title: An evidence mapping and analysis of registered COVID-19 clinical trials in China

text: BACKGROUND: This article aims to summarize the key characteristics of registered trials of 2019 novel coronavirus (COVID-19), in terms of their spatial and temporal distributions, types of design and interventions, and patient characteristics among others. METHODS: A comprehensive search of the registered COVID-19 trials has been performed on platforms including ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (WHO ICTRP), Chinese Clinical Trials Registry (CHiCTR), Australian Clinical Trials Registry, Britain's National Research Register (BNRR), Current Control Trials (CCT), and Glaxo Smith Kline Register. Trials registered at the first 8 weeks of the COVID-19 outbreak are included, without language restrictions. For each study, the registration information, study design, and administrator information are collected and summarized. RESULTS: A total of 220 registered trials were evaluated as of February 27, 2020. Hospital-initiated trials were the majority and account for 80% of the sample. Among the trials, pilot studies and phase 4 trials are more common and represent 35% and 19.1% of the sample, respectively. The median sample size of the registered trials is 100, with interquartile range 60-240. Further, 45.9% of the trials mentioned information on a data monitoring committee. 54.5% of the trials did not specify the disease severity among patients they intend to recruit. Four types of interventions are most common in the experimental groups across the registered studies: antiviral drugs, Traditional Chinese Medicine (TCM), biological agents, and hormone drugs. Among them, the TCM and biological agents are frequently used in pilot study and correspond to a variety of primary endpoints. In contrast, trials with antiviral drugs have more targeted primary outcomes such as "COVID-19 nucleic acid test" and "28-day mortality." CONCLUSIONS: We provide an evidence mapping and analysis of registered COVID-19 clinical trials in China. In particular, it is critical for ongoing and future studies to refine their research hypothesis and better identify their intervention therapies and the corresponding primary outcomes. It is also imperative for multiple public health divisions and research institutions to work together for integrative clinical data capture and sharing, with a common objective of improving future studies that evaluate COVID-19 interventions.


title: Protocolo de manejo clínico do Coronavírus (covid-19) na atenção primária à saúde: versão 8

text: No fim de 2019, o Novo Coronavírus foi nomeado como SARS-CoV-2 Este Novo Coronavírus produz a doença classificada como COVID-19, sendo agente causador de uma série de casos de pneumonia na cidade de Wuhan (China) [1] Ainda não há informações plenas sobre a história natural, nem medidas de efetividade inquestionáveis para manejo clínico dos casos de infecção humana pelo SARS-CoV-2, restando ainda muitos detalhes a serem esclarecidos [1] No entanto, sabe-se que o vírus tem alta transmissibilidade e provoca uma síndrome respiratória aguda que varia de casos leves  cerca de 80%  a casos muito graves com insuficiência respiratória entre 5% e 10% dos casos Sua letalidade varia, principalmente, conforme a faixa etária (Quadro 1) e condições clínicas associadas Portanto, é necessário agir Para esse fim, as melhores e mais recentes evidências foram utilizadas na redação deste documento Pela dinâmica da epidemia e da produção de conhecimento associada a ela, as informações podem sofrer alterações conforme avance o conhecimento sobre a doença dessa forma, este protocolo específico para serviços de Atenção Primária à Saúde / Estratégia Saúde da Família (APS/ESF) nos cenários de transmissão comunitária vai ser atualizado sempre que necessário A APS/ESF é a porta de entrada do Sistema Único de Saúde Durante surtos e epidemias, a APS/ESF tem papel fundamental na resposta global à doença em questão a APS/ESF oferece atendimento resolutivo, além de manter a longitudinalidade e a coordenação do cuidado em todos os níveis de atenção à saúde, com grande potencial de identificação precoce de casos graves que devem ser manejados em serviços especializados O objetivo deste documento é definir o papel dos serviços de APS/ESF no manejo e controle da infecção COVID-19, bem como disponibilizar os instrumentos de orientação clínica para os profissionais que atuam na porta de entrada do SUS a partir da transmissão comunitária de CoVId-19 no Brasil Considerando a existência de fase de transmissão comunitária da COVID-19, é imprescindível que os serviços de APS/ESF trabalhem com abordagem sindrômica do problema, não exigindo mais a identificação do fator etiológico por meio de exame específico Desta forma, este protocolo foca na abordagem clínica da Síndrome Gripal e da Síndrome Respiratória Aguda Grave (SRAG), independentemente do agente etiológico Como é de conhecimento de todos, múltiplos agentes virais são responsáveis por essas duas síndromes, sendo o vírus da Influenza o de maior magnitude nos últimos anos Entretanto, há evidências e dados internacionais indicando que a transcendência da COVID-19 pode superar a da Influenza Portanto, a abordagem pragmática deste protocolo unifica as condutas referentes a esses dois grupos de vírus


title: Protocolo de manejo clínico do Coronavírus (covid-19) na atenção primária à saúde: versão 6

text: No fim de 2019, o Novo Coronavírus foi nomeado como SARS-CoV-2 Este Novo Coronavírus produz a doença classificada como COVID-19, sendo agente causador de uma série de casos de pneumonia na cidade de Wuhan (China) [1] Ainda não há informações plenas sobre a história natural, nem medidas de efetividade inquestionáveis para manejo clínico dos casos de infecção humana pelo SARS-CoV-2, restando ainda muitos detalhes a serem esclarecidos [1] No entanto, sabe-se que o vírus tem alta transmissibilidade e provoca uma síndrome respiratória aguda que varia de casos leves  cerca de 80%  a casos muito graves com insuficiência respiratória entre 5% e 10% dos casos Sua letalidade varia, principalmente, conforme a faixa etária (Quadro 1) e condições clínicas associadas Portanto, é necessário agir Para esse fim, as melhores e mais recentes evidências foram utilizadas na redação deste documento Pela dinâmica da epidemia e da produção de conhecimento associada a ela, as informações podem sofrer alterações conforme avance o conhecimento sobre a doença Dessa forma, este protocolo específico para serviços de Atenção Primária à Saúde / Estratégia Saúde da Família (APS/ESF) nos cenários de transmissão comunitária vai ser atualizado sempre que necessário Fique atento a novas versões! A APS/ESF é a porta de entrada do Sistema Único de Saúde Durante surtos e epidemias, a APS/ESF tem papel fundamental na resposta global à doença em questão A APS/ESF oferece atendimento resolutivo, além de manter a longitudinalidade e a coordenação do cuidado em todos os níveis de atenção à saúde, com grande potencial de identificação precoce de casos graves que devem ser manejados em serviços especializados O objetivo deste documento é definir o papel dos serviços de APS/ESF no manejo e controle da infecção COVID-19, bem como disponibilizar os instrumentos de orientação clínica para os profissionais que atuam na porta de entrada do SUS a partir da transmissão comunitária de CoVId-19 no Brasil Considerando a existência de fase de transmissão comunitária da COVID-19, é imprescindível que os serviços de APS/ESF trabalhem com abordagem sindrômica do problema, não exigindo mais a identificação do fator etiológico por meio de exame específico Desta forma, este protocolo foca na abordagem clínica da Síndrome Gripal e da Síndrome Respiratória Aguda Grave (SRAG), independentemente do agente etiológico Como é de conhecimento de todos, múltiplos agentes virais são responsáveis por essas duas síndromes, sendo o vírus da Influenza o de maior magnitude nos últimos anos Entretanto, há evidências e dados internacionais indicando que a transcendência da COVID-19 pode superar a da Influenza Portanto, a abordagem pragmática deste protocolo unifica as condutas referentes a esses dois grupos de vírus


title: Distinctive trajectories of COVID-19 epidemic by age and gender: a retrospective modeling of the epidemic in South Korea

text: OBJECTIVES: Elderly people had suffered disproportional burden of COVID-19. We hypothesized that males and females in different age groups might have different epidemic trajectories. METHODS: Using publicly available data from South Korea, daily new COVID-19 cases were fitted with generalized additive models, assuming Poisson and negative binomial distributions. Epidemic dynamics by age and gender groups were explored with interactions between smoothed time terms and age and gender. RESULTS: A negative binomial distribution fitted the daily case counts best. Interaction between the dynamic patterns of daily new cases and age groups was statistically significant (p < 0.001), but not with gender group. People aged 20-39 years led the epidemic processes in the society with two peaks: one major peak around March 1 and a smaller peak around April 7, 2020. The epidemic process among people aged 60 or above was trailing behind that of younger people with smaller magnitude. After March 15, there was a consistent decline of daily new cases among elderly people, despite large fluctuations of case counts among young adults. CONCLUSIONS: Although young people drove the COVID-19 epidemic in the whole society with multiple rebounds, elderly people could still be protected from virus infection after the peak of epidemic.


Bloqueantes del sistema renina-angiotensina e infección por COVID-19./ [Renin-angiotensin system blockers and COVID-19 infection]


Novel coronavirus pneumonia and acute pulmonary thromboembolism: casualty or causality?


Two Middle East respiratory syndrome vaccines: first step for other coronavirus vaccines?


Face masks - a sustainable measure to mitigate COVID-19


title: Pandemic planning: plotting a course through the coronawars

text: The biological motor behind the current coronavirus pandemic has placed microbiology on a global stage, and given its practitioners a role among the architects of recovery. Planning for a return to normality or the new normal is a complex, multi-agency task for which healthcare scientists may not be prepared. This paper introduces a widely used military planning framework known as the Joint Military Appreciation Process, and outlines how it can be applied to deal with the next phase of the COVID-19 pandemic. Recognition of SARS-CoV-2's critical attributes, targetable vulnerabilities, and its most likely and most dangerous effects is a necessary precursor to scoping, framing and mission analysis. From this flows course of action development, analysis, concept of operations development, and an eventual decision to act on the plan. The same planning technique is applicable to the larger scale task of setting a microbiology-centric plan in the broader context of social and economic recovery.


