title: Seizing the Moment: Policy Advocacy to End Mass Incarceration in the Time of COVID-19

text: The mass human and economic casualties wrought by the COVID-19 pandemic laid bare the deep inequities at the base of the disproportionate losses and suffering experienced by diverse U.S. populations. But the urgency and enormity of unmet needs requiring bold policy action also provided a unique opportunity to learn from and partner with community-based organizations that often are at the frontlines of such work. Following a review of Kingdon's model of the policy-making process, we illustrate how a partnership in a large California county navigated the streams in the policy-making process and used the window of opportunity provided by the pandemic to address a major public health problem: the incarceration of over 2 million people, disproportionately African American and Latinx, in overcrowded, unsafe jails, prisons, and detention centers. We highlight tactics and strategies used, challenges faced, and implications for health educators as policy advocates during and beyond the pandemic.


Challenges for the Pediatricians During the Coronavirus Disease 2019 Pandemic Start From the Neonatal Period


Early Detection of Covid-19 through a Citywide Pandemic Surveillance Platform


title: Preliminary case report on the SARS-CoV-2 cluster in the UK, France, and Spain

text: Almost half of the confirmed COVID-19 cases detected so far in the United Kingdom are part of a large cluster of 13 British nationals who tested positive for SARS-CoV-2 in the UK, Spain, and France Transmissions among this cluster occurred at a ski resort in France, and originated from a single infected traveller returning from a conference in Singapore where he acquired the virus At least 21 individuals were exposed to the virus, tested, and quarantined, with 13 of those testing positive between the period of 6th February and 15th February Here, all publicly available information about the primarily UK/France cluster is consolidated, providing a complete and accessible summary of the cases and their connections Notable in this cluster are the number of individuals infected, the apparent absence of any severe illness among those infected, and a case of a "delayed positive" test during isolation after initially testing negative, at least 7 days after last possible contact


title: Clearance and persistence of SARS-CoV-2 RNA in patients with COVID-19

text: Patients with coronavirus disease-2019 may be discharged based on clinical resolution of symptoms, and evidence for viral RNA clearance from the upper respiratory tract. Understanding the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral clearance profile is crucial to establish a re-testing plan on discharge and ending isolation of patients. We aimed to evaluate the number of days that a patient needed to achieve undetectable levels of SARS-CoV-2 in upper respiratory tract specimens (nasopharyngeal swab and/or an oropharyngeal swab). The clearance and persistence of viral RNA was evaluated in two groups of positive patients: those who achieved two negative reverse transcription-polymerase chain reaction (RT-PCR) tests and those who kept testing positive. Patients were organized thereafter in two subgroups, mild illness patients discharged home and inpatients who had moderate to severe illness. Results from RT-PCR tests were then correlated with results from the evaluation of the immune response. The study evidenced that most patients tested positive for more than 2 weeks and that persistence of viral RNA is not necessarily associated with severe disease but may result from a weaker immune response instead.


Teledermatology for patient management, dermatology education and research during the COVID-19 pandemic


Una herramienta para apoyar el trabajo de los equipos quirúrgicos y afrontar la COVID-19./ Una herramienta para apoyar el trabajo de los equipos quirúrgicos y afrontar la COVID-19./ A tool to support the work of surgical teams and face the COVID-19 pandemic


title: Clinical and CT findings of COVID-19: differences among three age groups

text: BACKGROUND: The novel coronavirus pneumonia (coronavirus disease 2019, COVID-19) has spread around the world. We aimed to recapitulate the clinical and CT imaging features of COVID-19 and their differences in three age groups. METHODS: The clinical and CT data of patients with COVID-19 (n = 307) that had been divided into three groups (Group 1: < 40 years old; Group 2: 40 ≤ age < 60 years old; Group 3: ≥ 60 years old) according to age were analyzed retrospectively. RESULTS: Of all patients, 114 (37.1%) had histories of epidemiological exposure, 48 (15.6%) were severe/critical cases, 31 had hypertension (10.1%), 15 had diabetes mellitus (4.9%), 3 had chronic obstructive pulmonary disease (COPD, 1%). Among the three groups, severe/critical type, hypertension and diabetes occurred more commonly in the elderly group compared with Group 1&2 (P < 0.05, respectively). Cough and chest tightness/pain were more commonly appeared in Group 2&3 compared with Group 1 (P < 0.05, respectively). Compared with Group 1 and 2, there were more abnormal laboratory examination indexes (including CRP increase, abnormal percentage of lymphocytes, neutrophils and monocytes) in Group 3 (P < 0.05, respectively). CT images revealed that more lobes were affected and more subpleural lesions were involved in the elderly group, besides, crazy paving sign, bronchodilatation and pleural thickening were more commonly seen in the elderly group, with significant difference between Group 1&2, Group 2&3 (P < 0.05, respectively). CONCLUSIONS: COVID-19 presented representative clinical manifestations, laboratory examinations and CT findings, but three age groups possessed their own specific characteristics. Grasping the clinical and CT features stratified by age will be helpful for early definite diagnosis of COVID-19.


title: Generalized logistic growth modeling of the COVID-19 outbreak in 29 provinces in China and in the rest of the world

text: The COVID-19 has been successfully contained in China but is spreading all over the world. We calibrate the logistic growth model, the generalized logistic growth model, the generalized Richards model and the generalized growth model to the reported number of infected cases from for the whole of China, 29 provinces in China, and 19 countries and regions that are undergoing major outbreaks. We dissect the development of the epidemics in China and the impact of the drastic control measures both at the aggregate level and within each province. We quantitatively document four phases of the outbreak in China with a detailed analysis on the heterogeneous situations across provinces. The extreme containment measures implemented by China were very effective with some instructive variations across provinces. Borrowing from the experience of China, we made scenario projections on the development of the outbreak in other countries. We identified that Europe and US have passed the inflection point and entered into an after-peak trajectory, which is estimated longer than what a classical Logistic model predicts, in contrast to most provinces in China where the after-peak trajectory is much faster. We expect Europe to have 1.83 million final total confirmed cases (2452 per million population) and US to have 1.26 million final total confirmed cases (3851 per million population). We identified three groups of countries in different level of outbreak progress, and provide informative implications for the current global pandemic.


Combined mobile-phone and social-media sampling for web survey on social effects of COVID-19 in Spain Reply


title: Laboratory predictors of death from coronavirus disease 2019 (COVID-19) in the area of Valcamonica, Italy

text: Background Comprehensive information has been published on laboratory tests which may predict worse outcome in Asian populations with coronavirus disease 2019 (COVID-19). The aim of this study is to describe laboratory findings in a group of Italian COVID-19 patients in the area of Valcamonica, and correlate abnormalities with disease severity. Methods The final study population consisted of 144 patients diagnosed with COVID-19 (70 who died during hospital stay and 74 who survived and could be discharged) between March 1 and 30, 2020, in Valcamonica Hospital. Demographical, clinical and laboratory data were collected upon hospital admission and were then correlated with outcome (i.e. in-hospital death vs. discharge). Results Compared to patients who could be finally discharged, those who died during hospital stay displayed significantly higher values of serum glucose, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), urea, creatinine, high-sensitivity cardiac troponin I (hscTnI), prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), D-dimer, C reactive protein (CRP), ferritin and leukocytes (especially neutrophils), whilst values of albumin, hemoglobin and lymphocytes were significantly decreased. In multiple regression analysis, LDH, CRP, neutrophils, lymphocytes, albumin, APTT and age remained significant predictors of in-hospital death. A regression model incorporating these variables explained 80% of overall variance of in-hospital death. Conclusions The most important laboratory abnormalities described here in a subset of European COVID-19 patients residing in Valcamonica are highly predictive of in-hospital death and may be useful for guiding risk assessment and clinical decision-making.


title: Considerations for the management of home parenteral nutrition during the SARS-CoV-2 pandemic: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN

text: The management of patients with chronic intestinal failure requiring home parenteral nutrition has been and will continue to be impaired during the SARS-CoV-2 pandemic. Multidisciplinary intestinal failure teams may have to adapt their clinical approaches to home care, outpatient care as well as hospital admission and discharge in order to keep this vulnerable group of patients as safe and well as possible during the unprecedented challenges that countries are facing during the pandemic. Equally, it is important that expert advice from intestinal failure teams is available when home parenteral nutrition (HPN)-dependent patients require admission with SARS-CoV-2 infection. The Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of the European Society for Clinical Nutrition and Metabolism (ESPEN) has developed a position paper to outline areas for intestinal failure teams to consider when managing patients with chronic intestinal failure during the SARS-CoV-2 pandemic.


docid: edcyqvgd

title: Random Information Spread in Networks

text: Let G=(V,E) be an undirected loopless graph with possible parallel edges and s and t be two vertices of G. Assume that vertex s is labelled at the initial time step and that every labelled vertex copies its labelling to neighbouring vertices along edges with one labelled endpoint independently with probability p in one time step. In this paper, we establish the equivalence between the expected s-t first arrival time of the above spread process and the notion of the stochastic shortest s-t path. Moreover, we give a short discussion of analytical results on special graphs including the complete graph and s-t series-parallel graphs. Finally, we propose some lower bounds for the expected s-t first arrival time.


