title: Western Washington State COVID-19 Experience: Keys to Flattening the Curve and Effective Health System Response

text: BACKGROUND: Washington State experienced the first major outbreak of COVID-19 in the United States and despite a significant number of cases, has seen a relatively low death rate per million population compared to other states with major outbreaks and has seen a substantial decrease in the projections for healthcare utilization, i.e. "flattening the curve". This consensus report seeks to identify the key factors contributing to the effective health system disaster response in western WA. METHODS: A multidisciplinary, expert panel including individuals and organizations who were integral to managing the public health and emergency healthcare system response were engaged in a consensus process to identify the key themes and lessons learned and develop recommendations for ongoing management of the COVID-19 pandemic. RESULTS: Six key themes were identified including: early communication and coordination among stakeholders; regional coordination of the healthcare system response; rapid development and access to viral testing; proactive management of long-term care & skilled nursing facilities; proactive management of vulnerable populations; and effective physical distancing in the community. CONCLUSIONS: Based on the lessons learned in each of the areas identified by the panel, 11 recommendations are provided to support the healthcare system disaster response in managing future outbreaks.


Easier access to mechanical ventilation worldwide: an urgent need for low income countries, especially in face of the growing COVID-19 crisis


Considerations for remote learning in pathology during COVID-19 social distancing


Panic prescribing has become omnipresent during the COVID-19 pandemic


Asymptomatic case of Covid-19 in an infant with cystic fibrosis


Glucocorticoid and immunoglobulin to treat viral fulminant myocarditis


A company doctor's role during the COVID-19 pandemic


title: The impact of the COVID-19 outbreak on liver transplantation programs in Northern Italy

text: In January 2020, Novel Coronavirus Disease 2019 (COVID-19) resulted in a global pandemic, creating uncertainty toward the management of liver transplantation (LT) programs. Lombardy has been the most affected region in Italy: the current mortality rate of COVID-19 patients is 18.3% (10 022 deaths; April 10th) with hospitals in Lombardy having to expand the total number of ICU beds from 724 to 1381 to accommodate infected patients. There has been a drastic decrease in liver donors. From February 23rd until April 10th, 17 LTs were performed in Lombardy. Mean donor age was 49 years (range 18-74) whereas mean recipient age was 55 (13-69); mean MELD score was 12 (6-24). All donors underwent screening for SARS-CoV-2 prior to LT. Two patients tested positive after LT, and one patient died for COVID on POD 30. Sixteen patients are alive after an average of 30 days post-LT (range 3-46). 10 patients have been discharged. This study has found no specific reason concerning the safety of recipients, to stop LT programs. Several key lessons from our experience are reported. However, due to the complex circumstances which surround the viral outbreak, the cessation or a reduction in LT activity is a pragmatic requirement.


title: Validation of a chemiluminescent assay for specific SARS-CoV-2 antibody

text: Objectives Faced with the COVID-19 pandemic and its impact on the availability and quality of both therapeutic and diagnostic methods, the Belgian authorities have decided to launch a procedure for additional evaluation of the performance of serological tests offered for sale on the national territory. This has been proposed with a double aim: (1) an in-depth verification of the analytical and clinical performances presented by the manufacturer and (2) an economy of scale in terms of centralized validation for all the laboratories using the tests subject to evaluation. Methods A retrospective validation study was conducted including the serum of 125 patients in order to determine the analytical and clinical performances of the LIAISON®SARS-CoV-2 from DiaSorin® detecting anti-SARS-CoV-2 IgG and to compare its clinical performance with the enzyme-linked immunosorbent assay (ELISA) test from Euroimmun®, one of the first commercially available tests allowing the detection of anti-SARS-CoV-2 IgA and IgG. Results The performances of the LIAISON®SARS-CoV-2 satisfied all the acceptance criteria and provided "real world" analytical and clinical performances very close to the ones reported by the manufacturer in its insert kit. Comparison between the LIAISON®SARS-CoV-2 and the ELISA method did not reveal any difference between the two techniques in terms of sensitivities and specificities regarding the determination of the IgG. Conclusions This study reports the validation of the LIAISON®SARS-CoV-2 allowing to detect IgG antibodies specifically directed against SARS-CoV-2. The analytical and clinical performances are excellent, and the automation of the test offers important rates, ideal for absorbing an extension of testing.


title: Gestão da pandemia coronavírus em um hospital: relato de experiência profissional

text: Objetivo: descrever a experiência da gestão para o atendimento de paciente confirmado ou com suspeita de Coronavírus em um hospital da região metropolitana de Porto Alegre Método: relato de experiência sobre a gestão para o atendimento prestado a paciente confirmado ou com suspeita de Coronavírus em um hospital do sul do Brasil durante uma pandemia Resultados: descreveu-se a experiência com os fluxos operacionais de serviço, utilização de equipamentos de proteção individual, desafios e potencialidades vivenciados, assim como a saúde mental dos profissionais de saúde durante a pandemia Conclusões: o vírus foi recentemente descoberto e ainda são poucos os estudos sobre o tema, de modo que os protocolos e recomendações sofrem mudanças constantes Enfatiza-se diante disso, a relevância da manutenção de contínua atualização técnico científica (AU)Objetivo: describir la experiencia de manejo para el cuidado de pacientes confirmados o sospechosos con Coronavirus en un hospital de la región metropolitana de Porto alegre Método: informe de experiencia sobre el manejo de la atención brindada a pacientes confirmados o sospechosos con Coronavirus en un hospital en el sur de Brasil durante una pandemia Resultados: se describió la experiencia con los flujos de servicios operativos, el uso de equipos de protección personal, los desafíos y las potencialidades experimentadas, así como la salud mental de los profesionales de la salud durante la pandemia Conclusiones: el virus se descubrió recientemente y que todavía hay pocos estudios sobre el tema, por lo que los protocolos y recomendaciones cambian constantemente En vista de esto, se enfatiza la relevancia de mantener una actualización técnica científica continua (AU)Objective: to describe the management experience for the care of confirmed or suspected patients with Coronavirus in a hospital of metropolitan region of Porto Alegre Method: experience report on management for the care provided to confirmed or suspected patients with Coronavirus in a hospital in southern Brazil during a pandemic Results: the experience with operational service flows was described, use of personal protective equipment, challenges and potentialities experienced, as well as the mental health of health professionals during the pandemic Conclusions: the virus was recently discovered and that there are still few studies on the subject, so the protocols and recommendations are constantly changing In view of this, the relevance of maintaining continuous scientific technical updating is emphasized (AU)


title: Storytelling and Poetry in the time of Coronavirus

text: The Coronavirus crisis occurs at a time when many clinicians have already experienced burnout. One in three Irish doctors were suffering from burnout in the 2019 National Study of Wellbeing of Hospital Doctors in Ireland; rates are also high in Irish Psychiatry. We present a perspective on the use of Narrative in Medicine, and recognise that storytelling, and the patient history, are very much at the heart of medicine. Clinician storytelling, such as Schwartz Rounds and Balint group work, have very much come to the fore in Irish Psychiatry and in training. Projects such as Mind Reading have explored overlaps between clinicians, humanities experts and experts by experience. We give an overview of some approaches from the movement around narrative in medicine to bolster this. We explore why clinicians write- as ways to support identification, catharsis and a way to process experiences. Clinicians and patients may also use literature and poetry to promote coping. The historic context and practical strategies are highlighted, particularly with reference to Poetry use during the current crisis.


title: Single-cell landscape of bronchoalveolar immune cells in patients with COVID-19

text: Respiratory immune characteristics associated with Coronavirus Disease 2019 (COVID-19) severity are currently unclear. We characterized bronchoalveolar lavage fluid immune cells from patients with varying severity of COVID-19 and from healthy people by using single-cell RNA sequencing. Proinflammatory monocyte-derived macrophages were abundant in the bronchoalveolar lavage fluid from patients with severe COVID-9. Moderate cases were characterized by the presence of highly clonally expanded CD8+ T cells. This atlas of the bronchoalveolar immune microenvironment suggests potential mechanisms underlying pathogenesis and recovery in COVID-19.


SARS-CoV-2 RNA from droplets to faeces: A new focus for proctologists. Correspondence


COVID-19 in a patient with systemic sclerosis treated with tocilizumab for SSc-ILD


title: Real-time assessment of COVID-19 prevalence among multiple sclerosis patients: a multicenter European study

text: We assessed the prevalence and impact of COVID-19 among multiple sclerosis (MS) patients across Europe by leveraging participant data collected as part of the ongoing EU IMI2 RADAR-CNS major programme aimed at finding new ways of monitoring neurological disorders using wearable devices and smartphone technology. In the present study, 399 patients of RADAR-MS have been included (mean age 43.9 years, 60.7% females) with 87/399 patients (21.8%) reporting major symptoms suggestive of COVID-19. A trend for an increased risk of COVID-19 symptoms under alemtuzumab and cladribine treatments in comparison to injectables was observed. Remote monitoring technologies may support health authorities in monitoring and containing the ongoing pandemic.