FFP3, FFP2, N95, surgical masks and respirators: what should we be wearing for ophthalmic surgery in the COVID-19 pandemic?


title: SARS Unique Domain (SUD) of Severe Acute Respiratory Syndrome Coronavirus Induces NLRP3 Inflammasome-Dependent CXCL10-Mediated Pulmonary Inflammation

text: Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) initiates the cytokine/chemokine storm-mediated lung injury. The SARS-CoV unique domain (SUD) with three macrodomains (N, M, and C), showing the G-quadruplex binding activity, was examined the possible role in SARS pathogenesis in this study. The chemokine profile analysis indicated that SARS-CoV SUD significantly up-regulated the expression of CXCL10, CCL5 and interleukin (IL)-1ß in human lung epithelial cells and in the lung tissues of the mice intratracheally instilled with the recombinant plasmids. Among the SUD subdomains, SUD-MC substantially activated AP-1-mediated CXCL10 expression in vitro. In the wild type mice, SARS-CoV SUD-MC triggered the pulmonary infiltration of macrophages and monocytes, inducing CXCL10-mediated inflammatory responses and severe diffuse alveolar damage symptoms. Moreover, SUD-MC actuated NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome-dependent pulmonary inflammation, as confirmed by the NLRP3 inflammasome inhibitor and the NLRP3-/- mouse model. This study demonstrated that SARS-CoV SUD modulated NLRP3 inflammasome-dependent CXCL10-mediated pulmonary inflammation, providing the potential therapeutic targets for developing the antiviral agents.


Protecting healthcare workers from inhaled SARS-CoV-2 virus


title: Challenges in platelet inventory management at a tertiary care oncology center during the novel coronavirus disease (COVID-19) pandemic lockdown in India

text: The novel coronavirus disease (COVID-19) has been declared a pandemic by the world health organization and to limit the spread of the disease, many countries in the world, including India, had enforced a lockdown. Despite no restriction over the platelet donation activities, plateletpheresis donors became apprehensive regarding the possible risk of spread of the COVID-19 during the platelet donation and in the hospital premises. Many of them started hesitating for platelet donations. With this, the blood center started having an acute shortage of platelets. Various confidence-building steps were implemented by the blood center to promote voluntary plateletpheresis. The blood center staff and individual donors were educated to prevent the spread of COVID-19. The donor organizations and plateletpheresis donors were informed about the steps to be taken by the blood center during the donation and necessary steps for the prevention of the possible spread of COVID-19. With the help of these measures, the confidence of the individual platelet donors and the donor organizations was restored in the blood center and regular plateletpheresis was continued. These measures may also be useful to other blood centers in the COVID-19 pandemic and this experience may be useful if a similar pandemic lockdown happens in the future.


The impact of despecialisation and redeployment on surgical training in the midst of the COVID-19 pandemic


COVID-19 infection in Italian people with diabetes: Lessons learned for our future (an experience to be used)


Covid-19: New government study aims to track infection and immunity in population


Telemedicine and e-Health Solutions for COVID-19: Patients' Perspective


Short-term stress-related increasing cases of alopecia areata during the COVID-19 pandemic


title: Clinical characteristics of Coronavirus Disease 2019 patients in Beijing, China

text: The outbreak of Coronavirus Disease (COVID-19) in Wuhan have affected more than 250 countries and regions worldwide. However, most of the clinical studies have been focused on Wuhan, and little is known about the disease outside of Wuhan in China. In this retrospective cohort study, we report the early clinical features of 80 patients with COVID-19 admitted to the hospital in Beijing. The results show that 27 (33.8%) patients had severe illness. Six (7.5%) patients were admitted to the ICU, and 3 (3.8%) patients died. Forty-eight percent (39/80) of the patients had a history of living/traveling in Wuhan. Patients with severe- illness were significantly older (average age, 71 years old vs 44 years old) and had a high incidence of expectoration (59.3% vs 34.0%), shortness of breath (92.6% vs 9.4%), anorexia (51.9% vs 18.9%) and confusion(18.5% vs 0%) compared with nonsevere patients. The systolic blood pressure (median, 130 mmHg vs 120 mmHg) was higher and the oxygen saturation (median, 98.3% vs 92.0%) was significantly lower in severe patients than nonsevere patients. In addition, myoglobin (median, 56.0 ng/mL vs 35.0 ng/mL), troponin I (median, 0.02 pg/mL vs 0.01 pg/mL), C-reactive protein (median, 69.7 mg/L vs 12.9 mg/L) and neutrophils (median, 3.3×109/L vs 2.2×109/L) were significantly increased, while lymphocytes (median, 0.8×109/L vs 1.2×109/L), albumin (mean, 32.8 g/L vs 36.8 g/L) and the creatinine clearance rate (median, 91.2 vs 108.2 ml/min/1.73m2) were significantly decreased among severe patients. Our study revealed that older patients with high levels of C-reactive protein, myoglobin, troponin I, and neutrophil and high systolic blood pressure as well as low levels of lymphocytes, and albumin and a low creatinine clearance rate and oxygen saturation were more likely to have severe disease.


title: Manifestations of blood coagulation and its relation to clinical outcomes in severe COVID-19 patients: Retrospective analysis

text: INTRODUCTION: Characteristics of blood coagulation and its relation to clinical outcomes in COVID-19 patients are still rarely reported. We aimed to investigate the blood coagulation function and its influences on clinical outcomes of patients with syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: A total of 71 severe patients with confirmed SARS-CoV-2 infection who were treated in Wuhan First Hospital from February 12 to March 20, 2020, were enrolled. The blood coagulation data in these patients and in 61 healthy controls were collected. The patients with COVID-19 were divided into two groups: the aggravated group and the nonaggravated group, respectively, basing on whether the patients' conditions turned to critically ill or not after admission. RESULTS: Compared with healthy controls, patients with COVID-19 had significant performances with coagulation dysfunction, including dramatically elevated values of FIB, PT, APTT, INR, FDP, and D-Dimers but markedly reduced AT value (P < .05). Importantly, more noteworthy coagulation disorders similar to the differences between patients and controls were found in the aggravated patients with conditions deterioration after admission than those in the nonaggravated patients without conditions deterioration (P < .05). Moreover, the aggravated patients possessed a longer hospital stay and a higher mortality compared with the nonaggravated patients (P < .001). The coagulation parameters of COVID-19 patients were widely and closely related to the indexes of liver function and inflammation (P < .05), indicating the coagulation dysfunction of these patients may be caused by liver injury and inflammatory storm. CONCLUSION: Severe patients with SARS-CoV-2 infection often possess coagulation dysfunction on admission. A certain correlation exists in coagulation disorder and adverse clinical outcome among severe COVID-19 patients.


title: COVID-19 with bronchogram - a potential indication of prolonged treatment

text: Novel coronavirus disease-19 (COVID-19) has widely spread all over the world and seriously threatened people's health. This disease is currently diagnosed by clinical features, chest computed tomography (CT) scan, and nucleic acid test of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Recently, some studies have suggested parenchymal consolidation and air bronchogram in severe cases. However, the effective treatment for COVID-19 patients with bronchogram has not been discussed. Herein, we report a case of 47-year-old woman who suffered from COVID-19 with bronchogram. These findings revealed that the body temperature and clinical laboratory test all returned to normal after this patient received a prolonged treatment. Furthermore, chest CT showed the bronchogram and consolidation resolved and nucleic acid retest of SARS-CoV-2 was also negative. These results provide an important reference for treatment option of COVID-19 with bronchogram.


title: Could an endo-lysosomal ion channel be the Achilles heel of SARS-CoV2?

text: The ongoing SARS-CoV2 outbreak has developed into a global pandemic. Despite previous outbreaks of SARS-CoV and the related MERS-CoV in recent years, neither a vaccine nor any other medication for an effective treatment are currently available. Endo-lysosomal two-pore cation channels have now emerged as potential novel targets for SARS-CoV treatment.


The Importance of Video Visits in the Time of COVID-19


title: The potential chemical structure of anti-SARS-CoV-2 RNA-dependent RNA polymerase

text: An outbreak of coronavirus disease 2019 (COVID-19) occurred in Wuhan and it has rapidly spread to almost all parts of the world. For coronaviruses, RNA-dependent RNA polymerase (RdRp) is an important polymerase that catalyzes the replication of RNA from RNA template and is an attractive therapeutic target. In this study, we screened these chemical structures from traditional Chinese medicinal compounds proven to show antiviral activity in severe acute respiratory syndrome coronavirus (SARS-CoV) and the similar chemical structures through a molecular docking study to target RdRp of SARS-CoV-2, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV). We found that theaflavin has a lower idock score in the catalytic pocket of RdRp in SARS-CoV-2 (-9.11 kcal/mol), SARS-CoV (-8.03 kcal/mol), and MERS-CoV (-8.26 kcal/mol) from idock. To confirm the result, we discovered that theaflavin has lower binding energy of -8.8 kcal/mol when it docks in the catalytic pocket of SARS-CoV-2 RdRp by using the Blind Docking server. Regarding contact modes, hydrophobic interactions contribute significantly in binding and additional hydrogen bonds were found between theaflavin and RdRp. Moreover, one π-cation interaction was formed between theaflavin and Arg553 from the Blind Docking server. Our results suggest that theaflavin could be a potential SARS-CoV-2 RdRp inhibitor for further study.


