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Eur J Endocrinol

How important is obesity as a risk factor for respiratory failure, intensive care admission and death in hospitalised COVID-19 patients? Results from a single Italian centre.

Objective: Specific comorbidities and old age create a greater vulnerability to severe Coronavirus Disease 19 (COVID-19). While obesity seems to aggravate the course of disease, the actual impact of the BMI and the cutoff which increases illness severity are still under investigation. The aim of the study was to analyze whether the BMI represented a risk factor for respiratory failure, admission to the intensive care unit (ICU) and death. Research design and methods: A retrospective cohort study of 482 consecutive COVID-19 patients hospitalised between March 1 and April 20, 2020. Logistic regression analysis and Cox proportion Hazard models including demographic characteristics and comorbidities were carried out to predict the endpoints within 30 days from the onset of symptoms. Results: Of 482 patients, 104 (21.6%) had a BMI >/= 30 kg/m2. At logistic regression analysis, a BMI between 30 and 34.9 kg/m2 significantly increased the risk of respiratory failure (OR: 2.32; 95% CI: 1.31-4.09, P = 0.004) and admission to the ICU (OR: 4.96; 95% CI: 2.53-9.74, P < 0.001). A significantly higher risk of death was observed in patients with a BMI >/= 35 kg/m2 (OR: 12.1; 95% CI: 3.25-45.1, P < 0.001). Conclusions: Obesity is a strong, independent risk factor for respiratory failure, admission to the ICU and death among COVID-19 patients. A BMI >/= 30 kg/m2 identifies a population of patients at high risk for severe illness, whereas a BMI >/= 35 kg/m2 dramatically increases the risk of death.

Evaluation Study;Journal Article

Rottoli, Matteo;Bernante, Paolo;Belvedere, Angela;Balsamo, Francesca;Garelli, Silvia;Giannella, Maddalena;Cascavilla, Alessandra;Tedeschi, Sara;Ianniruberto, Stefano;Rosselli Del Turco, Elena;Tonetti, Tommaso;Ranieri, Vito Marco;Poggioli, Gilberto;Manzoli, Lamberto;Pagotto, Uberto;Viale, Pierluigi;Bartoletti, Michele

10.1530/EJE-20-0541

[Title]: How important is obesity as a risk factor for respiratory failure, intensive care admission and death in hospitalised COVID-19 patients? Results from a single Italian centre. [Abstract]: Objective: Specific comorbidities and old age create a greater vulnerability to severe Coronavirus Disease 19 (COVID-19). While obesity seems to aggravate the course of disease, the actual impact of the BMI and the cutoff which increases illness severity are still under investigation. The aim of the study was to analyze whether the BMI represented a risk factor for respiratory failure, admission to the intensive care unit (ICU) and death. Research design and methods: A retrospective cohort study of 482 consecutive COVID-19 patients hospitalised between March 1 and April 20, 2020. Logistic regression analysis and Cox proportion Hazard models including demographic characteristics and comorbidities were carried out to predict the endpoints within 30 days from the onset of symptoms. Results: Of 482 patients, 104 (21.6%) had a BMI >/= 30 kg/m2. At logistic regression analysis, a BMI between 30 and 34.9 kg/m2 significantly increased the risk of respiratory failure (OR: 2.32; 95% CI: 1.31-4.09, P = 0.004) and admission to the ICU (OR: 4.96; 95% CI: 2.53-9.74, P < 0.001). A significantly higher risk of death was observed in patients with a BMI >/= 35 kg/m2 (OR: 12.1; 95% CI: 3.25-45.1, P < 0.001). Conclusions: Obesity is a strong, independent risk factor for respiratory failure, admission to the ICU and death among COVID-19 patients. A BMI >/= 30 kg/m2 identifies a population of patients at high risk for severe illness, whereas a BMI >/= 35 kg/m2 dramatically increases the risk of death. [Keywords]:

Ann Epidemiol

Risk for COVID-19 infection and death among Latinos in the United States: examining heterogeneity in transmission dynamics.

PURPOSE: The purpose of this study was to ascertain COVID-19 transmission dynamics among Latino communities nationally. METHODS: We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (>/=17.8% Latino population) and all other counties through May 11, 2020. Adjusted rate ratios (aRRs) were estimated using COVID-19 cases and deaths via zero-inflated binomial regression models. RESULTS: COVID-19 diagnoses rates were greater in Latino counties nationally (90.9 vs. 82.0 per 100,000). In multivariable analysis, COVID-19 cases were greater in Northeastern and Midwestern Latino counties (aRR: 1.42, 95% CI: 1.11-1.84, and aRR: 1.70, 95% CI: 1.57-1.85, respectively). COVID-19 deaths were greater in Midwestern Latino counties (aRR: 1.17, 95% CI: 1.04-1.34). COVID-19 diagnoses were associated with counties with greater monolingual Spanish speakers, employment rates, heart disease deaths, less social distancing, and days since the first reported case. COVID-19 deaths were associated with household occupancy density, air pollution, employment, days since the first reported case, and age (fewer <35 yo). CONCLUSIONS: COVID-19 risks and deaths among Latino populations differ by region. Structural factors place Latino populations and particularly monolingual Spanish speakers at elevated risk for COVID-19 acquisition.

covid-19;disparity;hispanic;latino;race

Comparative Study;Journal Article

Rodriguez-Diaz, Carlos E;Guilamo-Ramos, Vincent;Mena, Leandro;Hall, Eric;Honermann, Brian;Crowley, Jeffrey S;Baral, Stefan;Prado, Guillermo J;Marzan-Rodriguez, Melissa;Beyrer, Chris;Sullivan, Patrick S;Millett, Gregorio A

10.1016/j.annepidem.2020.07.007

[Title]: Risk for COVID-19 infection and death among Latinos in the United States: examining heterogeneity in transmission dynamics. [Abstract]: PURPOSE: The purpose of this study was to ascertain COVID-19 transmission dynamics among Latino communities nationally. METHODS: We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (>/=17.8% Latino population) and all other counties through May 11, 2020. Adjusted rate ratios (aRRs) were estimated using COVID-19 cases and deaths via zero-inflated binomial regression models. RESULTS: COVID-19 diagnoses rates were greater in Latino counties nationally (90.9 vs. 82.0 per 100,000). In multivariable analysis, COVID-19 cases were greater in Northeastern and Midwestern Latino counties (aRR: 1.42, 95% CI: 1.11-1.84, and aRR: 1.70, 95% CI: 1.57-1.85, respectively). COVID-19 deaths were greater in Midwestern Latino counties (aRR: 1.17, 95% CI: 1.04-1.34). COVID-19 diagnoses were associated with counties with greater monolingual Spanish speakers, employment rates, heart disease deaths, less social distancing, and days since the first reported case. COVID-19 deaths were associated with household occupancy density, air pollution, employment, days since the first reported case, and age (fewer <35 yo). CONCLUSIONS: COVID-19 risks and deaths among Latino populations differ by region. Structural factors place Latino populations and particularly monolingual Spanish speakers at elevated risk for COVID-19 acquisition. [Keywords]: covid-19;disparity;hispanic;latino;race

J Gastrointest Surg

Development and Validation of a Clinical Risk Score for Intensive Care Resource Utilization After Colon Cancer Surgery: a Practical Guide to the Selection of Patients During COVID-19.

BACKGROUND: The purpose of this study was to develop and validate a prediction model and clinical risk score for Intensive Care Resource Utilization after colon cancer surgery. METHODS: Adult (>/= 18 years old) patients from the 2012 to 2018 ACS-NSQIP colectomy-targeted database who underwent elective colon cancer surgery were identified. A prediction model for 30-day postoperative Intensive Care Resource Utilization was developed and transformed into a clinical risk score based on the regression coefficients. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The model was validated in a separate test set of similar patients. RESULTS: In total, 54,893 patients underwent an elective colon cancer resection, of which 1224 (2.2%) required postoperative Intensive Care Resource Utilization. The final prediction model retained six variables: age (>/= 70; OR 1.90, 95% CI 1.68-2.14), sex (male; OR 1.73, 95% CI 1.54-1.95), American Society of Anesthesiologists score (III/IV; OR 2.52, 95% CI 2.15-2.95), cardiorespiratory disease (yes; OR 2.22, 95% CI 1.94-2.53), functional status (dependent; OR 2.81, 95% CI 2.22-3.56), and operative approach (open surgery; OR 1.70, 95% CI 1.51-1.93). The model demonstrated good discrimination (AUC = 0.73). A clinical risk score was developed, and the risk of requiring postoperative Intensive Care Resource Utilization ranged from 0.03 (0 points) to 19.0% (8 points). The model performed well on test set validation (AUC = 0.73). CONCLUSION: A prediction model and clinical risk score for postoperative Intensive Care Resource Utilization after colon cancer surgery was developed and validated.

covid-19;colon cancer;intensive care unit;surgery

Journal Article;Validation Study

Garfinkle, Richard;Abou-Khalil, Maria;Salama, Ebram;Marinescu, Daniel;Pang, Allison;Morin, Nancy;Demyttenaere, Sebastian;Liberman, A Sender;Vasilevsky, Carol-Ann;Boutros, Marylise

10.1007/s11605-020-04665-9

[Title]: Development and Validation of a Clinical Risk Score for Intensive Care Resource Utilization After Colon Cancer Surgery: a Practical Guide to the Selection of Patients During COVID-19. [Abstract]: BACKGROUND: The purpose of this study was to develop and validate a prediction model and clinical risk score for Intensive Care Resource Utilization after colon cancer surgery. METHODS: Adult (>/= 18 years old) patients from the 2012 to 2018 ACS-NSQIP colectomy-targeted database who underwent elective colon cancer surgery were identified. A prediction model for 30-day postoperative Intensive Care Resource Utilization was developed and transformed into a clinical risk score based on the regression coefficients. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The model was validated in a separate test set of similar patients. RESULTS: In total, 54,893 patients underwent an elective colon cancer resection, of which 1224 (2.2%) required postoperative Intensive Care Resource Utilization. The final prediction model retained six variables: age (>/= 70; OR 1.90, 95% CI 1.68-2.14), sex (male; OR 1.73, 95% CI 1.54-1.95), American Society of Anesthesiologists score (III/IV; OR 2.52, 95% CI 2.15-2.95), cardiorespiratory disease (yes; OR 2.22, 95% CI 1.94-2.53), functional status (dependent; OR 2.81, 95% CI 2.22-3.56), and operative approach (open surgery; OR 1.70, 95% CI 1.51-1.93). The model demonstrated good discrimination (AUC = 0.73). A clinical risk score was developed, and the risk of requiring postoperative Intensive Care Resource Utilization ranged from 0.03 (0 points) to 19.0% (8 points). The model performed well on test set validation (AUC = 0.73). CONCLUSION: A prediction model and clinical risk score for postoperative Intensive Care Resource Utilization after colon cancer surgery was developed and validated. [Keywords]: covid-19;colon cancer;intensive care unit;surgery

Virusdisease

COVID-19 diagnostic approaches: different roads to the same destination.

SARS-CoV2, a previously unknown strain of coronaviruses caused a severe respiratory disease called Coronavirus disease (COVID-19) which emerged from Wuhan city of China on 30 December 2019, and declared as Global health problem by World Health Organisation within a month. In less than two and half months (11 March, 2020) it was declared as a pandemic disease due to its rapid spreading ability, it covered more than 211 countries infecting around 1.7 million persons and claiming around 1.1 lakhs lives within merely 100 days of its emergence. Containment of the infection of this virus is the only available measure to control the disease as no vaccine or specific antiviral treatment is available. Confirmed detection of the virus followed by isolation of the infected person at the earliest possible is the only measure to prevent this disease. Although there are number of methods available for detection of virus and to combat this disease in the present pandemic situation, but these available diagnostic methods have their own limitations. The speedy and exponential global spread of this disease strongly urges the fast and economic diagnostics tools. Additional to the available diagnostic methods, there is a sudden surge for development of various of methods and platforms to diagnose the COVID-19. The review summarized the advantage and disadvantage of various diagnostic approaches being used presently for COVID-19, newer detection methods in developmental stage and the feasibility of advanced platforms like newer nano-sensor based on-the-spot detection technologies.

biosensor;covid-19;diagnostic method for covid-19;rt-pcr;sars-cov2

Journal Article;Review

Kumar, Ramesh;Nagpal, Suman;Kaushik, Samander;Mendiratta, Sanjay

10.1007/s13337-020-00599-7

[Title]: COVID-19 diagnostic approaches: different roads to the same destination. [Abstract]: SARS-CoV2, a previously unknown strain of coronaviruses caused a severe respiratory disease called Coronavirus disease (COVID-19) which emerged from Wuhan city of China on 30 December 2019, and declared as Global health problem by World Health Organisation within a month. In less than two and half months (11 March, 2020) it was declared as a pandemic disease due to its rapid spreading ability, it covered more than 211 countries infecting around 1.7 million persons and claiming around 1.1 lakhs lives within merely 100 days of its emergence. Containment of the infection of this virus is the only available measure to control the disease as no vaccine or specific antiviral treatment is available. Confirmed detection of the virus followed by isolation of the infected person at the earliest possible is the only measure to prevent this disease. Although there are number of methods available for detection of virus and to combat this disease in the present pandemic situation, but these available diagnostic methods have their own limitations. The speedy and exponential global spread of this disease strongly urges the fast and economic diagnostics tools. Additional to the available diagnostic methods, there is a sudden surge for development of various of methods and platforms to diagnose the COVID-19. The review summarized the advantage and disadvantage of various diagnostic approaches being used presently for COVID-19, newer detection methods in developmental stage and the feasibility of advanced platforms like newer nano-sensor based on-the-spot detection technologies. [Keywords]: biosensor;covid-19;diagnostic method for covid-19;rt-pcr;sars-cov2

J Coll Physicians Surg Pak

Computed Tomography Evaluation of Airway Changes in Adult Patients with COVID-19 Pneumonia.

OBJECTIVE: To investigate airway abnormalities on chest CT in adult patients with COVID-19 pneumonia. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China, from January to April, 2020. METHODOLOGY: CT scan images were analysed retrospectively. The main CT findings, including pulmonary opacities, airway wall visibility, wall thickening, luminal changes, and the formation of mucus plugs were evaluated. Airway segments were classified into three types based on the spatial relationship between conducting airways and pulmonary opacities. RESULTS: A total of 275 lesions were detected in 52 patients. Of these, 170 (61.82%) lesions were associated with 243 airway segments, including segments enclosed within lesions (type I, 152, 62.55%), crossing the lesions (type II, 51, 20.99%), and abutting the lesions (type III, 40, 16.46%). The bronchial walls of 154 (63.37%) segments were ill-defined; whereas, the walls of 89 (36.63%) segments were well-defined; in the latter group, 62 (69.66%) showed mild thickening. The bronchial lumen of 183 (75.31%) segments presented mild bronchiectasis and 60 (24.69%) segments appeared normal. Mucus plug was detected in one segment (0.41%). There were no cases of bronchial stenosis, and all bronchial segments located in normal lung regions appeared normal. The appearance of 196 (80.66%) affected bronchi was completely restored before hospital discharge. CONCLUSION: Typical airway changes in adult COVID-19 pneumonia include bronchial wall thickening without significant stenosis of the airway lumen and the absence of bronchial mucus plugs. Moreover, bronchi located in unaffected lung regions have a normal appearance. These characteristics have potential value in differential diagnosis. Key Words: Coronavirus disease, Airway, Computed tomography, Chest.

Journal Article;Observational Study

Sun, Zhanguo;Liu, Xiaolong;Wang, Jiehuan;Wang, Xiaoqiang;Liu, Wei;Chen, Yueqin

10.29271/jcpsp.2020.08.785

[Title]: Computed Tomography Evaluation of Airway Changes in Adult Patients with COVID-19 Pneumonia. [Abstract]: OBJECTIVE: To investigate airway abnormalities on chest CT in adult patients with COVID-19 pneumonia. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China, from January to April, 2020. METHODOLOGY: CT scan images were analysed retrospectively. The main CT findings, including pulmonary opacities, airway wall visibility, wall thickening, luminal changes, and the formation of mucus plugs were evaluated. Airway segments were classified into three types based on the spatial relationship between conducting airways and pulmonary opacities. RESULTS: A total of 275 lesions were detected in 52 patients. Of these, 170 (61.82%) lesions were associated with 243 airway segments, including segments enclosed within lesions (type I, 152, 62.55%), crossing the lesions (type II, 51, 20.99%), and abutting the lesions (type III, 40, 16.46%). The bronchial walls of 154 (63.37%) segments were ill-defined; whereas, the walls of 89 (36.63%) segments were well-defined; in the latter group, 62 (69.66%) showed mild thickening. The bronchial lumen of 183 (75.31%) segments presented mild bronchiectasis and 60 (24.69%) segments appeared normal. Mucus plug was detected in one segment (0.41%). There were no cases of bronchial stenosis, and all bronchial segments located in normal lung regions appeared normal. The appearance of 196 (80.66%) affected bronchi was completely restored before hospital discharge. CONCLUSION: Typical airway changes in adult COVID-19 pneumonia include bronchial wall thickening without significant stenosis of the airway lumen and the absence of bronchial mucus plugs. Moreover, bronchi located in unaffected lung regions have a normal appearance. These characteristics have potential value in differential diagnosis. Key Words: Coronavirus disease, Airway, Computed tomography, Chest. [Keywords]:

J Am Heart Assoc

Cardio-Oncology in the Era of the COVID-19 Pandemic and Beyond.

Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic and public health crisis. Increasing waves of intermittent infectious outbreaks have dramatically influenced care among broad populations. Over the past 2 decades, there has been a rapid increase in cancer survival, with >400 000 new survivors each year. The increasingly common presence of cardiovascular disease in patients during or after cancer treatment led to the rapid growth of the field of cardio-oncology with a mandate of identifying, treating, and preventing the various forms of cardiovascular disease seen among this population. This review evaluates the implications of the pandemic on the practice and study of cardio-oncology. The evolving understanding of the relationship between comorbid disease and clinical outcomes among this population is assessed. With the impetus of the pandemic, cardio-oncology can be deliberate in embracing changes to cardiac screening, monitoring, and intervention during oncology care. Bridging 2 specialties, consideration of the lessons learned in cancer and cardiovascular may pivotally inform ongoing therapeutic efforts. Further, the development of multicenter registries focused on understanding and optimizing outcomes among these patients should be considered. Together, these insights may critically inform strategies for the care of cardio-oncology patients in future phases of the COVID-19 pandemic and beyond.

covid-19;cancer;cardiac imaging;cardio-oncology;targeted therapies

Journal Article;Research Support, N.I.H., Extramural;Review

Addison, Daniel;Campbell, Courtney M;Guha, Avirup;Ghosh, Arjun K;Dent, Susan F;Jneid, Hani

10.1161/JAHA.120.017787

[Title]: Cardio-Oncology in the Era of the COVID-19 Pandemic and Beyond. [Abstract]: Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic and public health crisis. Increasing waves of intermittent infectious outbreaks have dramatically influenced care among broad populations. Over the past 2 decades, there has been a rapid increase in cancer survival, with >400 000 new survivors each year. The increasingly common presence of cardiovascular disease in patients during or after cancer treatment led to the rapid growth of the field of cardio-oncology with a mandate of identifying, treating, and preventing the various forms of cardiovascular disease seen among this population. This review evaluates the implications of the pandemic on the practice and study of cardio-oncology. The evolving understanding of the relationship between comorbid disease and clinical outcomes among this population is assessed. With the impetus of the pandemic, cardio-oncology can be deliberate in embracing changes to cardiac screening, monitoring, and intervention during oncology care. Bridging 2 specialties, consideration of the lessons learned in cancer and cardiovascular may pivotally inform ongoing therapeutic efforts. Further, the development of multicenter registries focused on understanding and optimizing outcomes among these patients should be considered. Together, these insights may critically inform strategies for the care of cardio-oncology patients in future phases of the COVID-19 pandemic and beyond. [Keywords]: covid-19;cancer;cardiac imaging;cardio-oncology;targeted therapies

World J Surg

Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study.

INTRODUCTION: Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. METHODS: A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. RESULTS: A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. CONCLUSION: Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.

Journal Article

Dick, Lachlan;Green, James;Brown, Jasmine;Kennedy, Ewan;Cassidy, Richard;Othman, Salasiah;Berlansky, Martin

10.1007/s00268-020-05760-3

[Title]: Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study. [Abstract]: INTRODUCTION: Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. METHODS: A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. RESULTS: A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. CONCLUSION: Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this. [Keywords]:

Hemoglobin

Impact of COVID-19 Infection on 24 Patients with Sickle Cell Disease. One Center Urban Experience, Detroit, MI, USA.

The city of Detroit has a large population of individuals with sickle cell disease, and hospitals in Detroit have seen some of the highest numbers of cases of coronavirus disease-19 (COVID-19) in 2020. The purpose of this study was to examine the pathophysiological characteristics of COVID-19 in patients with sickle cell disease or trait to determine whether these patients have unique manifestations that might require special consideration. This retrospective analysis included 24 patients with confirmed COVID-19 and sickle cell disease or trait who were seen at the Henry Ford Hospital, Detroit, MI, USA, between March 1 and April 15 2020. Of the 24 patients, 18 (75.0%) had heterozygous sickle cell trait, one (4.0%) was a double heterozygote for Hb S (HBB: c.20A>T)/beta(+)-thalassemia (beta(+)-thal), four had sickle cell anemia (beta(S)/beta(S)) and one (4.0%) had Hb S/Hb C (HBB: c.19G>A) disease. A total of 13 (54.0%) patients required hospitalization. All four patients with sickle cell anemia, developed acute pain crisis. We observed one patient who developed acute pulmonary embolism and no patients developed other sickle cell associated complications. Additionally, three (13.0%) patients required packed red blood cell transfusion without the need of exchange transfusion, and one patient required admission to the intensive care unit (ICU), mechanical ventilation and subsequently died. Patients with sickle cell disease or trait and laboratory-confirmed COVID-19 had a generally mild, or unremarkable, course of disease, with lower chances of intubation, ICU admission and death, but with a slightly longer hospitalization.

coronavirus disease-19 (covid-19);acute respiratory distress syndrome (ards);severe acute respiratory syndrome coronavirus 2 (sars-cov-2);sickle cell disease;sickle cell trait

Journal Article

Balanchivadze, Nino;Kudirka, Adam A;Askar, Sally;Almadhoun, Khaled;Kuriakose, Philip;Fadel, Raef;Dabak, Vrushali

10.1080/03630269.2020.1797775

[Title]: Impact of COVID-19 Infection on 24 Patients with Sickle Cell Disease. One Center Urban Experience, Detroit, MI, USA. [Abstract]: The city of Detroit has a large population of individuals with sickle cell disease, and hospitals in Detroit have seen some of the highest numbers of cases of coronavirus disease-19 (COVID-19) in 2020. The purpose of this study was to examine the pathophysiological characteristics of COVID-19 in patients with sickle cell disease or trait to determine whether these patients have unique manifestations that might require special consideration. This retrospective analysis included 24 patients with confirmed COVID-19 and sickle cell disease or trait who were seen at the Henry Ford Hospital, Detroit, MI, USA, between March 1 and April 15 2020. Of the 24 patients, 18 (75.0%) had heterozygous sickle cell trait, one (4.0%) was a double heterozygote for Hb S (HBB: c.20A>T)/beta(+)-thalassemia (beta(+)-thal), four had sickle cell anemia (beta(S)/beta(S)) and one (4.0%) had Hb S/Hb C (HBB: c.19G>A) disease. A total of 13 (54.0%) patients required hospitalization. All four patients with sickle cell anemia, developed acute pain crisis. We observed one patient who developed acute pulmonary embolism and no patients developed other sickle cell associated complications. Additionally, three (13.0%) patients required packed red blood cell transfusion without the need of exchange transfusion, and one patient required admission to the intensive care unit (ICU), mechanical ventilation and subsequently died. Patients with sickle cell disease or trait and laboratory-confirmed COVID-19 had a generally mild, or unremarkable, course of disease, with lower chances of intubation, ICU admission and death, but with a slightly longer hospitalization. [Keywords]: coronavirus disease-19 (covid-19);acute respiratory distress syndrome (ards);severe acute respiratory syndrome coronavirus 2 (sars-cov-2);sickle cell disease;sickle cell trait

Arch Osteoporos

The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study.

We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. PURPOSE: Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. METHODS: In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 ("prior to lockdown"), weeks 13th to 19th in 2020 ("lockdown") and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. RESULTS: Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). CONCLUSION: During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic.

covid-19;fragility fracture;hip fracture;older adults;secondary healthcare utilisation

Journal Article;Observational Study

Ogliari, Giulia;Lunt, Eleanor;Ong, Terence;Marshall, Lindsey;Sahota, Opinder

10.1007/s11657-020-00825-1

[Title]: The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study. [Abstract]: We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. PURPOSE: Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. METHODS: In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 ("prior to lockdown"), weeks 13th to 19th in 2020 ("lockdown") and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. RESULTS: Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). CONCLUSION: During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic. [Keywords]: covid-19;fragility fracture;hip fracture;older adults;secondary healthcare utilisation

Aging (Albany NY)

Predictors for imaging progression on chest CT from coronavirus disease 2019 (COVID-19) patients.

OBJECTIVE: This study aimed to investigate the potential parameters associated with imaging progression on chest CT from coronavirus disease 19 (COVID-19) patients. RESULTS: The average age of 273 COVID-19 patients enrolled with imaging progression were older than those without imaging progression (p = 0.006). The white blood cells, platelets, neutrophils and acid glycoprotein were all decreased in imaging progression patients (all p < 0.05), and monocytes were increased (p = 0.025). The parameters including homocysteine, urea, creatinine and serum cystatin C were significantly higher in imaging progression patients (all p < 0.05), while eGFR decreased (p < 0.001). Monocyte-lymphocyte ratio (MLR) was significantly higher in imaging progression patients compared to that in imaging progression-free ones (p < 0.001). Logistic models revealed that age, MLR, homocysteine and period from onset to admission were factors for predicting imaging progression on chest CT at first week from COVID-19 patients (all p < 0.05). CONCLUSION: Age, MLR, homocysteine and period from onset to admission could predict imaging progression on chest CT from COVID-19 patients. METHODS: The primary outcome was imaging progression on chest CT. Baseline parameters were collected at the first day of admission. Imaging manifestations on chest CT were followed-up at (6+/-1) days.

covid-19;mlr;age;coronavirus disease 2019;monocyte-lymphocyte ratio

Journal Article;Research Support, Non-U.S. Gov't

Yang, Zongguo;Shi, Jia;He, Zhang;Lu, Ying;Xu, Qingnian;Ye, Chen;Chen, Shishi;Tang, Bozong;Yin, Keshan;Lu, Yunfei;Chen, Xiaorong

10.18632/aging.102999

[Title]: Predictors for imaging progression on chest CT from coronavirus disease 2019 (COVID-19) patients. [Abstract]: OBJECTIVE: This study aimed to investigate the potential parameters associated with imaging progression on chest CT from coronavirus disease 19 (COVID-19) patients. RESULTS: The average age of 273 COVID-19 patients enrolled with imaging progression were older than those without imaging progression (p = 0.006). The white blood cells, platelets, neutrophils and acid glycoprotein were all decreased in imaging progression patients (all p < 0.05), and monocytes were increased (p = 0.025). The parameters including homocysteine, urea, creatinine and serum cystatin C were significantly higher in imaging progression patients (all p < 0.05), while eGFR decreased (p < 0.001). Monocyte-lymphocyte ratio (MLR) was significantly higher in imaging progression patients compared to that in imaging progression-free ones (p < 0.001). Logistic models revealed that age, MLR, homocysteine and period from onset to admission were factors for predicting imaging progression on chest CT at first week from COVID-19 patients (all p < 0.05). CONCLUSION: Age, MLR, homocysteine and period from onset to admission could predict imaging progression on chest CT from COVID-19 patients. METHODS: The primary outcome was imaging progression on chest CT. Baseline parameters were collected at the first day of admission. Imaging manifestations on chest CT were followed-up at (6+/-1) days. [Keywords]: covid-19;mlr;age;coronavirus disease 2019;monocyte-lymphocyte ratio

J Biol Dyn

Mathematical modelling on COVID-19 transmission impacts with preventive measures: a case study of Tanzania.

The outbreak of COVID-19 was first experienced in Wuhan City, China, during December 2019 before it rapidly spread over globally. This paper has proposed a mathematical model for studying its transmission dynamics in the presence of face mask wearing and hospitalization services of human population in Tanzania. Disease-free and endemic equilibria were determined and subsequently their local and global stabilities were carried out. The trace-determinant approach was used in the local stability of disease-free equilibrium point while Lyapunov function technique was used to determine the global stability of both disease-free and endemic equilibrium points. Basic reproduction number, R 0 , was determined in which its numerical results revealed that, in the presence of face masks wearing and medication services or hospitalization as preventive measure for its transmission, R 0 = 0.698 while in their absence R 0 = 3.8 . This supports its analytical solution that the disease-free equilibrium point E 0 is asymptotically stable whenever R 0 < 1 , while endemic equilibrium point E * is globally asymptotically stable for R 0 > 1 . Therefore, this paper proves the necessity of face masks wearing and hospitalization services to COVID-19 patients to contain the disease spread to the population.

covid-19;basic reproduction number;equilibrium points and stability

Journal Article

Mumbu, Abdul-Rahman J;Hugo, Alfred K

10.1080/17513758.2020.1823494

[Title]: Mathematical modelling on COVID-19 transmission impacts with preventive measures: a case study of Tanzania. [Abstract]: The outbreak of COVID-19 was first experienced in Wuhan City, China, during December 2019 before it rapidly spread over globally. This paper has proposed a mathematical model for studying its transmission dynamics in the presence of face mask wearing and hospitalization services of human population in Tanzania. Disease-free and endemic equilibria were determined and subsequently their local and global stabilities were carried out. The trace-determinant approach was used in the local stability of disease-free equilibrium point while Lyapunov function technique was used to determine the global stability of both disease-free and endemic equilibrium points. Basic reproduction number, R 0 , was determined in which its numerical results revealed that, in the presence of face masks wearing and medication services or hospitalization as preventive measure for its transmission, R 0 = 0.698 while in their absence R 0 = 3.8 . This supports its analytical solution that the disease-free equilibrium point E 0 is asymptotically stable whenever R 0 < 1 , while endemic equilibrium point E * is globally asymptotically stable for R 0 > 1 . Therefore, this paper proves the necessity of face masks wearing and hospitalization services to COVID-19 patients to contain the disease spread to the population. [Keywords]: covid-19;basic reproduction number;equilibrium points and stability

Hum Genomics

COVID-19 vulnerability: the potential impact of genetic susceptibility and airborne transmission.

The recent coronavirus disease (COVID-19), caused by SARS-CoV-2, is inarguably the most challenging coronavirus outbreak relative to the previous outbreaks involving SARS-CoV and MERS-CoV. With the number of COVID-19 cases now exceeding 2 million worldwide, it is apparent that (i) transmission of SARS-CoV-2 is very high and (ii) there are large variations in disease severity, one component of which may be genetic variability in the response to the virus. Controlling current rates of infection and combating future waves require a better understanding of the routes of exposure to SARS-CoV-2 and the underlying genomic susceptibility to this disease. In this mini-review, we highlight possible genetic determinants of COVID-19 and the contribution of aerosol exposure as a potentially important transmission route of SARS-CoV-2.

Journal Article;Review

Godri Pollitt, Krystal J;Peccia, Jordan;Ko, Albert I;Kaminski, Naftali;Dela Cruz, Charles S;Nebert, Daniel W;Reichardt, Juergen K V;Thompson, David C;Vasiliou, Vasilis

10.1186/s40246-020-00267-3

[Title]: COVID-19 vulnerability: the potential impact of genetic susceptibility and airborne transmission. [Abstract]: The recent coronavirus disease (COVID-19), caused by SARS-CoV-2, is inarguably the most challenging coronavirus outbreak relative to the previous outbreaks involving SARS-CoV and MERS-CoV. With the number of COVID-19 cases now exceeding 2 million worldwide, it is apparent that (i) transmission of SARS-CoV-2 is very high and (ii) there are large variations in disease severity, one component of which may be genetic variability in the response to the virus. Controlling current rates of infection and combating future waves require a better understanding of the routes of exposure to SARS-CoV-2 and the underlying genomic susceptibility to this disease. In this mini-review, we highlight possible genetic determinants of COVID-19 and the contribution of aerosol exposure as a potentially important transmission route of SARS-CoV-2. [Keywords]:

Zhongguo Yi Liao Qi Xie Za Zhi

[Discussion of Medical Protective Consumables Management to Fight against COVID-19 Pneumonia].

This article researches how to allocate medical protective consumables in hospital and ensure the safety of emergency marketing procurement under the condition that people are easily susceptible to COVID-19. To inform medical staffs about the standard instruction, we establish the corresponding hierarchical control management system and standards of medical protective consumables. To reduce the stress of clinical medical staff and prevent excessive protection, we enhance the training mechanisms and promote the superior normative guidance. The aim is to fully play the effectiveness of the key departments of medical protective consumables, reduce the risk of infection of clinical medical staff and ensure the safety of medical staffs.

covid-19 pneumonia;management;medical protective consumables

Journal Article

Yu, Jing;Zhu, Jianghua;Huang, Liang;Lyu, Zhongwei

10.3969/j.issn.1671-7104.2020.03.016

[Title]: [Discussion of Medical Protective Consumables Management to Fight against COVID-19 Pneumonia]. [Abstract]: This article researches how to allocate medical protective consumables in hospital and ensure the safety of emergency marketing procurement under the condition that people are easily susceptible to COVID-19. To inform medical staffs about the standard instruction, we establish the corresponding hierarchical control management system and standards of medical protective consumables. To reduce the stress of clinical medical staff and prevent excessive protection, we enhance the training mechanisms and promote the superior normative guidance. The aim is to fully play the effectiveness of the key departments of medical protective consumables, reduce the risk of infection of clinical medical staff and ensure the safety of medical staffs. [Keywords]: covid-19 pneumonia;management;medical protective consumables

J Med Virol

Epidemiological and clinical features of asymptomatic patients with SARS-CoV-2 infection.

