bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterisation of Acute Kidney Injury in Critically Ill Patients with Severe Coronavirus Disease-2019 (COVID-19)
Authors: Rubin Sébastien , Orieux Arthur , Prevel Renaud , Garric Antoine , Bats Marie-Lise , Dabernat Sandrine , Camou Fabrice , Guisset Olivier , Issa Nahema , Mourissoux Gaelle , Dewitte Antoine , Joannes-Boyau Olivier , Fleureau Catherine , Rozé Hadrien , Carrié Cédric , Petit Laurent , Clouzeau Benjamin , Sazio Charline , Bui Hoang-Nam , Pillet Odile , Rigothier Claire , Vargas Frederic , Combe Christian , Gruson Didier , Boyer Alexandre
Published: May 2020

Background

COVID-19-associated acute kidney injury frequency, severity and characterisation in critically ill patients has not been reported.

Methods

Single-center cohort performed from March 3, 2020, to April 14, 2020 in 4 intensive care units in Bordeaux University Hospital, France. All patients with COVID19 and pulmonary severity criteria were included. AKI was defined using KDIGO criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterisation (transient vs. persistent acute kidney injury; proteinuria, hematuria and glycosuria), and short-term outcomes was evaluated.

Results

71 patients were included, with basal serum creatinine of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median follow-up was 17 [12–23] days. AKI developed in a total of 57/71 (80%) patients with 35% Stage 1, 35% Stage 2, and 30% Stage 3 acute kidney injury; 10/57 (18%) required renal replacement therapy. Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median urine protein/creatinine of 82 [54–140] (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20 indicating predominant tubulo-interstitial injury. Only 2 (4%) patients had glycosuria. At Day 7 onset of after AKI, six (11%) patients remained dependent on renal replacement therapy, nine (16%) had SCr > 200 µmol/L, and four (7%) died. Day 7 and day 14 renal recovery occurred in 28% and 52 % respectively.

Conclusion

COVID-19-associated AKI is frequent, persistent severe and characterised by an almost exclusive tubulo-interstitial injury without glycosuria.
Higher BMI, but not obesity-related genetic polymorphisms, correlates with reduced structural connectivity of the reward network
Authors: Beyer Frauke , Zhang Rui , Scholz Markus , Wirkner Kerstin , Loeffler Markus , Stumvoll Michael , Villringer Arno , Witte A. Veronica
Published: May 2020

Background

Obesity is of complex origin, involving genetic and neurobehavioral factors. Most consistently, polymorphisms in the fat-and-obesity associated gene (FTO) may increase the risk for developing obesity by modulating dopaminergic signaling in the brain. Dopamine-dependent behaviors, such as reward processing, are crucial for eating behavior and are altered in obesity. Yet, few studies have investigated the association of obesity, related genetic variants and structural connectivity of the dopaminergic reward network.

Methods

We analyzed 378 participants (age range: 20 – 59 years, BMI range: 17 – 38 kg/m2) of the LIFE-Adult Study. Genotyping for the single nucleotid polymorphisms rs1558902 (FTO) and rs1800497 (near dopamine D2 receptor) was performed on a micro-array. Structural connectivity of the reward network was derived from diffusion-weighted magnetic resonance imaging at 3 Tesla using deterministic tractography of Freesurfer-de-rived regions of interest. Using graph metrics, we extracted summary measures of clustering coefficient and connectivity strength between frontal and striatal brain regions, normalized for global connectivity. We applied linear regression models to test the association of BMI, risk alleles of both variants and reward network connectivity.

Results

Higher BMI was significantly associated with reduced connectivity strength for fractional anisotropy (β= −0.0011, 95%-C.I. [−0.0019, −0.0003], p= 0.0062) and number of streamlines (β = −0.0026, 95%-C.I.:[−0.004,−0.0009], p= 0.0024), but not clustering coefficient. Strongest associations were found for right accumbens, right lateral orbitofrontal cortex and left putamen. As expected, the polymorphism rs1558902 in FTO was associated with higher BMI (F=7.9, p<0.001). None of the genetic variants was associated with reward network structural connectivity.

Conclusions

Here, we provide evidence that higher BMI correlates with reduced reward network structural connectivity. This result is in line with previous findings of obesity-related decline in white matter microstructure. We did not find any association of variants in FTO or near DRD2 receptor and reward network structural connectivity, indicating that the genetic influence of these variants is small or non-existent. Future research should investigate the behavioral implications of structural connectivity differences in the fronto-striatal network and incorporate larger sample sizes with longitudinal designs in order to gain further insight into the genetic determinants of obesity in the brain.
Associations between ambient air pollutants exposure and case fatality rate of COVID-19: a multi-city ecological study in China
Authors: Zhang Tiantian , Zhao Guoli , Luo Li , Li Yongzhen , Shi Wenming
Published: May 2020

Background

Environmental factors, including air pollution, can strongly impact on spatio-temporal patterns of infectious diseases outbreak. In this study, we aimed to investigate the association and correlation between ambient air pollutants and case fatality rate (CFR) of the novel coronavirus disease (COVID-19) in China.

