title: El SRAA y el SARS-CoV-2: el acertijo a resolver./ [The RAAS and SARS-CoV-2: A riddle to solve]

text: The first case of COVID-19 was reported on 31 December 2019 in Wuhan, China. Ever since there has been unprecedented and growing interest in learning about all aspects of this new disease. Debate has been generated as to the association between antihypertensive therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors and SARS-CoV-2 infection. While many questions as yet remain unanswered, the aim of this report is to inform health professionals about the current state of knowledge. Because this is an ever-evolving topic, the recommendation is that it be updated as new evidence becomes available. Below, we provide a review of pre-clinical and clinical studies that link coronavirus to the RAAS.


Reply to "Radiologic Findings of Coronavirus Disease (COVID-19): Clinical Correlation Is Recommended"


Understanding immune effects of oestrogens to explain the reduced morbidity and mortality in female versus male COVID-19 patients. Comparisons with autoimmunity and vaccination


Coping with COVID-19 - The life changing pandemic


Letter to the editor in response to the article: "Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis (Kumar et al.)"


Acute pulmonary embolism in COVID-19 disease


title: The Role of Health Technology and Informatics in Global Public Health Emergency: Practices and Implications from the COVID-19 Pandemic

text: UNSTRUCTURED: At present, COVID-19 is spreading around the world. It is a critical and important task to take all-out efforts to prevent and control the pandemic. Compared with Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome, COVID-19 spreads more rapidly owing to increased globalization, longer incubation period, and unobvious symptoms. As the coronavirus has the characteristics of strong transmission and weak lethality, and since the large-scale increase of infected people may drag down the healthcare systems, efforts are needed to treat critical patients, track and manage the health status of residents, and isolate suspected patients. The application of emerging health technologies and digital practices in healthcare such as artificial intelligence, telemedicine/telehealth, mobile health, big data, 5G, and the internet of things have become powerful "weapons" to fight against the pandemic and provide strong support in pandemic prevention and control. Applications and evaluations of all of these technologies or health delivery services are highlighted.


title: Autonomy in HIV testing: a call for a rethink of personal autonomy in the HIV response in sub-Saharan Africa

text: The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA.


title: Tilorone: a Broad-Spectrum Antiviral Invented in the USA and Commercialized in Russia and beyond

text: For the last 50 years we have known of a broad-spectrum agent tilorone dihydrochloride (Tilorone). This is a small-molecule orally bioavailable drug that was originally discovered in the USA and is currently used clinically as an antiviral in Russia and the Ukraine. Over the years there have been numerous clinical and non-clinical reports of its broad spectrum of antiviral activity. More recently we have identified additional promising antiviral activities against Middle East Respiratory Syndrome, Chikungunya, Ebola and Marburg which highlights that this old drug may have other uses against new viruses. This may in turn inform the types of drugs that we need for virus outbreaks such as for the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Tilorone has been long neglected by the west in many respects but it deserves further reassessment in light of current and future needs for broad-spectrum antivirals.


title: An Infinite-Dimensional SIS Model

text: In this article, we introduce an infinite-dimensional deterministic SIS model which takes into account the heterogeneity of the infections and the social network among a large population. We study the long-time behavior of the dynamic. We identify the basic reproduction number $R_0$ which determines whether there exists a stable endemic steady state (super-critical case: $R_0>1$) or if the only equilibrium is disease-free (critical and sub-critical case: $R_0\leq1$). As an application of this general study, we prove that the so-called ``leaky'' and ``all-or-nothing'' vaccination mechanism have the same effect on $R_0$. This framework is also very natural and intuitive to model lockdown policies and study their impact.


最悪の事態に備えるべき理由 : 新型コロナウイルスにどう対処するか (新型ウイルスの封じ込め・管理はできるのか)


title: Medical Transport for 769 COVID-19 Patients on a Cruise Ship by Japan Disaster Medical Assistance Team

text: The Diamond Princess cruise ship, carrying 3711 passengers and crew members, docked at Yokohama Port in Japan on February 3, 2020. A quarantine was immediately instituted because 1 passenger who had disembarked in Hong Kong was confirmed to have tested positive for coronavirus disease 2019 (COVID-19). After the quarantine began, all passengers and crew were tested using the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction assay on the ship, 696 of whom tested positive. In total, 769 patients, including 696 with COVID-19, required transport to a hospital. The Japan Disaster Medical Assistance Team (DMAT) successfully picked up and safely transported the COVID-19 patients using a novel classification system to prioritize patients. The Japan DMAT transported 203 patients to hospitals in Kanagawa and another 566 patients to hospitals in 15 different prefectures.


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title: COVID-19 in Parkinson's Disease Patients Living in Lombardy, Italy

text: BACKGROUND: It is unknown whether patients with PD are at greater risk of COVID-19, what their risk factors are, and whether their clinical manifestations differ from the general population. OBJECTIVES: The study aimed to address all these issues. METHODS: In a case-controlled survey, we interviewed 1,486 PD patients attending a single tertiary center in Lombardy, Italy and 1,207 family members (controls). RESULTS: One hundred five (7.1%) and 92 controls (7.6%) were identified as COVID-19 cases. COVID-19 patients were younger, more likely to suffer from chronic obstructive pulmonary disease, to be obese, and vitamin D nonsupplemented than unaffected patients. Six patients (5.7%) and 7 family members (7.6%) died from COVID-19. Patients were less likely to report shortness of breath and require hospitalization. CONCLUSIONS: In an unselected large cohort of nonadvanced PD patients, COVID-19 risk and mortality did not differ from the general population, but symptoms appeared to be milder. The possible protective role of vitamin D supplementation warrants future studies. © 2020 International Parkinson and Movement Disorder Society.


title: COVID-19 Lung Injury and High Altitude Pulmonary Edema: A False Equation with Dangerous Implications

text: Amid efforts to care for the large number of patients with COVID-19, there has been considerable speculation about whether the lung injury seen in these patients is different than ARDS from other causes. One idea that has garnered considerable attention, particularly on social media and in free open access medicine is the notion that lung injury due to COVID-19 is more similar to high altitude pulmonary edema (HAPE). Drawing on this concept, it has also been proposed that treatments typically employed in the management of HAPE and other forms of acute altitude illness, pulmonary vasodilators and acetazolamide, should be considered for COVID-19. Despite some similarities in clinical features between the two entities, such as hypoxemia, radiographic opacities and altered lung compliance, the pathophysiological mechanisms of HAPE and lung injury due to COVID-19 are fundamentally different and the entities cannot be viewed as equivalent. While of high utility in the management of HAPE and acute mountain sickness, systemically delivered pulmonary vasodilators and acetazolamide should not be used in the treatment of COVID-19, as they carry the risk of multiple adverse consequences including worsened ventilation-perfusion matching, impaired carbon dioxide transport, systemic hypotension and increased work of breathing.


title: Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India

text: COVID-19 has now become a pandemic. It has spread from Wuhan, China, in December 2019 to a large number of countries within three months. The objective of this work is to report the initial experience with epidemiologic and clinical features, as well as with the management of COVID-19 patients in India. This is a descriptive case series of the first 21 COVID-19 infected patients confirmed with polymerase chain reaction (PCR) and admitted to a tertiary care centre in India from 01.02.2020 to 19.03.2020. Clinical, laboratory, and radiologic data were collected, including age, sex, nationality, travel history, symptoms, duration of stay, and comorbidities. The mean age of the population was 40.3 years with a male preponderance. Thirteen (62%) patients had recent travel history outside India in the previous 30 days, two thirds of whom had travelled to Italy. The most common symptoms were fever and cough (42.9%) followed by sore throat, headache and breathlessness. Vital and laboratory parameters were preserved in all patients and none of them required ventilatory support. Among the first 21 patients diagnosed with COVID-19 infection in India, the typical clinical presentation consisted in a mild upper respiratory tract infection predominantly affecting the young male population. One patient required supplemental oxygen. All patients recovered with no residual symptoms. *The Safdarjung Hospital COVID 2019 working group: Nitesh Gupta, Sumita Agrawal, Pranav Ish, Suruchi Mishra, Rajni Gaind, Ganapathy Usha, Balvinder Singh, Manas Kamal Sen, Shibdas Chakrabarti (Consultant and Head, Pulmonary Medicine); NK Gupta (Professor, Pulmonary medicine); Dipak Bhattacharya (Consultant, Pulmonary medicine); Rohit Kumar (Assistant Professor, Pulmonary Medicine); Siddharth R. Yadav (Assistant Professor, Pulmonary Medicine); Rushika Saksena (Specialist, Microbiology); Rojaleen Das (Assistant Professor, Microbiology); Vikramjeet Dutta (Assistant Professor, Microbiology); Anupam Kr Anveshi (Senior Resident, Microbiology); Santvana Kohli (Assistant Professor, Anaesthesiology); Naveen KV (Assistant Professor, Anaesthesiology); Amandeep Jaswal (Assistant Professor, Anaesthesiology).


title: Cardiovigilance in COVID 19

text: The COVID19 (Corona Virus Disease: pandemic started in 2019) pandemic has created not only a public health problem, but as a clinical challenge as well. To the cardiologist, COVID 19 presents a wide spectrum of possibilities for clinical decision-making intervention and improvement. Cardiac dysfunction has been identified as a risk factor, a prognostic factor, a diagnostic tool, differential diagnosis, a complication of COVID 19, and a side effect of its treatment. Certain cardiotropic drugs have been implicated in the pathogenesis of COVID 19. The risk of transmission of COVID 19 is an occupational hazard which cannot be ignored by cardiologists. This review discusses the need and scope of cardio vigilance in COVID 19 management.