title: Guillain-Barré syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing

text: OBJECTIVE: To present the COVID-19-associated GBS, the prototypic viral-triggered autoimmune disease, in the context of other emerging COVID-19-triggered autoimmunities, and discuss potential concerns with ongoing neuroimmunotherapies. METHODS: Eleven GBS cases in four key COVID-19 hotspots are discussed regarding presenting symptoms, response to therapies and cross-reactivity of COVID spike proteins with nerve glycolipids. Emerging cases of COVID-19-triggered autoimmune necrotizing myositis (NAM) and encephalopathies are also reviewed in the context of viral invasion, autoimmunity and ongoing immunotherapies. RESULTS: Collective data indicate that in this pandemic any patient presenting with an acute paralytic disease-like GBS, encephalomyelitis or myositis-even without systemic symptoms, may represent the first manifestation of COVID-19. Anosmia, ageusia, other cranial neuropathies and lymphocytopenia are red flags enhancing early diagnostic suspicion. In Miller-Fisher Syndrome, ganglioside antibodies against GD1b, instead of QG1b, were found; because the COVID-19 spike protein also binds to sialic acid-containing glycoproteins for cell-entry and anti-GD1b antibodies typically cause ataxic neuropathy, cross-reactivity between COVID-19-bearing gangliosides and peripheral nerve glycolipids was addressed. Elevated Creatine Kinase (>10,000) is reported in 10% of COVID-19-infected patients; two such patients presented with painful muscle weakness responding to IVIg indicating that COVID-19-triggered NAM is an overlooked entity. Cases of acute necrotizing brainstem encephalitis, cranial neuropathies with leptomeningeal enhancement, and tumefactive postgadolinium-enhanced demyelinating lesions are now emerging with the need to explore neuroinvasion and autoimmunity. Concerns for modifications-if any-of chronic immunotherapies with steroids, mycophenolate, azathioprine, IVIg, and anti-B-cell agents were addressed; the role of complement in innate immunity to viral responses and anti-complement therapeutics (i.e. eculizumab) were reviewed. CONCLUSIONS: Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune neurological diseases necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection, like most other viruses, can potentially worsen patients with pre-existing autoimmunity, there is no evidence that patients with autoimmune neurological diseases stable on common immunotherapies are facing increased risks of infection.


title: Surgery in COVID-19 patients: operational directives

text: The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in healthcare. It is important to ensure the ability of surgeons and specialized professionals to function through the pandemic. A conscious effort should be made to minimize infection in this sector. A high mortality rate within this group would be detrimental.This manuscript is the result of a collaboration between the major Italian surgical and anesthesiologic societies: ACOI, SIC, SICUT, SICO, SICG, SIFIPAC, SICE, and SIAARTI. We aim to describe recommended clinical pathways for COVID-19-positive patients requiring acute non-deferrable surgical care. All hospitals should organize dedicated protocols and workforce training as part of the effort to face the current pandemic.


Intensive care unit admissions for pregnant and nonpregnant women with coronavirus disease 2019


Some drugs for COVID-19


Efforts to Minimize the Impact of Lockdown on Migrant Workers in India During the COVID-19 Pandemic


docid: avvsukmf

title: Diagnosis of coronavirus disease 2019 pneumonia in pregnant women: can we rely on lung ultrasound?


Callous attitude toward doctors during COVID-19


title: Open visiting in the NHS

text: Sam Foster, Chief Nurse, Oxford University Hospitals, considers the balance of the benefits of enabling visiting with infection prevention and control practice during this pandemic.


Collateral Damage During the COVID-19 Pandemic


title: Guidance for the Procurement of COVID-19 Convalescent Plasma: Differences between High and Low-Middle Income Countries

text: BACKGROUND AND OBJECTIVES: COVID-19 convalescent plasma (CCP) has been used, predominantly in high-income countries (HICs) to treat COVID-19; available data suggest the safety and efficacy of use. We sought to develop guidance for procurement and use of CCP, particularly in low and middle-income countries (LMICs) for which data are lacking. MATERIALS AND METHODS: A multidisciplinary, geographically representative group of individuals with expertise spanning transfusion medicine, infectious diseases and hematology was tasked with the development of a guidance document for CCP, drawing on expert opinion, survey of group members and review of available evidence. Three subgroups (i.e. donor, product and patient) were established based on self-identified expertise and interest. Here, the donor and product-related challenges are summarized and contrasted between HICs and LMICs with a view to guide related practices. RESULTS: The challenges to advance CCP therapy are different between HICs and LMICs. Early challenges in HICs related to recruitment and qualification of sufficient donors to meet the growing demand. Antibody testing also posed a specific obstacle given lack of standardization, variable performance of the assays in use and uncertain interpretation of results. In LMICs, an extant transfusion deficit, suboptimal models of donor recruitment (e.g. reliance on replacement and paid donors), limited laboratory capacity for pre-donation qualification and operational considerations could impede wide adoption. CONCLUSION: There has been wide scale adoption of CCP in many HICs, which could increase if clinical trials show efficacy of use. By contrast, LMICs, having received little attention, require locally applicable strategies for adoption of CCP.


Global perspectives on Covid-19 from the editorial board


Organoids of human airways to study infectivity and cytopathy of SARS-CoV-2


GP who was suspended for forging out-of-hours form can resume work to assist in pandemic


Cytosine drives evolution of SARS-CoV-2


Lessons in contact tracing from Germany


Differences in race and other state-level characteristics and associations with mortality from COVID-19 infection


Financial crisis at PAHO in the time of COVID-19: a call for action


title: [Analysis on the epidemic factors for the Corona Virus Disease]

text: Since December 2019, corona virus disease 2019 (COVID-19) , an emerging infection disease occurred in Wuhan, has spread in the mainland China. The epidemic factors on the basis of knowledge of SARS-CoV-2 were discussed in this paper. This puts a lot of pressure on clinical resources and care. SARS-CoV-2 is a novel corona virus, the onset of COVID-19 is slow, and the pathogenesis of SARS-CoV-2 remains unclear and may lead to multiple organ damage. These put a lot of pressure on clinical resources and care. Source of infection including the patients, asymptomatic carrier and patients in the incubation period are contagious. It is difficult to control source of infection. Routes of SARS-CoV-2 transmission are diversified and the main routes of transmission for COVID-19 are droplet transmission and close contact transmission. All population have susceptibility to SARS-CoV-2. Social factors such population movements and aggregation accelerated the spread of SARS-CoV-2. The Chinese government's adopted measures are positive and effective, and are accepted by the expert group from the World Health Organization. However, it will be a long-term hard work in the future to seriously summarize and think deeply to achieve public health security in China.


title: Analysis on the epidemic factors for the Corona Virus Disease/ 中华预防医学杂志

text: Since December 2019, corona virus disease 2019 (COVID-19) , an emerging infection disease occurred in Wuhan, has spread in the mainland China. The epidemic factors on the basis of knowledge of SARS-CoV-2 were discussed in this paper. This puts a lot of pressure on clinical resources and care. SARS-CoV-2 is a novel corona virus, the onset of COVID-19 is slow, and the pathogenesis of SARS-CoV-2 remains unclear and may lead to multiple organ damage. These put a lot of pressure on clinical resources and care. Source of infection including the patients, asymptomatic carrier and patients in the incubation period are contagious. It is difficult to control source of infection. Routes of SARS-CoV-2 transmission are diversified and the main routes of transmission for COVID-19 are droplet transmission and close contact transmission. All population have susceptibility to SARS-CoV-2. Social factors such population movements and aggregation accelerated the spread of SARS-CoV-2. The Chinese government’s adopted measures are positive and effective, and are accepted by the expert group from the World Health Organization. However, it will be a long-term hard work in the future to seriously summarize and think deeply to achieve public health security in China.


title: COVID-19 disease emergency operational instructions for Mental Health Departments issued by the Italian Society of Epidemiological Psychiatry

text: During the current COVID-19 disease emergency, it is not only an ethical imperative but also a public health responsibility to keep the network of community psychiatry services operational, particularly for the most vulnerable subjects (those with mental illness, disability, and chronic conditions). At the same time, it is necessary to reduce the spread of the COVID-19 disease within the outpatient and inpatient services affiliated with Mental Health Departments. These instructions, first published online on 16 March 2020 in their original Italian version, provide a detailed description of actions, proposed by the Italian Society of Epidemiological Psychiatry, addressed to Italian Mental Health Departments during the current COVID-19 pandemic. The overall goal of the operational instructions is to guarantee, during the current health emergency, the provision of the best health care possible, taking into account both public health necessities and the safety of procedures. These instructions could represent a useful resource to mental health providers, and stakeholders to face the current pandemic for which most of Mental Health Departments worldwide are not prepared to. These instructions could provide guidance and offer practical tools which can enable professionals and decision makers to foresee challenges, like those already experienced in Italy, which in part can be avoided or minimised if timely planned. These strategies can be shared and adopted, with the appropriate adjustments, by Mental Health Departments in other countries.


docid: qnqjfidd

title: Clinical Manifestation and Laboratory Characteristics of SARS-CoV-2 Infection in Pregnant Women

text: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has become a major challenge to public health in China and other countries, considering its pathogenicity across all age groups. Pregnancy is a unique physiological condition, and is characterized by altered immunity and elevated hormone levels to actively tolerate the semi-allogeneic fetus, which undergoes a sudden and substantial fluctuation during the immediate postpartum period. Changes in clinical features, laboratory characteristics, and imaging features of pregnant women during the pre-partum and post-partum periods require further elucidation. Here, we retrospectively analyzed the clinical features, laboratory characteristics, and imaging features of eight pregnant cases of SARS-CoV-2 infection during the pre-partum and post-partum periods. Our results showed that four of the eight pregnant women were asymptomatic before delivery but became symptomatic post-partum. Correspondingly, white blood cell (WBC) counts increased and lymphocyte (LYMPH) counts decreased. C-reactive protein (CRP) levels in the serum also increased to a higher level than those in general pregnancy. Therefore, it is imperative to closely monitor laboratory parameters including the WBC count, LYMPH count, and CRP, along with other imaging features in chest CT scans, to promptly prevent, diagnose, and treat a SARS-CoV-2 infection during pregnancy.


