title: Emergency preparedness and response (EP&R) by pharmacy professionals in India: Lessons from the COVID-19 pandemic and the way forward

text: The COVID-19 pandemic highlights the importance of Emergency Preparedness & Response (EP&R) education, training, capacity building and infrastructure development in India. During the pandemic, pharmacy professionals (PPs) in India have continued to provide medications, supplies and services. India's public-private healthcare system is complex and of variable quality. Lacunae in pharmacy education, training, and lack of resolution around pharmacist roles present challenges in providing health services to patients. Such lack of differentiation creates challenges around role specifications and appropriate placement of PPs in patient care and on EP&R task forces or representation at the policy level. This study aimed to gain rapid insights from PPs in India regarding their roles and preparedness for the COVID-19 pandemic. An online survey comprising 20 questions regarding EP&R and Operations management was developed using the Qualtrics® survey software and administered to a sample of PPs. Survey results indicate that PPs were actively involved in essential pharmacy services despite minimal EP&R training. Based on lessons learned during COVID-19, lacunae in knowledge, training and regulations were identified and recommendations are provided to broaden PP roles and enable them to be better prepared and actively engaged in EP&R for future emergencies.


title: OER Recommendations to Support Career Development

text: This Work in Progress Research paper departs from the recent, turbulent changes in global societies, forcing many citizens to re-skill themselves to (re)gain employment. Learners therefore need to be equipped with skills to be autonomous and strategic about their own skill development. Subsequently, high-quality, on-line, personalized educational content and services are also essential to serve this high demand for learning content. Open Educational Resources (OERs) have high potential to contribute to the mitigation of these problems, as they are available in a wide range of learning and occupational contexts globally. However, their applicability has been limited, due to low metadata quality and complex quality control. These issues resulted in a lack of personalised OER functions, like recommendation and search. Therefore, we suggest a novel, personalised OER recommendation method to match skill development targets with open learning content. This is done by: 1) using an OER quality prediction model based on metadata, OER properties, and content; 2) supporting learners to set individual skill targets based on actual labour market information, and 3) building a personalized OER recommender to help learners to master their skill targets. Accordingly, we built a prototype focusing on Data Science related jobs, and evaluated this prototype with 23 data scientists in different expertise levels. Pilot participants used our prototype for at least 30 minutes and commented on each of the recommended OERs. As a result, more than 400 recommendations were generated and 80.9% of the recommendations were reported as useful.


title: Coronavirus disease (COVID-19): Characteristics in children and considerations for dentists providing their care

text: The emergence of the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease (COVID-19) has led to a global pandemic and one of the most significant challenges to the healthcare profession. Dental practices are focal points for cross-infection, and care must be taken to minimise the risk of infection to, from, or between dental care professionals and patients. The COVID-19 epidemiological and clinical characteristics are still being collated but children's symptoms seem to be milder than those that adults experience. It is unknown whether certain groups, for example children with comorbidities, might be at a higher risk of more severe illness. Emerging data on disease spread in children, affected by COVID-19, have not been presented in detail. The purpose of this article was to report current data on the paediatric population affected with COVID-19 and highlight considerations for dentists providing care for children during this pandemic. All members of the dental team have a professional responsibility to keep themselves informed of current guidance and be vigilant in updating themselves as recommendations are changing so quickly.


Meeting Our New Challenges with Thoughtfulness, Dedication, and Sacrifice


title: Challenges and countermeasures for diagnosis and treatment work in hepatobiliary surgery in the epidemic of novel coronavirus pneumonia

text: The epidemic of coronavirus disease 2019 (COVID-19) has become a severe and complicated situation As of February 23, 2020, there have been more than 77,038 confirmed cases of new coronavirus infection nationwide COVID-19 is highly infectious and has a long incubation period and a variety of clinical manifestations, which has a great impact on society and economy and also seriously affects the daily operation of hepatobiliary surgery This article discusses and recommends the medical protection measures required for outpatient, ward, and operation of hepatobiliary surgery, in order to reduce the risk of nosocomial infection in hepatobiliary surgery during the COVID-19 epidemic


Why the SARS-Cov-2 has prolonged spreading time in children?


title: De la atención de un brote por un patógeno desconocido en Wuhan hasta la preparación y respuesta ante la posible emergencia del 2019-nCoV en México./ From the handling of an outbreak by an unknown pathogen in Wuhan to the preparedness and response in the face of the emergence of Covid-19 in Mexico

text: On December 31, 2019, the Chinese health authorities informed the international community, through the mechanisms established by the World Health Organization (WHO), of a pneumonia epidemic of unknown etiology in Wuhan, Hubei Province. The first cases were reported early in that month and were linked to a history of having visited a market where food and live animals are sold. On January 7, 2020, isolation and identification of the culprit pathogen was achieved using next-generation sequencing, while the number of affected subjects continued to rise. The publication of full-genomes of the newly identified coronavirus (initially called 2019-nCoV, now called SARS-CoV2) in public and private databases, of standardized diagnostic protocols and of the clinical-epidemiological information generated will allow addressing the Public Health Emergency of International Concern (PHEIC), declared on January 30 by the WHO. With this document, we intend to contribute to the characterization of the pneumonia epidemic, now designated coronavirus disease (Covid-19) review the strengths Mexico has in the global health concert and invite health professionals to join the preparedness and response activities in the face of this emergency.


Cardiac surgery and COVID-19


docid: hgrgkltk

title: Will COVID-19 infection be less severe in ulcerative colitis than in Crohn's patients due to a lower rate of smokers?


COVID-19 E Cirurgias Urgentes: O Que Mudou?/ [COVID-19 And Urgent Surgeries: What Has Changed?]


title: Post-natal follow-up for women and neonates during the COVID-19 pandemic: French National Authority for Health recommendations

text: INTRODUCTION: In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations, concerning post-natal follow-up for women and neonates during the COVID-19 pandemic. METHODS: A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.


title: A case series of chest imaging manifestation of COVID-19

text: Coronavirus disease 2019 (COVID-19) is caused by a infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. It started in Wuhan, China, in December 2019, after which quickly spread to many other countries around the world. Chest radiography (CXR) and computed tomography (CT) play key roles in managment and diagnosis of COVID-19. In this case series we are presenting three patients with predominant left-sided changes caused by COVID-19 infection.


Being Here Now: Perspectives of Preliminary Medicine Residents at the Epicenter of the COVID-19 Pandemic


COVID-19-associated acute necrotizing myelitis


BACKGROUND: In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Currently, data on changes in sexual behavior during the COVID-19 outbreak are limited. AIM: The present study aimed to obtain a preliminary understanding of the changes in people's sexual behavior, as a result of the pandemic, and explore the context in which they manifest. METHODS: A convenience sample of 270 men and 189 women who completed an online survey consisting of 12 items plus an additional question were included in the study. OUTCOMES: The study outcomes were obtained using a study-specific questionnaire to assess the changes in people's sexual behavior. RESULTS: While there was a wide range of individual responses, our results showed that 44% of participants reported a decrease in the number of sexual partners and about 37% of participants reported a decrease in sexual frequency. Multiple regression analysis showed that age, partner relationship, and sexual desire were closely related to sexual frequency. In addition, we found that most individuals with risky sexual experiences had a rapid reduction in risky sexual behavior. CLINICAL IMPLICATIONS: The current findings contribute to identifying another potential health implication associated with the COVID-19 pandemic and report preliminary evidence of the need to provide potential interventions for the population. STRENGTH & LIMITATIONS: This study is the first to perform a preliminary exploration of sexual behavior during the COVID-19 outbreak. The generalizability of the results is limited, given that only a small convenience sample was used. CONCLUSION: During the height of the COVID-19 outbreak, overall sexual activity, frequency, and risky behaviors declined significantly among young men and women in China. Li W, Li G, Xin C, et al. Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in China. J Sex Med 2020;17:1225-1228.


Covid-19 pandemic: Enhanced barrier measures during containment and in the ex-containment phase


Pediatric COVID-associated Multi-system Inflammatory Syndrome (PMIS)


title: Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection

text: The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China and rapidly spread in other countries in December 2019. The infected patients presented with fever, respiratory symptoms, sometimes with digestive and other systemic manifestations, and some progressed with a severe acute respiratory syndrome or even death. Associated digestive symptoms were frequently observed in the patients, with an unknown significance and mechanism. ACE2, as the major known functional receptor of the 2019 novel coronavirus (2019-nCoV) attracted our attention. We collected the clinical data of the 2019-nCoV-infected patients from published studies and extracted the data about the incidence of gastrointestinal symptoms. Furthermore, we used online datasets to analyze ACE2 expression in different human organs, especially in the small intestine, to explore the relationship between ACE2 expression patterns and clinical symptoms. We found that diarrhea accounted for a notable proportion of COVID-19 patients, ranging from 8.0% to 12.9%. The results reveal that ACE2 mRNA and protein are highly expressed in the small intestinal enterocytes but not in the goblet cells or intestinal immune cells. High expression of ACE2 on the surface cells in the digestive tract may lead to gastrointestinal symptoms and inflammation susceptibility. Overall, digestive symptoms were common in the COVID-19 patients. ACE2 expression on surface cells of the small intestine may mediate the invasion and amplification of the virus and activation of gastrointestinal inflammation. It is a possible mechanism of digestive symptoms in the COVID-19 patients and explains the presence of the virus in patients' stool samples. The study also highlights the necessity of taking stool samples for suspected patients to help in early diagnosis and assessment of disease status.