Few studies reported the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients with completely asymptomatic throughout the disease course. We investigated the epidemiological and clinical features of patients infected by SARS-CoV-2 without any symptoms. Patients with confirmed SARS-CoV-2 infection were retrospectively recruited. The demographic characteristics, clinical data, treatment, and outcomes of SARS-CoV-2 infected patients without any symptoms were analyzed. Fifteen (4.4%) of 342 SARS-CoV-2 infected patients did not develop any symptom during the course of the disease. The median time from exposure to diagnosis was 7.0 days (interquartile range [IQR]: 1.0-15.0 days). Of the 15 patients, 14 patients were diagnosed by tested positive for SARS-CoV-2 in throat swabs, while one patient was only tested positive for SARS-CoV-2 in anal swabs. During hospitalization, only 1 (6.7%) patient developed lymphopenia. Abnormalities of chest computed tomography examinations were detected in 8 (53.4%) patients on admission. As of 8 March 2020, all patients have been discharged. The median time of SARS-CoV-2 tested negative from admission was 7.0 days (IQR: 4.0-9.0 days). Patients without any symptoms but with SARS-CoV-2 exposure should be closely monitored and tested for SARS-CoV-2 both in anal and throat swabs to excluded the infection. Asymptomatic patients infected by SARS-CoV-2 have favorable outcomes.

asymptomatic;coronavirus disease 2019;severe acute respiratory syndrome coronavirus 2

Journal Article;Research Support, Non-U.S. Gov't

Xu, Tianmin;Huang, Rui;Zhu, Li;Wang, Jian;Cheng, Juan;Zhang, Biao;Zhao, Haiyan;Chen, Kang;Shao, Huaping;Zhu, Chuanwu;Wu, Chao;Liu, Longgen

10.1002/jmv.25944

[Title]: Epidemiological and clinical features of asymptomatic patients with SARS-CoV-2 infection. [Abstract]: Few studies reported the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients with completely asymptomatic throughout the disease course. We investigated the epidemiological and clinical features of patients infected by SARS-CoV-2 without any symptoms. Patients with confirmed SARS-CoV-2 infection were retrospectively recruited. The demographic characteristics, clinical data, treatment, and outcomes of SARS-CoV-2 infected patients without any symptoms were analyzed. Fifteen (4.4%) of 342 SARS-CoV-2 infected patients did not develop any symptom during the course of the disease. The median time from exposure to diagnosis was 7.0 days (interquartile range [IQR]: 1.0-15.0 days). Of the 15 patients, 14 patients were diagnosed by tested positive for SARS-CoV-2 in throat swabs, while one patient was only tested positive for SARS-CoV-2 in anal swabs. During hospitalization, only 1 (6.7%) patient developed lymphopenia. Abnormalities of chest computed tomography examinations were detected in 8 (53.4%) patients on admission. As of 8 March 2020, all patients have been discharged. The median time of SARS-CoV-2 tested negative from admission was 7.0 days (IQR: 4.0-9.0 days). Patients without any symptoms but with SARS-CoV-2 exposure should be closely monitored and tested for SARS-CoV-2 both in anal and throat swabs to excluded the infection. Asymptomatic patients infected by SARS-CoV-2 have favorable outcomes. [Keywords]: asymptomatic;coronavirus disease 2019;severe acute respiratory syndrome coronavirus 2

Pol Arch Intern Med

Molecular epidemiology of SARS CoV-2: a review of current data on genetic variability of the virus.

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), associated with coronavirus disease (COVID-19) is a novel pathogen recently introduced to the human population. It may be characterised by the rapid epidemic transmissions due to lack of the herd immunity and notable mortality, increasing with age and among patients with comorbidities. Outbreak forecasting and modelling suggest that infection numbers will continue to rise globally in the forthcoming months. Upon investigation of the disease patterns differences in mortality between south-European and north-European countries became striking with mortality in Italy and Spain exceeding 10% and <5% in Germany and Poland so far. It is unknown if this difference is associated with the higher virulence of the viral strains, differences in host genomics, access to medical resources or other unknown variables. Little is also known about SARS CoV-2 evolutionary and transmission patterns as limited number of the large-scale sequence and phylogenetic analyses have been performed so far. In this review, we aim to provide concise data on the SARS CoV-2 genomics, molecular evolution and variability with special consideration of the disease course.

Journal Article;Review

Parczewski, Milosz;Ciechanowicz, Andrzej

10.20452/pamw.15550

[Title]: Molecular epidemiology of SARS CoV-2: a review of current data on genetic variability of the virus. [Abstract]: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), associated with coronavirus disease (COVID-19) is a novel pathogen recently introduced to the human population. It may be characterised by the rapid epidemic transmissions due to lack of the herd immunity and notable mortality, increasing with age and among patients with comorbidities. Outbreak forecasting and modelling suggest that infection numbers will continue to rise globally in the forthcoming months. Upon investigation of the disease patterns differences in mortality between south-European and north-European countries became striking with mortality in Italy and Spain exceeding 10% and <5% in Germany and Poland so far. It is unknown if this difference is associated with the higher virulence of the viral strains, differences in host genomics, access to medical resources or other unknown variables. Little is also known about SARS CoV-2 evolutionary and transmission patterns as limited number of the large-scale sequence and phylogenetic analyses have been performed so far. In this review, we aim to provide concise data on the SARS CoV-2 genomics, molecular evolution and variability with special consideration of the disease course. [Keywords]:

PLoS One

Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China.

Radiologic characteristics of 2019 novel coronavirus (2019-nCoV) infected pneumonia (NCIP) which had not been fully understood are especially important for diagnosing and predicting prognosis. We retrospective studied 27 consecutive patients who were confirmed NCIP, the clinical characteristics and CT image findings were collected, and the association of radiologic findings with mortality of patients was evaluated. 27 patients included 12 men and 15 women, with median age of 60 years (IQR 47-69). 17 patients discharged in recovered condition and 10 patients died in hospital. The median age of mortality group was higher compared to survival group (68 (IQR 63-73) vs 55 (IQR 35-60), P = 0.003). The comorbidity rate in mortality group was significantly higher than in survival group (80% vs 29%, P = 0.018). The predominant CT characteristics consisted of ground glass opacity (67%), bilateral sides involved (86%), both peripheral and central distribution (74%), and lower zone involvement (96%). The median CT score of mortality group was higher compared to survival group (30 (IQR 7-13) vs 12 (IQR 11-43), P = 0.021), with more frequency of consolidation (40% vs 6%, P = 0.047) and air bronchogram (60% vs 12%, P = 0.025). An optimal cutoff value of a CT score of 24.5 had a sensitivity of 85.6% and a specificity of 84.5% for the prediction of mortality. 2019-nCoV was more likely to infect elderly people with chronic comorbidities. CT findings of NCIP were featured by predominant ground glass opacities mixed with consolidations, mainly peripheral or combined peripheral and central distributions, bilateral and lower lung zones being mostly involved. A simple CT scoring method was capable to predict mortality.

Journal Article

Yuan, Mingli;Yin, Wen;Tao, Zhaowu;Tan, Weijun;Hu, Yi

10.1371/journal.pone.0230548

[Title]: Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. [Abstract]: Radiologic characteristics of 2019 novel coronavirus (2019-nCoV) infected pneumonia (NCIP) which had not been fully understood are especially important for diagnosing and predicting prognosis. We retrospective studied 27 consecutive patients who were confirmed NCIP, the clinical characteristics and CT image findings were collected, and the association of radiologic findings with mortality of patients was evaluated. 27 patients included 12 men and 15 women, with median age of 60 years (IQR 47-69). 17 patients discharged in recovered condition and 10 patients died in hospital. The median age of mortality group was higher compared to survival group (68 (IQR 63-73) vs 55 (IQR 35-60), P = 0.003). The comorbidity rate in mortality group was significantly higher than in survival group (80% vs 29%, P = 0.018). The predominant CT characteristics consisted of ground glass opacity (67%), bilateral sides involved (86%), both peripheral and central distribution (74%), and lower zone involvement (96%). The median CT score of mortality group was higher compared to survival group (30 (IQR 7-13) vs 12 (IQR 11-43), P = 0.021), with more frequency of consolidation (40% vs 6%, P = 0.047) and air bronchogram (60% vs 12%, P = 0.025). An optimal cutoff value of a CT score of 24.5 had a sensitivity of 85.6% and a specificity of 84.5% for the prediction of mortality. 2019-nCoV was more likely to infect elderly people with chronic comorbidities. CT findings of NCIP were featured by predominant ground glass opacities mixed with consolidations, mainly peripheral or combined peripheral and central distributions, bilateral and lower lung zones being mostly involved. A simple CT scoring method was capable to predict mortality. [Keywords]:

Healthcare (Basel)

Feasibility Trial of an eHealth Intervention for Health-Related Quality of Life: Implications for Managing Patients with Chronic Pain during the COVID-19 Pandemic.

PURPOSE: This study was conducted to determine the feasibility of providing an eHealth intervention for health-related quality of life (HRQOL) to facilitate patient self-management. METHODS: A randomized controlled trial was conducted from 2019-2020 within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation. Eligible patients included those with chronic low back pain and a SPADE (sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue) cluster score >/= 55 based on the relevant scales from the Patient-Reported Outcomes Measurement Information System instrument with 29 items (PROMIS-29). Patients were randomized to the eHealth treatment group, which received a tailored HRQOL report and interpretation guide, or to a wait-list control group. The primary outcome was change in the SPADE cluster score, including its five component scales, over 3 months. Secondary outcomes were changes in low back pain intensity and back-related disability. Treatment effects were measured using the standardized mean difference (SMD) in change scores between groups. The eHealth intervention was also assessed by a survey of the experimental treatment group 1 month following randomization. RESULTS: A total of 102 patients were randomized, including 52 in the eHealth treatment group and 50 in the wait-list control group, and 100 (98%) completed the trial. A majority of patients agreed that the HRQOL report was easy to understand (86%), provided new information (79%), and took actions to read or learn more about self-management approaches to improve their HRQOL (77%). Although the eHealth intervention met the criteria for a small treatment effect in improving the overall SPADE cluster score (SMD = 0.24; p= 0.23) and anxiety (SMD = 0.24; p = 0.23), and for a small-to-medium treatment effect in improving depression (SMD = 0.37; p = 0.06) and back-related disability (SMD = 0.36; p = 0.07), none of these results achieved statistical significance because of limited sample size. CONCLUSION: Given the feasibility of rapid online deployment, low cost, and low risk of adverse events, this eHealth intervention for HRQOL may be useful for patients with chronic pain during the COVID-19 pandemic.

covid-19;back-related disability;chronic low back pain;ehealth;health-related quality of life;low back pain intensity;randomized controlled trial

Journal Article

Licciardone, John C;Pandya, Vishruti

10.3390/healthcare8040381

[Title]: Feasibility Trial of an eHealth Intervention for Health-Related Quality of Life: Implications for Managing Patients with Chronic Pain during the COVID-19 Pandemic. [Abstract]: PURPOSE: This study was conducted to determine the feasibility of providing an eHealth intervention for health-related quality of life (HRQOL) to facilitate patient self-management. METHODS: A randomized controlled trial was conducted from 2019-2020 within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation. Eligible patients included those with chronic low back pain and a SPADE (sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue) cluster score >/= 55 based on the relevant scales from the Patient-Reported Outcomes Measurement Information System instrument with 29 items (PROMIS-29). Patients were randomized to the eHealth treatment group, which received a tailored HRQOL report and interpretation guide, or to a wait-list control group. The primary outcome was change in the SPADE cluster score, including its five component scales, over 3 months. Secondary outcomes were changes in low back pain intensity and back-related disability. Treatment effects were measured using the standardized mean difference (SMD) in change scores between groups. The eHealth intervention was also assessed by a survey of the experimental treatment group 1 month following randomization. RESULTS: A total of 102 patients were randomized, including 52 in the eHealth treatment group and 50 in the wait-list control group, and 100 (98%) completed the trial. A majority of patients agreed that the HRQOL report was easy to understand (86%), provided new information (79%), and took actions to read or learn more about self-management approaches to improve their HRQOL (77%). Although the eHealth intervention met the criteria for a small treatment effect in improving the overall SPADE cluster score (SMD = 0.24; p= 0.23) and anxiety (SMD = 0.24; p = 0.23), and for a small-to-medium treatment effect in improving depression (SMD = 0.37; p = 0.06) and back-related disability (SMD = 0.36; p = 0.07), none of these results achieved statistical significance because of limited sample size. CONCLUSION: Given the feasibility of rapid online deployment, low cost, and low risk of adverse events, this eHealth intervention for HRQOL may be useful for patients with chronic pain during the COVID-19 pandemic. [Keywords]: covid-19;back-related disability;chronic low back pain;ehealth;health-related quality of life;low back pain intensity;randomized controlled trial

Curr Med Sci

Deficiency of Tfh Cells and Germinal Center in Deceased COVID-19 Patients.

The COVID-19 pandemic caused by SARS-CoV2 is characterized by a remarkable variation in clinical severity ranging from a mild illness to a fatal multi-organ disease. Understanding the dysregulated human immune responses in the fatal subjects is critical for management of COVID-19 patients and the pandemic. In this study, we examined the immune cell compositions in the lung tissues and hilar lymph nodes using immunohistochemistry on 6 deceased COVID-19 patients and 4 focal organizing pneumonia (FOP) patients who underwent lung surgery and served as controls. We found a dominant presence of macrophages and a general deficiency of T cells and B cells in the lung tissues from deceased COVID-19 patients. In contrast to the FOP patients, Tfh cells and germinal center formation were largely absent in the draining hilar lymph nodes in the deceased COVID-19 patients. This was correlated with reduced IgM and IgG levels compared to convalescent COVID-19 patients. In summary, our data highlight a defect of germinal center structure in deceased COVID-19 patients leading to an impaired humoral immunity. Understanding the mechanisms of this deficiency will be one of the key points for the management of this epidemic.

covid-19;t follicular helper cells;germinal center;immune responses

Case Reports;Journal Article

Duan, Ya-Qi;Xia, Ming-Hui;Ren, Liang;Zhang, Yan-Fang;Ao, Qi-Lin;Xu, San-Peng;Kuang, Dong;Liu, Qian;Yan, Bing;Zhou, Yi-Wu;Chu, Qian;Liu, Liang;Yang, Xiang-Ping;Wang, Guo-Ping

10.1007/s11596-020-2225-x

[Title]: Deficiency of Tfh Cells and Germinal Center in Deceased COVID-19 Patients. [Abstract]: The COVID-19 pandemic caused by SARS-CoV2 is characterized by a remarkable variation in clinical severity ranging from a mild illness to a fatal multi-organ disease. Understanding the dysregulated human immune responses in the fatal subjects is critical for management of COVID-19 patients and the pandemic. In this study, we examined the immune cell compositions in the lung tissues and hilar lymph nodes using immunohistochemistry on 6 deceased COVID-19 patients and 4 focal organizing pneumonia (FOP) patients who underwent lung surgery and served as controls. We found a dominant presence of macrophages and a general deficiency of T cells and B cells in the lung tissues from deceased COVID-19 patients. In contrast to the FOP patients, Tfh cells and germinal center formation were largely absent in the draining hilar lymph nodes in the deceased COVID-19 patients. This was correlated with reduced IgM and IgG levels compared to convalescent COVID-19 patients. In summary, our data highlight a defect of germinal center structure in deceased COVID-19 patients leading to an impaired humoral immunity. Understanding the mechanisms of this deficiency will be one of the key points for the management of this epidemic. [Keywords]: covid-19;t follicular helper cells;germinal center;immune responses

Eur Radiol

A deep learning approach to characterize 2019 coronavirus disease (COVID-19) pneumonia in chest CT images.

OBJECTIVES: To utilize a deep learning model for automatic detection of abnormalities in chest CT images from COVID-19 patients and compare its quantitative determination performance with radiological residents. METHODS: A deep learning algorithm consisted of lesion detection, segmentation, and location was trained and validated in 14,435 participants with chest CT images and definite pathogen diagnosis. The algorithm was tested in a non-overlapping dataset of 96 confirmed COVID-19 patients in three hospitals across China during the outbreak. Quantitative detection performance of the model was compared with three radiological residents with two experienced radiologists' reading reports as reference standard by assessing the accuracy, sensitivity, specificity, and F1 score. RESULTS: Of 96 patients, 88 had pneumonia lesions on CT images and 8 had no abnormities on CT images. For per-patient basis, the algorithm showed superior sensitivity of 1.00 (95% confidence interval (CI) 0.95, 1.00) and F1 score of 0.97 in detecting lesions from CT images of COVID-19 pneumonia patients. While for per-lung lobe basis, the algorithm achieved a sensitivity of 0.96 (95% CI 0.94, 0.98) and a slightly inferior F1 score of 0.86. The median volume of lesions calculated by algorithm was 40.10 cm(3). An average running speed of 20.3 s +/- 5.8 per case demonstrated the algorithm was much faster than the residents in assessing CT images (all p < 0.017). The deep learning algorithm can also assist radiologists make quicker diagnosis (all p < 0.0001) with superior diagnostic performance. CONCLUSIONS: The algorithm showed excellent performance in detecting COVID-19 pneumonia on chest CT images compared with resident radiologists. KEY POINTS: * The higher sensitivity of deep learning model in detecting COVID-19 pneumonia were found compared with radiological residents on a per-lobe and per-patient basis. * The deep learning model improves diagnosis efficiency by shortening processing time. * The deep learning model can automatically calculate the volume of the lesions and whole lung.

covid-19;deep learning;diagnosis;multidetector computed tomography;pneumonia

Comparative Study;Journal Article;Multicenter Study

Ni, Qianqian;Sun, Zhi Yuan;Qi, Li;Chen, Wen;Yang, Yi;Wang, Li;Zhang, Xinyuan;Yang, Liu;Fang, Yi;Xing, Zijian;Zhou, Zhen;Yu, Yizhou;Lu, Guang Ming;Zhang, Long Jiang

10.1007/s00330-020-07044-9

[Title]: A deep learning approach to characterize 2019 coronavirus disease (COVID-19) pneumonia in chest CT images. [Abstract]: OBJECTIVES: To utilize a deep learning model for automatic detection of abnormalities in chest CT images from COVID-19 patients and compare its quantitative determination performance with radiological residents. METHODS: A deep learning algorithm consisted of lesion detection, segmentation, and location was trained and validated in 14,435 participants with chest CT images and definite pathogen diagnosis. The algorithm was tested in a non-overlapping dataset of 96 confirmed COVID-19 patients in three hospitals across China during the outbreak. Quantitative detection performance of the model was compared with three radiological residents with two experienced radiologists' reading reports as reference standard by assessing the accuracy, sensitivity, specificity, and F1 score. RESULTS: Of 96 patients, 88 had pneumonia lesions on CT images and 8 had no abnormities on CT images. For per-patient basis, the algorithm showed superior sensitivity of 1.00 (95% confidence interval (CI) 0.95, 1.00) and F1 score of 0.97 in detecting lesions from CT images of COVID-19 pneumonia patients. While for per-lung lobe basis, the algorithm achieved a sensitivity of 0.96 (95% CI 0.94, 0.98) and a slightly inferior F1 score of 0.86. The median volume of lesions calculated by algorithm was 40.10 cm(3). An average running speed of 20.3 s +/- 5.8 per case demonstrated the algorithm was much faster than the residents in assessing CT images (all p < 0.017). The deep learning algorithm can also assist radiologists make quicker diagnosis (all p < 0.0001) with superior diagnostic performance. CONCLUSIONS: The algorithm showed excellent performance in detecting COVID-19 pneumonia on chest CT images compared with resident radiologists. KEY POINTS: * The higher sensitivity of deep learning model in detecting COVID-19 pneumonia were found compared with radiological residents on a per-lobe and per-patient basis. * The deep learning model improves diagnosis efficiency by shortening processing time. * The deep learning model can automatically calculate the volume of the lesions and whole lung. [Keywords]: covid-19;deep learning;diagnosis;multidetector computed tomography;pneumonia

Clin Pharmacol Ther

Prioritization of Anti-SARS-Cov-2 Drug Repurposing Opportunities Based on Plasma and Target Site Concentrations Derived from their Established Human Pharmacokinetics.