title: A chatbot architecture for promoting youth resilience

text: E-health technologies have the potential to provide scalable and accessible interventions for youth mental health. As part of a developing an ecosystem of e-screening and e-therapy tools for New Zealand young people, a dialog agent, Headstrong, has been designed to promote resilience with methods grounded in cognitive behavioral therapy and positive psychology. This paper describes the architecture underlying the chatbot. The architecture supports a range of over 20 activities delivered in a 4-week program by relatable personas. The architecture provides a visual authoring interface to its content management system. In addition to supporting the original adolescent resilience chatbot, the architecture has been reused to create a 3-week 'stress-detox' intervention for undergraduates, and subsequently for a chatbot to support young people with the impacts of the COVID-19 pandemic, with all three systems having been used in field trials. The Headstrong architecture illustrates the feasibility of creating a domain-focused authoring environment in the context of e-therapy that supports non-technical expert input and rapid deployment.


title: Assessing disability and relapses in multiple sclerosis on tele-neurology

text: BACKGROUND: As a consequence of the coronavirus disease 2019 (COVID-19) pandemic, a large amount of consultations will be delivered through tele-medicine, especially for diseases causing chronic disability and requiring immunomodulatory treatments, such as multiple sclerosis (MS). METHODS: We have hereby reviewed available tools for tele-neurology examination in MS, including components of neurological examination that can be assessed through video, patient-reported outcome measures (PROMs), and digital technology. RESULTS: Overall, we have suggested a battery for assessing MS disability and relapses on tele-medicine, which brings together conventional examination, PROMs (e.g., Patient Determined Disease Steps, MS Impact Scale), and cognitive tests (Symbol Digit Modalities Test) that can be delivered remotely and in multiple languages. DISCUSSION: The use of common tools for neurological examination could improve tele-neurology practice for both general neurologists and MS specialists, and quality of care for people with MS.


Rethinking the role of the school after COVID-19


title: Increased ozone levels during the COVID-19 lockdown: Analysis for the city of Rio de Janeiro, Brazil

text: The first COVID-19 case in Brazil was confirmed on February 25, 2020. Partial lockdown measures came into force in the city of Rio de Janeiro, Brazil, on March 23. While CO and NO2 levels showed significant reductions, PM10 levels were only reduced in the first partial lockdown week. By contrast, ozone levels increased in all studied locations. In this study, the factors leading to this behavior were analyzed. Monitoring data obtained at two automatic monitoring stations showed higher ratios between non-methane hydrocarbons and nitrogen oxides (NMHC/NOx) during the partial lockdown (up to 37.3%). The increase in ozone concentrations during the social distancing measures could be attributed to the increase in NMHC/NOx ratios since atmospheric chemistry in Rio de Janeiro is under VOC-controlled conditions. However, the increase was higher when air masses arrived from the industrial areas, not only because of the higher NMHC/NOx ratios, but also because the reactivity of VOC was highly increased by these air masses, which are rich in aromatic compounds.


Coronavirus disease 19 (Covid-19) and non-steroidal anti-inflammatory drugs (NSAID)


COVID-19 drives new threat to bats in China


title: Fast and accurate detection of Covid-19-related pneumonia from chest X-ray images with novel deep learning model

text: Background: Novel coronavirus disease has spread rapidly worldwide. As recent radiological literatures on Covid-19 related pneumonia is primarily focused on CT findings, the American College of Radiology (ACR) recommends using portable chest X-radiograph (CXR). A tool to assist for detection and monitoring of Covid-19 cases from CXR is highly required. Purpose: To develop a fully automatic framework to detect Covid-19 related pneumonia using CXR images and evaluate its performance. Materials and Methods: In this study, a novel deep learning model, named CovIDNet (Covid-19 Indonesia Neural-Network), was developed to extract visual features from chest x-ray images for the detection of Covid-19 related pneumonia. The model was trained and validated by chest x-rays datasets collected from several open source provided by GitHub and Kaggle. Results and Discussion: In the validation stage using open-source data, the accuracy to recognize Covid-19 and others classes reaches 98.44%, that is, 100% Covid-19 precision and 97% others precision. Discussion: The use of the model to classify Covid-19 and other pathologies might slightly decrease the accuracy. Although SoftMax was used to handle classification bias, this indicates the benefit of additional training upon the introduction of new set of data. Conclusion: The model has been tested and get 98.4% accuracy for open source datasets, the sensitivity and specificity are 100% and 96.97%, respectively.


Enhancing intensive care capacity: COVID-19 experience from a Tertiary Center in Israel


title: A model based study on the dynamics of COVID-19: Prediction and control

text: As there is no vaccination and proper medicine for treatment, the recent pandemic caused by COVID-19 has drawn attention to the strategies of quarantine and other governmental measures, like lockdown, media coverage on social isolation, and improvement of public hygiene, etc to control the disease. The mathematical model can help when these intervention measures are the best strategies for disease control as well as how they might affect the disease dynamics. Motivated by this, in this article, we have formulated a mathematical model introducing a quarantine class and governmental intervention measures to mitigate disease transmission. We study a thorough dynamical behavior of the model in terms of the basic reproduction number. Further, we perform the sensitivity analysis of the essential reproduction number and found that reducing the contact of exposed and susceptible humans is the most critical factor in achieving disease control. To lessen the infected individuals as well as to minimize the cost of implementing government control measures, we formulate an optimal control problem, and optimal control is determined. Finally, we forecast a short-term trend of COVID-19 for the three highly affected states, Maharashtra, Delhi, and Tamil Nadu, in India, and it suggests that the first two states need further monitoring of control measures to reduce the contact of exposed and susceptible humans.


title: Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

text: Importance: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated. Objective: To describe the clinical characteristics and outcomes in patients with COVID-19 pneumonia who developed acute respiratory distress syndrome (ARDS) or died. Design, Setting, and Participants: Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020. Exposures: Confirmed COVID-19 pneumonia. Main Outcomes and Measures: The development of ARDS and death. Epidemiological, demographic, clinical, laboratory, management, treatment, and outcome data were also collected and analyzed. Results: Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) patients were men. Eighty-four patients (41.8%) developed ARDS, and of those 84 patients, 44 (52.4%) died. In those who developed ARDS, compared with those who did not, more patients presented with dyspnea (50 of 84 [59.5%] patients and 30 of 117 [25.6%] patients, respectively [difference, 33.9%; 95% CI, 19.7%-48.1%]) and had comorbidities such as hypertension (23 of 84 [27.4%] patients and 16 of 117 [13.7%] patients, respectively [difference, 13.7%; 95% CI, 1.3%-26.1%]) and diabetes (16 of 84 [19.0%] patients and 6 of 117 [5.1%] patients, respectively [difference, 13.9%; 95% CI, 3.6%-24.2%]). In bivariate Cox regression analysis, risk factors associated with the development of ARDS and progression from ARDS to death included older age (hazard ratio [HR], 3.26; 95% CI 2.08-5.11; and HR, 6.17; 95% CI, 3.26-11.67, respectively), neutrophilia (HR, 1.14; 95% CI, 1.09-1.19; and HR, 1.08; 95% CI, 1.01-1.17, respectively), and organ and coagulation dysfunction (eg, higher lactate dehydrogenase [HR, 1.61; 95% CI, 1.44-1.79; and HR, 1.30; 95% CI, 1.11-1.52, respectively] and D-dimer [HR, 1.03; 95% CI, 1.01-1.04; and HR, 1.02; 95% CI, 1.01-1.04, respectively]). High fever (≥39 °C) was associated with higher likelihood of ARDS development (HR, 1.77; 95% CI, 1.11-2.84) and lower likelihood of death (HR, 0.41; 95% CI, 0.21-0.82). Among patients with ARDS, treatment with methylprednisolone decreased the risk of death (HR, 0.38; 95% CI, 0.20-0.72). Conclusions and Relevance: Older age was associated with greater risk of development of ARDS and death likely owing to less rigorous immune response. Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS. Moreover, treatment with methylprednisolone may be beneficial for patients who develop ARDS.


title: Update on treatment of COVID-19: ongoing studies between promising and disappointing results

text: The COVID-19 pandemic represents the greatest global public health crisis since the pandemic influenza outbreak of 1918. We are facing a new virus, so several antiviral agents previously used to treat other coronavirus infections such as SARS and MERS are being considered as the first potential candidates to treat COVID-19. Thus, several agents have been used by the beginning of the current outbreak in China first and all over the word successively, as reported in several different guidelines and therapeutic recommendations. At the same time, a great number of clinical trials have been launched to investigate the potential efficacy therapies for COVID-19 highlighting the urgent need to get as quickly as possible high-quality evidence. Through PubMed, we explored the relevant articles published on treatment of COVID-19 and on trials ongoing up to April 15, 2020.