docid: ribspvyf

title: Study of combining virtual screening and antiviral treatments of the Sars-CoV-2 (Covid-19)

text: The recent epidemic outbreak of a novel human coronavirus called SARS-CoV-2 and causing the respiratory tract disease COVID-19 has reached worldwide resonance and a global effort is being undertaken to characterize the molecular features and evolutionary origins of this virus. Therefore, rapid and accurate identification of pathogenic viruses plays a vital role in selecting appropriate treatments, saving people's lives and preventing epidemics. Additionally, general treatments, coronavirus-specific treatments, and antiviral treatments useful in fighting COVID-19 are addressed. This review sets out to shed light on the SARS-CoV-2 and host receptor recognition, a crucial factor for successful virus infection and taking immune-informatics approaches to identify B- and T-cell epitopes for surface glycoprotein of SARS-CoV-2. A variety of improved or new approaches also have been developed. It is anticipated that this will assist researchers and clinicians in developing better techniques for timely and effective detection of coronavirus infection. Moreover, the genomic sequence of the virus responsible for COVID-19, as well as the experimentally determined three-dimensional structure of the Main protease (Mpro) is available. The reported structure of the target Mpro was described in this review to identify potential drugs for COVID-19 using virtual high throughput screening.


title: Why tocilizumab could be an effective treatment for severe COVID-19?

text: A severe pneumonia-associated respiratory syndrome caused by a new coronavirus was identified in December 2019 (COVID-19), spread rapidly and has become a world-wide public health challenge. About 25% of COVID-19 patients experienced severe complications including acute respiratory distress syndrome (ARDS), and even progressed into an intensive care unit (ICU) admission and died. The exploration for the mortality causes and advancing novel therapeutic development of severe COVID-19 is crucial at the moment. The biopsy samples analysis at autopsy suggested that increased alveolar exudate caused by aberrant host immune response and inflammatory cytokine storm probably impedes alveolar gas exchange and contributes to the high mortality of severe COVID-19 patients. Our research has identified that pathogenic T cells and inflammatory monocytes incite inflammatory storm with large amount of interleukin 6, therefore monoclonal antibody that targets the IL-6 pathways may potentially curb inflammatory storm. Moreover, Tocilizumab treatment that blocking IL-6 receptors showed inspiring clinical results including temperature returned to normal quickly and respiratory function improved. Therefore, we suggest that Tocilizumab is an effective treatment in severe patients of COVID-19 to calm the inflammatory storm and reduce mortality.


Impact of Pre-existing Chronic Liver Disease on the Outcome of Patients with COVID-19 Disease


Repurposing antimalarials and other drugs for COVID-19


Impacts of immunosuppression and immunodeficiency on COVID-19: A systematic review and meta-analysis


Pre-labor anorectal swab for SARS-CoV-2 in COVID-19 pregnant patients: is it time to think about it?


title: Trends and prediction in daily incidence of novel coronavirus infection in China, Hubei Province and Wuhan City: an application of Farr's law

text: BACKGROUND: The recent outbreak of novel coronavirus (2019-nCoV) has infected tens of thousands of patients in China Studies have forecasted future trends of the incidence of 2019-nCoV infection, but appeared unsuccessful Farr's law is a classic epidemiology theory/practice for predicting epidemics Therefore, we used and validated a model based on Farr's law to predict the daily-incidence of 2019-nCoV infection in China and 2 regions of high-incidence METHODS: We extracted the 2019-nCoV incidence data of China, Hubei Province and Wuhan City from websites of the Chinese and Hubei health commissions A model based on Farr's law was developed using the data available on Feb 8, 2020, and used to predict daily-incidence of 2019-nCoV infection in China, Hubei Province and Wuhan City afterward RESULTS: We observed 50,995 (37,001 on or before Feb 8) incident cases in China from January 16 to February 15, 2020 The daily-incidence has peaked in China, Hubei Providence and Wuhan City, but with different downward slopes If no major changes occur, our model shows that the daily-incidence of 2019-nCoV will drop to single-digit by February 25 for China and Hubei Province, but by March 8 for Wuhan city However, predicted 75% confidence intervals of daily-incidence in all 3 regions of interest had an upward trend The predicted trends overall match the prospectively-collected data, confirming usefulness of these models CONCLUSIONS: This study shows the daily-incidence of 2019-nCoV in China, Hubei Province and Wuhan City has reached the peak and was decreasing However, there is a possibility of upward trend


"That which does not kill us, makes us stronger": COVID-19 and Posttraumatic Growth


title: Clinical features of the first cases and a cluster of Coronavirus Disease 2019 (COVID-19) in Bolivia imported from Italy and Spain

text: INTRODUCTION: In March 2020, Coronavirus Disease 2019 (COVID-19) arrived in Bolivia. Here, we report the main clinical findings, and epidemiological features of the first series of cases, and a cluster, confirmed in Bolivia. METHODS: For this observational, retrospective and cross-sectional study, information was obtained from the Hospitals and the Ministry of Health for the cases that were laboratory-diagnosed and related, during March 2020. rRT-PCR was used for the detection of the RNA of SARS-CoV-2 following the protocol Charité, Berlin, Germany, from nasopharyngeal swabs. RESULTS: Among 152 suspected cases investigated, 12 (7.9%) were confirmed with SARS-CoV-2 infected by rRT-PCR. The median age was 39 years (IQR 25-43), six of them male. Two cases proceed from Italy and three from Spain. Nine patients presented fever, and cough, five sore throat, and myalgia, among other symptoms. Only a 60 y-old woman with hypertension was hospitalized. None of the patients required ICU nor fatalities occurred in this group. CONCLUSIONS: This is the first report of surveillance of COVID-19 in Bolivia, with patients managed mainly with home isolation. Preparedness for a significant epidemic, as is going on in other countries, and the deployment of response plans for it, in the country is now taking place to mitigate the impact of the COVID-19 pandemic in the population.


A tribute to frontline corona warriors--Doctors who sacrificed their life while saving patients during the ongoing COVID-19 pandemic


docid: igqevibd

title: An urgent call to address the nutritional status of women and children in Nepal during COVID-19 crises

text: Due to the ongoing nationwide lockdown in Nepal, women and children face a greater risk of malnutrition and eventually leading to mortality and morbidity. To harness the progress made so far in improving the nutritional status of women and children, a focus on nutrition should be a part of the COVID-19 response plan.


title: Low performance of rapid antigen detection test as frontline testing for COVID-19 diagnosis

text: BACKGROUND: Ensuring accurate diagnosis is essential to limit the spread of SARS-CoV-2 and for the clinical management of COVID-19. Although real-time reverse transcription polymerase chain reaction (RT- qPCR) is the current recommended laboratory method to diagnose SARS-CoV-2 acute infection, several factors such as requirement of special equipment and skilled staff limit the use of these time-consuming molecular techniques. Recently, several easy to perform rapid antigen detection tests were developed and recommended in some countries as the first line of diagnostic. OBJECTIVES: The aim of this study was to evaluate the performances of the Coris COVID-19 Ag Respi-Strip test, a rapid immunochromatographic test for the detection of SARS-CoV-2 antigen, in comparison to RT-qPCR. RESULTS: 148 nasopharyngeal swabs were tested. Amongst the 106 positive RT-qPCR samples, 32 were detected by the rapid antigen test, given an overall sensitivity of 30.2%. All the samples detected positive with the antigen rapid test were also positive with RT-qPCR. CONCLUSIONS: Higher viral loads are associated with better antigen detection rates. Unfortunately, the overall poor sensitivity of the COVID-19 Ag Respi-Strip does not allow using it alone as the frontline testing for COVID-19 diagnosis.


COVID-19 reinforces the importance of handwashing


Infections without borders: a new coronavirus in Wuhan, China


title: Severe psychological distress among patients with epilepsy during the COVID-19 outbreak in southwest China

text: OBJECTIVE: To compare the severity of psychological distress between patients with epilepsy and healthy controls during the COVID-19 outbreak in southwest China, as well as identify potential risk factors of severe psychological distress among patients with epilepsy. METHODS: This cross-sectional case-control study examined a consecutive sample of patients older than 15 years treated at the epilepsy center of West China Hospital between February 1 and February 29, 2020. As controls, sex- and age-matched healthy visitors of inpatients (unrelated to the patients) were also enrolled during the same period. Data on demographics and attention paid to COVID-19 were collected by online questionnaire, data on epilepsy features were collected from electronic medical records, and psychological distress was evaluated using the 6-item Kessler Psychological Distress Scale (K-6). Potential risk factors of severe psychological distress were identified using multivariate logistic regression. RESULTS: The 252 patients and 252 controls in this study were similar along all demographic variables except family income. Patients with epilepsy showed significantly higher K-6 scores than healthy controls and spent significantly more time following the COVID-19 outbreak (both P < .001). Univariate analyses associated both diagnosis of drug-resistant epilepsy and time spent paying attention to COVID-19 with severe psychological distress (defined as K-6 score >12; both P ≤ .001). Multivariate logistic regression identified two independent predictors of severe psychological distress: time spent paying attention to COVID-19 (odds ratio [OR] = 1.172, 95% confidence interval [CI] = 1.073-1.280) and diagnosis of drug-resistant epilepsy (OR = 0.283, 95% CI = 0.128-0.623). SIGNIFICANCE: During public health outbreaks, clinicians and caregivers should focus not only on seizure control but also on mental health of patients with epilepsy, especially those with drug-resistant epilepsy. K-6 scores > 12 indicate severe psychological distress. This may mean, for example, encouraging patients to engage in other activities instead of excessively following media coverage of the outbreak.


title: Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US

text: State policies mandating public or community use of face masks or covers in mitigating novel coronavirus disease (COVID-19) spread are hotly contested. This study provides evidence from a natural experiment on effects of state government mandates in the US for face mask use in public issued by 15 states plus DC between April 8 and May 15. The research design is an event study examining changes in the daily county-level COVID-19 growth rates between March 31, 2020 and May 22, 2020. Mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage-points in 1-5, 6-10, 11-15, 16-20, and 21+ days after signing, respectively. Estimates suggest as many as 230,000-450,000 COVID-19 cases possibly averted By May 22, 2020 by these mandates. The findings suggest that requiring face mask use in public might help in mitigating COVID-19 spread. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].