There is a rapidly expanding literature on the in vitro antiviral activity of drugs that may be repurposed for therapy or chemoprophylaxis against severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). However, this has not been accompanied by a comprehensive evaluation of the target plasma and lung concentrations of these drugs following approved dosing in humans. Accordingly, concentration 90% (EC90 ) values recalculated from in vitro anti-SARS-CoV-2 activity data was expressed as a ratio to the achievable maximum plasma concentration (Cmax ) at an approved dose in humans (Cmax /EC90 ratio). Only 14 of the 56 analyzed drugs achieved a Cmax /EC90 ratio above 1. A more in-depth assessment demonstrated that only nitazoxanide, nelfinavir, tipranavir (ritonavir-boosted), and sulfadoxine achieved plasma concentrations above their reported anti-SARS-CoV-2 activity across their entire approved dosing interval. An unbound lung to plasma tissue partition coefficient (Kp Ulung ) was also simulated to derive a lung Cmax /half-maximal effective concentration (EC50 ) as a better indicator of potential human efficacy. Hydroxychloroquine, chloroquine, mefloquine, atazanavir (ritonavir-boosted), tipranavir (ritonavir-boosted), ivermectin, azithromycin, and lopinavir (ritonavir-boosted) were all predicted to achieve lung concentrations over 10-fold higher than their reported EC50 . Nitazoxanide and sulfadoxine also exceeded their reported EC50 by 7.8-fold and 1.5-fold in lung, respectively. This analysis may be used to select potential candidates for further clinical testing, while deprioritizing compounds unlikely to attain target concentrations for antiviral activity. Future studies should focus on EC90 values and discuss findings in the context of achievable exposures in humans, especially within target compartments, such as the lungs, in order to maximize the potential for success of proposed human clinical trials.

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't;Review

Arshad, Usman;Pertinez, Henry;Box, Helen;Tatham, Lee;Rajoli, Rajith K R;Curley, Paul;Neary, Megan;Sharp, Joanne;Liptrott, Neill J;Valentijn, Anthony;David, Christopher;Rannard, Steve P;O'Neill, Paul M;Aljayyoussi, Ghaith;Pennington, Shaun H;Ward, Stephen A;Hill, Andrew;Back, David J;Khoo, Saye H;Bray, Patrick G;Biagini, Giancarlo A;Owen, Andrew

10.1002/cpt.1909

[Title]: Prioritization of Anti-SARS-Cov-2 Drug Repurposing Opportunities Based on Plasma and Target Site Concentrations Derived from their Established Human Pharmacokinetics. [Abstract]: There is a rapidly expanding literature on the in vitro antiviral activity of drugs that may be repurposed for therapy or chemoprophylaxis against severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). However, this has not been accompanied by a comprehensive evaluation of the target plasma and lung concentrations of these drugs following approved dosing in humans. Accordingly, concentration 90% (EC90 ) values recalculated from in vitro anti-SARS-CoV-2 activity data was expressed as a ratio to the achievable maximum plasma concentration (Cmax ) at an approved dose in humans (Cmax /EC90 ratio). Only 14 of the 56 analyzed drugs achieved a Cmax /EC90 ratio above 1. A more in-depth assessment demonstrated that only nitazoxanide, nelfinavir, tipranavir (ritonavir-boosted), and sulfadoxine achieved plasma concentrations above their reported anti-SARS-CoV-2 activity across their entire approved dosing interval. An unbound lung to plasma tissue partition coefficient (Kp Ulung ) was also simulated to derive a lung Cmax /half-maximal effective concentration (EC50 ) as a better indicator of potential human efficacy. Hydroxychloroquine, chloroquine, mefloquine, atazanavir (ritonavir-boosted), tipranavir (ritonavir-boosted), ivermectin, azithromycin, and lopinavir (ritonavir-boosted) were all predicted to achieve lung concentrations over 10-fold higher than their reported EC50 . Nitazoxanide and sulfadoxine also exceeded their reported EC50 by 7.8-fold and 1.5-fold in lung, respectively. This analysis may be used to select potential candidates for further clinical testing, while deprioritizing compounds unlikely to attain target concentrations for antiviral activity. Future studies should focus on EC90 values and discuss findings in the context of achievable exposures in humans, especially within target compartments, such as the lungs, in order to maximize the potential for success of proposed human clinical trials. [Keywords]:

Disaster Med Public Health Prep

Performing Qualitative Mask Fit Testing Without a Commercial Kit: Fit Testing Which Can Be Performed at Home and at Work.

OBJECTIVE: Qualitative fit testing is a popular method of ensuring the fit of sealing face masks such as N95 and FFP3 masks. Increased demand due to the coronavirus disease 2019 (COVID-19) pandemic has led to shortages in testing equipment and has forced many institutions to abandon fit testing. Three key materials are required for qualitative fit testing: the test solution, nebulizer, and testing hood. Accessible alternatives to the testing solution have been studied. This exploratory qualitative study evaluates alternatives to the nebulizer and hoods for performing qualitative fit testing. METHODS: Four devices were trialed to replace the test kit nebulizer. Two enclosures were tested for their ability to replace the test hood. Three researchers evaluated promising replacements under multiple mask fit conditions to assess functionality and accuracy. RESULTS: The aroma diffuser and smaller enclosures allowed participants to perform qualitative fit tests quickly and with high accuracy. CONCLUSIONS: Aroma diffusers show significant promise in their ability to allow individuals to quickly, easily, and inexpensively perform qualitative fit testing. Our findings indicate that aroma diffusers and homemade testing hoods may allow for qualitative fit testing when conventional apparatus is unavailable. Additional research is needed to evaluate the safety and reliability of these devices.

behavioral risk factor surveillance;health communication;quality of health care;risk assessment;safety management

Journal Article

O'Kelly, Eugenia;Arora, Anmol;Pearson, Charlotte;Ward, James R;Clarkson, P John

10.1017/dmp.2020.352

[Title]: Performing Qualitative Mask Fit Testing Without a Commercial Kit: Fit Testing Which Can Be Performed at Home and at Work. [Abstract]: OBJECTIVE: Qualitative fit testing is a popular method of ensuring the fit of sealing face masks such as N95 and FFP3 masks. Increased demand due to the coronavirus disease 2019 (COVID-19) pandemic has led to shortages in testing equipment and has forced many institutions to abandon fit testing. Three key materials are required for qualitative fit testing: the test solution, nebulizer, and testing hood. Accessible alternatives to the testing solution have been studied. This exploratory qualitative study evaluates alternatives to the nebulizer and hoods for performing qualitative fit testing. METHODS: Four devices were trialed to replace the test kit nebulizer. Two enclosures were tested for their ability to replace the test hood. Three researchers evaluated promising replacements under multiple mask fit conditions to assess functionality and accuracy. RESULTS: The aroma diffuser and smaller enclosures allowed participants to perform qualitative fit tests quickly and with high accuracy. CONCLUSIONS: Aroma diffusers show significant promise in their ability to allow individuals to quickly, easily, and inexpensively perform qualitative fit testing. Our findings indicate that aroma diffusers and homemade testing hoods may allow for qualitative fit testing when conventional apparatus is unavailable. Additional research is needed to evaluate the safety and reliability of these devices. [Keywords]: behavioral risk factor surveillance;health communication;quality of health care;risk assessment;safety management

Clin Chem Lab Med

SARS-CoV-2 RNA identification in nasopharyngeal swabs: issues in pre-analytics.

Objectives: The direct identification of SARS-CoV-2 RNA in nasopharyngeal swabs is recommended for diagnosing the novel COVID-19 disease. Pre-analytical determinants, such as sampling procedures, time and temperature storage conditions, might impact on the end result. Our aim was to evaluate the effects of sampling procedures, time and temperature of the primary nasopharyngeal swabs storage on real-time reverse-transcription polymerase chain reaction (rRT-PCR) results. Methods: Each nasopharyngeal swab obtained from 10 hospitalized patients for COVID-19 was subdivided in 15 aliquots: five were kept at room temperature; five were refrigerated (+4 degrees C); five were immediately mixed with the extraction buffer and refrigerated at +4 degrees C. Every day and for 5 days, one aliquot per condition was analyzed (rRT-PCR) for SARS-CoV-2 gene E and RNaseP and threshold cycles (Ct) compared. To evaluate manual sampling, 70 nasopharyngeal swabs were sampled twice by two different operators and analyzed separately one from the other. Results: A total of 6/10 swabs were SARS-CoV-2 positive. No significant time or storage-dependent variations were observed in SARS-CoV-2 Ct. Re-sampling of swabs with SARS-CoV-2 Ct lower than 33 resulted in highly reproducible results (CV=2.9%), while a high variability was observed when Ct values were higher than 33 (CV=10.3%). Conclusions: This study demonstrates that time and temperature of nasopharyngeal swabs storage do not significantly impact on results reproducibility. However, swabs sampling is a critical step, and especially in case of low viral load, might be a potential source of diagnostic errors.

covid-19;sars-cov-2;nasopharyngeal swab;pre-analytical

Journal Article

Basso, Daniela;Aita, Ada;Navaglia, Filippo;Franchin, Elisa;Fioretto, Paola;Moz, Stefania;Bozzato, Dania;Zambon, Carlo-Federico;Martin, Barbara;Dal Pra, Chiara;Crisanti, Andrea;Plebani, Mario

10.1515/cclm-2020-0749

[Title]: SARS-CoV-2 RNA identification in nasopharyngeal swabs: issues in pre-analytics. [Abstract]: Objectives: The direct identification of SARS-CoV-2 RNA in nasopharyngeal swabs is recommended for diagnosing the novel COVID-19 disease. Pre-analytical determinants, such as sampling procedures, time and temperature storage conditions, might impact on the end result. Our aim was to evaluate the effects of sampling procedures, time and temperature of the primary nasopharyngeal swabs storage on real-time reverse-transcription polymerase chain reaction (rRT-PCR) results. Methods: Each nasopharyngeal swab obtained from 10 hospitalized patients for COVID-19 was subdivided in 15 aliquots: five were kept at room temperature; five were refrigerated (+4 degrees C); five were immediately mixed with the extraction buffer and refrigerated at +4 degrees C. Every day and for 5 days, one aliquot per condition was analyzed (rRT-PCR) for SARS-CoV-2 gene E and RNaseP and threshold cycles (Ct) compared. To evaluate manual sampling, 70 nasopharyngeal swabs were sampled twice by two different operators and analyzed separately one from the other. Results: A total of 6/10 swabs were SARS-CoV-2 positive. No significant time or storage-dependent variations were observed in SARS-CoV-2 Ct. Re-sampling of swabs with SARS-CoV-2 Ct lower than 33 resulted in highly reproducible results (CV=2.9%), while a high variability was observed when Ct values were higher than 33 (CV=10.3%). Conclusions: This study demonstrates that time and temperature of nasopharyngeal swabs storage do not significantly impact on results reproducibility. However, swabs sampling is a critical step, and especially in case of low viral load, might be a potential source of diagnostic errors. [Keywords]: covid-19;sars-cov-2;nasopharyngeal swab;pre-analytical

BMC Infect Dis

Different clinical presentations of two renal transplant recipients with coronavirus disease 2019: a case report.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus-2 has spread rapidly worldwide and disease spread is currently increasing. Data on the clinical picture of transplant recipients and management of the anti-rejection immunosuppressive therapy on COVID-19 infection are lacking. CASE PRESENTATION: We report two cases of COVID-19 infection in renal transplant recipients with variable clinical presentations. The first patient presented with mild respiratory symptoms and a stable clinical course. The second patient had more severe clinical characteristics and presented with severe pneumonia and multi-organ failure. Both patients received a combination therapy including antiviral treatment and reduced immunosuppression therapy and finally recovered. CONCLUSIONS: We report COVID-19 infection in two renal transplant recipients with a favorable outcome but different clinical courses, which may provide a reference value for treating such patients.

acute respiratory syndrome coronavirus 2;case report;coronavirus disease 2019;immunosuppressive therapy;renal transplant recipients

Case Reports;Journal Article

Li, Jing;Chen, Gang;Zhang, Mingmin;Tu, Shenghao;Chen, Chao

10.1186/s12879-020-05434-4

[Title]: Different clinical presentations of two renal transplant recipients with coronavirus disease 2019: a case report. [Abstract]: BACKGROUND: The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus-2 has spread rapidly worldwide and disease spread is currently increasing. Data on the clinical picture of transplant recipients and management of the anti-rejection immunosuppressive therapy on COVID-19 infection are lacking. CASE PRESENTATION: We report two cases of COVID-19 infection in renal transplant recipients with variable clinical presentations. The first patient presented with mild respiratory symptoms and a stable clinical course. The second patient had more severe clinical characteristics and presented with severe pneumonia and multi-organ failure. Both patients received a combination therapy including antiviral treatment and reduced immunosuppression therapy and finally recovered. CONCLUSIONS: We report COVID-19 infection in two renal transplant recipients with a favorable outcome but different clinical courses, which may provide a reference value for treating such patients. [Keywords]: acute respiratory syndrome coronavirus 2;case report;coronavirus disease 2019;immunosuppressive therapy;renal transplant recipients

Diagn Interv Imaging

COVID-19 pneumonia: A review of typical CT findings and differential diagnosis.

The standard of reference for confirming COVID-19 relies on microbiological tests such as real-time polymerase chain reaction (RT-PCR) or sequencing. However, these tests might not be available in an emergency setting. Computed tomography (CT) can be used as an important complement for the diagnosis of COVID-19 pneumonia in the current epidemic context. In this review, we present the typical CT features of COVID-19 pneumonia and discuss the main differential diagnosis.

covid-19 pneumonia;cryptogenic organizing pneumonia;pneumonia;tomography;x-ray computed

Journal Article;Review

Hani, C;Trieu, N H;Saab, I;Dangeard, S;Bennani, S;Chassagnon, G;Revel, M-P

10.1016/j.diii.2020.03.014

[Title]: COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. [Abstract]: The standard of reference for confirming COVID-19 relies on microbiological tests such as real-time polymerase chain reaction (RT-PCR) or sequencing. However, these tests might not be available in an emergency setting. Computed tomography (CT) can be used as an important complement for the diagnosis of COVID-19 pneumonia in the current epidemic context. In this review, we present the typical CT features of COVID-19 pneumonia and discuss the main differential diagnosis. [Keywords]: covid-19 pneumonia;cryptogenic organizing pneumonia;pneumonia;tomography;x-ray computed

Open Forum Infect Dis

Assessment of Oropharyngeal Specimens for Discontinuation of Transmission-Based COVID-19 Precautions.

We compared oropharyngeal swab test performance with nasopharyngeal testing for discontinuation of transmission-based COVID-19 precautions. We performed a retrospective review of confirmed COVID-19-positive patients who received paired nasopharyngeal and oropharyngeal SARS-CoV-2 tests for clearance from isolation from May 4, 2020, to May 26, 2020. Using nasopharyngeal swabs as the reference standard, we calculated the sensitivity, specificity, and negative predictive value of oropharyngeal swabs. We also calculated the kappa between the 2 tests. A total of 189 paired samples were collected from 74 patients. Oropharyngeal swab sensitivity was 38%, specificity was 87%, and negative predictive value was 70%. The kappa was 0.25. Our study suggests that oropharyngeal swabs are inferior to nasopharyngeal swabs for test-based clearance from COVID-19 isolation.

covid-19;coronavirus pcr;discharge strategies;oropharyngeal swabs;residential substance use treatment;transmission-based precautions

Journal Article

Barocas, Joshua A;Komaromy, Miriam;Haidar, Deeanna;Barlam, Tamar F;Orr, Beverley L;Miller, Nancy S

10.1093/ofid/ofaa382

[Title]: Assessment of Oropharyngeal Specimens for Discontinuation of Transmission-Based COVID-19 Precautions. [Abstract]: We compared oropharyngeal swab test performance with nasopharyngeal testing for discontinuation of transmission-based COVID-19 precautions. We performed a retrospective review of confirmed COVID-19-positive patients who received paired nasopharyngeal and oropharyngeal SARS-CoV-2 tests for clearance from isolation from May 4, 2020, to May 26, 2020. Using nasopharyngeal swabs as the reference standard, we calculated the sensitivity, specificity, and negative predictive value of oropharyngeal swabs. We also calculated the kappa between the 2 tests. A total of 189 paired samples were collected from 74 patients. Oropharyngeal swab sensitivity was 38%, specificity was 87%, and negative predictive value was 70%. The kappa was 0.25. Our study suggests that oropharyngeal swabs are inferior to nasopharyngeal swabs for test-based clearance from COVID-19 isolation. [Keywords]: covid-19;coronavirus pcr;discharge strategies;oropharyngeal swabs;residential substance use treatment;transmission-based precautions

J Pharm Pharm Sci

Current Drugs with Potential for Treatment of COVID-19: A Literature Review.

