prior information to obtain a posterior distribution for case trajectory. The compartmental model uses this distribution and predicts deaths using a random forest algorithm trained on COVID-19 data and population-level characteristics, yielding daily projections and interval estimates for infections and deaths in U.S. states. We evaluate forecasting accuracy on a two-week holdout set, finding that the model predicts COVID-19 cases and deaths well, with a mean absolute scaled error of 0.40 for cases and 0.32 for deaths throughout the two-week evaluation period. The substantial variation in predicted trajectories and associated uncertainty between states is illustrated by comparing three unique locations: New York, Ohio, and Mississippi. The sophistication and accuracy of this COVID-19 model offer reliable predictions and uncertainty estimates for the current trajectory of the pandemic in the U.S. and provide a platform for future predictions as shifting political and societal responses alter its course.


title: COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients

text: BACKGROUND Corona Virus Disease 2019 (COVID-19) is spreading worldwide. Effective screening for patients is important to limit the epidemic. However, some defects make the currently applied diagnosis methods are still not very ideal for early warning of patients. We aimed to develop a diagnostic model that allows for the quick screening of highly suspected patients using easy-to-get variables. METHODS A total of 1,311 patients receiving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleicacid detection were included, whom with a positive result were classified into COVID-19 group. Multivariate logistic regression analyses were performed to construct the diagnostic model. Receiver operating characteristic (ROC) curve analysis were used for model validation. RESULTS After analysis, signs of pneumonia on CT, history of close contact, fever, neutrophil-to-lymphocyte ratio (NLR), Tmax and sex were included in the diagnostic model. Age and meaningful respiratory symptoms were enrolled into COVID-19 early warning score (COVID-19 EWS). The areas under the ROC curve (AUROC) indicated that both of the diagnostic model (training dataset 0.956 [95%CI 0.935-0.977, P < 0.001]; validation dataset 0.960 [95%CI 0.919-1.0, P < 0.001] ) and COVID-19 EWS (training dataset 0.956 [95%CI 0.934-0.978, P < 0.001] ; validate dataset 0.966 [95%CI 0.929-1, P < 0.001]) had good discrimination capacity. In addition, we also obtained the cut-off values of disease severity predictors, such as CT score, CD8+ T cell count, CD4+ T cell count, and so on. CONCLUSIONS The new developed COVID-19 EWS was a considerable tool for early and relatively accurately warning of SARS-CoV-2 infected patients.


title: Evaluations of serological test in the diagnosis of 2019 novel coronavirus (SARS-CoV-2) infections during the COVID-19 outbreak

text: The ongoing SARS-CoV-2 outbreak has killed over twenty-one thousand and sickened over four hundred thousand people worldwide, posing a great challenge to global public health. A sensitive and accurate diagnosis method will substantially help to control disease expansion. Here, we developed a chemiluminescence-immunoassay method based on the recombinant nucleocapsid antigen and the magnetic beads for diagnosis of SARS-CoV-2 infections and surveillance of antibody changing pattern. Serums from 29 healthy individuals, 51 tuberculosis patients, and 79 SARS-CoV-2 confirmed patients were employed to evaluate the performance of this approach. Compared to the IgM testing, the IgG testing was more reliable in which it identified 65 SARS-CoV-2 infections from the 79 confirmed patients and only two false-positive cases from the 80 control group with a sensitivity and specificity reaching 82.28% and 97.5%, respectively. However, only a slight difference (not statistically significant) in the detected cases of SARS-CoV-2 infections was observed between the IgM and IgG testing manner in patients at a different time of onset of disease. A performance comparison between an ELISA kit using the same nucleocapsid antigen and our chemiluminescence method was undertaken. The same false-positive cases were seen in both methods from the paired control group, while ELISA kit can only detect half of the SARS-CoV-2 infections from paired SARS-CoV-2 confirmed patients group than that of the chemiluminescence method, indicating a higher performance for the chemiluminescence-immunoassay approach. Together, our studies provide a useful and valuable serological testing tool for the diagnosis of SARS-CoV-2 infections in the community.


title: The first 100 days of SARS-CoV-2 control in Vietnam

text: Background: One hundred days after SARS-CoV-2 was first reported in Vietnam on January 23rd, 270 cases have been confirmed, with no deaths. We describe the control measures used and their relationship with imported and domestically-acquired case numbers. Methods: Data on the first 270 SARS-CoV-2 infected cases and the timing and nature of control measures were captured by Vietnam's National Steering Committee for COVID-19 response. Apple and Google mobility data provided population movement proxies. Serial intervals were calculated from 33 infector-infectee pairs and used to estimate the proportion of pre-symptomatic transmission events and time-varying reproduction numbers. Results: After the first confirmed case on January 23rd, the Vietnamese Government initiated mass communications measures, contact tracing, mandatory 14-day quarantine, school and university closures, and progressive flight restrictions. A national lockdown was implemented between April 1st and 22nd. Around 200,000 people were quarantined and 266,122 RT-PCR tests conducted. Population mobility decreased progressively before lockdown. 60% (163/270) of cases were imported; 43% (89/208) of resolved infections were asymptomatic. 21 developed severe disease, with no deaths. The serial interval was 3.24 days, and 27.5% (95% confidence interval, 15.7%-40.0%) of transmissions occurred pre-symptomatically. Limited transmission amounted to a maximum reproduction number of 1.15 (95% confidence interval, 0.37-2.36). No community transmission has been detected since April 15th. Conclusions: Vietnam has controlled SARS-CoV-2 spread through the early introduction of communication, contact-tracing, quarantine, and international travel restrictions. The value of these interventions is supported by the high proportion of asymptomatic cases and imported cases, and evidence for substantial pre-symptomatic transmission.


title: Early phylodynamics analysis of the COVID-19 epidemics in France

text: France was one of the first countries to be reached by the COVID-19 pandemics. Here, we analyse 196 SARS-Cov-2 genomes collected between Jan 24 and Mar 24 2020, and perform a phylodynamics analysis. In particular, we analyse the doubling time, reproduction number (Rt) and infection duration associated with the epidemic wave that was detected in incidence data starting from Feb 27. We show that a slowing down of the epidemic spread can be detected in Mar, which is consistent with the implementation of the national lock-down on Mar 17. The inferred distributions for the infection duration and Rt are in line with those estimated from contact tracing data. Overall, this analysis shows the potential to use sequence genomic data to inform public health decisions in an epidemic crisis context.


title: Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy, MRI Brain and Cerebrospinal Fluid Findings: Case 2

text: The neurological complications of coronavirus disease 2019 (COVID-19) are being better understood as the pandemic progresses. We report a second case of a patient who presented with COVID-19 infection and encephalopathy to our institution. In addition, we report MRI brain and cerebrospinal fluid data. COVID-19 does not seem to cross the blood-brain barrier. The exact mechanisms of encephalopathy and pathological response of COVID-19 are unknown.


