title: Willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 epidemic: A cross-sectional study

text: AIMS: To investigate the willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 and to explore the associated factors. DESIGN: A cross-sectional survey. METHODS: Clinical nurses were conveniently recruited by an online link in three provinces out of Hubei, including Hunan (Central south), Chongqing (Southwest) and Xinjiang (Northwest) during 4-10 February 2020. A structured questionnaire was distributed by an online investigation system. Information on sociodemographic characteristics, willingness, possible influencing factors (previous experience, health status, training conditions, perceptions on volunteering to practice in Hubei, family attitude, and insurance) was collected. Binary logistic regression was conducted to explore the association of different factors with the willingness decision of nurses. RESULTS: A total of 11,183 nurses participated in this survey and a high proportion of them were willing to volunteer to practice in Hubei combating the epidemic. Nurses who were likely to volunteer had the following characteristics: younger, unmarried, members of the Communist Party of China, with senior professional qualification, working in critical care departments, with support from their families, with adequate training and learning, with good health status and low levels of anxiety. The regression model could explain 31.1% of the variances of the willingness decision of nurses. CONCLUSIONS: A high proportion of nurses in China were willing to practice in Hubei during the coronavirus disease 2019 epidemic. Adequate training and psychological support would facilitate nurses to volunteer during the outbreak of an infectious disease. IMPACT: The study identified a high proportion of nurses in China were willing to practice in Hubei combating the coronavirus disease 2019 epidemic. The findings will provide valuable references for nurses and decision makers to formulate better plans for increasing nursing workforce during such kind of public health crisis.


Back to the basics: Diluted bleach for COVID-19


On the responsible use of digital data to tackle the COVID-19 pandemic


What we learn in time of pestilence


title: Reflections of a COVID-19 Graduate Nurse Student

text: In the midst of pandemic and chaos, the world did not cease. Although shelter-in-place was mandated, advance practice nursing students did not waiver. The Class of 2021 advance practice nurses will enter preventive and tertiary care with patience and resiliency. While healthcare facilities were limiting non-essential staff and visitors, the Class of 2021 did not stop. While working as full-time nurses and preparing our families for the worse care scenarios, we did not deter from our goals. Rather we found new goals through reflection and will be better prepared to face the unknown.


title: Unexpected air pollution with marked emission reductions during the COVID-19 outbreak in China

text: The absence of motor vehicle traffic and suspended manufacturing during the COVID-19 pandemic in China produced a unique experiment to assess the efficiency of air pollution mitigation. Up to 90% reduction of certain emissions during the city-lockdown period can be identified from satellite and ground-based observations. Unexpectedly, extreme particulate matter levels simultaneously occurred in northern China. Our synergistic observation analyses and model simulations show that anomalously high humidity promoted aerosol heterogeneous chemistry, along with stagnant airflow and uninterrupted emissions from power plants and petrochemical facilities, contributing to severe haze formation. Also, because of non-linear production chemistry and titration of ozone in winter, reduced nitrogen oxides resulted in ozone enhancement in urban areas, further increasing the atmospheric oxidizing capacity and facilitating secondary aerosol formation.


title: Pharmaco-invasive Therapy for STEMI in a Patient with COVID-19: A Case Report

text: Coronavirus disease 2019 (COVID-19) is a pandemic that started in the Wuhan province of China in December 2019 It is associated with increased morbidity and mortality mainly due to severe acute respiratory syndrome 2 (SARS-Cov-2) Cardiac manifestations related to COVID-19 include demand ischemia, fulminant myocarditis, myocardial infarction and arrhythmias In this report, we present a case of ST-segment elevation myocardial infarction (STEMI) in a 68-year-old man with COVID-19 who initially presented with chest pain and shortness of breath Patient's STEMI was managed with pharmaco-invasive strategy with tissue plasminogen activator (t-PA) He then developed acute hypoxic respiratory failure that was managed in the intensive care unit (ICU), together with multi-organ failure from which the patient died 2 days after presentation Although the pathophysiologic mechanisms of STEMI in COVID-19 patients has not been clearly established, we hypothesize that interrelated pathogenetic factors, that we highlight in this report, can play a role in the development of STEMI, including plaque rupture secondary to systemic inflammation, increased pro-coagulants, endothelial dysfunction, impaired fibrinolysis and impaired oxygen utilization leading to demand/supply mismatch and myocardial ischemia


title: Virtual Screening of Natural Products against Type II Transmembrane Serine Protease (TMPRSS2), the Priming Agent of Coronavirus 2 (SARS-CoV-2)

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused about 2 million infections and is responsible for more than 100,000 deaths worldwide. To date, there is no specific drug registered to combat the disease it causes, named coronavirus disease 2019 (COVID-19). In the current study, we used an in silico approach to screen natural compounds to find potent inhibitors of the host enzyme transmembrane protease serine 2 (TMPRSS2). This enzyme facilitates viral particle entry into host cells, and its inhibition blocks virus fusion with angiotensin-converting enzyme 2 (ACE2). This, in turn, restricts SARS-CoV-2 pathogenesis. A three-dimensional structure of TMPRSS2 was built using SWISS-MODEL and validated by RAMPAGE. The natural compounds library Natural Product Activity and Species Source (NPASS), containing 30,927 compounds, was screened against the target protein. Two techniques were used in the Molecular Operating Environment (MOE) for this purpose, i.e., a ligand-based pharmacophore approach and a molecular docking-based screening. In total, 2140 compounds with pharmacophoric features were retained using the first approach. Using the second approach, 85 compounds with molecular docking comparable to or greater than that of the standard inhibitor (camostat mesylate) were identified. The top 12 compounds with the most favorable structural features were studied for physicochemical and ADMET (absorption, distribution, metabolism, excretion, toxicity) properties. The low-molecular-weight compound NPC306344 showed significant interaction with the active site residues of TMPRSS2, with a binding energy score of -14.69. Further in vitro and in vivo validation is needed to study and develop an anti-COVID-19 drug based on the structures of the most promising compounds identified in this study.


Under the coronavirus disease 2019 (COVID-19) pandemic circumstance, how to administrate cancer patients with fever during radiotherapy


TMPRSS2: Potential Biomarker for COVID-19 Outcomes


Eye health in older people at the time of corona


title: The new coronavirus that came from the East: analysis of the initial epidemic in Mexico

text: INTRODUCTION: As of March 23, 2020, suspension of non-essential activities was declared in Mexico throughout the country in order to mitigate the spread of the COVID-19 pandemic. OBJECTIVE: To analyze data on the first 1,510 laboratory-confirmed cases of COVID-19 in Mexico, and to describe the geographical distribution of the disease and its transmission dynamics. METHOD: Description of the first COVID-19 cases with real-time RT-PCR-positive test, as well as evaluation of epidemiological measures, cumulative incidence, rate of transmission, and mortality and lethality rates during the first month of the epidemic. RESULTS: Average age was 43 years, and 58 % were males; 44 % of initial cases were imported. Lethality in the population during the first month went from 1.08 to 3.97 per 100 cases; however, the trend is linear and similar to that observed in Europe. CONCLUSIONS: In Mexico, social distancing is being applied, but studies are still required on the dynamics of the epidemic, person-to-person transmission, incidence of subclinical infections, and patient survival.


title: SARS-CoV-2 causing pneumonia-associated respiratory disorder (COVID-19): diagnostic and proposed therapeutic options

text: SARS-CoV-2 is responsible for the outbreak of severe respiratory illness (COVID-19) in Wuhan City, China and is now spreading rapidly throughout the world. The prompt outbreak of COVID-19 and its quick spread without any controllable measure defines the severity of the situation. In this crisis, a collective pool of knowledge about the advancement of clinical diagnostic and management for COVID-19 is a prerequisite. Here, we summarize all the available updates on the multidisciplinary approaches for the advancement of diagnosis and proposed therapeutic strategies for COVID-19. Moreover, the review discusses different aspects of the COVID-19, including its epidemiology; incubation period; the general clinical features of patients; the clinical features of intensive care unit (ICU) patients; SARS-CoV-2 infection in the presence of co-morbid diseases and the clinical features of pediatric patients infected with the SARS-CoV-2. Advances in various diagnostic approaches, such as the use of real-time polymerase chain reaction (RT-PCR), chest radiography, and computed tomography (CT) imaging; and other modern diagnostic methods, for this infection have been highlighted. However, due to the unavailability of adequate evidence, presently there are no officially approved drugs or vaccines available against SARS-CoV-2. Additionally, we have discussed various therapeutic strategies for COVID-19 under different categories, like the possible treatment plans with drug (antiviral drugs and anti-cytokines) therapy for disease prevention. Lastly, potentials candidates for the vaccines against SARS-CoV-2 infection have been described. Collectively, the review provides an overview of the SARS-CoV-2 infection outbreak along with the recent advancements and strategies for diagnosis and therapy of COVID-19.


title: COVID-19 growth prediction using multivariate long short term memory

text: Coronavirus disease (COVID-19) spread forecasting is an important task to track the growth of the pandemic. Existing predictions are merely based on qualitative analyses and mathematical modeling. The use of available big data with machine learning is still limited in COVID-19 growth prediction even though the availability of data is abundance. To make use of big data in the prediction using deep learning, we use long short-term memory (LSTM) method to learn the correlation of COVID-19 growth over time. The structure of an LSTM layer is searched heuristically until the best validation score is achieved. First, we trained training data containing confirmed cases from around the globe. We achieved favorable performance compared with that of the recurrent neural network (RNN) method with a comparable low validation error. The evaluation is conducted based on graph visualization and root mean squared error (RMSE). We found that it is not easy to achieve the same quantity of confirmed cases over time. However, LSTM provide a similar pattern between the actual cases and prediction. In the future, our proposed prediction can be used for anticipating forthcoming pandemics. The code is provided here: https://github.com/cbasemaster/lstmcorona