PURPOSE: SARS-CoV-2 first emerged in China in December 2019 and rapidly spread worldwide. No vaccine or approved drug is available to eradicate the virus, however, some drugs that are indicated for other afflictions seems to be potentially beneficial to treat the infection albeit without unequivocal evidence. The aim of this article is to review the published background on the effectiveness of these drugs against COVID-19 Methods: A thorough literature search was conducted on recently published studies which have published between January 1 to March 25, 2020. PubMed, Google Scholar and Science Direct databases were searched Results: A total 22 articles were found eligible. 8 discuss about treatment outcomes from their applied drugs during treatment of COVID-19 patients, 4 report laboratory tests, one report animal trial and other 9 articles discuss recommendations and suggestions based on the treatment process and clinical outcomes of other diseases such as malaria, ebola, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The data and/or recommendations are categorized in 4 classes: (a) anti-viral and anti-inflammatory drugs, (b) anti-malaria drugs, (c) traditional Chinese drugs and (d) other treatments/drugs. CONCLUSION: All examined treatments, although potentiality effective against COVID-19, need either appropriate drug development or clinical trial to be suitable for clinical use.

Journal Article;Review

Md Insiat Islam Rabby

10.18433/jpps31002

[Title]: Current Drugs with Potential for Treatment of COVID-19: A Literature Review. [Abstract]: PURPOSE: SARS-CoV-2 first emerged in China in December 2019 and rapidly spread worldwide. No vaccine or approved drug is available to eradicate the virus, however, some drugs that are indicated for other afflictions seems to be potentially beneficial to treat the infection albeit without unequivocal evidence. The aim of this article is to review the published background on the effectiveness of these drugs against COVID-19 Methods: A thorough literature search was conducted on recently published studies which have published between January 1 to March 25, 2020. PubMed, Google Scholar and Science Direct databases were searched Results: A total 22 articles were found eligible. 8 discuss about treatment outcomes from their applied drugs during treatment of COVID-19 patients, 4 report laboratory tests, one report animal trial and other 9 articles discuss recommendations and suggestions based on the treatment process and clinical outcomes of other diseases such as malaria, ebola, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The data and/or recommendations are categorized in 4 classes: (a) anti-viral and anti-inflammatory drugs, (b) anti-malaria drugs, (c) traditional Chinese drugs and (d) other treatments/drugs. CONCLUSION: All examined treatments, although potentiality effective against COVID-19, need either appropriate drug development or clinical trial to be suitable for clinical use. [Keywords]:

Environ Resour Econ (Dordr)

A Study on Herd Immunity of COVID-19 in South Korea: Using a Stochastic Economic-Epidemiological Model.

Vaccination is an effective measure to control the diffusion of infectious disease such as COVID-19. This paper analyzes the basic reproduction number in South Korea which enables us to identify a necessary level of vaccine stockpile to achieve herd immunity. An susceptible-infected-susceptible model is adopted that allows a stochastic diffusion. The result shows that the basic reproduction number of South Korea is approximately 2 which is substantially lower than those of the other regions. The herd immunity calculated from economic-epidemiological model suggests that at least 62% of the susceptible population be vaccinated when COVID-19 vaccine becomes available.

covid-19;sis;stochastic disease;vaccination stockpile

Journal Article

Park, Hojeong;Kim, Songhee H

10.1007/s10640-020-00439-8

[Title]: A Study on Herd Immunity of COVID-19 in South Korea: Using a Stochastic Economic-Epidemiological Model. [Abstract]: Vaccination is an effective measure to control the diffusion of infectious disease such as COVID-19. This paper analyzes the basic reproduction number in South Korea which enables us to identify a necessary level of vaccine stockpile to achieve herd immunity. An susceptible-infected-susceptible model is adopted that allows a stochastic diffusion. The result shows that the basic reproduction number of South Korea is approximately 2 which is substantially lower than those of the other regions. The herd immunity calculated from economic-epidemiological model suggests that at least 62% of the susceptible population be vaccinated when COVID-19 vaccine becomes available. [Keywords]: covid-19;sis;stochastic disease;vaccination stockpile

Physica D

Accurate closed-form solution of the SIR epidemic model.

An accurate closed-form solution is obtained to the SIR Epidemic Model through the use of Asymptotic Approximants (Barlow et al., 2017). The solution is created by analytically continuing the divergent power series solution such that it matches the long-time asymptotic behavior of the epidemic model. The utility of the analytical form is demonstrated through its application to the COVID-19 pandemic.

analytic solution;approximant;asymptotic analysis;sir model

Journal Article

Barlow, Nathaniel S;Weinstein, Steven J

10.1016/j.physd.2020.132540

[Title]: Accurate closed-form solution of the SIR epidemic model. [Abstract]: An accurate closed-form solution is obtained to the SIR Epidemic Model through the use of Asymptotic Approximants (Barlow et al., 2017). The solution is created by analytically continuing the divergent power series solution such that it matches the long-time asymptotic behavior of the epidemic model. The utility of the analytical form is demonstrated through its application to the COVID-19 pandemic. [Keywords]: analytic solution;approximant;asymptotic analysis;sir model

Radiology

Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence.

Background The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe with alarming speed, morbidity, and mortality. Immediate triage of patients with chest infections suspected to be caused by COVID-19 using chest CT may be of assistance when results from definitive viral testing are delayed. Purpose To develop and validate an artificial intelligence (AI) system to score the likelihood and extent of pulmonary COVID-19 on chest CT scans using the COVID-19 Reporting and Data System (CO-RADS) and CT severity scoring systems. Materials and Methods The CO-RADS AI system consists of three deep-learning algorithms that automatically segment the five pulmonary lobes, assign a CO-RADS score for the suspicion of COVID-19, and assign a CT severity score for the degree of parenchymal involvement per lobe. This study retrospectively included patients who underwent a nonenhanced chest CT examination because of clinical suspicion of COVID-19 at two medical centers. The system was trained, validated, and tested with data from one of the centers. Data from the second center served as an external test set. Diagnostic performance and agreement with scores assigned by eight independent observers were measured using receiver operating characteristic analysis, linearly weighted kappa values, and classification accuracy. Results A total of 105 patients (mean age, 62 years +/- 16 [standard deviation]; 61 men) and 262 patients (mean age, 64 years +/- 16; 154 men) were evaluated in the internal and external test sets, respectively. The system discriminated between patients with COVID-19 and those without COVID-19, with areas under the receiver operating characteristic curve of 0.95 (95% CI: 0.91, 0.98) and 0.88 (95% CI: 0.84, 0.93), for the internal and external test sets, respectively. Agreement with the eight human observers was moderate to substantial, with mean linearly weighted kappa values of 0.60 +/- 0.01 for CO-RADS scores and 0.54 +/- 0.01 for CT severity scores. Conclusion With high diagnostic performance, the CO-RADS AI system correctly identified patients with COVID-19 using chest CT scans and assigned standardized CO-RADS and CT severity scores that demonstrated good agreement with findings from eight independent observers and generalized well to external data. (c) RSNA, 2020 Supplemental material is available for this article.

Journal Article;Multicenter Study

Lessmann, Nikolas;Sanchez, Clara I;Beenen, Ludo;Boulogne, Luuk H;Brink, Monique;Calli, Erdi;Charbonnier, Jean-Paul;Dofferhoff, Ton;van Everdingen, Wouter M;Gerke, Paul K;Geurts, Bram;Gietema, Hester A;Groeneveld, Miriam;van Harten, Louis;Hendrix, Nils;Hendrix, Ward;Huisman, Henkjan J;Isgum, Ivana;Jacobs, Colin;Kluge, Ruben;Kok, Michel;Krdzalic, Jasenko;Lassen-Schmidt, Bianca;van Leeuwen, Kicky;Meakin, James;Overkamp, Mike;van Rees Vellinga, Tjalco;van Rikxoort, Eva M;Samperna, Riccardo;Schaefer-Prokop, Cornelia;Schalekamp, Steven;Scholten, Ernst Th;Sital, Cheryl;Stoger, J Lauran;Teuwen, Jonas;Venkadesh, Kiran Vaidhya;de Vente, Coen;Vermaat, Marieke;Xie, Weiyi;de Wilde, Bram;Prokop, Mathias;van Ginneken, Bram

10.1148/radiol.2020202439

[Title]: Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence. [Abstract]: Background The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe with alarming speed, morbidity, and mortality. Immediate triage of patients with chest infections suspected to be caused by COVID-19 using chest CT may be of assistance when results from definitive viral testing are delayed. Purpose To develop and validate an artificial intelligence (AI) system to score the likelihood and extent of pulmonary COVID-19 on chest CT scans using the COVID-19 Reporting and Data System (CO-RADS) and CT severity scoring systems. Materials and Methods The CO-RADS AI system consists of three deep-learning algorithms that automatically segment the five pulmonary lobes, assign a CO-RADS score for the suspicion of COVID-19, and assign a CT severity score for the degree of parenchymal involvement per lobe. This study retrospectively included patients who underwent a nonenhanced chest CT examination because of clinical suspicion of COVID-19 at two medical centers. The system was trained, validated, and tested with data from one of the centers. Data from the second center served as an external test set. Diagnostic performance and agreement with scores assigned by eight independent observers were measured using receiver operating characteristic analysis, linearly weighted kappa values, and classification accuracy. Results A total of 105 patients (mean age, 62 years +/- 16 [standard deviation]; 61 men) and 262 patients (mean age, 64 years +/- 16; 154 men) were evaluated in the internal and external test sets, respectively. The system discriminated between patients with COVID-19 and those without COVID-19, with areas under the receiver operating characteristic curve of 0.95 (95% CI: 0.91, 0.98) and 0.88 (95% CI: 0.84, 0.93), for the internal and external test sets, respectively. Agreement with the eight human observers was moderate to substantial, with mean linearly weighted kappa values of 0.60 +/- 0.01 for CO-RADS scores and 0.54 +/- 0.01 for CT severity scores. Conclusion With high diagnostic performance, the CO-RADS AI system correctly identified patients with COVID-19 using chest CT scans and assigned standardized CO-RADS and CT severity scores that demonstrated good agreement with findings from eight independent observers and generalized well to external data. (c) RSNA, 2020 Supplemental material is available for this article. [Keywords]:

Respir Investig

Outcome of early-stage combination treatment with favipiravir and methylprednisolone for severe COVID-19 pneumonia: A report of 11 cases.

Although the use of corticosteroids is not recommended in the World Health Organization statement for the treatment of coronavirus disease 2019 (COVID-19), steroid therapy may be indicated for critical cases in specific situations. Here, we report the successful treatment of 11 cases of severe COVID-19 pneumonia with favipiravir and methylprednisolone. All cases were severe and patients required oxygen administration or had a blood oxygen saturation </=93% on room air. All were treated with favipiravir and methylprednisolone, and 10 of 11 patients responded well and required no further oxygen supplementation or ventilator management. This study shows the importance of the early-stage use of a combination of favipiravir and methylprednisolone in severe cases to achieve a favorable clinical outcome.

favipiravir;methylprednisolone;novel coronavirus disease 2019;severe illness

Journal Article

Murohashi, Kota;Hagiwara, Eri;Kitayama, Takaaki;Yamaya, Takafumi;Higa, Katsuyuki;Sato, Yozo;Otoshi, Ryota;Shintani, Ryota;Okabayashi, Hiroko;Ikeda, Satoshi;Niwa, Takashi;Nakazawa, Atsuhito;Oda, Tsuneyuki;Okuda, Ryo;Sekine, Akimasa;Kitamura, Hideya;Baba, Tomohisa;Komatsu, Shigeru;Iwasawa, Tae;Kaneko, Takeshi;Ogura, Takashi

10.1016/j.resinv.2020.08.001

[Title]: Outcome of early-stage combination treatment with favipiravir and methylprednisolone for severe COVID-19 pneumonia: A report of 11 cases. [Abstract]: Although the use of corticosteroids is not recommended in the World Health Organization statement for the treatment of coronavirus disease 2019 (COVID-19), steroid therapy may be indicated for critical cases in specific situations. Here, we report the successful treatment of 11 cases of severe COVID-19 pneumonia with favipiravir and methylprednisolone. All cases were severe and patients required oxygen administration or had a blood oxygen saturation </=93% on room air. All were treated with favipiravir and methylprednisolone, and 10 of 11 patients responded well and required no further oxygen supplementation or ventilator management. This study shows the importance of the early-stage use of a combination of favipiravir and methylprednisolone in severe cases to achieve a favorable clinical outcome. [Keywords]: favipiravir;methylprednisolone;novel coronavirus disease 2019;severe illness

Nat Hum Behav

COVID-19 Government Response Event Dataset (CoronaNet v.1.0).

Governments worldwide have implemented countless policies in response to the COVID-19 pandemic. We present an initial public release of a large hand-coded dataset of over 13,000 such policy announcements across more than 195 countries. The dataset is updated daily, with a 5-day lag for validity checking. We document policies across numerous dimensions, including the type of policy, national versus subnational enforcement, the specific human group and geographical region targeted by the policy, and the time frame within which each policy is implemented. We further analyse the dataset using a Bayesian measurement model, which shows the quick acceleration of the adoption of costly policies across countries beginning in mid-March 2020 through 24 May 2020. We believe that these data will be instrumental for helping policymakers and researchers assess, among other objectives, how effective different policies are in addressing the spread and health outcomes of COVID-19.

Journal Article

Cheng, Cindy;Barcelo, Joan;Hartnett, Allison Spencer;Kubinec, Robert;Messerschmidt, Luca

10.1038/s41562-020-0909-7

[Title]: COVID-19 Government Response Event Dataset (CoronaNet v.1.0). [Abstract]: Governments worldwide have implemented countless policies in response to the COVID-19 pandemic. We present an initial public release of a large hand-coded dataset of over 13,000 such policy announcements across more than 195 countries. The dataset is updated daily, with a 5-day lag for validity checking. We document policies across numerous dimensions, including the type of policy, national versus subnational enforcement, the specific human group and geographical region targeted by the policy, and the time frame within which each policy is implemented. We further analyse the dataset using a Bayesian measurement model, which shows the quick acceleration of the adoption of costly policies across countries beginning in mid-March 2020 through 24 May 2020. We believe that these data will be instrumental for helping policymakers and researchers assess, among other objectives, how effective different policies are in addressing the spread and health outcomes of COVID-19. [Keywords]:

J Paediatr Child Health

Filling in the gaps.

The COVID-19 pandemic, and our response to it, has created many voids in our lives, with no-one spared of its effects. As a result, we have all looked for, and found ways to fill in the gaps. In the midst of the epidemic, with healthcare providers in New York City pushed to the extremes of what can be asked of them, they have found ways to bridge the gulf between how they were trained to practice medicine, and what they are being asked to do now.

Journal Article;Personal Narrative

Khatami, Ameneh

10.1111/jpc.15026

[Title]: Filling in the gaps. [Abstract]: The COVID-19 pandemic, and our response to it, has created many voids in our lives, with no-one spared of its effects. As a result, we have all looked for, and found ways to fill in the gaps. In the midst of the epidemic, with healthcare providers in New York City pushed to the extremes of what can be asked of them, they have found ways to bridge the gulf between how they were trained to practice medicine, and what they are being asked to do now. [Keywords]:

J Thorac Cardiovasc Surg

Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. METHODS: A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. RESULTS: Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high -7.6% vs low -2.6%, P = .195). CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.

covid-19;cardiac surgery;cardiovascular surgery;case volume;coronavirus disease 2019

Journal Article

Ad, Niv;Luc, Jessica G Y;Nguyen, Tom C

10.1016/j.jtcvs.2020.06.077

[Title]: Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact. [Abstract]: OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. METHODS: A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. RESULTS: Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high -7.6% vs low -2.6%, P = .195). CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix. [Keywords]: covid-19;cardiac surgery;cardiovascular surgery;case volume;coronavirus disease 2019

J Am Med Dir Assoc

Reducing Social Isolation of Seniors during COVID-19 through Medical Student Telephone Contact.

Social isolation has been associated with many adverse health outcomes in older adults. We describe a phone call outreach program in which health care professional student volunteers phoned older adults, living in long-term care facilities and the community, at risk of social isolation during the COVID-19 pandemic. Conversation topics were related to coping, including fears or insecurities, isolation, and sources of support; health; and personal topics such as family and friends, hobbies, and life experiences. Student volunteers felt the calls were impactful both for the students and for the seniors, and call recipients expressed appreciation for receiving the calls and for the physicians who referred them for a call. This phone outreach strategy is easily generalizable and can be adopted by medical schools to leverage students to connect to socially isolated seniors in numerous settings.

covid-19;medical education;social isolation;telehealth

Journal Article

Office, Emma E;Rodenstein, Marissa S;Merchant, Tazim S;Pendergrast, Tricia Rae;Lindquist, Lee A

10.1016/j.jamda.2020.06.003

[Title]: Reducing Social Isolation of Seniors during COVID-19 through Medical Student Telephone Contact. [Abstract]: Social isolation has been associated with many adverse health outcomes in older adults. We describe a phone call outreach program in which health care professional student volunteers phoned older adults, living in long-term care facilities and the community, at risk of social isolation during the COVID-19 pandemic. Conversation topics were related to coping, including fears or insecurities, isolation, and sources of support; health; and personal topics such as family and friends, hobbies, and life experiences. Student volunteers felt the calls were impactful both for the students and for the seniors, and call recipients expressed appreciation for receiving the calls and for the physicians who referred them for a call. This phone outreach strategy is easily generalizable and can be adopted by medical schools to leverage students to connect to socially isolated seniors in numerous settings. [Keywords]: covid-19;medical education;social isolation;telehealth

Urology

Outreach and Influence of Surgical Societies' Recommendations on Minimally Invasive Surgery During the COVID-19 Pandemic-An Anonymized International Urologic Expert Inquiry.