title: Structural and simulation analysis of hotspot residues interactions of SARS-CoV 2 with human ACE2 receptor

text: The novel corona virus disease 2019 (SARS-CoV 2) pandemic outbreak was alarming. The binding of SARS-CoV (CoV) spike protein (S-Protein) Receptor Binding Domain (RBD) to Angiotensin converting enzyme 2 (ACE2) receptor initiates the entry of corona virus into the host cells leading to the infection. However, considering the mutations reported in the SARS-CoV 2 (nCoV), the structural changes and the binding interactions of the S-protein RBD of nCoV were not clear. The present study was designed to elucidate the structural changes, hot spot binding residues and their interactions between the nCoV S-protein RBD and ACE2 receptor through computational approaches. Based on the sequence alignment, a total of 58 residues were found mutated in nCoV S-protein RBD. These mutations led to the structural changes in the nCoV S-protein RBD 3d structure with 4 helices, 10 sheets and intermittent loops. The nCoV RBD was found binding to ACE2 receptor with 11 hydrogen bonds and 1 salt bridge. The major hot spot amino acids involved in the binding identified by interaction analysis after simulations includes Glu 35, Tyr 83, Asp 38, Lys 31, Glu 37, His 34 amino acid residues of ACE2 receptor and Gln 493, Gln 498, Asn 487, Tyr 505 and Lys 417 residues in nCoV S-protein RBD. Based on the hydrogen bonding, RMSD and RMSF, total and potential energies, the nCoV was found binding to ACE2 receptor with higher stability and rigidity. Concluding, the hotspots information will be useful in designing blockers for the nCoV spike protein RBD. [Formula: see text]Communicated by Ramaswamy H. Sarma.


title: Validation of the British Society of Thoracic Imaging guidelines for COVID-19 chest radiograph reporting

text: AIM: To validate the British Society of Thoracic Imaging issued guidelines for the categorisation of chest radiographs for coronavirus disease 2019 (COVID-19) reporting regarding reproducibility amongst radiologists and diagnostic performance. MATERIALS AND METHODS: Chest radiographs from 50 patients with COVID-19, and 50 control patients with symptoms consistent with COVID-19 from prior to the emergence of the novel coronavirus were assessed by seven consultant radiologists with regards to the British Society of Thoracic Imaging guidelines. RESULTS: The findings show excellent specificity (100%) and moderate sensitivity (44%) for guideline-defined Classic/Probable COVID-19, and substantial interobserver agreement (Fleiss' k=0.61). Fair agreement was observed for the "Indeterminate for COVID-19" (k=0.23), and "Non-COVID-19" (k=0.37) categories; furthermore, the sensitivity (0.26 and 0.14 respectively) and specificity (0.76, 0.80) of these categories for COVID-19 were not significantly different (McNemar's test p=0.18 and p=0.67). CONCLUSION: An amalgamation of the categories of "Indeterminate for COVID-19" and "Non-COVID-19" into a single "not classic of COVID-19" classification would improve interobserver agreement, encompass patients with a similar probability of COVID-19, and remove the possibility of labelling patients with COVID-19 as "Non-COVID-19", which is the presenting radiographic appearance in a significant minority (14%) of patients.


Comparative study of the clinical characteristics and epidemiological trend of 244 COVID-19 infected children with or without GI symptoms


title: A Confirmed Case of SARS-CoV-2 Pneumonia with Routine RT-PCR Negative and Virus Variation in Guangzhou, China

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is a newly recognized disease, and its diagnosis is primarily confirmed by routine RT-PCR detection of SARS-CoV-2. However, we report a confirmed case of SARS-CoV-2 pneumonia with routine RT-PCR negative. This case has been finally diagnosed by Nanopore sequencing combined with antibody of SARS-CoV-2. Simultaneously, the ORF and NP gene variation of SARS-CoV-2 were found. This case has highlighted that false negative results could be present in the routine RT-PCR diagnosis, especially with virus variation. At the moment, Nanopore pathogen sequencing and antibody detection have been found effective in clinical diagnosis.


title: Loss of Taste and Smell as Distinguishing Symptoms of COVID-19

text: In a household study, loss of taste and/or smell was the fourth most reported symptom (26/42; 62%) among COVID-19 case-patients and had the highest positive predictive value (83%; 95% CI: 55-95%) among household contacts. Olfactory and taste dysfunctions should be considered for COVID-19 case identification and testing prioritization.


Changing trends of ocular trauma in the time of COVID-19 pandemic


title: SARS-CoV-2: The viral shedding vs infectivity dilemma

text: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over four million people worldwide. There are multiple reports of prolonged viral shedding in people infected with SARS-CoV-2 but the presence of viral RNA on a test does not necessarily correlate with infectivity. The duration of quarantine required after clinical recovery to definitively prevent transmission is therefore uncertain. In addition, asymptomatic and presymptomatic transmission may occur, and infectivity may be highest early after onset of symptoms, meaning that contact tracing, isolation of exposed individuals and social distancing are essential public health measures to prevent further spread. This review aimed to summarise the evidence around viral shedding vs infectivity of SARS-CoV-2.


Tolstoy in the Time of Covid


title: COVID-19, mental health, and opioid use disorder: Old and new public health crises intertwine

text: The United States is facing both the coronavirus disease 2019 (COVID-19) pandemic and an ongoing epidemic of opioid overdose. Opioid use disorder is associated with other mental health problems, trauma, and social and health disparities. While the United States has acted to improve access to treatment for mental health and opioid use, research will be needed to understand the effectiveness of new policies in the context of COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: BSGIE survey on COVID-19 and gastrointestinal endoscopy in Belgium : results and recommendations

text: Background and aims: With the first wave of the COVID-19 pandemic declining, activities in the gastrointestinal clinic are being recommenced after a period of stringent measures. Since a second COVID-19 wave is not entirely ruled out health care professionals might remain faced with the need to perform endoscopic procedures in patients with a confirmed positive or unknown COVID-19 status. With this report we aim to provide a practical relevant overview of preparation and protective measures for gastroenterologists based on the currently available guidelines and our local experience and results of a national Belgian survey, to guarantee a fast recall of an adequate infection prevention if COVID-19 reoccurs. Methods: From the 23rd of March 2020 and the 13th of May 2020 we performed a Pubmed, Embase and Medline search, resulting in 37 papers on COVID-19 and endoscopy. Additionally, we combined these data with data acquired from the national BSGIE survey amongst Belgian gastroenterologists. Results: Based on 72 completed surveys in both university and non-university hospitals, the results show (1) a dramatic (<20%) or substantial (<50%) decrease of normal daily endoscopy in 74% and 22% of the units respectively, (2) a difference in screening and protective measures between university and non-university hospitals. These findings were subsequently compared with the current guidelines. Conclusion: Based on new data from the BSGIE survey and current guidelines we tried to realistically represent the current COVID-19 trends in protective measures, screening and indications for endoscopy and to provide a practical overview as preparation for a possible second wave.


SARS-CoV-2: A new virus but a familiar inflammation brain pattern


title: Lung Ultrasound in Children with COVID-19: Preliminary Findings

text: Recent evidence indicates the usefulness of lung ultrasound (LUS) in detecting coronavirus disease 19 (COVID-19) pneumonia. However, no data are available on the use of LUS in children with COVID-19 pneumonia. In this report, we describe LUS features of 10 consecutively admitted children with COVID-19 in two tertiary-level pediatric hospitals in Rome. LUS revealed signs of lung involvement during COVID-19 infection. In particular, vertical artifacts (70%), pleural irregularities (60%), areas of white lung (10%) and subpleural consolidations (10%) were the main findings in patients with COVID-19. No cases of pleural effusions were found. According to our experience, the routine use of LUS in the evaluation of children with suspected or confirmed COVID-19, when performed by clinicians with documented experience in LUS, was useful in diagnosing and monitoring pediatric COVID-19 pneumonia, reducing unnecessary radiation/sedation in children and exposure of health care workers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).


Liver and Kidney Injuries in COVID-19 and Their Effects on Drug Therapy;a Letter to Editor


title: Management of covid-19: a practical guideline for maternal and newborn health care providers in Sub-Saharan Africa

text: COVID-19 is a pandemic that is currently ravaging the world. Infection rate is steadily increasing in Sub-Saharan Africa. Pregnant women and their infants may suffer severe illnesses due to their lower immunity. This guideline prepares and equips clinicians working in the maternal and newborn sections in the sub-region to manage COVID-19 during pregnancy and childbirth.


title: Importance of respiratory airway management as well as psychological and rehabilitative treatments to COVID-19 patients

text: The clinical therapy for severe 2019 coronavirus disease (i.e., COVID-19) sufferers is relatively challenging. Herein, the processes involving salvage of a critical COVID-19 patient were retrospectively analyzed. The condition of an obese female critical COVID-19 sufferer progressively worsened in the initial period after admission. According to her symptoms and examination reports, endotracheal intubation and mechanical ventilation were timely conducted and meanwhile high-dose sedatives and analgesics were administrated. In the later therapeutic phase, however, sedative and analgesic dosages were gradually reduced, and psychological and rehabilitative therapies were conducted, concomitantly with enhancement of airway care to facilitate sputum expectoration. Eventually, the endotracheal tube was feasibly removed after intubation for 18 days and subsequently replaced with noninvasive ventilation and a high-flow nasal cannula oxygen therapy. Intensive airway care alongside psychological and rehabilitative therapies can shorten the mechanical ventilation time and improve the prognosis of COVID-19 sufferers.


title: COVID-19 in Lung Transplant Recipients

text: Solid organ transplant recipients are considered at a high risk for severe COVID-19 disease due to chronic immunosuppression, though their risk compared to that of the general population remains unclear. Management of lung transplant recipients can be particularly challenging given high levels of maintenance immunosuppression, high incidence of rejection, constant exposure of the graft to the external environment, and diagnostic uncertainty in patients with respiratory symptoms. There is currently limited data on manifestations, management, and outcomes in lung transplant recipients who develop this novel infection (1).