Travel restrictions violate international law


title: Using Technology to Maintain the Education of Residents During the COVID-19 Pandemic

text: BACKGROUND: The COVID-19 pandemic presents a unique challenge to surgical residency programs. Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations, the educational landscape for surgical residents is rapidly changing. In addition, the time course of these changes is undefined. METHODS: We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents, educators, and patients. Within the basic framework of limiting in-person gatherings, postponing or canceling elective operations in hospitals, and limiting rotations between sites, we propose innovative solutions to maintain rigorous education. RESULTS: We propose several innovative solutions including the flipped classroom model, online practice questions, teleconferencing in place of in-person lectures, involving residents in telemedicine clinics, procedural simulation, and the facilitated use of surgical videos. Although there is no substitute for hands-on learning through operative experience and direct patient care, these may be ways to mitigate the loss of learning exposure during this time. CONCLUSIONS: These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance. The support of national organizations may be beneficial in maintaining rigorous surgical education.


COVID-19: Important Therapy Considerations and Approaches in this Hour of Need


title: Active surveillance documents rates of clinical care seeking due to respiratory illness

text: BACKGROUND: Respiratory viral infections are a leading cause of disease worldwide. However, the overall community prevalence of infections has not been properly assessed, as standard surveillance is typically acquired passively among individuals seeking clinical care. METHODS: We conducted a prospective cohort study in which participants provided daily diaries and weekly nasopharyngeal specimens that were tested for respiratory viruses. These data were used to analyze healthcare seeking behavior, compared with cross-sectional ED data and NYC surveillance reports, and used to evaluate biases of medically attended ILI as signal for population respiratory disease and infection. RESULTS: The likelihood of seeking medical attention was virus-dependent: higher for influenza and metapneumovirus (19%-20%), lower for coronavirus and RSV (4%), and 71% of individuals with self-reported ILI did not seek care and half of medically attended symptomatic manifestations did not meet the criteria for ILI. Only 5% of cohort respiratory virus infections and 21% of influenza infections were medically attended and classifiable as ILI. We estimated 1 ILI event per person/year but multiple respiratory infections per year. CONCLUSION: Standard, healthcare-based respiratory surveillance has multiple limitations. Specifically, ILI is an incomplete metric for quantifying respiratory disease, viral respiratory infection, and influenza infection. The prevalence of respiratory viruses, as reported by standard, healthcare-based surveillance, is skewed toward viruses producing more severe symptoms. Active, longitudinal studies are a helpful supplement to standard surveillance, can improve understanding of the overall circulation and burden of respiratory viruses, and can aid development of more robust measures for controlling the spread of these pathogens.


National active surveillance to understand and inform neonatal care in COVID-19


title: Circles of Life: linking metabolic and epigenetic cycles to immunity

text: Metabolites are the essential substrates for epigenetic modification enzymes to write or erase the epigenetic blueprint in cells. Thus, the availability of nutrients and activity of metabolic pathways strongly influence the enzymatic function. Recent studies have shed light on the choreography between metabolome and epigenome in the control of immune cell differentiation and function, with a major focus on histone modifications. Yet, despite its importance in gene regulation, DNA methylation and its relationship with metabolism is relatively unclear. In this review, we will describe how the metabolic flux can influence epigenetic networks in innate and adaptive immune cells, with a focus on DNA methylation cycle and the metabolites S-adenosylmethionine (SAM) and α-ketoglutarate (αKG). Future directions will be discussed for this rapidly emerging field.


docid: vcvuvspj

title: Keys for analysis of diagnostic and serologic tests for CoV-2

text: Based on a review of the medical literature, the authors document the key points regarding the tests available in France to screen for and diagnose of CoV-2 infestation.


Learning from mistakes during the pandemic: the Lombardy lesson


Research disruptions and recovery


docid: aozcozvq

title: A butterfly flaps its wings: Extinction of biological experience and the origins of allergy

text: OBJECTIVE: To explore links between biodiversity on all scales and allergic disease as a measure of immune dysregulation. DATA SOURCES: PubMed and Web of Science were searched using the keywords biodiversity, nature relatedness, allergic disease, microbiome, noncommunicable diseases, coronavirus disease 2019, and associated terms. STUDY SELECTION: Studies were selected based on relevance to human health and biodiversity. RESULTS: Contact with natural environments enriches the human microbiome, promotes regulated immune responses, and protects against allergy and both acute and chronic inflammatory disorders. These important links to ecopsychological constructs of the extinction of experience, which indicates that loss of direct, personal contact with biodiversity (wildlife and the more visible elements of the natural world), might lead to emotional apathy and irresponsible behaviors toward the environment. CONCLUSION: The immune system is a useful early barometer of environmental effects and, by means of the microbiome, is a measure of the way in which our current experiences differ from our ancestral past. Although we would benefit from further research, efforts to increase direct, personal contact with biodiversity have clear benefits for multiple aspects of physical and mental health, the skin and gut microbiome, immune function, food choices, sleep, and physical activity and promote environmental responsibility.


title: Review of Current Advances in Serologic Testing for COVID-19

text: OBJECTIVES: To examine and summarize the current literature on serologic methods for the detection of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: A literature review was performed using searches in databases including PubMed, medRxiv, and bioRxiv. Thirty-two peer-reviewed papers and 23 preprints were examined. RESULTS: The studies included lateral flow immunoassay, enzyme-linked immunosorbent assay, chemiluminescence immunoassay, and neutralizing antibody assays. The use of all major SARS-CoV-2 antigens was demonstrated to have diagnostic value. Assays measuring total antibody reactivity had the highest sensitivity. In addition, all the methods provided opportunities to characterize the humoral immune response by isotype. The combined use of IgM and IgG detection resulted in a higher sensitivity than that observed when detecting either isotype alone. Although IgA was rarely studied, it was also demonstrated to be a sensitive marker of infection, and levels correlated with disease severity and neutralizing activity. CONCLUSIONS: The use of serologic testing, in conjunction with reverse transcription polymerase chain reaction testing, was demonstrated to significantly increase the sensitivity of detection of patients infected with SARS-CoV-2. There was conflicting evidence regarding whether antibody titers correlated with clinical severity. However, preliminary investigations indicated some immunoassays may be a surrogate for the prediction of neutralizing antibody titers and the selection of recovered patients for convalescent serum donation.


United States strains to act as cases set record


Extracorporeal Membrane Oxygenation During the Coronavirus Disease 2019 Pandemic


title: COVID-19, Australia: Epidemiology Report 15 (Reporting week to 23:59 AEST 10 May 2020)

text: Confirmed cases in Australia notified up to 10 May 2020: notifications = 6,971; deaths = 98. The incidence of new cases of COVID-19 has reduced dramatically since a peak in mid-March. The reduction in international travel, social distancing measures and public health action have likely been effective in slowing the spread of the disease, in the Australian community. Cases of COVID-19 continue to be notified by jurisdictions, albeit at a slowed rate. Testing rates over the past week have increased markedly, with a very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is important that testing rates and community adherence to public health measures remain high to support the continued suppression of the virus, particularly in vulnerable high-risk groups and settings. In the past reporting week new cases in Australia are mostly considered to be locally acquired, consistent with the drop in international travel. Most locally-acquired cases can be linked back to a known case or cluster. Although the proportion of locally-acquired cases has increased, the overall rate of cases, regardless of place of acquisition, continues to decrease. The crude case fatality rate in Australia remains low (1.4%), compared with the WHO reported global rate (6.9%). The low case fatality rate is likely reflective of high case detection and high quality of health care services in Australia. Deaths from COVID-19 in Australia have occurred predominantly among the elderly and those with comorbidities, with no deaths occurring in those under 40 years. The highest rate of COVID-19 continues to be among people aged 60-79 years, with a third of these cases associated with several outbreaks linked to cruise ships. The lowest rate of disease is in young children, a pattern reflected in international reports. Internationally, cases continue to increase, with some areas such as Brazil and India showing a dramatic rise in reported cases. Although some low-income countries have currently reported few cases, it is possible that this is due to limited diagnostic and public health capacity, and may not be reflective of disease occurrence.


docid: facljitz

title: Nicaragua's response to COVID-19


title: Growth mechanism for nanotips in high electric fields

text: In this work we show using atomistic simulations that the biased diffusion in high electric field gradients creates a mechanism whereby nanotips may start growing from small surface asperities. It has long been known that atoms on a metallic surface have biased diffusion if electric fields are applied and that microscopic tips may be sharpened using fields, but the exact mechanisms have not been well understood. Our Kinetic Monte Carlo simulation model uses a recently developed theory for how the migration barriers are affected by the presence of an electric field. All parameters of the model are physically motivated and no fitting parameters are used. The model has been validated by reproducing characteristic faceting patterns of tungsten surfaces that have in previous experiments been observed to only appear in the presence of strong electric fields. The growth effect is found to be enhanced by increasing fields and temperatures.


Gedanken zum Gesundheitswesen Schweiz nach der COVID-19-Krise


title: Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms

text: Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women's Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV.


Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19)


Maxillofacial Trauma Management During COVID-19: Multidisciplinary Recommendations


The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis


title: BERTweet: A pre-trained language model for English Tweets

text: We present BERTweet, the first public large-scale pre-trained language model for English Tweets. Our BERTweet is trained using the RoBERTa pre-training procedure (Liu et al., 2019), with the same model configuration as BERT-base (Devlin et al., 2019). Experiments show that BERTweet outperforms strong baselines RoBERTa-base and XLM-R-base (Conneau et al., 2020), producing better performance results than the previous state-of-the-art models on three Tweet NLP tasks: Part-of-speech tagging, Named-entity recognition and text classification. We release BERTweet to facilitate future research and downstream applications on Tweet data. Our BERTweet is available at: https://github.com/VinAIResearch/BERTweet


Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for COVID-19 responses


How imaging should properly be used in COVID-19 outbreak: an Italian experience


title: Vaginal delivery after 37 days of a convalescent pregnant woman with COVID-19: a case report

text: We present a case report of a healthy neonate born by vaginal delivery to a woman who had recovered from COVID-19 after 37 days of discharge The pregnant woman had fever, cough, and chills at 33 +1 gestational weeks and was diagnosed with COVID-19 by coronavirus nucleic acid test one day later She recovered and was discharged after a series of treatment, and the 2019 novel coronavirus nucleic acid test and pulmonary CT were negative at the 2nd and 4th weeks after being discharged The patient was admitted in early labor at 38 +4 gestational weeks and delivered a healthy newborn vaginally at that day Both the mother and the baby were in good condition All the maternal or neonatal specimens taken immediately after birth in the delivery room for 2019 novel coronavirus nucleic acid tests were negative, including the maternal pharynx, rectal and cervical secretions, amniotic fluid, an neonatal pharynx and rectal swabs The qualitative examination of 2019 novel coronavirus antibodies in the maternal venous blood test showed that both IgG and IgM were positive While the same test for neonatal cord blood and femoral vein blood showed negative results No inflammatory reaction was found in the placenta and immunohistochemistry detection of novel coronavirus N protein was negative The mother and newborn were observed postnatally and treated in the same ward, neither of them had fever, cough or fatigue, and were discharged three days after delivery The qualitative examination of 2019 novel coronavirus antibodies (IgM and IgG) in the femoral vein blood of the nenonate 27 days old showed negative results


title: Repurposing anticancer drugs for COVID-19-induced inflammation, immune dysfunction, and coagulopathy

text: Three cardinal manifestations of neoplasia, namely inflammation, immune dysfunction, and coagulopathy are also seen in patients with severe SARS-CoV-2 infection, providing a biological rationale for testing selected anticancer drugs for their ability to control the symptoms and/or modify the course of COVID-19.


title: Molecular docking and binding mode analysis of selected FDA approved drugs against COVID-19 selected key protein targets: An effort towards drug repurposing to identify the combination therapy to combat COVID-19

text: The emergence of COVID-19 has severely compromised the arsenal of antiviral and antibiotic drugs. Drug discovery is a multistep process with a high failure rate, high cost and it takes approximately 10-12 years for the development of new molecules into the clinical candidate. On the other side, drug repurposing also called old drugs for new uses, is an attractive alternative approach for a new application of marketed FDA approved or investigational drugs. In the current pandemic situation raised due to COVID-19, repurposing of existing FDA approved drugs are emerging as the first line of the treatment. The causative viral agent of this highly contagious disease and acute respiratory syndrome coronavirus (SARS-CoV) shares high nucleotide similarity. Therefore, many existing viral targets are structurally expected to be similar to SARS-CoV and likely to be inhibited by the same compounds. Here, we selected three viral key proteins based on their vital role in viral life cycle: ACE2 (helps in entry into the human host), viral nonstructural proteins RNA-dependent RNA polymerase (RdRp) NSP12, and NSP16 which helps in replication, and viral latency (invasion from immunity). The FDA approved drugs chloroquine (CQ), hydroxychloroquine (HCQ), remdesivir (RDV) and arbidol (ABD) are emerging as promising agents to combat COVID-19. Our hypothesis behind the docking studies is to determine the binding affinities of these drugs and identify the key amino acid residues playing a key role in their mechanism of action. The docking studies were carried out through Autodock and online COVID-19 docking server. Further studies on a broad range of FDA approved drugs including few more protein targets, molecular dynamics studies, in-vitro and in-vivo biological evaluation are required to identify the combination therapy targeting various stages of the viral life cycle.


title: Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020

text: We report a 2-family cluster of persons infected with severe acute respiratory syndrome coronavirus 2 in the city of Zhoushan, Zhejiang Province, China, during January 2020. The infections resulted from contact with an infected but potentially presymptomatic traveler from the city of Wuhan in Hubei Province.


title: COVID-19 in context: Why do people die in emergencies? It's probably not because of collective psychology

text: Notions of psychological frailty have been at the forefront of debates around the public response to the COVID-19 pandemic. In particular, there is the argument that collective selfishness, thoughtless behaviour, and over-reaction would make the effects of COVID-19 much worse. The same kinds of claims have been made in relation to other kinds of emergencies, such as fires, earthquakes, and sinking ships. We argue that in these cases as well as in the case of the COVID-19 pandemic, other factors are better explanations for fatalities - namely under-reaction to threat, systemic or structural factors, and mismanagement. Psychologizing disasters serves to distract from the real causes and thus from who might be held responsible. Far from being the problem, collective behaviour in emergencies - including the solidarity and cooperation so commonly witnessed among survivors - is the solution, one that should be harnessed more effectively in policy and practice.


docid: rfmhszlu

title: Appropriate care for neonates born to mothers with COVID-19 disease

text: The global COVID-19 pandemic has been associated with high rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, morbidity and mortality in the general population. Evidence-based guidance on caring for babies born to mothers with COVID-19 is needed. There is currently insufficient evidence to suggest vertical transmission between mothers and their newborn infants. However, transmission can happen after birth from mothers or other carers. Based on the currently available data, prolonged skin-to-skin contact and early and exclusive breastfeeding remain the best strategies to reduce the risks of morbidity and mortality for both the mother with COVID-19 and her baby.


title: Comparing Nasopharyngeal and Mid-Turbinate Nasal Swab Testing for the Identification of SARS-CoV-2

text: Testing of paired mid-turbinate (MT) nasal and nasopharyngeal (NP) swabs, collected by trained personnel from 40 patients with COVID-19 showed more NP (76/95, 80%) than MT swabs tested positive (61/95, 64%; p=0.02). Among samples collected a week after study enrollment, fewer MT than NP samples were positive (45% vs 76%; p=0.001).


title: Manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19. Una revisión narrativa./ [Nutritional management of the critically ill inpatient with COVID-19. A narrative review]

text: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.


title: Sex-Specific SARS-CoV-2 Mortality: Among Hormone-Modulated ACE2 Expression, Risk of Venous Thromboembolism and Hypovitaminosis D

text: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease (COVID-19) appears to have a higher mortality rate in presence of comorbidities and in men. The latter suggests the presence of a possible sex-dependent susceptibility. An enzymatic system involved in this different predisposition could be represented by angiotensin converting enzyme 2 (ACE2). ACE2 is activated and down-regulated by the spike protein of the virus and allows the penetration of SARS-CoV-2 into epithelial cells and myocardium. Data on the experimental animal have shown that 17ß-estradiol increases the expression and activity of ACE2 in both adipose tissue and kidney. Spontaneously hypertensive male mice have a higher myocardial ACE2 expression than females and its levels decrease after orchiectomy. In addition to this first aspect, the recent evidence of an increased frequency of venous thromboembolism in patients with COVID-19 (a clinical element associated with a worse prognosis) calls the attention on the safety of treatment with testosterone, in particular in hypogonadal men with greater genetic predisposition. Evidence that sex hormones are able to modulate the expression of ACE2 could help in interpreting epidemiological results and in designing more appropriate intervention strategies. Moreover, the vitamin D deficiency in elderly men may be worthy of further study regarding the epidemiological aspects of this different susceptibility and lethality between sexes.


Letter to the Editor: Update on the followed-up CT exam of the first CoVID-19 pneumonia in Taiwan


Pharmacologic therapeutic options for thromboprophylaxis in COVID-19


Manifestaciones neurológicas de la infección por SARS-CoV-2./ [Neurological manifestations of SARS-CoV-2 infection]


title: Reaching the Hispanic Community About COVID-19 Through Existing Chronic Disease Prevention Programs

text: Publicly available data on racial and ethnic disparities related to coronavirus disease 2019 (COVID-19) are now surfacing, and these data suggest that the novel virus has disproportionately sickened Hispanic communities in the United States. We discuss why Hispanic communities are highly vulnerable to COVID-19 and how adaptations were made to existing infrastructure for Penn State Project ECHO (Extension for Community Healthcare Outcomes) and Better Together REACH (a community-academic coalition using grant funds from Racial and Ethnic Approaches to Community Health) to address these needs. We also describe programming to support COVID-19 efforts for Hispanic communities by using chronic disease prevention programs and opportunities for replication across the country.


title: Rapid Deployment of a Drive-Through Prenatal Care Model in Response to the Coronavirus Disease 2019 (COVID-19) Pandemic

text: Coronavirus disease 2019 (COVID-19) has been declared a public health emergency for the entire United States. Providing access to prenatal health care while limiting exposure of both obstetric health care professionals and patients to COVID-19 is challenging. Although reductions in the frequency of prenatal visits and implementation of telehealth interventions provide some options, there still remains a need for patient-health care professional visits. A drive-through prenatal care model was developed in which pregnant women would remain in their automobiles while being assessed by the health care professional, thus reducing potential patient, health care professional, and staff exposure to COVID-19. Drive-through prenatal visits would include key elements that some institutions cannot perform by telehealth encounters, such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient-health care professional interaction, thereby reducing patient anxiety resulting from the reduction in the number of planned clinic visits with an obstetric health care professional as well as fear of virus exposure in the clinic setting. We describe the rapid development of a drive-through prenatal care model that is projected to reduce the number of in-person clinic visits by 33% per patient compared with the traditional prenatal care paradigm, using equipment and supplies that most obstetric clinics in the United States can access.