OBJECTIVE: To assess the outreach and influence of the main recommendations of surgical governing bodies on adaptation of minimally invasive laparoscopic surgery (MIS) procedures during the coronavirus disease 2019 (COVID-19) pandemic in an anonymized multi-institutional survey. MATERIALS AND METHODS: International experts performing MIS were selected on the basis of the contact database of the speakers of the Friends of Israel Urology Symposium. A 24-item questionnaire was built using main recommendations of surgical societies. Total cases/1 Mio residents as well as absolute number of total cases were utilized as surrogates for the national disease burden. Statistics and plots were performed using RStudio v0.98.953. RESULTS: Sixty-two complete questionnaires from individual centers performing MIS were received. The study demonstrated that most centers were aware of and adapted their MIS management to the COVID-19 pandemic in accordance to surgical bodies' recommendations. Hospitals from the countries with a high disease burden put these adoptions more often into practice than the others particularly regarding swabs as well as CO2 insufflation and specimen extraction procedures. Twelve respondents reported on presumed severe acute respiratory syndrome coronavirus 2 transmission during MIS generating hypothesis for further research. CONCLUSION: Guidelines of surgical governing bodies on adaptation of MIS during the COVID-19 pandemic demonstrate significant outreach and implementation, whereas centers from the countries with a high disease burden are more often poised to modify their practice. Rapid publication and distribution of such recommendation is crucial during future epidemic threats.

Journal Article;Multicenter Study

Boehm, Katharina;Thomas, Anita;Bex, Axel;Black, Peter C;Coburn, Michael;Haferkamp, Axel;Hamdy, Freddie;Kaufman, Ronald P Jr;Klotz, Laurence;Lerner, Seth P;Pushkar, Dmitry;Ramon, Jacob;Rosenzweig, Barak;Tsaur, Igor

10.1016/j.urology.2020.07.043

[Title]: Outreach and Influence of Surgical Societies' Recommendations on Minimally Invasive Surgery During the COVID-19 Pandemic-An Anonymized International Urologic Expert Inquiry. [Abstract]: OBJECTIVE: To assess the outreach and influence of the main recommendations of surgical governing bodies on adaptation of minimally invasive laparoscopic surgery (MIS) procedures during the coronavirus disease 2019 (COVID-19) pandemic in an anonymized multi-institutional survey. MATERIALS AND METHODS: International experts performing MIS were selected on the basis of the contact database of the speakers of the Friends of Israel Urology Symposium. A 24-item questionnaire was built using main recommendations of surgical societies. Total cases/1 Mio residents as well as absolute number of total cases were utilized as surrogates for the national disease burden. Statistics and plots were performed using RStudio v0.98.953. RESULTS: Sixty-two complete questionnaires from individual centers performing MIS were received. The study demonstrated that most centers were aware of and adapted their MIS management to the COVID-19 pandemic in accordance to surgical bodies' recommendations. Hospitals from the countries with a high disease burden put these adoptions more often into practice than the others particularly regarding swabs as well as CO2 insufflation and specimen extraction procedures. Twelve respondents reported on presumed severe acute respiratory syndrome coronavirus 2 transmission during MIS generating hypothesis for further research. CONCLUSION: Guidelines of surgical governing bodies on adaptation of MIS during the COVID-19 pandemic demonstrate significant outreach and implementation, whereas centers from the countries with a high disease burden are more often poised to modify their practice. Rapid publication and distribution of such recommendation is crucial during future epidemic threats. [Keywords]:

J Med Internet Res

Topics, Delivery Modes, and Social-Epistemological Dimensions of Web-Based Information for Patients Undergoing Renal Transplant and Living Donors During the COVID-19 Pandemic: Content Analysis.

BACKGROUND: The COVID-19 pandemic has markedly affected renal transplant care. During this time of social distancing, limited in-person visits, and uncertainty, patients and donors are relying more than ever on telemedicine and web-based information. Several factors can influence patients' understanding of web-based information, such as delivery modes (instruction, interaction, and assessment) and social-epistemological dimensions (choices in interactive knowledge building). OBJECTIVE: The aim of this study was to systemically evaluate the content, delivery modes, and social-epistemological dimensions of web-based information on COVID-19 and renal transplantation at time of the pandemic. METHODS: Multiple keyword combinations were used to retrieve websites on COVID-19 and renal transplantation using the search engines Google.com and Google.nl. From 14 different websites, 30 webpages were examined to determine their organizational sources, topics, delivery modes, and social-epistemological dimensions. RESULTS: The variety of topics and delivery modes was limited. A total of 13 different delivery modes were encountered, of which 8 (62%) were instructional and 5 (38%) were interactional; no assessment delivery modes were observed. No website offered all available delivery modes. The majority of delivery modes (8/13, 62%) focused on individual and passive learning, whereas group learning and active construction of knowledge were rarely encountered. CONCLUSIONS: By taking interactive knowledge transfer into account, the educational quality of eHealth for transplant care could increase, especially in times of crisis when rapid knowledge transfer is needed.

covid-19;constructivism;ehealth;health communication;internet;patient education;renal transplantation;social-epistemological dimensions;teaching modes;web-based information;websites

Journal Article

van Klaveren, Charlotte W;de Jong, Peter G M;Hendriks, Renee A;Luk, Franka;de Vries, Aiko P J;van der Boog, Paul J M;Reinders, Marlies E J

10.2196/22068

[Title]: Topics, Delivery Modes, and Social-Epistemological Dimensions of Web-Based Information for Patients Undergoing Renal Transplant and Living Donors During the COVID-19 Pandemic: Content Analysis. [Abstract]: BACKGROUND: The COVID-19 pandemic has markedly affected renal transplant care. During this time of social distancing, limited in-person visits, and uncertainty, patients and donors are relying more than ever on telemedicine and web-based information. Several factors can influence patients' understanding of web-based information, such as delivery modes (instruction, interaction, and assessment) and social-epistemological dimensions (choices in interactive knowledge building). OBJECTIVE: The aim of this study was to systemically evaluate the content, delivery modes, and social-epistemological dimensions of web-based information on COVID-19 and renal transplantation at time of the pandemic. METHODS: Multiple keyword combinations were used to retrieve websites on COVID-19 and renal transplantation using the search engines Google.com and Google.nl. From 14 different websites, 30 webpages were examined to determine their organizational sources, topics, delivery modes, and social-epistemological dimensions. RESULTS: The variety of topics and delivery modes was limited. A total of 13 different delivery modes were encountered, of which 8 (62%) were instructional and 5 (38%) were interactional; no assessment delivery modes were observed. No website offered all available delivery modes. The majority of delivery modes (8/13, 62%) focused on individual and passive learning, whereas group learning and active construction of knowledge were rarely encountered. CONCLUSIONS: By taking interactive knowledge transfer into account, the educational quality of eHealth for transplant care could increase, especially in times of crisis when rapid knowledge transfer is needed. [Keywords]: covid-19;constructivism;ehealth;health communication;internet;patient education;renal transplantation;social-epistemological dimensions;teaching modes;web-based information;websites

Pediatr Crit Care Med

The Impact of Coronavirus Disease 2019 Pandemic on U.S. and Canadian PICUs.

OBJECTIVES: There are limited reports of the impact of the coronavirus disease 2019 pandemic focused on U.S. and Canadian PICUs. This hypothesis-generating report aims to identify the United States and Canadian trends of coronavirus disease 2019 in PICUs. DESIGN AND SETTING: To better understand how the coronavirus disease 2019 pandemic was affecting U.S. and Canadian PICUs, an open voluntary daily data collection process of Canadian and U.S. PICUs was initiated by Virtual Pediatric Systems, LLC (Los Angeles, CA; http://www.myvps.org) in mid-March 2020. Information was made available online to all PICUs wishing to participate. A secondary data collection was performed to follow-up on patients discharged from those PICUs reporting coronavirus disease 2019 positive patients. MEASUREMENTS AND MAIN RESULTS: To date, over 180 PICUs have responded detailing 530 PICU admissions requiring over 3,467 days of PICU care with 30 deaths. The preponderance of cases was in the eastern regions. Twenty-four percent of the patients admitted to the PICUs were over 18 years old. Fourteen percent of admissions were under 2 years old. Nearly 60% of children had comorbidities at admission with the average length of stay increasing by age and by severity of comorbidity. Advanced respiratory support was necessary during 67% of the current days of care, with 69% being conventional mechanical ventilation. CONCLUSIONS: PICUs have been significantly impacted by the pandemic. They have provided care not only for children but also adults. Patients with coronavirus disease 2019 have a high frequency of comorbidities, require longer stays, more ventilatory support than usual PICU admissions. These data suggest several avenues for further exploration.

Journal Article

Sachdeva, Ramesh;Rice, Tom B;Reisner, Brian;Brundage, Nancy;Hulbert, Cheryl;Kaminski, Alex;Wetzel, Randall C

10.1097/PCC.0000000000002510

[Title]: The Impact of Coronavirus Disease 2019 Pandemic on U.S. and Canadian PICUs. [Abstract]: OBJECTIVES: There are limited reports of the impact of the coronavirus disease 2019 pandemic focused on U.S. and Canadian PICUs. This hypothesis-generating report aims to identify the United States and Canadian trends of coronavirus disease 2019 in PICUs. DESIGN AND SETTING: To better understand how the coronavirus disease 2019 pandemic was affecting U.S. and Canadian PICUs, an open voluntary daily data collection process of Canadian and U.S. PICUs was initiated by Virtual Pediatric Systems, LLC (Los Angeles, CA; http://www.myvps.org) in mid-March 2020. Information was made available online to all PICUs wishing to participate. A secondary data collection was performed to follow-up on patients discharged from those PICUs reporting coronavirus disease 2019 positive patients. MEASUREMENTS AND MAIN RESULTS: To date, over 180 PICUs have responded detailing 530 PICU admissions requiring over 3,467 days of PICU care with 30 deaths. The preponderance of cases was in the eastern regions. Twenty-four percent of the patients admitted to the PICUs were over 18 years old. Fourteen percent of admissions were under 2 years old. Nearly 60% of children had comorbidities at admission with the average length of stay increasing by age and by severity of comorbidity. Advanced respiratory support was necessary during 67% of the current days of care, with 69% being conventional mechanical ventilation. CONCLUSIONS: PICUs have been significantly impacted by the pandemic. They have provided care not only for children but also adults. Patients with coronavirus disease 2019 have a high frequency of comorbidities, require longer stays, more ventilatory support than usual PICU admissions. These data suggest several avenues for further exploration. [Keywords]:

IDCases

Meningoencephalitis from SARS-CoV-2 infection.

The current global pandemic of COVID-19 disease is caused by a novel coronavirus SARS-CoV-2. This typically causes severe respiratory illness, however, as cases have multiplied across the globe, protean manifestations involving multiple organ systems have been described. We report a case of a 35-year-old woman with meningoencephalitis associated with COVID-19 disease who presented with altered mental status and rhythmic limb movements. Although rare, meningoencephalitis should be considered as a possible manifestation of COVID-19 disease.

covid-19;csf;coronavirus;meningoencephalitis;nervous system;sars-cov-2

Case Reports

Hafizi, Fatima;Kherani, Saleema;Shams, Madeeha

10.1016/j.idcr.2020.e00919

[Title]: Meningoencephalitis from SARS-CoV-2 infection. [Abstract]: The current global pandemic of COVID-19 disease is caused by a novel coronavirus SARS-CoV-2. This typically causes severe respiratory illness, however, as cases have multiplied across the globe, protean manifestations involving multiple organ systems have been described. We report a case of a 35-year-old woman with meningoencephalitis associated with COVID-19 disease who presented with altered mental status and rhythmic limb movements. Although rare, meningoencephalitis should be considered as a possible manifestation of COVID-19 disease. [Keywords]: covid-19;csf;coronavirus;meningoencephalitis;nervous system;sars-cov-2

J Electroanal Chem (Lausanne)

Recent advances and challenges in electrochemical biosensors for emerging and re-emerging infectious diseases.

The rise of emerging infectious diseases (EIDs) as well as the increase in spread of existing infections is threatening global economies and human lives, with several countries still fighting repeated onslaught of a few of these epidemics. The catastrophic impact a pandemic has on humans and economy should serve as a reminder to be better prepared to the advent of known and unknown pathogens in the future. The goal of having a set of initiatives and procedures to tackle them is the need of the hour. Rapid detection and point-of-care (POC) analysis of pathogens causing these diseases is not only a problem entailing the scientific community but also raises challenges in tailoring appropriate treatment strategies to the healthcare sector. Among the various methods used to detect pathogens, Electrochemical Biosensor Technology is at the forefront in the development of POC devices. Electrochemical Biosensors stand in good stead due to their rapid response, high sensitivity and selectivity and ease of miniaturization to name a few advantages. This review explores the innovations in electrochemical biosensing based on the various electroanalytical techniques including voltammetry, impedance, amperometry and potentiometry and discusses their potential in diagnosis of emerging and re-emerging infectious diseases (Re-EIDs), which are potential pandemic threats.

amperometry;covid-19;corona virus;impedance;potentiometry;voltammetry

Journal Article;Review

Menon, Shalini;Mathew, Manna Rachel;Sam, Sonia;Keerthi, K;Kumar, K Girish

10.1016/j.jelechem.2020.114596

[Title]: Recent advances and challenges in electrochemical biosensors for emerging and re-emerging infectious diseases. [Abstract]: The rise of emerging infectious diseases (EIDs) as well as the increase in spread of existing infections is threatening global economies and human lives, with several countries still fighting repeated onslaught of a few of these epidemics. The catastrophic impact a pandemic has on humans and economy should serve as a reminder to be better prepared to the advent of known and unknown pathogens in the future. The goal of having a set of initiatives and procedures to tackle them is the need of the hour. Rapid detection and point-of-care (POC) analysis of pathogens causing these diseases is not only a problem entailing the scientific community but also raises challenges in tailoring appropriate treatment strategies to the healthcare sector. Among the various methods used to detect pathogens, Electrochemical Biosensor Technology is at the forefront in the development of POC devices. Electrochemical Biosensors stand in good stead due to their rapid response, high sensitivity and selectivity and ease of miniaturization to name a few advantages. This review explores the innovations in electrochemical biosensing based on the various electroanalytical techniques including voltammetry, impedance, amperometry and potentiometry and discusses their potential in diagnosis of emerging and re-emerging infectious diseases (Re-EIDs), which are potential pandemic threats. [Keywords]: amperometry;covid-19;corona virus;impedance;potentiometry;voltammetry

Case Rep Womens Health

Fetal deaths in pregnancies with SARS-CoV-2 infection in Brazil: A case series.

Background: There are few reports of miscarriages or stillbirths in women infected with SARS-CoV-2. We present five consecutive cases of fetal death (>/=12 weeks) without other putative causes in women with laboratory-confirmed (RT-PCR) COVID-19 managed in a single Brazilian institution. Case series: All five women were outpatients with mild or moderate forms of COVID-19 and were not taking any medication. Four were nulliparous, all were overweight or obese, and none had any comorbidities or pregnancy complications that could contribute to fetal demise. Fetal death occurred at 21-38 weeks of gestation, on COVID-days 1-22. SARS-Cov-2 was detected by RT-PCR in amniotic fluid in one case and in placental specimens in two cases. All five women had acute chorioamnionitis on placental histology, massive deposition of fibrin, mixed intervillitis/villitis, and intense neutrophil and lymphocyte infiltration. One fetus had neutrophils inside alveolar spaces, suggestive of fetal infection. Conclusions: These five cases of fetal demise in women with confirmed COVID-19 without any other significant clinical or obstetric disorders suggest that fetal death can be an outcome of SARS-CoV-2 infection in pregnancy. The intense placental inflammatory reaction in all five cases raises the possibility of a direct effect of SARS-CoV-2 on the placenta.

af, amniotic fluid;abortion;bmi, body mass index;bp, blood pressure;covid-19;cs, cesarean section;ed, emergency department;fhr, fetal heart rate;fetal death;ga, gestational age;hr, heart rate;infectious disease transmission;rr, respiratory rate;spo2, oxygen saturation;spontaneous;stillbirth;us, ultrasound;vertical;z-storch, zika, syphillis, toxoplasmosis, rubella, cytomegalovirus, herpes

Case Reports

Richtmann, Rosana;Torloni, Maria Regina;Oyamada Otani, Andre Ricardo;Levi, Jose Eduardo;Crema Tobara, Mariana;de Almeida Silva, Camila;Dias, Livio;Miglioli-Galvao, Lisia;Martins Silva, Pollyanna;Macoto Kondo, Mario

10.1016/j.crwh.2020.e00243

[Title]: Fetal deaths in pregnancies with SARS-CoV-2 infection in Brazil: A case series. [Abstract]: Background: There are few reports of miscarriages or stillbirths in women infected with SARS-CoV-2. We present five consecutive cases of fetal death (>/=12 weeks) without other putative causes in women with laboratory-confirmed (RT-PCR) COVID-19 managed in a single Brazilian institution. Case series: All five women were outpatients with mild or moderate forms of COVID-19 and were not taking any medication. Four were nulliparous, all were overweight or obese, and none had any comorbidities or pregnancy complications that could contribute to fetal demise. Fetal death occurred at 21-38 weeks of gestation, on COVID-days 1-22. SARS-Cov-2 was detected by RT-PCR in amniotic fluid in one case and in placental specimens in two cases. All five women had acute chorioamnionitis on placental histology, massive deposition of fibrin, mixed intervillitis/villitis, and intense neutrophil and lymphocyte infiltration. One fetus had neutrophils inside alveolar spaces, suggestive of fetal infection. Conclusions: These five cases of fetal demise in women with confirmed COVID-19 without any other significant clinical or obstetric disorders suggest that fetal death can be an outcome of SARS-CoV-2 infection in pregnancy. The intense placental inflammatory reaction in all five cases raises the possibility of a direct effect of SARS-CoV-2 on the placenta. [Keywords]: af, amniotic fluid;abortion;bmi, body mass index;bp, blood pressure;covid-19;cs, cesarean section;ed, emergency department;fhr, fetal heart rate;fetal death;ga, gestational age;hr, heart rate;infectious disease transmission;rr, respiratory rate;spo2, oxygen saturation;spontaneous;stillbirth;us, ultrasound;vertical;z-storch, zika, syphillis, toxoplasmosis, rubella, cytomegalovirus, herpes

PLoS One

Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis.