Pandemic researchers - recruit your own best critics


title: [Radiological manifestation of COVID-19]

text: In this case report, a 70-year-old male was admitted to the hospital with respiratory tract symptoms and a fever, and he was isolated, suspected of COVID-19. A chest radiograph showed bilateral consolidations, and subsequent chest CT scan revealed bilateral and peripheral ground glass opacities, which are the most common radiological manifestations of COVID-19. The characteristic radiological findings can be exploited in the diagnosis of COVID-19, and radiologists should have knowledge of the usual manifestations of COVID-19, as they may play a role in early detection and diagnosis of the disease.


title: Validation of a self-administered olfactory and gustatory test for the remotely evaluation of COVID-19 patients in home quarantine

text: BACKGROUND: Chemosensitive disorders are very frequent in the early stages of COVID-19 and in paucisymptomatic cases. These patients are typically placed in home quarantine. This study has the aim of validating a new olfactory and gustatory objective evaluation test in these patients. METHODS: Thirty-three home-quarantined COVID-19 patients have undergone a self-administered chemosensitive test the day before the control swab. On this occasion, the patients underwent operator-administered already validated tests. The results were finally compared. RESULTS: The differences between the results of the two tests were not significant for both the olfaction (P =.201) and the taste (P =.180). CONCLUSION: The olfactory and gustatory evaluation by self-administered test can be considered a valid tool, fundamental for obtaining objective qualitative and quantitative data on the extent of chemosensitive disorders in home-quarantined COVID-19 patients.


title: Does coronavirus affect the audio-vestibular system? A rapid systematic review

text: Objective: This rapid systematic review investigated audio-vestibular symptoms associated with coronavirus.Design: The protocol for the rapid review was registered in the International Prospective Register of Systematic Reviews and the review methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the National Institute of Heath quality assessment tools.Study sample: After rejecting more than 2300 records, there were five case reports and two cross-sectional studies that met the inclusion criteria.Results: No records of audio-vestibular symptoms were reported with the earlier types of coronavirus (i.e. severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome [MERS]). Reports of hearing loss, tinnitus, and vertigo have rarely been reported in individuals who tested positive for the SARS-CoV-2.Conclusion: Reports of audio-vestibular symptoms in confirmed COVID-19 cases are few, with mostly minor symptoms, and the studies are of poor quality. Emphasis over time is likely to shift from life-threatening concerns to longer-term health-related consequences such as audio-vestibular dysfunction. High-quality studies are needed to investigate the acute effects of COVID-19, as well as for understanding long-term risks, on the audio-vestibular system. Review registration: Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020184932).


Transference of COVID-19 patient in hospitals - A crucial phase


title: Summary of consensus documents: prevention and control of the 2019 novel conoravirus infection in newborn infants */ 重庆医学

text: Since the end of 2019, an outbreak of pneumonia caused by a novel coronavirus named 2019 novel coronavirus (2019-nCoV) has occurred in in China. The dramatically rapid spread and strong infectivity of this virus has attracted global attention. Neonates are thought to be susceptible to the virus, because their immune system is not well developed. Neonates have been reported to be affected by this virus. The Chinese Medical Association, Chinese Medical Doctor Association, Pediatric Professional Committee of the Chinese People's Liberation Army have put forward strategies for the effective prevention and control of the 2019-nCoV infection in neonates. This expert review summarized the key points of the above three prevention and control consensus and programs.


title: Invasive pulmonary aspergillosis complicating COVID-19 in the ICU - A case report

text: It is not yet known, if critically ill COVID-19 patients are prone to fungal infections. We report a 69-year-old patient without typical risk factors for invasive pulmonary aspergillosis (IPA), who developed IPA two weeks after onset of symptoms. Our report shows that IPA may occur in critically ill COVID-19 patients.


title: Umbilical cord blood therapy to prevent progression of COVID-19 related pneumonia: a structured summary of a study protocol for a pilot randomised controlled trial

text: OBJECTIVES: Objective: To undertake a pilot, feasibility RCT of umbilical cord blood derived cell therapy for treatment of adult patients infected with SARS-CoV-2 virus related moderate-to-severe pneumonia to prevent progression to severe ARDS. HYPOTHESIS: Expanded cord blood derived cell therapy will be feasible, well tolerated and show potential efficacy in the treatment of acute COVID-19 related moderate to severe pneumonia in adult patients because of their powerful anti-inflammatory and immunomodulatory properties. TRIAL DESIGN: Pilot, parallel design randomised controlled trial. PARTICIPANTS: The trial will recruit 24 hospitalised patients with confirmed SARS-CoV-2 infection and pneumonia from July to December 2020 at Monash Medical Centre in Melbourne, Australia. INTERVENTION AND COMPARATOR: Intervention: Intravenous injection of expanded umbilical cord blood cells at a dose of 5 million cells/kg (maximum dose - 500 million cells). Cell infusion will occur over 30-60 minutes through a peripheral intravenous cannula. Standard supportive care will continue as needed. Comparator: Standard supportive care. MAIN OUTCOMES: Safety and tolerability of cell administration within first 24 hours of administration; clinical improvement on a seven-category clinical improvement ordinal scale. RANDOMISATION: Randomisation will be done using computer generated allocation to intervention/ control groups in a 1:1 ratio (in blocks of 6) using sealed opaque envelopes. BLINDING (MASKING): This will be an unblinded study, given that it is the first study using expanded cord blood cells in COVID-19 patients. There will be no placebo infusion. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Twelve participants in each group. Total n=24. TRIAL STATUS: CBC-19 protocol v2, dated 23rd April 2020. Recruitment has not started yet. Estimated recruitment timeline is between 1st July - 31st December 2020. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12620000478910, registered 16th April 2020. 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: Telehealth Availability in US Hospitals in the Face of the COVID-19 Pandemic

text: BACKGROUND: Telehealth is likely to play a crucial role in treating COVID-19 patients. However, not all US hospitals possess telehealth capabilities. This brief report was designed to explore US hospitals' readiness with respect to telehealth availability. We hope to gain deeper insight into the factors affecting possession of these valuable capabilities, and how this varies between rural and urban areas. METHODS: Based on 2017 data from the American Hospital Association survey, Area Health Resource Files and Medicare cost reports, we used logistic regression models to identify predictors of telehealth and eICU capabilities in US hospitals. RESULTS: We found that larger hospitals (OR(telehealth) = 1.013; P < .01) and system members (OR(telehealth) = 1.55; P < .01) (OR(eICU) = 1.65; P < .01) had higher odds of possessing telehealth and eICU capabilities. We also found evidence suggesting that telehealth and eICU capabilities are concentrated in particular regions; the West North Central region was the most likely to possess capabilities, given that these hospitals had higher odds of possessing telehealth (OR = 1.49; P < .10) and eICU capabilities (OR = 2.15; P < .05). Rural hospitals had higher odds of possessing telehealth capabilities as compared to their urban counterparts, although this relationship was marginally significant (OR = 1.34, P < .10). CONCLUSIONS: US hospitals vary in their preparation to use telehealth to aid in the COVID-19 battle, among other issues. Hospitals' odds of possessing the capability to provide such services vary largely by region; overall, rural hospitals have more widespread telehealth capabilities than urban hospitals. There is still great potential to expand these capabilities further, especially in areas that have been hard hit by COVID-19.


Recognizing and supporting morally injured ICU professionals during the COVID-19 pandemic


title: Response to letter concerning our Pregnancy manuscript

text: We agree that timely delivery is the first line of defense; however, as we pointed out, all patients had been delivered prior to enrollment in our study. Post-partum hepatology consultation is multifactorial: the emergent nature of the deliveries, life-threatening status of the patients, and the assumption of improvement leads to postponing Hepatology consultation until it is apparent that liver failure does not resolve.


In reply to COVID-19 intubation kits and intubation spots


title: Systemic endothelial dysfunction: a common pathway for COVID-19, cardiovascular and metabolic diseases

text: Some of the mechanisms and conditions underlying endothelial dysfunction.A-human skin capillaries, visualized with high-resolution intravital color microscopy in the finger of a patient with obesity, metabolic syndrome and coronary artery disease.B- healthy control. The reduced number of capillaries can be noticed in A compared to B.Image 1.


title: Clinical analysis of risk factors for severe COVID-19 patients with type 2 diabetes

text: AIMS: To describe characteristics of COVID-19 patients with type 2 diabetes and to analyze risk factors for severity. METHODS: Demographics, comorbidities, symptoms, laboratory findings, treatments and outcomes of COVID-19 patients with diabetes were collected and analyzed. RESULTS: Seventy-fourCOVID-19 patients with diabetes were included. Twenty-seven patients (36.5%) were severe and 10 patients (13.5%) died. Higher levels of blood glucose, serum amyloid A (SAA), C reactive protein and interleukin 6 were associated with severe patients compared to non-severe ones (P<0.05). Levels of albumin, cholesterol, high density lipoprotein, small and dense low density lipoprotein and CD4+T lymphocyte counts in severe patients were lower than those in non-severe patients (P<0.05). Logistic regression analysis identified decreased CD4+T lymphocyte counts (odds ratio [OR]=0.988, 95%Confidence interval [95%CI] 0.979-0.997) and increased SAA levels (OR=1.029, 95%CI 1.002-1.058) as risk factors for severity of COVID-19 with diabetes (P<0.05). CONCLUSIONS: Type 2 diabetic patients were more susceptible to COVID-19 than overall population, which might be associated with hyperglycemia and dyslipidemia. Aggressive treatment should be suggested, especially when these patients had low CD4+T lymphocyte counts and high SAA levels.


title: A Real-World Evidence Framework for Optimizing Dosing in All Patients with COVID-19

text: Potential treatments for coronavirus disease 2019 (COVID-19) are being investigated at unprecedented speed, and successful treatments will rapidly be used in tens or hundreds of thousands of patients. To ensure safe and effective use in all those patents it is essential also to develop, at unprecedented speed, a means to provide frequently updated, optimal dosing information for all patient subgroups. Success will require immediate collaboration between drug developers, academics, and regulators.