title: Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID-19 Pandemic

text: OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has caused physicians and surgeons to consider restructuring traditional cancer management paradigms. We aim to review the current evidence regarding the diagnosis and management of head and neck cancer, with an emphasis on the role of the multidisciplinary team (MDT) during a pandemic. DATA SOURCES: COVID-19 resources from PubMed, Google Scholar, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Head and Neck Society were examined. REVIEW METHODS: Studies and guidelines related to the multidisciplinary management of head and neck cancer in the COVID-19 setting were reviewed. A total of 54 studies were included. Given the continuously evolving body of literature, the sources cited include the latest statements from medical and dental societies. RESULTS: The unpredictable fluctuation of hospital resources and the risk of the nosocomial spread of SARS-CoV-2 have direct effects on head and neck cancer management. Using an MDT approach to help define "essential surgery" for immediately life- or function-threatening disease processes in the context of available hospital resources will help to maximize outcomes. Early enrollment in an MDT is often critical for considering nonsurgical options to protect patients and health care workers. The role of the MDT continues after cancer treatment, if delivered, and the MDT plays an essential role in surveillance and survivorship programs in these challenging times. CONCLUSION: Head and neck cancer management during the COVID-19 pandemic poses a unique challenge for all specialists involved. Early MDT involvement is important to maximize patient outcomes and satisfaction in the context of public and community safety.


title: Manifestations of Digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study/ 中华消化杂志

text: Objective@#To study the manifestations of digestive system of hospitalized patients with novel coronavirus pneumonia (NCP) in Wuhan, China, and to provide reference for disease control and treatment.@*Methods@#The data of hospitalized patients with NCP in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology was retrospectively analyzed, which included general information, nucleic acid test, severity degree of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected chi-square test and independent sample median test were performed for statistical analysis.@*Results@#Among the 305 patients there were 146 males (47.9%) and 159 females (52.1%), median age 57 years old. Nucleic acid assay of nasopharynx swab or pharynx swab of 84.1% (228/271) patients were positive. Forty-six patients (15.1%) were in critical group and 259 patients (84.9%) were in non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms mainly were fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, median time was 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. Excluding possible drug-related diarrhea, the incidence of diarrhea still was 22.2%. Only 6.9% (4/58) of patients were found leukocytes or fecal occult blood positive in regular stool test. ALT, AST, or bilirubin increased in 39.1% (119/304) of patients at admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased bilirubin level, average level was (37.4 ± 21.1) μmol/L. The median age of critical group was older than that of non-critical group (65.5 years vs. 56 years), at admission the rates of abnormal liver function test abnormal and slightly increased AST (40~80 U/L) of critical group were both higher than those of non-critical group (67.4% (31/46) vs. 34.1% (88/258) and 47.8% (22/46) vs. 21.7% (56/228)), and the differences were statistically significant (x2=5.885, 18.154 and 15.723;all P <0.05). There were no statistically significant differences in the proportion of male (58.7% (27/46) vs. 45.9% (119/259)), the positive rate of nucleic acid detection (94.6% (35/37) vs. 82.5% (193/234)), the percentage of patients with gastrointestinal symptoms (85.0% (17/20) vs. 78.5% (142/181)), the rate of diarrhea (44.7% (17/38)vs. 50.2% (129/257)) and ratio of patients with abnormal bilirubin level (6.5% (3/46) vs. 1.2% (3/258)) (all P>0.05).@*Conclusions@#The manifestation of digestive system of hospitalized NCP patients in Wuhan is significant, the ratio of patients with diarrhea and abnormal aminotransferase level is high. And at admission the rate of patients with abnormal liver function rate of critical group is higher than that of non-critical group, which will provide reference for the prevention and treatment of NCP.


title: Second waves, social distancing, and the spread of COVID-19 across America

text: We recently described a dynamic causal model of a COVID-19 outbreak within a single region. Here, we combine several of these (epidemic) models to create a (pandemic) model of viral spread among regions. Our focus is on a second wave of new cases that may result from loss of immunity--and the exchange of people between regions--and how mortality rates can be ameliorated under different strategic responses. In particular, we consider hard or soft social distancing strategies predicated on national (Federal) or regional (State) estimates of the prevalence of infection in the population. The modelling is demonstrated using timeseries of new cases and deaths from the United States to estimate the parameters of a factorial (compartmental) epidemiological model of each State and, crucially, coupling between States. Using Bayesian model reduction, we identify the effective connectivity between States that best explains the initial phases of the outbreak in the United States. Using the ensuing posterior parameter estimates, we then evaluate the likely outcomes of different policies in terms of mortality, working days lost due to lockdown and demands upon critical care. The provisional results of this modelling suggest that social distancing and loss of immunity are the two key factors that underwrite a return to endemic equilibrium.


title: Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19

text: SARS-CoV-2 is the virus that causes coronavirus disease (COVID-19) which has reached pandemic levels resulting in significant morbidity and mortality affecting every inhabited continent. The large number of patients requiring intensive care threatens to overwhelm healthcare systems globally. Likewise, there is a compelling need for a COVID-19 disease severity test to prioritize care and resources for patients at elevated risk of mortality. Here, an integrated point-of-care COVID-19 Severity Score and clinical decision support system is presented using biomarker measurements of C-reactive protein (CRP), N-terminus pro B type natriuretic peptide (NT-proBNP), myoglobin (MYO), D-dimer, procalcitonin (PCT), creatine kinase-myocardial band (CK-MB), and cardiac troponin I (cTnI). The COVID-19 Severity Score combines multiplex biomarker measurements and risk factors in a statistical learning algorithm to predict mortality. The COVID-19 Severity Score was trained and evaluated using data from 160 hospitalized COVID-19 patients from Wuhan, China. Our analysis finds that COVID-19 Severity Scores were significantly higher for the group that died versus the group that was discharged with median (interquartile range) scores of 59 (40-83) and 9 (6-17), respectively, and area under the curve of 0.94 (95% CI 0.89-0.99). Although this analysis represents patients with cardiac comorbidities (hypertension), the inclusion of biomarkers from other pathophysiologies implicated in COVID-19 (e.g., D-dimer for thrombotic events, CRP for infection or inflammation, and PCT for bacterial co-infection and sepsis) may improve future predictions for a more general population. These promising initial models pave the way for a point-of-care COVID-19 Severity Score system to impact patient care after further validation with externally collected clinical data. Clinical decision support tools for COVID-19 have strong potential to empower healthcare providers to save lives by prioritizing critical care in patients at high risk for adverse outcomes.


title: Unpredictable Fall of Severe Emergent Cardiovascular Diseases Hospital Admissions During the COVID-19 Pandemic: Experience of a Single Large Center in Northern Italy

text: Background Northern Italy is one of the epicenters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) pandemic in Europe. The impact of the pandemic and the consequent lockdown on medical emergencies other than those SARS-CoV 2 pandemic related is largely unknown. The aim of this study was to analyze the epidemiologic impact of coronavirus disease 2019 pandemic on hospital admission for severe emergent cardiovascular diseases (SECDs) in a single Northern Italy large tertiary referral center. Methods and Results We quantified SECDs admissions to the Cardiology Division of Udine University Hospital between March 1, 2020 and March 31, 2020 and compared them with those of the same time frame during 2019. Compared with March 2019, we observed a significant reduction in all SECDs admissions: -30% for ST-segment-elevation acute coronary syndromes, -66% for non-ST-segment-elevation acute coronary syndromes and -50% for severe bradyarrhythmia. Conclusions A significant decrease in all SECDs admissions has been observed during the SARS-CoV 2. pandemic and was unlikely caused by a reduction in the incidence of cardiovascular diseases. Fear of contagion may have contributed to the unpredictable drop of SECDs. Social education about early recognition of symptoms of life-threatening cardiac conditions requiring appropriate care in a timely fashion may help to reduce this counterproductive phenomenon.


title: Reproductive number of the COVID-19 epidemic in Switzerland with a focus on the Cantons of Basel-Stadt and Basel-Landschaft

text: The reproductive number in Switzerland was between 1.5 and 2 during the first third of March, and has consistently decreased to around 1. After the announcement of the latest strict measure on 20 March 2020, namely that gatherings of more than five people in public spaces are prohibited, the reproductive number dropped significantly below 1; the authors of this study estimate the reproductive number to be between 0.6 and 0.8 in the first third of April.


title: COVID-19 and Fake News in the Dominican Republic

text: The first case of novel coronavirus disease (COVID-19) in the Dominican Republic coincided with a period of political crisis. Distrust in governmental institutions shaped the critical phase of early response. Having a weak public health infrastructure and a lack of public trust, the Ministry of Health (MoH) began the fight against COVID-19 with a losing streak. Within 45 days of the first reported case, the political crisis and turmoil caused by "fake news" are limiting the capacity and success of the MoH response to the pandemic.