title: [Clinical analysis of 150 cases of 2019 novel coronavirus infection in Nanyang City, Henan Province]

text: Objective: To analyze the epidemiological characteristics and clinical features of the patients with 2019-nCoV infection in Nanyang City, so as to provide evidence for clinical diagnosis and treatment. Methods: The epidemiology, clinical symptoms, atory and radiologic data of 150 patients with 2019-nCoV infection admitted to the designated hospitals in Nanyang City from January 24,2020 to February 16, 2020 were retrospectively analyzed. Results: The 150 patients with 2019 nCov infection consisted of 67 men and 83 women, and the median age was (45±16) years; 69 of them were the first generation case,60 of them were the second generation case, 6 of them were the third generation case,the median incubation period of the first generation case was (5.4±2.2) days, and the second generation case was (6.7±3.1) days, and the first-generation cases are the majority in severe patients (69%) . The most common basic disease was hypertension (13 cases, 9%), diabetes (9 cases, 6%), and the most common symptom is fever(142 cases, 95%, 63% showed moderate fever) , cough and sputum(108 cases,72%), fatigue(23 cases,15%), anorexia(20 cases, 13%), headache, diarrhea, muscle soreness, sore throat as the first symptoms. The average time from onset of symptoms to consultation was (4.2±2.2) days for all patients. The changes in peripheral blood cells were mainly lymphonpenia (83 cases, 55%) and eosinophilia (95 cases, 63%), The lymphocyte count of the severe and critically ill patients was more significantly reduced, and some patients had increased myocardial enzymes, mainly LDH (47 cases, 31%), and a few patients had liver function damage, mainly manifested in ALT and AST. High, very few patients have renal impairment. Among the inflammation-related indicators, the main manifestations are increased CRP (66 cases, 43%) and ESR (86 cases, 57%), elevated D-Dimer in 29% of patients. 144 cases have different degrees of infective lesions in chest CT examination, with 30 cases (21%) on one side and 144 cases (79%) on both sides. Morphologically, most of the lesions were patchy ground glass lesions, which could be accompanied by air bronchus signs and some consolidation and paving stone signs. Of the cases showing "white lung", 87% were sever ill or critically ill. After active treatment, 45% of patients were discharged according to discharge standards. 33% of sever and critically ill patients were discharged, 49% of them were degraded hospitalization.The average length of hospitalization was (12±4) days. Conclusion: A history of epidemiological exposure, fever, chest CT with signs of pneumonia, normal or decreased WBC, and lymphocytopenia, eosinophilia are the clinical basis for the diagnosis of this disease, and most of the sever patients were the first generation cases. The degree of lymphocytopenia is related to the severity of the disease.


COVID-19 : Pacific Islands challenges


title: Changes in the Type of Sports Activity Due to COVID-19: Hypochondriasis and the Intention of Continuous Participation in Sports

text: This study focused on empirically analyzing sport activity participants' perceptions of hypochondriasis caused by fear of infection and changes in continuous participatory behavior patterns. To this end, a comparative analysis was conducted with a focus on the forms of participation and age of sport activity participants. For the final comparative analysis, a 2 × 3 factorial multivariate analysis of variance was conducted after confirming the validity and reliability of data based on 229 questionnaires collected from healthy respondents who have never been infected with COVID-19. The results showed statistically significant differences between worry about illness, which is a subscale of hypochondriasis, disease phobia, thanatophobia, and intent to continue according to age. Statistically significant differences were also found when considering the type of sport for worry about illness, which is a subscale of hypochondriasis, disease phobia, symptom preoccupation, and intent to continue. Furthermore, interaction effects between the two independent variables, i.e., age and type of sport, were found for disease phobia, a subscale of hypochondriasis, and thanatophobia. In summary, age and type of sport, which are important factors for the COVID-19 infection and symptoms, were found to affect the sport activity patterns. These results proved that COVID-19 may have caused the participants to have different perceptions depending on their characteristics and change their form of continuous participation. These findings will provide useful data for predicting the perception and behavioral patterns of sports participants if diseases like COVID-19 occur in the future. They also show how to live a healthy life through exercise.


title: Litigation and patient-carer, safety issues in the COVID-19 crisis

text: John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent reports on litigation issues and patient-health carer safety in the COVID-19 crisis.


Covid-19: Local health teams trace eight times more contacts than national service


COVID-19: síndrome febril y clínica neurológica en neonato./ [COVID-19: Fever syndrome and neurological symptoms in a neonate]


docid: qmyngkvv

title: Phase- and epidemic region-adjusted estimation of the number of coronavirus disease 2019 cases in China

text: The outbreak of the coronavirus disease 2019 was first reported in Wuhan in December 2019 and gradually spread to other areas in China. After implementation of prevention and control measures, the estimation of the epidemic trend is needed. A phase- and region-adjusted SEIR model was applied for modeling and predicting the number of cases in Wuhan, Hubei Province and regions outside Hubei Province in China. The estimated number of infections could reach its peak in late February 2020 in Wuhan and Hubei Province, which is 55 303-84 520 and 83 944-129 312, respectively, while the epidemic peaks in regions outside Hubei Province in China could appear on February 13, 2020 with the estimated 13 035-19 108 cases. According to the estimation, the outbreak would abate in March and April all over China. Current estimation provided evidence for planned work resumption under stringent prevention and control in China to further support the fight against the epidemic. Nevertheless, there is still possibility of the second outbreak brought by the work resumption and population migration, especially from Hubei Province and high intensity cities outside Hubei Province. Strict prevention and control measures still need to be considered in the regions with high intensity of epidemic and densely-populated cities.


docid: jyzzldpd

title: ß-Arrestin-Biased Angiotensin II Receptor Agonists for COVID-19


Covid lays bare the brittleness of a concentrated and consolidated food system


Response to: Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic


Gains from the Novel Corona Virus


title: Structural barriers to adhering to health behaviours in the context of the COVID-19 crisis: Considerations for low- and middle-income countries

text: ABSTRACT In seeking to limit the number of new infections of COVID-19, governments around the world have implemented national lockdowns and guidelines about safe behaviours. Lockdown requires people to stay home and only leave when essential such as to purchase groceries and medication. In low- and middle-income countries, many of which have large proportions of the population living in precarity, lockdown forces millions of people to spend prolonged periods of time together in close proximity to one another and with limited resources. In many ways, efforts to contain the spread of COVID-19 in densely populated communities with limited access to food, water and sanitation may seem counter-intuitive and even impossible under conditions of precarity. In this paper, we explore the barriers to implementation of lockdown rules in conditions of precarity. We conceptualise the structural barriers by drawing on the Theoretical Domains Framework to explain how these barriers influence adherence to lockdown rules. We argue that without sufficient support or intervention to help poor communities mitigate these structural barriers, adhering to lockdown rules is difficult, resulting in continued COVID-19 infections.


New information technology (IT)-related approaches could facilitate psychiatric treatments in general hospital psychiatry during the COVID-19 pandemic


title: Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea

text: BACKGROUND: Health care-associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation-separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)-on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. METHODS: Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. RESULTS: As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. CONCLUSIONS: The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.


docid: oceqlwhf

title: Simulation-based skills training in non-performing orthopedic surgeons: skills acquisition, motivation, and flow during the COVID-19 pandemic


title: Estimates of the ongoing need for social distancing and control measures post-"lockdown" from trajectories of COVID-19 cases and mortality

text: By 21st May 2020, SARS-CoV-2 had caused more than 5 million cases of COVID-19 across more than 200 countries. Most countries with significant outbreaks have introduced social distancing or "lockdown" measures to reduce viral transmission. So the key question now is when, how, and to what extent, these measures can be lifted.Publically available data, on daily numbers of newly-confirmed cases and mortality, were used to fit regression models estimating trajectories, doubling times and the reproduction number (R0) of the disease, before and under the control measures. These data ran up to 21st May 2020, and were sufficient for analysis in 89 countries.The estimates of R0, before lockdown, based on these data were broadly consistent with those previously published: between 2.0 and 3.7 in the countries with the largest number of cases available for analysis (USA, Italy, Spain, France and UK). There was little evidence to suggest that the restrictions had reduced R far below 1 in many places, with France having the most rapid reductions - R0 0.76 (95%CI 0.72-0.82), based on cases and 0.77 (95%CI 0.73-0.80) based on mortality.Intermittent lockdown has been proposed as a means of controlling the outbreak while allowing periods of increase freedom and economic activity. These data suggest that few countries could have even 1â week per month unrestricted without seeing resurgence of the epidemic. Similarly, restoring 20% of the activity that has been prevented by the lockdowns looks difficult to reconcile with preventing the resurgence of the disease in most countries.