COVID-19 and Dialysis Units: What Do We Know Now and What Should We Do?


title: [Clinical efficacy of Matrine and Sodium Chloride Injection in treatment of 40 cases of COVID-19]

text: In this paper, we analyzed medical records of 40 patients with coronavirus disease 2019(COVID-19), in order to explore the clinical efficacy of Matrine and Sodium Chloride Injection in the treatment of COVID-19. The investigation was based on the results of a previous animal test, which was aimed to investigate and confirme the clinical efficacy of Matrine and Sodium Chloride Injection in the treatment of COVID-19. The animal test demonstrated that Matrine and Sodium Chloride Injection has a significant therapeutic effect on the human coronavirus pneumonia for the model mice. The lung inhibition index reached up to 86.86%. The evaluation was conducted on 40 confirmed cases of COVID-19 treated at Jingzhou Hospital of Infectious Disease(Chest Hospital) of Hubei Pro-vince from January 30~(th) to March 21~(th), 2020. In these cases, patients were treated with other integrated Chinese and Western medicines regimens in the recommended Matrine and Sodium Chloride Injection diagnosis and treatment regimen. The clinical manifestations, laboratory data, nucleic acid clearance time, and imaging data were compared and analyzed before and after treatment. After administration with Matrine and Sodium Chloride Injection, the clinical symptoms of 40 cases were alleviated markedly, and their blood analysis and biochemical indexes returned to normal. The lung CT showed more than 50% of lesion absorption rate, and the viral nucleic acid test showed the average clearance time of patients was 16.6 days, and the average length of hospital stay was 25.9 days. After administration with Matrine and Sodium Chloride Injection, the symptoms of cough and fatigue were alleviated significantly, and the appetite was significantly improved compared with before, especially for patients with gastrointestinal symptoms. Additionally, laboratory indicators, especially absolute value and ratio of lymphocytes and CRP were significantly alleviated. According to the chest CT for short-term review, the absorption of lung lesions was faster than before, especially for grid-like and fibrotic lesions. Compared with antiviral drugs, such as Abidol and Kriging, the nucleic acid clearance time was significantly shorter than the cases treated with Matrine and Sodium Chloride Injection. The clinical effective rate of 40 cases was 100.0%. We believed that Matrine and Sodium Chloride Injection have a good clinical effect in the treatment of COVID-19, and suggested increasing the clinical application and further conducting large-sample-size cli-nical verification.


title: The Biology of Lactoferrin, an Iron-Binding Protein That Can Help Defend Against Viruses and Bacteria

text: Lactoferrin is a nutrient classically found in mammalian milk. It binds iron and is transferred via a variety of receptors into and between cells, serum, bile, and cerebrospinal fluid. It has important immunological properties, and is both antibacterial and antiviral. In particular, there is evidence that it can bind to at least some of the receptors used by coronaviruses and thereby block their entry. Of importance are Heparan Sulfate Proteoglycans (HSPGs) and the host receptor angiotensin-converting enzyme 2 (ACE2), as based on other activities lactoferrin might prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from attaching to the host cells. Lactoferrin (and more specifically enteric-coated LF because of increased bioavailability) may consequently be of preventive and therapeutic value during the present COVID-19 pandemic.


Electrotherapy and electrophysiology procedures during the coronavirus disease 2019 pandemic: an opinion of the Heart Rhythm Section of the Polish Cardiac Society (with an update)


title: 2019_nCoV/SARS-CoV-2: rapid classification of betacoronaviruses and identification of Traditional Chinese Medicine as potential origin of zoonotic coronaviruses

text: The current outbreak of a novel severe acute respiratory syndrome-like coronavirus, 2019_nCoV (now named SARS-CoV-2), illustrated difficulties in identifying a novel coronavirus and its natural host, as the coding sequences of various Betacoronavirus species can be highly diverse. By means of whole-genome sequence comparisons, we demonstrate that the noncoding flanks of the viral genome can be used to correctly separate the recognized four betacoronavirus subspecies. The conservation would be sufficient to define target sequences that could, in theory, classify novel virus species into their subspecies. Only 253 upstream noncoding sequences of Sarbecovirus are sufficient to identify genetic similarities between species of this subgenus. Furthermore, it was investigated which bat species have commercial value in China, and would thus likely be handled for trading purposes. A number of coronavirus genomes have been published that were obtained from such bat species. These bats are used in Traditional Chinese Medicine, and their handling poses a potential risk to cause zoonotic coronavirus epidemics. SIGNIFICANCE AND IMPACT OF THE STUDY: The noncoding upstream and downstream flanks of coronavirus genomes allow for rapid classification of novel Betacoronavirus species and correct identification of genetic relationships. Although bats are the likely natural host of 2019_nCoV, the exact bat species that serves as the natural host of the virus remains as yet unknown. Chinese bat species with commercial value were identified as natural reservoirs of coronaviruses and are used in Traditional Chinese Medicine. Since their trading provides a potential risk for spreading zoonoses, a change in these practices is highly recommended.


Severe Covid-19 disease: rather AVDS than ARDS?


SARS-CoV-2 und COVID-19: Viele offene Fragen./ [The new corona virus: many unanswered questions]


title: Pulmonary and systemic involvement of COVID-19 assessed by ultrasound-guided minimally invasive autopsy

text: AIMS: Brazil ranks high in the number of COVID-19 cases and COVID-19's mortality rate. In this context, autopsies are important to confirm the disease, determine associated conditions, and study the pathophysiology of this novel disease. In order to follow biosafety recommendations, we used Ultrasound-Guided Minimally Invasive Autopsy (MIA-US) to assess the systemic involvement of COVID-19 and present the results of ten initial autopsies. METHODS AND RESULTS: We used MIA-US for tissue sampling of lungs, liver, heart, kidneys, spleen, brain, skin, skeletal muscle and testis for histology and RT-PCR to detect SARS-COV-2-RNA. All patients presented exudative/proliferative Diffuse Alveolar Damage. There were intense pleomorphic cytopathic effects on the respiratory epithelium, including airway and alveolar cells. Fibrinous thrombi in alveolar arterioles were present in eight patients and all patients presented a high density of alveolar megakaryocytes. Small thrombi were less frequently observed in glomeruli, spleen, heart, dermis, testis, and liver sinusoids. The main systemic findings were associated with comorbidities, age, and sepsis, in addition to possible tissue damage due to the viral infection such as myositis, dermatitis, myocarditis and orchitis. CONCLUSIONS: MIA-US is safe and effective for the study of severe COVID-19. Our findings show that COVID-19 is a systemic disease with major events in the lungs and involvement of various organs and tissues. Pulmonary changes are the result of severe epithelial injury and microthrombotic vascular phenomena. These findings indicate that both epithelial and vascular injury should be addressed in therapeutic approaches.


title: Modelling the evolution trajectory of COVID-19 in Wuhan, China: experience and suggestions

text: OBJECTIVES: In December 2019, a novel coronavirus disease (COVID-19) emerged in Wuhan city, China, which has subsequently led to a global pandemic. At the time of writing, COVID-19 in Wuhan appears to be in the final phase and under control. However, many other countries, especially the US, Italy and Spain, are still in the early phases and dealing with increasing cases every day. Therefore, this article aims to summarise and share the experience of controlling the spread of COVID-19 in Wuhan and provide effective suggestions to enable other countries to save lives. STUDY DESIGN: Data from the National Health Commission of China are used to investigate the evolution trajectory of COVID-19 in Wuhan and discuss the impacts of the intervention strategies. METHODS: A four-stage modified Susceptible-Exposed-Infectious-Removed (SEIR) model is presented. This model considers many influencing factors, including chunyun (the Spring festival), sealing off the city and constructing the Fangcang shelter hospitals. In addition, a novel method is proposed to address the abnormal data on 12-13 February as a result of changing diagnostic criteria. Four different scenarios are considered to capture different intervention measures in practice. The exposed population in Wuhan who moved out before sealing off the city have also been identified, and an analysis on where they had gone was performed using the Baidu Migration Index. RESULTS: The results demonstrate that the four-stage model was effective in forecasting the peak, size and duration of COVID-19. We found that the combined intervention measures are the only effective way to control the spread and not a single one of them can be omitted. We estimate that England will be another epicentre owing to its incorrect response at the initial stages of COVID-19. Fortunately, big data technology can help provide early warnings to new areas of the pandemic. CONCLUSIONS: The four-stage SEIR model was effective in capturing the evolution trajectory of COVID-19. Based on the model analysis, several effective suggestions are proposed to prevent and control the pandemic for countries that are still in the initial phases.


title: Complexo teníase/cisticercose: uma revisão

text: As verminoses são doenças frequentes causadas por diferentes tipos de vermes. A teníase e a cisticercose são duas entidades mórbidas distintas, causadas, respectivamente, pelas Tenia e sua forma larvária Cysticercus cellulosae. O complexo teníase/cisticercose é causado pela mesma espécie de cestódio, em fases diferentes do seu ciclo de vida. Estas verminoses podem contaminar o homem por meio de alimentos contaminados. O controle dessas doenças tem como estratégia fundamental a interrupção do ciclo de vida do parasito, por meio de controle higienicossanitário. Neste trabalho realizou-se um levantamento bibliográfico, buscando ressaltar as principais características destas verminoses, sua epidemiologia, forma de diagnóstico e controle realizado pela indústria de alimentos para segurança dos consumidores.(AU)


SARS-CoV-2 positivity in a discharged COVID-19 patient: a case report


Oral cavity lesions as a manifestation of the novel virus (COVID-19)


title: I May Not Have Symptoms, but COVID-19 Is a Huge Headache

text: The COVID-19 pandemic was an unprecedented surprise, to say the least. Academia is rooted in group assemblies - from classroom to conferences - which were promptly cancelled and/or shifted to remote efforts. Here are some perspectives from Professors involved.


title: Rapidly increasing cumulative incidence of coronavirus disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020

text: The cumulative incidence of coronavirus disease (COVID-19) cases is showing similar trends in European Union/European Economic Area countries and the United Kingdom confirming that, while at a different stage depending on the country, the COVID-19 pandemic is progressing rapidly in all countries. Based on the experience from Italy, countries, hospitals and intensive care units should increase their preparedness for a surge of patients with COVID-19 who will require healthcare, and in particular intensive care.