BACKGROUND: The ongoing pandemic of Novel Coronavirus Disease 2019 (COVID-19) infection has created a global emergency. Despite the infection causes a mild illness to most people, some patients are severely affected, demanding an urgent need to better understand how to risk-stratify infected subjects. DESIGN: This is a meta-analysis of observational studies evaluating cardiovascular (CV) complications in hospitalized COVID-19 patients and the impact of cardiovascular risk factors (RF) or comorbidities on mortality. METHODS: Data sources: PubMed, Scopus, and ISI from 1 December 2019 through 11 June 2020; references of eligible studies; scientific session abstracts; cardiology web sites. We selected studies reporting clinical outcomes of hospitalized patients with COVID-19. The main outcome was death. Secondary outcomes were cardiovascular symptoms and cardiovascular events developed during the COVID-19-related hospitalization. Extracted data were recorded in excel worksheets and analysed using statistical software (MedCalc, OpenMetanalyst, R). We used the proportion with 95% CI as the summary measure. A Freeman-Tukey transformation was used to calculate the weighted summary proportion under the random-effects model. Heterogeneity was assessed by using the Cochran Q test and I2 values. RESULTS: Among 77317 hospitalized patients from 21 studies, 12.86% had cardiovascular comorbidities or RF. Cardiovascular complications were registered in 14.09% of cases during hospitalization. At meta-regression analysis, pre-existing cardiovascular comorbidities or RF were significantly associated to cardiovascular complications in COVID-19 patients (p = 0.019). Pre-existing cardiovascular comorbidities or RF (p<0.001), older age (p<0.001), and the development of cardiovascular complications during the hospitalization (p = 0.038) had a significant interaction with death. CONCLUSIONS: Cardiovascular complications are frequent among COVID-19 patients, and might contribute to adverse clinical events and mortality, together with pre-existing cardiovascular comorbidities and RF. Clinicians worldwide should be aware of this association, to identifying patients at higher risk.

Journal Article;Meta-Analysis

Sabatino, Jolanda;De Rosa, Salvatore;Di Salvo, Giovanni;Indolfi, Ciro

10.1371/journal.pone.0237131

[Title]: Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis. [Abstract]: BACKGROUND: The ongoing pandemic of Novel Coronavirus Disease 2019 (COVID-19) infection has created a global emergency. Despite the infection causes a mild illness to most people, some patients are severely affected, demanding an urgent need to better understand how to risk-stratify infected subjects. DESIGN: This is a meta-analysis of observational studies evaluating cardiovascular (CV) complications in hospitalized COVID-19 patients and the impact of cardiovascular risk factors (RF) or comorbidities on mortality. METHODS: Data sources: PubMed, Scopus, and ISI from 1 December 2019 through 11 June 2020; references of eligible studies; scientific session abstracts; cardiology web sites. We selected studies reporting clinical outcomes of hospitalized patients with COVID-19. The main outcome was death. Secondary outcomes were cardiovascular symptoms and cardiovascular events developed during the COVID-19-related hospitalization. Extracted data were recorded in excel worksheets and analysed using statistical software (MedCalc, OpenMetanalyst, R). We used the proportion with 95% CI as the summary measure. A Freeman-Tukey transformation was used to calculate the weighted summary proportion under the random-effects model. Heterogeneity was assessed by using the Cochran Q test and I2 values. RESULTS: Among 77317 hospitalized patients from 21 studies, 12.86% had cardiovascular comorbidities or RF. Cardiovascular complications were registered in 14.09% of cases during hospitalization. At meta-regression analysis, pre-existing cardiovascular comorbidities or RF were significantly associated to cardiovascular complications in COVID-19 patients (p = 0.019). Pre-existing cardiovascular comorbidities or RF (p<0.001), older age (p<0.001), and the development of cardiovascular complications during the hospitalization (p = 0.038) had a significant interaction with death. CONCLUSIONS: Cardiovascular complications are frequent among COVID-19 patients, and might contribute to adverse clinical events and mortality, together with pre-existing cardiovascular comorbidities and RF. Clinicians worldwide should be aware of this association, to identifying patients at higher risk. [Keywords]:

Nat Biotechnol

Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics.

We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0-2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0-2 d ahead of the percentage of positive tests by date of specimen collection, 1-4 d ahead of local hospital admissions and 6-8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics.

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't

Peccia, Jordan;Zulli, Alessandro;Brackney, Doug E;Grubaugh, Nathan D;Kaplan, Edward H;Casanovas-Massana, Arnau;Ko, Albert I;Malik, Amyn A;Wang, Dennis;Wang, Mike;Warren, Joshua L;Weinberger, Daniel M;Arnold, Wyatt;Omer, Saad B

10.1038/s41587-020-0684-z

[Title]: Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics. [Abstract]: We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0-2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0-2 d ahead of the percentage of positive tests by date of specimen collection, 1-4 d ahead of local hospital admissions and 6-8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics. [Keywords]:

Viruses

Virology, Epidemiology, Pathogenesis, and Control of COVID-19.

The outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China has been brought to global attention and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Scientific advancements since the pandemic of severe acute respiratory syndrome (SARS) in 2002~2003 and Middle East respiratory syndrome (MERS) in 2012 have accelerated our understanding of the epidemiology and pathogenesis of SARS-CoV-2 and the development of therapeutics to treat viral infection. As no specific therapeutics and vaccines are available for disease control, the epidemic of COVID-19 is posing a great threat for global public health. To provide a comprehensive summary to public health authorities and potential readers worldwide, we detail the present understanding of COVID-19 and introduce the current state of development of measures in this review.

covid-19;sars-cov-2;epidemiology;pathogenesis;therapeutics

Journal Article;Review

Jin, Yuefei;Yang, Haiyan;Ji, Wangquan;Wu, Weidong;Chen, Shuaiyin;Zhang, Weiguo;Duan, Guangcai

10.3390/v12040372

[Title]: Virology, Epidemiology, Pathogenesis, and Control of COVID-19. [Abstract]: The outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China has been brought to global attention and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Scientific advancements since the pandemic of severe acute respiratory syndrome (SARS) in 2002~2003 and Middle East respiratory syndrome (MERS) in 2012 have accelerated our understanding of the epidemiology and pathogenesis of SARS-CoV-2 and the development of therapeutics to treat viral infection. As no specific therapeutics and vaccines are available for disease control, the epidemic of COVID-19 is posing a great threat for global public health. To provide a comprehensive summary to public health authorities and potential readers worldwide, we detail the present understanding of COVID-19 and introduce the current state of development of measures in this review. [Keywords]: covid-19;sars-cov-2;epidemiology;pathogenesis;therapeutics

Minds Mach (Dordr)

Analysing the Combined Health, Social and Economic Impacts of the Corovanvirus Pandemic Using Agent-Based Social Simulation.

During the COVID-19 crisis there have been many difficult decisions governments and other decision makers had to make. E.g. do we go for a total lock down or keep schools open? How many people and which people should be tested? Although there are many good models from e.g. epidemiologists on the spread of the virus under certain conditions, these models do not directly translate into the interventions that can be taken by government. Neither can these models contribute to understand the economic and/or social consequences of the interventions. However, effective and sustainable solutions need to take into account this combination of factors. In this paper, we propose an agent-based social simulation tool, ASSOCC, that supports decision makers understand possible consequences of policy interventions, but exploring the combined social, health and economic consequences of these interventions.

Journal Article

Dignum, Frank;Dignum, Virginia;Davidsson, Paul;Ghorbani, Amineh;van der Hurk, Mijke;Jensen, Maarten;Kammler, Christian;Lorig, Fabian;Ludescher, Luis Gustavo;Melchior, Alexander;Mellema, Rene;Pastrav, Cezara;Vanhee, Lois;Verhagen, Harko

10.1007/s11023-020-09527-6

[Title]: Analysing the Combined Health, Social and Economic Impacts of the Corovanvirus Pandemic Using Agent-Based Social Simulation. [Abstract]: During the COVID-19 crisis there have been many difficult decisions governments and other decision makers had to make. E.g. do we go for a total lock down or keep schools open? How many people and which people should be tested? Although there are many good models from e.g. epidemiologists on the spread of the virus under certain conditions, these models do not directly translate into the interventions that can be taken by government. Neither can these models contribute to understand the economic and/or social consequences of the interventions. However, effective and sustainable solutions need to take into account this combination of factors. In this paper, we propose an agent-based social simulation tool, ASSOCC, that supports decision makers understand possible consequences of policy interventions, but exploring the combined social, health and economic consequences of these interventions. [Keywords]:

SN Compr Clin Med

Reactivation of SARS-CoV-2 after Asymptomatic Infection while on High-Dose Corticosteroids. Case Report.

As SARS-CoV-2 and its related clinical syndrome (COVID-19) became a pandemic worldwide, questions regarding its clinical presentation, infectivity, and immune response have been the subject of investigation. We present a case of a patient previously considered recovered from nosocomially transmitted asymptomatic COVID-19 illness, who presented with new respiratory, radiological, and RT-PCR findings consistent with COVID-19, while on high-dose prednisolone due to a suspected secondary demyelinating disease. Importantly, it led to three subsequent cases within patient's household after discharge from the hospital. After reviewing this case in light of current evidence and debates surrounding SARS-CoV-2 RT-PCR results, we hypothesize that patients on corticosteroids may have particular viral shedding dynamics and should prompt a more conservative approach in regard to isolation discontinuation and monitoring.

covid-19;case report;corticosteroids;rt-pcr;viral shedding

Journal Article

Patrocinio de Jesus, Rita;Silva, Raquel;Aliyeva, Elzara;Lopes, Luis;Portugalyan, Mihran;Antunes, Liliana;Diaz, Priscila;Costa, Carolina;Araujo, Ana Carolina;Coelho, Silvia;Mendes, Joao Joao;Gomes, Sara;Serra, Isabel;Freitas, Paulo

10.1007/s42399-020-00548-x

[Title]: Reactivation of SARS-CoV-2 after Asymptomatic Infection while on High-Dose Corticosteroids. Case Report. [Abstract]: As SARS-CoV-2 and its related clinical syndrome (COVID-19) became a pandemic worldwide, questions regarding its clinical presentation, infectivity, and immune response have been the subject of investigation. We present a case of a patient previously considered recovered from nosocomially transmitted asymptomatic COVID-19 illness, who presented with new respiratory, radiological, and RT-PCR findings consistent with COVID-19, while on high-dose prednisolone due to a suspected secondary demyelinating disease. Importantly, it led to three subsequent cases within patient's household after discharge from the hospital. After reviewing this case in light of current evidence and debates surrounding SARS-CoV-2 RT-PCR results, we hypothesize that patients on corticosteroids may have particular viral shedding dynamics and should prompt a more conservative approach in regard to isolation discontinuation and monitoring. [Keywords]: covid-19;case report;corticosteroids;rt-pcr;viral shedding

J Infect Dev Ctries

Transmission dynamics of Covid-19 in Italy, Germany and Turkey considering social distancing, testing and quarantine.

INTRODUCTION: There are significant differences in the active cases and fatality rates of Covid-19 for different European countries. METHODOLOGY: The present study employs Monte Carlo based transmission growth simulations for Italy, Germany and Turkey. The probabilities of transmission at home, work and social networks and the number of initial cases have been calibrated to match the basic reproduction number and the reported fatality curves. Parametric studies were conducted to observe the effect of social distancing, work closure, testing and quarantine of the family and colleagues of positively tested individuals. RESULTS: It is observed that estimates of the number of initial cases in Italy compared to Turkey and Germany are higher. Turkey will probably experience about 30% less number of fatalities than Germany due its smaller elderly population. If social distancing and work contacts are limited to 25% of daily routines, Germany and Turkey may limit the number of fatalities to a few thousands as the reproduction number decreases to about 1.3 from 2.8. Random testing may reduce the number of fatalities by 10% upon testing least 5/1000 of the population. Quarantining of family and workmates of positively tested individuals may reduce the total number of fatalities by about 50%. CONCLUSIONS: The fatality rate of Covid-19 is estimated to be about 1.5% based on the simulation results. This may further be reduced by limiting the number of non-family contacts to two, conducting tests more than 0.5% of the population and immediate quarantine of the contacts for positively tested individuals.

covid-19;germany;italy;turkey;social distancing;transmission

Journal Article

Gul, Serdar;Tuncay, Kagan;Binici, Baris;Aydin, Beyazit Bestami

10.3855/jidc.12844

[Title]: Transmission dynamics of Covid-19 in Italy, Germany and Turkey considering social distancing, testing and quarantine. [Abstract]: INTRODUCTION: There are significant differences in the active cases and fatality rates of Covid-19 for different European countries. METHODOLOGY: The present study employs Monte Carlo based transmission growth simulations for Italy, Germany and Turkey. The probabilities of transmission at home, work and social networks and the number of initial cases have been calibrated to match the basic reproduction number and the reported fatality curves. Parametric studies were conducted to observe the effect of social distancing, work closure, testing and quarantine of the family and colleagues of positively tested individuals. RESULTS: It is observed that estimates of the number of initial cases in Italy compared to Turkey and Germany are higher. Turkey will probably experience about 30% less number of fatalities than Germany due its smaller elderly population. If social distancing and work contacts are limited to 25% of daily routines, Germany and Turkey may limit the number of fatalities to a few thousands as the reproduction number decreases to about 1.3 from 2.8. Random testing may reduce the number of fatalities by 10% upon testing least 5/1000 of the population. Quarantining of family and workmates of positively tested individuals may reduce the total number of fatalities by about 50%. CONCLUSIONS: The fatality rate of Covid-19 is estimated to be about 1.5% based on the simulation results. This may further be reduced by limiting the number of non-family contacts to two, conducting tests more than 0.5% of the population and immediate quarantine of the contacts for positively tested individuals. [Keywords]: covid-19;germany;italy;turkey;social distancing;transmission

J Neurovirol

Neurological manifestations of COVID-19: available evidences and a new paradigm.

The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients.

covid-19;gene enrichment;gene prioritization;neurological damage;sars-cov-2

Journal Article;Review

Khatoon, Fatima;Prasad, Kartikay;Kumar, Vijay

10.1007/s13365-020-00895-4

[Title]: Neurological manifestations of COVID-19: available evidences and a new paradigm. [Abstract]: The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients. [Keywords]: covid-19;gene enrichment;gene prioritization;neurological damage;sars-cov-2

JACC Clin Electrophysiol

Arrhythmias and COVID-19: A Review.

Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies.

covid-19;qt prolongation;sars-cov-2;arrhythmias;channelopathies;myocarditis;torsades de pointes

Journal Article;Review

Dherange, Parinita;Lang, Joshua;Qian, Pierre;Oberfeld, Blake;Sauer, William H;Koplan, Bruce;Tedrow, Usha

10.1016/j.jacep.2020.08.002

[Title]: Arrhythmias and COVID-19: A Review. [Abstract]: Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies. [Keywords]: covid-19;qt prolongation;sars-cov-2;arrhythmias;channelopathies;myocarditis;torsades de pointes

BMC Infect Dis

The coronavirus diseases 2019 (COVID-19) pneumonia with spontaneous pneumothorax: a case report.

BACKGROUND: The outbreak of the novel coronavirus (COVID-19) that was firstly reported in Wuhan, China, with cases now confirmed in more than 100 countries. However, COVID-19 pneumonia with spontaneous pneumothorax is unknown. CASE PRESENTATION: We reported a case of 66-year-old man infected with COVID-19, presenting with fever, cough and myalgia; The patient received supportive and empirical treatment including antiviral treatment, anti-inflammatory treatment, oxygen supply and inhalation therapy; The symptoms, CT images, laboratory results got improved after the treatments, and a throat swab was negative for COVID-19 PCR test; However, on the hospital day 30, the patient presented with a sudden chest pain and dyspnea. CT showed a 30-40% left-sided pneumothorax. Immediate thoracic closed drainage was performed and his dyspnea was rapidly improved. With five more times negative PCR tests for SARS-CoV-2 virus, the patient was discharged and home quarantine. CONCLUSION: This case highlights the importance for clinicians to pay attention to the appearance of spontaneous pneumothorax, especially patients with severe pulmonary damage for a long course, as well as the need for early image diagnose CT and effective treatment once pneumothorax occurs.

covid-19;pneumonia;pneumothorax;sars-cov-2 virus

Case Reports;Journal Article

Chen, Xiaoxing;Zhang, Guqin;Tang, Yueting;Peng, Zhiyong;Pan, Huaqin

10.1186/s12879-020-05384-x

[Title]: The coronavirus diseases 2019 (COVID-19) pneumonia with spontaneous pneumothorax: a case report. [Abstract]: BACKGROUND: The outbreak of the novel coronavirus (COVID-19) that was firstly reported in Wuhan, China, with cases now confirmed in more than 100 countries. However, COVID-19 pneumonia with spontaneous pneumothorax is unknown. CASE PRESENTATION: We reported a case of 66-year-old man infected with COVID-19, presenting with fever, cough and myalgia; The patient received supportive and empirical treatment including antiviral treatment, anti-inflammatory treatment, oxygen supply and inhalation therapy; The symptoms, CT images, laboratory results got improved after the treatments, and a throat swab was negative for COVID-19 PCR test; However, on the hospital day 30, the patient presented with a sudden chest pain and dyspnea. CT showed a 30-40% left-sided pneumothorax. Immediate thoracic closed drainage was performed and his dyspnea was rapidly improved. With five more times negative PCR tests for SARS-CoV-2 virus, the patient was discharged and home quarantine. CONCLUSION: This case highlights the importance for clinicians to pay attention to the appearance of spontaneous pneumothorax, especially patients with severe pulmonary damage for a long course, as well as the need for early image diagnose CT and effective treatment once pneumothorax occurs. [Keywords]: covid-19;pneumonia;pneumothorax;sars-cov-2 virus

Hematol Oncol Stem Cell Ther

Bronchoalveolar lavage-based COVID-19 testing in patients with cancer.