Combination of JAKinibs with Methotrexate or Anti-Cytokine Biologics in Patients with Severe COVID-19


title: COVID-19-related Genes in Sputum Cells in Asthma. Relationship to Demographic Features and Corticosteroids

text: Rationale: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ACE2 (angiotensin-converting enzyme 2), and TMPRSS2 (transmembrane protease serine 2) mediate viral infection of host cells. We reasoned that differences in ACE2 or TMPRSS2 gene expression in sputum cells among patients with asthma may identify subgroups at risk for COVID-19 morbidity.Objectives: To determine the relationship between demographic features and sputum ACE2 and TMPRSS2 gene expression in asthma.Methods: We analyzed gene expression for ACE2 and TMPRSS2, and for ICAM-1 (intercellular adhesion molecule 1) (rhinovirus receptor as a comparator) in sputum cells from 330 participants in SARP-3 (Severe Asthma Research Program-3) and 79 healthy control subjects.Measurements and Main Results: Gene expression of ACE2 was lower than TMPRSS2, and expression levels of both genes were similar in asthma and health. Among patients with asthma, male sex, African American race, and history of diabetes mellitus were associated with higher expression of ACE2 and TMPRSS2. Use of inhaled corticosteroids (ICS) was associated with lower expression of ACE2 and TMPRSS2, but treatment with triamcinolone acetonide did not decrease expression of either gene. These findings differed from those for ICAM-1, where gene expression was increased in asthma and less consistent differences were observed related to sex, race, and use of ICS.Conclusions: Higher expression of ACE2 and TMPRSS2 in males, African Americans, and patients with diabetes mellitus provides rationale for monitoring these asthma subgroups for poor COVID-19 outcomes. The lower expression of ACE2 and TMPRSS2 with ICS use warrants prospective study of ICS use as a predictor of decreased susceptibility to SARS-CoV-2 infection and decreased COVID-19 morbidity.


title: Predição de casos e óbitos de COVID-19 em Mato Grosso e no Brasil

text: Objetivos: prever a tendência epidemiológica de casos e óbitos do COVID-19 no Brasil e, especificamente, em Mato Grosso, por meio do modelo estatístico duplo exponencial Métodos: para a realização deste trabalho, foram utilizados dados de casos e óbitos do COVID-19 fornecidos pelo Ministério da Saúde do Brasil e Secretaria de Estado de Saúde de Mato Grosso, e, para realizar as previsões com esses dados, foi utilizada a técnica estatística de séries temporais, considerando o modelo exponencial duplo, e para o processamento dos dados, foi utilizado o programa MINITAB V 17 Resultados: os resultados mostram que os valores ajustados pelo modelo exponencial duplo transformado dos casos e óbitos estão muito próximos dos valores observados de COVID-19 no Brasil e, principalmente, em Mato Grosso, no período considerado, indicando que esse modelo é adequado para os dados em estudo, o qual foi verificado, prevendo alguns valores com seus respectivos intervalos de confiança de 95% Conclusões: a possibilidade de se estimar, pautado em análises estatísticas, o número de casos e óbitos de COVID-19 que ocorrerá no Brasil e no estado de Mato Grosso poderá instrumentalizar os gestores para o planejamento de ações estratégicas de prevenção, monitoramento e controle da pandemia (AU)Objective: to predict the epidemiological trend of COVID-19 cases and deaths in Brazil and Mato Grosso state using the double exponential statistical model Methods: in order to carry out this work, data on cases and deaths from COVID-19 provided by the Ministry of Health of Brazil and the State Secretariat of Health of Mato Grosso were used and to make the predictions with these data, the time series statistical technique was used, considering the double exponential model and the MINITAB V 17 program was used for data processing Results: the results show that the values adjusted by the double exponential transformed model of cases and deaths are very close to the observed values of COVID-19 in Brazil and Mato Grosso, in the period considered, indicating that this model is suitable for the data under study, which was verified by predicting some values with their respective 95% confidence intervals Conclusions: the possibility of estimating, based on statistical analysis, the number of cases and deaths of COVID-19 that will occur in Brazil and in the state of Mato Grosso, may instrumentalize the managers for the planning of strategic actions for prevention, monitoring and control of pandemic (AU)


Tele-ophthalmology amid COVID-19 pandemic-Hong Kong experience


The risk of COVID-19 transmission in favelas and slums in Brazil


Internet-Related Behaviors and Psychological Distress Among Schoolchildren During COVID-19 School Suspension


Letter to the editor: The role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in developing a COVID-19 comorbidity-based host risk score


title: Kawasaki Disease Features and Myocarditis in a Patient with COVID-19

text: A 10-year-old male with prolonged fever, rash, and conjunctivitis presented to the emergency department with concern for Kawasaki disease, found to have myocarditis and PCR positive for SARS-CoV-2.


title: Impact of Personal Protective Equipment on Surgical Performance During the COVID-19 Pandemic

text: BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has exposed surgeons to hazardous working conditions, imposing the need for personal protective equipment (PPE) use during surgery. The use of such equipment may affect their non-technical skills, augment fatigue, and affect performance. This study aimed to assess the surgeons' perceptions of the impact of wearing PPE during emergency surgery throughout the pandemic. METHODS: An international cooperation group conducted an anonymous online survey among surgeons from over 30 countries, to assess perceptions about the impact of PPE use on non-technical skills, overall comfort, decision making, and surgical performance during emergency surgery on COVID-19 patients. RESULTS: Responses to the survey (134) were received from surgeons based on 26 countries. The vast majority (72%) were males. More than half of the respondents (54%) felt that their surgical performance was hampered with PPE. Visual impairment was reported by 63%, whereas 54% had communication impediments. Less than half (48%) felt protected with the use of PPE, and the same proportion perceived that the use of such equipment influenced their decision making. Decreased overall comfort was cited by 66%, and 82% experienced increased surgical fatigue. CONCLUSIONS: Surgeons perceived impediment for both visibility and communication, and other non-technical skills while using PPE on emergency surgery in COVID-19 patients. Their perceived lack of protection and comfort and increased fatigue may have inhibited their optimal surgical performance. More attention should be placed in the design of more user-friendly equipment, given the possibility of a second wave of the pandemic.


title: Conditional cell reprogramming for modeling host-virus interactions and human viral diseases

text: Conventional cancer and transformed cell lines are widely used in cancer biology and other fields within biology. These cells usually have abnormalities from the original tumor itself, but may also develop abnormalities due to genetic manipulation, or genetic and epigenetic changes during long-term passages. Primary cultures may maintain lineage functions as the original tissue types, yet they have a very limited life span or population doubling time because of the nature of cellular senescence. Primary cultures usually have very low yields, and the high variability from any original tissue specimens, largely limiting their applications in research. Animal models are often used for studies of virus infections, disease modeling, development of antiviral drugs, and vaccines. Human viruses often need a series of passages in vivo to adapt to the host environment because of variable receptors on the cell surface and may have intracellular restrictions from the cell types or host species. Here, we describe a long-term cell culture system, conditionally reprogrammed cells (CRCs), and its applications in modeling human viral diseases and drug discovery. Using feeder layer coculture in presence of Y-27632 (conditional reprogramming, CR), CRCs can be obtained and rapidly propagated from surgical specimens, core or needle biopsies, and other minimally invasive or noninvasive specimens, for example, nasal cavity brushing. CRCs preserve their lineage functions and provide biologically relevant and physiological conditions, which are suitable for studies of viral entry and replication, innate immune responses of host cells, and discovery of antiviral drugs. In this review, we summarize the applications of CR technology in modeling host-virus interactions and human viral diseases including severe acute respiratory syndrome coronavirus-2 and coronavirus disease-2019, and antiviral discovery.


Avoiding indirect effects of COVID-19 on maternal and child health


title: Preliminary analysis of COVID-19 spread in Italy with an adaptive SEIRD model

text: In this paper we propose a Susceptible-Infected-Exposed-Recovered-Dead (SEIRD) differential model for the analysis and forecast of the COVID-19 spread in some regions of Italy, using the data from the Italian Protezione Civile from February 24th 2020. In this study investigate an adaptation of the model. Since several restricting measures have been imposed by the Italian government at different times, starting from March 8th 2020, we propose a modification of SEIRD by introducing a time dependent transmitting rate. In the numerical results we report the maximum infection spread for the three Italian regions firstly affected by the COVID-19 outbreak(Lombardia, Veneto and Emilia Romagna). This approach will be successively extended to other Italian regions, as soon as more data will be available.


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title: The neglected health of international migrant workers in the COVID-19 epidemic


title: Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19

text: Imaging modalities play a crucial role in the management of suspected COVID-19 patients. Before reverse transcription polymerase chain reaction (RT-PCR) test results are positive, 60-93% of patients have positive chest computed tomographic (CT) findings consistent with COVID-19. We report a case of positive lung ultrasound findings consistent with COVID-19 in a woman with an initially negative RT-PCR result. The lung ultrasound-imaging findings were present between the negative and subsequent positive RT-PCR tests and correlated with CT findings. The point-of-care lung-ultrasound examination was easy to perform and, as such, could play an important role in the triage of women with suspected COVID-19. The neonatal swabs, cord blood and placental swab RT-PCR tests were negative for SARS-CoV-2, a finding consistent with the published literature suggesting no vertical transmission of this virus in pregnant women. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.


title: Protocol for a randomized controlled trial comparing wound COmplications in elective midline laparotomies after FAscia Closure using two different Techniques Of Running sutures: COFACTOR trial

text: BACKGROUND: Wound complications following midline laparotomies are common and the main source of postoperative morbidity including superficial or deep wound infection, skin dehiscence, fascia dehiscence, and incisional hernia. Abdominal closure complications are strongly associated with suture technique and material, in addition to other factors related to the patient and type of surgery performed. The traditional technique is to place the fascia sutures 1 cm apart and at least 1 cm away from the fascia edge. A Swedish study described a new technique of placing the sutures 5 mm apart and 5 mm away from the fascia edge, resulting in lower rates of abdominal wound complications. This study has a number of limitations. There is a need for improved quality evidence to convince the surgical community to change the closure technique of abdominal wounds aiming to reduce morbidity, which is exemplified in incisional hernias and other various postop complications. METHODS: This is a 1:1 randomized, controlled, patient- and assessor-blinded, parallel design, superiority trial, with a primary endpoint of incisional hernia at 1 year. The study will be conducted at AUBMC over a 3-year period. Patients planned for a non-emergent midline laparotomy for general surgery or vascular procedure will be randomized to either fascia closure technique. In order to detect a drop of 12% in the incidence of incisional hernia, with 80% power and an alpha of 0.05, we will need to recruit 114 patients per arm. After adjusting for loss to follow-up, target recruitment is 274 subjects. We will compare both arms for the primary, secondary, and exploratory outcomes, using chi-square or t test as appropriate. Univariate and multivariate logistic regression will be done. DISCUSSION: This trial will assess postop complications following abdominal midline wound closures via two different suturing techniques. This trial will generate evidence-based conclusions that will allow surgeons to assess the role of a new abdominal closure technique in decreasing short- and long-term postoperative complications, for a commonly performed procedure. TRIAL REGISTRATION: ClinicalTrials.gov NCT03527433 . Registered on 17 May 2018 before starting participant enrollment.


