title: Identification of potent and safe antiviral therapeutic candidates against SARS-CoV-2

text: COVID-19 pandemic has infected millions of people with mortality exceeding 300,000. There is an urgent need to find therapeutic agents that can help clear the virus to prevent the severe disease and death. Identifying effective and safer drugs can provide with more options to treat the COVID-19 infections either alone or in combination. Here we performed a high throughput screen of approximately 1700 US FDA approved compounds to identify novel therapeutic agents that can effectively inhibit replication of coronaviruses including SARS-CoV-2. Our two-step screen first used a human coronavirus strain OC43 to identify compounds with anti-coronaviral activities. The effective compounds were then screened for their effectiveness in inhibiting SARS-CoV-2. These screens have identified 24 anti-SARS-CoV-2 drugs including previously reported compounds such as hydroxychloroquine, amlodipine, arbidol hydrochloride, tilorone 2HCl, dronedarone hydrochloride, and merfloquine hydrochloride. Five of the newly identified drugs had a safety index (cytotoxic/effective concentration) of >600, indicating wide therapeutic window compared to hydroxychloroquine which had safety index of 22 in similar experiments. Mechanistically, five of the effective compounds were found to block SARS-CoV-2 S protein-mediated cell fusion. These FDA approved compounds can provide much needed therapeutic options that we urgently need in the midst of the pandemic.


title: An artificial intelligence-based first-line defence against COVID-19: digitally screening citizens for risks via a chatbot

text: To combat the pandemic of the coronavirus disease (COVID-19), numerous governments have established phone hotlines to prescreen potential cases. These hotlines have struggled with the volume of callers, leading to wait times of hours or, even, an inability to contact health authorities. Symptoma is a symptom-to-disease digital health assistant that can differentiate more than 20,000 diseases with an accuracy of more than 90%. We tested the accuracy of Symptoma to identify COVID-19 using a set of diverse clinical cases combined with case reports of COVID-19. We showed that Symptoma can accurately distinguish COVID-19 in 96.32% of clinical cases. When considering only COVID-19 symptoms and risk factors, Symptoma identified 100% of those infected when presented with only three signs. Lastly, we showed that Symptoma’s accuracy far exceeds that of simple “yes-no” questionnaires widely available online. In summary, Symptoma provides unparalleled accuracy in systematically identifying cases of COVID-19 while also considering over 20,000 other diseases. Furthermore, Symptoma allows free text input, furthered with disease-specific follow up questions, in 36 languages. Combined, these results and accessibility give Symptoma the potential to be a key tool in the global fight against COVID-19. The Symptoma predictor is freely available online at https://www.symptoma.com.


title: The Influence of Time-Limited Immunity on a COVID-19 Epidemic: A Simulation Study

text: A series of spreadsheet simulations using SEIS, SEIR, and SEIRS models showed that different durations of effective immunity could have important consequences for the prevalence of an epidemic disease with COVID-19 characteristics. Immunity that lasted four weeks, twelve weeks, six months, one year, and two years was tested with pathogen R0 values of 1.5, 2.3, and 3.0. Shorter durations of immunity resulted in oscillations in disease prevalence. Immunity that lasted from three months to two years produced recurrent disease outbreaks triggered by the expiration of immunity. If immunity faded out gradually instead of persisting at full effectiveness to the end of the immune period, the recurrent outbreaks became more frequent. The duration of effective immunity is an important consideration in the epidemiology of a disease like COVID-19.


title: Vitamin D status, body mass index, ethnicity and COVID-19: Initial analysis of the first-reported UK Biobank COVID-19 positive cases (n 580) compared with negative controls (n 723)

text: In this short report we present a preliminary assessment of the serum 25-hydroxyvitamin D status (25(OH)D), body mass index (BMI), ethnicity and other lifestyle factors in the first-reported UK Biobank COVID-19 positive cases (n 580) compared with negative controls (n 723). The COVID-19 cases include those who have been treated as a hospital in-patient as well as those who have not, and are from England only. Mean (SD) for age was 57.5 (8.7) in positive cases and 57.9 (8.7) in negative controls.


title: A systematic review of Anakinra, Tocilizumab, Sarilumab and Siltuximab for coronavirus-related infections

text: Background There is accumulating evidence for an overly activated immune response characterised by the release of pro-inflammatory cytokines in severe Covid-19. Suppression of the inflammatory response with immunomodulatory therapies may be a potential therapeutic strategy. We systematically review and assess the effectiveness of specific interleukin-1 and -6 inhibitors for the treatment of coronavirus-related infections. Methods Electronic databases, pre-print servers and clinical trial registries were searched to identify current and ongoing studies of immunomodulatory agents (anakinra, sarilumab, siltuximab and tocilizumab) for the treatment of Covid-19 and other coronavirus related super infections. The co-primary outcome was time to hospital discharge (days) and severity on an ordinal scale measured at day 15. Results Five retrospective studies (tocilizumab, two case series and two case reports; siltuximab, one case series) were shortlisted for inclusion, totalling 59 patients. All studies had a moderate or high risk of bias, with multiple limitations. Insufficient data and inter-study heterogeneity prevented meta-analysis. Primary outcomes were inconsistently reported but suggest many patients experienced an improvement in status seven days following therapy. The case fatality ratio (CFR) of patients with severe Covid-19 included in our review was 6.8%, a figure substantially lower than that estimated in non-interventional case series. Of the studies measuring IL-6, all reported elevated baseline levels. Twenty-five ongoing registered clinical trials exploring immunomodulatory agents in Covid-19 were identified, although inconsistency in participants and endpoints are noted. Conclusion Inhibition of IL-6 with tocilizumab and siltuximab requires further evaluation in managing the assumed hyperinflammatory response associated with severe Covid-19. These early data are considered hypothesis generating and justify the need for well-designed randomised clinical studies.


title: Population vulnerability to COVID-19 in Europe: a burden of disease analysis

text: Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods: Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 for vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results: Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made the highest rates were observed for Bulgaria, Czech Republic, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion: Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.


title: Impact of small-area lockdowns for the control of the COVID-19 pandemic

text: Background Countries confronting the COVID-19 pandemic are implementing different social distancing strategies. We evaluated the impact of small-area lockdowns in Chile, aimed to reduce viral transmission while minimizing the population disrupted. The effectiveness of this intervention on the outbreak control is unknown. Methods A natural experiment assessing the impact of small-area lockdowns between February 15th and April 25th, 2020. We used mobility data and official governmental reports to compare regions with small-area lockdowns versus regions without. The primary outcome was the mean difference in the effective reproductive number (Re) of COVID-19. Secondary outcomes were changes in mobility indicators. We used quasi-experimental methods for the analysis and examined the impact of other concurrent public health interventions to disentangle their effects. Results Small-area lockdown produced a sizable reduction in human mobility, equivalent to an 11.4% reduction (95%CI -14.4% to -8.38%) in public transport and similar effects in other mobility indicators. Ten days after implementation, the small-area lockdown produced a reduction of the effective reproductive number (Re) of 0.86 (95%CI -1.70 to -0.02). School and university closures, implemented earlier, led to a 40% reduction in urban mobility. Closure of educational institutions resulted in an even greater Re reduction compared with small-area lockdowns. Conclusions Small-area lockdowns produced a reduction in mobility and viral transmission, but the effects were smaller than the early closures of schools and universities. Small-area lockdowns may have a relevant supporting role in reducing SARS-CoV-2 transmission and could be useful for countries considering scaling-down stricter social distancing interventions.


docid: cektbcar

title: Physikalischer Schutz vor respiratorischen Viren

text: Durch die Bildung eines Films auf den Zellen der Nasenschleimhaut kann ein Spray dabei helfen, sich vor Erkältungsviren zu schützen Der aus Rotalgen gewonnene Wirkstoff Carragelose bildet eine physikalische Barriere auf der Nasenschleimhaut, in der sich respiratorische Viren - darunter auch humane Coronaviren - verfangen So wird der Kontakt zwischen ihnen und menschlichen Zellen weitestgehend unterbunden und der weitere Infektionsweg deutlich erschwert In klinischen Studien an Patienten mit viral bedingten grippalen Infekten konnte gezeigt werden, dass Carragelose-haltige Sprays zur Anwendung in der Nase (wie algovir Effekt) die Viruslast nach drei bis vier Behandlungstagen um mehr als 90% reduzieren können Getestet wurde die Wirksamkeit des Wirkstoffs unter anderem an verschiedenen Typen humaner Coronaviren - jedoch nicht an dem Coronavirus SARS-CoV-2 Daher können derzeit keine endgültigen Rückschlüsse zur Aktivität und Effektivität des Wirkstoffs gegen 2SARS-CoV-2 gezogen werden Allerdings haben Carragelose-Erkältungssprays ein ausgezeichnetes Sicherheitsprofil, weshalb sie durchaus ergänzend zu den gängigen Maßnahmen zum Schutz vor respiratorischen Viren wie Händedesinfektion und Mundschutz angewendet und den Apothekenkunden empfohlen werden können AU - API, Redaktion


title: The new coronavirus is finally slamming Russia. Is the country ready?

text: For weeks, Russia seemed to have dodged a bullet As coronavirus disease 2019 (COVID-19) raged just across the border in China, Russia was virtually untouched, reporting just seven confirmed infections as recently as 10 March Since then, the number has risen fast: Russia has now reported 840 infections, about two-thirds of them in the Moscow region


title: Laboratory findings that predict a poor prognosis in COVID-19 patients with diabetes: A meta-analysis

text: Diabetes is one of the main comorbidities in patients infected with the SARS-CoV-2 virus, the causative agent of the new coronavirus disease 2019 (COVID-19). Because the presence of diabetes and COVID-19 in the same patient is related to a poor clinical prognosis and a high probability of death, it is necessary to determine what findings allow us to predict a good or bad resolution of the disease in order to opt for a traditional treatment or a more incisive one. In this way, in the present work we analyze which laboratory parameters showed differences in patients with COVID-19 and diabetes who recovered and in those who had complications or died.