COVID-19 The Great Disruptor


title: [Clinical analysis of 23 patients with coronavirus disease 2019 in Xinyang City of Henan Province]

text: OBJECTIVE: To analyze the epidemiological characteristics and clinical features of the patients with coronavirus disease 2019 (COVID-19), so as to provide basis for clinical diagnosis. METHODS: The epidemiology, clinical symptoms, laboratory and radiologic data of 23 patients with COVID-19 admitted to the Fifth People's Hospital of Xinyang City from January 22nd to January 29th, 2020 were retrospectively analyzed. RESULTS: There was 23 patients with COVID-19, with 15 men and 8 women, and the median age was 46.0 (40.5, 52.0) years old (ranged from 27 years old to 80 years old). Nine patients had basic disease (39.1%), including hypertension (17.4%), cardiovascular diseases (17.4%), diabetes (8.7%), hypothyroidism (4.3%) and past history of tuberculosis (4.3%). All the 23 patients had contact history in Wuhan area or with confirmed cases. Clinical symptoms included fever (100%), cough (69.6%), expectoration (43.5%), myalgia (26.1%), headache (17.4%) and dyspnea (17.4%), and the less common symptom was diarrhea (4.3%). Blood routine tests showed leukocytopenia in 11 patients (47.8%), normal leukocyte counts in 10 patients (43.5%), and leukocytosis in 2 patients (8.7%); lymphopenia was found in 13 patients (56.5%). All 23 patients had different degrees of infective lesions in chest CT, with 7 patients (30.4%) on one side and 16 patients (69.6%) on both sides. There were 19 mild patients, 4 severe patients, and no critical or death case. Complications included acute respiratory distress syndrome (17.4%). No patient was reported with liver, kidney or heart dysfunction or secondary infection. CONCLUSIONS: Epidemic history of contact, fever, pneumonia signs of chest CT, normal or decreased count of leukocyte and lymphopenia are the clinical basis for diagnosis of COVID-19. However, at present, the treatment of patients has not been completed, and the effective treatment strategy and final prognosis are unclear.


title: Massive coronary thrombosis caused primary percutaneous coronary intervention to fail in a COVID-19 patient with ST-elevation myocardial infarction

text: COVID-19 is a new viral infection that has a significant impact on global health and economy. Because of its rapid spread worldwide, it may influence the prognosis of other medical conditions, such as ST-segment elevation myocardial infarction (STEMI). We report a case of a 58-year female patient admitted with an infero-posterior STEMI on the background of recently positive COVID-19 swab. Reperfusion was attempted through primary PCI but unfortunately failed to restore coronary blood flow due to massive thrombotic burden despite several attempts of balloon dilatation and aspiration thrombectomy. She sadly died later on because of hemodynamic deterioration. This scenario raises concerns about Neutrophil Extracellular Traps (NETS) which might potentially have propagated inflammation and thrombosis via platelets' aggregation leading to enhanced coagulopathy and massive coronary thrombosis. Therefore, we suggest primary PCI as the first-choice of revascularization in patients with combined COVID-19 and STEMI. Additionally, we emphasize on the importance of using the potent new generation P2Y12 inhibitors along with GPIIb/IIIa inhibitors in every STEMI patient with COVID-19 to achieve favorable conditions for primary PCI as well as favorable outcomes after stent implantation.


The Impact of the COVID-19 Pandemic on Vulnerable Older Adults in the United States


title: Facing SARS-CoV-2 Pandemic at a COVID-19 Regional Children's Hospital in Italy

text: BACKGROUND: In Italy, the response to coronavirus disease 2019 (COVID-19) pandemic upgraded from social distancing on February 23, 2020, to national lockdown on March 11, 2020. We described how the pandemic affected a tertiary care children hospital with a dedicated COVID-19 regional center. METHODS: We analyzed the characteristics of emergency department (ED) visits, urgent hospitalizations and severe acute respiratory syndrome (SARS)-COV-2 reverse transcription-polymerase chain reaction testing, and COVID-19 patients across 3 response phases: before the first Italian case, before national lockdown and during lockdown. RESULTS: ED visits decreased from a daily mean of 239.1 before the first COVID-19 Italian case, to 79.6 during lockdown; urgent hospitalizations decreased from 30.6 to 21.2. As of April 20, 2020, 1970 persons were tested for SARS-CoV-2 reverse transcription-polymerase chain reaction and 2.6% were positive. Positive rates were 1.2% in the ED, 21.1% in the COVID center and 0.5% in other wards. The median age of COVID-19 patients (N = 33) was 6.7 years, 27% had coexisting conditions and 79% were related to family clusters. CONCLUSIONS: The pandemic strongly impacted on the use of hospital services, with a 67% reduction in ED visits and a 31% reduction in urgent hospitalizations. Separating the flows of suspected patients from all other patients, and centralization of suspected and confirmed cases in the COVID center enabled to control the risk of nosocomial SARS-CoV-2 transmission. Delay in hospital use for urgent care must be avoided, and clear communication on infection prevention and control must be provided to families. Further studies are needed to assess how the reduction in hospital use affected children healthcare needs during the pandemic.


Gaucher disease and SARS-CoV-2 infection: Emerging management challenges


title: Containment of COVID-19 cases among healthcare workers: The role of surveillance, early detection, and outbreak management

text: OBJECTIVE: Staff surveillance is crucial during the containment phase of a pandemic to help reduce potential healthcare-associated transmission and sustain good staff morale. During an outbreak of SARS-COV-2 with community transmission, our institution used an integrated strategy for early detection and containment of COVID-19 cases among healthcare workers (HCWs). METHODS: Our strategy comprised 3 key components: (1) enforcing reporting of HCWs with acute respiratory illness (ARI) to our institution's staff clinic for monitoring; (2) conducting ongoing syndromic surveillance to obtain early warning of potential clusters of COVID-19; and (3) outbreak investigation and management. RESULTS: Over a 16-week surveillance period, we detected 14 cases of COVID-19 among HCWs with ARI symptoms. Two of the cases were linked epidemiologically and thus constituted a COVID-19 cluster with intrahospital HCW-HCW transmission; we also detected 1 family cluster and 2 clusters among HCWs who shared accommodation. No transmission to HCWs or patients was detected after containment measures were instituted. Early detection minimized the number of HCWs requiring quarantine, hence preserving continuity of service during an ongoing pandemic. CONCLUSIONS: An integrated surveillance strategy, outbreak management, and encouraging individual responsibility were successful in early detection of clusters of COVID-19 among HCWs. With ongoing local transmission, vigilance must be maintained for intrahospital spread in nonclinical areas where social mingling of HCWs occurs. Because most individuals with COVID-19 have mild symptoms, addressing presenteeism is crucial to minimize potential staff and patient exposure.


Application of 'mobile hospital' against 2019-nCoV in China


title: A stochastic epidemic model of COVID-19 disease

text: To model the evolution of diseases with extended latency periods and the presence of asymptomatic patients like COVID-19, we define a simple discrete time stochastic SIR-type epidemic model. We include both latent periods as well as the presence of quarantine areas, to capture the evolutionary dynamics of such diseases.


title: Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension

text: Several factors have been proposed to explain the high death rate of the coronavirus disease 2019 (COVID-19) outbreak, including hypertension and hypertension-related treatment with Renin Angiotensin System inhibitors. Also, age and multimorbidity might be confounders. No sufficient data are available to demonstrate their independent role. We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to verify whether renin-angiotensin system inhibitors are related to COVID-19 severe outcomes. We analyzed information from Italian patients diagnosed with COVID-19, admitted in 26 hospitals. One thousand five hundred ninety-one charts (male, 64.1%; 66±0.4 years) were recorded. At least 1 preexisting condition was observed in 73.4% of patients, with hypertension being the most represented (54.9%). One hundred eighty-eight deaths were recorded (11.8%; mean age, 79.6±0.9 years). In nonsurvivors, older age, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery diseases, and heart failure were more represented than in survivors. The Charlson Comorbidity Index was significantly higher in nonsurvivors compared with survivors (4.3±0.15 versus 2.6±0.05; P<0.001). ACE (angiotensin-converting enzyme) inhibitors, diuretics, and ß-blockers were more frequently used in nonsurvivors than in survivors. After correction by multivariate analysis, only age (P=0.0001), diabetes mellitus (P=0.004), chronic obstructive pulmonary disease (P=0.011), and chronic kidney disease (P=0.004) but not hypertension predicted mortality. Charlson Comorbidity Index, which cumulates age and comorbidities, predicts mortality with an exponential increase in the odds ratio by each point of score. In the COVID-19 outbreak, mortality is predicted by age and the presence of comorbidities. Our data do not support a significant interference of hypertension and antihypertensive therapy on COVID-19 lethality. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT04331574.


A call to action for public health nurses during the COVID-19 pandemic


Coronavirus conversations, in a time of logarithm


title: Serial interval of novel coronavirus (COVID-19) infections

text: OBJECTIVE: To estimate the serial interval of novel coronavirus (COVID-19) from information on 28 infector-infectee pairs. METHODS: We collected dates of illness onset for primary cases (infectors) and secondary cases (infectees) from published research articles and case investigation reports. We subjectively ranked the credibility of the data and performed analyses on both the full dataset (n = 28) and a subset of pairs with highest certainty in reporting (n = 18). In addition, we adjust for right truncation of the data as the epidemic is still in its growth phase. RESULTS: Accounting for right truncation and analyzing all pairs, we estimated the median serial interval at 4.0 days (95% credible interval [CrI]: 3.1, 4.9). Limiting our data to only the most certain pairs, the median serial interval was estimated at 4.6 days (95% CrI: 3.5, 5.9). CONCLUSIONS: The serial interval of COVID-19 is close to or shorter than its median incubation period. This suggests that a substantial proportion of secondary transmission may occur prior to illness onset. The COVID-19 serial interval is also shorter than the serial interval of severe acute respiratory syndrome (SARS), indicating that calculations made using the SARS serial interval may introduce bias.


docid: smtisrex

title: Covid-19 disease will cause a global catastrophe in terms of mental health: A hypothesis


docid: mtqjflnk

title: Body Mass Index, Weight Discrimination, and Psychological, Behavioral, and Interpersonal Responses to the Coronavirus Pandemic

text: OBJECTIVE: To examine whether body mass index (BMI) and weight discrimination are associated with psychological, behavioral, and interpersonal responses to the coronavirus pandemic. METHODS: Using a prospective design, participants (N=2,094) were first assessed in early February 2020 before the coronavirus crisis in the United States and again in mid-March 2020 during the President's 15 Days to Slow the Spread guidelines. Weight, height, and weight discrimination were assessed in the February survey. Psychological, behavioral, and interpersonal responses to the coronavirus were assessed in the March survey. RESULTS: Pre-pandemic experiences with weight discrimination were associated with greater concerns about the virus, engaging in more preventative behaviors, less trust in people and institutions to manage the outbreak, and greater perceived declines in connection to one's community. BMI tended to be unrelated to these responses. CONCLUSIONS: Despite the risks of complications of COVID-19 associated with obesity, individuals with higher BMI were neither more concerned about the virus nor taking more behavioral precautions than individuals in other weight categories. Weight discrimination, in contrast, may heighten vigilance to threat, which may have contributed to both positive (greater concern, more precautionary behavior) and negative (less trust, declines community connection) responses to the pandemic.