Methods

Publicly accessible data on COVID-19 average CFR were utilized in the data analysis. The ambient daily air pollutants including fine particulate matter (PM2.5), inhalable particles (PM10) and nitrogen dioxide (NO2) during the period from December 25, 2019 to March 5, 2020 were obtained from National Air Quality Real-time Publishing System of China. Ecological analysis was performed to explore the association and correlation between the cumulative average exposure of ambient air pollutants at different lag days (14 and 28 days) and average CFR in China outside Hubei and cities in Hubei province via model fitting.

Results

The average case fatality rate was highest in Wuhan city (4.53%) and the cumulative average exposure of ambient PM2.5, PM10 and NO2 at lag 28 days was 55.8±12.1μg/m3, 66.8±9.2μg/m3, 20.7±4.4μg/m3, respectively in Hubei province during the study period. Ecological analysis showed that ambient PM2.5, PM10 and NO2 exposure at both lag 14 and 28 days was positively correlated with average CFR in China outside Hubei (province-level). For city-level analysis in Hubei, significant associations were only found between cumulative ambient NO2 exposure and average CFR(r=0.693 for Lag0-14, r=0.697 for Lag0-28, respectively) during the same period.

Conclusion

Our findings suggested ambient PM2.5, PM10 and NO2 exposure, especially at 28 lag days, positively associated with the case fatality rate of COVID-19 in China. These results could help provide guidance for identifying potential exposure window and preventing and controlling the epidemic.
Study of Hepatitis C Virus infection among multi-transfused patients with inherited β-globin synthesis gene defect, in the eastern region of India
Authors: Dutta Supradip , Biswas Aritra , Choudhury Promisree , Bakshi Sagnik , Chowdhury Prosanto , Bhattacharyya Maitreyee , Chakraborty Sharmistha , Dutta Shanta , Sadhukhan Provash C
Published: May 2020

Background

Post transfusion acquired HCV infection is common in high-risk group individuals such as multi-transfused β-thalassemia patients who depend on regular blood transfusions. This study was conducted to determine epidemiology and distribution of HCV in multi-transfused β-thalassemia patients, in West Bengal, India.

Methods

Over a span of six years blood samples were collected from HCV sero-reactive β-thalassemic patients and processed for viral RNA isolation followed by nested RT-PCR for qualitative viremia detection. HCV genotype was determined by amplifying partial HCV core gene by nested RT-PCR, DNA sequencing and using NCBI genotyping tools. Phylogenetic and phylogeographic studies were performed with online MEGA-X and BEAST 1.10.0 software respectively.

Results

Out of 917 multi-transfused HCV sero-reactive β-thalassemic patients, 598 (65.21%) were positive for HCV RNA while 250 (41.80%) had spontaneously cleared the virus. Female thalassemic patients and individuals belonging to ages 10-14 years had higher chances of spontaneous clearance. The most prevalent circulatory HCV genotype was 3a (78.11%) followed by 1b (12.20%). Phylogeographic analyses revealed that the 3a strains share similarity with Pakistan, Sri Lanka and Thailand whereas the 1b strains share similarity with Thailand, Vietnam, Russia and China.

Conclusion

The prevalence of HCV infection is very high among Indian β-thalassemic patients, necessitates a critical look into the prevailing transfusion practices and requires implementation of more rigid donor screening criteria to decrease the rate of transfusion transmitted HCV infection, especially in multi-transfused thalassemic patients. The use of more sensitive NAT based assays for HCV detection in donor blood is a compressing need of the hour.
Perceived Stress and Psychological (Dis)Stress among Indian Endodontists During COVID19 Pandemic Lock down
Authors: Kumar Anil RN , Karumaran SC , Kattula Deepthi , Thavarajah Rooban , Anusa AM
Published: May 2020

ASBTRACT

Background

The novel 2019 coronavirus(COVID-19) spreads by respiratory and aerosols. COVID19 driven pandemic causes panic, fear and stress among all strata of society. Like all other medical professions, dentists, particularly endodontists, who are highly exposed to aerosols would be exposed to stress. The aim of this study was to assess the (dis)stress among Indian endodontists and the factors that could influence the (dis)stress.

Methods

From 8th April to 16th April 2020, we conducted an online survey in closed endodontic social media using snowball sampling technique, collecting basic demographic data, practice setting and relevant data. Psychological stress and perceived distress were collected through COVID-19 Peri-traumatic Distress Index (CPDI) and Perceived stress scale (PSS). Multinomial regression analysis was performed to estimate relative risk rate and P≤0.05 was considered significant.

Results

This study had 586 Indian endodontists completing this survey across India. Of these, 311 (53.07%) were males, 325(55%) in the age group of 25-35 years, 64%in urban areas, 13.14% in solo-practice and a fourth of them were residents. Female endodontists had high perceived stress (RRR=2.46,P=0.01) as compared to males, as measured by PSS. Younger endodontists<25 years(RRR=9.75;P=0.002) and 25-35years (RRR=4.60;P=0.004) as compared with >45 years age-group had more distress. Exclusive consultants had RRR= 2.90, P=0.02, for mild-to-moderate distress as compared to normal. Factors driving this phenomenon are considered.