Angiotensin-converting enzyme-2 in SARS-CoV-2 infection: good or bad?


title: TWIRLS, a knowledge-mining technology, suggests a possible mechanism for the pathological changes in the human host after coronavirus infection via ACE2

text: Faced with the current large-scale public health emergency, collecting, sorting, and analyzing biomedical information related to the "SARS-CoV-2" should be done as quickly as possible to gain a global perspective, which is a basic requirement for strengthening epidemic control capacity. However, for human researchers studying viruses and hosts, the vast amount of information available cannot be processed effectively and in a timely manner, particularly if our scientific understanding is also limited, which further lowers the information processing efficiency. We present TWIRLS (Topic-wise inference engine of massive biomedical literatures), a method that can deal with various scientific problems, such as liver cancer, acute myeloid leukemia, and so forth, which can automatically acquire, organize, and classify information. Additionally, this information can be combined with independent functional data sources to build an inference system via a machine-based approach, which can provide relevant knowledge to help human researchers quickly establish subject cognition and to make more effective decisions. Using TWIRLS, we automatically analyzed more than three million words in more than 14,000 literature articles in only 4 hr. We found that an important regulatory factor angiotensin-converting enzyme 2 (ACE2) may be involved in host pathological changes on binding to the coronavirus after infection. On triggering functional changes in ACE2/AT2R, the cytokine homeostasis regulation axis becomes imbalanced via the Renin-Angiotensin System and IP-10, leading to a cytokine storm. Through a preliminary analysis of blood indices of COVID-19 patients with a history of hypertension, we found that non-ARB (Angiotensin II receptor blockers) users had more symptoms of severe illness than ARB users. This suggests ARBs could potentially be used to treat acute lung injury caused by coronavirus infection.


Initial COVID-19 affecting cardiac patients in China


title: Immune Responses to SARS-CoV, MERS-CoV and SARS-CoV-2

text: The world has given an outbreak alarm in the last two decades, with different members of the coronavirus family infecting people at different times. The spread of the SARS-CoV-2 virus, which last appeared in December 2019 in China and spread rapidly to all over the world, has led the scientific world to studies on these viruses. While scientists are trying to develop vaccines or drugs against the virus, the body's immune response to the virus is emerged the biggest guide. In this review, we aimed to provide a good view on immune strategies by comparing immunological responses to SARS-CoV-2 disease among other members of the family, SARS-CoV and MERS-CoV. In the near future, it may contribute to vaccine or drug studies to be developed on immune intervention.


Eosinopenia is associated with greater severity in patients with coronavirus disease 2019


COVID-19 in South Africa: lockdown strategy and its effects on public health and other contagious diseases


Chest CT Findings in 2019 Novel Coronavirus (2019-nCoV) Infections from Wuhan, China: Key Points for the Radiologist


title: Environmental surface testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during prolonged isolation of an asymptomatic carrier

text: Environmental surface testing was performed to search for evidence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) environmental contamination by an asymptomatic SARS-CoV-2 carrier with persistently high viral loads under isolation. No evidence of environmental contamination was found. Further studies are needed to measure environmental contamination by SARS-CoV-2 carriers and to determine reasonable isolation periods.


The Forensic Psychiatry in the time of Coronavirus: the Italian security residences put to the test in a public health emergency


title: Historical and methodological highlights of quarantine measures: from ancient plague epidemics to current coronavirus disease (COVID-19) pandemic

text: The ongoing 2020 coronavirus disease (COVID-19) pandemic is an enormous challenge for the health systems and the entire societies of the countries involved. Since at present the outbreak continues to evolve (April 2020), the World Health Organization (WHO) has declared it a public health emergency of international concern, specifying that public health interventions aimed at the prevention of the further spread of this disease include quarantine. Quarantine, that may be defined as a restraint on the activities of people or on the traffic of goods, targeted to the prevention of the diffusion of communicable pathologies, is a health concept profoundly rooted in the history of mankind. The lessons of the past are always pertinent for the present and for the future, in particular from a public health standpoint. One of the most relevant of them is connected with previous influenza pandemics, similar to the current COVID-19 2019/2020 pandemic, and it indicates that it is practically impossible, even in recent times, to contain the infection in the geographic area where it has risen and to prevent its trans-national disseminated spread. With specific reference to the COVID-19 pandemic, therefore, health authorities still adopt "classical" preventive interventions, namely workplace social distancing measures and quarantine, to reduce the transmission of the disease. Only the future will testify the precise overall effectiveness of preventive public health measures in containing the impact of the present coronavirus pandemic. However, what in this epidemiological scenario is already known, is that the multi-century international health value of quarantine remains essential and unavoidable.


Steroid injections for pain management in the COVID-19 era


title: [Assessment of the psychological status of urologists during the COVID-19 pandemic]

text: The aim of this study was to analyze the symptoms of depression, anxiety, and stress in urologists during the COVID-19 pandemic. MATERIALS AND METHODS: 90 urologists aged 25 to 60 years (M=37.27, S.D.=9.53), 93% of them were men, participated in the online survey. They answered questions about their attitude to their job as doctors and the impact of COVID-19. They filled out the Depression, Anxiety and Stress Scales (DASS-21), the Ten Item Personality Inventory (TIPI) and answered questions assessing their sense of control. RESULTS: The greatest concern among urologists is the risk of getting infected with COVID-19 (for 30% of the doctors). 43% of urologists state that their profession interesting. A positive attitude to work, as well as the Big Five traits (Conscientiousness, Emotional Stability and Agreeableness) are associated with lower levels of depression, anxiety, stress and lack of control. Working with COVID-19 patients reduces stress and increases the sense of control. Age and high levels of Emotional Stability predicted lower levels of anxiety, depression and stress. DISCUSSION: Working with COVID-19 patients allows doctors to feel more control over what is happening. A sense of control, in turn, and a positive attitude towards work are associated with a lower levels of depression, anxiety and stresssymptoms. CONCLUSION: The results of this study can be used in selection of therapeutic targets for psychotherapy, administered to doctors; in prevention of symptoms of anxiety, stress and depression among doctors; and in professional selection of doctors for working in crisis situations.


Compassionate Use of Remdesivir in Covid-19. Reply


Points to consider in the preparation and transfusion of COVID-19 convalescent plasma


title: Proteogenomics analysis unveils a TFG-RET gene fusion and druggable targets in papillary thyroid carcinomas

text: Papillary thyroid cancer (PTC) is the most common type of endocrine malignancy. By RNA-seq analysis, we identify a RET rearrangement in the tumour material of a patient who does not harbour any known RAS or BRAF mutations. This new gene fusion involves exons 1-4 from the 5' end of the Trk fused Gene (TFG) fused to the 3' end of RET tyrosine kinase leading to a TFG-RET fusion which transforms immortalized human thyroid cells in a kinase-dependent manner. TFG-RET oligomerises in a PB1 domain-dependent manner and oligomerisation of TFG-RET is required for oncogenic transformation. Quantitative proteomic analysis reveals the upregulation of E3 Ubiquitin ligase HUWE1 and DUBs like USP9X and UBP7 in both tumor and metastatic lesions, which is further confirmed in additional patients. Expression of TFG-RET leads to the upregulation of HUWE1 and inhibition of HUWE1 significantly reduces RET-mediated oncogenesis.


Managing ophthalmic practices in a referral emergency COVID-19 hospital in north-east Italy


title: Hyperpyrexia and metabolic alkalosis in a COVID-19 patient

text: Hyperpyrexia can be a challenging and serious complication of SARS-CoV-2 infection. This article is protected by copyright. All rights reserved.


No adequate evidence indicating hypertension as an independent risk factor for COVID-19 severity


title: Projecting the impact of the coronavirus disease-19 pandemic on childhood obesity in the United States: A microsimulation model

text: PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic in the United States led to nationwide stay-at-home orders and school closures. Declines in energy expenditure resulting from canceled physical education classes and reduced physical activity may elevate childhood obesity risk. This study estimated the impact of COVID-19 on childhood obesity. METHODS: A microsimulation model simulated the trajectory of a nationally representative kindergarten cohort's body mass index z-scores and childhood obesity prevalence from April 2020 to March 2021 under the control scenario without COVID-19 and under the 4 alternative scenarios with COVID-19-Scenario 1: 2-month nationwide school closure in April and May 2020; Scenario 2: Scenario 1 followed by a 10% reduction in daily physical activity in the summer from June to August; Scenario 3: Scenario 2 followed by 2-month school closure in September and October; and Scenario 4: Scenario 3 followed by an additional 2-month school closure in November and December. RESULTS: Relative to the control scenario without COVID-19, Scenarios 1, 2, 3, and 4 were associated with an increase in the mean body mass index z-scores by 0.056 (95% confidence interval (95%CI): 0.055-0.056), 0.084 (95%CI: 0.084-0.085), 0.141 (95%CI: 0.140-0.142), and 0.198 (95%CI: 0.197-0.199), respectively, and an increase in childhood obesity prevalence by 0.640 (95%CI: 0.515-0.765), 0.972 (95%CI: 0.819-1.126), 1.676 (95%CI: 1.475-1.877), and 2.373 (95%CI: 2.135-2.612) percentage points, respectively. Compared to girls and non-Hispanic whites and Asians, the impact of COVID-19 on childhood obesity was modestly larger among boys and non-Hispanic blacks and Hispanics, respectively. CONCLUSION: Public health interventions are urgently called to promote an active lifestyle and engagement in physical activity among children to mitigate the adverse impact of COVID-19 on unhealthy weight gains and childhood obesity.