title: Pandemia por COVID-19 no Brasil: análise da demanda e da oferta de leitos hospitalares e equipamentos de ventilação assistida segundo diferentes cenários/ Pandemia por COVID-19 en Brasil: análisis de la demanda y oferta de camas hospitalarias, así como equipamientos de ventilación asistida, según diferentes escenarios/ The COVID-19 pandemic in Brazil: analysis of supply and demand of hospital and ICU beds and mechanical ventilators under different scenarios

text: O objetivo deste estudo é analisar a pressão sobre o sistema de saúde no Brasil decorrente da demanda adicional gerada pela COVID-19. Para tanto, foi realizado um conjunto de simulações para estimar a demanda de leitos gerais (microrregiões de saúde), leitos de UTI e equipamentos de ventilação assistida (macrorregiões de saúde) em diferentes cenários, para intensidade (taxas de infecção equivalentes a 0,01, 0,1 e 1 caso por 100 habitantes) e horizontes temporais (1, 3 e 6 meses). Os resultados evidenciam uma situação crítica do sistema para atender essa demanda potencial, uma vez que diversas microrregiões e macrorregiões de saúde operariam além de sua capacidade, comprometendo o atendimento a pacientes principalmente aqueles com sintomas mais severos. O estudo apresenta três mensagens relevantes. Em primeiro lugar, é necessário reduzir a velocidade de propagação da COVID-19 na população brasileira, permitindo um tempo maior para a reorganização da oferta e aliviando a pressão sobre o sistema de saúde. Segundo, é necessário expandir o número de leitos disponíveis. Ainda que o setor privado contribua para amortecer o déficit de demanda, a oferta conjunta dos dois setores não seria suficiente em várias macrorregiões. A construção de hospitais de campanha é importante, tanto em locais onde historicamente há vazios assistenciais como também naqueles onde já se observa uma pressão do lado da demanda. A terceira mensagem diz respeito à organização regionalizada dos serviços de saúde que, apesar de adequada em situações de demanda usual, em momentos de pandemia este desenho implica desafios adicionais, especialmente se a distância que o paciente tiver de percorrer for muito grande.


title: Herbivore-induced activation of viral phosphatase disarms plant antiviral immunities for pathogen transmission

text: The survival of pathogens depends on their ability to overcome host immunity, especially arthropod-borne viruses (arboviruses) which must withstand the immune responses of both the host and the arthropod vector. Successful arboviruses often modify host immunity to accelerate pathogen transmission; however, few studies have explored the underlying mechanism. Here we report attracted herbivore infestation on the virus-infected plants promote transmission by the associated vector herbivore. This herbivore-induced defense suppression underpins a subversive mechanism used by Begomovirus, the largest genus of plant viruses, to compromise host defense for pathogen transmission. Begomovirus-infected plants accumulated βC1 proteins in the phloem where they were bound to host defense regulators, transcription factor WRKY20 and two mitogen-activated protein kinases MPK3 and MPK6. Once perceiving whitefly herbivory or endogenous secreted peptide PEP1, the plants started dephosphorylation on serine33 and stimulated βC1 protein as a phosphatase. βC1 dephosphorylated MPK3/6 and WRKY20, the latter negatively regulated salicylic acid signaling and vascular callose deposition. This viral hijacking of WRKY20 accumulated more vascular callose by which enforced whitefly prolonged salivation and phloem sap ingestion, therefore impelling more virus transmission among plants. We present a scenario in which viruses dynamically respond to the presence of their vectors, suppressing host immunity and promoting pathogen transmission only when needed.


Breaking News: The Harm of Treating Fear in COVID-19


title: A digital supply chain twin for managing the disruption risks and resilience in the era of Industry 4.0

text: We theorize a notion of a digital supply chain (SC) twin–a computerized model that represents network states for any given moment in real time. We explore the conditions surrounding the design and implementation of the digital twins when managing disruption risks in SCs. The combination of model-based and data-driven approaches allows uncovering the interrelations of risk data, disruption modeling, and performance assessment. The SC shocks and adaptations amid the COVID-19 pandemic along with post-pandemic recoveries provide indisputable evidences for the urgent needs of digital twins for mapping supply networks and ensuring visibility. The results of this study contribute to the research and practice of SC risk management by enhancing predictive and reactive decisions to utilize the advantages of SC visualization, historical disruption data analysis, and real-time disruption data and ensure end-to-end visibility and business continuity in global companies.


title: Investigation on the interaction between nifedipine and ritonavir containing antivirus regimens: a physiologically-based pharmacokinetic/pharmacodynamic analysis

text: Background and Objective Hypertension is a common comorbidity of patients with COVID-19, SARS or HIV infection. Those patients are often treated with commonly used antiviral and antihypertensive agents concomitantly, such as ritonavir-containing regimens and nifedipine. Since ritonavir is a strong inhibitor of CYP3A, when nifedipine is combined with ritonavir-containing antiviral drugs, there is a potential risk of drug-drug interaction. This study aimed to provide guidance on nifedipine treatment during and after co-administration with ritonavir-containing regimens using a physiologically-based pharmacokinetic/pharmacodynamic (PBPK/PD) analysis. Methods A PBPK/PD model was developed for nifedipine by the software of Simcyp, and the model was verified using published data. The effects of ritonavir on nifedipine exposures and systolic blood pressure were assessed for instant-release, sustained-release and controlled-release formulations. Moreover, various nifedipine regimens were investigated when co-administrated with and withdrawing ritonavir. Results PBPK/PD models for three formulations of nifedipine were successfully established. The model predicted pharmacokinetic profiles of nifedipine were comparable to the published data. Ratios of predicted versus observed AUCDDI/AUCNifedipine of nifedipine were within 0.70- to 1.83-fold. Model simulations showed that the inhibitory effect of ritonavir on CYP3A4 increased the Cmax of nifedipine by 9.82-34.35 times and the AUC by 44.94-50.77 times at steady state. Moreover, nifedipine dose reduced to 1/16 of the regular dose during ritonavir co-administration could lead to severe hypotension. Conclusions Ritonavir had a pronounced influence on the pharmacokinetics and antihypertensive effect of nifedipine. It is not recommended for patients to take nifedipine and ritonavir-containing regimens simultaneously.