The Coronavirus Pandemic and the Impact on Donation and Transplantation in Brazil


title: Epidemiological characteristics of the first 100 cases of coronavirus disease 2019 (COVID-19) in Hong Kong Special Administrative Region, China, a city with a stringent containment policy

text: BACKGROUND: Hong Kong (HK) is a densely populated city near the epicentre of the coronavirus disease 2019 (COVID-19) outbreak. Stringent border control together with aggressive case finding, contact tracing, social distancing and quarantine measures were implemented to halt the importation and spread of the virus. METHODS: We performed an epidemiological study using government information covering the first 100 confirmed cases to examine the epidemic curve, incidence, clusters, reproduction number (Rt), incubation period and time to containment. RESULTS: A total of 93 of the 100 cases were HK residents (6 infected in Mainland China, 10 on the Diamond Princess Cruise). Seven were visitors infected in Mainland China before entering HK. The majority (76%) were aged ≥45 years, and the incidence increased with age (P < 0.001). Escalation of border control measures correlated with a decrease in the proportion (62.5% to 0%) of cases imported from Mainland China, and a reduction in Rt (1.07 to 0.75). The median incubation period was 4.2 days [95% confidence interval (CI), 4.0-4.5; 5th and 95th percentiles: 1.3 and 14.0). Most clusters with identifiable epidemiological links were households involving 2-4 people. Three medium-spreading events were identified: two from New Year gatherings (6-11 people), and another from environmental contamination of a worship hall (12 people). Despite intensified contact tracing, containment was delayed in 78.9% of cases (mean = 5.96 days, range = 0-24 days). An unusual transmission in a multi-storey building via faulty toilet plumbing was suspected with >100 residents evacuated overnight. Our analysis indicated that faulty plumbing was unlikely to be the source of this transmission. CONCLUSIONS: Timely stringent containment policies minimized the importation and transmission of COVID-19 in HK.


Telehealth and Telemedicine in the COVID-19 era: A World of Opportunities for the Neurosurgeons


title: An exclusive 42 amino acid signature in pp1ab protein provides insights into the evolutive history of the 2019 novel human-pathogenic coronavirus (SARS-CoV-2)

text: The city of Wuhan, Hubei province, China, was the origin of a severe pneumonia outbreak in December 2019, attributed to a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), causing a total of 2761 deaths and 81109 cases (25 February 2020). SARS-CoV-2 belongs to genus Betacoronavirus, subgenus Sarbecovirus. The polyprotein 1ab (pp1ab) remains unstudied thoroughly since it is similar to other sarbecoviruses. In this short communication, we performed phylogenetic-structural sequence analysis of pp1ab protein of SARS-CoV-2. The analysis showed that the viral pp1ab has not changed in most isolates throughout the outbreak time, but interestingly a deletion of 8 aa in the virulence factor nonstructural protein 1 was found in a virus isolated from a Japanese patient that did not display critical symptoms. While comparing pp1ab protein with other betacoronaviruses, we found a 42 amino acid signature that is only present in SARS-CoV-2 (AS-SCoV2). Members from clade 2 of sarbecoviruses have traces of this signature. The AS-SCoV2 located in the acidic-domain of papain-like protein of SARS-CoV-2 and bat-SL-CoV-RatG13 guided us to suggest that the novel 2019 coronavirus probably emerged by genetic drift from bat-SL-CoV-RaTG13. The implication of this amino acid signature in papain-like protein structure arrangement and function is something worth to be explored.


Heparin induced thrombocytopenia antibodies in COVID-19


title: Persistent hiccups as an atypical presenting complaint of COVID-19

text: Hiccups (singultus) are reflex inspiratory movements that involve the swallowing reflex arc and can be classified as acute (<48 h) or persistent (>48 h). A 62-year-old man with no history of malignancy or pulmonary disease presented to the Emergency Department with a four-day history of persistent hiccups. Other than episodic hiccupping, his physical examination was otherwise unremarkable. An abnormal chest X-ray led to a CT scan of the chest with IV contrast, which demonstrated regional, peripheral groundglass opacities of the upper lobes with small focal groundglass opacities scattered throughout the lungs. He was tested for COVID-19 per admission protocol, started on hydroxychloroquine, his hiccups improved, and he was discharged to home after 3 days. An emergency medicine physician should keep COVID-19 on the differential and be vigilant of exposure in atypical presentations.


Dealing with COVID-19: initial perspectives of a small radiology department


title: Masters of disasters? Challenges and opportunities for SMEs in times of crisis

text: Small and medium-sized enterprises (SMEs) are the backbone of every economy. So, when an external crisis jeopardizes markets, such as the recent COVID-19 outbreak, SMEs are hit with great force. Their so-called liability of smallness, a lack of resources that would shield them from outside shocks, worsens the situation. This manuscript conducts a literature study on 69 manuscripts that studied SMEs in previous crises and proposes ways to overcome economic downturns in the areas of finance, strategy and the institutional environment. The paper finds a "strategy/funding chicken-and-egg-problem" and proposes an effectual world view when dealing with situations of great uncertainty.


title: Excess deaths hidden 100 days after the quarantine in Peru by COVID-19

text: Objective: To make an estimate of the excess deaths caused by COVID-19 in the non-violent mortality of Peru, controlling for the effect of quarantine. Methods: Analysis of longitudinal data from the departments of Peru using official public information from the National Death Information System and the Ministry of Health of Peru. The analysis is performed between January 1, 2018 and June 23, 2020 (100 days of quarantine). The daily death rate per million inhabitants has been used. The days in which the departments were quarantined with a limit number of accumulated cases of COVID-19 were used to estimate the quarantine impact. Three limits were established for cases: less than 1, 10 and 100 cases. Result: In Peru, the daily death rate per million inhabitants decreased by -1.89 (95% CI: -2.70; -1.07) on quarantine days and without COVID-19 cases. When comparing this result with the total number of non-violent deaths, the excess deaths during the first 100 days of quarantine is 36,230. This estimate is 1.12 times the estimate with data from 2019 and 4.2 times the deaths officers by COVID-19. Conclusion: Quarantine reduced nonviolent deaths; however, they are overshadowed by the increase as a direct or indirect cause of the pandemic. Therefore, the difference between the number of current deaths and that of past years underestimates the real excess of deaths.


title: Fangcang shelter hospitals: a novel concept for responding to public health emergencies

text: Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.


Phototherapy and vitamin D: the importance in COVID-19 era


title: Adaptation of the National Plan for the Prevention and Fight Against Pandemic Influenza to the 2020 COVID-19 Epidemic in France

text: On Tuesday, March 17, 2020, at noon, France became the third European country to impose a nationwide containment policy in the fight against epidemic coronavirus disease 2019 (COVID-19) viral infection. Announcing that the country was at "war," President Macron called upon all to play a role in mitigating against further development of contagion. This extreme measure never seen before during peace time was the result of adapting not only the French Pandemic Influenza Plan (PIP) being applied to the national context but also real-time clinical, epidemiological, and scientific information about the evolution of COVID-19 infection in the country. The situation was further complicated by local municipal elections and political agendas by populist opinions. Despite mass communication about the importance of individual behavioral attitudes to counter disease propagation, few heeded government advice. Consequently, the situation rapidly deteriorated with increasing number of cases that started to overwhelm health services. As a result, decisive and immediate action was taken by the State for the national public health interest. This report from the field details the timely events that contributed to this extreme policy decision taken by France. A policy decision that other Western democracies have since applied as the pandemic disseminated across the globe.


title: Prostate Cancer Radiotherapy Recommendations in Response to COVID-19

text: Purpose: During a global pandemic the benefit of routine visits and treatment of cancer patients must be weighed against the risks to patients, staff, and society. Prostate cancer is one of the most common cancers Radiation Oncology departments treat, and efficient resource utilization is essential in the setting of a pandemic. Herein, we aim to establish recommendations and a framework by which to evaluate prostate radiotherapy management decisions. Patients and Methods: Radiation Oncologists from the United States and United Kingdom rapidly conducted a systematic review and agreed upon recommendations to safely manage prostate cancer patients during the COVID-19 pandemic. A RADS framework was created: Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy was applied to determine appropriate approaches. Results: Recommendations are provided by National Comprehensive Cancer Network (NCCN) risk group, including clinical node positive, post-prostatectomy, oligometastatic, and low volume M1 disease. Across all prostate cancer stages, telemedicine consultations and return visits were recommended when resources/staff available. Delays in consultations and return visits was deemed safe based on stage of disease between 1-6 months. Treatment can be avoided or delayed until safe for very low, low, and favorable intermediate-risk disease. Unfavorable intermediate-risk, high-risk, clinical node positive, recurrence post-surgery, oligometastatic, and low-volume M1 disease can receive neoadjuvant hormone therapy for 4-6 months as necessary. Ultrahypofractionation was preferred for localized, oligometastatic, and low volume M1, and moderate hypofractionation was preferred for post-prostatectomy and clinical node positive disease. Salvage was preferred to adjuvant radiation. Conclusion: Resources can be reduced for all identified stages of prostate cancer. The RADS (Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy) framework can be applied to other disease sites to help with decision making in a global pandemic.