Conclusions

During the lock down due to COVID-19, 1-in-2 Indian endodontists had distress, as measured by CPDI and 4-in-5 of them had perceived stress, as indicated by PSS. Our model identified certain factors driving the (dis)stress, which would help policy framers to initiate appropriate response.
Inference of causal relationships between sleep-related traits and 1,527 phenotypes using genetic data
Authors: García-Marín Luis M. , Campos Adrián I. , Martin Nicholas G. , Cuéllar-Partida Gabriel , Rentería Miguel E.
Published: May 2020

Study Objective

Sleep is essential for both physical and mental health. There is an increasing interest in understanding how different factors shape individual variation in sleep duration, quality and patterns, or confer risk for sleep disorders. The present study aimed to identify novel causal relationships between sleep-related traits and other phenotypes, using a genetics-driven hypothesis-free approach not requiring longitudinal data.

Methods

We used genetic data and the latent causal variable (LCV) method to screen the phenome and infer causal relationships between seven sleep-related traits (insomnia, daytime dozing, easiness of getting up in the morning, snoring, sleep duration, napping, and morningness) and 1,527 different phenotypes.

Results

We identify 84 significant causal relationships. Among other findings, poor health of musculoskeletal and connective tissue disorders increase insomnia risk and reduce sleep duration; depression-related traits increase insomnia and daytime dozing; insomnia, napping and snoring are affected by obesity and cardiometabolic traits and diseases; and working with asbestos, thinner, or glues increases insomnia, potentially through an increased risk of respiratory disease.

Conclusion

Overall, our results indicate that changes in sleep variables are predominantly the consequence, rather than the cause, of other underlying phenotypes and diseases. These insights could inform the design of future epidemiological and interventional studies in sleep medicine and research.
Mobility Reduction and Covid-19 Transmission Rates
Authors: Bergman Nittai K. , Fishman Ram
Published: May 2020

Assessing the contribution of mobility restrictions to the control of Covid-19 diffusion is an urgent challenge of global import. We analyze the relation between transmission rates (estimated effective reproduction numbers) and societal mobility levels using fine-grained daily mobility data from Google and Apple in an international panel of 87 countries and a panel of all states in the United States. Reduced form regression estimates that flexibly control for time trends suggest that a 10 percentage point reduction in mobility is associated with a 0.04-0.09 reduction in the value of the effective reproduction number, R(t), depending on geographical region and modelling choice. According to these estimates, to avoid the critical value of R = 1, easing mobility restrictions may have to be limited to below pre-pandemic levels or delayed until other non-mobility related preventative measures reduce R to a level of 0.55–0.7 in Europe, a level of 0.64–0.76 in Asia, and a level of 0.8 in the United States. Given gaps in data availability and inference challenges, these estimates should be interpreted with caution.
A simple model to fit the time evolution of the daily death rate of Covid-19 in European Union countries
Authors: Beau Tristan , Browaeys Julien , Dadoun Olivier
Published: May 2020

We suggest a minimal model to describe the evolution of daily deaths due to Covid-19 in the European Union (EU) and UK, without any epidemiological hypothesis. Assuming current lockdown conditions were to remain in place, as of May 3rd 2020, this ad hoc fitting model is forecasting a total of 204 586 deaths in the EU. We could currently be at 2/3 of the total casualty count, and reach an overall death rate of one over 2 500 people.
Neutrophil calprotectin identifies severe pulmonary disease in COVID-19
Authors: Shi Hui , Zuo Yu , Yalavarthi Srilakshmi , Gockman Kelsey , Zuo Melanie , Madison Jacqueline A. , Blair Christopher , Woodward Wrenn , Lezak Sean P. , Lugogo Njira L. , Woods Robert J. , Lood Christian , Knight Jason S. , Kanthi Yogendra
Published: May 2020

Severe cases of coronavirus disease 2019 (COVID-19) are regularly complicated by respiratory failure. While it has been suggested that elevated levels of blood neutrophils associate with worsening oxygenation in COVID-19, it is unknown whether neutrophils are drivers of the thrombo-inflammatory storm or simple bystanders. To better understand the potential role of neutrophils in COVID-19, we measured levels of the neutrophil activation marker S100A8/A9 (calprotectin) in hospitalized patients and determined its relationship to severity of illness and respiratory status. Patients with COVID-19 (n=172) had markedly elevated levels of calprotectin in their blood. Calprotectin tracked with other acute phase reactants including C-reactive protein, ferritin, lactate dehydrogenase, and absolute neutrophil count, but was superior in identifying patients requiring mechanical ventilation. In longitudinal samples, calprotectin rose as oxygenation worsened. When tested on day 1 or 2 of hospitalization (n=94 patients), calprotectin levels were significantly higher in patients who progressed to severe COVID-19 requiring mechanical ventilation (8039 ± 7031 ng/ml, n=32) as compared to those who remained free of intubation (3365 ± 3146, p<0.0001). In summary, serum calprotectin levels track closely with current and future COVID-19 severity, implicating neutrophils as potential perpetuators of inflammation and respiratory compromise in COVID-19.
How to Flatten the post-lockdown epidemic trajectory
Authors: Sasikumar Roschen , Haridas Ajit
Published: May 2020