title: Cardiopulmonary resuscitation in patients with COVID-19 in the hospital environment/ Reanimación cardiopulmonar en pacientes con enfermedad por COVID-19 en el ambiente hospitalario

text: The COVID-19 pandemic has forced us to rethink the way we practice some aspects of medicine. Cardiopulmonary resuscitation is a practice that generates aerosol particles from the airway, which increases the risk of SARS-CoV-2 infection. In this review, the international recommendations on the subject are consulted, high-risk moments are defined and recommendations are established on compressions, ventilation, electrical therapy and even pharmacology in patients with cardiac arrest and with a diagnosis of COVID-19, seeking not only the well-being of the patient, but also the safety of health personnel.


title: The potential role of IL-6 in monitoring severe case of coronavirus disease 2019

text: Abstract. Background: The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan City, China spreads rapidly since December, 2019. Most patients show mild symptoms, but some of them develop into severe disease. There is currently no specific medication. The purpose of this study is to to explore changes of markers in peripheral blood of severe COVID-19 patients, which may be of value in disease monitoring. Methods Clinical data of patients with nonsevere and severe type COVID-19 diagnosed by laboratory test in our institution were collected. The relationship between peripheral blood cells and cytokines, clinical manifestation and outcome was analyzed. Results A total of 69 severe type COVID-19 patients were included. On admission, the median age of severe cases was 56-year old, with 52.17% female patient. The most common symptoms were fever (79.72%), cough (63.77%), shortness of breath (57.97%) and fatigue (50.72%). Diarrhea is less common. The most common comorbidity is hypertension. Upon admission, the proportion of bilateral pulmonary involvement and interstitial abnormalities evidenced by chest computed tomography (CT) imaging in severe cases was 60.87% and 27.54%, respectively. Compared with patients with nonsevere disease, those with severe disease showed obvious lymphocytopenia. Elevated level of lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin and D-dimer was found in most cases. Two patients (2.9%) needed transfer to the intensive care unit. Baseline immunological parameters and most of the inflammatory parameters were basically within the normal range. However, baseline interleukin-6 (IL-6) was significantly increased in severe type, which was closely related to the maximal body temperature during hospitalization and to CT findings. Baseline IL-6 was also significantly related to the increase of baseline level of CRP, LDH, ferritin and D-dimer. The increase of baseline IL-6 level suggests that it may positively correlate with the severity of COVID-19. Among the 30 severe type patients whose IL-6 was assessed before and after treatment, significant decrease in IL-6 and improved CT assessment was found in 25 patients after treatment. Whereas the IL-6 level was further increased in 3 cases, which was closely related to disease progression. It is suggested that IL-6 may be used as a marker for disease monitoring in severe COVID-19 patients. Conclusions On admission, the baseline level of IL-6, CRP, LDH and ferritin was closely related to the severity of COVID-19, and the elevated IL-6 was significantly related to the clinical manifestation of severe type patients. The decrease of IL-6 was closely related to treatment effectiveness, while the increase of IL-6 indicated disease exacerbation. Collectively, the dynamic change of IL-6 level can be used as a marker for disease monitoring in patients with severe COVID-19.


Should computed tomography (CT) be used as a screening or follow-up tool for asymptomatic patients with SARS-CoV-2 infection?


title: SARS-CoV-2 genetic variations associated with COVID-19 severity

text: Herein, we performed a genome-wide association study on SARS-CoV-2 genomes to identify genetic variations that might be associated with the COVID-19 severity. 152 full-length genomes of SARS-CoV-2 that were generated from original clinical samples and whose patient status could be determined conclusively as either asymptomatic or symptomatic were retrieved from the GISAID database. We found that nucleotide variations at the genomic position 11,083, locating in the coding region of non-structural protein 6, were associated with the COVID-19 severity. While the 11083G variant (i.e. having G at the position 11,083) was more commonly found in symptomatic patients, the 11083T variant appeared to associate more often with asymptomatic infections. We also identified three microRNAs that differentially target the two variants, namely miR-485-3p, miR-539-3p, and miR-3149. This may in part contribute to the differential association of the two SARS-CoV-2 variants with the disease severity.


title: Labs scramble to spot hidden coronavirus infections

text: The seeming precision of the global tallies of cases and deaths caused by the novel coronavirus now spreading from Wuhan, China belies an alarming fact (A study group of the International Committee on Taxonomy of Viruses christened the novel virus severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, the same day) But many news stories have reported shortages of diagnostics in Hubei


title: Prolonged low-dose methylprednisolone in patients with severe COVID-19 pneumonia

text: Background In hospitalized patients with COVID-19 pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for ICU and mortality. Methods We conducted a multicenter, observational study to explore the association between exposure to prolonged, low-dose, MP treatment and need for ICU referral, intubation or death within 28 days (composite primary endpoint) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels. Results Findings are reported as MP (n=83) vs. control (n=90). The composite primary endpoint was met by 19 vs. 40 [adjusted hazard ratio (HR) 0.41; 95% confidence interval (CI): 0.24-0.72]. Transfer to ICU and need for invasive MV was necessary in 15 vs. 27 (p=0.07) and 14 vs. 26 (p=0.10), respectively. By day 28, the MP group had fewer deaths (6 vs. 21, adjusted HR=0.29; 95% CI: 0.12-0.73) and more days off invasive MV (24.0 plus-or-minus sign 9.0 vs. 17.5 plus-or-minus sign 12.8; p=0.001). Study treatment was associated with rapid improvement in PaO2:FiO2 and CRP levels. The complication rate was similar for the two groups (p=0.84). Conclusion In patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Randomized controlled studies are needed to confirm these findings.


title: Analysis on application of Chinese materia medica in treatment of COVID-19 by suppressing cytokine storm/ 中药在抗新型冠状病毒肺炎（COVID-19）引起的细胞因子风暴中的应用分析

text: At the end of December, 2019, a novel coronavirus disease (COVID-19) outbreak was found in China. COVID-19 spreads all over 268 countries, and more than 70 000 people got infected till February 23th, 2020. COVID-19 can result in acute respiratory distress syndrome and multiple organ failure due to its strong infectivity and extensive spread. These severe complications are believed to be the consequence of cytokine storm caused by the virus infection. In the “Diagnosis and treatment of novel coronavirus pneumonia”, glucocorticoid is recommended as the immunosuppressive agents to prevent acute immune reaction in critical patients. However, the usage of glucocorticoid may bring severe residual effects such as superinfection risks, prolonged course of disease. Traditional Chinese medicine might have advantages in the moderation of immune system. Actually, TCM is now applied in the treatment of COVID-19 clinically, and exhibits excellent therapeutic effects. In this review, the potential usage of TCM or traditional prescriptions in inhibiting cytokine storm and treating in acute lung injury were analyzed, which would be an effective strategy for the treatment of COVID-19.


title: Susceptibility-adjusted herd immunity threshold model and potential R0 distribution fitting the observed Covid-19 data in Stockholm

text: The reproduction number, R0, is commonly used, and sometimes misused, in conjunction with the classic Kermack and McKindrick theory based on the assumption of homogeneity, in order to estimate herd immunity threshold (HIT). This provides a crude first estimate of HIT, with more elaborate modelling required to arrive at a more realistic value. Early estimates of HIT for Covid-19 were based on this simplistic homogeneous approach, yielding high HIT values that have since been revised downwards with more sophisticated network modelling taking account of R0 heterogeneity and with reference to the low HIT found from serological sampling in Stockholm County. The aim of this paper is to describe a simple model in which host susceptibility is directly linked to the heterogeneous R0 distribution, to shed further light on the mechanisms involved and to arrive at a bimodal R0 distribution consistent with the Covid-19 HIT observed in Stockholm County.


title: Neighborhood income and physical distancing during the COVID-19 pandemic in the U.S.

text: Introduction: Although physical distancing has been the primary strategy to reduce the spread of COVID-19 in the U.S., people's ability to distance may vary by socioeconomic characteristics, leading to higher transmission risk in low-income neighborhoods. Methods: We used mobility data from a large, anonymized sample of smartphone users to assess the relationship between neighborhood median household income and physical distancing during the COVID-19 epidemic. We assessed changes in several behaviors including: spending the day entirely at home; working outside the home; and visits to supermarkets, parks, hospitals, and other locations. We also assessed differences in effects of state policies on physical distancing across neighborhood income levels. Results: We found a strong gradient between neighborhood income and physical distancing. Compared to January and February 2020, the proportion of individuals spending the day entirely at home in April 2020 increased by 10.9 percentage points in low-income neighborhoods and by 27.1 percentage points in high-income neighborhoods. During April 2020, people in low-income neighborhoods were more likely to work outside the home, compared to people in higher-income neighborhoods, but not more likely to visit non-work locations. State physical distancing orders were associated with a 1.5 percentage-point increase (95% CI [0.9, 2.1], p < 0.001) in staying home in low-income neighborhoods and a 2.4 percentage point increase (95% CI [1.4, 3.4], p < 0.001) in high-income neighborhoods. Discussion: People in lower-income neighborhoods have faced barriers to physical distancing, particularly the need to work outside the home. State physical distancing policies have not mitigated these disparities.