title: Treatment algorithm for COVID-19: a multidisciplinary point of view

text: The novel coronavirus (Sars-CoV-2) pandemic has spread rapidly, from December to the end of March, to 185 countries, and there have been over 3,000,000 cases identified and over 200,000 deaths. For a proportion of hospitalized patients, death can occur within a few days, mainly for adult respiratory distress syndrome or multi-organ dysfunction syndrome. In these patients, clinical signs and symptoms, as well as laboratory abnormalities, suggest a cytokine storm syndrome in response to the viral infection. No current targeted treatment is yet available for COVID-19, an unknown disease up to 2 months ago, which challenges doctors and researchers to find new drugs or reallocate other treatments for these patients. Since the beginning of the COVID-19 outbreak, a growing body of information on diagnostic and therapeutic strategies has emerged, mainly based on preliminary experience on retrospective studies or small case series. Antivirals, antimalarials, corticosteroids, biotechnological and small molecules, convalescent plasma and anticoagulants are among the drugs proposed for the treatment or in tested for COVID-19. Given the complexity of this new condition, a multidisciplinary management seems to be the best approach. Sharing and integrating knowledge between specialists, to evaluate the correct timing and setting of every treatment, could greatly benefit our patients. We reviewed the literature, combining it with our experiences and our specialist knowledge, to propose a management algorithm, correlating the clinical features with laboratory and imaging findings to establish the right timing for each treatment.Key Pointsâ¢ Critically ill COVID-19 patients show signs of cytokine storm syndrome.â¢ No current targeted therapy is available, but a lot of drugs are in tested.â¢ A multidisciplinary approach is crucial to manage COVID-19.â¢ Choosing the correct timing of treatment is of pivotal importance to avoid the most severe complications.


A Novel Coronavirus Outbreak from Wuhan City in China, Rapid Need for Emergency Departments Preparedness and Response;a Letter to Editor


title: The Impact of Isolation Measures Due to COVID-19 on Energy Intake and Physical Activity Levels in Australian University Students

text: The coronavirus disease 2019 (COVID-19) pandemic resulted in physical isolation measures in many parts of the world. In Australia, nationwide restrictions included staying at home, unless seeking medical care, providing care, purchasing food, undertaking exercise, or attending work in an essential service. All undergraduate university classes transitioned to online, mostly home-based learning. We, therefore, examined the effect of isolation measures during the early phase of the COVID-19 pandemic in Australia (March/April) on diet (24-h recall) and physical activity (Active Australia Survey) patterns in third-year biomedical students. Findings were compared with students enrolled in the same course in the previous two years. In females, but not males, energy intake was ~20% greater during the pandemic, and snacking frequency and energy density of consumed snacks also increased compared with 2018 and 2019. Physical activity was impacted for both sexes during the pandemic with ~30% fewer students achieving "sufficient" levels of activity, defined by at least 150 min over at least five sessions, compared with the previous two years. In a follow-up study six to eight weeks later (14-18% response rate), during gradual easing of nationwide restrictions albeit continued gym closures and online learning, higher energy intake in females and reduced physical activity levels in both sexes persisted. These data demonstrate the health impacts of isolation measures, with the potential to affect long-term diet and activity behaviours.


Perinatal mental health and COVID-19 in Japan


title: Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health

text: The coronavirus disease (COVID-19) pandemic has revealed many areas of public health preparedness that are lacking, especially in lower- and middle-income countries. Digital interventions provide many opportunities for strengthening health systems and could be vital resources in the current public health emergency. We provide several use cases for infection control, home-based diagnosis and screening, empowerment through information, public health surveillance and epidemiology, and leveraging crowd-sourced data. A thoughtful, concerted effort-leveraging existing experience and robust enterprise-grade technologies-can have a substantive impact on the immediate and distal consequences of COVID-19.


title: Discharged COVID-19 Patients Testing Positive Again for SARS-CoV-2 RNA: A Minireview of Published Studies from China

text: In the ongoing COVID-19 pandemic, one potential cause of concern is that some discharged COVID-19 patients are testing positive again for SARS-CoV-2 RNA. To better understand what is happening and to provide public health policy planners and clinicians timely information, we have searched and reviewed published studies about discharged patients testing positive again for the SARS-CoV-2 RNA. Our search found 12 reports, all of which described patients in China. Our review of these reports indicates the presence of discharged patients who remain asymptomatic but test positive. However, it is unclear whether they are contagious because a positive RT-PCR test does not necessarily indicate the presence of replicating and transmissible virus. Our review suggests the need for timely, parallel testing of different samples, including for example, fecal specimens, from COVID-19 patients before and after they are discharged from hospitals. This article is protected by copyright. All rights reserved.


Outbreak of a novel coronavirus


COVID-19 and ectodermal dysplasias. Recommendations are necessary


In reply: Making transesophageal echocardiography safer during COVID-19: is there a role for probe protective equipment (pPE)?


COVID-19: Magnifying the Effect of Health Disparities


Cancer and COVID-19 - potentially deleterious effects of delaying radiotherapy


title: Digital personal health libraries: a systematic literature review

text: Objective: This paper gives context on recent literature regarding the development of digital personal health libraries (PHL) and provides insights into the potential application of consumer health informatics in diverse clinical specialties. Materials and Methods: A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Here, 2,850 records were retrieved from PubMed and EMBASE in March 2020 using search terms: personal, health, and library. Information related to the health topic, target population, study purpose, library function, data source, data science method, evaluation measure, and status were extracted from each eligible study. In addition, knowledge discovery methods, including co-occurrence analysis and multiple correspondence analysis, were used to explore research trends of PHL. Results: After screening, this systematic review focused on a dozen articles related to PHL. These encompassed health topics such as infectious diseases, congestive heart failure, electronic prescribing. Data science methods included relational database, information retrieval technology, ontology construction technology. Evaluation measures were heterogeneous regarding PHL functions and settings. At the time of writing, only one of the PHLs described in these articles is available for the public while the others are either prototypes or in the pilot stage. Discussion: Although PHL researches have used different methods to address problems in diverse health domains, there is a lack of an effective PHL to meet the needs of older adults. Conclusion: The development of PHLs may create an unprecedented opportunity for promoting the health of older consumers by providing diverse health information.


Concerns About COVID-Related Collateral Damage for Patients With COPD


title: Protection and response of a tertiary hospital in South Korea to the COVID-19 outbreak

text: OBJECTIVE: Here, we present an overview of how a tertiary hospital responded to maintain necessary activities and protect patients and staff from COVID-19 outbreak. METHODS: Gil Medical Center, a tertiary hospital in Incheon, operated special response team since January 21, 2020. All visitors were assessed for body temperature and respiratory symptoms, and were screened for recent overseas travel. Suspected COVID-19 patients were taken to a screening clinic. All febrile patients with or without respiratory symptoms were taken to a respiratory safety clinic. An isolation ward, which consisted of 10 negative-pressure rooms, was used to treat confirmed-cases. More than 120 beds were prepared for the outbreak and patients with pneumonia were preemptively isolated. RESULTS: By May 5th, 480,960 visitors were assessed at control station, 3,350 patients visited the triage center, and 1,794 were treated in the respiratory safety clinic. Seventeen confirmed-cases were admitted to the negative isolation ward, and 350 patients with pneumonia were preemptively isolated. Total 2,977 SARS-CoV-2 PCR tests were performed. CONCLUSIONS: Tertiary hospitals play an important role in both treating COVID-19 patients and non-COVID-19 patients. Hospitals have to protect themselves from unexpected in-hospital transmission. Multifaceted response must be undertaken to protect tertiary hospitals during the COVID-19 epidemic.


Surviving the first COVID-19 wave and learning lessons for the second


Un numéro spécial Covid-19 du Journal de chirurgie viscérale : quels problèmes, quels dangers et quelles solutions sont identifiés?/ [A special edition of the Journal of Visceral Surgery on Covid-19: what problems, dangers and solutions have been identified?]


title: Mesenchymal stem cell (MSc) secretome: A possible therapeutic strategy for intensive-care COVID-19 patients

text: As an emerging global health challenge, COVID-19 requires international knowledge to reach novel possible therapeutic strategies, especially for intensive-care patients. During the early stages of infection, pneumocytes II are the primary infected cells, harming the respiratory system. We have previous evidence in murine models that MSc's secretome can be used to treat pulmonary injuries induced with bleomycin, due to its content: growth factors, extracellular vesicles, and exosomes. We hypothesize and strongly recommend MSc secretome testing and production, in xenofree conditions, to be used as an alternative approach in SARS-Cov-2 patients in critical conditions.


title: Parametric analysis of early data on COVID-19 expansion in selected European countries

text: We analyze the early data on COVID-19 expansion in selected European countries using an analytical parametric model. A description of the time dependence of the disease expansion and a method to evaluate trends of the expansion are proposed. Several features are observed in the data, namely a high predictability of the expansion of disease in Italy and a convergence of the"pushback"parameter towards a limiting value in all the countries where restrictive measures have been adopted. Basic predictions for the evolution of the disease expansion are made for selected countries with a stable evolution in the parametric space of the model. The findings presented here should contribute to the understanding of the behavior of the disease expansion and the role of the restrictive measures on the evolution of the expansion.


