Query: sars-cov-2 taiwan

title: Universal masking to prevent SARS CoV 2 transmission from Taiwan's practices.
abstract: In the fight against the COVID 19 pandemic, Taiwan, with its universal masking policy, slowed down the spread of cases and flattened its epidemic curve without enforcing lockdown or mass quarantine in 2020. This study identifies the distinguishing features of Taiwan's universal masking policy practice, such as priority, continuous improvement, multi stakeholder partnership, transparency and accountability, and altruism and social solidarity. By confronting uncertainty through the COVID 19 crisis, this study suggests that face masking, rather than being just a physical barrier of non pharmacological intervention, can be adopted as an interactive policy platform to empower the public for stimulating cross sector collaboration towards social innovation and creating spillover effects, such as acts of public trust, altruism, and solidarity.

title: Potential natural products that target the SARS CoV 2 spike protein identified by structure based virtual screening, isothermal titration calorimetry and lentivirus particles pseudotyped (Vpp) infection assay
abstract: syndrome coronavirus 2 (SARS CoV 2) enters cells through the binding of the viral spike protein with human angiotensin converting enzyme 2 (ACE2) resulting in the development of coronavirus disease 2019  To date, few antiviral drugs are available that can effectively block viral infection. This study aimed to identify potential natural products from Taiwan Database of Extracts and Compounds (TDEC) that may prevent the binding of viral spike proteins with human ACE2 proteins.  The structure based virtual screening was performed using the AutoDock Vina program within PyRX software, the binding affinities of compounds were verified using isothermal titration calorimetry (ITC) the inhibitions of SARS CoV 2 viral infection efficacy were examined by lentivirus particles pseudotyped (Vpp) infection assay, and the cell viability was tested by 293T cell in MTT assay.  We identified 39 natural products targeting the viral receptor binding domain (RBD) of the SARS CoV 2 spike protein in silico. In ITC binding assay, dioscin, celastrol, saikosaponin C, epimedin C, torvoside K, and amentoflavone showed dissociation constant (K d) 0.468 mM, 1.712 mM, 6.650 mM, 2.86 mM, 3.761 mM and 4.27 mM, respectively. In Vpp infection assay, the compounds have significantly and consistently inhibition with the 50 90% inhibition of viral infection efficacy. In cell viability, torvoside K, epimedin, amentoflavone, and saikosaponin C showed IC50 100 mM; dioscin and celastrol showed IC50 1.5625 mM and 0.9866 mM, respectively. These natural products may bind to the viral spike protein, preventing SARS CoV 2 from entering cells.  1. Natural Products. Taxonomy (classification by evise) SARS CoV 2, Structure Based Virtual Screening, Isothermal Titration Calorimetry and Lentivirus Particles Pseudotyped (Vpp) Infection Assay, in silico and in vitro study.

title: Genomic analysis of early transmissibility assessment of the D614G mutant strain of SARS CoV 2 in travelers returning to Taiwan from the United States of America
abstract: There is a global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) Information on viral genomics is crucial for understanding global dispersion and for providing insight into viral pathogenicity and transmission. Here, we characterized the SARS CoV 2 genomes isolated from five travelers who returned to Taiwan from the United States of America (USA) between March and April 2020.  Haplotype network analysis was performed using genome wide single nucleotide variations to trace potential infection routes. To determine the genetic variations and evolutionary trajectory of the isolates, the genomes of isolates were compared to those of global virus strains from GISAID. Pharyngeal specimens were confirmed to be SARS CoV 2 positive by RT PCR. Direct whole genome sequencing was performed, and viral assemblies were subsequently uploaded to GISAID. Comparative genome sequence and single nucleotide variation analyses were performed.  The D614G mutation was identified in imported cases, which separated into two clusters related to viruses originally detected in the USA. Our findings highlight the risk of spreading SARS CoV 2 variants through air travel and the need for continued genomic tracing for the epidemiological investigation and surveillance of SARS CoV 2 using viral genomic data.  Continuous genomic surveillance is warranted to trace virus circulation and evolution in different global settings during future outbreaks.