docid: dvpqkmnh

title: The Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Directly Decimates Human Spleens and Lymph Nodes

text: While lymphocytopenia is a common characteristic of patients infected by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the mechanisms responsible for this depletion are unclear. Through careful inspection of the spleens and lymph nodes (LNs) from six cases with postmortem examinations, we observed that SARS-CoV-2 could directly infect secondary lymphoid organs to induce cell death. Immunohistochemistry demonstrated ACE2 (angiotensin-converting enzyme 2), the potential receptor of SARS-CoV-2, expresses on tissue-resident CD169+ macrophages in spleens and LNs. Immunofluorescent staining confirmed that viral nucleocaspid protein (NP) can be found in ACE2+ cells, CD169+ macrophages, but not in CD3+ T cells or B220+ B cells in spleens and LNs. SARS-CoV-2 infection induces severe tissue damage including lymph follicle depletion, splenic nodule atrophy, histiocyte hyperplasia and lymphocyte reductions. Moreover, in situ TUNEL staining illustrated that viral infection leads to severe lymphocyte apoptosis, which might be mediated by viral antigens inducing Fas upregulation. Furthermore, SARS-CoV-2 also triggers macrophages to produce IL-6, a proinflammatory cytokine that directly promotes lymphocyte necrosis. Collectively, these results demonstrate that SARS-CoV-2 directly neutralizes human spleens and LNs through infecting tissue- resident CD169+ macrophages.


title: A prospect on the use of antiviral drugs to control local outbreaks of COVID-19

text: Background: Current outbreaks of COVID-19 are threatening the health care systems of several countries around the world. Control measures, based on isolation and quarantine, have been shown to decrease and delay the burden of the ongoing epidemic. With respect to the ongoing COVID-19 epidemic, recent modelling work shows that this intervention technique may be inadequate to control local outbreaks, even when perfect isolation is assumed. Furthermore, the effect of infectiousness prior to symptom onset combined with a significant proportion of asymptomatic infectees further complicates the use of contact tracing. Antivirals, which decrease the viral load and reduce the infectiousness, could be integrated in the control measures in order to augment the feasibility of controlling the epidemic. Methods: Using a simulation-based model of viral transmission we tested the efficacy of different intervention measures for the control of COVID-19. For individuals that were identified through contact tracing, we evaluate two procedures: monitoring individuals for symptoms onset and testing of individuals. Moreover, we investigate the effect of a potent antiviral compound on the contact tracing process. Findings: The use of an antiviral drug, in combination with contact tracing, quarantine and isolation, results in a significant decrease of the final size, the peak incidence, and increases the probability that the outbreak will fade out. Interpretation: For an infectious disease in which presymptomatic infections are plausible, an intervention measure based on contact tracing performs better when realized together with testing instead of monitoring, provided that the test is able to detect infections during the incubation period. In addition, in all tested scenarios, the model highlights the benefits of the administration of an antiviral drug in addition to quarantine, isolation and contact tracing. The resulting control measure, could be an effective strategy to control local and re-emerging outbreaks of COVID-19.


The Impact of COVID-19 on Cancer Patients: Lessons From China & Italy


title: Comparison of psychological distress and demand induced by COVID-19 during the lockdown period in patients undergoing peritoneal dialysis and hemodialysis: a cross-section study in a tertiary hospital

text: Background: Since the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. To explore the psychological distress and the psychological demand induced by COVID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal (PD) patients during the lockdown period. Methods: Questionnaires were given to the dialysis patients in West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients' trauma-related distress in response to COVID-19. Results: 232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00-19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms. HD patients had a significant higher IES score than PD patients (11.50 vs 8.00) (p<0.05). HD patients already got more psychological support from the medical staff. There was no significant difference on further demand of psychological support between the two groups. In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p<0.05). Conclusions: HD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients.


title: Phase 1/2 Study to Describe the Safety and Immunogenicity of a COVID-19 RNA Vaccine Candidate (BNT162b1) in Adults 18 to 55 Years of Age: Interim Report

text: Abstract In March 2020, the WHO declared a pandemic of coronavirus disease 2019 (COVID-19), due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With >8.8 million cases and >450,000 deaths reported globally, a vaccine is urgently needed. We report the available safety, tolerability, and immunogenicity data from an ongoing placebo-controlled, observer-blinded dose escalation study among healthy adults, 18-55 years of age, randomized to receive 2 doses, separated by 21 days, of 10 g, 30 g, or 100 g of BNT162b1, a lipid nanoparticle-formulated, nucleoside-modified, mRNA vaccine that encodes trimerized SARS-CoV-2 spike glycoprotein RBD. Local reactions and systemic events were dose-dependent, generally mild to moderate, and transient. RBD-binding IgG concentrations and SARS-CoV-2 neutralizing titers in sera increased with dose level and after a second dose. Geometric mean neutralizing titers reached 1.8- to 2.8-fold that of a panel of COVID-19 convalescent human sera. These results support further evaluation of this mRNA vaccine candidate.


title: Tobacco Smoking a Potential Risk Factor in Transmission of COVID-19 Infection

text: Corona Virus disease 2019 (COVID-19) is a global pandemic and is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) group of viruses. To date, April 25, 2020, more than 2.4 million humans are infected and more than a hundred thousand deaths have been reported from more than 200 countries from COVID-19. There is no evidence-based treatment for the infection and prevention of transmission using social distancing, isolation and hygiene measures is widely recommended. Tobacco smoking is rampant in communities around the globe and the addiction to tobacco results in deaths of more than 8 million individuals each year. As COVID-19 transmits through salivary droplets and causes severe lung pneumonia, tobacco smokers are also at high risk of severe COVID-19 infection due to poor lung function, cross-infection and susceptible hygiene habits. Smoking tobacco (cigarette, e-cigarettes or waterpipe) produces exhaled smoke, coughing or sneezing, aerosols containing SARS-CoV-2 in the surroundings and contaminating surfaces. Therefore, smoking tobacco is a possible mode of transmission for the virus for both active and passive smokers. Smoking should be considered a risk factor for the disease transmission until further availability of evidence and measures to limit its direct and indirect effects should be implemented within the community.


title: The impact of the COVID19 pandemic and initial period of lockdown on the mental health and wellbeing of UK adults

text: Mental health and wellbeing impacts of COVID19 were assessed in a convenience sample of 600 UK adults using a cross-sectional design. Recruited over a two-week period during the initial phase of the government lockdown, participants completed an online survey that included COVID19-related questions, the Hospital Anxiety and Depression Scale, the WHO-5 and the OXCAP-MH. Self-isolating prior to lockdown, increased feelings of isolation since the lockdown, and having COVID19-related livelihood concerns, were associated with poorer mental health, wellbeing and quality of life. Perceiving increased kindness, community connectedness, and being an essential worker were associated with better mental health and wellbeing outcomes.


title: Novel Coronavirus in Nigeria: Epidemiological analysis of the first 45 days of the pandemic

text: Background On December 31, 2019, the World Health Organization (WHO) was notified of a novel coronavirus in China that was later named COVID-19. On March 11, 2020, the outbreak of COVID-19 was declared a pandemic. The first instance of the virus in Nigeria was documented on February 27, 2020. Methods This study provides a preliminary epidemiological analysis of the first 45 days of COVID-19 outbreak in Nigeria quantifying. We estimated the early transmissibility via time-varying reproduction number based on Bayesian method that incorporates uncertainty in the distribution of serial interval (time interval between symptoms onset in an infected individual and the infector) and adjusted for disease importation. Findings By April 11, 2020, 318 confirmed cases and 10 deaths from COVID-19 have occurred in Nigeria. At day 45, the exponential growth rate was 0.07 (95% Confidence Interval (CI): 0.05-0.10) with doubling time of 9.84 days (95% CI: 7.28 - 15.18). Separately for travel related and local cases the doubling time was 12.88 days and 2.86 days, respectively. Furthermore, we estimated the reproduction number for each day of the outbreak using three-weekly window while adjusting for travel related cases. The estimated reproduction number was 4.98 (95% CrI: 2.65 -8.41) at day 22 (March 19, 2020), peaking at 5.61 (95% CrI: 3.83 -7.88) at day 25 (March 22, 2020). The median reproduction number over the study period was 2.71 and the latest value at April 11, 2020 was 1.42 (95% CI: 1.26 - 1.58). Interpretation These 45-day estimates suggested that cases of COVID-19 in Nigeria have been remarkably lower than expected and the preparedness to detect needs to be shifted to stop local transmission.


title: Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review

text: The current pandemic of COVID-19 has lead to conflicting opinions on whether wearing facemasks outside of health care facilities protects against the infection. To better understand the value of wearing facemasks we undertook a rapid systematic review of existing scientific evidence about development of respiratory illness, linked to use of facemasks in community settings. METHODS: We included all study designs. There were 31 eligible studies (including 12 RCTs). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention in 28 studies were performed. Results were reported by design, setting and type of face barrier in primary prevention, and by who wore the facemask (index patient or well contacts) in secondary prevention trials. The preferred outcome was influenza-like illness (ILI) but similar outcomes were pooled with ILI when ILI was unavailable. GRADE quality assessment was based on RCTs with support from observational studies. RESULTS: Where specific information was available, most studies reported about use of medical grade (surgical paper masks). In 3 RCTs, wearing a facemask may very slightly reduce the odds of developing ILI/respiratory symptoms, by around 6% (OR 0.94, 95% CI 0.75 to 1.19, I2 29%, low certainty evidence). Greater effectiveness was suggested by observational studies. When both house-mates and an infected household member wore facemasks the odds of further household members becoming ill may be modestly reduced by around 19% (OR 0.81, 95%CI 0.48 to 1.37, I 2 45%, 5 RCTs, low certainty evidence). The protective effect was very small if only the well person(OR 0.93, 95% CI 0.68 to 1.28, I2 11%, 2 RCTs, low uncertainty evidence) or the infected person wore the facemask (very low certainty evidence). DISCUSSION: Based on the RCTs we would conclude that wearing facemasks can be very slightly protective against primary infection from casual community contact, and modestly protective against household infections when both infected and uninfected members wear facemasks. However, the RCTs often suffered from poor compliance and controls using facemasks. Across observational studies the evidence in favour of wearing facemasks was stronger. We expect RCTs to under-estimate the protective effect and observational studies to exaggerate it. The evidence is not sufficiently strong to support widespread use of facemasks as a protective measure against COVID-19. However, there is enough evidence to support the use of facemasks for short periods of time by particularly vulnerable individuals when in transient higher risk situations. Further high quality trials are needed to assess when wearing a facemask in the community is most likely to be protective.


title: Transmission potential of COVID-19 in South Korea

text: Since the first identified individual of 2019 novel coronavirus (COVID-19) infection on Jan 20, 2020 in South Korea, the number of confirmed cases rapidly increased. As of Feb 26, 2020, 1,261 cases of COVID-19 including 12 deaths were confirmed in South Korea. Using the incidence data of COVID-19, we estimate the reproduction number at 1.5 (95% CI: 1.4-1.6), which indicates sustained transmission and support the implementation of social distancing measures to rapidly control the outbreak.


Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro


title: SARS-CoV-2 serological analysis of COVID-19 hospitalized patients, pauci-symptomatic individuals and blood donors.

text: It is of paramount importance to evaluate the prevalence of both asymptomatic and symptomatic cases of SARS-CoV-2 infection and their antibody response profile. Here, we performed a pilot study to assess the levels of anti-SARS-CoV-2 antibodies in samples taken from 491 pre- epidemic individuals, 51 patients from Hopital Bichat (Paris), 209 pauci-symptomatic individuals in the French Oise region and 200 contemporary Oise blood donors. Two in-house ELISA assays, that recognize the full-length nucleoprotein (N) or trimeric Spike (S) ectodomain were implemented. We also developed two novel assays: the S-Flow assay, which is based on the recognition of S at the cell surface by flow-cytometry, and the LIPS assay that recognizes diverse antigens (including S1 or N C- terminal domain) by immunoprecipitation. Overall, the results obtained with the four assays were similar, with differences in sensitivity that can be attributed to the technique and the antigen in use. High antibody titers were associated with neutralisation activity, assessed using infectious SARS-CoV- 2 or lentiviral-S pseudotypes. In hospitalized patients, seroconversion and neutralisation occurred on 5-14 days post symptom onset, confirming previous studies. Seropositivity was detected in 29% of pauci-symptomatic individuals within 15 days post-symptoms and 3 % of blood of healthy donors collected in the area of a cluster of COVID cases. Altogether, our assays allow for a broad evaluation of SARS-CoV2 seroprevalence and antibody profiling in different population subsets.


title: Rapid whole genome sequence typing reveals multiple waves of SARS-CoV-2 spread

text: As the pandemic SARS-CoV-2 virus has spread globally its genome has diversified to an extent that distinct clones can now be recognized, tracked, and traced. Identifying clonal groups allows for assessment of geographic spread, transmission events, and identification of new or emerging strains that may be more virulent or more transmissible. Here we present a rapid, whole genome, allele-based method (GNUVID) for assigning sequence types to sequenced isolates of SARS-CoV-2 sequences. This sequence typing scheme can be updated with new genomic information extremely rapidly, making our technique continually adaptable as databases grow. We show that our method is consistent with phylogeny and recovers waves of expansion and replacement of sequence types/clonal complexes in different geographical locations. GNUVID is available as a command line application (https://github.com/ahmedmagds/GNUVID).


title: COVID-MATCH65 - A prospectively derived clinical decision rule for severe acute respiratory syndrome coronavirus 2

text: Due to the ongoing COVID-19 pandemic and increased pressure on testing resources, understanding the clinical and epidemiological features closely associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is vital at point of care to enable risk stratification. We demonstrate that an internally derived and validated clinical decision rule, COVID-MATCH65, has a high sensitivity (92.6%) and NPV (99.5%) for SARS-CoV-2 and could be used to aid COVID-19 risk-assessment and resource allocation for SARS-CoV-2 diagnostics.


Nowhere left to hide? Privacy has been eroded in Turkey for many years now. People fear that tackling Covid-19 might take away their last private free space


title: Simulation of COVID-19 Incubation Period and the Effect of Probability Distribution Functionon Model Training Using MIMANSA

text: Coronavirus disease 2019 (COVID-19) has infected people all over the world. While scientists are busy finding a vaccine and medicine, it becomes difficult to control the spread and manage patients. Mathematical models help one get a better feel for the challenges in patient management. With this in mind, our team developed a model called Multilevel Integrated Model with a Novel Systems Approach (MIMANSA). MIMANSA is a multi-parametric model. One of the challenges in the design of MIMANSA was to simulate the incubation period of coronavirus. The incubation period decides when virus-infected patients would show symptoms. The probability distribution function (PDF), when applied to the number of virus-infected cases, gives a good representation of the process of the incubation period. The probability distribution functions can take various forms. In this paper, we explore a variety of PDFs and their impact on parameter estimation in the MIMANSA model. For our experiments, we used Weibull, Gaussian, uniform, and Gamma distribution. To ensure a fair comparison of Weibull, Gaussian, and Gamma distribution, we matched the peak value of the distribution. Our results show that the Weibull distribution with shape 7.7 and scale 7 for 14 days gives a better training model and predictions.


title: Prefusion spike protein stabilization through computational mutagenesis

text: A novel severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2) has emerged as a human pathogen, causing global pandemic and resulting in over 400,000 deaths worldwide. The surface spike protein of SARS-CoV-2 mediates the process of coronavirus entry into human cells by binding angiotensin-converting enzyme 2 (ACE2). Due to the critical role in viral-host interaction and the exposure of spike protein, it has been a focus of most vaccines’ developments. However, the structural and biochemical studies of the spike protein are challenging because it is thermodynamically metastable1. Here, we develop a new pipeline that automatically identifies mutants that thermodynamically stabilize the spike protein. Our pipeline integrates bioinformatics analysis of conserved residues, motion dynamics from molecular dynamics simulations, and other structural analysis to identify residues that significantly contribute to the thermodynamic stability of the spike protein. We then utilize our previously developed protein design tool, Eris, to predict thermodynamically stabilizing mutations in proteins. We validate the ability of our pipeline to identify protein stabilization mutants through known prefusion spike protein mutants. We finally utilize the pipeline to identify new prefusion spike protein stabilization mutants.


title: Facing the University Environment with Covid-19 Pandemic: A Comparative Analysis between Romania and South Korea

text: The Covid-19 determined pandemic has affected all branches of socio-economic life, and the educational environment has not been bypassed The students' reaction to the measures of the total transfer of the teaching-learning process in the online environment, by universities closure, is proving to be one of the challenges determined by the current global pandemic manifestation The impact is highlighted by major changes with obvious patterns in the short time period The academic world is witnessing this changing from the position of forced adaptation, both teachers, administrative staff, and students being in the situation of reconsidering the entire system, in organization and functionality The on-line platforms have replaced the classrooms, the communication is made exclusively virtual, and the reactions caused by this form of reconfiguration are felt in multiple ways The present paper approaches the students' reaction to this necessity for adaptation, by comparison between the university environment from Romania and the one from South Korea The results indicate multiple similarities and minor differences between these two countries A main conclusion is that in technically, organizationally and emotionally-affective perspective, the situation is very similar, the differences being present only from a financial point of view and about the intention in student-teacher communication


title: Transmission and clinical characteristics of coronavirus disease 2019 in 104 outside-Wuhan patients, China

text: Background: Cases with coronavirus disease 2019 (COVID-19) emigrated from Wuhan escalated the risk of spreading in other cities. This report focused on the outside-Wuhan patients to assess the transmission and clinical characteristics of this illness. Methods: Contact investigation was conducted on each patient who admitted to the assigned hospitals in Hunan Province (geographically adjacent to Wuhan) from Jan 22, 2020 to Feb 12, 2020. Demographic, clinical, laboratory and radiological characteristics, medication therapy and outcomes were collected and analyzed. Patients were confirmed by PCR test. Results: Of the 104 patients, 48 (46.15%) were imported cases and 56 (53.85%) were indigenous cases; 93 (89.42%) had a definite contact history with infections. Family clusters were the major body of patients. Transmission along the chain of 3 &ldquo:generations” was observed. Mean age was 43 (rang, 8-84) years (including 3 children) and 49 (47.12%) were male. Most patients had typical symptoms, 5 asymptomatic infections were found and 2 of them infected their relatives. The median incubation period was 6 (rang, 1-32) days, of 8 patients ranged from 18 to 32 days. Just 9 of 16 severe patients required ICU care. Until Feb 12, 2020, 40 (38.46%) discharged and 1 (0.96%) died. For the antiviral treatment, 80 (76.92%) patients received traditional Chinese medicine therapy. Conclusions: Family but not community transmission occupied the main body of infections in the two centers. Asymptomatic transmission demonstrated here warned us that it may bring more risk to the spread of COVID-19. The incubation period of 8 patients exceeded 14 days.


title: Optimal strategies for quarantine stopping in France. General expected patterns of strategies focusing on contact between age groups

text: Due to the COVID-19 pandemic, many countries have implemented a complete lock-down of their population that may not be sustainable for long. To identify the best strategy to replace this full lock-down, sophisticated models that rely on mobility data have been developed. In this study, using the example of France as a case-study, we develop a simple model considering contacts between age classes to derive the general impact of partial lock-down strategies targeted at specific age groups. We found that epidemic suppression can only be achieved by targeting isolation of young and middle age groups with high efficiency. All other strategies tested result in a flatter epidemic curve, with outcomes in (e.g. mortality and health system over-capacity) dependent of the age groups targeted and the isolation efficiency. Targeting only the elderly can decrease the expected mortality burden, but in proportions lower than more integrative strategies involving several age groups. While not aiming to provide quantitative forecasts, our study shows the benefits and constraints of different partial lock-down strategies, which could help guide decision-making.


