Query: covid 19 psychological care

title: [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID 19) in China]
abstract: An outbreak of 2019 novel coronavirus diseases (COVID 19) in Wuhan, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020.  All COVID 19 cases reported through February 11, 2020 were extracted from China's Infectious Disease Information System. Analyses included: 1) summary of patient characteristics; 2) examination of age distributions and sex ratios; 3) calculation of case fatality and mortality rates; 4) geo temporal analysis of viral spread; 5) epidemiological curve construction; and 6) subgroup analysis.  A total of 72 314 patient records 44 672 (61.8% confirmed cases, 16 186 (22.4% suspected cases, 10567 (14.6% clinical diagnosed cases (Hubei only) and 889 asymptomatic cases (1.2% contributed data for the analysis. Among confirmed cases, most were aged 30 79 years (86.6% diagnosed in Hubei (74.7% and considered mild (80.9% A total of 1 023 deaths occurred among confirmed cases for an overall case fatality rate of 2.3% The COVID 19 spread outward from Hubei sometime after December 2019 and by February 11, 2020, 1 386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked in January 23 26, then began to decline leading up to February 11. A total of 1 716 health workers have become infected and 5 have died (0.3%  The COVID 19 epidemic has spread very quickly. It only took 30 days to expand from Hubei to the rest of Mainland China. With many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.

title: COVID 19: what has been learned and to be learned about the novel coronavirus disease
abstract: The outbreak of Coronavirus disease 2019 (COVID 19) caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS CoV 2) has thus far killed over 3,000 people and infected over 80,000 in China and elsewhere in the world, resulting in catastrophe for humans. Similar to its homologous virus, SARS CoV, which caused SARS in thousands of people in 2003, SARS CoV 2 might also be transmitted from the bats and causes similar symptoms through a similar mechanism. However, COVID 19 has lower severity and mortality than SARS but is much more transmissive and affects more elderly individuals than youth and more men than women. In response to the rapidly increasing number of publications on the emerging disease, this article attempts to provide a timely and comprehensive review of the swiftly developing research subject. We will cover the basics about the epidemiology, etiology, virology, diagnosis, treatment, prognosis, and prevention of the disease. Although many questions still require answers, we hope that this review helps in the understanding and eradication of the threatening disease.

title: [Management of corona virus disease 19 (COVID 19) the Zhejiang experience]
abstract: The current epidemic situation of corona virus disease 19 (COVID 19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID 19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four Anti and Two Balance" for clinical practice. The "Four Anti and Two Balance"strategy included antivirus, anti shock, anti hyoxemia, anti secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision making. Sputum was observed with the highest positive rate of RT PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four Anti and Two Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID 19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT) meanwhile secondary fungal infection should be concerned.Some patients with COVID 19 showed intestinal microbialdysbiosis with decreasedprobiotics such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID 19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS CoV 2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID 19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID 19.

title: Preparing for COVID 19: early experience from an intensive care unit in Singapore
abstract: Dear Editor, About a third of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) become critically ill and require intensive care unit (ICU) admission  As the COVID 19 (coronavirus disease19) outbreak spreads  ICUs outside of China need to prepare for a potential surge of critically ill patients and counter the high transmissibility of SARS CoV 2  Liu et al. have described their important preparations  and we would like to expand on their good advice by sharing lessons learnt from our early experience. By 17 February 2020, Singapore recorded the highest number of confirmed cases outside of mainland China with several clusters of local transmission. All healthcare institutions adopted a common strategy of containment, with isolation of all suspected or confirmed cases of COVID 19 in negative pressure rooms. We were fortunate that most ICU beds were single rooms this infrastructure was put in place following the outbreak of SARS in 2003. We realized preparing ICUs for patients with COVID19 had numerous other requirements. First, infection control not only involved strict adherence to personal protective equipment for the individual, but also involved changes in group dynamics. We organized our ICU to mitigate the effects of any infected staff by avoiding potential spread between teams (see Table 1) Related to infection control, the medical ICU was given the task to cohort suspect or confirmed cases, including with periand postpartum care of pregnant women. Second, evolving information necessitated rapid and regular communications with large, disparate groups of clinicians. Third, we had to train non ICU acute medical staff dealing with critically ill patients prior to ICU admission, especially for resuscitation. Fourth, we had to reexamine specific ICU services. Given that extracorporeal membrane oxygenation (ECMO) for severe viral pneumonia is well established  we prepared to cohort all COVID 19 patients in the medical ICU and have a satellite team from the cardiothoracic ICU manage the ECMO circuit. Lastly, we realized staff morale took an early hit due to multiple factors, including increased workload due to implementation of strict infection control measures, uncertainty over the effectiveness of personal protective equipment, anxiety over the lethality of any infection, concern for the well being of their family members and stigmatization by members of the public. To address the various issues of infection control, information flow, resuscitation training, advanced ICU services and psychological well being of staff, we formulated several principles and solutions, which we hope can help other ICUs prepare for COVID 19

title: COVID 19 SARS CoV 2 The 2019 Coronavirus Scare 1
abstract: The Coronavirus scare that emanated from Wuhan, China in December of 2019 is an epidemic of testing. There is no proof that a virus is being detected by the test and there is absolutely no concern about whether there are a significant number of false positives on the test. What is being published in medical journals is not science, every paper has the goal of enhancing the panic by interpreting the data only in ways that benefit the viral theory, even when the data is confusing or contradictory. In other words, the medical papers are propaganda.