Safety testing improvised COVID-19 personal protective equipment based on a modified full-face snorkel mask


title: COVID-19 infections and deaths among Connecticut nursing home residents: facility correlates

text: OBJECTIVE: To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with COVID-19 confirmed cases and deaths by April 16, 2020 among Connecticut nursing home residents. DESIGN: Cross-sectional analysis on Connecticut nursing home (n=215) COVID-19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two-part models determined the associations of key nursing home characteristics with the likelihood of at least 1 confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least 1 confirmed case (death). RESULTS: The average number of confirmed cases was 8 per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least 1 confirmed case, every 20 minutes (per resident day) increase in RN staffing was associated with 22% fewer confirmed cases (incidence rate ratio [IRR]=0.78, 95% confidence interval [CI] 0.68-0.89, p<0.001); compared to 1- to 3-star facilities, 4- or 5-star facilities had 13% fewer confirmed cases (IRR=0.87, 95% CI 0.78-0.97, p<0.015); and facilities with high concentration of Medicaid residents (IRR=1.16, 95% CI 1.02-1.32, p=0.025) or racial/ethnic minority residents (IRR=1.15, 95% CI 1.03-1.29, p=0.026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least 1 death, every 20 minutes increase in RN staffing significantly predicted 26% fewer COVID-19 deaths (IRR=0.74, 95% CI 0.55-1.00, p=0.047). Other focused characteristics did not show statistically significant associations with deaths. CONCLUSIONS: Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.


title: Interdependent Citizens: The Ethics of Care in Pandemic Recovery

text: The crisis of Covid-19 has forced us to notice two things: our human interdependence and American society's tolerance for what Nancy Krieger has called "inequalities embodied in health inequities," reflected in data on Covid-19 mortality and geographies. Care is integral to our recovery from this catastrophe and to the development of sustainable public health policies and practices that promote societal resilience and reduce the vulnerabilities of our citizens. Drawing on the insights of Joan Tronto and Eva Feder Kittay, we argue that the ethics of care offers a critical alternative to utilitarian and deontological approaches and provides a street-ready framework for integration into public health deliberations to anchor public policy and investments concerning the recovery and future well-being of America's citizens and society.


title: A Novel Vaccine Employing Non-Replicating Rabies Virus Expressing Chimeric SARS-CoV-2 Spike Protein Domains: Functional Inhibition of Viral/Nicotinic Acetylcholine Receptor Complexes

text: The emergence of the novel ß-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global pandemic of coronavirus disease 2019 (COVID-19). Clinical studies have documented that potentially severe neurological symptoms are associated with SARS-CoV-2 infection, thereby suggesting direct CNS penetration by the virus. Prior studies have demonstrated that the destructive neurological effects of rabies virus (RABV) infections are mediated by CNS transport of the virus tightly bound to the nicotinic acetylcholine receptor (nAChR). By comparison, it has been hypothesized that a similar mechanism exists to explain the multiple neurological effects of SARS-CoV-2 via binding to peripheral nAChRs followed by orthograde or retrograde transport into the CNS. Genetic engineering of the RABV has been employed to generate novel vaccines consisting of non-replicating RABV particles expressing chimeric capsid proteins containing human immunodeficiency virus 1 (HIV-1), Middle East respiratory syndrome (MERS-CoV), Ebolavirus, and hepatitis C virus (HCV) sequences. Accordingly, we present a critical discussion that integrates lessons learned from prior RABV research and vaccine development into a working model of a SARS-CoV-2 vaccine that selectively targets and neutralizes CNS penetration of a tightly bound viral nAChR complex.


title: Acute acral cutaneous manifestations during the COVID-19 pandemic: a single center experience

text: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), was first reported in China on December 2019. Almost 5 months into the pandemic, little is still known about cutaneous manifestations in COVID-19. In fact, the prevalence of cutaneous signs varies greatly in the literature, ranging from 0.2% to 20.4%. Given their potential association with COVID-19, acral lesions have received special attention worldwide, both in the medical literature and the media. Our aim is to share our experience regarding acral manifestations during this pandemic.


title: ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of diabetes insipidus and hyponatraemia

text: COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


title: Clinical course of three postoperative symptomatic Covid-19 cases in patients after lung lobectomy

text: Covid-19 is a highly contagious viral infection caused by the SARS-CoV-2 virus. Its rapid spread and severe clinical presentation influences patient management in all specialties including thoracic surgery. We report three cases of Covid-19 occurring in patients shortly after thoracotomy and thoracoscopy procedures, illustrating the imminent threat of SARS-CoV-2 infection for thoracic surgery patients.


title: Large-Scale Screening of COVID-19 from Community Acquired Pneumonia using Infection Size-Aware Classification

text: The worldwide spread of coronavirus disease (COVID-19) has become a threatening risk for global public health. It is of great importance to rapidly and accurately screen patients with COVID-19 from community acquired pneumonia (CAP). In this study, a total of 1658 patients with COVID-19 and 1027 patients of CAP underwent thin-section CT. All images were preprocessed to obtain the segmentations of both infections and lung fields, which were used to extract location-specific features. An infection Size Aware Random Forest method (iSARF) was proposed, in which subjects were automated categorized into groups with different ranges of infected lesion sizes, followed by random forests in each group for classification. Experimental results show that the proposed method yielded sensitivity of 0.907, specificity of 0.833, and accuracy of 0.879 under five-fold cross-validation. Large performance margins against comparison methods were achieved especially for the cases with infection size in the medium range, from 0.01% to 10%. The further inclusion of Radiomics features show slightly improvement. It is anticipated that our proposed framework could assist clinical decision making.


Covid-19: pandemic healthcare centres should have already existed


US NICUs and donor milk banks brace for COVID-19


title: Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective

text: The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock. The cardiac manifestations of COVID-19 might be related to the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications. COVID-19 has profoundly reshaped usual care of both ambulatory and acute cardiac patients, by leading to the cancellation of elective procedures and by reducing the efficiency of existing pathways of urgent care, respectively. Decreased use of health care services for acute conditions by non-COVID-19 patients has also been reported and attributed to concerns about acquiring in-hospital infection. Innovative approaches that leverage modern technologies to tackle the COVID-19 pandemic have been introduced, which include telemedicine, dissemination of educational material over social media, smartphone apps for case tracking, and artificial intelligence for pandemic modelling, among others. This article provides a comprehensive overview of the pathophysiology and cardiovascular implications of COVID-19, its impact on existing pathways of care, the role of modern technologies to tackle the pandemic, and a proposal of novel management algorithms for the most common acute cardiac conditions.


title: Coronavirus Disease 2019 and the Cerebrovascular-Cardiovascular Systems: What Do We Know So Far?

text: The severe acute respiratory syndrome coronavirus 2 pandemic of 2019 to 2020 has resulted in multiple hospitalizations, deaths, and economic hardships worldwide. Although respiratory involvement in patients with coronavirus disease 2019 (COVID-19) is well known, the potential cardiovascular and cerebrovascular manifestations are less understood. We performed a PubMed and Google Scholar search and reviewed relevant literature on COVID-19 and cardiovascular system involvement. Severe acute respiratory syndrome coronavirus 2 possesses high affinity for angiotensin-converting enzyme 2 receptor, which is highly concentrated in the lungs and cardiovascular tissue, thereby provoking concern for cardiovascular involvement in COVID-19 cases. Preexisting cardiovascular and cerebrovascular disease has been shown in previous reports to be a risk factor for severe infection. On the basis of our review of published studies, COVID-19 patients may be more likely to experience acute cardiac injury, arrhythmia, coagulation defects, and acute stroke and are likely to have poorer outcomes as a result. As the COVID-19 pandemic continues, more data about potential cardiovascular and cerebrovascular manifestations of the disease are required.


Organoids demonstrate gut infection by SARS-CoV-2


title: Clinical update on COVID-19 in pregnancy: A review article

text: The data pertaining to the COVID-19 pandemic has been rapidly evolving since the first confirmed case in December 2019. This review article presents a comprehensive analysis of the current data in relation to COVID-19 and its effect on pregnant women, including symptoms, disease severity and the risk of vertical transmission. We also review the recommended management of pregnant women with suspected or confirmed COVID-19 and the various pharmacological agents that are being investigated and may have a role in the treatment of this disease. At present, it does not appear that pregnant women are at increased risk of severe infection than the general population, although there are vulnerable groups within both the pregnant and nonpregnant populations, and clinicians should be cognizant of these high-risk groups and manage them accordingly. Approximately 85% of women will experience mild disease, 10% more severe disease and 5% critical disease. The most common reported symptoms are fever, cough, shortness of breath and diarrhea. Neither vaginal delivery nor cesarean section confers additional risks, and there is minimal risk of vertical transmission to the neonate from either mode of delivery. We acknowledge that the true effect of the virus on both maternal and fetal morbidity and mortality will only be evident over time. We also discuss the impact of social isolation can have on the mental health and well-being of both patients and colleagues, and as clinicians, we must be mindful of this and offer support as necessary.