title: Estimating required lockdown cycles before immunity to SARS-CoV-2: Model-based analyses of susceptible population sizes, S0, in seven European countries including the UK and Ireland

text: Background: Following stringent social distancing measures, some European countries are beginning to report a slowed or negative rate of growth of daily case numbers testing positive for the novel coronavirus. The notion that the first wave of infection is close to its peak begs the question of whether future peaks or second waves are likely. We sought to determine the current size of the effective (i.e. susceptible) population for seven European countries - to estimate immunity levels following this first wave. We compare these numbers to the total population sizes of these countries, in order to investigate the potential for future peaks. Methods: We used Bayesian model inversion to estimate epidemic parameters from the reported case and death rates from seven countries using data from late January 2020 to April 5th 2020. Two distinct generative model types were employed: first a continuous time dynamical-systems implementation of a Susceptible-Exposed-Infectious-Recovered (SEIR) model and second: a partially observable Markov Decision Process (MDP) or hidden Markov model (HMM) implementation of an SEIR model. Both models parameterise the size of the initial susceptible population (S0), as well as epidemic parameters. Parameter estimation (data fitting) was performed using a standard Bayesian scheme (variational Laplace) designed to allow for latent unobservable states and uncertainty in model parameters. Results: Both models recapitulated the dynamics of transmissions and disease as given by case and death rates. The peaks of the current waves were predicted to be in the past for four countries (Italy, Spain, Germany and Switzerland) and to emerge in 0.5-2 weeks in Ireland and 1-3 weeks in the UK. For France one model estimated the peak within the past week and the other in the future in two weeks. Crucially, Maximum a posteriori (MAP) estimates of S0 for each country indicated effective population sizes of below 20% (of total population size), under both the continuous time and HMM models. Using for all countries, with a Bayesian weighted average across all seven countries and both models, we estimated that 6.4% of the total population would be immune. From the two models the maximum percentage of the effective population was estimated at 19.6% of the total population for the UK, 16.7% for Ireland, 11.4% for Italy, 12.8% for Spain, 18.8% for France, 4.7% for Germany and 12.9% for Switzerland. Conclusion: Our results indicate that after the current wave, a large proportion of the total population will remain without immunity. This suggests that in the absence of strong seasonal effects, new medications or more comprehensive contact tracing, a further set of epidemic waves in different geographic centres are likely. These findings may have implications for exit strategies from any lockdown stage.


title: Increased plasma heparanase activity in COVID-19 patients

text: Background: Several reports suggest endothelial dysfunction and loss of endothelial barrier function in COVID-19. It is well established that the endothelial glycocalyx-degrading enzyme heparanase (HPSE) contributes to vascular leakage and inflammation. Low molecular weight heparins (LMWH) serve as an inhibitor of heparanase. We hypothesize that heparanase contributes to the pathogenesis of COVID-19, and that HPSE may be inhibited by the use of LMWH. Methods: Heparanase activity and heparan sulfate levels were measured in plasma of healthy controls (n=10) and COVID-19 patients (n=48). Findings: Heparanase activity and heparan sulfate levels were significantly elevated in plasma of COVID-19 patients. There was an association between heparanase activity and disease severity including the need for intensive care and mechanical ventilation, lactate dehydrogenase levels and creatinine levels. Use of prophylactic low molecular weight heparin in non-ICU patients was associated with a reduced HPSE activity. Interpretation: Prophylactic doses of low molecular weight heparin reduces heparanase activity in COVID-19. In addition to HPSE inhibition, low molecular weight heparin contributes to anti-coagulation and may exert anti-inflammatory effects. Since there is no other clinically applied heparanase inhibitor currently available, treatment of COVID-19 patients with low molecular weight heparins should be explored. Funding: This study was financially supported by the Radboudumc PhD fellow program, consortium grant LSHM16058-SGF (GLYCOTREAT; a collaborative project financed by the PPP allowance made available by Top Sector Life Sciences & Health to the Dutch Kidney Foundation to stimulate public-private partnerships), ERC Advanced grant (#833247) and a Spinoza Grant of the Netherlands Organization for Scientific Research.


title: Impact of hospitalised patients with COVID-19 taking Renin-Angiotensin-Aldosterone System inhibitors: a systematic review and meta-analysis

text: Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS) notably Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) have been scrutinised in hypertensive patients hospitalised with coronavirus disease 2019 (COVID-19) following some initial data they might adversely affect prognosis. With an increasing number of COVID-19 cases worldwide and the likelihood of a second wave of infection it is imperative to better understand the impact RAAS inhibitor use in antihypertensive covid positive hospitalised patients. A systematic review and meta-analysis of ACEi or ARB in patients admitted with COVID-19 was conducted. PubMed and Embase were searched and six studies were included in the meta-analysis. Pooled analysis demonstrated that 18.3% of the patients admitted with COVID-19 were prescribed ACEi/ARBs (0.183, CI 0.129 to 0.238, p<0.001). The use of RAAS inhibitors did not show any association with critical events (Pooled OR 0.833 CI 0.605 to 1.148, p=0.264) or death (Pooled OR 0.650, CI 0.356 to 1.187, p=0.161). In conclusion, our meta-analysis including critical events and mortality data on patients prescribed ACEi/ARB and hospitalised with COVID-19, found no evidence to associate ACEi/ARB with death or adverse events.


title: Public Knowledge and Practices regarding COVID-19: A cross-sectional survey from Pakistan

text: Effective mitigation of coronavirus diseases (COVID-19) pandemic required true adoption of precautionary measures by the masses, that primarily depends upon their knowledge and practices behaviors. The current study aimed to evaluate the knowledge; practices of Pakistani residents regarding COVID-19 and factors associated with good knowledge and positive practices. A cross-sectional online survey was conducted from 15-April 2020 to 20 May 2020 among 689 Pakistanis by using a validated self-administered questionnaire. Regression analysis was applied to find potential predictor of knowledge and practices. Of 689 participants, more than half had good knowledge; 80% had good practices regarding COVID-19 and majority seek knowledge from social media. Knowledge was significantly higher (OR>1.00, p<0.05) among educated and higher income participants. Positive practices were significantly (OR>1.00, p<0.05) related to the older age ([≥]50 years), higher education, higher income and good knowledge regarding COVID-19. The study concluded that Pakistani residents had good knowledge and practices towards COVID-19 yet there are gaps in specific aspects of knowledge, and practice that should be focused in future awareness and educational campaigns. The study recommends the ministry of health authorities to promote all precautionary and preventive measures of COVID-19-consisting of a better-organized approach- to all strata of society: less privileged people, older ones and less educated people, in order to have equilibrium of knowledge about COVID-19; hence effective implementation of precautionary measures.