title: COVID 19 infection epidemic: the medical management strategies in Heilongjiang Province, China
abstract: In late December 2019, an outbreak of the 2019 novel coronavirus (COVID 19) caused a substantial public health crisis in Wuhan, China, and then expeditiously spread all over China [1 3] As of March 4, 2020, 80,409 cases of COVID 19 had been confirmed in mainland China  While in Heilongjiang province, which locates in northeastern China with 38.24 million residents and an area of 473,000 km, all of its 13 cities were affected, making it one of the most serious areas for the outbreak of COVID 19 in China. Up to February 23, 2020, there were 480 confirmed cases of COVID 19; however, no newly diagnosed cases since then. Most of the infected patients were male and there were 13 deaths (2.7% A series of protocols had been established since the first confirmed case emerged, and we herein summarize our experience from Heilongjiang province in dealing with COVID 19.

title: Coronavirus Disease 2019 (COVID 19) Emerging and Future Challenges for Dental and Oral Medicine
abstract: The epidemic of coronavirus disease 2019 (COVID 19) originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID 19 has been recognized in 34 countries, with a total of 80,239 laboratory confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID 19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID 19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.

title: The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID 19) outbreak an update on the status
abstract: An acute respiratory disease, caused by a novel coronavirus (SARS CoV 2, previously known as 2019 nCoV) the coronavirus disease 2019 (COVID 19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID 19 epidemic as a public health emergency of international concern. The emergence of SARS CoV 2, since the severe acute respiratory syndrome coronavirus (SARS CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS CoV) in 2012, marked the third introduction of a highly pathogenic and large scale epidemic coronavirus into the human population in the twenty first century. As of 1 March 2020, a total of 87,137 confirmed cases globally, 79,968 confirmed in China and 7169 outside of China, with 2977 deaths (3.4% had been reported by WHO. Meanwhile, several independent research groups have identified that SARS CoV 2 belongs to b coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host. The novel coronavirus uses the same receptor, angiotensin converting enzyme 2 (ACE2) as that for SARS CoV, and mainly spreads through the respiratory tract. Importantly, increasingly evidence showed sustained human to human transmission, along with many exported cases across the globe. The clinical symptoms of COVID 19 patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID 19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.

title: The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital.
abstract: The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational impact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response.  Two principal authors met with core team members and mental health care providers at Mount Sinai Hospital, Toronto, to compile retrospectively descriptions of the experiences of staff and patients based on informal observation. All authors reviewed and analyzed the descriptions in an iterative process between Apr. 3 and Apr. 13, 2003.  In a 4 week period, 19 individuals developed SARS, including 11 health care workers. The hospital's response included establishing a leadership command team and a SARS isolation unit, implementing mental health support interventions for patients and staff, overcoming problems with logistics and communication, and overcoming resistance to directives. Patients with SARS reported fear, loneliness, boredom and anger, and they worried about the effects of quarantine and contagion on family members and friends. They experienced anxiety about fever and the effects of insomnia. Staff were adversely affected by fear of contagion and of infecting family, friends and colleagues. Caring for health care workers as patients and colleagues was emotionally difficult. Uncertainty and stigmatization were prominent themes for both staff and patients.  The hospital's response required clear communication, sensitivity to individual responses to stress, collaboration between disciplines, authoritative leadership and provision of relevant support. The emotional and behavioural reactions of patients and staff are understood to be a normal, adaptive response to stress in the face of an overwhelming event.

title: Vicarious traumatization in the general public, members, and non members of medical teams aiding in COVID 19 control
abstract: Since December 2019, more than 79,000 people have been diagnosed with infection of the Corona Virus Disease 2019 (COVID 19) A large number of medical staff was sent to Wuhan city and Hubei province to aid COVID 19 control. Psychological stress, especially vicarious traumatization caused by the COVID 19 pandemic, should not be ignored. To address this concern, the study employed a total of 214 general public and 526 nurses (i.e. 234 front line nurses and 292 non front line nurses) to evaluate vicarious traumatization scores via a mobile app based questionnaire. Front line nurses are engaged in the process of providing care for patients with COVID 19. The results showed that the vicarious traumatization scores for front line nurses including scores for physiological and psychological responses, were significantly lower than those of non front line nurses (P 0.001) Interestingly, the vicarious traumatization scores of the general public were significantly higher than those of the front line nurses (P 0.001) however, no statistical difference was observed compared to the scores of non front line nurses (P 0.05) Therefore, increased attention should be paid to the psychological problems of the medical staff, especially non front line nurses, and general public under the situation of the spread and control of COVID 19. Early strategies that aim to prevent and treat vicarious traumatization in medical staff and general public are extremely necessary.