Populations are locked down during an epidemic to slow down the rate of infection so that epidemic trajectory is "flattened". This helps to keep cases at a manageable level. Given the enormous economic damage and misery caused by a lockdown, it is imperative to keep the lockdown period limited. A lockdown is useful only if it can be ensured that after the lockdown is lifted, the epidemic trajectory does not rise sharply again. We present here the results from a mathematical model of the epidemic which examines how the timing, strength and duration of the lockdown affects the post-lockdown epidemic trajectory. Our results show the following:

A early lockdown (imposed when less than 1% of the population has been infected), of any reasonable duration, cannot prevent the return of the epidemic when the lockdown is lifted. The curve starts climbing soon after lifting the lockdown and reaches a peak of the same height as the no-lockdown curve

The post-lockdown trajectory can be flattened only if the lockdown is imposed after about 10% of the population has recovered after infection.

The slope of the post-lockdown epidemic curve depends on the level of immunity built up in the population before and during the lockdown period. Application of lockdown around the inflexion point of the epidemic curve (the point of maximum slope of the curve) ensures that the post-lockdown curve is also flattened.
A simple arithmetic rationale for crushing the epidemic curve of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) instead of flattening it
Authors: Killeen Gerry F.
Published: May 2020

Countries with ambitious strategies to crush the curve of their epidemic trajectories, to promptly eliminate SARS-CoV-2 transmission at national level, include China, Korea, Japan, Taiwan, New Zealand and Australia. In stark contrast, many of the European countries hit hardest over the last two months, including Italy, Spain, France, Ireland and the United Kingdom, currently appear content to merely flatten the curve of their epidemic trajectories so that transmission persists at rates their critical care services can cope with. Here is presented a simple set of arithmetic modelling analyses that explain why preferable crush the curve strategies, to eliminate transmission within months, would require only a modest amount of additional containment effort when compared to flatten the curve strategies that allow epidemics to persist at a steady, supposedly manageable level for years, decades or even indefinitely.
Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Outcome of COVID-19 : A Systematic Review and Meta-analysis
Authors: Abdulhak Aref A. Bin , Kashour Tarek , Noman Anas , Tlayjeh Haytham , Mohsen Ala , Al-Mallah Mouaz H. , Tleyjeh Imad M.
Published: May 2020

Importance

There is conflicting evidence about the role of angiotensin converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) in the pathogenesis and outcome of patients infected with acute severe respiratory syndrome coronavirus 2 (SARS-CoV-2) and growing public concerns about their use during this pandemic.

Objective

We sought to systematically review the literature and perform a meta-analysis about prior use of ACEI/ARBs and outcome of COVID-19 patients.

Data source

We searched multiple data sources including PubMed, ClinicalTrial.org, and medrxiv.org from November 2019 through May 3, 2020.

Study selection

Any study that reported on the role of ACEIs / ARBs and outcome of COIVD-19 is eligible. Two authors independently reviewed eligible studies and extracted data into a prespecified data collection form.

Data synthesis

An inverse variance meta-analytic approach was used to pool adjusted odds ratios using a random effect model meta-analysis. I 2 test was used to assess in between studies heterogeneity. The Newcastle-Ottawa quality assessment scale was used to assess the quality of included studies.

Main outcome and Measures

The association between the prior use of ACEIs / ARBs and the mortality among SARS-CoV-2 infected patients was assessed using pooled OR and 95% confidence interval. For studies that did not report adjusted effect estimates for mortality, we used their adjusted effect estimate of critical outcome to estimate another pooled OR for critical or fatal outcome and its 95% confidence interval.

Results

Nine studies were included in this systematic review. The studies included a total of 58,615 patients infected with SARS-CoV-2. Prior use of ACEIs and/or ARBs was associated with a significant reduction of inpatient mortality among SARS-CoV-2 infected patients, with a pooled adjusted OR from 4 studies of 0.33, 95% CI [0.22, 0.49] with no between studies heterogeneity (12=0%) and with a significant reduction of critical or fatal outcome, with a pooled adjusted OR from 5 studies of 0.32, 95% CI [0.22, 0.46] (12 =32%).

Conclusion

Our meta-analysis suggests that use of ACEIs/ARBs is associated with a decreased risk of death or critical outcome among SARS-CoV-2 infected patients. This finding is limited by the observational nature of the included studies. However, it provides a reassurance to the public not to stop prescribed ACEIs/ARBs due to fear of severe COVID-19. It also calls upon investigators and ethics committees to reconsider the ongoing randomized trials of discontinuation of these drugs.
Suppression of Groups Intermingling as Appealing Option For Flattening and Delaying the Epidemiologic Curve While Allowing Economic and Social Life at Bearable Level During COVID-19 Pandemic
Authors: Bâldea Ioan
Published: May 2020