docid: rytwwgvj

title: Design of a robot end effector with measurement system for precise pick-and-place of square objects

text: Abstract Future manufacturing requires increasing participation of the robots for pick-and-place task. One of the main error sources that reduce the final accuracy of the task is the pose deviation between the end effector (EF) of the robot and its manipulated target object (TO). In this paper, to improve the accuracy, an end effector and its affiliated measurement system, which can measure the relative pose deviation between the TO and the EF, was designed for the precise pick-and-place of the square TOs. In the design, an additional measurement frame (“Frame” for short) with CCD laser displacement sensors was established as a media to transform the pose of the TO to the expression in the coordinate system (CS) of the EF by both describing the pose of the EF and of the TO in the Frame’s CS separately. The geometric model of the entire design, in which the pose deviation of the TO was expressed as a function of the readings of the 16 CCD displacement sensors, was also established. To verify the effectiveness of the design and of the accuracy of the geometric model, an experiment was performed on an ABB irb4600 robot to compensate the error between the EF and its grasped TO in a pick-and-place task. Results show that the average errors can be reduced by around 85%.


title: Lack of susceptibility of poultry to SARS-CoV-2 and MERS-CoV

text: Chickens, turkeys, ducks, quail and geese were challenged with SARS-CoV-2 or MERS-CoV. No disease was observed, no virus replication was detected, and antibodies were not detected in serum. Neither virus replicated in embryonating chicken’s eggs. Poultry are unlikely to serve a role in the maintenance of either virus.


title: Introduction to and spread of COVID-19 in care homes in Norfolk, UK

text: BACKGROUND: Residential care homes for the elderly have been important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. METHODS: We undertook a secondary analysis of a dataset about 248 care homes in the county of Norfolk, eastern England. The dataset recorded categories of staff (nurses, care workers and non-care workers), their status (available, absent due to leave or sickness and extra staff needed to address the coronavirus pandemic) in the period 6 April -6 May 2020. Counts of residents (if any) at each care home with COVID-19 were also available, as well as descriptions of access by the home to personal protection equipment (PPE: gloves, masks, eye protection, aprons and Sanitiser). PPE access was categorised as (most to least) green, amber or red. We undertook two stage modelling, first for any detection of COVID-19 in the homes, and a second model to relate any increases in case counts after introduction to staffing or PPE levels. RESULTS: We found that the counts of non-care workers had strongest relationships (and only link significant at p < 0.05) to any introduction of SARS-CoV-2 to the homes. After a home had at least one detected case, higher staff levels and more severe PPE shortages were most linked to higher case counts (p < 0.05) during the monitoring period. CONCLUSION: Better managing aspects of staff interaction with residents and some working practices should help reduce ingression to and spread of COVID-19 within residential homes for the elderly.


title: An emerging antiviral takes aim at COVID-19

text: As the COVID-19 pandemic shut down much of the world, George Painter’s life geared up considerably In a matter of weeks, Painter and his collaborators have seen the antiviral they were working on—EIDD-2801—go from a promising therapeutic for influenza to a potential weapon in the fight against COVID-19, the disease caused by the novel coronavirus The drug candidate began a human safety trial in the UK in mid-April, and a US trial is planned to begin in the next few weeks Painter, a virologist and chemist by training, has devoted his career to working on antivirals, coinventing several approved drugs for HIV and hepatitis B In 2013, after decades in industry, he joined Drug Innovation Ventures at Emory (DRIVE) as its CEO and became director of the Emory Institute for Drug Development (EIDD) DRIVE and the EIDD aim to move drug candidates from early-stage development and preclinical testing to proof-of-concept[truncated]


title: A Model for Supply-Chain Decisions for Resource Sharing with an Application to Ventilator Allocation to Combat COVID-19

text: This paper presents a stochastic optimization model for allocating and sharing a critical resource in the case of a pandemic. The demand for different entities peaks at different times, and an initial inventory from a central agency is to be allocated. The entities (states) may share the critical resource with a different state under a risk-averse condition. The model is applied to study the allocation of ventilator inventory in the COVID-19 pandemic by the Federal Emergency Management Agency of the U.S. Department of Homeland Security (FEMA) to different states in the US. Findings suggest that if less than 60% of the ventilator inventory is available for non-COVID-19 patients, FEMA's stockpile of 20,000 ventilators (as of 03/23/2020) would be nearly adequate to meet the projected needs. However, when more than 75% of the available ventilator inventory must be reserved for non-COVID-19 patients, various degrees of shortfall are expected. In an extreme case, where the demand is assumed to be concentrated in the top-most quartile of the forecast confidence interval, the total shortfall over the planning horizon (till 05/31/20) is about 28,500 ventilator days, with a peak shortfall of 2,700 ventilators on 04/12/20. The results also suggest that in the worse-than-average to severe demand scenario cases, NY requires between 7,600-9,200 additional ventilators for COVID-19 patients during its peak demand. However, between 400 to 2,000 of these ventilators can be given to a different state after the peak demand in NY has subsided.


title: Respiratory Distress in SARS-CoV-2 without Lung Damage: Phrenic Paralysis Should Be Considered in COVID-19 Infection

text: We describe an overweight COVID-19 patient with respiratory distress preceded by anosmia/dysgeusia with no lung injury shown on CT, angio-CT or ventilation/perfusion scans. Orthopnoea and paradoxical abdominal respiration were identified. Phrenic paralysis, demonstrated by examination of patient breathing, and on x-ray while standing breathing in and out, explained the respiratory distress. This is a rare and previously undescribed neurological complication of COVID-19 infection caused by vagus nerve injury. LEARNING POINTS: Phrenic paralysis must be kept in mind as a rare neurological complication of COVID-19. Vagus nerve palsy is a neurological manifestation as anosmia and dysgeusia, that were already identified in the olfactory system of COVID-19 patients.


title: SARS-CoV-2 contributes to altering the post-transcriptional regulatory networks across human tissues by sponging RNA binding proteins and micro-RNAs

text: The outbreak of a novel coronavirus SARS-CoV2 responsible for COVID-19 pandemic has caused worldwide public health emergency. Due to the constantly evolving nature of the coronaviruses, SARS-CoV-2 mediated alteration on post-transcriptional gene regulation across human tissues remains elusive. In this study, we systematically dissected the crosstalk and dysregulation of human post-transcriptional regulatory networks governed by RNA binding proteins (RBPs) and micro-RNAs (miRs), due to SARS-CoV-2 infection. We uncovered that 13 out of 29 SARS-CoV-2 encoded proteins directly interact with 51 human RBPs of which majority of them were abundantly expressed in gonadal tissues and immune cells. We further performed functional analysis of differentially expressed genes in mock treated versus SARS-CoV-2 infected lung cells that revealed an enrichment for immune response, cytokine mediated signaling, and metabolism associated genes. This study also characterized the alternative splicing events in SARS-CoV-2 infected cells compared to control demonstrating that skipped exons and mutually exclusive exons were the most abundant events that potentially contributed to differential outcomes in response to viral infection. Motif enrichment analysis on the RNA genomic sequence of SARS-CoV-2 clearly revealed an enrichment for RBPs such as SRSFs, PCBPs, ELAVs and HNRNPs illustrating the sponging of RBPs by SARS-CoV-2 genome. Similar analysis to study the interactions of miRs with SARS-CoV-2 revealed the potential for several miRs to be sponged, suggesting that these interactions may contribute to altered pos-transcriptional regulation across human tissues. Given the need to understand the interactions of SARS-CoV-2 with key pos-transcriptional regulators in the human genome, this study provides a systematic analysis to dissect the role of dysregulated post-transcriptional regulatory networks controlled by RBPs and miRs, across tissues types during SARS-CoV2 infection.