First Person: ‘I Survived COVID-19’


title: Evaluation on the diagnostic efficiency of different methods in detecting COVID-19.

text: Objective: To evaluate the diagnostic efficiency of different methods in detecting COVID-19 to provide preliminary evidence on choosing favourable method for COVID-19 detection. Methods: PubMed, Web of Science and Embase databases were searched for identifing eligible articles. All data were calculated utilizing Meta Disc 1.4, Revman 5.3.2 and Stata 12. The diagnostic efficiency was assessed via these indicators including summary sensitivity and specificity, positive likelihood ratio (PLR), negative LR (NLR), diagnostic odds ratio (DOR), summary receiver operating characteristic curve (sROC) and calculate the AUC. Results: 18 articles (3648 cases) were included. The results showed no significant threshold exist. EPlex: pooled sensitivity was 0.94; specificity was 1.0; PLR was 90.91; NLR was 0.07; DOR was 1409.49; AUC=0.9979, Q*=0.9840. Panther Fusion: pooled sensitivity was 0.99; specificity was 0.98; PLR was 42.46; NLR was 0.02; DOR was 2300.38; AUC=0.9970, Q*=0.9799. Simplexa: pooled sensitivity was 1.0; specificity was 0.97; PLR was 26.67; NLR was 0.01; DOR was 3100.93; AUC=0.9970, Q*=0.9800. Cobas: pooled sensitivity was 0.99; specificity was 0.96; PLR was 37.82; NLR was 0.02; DOR was 3754.05; AUC=0.9973, Q*=0.9810. RT-LAMP: pooled sensitivity was 0.98; specificity was 0.99; PLR was 36.22; NLR was 0.04; DOR was 751.24; AUC=0.9905, Q*=0.9596. Xpert Xpress: pooled sensitivity was 0.99; specificity was 0.97; PLR was 27.44; NLR was 0.01; DOR was 3488.15; AUC=0.9977, Q*=0.9829. Conclusions: These methods (ePlex, Panther Fusion, Simplexa, Cobas, RT-LAMP and Xpert Xpress) bear higher sensitivity and specificity, and might be efficient methods complement to the gold standard.


title: Quantifying interpersonal contact in the United States during the spread of COVID-19: first results from the Berkeley Interpersonal Contact Study

text: By the start of April 2020, the majority of people living in the United States were under orders to dramatically restrict their daily activities in order to reduce transmission of the virus that can cause COVID-19. These strong social distancing measures will be effective in controlling the spread of the virus only if they are able to reduce the amount of close interpersonal contact in a population. It is therefore crucial for researchers and policymakers to empirically measure the extent to which these policies have actually reduced interpersonal interaction. We created the Berkeley Interpersonal Contact Study (BICS) to help achieve this goal. Here, we report the first set of BICS results, based on data collected in the United States between March 22, 2020 and April 8, 2020. We find evidence that rates of interpersonal contact have greatly been reduced at all ages in the United States.


title: Modeling of COVID-19 Pandemic and Scenarios for Containment

text: The impact of COVID-19 pandemic on the global health and world's economy have been profound and unseen since the Spanish flu of 1918-19. As of now, many countries have been severely affected, partly because of slow responses to the crisis, ill-preparedness of their health system, and the fragile health infrastructure and the shortage of protective equipment. This note evaluates various scenarios, based on an estimation of number of identified and unidentified infected cases, and examines the effectiveness of different policy responses to contain this pandemic. Our result, based on an estimation of the model for Iran, show that in many instances the number of unidentified cases, including asymptomatic individuals, could be much bigger than the reported numbers. The results confirm that in such circumstances, social distancing alone cannot be an effective policy unless a large portion of the population confine themselves for an extended period of time, which is not only difficult to implement, but it could also prove extremely costly and damaging to the economy. An alternative policy, this note argues, is to couple effective social distancing with extensive testing, even to those who are asymptomatic, and isolate the identified cases actively. Otherwise, many lives will be lost, and the health system will collapse, adding to the ongoing economic troubles that many countries have started to encounter.


title: An E460D substitution in the NS5 protein of tick-borne encephalitis virus confers resistance to the inhibitor Galidesivir (BCX4430) and also attenuates the virus for mice

text: The adenosine analogue Galidesivir (BCX4430), a broad-spectrum RNA virus inhibitor, has entered a Phase 1 clinical safety and pharmacokinetics study in healthy subjects and is under clinical development for treatment of Ebola virus infection. Moreover, Galidesivir also inhibits the reproduction of tick-borne encephalitis virus (TBEV) and numerous other medically important flaviviruses. Until now, studies of this antiviral agent have not yielded resistant viruses. Here, we demonstrate that an E460D substitution, in the active site of TBEV RNA-dependent-RNA-polymerase (RdRp), confers resistance to Galidesivir in cell culture. Stochastic molecular simulations indicate that the steric freedom caused by the E460D substitution increases close electrostatic interactions between the inhibitor and the interrogation residue of the TBEV RdRp motif F, resulting in rejection of the analogue as an incorrect/modified nucleotide. Galidesivir-resistant TBEV exhibited no cross-resistance to structurally different antiviral nucleoside analogues, such as 7-deaza-2’-C-methyladenosine, 2’-C-methyladenosine and 4’-azido-aracytidine. Although, the E460D substitution led only to a subtle decrease in viral fitness in cell culture, Galidesivir-resistant TBEV was highly attenuated in vivo, with 100% survival rate and no clinical signs observed in infected mice. Our results contribute to understanding the molecular basis of Galidesivir antiviral activity, flavivirus resistance to nucleoside inhibitors and the potential contribution of viral RdRp to flavivirus neurovirulence. Importance Tick-borne encephalitis virus (TBEV) is a pathogen that causes severe human neuroinfections in large areas of Europe and Asia and for which there is currently no specific therapy. We have previously found that Galidesivir (BCX4430), a broad-spectrum RNA virus inhibitor, which is under clinical development for treatment of Ebola virus infection, has a strong antiviral effect against TBEV. For any antiviral drug, it is important to generate drug-resistant mutants to understand how the drug works. Here, we produced TBEV mutants resistant to Galidesivir and found that the resistance is caused by a single amino acid substitution in an active site of the viral RNA-dependent RNA polymerase, an enzyme which is crucial for replication of viral RNA genome. Although, this substitution led only to a subtle decrease in viral fitness in cell culture, Galidesivir-resistant TBEV was highly attenuated in a mouse model. Our results contribute to understanding the molecular basis of Galidesivir antiviral activity.


title: The effect of opening up the US on COVID-19 spread

text: In response to the pandemic development of the novel coronavirus (SARS-CoV-2), governments worldwide have implemented strategies of suppression by non-pharmaceutical interventions (NPIs). Such NPIs include social distancing, school closures, limiting international travel and complete lockdown. Worldwide the NPIs enforced to limit the spread of COVID-19 are now being lifted. Understanding how the risk increases when NPIs are lifted is important for decision making. Treating NPIs equally across countries and regions limits the possibility for modelling differences in epidemic response, as the response to the NPIs influences can vary between regions and this can affect the epidemic outcome, so do the strength and speed of lifting these. Our solution to this is to measure mobility changes from mobile phone data and their impacts on the basic reproductive number. We model the epidemic in all US states to compare the difference in outcome if NPIs are lifted or retained. We show that keeping NPIs just a few weeks longer has a substantial impact on the epidemic outcome.


docid: orfufwdg

title: Epidemiological Transition of Covid-19 in India from Higher to Lower HDI States and Territories: Implications for Prevention and Control

text: Objective: Social determinants of evolving covid-19 pandemic have not been well studied. To determine trends in transition of this epidemic in India we performed a study in states at various levels of human development index (HDI). Methods: We used publicly available data sources to track progress of covid-19 epidemic in India in different states and territories where it was reported in significant numbers. The states (n=20) were classified into tertiles of HDI and weekly trends in cases and deaths plotted from 15 March to 2 May 2020. To assess association of HDI with state-level covid-19 burden we performed Pearson correlation. Logarithmic trends were evaluated for calculation of projections. A microlevel study was performed in select urban agglomerations for identification of socioeconomic status (SES) differentials. Results: There is wide regional variation in covid-19 cases and deaths in India from mid-March to early-May 2020. High absolute numbers have been reported from states of Maharashtra, Gujarat, Delhi, Madhya Pradesh, Rajasthan and Tamilnadu. Growth rate in cases and deaths is slow in high HDI states while it has increased rapidly in middle and lower HDI states. In mid-March 2020 there was a strong positive correlation of state-level HDI with weekly covid-19 cases (r= 0.37, 0.40) as well as deaths (r= 0.31, 0.42). This declined by early-May for cases (r= 0.04, 0.06) as well as deaths (r= -0.005, 0.001) with significant negative logarithmic trend (cases R squared= 0.92; deaths R squared= 0.84). These trends indicate increasing cases and deaths in low HDI states. Projection reveals that this trend is likely to continue to early-June 2020. Microlevel evaluation shows that urban agglomerations are major focus of the disease in India and it has transited from middle SES to low SES locations. Conclusion: There is wide variability in burden of covid-19 in India. Slow growth and flattening of curve is observed in high-HDI states while disease is increasing in mid and lower HDI states. Projections reveal that lower HDI states would achieve parity with high HDI states by early-June 2020. Covid-19 is mostly present in urban agglomerations where it has transited from upper-middle to low SES locations. Public health strategies focusing on urban low SES locations and low HDI states are crucial to decrease covid-19 burden in India.


title: Awareness and indicators of low energy availability in male and female dancers

text: Abstract Objectives To investigate awareness and indicators of low energy availability (LEA) in male and female dancers Methods A dance-specific energy availability questionnaire (DEAQ) was developed and administered online internationally to dancers in full time training. The DEAQ drew on current validated, published questionnaires for LEA, linked to the clinical outcomes of relative energy deficiency in sport (RED-S). Questions addressed recognised physiological indicators and consequences of LEA in the context of dance, together with psychological drivers and aetiological factors specific to dance training. LEA was quantified using a scoring system to include these characteristics. Results 247 responses to the DEAQ were analysed (225 female and 22 male), mean age 20.7 years (SD 7.9) with transition to full time training at 15.0 years (SD 7.9) and 85% practising ballet. Psychological, physiological and physical characteristics consistent with LEA were reported by 57% of the female dancers and 29% of male dancers, indicating a risk of RED-S. The unique nature of dance training, in terms of demands and environment, was found to be potentially influential in development of this situation. Less than a third (29%) of dancers were aware of RED-S. Conclusion This study found dancers to be a specific group of high-level exercisers displaying indicators of LEA and consequently at risk of developing the adverse clinical health and performance consequences of RED-S. Awareness of RED-S was low. The DEAQ has the potential to raise awareness and be a practical, objective screening tool to identify dancers in LEA, at risk of developing RED-S.