A possible role for B cells in COVID-19? Lesson from patients with agammaglobulinemia


Ethical outpatient dermatology care during the coronavirus (COVID-19) pandemic


Covid-19 infection in psoriasis patients treated with cyclosporin


title: Healthcare Ethics During a Pandemic

text: As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives?With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel struggle with acute shortages of equipment-both to treat patients and protect themselves. With their personal and possibly their family's lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks-including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers' risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal.


title: Preliminary CT findings of coronavirus disease 2019 (COVID-19)

text: OBJECTIVES: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This paper aims to examine the CT imaging characteristics of COVID-19. METHODS: We evaluated CT images obtained between 10 January 2019 and 16 February 2020 at Taihe Hospital. Scans were conducted 2-6 times per patient and the re-testing interval was 2-7 days. Ninety-five patients with positive SARS-CoV-2 nucleic acid test results were included in this study and we retrospectively analysed their CT imaging characteristics. RESULTS: Ninety-five patients underwent 2-3 SARS-CoV-2 nucleic acid tests and received a definitive diagnosis of COVID-19. Fifty-three were male and 42 were female, and their mean age was 42 ± 12 years (range: 10 months to 81 years). Sixty-nine patients (72.6%) experienced fever, fatigue, and dry cough, while 15 (15.8%) had poor appetite and fatigue, and 11 (11.6%) had a dry cough and no fever. On CT imaging, early stage patients (n = 53, 55.8%) showed peripheral subpleural ground-glass opacities; these were mainly local patches (22/53, 41.5%), while some lesions were accompanied by interlobular septal thickening. Thirty-four (35.8%) patients were classified in the 'progression stage' based on CT imaging; these patients typically showed lesions in multiple lung segments and lobes (21/34ï¼61.8%), and an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows(30.5%). Two patients (2.1%) showed a severe presentation on CT. These showed diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening and air bronchograms, entire lung involvement with a "white lung" presentation, and mild pleural effusion. Six patients in remission (6.3%), visible lesion absorption, fibrotic lesions. Based on clinical signs, 71 (74.7%), 22 (23.2%), and 2 (2.1%) patients had mild or moderate, severe, and critical disease, respectively. Within the follow-up period, 93 patients recovered and were discharged, including the 53 early stage patients and 34 progression stage patients. The length of hospitalisation was 7-28 days (mean: 10 ± 3.5 days). On discharge, lesions were significantly reduced in area and had in many cases completely disappeared, while slight pulmonary fibrosis was present in some patients. One severe stage patient was still hospitalised at the end of the follow-up period and the other severe stage patient died. The overall mortality rate was 1.05%. CONCLUSIONS: Understanding the CT imaging characteristics of COVID-19 is important for early lesion detection, determining the nature of lesions, and assessing disease severity.


title: Cytokine storm in COVID-19 and parthenolide: Preclinical evidence

text: A group of patients with pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported from China in December 2019. Although several antiviral drugs are widely tested, none of them has been approved as specific antiviral therapy for coronavirus disease 2019 (COVID-19). Accumulating evidence established a hyperinflammatory states or cytokine storm in COVID-19. Among these cytokines, IL-6 plays a key role in cytokine storm and can predict the adverse clinical outcomes and fatality in these patients. Based on the evidence of the significant role of IL-6 in cytokine storm, diabetes mellitus, and cardiovascular diseases as principal comorbidities, it seems that anti-cytokine therapy may be useful in patients with severe COVID-19 to reduce mortality. Recent studies demonstrated that herbal-derived natural products had immunosuppressive and anti-inflammatory properties and exhibited exceptional act on mediators of inflammation. Parthenolide is the principal sesquiterpene lactones and the main biologically active constituent Tanacetum parthenium (commonly known as feverfew) which has could significantly reduce IL-1, IL-2, IL-6, IL-8, and TNF-α production pathways established in several human cell line models in vitro and in vivo studies. Therefore, parthenolide may be one of the herbal candidates for clinical evaluation.


title: Risk factors for predicting mortality in elderly patients with COVID-19: A review of clinical data in China

text: While elderly patients are at high risk of fatality, research concerning COVID-19 has largely been done on clarifying the clinical features. As such, the present work aims to identify risk factors for mortality in elderly patients with COVID-19. Given that single-centre studies are less likely informative as elderly remains a minority in the total Chinese population, the present study reviewed the clinical data of geriatric COVID-19 patients gathered from different sources in the public domain. Based on the data of 154 individuals from 26 provinces, age remained a key mortality risk factor among geriatric patients of different ages. While dyspnoea and chest pain/discomfort were more commonly seen in deceased patients as they represented severe pneumonia, fever was more prominent in surviving patients. This was likely due to the lower baseline body temperature observed in elderly which translated to a lower maximum temperature of fever. However, lowering the threshold temperature for fever is not recommended in surveillance. Instead, baseline body temperature measured on a regular basis should be used to define the threshold temperature for fever. Against mixed results, more research should be done on identifying comorbidities associated with mortality in geriatric patients.


Social Media can have an impact on how we manage and investigate the COVID-19 pandemic


Hospitalized patients with COVID-19 and HIV: a case series


title: SARS-CoV-2 and COVID-19: From the Bench to the Bedside

text: First isolated in China in early 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the novel coronavirus responsible for the ongoing pandemic of Coronavirus Disease 2019 (COVID-19). The disease has been spreading rapidly across the globe, with the largest burden falling on China, Europe, and the United States. COVID-19 is a new clinical syndrome, characterized by respiratory symptoms with varying degrees of severity, from mild upper respiratory illness to severe interstitial pneumonia and acute respiratory distress syndrome, aggravated by thrombosis in the pulmonary microcirculation. Three main phases of disease progression have been proposed for COVID-19: an early infection phase, a pulmonary phase, and a hyperinflammation phase. Although current understanding of COVID-19 treatment is mainly derived from small uncontrolled trials that are affected by a number of biases, strong background noise, and a litany of confounding factors, emerging awareness suggests that drugs currently used to treat COVID-19 (antiviral drugs, antimalarial drugs, immunomodulators, anticoagulants, and antibodies) should be evaluated in relation to the pathophysiology of disease progression. Drawing upon the dramatic experiences taking place in Italy and around the world, here we review the changes in the evolution of the disease and focus on current treatment uncertainties and promising new therapies.


Playing into Stereotypes: Engaging Millennials and Generation Z in the COVID-19 Pandemic Response


What the stock market tells us about the post-COVID-19 world


title: Transition Probabilities for Flavor Eigenstates of Non-Hermitian Hamiltonians in the PT-Broken Phase

text: We investigate the transition probabilities for the"flavor"eigenstates in the two-level quantum system, which is described by a non-Hermitian Hamiltonian with the parity and time-reversal (PT) symmetry. Particularly, we concentrate on the so-called PT-broken phase, where two eigenvalues of the non-Hermitian Hamiltonian turn out to be a complex conjugate pair. In this case, we find that the transition probabilities will be unbounded in the limit of infinite time $t \to +\infty$. After making a connection between the PT-broken phase and the neutral-meson system in particle physics, we observe that the infinite-time behavior of the transition probabilities can be attributed to the negative decay width of one eigenstate of the non-Hermitian Hamiltonian. We also present some brief remarks on the situation at the so-called exceptional point, where both the eigenvalues and eigenvectors of the Hamiltonian coalesce.


title: A Compressed Sensing Approach to Group-testing for COVID-19 Detection

text: We propose Tapestry, a novel approach to pooled testing with application to COVID-19 testing with quantitative Polymerase Chain Reaction (PCR) that can result in shorter testing time and conservation of reagents and testing kits. Tapestry combines ideas from compressed sensing and combinatorial group testing with a novel noise model for PCR. Unlike Boolean group testing algorithms, the input is a quantitative readout from each test, and the output is a list of viral loads for each sample. While other pooling techniques require a second confirmatory assay, Tapestry obtains individual sample-level results in a single round of testing. When testing $n$ samples with $t$ tests, as many as $k= O(t / \log n)$ infected samples can be identified at clinically-acceptable false positive and false negative rates. This makes Tapestry viable even at prevalence rates as high as 10\%. Tapestry has been validated in simulations as well as in wet lab experiments with oligomers. Clinical trials with Covid-19 samples are underway. An accompanying Android application Byom Smart Testing which makes the Tapestry protocol straightforward to implement in testing centres is available for free download.


Perspectives on Surgery in the Time of COVID-19: Safety First


docid: ukdmvihr

title: Head and neck cancer care in the COVID-19 pandemic: A brief update


title: 3D CT of Novel Coronavirus (COVID-19) Pneumonia

text: This article has online supplemental material.


docid: dxeqsauf

title: The Outbreak Cases with the Novel Coronavirus Suggest Upgraded Quarantine and Isolation in Korea


title: A Bayesian - Deep Learning model for estimating Covid-19 evolution in Spain

text: This work proposes a semi-parametric approach to estimate Covid-19 (SARS-CoV-2) evolution in Spain. Considering the sequences of cases, deaths, and recovered of all Spanish regions, it combines modern Deep Learning (DL) techniques for analyzing sequences with the usual Bayesian Poisson-Gamma model for counts. DL model provides a suitable description of observed sequences but no reliable uncertainty quantification around it can be obtained. To overcome this we use the prediction from DL as an expert elicitation of the expected number of counts and thus obtaining the posterior predictive distribution of counts in an orthodox Bayesian analysis. The overall resulting model allows us to either predict the future evolution of the sequences on all regions, as well as, estimating the consequences of eventual future scenarios.


title: Prevalence of Covid-19 Infection and Subsequent Cohorting in a Residential Substance Use Treatment Program in Boston, MA

text: OBJECTIVES: The global pandemic of coronavirus disease 2019 (Covid-19) may disproportionately affect persons in congregate settings, including those in residential substance use treatment facilities. To limit the spread of SARS-CoV-2 through congregate settings, universal testing may be necessary. We aimed to determine the point prevalence of SARS-CoV-2 in a residential treatment program setting and to understand the unique challenges of Covid-19 transmission in this setting. METHODS: We performed a case series of SARS-CoV-2 rT-PCR testing via nasopharyngeal in a residential substance use treatment program for women in Boston. Staff and residents of the treatment program were tested for SARS-CoV-2. The primary outcome was SARS-CoV-2 test result. RESULTS: A total of 31 residents and staff were tested. Twenty-seven percent (6/22) of the residents and 44% (4/9) of staff tested positive for SARS-CoV-2. All of the SARS-CoV-2 positive residents resided in the same residential unit. Two positive cases resided together with two negative cases in a 4-person room. Two other positive cases resided together in a 2-person room. One positive case resided with two negative cases in a 3-person room. One positive case resided with a negative case in a 2-person room. Based on test results, residents were cohorted by infection status and continued to participate in addiction treatment on-site. CONCLUSIONS: SARS-CoV-2 infection was common among staff and residents within a residential substance use treatment program for women in Boston. Universal SARS-CoV-2 testing in residential substance use programs can be instituted to reduce the risk of further transmission and continue addiction treatment programming when accompanied by adequate space, supplies, and staffing.