Transcatheter Aortic Valve Replacement in the Coronavirus Disease 2019 (COVID-19) Era


title: Estimation of the serial interval and basic reproduction number of COVID-19 in Qom, Iran, and three other countries: A data-driven analysis in the early phase of the outbreak

text: The outbreak of COVID-19 was first reported from China, and on 19 February 2020, the first case was confirmed in Qom, Iran. The basic reproduction number (R0 ) of infection is variable in different populations and periods. This study aimed to estimate the R0 of COVID-19 in Qom, Iran, and compare it with that in other countries. For estimation of the serial interval, we used data of the 51 confirmed cases of COVID-19 and their 318 close contacts in Qom, Iran. The number of confirmed cases daily in the early phase of the outbreak and estimated serial interval were used for R0 estimation. We used the time-varying method as a method with the least bias to estimate R0 in Qom, Iran, and in China, Italy and South Korea. The serial interval was estimated with a gamma distribution, a mean of 4.55 days and a standard deviation of 3.30 days for the COVID-19 epidemic based on Qom data. The R0 in this study was estimated to be between 2 and 3 in Qom. Of the four countries studied, the lowest R0 was estimated in South Korea (1.5-2) and the highest in Iran (4-5). Sensitivity analyses demonstrated that R0 is sensitive to the applied mean generation time. To the best of the authors' knowledge, this study is the first to estimate R0 in Qom. To control the epidemic, the reproduction number should be reduced by decreasing the contact rate, decreasing the transmission probability and decreasing the duration of the infectious period.


title: Locus CauMT1 provides a higher resolution alternative to ribosomal gene sequencing for initial Candida auris genotyping

text: Prior to SARS-CoV-2, New York City was the epicenter for another recently emerged pathogen: Candida auris. .


title: A three-generation family cluster with COVID-19 infection: should quarantine be prolonged?

text: OBJECTIVES: Families are a transmission route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of the close contact. Monitoring of the viral load will be a valuable method to reduce the optimal number of quarantine days, especially in presymptomatic and symptomatic carriers of their households. The traditional three-generation families living together are seen frequently in East Asia, including in Taiwan. STUDY DESIGN: We report on a family cluster with six individuals infected with coronavirus disease in Taiwan. METHODS: The current public policy in Taiwan is quarantine for at least 14 days, based on the incubation period, or until the patient has tested negative three days in a row using the SARS-CoV-2 reverse transcription polymerase chain reaction. Details on the onset date of clinical symptoms, throat swab conversion, and course of disease were collected from medical records retrospectively. RESULTS: In the household of this three-generation Taiwanese family, the infection rate was 60%. The ratio of males to females was 4:2, and the age range was 11-85 years. The prevalence of asymptomatic disease was 33.3% (2/6). The longest throat swab conversion time was 37 days, and the estimated course of disease from symptoms to first conversion of throat swab was 59 days. CONCLUSIONS: Large families, including three-generation families in a single dwelling, should be monitored when the index case is found. Presymptomatic and symptomatic family members could be quarantined for an appropriate duration which, in our experience, is 2 months.


title: Possible long-term endocrine-metabolic complications in COVID-19: lesson from the SARS model

text: The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is centralizing the interest of the scientific world. In the next months, long-term consequences on the endocrine system may arise following COVID-19. In this article, we hypothesized the effects of SARS-CoV-2 taking into account what learned from the severe acute respiratory syndrome coronavirus (SARS-CoV) that caused SARS in 2003.


title: Effective immunity and second waves: a dynamic causal modelling study

text: This technical report addresses a pressing issue in the trajectory of the coronavirus outbreak; namely, the rate at which effective immunity is lost following the first wave of the pandemic. This is a crucial epidemiological parameter that speaks to both the consequences of relaxing lockdown and the propensity for a second wave of infections. Using a dynamic causal model of reported cases and deaths from multiple countries, we evaluated the evidence models of progressively longer periods of immunity. The results speak to an effective population immunity of about three months that, under the model, defers any second wave for approximately six months in most countries. This may have implications for the window of opportunity for tracking and tracing, as well as for developing vaccination programmes, and other therapeutic interventions.


Genetic epilepsies and COVID-19 pandemic: Lessons from the caregiver perspective


title: The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak

text: Motivated by the rapid spread of coronavirus disease 2019 (COVID-19) in mainland China, we use a global metapopulation disease transmission model to project the impact of travel limitations on the national and international spread of the epidemic. The model is calibrated on the basis of internationally reported cases and shows that, at the start of the travel ban from Wuhan on 23 January 2020, most Chinese cities had already received many infected travelers. The travel quarantine of Wuhan delayed the overall epidemic progression by only 3 to 5 days in mainland China but had a more marked effect on the international scale, where case importations were reduced by nearly 80% until mid-February. Modeling results also indicate that sustained 90% travel restrictions to and from mainland China only modestly affect the epidemic trajectory unless combined with a 50% or higher reduction of transmission in the community.


Nursing Home in the COVID-19 Outbreakï¼Challengeï¼Recovery, and Resiliency


Acute kidney injury is associated with the mortality of coronavirus disease 2019


title: Valor nutritivo e características fermentativas da silagem de capim-elefante com diferentes proporções de casca de café/ Nutritional value and characteristics of elephant grass silage with different proportions of coffe hulls

text: Avaliaram-se o valor nutritivo e as características bromatológicas de silagens de capim-elefante (CE), cultivar mineiro, cortado aos 70 dias de rebrota, com adição de quatro níveis de casca de café (1-CE; 2-CE + 10%; 3-CE + 20% e 4-CE + 30%). Utilizou-se o delineamento experimental em blocos casualizados com quatro tratamentos e seis repetições. Foram determinados nas silagens os teores de lignina, celulose, cafeína, DIVMS, pH, N-NH3 e as perdas de efluente e gás. Os valores de MS aumentaram enquanto o pH reduziu linearmente com o aumento da casca de café na silagem de capim elefante. A produção de efluente ocorreu somente na silagem sem casca de café nos cinco primeiros dias, com maior produção nos três primeiros. Os valores de N-NH3 decresceram linearmente com o aumento da casca de café. Houve aumento do teor de PB à medida do aumento da casca de café. Houve aumento de FDN e redução FDA e DIVMS linear com o aumento da casca de café. Esses resultados mostram que a casca de café como aditivo foi efetivo em melhorar as características da silagem de capim-elefante cortado aos 70 dias de idade.(AU)


title: Patients Perceptions of Telemedicine Visits Before and After the Coronavirus Disease 2019 Pandemic

text: Purpose: This study sought to determine whether the necessitated use of telemedicine due to coronavirus disease 2019, and limited choice of both the provider and patient, impacts the perceptions of telemedicine by patients who experienced telemedicine prepandemic and those who first experienced telemedicine during the pandemic. Methodology: Participants for this survey were a convenience sample. An invitation to participate was shared through social media and e-mail listservs. To participate, individuals had to be at least 18 years of age and gave consent to their data being used. The online survey took â¼10-15 min to complete, the survey was available from March 31 to April 20, 2020. Results: Two hundred sixty-four (n = 264, 60.8%) individuals had used telemedicine on or before December 2019 and 170 (39.2%) individuals used telemedicine for the first time January 2020 or later. There were no significant differences in demographics between groups, except that new users were more likely to have a primary care physician [F(407) = 13.51, p < 0.001]. Satisfaction of telemedicine was measured using a 10-item scale, demonstrating that all participants were overall satisfied with their telemedicine experience(s), (mean = 1.67, standard deviation = 0.61). Broadly, the differences in perceptions between the groups included the reasons for using telemedicine, perceptions of quality of in-person care, continuity of care, and a technical issue. Conclusions: Overall, patients are satisfied using telemedicine, however, for new users, both providers and patients, some acclimation needs to occur.


European Task Force on Atopic Dermatitis statement on severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection and atopic dermatitis


title: Obesity is associated with worse outcomes in COVID-19: Analysis of Early Data From New York City

text: OBJECTIVE: The 2019 novel coronavirus disease (COVID-19) has triggered a rapidly-expanding global pandemic in which patients exhibit a wide spectrum of disease severity. Given the high prevalence of obesity in the United States, we hypothesized that the presence of obesity may play a role in the clinical course of COVID-19 patients. METHODS: This is a retrospective review of adult patients admitted with confirmed SARS-CoV-2. Demographics, clinical characteristics, laboratory data, and clinical outcomes were abstracted. BMI (kg/m2 ) was analyzed with regard to a composite outcome of ICU admission or death, and intubation rate. RESULTS: 770 patients were included (61% male, mean age 63.5 yrs). Obese patients were more likely to present with fever, cough and shortness of breath. Obesity was also associated with a significantly higher rate of ICU admission or death (RR = 1.58, p = 0.002) even after adjusting for age, race and troponin level. CONCLUSIONS: Obese patients had an increased risk of critical illness leading to ICU admission or death compared to normal weight individuals. This study confirms that obesity is a major risk factor for COVID-19 disease severity, significantly impacting disease presentation and critical care requirements.


title: Crucial Inflammatory Mediators and Efficacy of Drug Interventions in Pneumonia Inflated COVID-19: An Invivo Mathematical Modelling Study

text: The virus SARS-COV-2 caused disease COVID-19 has been declared a pandemic by WHO. Currently, over 210 countries and territories have been affected. Careful, well-designed drugs and vaccine for the total elimination of this virus seem to be the need of the hour. In this context, the invivo mathematical modelling studies can be extremely helpful in understanding the efficacy of the drug interventions. These studies can also help understand the role of the crucial inflammatory mediators and the behaviour of immune response towards this novel coronavirus. Motivated by these facts, in this paper, we study the invivo dynamics of Covid-19. The results obtained here are inline with some of the clinical findings for Covid-19. This invivo modelling study involving the crucial biomarkers of Covid-19 is the first of its kind and the results obtained from this can be helpful to researchers, epidemiologists, clinicians and doctors who are working in this field.