Navigating COVID-19 in the developing world


[COVID-19 with post-chemotherapy agranulocytosis in childhood acute leukemia: a case report]


title: COVID 19 in neonates

text: Corona virus disease 2019 started in December 2019 as an outbreak of unexplained pneumonias in Wuhan, a city in Hubei province of China. This illness emerged as an epidemic in China and later spread to almost all countries over the globe except Antarctica. This is caused by a beta Corona virus, which is genetically similar to SARS virus. The predominant mode of transmission is via droplet spread, when the infected person coughs, sneezes or talks the virus is released in the respiratory secretions. As there are only a few cases of COVID 19 in neonates, there is no convincing evidence to support the possibility of vertical transmission. Clinical presentation in neonates is nonspecific, commonly observed are temperature instability, respiratory distress, poor feeding, lethargy, vomiting and diarrhea. Laboratory examinations may be nonspecific. Definitive test for 2019-nCoV is the detection of viral nucleic acid by real-time fluorescence polymerase chain reaction (RT-PCR). Suspected and confirmed COVID positive mothers should be delivered in separate delivery rooms and operation theaters. Since there is no approved treatment or drug for this disease, prevention of infection and breaking the chain of transmission plays a crucial role.


Bioactive compounds with possible inhibitory activity of Angiotensin-Converting Enzyme-II; a gate to manage and prevent COVID-19


Waste in covid-19 research


Cancer patients in Covid-19 era: Swimming against the tide


title: Lower nasopharyngeal viral load during the latest phase of COVID-19 pandemic in a Northern Italy University Hospital

text: Objectives A milder clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been anecdotally reported over the latest phase of COVID-19 pandemic in Italy. Several factors may contribute to this observation, including the effect of lockdown, social distancing, lower humidity, lower air pollution, and potential changes in the intrinsic pathogenicity of the virus. In this regard, the clinical severity of COVID-19 could be attenuated by mutations in SARS-CoV-2 genome that decrease its virulence, as well as by lower virus inocula. Methods In this pilot study, we compared the reverse transcription polymerase chain reaction (RT-PCR) amplification profile of 100 nasopharyngeal swabs consecutively collected in April, during the peak of SARS-CoV-2 epidemic, to that of 100 swabs collected using the same procedure in May. Results The mean Ct value of positive samples collected in May was significantly higher than that of samples collected in the previous period (ORF 1a/b gene: 31.85 ± 0.32 vs. 28.37 ± 0.5, p<0.001; E gene: 33.76 ± 0.38 vs. 29.79 ± 0.63, p<0.001), suggesting a lower viral load at the time of sampling. No significant differences were observed between male and females in the two periods, whilst higher viral loads were found in (i) patients over 60-years old, and (ii) patients that experienced severe COVID-19 during the early stages of the pandemic. Conclusions This pilot study prompts further investigation on the correlation between SARS-CoV-2 load and different clinical manifestation of COVID-19 during different phases of the pandemic. Laboratories should consider reporting quantitative viral load data in the molecular diagnosis of SARS-CoV-2 infection.


title: Respiratory Protection Considerations for Healthcare Workers During the COVID-19 Pandemic

text: The COVID-19 pandemic has resulted in a surge of patients that exceeds available human and physical resources in many settings, triggering the implementation of crisis standards of care. High-quality respiratory protection is essential to reduce exposure among healthcare workers, yet dire shortages of personal protective equipment in the United States threaten the health and safety of this essential workforce. In the context of rapidly changing conditions and incomplete data, this article outlines 3 important strategies to improve healthcare workers' respiratory protection. At a minimum, healthcare workers delivering care to patients with confirmed or suspected COVID-19 should wear N95 respirators and full-face shields. Several mechanisms exist to boost and protect the supply of N95 respirators, including rigorous decontamination protocols, invoking the Defense Production Act, expanded use of reusable elastomeric respirators, and repurposing industrial N95 respirators. Finally, homemade facial coverings do not protect healthcare workers and should be avoided. These strategies, coupled with longer-term strategies of investments in protective equipment research, infrastructure, and data systems, provide a framework to protect healthcare workers immediately and enhance preparedness efforts for future pandemics.


title: SARS-CoV-2: a storm is raging

text: The pandemic coronavirus infectious disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe. In this issue of the JCI, Chen and colleagues compared the clinical and immunological characteristics between moderate and severe COVID-19. The authors found that respiratory distress on admission is associated with unfavorable outcomes. Increased cytokine levels (IL-6, IL-10, and TNF-α), lymphopenia (in CD4+ and CD8+ T cells), and decreased IFN-Î³ expression in CD4+ T cells are associated with severe COVID-19. Overall, this study characterized the cytokine storm in severe COVID-19 and provides insights into immune therapeutics and vaccine design.


Obesity Phenotype is a Predictor of COVID-19 Disease Susceptibility


title: Association between social support and anxiety among pregnant women in the third trimester during the coronavirus disease 2019 (COVID-19) epidemic in Qingdao, China: The mediating effect of risk perception

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a public health emergency of international concern and poses a threat to the mental health of pregnant women. AIM: The purpose of this study was to investigate the relationship between social support and anxiety, and the mediating effect of risk perception during the COVID-19 epidemic in the third trimester pregnant women in Qingdao, China. METHODS: From 16 to 21 February 2020, an online survey was conducted, which collected the information on demographic data, anxiety, social support and risk perception to COVID-19 of women with established medical records in the ambulatory of the Department of Obstetrics at the Affiliated Hospital of Qingdao University. Anxiety was assessed by the Self-Rating Anxiety Scale (SAS), social support was assessed by the Social Support Rating Scale (SSRS) and risk perception was assessed by a self-designed questionnaire. RESULTS: This study had 308 participants with an average of 31.02 ± 3.91 years. During the period of prevention and control of the epidemic, most pregnant women adopted protective measures, such as wearing masks (97.4%), washing hands frequently (88.3%) and staying at home (76.3%). The average SAS, SSRS and risk perception scores of the participants were 42.45 ± 6.98, 44.60 ± 7.00 and 21.60 ± 5.74, respectively. The total effect of maternal social support on anxiety was -2.63 (95% confidence interval (CI): -4.40 ~ -1.44, p < .001), the direct effect was -1.44 (95% CI: -2.74 ~ -0.35, p < .05) and the indirect effect was -1.19 (95% CI: -2.49 ~ -0.51, p < .001). CONCLUSION: The third trimester pregnant women had a high level of social support, a medium level of risk perception to COVID-19 and were susceptible to anxiety. Risk perception played a mediating role between social support and anxiety.


title: Assessing air quality changes in large cities during COVID-19 lockdowns: The impacts of traffic-free urban conditions in Almaty, Kazakhstan

text: Number of cities worlwide experienced air quality improvements during COVID-19 lockdowns; however, such changes may have been different in places with major contributions from nontraffic related sources. In Almaty, a city-scale quarantine came into force on March 19, 2020, which was a week after the first COVID-19 case was registered in Kazakhstan. This study aims to analyze the effect of the lockdown from March 19 to April 14, 2020 (27 days), on the concentrations of air pollutants in Almaty. Daily concentrations of PM2.5, NO2, SO2, CO, O3, and BTEX were compared between the periods before and during the lockdown. During the lockdown, the PM2.5 concentration was reduced by 21% with spatial variations of 6-34% compared to the average on the same days in 2018-2019, and still, it exceeded WHO daily limit values for 18 days. There were also substantial reductions in CO and NO2 concentrations by 49% and 35%, respectively, but an increase in O3 levels by 15% compared to the prior 17 days before the lockdown. The concentrations of benzene and toluene were 2-3 times higher than those during in the same seasons of 2015-2019. The temporal reductions may not be directly attributed to the lockdown due to favorable meteorological variations during the period, but the spatial effects of the quarantine on the pollution levels are evidenced. The results demonstrate the impact of traffic on the complex nature of air pollution in Almaty, which is substantially contributed by various nontraffic related sources, mainly coal-fired combined heat and power plants and household heating systems, as well as possible small irregular sources such as garbage burning and bathhouses.


APOE e4 genotype predicts severe COVID-19 in the UK Biobank community cohort


title: Chemotherapy strategy for colorectal cancer under the outbreak of novel coronavirus pneumonia/ 中华胃肠外科杂志

text: The outbreak of novel coronavirus pneumonia (NCP) makes the medical treatment of colorectal cancers difficult. Cancer patients are more susceptible to infection and tumor history is defined as an important factor of poor prognosis, which challenges both doctors and patients. For metastatic colorectal cancer (CRC) patients, maintenance therapy is the optimal choice. The patients with tumor progression or poor biological behaviorshould receive or or continue combination chemotherapy. Adjuvant chemotherapy should reduce the intensity of treatment and shorten the therapy time. Fever patients during chemotherapy need to receive differential diagnosis and screening according to national standards. Patients with stable diseases and good general conditions may delay imaging examination.. Clinicians should make individual clinical decisions based on the specifics of each patient durding epidemic situation.


title: [Chemotherapy strategy for colorectal cancer under the outbreak of novel coronavirus pneumonia]


Androgen hazards with COVID-19


title: Pitfalls in telemedicine consultations in the era of COVID 19 and how to avoid them

text: BACKGROUND AND AIMS: With restrictions on face to face clinical consultations in the COVID-19 pandemic, Telemedicine has become an essential tool in providing continuity of care to patients. We explore the common pitfalls in remote consultations and strategies that can be adopted to avoid them. METHODS: We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020 including 'COVID-19', 'telemedicine' and 'remote consultations'. RESULTS: Telemedicine has become an integral part to support patient's clinical care in the current COVID-19 pandemic now and will be in the future for both primary and secondary care. Common pitfalls can be identified and steps can be taken to prevent them. CONCLUSION: Telemedicine it is going to play a key role in future of health medicine, however, telemedicine technology should be applied in appropriate settings and situations. Suitable training, enhanced documentations, communication and observing information governance guidelines will go a long way in avoiding pitfalls associated with remote consultations.