Letter to the Editor: Risk of Hospital-Acquired Coronavirus Disease 2019 (COVID-19) Infection During Admission for Semiurgent Neurosurgical Procedures


title: Data Analysis of Infection Rates Among Exposed Healthcare Workers Could Reveal Effective Prophylactics Against SARS-CoV-2

text: The global crisis provoked by the SARS-CoV-2 pandemic, and the economic and social consequences associated to the essential policies applied to contain it, necessitates the expedited development of therapeutic solutions. It is a priority to produce data both rapidly and accurately in order to identify current therapies that can be repurposed to offer protection from SARS-CoV-2 infection. As healthcare workers are both at high risk for infection and able to be readily diagnosed, they offer a potential wealth of data to be analyzed. A systematic data analysis of exposure and infection rates among healthcare workers could yield patterns identifying common protective factors, such as medications with prophylactic potential against SARS-CoV-2, that can be fast-tracked into available therapies. With results suggesting their activity against other coronaviruses and their widespread adoption, Antiretroviral cocktails could be a promising initial target for such large-scale data analysis approach.


title: Rapid Scaling Up of Telehealth Treatment for Tobacco-Dependent Cancer Patients During the COVID-19 Outbreak in New York City

text: Background: The (COVID-19) pandemic resulted in sudden disruption of routine clinical care necessitating rapid transformation to maintain clinical care while safely reducing virus contagion. Introduction: Memorial Sloan Kettering (MSK) experienced a rapid evolution from delivery of in-person cessation counseling services to virtual telehealth treatments for our tobacco-dependent cancer patients. Aim: To examine the effect of rapid scaling of tobacco treatment telehealth on patient engagement, as measured by attendance rates for in-person counseling visits versus remote telehealth counseling visits. We also describe the patient, clinician, and health care system challenges encountered in rapid expansion of individual and group tobacco telehealth services. Methods: Data collected from the electronic medical record during the first 4 months of the COVID-19 pandemic were examined for tobacco treatment counseling. Results: From January 1, 2020 to March 30, 2020, markedly improved patient engagement was observed in ambulatory tobacco treatment services with greater attendance at scheduled telehealth visits than in-person visits, 75% versus 60.3%, odds ratio 1.84 (confidence interval: 1.26-2.71; p < 0.001). In addition, bedside hospital counseling visits were transformed into inpatient telephone visits with high levels of sustained patient engagement. Lastly, group telehealth services were launched rapidly to increase capacity and provide greater psychosocial support for cancer patients struggling with tobacco dependence. Discussion: Clinical, Information Technology (IT), and hospital system barriers were successfully addressed for most cancer patients seeking individual telehealth treatment. Group telehealth services were found to be feasible and acceptable. Conclusions: MSK's rapid leap into virtual care delivery mitigated disruption of tobacco treatment services and demonstrated strong feasibility and acceptance for managing complex tobacco-dependent patients.


title: Estimating and Projecting Air Passenger Traffic during the COVID-19 Coronavirus Outbreak and its Socio-Economic Impact

text: The main focus of this study is to collect and prepare data on air passengers traffic worldwide with the scope of analyze the impact of travel ban on the aviation sector. Based on historical data from January 2010 till October 2019, a forecasting model is implemented in order to set a reference baseline. Making use of airplane movements extracted from online flight tracking platforms and on-line booking systems, this study presents also a first assessment of recent changes in flight activity around the world as a result of the COVID-19 pandemic. To study the effects of air travel ban on aviation and in turn its socio-economic, several scenarios are constructed based on past pandemic crisis and the observed flight volumes. It turns out that, according to this hypothetical scenarios, in the first Quarter of 2020 the impact of aviation losses could have negatively reduced World GDP by 0.02% to 0.12% according to the observed data and, in the worst case scenarios, at the end of 2020 the loss could be as high as 1.41-1.67% and job losses may reach the value of 25-30 millions. Focusing on EU27, the GDP loss may amount to 1.66-1.98% by the end of 2020 and the number of job losses from 4.2 to 5 millions in the worst case scenarios. Some countries will be more affected than others in the short run and most European airlines companies will suffer from the travel ban.


text: Due to the coronavirus global crisis, most countries have put in place restrictive measures in order to confine the pandemia and contain the number of casualties. Among the restrictive measures, air traffic suspension is certainly quite effective in reducing the mobility on the global scale in the short term but it also has high socio-economic impact on the long and short term. The main focus of this study is to collect and prepare data on air passengers traffic worldwide with the scope of analyze the impact of travel ban on the aviation sector. Based on historical data from January 2010 till October 2019, a forecasting model is implemented in order to set a reference baseline. Making use of airplane movements extracted from online flight tracking platforms and on-line booking systems, this study presents also a first assessment of recent changes in flight activity around the world as a result of the COVID-19 pandemic. To study the effects of air travel ban on aviation and in turn its socio-economic, several scenarios are constructed based on past pandemic crisis and the observed flight volumes. It turns out that, according to these hypothetical scenarios, in the first Quarter of 2020 the impact of aviation losses could have negatively reduced World GDP by 0.02% to 0.12% according to the observed data and, in the worst case scenarios, at the end of 2020 the loss could be as high as 1.41-1.67% and job losses may reach the value of 25-30 millions. Focusing on EU27, the GDP loss may amount to 1.66-1.98% by the end of 2020 and the number of job losses from 4.2 to 5 millions in the worst case scenarios. Some countries will be more affected than others in the short run and most European airlines companies will suffer from the travel ban. We hope that that these preliminary results may be of help for informed policy making design of exit strategies from this global crisis.


title: Systematic review of the efficacy and safety of antiretroviral drugs against SARS, MERS or COVID-19: initial assessment

text: INTRODUCTION: Several antiretroviral drugs are being considered for the treatment of COVID-19, the disease caused by a newly identified coronavirus, (SARS-CoV-2). We systematically reviewed the clinical outcomes of using antiretroviral drugs for the prevention and treatment of coronaviruses and planned clinical trials. METHODS: Three databases were screened from inception to 30 March 2020 for studies reporting clinical outcomes of patients with SARS, MERS or COVID-19 treated with antiretrovirals. RESULTS: From an initial screen of 433 titles, two randomized trials and 24 observational studies provided clinical outcome data on the use of antiretroviral drugs; most studies reported outcomes using LPV/r as treatment. Of the 21 observational studies reporting treatment outcomes, there were three studies among patients with SARS, six studies among patients with MERS and 12 studies among patients with COVID-19. In one randomized trial 99 patients with severe COVID-19 illness were randomized to receive LPV/r (400/100 mg twice a day) and 100 patients to standard of care for 14 days: LPV/r was not associated with a statistically significant difference in time to clinical improvement, although LPV/r given within 12 days of symptoms was associated with shorter time to clinical improvement; 28 day mortality was numerically lower in the LPV/r group (14/99) compared to the control group (25/100), but this difference was not statistically significant. The second trial found no benefit. The certainty of the evidence for the randomized trials was low. In the observational studies 3 out of 361 patients who received LPV/r died; the certainty of evidence was very low. Three studies reported a possible protective effect of LPV/r as post-exposure prophylaxis. Again, the certainty of the evidence was very low due to uncertainty due to limited sample size. CONCLUSIONS: On the basis of the available evidence it is uncertain whether LPV/r and other antiretrovirals improve clinical outcomes or prevent infection among patients at high risk of acquiring COVID-19.


COVID 19: Impact of lock-down on mental health and tips to overcome


title: Saúde do idoso em tempos de pandemia Covid-19

text: Objetivo: trata-se de comunicação livre com intenção de abordar de forma reflexiva e crítica aspectos relacionados à saúde do idoso nos tempos de pandemia COVID-19 Desenvolvimento: os idosos são destaque na pandemia COVID-19, especialmente aqueles com doenças crônicas e, com isso, ascendem-se preocupações com a diversidade do envelhecimento e com o idoso Logo, as ações adotadas devem se fundamentar nos pilares da gerontologia, com manutenção da autonomia e independência;evitando ageísmo;com ajuste das ações de distanciamento social, impedindo a síndrome geriátrica de isolamento social Não se verificou ênfase diferenciada para os idosos nos Protocolos de Manejo Clínico do Coronavírus, sendo essencial inclusão deste público nas diretrizes do Ministério da Saúde Considerações finais: urge a necessidade do Cuidado Gerontológico de Enfermagem robusto, qualificado e seguro, mediante fundamental capacitação profissional, sendo necessário ressignificar as ações de atenção ao idoso, respeitando a pluralidade, com foco no momento pandêmico e vislumbrando cenários futuros


Novel Coronavirus Infection in Febrile Infants Aged 60 Days and Younger


title: Efficacy and safety of Lianhuaqingwen capsules, a repurposed Chinese herb, in patients with coronavirus disease 2019: A multicenter, prospective, randomized controlled trial

text: BACKGROUND: Coronavirus disease 2019 (Covid-19) has resulted in a global outbreak. Few existing targeted medications are available. Lianhuaqingwen (LH) capsule, a repurposed marketed Chinese herb product, has been proven effective for influenza. PURPOSE: To determine the safety and efficacy of LH capsule in patients with Covid-19. METHODS: We did a prospective multicenter open-label randomized controlled trial on LH capsule in confirmed cases with Covid-19. Patients were randomized to receive usual treatment alone or in combination with LH capsules (4 capsules, thrice daily) for 14 days. The primary endpoint was the rate of symptom (fever, fatigue, coughing) recovery. RESULTS: We included 284 patients (142 each in treatment and control group) in the full-analysis set. The recovery rate was significantly higher in treatment group as compared with control group (91.5% vs. 82.4%, p = 0.022). The median time to symptom recovery was markedly shorter in treatment group (median: 7 vs. 10 days, p < 0.001). Time to recovery of fever (2 vs. 3 days), fatigue (3 vs. 6 days) and coughing (7 vs. 10 days) was also significantly shorter in treatment group (all p < 0.001). The rate of improvement in chest computed tomographic manifestations (83.8% vs. 64.1%, p < 0.001) and clinical cure (78.9% vs. 66.2%, p = 0.017) was also higher in treatment group. However, both groups did not differ in the rate of conversion to severe cases or viral assay findings (both p > 0.05). No serious adverse events were reported. CONCLUSION: In light of the safety and effectiveness profiles, LH capsules could be considered to ameliorate clinical symptoms of Covid-19.