title: On the use of immune checkpoint inhibitors in patients with viral infections including COVID-19

text: The present review summarizes up-to-date evidence addressing the frequently discussed clinical controversies regarding the use of immune checkpoint inhibitors (ICIs) in cancer patients with viral infections, including AIDS, hepatitis B and C, progressive multifocal leukoencephalopathy, influenza, and COVID-19. In detail, we provide available information on (1) safety regarding the risk of new infections, (2) effects on the outcome of pre-existing infections, (3) whether immunosuppressive drugs used to treat ICI-related adverse events affect the risk of infection or virulence of pre-existing infections, (4) whether the use of vaccines in ICI-treated patients is considered safe, and (5) whether there are beneficial effects of ICIs that even qualify them as a therapeutic approach for these viral infections.


title: Insights into SARS-CoV-2 genome, structure, evolution, pathogenesis and therapies: Structural genomics approach

text: The sudden emergence of severe respiratory disease, caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently become a public health emergency. Genome sequence analysis of SARS-CoV-2 revealed its close resemblance to the earlier reported SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). However, initial testing of the drugs used against SARS-CoV and MERS-CoV has been ineffective in controlling SARS-CoV-2. The present study highlights the genomic, proteomic, pathogenesis, and therapeutic strategies in SARS-CoV-2 infection. We have carried out sequence analysis of potential drug target proteins in SARS-CoV-2 and, compared them with SARS-CoV and MERS viruses. Analysis of mutations in the coding and non-coding regions, genetic diversity, and pathogenicity of SARS-CoV-2 has also been done. A detailed structural analysis of drug target proteins has been performed to gain insights into the mechanism of pathogenesis, structure-function relationships, and the development of structure-guided therapeutic approaches. The cytokine profiling and inflammatory signalling are different in the case of SARS-CoV-2 infection. We also highlighted possible therapies and their mechanism of action followed by clinical manifestation. Our analysis suggests a minimal variation in the genome sequence of SARS-CoV-2, may be responsible for a drastic change in the structures of target proteins, which makes available drugs ineffective.


title: Humanitarian Needs: The Arthroplasty Community and the COVID-19 Pandemic

text: BACKGROUND: As the world struggles with the COVID-19 pandemic, health care providers are on the front lines. We highlight the value of engaging in humanitarian medical work, contributions of the hip and knee arthroplasty community to date, and future needs after the resolution of the pandemic. We sought to understand how the arthroplasty community can contribute, based on historical lessons from prior pandemics and recessions, current needs, and projections of the COVID-19 impact. METHODS: We polled members of medical mission groups led by arthroplasty surgeons to understand their current efforts in humanitarian medical work. We also polled orthopedic colleagues to understand their role and response. Google Search and PubMed were used to find articles relevant to the current environment of the COVID-19 pandemic, humanitarian needs after previous epidemics, and the economic effects of prior recessions on elective surgery. RESULTS: Hip and knee arthroplasty surgeons are not at the center of the pandemic but are providing an invaluable supportive role through continued care of musculoskeletal patients and unloading of emergency rooms. Others have taken active roles assisting outside of orthopedics. Arthroplasty humanitarian organizations have donated personal protective equipment and helped to prepare their partners in other countries. Previous pandemics and epidemics highlight the need for sustained humanitarian support, particularly in poor countries or those with ongoing conflict and humanitarian crises. CONCLUSION: There are opportunities now to make a difference in this health care crisis. In the aftermath, there will be a great need for humanitarian work both here and throughout the world.


title: Estimating number of cases and spread of coronavirus disease (COVID-19) using critical care admissions, United Kingdom, February to March 2020

text: An exponential growth model was fitted to critical care admissions from two surveillance databases to determine likely coronavirus disease (COVID-19) case numbers, critical care admissions and epidemic growth in the United Kingdom before the national lockdown. We estimate, on 23 March, a median of 114,000 (95% credible interval (CrI): 78,000-173,000) new cases and 258 (95% CrI: 220-319) new critical care reports, with 527,000 (95% CrI: 362,000-797,000) cumulative cases since 16 February.


title: Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study

text: BACKGROUND: An outbreak of COVID-19 in Iran has spread throughout the country. Identifying the epidemiological characteristics of this disease will help to make appropriate decisions and thus control the epidemic. The aim of this study was characterization of the epidemiological features of COVID-19 in Iran. METHODS: In this retrospective study, data related to the epidemiological characteristics of COVID-19 patients admitted to Baqiyatallah Hospital in Tehran, Iran, from 19 February 2020 to 15 April 2020 have been analyzed and reported. Patient characteristics including age, gender and underlying diseases were investigated. Data were collected through patient records. Sex ratio, Case Fatality Rate (CFR) and daily trend of cases were also determined. A multiple logistic regression analysis was also performed to assess affecting factors on mortality. RESULTS: From February 19, 2020 to April 15, 2020, 12870 patients referred to the hospital emergency department, of which 2968 were hospitalized with COVID-19 diagnosis. The majority of cases were in the age group of 50 to 60 years of old. The male-to-female ratio was 1.93:1. A total of 239 deaths occurred among all cases for an overall CFR of 1.85% based on the total number of patients (both outpatient and inpatient) and 8.06% among hospitalized patients. Out of all patients 10.89% had comorbidity. Diabetes, chronic respiratory diseases, hypertension, cardiovascular diseases, chronic Kidney diseases and cancer were the most common comorbidities with 3.81, 2.02 , 1.99 , 1.25, 0.60 and 0.57 %, respectively. Male gender (OR=1.45, 95% CI: 1.08-1.96), older age (OR=1.05, 95% CI: 1.04-1.06) and having underlying diseases (OR=1.53, 95% CI: 1.04-2.24) were significantly associated with mortality. CONCLUSIONS: The results of this study showed that Male gender, older age and having comorbidities were significantly associated with the risk of death among COVID-19 patients. It is important to pay special attention to male elderly patients with underlying diseases.


title: Estimating the Size of a COVID-19 Epidemic from Surveillance Systems

text: Public health policy makers in countries with Coronavirus Disease 2019 (COVID-19) outbreaks face the decision of when to switch from measures that seek to contain and eliminate the outbreak to those designed to mitigate its effects. Estimates of epidemic size are complicated by surveillance systems that cannot capture all cases, and by the need for timely estimates as the epidemic is ongoing. This article provides a Bayesian methodology to estimate outbreak size from one or more surveillance systems such as virologic testing of pneumonia cases or samples from a network of general practitioners.


docid: ooboeurk

title: COVID-19, an emerging coronavirus infection: advances and prospects in designing and developing vaccines, immunotherapeutics, and therapeutics

text: The novel coronavirus infection (COVID-19 or Coronavirus disease 2019) that emerged from Wuhan, Hubei province of China has spread to many countries worldwide. Efforts have been made to develop vaccines against human coronavirus (CoV) infections such as MERS and SARS in the past decades. However, to date, no licensed antiviral treatment or vaccine exists for MERS and SARS. Most of the efforts for developing CoV vaccines and drugs target the spike glycoprotein or S protein, the major inducer of neutralizing antibodies. Although a few candidates have shown efficacy in in vitro studies, not many have progressed to randomized animal or human trials, hence may have limited use to counter COVID-19 infection. This article highlights ongoing advances in designing vaccines and therapeutics to counter COVID-19 while also focusing on such experiences and advances as made with earlier SARS- and MERS-CoVs, which together could enable efforts to halt this emerging virus infection.


title: Erste Ergebnisse zu Untersuchungen der menschlichen Hornhaut auf SARS-CoV2-RNA./ [First results of investigations of SARS-CoV2 RNA in human corneal tissue]

text: Preliminary investigations of human corneal tissues from coronavirus disease 2019 (COVID-19) cadaveric donors indicated that no severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is present. Current eye banking guidelines do not recommend any type of routine testing for SARS-CoV2 RNA in post-mortem donor tissue. This is partly based on factors that can influence the test results of the reverse transcription polymerase chain reaction (RT-PCR).


COVID-19 and personal protective equipment: Treatment and prevention of skin conditions related to the occupational use of personal protective equipment


Patient self-proning with high-flow nasal cannula improves oxygenation in COVID-19 pneumonia


title: COVID-19 in a young man with hypertension: A case study of missed opportunities in intensive progression

text: We report the case of a young patient diagnosed with coronavirus disease 2019 with a history of hypertension. The patient improved after antiviral treatment but eventually developed severe respiratory distress syndrome and cardiac insufficiency. His respiratory secretions were tested for nucleic acids and returned negative twice. Computed tomography imaging of the patient showed evidence of viral pneumonia on the 11th day of onset and continued to worsen. The patient was finally intubated and transferred to a higher-level care centre for further treatment. We were very focused on infectious disease protection throughout the treatment, however, suboptimal treatment was provided due to the switch in antihypertensive medication, lack of early nutritional support and fluid restriction management.