title: A comparative multi-centre study on the clinical and imaging features of comfirmed and uncomfirmed patients with COVID-19

text: Background Previous studies had described the differences in clinical characteristics between ICU and non-ICU patients. However, seldom study focused on confirmed and unconfirmed groups. Our aim was to compare clinical and imaging characteristics of COVID-19 patients outside Hubei province between confirmed and unconfirmed group. Methods We retrospectively enrolled 163 consecutive adult patients with suspected COVID-19 from three tertiary hospitals in two provinces outside Hubei province from January 12, 2020 to February 13, 2020 and the differences in epidemiological, clinical, laboratory and imaging characteristics between the two groups were compared. Results This study enrolled 163 patients with 62 confirmed cases and 101 unconfirmed cases. Most confirmed patients were clustered (31, 50.0%) and with definite epidemiological exposure. Symptoms of COVID-19 were nonspecific, largely fever and dry cough. Laboratory findings in confirmed group were characterized by normal or reduced white blood cell count, reduced the absolute value of lymphocytes, and elevated levels of C-reactive protein (CRP) and accelerated Erythrocyte sedimentation rate (ESR). The typical chest CT imaging features of patients with confirmed COVID-19 were peripherally distributed multifocal GGO with predominance in the lower lung lobe. Compared with unconfirmed patients, confirmed patients had significantly higher proportion of dry cough, leucopenia, lymphopenia and accelerated ESR (P<0.05); but not with alanine aminotransferase, aspartate aminotransferase, D-dimer, lactic dehydrogenase, and myoglobin (P>0.05). Proportion of peripheral, bilateral or lower lung distribution and multi-lobe involvement, GGO, crazy-paving pattern, air bronchogram and pleural thickening in the confirmed group were also higher (P<0.05). Conclusions Symptoms of COVID-19 were nonspecific. Leukopenia, lymphopenia and ESR, as well as chest CT could be used as a clue for clinical diagnosis of COVID-19.


title: Multi-epitope-based peptide vaccine design against SARS-CoV-2 using its spike protein

text: SARS CoV-2 has particularly been efficient in ensuring that many countries are brought to a standstill. With repercussions ranging from rampant mortality, fear, paranoia and economic recession, the virus has brought together countries in order to look at possible therapeutic countermeasures. With prophylactic interventions possibly months away from being particularly effective, a slew of measures and possibilities concerning the design of vaccines are being worked upon. We attempted a structure-based approach utilizing a combination of epitope prediction servers to develop a multi-epitope-based subunit vaccine that involves the two major domains of the spike glycoprotein of SARS CoV-2 (S1 and S2) coupled with a substantially effective chimeric adjuvant to create stable vaccine constructs through MD simulations. The designed constructs were evaluated based on their docking with Toll Like Receptor (TLR) 4. Our findings provide an epitope-based peptide fragment; which can be a potential candidate for the development of a vaccine against SARS-CoV-2. Recent experimental studies based on determining immunodominant regions across the spike glycoprotein of SARS-CoV-2 indicate the presence of the predicted epitopes included in this study.


title: Early Detection and Assessment of Covid-19

text: Background: Since the Covid-19 global pandemic emerged, developing countries have been facing multiple challenges over its diagnosis. We aimed to establish a relationship between the signs and symptoms of COVID-19 for early detection and assessment to reduce the transmission rate of SARS-Cov-2. Methods: We collected published data on the clinical features of Covid-19 retrospectively and categorized them into physical and blood biomarkers. Common features were assigned scores by the Borg scoring method with slight modifications and were incorporated into a newly-developed Hashmi-Asif Covid-19 assessment Chart. Correlations between signs and symptoms with the development of Covid-19 was assessed by Pearson correlation and Spearman Correlation coefficient (rho). Linear regression analysis was employed to assess the highest correlating features. The frequency of signs and symptoms in developing Covid-19 was assessed through Chi-square test two tailed with Cramer's V strength. Changes in signs and symptoms were incorporated into a chart that consisted of four tiers representing disease stages. Results: Data from 10,172 Covid-19 laboratory confirmed cases showed a correlation with Fever in 43.9% (P = 0.000) cases, cough 54.08% and dry mucus 25.68% equally significant (P = 0.000), Hyperemic pharyngeal mucus membrane 17.92% (P = 0.005), leukopenia 28.11% (P = 0.000), lymphopenia 64.35% (P = 0.000), thrombopenia 35.49% (P = 0.000), elevated Alanine aminotransferase 50.02% (P = 0.000), and Aspartate aminotransferase 34.49% (P = 0.000). The chart exhibited a maximum scoring of 39. Normal tier scoring was ≤ 12/39, mild state scoring was 13–22/39, and star values scoring was ≥7/15; this latter category on the chart means Covid-19 is progressing and quarantine should be adopted. Moderate stage scored 23–33 and severe scored 34–39 in the chart. Conclusion: The Hashmi-Asif Covid-19 Chart is significant in assessing subclinical and clinical stages of Covid-19 to reduce the transmission rate.


title: Cardiorespiratory physiological perturbations after acute smoke-induced lung injury and during extracorporeal membrane oxygenation support in sheep

text: Background Numerous successful therapies developed for human medicine involve animal experimentation. Animal studies that are focused solely on translational potential, may not sufficiently document unexpected outcomes. Considerable amounts of data from such studies could be used to advance veterinary science. For example, sheep are increasingly being used as models of intensive care and therefore, data arising from such models must be published. In this study, the hypothesis is that there is little information describing cardiorespiratory physiological data from sheep models of intensive care and the author aimed to analyse such data to provide biological information that is currently not available for sheep that received extracorporeal life support (ECLS) following acute smoke-induced lung injury. Methods Nineteen mechanically ventilated adult ewes undergoing intensive care during evaluation of a form of ECLS (treatment) for acute lung injury were used to collate clinical observations. Eight sheep were injured by acute smoke inhalation prior to treatment (injured/treated), while another eight were not injured but treated (uninjured/treated). Two sheep were injured but not treated (injured/untreated), while one received room air instead of smoke as the injury and was not treated (placebo/untreated). The data were then analysed for 11 physiological categories and compared between the two treated groups. Results Compared with the baseline, treatment contributed to and exacerbated the deterioration of pulmonary pathology by reducing lung compliance and the arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio. The oxygen extraction index changes mirrored those of the PaO2/FiO2 ratio. Decreasing coronary perfusion pressure predicted the severity of cardiopulmonary injury. Conclusions These novel observations could help in understanding similar pathology such as that which occurs in animal victims of smoke inhalation from house or bush fires, aspiration pneumonia secondary to tick paralysis and in the management of the severe coronavirus disease 2019 (COVID-19) in humans.