title: Is Guillain-Barrè syndrome triggered by SARS-CoV-2? Case report and literature review

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the infectious agent responsible for coronavirus disease 2019 (COVID-19). Respiratory and gastrointestinal manifestations of SARS-CoV-2 are well described, less defined is the clinical neurological spectrum of COVID-19. We reported a case of COVID-19 patient with acute monophasic Guillain-Barré syndrome (GBS), and a literature review on the SARS-CoV-2 and GBS etiological correlation. CASE DESCRIPTION: A 68 years-old man presented to the emergency department with symptoms of acute progressive symmetric ascending flaccid tetraparesis. Oropharyngeal swab for SARS-CoV-2 tested positive. Neurological examination showed bifacial nerve palsy and distal muscular weakness of lower limbs. The cerebrospinal fluid assessment showed an albuminocytologic dissociation. Electrophysiological studies showed delayed distal latencies and absent F waves in early course. A diagnosis of Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) subtype of GBS was then made. CONCLUSIONS: Neurological manifestations of COVID-19 are still under study. The case we described of GBS in COVID-19 patient adds to those already reported in the literature, in support of SARS-CoV-2 triggers GBS. COVID-19 associated neurological clinic should probably be seen not as a corollary of classic respiratory and gastrointestinal symptoms, but as SARS-CoV-2-related standalone clinical entities. To date, it is essential for all Specialists, clinicians and surgeons, to direct attention towards the study of this virus, to better clarify the spectrum of its neurological manifestations.


docid: vzsmjjwo

title: Covid-19 - A Reminder to Reason


Pediatric radiology and the COVID-19 pandemic


Faut-il une surveillance ophtalmologique en cas de traitement de courte durée par hydroxychloroquine en cette période d'épidémie au COVID-19 ?/ [Is there a need for ophthalmological surveillance in the case of short-term hydroxychloroquine treatment during this COVID-19 pandemic?]


Are individuals with cardiovascular disease at risk of COVID-19-related mental health problems or individuals with cardiovascular disease at risk of cardiovascular disease-related mental health problems during COVID-19? A psychological-psychiatric perspective


title: A valuable and affordable handheld ultrasound in combating COVID-19

text: The handheld ultrasound demonstrates clinical and economic value in combating COVID-19 based on interviews with frontline ultrasound physician and cardiologist as well as a national expert in medical ultrasound.


title: Social Welfare in Search Games with Asymmetric Information

text: We consider games in which players search for a hidden prize, and they have asymmetric information about the prize location. We study the social payoff in equilibria of these games. We present sufficient conditions for the existence of an equilibrium that yields the first-best payoff (i.e., the highest social payoff under any strategy profile), and we characterize the first-best payoff. The results have interesting implications for innovation contests and R&D races.


Covid-19: Japan's success despite inept bureaucracy and incompetence


COVID-19: Japan's success despite inept bureaucracy and incompetence


title: Cardiovascular disease and COVID-19

text: BACKGROUND AND AIMS: Many patients with coronavirus disease 2019 (COVID-19) have underlying cardiovascular (CV) disease or develop acute cardiac injury during the course of the illness. Adequate understanding of the interplay between COVID-19 and CV disease is required for optimum management of these patients. METHODS: A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic. RESULTS: Respiratory illness is the dominant clinical manifestation of COVID-19; CV involvement occurs much less commonly. Acute cardiac injury, defined as significant elevation of cardiac troponins, is the most commonly reported cardiac abnormality in COVID-19. It occurs in approximately 8-12% of all patients. Direct myocardial injury due to viral involvement of cardiomyocytes and the effect of systemic inflammation appear to be the most common mechanisms responsible for cardiac injury. The information about other CV manifestations in COVID-19 is very limited at present. Nonetheless, it has been consistently shown that the presence of pre-existing CV disease and/or development of acute cardiac injury are associated with significantly worse outcome in these patients. CONCLUSIONS: Most of the current reports on COVID-19 have only briefly described CV manifestations in these patients. Given the enormous burden posed by this illness and the significant adverse prognostic impact of cardiac involvement, further research is required to understand the incidence, mechanisms, clinical presentation and outcomes of various CV manifestations in COVID-19 patients.


title: Coronavirus (COVID-19) in Haiti: A Call for Action

text: Recently, the cholera outbreak in Haiti demonstrated just how unprepared the country is to rapidly isolate an outbreak of this magnitude, and its vulnerability to the COVID-19 pandemic. This communication briefly examines the health system in Haiti and its vulnerability toward the COVID-19 outbreak.


title: Cadaveric Simulation of Otologic Procedures: An Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic

text: OBJECTIVE: The otolaryngology community has significant concerns regarding the spread of SARS-CoV-2 through droplet contamination and viral aerosolization during head and neck examinations and procedures. The objective of this study was to investigate the droplet and splatter contamination from common otologic procedures. STUDY DESIGN: Cadaver simulation series. SETTING: Dedicated surgical laboratory. METHODS: Two cadaver heads were prepped via bilateral middle cranial fossa approaches to the tegmen (n = 4). Fluorescein was instilled through a 4-mm burr hole drilled into the middle cranial fossa floor, and presence in the middle ear was confirmed via microscopic ear examination. Myringotomy with ventilation tube placement and mastoidectomy were performed, and the distribution and distance of resulting droplet splatter patterns were systematically evaluated. RESULTS: There were no fluorescein droplets or splatter contamination observed in the measured surgical field in any direction after myringotomy and insertion of ventilation tube. Gross contamination from the surgical site to 6 ft was noted after complete mastoidectomy, though, when performed in standard fashion. CONCLUSION: Our results show that there is no droplet generation during myringotomy with ventilation tube placement in an operating room setting. Mastoidectomy, however, showed gross contamination 3 to 6 ft away in all directions measured. Additionally, there was significantly more droplet and splatter generation to the left of the surgeon when measured at 1 and 3 ft as compared with all other measured directions.


title: Selective CD8 cell reduction by SARS-CoV-2 is associated with a worse prognosis and systemic inflammation in COVID-19 patients

text: The lymphopenia exhibited in patients with COVID-19 has been associated with a worse prognosis in the development of the disease. To understand the factors associated with a worse evolution of COVID-19, we analyzed comorbidities, indicators of inflammation such as CRP and the ratio of neutrophils/lymphocytes, as well as the count of blood cells with T-lymphocyte subtypes in 172 hospitalized patients with COVID-19 pneumonia. Patients were grouped according to their needs for mechanical ventilation (ICU care) or not. Within the comorbidities studied, obesity was the only associated with greater severity and ICU admission. Both the percentage and the absolute number of neutrophils were higher in patients needing ICU care than non-ICU patients, whereas absolute lymphocyte count, and especially the percentage of lymphocytes, presented a deep decline in critical patients. There was no difference between the two groups of patients for CD4 T-lymphocytes, neither in percentage of lymphocyte nor in absolute number, however for CD8 T-cells the differences were significant for both parameters which were in decline in ICU patients. There was a firm correlation between the highest values of inflammation indicators with the decrease in percentage of CD8 T-lymphocytes. This effect was not seen with CD4 cells. Obesity together with lymphopenia, especially whether preferentially affects to CD8 T- lymphocytes, are factors that can predict a poor prognosis in patients with COVID-19.


title: COVID-19 lockdown induces structural changes in mobility networks -- Implication for mitigating disease dynamics

text: In the wake of the COVID-19 pandemic many countries implemented containment measures to reduce disease transmission. Studies using digital data sources show that the mobility of individuals was effectively reduced in multiple countries. However, it remains unclear whether these reductions caused deeper structural changes in mobility networks, and how such changes may affect dynamic processes on the network. Here we use movement data of mobile phone users to show that mobility in Germany has not only been reduced considerably: Lockdown measures caused substantial and lasting structural changes in the mobility network. We find that long-distance travel was reduced disproportionately strongly. The trimming of long-range network connectivity leads to a more local, clustered network and a moderation of the"small-world"effect. We demonstrate that these structural changes have a considerable effect on epidemic spreading processes by"flattening"the epidemic curve and delaying the spread to geographically distant regions.


title: Why communities must be at the centre of the Coronavirus disease 2019 response: Lessons from Ebola and human immunodeficiency virus in Africa

text: As the Coronavirus disease 2019 (COVID-19) pandemic has spread globally, with no effective treatment or vaccine yet available, governments in many countries have put in place social interventions to control the outbreak. The various lockdown measures may have devastating impacts on economies and livelihoods. This approach risks undermining public trust in government responses and therefore undermines efforts to promote behaviour change, which is key to the success of social interventions. Important lessons can be drawn from past Ebola outbreaks and the human immunodeficiency virus pandemic on how communities should be central to COVID-19 responses. Communities are complex and only their members can inform public health experts about their lived realities, the community's understanding of the outbreak and what will work locally to reduce transmission. The public should be encouraged to take positive actions to ensure their own health and well-being, rather than made to feel powerless. Communities should be supported to develop their own response plans, community leaders should be recognised as vital assets, community representatives should have equal inclusion in strategic meetings and greater empathy should be built into decision-making processes.


title: Inferring super-spreading from transmission clusters of COVID-19 in Hong Kong, Japan and Singapore

text: Super-spreading events in an outbreak can change the nature of an epidemic. Therefore, it is useful for public health teams to determine if an ongoing outbreak has any contribution from such events, which may be amenable to interventions. We estimated the basic reproductive number (R0) and the dispersion factor (k) from empirical data on clusters of epidemiologically-linked COVID-19 cases in Hong Kong, Japan and Singapore. This allowed us to infer the presence or absence of super-spreading events during the early phase of these outbreaks. The relatively large values of k implied that large cluster sizes, compatible with super-spreading, were unlikely.