Letter: Neurosurgery Residency in the COVID-19 Era: Experiences and Insights From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania


Novel Coronavirus-19 (COVID-19) in the immunocompromised transplant recipient: #Flatteningthecurve


Retos clínicos en pacientes con enfermedad pulmonar obstructiva crónica que han sufrido una infección por SARS-CoV-2./ Retos clínicos en pacientes con enfermedad pulmonar obstructiva crónica que han sufrido una infección por SARS-CoV-2./ Clinical challenges in chronic obstructive pulmonary disease in patients who suffered SARS-CoV-2 infection


title: Novel coronavirus disease (COVID-19) in children

text: Coronavirus disease (COVID-19) was firstly reported at the end of 2019. The disease rapidly spread all around the world in a few months and was declared a worldwide pandemic by WHO in March 2020. By April 9, there were 1,436,198 confirmed COVID-19 cases in the world, nearly with 6% mortality rate. This novel infectious disease causes respiratory tract illness that may generally occur as mild upper respiratory tract disease or pneumonia. In older patients and/or patients with underlying conditions, it may result in acute respiratory distress syndrome, multi organ failure and even death. According to the current literature, children account approximately for 1%5% of diagnosed COVID-19 cases. Generally, COVID-19 seems to be a less severe disease for children than adults. Approximately 90% of pediatric patients are diagnosed as asymptomatic, mild, or moderate disease. However, up to 6.7% of cases may be severe. Severe illness is generally seen in patients smaller than 1 year of age and patients who have underlying disesases. The epidemiological and clinical patterns of COVID-19 and treatment approaches in pediatric patients still remain unclear although many pediatric reports are published. This review aims to summarize the current epidemics, clinical presentations, diagnosis, and treatment of COVID-19 in pediatric patients.


title: The burden, admission, and outcome of COVID-19 in Africa: protocol for a systematic review and meta-analysis

text: Background: According to the World Health Organization (WHO), the outbreak of coronavirus disease in 2019 (COVID-19) has been declared as pandemic and public health emergency that infected more than 5 million people worldwide at the time of writing this protocol. Strong evidence for the burden, admission, and outcome of COVID-19 has not been published in Africa. Therefore, this protocol will be served as a guideline to conduct a systematic review and meta-analysis of the burden, admission, and outcome of COVID-19 in Africa. Methods: Published and unpublished studies on the burden, admission, and outcome of COVID-19 in Africa and written in any language will be included. Databases (PubMed / MEDLINE, Google Scholar, Google, EMBASE, Web of Science, Microsoft Academic, WHO COVID-19 database, Cochran Library, Africa Wide Knowledge, and Africa Index Medicus) from December 2019 to May 2020 will be searched. Two independent reviewers will select, screen, extract data, and assess the risk of bias. The proportion will be measured using a random-effects model. Subgroup analysis will be conducted to manage hetrogeinity. The presence of publication bias will be assessed using Egger's test and visual inspection of the funnel plots. This systematic and meta-analysis review protocol will be reported per the PRISMA-P guidelines. Conclusion: This systematic review and meta-analysis protocol will be expected to quantify the burden, admission, and outcome of COVID-19 in Africa. Systematic review registration: This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) in March 2020 and accepted with the registration number: CRD42020179321(https://www.crd.york.ac.uk/PROSPERO).


title: Viral air load due to sedimenting and evaporating droplets produced by speaking

text: The effect of evaporation on droplet sedimentation times is crucial for estimating the risk of infection from virus-containing airborne droplets. For droplet radii in the range 100 nm<R<60 {\mu}m, evaporation can be described in the stagnant-flow approximation and is diffusion limited. Analytical equations are presented for the droplet evaporation rate, the time-dependent droplet size and the sedimentation time, including the significant effect of evaporation cooling. Evaporation makes the time for large droplets to sediment much longer and thus significantly increases the viral air load. Using recent estimates for SARS-CoV-2 concentrations in sputum and droplet production rates while speaking, a single infected person that constantly speaks without a mouth cover produces a total air load of more than 10^4 virions. In a mid-size closed room, this leads to a viral inhalation frequency of at least 2.5 per minute. Low relative humidity, as encountered inside buildings in winter and in airliners, speeds evaporation and thus keeps initially larger droplets suspended in air.


The power of 'pause': A time for medical students to reflect and mobilise


The electronic medical record and COVID-19: Is it up to the challenge?


Dermatoethics: Self-Prescribing Plaquenil during the COVID-19 Pandemic


title: In the shadow of HIV & TB: A commentary on the COVID epidemic in South Africa

text: While COVID-19 has become a global pandemic that has spread to all regions of the globe, local historic, health, and socio-environmental factors shape the epidemiological contours, response, and social challenges present within each affected nation. Thus, while countries like China, Italy, Iran, Brazil, and the United States have all been hard hit by the pandemic, there are critical differences across these nations in a number of variables (e.g. demographic features, health histories, healthcare systems, infection case rates, case fatality rates, national responses). In other words, within the global pandemic there are multiple importantly distinct national epidemics. Overcoming the grave threats to public health presented by COVID-19 requires both international cooperation and country-specific efforts that reflect local histories, needs, and resources. Already concerns are being expressed among health officials about how COVID-19 might be devastating in Africa. Currently, South Africa has the highest number of diagnosed COVID-19 cases on the continent and has been identified as being at high risk in the pandemic. This paper examines the public health response to the COVID-19 threat, how the prior and ongoing HIV and TB epidemics shape the COVID-19 epidemic and influence the response, and the potential ramifications of the response.


title: Heart Failure in the Time of COVID-19

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a new threat to healthcare systems. In this setting, heart failure units have faced an enormous challenge: taking care of their patients while at the same time avoiding patients' visits to the hospital. OBJECTIVE: The aim of this study was to evaluate the results of a follow-up protocol established in an advanced heart failure unit at a single center in Spain during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: During March and April 2020, a protocolized approach was implemented in our unit to reduce the number of outpatient visits and hospital admissions throughout the maximum COVID-19 spread period. We compared emergency room (ER) visits, hospital admissions, and mortality with those of January and February 2020. RESULTS: When compared to the preceding months, during the COVID pandemic there was a 56.5% reduction in the ER visits and a 46.9% reduction in hospital admissions, without an increase in mortality (9 patients died in both time periods). A total of 18 patients required a visit to the outpatient clinic for decompensation of heart failure or others. CONCLUSION: Our study suggests that implementing an active-surveillance protocol in acutely decompensated heart failure units during the SARS-CoV-2 pandemic can reduce hospital admissions, ER visits and, potentially, viral transmission, in a cohort of especially vulnerable patients.


title: Americans' COVID-19 Stress, Coping, and Adherence to CDC Guidelines

text: IMPORTANCE: Documenting Americans' stress responses to an unprecedented pandemic and their degree of adherence to CDC guidelines is essential for mental health interventions and policy-making. OBJECTIVE: To provide the first snapshot of immediate impact of COVID-19 on Americans' stress, coping, and guideline adherence. DESIGN: Data were collected from an online workers' platform for survey research (Amazon's Mechanical Turk) from April 7 to 9, 2020. The current data represents the baseline of a longitudinal study. Best practices for ensuring high-quality data were employed. PARTICIPANTS: Individuals who are 18 years of age or older, living in the USA, and English-speaking were eligible for the study. Of 1086 unique responses, 1015 completed responses are included. SETTING: Population-based. MAIN OUTCOMES: Exposure to and stressfulness of COVID-19 stressors, coping strategies, and adherence to CDC guidelines. RESULTS: The sample was 53.9% women (n = 547), with an average age of 38.9 years (SD = 13.50, range = 18-88), most of whom were White (n = 836, 82.4%), non-Hispanic (n = 929, 91.5%), and straight/heterosexual (n = 895, 88.2%); 40% were currently married (n = 407), and 21.6% (n = 219) were caregivers. About half (50.5%) endorsed having at least "mostly" enough money to meet their needs. Respondents' locations across the USA ranged from 18.5% in the Northeast to 37.8% in the South. The most commonly experienced stressors were reading/hearing about the severity and contagiousness of COVID-19, uncertainty about length of quarantine and social distancing requirements, and changes to social and daily personal care routines. Financial concerns were rated most stressful. Younger age, female gender, and caregiver status increased risk for stressor exposure and greater degree of stressfulness. The most frequently reported strategies to manage stress were distraction, active coping, and seeking emotional social support. CDC guideline adherence was generally high, but several key social distancing and hygiene behaviors showed suboptimal adherence, particularly for men and younger adults. CONCLUSIONS AND RELEVANCE: Americans have high COVID-19 stress exposure and some demographic subgroups appear particularly vulnerable to stress effects. Subgroups less likely to adhere to CDC guidelines may benefit from targeted information campaigns. these findings may guide mental health interventions and inform policy-making regarding implications of specific public health measures.


title: Long-term conditions and severe acute respiratory syndrome SARS-CoV-2 (COVID-19)

text: Observation of infection trends through the course of the ongoing COVID-19 pandemic has indicated that those with certain pre-existing chronic conditions, such as hypertension, chronic obstructive pulmonary disease and obesity, are particularly likely to develop severe infection and experience disastrous sequelae, including near-fatal pneumonia. This article aims to outline how SARS-CoV-2 affects people and to consider why individuals living with long-term conditions are at increased risk from infection caused by this virus. A summary of available clinical guidelines with recommendations is presented, to provide community nurses with the up-to-date information required for protecting individuals living with a number of long-term conditions. Additionally, special measures required are outlined, so that community nurses may reflect on how to best provide nursing care for individuals living with long-term conditions and understand protection measures for individuals at increased risk from severe COVID-19.