Coronavirus Threatens Blood Supply: Patient Blood Management Now!


title: The Role of Anticoagulation in COVID-19-Induced Hypercoagulability

text: PURPOSE OF REVIEW: We aim to provide a comprehensive analysis of hypercoagulability in individuals affected by COVID-19. Our goal is to describe the hypercoagulable state related to the infection and provide guidance regarding the possible benefits of anti-coagulation with the support of evidence from current literature. RECENT FINDINGS: The incidence of thrombotic disease in individuals affected by COVID-19 is reported as high as 31%. A significant mortality benefit has been observed with the use of therapeutic anticoagulation in high-risk individuals. Literature supports the use of scoring systems, such as the sepsis-induced coagulopathy score, to risk-stratify individuals who might benefit from anticoagulation. COVID-19-induced hypercoagulability has been demonstrated to play a significant role in overall COVID-19 outcomes. Current literature shows promising evidence with the use of therapeutic anticoagulation in high-risk individuals. Further studies are needed to better analyze the risks and benefits of anticoagulation in this specific patient population.


The surgeon and the COVID-19 pandemic


title: Meropenem for management of valproic acid overdose: a case report

text: Objectives Valproic acid (VPA) is an anticonvulsant used in several clinical scenarios. VPA has been increasingly associated with intentional or unintentional overdose. In patients presenting with severe VPA overdose, supportive care and airway protection are cornerstones of treatment, while levocarnitine is suggested in patients with hyperammonemia and hemodialysis is recommended in patients with VPA serum concentrations (SC) >1,300 mg/L and presence of cerebral edema or shock. Meropenem is a carbapenem antibiotic with a broad spectrum of activity. The pharmacological interaction between VPA and meropenem is characterized by a rapid decrease in VPA concentrations, which contraindicates concurrent use. Case presentation The following case report describes the use of meropenem to enhance the clearance of VPA in the case of severe VPA overdose. A patient with altered mental status was transported to the emergency department (ED) after VPA overdose. Meropenem was prescribed for significant elevated VPA SC. An important decline in SC was observed with short-term meropenem dosing, and an improvement in mental status occurred shortly after administration. Conclusions Carbapenem therapy has the potential to be used as last line strategy in the management of severe VPA overdose in patients where SC represent a significant risk of toxicity and clinical symptoms suggest difficulty managing the patient.


docid: hiuepglh

title: Identifying SARS-CoV-2-related coronaviruses in Malayan pangolins

text: The ongoing outbreak of viral pneumonia in China and across the world is associated with a new coronavirus, SARS-CoV-21. This outbreak has been tentatively associated with a seafood market in Wuhan, China, where the sale of wild animals may be the source of zoonotic infection2. Although bats are probable reservoir hosts for SARS-CoV-2, the identity of any intermediate host that may have facilitated transfer to humans is unknown. Here we report the identification of SARS-CoV-2-related coronaviruses in Malayan pangolins (Manis javanica) seized in anti-smuggling operations in southern China. Metagenomic sequencing identified pangolin-associated coronaviruses that belong to two sub-lineages of SARS-CoV-2-related coronaviruses, including one that exhibits strong similarity in the receptor-binding domain to SARS-CoV-2. The discovery of multiple lineages of pangolin coronavirus and their similarity to SARS-CoV-2 suggests that pangolins should be considered as possible hosts in the emergence of new coronaviruses and should be removed from wet markets to prevent zoonotic transmission.


Nutritional recommendations for CoVID-19 quarantine


Postinfectious brainstem encephalitis associated with SARS-CoV-2


Why Am I, as a Geriatric Medicine Fellow with Symptoms, Unable to Get Tested for COVID-19 While Politicians, Oil Executives, and NBA Players Are?


docid: wewgsbyo

title: Significancia estad\'istica del exceso de muertes en Chile durante pandemia COVID-19

text: The study of mortality and the calculation of excess deaths is a fundamental tool for understanding the effect of epidemics / pandemics and the seasonal cycles of endemic / epidemic diseases such as influenza, which is of great importance in times of crisis, according to the WHO and different authors. In this study, we analyzed the indicator of excess deaths in Chile during the COVID-19 pandemic. Simultaneously, research is being carried out to corroborate and characterize possible causes of the underestimation of deaths by official health agencies.


title: Body perception in chimpanzees and humans: The expert effect

text: Both humans and chimpanzees have better performances when recognizing faces or bodies when the stimuli are upright compared to inverted. This is called the inversion effect. It suggests that these two species use a specific way to process faces and bodies. Previous research has suggested that humans also show the inversion effect to objects that they have expertise about, and this is called the expert effect. We investigated whether chimpanzees show the expert effect and how humans and chimpanzees differ by testing chimpanzees (human experts) with human body stimuli and testing humans (chimpanzee experts) with chimpanzee and human body stimuli in body recognition tasks. The main finding was that humans (chimpanzee experts) showed the expert effect to chimpanzee bodies, while chimpanzees partially showed it to human bodies. This suggests that compared with chimpanzees, the special processing in humans can be more flexibly tuned for other objects. We also tested humans that were not chimpanzee experts using chimpanzee body stimuli. Although they showed similar performances as the chimpanzee experts, the two groups had differences in some situations, indicating the effect of expertise. This study revealed the important role of experience in object processing in humans, and our evolutionary relatives, chimpanzees.


Coronavirus: a veterinary perspective


title: Cluster of Coronavirus Disease Associated with Fitness Dance Classes, South Korea

text: During 24 days in Cheonan, South Korea, 112 persons were infected with severe acute respiratory syndrome coronavirus 2 associated with fitness dance classes at 12 sports facilities. Intense physical exercise in densely populated sports facilities could increase risk for infection. Vigorous exercise in confined spaces should be minimized during outbreaks.


title: Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry

text: BACKGROUND: Racial disparities in postoperative complications have been demonstrated in bariatric surgery, yet the relationship of race to complication severity is unknown. STUDY DESIGN: Adult laparoscopic primary bariatric procedures were queried from the 2015 and 2016 MBSAQIP registry. Adjusted logistic and multinomial regressions were used to examine the relationships between race and 30-day complications categorized by the Clavien-Dindo grading system. RESULTS: A total of 212,970 patients were included in the regression analyses. For Black patients, readmissions were higher (OR = 1.39, p < 0.0001) and the odds of a Grade 1, 3, 4, or 5 complication were increased compared with White patients (OR = 1.21, p < 0.0001; OR = 1.21, p < 0.0001; OR = 1.22, p = 0.01; and OR = 1.43, p = 0.04) respectively. The odds of a Grade 3 complication for Hispanic patients were higher compared with White patients (OR = 1.59, p < 0.0001). CONCLUSION: Black patients have higher odds of readmission and multiple grades of complications (including death) compared with White patients. Hispanic patients have higher odds of a Grade 3 complication compared with White patients. No significant differences were found with other races. Specific causes of these disparities are beyond the limitations of the dataset and stand as a topic for future inquiry.


title: Changes in Urology After the First Wave of the COVID-19 Pandemic

text: The COVID-19 pandemic has changed the world. Urology needs to overcome these challenges. Our duty is to provide care under any circumstances and our privilege is to re-examine and advance our field. The use of novel communication and health technologies will ensure safety while maintaining high-quality care.


Interim Management of COVID-19 by Repurposed Homeopathic Medicines


title: Evaluating the effects of campaign-style environmental governance: evidence from Environmental Protection Interview in China

text: Campaign-style governance is one of the political methods adopted by the Communist Party of China and the Chinese government, which is usually used to make up for shortcomings when regular governance policies fail because the defined tasks are incompatible with other policy goals, especially in the field of environmental governance. An "Environmental Protection Interview (EPI)" is one of the campaign-style environmental governance methods that target local officials. In this paper, the causal relationship between the implementation of EPI and pollutant emission reduction was confirmed using the method of Time-Varying Difference-in-difference (Time-Varying DID) to compensate for endogeneity problem and ensure that the results are still valid after several robustness checks. Our regional heterogeneous analysis shows that the policy effects of EPI decrease from east to west in China and that they have different emission reduction effects on various types of pollutants. Unfortunately, the results also suggest that policy implementation only temporarily affects pollutant emission reduction, which could be attributed to the governance approaches of campaign-style enforcement according to the impact mechanism analysis. This paper implies that the EPI should be continued to be implemented in the future with some improvements on pollutant reduction mechanisms to ensure effective adoption.


docid: oxokbyqz

title: PANDA: Policy-aware Location Privacy for Epidemic Surveillance

text: In this demonstration, we present a privacy-preserving epidemic surveillance system. Recently, many countries that suffer from coronavirus crises attempt to access citizen's location data to eliminate the outbreak. However, it raises privacy concerns and may open the doors to more invasive forms of surveillance in the name of public health. It also brings a challenge for privacy protection techniques: how can we leverage people's mobile data to help combat the pandemic without scarifying our location privacy. We demonstrate that we can have the best of the two worlds by implementing policy-based location privacy for epidemic surveillance. Specifically, we formalize the privacy policy using graphs in light of differential privacy, called policy graph. Our system has three primary functions for epidemic surveillance: location monitoring, epidemic analysis, and contact tracing. We provide an interactive tool allowing the attendees to explore and examine the usability of our system: (1) the utility of location monitor and disease transmission model estimation, (2) the procedure of contact tracing in our systems, and (3) the privacy-utility trade-offs w.r.t. different policy graphs. The attendees can find that it is possible to have the full functionality of epidemic surveillance while preserving location privacy.