COVID-19: A Call for Action, Collaboration, Reason, and Unity


Heart failure management during the COVID-19 outbreak in Italy: a telemedicine experience from a heart failure university tertiary referral centre


title: Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED's Experience During the COVID-19 Pandemic

text: OBJECTIVE: Prolonged and unaddressed hypoxia can lead to poor patient outcomes. Proning has become a standard treatment in the management of patients with ARDS who have difficulty achieving adequate oxygen saturation. The purpose of this study was to describe the use of early proning of awake, non-intubated patients in the emergency department (ED) during the COVID-19 pandemic. METHODS: This pilot study was carried out in a single urban ED in New York City. We included patients suspected of having COVID-19 with hypoxia on arrival. A standard pulse oximeter was used to measure SpO2 . SpO2 measurements were recorded at triage and after 5 minutes of proning. Supplemental oxygenation methods included non-rebreather mask (NRB) and nasal cannula. We also characterized post-proning failure rates of intubation within the first 24 hours of arrival to the ED. RESULTS: Fifty patients were included. Overall, the median SpO2 at triage was 80% (IQR 69 to 85). After application of supplemental oxygen was given to patients on room air it was 84% (IQR 75 to 90). After 5 minutes of proning was added SpO2 improved to 94% (IQR 90 to 95). Comparison of the pre- to post-median by the Wilcoxon Rank-sum test yielded P = 0.001. Thirteen patients (24%) failed to improve or maintain their oxygen saturations and required endotracheal intubation within 24 hours of arrival to the ED. CONCLUSION: Awake early self-proning in the emergency department demonstrated improved oxygen saturation in our COVID-19 positive patients. Further studies are needed to support causality and determine the effect of proning on disease severity and mortality.


title: Reconstructive surgery protocol recommendations during COVID-19 pandemia./ Recomendaciones de actuacion en cirugia reconstructiva urologica durante la pandemia Covid-19

text: OBJECTIVES: Offer some recommendations or guidelines during the evolution of the COVID-19 pandemic in terms of diagnosis, treatment and follow-upin the field of Reconstructive Urology MATERIAL AND METHOD: The document is based on the evidence on SARS/Cov-2 and the authors' experience in managing COVID-19 in their institutions, including specialists from Andalusia, Madrid, Cantabria,the Valencian Community and Catalonia A web and PubMed search was performed using "SARS-CoV-2", "COVID-19", "COVID-19 Urology", "COVID19 urology complications", "COVID-19 reconstructive surgery" A narrative review of the literature was carried out (5/17/2020) and after the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria and reach a quick consensus Finally, a definitive version was made, agreed by all the authors (5/22/2020) RESULTS: The authors defined the following surgical priorities for Urological Reconstructive Surgery: Emergency/Urgency (life-threatening or emergencies still in anormal situation), Elective Urgency/High priority (potentially dangerous pathology if postponed for more than 1month), Elective Surgery/Intermediate priority (pathology with little probability of being dangerous but it is recommended not to delay more than 6 months), Delayed surgery/Low priority (non-dangerous pathology if it is postponed for more than 6 months) According to this classification, the Working Group agreed on the distribution of the different surgical scenarios of Reconstructive Urology In addition, consensus was reached on recommendations regarding the diagnosis and follow-up of pathology in the field of Reconstructive Urology CONCLUSIONS: Tools should be implemented to facilitate the gathering of the medical visit and diagnostic tests Redistribution of surgical procedures based on priority degrees is necessary during the pandemic and transition period The use of telemedicine is essential forfollow-up, by computer, telephone or videoconference OBJETIVOS: Establecer unas recomendaciones o guia de actuacion durante la evolucion de la pandemia COVID-19 en cuanto al diagnostico, tratamiento y seguimiento en el campo de la Urologia Reconstructiva MATERIAL y METODO: El documento se basa en la evidencia sobre SARS/Cov-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones, incluyendo especialistas de Andalucia, Madrid, Cantabria, Comunidad Valenciana y Cataluna Se realizo una busqueda web y en PubMed utilizando SARS-CoV-2, COVID-19, COVID-19 Urology, COVID19 urology complications, COVID-19 reconstructive surgery Se realizo una revision narrativa dela literatura (17/5/2020) y tras la tecnica de grupo nominal modificada debido a las restricciones extraordinarias, se realizo un primer borrador para unificar criterios y llegar a un rapido consenso Finalmente, se realizo una version definitiva, consensuada por todoslos autores el 22/5/2020 RESULTADOS: Los autores definieron para la Cirugia Urologica Reconstructiva las siguientes prioridades quirurgicas: Emergencia/Urgencia (Riesgo vital o urgencias aun en situacion de normalidad), Urgencia Electiva/Alta prioridad (Patologia potencialmente peligros asi se pospone mas de 1 mes), Cirugia Electiva/Prioridad intermedia (Patologia con poca probabilidad de ser peligrosa pero se recomienda no retrasar mas de 6 meses), Cirugia demorable/Baja prioridad (Patologia no peligrosa si se pospone mas de 6 meses) Acorde a esta clasificacion, el Grupo de Trabajo consensuo la distribucion de los diferentes escenarios quirurgicos de la Urologia Reconstructiva Ademas, se llego a consenso sobre recomendaciones en cuanto al diagnostico y seguimiento de la patologia en el ambito de la Urologia Reconstructiva CONCLUSIONES: Deben implementarse mecanismos que faciliten la agrupacion de la visita medica y pruebas diagnosticas La redistribucion de los procedimientos quirurgicos en funcion de los grados de prioridad es imprescindible durante el periodo de pandemia y de transicion El empleo de la telemedicina es necesario para el segu miento, mediante via informatica, telefonica o videoconferencia


title: [Reconstructive surgery protocol recommendations during COVID-19 pandemia.]

text: OBJECTIVES: Offer some recommendations or guidelines during the evolution of the COVID-19 pandemic in terms of diagnosis, treatment and follow-upin the field of Reconstructive Urology MATERIAL AND METHOD: The document is based on the evidence on SARS/Cov-2 and the authors' experience in managing COVID-19 in their institutions, including specialists from Andalusia, Madrid, Cantabria,the Valencian Community and Catalonia A web and PubMed search was performed using "SARS-CoV-2", "COVID-19", "COVID-19 Urology", "COVID19 urology complications", "COVID-19 reconstructive surgery" A narrative review of the literature was carried out (5/17/2020) and after the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria and reach a quick consensus Finally, a definitive version was made, agreed by all the authors (5/22/2020) RESULTS: The authors defined the following surgical priorities for Urological Reconstructive Surgery: Emergency/Urgency (life-threatening or emergencies still in anormal situation), Elective Urgency/High priority (potentially dangerous pathology if postponed for more than 1month), Elective Surgery/Intermediate priority (pathology with little probability of being dangerous but it is recommended not to delay more than 6 months), Delayed surgery/Low priority (non-dangerous pathology if it is postponed for more than 6 months) According to this classification, the Working Group agreed on the distribution of the different surgical scenarios of Reconstructive Urology In addition, consensus was reached on recommendations regarding the diagnosis and follow-up of pathology in the field of Reconstructive Urology CONCLUSIONS: Tools should be implemented to facilitate the gathering of the medical visit and diagnostic tests Redistribution of surgical procedures based on priority degrees is necessary during the pandemic and transition period The use of telemedicine is essential forfollow-up, by computer, telephone or videoconference


Rising tide: Responding to the mental health impact of the COVID-19 pandemic


Undocumented U.S. Immigrants and Covid-19


CT Manifestations of Two Cases of 2019 Novel Coronavirus (2019-nCoV) Pneumonia


Impact of social distancing on mental health during the COVID-19 pandemic: An urgent discussion


French ICUs fight back: An example of regional ICU organisation to tackle the SARS-CoV-2 outbreak


title: Nash SIR: An Economic-Epidemiological Model of Strategic Behavior During a Viral Epidemic

text: This paper develops a Nash-equilibrium extension of the classic SIR model of infectious-disease epidemiology ("Nash SIR"), endogenizing people's decisions whether to engage in economic activity during a viral epidemic and allowing for complementarity in social-economic activity. An equilibrium epidemic is one in which Nash equilibrium behavior during the epidemic generates the epidemic. There may be multiple equilibrium epidemics, in which case the epidemic trajectory can be shaped through the coordination of expectations, in addition to other sorts of interventions such as stay-at-home orders and accelerated vaccine development. An algorithm is provided to compute all equilibrium epidemics.


From Mitigation to Containment of the COVID-19 Pandemic: Putting the SARS-CoV-2 Genie Back in the Bottle


The Promise and Challenge of Home Health Services During the COVID-19 Pandemic


title: COVID-19 and the Chemical Senses: Supporting Players Take Center Stage

text: The main neurological manifestation of COVID-19 is loss of smell or taste. The high incidence of smell loss without significant rhinorrhea or nasal congestion suggests that SARS-CoV-2 targets the chemical senses through mechanisms distinct from those used by endemic coronaviruses or other common cold-causing agents. Here we review recently developed hypotheses about how SARS-CoV-2 might alter the cells and circuits involved in chemosensory processing and thereby change perception. Given our limited understanding of SARS-CoV-2 pathogenesis, we propose future experiments to elucidate disease mechanisms and highlight the relevance of this ongoing work to understanding how the virus might alter brain function more broadly.