docid: hxansnzz

title: Fighting COVID-19: Early Teledermatology Lessons Learned


Strategies to support health care providers during the COVID-19 pandemic


Digestive endoscopy during Covid-19 outbreak in Italy: a tertiary referral center experience


title: Treatment of severely ill COVID-19 patients with anti-interleukin drugs (COV-AID): A structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: The purpose of this study is to test the safety and effectiveness of individually or simultaneously blocking IL-6, IL-6 receptor and IL-1 versus standard of care on blood oxygenation and systemic cytokine release syndrome in patients with COVID-19 coronavirus infection and acute hypoxic respiratory failure and systemic cytokine release syndrome. TRIAL DESIGN: A phase 3 prospective, multi-center, interventional, open label, 6-arm 2x2 factorial design study. PARTICIPANTS: Subjects will be recruited at the specialized COVID-19 wards and/or ICUs at 16 Belgian participating hospitals. Only adult (≥18y old) patients will be recruited with recent (≤16 days) COVID-19 infection and acute hypoxia (defined as PaO2/FiO2 below 350mmHg or PaO2/FiO2 below 280 on supplemental oxygen and immediately requiring high flow oxygen device or mechanical ventilation) and signs of systemic cytokine release syndrome characterized by high serum ferritin, or high D-dimers, or high LDH or deep lymphopenia or a combination of those, who have not been on mechanical ventilation for more than 24 hours before randomisation. Patients should have had a chest X-ray and/or CT scan showing bilateral infiltrates within the last 2 days before randomisation. Patients with active bacterial or fungal infection will be excluded. INTERVENTION AND COMPARATOR: Patients will be randomized to 1 of 5 experimental arms versus usual care. The experimental arms consist of Anakinra alone (anti-IL-1 binding the IL-1 receptor), Siltuximab alone (anti-IL-6 chimeric antibody), a combination of Siltuximab and Anakinra, Tocilizumab alone (humanised anti-IL-6 receptor antibody) or a combination of Anakinra with Tocilizumab in addition to standard care. Patients treated with Anakinra will receive a daily subcutaneous injection of 100mg for a maximum of 28 days or until hospital discharge, whichever comes first. Siltuximab (11mg/kg) or Tocilizumab (8mg/kg, with a maximum dose of 800mg) are administered as a single intravenous injection immediately after randomization. MAIN OUTCOMES: The primary end point is the time to clinical improvement defined as the time from randomization to either an improvement of two points on a six-category ordinal scale measured daily till day 28 or discharge from the hospital or death. This ordinal scale is composed of (1) Death; (2) Hospitalized, on invasive mechanical ventilation or ECMO; (3) Hospitalized, on non-invasive ventilation or high flow oxygen devices; (4) Hospitalized, requiring supplemental oxygen; (5) Hospitalized, not requiring supplemental oxygen; (6) Not hospitalized. RANDOMISATION: Patients will be randomized using an Interactive Web Response System (REDCap). A 2x2 factorial design was selected with a 2:1 randomization regarding the IL-1 blockade (Anakinra) and a 1:2 randomization regarding the IL-6 blockade (Siltuximab and Tocilizumab). BLINDING (MASKING): In this open-label trial neither participants, caregivers, nor those assessing the outcomes are blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 342 participants will be enrolled: 76 patients will receive usual care, 76 patients will receive Siltuximab alone, 76 patients will receive Tocilizumab alone, 38 will receive Anakinra alone, 38 patients will receive Anakinra and Siltuximab and 38 patients will receive Anakinra and Tocilizumab. TRIAL STATUS: COV-AID protocol version 3.0 (15 Apr 2020). Participant recruitment is ongoing and started on April 4th 2020. Given the current decline of the COVID-19 pandemic in Belgium, it is difficult to anticipate the rate of participant recruitment. TRIAL REGISTRATION: The trial was registered on Clinical Trials.gov on April 1st, 2020 (ClinicalTrials.gov Identifier: NCT04330638) and on EudraCT on April 3rd 2020 (Identifier: 2020-001500-41). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


title: Characteristics of the initial patients hospitalized for COVID-19: a single-center report

text: BACKGROUND: Novel coronavirus 19 infection (COVID-19) has become a global pandemic and Turkey had the first coronavirus patient tested positive in 10 March 2020. AIMS: In this analysis we have discussed the characteristics of Turkish patients who have been hospitalized for COVID-19 infection. STUDY DESIGN: Cross sectional study Methods: This retrospective study included all the patients who have been hospitalized for novel coronavirus at blinded for peer review -Department of Internal Medicine between 15th March 2020 and 28th March 2020. Patients were screened with real time PCR (2019nCoV), chest X-ray and computer tomography. Also, their demographic characteristics including sex, age, occupation, comorbid disease etc. were recorded. RESULTS: There were 70 patients for analysis. Thirty-seven patients (52.9 %) tested positive for coronavirus infection with PCR. Mean age was 55.8 (min 24- max 87). There were 49 men (70.0%). Two patients (2%) were sent home and eleven patients (15.7%) were transferred to intensive care unit (ICU). Patients in ICU had statistically higher, pulse rate, respiratory rate, aspartate aminotransferase, lactate dehydrogenase, c-reactive protein, d-dimer, fibrinogen, activated partial thromboplastin time, troponin and procalcitonin compared to patients followed in clinics. CONCLUSION: Turkey has avoided the disease for some time but as inevitable as it is, our country has been added to the countries which are infected.


Extracorporeal membrane oxygenation for COVID-19-associated severe acute respiratory distress syndrome and risk of thrombosis


docid: lrmpdswm

title: COVID-19 and the eye immunity: lesson learned from the past and possible new therapeutic insights


title: Current status and progress of 2019 novel coronavirus pneumonia/ 中华危重病急救医学

text: Recently, the 2019 novel coronavirus (2019-nCoV) pneumonia outbroke in Wuhan and rapidly spread to all over China and even the world. Because of the strong infectivity and various clinical symptoms, it has brought certain difficulties to the epidemic prevention and control. Currently there is no specific drug for 2019-nCoV. Previous drugs used to treat other coronaviruses may be effective, but further clinical trials remain needed. We reviewed literature on the epidemiology, etiology, clinical manifestations, imaging manifestations, laboratory examination, diagnosis, complications, treatment and outcome of 2019-nCoV pneumonia.


docid: uultssgk

title: Routes for COVID-19 importation in Brazil


CT and COVID-19: Chinese experience and recommendations concerning detection, staging and follow-up


title: Crafting Jobs for Occupational Satisfaction and Innovation among Manufacturing Workers Facing the COVID-19 Crisis

text: China's manufacturing employees are confronted with unprecedent occupational and innovation challenges caused by the ongoing COVID-19 crisis coupled with the pressure of being replaced by digital technologies. To gain a better understanding of the rising occupational uncertainty during this critical time, based on the job demands-resources (JD-R) theory, we examined the associations of employees' job crafting behaviors (JCB) with their occupational satisfaction and innovation workplace behavior (IWB), as well as the mediating effect of work engagement on the above relationships. The final usable data were obtained from the formal survey of 311 employees of six manufacturing companies that have returned to work amid COVID-19. Structural equation modelling was adopted to analyze the data. Results show that employees' JCB strengthens their occupational satisfaction and IWB via work engagement. Theoretically, our research enriches the existing body of knowledge about JCB from a cross-disciplinary angle integrating the perspectives of career and psychology. Practically, we offer valuable first-hand evidence about how manufacturing employees conducted JCB to re-orient their careers and to innovate in the face of the high unemployment situation.


title: FiberStars: Visual Comparison of Diffusion Tractography Data between Multiple Subjects

text: Tractography from high-dimensional diffusion magnetic resonance imaging (dMRI) data allows brain's structural connectivity analysis. Recent dMRI studies aim to compare connectivity patterns across thousands of subjects to understand subtle abnormalities in brain's white matter connectivity across disease populations. Besides connectivity differences, researchers are also interested in investigating distributions of biologically sensitive dMRI derived metrics across subject groups. Existing software products focus solely on the anatomy or are not intuitive and restrict the comparison of multiple subjects. In this paper, we present the design and implementation of FiberStars, a visual analysis tool for tractography data that allows the interactive and scalable visualization of brain fiber clusters in 2D and 3D. With FiberStars, researchers can analyze and compare multiple subjects in large collections of brain fibers. To evaluate the usability of our software, we performed a quantitative user study. We asked non-experts to find patterns in a large tractography dataset with either FiberStars or AFQ-Browser, an existing dMRI exploration tool. Our results show that participants using FiberStars can navigate extensive collections of tractography faster and more accurately. We discuss our findings and provide an analysis of the requirements for comparative visualizations of tractography data. All our research, software, and results are available openly.


COVID-19 and Risks Posed to Personnel During Endotracheal Intubation


A global public health emergency and the MJA rapid review process


title: Detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human breast milk of a mildly symptomatic patient with coronavirus disease 2019 (COVID-19)

text: SARS-CoV-2 is a novel coronavirus and causative pathogen to the pandemic illness COVID-19. Although RNA has been detected in various clinical samples, no reports to date have documented SARS-CoV-2 in human milk. This case report describes an actively breastfeeding patient with COVID-19 infection with detectable viral RNA in human milk.


Janus-faced course of COVID-19 infection in patients with hematological malignancies


Managing individual and population risk from covid-19


Obesity could shift severe COVID-19 disease to younger ages


Off-target ACE2 ligands: Possible therapeutic option for CoVid-19?


The Use of Captopril-Angiotensin Converting Enzyme (ACE) Inhibitor for Cystinuria During COVID-19 Pandemic


title: Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China

text: The first case of 2019-nCoV pneumonia infection occurred in Wuhan, Hubei Province, South China Seafood Market in December 2019. As a group with a high probability of infection, health workers are faced with a certain degree of psychological challenges in the process of facing the epidemic. This study attempts to evaluate the impact of 2019-nCoV outbreak on the psychological state of Chinese health workers and to explore the influencing factors. During the period from 31 January 2020 to 4 February 2020, the 'Questionnaire Star' electronic questionnaire system was used to collect data. The 2019-nCoV impact questionnaire and The Impact of Event Scale (IES) were used to check the psychological status of health workers in China. A total of 442 valid data were collected in this study. Seventy-four (16.7%) male and 368 (83.3%) female individuals participated in this study. The average score of high arousal dimension was 5.15 (s.d. = 4.71), and the median score was 4.0 (IQR 2.0, 7.0). The average score of IES was 15.26 (s.d. = 11.23), and the median score was 13.5 (IQR 7.0, 21.0). Multiple regression analysis showed that there were critical statistical differences in high arousal scores among different gender groups (male 3.0 vs. female 5.0, P = 0.075). Whether being quarantined had significant statistical differences of IES scores (being quarantined 16.0 vs. not being quarantined 13.0, P = 0.021). The overall impact of the 2019-nCoV outbreak on health workers is at a mild level. Chinese health workers have good psychological coping ability in the face of public health emergencies.