title: Understanding, prevention and treatment of COVID-19 from perspective of ethnic medicine/ 民族医药对新型冠状病毒肺炎的认识及防治措施

text: The coronavirus disease 2019 (COVID-19) has been developing rapidly since the outbreak of Wuhan in December 2019. It has spread to many regions in the world in the short term, which has attracted wide attention at home and abroad. With the active intervention of traditional medicine, the epidemic situation has been effectively controlled, especially for the treatment of severe and critical patients, which shows its unique advantages. Since the outbreak of COVID-19, ethnic medical practitioners have made suggestions on the understanding and prevention measures of COVID-19 based on the theory of ethnic medicine. We should optimize the individual internal environment of patients with individualized traditional medicine prescription, combine the environmental factors such as the soil and space for the emergence and spread of the disease, and contribute our own strength to fighting against the epidemic as soon as possible and ensure the life and health of the minority people. It was suggested to set up a project to excavate, sort out, research and develop the preparations of medical institutions for the prevention and treatment of “pestilence” by national medicine, and make sufficient preparations for the prevention and treatment of “pestilence” caused by various viruses that may occur frequently, so as to protect human health.


title: Preventing respiratory illness in older adults aged 60 years and above living in long-term care: A rapid overview of reviews

text: Background: The overall objective of this rapid overview of reviews (overview hereafter) was to identify evidence from systematic reviews (SRs) for infection control and prevention practices for adults aged 60 years and older in long-term care settings. Methods: Comprehensive searches in MEDLINE, EMBASE, the Cochrane Library, biorxiv.org/medrxiv.org, clinicaltrials.gov and the Global Infectious Disease Epidemiology Network (GIDEON) were carried out in early March 2020. Title/abstract and full-text screening, data abstraction, and quality appraisal (AMSTAR 2) were carried out by single reviewers. Results: A total of 6 SRs published between 1999 and 2018 were identified and included in the overview. The SRs included between 1 and 37 primary studies representing between 140 to 908 patients. All of the primary studies included in the SRs were carried out in long-term care facilities (LTCF) and examined pharmacological, non-pharmacological, or combined interventions. One high quality SR found mixed results for the effectiveness of hand hygiene to prevent infection (2 studies statistically significant positive results, 1 study non-statistically significant results). One moderate quality SR with meta-analysis found a moderate non-statistically significant effect for personal protective equipment (PPE) in preventing infection and found no statistically significant results for the effectiveness of social isolation. One moderate quality SR reported statically significant evidence for the effectiveness of amantadine and amantadine + PPE to prevent infection with respiratory illness in LTCF. Conclusion: The current evidence suggests that with antiviral chemoprophylaxis with adamantine is effective in managing respiratory illness in residents of long-term care facilities. The rest of the strategies can be used in long-term care facilities, yet have limited evidence supporting their use from systematic reviews.


docid: ymvrserl

title: Immunoinformatic identification of B cell and T cell epitopes in the SARS-CoV-2 proteome

text: A novel coronavirus (SARS-CoV-2) emerged from China in late 2019 and rapidly spread across the globe, infecting millions of people and generating societal disruption on a level not seen since the 1918 influenza pandemic. A safe and effective vaccine is desperately needed to prevent the continued spread of SARS-CoV-2; yet, rational vaccine design efforts are currently hampered by the lack of knowledge regarding viral epitopes targeted during an immune response, and the need for more in-depth knowledge on betacoronavirus immunology. To that end, we developed a computational workflow using a series of open-source algorithms and webtools to analyze the proteome of SARS-CoV-2 and identify putative T cell and B cell epitopes. Using increasingly stringent selection criteria to select peptides with significant HLA promiscuity and predicted antigenicity, we identified 41 potential T cell epitopes (5 HLA class I, 36 HLA class II) and 6 potential B cell epitopes, respectively. Docking analysis and binding predictions demonstrated enrichment for peptide binding to HLA-B (class I) and HLA-DRB1 (class II) molecules. Overlays of predicted B cell epitopes with the structure of the viral spike (S) glycoprotein revealed that 4 of 6 epitopes were located in the receptor-binding domain of the S protein. To our knowledge, this is the first study to comprehensively analyze all 10 (structural, non-structural and accessory) proteins from SARS-CoV-2 using predictive algorithms to identify potential targets for vaccine development. Significance Statement The novel coronavirus SARS-CoV-2 recently emerged from China, rapidly spreading and ushering in a global pandemic. Despite intensive research efforts, our knowledge of SARS-CoV-2 immunology and the proteins targeted by the immune response remains relatively limited, making it difficult to rationally design candidate vaccines. We employed a suite of bioinformatic tools, computational algorithms, and structural modeling to comprehensively analyze the entire SARS-CoV-2 proteome for potential T cell and B cell epitopes. Utilizing a set of stringent selection criteria to filter peptide epitopes, we identified 41 T cell epitopes (5 HLA class I, 36 HLA class II) and 6 B cell epitopes that could serve as promising targets for peptide-based vaccine development against this emerging global pathogen.


Radiologic management of COVID-19: Preliminary experience of the iranian society of radiology COVID-19 consultant group (ISRCC)


docid: pjoqahhk

title: Discrete simulation analysis of COVID-19 and prediction of isolation bed numbers

text: Background. The outbreak of COVID-19 has been defined by the World Health Organization as a pandemic, and containment depends on traditional public health measures. However, the explosive growth of the number of infected cases in a short period of time has caused tremendous pressure on medical systems. Adequate isolation facilities are essential to control outbreaks, so this study aims to quickly estimate the demand and number of isolation beds. Methods. We established a discrete simulation model for epidemiology. By adjusting or fitting necessary epidemic parameters, the effects of the following indicators on the development of the epidemic and the occupation of medical resources were explained: (1) incubation period, (2) response speed and detection capacity of the hospital, (3) disease cure time, and (4) population mobility. Finally, a method for predicting the reasonable number of isolation beds was summarized through multiple linear regression. Results. Through simulation, we show that the incubation period, response speed and detection capacity of the hospital, disease cure time, degree of population mobility, and infectivity of cured patients have different effects on the infectivity, scale, and duration of the epidemic. Among them, (1) incubation period, (2) response speed and detection capacity of the hospital, (3) disease cure time, and (4) population mobility have a significant impact on the demand and number of isolation beds (P <0.05), which agrees with the following regression equation: N = P * (-0.273 + 0.009I +0.234M + 0.012T1 + 0.015T2) * (1+V).