title: Estimating the Number of Infected Cases in COVID-19 Pandemic

text: The COVID-19 pandemic has caused major disturbance to human life. An important reason behind the widespread social anxiety is the huge uncertainty about the pandemic. One major uncertainty is how many or what percentage of people have been infected? There are published and frequently updated data on various statistics of the pandemic, at local, country or global level. However, due to various reasons, many cases were not included in those reported numbers. We propose a structured approach for the estimation of the number of unreported cases, where we distinguish cases that arrive late in the reported numbers and those who had mild or no symptoms and thus were not captured by any medical system at all. We use post-report data for the estimation of the former and population matching to the latter. We estimate that the reported number of infected cases in the US should be corrected by multiplying a factor of 220.54% as of Apr 20, 2020. The infection ratio out of the US population is estimated to be 0.53%, implying a case mortality rate at 2.85% which is close to the 3.4% suggested by the WHO.


title: Guía técnica para el cuidado de la salud mental del personal de la salud en el contexto del COVID-19

text: El documento contiene los procedimientos para el cuidado y autocuidado de la salud mental del personal de la salud que brinda atención a las personas con sospecha o con diagnóstico de infección por COVID-19


title: The Family Caregiving Crisis Meets an Actual Pandemic

text: The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to those who work with the seriously ill population, including both health care providers and the family caregivers providing unpaid care. We rely on this lay workforce as health care routinely transitions care to the home, and now more than ever, we are depending on them in the current pandemic. As palliative care and other health care providers become overwhelmed with patients critically ill with COVID-19, and routine care becomes delayed, we have a charge to recognize and work with family caregivers. Our commentary provides rationale for the need to focus on family caregivers and key considerations for how to include them in pandemic clinical decision making.


title: Key Questions for Modelling COVID-19 Exit Strategies

text: Combinations of intense non-pharmaceutical interventions (lockdowns) were introduced in countries worldwide to reduce SARS-CoV-2 transmission. Many governments have begun to implement lockdown exit strategies that allow restrictions to be relaxed while attempting to control the risk of a surge in cases. Mathematical modelling has played a central role in guiding interventions, but the challenge of designing optimal exit strategies in the face of ongoing transmission is unprecedented. Here, we report discussions from the Isaac Newton Institute Models for an exit strategy workshop (11-15 May 2020). A diverse community of modellers who are providing evidence to governments worldwide were asked to identify the main questions that, if answered, will allow for more accurate predictions of the effects of different exit strategies. Based on these questions, we propose a roadmap to facilitate the development of reliable models to guide exit strategies. The roadmap requires a global collaborative effort from the scientific community and policy-makers, and is made up of three parts: i. improve estimation of key epidemiological parameters; ii. understand sources of heterogeneity in populations; iii. focus on requirements for data collection, particularly in Low-to-Middle-Income countries. This will provide important information for planning exit strategies that balance socio-economic benefits with public health.


title: Cardiovascular Considerations in Treating Patients With Coronavirus Disease 2019 (COVID-19)

text: A novel betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly across the globe since December 2019. Coronavirus disease 2019 (COVID-19) has a significantly higher mortality rate than seasonal influenza and has disproportionately affected older adults, especially those with cardiovascular disease and related risk factors. Adverse cardiovascular sequelae, such as myocarditis, acute myocardial infarction, and heart failure, have been reported in patients with COVID-19. No established treatment is currently available; however, several therapies, including remdesivir, hydroxychloroquine and chloroquine, and interleukin (IL)-6 inhibitors, are being used off-label and evaluated in ongoing clinical trials. Considering these therapies are not familiar to cardiovascular clinicians managing these patients, this review describes the pharmacology of these therapies in the context of their use in patients with cardiovascular-related conditions.


title: Innate immunity in COVID-19 patients mediated by NKG2A receptors, and potential treatment using Monalizumab, Cholroquine, and antiviral agents

text: Following the outbreak of a novel coronavirus (SARS-CoV-2), studies suggest that the resultant disease (COVID-19) is more severe in individuals with a weakened immune system. Cytotoxic T-cells (CTLs) and Natural Killer (NK) cells are required to generate an effective immune response against viruses, functional exhaustion of which enables disease progression. Patients with severe COVID-19 present significantly lower lymphocyte, and higher neutrophil, counts in blood. Specifically, CD8+ lymphocytes and NK cells were significantly reduced in cases of severe infection compared to patients with mild infection and healthy individuals. The NK group 2 member A (NKG2A) receptor transduces inhibitory signalling, suppressing NK cytokine secretion and cytotoxicity. Overexpression of NKG2A has been observed on CD8+ and NK cells of COVID-19 infected patients compared to healthy controls, while NKG2A overexpression also functionally exhausts CD8+ cells and NK cells, resulting in a severely compromised innate immune response. Blocking NKG2A on CD8+ cells and NK cells in cancers modulated tumor growth, restoring CD8+ T and NK cell function. A recently proposed mechanism via which SARS-CoV-2 overrides innate immune response of the host is by over-expressing NKG2A on CD+ T and NK cells, culminating in functional exhaustion of the immune response against the viral pathogen. Monalizumab is an inhibiting antibody against NKG2A which can restore the function of CD8 + T and NK cells in cancers, successfully ceasing tumor progression with no significant side effects in Phase 2 clinical trials. We hypothesize that patients with severe COVID-19 have a severely compromised innate immune response and could be treated via the use of Monalizumab, interferon α, chloroquine, and other antiviral agents.


title: Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease

text: INTRODUCTION: As of 22 June 2020, Severe Acute Respiratory Syndrome (SARS)-coronavirus (CoV)-2 has infected more than 8.95 million people worldwide, causing > 468,000 deaths. The virus is transmitted through respiratory droplets and physical contact from contaminated surfaces to the mucosa. Hand hygiene and oral decontamination among other measures are key to preventing the spread of the virus. We report the in vitro virucidal activity of topical and oral povidone-iodine (PVP-I) products against SARS-CoV-2. METHODS: Suspension assays were used to assess the virucidal activity of PVP-I against SARS-CoV-2. Products were tested at a contact time of 30 s for virucidal activity. Viral titres were calculated using the Spearman-Kärber method and reported as median tissue culture infectious dose (TCID50)/mL. RESULTS: All four products [antiseptic solution (PVP-I 10%), skin cleanser (PVP-I 7.5%), gargle and mouth wash (PVP-I 1%) and throat spray (PVP-I 0.45%)] achieved ≥ 99.99% virucidal activity against SARS-CoV-2, corresponding to ≥ 4 log10 reduction of virus titre, within 30 s of contact. CONCLUSION: This study provides evidence of rapid and effective virucidal activity of PVP-I against SARS-CoV-2. PVP-I-based products are widely available for medical and personal use for hand hygiene and oral decontamination, and could be readily integrated into coronavirus disease, COVID-19, infection control measures in hospital and community settings.


Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children (MIS-C) that is related to COVID-19: a single center experience of 44 cases


title: Genetically modified live attenuated vaccine: a potential strategy to combat visceral leishmaniasis

text: Visceral leishmaniasis (VL) is caused by a protozoan parasite Leishmania donovani mainly influencing the population of tropical and subtropical regions across the globe. The arsenal of drugs available is limited, and prolonged use of such drugs makes parasite to become resistant. Therefore, it is very imperative to develop a safe, cost-effective and inexpensive vaccine against VL. Although in recent years many strategies have been pursued by researchers, but so far only some of the vaccine candidates reached for clinical trial and more than half of them are still in pipeline. There is now a broad consent among Leishmania researchers that the perseverance of parasite is very essential for eliciting a protective immune response and may perhaps be attained by live attenuated parasite vaccination. For making a live attenuated parasite it is very essential to ensure that the parasite is deficient of virulence and should further study genetically modified parasites to perceive the mechanism of pathogenesis. So it is believed that in the near future, a complete understanding of the Leishmania genome will explore clear strategies to discover a novel vaccine. This review describes the need for a genetically modified live attenuated vaccine against VL, and obstacles associated with its development.


docid: mflpgken

title: Reactivation of COVID-19-14 days from the onset of symptoms may not be enough to allow dental treatment


title: Reactivation of COVID-19 - 14 days from the onset of symptoms may not be enough to allow dental treatment

text: The pandemic of coronavirus disease 2019 (COVID-19) has become a global health disaster (Phelan et al., 2020). On the level of dental practice, the risk of cross infection between infected patients and dental professionals is quite alarming. The current recommendations suggest that dental treatment of patients with suspected/confirmed coronavirus disease should be postponed for at least 14 days from the onset of symptoms (Peng et al., 2020).