Prove or Improve? Less Funding? Use the Capital Available in Homeopathic Practice


title: Rational evaluation of various epidemic models based on the COVID-19 data of China

text: During the study of epidemics, one of the most significant and also challenging problems is to forecast the future trends, on which all follow-up actions of individuals and governments heavily rely. However, to pick out a reliable predictable model/method is far from simple, a rational evaluation of various possible choices is eagerly needed, especially under the severe threat of COVID-19 pandemics now. Based on the public COVID-19 data of seven provinces/cities in China reported during the spring of 2020, we make a systematical investigation on the forecast ability of eight widely used empirical functions, four statistical inference methods and five dynamical models. We highlight the significance of a well balance between model complexity and accuracy, over-fitting and under-fitting, as well as model robustness and sensitivity. We further introduce the Akaike information criterion, root mean square error and robustness index to evaluate various epidemic models/methods. Through extensive simulations, we find that the inflection point plays a crucial role in forecasting. We further notice the Logistic function steadily underestimate the final epidemic size, while the Gomertz's function makes an overestimation in all cases. Since the methods of sequential Bayesian and time dependent reproduction number take the non-constant nature of the effective reproduction number into consideration, we suggest to employ them especially in the late stage of an epidemic. The transition-like behavior of exponential growth method from underestimation to overestimation with respect to the inflection point might be useful for constructing a more reliable forecast. Towards the ODE models, the SEIR-QD and SEIR-PO models are shown to be suitable for modeling the COVID-19 epidemics, whose success could be attributed to the inclusion of self-protection and quarantine.


Physical distancing, face masks, and eye protection for prevention of COVID-19


title: Temperature, Humidity, and Latitude Analysis to Estimate Potential Spread and Seasonality of Coronavirus Disease 2019 (COVID-19)

text: Importance: Coronavirus disease 2019 (COVID-19) infection has resulted in a global crisis. Investigating the potential association of climate and seasonality with the spread of this infection could aid in preventive and surveillance strategies. Objective: To examine the association of climate with the spread of COVID-19 infection. Design, Setting, and Participants: This cohort study examined climate data from 50 cities worldwide with and without substantial community spread of COVID-19. Eight cities with substantial spread of COVID-19 (Wuhan, China; Tokyo, Japan; Daegu, South Korea; Qom, Iran; Milan, Italy; Paris, France; Seattle, US; and Madrid, Spain) were compared with 42 cities that have not been affected or did not have substantial community spread. Data were collected from January to March 10, 2020. Main Outcomes and Measures: Substantial community transmission was defined as at least 10 reported deaths in a country as of March 10, 2020. Climate data (latitude, mean 2-m temperature, mean specific humidity, and mean relative humidity) were obtained from ERA-5 reanalysis. Results: The 8 cities with substantial community spread as of March 10, 2020, were located on a narrow band, roughly on the 30° N to 50° N corridor. They had consistently similar weather patterns, consisting of mean temperatures of between 5 and 11 °C, combined with low specific humidity (3-6 g/kg) and low absolute humidity (4-7 g/m3). There was a lack of substantial community establishment in expected locations based on proximity. For example, while Wuhan, China (30.8° N) had 3136 deaths and 80â¯757 cases, Moscow, Russia (56.0° N), had 0 deaths and 10 cases and Hanoi, Vietnam (21.2° N), had 0 deaths and 31 cases. Conclusions and Relevance: In this study, the distribution of substantial community outbreaks of COVID-19 along restricted latitude, temperature, and humidity measurements was consistent with the behavior of a seasonal respiratory virus. Using weather modeling, it may be possible to estimate the regions most likely to be at a higher risk of substantial community spread of COVID-19 in the upcoming weeks, allowing for concentration of public health efforts on surveillance and containment.


title: Emergency Authorization of Chloroquine and Hydroxychloroquine for Treatment of COVID-19

text: The world is suffering a respiratory pandemic disease caused by a novel coronavirus (2019-nCoV), commonly known as COVID-19 (coronavirus disease 2019). The Food and Drug Administration issued an emergency authorization for chloroquine and hydroxychloroquine as experimental treatments for COVID-19 leading to a shortage of both medications. A literature review conducted in April 2020 shows a lack of high-quality data available, resulting in ambiguous guideline recommendations. Decisions to use either drug should be made with careful consideration of risks versus benefits along with proper monitoring. Because of its higher potency and better safety profile, hydroxychloroquine may be the more reasonable treatment option if treatment is initiated.


Promoting biosecurity by professionalizing biosecurity


title: Cross-reactive Antibody Response between SARS-CoV-2 and SARS-CoV Infections

text: The World Health Organization has declared the ongoing outbreak of COVID-19, which is caused by a novel coronavirus SARS-CoV-2, a pandemic. There is currently a lack of knowledge about the antibody response elicited from SARS-CoV-2 infection. One major immunological question concerns antigenic differences between SARS-CoV-2 and SARS-CoV. We address this question by analyzing plasma from patients infected by SARS-CoV-2 or SARS-CoV and from infected or immunized mice. Our results show that, although cross-reactivity in antibody binding to the spike protein is common, cross-neutralization of the live viruses may be rare, indicating the presence of a non-neutralizing antibody response to conserved epitopes in the spike. Whether such low or non-neutralizing antibody response leads to antibody-dependent disease enhancement needs to be addressed in the future. Overall, this study not only addresses a fundamental question regarding antigenicity differences between SARS-CoV-2 and SARS-CoV but also has implications for immunogen design and vaccine development.


title: Extrapulmonary and atypical clinical presentations of COVID-19

text: The novel coronavirus (SARS-CoV2) has led to an outbreak of multiple cases of pneumonia in Wuhan city in December 2019. The disease caused by this virus was named coronavirus disease 2019 or "COVID-19", which was declared by the World Health Organization as a global pandemic in March 2020. It typically presents with respiratory symptoms and febrile illness. However, there are few reported extrapulmonary and atypical presentations, such as hemoptysis, cardiac, neurological, gastrointestinal, ocular, and cutaneous manifestations, as well as venous and arterial thrombosis. Lack of awareness of these presentations might lead to misdiagnosis, delayed diagnosis, and isolation of suspected patients which increases the risk of transmission of infection between patients and doctors. All these issues will be discussed in this review.


Electron microscopy of SARS-CoV-2: a challenging task - Authors' reply


title: My first call on Covid duty

text: The Covid-19 pandemic has meant that all available health workers have been summoned to serve the community. Here, I describe my first experience as a resident doctor of shift duty in the Covid ICU of a large municipal hospital in Mumbai, with its accompanying fears and discomforts, all contributing to learning painful but valuable lessons.. Keywords: Covid-19, ICU, pandemic, public health system, learning.


title: The hallmarks of COVID-19 disease

text: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that has caused a worldwide pandemic of the human respiratory illness COVID-19, resulting in a severe threat to public health and safety. Analysis of the genetic tree suggests that SARS-CoV-2 belongs to the same Betacoronavirus group as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Although the route for viral transmission remains a mystery, SARS-CoV-2 may have originated in an animal reservoir, likely that of bat. The clinical features of COVID-19, such as fever, cough, shortness of breath, and fatigue, are similar to those of many acute respiratory infections. There is currently no specific treatment for COVID-19, but antiviral therapy combined with supportive care is the main strategy. Here, we summarize recent progress in understanding the epidemiological, virological, and clinical characteristics of COVID-19 and discuss potential targets with existing drugs for the treatment of this emerging zoonotic disease.


Powerless in the ICU: Perspectives from ICUs in the Face of COVID-19


How the COVID-19 pandemic illustrated the importance of emergency medicine, and its vital role as a pillar of the healthcare system


Ethics of controlled human infection to address COVID-19


docid: yxrblxyw

title: Sex-specific clinical characteristics and prognosis of coronavirus disease-19 infection in Wuhan, China: A retrospective study of 168 severe patients

text: To confirm the relationship between sex and the progression of Coronavirus Disease-19 (COVID-19), and its potential mechanism, among severe patients. For this retrospective study, we included 168 consecutive severe patients with pathogen-confirmed COVID-19 who were hospitalized between January 16th and February 4th, 2020, at Tongji Hospital in Wuhan, China. Clinical characteristics, laboratory parameters, and outcomes were compared and analyzed between males and females. In the present study, we analyzed 168 severe patients with COVID-19, including 86 males and 82 females, and 48 patients (28.6%) were diagnosed as critically ill. Of 86 male patients, 12.8% (11/86) died and 75.6% (65/86) were discharged; of 82 female patients, 7.3% (6/82) died and 86.6% (71/82) were discharged. Eleven laboratory parameters showed significant differences between male and female patients, and six of them were higher during the whole clinical course in patients who died than in patients who were discharged. In adjusted logistic regression analysis, males with comorbidities presented a higher risk of being critically ill than males without comorbidities (OR = 3.824, 95% CI = 1.279-11.435). However, this association attenuated to null in female patients (OR = 2.992, 95% CI = 0.937-9.558). A similar sex-specific trend was observed in the relation between age and critically ill conditions. We highlighted sex-specific differences in clinical characteristics and prognosis. Male patients appeared to be more susceptible to age and comorbidities. Sex is an important biological variable that should be considered in the prevention and treatment of COVID-19.