In this work, we simulate the COVID-19 pandemic dynamics in a population modeled as a network of groups wherein infection can propagate both via intra-group and via inter-group interactions. Our results emphasize the importance of diminishing the inter-group infections in the effort of substantial flattening and delaying of the epi(demiologic) curve with concomitant mitigation of disastrous economy and social consequences. To exemplify with a limiting case, splitting a population into m (say, 5 or 10) noninteracting groups while keeping intra-group interaction unchanged yields a stretched epidemiologic curve having the maximum number of daily infections reduced and postponed in time by the same factor m (5 or 10). More generally, our study suggests a practical approach to fight against SARS-CoV-2 virus spread based on population splitting into groups and minimizing intermingling between them. This strategy can be pursued by large-scale infrastructure reorganization of activity at different levels in big logistic units (e.g., large productive networks, factories, enterprises, warehouses, schools, (seasonal) harvest work). Importantly, unlike total lockdwon strategy, the proposed approach prevents economic ruin and keeps social life at a more bearable level than distancing everyone from anyone.
The disease-induced herd immunity level for Covid-19 is substantially lower than the classical herd immunity level
Authors: Britton Tom , Ball Frank , Trapman Pieter
Published: May 2020

Most countries are suffering severely from the ongoing covid-19 pandemic despite various levels of preventive measures. A common question is if and when a country or region will reach herd immunityh. The classical herd immunity levelhCis defined ashC=1−1/R0, whereR0is the basic reproduction number, for covid-19 estimated to lie somewhere in the range 2.2-3.5 depending on country and region. It is shown here that the disease-induced herd immunity levelhD, after an outbreak has taken place in a country/region with a set of preventive measures put in place, is actually substantially smaller thanhC. As an illustration we show that ifR0=2.5 in an age-structured community with mixing rates fitted to social activity studies, and also categorizing individuals into three categories: low active, average active and high active, and where preventive measures affect all mixing rates proportionally, then the disease-induced herd immunity level ishD= 43% rather thanhC=1−1/2.5 = 60%. Consequently, a lower fraction infected is required for herd immunity to appear. The underlying reason is that when immunity is induced by disease spreading, the proportion infected in groups with high contact rates is greater than that in groups with low contact rates. Consequently, disease-induced immunity is stronger than when immunity is uniformly distributed in the community as in the classical herd immunity level.
Who can go back to work when the COVID-19 pandemic remits?
Authors: Hierro Luis Angel , Cantarero David , Patiño David , Arenaza Daniel Rodríguez-Pérez de
Published: May 2020

This paper seeks to determine which workers affected by lockdown measures can return to work when a government decides to apply lockdown exit strategies. This system, which we call Sequential Selective Multidimensional Decision (SSMD), involves deciding sequentially, by geographical areas, sectors of activity, age groups and immunity, which workers can return to work at a given time according to the epidemiological criteria of the country as well as that of a group of reference countries, used as a benchmark, that have suffered a lower level of lockdown de-escalation strategies. We apply SSMD to Spain, based on affiliation to the Social Security system prior to the COVID-19 pandemic, and conclude that 98.37% of the population could be affected. The proposed system makes it possible to accurately identify the target population for serological IgG antibody tests in the work field, as well as those affected by special income replacement measures due to lockdown being maintained over a longer period.
Age-adjusted associations between comorbidity and outcomes of COVID-19: a review of the evidence
Authors: Mason Kate E. , McHale Philip , Pennington Andy , Maudsley Gillian , Day Jennifer , Barr Ben
Published: May 2020

Background

Current evidence suggests that older people and people with underlying comorbidities are at increased risk of severe disease and death following hospitalisation with COVID-19. As comorbidity increases with age, it is necessary to understand the age-adjusted relationship between comorbidity and COVID-19 outcomes, in order to enhance planning capabilities and our understanding of COVID-19.

Methods

We conducted a rapid, comprehensive review of the literature up to 10 April 2020, to assess the international empirical evidence on the association between comorbidities and severe or critical care outcomes of COVID-19, after accounting for age, among hospitalised patients with COVID-19.

Results

After screening 579 studies, we identified seven studies eligible for inclusion and these were synthesised narratively. All were from China. The emerging evidence base mostly indicates that after adjustment for age (and in some cases other potential confounders), obesity, hypertension, diabetes mellitus, chronic obstructive airways disease (COPD), and cancer are all associated with worse outcomes. The largest study, using a large nationwide sample of COVID-19 patients in China, found that those with multiple comorbidities had more than twice the risk of a severe outcome or death compared with patients with no comorbidities, after adjusting for age and smoking (HR=2.59, 95% CI 1.61, 4.17).