title: Tocilizumab alleviates cytokine storm with acute respiratory distress syndrome in severe SARS CoV 2 infection in Taiwan
abstract: The coronavirus disease 2019 (COVID 19) is a catastrophic state involving various organs mediated by massive sequential proinflammatory cytokines. The pathophysiology of severe SARS CoV 2 infectioninduced respiratory distress and cytokine release syndrome was similar to the SARS outbreak in 2003. The sequential fulminant cytokine storm results in fatal and permanent damage of vital organs. Serum interleukin (IL) 6 concentration in COVID 19 was proven to have good predictive accuracy for intubation/mortality and oxygen requirement. Therefore, treatment strategies in these critical patients with COVID 19 should combine adequate antibiotics and anti cytokine therapy simultaneously, although the effect of IL 6 blockade or Janus kinase inhibitor for COVID 19 is still inconclusive. In real world clinical practice, we had a successful experience in the use of tocilizumab (a monoclonal antibody to IL 6 receptor) in one critical and catastrophically ill Taiwanese female patient who suffered from a severe SARS CoV 2 infection with a high serum level of IL 6. A 75 year old Taiwanese woman travelled to South America and Europe and was quarantined in hospital due to being confirmed positive for SARS CoV 2 infection. Unfortunately, rapidly progressive dyspnoea with unstable haemodynamics ensued within a few days that prompted endotracheal intubation, mechanical ventilation and venovenous extracorporeal membrane oxygenation (VV ECMO) Broad spectrum antibiotics were given. However, bilateral pulmonary consolidation occurred  with deteriorating hypoxaemia resulting in acute respiratory distress syndrome. Serum IL 6 concentration revealed was four times normal and we administered tocilizumab 8 mg/kg intravenously. Amazingly, the respiratory distress and shock dramatically improved, as evidenced by clearing of the radiological consolidation  and improvement in hypoxia 24 h thereafter. Two to three weeks later, she was successfully extubated and weaned successfully from VV ECMO and was discharged from hospital

title: Impact of physical distancing policy on reducing transmission of SARS CoV 2 globally: Perspective from government's response and residents' compliance
abstract: COVID 19 was declared a public health emergency by the World Health Organization (WHO) in January 2020. Various physical distancing interventions were introduced to flatten the epidemic curve and reduce the disease burden. We evaluated the impacts of policy stringency and residents' compliance on time varying reproduction number in 17 countries.  Data were from WHO reports of local transmission (February 28 to April 8, 2020) in Australia, Canada, Finland, France, Germany, Greece, Italy, Spain, Sweden, Thailand, the UK, US and Vietnam. Earlier local transmission data where available from press releases were added for Japan, South Korea, Singapore and Taiwan starting January 28, 2020. COVID 19 policy responses were from the Oxford Covid 19 Government Response Tracker with 17 indicators. Changes in people's behaviors were from Google's COVID 19 community mobility reports and Apple Maps' mobility trends reports. We estimated the daily time varying reproduction number (Rt) by country. 0 7 and 14 day lagged effects of non pharmaceutical interventions and changes in human mobility on Rt were estimated by linear mixed effects models.  Rt initially surged rapidly, then declined gradually depending on policy stringency. The highest mean policy stringency scores were for Italy (69.97) and South Korea (61.00) Variations in stringency scores were higher in Europe, the US and Australia than in Asia. The human mobility reduction was greater in countries with strict policies (median stringency score 50) In terms of immediate (0 day lag) effects, Rt reductions were found for workplace closure, limited gathering, and stay at home policies. At a 7 day lag, Rt reductions were found for workplace closure, restrictions on gatherings, stay at home requirements, international travel controls, contact tracing and reducing walking around. At a 14 day lag, Rt reductions were found for restrictions on gatherings, less visiting and staying in parks, and reduced walking around.  The findings show physical distancing policies and residents' compliance can slow transmission, with the lag to effect time varying by policy.

title: A symptomatic near term pregnant woman recovered from SARS CoV 2 infection
abstract: 2019 (COVID 19) is a global health crisis. Although pregnant women are a vulnerable population during the infectious pandemics, extremely rare cases of pregnant women infected by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) are described in Taiwan. We share our experience to manage a pregnant women with COVID 19 in the third trimester and subsequent delivery at term. Case report A 43 year old woman presented with sore throat, cough and rhinorrhea was diagnosed as laboratory confirmed SARS CoV 2 infection at the 35 gestational weeks (GW) During the hospitalization, the disease progressed with a need of oxygen supplement and prednisolone therapy. She was discharged uneventfully at 37 GW. Finally, she delivered a female baby with Apgar score of 8 to 9 points at 38 GW by cesarean section due to the deformity of pelvic cavity resulted from previous surgery for pelvic bone tumor. Both mother and her offspring (without SARS CoV 2 infection) were discharged uneventfully.  Our report adds the growing body of experience toward management of pregnant women with SARS CoV 2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.