SuperNurse? Troubling the Hero Discourse in COVID Times


Commentary: House calls, phone calls, or FaceTime! Postdischarge outcomes are improved by education and follow-up


Many paths to COVID-19 lymphocyte dysfunction


title: Roadmap to Resuming Care for Liver Diseases after COVID-19

text: The global pandemic of coronavirus disease-2019 (COVID-19) has led to significant disruptions in care delivery. Patients with chronic liver diseases require a high level of care and are therefore particularly vulnerable to disruptions in medical services during COVID-19. Recent data has also identified chronic liver disease as an independent risk factor for COVID-19 related hospital mortality. In response to the pandemic, national and international societies have recommended interim changes to the management of patients with liver diseases. These modifications included the implementation of telehealth, postponement or cancellation of elective procedures and other non-urgent patient care-related activities. There is concern that reduced access to diagnosis and treatment can also lead to increased morbidity in patients with liver diseases and we may witness a delayed surge of hospitalizations related to decompensated liver disease after the COVID-19 pandemic has receded. Therefore, it is paramount that liver practices craft a comprehensive plan for safe resumption of clinical operations while minimizing the risk of exposure to patients and healthcare professionals. Here, we provide a broad roadmap for how to safely resume care for patients with chronic liver disease according to various phases of the pandemic with particular emphasis on outpatient care, liver transplantation, liver cancer care and endoscopy.


COVID-19 associated coagulopathy: The crowning glory of thrombo-inflammation concept


High-immunological risk living donor renal transplant during the COVID-19 outbreak: Uncertainties and ethical dilemmas


title: "COVOID": A flexible, freely available stochastic individual contact model for exploring COVID-19 intervention and control strategies

text: BACKGROUND: Throughout March 2020, leaders in countries across the globe were making crucial decisions about how and when to implement public health interventions to combat COVID-19. They urgently needed tools to help them to explore what will work best in their specific circumstances of epidemic size and spread and feasible intervention scenarios. OBJECTIVE: We sought to rapidly develop a flexible, freely available simulation model for use by modellers and researchers to allow investigation of how various public health interventions implemented at various time points might change the shape of the COVID-19 epidemic curve. METHODS: "COVOID" (COVID-19 Open-source Infection Dynamics) is a stochastic individual contact model (ICM), which extends the ICMs provided by the open-source EpiModel package for the R statistical computing environment. To demonstrate its use and inform urgent decisions as at 30 March 2020, we modelled similar intervention scenarios to those reported by other investigators using various model types, as well as novel scenarios. The scenarios involved isolation of cases, moderate social distancing and stricter population "lock-downs" enacted over varying time periods, in a hypothetical population of 100,000 people. On 30 April 2020, we simulated the epidemic curve for the three contiguous local areas (population 287,344) in eastern Sydney, Australia, that recorded 5.3% of Australian cases of COVID-19 through to 30 April 2020, under five different intervention scenarios, and compared the modelled predictions with the observed epidemic curve for these areas. RESULTS: COVOID allocates each member of a population to one of seven compartments. The number of times individuals in the various compartments interact with each other and their probability of transmitting infection at each interaction can be varied to simulate the effects of interventions. Using COVOID on 30 March 2020, we were able to replicate the epidemic response patterns to specific social distancing intervention scenarios reported by others. The simulated curve for three local areas of Sydney from 1 March to 30 April 2020 was similar to the observed epidemic curve, in terms of peak numbers of cases, total numbers of cases and duration, under a scenario representing the public health measures that were actually enacted, including case isolation and ramp-up of testing and social distancing measures. CONCLUSIONS: COVOID allows rapid modelling of many potential intervention scenarios, can be tailored to diverse settings and requires only standard computing infrastructure. It replicates the epidemic curves produced by other models that require highly detailed population-level data, and its predicted epidemic curve, using parameters simulating the public health measures that were enacted, was similar in form to that actually observed in Sydney, Australia. Our team and collaborators are currently developing an extended open-source COVOID package comprising a suite of tools to explore intervention scenarios using several categories of model.


docid: zafipokx

title: COVID-19's Impact on Genetics at One Medical Center in New York


title: SARS - CoV-2: Reasons of epidemiology of severe ill disease cases and therapeutic approach using trivalent vaccine (tetanus, diphtheria and Bordetella pertussis)

text: The novel coronavirus Covid-19 follows transmission route and clinical presentation of all community-acquired coronaviruses. Instead, the rate of transmission is significative higher, with a faster spread of the virus responsible of the worldwide outbreak and a significative higher mortality rate due to the development of a severe lung injury. Most noteworthy is the distribution of death rate among age groups. Children and younger people are almost protected from severe clinical presentation. Possible explanation of this phenomenon could be the ability of past vaccinations (especially tetanic, diphtheria toxoids and inactivated bacteria as pertussis) to stimulate immune system and to generate a scattered immunity against non-self antigens in transit, as coronaviruses and other community-circulating viruses and make immune system readier to develop specific immunity against Covid-19. The first support to this hypothesis is the distribution of mortality rate during historical pandemics ("Spanish flu" 1918, "Asian flu" 1956 and "the Hong Kong flu" 1968) among age groups before and after the introduction of vaccines. The immunological support to the hypothesis derives from recent studies about immunotherapy for malignancies, which propose the use of oncolytic vaccines combined with toxoids in order to exploit CD4 + memory T cell recall in supporting the ongoing anti-tumour response. According to this hypothesis vaccine formulations (tetanus, diphtheria, Bordetella pertussis) could be re-administrate after the first contact with Covid-19, better before the development of respiratory severe illness and of course before full-blown ARDS (Acute Respiratory Distress Syndrome). The CD4 + memory exploiting could help immune system to recall immunity of already know antigens against coronaviruses, avoiding or limiting "lung crash" until virus specific immunity develops and making it faster and prolonged. Finally, this administration could be helpful not only in already infected patients, but also before infection. In fact, people could have an immune system more ready when the contact with the Covid-19 will occur.


docid: mtngelbr

title: SARS-CoV-2 variants: Relevance for symptom granularity, epidemiology, immunity (herd, vaccines), virus origin and containment?

text: The origin of the SARS-CoV-2 virus remains enigmatic. It is likely to be a continuum resulting from inevitable mutations and recombination events. These genetic changes keep developing in the present epidemic. Mutations tending to deplete the genome in its cytosine content will progressively lead to attenuation as a consequence of Muller's ratchet, but this is counteracted by recombination when different mutants co-infect the same host, in particular, in clusters of infection. Monitoring as a function of time the genome sequences in closely related cases is critical to anticipate the future of SARS-CoV-2 and hence of COVID-19.


docid: lnryqteg

title: Protection comes at a cost: Doctor's life inside personal protection equipment


Partha Kar: Covid-19-time for parity in commissioning diabetes services


title: Skin manifestations of COVID-19

text: Cutaneous manifestations, a well-known effect of viral infections, are beginning to be reported in patients with COVID-19 disease. These manifestations most often are morbilliform rash, urticaria, vesicular eruptions, acral lesions, and livedoid eruptions. Some of these cutaneous manifestations arise before the signs and symptoms more commonly associated with COVID-19, suggesting that they could be presenting signs of COVID-19. utaneous manifestations are well known to occur in the setting of viral illnesses, and occasionally these manifestations have diagnostic or prognostic value. With COVID-19, although we are at a relatively early point in the pandemic, cutaneous manifestations in infected patients are beginning to emerge from around the world. In this article, we describe some of the current cutaneous abnormalities observed in patients with COVID-19.


Delayed emergency surgical presentation: impact of corona virus disease (COVID-19) on non-COVID patients


title: Acute pulmonary embolism in COVID-19 disease: Preliminary report on seven patients

text: There is some evidence that Covid 19 pneumonia is associated with prothrombotic status and increased risk of venous thromboembolic events (deep venous thrombosis and pulmonary embolism). Over a two-week period we admitted in our Unit 25 patients with Covid-19 pneumonia, of these pulmonary embolism was diagnosed using computed tomography angiography in 7. We report on clinical and biochemical features of these patients. They were all males, with a mean age of 70.3 years (range 58-84); traditional risk factors for venous thromboembolism were identified in the majority of patients with pulmonary embolism, however not differently from those without pulmonary embolism. Clinical presentation of pulmonary embolism patients was usually characterized by persistence or worsening of respiratory symptoms, with increasing oxygen requirement. D-dimer levels were several fold higher than the upper threshold of normal; in patients in whom PE was recognized during hospital stay, a rapid and relevant increase of D-dimer levels was observed. Computed tomographic findings ranged from massive acute pulmonary embolism to a segmental or sub-segmental pattern; furthermore, thrombosis of sub-segmental pulmonary arteries within lung infiltrates were occasionally seen, suggesting local mechanisms. Six out of 7 patients were treated with unfractionated or low molecular weight heparin with clinical benefit within few days; one patient needed systemic thrombolysis (death from hemorrhagic complication).


Lung function monitoring in the era of respiratory pandemics


Microbiota-derived metabolites help regulatory B cells suppress arthritis


title: Telehealth Opportunities for the Otolaryngologist: A Silver Lining During the COVID-19 Pandemic

text: The utilization of telemedicine has seen a relatively slow progression over the past 50 years in the US health care system. Technological challenges limiting the ease of use of robust video platforms have been a major factor. Additionally, the perception by many health care providers that telehealth is reserved for only the rural population or that it provides limited value due to the inability to perform in-depth physical examinations contributes to the slow adoption. The COVID-19 pandemic, with its massive disruption in social interaction by way of "stay at home" orders, is serving as a catalyst for improving telehealth. Large health systems are investing millions of dollars and increasing telehealth visit numbers 100-fold to access patients. The "telehealth movement" is here to stay and will undoubtedly be incorporated into providers' daily lives years after the COVID-19 pandemic. By embracing virtual access to health care, otolaryngologists will be able to influence improvements to these systems and broaden access options for patient care well into the future.