Use of COVID-19 convalescent plasma in low- and middle-income countries: a call for ethical principles and the assurance of quality and safety


The COVID-19 pand-ECMO-ic


MITS: an interim step towards improved cause of death data


Critically ill patients with COVID-19 in New York City (vol 395, pg 1740, 2020)


Critically ill patients with COVID-19 in New York City


title: Guess Who's Coming to Dinner: COVID-19 in a COVID-free Unit

text: OBJECTIVE: To assess the impact of the pandemic on surgical activity and the occurrence and features of Covid-19 in a Covid-free urologic unit in a regional hospital in Northern Italy. MATERIALS AND METHODS: Our Department is the only urologic service in the Trento Province, near Lombardy, the epicenter of Covid-19 in our Country. We reviewed the surgical and ward activities during the 4 weeks following the national lockdown (March 9 to April 5, 2020). The following outcomes were investigated: surgical load, rate of admissions and bed occupation, and the rate and characteristics of unrecognized Covid-positive patients. Data were compared with that of the same period of 2019 (March 11 to April 7). RESULTS AND CONCLUSION: About 63%, 70%, 64%, and 71%, decline in surgery, endoscopy, bed occupation, and admission, respectively, occurred during the 4 weeks after the lockdown, as compared to 2019. Urgent procedures also declined by 32%. Three (8%) of 39 admissions regarded unrecognized Covid-19 overlapping or misinterpreted with urgent urologic conditions such as fever-associated urinary stones or hematuria. In spite of a significant reduction of activity, a non-negligible portion of admissions to our Covid-free unit regarded unrecognized Covid-19. In order to preserve its integrity, we propose an enhanced triage prior to the admission to a Covid-free unit including not only routine questions on fever and respiratory symptoms but also nonrespiratory symptoms, history of exposure, and a survey about the social and geographic origin of the patient.


docid: zpwgxibh

title: COVID-19 Outbreak in France: Setup and Activities of a Mobile Extracorporeal Membrane Oxygenation Team During the First 3 Weeks


Adjuvant corticosteroid therapy for critically ill patients with COVID-19


COVID-19 associated encephalopathy: Is there a specific EEG pattern?


title: SARS-CoV-2 was already spreading in France in late December 2019

text: The COVID-19 epidemic is believed to have started in late January 2020 in France. Here we report a case of a patient hospitalised in December 2019 in an intensive care unit in a hospital in the north of Paris for haemoptysis with no aetiological diagnosis. RT-PCR was performed retrospectively on the stored respiratory sample and confirmed the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Based on this result, it appears that the COVID-19 epidemic started much earlier in France.


title: The Environmental Impacts of the Coronavirus

text: The Covid-19 coronavirus pandemic has resulted in global lockdowns, sharply curtailing economic activity. It is a unique experiment with substantial impacts that will form the agenda for research. There are five sets of questions: the short-term impacts on emissions, the natural environment and environmental policy, including regulations and COP26; longer-term consequences from the deployment of macroeconomic monetary and fiscal stimuli, and investment in green deals; possible further deglobalisation and its impact on climate change and nature; intergenerational environmental impacts including debt and pollution burdens on future generations; and possible behavioural changes to the environment, both positive and negative.


Managing fragility fractures during the COVID-19 pandemic


Separated pathways in the endoscopy unit for COVID-19 patients


Codon bias analysis may be insufficient for identifying host(s) of a novel virus


title: When and How to Lift the Lockdown? Global COVID-19 Scenario Analysis and Policy Assessment using Compartmental Gaussian Processes

text: The coronavirus disease 2019 (COVID-19) global pandemic has led many countries to impose unprecedented lockdown measures in order to slow down the outbreak. Questions on whether governments have acted promptly enough, and whether lockdown measures can be lifted soon have since been central in public discourse. Data-driven models that predict COVID-19 fatalities under different lockdown policy scenarios are essential for addressing these questions and informing governments on future policy directions. To this end, this paper develops a Bayesian model for predicting the effects of COVID-19 lockdown policies in a global context -- we treat each country as a distinct data point, and exploit variations of policies across countries to learn country-specific policy effects. Our model utilizes a two-layer Gaussian process (GP) prior -- the lower layer uses a compartmental SEIR (Susceptible, Exposed, Infected, Recovered) model as a prior mean function with"country-and-policy-specific"parameters that capture fatality curves under"counterfactual"policies within each country, whereas the upper layer is shared across all countries, and learns lower-layer SEIR parameters as a function of a country's features and its policy indicators. Our model combines the solid mechanistic foundations of SEIR models (Bayesian priors) with the flexible data-driven modeling and gradient-based optimization routines of machine learning (Bayesian posteriors) -- i.e., the entire model is trained end-to-end via stochastic variational inference. We compare the projections of COVID-19 fatalities by our model with other models listed by the Center for Disease Control (CDC), and provide scenario analyses for various lockdown and reopening strategies highlighting their impact on COVID-19 fatalities.


Unfavorable outcomes in pregnant patients with COVID-19


Faecal immunohistochemical testing in the COVID-19 era: balancing risk and costs


docid: xkbpmjtx

title: Emergencia del coronavirus SARS-CoV2 en China y la respuesta en México./ Emergence of novel coronavirus SARS-CoV2 in China and the response in Mexico


The Impact of the Covid-19 Pandemic on Stroke Volume


title: Protein-ligand interaction study to identify potential dietary compounds binding at the active site of therapeutic target proteins of SARS-CoV-2

text: Objective: Total 186 biologically important phenylpropanoids and polyketides compounds from different Indian medicinal plants and dietary sources were screened to filter potential compounds that bind at the active site of the therapeutic target proteins of SARS-CoV-2. Method: The molecular docking studies were carried out by using the Autodock Vina. The in silico ADMET and drug-likeness properties of the compounds were predicted from SwissADME server. Result: The molecular docking study of the 186 compounds with the therapeutic target proteins (Mpro, PLpro, RdRp, SGp and ACE2) of SARS-CoV-2 resulted 40 compounds that bind at the active site with dock score above -8.0 kcal/mol. Conclusion: Based on the in silico ADMET study and drug-likeness prediction of 40 compounds, we proposed petunidin, baicalein, cyanidin, 7-hydroxy-3',4'-methylenedioxyflavan, quercetin and ellagic acid among the 186 biologically important phenylpropanoids and polyketides as potential lead compounds, which can further be investigated pharmacologically and clinically to formulate therapeutic approaches for the COVID-19.


title: EMIXER: End-to-end Multimodal X-ray Generation via Self-supervision

text: Deep generative models have enabled the automated synthesis of high-quality data for diverse applications. However, the most effective generative models are specialized to data from a single domain (e.g., images or text). Real-world applications such as healthcare require multi-modal data from multiple domains (e.g., both images and corresponding text), which are difficult to acquire due to limited availability and privacy concerns and are much harder to synthesize. To tackle this joint synthesis challenge, we propose an End-to-end MultImodal X-ray genERative model (EMIXER) for jointly synthesizing x-ray images and corresponding free-text reports, all conditional on diagnosis labels. EMIXER is an conditional generative adversarial model by 1) generating an image based on a label, 2) encoding the image to a hidden embedding, 3) producing the corresponding text via a hierarchical decoder from the image embedding, and 4) a joint discriminator for assessing both the image and the corresponding text. EMIXER also enables self-supervision to leverage vast amount of unlabeled data. Extensive experiments with real X-ray reports data illustrate how data augmentation using synthesized multimodal samples can improve the performance of a variety of supervised tasks including COVID-19 X-ray classification with very limited samples. The quality of generated images and reports are also confirmed by radiologists. We quantitatively show that EMIXER generated synthetic datasets can augment X-ray image classification, report generation models to achieve 5.94% and 6.9% improvement on models trained only on real data samples. Taken together, our results highlight the promise of state of generative models to advance clinical machine learning.


title: Internet of Medical Things (IoMT) for orthopaedic in COVID-19 pandemic: Roles, challenges, and applications

text: Internet of Medical Things (IoMT) is an innovative mean of amalgamating medical devices and their applications to connect with the healthcare information technology systems by using networking technologies. We have explored the possibilities of confronting the ongoing COVID-19 pandemic by implementing the IoMT approach while offering treatment to orthopaedic patients. The data sharing, report monitoring, patients tracking, information gathering and analysis, hygiene medical care, etc. are the various cloud and connected network-based services of IoMT. It can completely change the working layout of the healthcare facilities while treating orthopaedic patients with a superior level of care and more satisfaction, especially during this pandemic COVID-19 lockdown. Remote-location healthcare has also become feasible with the proposed IoMT approach.


title: Consensus recommendations for the care of children receiving chronic dialysis in association with the COVID-19 epidemic

text: Coronavirus disease 2019 (COVID-19) has rapidly spread not only in China but throughout the world. Children with kidney failure (chronic kidney disease (CKD) stage 5) are at significant risk for COVID-19. In turn, a set of recommendations for the prevention and control of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 in pediatric hemodialysis (HD) centers and in home peritoneal dialysis (PD) settings have been proposed. The recommendations are based on the epidemiological features of the SARS-CoV-2 virus and COVID-19 disease, susceptibility factors, and preventive and control strategies. These recommendations will be updated as new information regarding SARS-CoV-2 and COVID-19 becomes available.


title: Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020

text: On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic (1). As of March 28, 2020, a total of 571,678 confirmed COVID-19 cases and 26,494 deaths have been reported worldwide (2). Reports from China and Italy suggest that risk factors for severe disease include older age and the presence of at least one of several underlying health conditions (3,4). U.S. older adults, including those aged ≥65 years and particularly those aged ≥85 years, also appear to be at higher risk for severe COVID-19-associated outcomes; however, data describing underlying health conditions among U.S. COVID-19 patients have not yet been reported (5). As of March 28, 2020, U.S. states and territories have reported 122,653 U.S. COVID-19 cases to CDC, including 7,162 (5.8%) for whom data on underlying health conditions and other known risk factors for severe outcomes from respiratory infections were reported. Among these 7,162 cases, 2,692 (37.6%) patients had one or more underlying health condition or risk factor, and 4,470 (62.4%) had none of these conditions reported. The percentage of COVID-19 patients with at least one underlying health condition or risk factor was higher among those requiring intensive care unit (ICU) admission (358 of 457, 78%) and those requiring hospitalization without ICU admission (732 of 1,037, 71%) than that among those who were not hospitalized (1,388 of 5,143, 27%). The most commonly reported conditions were diabetes mellitus, chronic lung disease, and cardiovascular disease. These preliminary findings suggest that in the United States, persons with underlying health conditions or other recognized risk factors for severe outcomes from respiratory infections appear to be at a higher risk for severe disease from COVID-19 than are persons without these conditions.