Conclusions

This review summarises for clinicians, policymakers, and academics the most robust evidence to date on this topic, to inform the management of patients and control measures for tackling the pandemic. Given the intersection of comorbidity with ethnicity and social disadvantage, these findings also have important implications for health inequalities. As the pandemic develops, further research should confirm these trends in other settings outside China and explore mechanisms by which various underlying health conditions increase risk of severe COVID-19.
Bidirectional contact tracing dramatically improves COVID-19 control
Authors: Bradshaw William J. , Alley Ethan C. , Huggins Jonathan H. , Lloyd Alun L. , Esvelt Kevin M.
Published: May 2020

Contact tracing is critical to controlling COVID-19, but most protocols only “forward-trace” to notify people who were recently exposed. Using a stochastic branching-process model, we show that “bidirectional” tracing to identify infector individuals and their other infectees robustly improves outbreak control, reducing the effective reproduction number (Reff) by at least ∼0.3 while dramatically increasing resilience to low case ascertainment and test sensitivity. Adding smartphone-based exposure notification can further reduce Reff by 0.25, but only if nearly all smartphones can detect exposure events. Our results suggest that with or without digital approaches, implementing bidirectional tracing will enable health agencies to control COVID-19 more effectively without requiring high-cost interventions.
The RBD Of The Spike Protein Of SARS-Group Coronaviruses Is A Highly Specific Target Of SARS-CoV-2 Antibodies But Not Other Pathogenic Human and Animal Coronavirus Antibodies
Authors: Premkumar Lakshmanane , Segovia-Chumbez Bruno , Jadi Ramesh , Martinez David R. , Raut Rajendra , Markmann Alena , Cornaby Caleb , Bartelt Luther , Weiss Susan , Park Yara , Edwards Caitlin E. , Weimer Eric , Scherer Erin M. , Roupael Nadine , Edupuganti Sri , Weiskopf Daniela , Tse Longping V. , Hou Yixuan J. , Margolis David , Sette Alessandro , Collins Matthew H. , Schmitz John , Baric Ralph S. , de Silva Aravinda M.
Published: May 2020

A new Severe Acute Respiratory Syndrome Coronavirus variant (SARS-CoV-2) that first emerged in late 2019 is responsible for a pandemic of severe respiratory illness. People infected with this highly contagious virus present with clinically inapparent, mild or severe disease. Currently, the presence of the virus in individual patients and at the population level is being monitored by testing symptomatic cases by PCR for the presence of viral RNA. There is an urgent need for SARS-CoV-2 serologic tests to identify all infected individuals, irrespective of clinical symptoms, to conduct surveillance and implement strategies to contain spread. As the receptor binding domain (RBD) of the viral spike (S) protein is poorly conserved between SARS-CoVs and other pathogenic human coronaviruses, the RBD represents a promising antigen for detecting CoV specific antibodies in people. Here we use a large panel of human sera (70 SARS-CoV-2 patients and 71 control subjects) and hyperimmune sera from animals exposed to zoonotic CoVs to evaluate the performance of the RBD as an antigen for accurate detection of SARS-CoV-2-specific antibodies. By day 9 after the onset of symptoms, the recombinant SARS-CoV-2 RBD antigen was highly sensitive (98%) and specific (100%) to antibodies induced by SARS-CoVs. We observed a robust correlation between levels of RBD binding antibodies and SARS-CoV-2 neutralizing antibodies in patients. Our results, which reveal the early kinetics of SARS-CoV-2 antibody responses, strongly support the use of RBD-based antibody assays for population-level surveillance and as a correlate of neutralizing antibody levels in people who have recovered from SARS-CoV-2 infections.
Pharyngeal carriage of inoculated recombinant commensal bacteria generates antigen-specific immunological memory
Authors: Laver Jay R , Gbesemete Diane , Dale Adam P , Pounce Zoe C , Webb Carl N , Roche Eleanor F , Berreen Graham , Belogiannis Konstantinos , Hill Alison R , Ibrahim Muktar M , Cleary David W , Pandey Anish K , Humphries Holly E , Allen Lauren , de Graaf Hans , Maiden Martin C , Faust Saul N , Gorringe Andrew R , Read Robert C
Published: May 2020

The human nasopharynx is colonized by commensal bacteria and pathobionts, which comprise a complex microbial ecosystem capable of generating primary and secondary immune responses. Experimental intranasal infection of human adults with the commensal Neisseria lactamica results in safe, sustained colonization. Herein is described a novel technology to chromosomally transform N. lactamica with heterologous antigen, for the purpose of safe delivery to the mucosal surface and the generation of an antigen-specific immune response. N. lactamica was transformed to express the meningococcal vaccine antigen Neisseria Adhesin A (NadA) and was inoculated intranasally into humans at a dose of 105 colony-forming units. NadA-expressing N. lactamica colonized these individuals and was carried asymptomatically for 3 months. Colonization with NadA-expressing N. lactamica generated NadA-specific IgG-secreting plasma cells within 14 days of colonization and both NadA-specific IgG and NadA-specific IgG memory B cells within 28 days of colonization. NadA-specific IgG memory B cells circulate in the bloodstream of colonized participants for at least 90 days. Genetically transformed N. lactamica has the potential to be a safe bacterial vehicle to generate beneficial immune responses to a wide range of heterologous antigens during sustained pharyngeal carriage.
Sensitivity and specificity of a rapid test for assessment of exposure to SARS-CoV-2 in a community-based setting in Brazil
Authors: Pellanda Lucia Campos , da Ros Wendland Eliana Márcia , McBride Alan John Alexander , Tovo-Rodrigues Luciana , Ferreira Marcos Roberto Alves , Dellagostin Odir Antônio , da Silveira Mariangela Freitas , de Barros Aluisio Jardim Dornellas , Hallal Pedro Curi , Victora Cesar Gomes
Published: May 2020

Background

While the recommended laboratory diagnosis of COVID-19 is a molecular based assay, population-based studies to determine the prevalence of COVID-19 usually use serological assays.