Coronavirus Epidemic Outbreak in Europe. Comparison with the Dynamics in Mainland China


title: Examination of a first-in-class bis-dialkylnorspermidine-terphenyl antibiotic in topical formulation against mono and polymicrobial biofilms

text: Biofilm-impaired tissue is a significant factor in chronic wounds such as diabetic foot ulcers. Most, if not all, anti-biotics in clinical use have been optimized against planktonic phenotypes. In this study, an in vitro assessment was performed to determine the potential efficacy of a unique first-in-class series of antibiofilm antibiotics and compare outcomes to current clinical standards of care. The agent, CZ-01179, was formulated into a hydrogel and tested against mature biofilms of a clinical isolate of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa ATCC 27853 using two separate methods. In the first method, biofilms were grown on cellulose discs on an agar surface. Topical agents were spread on gauze and placed over the biofilms for 24 h. Biofilms were quantified and imaged with confocal and scanning electron microscopy. In the second method, biofilms were grown on bioabsorbable collagen coupons in a modified CDC biofilm reactor. Coupons were immersed in treatment for 24 h. The first method was limited in its ability to assess efficacy. Efficacy profiles against biofilms grown on collagen were more definitive, with CZ-01179 gel eradicating well-established biofilms to a greater degree compared to clinical standards. In conclusion, CZ-01179 may be a promising topical agent that targets the biofilm phenotype. Pre-clinical work is currently being performed to determine the translatable potential of CZ-01179 gel.


title: A Comparative Study of Dimensional Tolerancing Capabilities and Microstructure Formation between Binder Jet Additively Manufactured Sand Molds and Olivine Green Sand Molds for Metalcasting of A356.0

text: Abstract The development of additive manufacturing in the 1980s led to a revolution in various metalcasting processes as early as the 1990s, including the use of polymer 3D printing for the manufacture of sand casting patterns. While additive manufacturing has entered many metalcasting processes, including both expendable and permanent mold processes, this paper specifically examines the sand casting process. ExOne’s development of binder jetting technology over the last 20 years has allowed designers in the sand casting field to directly 3D print sand molds for metalcasting. Use of binder jet additively manufactured sand molds allows for quicker turnaround time for testing prototypes, new gating designs, and for producing one-off parts. Additive manufacturing of sand molds for metalcasting may implement any of the same foundry sands as green sand processes, but uses a furan binder instead of the traditional mixture of bentonite clay and water. The use of a chemical binder had led to questions about the resulting dimensional capabilities and mechanical properties of the castings produced by the mold. This study investigated the dimensional tolerancing capabilities, surface finish, mechanical properties, microstructure, and defects present in identical castings made from both a traditional olivine green sand molding process and a binder jet additively manufactured silica sand molding process. It was concluded that binder jet additively manufactured sand molds are capable of either equal or better dimensional accuracy and tolerance capabilities than traditional olivine green sand molds. The olivine green sand parts had an average of approximately 1 μm better surface finish than the binder jet sand molds; however, it is likely that both the addition of sea coal to the green sand and the difference in final part color significantly affected this result. The mean hardness of the binder jet parts was 58.9 HBW with a standard deviation of 5.6 HBW, compared to the mean of the green sand parts of 47.7 HBW with a standard deviation of 7.2 HBW. The hardness findings were confirmed by the presence of a finer microstructure in the binder jet parts than the green sand parts. While both types of molds produced parts with defects, a greater variety of defects was evident in the olivine green sand molds. Porosity tended to move toward the surface of the olivine green sand parts, but was relatively evenly spread through the additively manufactured sand mold parts.


title: Territorial traps in controlling the COVID-19 pandemic

text: The COVID-19 pandemic is global in scope, yet responses to the pandemic have varied considerably by national context, thereby reinforcing what Agnew (1994) has called the ‘territorial trap’. This commentary extends geographical scholarship by considering three territorial traps at play in controlling the COVID-19 pandemic, mainly pertaining to the governance of international travel and migration, inter-state coordination, and territorial thinking.


title: Parents’ perceptions on physical activity for their children with autism spectrum disorders during the novel Coronavirus outbreak

text: Considering that parents are one of the key figures in their child’s participation in physical activity, it is extremely important to examine parents’ perceptions and experiences of physical activity in order to protect children with Autism Spectrum Disorders (ASD) from the inactive life during the novel Coronavirus (COVID-19) outbreak and to include them in physical activities in the home environment. Although it is still a new subject, there is no research that addresses parents’ physical activity knowledge, needs and recommendations for the physical activity experiences of children with ASD during the COVID-19 outbreak, and offers solutions accordingly. Considering this gap in the literature, the aim of this qualitative study is to explore parents’ perceptions on physical activity for their children with ASD. Participants of the study were 10 parents with children with ASD, who participated in one-to-one semi-structured phone calls. Interview data were analyzed thematically. The analysis of the data revealed three main themes: 1) Possible benefits of physical activity during the COVID-19 outbreak, 2) Physical activity barriers during the COVID-19 outbreak, and 3) Recommendations for physical activity during the COVID-19 outbreak. The results revealed that parents thought that physical activities had a positive effect on the development areas of their children with ASD. It was determined that parents want to involve their children in physical activities in the home environment, but they have barriers that they need to overcome.


title: The effect of international travel restrictions on internal spread of COVID-19

text: Background: Countries have restricted international arrivals to delay the spread of COVID-19. These measures carry a high economic and social cost. They may have little impact on COVID-19 epidemics if there are many more cases resulting from local transmission compared to imported cases. Methods: To inform decisions about international travel restrictions, we compared the ratio of expected COVID-19 cases from international travel (assuming no travel restrictions) to the expected COVID-19 cases arising from internal spread on an average day in May 2020 in each country. COVID-19 prevalence and incidence were estimated using a modelling framework that adjusts reported cases for under-ascertainment and asymptomatic infections. Findings: With May 2019 travel volumes, imported cases account for <10% of total incidence in 103 (95% credible interval: 76 - 130) out of 142 countries, and <1% in 48 (95% CrI: 9 - 95). If we assume that travel would decrease compared to May 2019 even in the absence of formal restrictions, then imported cases account for <10% of total incidence in 109-123 countries and <1% in 61-88 countries (depending on the assumptions about travel reductions). Interpretation: While countries can expect infected travellers to arrive in the absence of travel restrictions, in most countries these imported cases likely contribute little to local COVID-19 epidemics. Stringent travel restrictions may have limited impact on epidemic dynamics except in countries with low COVID-19 incidence and large numbers of arrivals from other countries.


docid: tylwbnpl

title: SARS-CoV-2 and ORF3a: Non-Synonymous Mutations and Polyproline Regions

text: The effect of the rapid accumulation of non-synonymous mutations on the pathogenesis of SARS-CoV-2 is not yet known. To predict the impact of non-synonymous mutations and polyproline regions identified in ORF3a on the formation of B-cell epitopes and their role in evading the immune response, nucleotide and protein sequences of 537 available SARS-CoV-2 genomes were analyzed for the presence of non-synonymous mutations and polyproline regions. Mutations were correlated with changes in epitope formation. A total of 19 different non-synonymous amino acids substitutions were detected in ORF3a among 537 SARS-CoV-2 strains. G251V was the most common and identified in 9.9% (n=53) of the strains and was predicted to lead to the loss of a B-cell like epitope in ORF3a. Polyproline regions were detected in two strains (EPI_ISL_410486, France and EPI_ISL_407079, Finland) and affected epitopes formation. The accumulation of non-synonymous mutations and detected polyproline regions in ORF3a of SARS-CoV-2 could be driving the evasion of the host immune response thus favoring viral spread. Rapid mutations accumulating in ORF3a should be closely monitored throughout the COVID-19 pandemic. Importance At the surge of the COVID-19 pandemic and after three months of the identification of SARS-CoV-2 as the disease-causing pathogen, nucleic acid changes due to host-pathogen interactions are insightful into the evolution of this virus. In this paper, we have identified a set of non-synonymous mutations in ORF3a and predicted their impact on B-cell like epitope formation. The accumulation of non-synonymous mutations in ORF3a could be driving protein changes that mediate immune evasion and favoring viral spread.


title: Organising outpatient dialysis services during the COVID-19 pandemic. A simulation and mathematical modelling study.