Social Media Spread During Covid-19: The Pros and Cons of Likes and Shares


title: Introduction on collective quarantine of close contacts of patients with COVID-19 for medical observation in China: from the perspective of frontline staff

text: The World Health Organization (WHO) has deemed coronavirus disease 2019 (COVID-19) to be a pandemic. The strict prevention and control measures taken by China have proven to be effective, creating a window of opportunity for other countries. The tracking and management of contacts of patients with COVID-19 are important components of prevention and control measures. This article briefly describes the placement of close contacts of patients with COVID-19 under collective quarantine for medical observation in China from the perspective of frontline staff. This article focuses on a community in the Jiading District of Shanghai to provide a reference for placement of close contacts of patients with COVID-19 under collective quarantine for medical observation in other countries and regions.


title: [Perinatal and neonatal management plan for prevention and control of SARS-CoV-2 infection (2nd Edition)]

text: Since late December 2019, SARS-CoV-2 infection has spread to all parts of the country and overseas, and the outbreak continues. At the end of January 2020, the Working Group for the Prevention and Control of Neonatal SARS-CoV-2 Infection in the Perinatal Period of the Editorial Committee of Chinese Journal of Contemporary Pediatrics worked out the perinatal and neonatal management plan for prevention and control of SARS-CoV-2 infection (1st Edition). This plan has been verified by clinical practice for 3 weeks. With the further understanding of SARS-CoV-2 infection, especially the emergence of SARS-CoV-2 infection cases in pregnant women and neonates, it is necessary to update the first edition of the management plan so as to offer a better guide on clinical practice. Therefore, the Working Group has worked out the second edition of the management plan.


title: Burden of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

text: MERS-coronavirus infection is currently responsible for considerable morbidity and mortality in Saudi Arabia. Understanding its burden, as an emerging infectious disease, is vital for devising appropriate control strategies. In this study, the burden of MERS-CoV was estimated over 31months period from June 6, 2012 to January 5, 2015. The total number of patients was 835; 528 (63.2%) patients were male, 771 (92.3%) patients were ≥25 years of age, and 210 (25.1%) patients were healthcare workers. A total of 751 (89.9%) patients required hospitalization. The median duration between onset of illness and hospitalization was 2 days (interquartile range, 0-5). The median length of hospital stay was 14 days (IQR, 6-27). The overall case fatality rate was 43.1%. Basic reproductive number was 0.9. Being Saudi, non-healthcare workers, and age ≥65 years were significantly associated with higher mortality. In conclusion, MERS-CoV infection caused a substantial health burden in Saudi Arabia.


title: The Use of Digital Health in the Detection and Management of COVID-19

text: Digital health is uniquely positioned to enhance the way we detect and manage infectious diseases. This commentary explores the potential of implementing digital technologies that can be used at different stages of the COVID-19 outbreak, including data-driven disease surveillance, screening, triage, diagnosis, and monitoring. Methods that could potentially reduce the exposure of healthcare providers to the virus are also discussed.


Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases


title: COVID-19 Among Workers in Meat and Poultry Processing Facilities - 19 States, April 2020

text: Congregate work and residential locations are at increased risk for infectious disease transmission including respiratory illness outbreaks. SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is primarily spread person to person through respiratory droplets. Nationwide, the meat and poultry processing industry, an essential component of the U.S. food infrastructure, employs approximately 500,000 persons, many of whom work in proximity to other workers (1). Because of reports of initial cases of COVID-19, in some meat processing facilities, states were asked to provide aggregated data concerning the number of meat and poultry processing facilities affected by COVID-19 and the number of workers with COVID-19 in these facilities, including COVID-19-related deaths. Qualitative data gathered by CDC during on-site and remote assessments were analyzed and summarized. During April 9-27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19-related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. Methods to decrease transmission within the facility include worker symptom screening programs, policies to discourage working while experiencing symptoms compatible with COVID-19, and social distancing by workers. Source control measures (e.g., the use of cloth face covers) as well as increased disinfection of high-touch surfaces are also important means of preventing SARS-CoV-2 exposure. Mitigation efforts to reduce transmission in the community should also be considered. Many of these measures might also reduce asymptomatic and presymptomatic transmission (3). Implementation of these public health strategies will help protect workers from COVID-19 in this industry and assist in preserving the critical meat and poultry production infrastructure (4).


title: CD147 as a Target for COVID-19 Treatment: Suggested Effects of Azithromycin and Stem Cell Engagement

text: The expressive number of deaths and confirmed cases of SARS-CoV-2 call for an urgent demand of effective and available drugs for COVID-19 treatment. CD147, a receptor on host cells, is a novel route for SARS-CoV-2 invasion. Thus, drugs that interfere in the spike protein/CD147 interaction or CD147 expression may inhibit viral invasion and dissemination among other cells, including in progenitor/stem cells. Studies suggest beneficial effects of azithromycin in reducing viral load of hospitalized patients, possibly interfering with ligand/CD147 receptor interactions; however, its possible effects on SARS-CoV-2 invasion has not yet been evaluated. In addition to the possible effect in invasion, azithromycin decreases the expression of some metalloproteinases (downstream to CD147), induces anti-viral responses in primary human bronchial epithelial infected with rhinovirus, decreasing viral replication and release. Moreover, resident lung progenitor/stem are extensively differentiated into myofibroblasts during pulmonary fibrosis, a complication observed in COVID-19 patients. This process, and the possible direct viral invasion of progenitor/stem cells via CD147 or ACE2, could result in the decline of these cellular stocks and failing lung repair. Clinical tests with allogeneic MSCs from healthy individuals are underway to enhance endogenous lung repair and suppress inflammation.


title: The value of urine biochemical parameters in the prediction of the severity of coronavirus disease 2019

text: Background Among patients with coronavirus disease 2019 (COVID-19), the cases of a significant proportion of patients are severe. A viral nucleic acid test is used for the diagnosis of COVID-19, and some hematological indicators have been used in the auxiliary diagnosis and identification of the severity of COVID-19. Regarding body fluid samples, except for being used for nucleic acid testing, the relationship between COVID-19 and routine body fluid parameters is not known. Our aim was to investigate the value of urine biochemical parameters in the prediction of the severity of COVID-19. Methods A total of 119 patients with COVID-19 were enrolled at Renmin Hospital of Wuhan University. According to the severity of COVID-19, the patients were divided into three groups (moderate 67, severe 42 and critical 10), and 45 healthy persons were enrolled in the same period as healthy controls. The relationship between the results of urine biochemical parameters and the severity of COVID-19 was analyzed. Results The positive rates of urine occult blood (BLOOD) and proteinuria (PRO) were higher in COVID-19 patients than in healthy controls (p < 0.05); the urine specific gravity (SG) value was lower in patients than in healthy controls (p < 0.05), and the urine potential of hydrogen (pH) value was higher in patients than in healthy controls (p < 0.01). The positive rates of urine glucose (GLU-U) and PRO in the severe and critical groups were higher than those in the moderate group (p < 0.01 and p < 0.05, respectively); other biochemical parameters of urine were not associated with the severity of COVID-19. Conclusions Some urine biochemical parameters are different between patients with severe acute respiratory syndrome (SARS)-CoV-2 and healthy controls, and GLU-U and PRO may be helpful for the differentiation of COVID-19 severity.


title: Shelter-In-Place Orders Reduced COVID-19 Mortality And Reduced The Rate Of Growth In Hospitalizations

text: Most states enacted shelter-in-place orders (SIPOs) in mitigating the coronavirus disease 2019 (COVID-19) pandemic. Emerging evidence indicates SIPOs have reduced COVID-19 cases. Using data starting at different dates in March through May 15, 2020, we examine effects of SIPOs on daily growth rates of COVID-19 deaths and hospitalizations using event study models. We find that SIPOs reduced the daily mortality growth rate after nearly three weeks from enactment, and the daily growth rate of hospitalizations two weeks after enactment. After 42 days from enactment, the daily mortality growth rate declined by up to 6.1 percentage points. Projections suggest as many as 250,000-370,000 deaths possibly averted by May 15 in the 42 states plus the District of Columbia with statewide SIPOs. The daily hospitalization growth rate examined in 19 states with SIPOs and 3 states without SIPOs with data on hospitalizations has declined by up to 8.4 percentage points after 42 days. This evidence suggests that SIPOs have been effective in reducing the daily growth rates of COVID-19 deaths and hospitalizations. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].


Early Rehabilitation for Critically Ill Patients With COVID-19: More Benefits Than Risks


title: Exercise in the time of COVID-19

text: The COVID-19 pandemic has restricted the physical activity of the population, but maintaining exercise could reduce the risk of contracting the infection itself and mitigate the effects of quarantine.


Strategies for the prevention and management of coronavirus disease 2019


title: Home Birth in the Era of COVID-19: Counseling and Preparation for Pregnant Persons Living with HIV

text: With the coronavirus disease 2019 (COVID-19) pandemic in the United States, a majority of states have instituted "shelter-in-place" policies effectively quarantining individuals-including pregnant persons-in their homes. Given the concern for COVID-19 acquisition in health care settings, pregnant persons with high-risk pregnancies-such as persons living with HIV (PLHIV)-are increasingly investigating the option of a home birth. Although we strongly recommend hospital birth for PLHIV, we discuss our experience and recommendations for counseling and preparation of pregnant PLHIV who may be considering home birth or at risk for unintentional home birth due to the pandemic. We also discuss issues associated with implementing a risk mitigation strategy involving high-risk births occurring at home during a pandemic. KEY POINTS: · Coronavirus disease 2019 pandemic has increased interest in home birth.. · Women living with HIV are pursuing home birth.. · Safe planning is paramount for women living with HIV desiring home birth, despite recommending against the practice..