Objective

To evaluate the sensitivity and specificity of a rapid diagnostic test for COVID-19 compared to quantitative reverse transcription polymerase chain reaction (qRT-PCR).

Methods

We evaluated the sensitivity using a panel of finger prick blood samples from participants >18 years of age that had been tested for COVID-19 by qRT-PCR. For assessing specificity, we used serum samples from the 1982 Pelotas (Brazil) Birth Cohort participants collected in 2012 with no exposure to SARS-CoV-2.

Results

The sensitivity of the test was 77.1% (95% CI 66.6 - 85.6), based upon 83 subjects who had tested positive for qRT-PCR at least 10 days before the rapid diagnostic test (RDT). Based upon 100 sera samples, specificity was 98.0% (95% CI 92.9 - 99.8). There was substantial agreement (Kappa score 0.76) between the qRT-PCR results and the RDT.

Interpretation

The validation results are well in line with previous assessments of the test, and confirm that it is sufficiently precise for epidemiological studies aimed at monitoring levels and trends of the COVID-19 pandemic.
Metapopulation modeling of COVID-19 advancing into the countryside: an analysis of mitigation strategies for Brazil
Authors: Costa Guilherme S. , Cota Wesley , Ferreira Silvio C.
Published: May 2020

Since the first case of COVID-19 was confirmed in Brazil on 19 February 2020, this epidemic has spread throughout all states and at least 2142 of 5570 municipalities up to 30 April 2020. In order to understand this spreading, we investigate a stochastic epidemic model using a metapopulation approach. Simulations are supplied with real data for mobility, demography, and confirmed cases of COVID-19 extracted from public sources. Contagion follows a compartmental epidemic model for each municipality; the latter, in turn, interact with each other through recurrent mobility. Considering the number of municipalities with confirmed COVID-19 cases, simulations can infer the level of mitigation (strong, moderate, or none) that each state is effectively adopting. Properties of the epidemic curves such as time and value of epidemic peak and outbreak duration have very broad distributions across different geographical locations. This outbreak variability is observed on several scales from state, passing through intermediate, immediate down to municipality levels. The epidemic waves start from several foci concentrated in highly populated regions and propagate towards the countryside. Correlations between delay of the epidemic outbreak and distance from the respective capital cities are strong in several states, showing propagation towards the countryside, and weak in others, signaling strong influences of multiple centers, not necessarily within the same state. Our take home message is that the responses of different regions to the same mitigation protocol can vary enormously such that the policies of combating COVID-19, such as quarantine or lockdown, must be engineered according to the region specificity but integrated with the overall situation. Even though we restricted our study to Brazil, we believe that these ideas can be generalized to other countries with continental scales and heterogeneous demographic distributions.
Mathematical Modeling & the Transmission Dynamics of SARS-CoV-2 in Cali, Colombia: Implications to a 2020 Outbreak & public health preparedness
Authors: Rojas Jorge Humberto , Paredes Marlio , Banerjee Malay , Akman Olcay , Mubayi Anuj
Published: May 2020

Introduction

As SARS-COV-2 and the disease COVID-19 is sweeping through countries after countries around the globe, it is critical to understand potential burden of a future outbreak in cities of Colombia. This pandemic has affected most of the countries in the world because the high global movement of individuals and excessive cost in interventions.

Objective

Using demographic data from city of Cali, disease epidemiological information from affected countries and mathematical models, we estimated the rate of initial exponential growth of new cases and the basic reproductive rate for a potential outbreak in city of Cali in Colombia.

Materials and methods

We used dynamical models with different modeling assumptions such as use of various types of interventions and/or epidemiological characteristics to compare and contrast the differences between Colombian cities and between Latin American countries.

Results

Under the assumption of homogeneously mixing population and limited resources, we predicted expected number of infected, hospitalized, in Intensive Care Units (ICU) and deaths during this potential COVID-19 outbreak. Our results suggest that on a given day in Cali there may be up to around 73000 cases who might need hospitalization under no intervention. However, this number drastically reduces if we carry out only-isolation intervention (with 16 days of symptomatic infection; ~13,000 cases) versus both quarantining for 6 days and isolation within 16 days (~3500 cases). The peak in Cali will reach in 2-3 months.

Conclusions

The estimates from these studies provides different scenarios of outbreaks and can help Cali to be better prepared during the ongoing COVID-19 outbreak.
Rapidly Measuring Spatial Accessibility of COVID-19 Healthcare Resources: A Case Study of Illinois, USA
Authors: Kang Jeon-Young , Michels Alexander , Lyu Fangzheng , Wang Shaohua , Agbodo Nelson , Freeman Vincent L , Wang Shaowen
Published: May 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. Specifically, the rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The study compared the spatial accessibility measures for COVID-19 patients to those of general population, identifying which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources caused by COVID-19. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. Our findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.
Sudden death in patients with sleep apnea: a systematic review and meta-analysis
Authors: Heilbrunn Emily S. , Ssentongo Paddy , Chinchilli Vernon M. , Ssentongo Anna E.
Published: May 2020

Background

Over 1 billion individuals across the globe experience some form of sleep apnea, and this number is steadily rising. Obstructive sleep apnea (OSA) can negatively influence one’s quality of life and potentially increase the risk of mortality. However, this association between OSA and mortality has not been comprehensively and thoroughly explored. This meta-analysis was conducted to conclusively estimate the risk of death for all-cause mortality and cardiovascular mortality in OSA patients.