Building an international consortium for tracking coronavirus health status


docid: ouicsrhb

title: COVID-19 quarantine and acute pulmonary embolism


title: Extracorporeal Membrane Oxygenation for Pediatric Patients With Coronavirus Disease 2019-Related Illness

text: OBJECTIVE: To describe current hospital guidelines and the opinions of extracorporeal membrane oxygenation leaders at U.S. children's hospitals concerning the use of extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patients. DESIGN: Confidential, self-administered questionnaire. SETTING: One hundred twenty-seven U.S. pediatric extracorporeal membrane oxygenation centers. SUBJECTS: Extracorporeal membrane oxygenation center program directors and coordinators. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In March 2020, a survey was sent to 127 pediatric extracorporeal membrane oxygenation centers asking them to report their current hospital extracorporeal membrane oxygenation guidelines for coronavirus disease 2019-positive patients. Respondents were also asked their opinion on three ethical dilemmas including: prioritization of children over adults for extracorporeal membrane oxygenation use, institution of do-not-resuscitate orders, and the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019-positive patients. Forty-seven extracorporeal membrane oxygenation centers had enacted guidelines including 46 (100%) that offer venovenous-extracorporeal membrane oxygenation and 42 (89%) that offer venoarterial-extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patients. Forty-four centers (94%) stated that the indications for extracorporeal membrane oxygenation candidacy in coronavirus disease 2019 disease were similar to those used in other viral illnesses, such as respiratory syncytial virus or influenza. Most program directors (98%) did not endorse that children hospitalized with coronavirus disease 2019 should be made do-not-resuscitate and had variable opinions on whether children should be given higher priority over adults when rationing extracorporeal membrane oxygenation. Over half of program directors (60%) did not support the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019. CONCLUSIONS: The majority of pediatric extracorporeal membrane oxygenation centers have proactively established guidelines for the use of extracorporeal membrane oxygenation for coronavirus disease 2019-related illnesses. Further work is needed to help guide the fair allocation of extracorporeal membrane oxygenation resources and to determine the appropriateness of extracorporeal cardiopulmonary resuscitation.


Qual o papel da Atenção Primária à Saúde diante da pandemia provocada pela COVID-19?/ Qual o papel da Atenção Primária à Saúde diante da pandemia provocada pela COVID-19?/ What is the role of Primary Health Care in the COVID-19 pandemic?


Covid-19: Government appoints former Olympics chief to lead PPE production drive


title: Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review

text: OBJECTIVE: To evaluate the effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome by performing a systematic review of available published literature on pregnancies affected by COVID-19. METHODS: We performed a systematic review to evaluate the effect of COVID-19 on pregnancy, perinatal and neonatal outcome. We conducted a comprehensive literature search using PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure Database and Wan Fang Data up to and including 20 April 2020 (studies were identified through PubMed alert after that date). For the search strategy, combinations of the following keywords and medical subject heading (MeSH) terms were used: 'SARS-CoV-2', 'COVID-19', 'coronavirus disease 2019', 'pregnancy', 'gestation', 'maternal', 'mother', 'vertical transmission', 'maternal-fetal transmission', 'intrauterine transmission', 'neonate', 'infant' and 'delivery'. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient being pregnant on admission and availability of clinical characteristics, including at least one maternal, perinatal or neonatal outcome. Exclusion criteria were non-peer-reviewed or unpublished reports, unspecified date and location of the study, suspicion of duplicate reporting and unreported maternal or perinatal outcomes. No language restrictions were applied. RESULTS: We identified a high number of relevant case reports and case series, but only 24 studies, including a total of 324 pregnant women with COVID-19, met the eligibility criteria and were included in the systematic review. These comprised nine case series (eight consecutive) and 15 case reports. A total of 20 pregnant patients with laboratory-confirmed COVID-19 were included in the case reports. In the combined data from the eight consecutive case series, including 211 (71.5%) cases of laboratory-confirmed and 84 (28.5%) of clinically diagnosed COVID-19, the maternal age ranged from 20 to 44 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath, fatigue and myalgia. The rate of severe pneumonia reported amongst the case series ranged from 0% to 14%, with the majority of the cases requiring admission to the intensive care unit. Almost all cases from the case series had positive computed tomography chest findings. All six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Only four cases of spontaneous miscarriage or termination were reported. In the consecutive case series, 219/295 women had delivered at the time of reporting and 78% of them had Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at both 1 and 5 min ranged from 7 to 10. Only eight neonates had birth weight < 2500 g and nearly one-third of neonates were transferred to the neonatal intensive care unit. There was one case of neonatal asphyxia and death. In 155 neonates that had nucleic-acid testing in throat swab, all, except three cases, were negative for SARS-CoV-2. There were no cases of maternal death in the eight consecutive case series. Seven maternal deaths, four intrauterine fetal deaths (one with twin pregnancy) and two neonatal deaths (twin pregnancy) were reported in a non-consecutive case series of nine cases with severe COVID-19. In the case reports, two maternal deaths, one neonatal death and two cases of neonatal SARS-CoV-2 infection were reported. CONCLUSIONS: Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good-quality data to draw unbiased conclusions with regard to the severity of the disease or specific complications of COVID-19 in pregnant women, as well as vertical transmission, perinatal and neonatal complications. In order to answer specific questions in relation to the impact of COVID-19 on pregnant women and their fetuses, through meaningful good-quality research, we urge researchers and investigators to present complete outcome data and reference previously published cases in their publications, and to record such reporting when the data of a case are entered into one or several registries. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.


Covid-19 and mobile phone hygiene in healthcare settings


Cohort PCR Testing: A Strategic Method for Rapid SARS-CoV-2 Screening


title: [The War Against the Coronavirus Disease (COVID-2019): Keys to Successfully Defending Taiwan]

text: The outbreak of COVID-19 triggered the largest human-virus war in this century. Current evidence indicates that the SARS-CoV-2 strain of coronavirus is mainly transmitted by droplets either by direct or indirect contact. The duration of infectiousness of COVID-19 ranges from 1-2 days before and 7-10 days after the onset of symptoms. It is often difficult to detect the signs and symptoms of infection and to implement timely intervention during the very early stage of infection. Thus, finding and isolating symptomatic patients may not be sufficient to contain this epidemic. Therefore, it is very important to wear masks, take personal precautions, and practice recommended social distancing to achieve source control and stop transmission. Taiwan has learned from its previous experience with the SARS epidemic and prepared for the potential of new disease outbreaks for at least 17 years. This helped the government to implement a multifaceted strategy in the early stages of the COVID-19 outbreak. Taiwan's effective response has made the country a model for pandemic response policy that has been appreciated internationally. This paper examines COVID-19 epidemic prevention from the perspective of infection control strategies. In Taiwan, hospital infection control, which is practiced nationwide, emphasizes the importance to epidemic prevention of collecting and tracking travel history, occupation, contact history, cluster (TOCC) information; practicing hand hygiene; promoting the correct use of personal protective equipment; and maintaining safe distances from others. Personal control measures are recognized as critical to providing a safe environment for patients and staff.


title: Analysing the resilience of the European commodity production system with PyResPro, the Python Production Resilience package

text: This paper presents a Python object-oriented software and code to compute the annual production resilience indicator. The annual production resilience indicator can be applied to different anthropic and natural systems such as agricultural production, natural vegetation and water resources. Here, we show an example of resilience analysis of the economic values of the agricultural production in Europe. The analysis is conducted for individual time-series in order to estimate the resilience of a single commodity and to groups of time-series in order to estimate the overall resilience of diversified production systems composed of different crops and/or different countries. The proposed software is powerful and easy to use with publicly available datasets such as the one used in this study.


title: Point-of-Care diagnostic of SARS-CoV-2: knowledge, attitudes, and perceptions (KAP) of medical workforce in Italy

text: INTRODUCTION: The present study aims to characterize knowledge, attitudes and beliefs in a sample of medical professionals towards point-of-care (POC) rapid tests for SARS-CoV-2 in Italy (April 2020). MATERIAL AND METHODS: A total of 561 professionals (42.6% males, 26.9% ≥ 50-year-old) compiled a specifically designed web questionnaire on characteristics of POC rapid tests. They were asked whether they would change daily practice and make clinical decisions according to POC tests. Multivariate odds ratios (aOR) for predictors of propensity towards the aforementioned behavioral outcomes were calculated through regression analysis. RESULTS: Overall, only 51.9% knew the official recommendations of the Italian Health Authorities for POC tests, while 26.0% of respondents considered POC tests for COVID-19 highly reliable. Still, 40.3% of respondents would change daily practice because of such tests, and 38.5% would make clinical decisions based of their results. Actual understanding of specificity and sensitivity of POC tests was not associated with assessed behavioral outcomes: main positive effectors were identified in perceived reliability and usefulness of rapid tests, acknowledging the existence of official recommendations, understanding the limited clinical implications of POC tests, and working as occupational physicians were characterized as negative effectors. Conclusions. Propensity of sampled professionals towards POC tests for COVID-19 was diffusely unsatisfying. While actual understanding of accuracy of such tests was not a main effector of propensity, previous experiences with other POC tests in daily practice, particularly among occupational physicians may have impaired overall acceptance of such instruments.