title: Maternal and fetal outcomes of the pregnant woman with COVID 19: The first case report in Taiwan
abstract: A real Taiwan experience to deal with near term pregnant woman infected by severe acute respiratory syndrome coronavirus 2, SARS CoV 2 (coronavirus disease 2019, COVID 19) is extremely limited. We described the first case in Taiwan. Case report A 30 year old woman, primigravida had a laboratory confirmed COVID 19 infection at 36 gestational weeks (GW) She was asymptomatic. Ten days later, she was hospitalized and receive a selective cesarean section with a term baby weighted 3142 gm (Apgar score 8 and 9 at 1st and 5th minute, respectively) at 38 GW. No evidence of in utero and direct transmission was found and newborn was free of COVID 19.  It is still uncertain whether timing or mode of delivery is appropriate in SARS CoV 2 infected pregnant woman in near term, but we suggested that a selective delivery time at 38 GW or later, regardless of which mode of delivery is finally decided, can be considered.

title: Antcins from Antrodia cinnamomea and Antrodia salmonea Inhibit Angiotensin Converting Enzyme 2 (ACE2) in Epithelial Cells: Can Be Potential Candidates for the Development of SARS CoV 2 Prophylactic Agents
abstract: Antcins are newly identified steroid like compounds from Taiwan's endemic medicinal mushrooms Antrodia cinnamomea and Antrodia salmonea. Scientific studies of the past two decades confirmed that antcins have various pharmacological activities, including potent anti oxidant and anti inflammatory effects. The severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) caused the coronavirus disease 2019 (COVID 19) pandemic and is characterized as a significant threat to global public health. It was recently identified that SARS CoV 2 required angiotensin converting enzyme 2 (ACE2) a receptor which supports host cell entry and disease onset. Here, we report a novel function of antcins, in which antcins exhibit inhibitory effects on ACE2. Compared to the untreated control group, treatment with various antcins (antcin A, antcin B, antcin C, antcin H, antcin I, and antcin M) significantly inhibited ACE2 activity in cultured human epithelial cells. Indeed, among the investigated antcins, antcin A, antcin B, antcin C, and antcin I showed a pronounceable inhibition against ACE2. These findings suggest that antcins could be novel anti ACE2 agents to prevent SARS CoV 2 host cell entry and the following disease onset.

title: Prevalence and Factors Associated with the Reuse of Mask during the COVID 19 Pandemic: A Nationwide Survey in Taiwan
abstract: Mask usage is an effective measure to prevent severe acute respiratory syndrome coronavirus 2 (SARS COV 2) infection; however, mask reuse is not recommended. Studies examining the factors associated with mask reuse during the coronavirus disease (COVID 19) pandemic are limited. This nationwide survey aimed to determine the prevalence and factors associated with mask reuse among Taiwanese citizens during the pandemic. From 18 May through 31 May 2020, a computer assisted telephone interview system was used to randomly select Taiwanese citizens for interview regarding COVID 19 preventive behaviors and knowledge on mask usage. For a total of 1075 participants, the overall mean age was 57.4 years, and 82.2% of participants reported mask reuse during the COVID 19 pandemic. After controlling for other covariates, participants who had a greater knowledge of mask usage or had a high supply of masks were less likely to reuse masks during the pandemic. Moreover, generalized estimating equations (GEE) analysis showed that, compared with the participants' mask wearing behaviors before the COVID 19 pandemic, they were more likely to reuse masks during the pandemic. Thus, it is imperative to educate people on the correct usage of masks. Furthermore, the government should provide sufficient masks to the general population to reduce mask reuse.

title: Public Health Interventions for COVID 19 Reduce Kawasaki Disease in Taiwan
abstract: Kawasaki disease (KD) is a syndrome of unknown cause that results in high fever and coronary vasculitis in children. The incidence of KD increased in Taiwan over the past few decades. Taiwanese government executed domains of early screening, effective methods for isolation or quarantine, and digital technologies for identifying potential cases for the early elimination strategy for coronavirus disease 2019 (COVID 19) and public health interventions for the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) or COVID 19 pandemic, leading to an effective reduction of the risk of airway infections in children. The purpose of this study is to analyze whether those public health interventions reduce the incidence of KD in 2020.  Patients with KD who visited Chang Gung Memorial Hospital (CGMH) between 1 January, 2018, and 31 December, 2020 were included for trend analysis. This is a retrospective case series study conducted at the CGMH, which consists of a network of seven hospital branches equipped with more than 10,000 beds in different areas of Taiwan.  Compared with the 2018 and 2019 databases, the incidence of KD decreased significantly by 30% and 31% respectively (p 0.05) in 2020, when public health interventions were comprehensively implemented in Taiwan. This result shows that the incidence of KD decreased during the COVID 19 pandemic in Taiwan without change of the presentation KD (typical or incomplete) and percentage of IVIG resistance in 2020.  As public health interventions were carried out for the SARS CoV 2 pandemic, the incidence of KD was significantly reduced in Taiwan. Is KD a preventable disease?