Study Design

4,613 articles from databases including PUBMED, OVID & Joana Briggs, and SCOPUS were comprehensively assessed by two reviewers (AES & ESH) for inclusion criteria. 28 total articles were included, with 22 of them being used for quantitative analysis. Pooled effects of all-cause mortality, cardiac mortality, and sudden death were calculated by utilizing the metaprop function in R Statistical Software and the random-effects model with appropriate 95% confidence intervals.

Results

Analysis on 42,032 individuals revealed that those with OSA were twice as likely to die from cardiac mortality compared to those without sleep apnea (HR= 1.94, 95%CI 1.39-2.70). Likewise, individuals with OSA were 1.7 times as likely to die from all-cause sudden death compared to individuals without sleep apnea (HR= 1.74, 95%CI 1.40-2.10). There was a significant dose response relationship between severity of sleep apnea and incidence risk of death, where those with severe sleep apnea were

Conclusions

Individuals with obstructive sleep apnea are at an increased risk for all-cause mortality and cardiac mortality. Further research related to appropriate interventions and treatments are necessary in order to reduce this risk and optimize survival in this population.

Key Messages

What is the key question?

Are individuals with sleep apnea at an increased risk for cardiovascular mortality and sudden death?

What is the bottom Line?

Sleep apnea is associated with an increased risk of cardiovascular mortality and sudden death, with a dose response relationship, where those with severe sleep apnea are at the highest risk of mortality.

Why read on?

This is the first systematic review and meta-analyses to synthesize and quantify the risk of mortality in those with sleep apnea, highlighting important directions for future research.

Prospero Registration ID

CRD42020164941
TAMING COVID-19 EPIDEMIC IN SÃO PAULO WITH A LOGISTIC MODEL AND NON-PHARMACEUTICAL MEASURES
Authors: Marchesin Marcelo
Published: May 2020

Abstract.

In this paper I use the simple logistic mathematical model to represent the development of COVID-19 epidemic in São Paulo city under quarantine regime and I estimate the total amount of time it is necessary to decrease the number of seriously ill patients in order to reduce the demand for hospital beds of Intensive Care Units (ICU) to tolerable levels. Clearly the same reasoning and mathematical methods used in here can be used for any other city in similar conditions of social isolation.
Prepared and highly committed despite the risk of COVID-19 infection: A cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore
Authors: Lau Jerrald , Tan David Hsien-Yung , Wong Gretel Jianlin , Lew Yii-Jen , Chua Ying-Xian , Low Lian-Leng , Ho Han-Kwee , Kwek Thiam-Soo , Toh Sue-Anne Ee-Shiow , Tan Ker-Kan
Published: May 2020

BACKGROUND

Primary care physicians (PCPs) play a crucial role as first points-of-contact between suspected cases and the healthcare system in the current Coronavirus Disease 2019 (COVID-19) pandemic. An overlooked angle is the potential psychosocial impact on PCPs as they place themselves at increased risk of infection. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak.

METHODS

216 PCPs actively practicing in either a public or private clinic were convenience sampled from three primary care organizations in Singapore. Participants completed an online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19.

RESULTS

A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection, and a source of risk and concern to loved ones. PCPs reported acceptance of these risks and the need to care for COVID-19 patients. Overall perceived pandemic preparedness was extremely high. PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors.

CONCLUSIONS

Primary care will continue to be crucial in outbreak management efforts. Healthcare organizations should continue to support PCPs by managing their psychosocial and professional needs.
A survey of the Loureedia genus (Araneae, Eresidae) with a new species from Iran and the first assessment of illegal wildlife trade as a threat to the group
Authors: Henriques Sérgio
Published: May 2020

We describe and illustrate a new species of velvet spider from Iran,L. venaticasp. n., the first species of this genus outside of the Mediterranean region. We also resurrectEresus jerbaefrom synonym, as a distinct and valid Loureedia species,L.jerbaecomb.n, and record this genus to Jordan for the first time.

We map the distribution of all available observations ofL.venatica sp.n. andL.jerbaecomb.n, based on museum specimens and on photographic records, using these observations, and the uncertainty therein, to estimate the species range and how it would be classified under the IUCN Red List. Addressing two of the obstacles to the conservation of poorly known taxa, the Linnaean shortfall, by increasing the number of described species, and the Wallacean shortfall, by increasing current knowledge of species distribution as well as their range.

We also found thatLoureedia jerbaecomb.n. from Tunisia is been sold as an exotic pet, and that photos of IranianLoureedia venaticasp.n. are being used to advertise the sale of this genus in the pet trade. We discuss the impacts this likely causes to these species, as well these species extinction risk under the IUCN Red List.