title: A Cybernetics-based Dynamic Infection Model for Analyzing SARS-COV-2 Infection Stability and Predicting Uncontrollable Risks

text: Since December 2019, COVID-19 has raged in Wuhan and subsequently all over China and the world. We propose a Cybernetics-based Dynamic Infection Model (CDIM) to the dynamic infection process with a probability distributed incubation delay and feedback principle. Reproductive trends and the stability of the SARS-COV-2 infection in a city can then be analyzed, and the uncontrollable risks can be forecasted before they really happen. The infection mechanism of a city is depicted using the philosophy of cybernetics and approaches of the control engineering. Distinguished with other epidemiological models, such as SIR, SEIR, etc., that compute the theoretical number of infected people in a closed population, CDIM considers the immigration and emigration population as system inputs, and administrative and medical resources as dynamic control variables. The epidemic regulation can be simulated in the model to support the decision-making for containing the outbreak. City case studies are demonstrated for verification and validation.


title: Spatio-temporal propagation of COVID-19 pandemics

text: The new coronavirus known as COVID-19 is rapidly spreading since December 2019. Without any vaccination or medicine, the means of controlling it are limited to quarantine and social distancing. Here we study the spatio-temporal propagation of the COVID-19 virus in China and compare it to other global locations. Our results suggest that the disease propagation is highly related to population migration from Hubei resembling a Lévy flight which is characteristic of human mobility and thus could be controlled by efficient quarantines. Since quarantine is usually applied on a city level, more insight can be obtained in analyzing the epidemic in cities. Our results suggest that the disease spread in a city in China is characterized by two-stages process. At early times, at order of few days, the infection rate in the city is close to constant probably due to the lack of means to detect infected individuals before infection signs are observed and at later times it decays approximately exponentially due to quarantines. These two stages can explain the significant differences between the propagation in China and in other world-wide locations. While most cities in China control the disease which resulted in the decaying stage, in other world-wide countries the situation is still becoming worse probably due to less social interactions control and overloaded health systems which reflects in the death and recovery rates.


title: Flexible machine learning prediction of antigen presentation for rare and common HLA-I alleles

text: The recent increase of immunopeptidomic data, obtained by mass spectrometry (MS) or binding assays, opens unprecedented possibilities for investigating endogenous antigen presentation by the highly polymorphic human leukocyte antigen class I (HLA-I) protein. We introduce a flexible and easily interpretable peptide presentation prediction method. We validate its performance as a predictor of cancer neoantigens and viral epitopes and use it to reconstruct peptide motifs presented on specific HLA-I molecules.


docid: nboplruu

title: Coronavirus in cats, climate cancellation and missing African trials


title: Poor correlation between antibody titers and neutralizing activity in sera from SARS-CoV-2 infected subjects

text: Plenty of serologic tests for SARS-CoV-2 have been developed so far, thus documenting the importance of evaluating the relevant features of the immune response to this viral agent. The performance of these assays is currently under investigation. Amongst them, LIAISON SARS-CoV-2 S1/S2 IgG by DiaSorin and Elecsys Anti-SARS-CoV-2 cobas by Roche are currently used by laboratory medicine hospital departments in Italy and many other countries. In the present study, we have firstly compared two serologic tests on serum samples collected at two different time points from forty-six laboratory-confirmed COVID-19 subjects. Secondly, eighty-five negative serum samples collected before the SARS-CoV-2 pandemic were analyzed. Thirdly, possible correlations between antibody levels and the resulting neutralizing activity against a clinical isolate of SARS-CoV-2 were evaluated. Results revealed that both tests are endowed with low sensitivity on the day of hospital admission, which increased to 97.8 and 100% for samples collected after 15 days for DiaSorin and Roche tests, respectively. The specificity of the two tests ranges from 96.5 to 100%, respectively. Importantly, a poor direct correlation between antibody titers and neutralizing activity levels was evidenced in the present study.


title: Poorly known aspects of flattening the curve of COVID-19

text: This work concerns the too-often mentioned flattening of the curve of COVID-19. The diffusion of the virus is analyzed with logistic-curve fits on the 25 countries most affected at the time of the writing and in which the diffusion curve was more than 95% completed. A negative correlation observed between the final number of infections and the slope of the logistic curve corroborates a result obtained long time ago via an extensive simulation study. There is both theoretical arguments and experimental evidence for the existence of such correlations. The flattening of the curve results in a retardation of the curve's midpoint, which entails an increase in the final number of infections. It is possible that more lives are lost at the end by this process. Our analysis also permits evaluation of the various governments' interventions in terms of rapidity of response, efficiency of the actions taken (the amount of flattening achieved), and the number of days by which the curve was delayed. Not surprisingly, early decisive response proves to be the optimum strategy among the countries studied.


title: Tissue-specific delivery system via AFF-1-coated pseudotyped Vesicular Stomatitis Virus in C. elegans

text: Viral-based vectors are widely used for fundamental and translational research; however, production of a tissue-specific targeting vector is often a challenging step. Here, we develop a cell type-specific delivery system, based on vesicular stomatitis virus lacking the viral fusion protein (fusogen) and pseudotyped with AFF-1, a C. elegans cell-to-cell bilateral fusogen from the fusexin family. Following injection of AFF-1-coated virus into the C. elegans pseudocoelom that functions as a circulatory system, we observe specific infection of different cells that express EFF-1 or AFF-1 fusogens. EFF-1-expressing epidermal cells are preferentially infected, whereas mononucleated body wall muscles (BWMs) that do not express any fusogen are rarely infected. The epidermal cells infection is abolished when the host cells do not express EFF-1, while ectopic expression of EFF-1 on BWMs induces their abnormal cell-cell fusion, produces paralyzed-dumpy animals and enhances muscle infection by AFF-1-coated viruses. Thus, our data uncover that AFF-1-coated pseudotyped viruses can be retargeted to desired cells in a controlled manner and serve as a cell-specific delivery system in nematodes with potential applications in regenerative processes, therapies such as dendritic reconnection following injuries, and studies of diverse cellular and viral fusogens. Summary AFF-1-coated virus infects skin cells and rarely muscle cells in C. elegans Epithelial cell-specific infection requires eff-1 activity Pseudoviral infection depends on the amount of eff-1 in target cells Ectopic EFF-1 in muscle cells induces their fusion and viral infection Graphical abstract