COVID-19 and Down syndrome


Distance learning for vascular surgeons in the era of a pandemic


Profile of a killer: the complex biology powering the coronavirus pandemic


Predictive models for COVID-19-related deaths and infections


docid: hwmonzoy

title: Beginn der Lösung der COVID-19-Pandemie in China  Kann das Virus zurückkehren?/ Initial resolution of the COVID-19 pandemic in China-can the virus return?


docid: mgifvqbl

title: Systematic rapid living review on rehabilitation needs due to Covid-19: update to May 31st 2020

text: BACKGROUND: This paper adds to the series of systematic rapid living reviews, started in April 2020, to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to the Covid-19 pandemic. OBJECTIVES: To present the results of a systematic search performed on papers published from May 1st to May 31st, 2020. METHODS: An extensive search on the main medical literature databases for articles published (including Epub), in English, from May 1st to May 31st, 2020 was performed, according to the methodology already described in the previous 2 rapid reviews, with 2 important improvements: first, we made the search string more comprehensive; second, we relied on accredited terminologies to describe the study designs and report the rehabilitation settings. RESULTS: Fifty-eight out of 618 articles were finally included for qualitative analysis. The number of primary studies has increased, with respect to the previous months, although still around 60% papers are just expert opinions. Six papers report on the prevalence and /or characteristics of emerging disability after COVID-19, 12 on rehabilitation approaches to COVID-19 patients, up to 25 on the organization of rehabilitation services after COVID-19, 13 papers on the impact of COVID-19 on health conditions of rehabilitative interest and only 2 on late complications due to COVID-19 that may be of rehabilitative interest. CONCLUSIONS: Nowadays, all patients with disability, regardless of COVID-19 infection, are suffering because of restrictions imposed to rehabilitation service delivery. Neurological involvement is often present during acute and post-acute stage, conveying the risk of a long-lasting disability. Accordingly, careful neurological monitoring should be granted. Although new therapies are under development, the main gap in the available scientific literature is the lack of high-quality primary studies, so experimental studies on the effects of rehabilitation are still warranted.


Unlocking the lockdown of science and demystifying COVID-19: how autopsies contribute to our understanding of a deadly pandemic


Harnessing the natural anti-glycan immune response to limit the transmission of enveloped viruses such as SARS-CoV-2


Response to recent commentaries regarding the involvement of angiotensin-converting enzyme 2 (ACE2) and renin-angiotensin system blockers in SARS-CoV-2 infections


Impact of the coronavirus disease 2019 pandemic on spinal surgery in Singapore


title: Letter to the Editor "COVID-19 and Neurosurgical Education in Africa: Making Lemonade from Lemons"

text: Never in history has the fabric of African neurosurgery been challenged as it is today with the advent of the novel coronavirus identified in 2019 (COVID-19). Even the most robust and resilient neurosurgical educational systems in the continent have been brought to their knees with neurosurgical trainees and young neurosurgeons bearing the brunt. In the face of this new reality, and in order to limit the impact of the current COVID-19 pandemic, multiple programs have implemented physical distancing to reduce in-person interactions. In some cases, residents have been asked to stay home at least until they are instructed otherwise. This unfortunate event presents an innovative opportunity for neurosurgical education in Africa. Herein, we detail the framework of an online neurosurgical education initiative to advance the education of African residents and young neurosurgeons during and after the COVID-19 pandemic.


title: Preliminary epidemiological analysis on children and adolescents with novel coronavirus disease (2019-nCoV) in a central area of Calabria region

text: not available.


title: Laboratory testing of SARS-CoV, MERS-CoV, and SARS-CoV-2 (2019-nCoV): Current status, challenges, and countermeasures

text: Emerging and reemerging infectious diseases are global public concerns. With the outbreak of unknown pneumonia in Wuhan, China in December 2019, a new coronavirus, SARS-CoV-2 has been attracting tremendous attention. Rapid and accurate laboratory testing of SARS-CoV-2 is essential for early discovery, early reporting, early quarantine, early treatment, and cutting off epidemic transmission. The genome structure, transmission, and pathogenesis of SARS-CoV-2 are basically similar to SARS-CoV and MERS-CoV, the other two beta-CoVs of medical importance. During the SARS-CoV and MERS-CoV epidemics, a variety of molecular and serological diagnostic assays were established and should be referred to for SARS-CoV-2. In this review, by summarizing the articles and guidelines about specimen collection, nucleic acid tests (NAT) and serological tests for SARS-CoV, MERS-CoV, and SARS-CoV-2, several suggestions are put forward to improve the laboratory testing of SARS-CoV-2. In summary, for NAT: collecting stool and blood samples at later periods of illness to improve the positive rate if lower respiratory tract specimens are unavailable; increasing template volume to raise the sensitivity of detection; putting samples in reagents containing guanidine salt to inactivate virus as well as protect RNA; setting proper positive, negative and inhibition controls to ensure high-quality results; simultaneously amplifying human RNase P gene to avoid false-negative results. For antibody test, diverse assays targeting different antigens, and collecting paired samples are needed.


Epidemiological and Clinical Characteristics of Three Family Clusters of COVID-19 Transmitted by Latent Patients in China


title: Strategy of hospital logistic support to the battle against novel coronavirus pneumonia/ 中华医院管理杂志

text: Nowadays hospitals have been at the forefront fighting against novel coronavirus pneumonia, with diagnosing and treating of patients as a top priority. In order to ensure the smooth progress of diagnosis and treatment, and prevent the occurrence of nosocomial infection, logistics support needs to make allowances for the isolation ward in time from the perspectives of logistics, facilities and equipment, and to transform the in-and-out double channels of ward access as required, thus setting up the partition of the three zones. Secondly, logistics support needs to optimize the logistics service workflow, including the medical waste management, the environmental disinfection isolation, and to optimize the catering service within hospitals to reduce the gathering and flow of personnel. Thirdly, logistics support needs to increase personnel training, and to eliminate psychological panic as well as to stabilize the logistics support team by putting logistics management cadres on the front line. Meanwhile, the logistics department needs to take over the hospital access screening work, strictly manage those who enter the hospital, maximize the safety and reliability of the logistics support within the hospital, and ensure the smooth progress of the epidemic prevention work.


docid: axymuyev

title: A decision support system for optimizing the cost of social distancing in order to stop the spread of COVID-19

text: Currently there are many attempts around the world to use computers, smartphones, tablets and other electronic devices in order to stop the spread of COVID-19. Most of these attempts focus on collecting information about infected people, in order to help healthy people avoid contact with them. However, social distancing decisions are still taken by the governments empirically. That is, the authorities do not have an automated tool to recommend which decisions to make in order to maximize social distancing and to minimize the impact for the economy. In this paper we address the aforementioned problem and we design an algorithm that provides social distancing methods (i.e., what schools, shops, factories, etc. to close) that are efficient (i.e., that help reduce the spread of the virus) and have low impact on the economy. On short: a) we propose several models (i.e., combinatorial optimization problems); b) we show some theoretical results regarding the computational complexity of the formulated problems; c) we give an algorithm for the most complex of the previously formulated problems; d) we implement and test our algorithm; and e) we show an integer linear program formulation for our problem.


title: Molecular immune pathogenesis and diagnosis of COVID-19

text: Coronavirus disease 2019 (COVID-19) is a kind of viral pneumonia with an unusual outbreak in Wuhan, China, in December 2019, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The emergence of SARS-CoV-2 has been marked as the third introduction of a highly pathogenic coronavirus into the human population after the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) in the twenty-first century. In this minireview, we provide a brief introduction of the general features of SARS-CoV-2 and discuss current knowledge of molecular immune pathogenesis, diagnosis and treatment of COVID-19 on the base of the present understanding of SARS-CoV and MERS-CoV infections, which may be helpful in offering novel insights and potential therapeutic targets for combating the SARS-CoV-2 infection.


title: Delayed Recognition of Community Transmission of COVID-19 Resulting in Healthcare Worker Infections

text: We describe a case of delayed COVID-19 diagnosis due to unrecognized community transmission in Atlanta, Georgia in mid-February 2020. This case resulted in transmission of COVID-19 to three of the four healthcare workers present during a diagnostic bronchoscopy procedure where only procedural masks were worn.