text: Background This study presents two simulation modelling tools to support the organisation of networks of dialysis services during the COVID-19 pandemic. These tools were developed to support renal services in the South of England (the Wessex region caring for 650 patients), but are applicable elsewhere. Methods A discrete-event simulation was used to model a worst case spread of COVID-19 (80% infected over three months), to stress-test plans for dialysis provision throughout the COVID-19 outbreak. We investigated the ability of the system to manage the mix of COVID-19 positive and negative patients, and examined the likely effects on patients, outpatient workloads across all units, and inpatient workload at the centralised COVID-positive inpatient unit. A second Monte-Carlo vehicle routing model estimated the feasibility of patient transport plans and relaxing the current policy of single COVID-19 patient transport to allow up to four infected patients at a time. Results If current outpatient capacity is maintained there is sufficient capacity in the South of England to keep COVID-19 negative/recovered and positive patients in separate sessions, but rapid reallocation of patients may be needed (as sessions are cleared of negative/recovered patients to enable that session to be dedicated to positive patients). Outpatient COVID-19 cases will spillover to a secondary site while other sites will experience a reduction in workload. The primary site chosen to manage infected patients will experience a significant increase in outpatients and in-patients. At the peak of infection, it is predicted there will be up to 140 COVID-19 positive patients with 40 to 90 of these as inpatients, likely breaching current inpatient capacity (and possibly leading to a need for temporary movement of dialysis equipment). Patient transport services will also come under considerable pressure. If patient transport operates on a policy of one positive patient at a time, and two-way transport is needed, a likely scenario estimates 80 ambulance drive time hours per day (not including fixed drop-off and ambulance cleaning times). Relaxing policies on individual patient transport to 2-4 patients per trip can save 40-60% of drive time. In mixed urban/rural geographies steps may need to be taken to temporarily accommodate renal COVID-19 positive patients closer to treatment facilities. Conclusions Discrete-event simulation simulation and Monte-Carlo vehicle routing model provides a useful method for stress-testing inpatient and outpatient clinical systems prior to peak COVID-19 workloads.


Coronavirus set to cause huge carbon emissions fall


title: SARS-CoV-2 infection in London, England: Impact of lockdown on community point-prevalence, March-May 2020

text: COVID-19 point prevalence PCR community testing allows disease burden estimation. In a sample of London residents, point prevalence decreased from 2.2% (95%CI 1.4;3.5) in early April (reflecting infection around lockdown implementation) to 0.2% (95%CI 0.03-1.6) in early May (reflecting infection 3-5 weeks into lockdown). Extrapolation from reports of confirmed cases suggest that 5-7.6% of total infections were confirmed by testing during this period. These data complement seroprevalence surveys improving the understanding of transmission in London.


title: Pregnancy and breastfeeding during COVID-19 pandemic: A systematic review of published pregnancy cases

text: Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19, as well as the characteristics of COVID-19 positive women who delivered in Portugal by 31 of March 2020. Methods: Searches were conducted in PubMed up to 8 April 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality. Portuguese cases were ascertained by contact with all Portuguese maternities and based on the information provided by their health professionals. Results: We identified 30 original studies reporting 212 cases of pregnant women with COVID-19 (30 discharged while pregnant), 200 from China and 12 from other countries. The 182 published deliveries resulted in one stillbirth and 185 live births. Four women with severe COVID-19 required admission to an intensive care unit but no cases of maternal death were reported. There was one neonatal death. Preterm births occurred in 28.7% of cases, but it is unclear whether this was iatrogenic. All cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus were negative. Four newborns were positive for SARS-CoV-2 and three newborns had high levels of IgM antibodies. None of the first eight infants born in Portugal tested positive. Breast milk samples from 13 mothers and described in seven studies showed no evidence of SARS-CoV-2. Conclusion: The evidence related to the effect of COVID-19 on pregnant women is still limited. Pregnant women and newborns should be considered particularly vulnerable populations regarding COVID-19 prevention and management strategies.


What Lies Beneath: Love in the Time of COVID-19


title: French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic

text: Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in China, various measures have been adopted in order to attenuate the impact of the virus on the population. With regard to spine surgery, French physicians are devoted to take place in the national plan against COVID-19, the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients. A three levels stratification was elaborated with Level I: Urgent surgical indications, Level II: Surgical indications associated to a potential loss of chance for the patient and Level III: Non-urgent surgical indications. We also report French experience in a COVID-19 cluster region illustrated by two clinical cases. We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.


title: Biodiversity Research and Innovation in Antarctica and the Southern Ocean

text: This article examines biodiversity research and innovation in Antarctica and the Southern Ocean based on a review of 150,401 scientific articles and 29,690 patent families for Antarctic species. The paper exploits the growing availability of open access databases, such as the Lens and Microsoft Academic Graph, along with taxonomic data from the Global Biodiversity Information Facility (GBIF) to explore the scientific and patent literature for the Antarctic at scale. The paper identifies the main contours of scientific research in Antarctica before exploring commercially oriented biodiversity research and development in the scientific literature and patent publications. The paper argues that biodiversity is not a free good and must be paid for. Ways forward in debates on commercial research and development in Antarctica can be found through increasing attention to the valuation of ecosystem services, new approaches to natural capital accounting and payment for ecosystem services that would bring the Antarctic, and the Antarctic Treaty System, into the wider fold of work on the economics of biodiversity. Economics based approaches can be criticised for reducing biodiversity to monetary exchange values at the expense of recognition of the wider values of biodiversity and its services. However, approaches grounded in the economics of biodiversity provide a transparent framework for approaching commercial activity in the Antarctic and introducing requirements for investments in the conservation of Antarctic biodiversity by those who seek to profit from it.


title: The key role of zinc in elderly immunity: A possible approach in the COVID-19 crisis

text: BACKGROUND & AIMS: The COVID-19 infection can lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mainly affecting patients aged 60 and older. Preliminary data suggest that the nutritional status can change the course of the infection, and on the matter, zinc is crucial for growth, development, and the maintenance of immune function. In the absence of treatment for this virus, there is an urgent need to find alternative methods that can contribute to control of disease. The aim of this paper is to establish the relation between zinc and COVID-19. METHODS AND RESULTS: From the prior scientific knowledge, we have performed a review of the literature and examine the role of zinc in immune function in the infection by COVID-19. Our findings are that the zinc as an anti-inflammatory agent may help to optimize immune function and reduce the risk of infection. CONCLUSIONS: Zinc supplementation can be a useful strategy to reduce the global burden of infection in the elderly, there is a need the increased reporting to improve our understanding of COVID-19 and the care of affected patients.


title: Immunodepletion with Hypoxemia: A Potential High Risk Subtype of Coronavirus Disease 2019

text: Background The outbreak of COVID-2019 is becoming a global public health emergency. Although its basic clinical features have been reported, the dynamic characteristics of immune system in COVID-2019 patients, especially those critical patients with refractory hypoxemia, are not yet well understood. We aim to describe the dynamic characteristics of immune system in 3 critical patients with refractory hypoxemia, and discuss the relationship between hypoxemia severity and immune cell levels, and the changes of gut microbes of COVID-2019 patient. Methods This is a retrospective study from 3 patients with 2019-nCoV infection admitted to Renmin Hospital of Wuhan University, a COVID-2019 designated hospital in Wuhan, from January 31 to February 6, 2020. All patients were diagnosed and classified based on the Diagnosis and Treatment of New Coronavirus Pneumonia (6th edition) published by the National Health Commission of China4. We recorded the epidemiological history, demographic features, clinical characteristics, symptoms and signs, treatment and clinical outcome in detail. Blood samples were collected and we determined the expression levels of immune cells (CD3+ T cells, CD4+ T cells, CD8+ T cells, CD19+ B cells, and CD16+56+ NK cells) in different time points. Nanopore Targeted Sequencing was used to determine the alterations of gut microbiota homeostasis. Results Apart from the clinical features described previously4, we found that four patients had decreased immune cells and refractory hypoxemia during the hospitalization, and the severity of hypoxemia was strongly correlated to the expression levels of immune cells. Additionally, we found that the proportion of probiotics was significantly reduced, such as Bifidobacterium, Lactobacillus, and Eubacterium, and the proportion of conditioned pathogenic bacteria was significantly increased, such as Corynebacterium of Actinobacteria and Ruthenibacterium of Firmicutes. Notably, all patients died. Conclusions We discussed the dynamic characteristics of host immune system and the imbalance of gut microbiota in 3 critical patients with COVID-2019. Hypoxemia severity was closely related with host immune cell levels, and the vicious circle between immune disorder and gut microbiota imbalance may be a high risk of fatal pneumonia. To the best of our knowledge, this is the first study which revealing that immunodepletion with refractory hypoxemia is a potential high risk subtype of COVID-2019 and the vicious circle between immune disorder and gut dysbiosis may be a high risk of fatal pneumonia.


title: Forecasting Covid-19 Outbreak Progression in Italian Regions: A model based on neural network training from Chinese data

text: Background. Epidemiological figures of Covid19 epidemic in Italy are worse than those observed in China. Methods. We modeled the Covid19 outbreak in Italian Regions vs. Lombardy to assess the epidemics progression and predict peaks of new daily infections and total cases by learning from the entire Chinese epidemiological dynamics. We trained an artificial neural network model, a modified auto-encoder with Covid19 Chinese data, to forecast epidemic curve of the different Italian regions, and use the susceptible/exposed/infected/removed (SEIR) compartment model to predict the spreading and peaks. We have estimated the basic reproduction number (R0), which represents the average number of people that can be infected by a person who has already acquired the infection - both by fitting the exponential growth rate of the infection across a one month period, and also by using a day by day assessment, based on single observations. Results. The expected peak of SEIR model for new daily cases was at the end of March at national level. The peak of overall positive cases is expected by April 11th in Southern Italian Regions, a couple of days after that of Lombardy and Northern regions. According to our model, total confirmed cases in all Italy regions could reach 160,000 cases by April 30th and stabilize at a plateau. Conclusions. Training neural networks on Chinese data and use the knowledge to forecast Italian spreading of Covid19 has resulted in a good fit, measured with the mean average precision between official Italian data and the forecast.