The need to implement non-industry COVID-19 clinical trials in non-high-income countries


title: Rapid Implementation of Inpatient Telepalliative Medicine Consultations During COVID-19 Pandemic

text: As coronavirus disease 2019 cases increase throughout the country and health care systems grapple with the need to decrease provider exposure and minimize personal protective equipment use while maintaining high-quality patient care, our specialty is called on to consider new methods of delivering inpatient palliative care (PC). Telepalliative medicine has been used to great effect in outpatient and home-based PC but has had fewer applications in the inpatient setting. As we plan for decreased provider availability because of quarantine and redeployment and seek to reach increasingly isolated hospitalized patients in the face of coronavirus disease 2019, the need for telepalliative medicine in the inpatient setting is now clear. We describe our rapid and ongoing implementation of telepalliative medicine consultation for our inpatient PC teams and discuss lessons learned and recommendations for programs considering similar care models.


title: Public-Private-People Partnerships (4P) for Improving the Response to COVID-19 in Iran

text: Public-Private-People Partnership is a significant element in disaster response. COVID-19 as a pandemic has been the worst disaster in the last decades in Iran in terms of exposure and magnitude. In order to respond effectively, the Iranian government needs an extra capacity which may be provided by the private sector and people. This study aims to collect evidences of Public-Private-People partnerships pertaining to COVID-19 response in Iran from February to April 2020. Partnership case studies are classified into three categories as follows: 1) Public-private partnerships; 2) public-people partnerships; and 3) private-people partnerships. It was found that the Iranian government has removed or diminished some of the barriers to cooperation. There was also more cooperation between the people, the private sector, and the public sector than during normal times (vs disasters). People participated in the response procedure through some associations or groups, such as religious and ethnic communities, as well as through non-governmental organizations. It is showed that 4P is vital in disasters response and in particular to epidemics. The government can be more active in partnerships with private sector, and people in emergencies such as COVID-19 Pandemic. Enhancing social capital, institutionalization, and developing required infrastructures by the government will improve public-private partnerships.


The Shifting Landscape of Genitourinary Oncology During the COVID-19 Pandemic and how Italian Oncologists Reacted: Results from a National Survey


COVID-19 Nonessential Surgery Restrictions and Spine Surgery: A German Experience


Rapid onset honeycombing fibrosis in spontaneously breathing patient with Covid-19


The colliding epidemics of COVID-19, Ebola, and measles in the Democratic Republic of the Congo


COVID-19, Medical Education, and Bone Health: Insights From Project ECHO


title: Structural Basis of the Potential Binding Mechanism of Remdesivir to SARS-CoV-2 RNA-Dependent RNA Polymerase

text: Starting from late 2019, the coronavirus disease 2019 (COVID-19) has emerged as a once-in-a-century pandemic with deadly consequences, which urgently calls for new treatments, cures, and supporting apparatuses. Recently, because of its positive results in clinical trials, remdesivir was approved by the Food and Drug Administration to treat COVID-19 through Emergency Use Authorization. Here, we used molecular dynamics simulations and free energy perturbation methods to study the inhibition mechanism of remdesivir to its target SARS-CoV-2 virus RNA-dependent RNA polymerase (RdRp). We first constructed the homology model of this polymerase based on a previously available structure of SARS-CoV NSP12 RdRp (with a sequence identity of 95.8%). We then built a putative preinsertion binding structure by aligning the remdesivir + RdRp complex to the ATP bound poliovirus RdRp without the RNA template. The putative binding structure was further optimized with molecular dynamics simulations. The resulting stable preinsertion state of remdesivir appeared to form hydrogen bonds with the RNA template when aligned with the newly solved cryo-EM structure of SARS-CoV-2 RdRp. The relative binding free energy between remdesivir and ATP was calculated to be -2.80 ± 0.84 kcal/mol, where remdesivir bound much stronger to SARS-CoV-2 RdRp than the natural substrate ATP. The â¼100-fold improvement in the Kd from remdesivir over ATP indicates an effective replacement of ATP in blocking of the RdRp preinsertion site. Key residues D618, S549, and R555 are found to be the contributors to the binding affinity of remdesivir. These findings suggest that remdesivir can potentially act as a SARS-CoV-2 RNA-chain terminator, effectively stopping its RNA replication, with key residues also identified for future lead optimization and/or drug resistance studies.


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title: Why baby alligators in some spots could be 98% female by century's end


title: A review on the cleavage priming of the spike protein on coronavirus by angiotensin-converting enzyme-2 and furin

text: The widespread antigenic changes lead to the emergence of a new type of coronavirus (CoV) called as severe acute respiratory syndrome (SARS)-CoV-2 that is immunologically different from the previous circulating species. Angiotensin-converting enzyme-2 (ACE-2) is one of the most important receptors on the cell membrane of the host cells (HCs) which its interaction with spike protein (SP) with a furin-cleavage site results in the SARS-CoV-2 invasion. Hence, in this review, we presented an overview on the interaction of ACE-2 and furin with SP. As several kinds of CoVs, from various genera, have at their S1/S2 binding site a preserved site, we further surveyed the role of furin cleavage site (FCS) on the life cycle of the CoV. Furthermore, we discussed that the small molecular inhibitors can limit the interaction of ACE-2 and furin with SP and can be used as potential therapeutic platforms to combat the spreading CoV epidemic. Finally, some ongoing challenges and future prospects for the development of potential drugs to promote targeting specific activities of the CoV were reviewed. In conclusion, this review may pave the way for providing useful information about different compounds involved in improving the effectiveness of CoV vaccine or drugs with minimum toxicity against human health.Communicated by Ramaswamy H. Sarma.


Can Google® trends predict COVID-19 incidence and help preparedness? The situation in Colombia


title: Developing a Measure of the Impact of COVID-19 Social Distancing on Household Conflict and Cohesion

text: This report introduces the COVID-19 Family Environment Scale (CHES), which aims to measure the impact of social distancing due to COVID-19 on household conflict and cohesion. Existing measures do not capture household experiences relevant to the pandemic, in which families are largely confined to their homes while sharing a life-threatening situation. Using best practice guidelines, we developed a pool of items and revised them with review by a panel of experts, and cognitive interviewing with community respondents. We administered the CHES by online survey to 3,965 adults. The CHES consists of 15 items for each of two subscales, Household Conflict (α = .847), and Household Cohesion (α = .887). Exploratory factor analysis yielded two factors, corresponding to the intended conflict and cohesion items, which accounted for 22% of variance. Confirmatory factor analysis partially supported the 2-factor model (RMSEA = .057; CFI = .729, TLI = .708, and SRMR = .098). The CHES also contains 25 optional items to describe respondent and household characteristics, and household-level COVID-19 exposure. The CHES, publicly available at https://elcentro.sonhs.miami.edu/research/measures-library/covid-19/index.html,provides a tool for measuring the impact of the COVID-19 pandemic on important determinants of resilience in the face of major stressful events. Further work is needed to address the factor structure and establish validity of the CHES.


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title: Research on reducing burnout in health care workers in critical situations such as COVID-19 outbreak


Time to spatialise epidemiology in China


The Response of the Anesthesia & Analgesia Community to Coronavirus Disease 2019 (COVID-19)


title: Conducting Clinical Research During the COVID-19 Pandemic: Investigator and Participant Perspectives

text: As the medical landscape changes daily with the coronavirus disease (COVID-19) pandemic, clinical researchers are caught off-guard and are forced to make decisions on research visits in their ongoing clinical trials. Although there is some guidance from local and national organizations, the principal investigator (PI) is ultimately responsible for determining the risk-benefit ratio of conducting, rescheduling, or cancelling each research visit. The PI should take into consideration the ethical principles of research, local/national guidance, the community risk of the pandemic in their locale, staffing strain, and the risk involved to each participant, to ultimately decide on the course of action. While balancing the rights and protection of the human subject, we seldom examine patients' views and opinions about their scheduled research visit(s). This article discusses the ethical principles of beneficence and autonomy in helping the decision-making process. We discuss ways to weigh-in local and national guidance, staffing strain, and institutional support into the decision-making process and outline potential changes needed for regulatory bodies depending on the decision. Further, we discuss the need to weigh-in the individual risk-benefit ratio for each participant and present a decision tree to navigate this complex process. Finally, we examine participant and caregiver perspectives on their fears, sense of preparedness, and factors that they consider before deciding whether to keep or postpone the research appointments. This entry also provides PIs ways to support their research participants in both scenarios, including provision of psychological support.


title: Swine acute diarrhea syndrome coronavirus (SADS-CoV) antagonizes interferon-ß production via blocking IPS-1 and RIG-I

text: Swine acute diarrhea syndrome coronavirus (SADS-CoV), a newly emerging enteric coronavirus, is considered to be associated with swine acute diarrhea syndrome (SADS) which has caused significantly economic losses to the porcine industry. Interactions between SADS-CoV and the host innate immune response is unclear yet. In this study, we used IPEC-J2 cells as a model to explore potential evasion strategies employed by SADS-CoV. Our results showed that SADS-CoV infection failed to induce IFN-ß production, and inhibited poly (I:C) and Sendai virus (SeV)-triggered IFN-ß expression. SADS-CoV also blocked poly (I:C)-induced phosphorylation and nuclear translocation of IRF-3 and NF-κB. Furthermore, SADS-CoV did not interfere with the activity of IFN-ß promoter stimulated by IRF3, TBK1 and IKKÎµ, but counteracted its activation induced by IPS-1 and RIG-I. Collectively, this study is the first investigation that shows interactions between SADS-CoV and the host innate immunity, which provides information of the molecular mechanisms underlying SASD-CoV infection.