title: Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients

text: BACKGROUND: Studies of the novel coronavirus-induced disease COVID-19 in Wuhan, China, have elucidated the epidemiological and clinical characteristics of this disease in the general population. The present investigation summarizes the clinical characteristics and early prognosis of COVID-19 infection in a cohort of patients with fractures. METHODS: Data on 10 patients with a fracture and COVID-19 were collected from 8 different hospitals located in the Hubei province from January 1, 2020, to February 27, 2020. Analyses of early prognosis were based on clinical outcomes and trends in laboratory results during treatment. RESULTS: All 10 patients presented with limited activity related to the fracture. The most common signs were fever, cough, and fatigue at the time of presentation (7 patients each). Other, less common signs included sore throat (4 patients), dyspnea (5 patients), chest pain (1 patient), nasal congestion (1 patient), headache (1 patient), dizziness (3 patients), abdominal pain (1 patient), and vomiting (1 patient). Lymphopenia (<1.0 × 10 cells/L) was identified in 6 of 10 patients, 9 of 9 patients had a high serum level of D-dimer, and 9 of 9 patients had a high level of C-reactive protein. Three patients underwent surgery, whereas the others were managed nonoperatively because of their compromised status. Four patients died on day 8 (3 patients) or day 14 (1 patient) after admission. The clinical outcomes for the surviving patients are not yet determined. CONCLUSIONS: The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture. This finding may be related to the duration between the development of symptoms and presentation. Surgical treatment should be carried out cautiously or nonoperative care should be chosen for patients with fracture in COVID-19-affected areas, especially older individuals with intertrochanteric fractures. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Plexiglas barrier box to improve ERCP safety during the COVID-19 pandemic


docid: bvzchvft

title: The "venous perspective" in Lombardia (Italy) during the first weeks of the COVID-19 epidemic


title: What Is the Appropriate Use of Laparoscopy over Open Procedures in the Current COVID-19 Climate?

text: INTRODUCTION: Among surgeons worldwide, a concern with the use of minimally invasive techniques has been raised due to a proposed risk of viral transmission of the coronavirus disease of 2019 (COVID-19) with the creation of pneumoperitoneum. Due to this proposed concern, we sought to collect the available data and evaluate the use of laparoscopy and the risk of COVID-19 transmission. METHODS: A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. RESULTS: Few studies have been performed on viral transmission during surgery, but to date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open or laparoscopic. There is no societal consensus on limiting or restricting laparoscopic or robotic surgery; however, there is expert consensus on the modification of standard practices to minimize any risk of transmission. CONCLUSIONS: Despite very little evidence to support viral transmission through laparoscopic or open approaches, we recommend making modifications to surgical practice such as the use of smoke evacuation and minimizing energy device use among other measures to minimize operative staff exposure to aerosolized particles.


title: Experiences and practices in the current prevention and control of the novel coronavirus pneumonia in China

text: Since December 2019, a number of new infectious diseases, mainly lung diseases caused by novel coronavirus infections, have been discovered in Wuhan, Hubei province. With the spread of the epidemic, cases in other regions of China and abroad have been confirmed. This sudden outbreak of a new type of infectious disease has seriously threatened people's health and safety, and China has adopted strong prevention and control measures in response. To provide a reference for international health emergency management workers, this article summarizes, from an academic perspective, the main prevention and control measures taken in China.


docid: aogcimly

title: Student nurses' ethical views on responses to the severe acute respiratory syndrome outbreak

text: BACKGROUND: Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. OBJECTIVE: We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. RESEARCH DESIGN: A questionnaire survey was carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. ETHICAL CONSIDERATIONS: This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. FINDINGS: Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students' attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. CONCLUSION: As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress.


A case of COVID-19 with long duration of viral shedding


title: Coronavirus Endoribonuclease and Deubiquitinating Interferon Antagonists Differentially Modulate the Host Response during Replication in Macrophages

text: Coronaviruses (CoVs) encode multiple interferon (IFN) antagonists that modulate the host response to virus replication. Here, we evaluated the host transcriptional response to infection with murine coronaviruses encoding independent mutations in one of two different viral antagonists, the deubiquitinase (DUB) within nonstructural protein 3 or the endoribonuclease (EndoU) within nonstructural protein 15. We used transcriptomics approaches to compare the scope and kinetics of the host response to the wild-type (WT), DUBmut, and EndoUmut viruses in infected macrophages. We found that the EndoUmut virus activates a focused response that predominantly involves type I interferons and interferon-related genes, whereas the WT and DUBmut viruses more broadly stimulate upregulation of over 2,800 genes, including networks associated with activating the unfolded protein response (UPR) and the proinflammatory response associated with viral pathogenesis. This study highlights the role of viral interferon antagonists in shaping the kinetics and magnitude of the host response during virus infection and demonstrates that inactivating a dominant viral antagonist, the coronavirus endoribonuclease, dramatically alters the host response in macrophages.IMPORTANCE Macrophages are an important cell type during coronavirus infections because they "notice" the infection and respond by inducing type I interferons, which limits virus replication. In turn, coronaviruses encode proteins that mitigate the cell's ability to signal an interferon response. Here, we evaluated the host macrophage response to two independent mutant coronaviruses, one with reduced deubiquitinating activity (DUBmut) and the other containing an inactivated endoribonuclease (EndoUmut). We observed a rapid, robust, and focused response to the EndoUmut virus, which was characterized by enhanced expression of interferon and interferon-related genes. In contrast, wild-type virus and the DUBmut virus elicited a more limited interferon response and ultimately activated over 2,800 genes, including players in the unfolded protein response and proinflammatory pathways associated with progression of significant disease. This study reveals that EndoU activity substantially contributes to the ability of coronaviruses to evade the host innate response and to replicate in macrophages.


title: Telehealth in Uro-oncology Beyond the Pandemic: Toll or Lifesaver?

text: BACKGROUND: Telehealth services are rapidly embraced in uro-oncology due to the current coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To determine patients' perspective on adoption of telehealth as a response to the pandemic and its sustainability in the future. DESIGN, SETTING, AND PARTICIPANTS: Following a COVID-19 outbreak, 101 patients with advanced genitourinary cancers are currently managed "virtually" for therapy administration at our tertiary care unit. They were surveyed about the current situation, and current and long-term employment of telehealth. INTERVENTION: Rapid implementation of virtual patient management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients' perception of anxiety of COVID-19 and cancer, perspective on telehealth measures as a reaction to the current COVID-19 pandemic, and long-term acceptance were used as outcomes. Wilcoxon matched-pair signed rank test, chi-square test, and Mann-Whitney U test were performed. RESULTS AND LIMITATIONS: Of 101 patients, 92 answered the questionnaire, with 71 (77.2%) responding virtually by e-mail or phone call. Anxiety of cancer (6/10, interquartile range [IQR] 3-8) superseded that of COVID-19 (four/10, IQR 2-5.25, p<0.001), and patients oppose temporary treatment interruption. Of the patients, 66.0% perceive their susceptibility to COVID-19 as equal to or lower than the general population and 52.2% believe that COVID-19 will not affect their therapy. In future, patients (62.6%) prefer to maintain in-person appointments as opposed to complete remote care, but accept remote care during the pandemic (eight/10, IQR 5-9). Beyond the crisis, maintaining telehealth has low preference rates (four/10, IQR 2-7), with high acceptance for external laboratory controls (60.9%) and online visit management (48.9%), but lower acceptance for remote treatment planning including staging discussions (44.6%) and for referral to secondary care oncologists (17.4%). CONCLUSIONS: Despite the pandemic, cancer remains the key concern and patients are not willing to compromise on their treatment. Rapid implementation of telehealth is tolerated well during the need of social distancing, with a clear "red line" concerning changes in existing patient-physician relationships. Balancing future implementation of telehealth while considering patients' demand for personal relationships will ensure human dignity in uro-oncology. PATIENT SUMMARY: We queried patients with genitourinary cancers treated in an almost virtual setting following a local coronavirus outbreak. Acceptance of telehealth during the current situation is high; however, long-term implementation of the adapted services is less favored. We deduce that patient-physician relationship is crucial for cancer patients and needs to be balanced against measures for social distancing to forge the future management.


title: Anosmia and Ageusia: Not an Uncommon Presentation of Covid-19 Infection in Children and Adolescents

text: Since the emergence of a cluster of viral pneumonia cases in Wuhan, Hubei Province, People's Republic of China, at the end of December 2019, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), a novel coronavirus also known as "coronavirus disease 2019 (COVID-19)," as of 7 April 2020, more than 1,214,466 cases of COVID-19 have been reported in more than 200 countries and territories, resulting in more than 67,767 deaths. The disease was recognized by World Health Organization (WHO) as a pandemic on 11 March 2020. Published reports of adult patients with COVID-19 infection described symptoms including fever, cough, fatigue, sputum production, headache, dyspnoea and diarrhoea. Children usually showed milder respiratory symptoms or were asymptomatic, while loss of taste or sensation of smell were seldom reported. In this paper, we report three cases of pediatric patients with COVID-19 infection who presented with anosmia and/or ageusia.


title: Triaging advanced GI endoscopy procedures during the COVID-19 pandemic: consensus recommendations using the Delphi method

text: BACKGROUND AND AIMS: There is a lack of consensus on which GI endoscopic procedures should be performed during the COVID-19 pandemic, and which procedures could be safely deferred without having a significant impact on outcomes. METHODS: We selected a panel of 14 expert endoscopists. We identified 41 common indications for advanced endoscopic procedures from the ASGE Appropriate Use of GI Endoscopy guidelines. Using a modified Delphi method, we first achieved consensus on the patient-important outcome for each procedural indication. Panelists prioritized consensus patient-important outcome when categorizing each indication into one of the following 3 procedural time periods: (1) time-sensitive emergent (schedule within 1 week), (2) time-sensitive urgent (schedule within 1 to 8 weeks), and (3) non-time sensitive (defer for >8 weeks and then reassess the timing). Three anonymous rounds of voting were allowed before attempts at consensus were abandoned. RESULTS: All 14 invited experts agreed to participate in the study. The prespecified consensus threshold of 51% was achieved for assigning patient-important outcome(s) to each advanced endoscopy indication. The prespecified consensus threshold of 66.7% was achieved for 40 of 41 advanced endoscopy indications in stratifying them into 1 of 3 procedural time periods. For 12 of 41 indications, 100% consensus was achieved; for 20 of 41 indications, 75% to 99% consensus was achieved. CONCLUSIONS: By using a Modified Delphi method that prioritized patient-important outcomes, we developed consensus recommendations on procedural timing for common indications for advanced endoscopy. These recommendations and the structured decision framework provided by our study can inform decision making as endoscopy services are reopened.


Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19)


title: #pandemicpedagogy: Using Twitter for Knowledge Exchange

text: The COVID-19 crisis has resulted in homeworking becoming the norm internationally. As a result, international, national and institutional medical education conferences, workshops and seminars have been cancelled or postponed indefinitely. Consequently, the opportunity for knowledge exchange and networking has been reduced. Hull York Medical School runs a medical education research unit with associated masters and PhD programmes that rely on conferences as opportunities for postgraduate students to learn from others in the field, showcase their research and innovative pedagogy, as well as network for future employment.


#pandemicpedagogy: Using Twitter for knowledge exchange


title: Impact of the COVID-19 pandemic on the workflow of an ambulatory endoscopy center: an assessment by discrete event simulation

text: BACKGROUND AND AIMS: As community-based ambulatory endoscopy centers (AECs) across the nation are trying to reopen and safely resume outpatient endoscopic procedures after the unprecedented lockdown related to the coronavirus disease 2019 (COVID-19) pandemic, guidelines recommend pretesting and screening for COVID-19 along with other mitigation measures for the safety of patients and staff. The impact of such changes in the workflow of AECs on throughput and other performance indicators is largely unknown, although a significant reduction in revenue stream is expected. METHODS: A discrete event simulation-based model was developed in the setting of a small to medium community-based single-specialty AEC to quantify the impact of COVID-19-related workflow changes on performance indicators and cost per case compared with the pre-COVID-19 baseline. RESULTS: In the simulation model, post-COVID-19 recommended workflow changes significantly impacted the operational and productivity metrics and, in turn, adversely affected financial metrics. Overall, there was a significant decrease in staff utilization and consequent increase in total facility time, waiting time for patients, and cost per case because of a bottleneck at the time of preprocedure COVID-19 screening and testing while practicing social distancing. Strategies to minimize this adverse impact on productivity were assessed. CONCLUSIONS: Pretesting and screening for COVID-19 as recommended by current guidelines will significantly impact the productivity and revenue stream of AECs. Urgent measures by payors are needed to adjust the facility reimbursement of endoscopy centers to ensure successful reopening and ramping up outpatient endoscopy services in these facilities already hit hard by the pandemic.


docid: cdughexc

text: BACKGROUND AND AIMS: As community-based ambulatory endoscopy centers across the nation are trying to reopen and safely resume outpatient endoscopic procedures after the unprecedented lockdown related to the COVID-19 pandemic, guidelines recommend pre-testing and screening for COVID-19 along with other mitigation measures for the safety of patients and staff. The impact of such changes in the workflow of ambulatory endoscopy centers on throughput and other performance indicators is largely unknown although a significant reduction in revenue stream is expected. METHODS: A discrete event simulation-based model was developed in the setting of a small to medium community-based single-specialty ambulatory endoscopy center to quantify the impact of COVID-19 related workflow changes on performance indicators and cost per case compared with the pre-COVID-19 baseline. RESULTS: In the simulation model, post-COVID-19 recommended workflow changes significantly impacted the operational and productivity metrics and, in turn, adversely affected the financial metrics. Overall, there was a significant decrease in staff utilization, and consequent increase in total facility time, waiting time for patients, and cost per case because of a bottleneck at the time of preprocedure COVID-19 screening and testing while practicing social distancing. Strategies to minimize this adverse impact on productivity were assessed. CONCLUSION: Pretesting and screening for COVID-19 as recommended by current guidelines will significantly impact the productivity and revenue stream of ambulatory endoscopy centers. Urgent measures by the payors are needed to adjust the facility reimbursement of endoscopy centers to ensure successful reopening and ramping up outpatient endoscopy services in these facilities already hit hard by the pandemic.


title: Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study

text: OBJECTIVE: To examine the protective effects of appropriate personal protective equipment for frontline healthcare professionals who provided care for patients with coronavirus disease 2019 (covid-19). DESIGN: Cross sectional study. SETTING: Four hospitals in Wuhan, China. PARTICIPANTS: 420 healthcare professionals (116 doctors and 304 nurses) who were deployed to Wuhan by two affiliated hospitals of Sun Yat-sen University and Nanfang Hospital of Southern Medical University for 6-8 weeks from 24 January to 7 April 2020. These study participants were provided with appropriate personal protective equipment to deliver healthcare to patients admitted to hospital with covid-19 and were involved in aerosol generating procedures. 77 healthcare professionals with no exposure history to covid-19 and 80 patients who had recovered from covid-19 were recruited to verify the accuracy of antibody testing. MAIN OUTCOME MEASURES: Covid-19 related symptoms (fever, cough, and dyspnoea) and evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, defined as a positive test for virus specific nucleic acids in nasopharyngeal swabs, or a positive test for IgM or IgG antibodies in the serum samples. RESULTS: The average age of study participants was 35.8 years and 68.1% (286/420) were women. These study participants worked 4-6 hour shifts for an average of 5.4 days a week; they worked an average of 16.2 hours each week in intensive care units. All 420 study participants had direct contact with patients with covid-19 and performed at least one aerosol generating procedure. During the deployment period in Wuhan, none of the study participants reported covid-19 related symptoms. When the participants returned home, they all tested negative for SARS-CoV-2 specific nucleic acids and IgM or IgG antibodies (95% confidence interval 0.0 to 0.7%). CONCLUSION: Before a safe and effective vaccine becomes available, healthcare professionals remain susceptible to covid-19. Despite being at high risk of exposure, study participants were appropriately protected and did not contract infection or develop protective immunity against SARS-CoV-2. Healthcare systems must give priority to the procurement and distribution of personal protective equipment, and provide adequate training to healthcare professionals in its use.


title: Cardiac injuries in coronavirus disease 2019 (COVID-19)

text: As the coronavirus disease 2019 (COVID-19) epidemic worsens, this global pandemic is impacting more than 200 countries/regions and more than 4,500,000 confirmed cases worldwide. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which might attack not only the respiratory system, but also the other important organs, including the heart. It was reported that COVID-19 patients with a past history of cardiovascular diseases would have a higher mortality. Meanwhile, elevated troponin levels were frequently observed in COVID-19 cases. Besides the comprehensive treatments for COVID-19, as a cardiologist, we should also remain vigilant about the cardiac injuries, especially those with severe emergent cardiovascular symptoms.


Effects of 5-alpha reductase inhibitors on lung function: A reason for discontinuation during COVID-19 pandemic?


Could Sars-coronavirus-2 trigger autoimmune and/or autoinflammatory mechanisms in genetically predisposed subjects?


title: Caring for our cancer patients in the wake of COVID-19

text: In response to our current global pandemic, unprecedented healthcare changes may have significant consequences for cancer patients in the United Kingdom. We explore why cancer patients may be more susceptible to severe infection and complications, highlighting various interventions that may help to ensure continuity of care in this unique cohort.


Letter to the Editor: COVID-19 in patients with diabetes: Risk factors that increase morbidity


title: Social isolation and the mitigation of coronavirus anxiety: The mediating role of meaning

text: This study examined core belief violation and meaning making as mechanisms mediating the relationship between adherence to social isolation policies for mitigating coronavirus transmission and reduced coronavirus anxiety (CA). Adherence to social isolation policies (social distancing, sheltering in place, and cessation of long-distance travel), use of nonsocial precautionary measures (handwashing, wearing a mask), core belief violation, meaning made of the COVID pandemic, and CA were assessed in a sample of 408 North Americans. Process analysis revealed that adhering to social isolation policies predicted lower levels of CA and that this effect was largely mediated by conservation of core beliefs (e.g., in predictability, control, and self-agency) and ability to make meaning of the pandemic. In contrast, exclusive reliance on nonsocial protections such as handwashing and mask wearing was associated with high levels of CA. These results suggest that social isolation policies support the integrity of adherents' meaning systems, thereby mitigating distress, which carries useful implications for both policy and psychological intervention.


title: "Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease"

text: AIMS: CoV-19/SARS-CoV-2 is a highly pathogenic virus that is causing a global pandemic with a high number of deaths and infected people. To contain the diffusion of infection, several governments have enforced restrictions on outdoor activities or even collective quarantine on the population. The present commentary briefly analyzes the effects of quarantine on lifestyle, including nutrition and physical activity and the impact of new technologies in dealing with this situation. DATA SYNTHESIS: Quarantine is associated with stress and depression leading to unhealthy diet and reduced physical activity. A diet poor in fruit and vegetables is frequent during isolation, with a consequent low intake of antioxidants and vitamins. However, vitamins have recently been identified as a principal weapon in the fight against the Cov-19 virus. Some reports suggest that Vitamin D could exert a protective effect on such infection. During quarantine, strategies to further increase home-based physical activity and to encourage adherence to a healthy diet should be implemented. The WHO has just released guidance for people in self-quarantine, those without any symptoms or diagnosis of acute respiratory illness, which provides practical advice on how to stay active and reduce sedentary behavior while at home. CONCLUSION: Quarantine carries some long-term effects on cardiovascular disease, mainly related to unhealthy lifestyle and anxiety. Following quarantine, a global action supporting healthy diet and physical activity is mandatory to encourage people to return to a good lifestyle routine.