Adapting to the COVID-19 Pandemic: Continuing HIV Prevention Services for Adolescents Through Telemonitoring, Brazil


title: El servicio de farmacia: Gestión integral de productos sanitarios en SARS-CoV-2./ Hospital Pharmacy: Comprehensive management of medical devices during SARS-CoV-2

text: Medical devices have become essential to the prevention and control of the COVID-19 pandemic, being crucial for health professionals and patients in particular, and the population in general. It is important to be aware of the laws that regulate the management, distribution, and control of medical devices. Article 82 of the Spanish Law 29/2006 on Guarantees and Rational Use of Medicines and Medical Devices establishes that it is the responsibility of Hospital Pharmacy Services "to participate in and coordinate the purchase of medicines and medical devices in the hospital to ensure an efficient acquisition and rational use of medical devices". For this reason, working groups of the Spanish Society of Hospital Pharmacy and other scientific societies have issued technical guidelines and consensus statements to provide technical support and updated information on the use of masks, individual protection equipments and other medical devices. In addition, the shortage of medical devices caused by the high demand has resulted in the uncontrolled production and distribution of medical devices. This phenomenon, added to the fraudulent selling of medical devices, highlights the need for a closer surveillance of the market to guarantee the efficacy and safety of available medical devices. A rational use of medical devices is necessary to ensure the availability and safety of these products, which requires the involvement of different stakeholders, including hospital pharmacists. Thus, it is essential that hospital pharmacists receive specific training in technical aspects concerning the possession and use of medical devices. This will help guarantee an effective and safe use of medical products. The acquisition and use of medical devices requires a keen understanding of the technical and legal aspects concerning these products, which makes hospital pharmacists essential for the integral management of medical devices.


title: A rapid screening method for testing the efficiency of masks in breaking down aerosols

text: The highest risk of novel coronavirus SARS-CoV-2 to be spread through human-to-human transmission has boosted the use of personal protective equipment at worldwide level. In Europe, the medical face masks must be tested to certify the essential requirements in agreement with European Standard EN 14683:2019, and face masks for industrial use in agreement with European Standard EN 149:2009. Due to the need of large quantitative of medical and non-medical face masks in coronavirus outbreak, several Italian industries are working for shift a portion of their manufacturing capacity for producing medical and non-medical face mask. For screening evaluation of the effectiveness of personal protective equipment produced by reconverted industries, ARPA Lazio and the Department of Chemical Science and Technologies of Tor Vergata University have set-up an analytical system able to simulate the respiratory action and to measure the percentage of particles that pass through the face masks using optical particle counter (based on the EN 16890: 2017 that uses the same light scattering principle to evaluate the filter filtration efficiency). This set-up was challenged using face masks produced by reconverted industries and the data were compared with ones obtained using medical face mask.


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title: Possible treatment of Covid-19 with a therapeutic vaccine


Interactions of recommended COVID-19 drugs with commonly used psychotropics


What the law says about PPE responsibility


Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses with Overlapping Clinical Features


title: Multiplex Ventilation: A Simulation-Based Study of Ventilating 2 Patients With a Single Ventilator

text: BACKGROUND: The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients' resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (VT), end-expiratory lung volume (EELV), and imputed pH. METHODS: Two separate breathing simulators were ventilated with a ventilator using pressure control and volume control ventilation modes. Evidence-based lung models simulated a range of differences in resistance and compliance (6 pairs of simulated patients). Differences in VT, EELV, and imputed pH were recorded. RESULTS: Depending on differences in resistance and compliance, differences in VT ranged from 1% (with equal resistance and compliance) to 79%. Differences in EELV ranged from 2% to 109%, whereas differences in pH ranged from 0% to 5%. Failure due to excessive VT (ie, > 8 mL/kg) did not occur, but failure due to excessive EELV difference (ie, > 10%) was evident in 50% of patient pairs. There was no difference in failure rate between volume control and pressure control ventilation modes. CONCLUSIONS: These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of VT delivered to each patient, and (3) provision for individual PEEP. We provide suggestions for solving these problems.


docid: ksiaulkd

title: Digital triage for people with multiple sclerosis in the age of COVID-19 pandemic

text: We propose a possible approach for the remote monitoring of infection risk in people with multiple sclerosis, especially those on immunosuppressant drugs, during COVID-19 pandemic. We developed a digital triage tool to be sent to patients to quickly identify people with high risk of COVID-19 infection. This tool will also limit unnecessary accesses to the MS centers reducing the risk of spreading the infection.


title: Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19

text: As a zoonotic disease that has already spread globally to several million human beings and possibly to domestic and wild animals, eradication of coronavirus disease 2019 (COVID-19) appears practically impossible. There is a pressing need to improve our understanding of the immunology of this disease to contain the pandemic by developing vaccines and medicines for the prevention and treatment of patients. In this review, we aim to improve our understanding on the immune response and immunopathological changes in patients linked to deteriorating clinical conditions such as cytokine storm, acute respiratory distress syndrome, autopsy findings and changes in acute-phase reactants, and serum biochemistry in COVID-19. Similar to many other viral infections, asymptomatic disease is present in a significant but currently unknown fraction of the affected individuals. In the majority of the patients, a 1-week, self-limiting viral respiratory disease typically occurs, which ends with the development of neutralizing antiviral T cell and antibody immunity. The IgM-, IgA-, and IgG-type virus-specific antibodies levels are important measurements to predict population immunity against this disease and whether cross-reactivity with other coronaviruses is taking place. High viral load during the first infection and repeated exposure to virus especially in healthcare workers can be an important factor for severity of disease. It should be noted that many aspects of severe patients are unique to COVID-19 and are rarely observed in other respiratory viral infections, such as severe lymphopenia and eosinopenia, extensive pneumonia and lung tissue damage, a cytokine storm leading to acute respiratory distress syndrome, and multiorgan failure. Lymphopenia causes a defect in antiviral and immune regulatory immunity. At the same time, a cytokine storm starts with extensive activation of cytokine-secreting cells with innate and adaptive immune mechanisms both of which contribute to a poor prognosis. Elevated levels of acute-phase reactants and lymphopenia are early predictors of high disease severity. Prevention of development to severe disease, cytokine storm, acute respiratory distress syndrome, and novel approaches to prevent their development will be main routes for future research areas. As we learn to live amidst the virus, understanding the immunology of the disease can assist in containing the pandemic and in developing vaccines and medicines to prevent and treat individual patients.


title: BIMCV COVID-19+: a large annotated dataset of RX and CT images from COVID-19 patients

text: This paper describes BIMCV COVID-19+, a large dataset from the Valencian Region Medical ImageBank (BIMCV) containing chest X-ray images CXR (CR, DX) and computed tomography (CT) imaging of COVID-19+ patients along with their radiological findings and locations, pathologies, radiological reports (in Spanish), DICOM metadata, Polymerase chain reaction (PCR), Immunoglobulin G (IgG) and Immunoglobulin M (IgM) diagnostic antibody tests. The findings have been mapped onto standard Unified Medical Language System (UMLS) terminology and cover a wide spectrum of thoracic entities, unlike the considerably more reduced number of entities annotated in previous datasets. Images are stored in high resolution and entities are localized with anatomical labels and stored in a Medical Imaging Data Structure (MIDS) format. In addition, 10 images were annotated by a team of radiologists to include semantic segmentation of radiological findings. This first iteration of the database includes 1,380 CX, 885 DX and 163 CT studies from 1,311 COVID-19+ patients. This is, to the best of our knowledge, the largest COVID-19+ dataset of images available in an open format. The dataset can be downloaded from http://bimcv.cipf.es/bimcv-projects/bimcv-covid19.


title: Response of Practicing Chiropractors during the Early Phase of the COVID-19 Pandemic: A Descriptive Report

text: OBJECTIVE: The coronavirus disease-2019 (COVID-19) pandemic has strained all levels of healthcare and it is not known how chiropractic practitioners have responded to this crisis. The purpose of this report is to describe responses by a sample of chiropractors during the early stages of the COVID-19 pandemic. METHODS: We used a qualitative-constructivist design to understand chiropractic practice during the COVID-19 pandemic, as described by the participants. A sample of chiropractic practitioners (doctors of chiropractic, chiropractors) from various international locations were invited to participate. Each described the public health response to COVID-19 in their location and the actions that they took in their chiropractic practices from April 20 through May 4, 2020. A summary report was created from their responses and common themes were identified. RESULTS: Eighteen chiropractic practitioners representing 17 locations and 11 countries participated. A variety of practice environments were represented in this sample, including, solo practice, mobile practice, private hospital, US Veterans Administration health care, worksite health center, and group practice. They reported that they recognized and abided by changing governmental regulations. They observed their patients experience increased stress and mental health concerns resulting from the pandemic. They adopted innovative strategies, such as telehealth, to do outreach, communicate with, and provide care for patients. They abided by national and World Health Organization recommendations and they adopted creative strategies to maintain connectivity with patients through a people-centered, integrated, and collaborative approach. CONCLUSION: Although the chiropractors in this sample practiced in different cities and countries, their compliance with local regulations, concern for staff and patient safety, and people-centered responses were consistent. This sample covers all 7 World Federation of Chiropractic regions (ie, African, Asian, Eastern Mediterranean, European, Latin American, North American, and Pacific) and provides insights into measures taken by chiropractors during the early stages of the COVID-19 pandemic. This information may assist the chiropractic profession as it prepares for different scenarios as new evidence about this disease evolves.