Patients With the Novel SARS-Cov-2 Disease Require a Novel Standard of Care-Med-Psych


title: How do Agile Software Startups deal with uncertainties by Covid-19 pandemic?

text: The dissipation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 100 countries in a couple of weeks. The evolution of the disease and its economic impact is highly uncertain, which brings challenges for newly created software companies. Software startups are companies that create innovative software products and services in a dynamic and fast-growing market. Agile Software Methods aims to enable startups in responding to uncertainty caused by Covid-19. This paper investigates the impact of Covid-19 in a real software startup context to understand how they have reacted against uncertainties caused by Covid-19. As a research methodology, action research within Di2Win, a Brazilian software startup, has been applied. The study was carried out throughout six sprints, during the quarantine. Practices employed to mitigate threats while simultaneously allowing teams to remain open to opportunities and challenges are detailed. This paper shares lessons learned that could help agile software startups improve their way of work in an uncertain environment caused by the Covid-19 pandemic.


Latest updates on COVID-19 from the European Centre for Disease Prevention and Control


OBJECTIVES: This study analyzed salivary samples of COVID-19 patients and compared the results with their clinical and laboratory data. METHODS: Salivary samples of 25 COVID-19 patients were analyzed by rRT-PCR. The following data were collected: age, sex, comorbidities, drugs. Lactate dehydrogenase (LDH) and ultrasensitive reactive C protein (usRCP) values were registered on the same day when a salivary swab was collected. Prevalence of positivity in saliva and association between clinical data and the cycle threshold as a semiquantitative indicator of viral load were considered. RESULTS: Twenty-five subjects were recruited into this study, 17 males and 8 females. The mean age was 61.5 +/- 11.2 years. Cardiovascular and/or dysmetabolic disorders were observed in 65.22% of cases. All the samples tested positive for the presence of SARS-CoV-2, while there was an inverse association between LDH and Ct values. Two patients showed positive salivary results on the same days when their pharyngeal or respiratory swabs showed conversion. CONCLUSIONS: Saliva is a reliable tool to detect SARS-CoV-2. The role of saliva in COVID-19 diagnosis could not be limited to a qualitative detection of the virus, but it may also provide information about the clinical evolution of the disease.


title: Clinical implications and economic effects of the corona virus pandemic on gynaecology, obstetrics and reproductive medicine in Germany-learning from Italy

text: The infection with the novel SARS Cov-2 corona virus, the cause of severe acute respiratory distress syndrome, possessing its origin in the Chinese province Hubei, has reached the extent of a global pandemic within a few months. After aerosol infection, most people experience mild respiratory infection with cold symptoms such as cough and fever, and healing within two weeks. In about 5% of those infected, however, a severe course develops with the occurrence of multiple sub pleural bronchopulmonary infiltrates and even death as a result of respiratory failure. The corona virus pandemic has multiple impacts on social life that have not been seen before. For example, the government adopted measures to curb the exponential spread of the virus, which included a significant reduction in social contacts. Furthermore, the specialist societies recommended that no elective treatments be carried out during the pandemic period. This review article considers epidemiological aspects of novel corona virus infection and presents both the clinical as well the possible economic effects of the pandemic on gynaecology, obstetrics and reproductive medicine in Germany in the past, present and future. In addition, useful preventive measures for daily clinical work and the previously known scientific findings dealing with the impact of corona virus on pregnancy and birth are discussed.


title: Different computed tomography patterns of Coronavirus Disease 2019 (COVID-19) between survivors and non-survivors

text: This study aimed to compare the chest computed tomography (CT) findings between survivors and non-survivors with Coronavirus Disease 2019 (COVID-19). Between 12 January 2020 and 20 February 2020, the records of 124 consecutive patients diagnosed with COVID-19 were retrospectively reviewed and divided into survivor (83/124) and non-survivor (41/124) groups. Chest CT findings were qualitatively compared on admission and serial chest CT scans were semi-quantitively evaluated between two groups using curve estimations. On admission, significantly more bilateral (97.6% vs. 73.5%, p = 0.001) and diffuse lesions (39.0% vs. 8.4%, p < 0.001) with higher total CT score (median 10 vs. 4, p < 0.001) were observed in non-survivor group compared with survivor group. Besides, crazy-paving pattern was more predominant in non-survivor group than survivor group (39.0% vs. 12.0%, p < 0.001). From the prediction of curve estimation, in survivor group total CT score increased in the first 20 days reaching a peak of 6 points and then gradually decreased for more than other 40 days (R2 = 0.545, p < 0.001). In non-survivor group, total CT score rapidly increased over 10 points in the first 10 days and gradually increased afterwards until ARDS occurred with following death events (R2 = 0.711, p < 0.001). In conclusion, persistent progression with predominant crazy-paving pattern was the major manifestation of COVID-19 in non-survivors. Understanding this CT feature could help the clinical physician to predict the prognosis of the patients.


A predictive model for disease progression in non-severe illness patients with Corona Virus Disease 2019


title: SARS-CoV-2 RNA identification in nasopharyngeal swabs: issues in pre-analytics

text: Objectives The direct identification of SARS-CoV-2 RNA in nasopharyngeal swabs is recommended for diagnosing the novel COVID-19 disease. Pre-analytical determinants, such as sampling procedures, time and temperature storage conditions, might impact on the end result. Our aim was to evaluate the effects of sampling procedures, time and temperature of the primary nasopharyngeal swabs storage on real-time reverse-transcription polymerase chain reaction (rRT-PCR) results. Methods Each nasopharyngeal swab obtained from 10 hospitalized patients for COVID-19 was subdivided in 15 aliquots: five were kept at room temperature; five were refrigerated (+4 °C); five were immediately mixed with the extraction buffer and refrigerated at +4 °C. Every day and for 5 days, one aliquot per condition was analyzed (rRT-PCR) for SARS-CoV-2 gene E and RNaseP and threshold cycles (Ct) compared. To evaluate manual sampling, 70 nasopharyngeal swabs were sampled twice by two different operators and analyzed separately one from the other. Results A total of 6/10 swabs were SARS-CoV-2 positive. No significant time or storage-dependent variations were observed in SARS-CoV-2 Ct. Re-sampling of swabs with SARS-CoV-2 Ct lower than 33 resulted in highly reproducible results (CV=2.9%), while a high variability was observed when Ct values were higher than 33 (CV=10.3%). Conclusions This study demonstrates that time and temperature of nasopharyngeal swabs storage do not significantly impact on results reproducibility. However, swabs sampling is a critical step, and especially in case of low viral load, might be a potential source of diagnostic errors.


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title: Rapid publications risk the integrity of science in the era of COVID-19

text: BACKGROUND: Preprint manuscripts, rapid publications and opinion pieces have been essential in permitting the lay press and public health authorities to preview data relating to coronavirus disease 2019 (COVID-19), including the range of clinical manifestations and the basic epidemiology early on in the pandemic. However, the rapid dissemination of information has highlighted some issues with communication of scientific results and opinions in this time of heightened sensitivity and global concern. MAIN TEXT: Rapid publication of COVID-19 literature through expedited review, preprint publications and opinion pieces are important resources for the medical scientific community. Yet the risks of unverified information loom large in times when the healthcare community is desperate for information. Information that has not been properly vetted, or opinion pieces without solid evidence, may be used to influence public health policy decisions. We discuss three examples of unverified information and the consequences in this time of high anxiety surrounding COVID-19. CONCLUSIONS: In an era when information can be widely and swiftly disseminated, it is important to ensure that the scientific community is not an inadvertent source of misinformation. This will require a multimodal approach, with buy-in from editors, publishers, preprint servers, authors and journalists. The landscape of medical publications has changed, and a collaborative approach is required to maintain a high standard of scientific communications.


What can plastic and reconstructive medical staffs do during the COVID-19 outbreak?


title: Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

text: OBJECTIVE: Bedside chest ultrasonography, when integrated with clinical data, is an accurate tool for improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasonographic screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)-related pneumonia and improving the appropriateness of hospital referral of residents. DESIGN: Pragmatic, descriptive, feasibility study from April 2 to April 9, 2020. SETTING AND PARTICIPANTS: A total of 83 older residents (age 85 ± 8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in 5 nursing homes in Northern Italy. METHODS: Chest ultrasonography was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring 4 different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations, and pleural line indentation, was detected. The specialist team integrated ultrasonography data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed. RESULTS: The most frequent reasons for ultrasonographic evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasonographic findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and 6 of them required hospitalization. Twelve patients had ultrasonographic patterns suggesting other respiratory diseases, and 2 patients with normal ultrasonographic findings were diagnosed with COPD exacerbation. CONCLUSIONS AND IMPLICATIONS: In nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management.


title: Clinical Factors, Preventive Behaviours and Temporal Outcomes Associated with COVID-19 Infection in Health Professionals at a Spanish Hospital

text: The novel coronavirus disease (COVID-19) outbreak has quickly spread around the world, with Spain being one of the most severely affected countries. Healthcare professionals are an important risk group given their exposure. The aims of this study were to determine the prevalence of symptoms, main concerns as patients, preventive behaviours of healthcare professionals, and the different temporal outcomes associated with the negativization of PCR results. A total of 238 professionals were analysed and follow-up was conducted from 11 March to 21 April 2020 through clinical records, in-depth surveys, and telephone interviews. Symptoms, concerns, and preventive measures were documented, and temporal outcomes (start and end of symptoms, first positive PCR, and negativization of PCR) were analysed through survival analyses. A high prevalence of gastrointestinal symptoms (especially in women and older professionals), fever, cough, and fatigue were reported. The main concern was contagion in the work and home environment. Professionals (especially men) reported low use of face masks before the pandemic. Our analysis indicates that the median times for the negativization of PCR testing to confirm the resolution of infection is 15 days after the end of symptoms, or 25 days after the first positive PCR test. Our results suggest that these times are longer for women and for professionals aged ≥55 years, therefore follow-up strategies should be optimized in light of both variables. This is the first study we are aware of to report factors associated with the time to negativization of PCR results. We present the first rigorous estimates of time outcomes and hope that these data can be valuable to continue feeding the prediction models that are currently being developed. Similar studies are required to corroborate our results.