title: Pseudo acute myocardial infarction in a young COVID-19 patient

text: A 29 year old man tested positive for COVID-19 and developed acute respiratory distress syndrome (ARDS). While mechanically ventilated, his electrocardiogram (EKG) showed inferior ST segment elevations, with normal serial cardiac troponin I and transthoracic echocardiograms. He was treated conservatively, with complete clinical recovery and resolution of his EKG abnormalities.


title: Emergency Colorectal Surgery in a COVID-19 Pandemic Epicenter

text: Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a considerable risk during emergency colorectal surgery in a pandemic epicenter. It is well known that the primary route of SARS-CoV-2 transmission is through respiratory droplets. However, little is known about shedding of the virus in bodily fluids and associated risks. Although the current moratorium on elective surgery addresses multiple ongoing concerns, including the management of precious resources as well as unknown exposure risks, surgeons undeniably must face and mitigate risks related to exposure to patient airway management-related aerosols, bodily fluids, surgical smoke, contaminated insufflation, and specimen handling in emergency colorectal surgery. Given the significant concern of airborne transmission, the authors recommend conventional, in lieu of laparoscopic, access in emergency colorectal surgery in a COVID-19 pandemic epicenter.


title: COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan

text: Since SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.


Being a rheumatologist and a patient with a rheumatic disease today: A perspective at the time of COVID-19


title: COVID-19Base: A knowledgebase to explore biomedical entities related to COVID-19

text: We are presenting COVID-19Base, a knowledgebase highlighting the biomedical entities related to COVID-19 disease based on literature mining. To develop COVID-19Base, we mine the information from publicly available scientific literature and related public resources. We considered seven topic-specific dictionaries, including human genes, human miRNAs, human lncRNAs, diseases, Protein Databank, drugs, and drug side effects, are integrated to mine all scientific evidence related to COVID-19. We have employed an automated literature mining and labeling system through a novel approach to measure the effectiveness of drugs against diseases based on natural language processing, sentiment analysis, and deep learning. To the best of our knowledge, this is the first knowledgebase dedicated to COVID-19, which integrates such large variety of related biomedical entities through literature mining. Proper investigation of the mined biomedical entities along with the identified interactions among those, reported in COVID-19Base, would help the research community to discover possible ways for the therapeutic treatment of COVID-19.


title: Statistical Physics of Epidemic on Network Predictions for SARS-CoV-2 Parameters

text: The SARS-CoV-2 pandemic has necessitated mitigation efforts around the world. We use only reported deaths in the two weeks after the first death to determine infection parameters, in order to make predictions of hidden variables such as the time dependence of the number of infections. Early deaths are sporadic and discrete so the use of network models of epidemic spread is imperative, with the network itself a crucial random variable. Location-specific population age distributions and population densities must be taken into account when attempting to fit these events with parametrized models. These characteristics render naive Bayesian model comparison impractical as the networks have to be large enough to avoid finite-size effects. We reformulated this problem as the statistical physics of independent location-specific `balls' attached to every model in a six-dimensional lattice of 56448 parametrized models by elastic springs, with model-specific `spring constants' determined by the stochasticity of network epidemic simulations for that model. The distribution of balls then determines all Bayes posterior expectations. Important characteristics of the contagion are determinable: the fraction of infected patients that die ($0.017\pm 0.009$), the expected period an infected person is contagious ($22 \pm 6$ days) and the expected time between the first infection and the first death ($25 \pm 8$ days) in the US. The rate of exponential increase in the number of infected individuals is $0.18\pm 0.03$ per day, corresponding to 65 million infected individuals in one hundred days from a single initial infection, which fell to 166000 with even imperfect social distancing effectuated two weeks after the first recorded death. The fraction of compliant socially-distancing individuals matters less than their fraction of social contact reduction for altering the cumulative number of infections.


Re: Yu et al.: Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019(COVID-19) Patients


Cognitive biases operating behind the rejection of government safety advisories during COVID19 Pandemic


[First case of 2019 novel coronavirus infection in children in Shanghai]


title: COVID-19 and the heart: An update for clinicians

text: SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly with clinical syndromes of acute myocardial injury, myocarditis, acute coronary syndromes, heart failure, arrhythmias, and venous thromboembolism. Some therapeutics under investigation for COVID-19 may also have adverse cardiac effects. The involvement of the RAAS system in viral entry makes it pertinent to consider the effects of medications that modulate the system. Comprehensive knowledge of peculiar cardiovascular manifestations of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is needed for optimal patient management.


title: Facemasks for prevention of viral respiratory infections in community settings: A systematic review and meta-analysis

text: Background: There is paucity of evidence on the effectiveness of facemask use in COVID-19 in community settings. Objectives: We aimed to estimate the effectiveness of facemask use alone or along with hand hygiene in community settings in reducing the transmission of viral respiratory illness. Methods: We searched PubMed and Embase for randomized controlled trials on facemask use in community settings to prevent viral respiratory illnesses published up to April 25, 2020. Two independent reviewers were involved in synthesis of data. Data extraction and risk-of-bias assessment were done in a standard format from the selected studies. Outcome data for clinically diagnosed or self-reported influenza-like illness (ILI) was recorded from individual studies. Pooled effect size was estimated by random-effects model for "facemask only versus control" and "facemask plus hand hygiene versus control." Results: Of the 465 studies from PubMed and 437 studies from Embase identified from our search, 9 studies were included in qualitative synthesis and 8 studies in quantitative synthesis. Risk of bias was assessed as low (n = 4), medium (n = 3), or high (n = 1) risk. Interventions included using a triple-layered mask alone or in combination with hand hygiene. Publication bias was not significant. There was no significant reduction in ILI either with facemask alone (n = 5, pooled effect size: -0.17; 95% confidence interval [CI]: -0.43-0.10; P = 0.23; I2 = 10.9%) or facemask with handwash (n = 6, pooled effect size: (n=6, pooled effect size: -0.09; 95% CI: -0.58 to 0.40; P = 0.71, I2 = 69.4%). Conclusion: : Existing data pooled from randomized controlled trials do not reveal a reduction in occurrence of ILI with the use of facemask alone in community settings.


title: Effects of Covid-19 Lockdown on Mental Health and Sleep Disturbances in Italy

text: Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored. A national cross-sectional survey was performed during the last 14 days of the Italian lockdown. Questionnaires assessed socio-demographics characteristic, behaviors and healthcare access. The outcomes were assessed using Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2. Participants with sleep disturbances completed the Insomnia Severity Index. The sample size was 1515. Depression and anxiety symptom prevalence was 24.7% and 23.2%; 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, an increased time spent on the internet and an avoidance of activities through peer pressure increased the likelihood of at least one mental health outcome. Increasing age, an absence of work-related troubles and being married or being a cohabitant reduced such a probability. Females and participants with chronic conditions were associated with a higher prevalence of sleep disturbances. It is crucial to study effective interventions, specifically planning strategies, for more vulnerable groups and to consider the role of the internet.


¿Estamos preparados?/ ¿Estamos preparados?/ Are we ready?


Coronavirus: global stocks of protective gear are depleted, with demand at "100 times" normal level, WHO warns


title: COVID-19 and Digital Resilience: Evidence from Uber Eats

text: We analyze how digital platforms can increase the survival rate of firms during a crisis by providing continuity in access to customers. Using order-level data from Uber Technologies, we study how the COVID-19 pandemic and the ensuing shutdown of businesses in the United States affected independent, small business restaurant supply and demand on the Uber Eats platform. We find evidence that small restaurants experience significant increases in total activity, orders per day, and orders per hour following the closure of the dine-in channel, and that these increases may be due to both demand-side and supply-side shocks. We document an increase in the intensity of competitive effects following the shock, showing that growth in the number of providers on a platform induces both market expansion and heightened inter-provider competition. Our findings underscore the critical role that digital will play in creating business resilience in the post-COVID economy, and provide new managerial insight into how supply-side and demand-side factors shape business performance on a platform.


title: [Consideration of surgeons participating in 2019 coronavirus disease emergency medical rescue]

text: As a newly epidemic, 2019 coronavirus disease (COVID-19) with a concentrated outbreak poses a great challenge to medical treatment. The severe and critical patients are complex complicatied with the psychological problems, and the medical staff are overworked and under tremendous psychological pressure. The surgeon participated in emergency medical rescue could provide professional treatment for the patients combined with surgical diseases, as well as specialized training for the non-surgeon crew, to reduce surgical-related mortality. With the advantages of good team consciousness, strong aseptic concept and good psychological quality, the surgeons can quickly adapt to and carry out rescue work under the premise of good self-protection. Surgeons need to develop critical care management concepts and focus on the critical care support equipment. Some suggestions are put forward for the standardized training of resident surgeons to cultivate compound talents. It is hoped that this article can lead to the thinking of how to participate in the emergency medical rescue of infectious diseases among surgeons and provide some enlightenment for future surgical education.


COVID-19 Strikes the Vulnerable