title: Epidemiological characterization of asymptomatic carriers of COVID-19 in Colombia

text: Objective: Asymptomatic carriers (AC) of the new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) represent an important source of spread for Coronavirus Disease 2019 (COVID-19). Early diagnosis of these cases is a powerful tool to control the pandemic. Our objective was to characterize patients with AC status and identify associated sociodemographic factors. Methods: Using a cross-sectional design and the national database of daily occurrence of COVID-19, we characterized both socially and demographically all ACs. Additional Correspondence Analysis and Logistic Regression Model were performed to identify characteristics associated with AC state (OR, 95% CI). Results: 2338 ACs (11.8%; 95% CI, 11.3-12.2%) were identified, mainly in epidemiological week 18 [EW] (3.98; 3.24-4.90). Age [≤]39 years (1.56; 1.42-1.72). Male sex (1.39; 1.26-1.53), cases imported from Argentina, Spain, Peru, Brazil, Costa Rica or Mexico (3.37; 1.47-7.71) and autochthonous cases (4.35 ; 2.12-8.93) increased the risk of identifying AC. We also identified groups of departments with moderate (3.68; 3.13-4.33) and strong (8.31; 6.10-7.46) association with AC. Discussion: Sociodemographic characteristics strongly associated with AC were identified, which may explain its epidemiological relevance and usefulness to optimize mass screening strategies and prevent person-to-person transmission.


title: Modeling Exit Strategies from COVID-19 Lockdown with a Focus on Antibody Tests

text: This paper presents two epidemiological models that have been developed in order to study the disease dynamics of the COVID-19 pandemic and exit strategies from the lockdown which has been imposed on many countries world-wide. A strategy is needed such that both the health system is not overloaded letting people die in an uncontrolled way and also such that the majority of people can get back their social contacts as soon as possible. We investigate the potential effects of a combination of measures such as continuation of hygienic constraints after leaving lockdown, isolation of infectious persons, repeated and adaptive short-term contact reductions and also large-scale use of antibody tests in order to know who can be assumed to be immune and participate at public life without constraints. We apply two commonly used modeling approaches: extended SEIR models formulated both as System Dynamics and Agent-Based Simulation, in order to get insight into the disease dynamics of a complete country like Germany and also into more detailed behavior of smaller regions. We confirm the findings of other models that without intervention the consequences of the pandemic can be catastrophic and we extend such findings with effective strategies to overcome the challenge. Based on the modeling assumptions it can be expected that repeated short-term contact reductions will be necessary in the next years to avoid overload of the health system and that on the other side herd immunity can be achieved and antibody tests are an effective way to mitigate the contact reductions for many.


Neuropalliative Care During COVID-19—Addressing Isolation, Fear, and Terminal Illness


title: ‘We had to act.’ How coronavirus fears forced physics society to nix giant meeting

text: Harold Dorwin/Center for Astrophysics/Harvard & Smithsonian The March Meeting of the American Physical Society (APS) wasn’t the first event canceled for fear of the coronavirus, but it was nixed in dramatic fashion


title: The "Double Eights Mask Brace" Improves the Fit and Protection and Protection of a Basic Surgical Mask Amidst Covid-19 Pandemic

text: Study Objective: The COVID-19 pandemic has resulted in widespread shortages in personal protective equipment, including N95 respirators. While basic surgical facemasks are more commonly available, their efficacy is limited due primarily to their poor face seal. This pilot study examined the impact of a rubber band mask brace on a basic surgical mask, as determined by quantitative fit testing. Methods: Subjects wearing a basic surgical facemask and the rubber band mask brace underwent quantitative fit testing using machinery designed to certify N95 mask fit. Subjects were tested with the brace anchored behind their eyes, with a paperclip behind the head, and on the side knobs of their face shields. The primary outcome measure was whether the subject passed the quantitative fit test at or above the OSHA verified standard for N95 masks. Results: Subjects (n=11) were 54.5% female, with a median height of 70 inches (IQR 68-74), weight of 170 lbs (IQR 145-215) and BMI of 24.6 (IQR 22.2-27.2), and encompassing 5 distinct N95 mask fit types. We found that 45%, 100% and 100% of subjects passed the quantitative fit test when the brace was anchored behind the ears, with a paperclip and on a face shield respectively. Conclusion: Of the 11 subjects included in the analysis, across a range of body habitus and N95 mask fit types, all passed the quantitative fit test when the mask brace was anchored on either face shield or with a paperclip. This data suggests the brace would offer an improved margin of safety when worn with a basic surgical mask.


title: EXPLAINABLE-BY-DESIGN APPROACH FOR COVID-19 CLASSIFICATION VIA CT-SCAN

text: The COVID-19 disease has widely spread all over the world since the beginning of 2020. On January 30, 2020 the World Health Organization (WHO) declared a global health emergency. At the time of writing this paper the number of infected about 2 million people worldwide and took over 125,000 lives, the advanced public health systems of European countries as well as of USA were overwhelmed. In this paper, we propose an eXplainable Deep Learning approach to detect COVID-19 from computer tomography (CT) - Scan images. The rapid detection of any COVID-19 case is of supreme importance to ensure timely treatment. From a public health perspective, rapid patient isolation is also extremely important to curtail the rapid spread of the disease. From this point of view the proposed method offers an easy to use and understand tool to the front-line medics. It is of huge importance not only the statistical accuracy and other measures, but also the ability to understand and interpret how the decision was made. The results demonstrate that the proposed approach is able to surpass the other published results which were using standard Deep Neural Network in terms of performance. Moreover, it produces highly interpretable results which may be helpful for the early detection of the disease by specialists.


title: Caring for Health Professionals in the COVID-19 Pandemic Emergency: Toward an “Epidemic of Empathy” in Healthcare

text: Psychological research into healthcare opened the door to understanding people's emotional reactions when experiencing events perceived as life-threatening. This is the case of the current outbreak of the novel Coronavirus disease (COVID-19) that has recently been declared “a public health emergency of international concern (PHEIC)” by the World Health Organization (WHO). The response to an influenza pandemic might generate remarkable stress and emotional turmoil to healthcare providers who work during the outbreak. Prior experience with disasters, pandemics, and major traumatic events indicates that enhanced support to healthcare professionals enabling them to become aware of their own emotions and effectively share their perspective and lived experience with patients can help them in remaining efficient and focused during these stressful events. This outbreak marks a vital moment where healthcare systems can endorse an “epidemic of empathy” aimed at bringing science and humanism together to benefit patients and consolidate citizens' trust in healthcare providers during this and future healthcare crisis. Perhaps, the greatest opportunity for managing people fears during health emergencies—like the COVID-19 one—lies, in the short term, in restoring our connections with each other. Today, we are all called to rebuild a sense of community and the ties that bind us together as human beings.


title: Impact of control strategies on COVID-19 pandemic and the SIR model based forecasting in Bangladesh.

text: COVID-19 is transmitting worldwide drastically and infected nearly two and half million of people sofar. Till date 2144 cases of COVID-19 is confirmed in Bangladesh till 18th April though the stage-3/4 transmission is not validated yet. To project the final infection numbers in Bangladesh we used the SIR mathematical model. We also tried to demonstrate the impact of control strategies like social distancing on the COVID-19 transmission. Due to large population and socio-economic characteristics, we assumed 60% social distancing and lockdown can be possible. Assuming that, the predicated final size of infections will be 3782558 on the 92th day from the first infections. To estimate the impact of social distancing we assumed eight different scenarios, the predicted results confirmed the positive impact of this type of control strategies suggesting that by strict social distancing and lockdown, COVID-19 infection can be under control and then the infection cases will steadily decrease down to zero.


title: Systematic Review of the Registered Clinical Trials of Coronavirus Disease 2019 (COVID-19)

text: Background: Since the outbreak of coronavirus disease 2019 (COVID-19), many researchers in China have immediately carried out clinical research scheme of the COVID-19. But, there is still a lack of systematic review of registered clinical trials. Therefore, we conducted a systematic review of the clinical trials of COVID-19 to summarize the characteristics of the COVID-19 registered clinical trials. Methods: This study is based on the recommendations of the PRISMA in the Cochrane handbook. The databases from the Chinese Clinical Registration Center and the ClinicalTrials.gov were searched to collect the registered clinical trials of COVID-19. The retrieval inception date is February 9, 2020. Two researchers independently selected the literature based on inclusion and exclusion criteria, extracted data and evaluated the risk of bias. Results: A total of 75 registered clinical trials (63 interventional studies and 12 observational studies) of COVID-19 were obtained. A majority of clinical trials were sponsored by Chinese hospitals. Only 11 trials have begun to recruit patients, and none of the registered clinical trials had been completed; 34 trials were early clinical exploratory trials or in a pre-experiment stage, 15 trials belonged to phrase Ⅲ and 4 trials were phrase Ⅳ. The methods of intervention included traditional Chinese medicine involving 26 trials, Western medicine involving 30 trials, and integrated traditional Chinese medicine and Western medicine involving 19 trials. The subjects were mainly non-critical adult patients (≥ 18 years old). The median sample size of the trials was 100 (IQR: 60 - 200), and the median execute time of the trials was 179 d (IQR: 94 - 366 d). The main outcomes were clinical observation and examinations. Overall, both the methodology quality of interventional trials and observational studies were low. Conclusions: Disorderly and intensive clinical trials of COVID-19 using traditional Chinese medicine and western medicine are ongoing or will being carried out in China. However, based on the low methodology quality and small sample size and long studies execute time, we will not be able to obtain reliable, high-quality clinical evidence about COVID-19 treatment in the near future. Improving the quality of study design, prioritizing promising drugs, and using different designs and statistical methods are worth advocating and recommending for the clinical trials of COVID-19 in China.