title: Association of Population Migration and Coronavirus Disease 2019 Epidemic Control

text: Background and Objective To analyze the impact of different patterns of migration flow in two cities, Hefei and Shenzhen, on the epidemic and disease control of Coronavirus Disease 2019 (COVID-19), in order to provide insight for making differentiated controlling policies. Methods We collected demographic and epidemiological information of confirmed COVID-19 cases in Hefei and Shenzhen between January 19 and February 11, 2020, from data officially published by the provincial and municipal Centers for Disease Control and Prevention (CDC). From these data we calculated basic reproduction number R0 to reflect the rate of spread of COVID-19 in these cities. Aggregated data of population migration during the same period was extracted from Baidu Migration. The change of R0 in the two cites were analyzed and compared. Spearman correlation analysis between R0 and population inflow from epidemic focus were performed. Results A total of 157 confirmed cases was identified in Hefei by 24:00 February 11, 2020, with an average age of 44.4±15.6 years, 74 female (47.1%) and 386 confirmed cases were identified in Shenzhen, with an average age of 45.15±17.99 years, 202 female (52.3%). Significant difference in the proportion of imported cases between the two cities was observed (Hefei vs Shenzhen, 24.2% vs 74.9%, p=0.000). Before January 31 2020, during the initial stage of the Level 1 Response to Major Public Health Emergencies, there was no significant association observed in Shenzhen between R0 and the proportion of population inflow from the epidemic focus (P =0.260, r=-0.452); meanwhile in Hefei, such association was strong (P =0.000, r=1.0). However, after the initial stage of response, the situation reversed. A weak association was observed in Shenzhen between be R0 and the proportion of population inflow from the epidemic focus (P=0.073, r=0.536) but not in Hefei (P =0.498, r=0.217). Conclusion Following Level 1 Response, consistent decline of R0 of COVID-19 was observed in both Hefei and Shenzhen. Different patterns of disease spread were observed in the two cities, driven by different patterns of population migration. This indicated that population migration should be taken into consideration when we set controlling policy of a novel infectious disease.


title: Paramedic intubation during a pandemic: Where are the consensus guidelines?

text: There is no denying that paramedic-led intubation is a contentious issue in out-of-hospital care. Guidelines for the management of COVID-19 are developed with both patient-centred care as well as provider safety in mind, with intubation the preferred airway management strategy in patients suspected to have contracted COVID-19 requiring airway protection or invasive ventilation. However, this has re-ignited a debate which began during the Severe Acute Respiratory Syndrome (SARS) outbreak in the early 2000s around whether the benefit of paramedic-led intubation outweighs the risks to providers during a pandemic. The aim of this commentary is to revisit the evidence around paramedic-led intubation and provide a perspective on paramedic-led intubation during the COVID-19 pandemic. It is hoped this will stimulate further discussion around the benefits and risks of paramedic intubation in the setting of a pandemic.


title: Classification of Coronavirus Images using Shrunken Features

text: Necessary screenings must be performed to control the spread of the Corona Virus (COVID-19) in daily life and to make a preliminary diagnosis of suspicious cases. The long duration of pathological laboratory tests and the wrong test results led the researchers to focus on different fields. Fast and accurate diagnoses are essential for effective interventions with COVID-19. The information obtained by using X-ray and Computed Tomography (CT) images is vital in making clinical diagnoses. Therefore it was aimed to develop a machine learning method for the detection of viral epidemics by analyzing X-ray images. In this study, images belonging to 6 situations, including coronavirus images, are classified. Since the number of images in the dataset is deficient and unbalanced, it is more convenient to analyze these images with hand-crafted feature extraction methods. For this purpose, firstly, all the images in the dataset are extracted with the help of four feature extraction algorithms. These extracted features are combined in raw form. The unbalanced data problem is eliminated by producing feature vectors with the SMOTE algorithm. Finally, the feature vector is reduced in size by using a stacked auto-encoder and principal component analysis to remove interconnected features in the feature vector. According to the obtained results, it is seen that the proposed method has leveraging performance, especially in order to make the diagnosis of COVID-19 in a short time and effectively.


title: Characterization and treatment of SARS-CoV-2 in nasal and bronchial human airway epithelia

text: In the current COVID-19 pandemic context, proposing and validating effective treatments represents a major challenge. However, the lack of biologically relevant pre-clinical experimental models of SARS-CoV-2 infection as a complement of classic cell lines represents a major barrier for scientific and medical progress. Here, we advantageously used human reconstituted airway epithelial models of nasal or bronchial origin to characterize viral infection kinetics, tissue-level remodeling of the cellular ultrastructure and transcriptional immune signatures induced by SARS-CoV-2. Our results underline the relevance of this model for the preclinical evaluation of antiviral candidates. Foremost, we provide evidence on the antiviral efficacy of remdesivir and the therapeutic potential of the remdesivir-diltiazem combination as a rapidly available option to respond to the current unmet medical need imposed by COVID-19. One Sentence Summary New insights on SARS-CoV-2 biology and drug combination therapies against COVID-19.


docid: odlcfhcr

title: Continuous positive airway pressure face-mask ventilation to manage massive influx of patients requiring respiratory support during the SARS-CoV-2 outbreak

text: Background: Since December 2019, a global outbreak of coronavirus disease (COVID-19) is responsible for massive influx of patients with acute respiratory failure in hospitals. We describe the characteristics, clinical course, and outcomes of COVID-19 patients treated with continuous positive airway pressure (CPAP) in a large public hospital in France. Method: It is a single centre retrospective observational cohort. From 27th March to 23rd April, consecutive patients receiving 10 to 15 l/min of oxygen with a non-rebreather mask, who had signs of respiratory failure or were unable to maintain an SpO2 > 90%, were treated by CPAP with a face-mask unless the ICU physician judged that immediate intubation was indicated. The main outcome under study was reasons for CPAP discontinuation. Results: A total of 585 patients were admitted in Delafontaine hospital for COVID-19. ICU was quickly overwhelmed. Fifty-nine out of 159 (37%) patients requiring ICU care had to be referred to other hospitals. CPAP therapy was initiated in 49 patients and performed out of ICU in 41 (84%). Reasons for discontinuation of CPAP were intubation for invasive ventilation in 25 (51%) patients, improvement in 16 (33%), poor tolerance in 6 (12%) and death in 2 (4%). A decision not to intubate had been taken for the 2 patients who died while on CPAP. Conclusions: Treatment with CPAP is feasible and safe in a non-ICU environment in the context of a massive influx of patients. One third of these patients with high oxygen requirements did not eventually need invasive ventilation.


COVID-19 lockdown and the tobacco product ban in South Africa