Patient acceptance of using telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak


Covid-19 infection, liver injury and prognosis: a suggestion


Commentary: Lung Donation after Circulatory Death in the United States. Current and Future Challenges


title: Attitudes and Psychological Factors Associated With News Monitoring, Social Distancing, Disinfecting, and Hoarding Behaviors Among US Adolescents During the Coronavirus Disease 2019 Pandemic

text: Importance: As coronavirus disease 2019 (COVID-19) spreads across the world, it is critical to understand the psychological factors associated with pandemic-related behaviors. This perspecitve may be especially important to study among adolescents, who are less likely to experience severe symptoms but contribute to the spread of the virus. Objective: To examine psychological factors associated with adolescents' behaviors during the COVID-19 pandemic. Design, Setting, and Participants: This self-reported survey conducted from March 20 to 22, 2020, recruited a population-based sample of adolescents via social media to complete an anonymous survey. Participants were eligible if they had internet access, lived in the United States, and were aged 13 to 18 years. Main Outcomes and Measures: Outcomes included COVID-19 news monitoring, social distancing, disinfecting, and hoarding behaviors during the 7 days after the United States declared a national emergency. The psychological factors were attitudes about COVID-19 severity, social responsibility values, social trust, and self-interest. The a priori hypotheses were that greater attitudes about the severity of COVID-19, greater social responsibility, and greater social trust would be associated with greater news monitoring, social distancing, and disinfecting, whereas greater self-interest would be associated with more hoarding. Results: The sample included 770 adolescents collected via convenience sampling (mean [SD] age, 16.3 [1.1] years; 575 girls [74.7%]). Many teens reported not engaging in pure social distancing (528 [68.6%]), but they were monitoring the news (688 [89.4%]) and disinfecting daily (676 [87.8%]). Some teens reported hoarding (152 [19.7%]). Attitudes about the greater severity of COVID-19 were associated with more social distancing (ß = 0.18; 95% CI = 0.10 to 0.25), disinfecting (ß = 0.16; 95% CI = 0.08 to 0.23), and news monitoring (ß = 0.26; 95% CI = 0.18 to 0.33) but also more hoarding (ß = 0.08; 95% CI = 0.01 to 0.16). Greater social responsibility was associated with more disinfecting (ß = 0.24; 95% CI = 0.17 to 0.32) and news monitoring (ß = 0.14; 95% CI = 0.07 to 0.22) and less hoarding (ß = -0.07; 95% CI = -0.14 to -0.01). Greater self-interest values were associated with less social distancing (ß = -0.08; 95% CI = -0.15 to -0.01) and more hoarding (ß = 0.08; 95% CI = 0.01 to 0.15). Greater social trust was associated with less hoarding (ß = -0.09; 95% CI, -0.16 to -0.02). Conclusions and Relevance: The results of this survey study suggest that emphasizing the severity of COVID-19 and the social implications of pandemic-related behaviors may be important for teens, particularly for those who are not following preventive health behaviors or who are engaging in hoarding.


Commentary on: The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? A One Health approach to coronaviruses


title: [Validation of surgical masks during COVID19 emergency: activities at the University of Napoli Federico II]/ Validazione di maschere chirurgiche nella fase di emergenza COVID19: lesperienza dellUniversita degli Studi di Napoli Federico II

text: SUMMARY: During COVID-19 pandemic crisis, Italian Government has approved Law Decree no 18 of 17 march 2020, in which art 15 allows enterprises to produce, import and commercialize surgical masks notwithstanding the current rules of product certification It is just required that the interested enterprises send to the Italian National Institute of Health a selfcertification in which they declare the technical characteristics of the masks and that masks are produced according to the safety requirements In this context, a technical-scientific unit was established at the University of Napoli Federico II to provide interested enterprises with state-of-the-art consultancy, testing and measurement services, adhering to rigorous scientific protocols Characterization tests were carried out on 163 surgical masks and/or materials for their construction and they have enabled the identification of pre-screening criteria to simplify the procedure for evaluating surgical masks using methods for assessing the filtration efficiency of particles and aerosols Based on experimental results, it has been observed that a filtration efficiency for particles with sizes larger that 650 nm (PFE>650) exceeding 35% might guarantees a bacterial filtration efficiency (BFE) higher than 95% while BFE values higher than 98% are obtained when the PFE>650 is larger than 40% PFE measurement is extremely simpler with respect to BFE, the latter being time-consuming and requiring specific equipment and methods for its realization Many tested materials have shown the capability to assure high filtration efficiencies but Spundonded-Meltblown-Spunbonded (SMS), that are layers of non-woven fabric with different weights of Meltblown, can simultaneously guarantee high particle filtration efficiencies with pressure drop values (breathability) in the limits to classify the surgical masks as Type II/IIR In fact, the fabric products analyzed so far have not been able to simultaneously guarantee adequate BFE and breathability values On the contrary, Spunbonds of adequate weights can virtually verify both requirements and accredit themselves as possible materials for the production of surgical masks, at least of Type I Further studies are needed to verify the possibility of producing low-cost, reusable surgical masks that could meet the criteria of circular economy A seguito dellepidemia da COVID-19, in Italia lart 15 del decreto-legge 17 marzo 2020 n 18 ha permesso di produrre, importare e immettere in commercio mascherine chirurgiche in deroga alle vigenti disposizioni mediante linvio allIstituto Superiore di Sanita di una autocertificazione da parte dei soggetti interessati nella quale siano attestate le caratteristiche tecniche delle mascherine e sia dichiarato che le stesse rispettano tutti i requisiti di sicurezza In questo ambito, e stato istituito presso lUniversita degli Studi di Napoli Federico II, un presidio tecnico-scientifico per fornire alle aziende interessate servizi di consulenza, prova e misurazione, allo stato dellarte e aderenti a rigorosi protocolli scientifici Nel corso di queste attivita, il presidio tecnico scientifico ha effettuato prove di caratterizzazione su 163 mascherine chirurgiche e/o materiali per la loro costruzione Queste hanno permesso di individuare dei criteri di pre-screening per semplificare la procedura di valutazione delle mascherine chirurgiche utilizzando metodi di valutazione dellefficienza di filtrazione di polveri e di aerosol In particolare, si e osservato che una efficienza di filtrazione polveri con diametro superiore a 650 nm (PFE>650) maggiore del 35% garantisce un livello di efficienza di filtrazione batterica (BFE) superiore al 95% mentre valori della BFE superiori al 98% sono ottenuti quando il valore della PFE>650 e superiore al 40% La misura della PFE e una misura estremamente pio semplice rispetto alla prova di BFE che richiede tempo, specifiche attrezzature e metodi per la sua realizzazione Alcuni materiali provati hanno mostrato la possibilita di garantire elevate efficienze di filtrazi ne ma solo gli Spundonded-Meltblown-Spunbonded (SMS) che sono stratificazioni di tessuto non tessuto a diverse grammature di Meltblown, riescono a garantire contemporaneamente alte efficienze di filtrazione polveri con i valori di perdite di carico (respirabilita) richiesti per classificare una mascherina chirurgica come Tipo II/IIR secondo la normativa vigente Infatti, i prodotti in tessuto fino ad ora analizzati non sono stati in grado di garantire contemporaneamente adeguati valori di BFE e di respirabilita Al contrario, assemblati di Spunbond di adeguata grammatura e spessore potrebbero virtualmente verificare entrambi i requisiti e accreditarsi come possibili materiali per la produzione di maschere chirurgiche di Tipo I Ulteriori studi saranno necessari per verificare la possibilita di ottenere mascherine chirurgiche a basso costo e che possano essere riutilizzate nellottica di una maggiore sostenibilita ambientale e di una maggiore sicurezza degli approvvigionamenti


title: Validazione di maschere chirurgiche nella fase di emergenza COVID19: l'esperienza dell'Università degli Studi di Napoli Federico II./ [Validation of surgical masks during COVID19 emergency: activities at the University of Napoli Federico II]

text: SUMMARY: During COVID-19 pandemic crisis, Italian Government has approved Law Decree no. 18 of 17 march 2020, in which art. 15 allows enterprises to produce, import and commercialize surgical masks notwithstanding the current rules of product certification. It is just required that the interested enterprises send to the Italian National Institute of Health a selfcertification in which they declare the technical characteristics of the masks and that masks are produced according to the safety requirements. In this context, a technical-scientific unit was established at the University of Napoli Federico II to provide interested enterprises with state-of-the-art consultancy, testing and measurement services, adhering to rigorous scientific protocols. Characterization tests were carried out on 163 surgical masks and/or materials for their construction and they have enabled the identification of pre-screening criteria to simplify the procedure for evaluating surgical masks using methods for assessing the filtration efficiency of particles and aerosols. Based on experimental results, it has been observed that a filtration efficiency for particles with sizes larger that 650 nm (PFE>650) exceeding 35% might guarantees a bacterial filtration efficiency (BFE) higher than 95% while BFE values higher than 98% are obtained when the PFE>650 is larger than 40%. PFE measurement is extremely simpler with respect to BFE, the latter being time-consuming and requiring specific equipment and methods for its realization. Many tested materials have shown the capability to assure high filtration efficiencies but Spundonded-Meltblown-Spunbonded (SMS), that are layers of non-woven fabric with different weights of Meltblown, can simultaneously guarantee high particle filtration efficiencies with pressure drop values (breathability) in the limits to classify the surgical masks as Type II/IIR. In fact, the fabric products analyzed so far have not been able to simultaneously guarantee adequate BFE and breathability values. On the contrary, Spunbonds of adequate weights can virtually verify both requirements and accredit themselves as possible materials for the production of surgical masks, at least of Type I. Further studies are needed to verify the possibility of producing low-cost, reusable surgical masks that could meet the criteria of circular economy.


Why inequality could spread COVID-19


title: Practical lessons learned for assessing and treating bipolar disorder via telehealth modalities during the COVID-19 pandemic

text: We briefly frame challenges and steps to overcoming those challenges in delivering care for patients with bipolar disorder via telehealth or telephone during COVID-19. Telehealth provides an invaluable opportunity to provide care for patients even under circumstances of social isolation. The issues discussed in this debate are intended to guide and assist clinicians, both in assessment and intervention, in adjusting to the use of virtual care for patients with bipolar disorder.


docid: vdycpyqx

title: Letter to The Editor: COVID-19: Looking South and East in the World for Guidance


Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19)


title: Ramping Up the Delivery of Cardiac Surgery During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons

text: The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions. This "flattening of the curve" has inevitably prompted discussions around reopening of the economy, relaxing some public health restrictions, and resuming nonurgent health care delivery. This document provides a template for cardiac surgical programs to begin to ramp-up the delivery of cardiac surgery in a deliberate and graded fashion as the COVID-19 pandemic burden begins to ease that is guided by 3 principles. First, all recommendations from public health authorities regarding COVID-19 containment must continue to be followed to minimize disease spread, ensure patient safety, and protect health care personnel. Second, patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. Finally, case volumes should be steadily increased in a mutually agreed upon fashion and must balance the clinical needs of patients awaiting surgery against the overall requirements of the health care system.


COVID-19: Reflections


title: Validation of a digital pathology system including remote review during the COVID-19 pandemic

text: Remote digital pathology allows healthcare systems to maintain pathology operations during public health emergencies. Existing Clinical Laboratory Improvement Amendments regulations require pathologists to electronically verify patient reports from a certified facility. During the 2019 pandemic of COVID-19 disease, caused by the SAR-CoV-2 virus, this requirement potentially exposes pathologists, their colleagues, and household members to the risk of becoming infected. Relaxation of government enforcement of this regulation allows pathologists to review and report pathology specimens from a remote, non-CLIA certified facility. The availability of digital pathology systems can facilitate remote microscopic diagnosis, although formal comprehensive (case-based) validation of remote digital diagnosis has not been reported. All glass slides representing routine clinical signout workload in surgical pathology subspecialties at Memorial Sloan Kettering Cancer Center were scanned on an Aperio GT450 at ×40 equivalent resolution (0.26 µm/pixel). Twelve pathologists from nine surgical pathology subspecialties remotely reviewed and reported complete pathology cases using a digital pathology system from a non-CLIA certified facility through a secure connection. Whole slide images were integrated to and launched within the laboratory information system to a custom vendor-agnostic, whole slide image viewer. Remote signouts utilized consumer-grade computers and monitors (monitor size, 13.3-42 in.; resolution, 1280 × 800-3840 × 2160 pixels) connecting to an institution clinical workstation via secure virtual private network. Pathologists subsequently reviewed all corresponding glass slides using a light microscope within the CLIA-certified department. Intraobserver concordance metrics included reporting elements of top-line diagnosis, margin status, lymphovascular and/or perineural invasion, pathology stage, and ancillary testing. The median whole slide image file size was 1.3 GB; scan time/slide averaged 90 s; and scanned tissue area averaged 612 mm2. Signout sessions included a total of 108 cases, comprised of 254 individual parts and 1196 slides. Major diagnostic equivalency was 100% between digital and glass slide diagnoses; and overall concordance was 98.8% (251/254). This study reports validation of primary diagnostic review and reporting of complete pathology cases from a remote site during a public health emergency. Our experience shows high (100%) intraobserver digital to glass slide major diagnostic concordance when reporting from a remote site. This randomized, prospective study successfully validated remote use of a digital pathology system including operational feasibility supporting remote review and reporting of pathology specimens, and evaluation of remote access performance and usability for remote signout.


title: Transmission Potential of Asymptomatic and Paucisymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections: A 3-Family Cluster Study in China

text: Data concerning the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic and paucisymptomatic patients are lacking. We report a 3-family cluster of infections involving asymptomatic and paucisymptomatic transmission. Eight of 15 (53%) members from 3 families were confirmed with SARS-CoV-2 infection. Of 8 patients, 3 were asymptomatic and 1 was paucisymptomatic. An asymptomatic mother transmitted the virus to her son, and a paucisymptomatic father transmitted the virus to his 3-month-old daughter. SARS-CoV-2 was detected in the environment of 1 household. The complete genomes of SARS-CoV-2 from the patients were > 99.9% identical and were clustered with other SARS-CoV-2 sequences reported from China and other countries.


title: A case of an Infant with SARS-CoV-2 hepatitis early after liver transplantation

text: We present a case of a pediatric liver transplant recipient diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection four days after receiving a living donor liver allograft from her mother. The recipient was a 6-month-old with end-stage liver disease due to biliary atresia and failed Kasai. The infant had an uncomplicated implantation, excellent graft function and down-trending liver enzymes until developing fevers, diarrhea, and moderate respiratory distress requiring non-invasive respiratory support. SARS-CoV-2 testing (nasal swab Polymerase Chain Reaction) was positive on post-operative day (POD) 4. Liver enzymes peaked ~1000 U/L (5-fold higher than the previous day) on POD 6. Histology demonstrated a mixed picture of moderate acute hepatitis and classical elements of mild to moderate acute cellular rejection. Her hepatitis and respiratory symptoms improved coincident with completing treatment with hydroxychloroquine, reduced immunosuppression, and intravenous gamma globulin (IVIG).


title: COVID-19 Pandemic: A Time for Collaboration and A Unified Global Health Front

text: Coronavirus disease 2019 (COVID-19) has, in the span of weeks, immobilized entire countries and mobilized leading institutions worldwide in a race towards treatments and preventions. While several solutions such as telemedicine and online education platforms have been implemented to reduce human contact and further transmission, countries need to favour collectivism both within and beyond their borders. Inspired by experiences of previous outbreaks such as SARS in 2003 and Ebola in 2014-2015, global solidarity is a must in order to prevent further morbidity and mortality. Examples in leadership and collaborations ranging from research funds from the Bill and Melinda Gates Foundation to mask donations by the Jack Ma Foundation should be celebrated as examples to follow. Open communication and transparency will be crucial in monitoring the evolution of the disease in the global effort of flattening the curve. This crisis will challenge the integrity and fuel innovation of health systems worldwide, whilst posing a new quality chasm that warrants increased recognition.


How the coronavirus crisis is affecting your dreams


title: The hemocyte counts as a potential biomarker for predicting disease progression in COVID-19: a retrospective study

text: Objectives In December 2019, there was an outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, and since then, the disease has been increasingly spread throughout the world. Unfortunately, the information about early prediction factors for disease progression is relatively limited. Therefore, there is an urgent need to investigate the risk factors of developing severe disease. The objective of the study was to reveal the risk factors of developing severe disease by comparing the differences in the hemocyte count and dynamic profiles in patients with severe and non-severe COVID-19. Methods In this retrospectively analyzed cohort, 141 confirmed COVID-19 patients were enrolled in Taizhou Public Health Medical Center, Taizhou Hospital, Zhejiang Province, China, from January 17, 2020 to February 26, 2020. Clinical characteristics and hemocyte counts of severe and non-severe COVID patients were collected. The differences in the hemocyte counts and dynamic profiles in patients with severe and non-severe COVID-19 were compared. Multivariate Cox regression analysis was performed to identify potential biomarkers for predicting disease progression. A concordance index (C-index), calibration curve, decision curve and the clinical impact curve were calculated to assess the predictive accuracy. Results The data showed that the white blood cell count, neutrophil count and platelet count were normal on the day of hospital admission in most COVID-19 patients (87.9%, 85.1% and 88.7%, respectively). A total of 82.8% of severe patients had lymphopenia after the onset of symptoms, and as the disease progressed, there was marked lymphopenia. Multivariate Cox analysis showed that the neutrophil count (hazard ratio [HR] = 4.441, 95% CI = 1.954-10.090, p = 0.000), lymphocyte count (HR = 0.255, 95% CI = 0.097-0.669, p = 0.006) and platelet count (HR = 0.244, 95% CI = 0.111-0.537, p = 0.000) were independent risk factors for disease progression. The C-index (0.821 [95% CI, 0.746-0.896]), calibration curve, decision curve and the clinical impact curve showed that the nomogram can be used to predict the disease progression in COVID-19 patients accurately. In addition, the data involving the neutrophil count, lymphocyte count and platelet count (NLP score) have something to do with improving risk stratification and management of COVID-19 patients. Conclusions We designed a clinically predictive tool which is easy to use for assessing the progression risk of COVID-19, and the NLP score could be used to facilitate patient stratification management.


DC/L-SIGNs of hope in the COVID-19 pandemic


title: In vitro diagnostics of coronavirus disease 2019: Technologies and application

text: Laboratory-based diagnostic measures including virological and serological tests are essential for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Real-time reverse transcription-polymerase chain reactions (rRT-PCR) can detect SARS-COV-2 by targeting open reading frame-1 antibodies (ORF1ab), envelope protein, nucleocapsid protein, RNA-dependent RNA polymerase genes, and the N1, N2, and N3 (3N) target genes. Therefore, rRT-PCR remains the primary method of diagnosing SARS-CoV-2 despite being limited by false-negative results, long turnaround, complex protocols, and a need for skilled personnel. Serological diagnosis of coronavirus disease 2019 (COVID-19) is simple and does not require complex techniques and equipment, rendering it suitable for rapid detection and massive screening. However, serological tests cannot confirm SARS-CoV-2, and results will be false-negative when antibody concentrations fall below detection limits. Balancing the increased use of laboratory tests, risk of testing errors, need for tests, burden on healthcare systems, benefits of early diagnosis, and risk of unnecessary exposure is a significant and persistent challenge in diagnosing COVID-19.


title: Bracing for impact with new 4R's in the COVID-19 pandemic - A provincial thoracic radiation oncology consensus

text: As COVID-19 pandemic continues to explode, cancer centers worldwide are trying to adapt and are struggling with this constantly changing scenario. Intending to ensure patient safety and deliver quality care, we sought consensus on the preferred thoracic radiation regimen in a Canadian province with 4 new R's of COVID era.


A matter of time: duration and choice of venous thromboprophylaxis in patients diagnosed with COVID-19


Nutritional management in hospital setting during SARS-CoV-2 pandemic: a real-life experience


title: Longitudinal association between markers of liver injury and mortality in COVID-19 in China

text: Coronavirus disease 2019 (COVID-19) is a new infectious disease. To reveal the hepatic injury related to this disease and its clinical significance, we conducted a multicenter retrospective cohort study that included 5,771 adult patients with COVID-19 pneumonia in Hubei Province. We reported the distributional and temporal patterns of liver injury indicators in these patients and determined their associated factors and death risk. Longitudinal liver function tests were retrospectively analyzed and correlated with the risk factors and death. Liver injury dynamic patterns differed in alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBIL). AST elevated first, followed by ALT, in severe patients. ALP modestly increased during hospitalization and largely remained in the normal range. The fluctuation in TBIL levels was mild in the non-severe and the severe group. AST abnormality was associated with the highest mortality risk compared to other indicators of liver injury during hospitalization. Common factors associated with elevated liver injury indicators were lymphocyte count decrease, neutrophil count increase, and male gender. CONCLUSION: The dynamic patterns of liver injury indicators and their potential risk factors may provide an important explanation for the COVID-19-associated liver injury. Because elevated liver injury indicators, particularly AST, are strongly associated with the mortality risk, our study indicates that these parameters should be monitored during hospitalization.