OBJECTIVE/BACKGROUND: A few case reports in the setting of coronavirus disease 2019 (COVID-19) and multiplex polymerase chain reaction (PCR)-based assays for common respiratory pathogens have shown a higher yield of bronchoalveolar lavage (BAL) samples than upper airway specimens in immunocompromised patients. METHODS: A retrospective study was conducted reviewing patients diagnosed with COVID-19 at the Medical College of Wisconsin (Milwaukee, WI, USA) between March 13, 2020 and June 11, 2020. All patients tested positive for SARS-CoV-2 via real-time reverse transcriptase PCR (RT-PCR), through a nasopharyngeal or a bronchoscopy specimen. RESULTS: During the study period, 53 bronchoscopy procedures were performed at the institution, of which five patients tested positive for COVID-19. Of the five patients, three underwent BAL testing based on high clinical suspicion for COVID-19 after the nasopharyngeal (NP) swab(s) was negative. All three patients had underlying cancers and had lymphopenia for a considerable duration prior to being diagnosed with COVID-19. Two patients had better outcomes that could be attributed to earlier BAL specimen testing resulting in timely medical intervention. CONCLUSION: This study underscores the need for early lower respiratory tract sampling, whenever possible, in patients with cancer and prolonged lymphopenia. High clinical suspicion ought to supersede false-negative NP reverse transcriptase-PCR as early bronchoscopic evaluation in cancer patients, who are either receiving active treatment or are immunosuppressed, can allow timely institution of efficacious treatment, enrollment into clinical trials, as well as effective infection control. In the apt clinical setting in patients with cancer, presumptive treatment may also be considered to minimize exposure to healthcare providers and proceduralists.

bronchoalveolar lavage;cancer;coronavirus disease 2019 (covid-19);corticosteroids;hematological malignancy;immunocompromised;sars-cov-2;lymphopenia

Case Reports;Journal Article

Abid, Muhammad Bilal;Chhabra, Saurabh;Buchan, Blake;Graham, Mary Beth;Abedin, Sameem;Thapa, Bicky;D'Souza, Anita;George, Ben;Hamadani, Mehdi

10.1016/j.hemonc.2020.09.002

[Title]: Bronchoalveolar lavage-based COVID-19 testing in patients with cancer. [Abstract]: OBJECTIVE/BACKGROUND: A few case reports in the setting of coronavirus disease 2019 (COVID-19) and multiplex polymerase chain reaction (PCR)-based assays for common respiratory pathogens have shown a higher yield of bronchoalveolar lavage (BAL) samples than upper airway specimens in immunocompromised patients. METHODS: A retrospective study was conducted reviewing patients diagnosed with COVID-19 at the Medical College of Wisconsin (Milwaukee, WI, USA) between March 13, 2020 and June 11, 2020. All patients tested positive for SARS-CoV-2 via real-time reverse transcriptase PCR (RT-PCR), through a nasopharyngeal or a bronchoscopy specimen. RESULTS: During the study period, 53 bronchoscopy procedures were performed at the institution, of which five patients tested positive for COVID-19. Of the five patients, three underwent BAL testing based on high clinical suspicion for COVID-19 after the nasopharyngeal (NP) swab(s) was negative. All three patients had underlying cancers and had lymphopenia for a considerable duration prior to being diagnosed with COVID-19. Two patients had better outcomes that could be attributed to earlier BAL specimen testing resulting in timely medical intervention. CONCLUSION: This study underscores the need for early lower respiratory tract sampling, whenever possible, in patients with cancer and prolonged lymphopenia. High clinical suspicion ought to supersede false-negative NP reverse transcriptase-PCR as early bronchoscopic evaluation in cancer patients, who are either receiving active treatment or are immunosuppressed, can allow timely institution of efficacious treatment, enrollment into clinical trials, as well as effective infection control. In the apt clinical setting in patients with cancer, presumptive treatment may also be considered to minimize exposure to healthcare providers and proceduralists. [Keywords]: bronchoalveolar lavage;cancer;coronavirus disease 2019 (covid-19);corticosteroids;hematological malignancy;immunocompromised;sars-cov-2;lymphopenia

Clin Infect Dis

Lessons from Mass-Testing for COVID-19 in Long Term Care Facilities for the Elderly in San Francisco.

COVID-19 can cause significant mortality in the elderly in Long Term Care Facilities (LTCF). We describe four LTCF outbreaks where mass testing identified a high proportion of asymptomatic infections (4-41% in health care workers and 20-75% in residents), indicating that symptom-based screening alone is insufficient for monitoring for COVID-19 transmission.

covid-19;coronavirus;elderly;health care worker;infection control;mass testing;skilled nursing facility

Journal Article

Louie, Janice K;Scott, Hyman M;DuBois, Amie;Sturtz, Natalya;Lu, Wendy;Stoltey, Juliet;Masinde, Godfred;Cohen, Stephanie;Sachdev, Darpun;Philip, Susan;Bobba, Naveena;Aragon, Tomas

10.1093/cid/ciaa1020

[Title]: Lessons from Mass-Testing for COVID-19 in Long Term Care Facilities for the Elderly in San Francisco. [Abstract]: COVID-19 can cause significant mortality in the elderly in Long Term Care Facilities (LTCF). We describe four LTCF outbreaks where mass testing identified a high proportion of asymptomatic infections (4-41% in health care workers and 20-75% in residents), indicating that symptom-based screening alone is insufficient for monitoring for COVID-19 transmission. [Keywords]: covid-19;coronavirus;elderly;health care worker;infection control;mass testing;skilled nursing facility

Br J Haematol

Protecting vulnerable patients with inherited anaemias from unnecessary death during the COVID-19 pandemic.

With the developing COVID-19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self-isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life-saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID-19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID-19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID-19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.

Journal Article

Roy, Noemi B A;Telfer, Paul;Eleftheriou, Perla;de la Fuente, Josu;Drasar, Emma;Shah, Farrukh;Roberts, David;Atoyebi, Wale;Trompeter, Sara;Layton, D Mark;Lugthart, Sanne;Stuart-Smith, Sara;Chakravorty, Subarna;Wright, Josh;Porter, John;Inusa, Baba;Howard, Jo

10.1111/bjh.16687

[Title]: Protecting vulnerable patients with inherited anaemias from unnecessary death during the COVID-19 pandemic. [Abstract]: With the developing COVID-19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self-isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life-saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID-19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID-19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID-19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population. [Keywords]:

Virus Res

Prospect of SARS-CoV-2 spike protein: Potential role in vaccine and therapeutic development.

The recent outbreak of the betacoronavirus SARS-CoV-2 has become a significant concern to public health care worldwide. As of August 19, 2020, more than 22,140,472 people are infected, and over 781,135 people have died due to this deadly virus. In the USA alone, over 5,482,602 people are currently infected, and more than 171,823 people have died. SARS-CoV-2 has shown a higher infectivity rate and a more extended incubation period as compared to previous coronaviruses. SARS-CoV-2 binds much more strongly than SARS-CoV to the same host receptor, angiotensin-converting enzyme 2 (ACE2). Previously, several methods to develop a vaccine against SARS-CoV or MERS-CoV have been tried with limited success. Since SARS-CoV-2 uses the spike (S) protein for entry to the host cell, it is one of the most preferred targets for making vaccines or therapeutics against SARS-CoV-2. In this review, we have summarised the characteristics of the S protein, as well as the different approaches being used for the development of vaccines and/or therapeutics based on the S protein.

covid-19;sars-cov-2;spike protein;therapeutic;vaccine

Journal Article;Research Support, N.I.H., Extramural;Review

Samrat, Subodh Kumar;Tharappel, Anil M;Li, Zhong;Li, Hongmin

10.1016/j.virusres.2020.198141

[Title]: Prospect of SARS-CoV-2 spike protein: Potential role in vaccine and therapeutic development. [Abstract]: The recent outbreak of the betacoronavirus SARS-CoV-2 has become a significant concern to public health care worldwide. As of August 19, 2020, more than 22,140,472 people are infected, and over 781,135 people have died due to this deadly virus. In the USA alone, over 5,482,602 people are currently infected, and more than 171,823 people have died. SARS-CoV-2 has shown a higher infectivity rate and a more extended incubation period as compared to previous coronaviruses. SARS-CoV-2 binds much more strongly than SARS-CoV to the same host receptor, angiotensin-converting enzyme 2 (ACE2). Previously, several methods to develop a vaccine against SARS-CoV or MERS-CoV have been tried with limited success. Since SARS-CoV-2 uses the spike (S) protein for entry to the host cell, it is one of the most preferred targets for making vaccines or therapeutics against SARS-CoV-2. In this review, we have summarised the characteristics of the S protein, as well as the different approaches being used for the development of vaccines and/or therapeutics based on the S protein. [Keywords]: covid-19;sars-cov-2;spike protein;therapeutic;vaccine

Lancet Infect Dis

Connecting clusters of COVID-19: an epidemiological and serological investigation.

BACKGROUND: Elucidation of the chain of disease transmission and identification of the source of coronavirus disease 2019 (COVID-19) infections are crucial for effective disease containment. We describe an epidemiological investigation that, with use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays, established links between three clusters of COVID-19. METHODS: In Singapore, active case-finding and contact tracing were undertaken for all COVID-19 cases. Diagnosis for acute disease was confirmed with RT-PCR testing. When epidemiological information suggested that people might have been nodes of disease transmission but had recovered from illness, SARS-CoV-2 IgG serology testing was used to establish past infection. FINDINGS: Three clusters of COVID-19, comprising 28 locally transmitted cases, were identified in Singapore; these clusters were from two churches (Church A and Church B) and a family gathering. The clusters in Church A and Church B were linked by an individual from Church A (A2), who transmitted SARS-CoV-2 infection to the primary case from Church B (F1) at a family gathering they both attended on Jan 25, 2020. All cases were confirmed by RT-PCR testing because they had active disease, except for A2, who at the time of testing had recovered from their illness and tested negative. This individual was eventually diagnosed with past infection by serological testing. ELISA assays showed an optical density of more than 1.4 for SARS-CoV-2 nucleoprotein and receptor binding domain antigens in titres up to 1/400, and viral neutralisation was noted in titres up to 1/320. INTERPRETATION: Development and application of a serological assay has helped to establish connections between COVID-19 clusters in Singapore. Serological testing can have a crucial role in identifying convalescent cases or people with milder disease who might have been missed by other surveillance methods. FUNDING: National Research Foundation (Singapore), National Natural Science Foundation (China), and National Medical Research Council (Singapore).

Journal Article;Research Support, Non-U.S. Gov't

Yong, Sarah Ee Fang;Anderson, Danielle Elizabeth;Wei, Wycliffe E;Pang, Junxiong;Chia, Wan Ni;Tan, Chee Wah;Teoh, Yee Leong;Rajendram, Priyanka;Toh, Matthias Paul Han Sim;Poh, Cuiqin;Koh, Valerie T J;Lum, Joshua;Suhaimi, Nur-Afidah Md;Chia, Po Ying;Chen, Mark I-Cheng;Vasoo, Shawn;Ong, Benjamin;Leo, Yee Sin;Wang, Linfa;Lee, Vernon J M

10.1016/S1473-3099(20)30273-5

[Title]: Connecting clusters of COVID-19: an epidemiological and serological investigation. [Abstract]: BACKGROUND: Elucidation of the chain of disease transmission and identification of the source of coronavirus disease 2019 (COVID-19) infections are crucial for effective disease containment. We describe an epidemiological investigation that, with use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays, established links between three clusters of COVID-19. METHODS: In Singapore, active case-finding and contact tracing were undertaken for all COVID-19 cases. Diagnosis for acute disease was confirmed with RT-PCR testing. When epidemiological information suggested that people might have been nodes of disease transmission but had recovered from illness, SARS-CoV-2 IgG serology testing was used to establish past infection. FINDINGS: Three clusters of COVID-19, comprising 28 locally transmitted cases, were identified in Singapore; these clusters were from two churches (Church A and Church B) and a family gathering. The clusters in Church A and Church B were linked by an individual from Church A (A2), who transmitted SARS-CoV-2 infection to the primary case from Church B (F1) at a family gathering they both attended on Jan 25, 2020. All cases were confirmed by RT-PCR testing because they had active disease, except for A2, who at the time of testing had recovered from their illness and tested negative. This individual was eventually diagnosed with past infection by serological testing. ELISA assays showed an optical density of more than 1.4 for SARS-CoV-2 nucleoprotein and receptor binding domain antigens in titres up to 1/400, and viral neutralisation was noted in titres up to 1/320. INTERPRETATION: Development and application of a serological assay has helped to establish connections between COVID-19 clusters in Singapore. Serological testing can have a crucial role in identifying convalescent cases or people with milder disease who might have been missed by other surveillance methods. FUNDING: National Research Foundation (Singapore), National Natural Science Foundation (China), and National Medical Research Council (Singapore). [Keywords]:

PLoS One

Hydroxychloroquine and tocilizumab therapy in COVID-19 patients-An observational study.

Hydroxychloroquine has been touted as a potential COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has also been proposed as a treatment of critically ill patients. In this retrospective observational cohort study drawn from electronic health records we sought to describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients. Patients were hospitalized at a 13-hospital network spanning New Jersey USA between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020. Among 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80-1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83-1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75-1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57-1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%. This observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials. Trial Registration: Clinicaltrials.gov Identifier: NCT04347993.

Journal Article;Multicenter Study;Observational Study

Ip, Andrew;Berry, Donald A;Hansen, Eric;Goy, Andre H;Pecora, Andrew L;Sinclaire, Brittany A;Bednarz, Urszula;Marafelias, Michael;Berry, Scott M;Berry, Nicholas S;Mathura, Shivam;Sawczuk, Ihor S;Biran, Noa;Go, Ronaldo C;Sperber, Steven;Piwoz, Julia A;Balani, Bindu;Cicogna, Cristina;Sebti, Rani;Zuckerman, Jerry;Rose, Keith M;Tank, Lisa;Jacobs, Laurie G;Korcak, Jason;Timmapuri, Sarah L;Underwood, Joseph P;Sugalski, Gregory;Barsky, Carol;Varga, Daniel W;Asif, Arif;Landolfi, Joseph C;Goldberg, Stuart L

10.1371/journal.pone.0237693

[Title]: Hydroxychloroquine and tocilizumab therapy in COVID-19 patients-An observational study. [Abstract]: Hydroxychloroquine has been touted as a potential COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has also been proposed as a treatment of critically ill patients. In this retrospective observational cohort study drawn from electronic health records we sought to describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients. Patients were hospitalized at a 13-hospital network spanning New Jersey USA between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020. Among 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80-1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83-1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75-1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57-1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%. This observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials. Trial Registration: Clinicaltrials.gov Identifier: NCT04347993. [Keywords]:

Life (Basel)

Molecular Epidemiology Analysis of SARS-CoV-2 Strains Circulating in Romania during the First Months of the Pandemic.

BACKGROUND: The spread of SARS-CoV-2 generated an unprecedented global public health crisis. Soon after Asia, Europe was seriously affected. Many countries, including Romania, adopted lockdown measures to limit the outbreak. AIM: We performed a molecular epidemiology analysis of SARS-CoV-2 viral strains circulating in Romania during the first two months of the epidemic in order to detect mutation profiles and phylogenetic relatedness. METHODS: Respiratory samples were directly used for shotgun sequencing. RESULTS: All Romanian sequences belonged to lineage B, with a different subtype distribution between northern and southern regions (subtype B.1.5 and B.1.1). Phylogenetic analysis suggested that the Romanian epidemic started with multiple introduction events from other European countries followed by local transmission. Phylogenetic links between northern Romania and Spain, Austria, Scotland and Russia were observed, as well as between southern Romania and Switzerland, Italy, France and Turkey. One viral strain presented a previously unreported mutation in the Nsp2 gene, namely K489E. Epidemiologically-defined clusters displayed specific mutations, suggesting molecular signatures for strains coming from areas that were isolated during the lockdown. CONCLUSIONS: Romanian epidemic was initiated by multiple introductions from European countries followed by local transmissions. Different subtype distribution between northern and southern Romania was observed after two months of the pandemic.

romania;sars-cov-2;wgs;coronavirus;mutations;outbreak;pandemic;phylogenetic analysis

Journal Article

Surleac, Marius;Banica, Leontina;Casangiu, Corina;Cotic, Marius;Florea, Dragos;Sandulescu, Oana;Milu, Petre;Streinu-Cercel, Anca;Vlaicu, Ovidiu;Paraskevis, Dimitrios;Paraschiv, Simona;Otelea, Dan

10.3390/life10080152

[Title]: Molecular Epidemiology Analysis of SARS-CoV-2 Strains Circulating in Romania during the First Months of the Pandemic. [Abstract]: BACKGROUND: The spread of SARS-CoV-2 generated an unprecedented global public health crisis. Soon after Asia, Europe was seriously affected. Many countries, including Romania, adopted lockdown measures to limit the outbreak. AIM: We performed a molecular epidemiology analysis of SARS-CoV-2 viral strains circulating in Romania during the first two months of the epidemic in order to detect mutation profiles and phylogenetic relatedness. METHODS: Respiratory samples were directly used for shotgun sequencing. RESULTS: All Romanian sequences belonged to lineage B, with a different subtype distribution between northern and southern regions (subtype B.1.5 and B.1.1). Phylogenetic analysis suggested that the Romanian epidemic started with multiple introduction events from other European countries followed by local transmission. Phylogenetic links between northern Romania and Spain, Austria, Scotland and Russia were observed, as well as between southern Romania and Switzerland, Italy, France and Turkey. One viral strain presented a previously unreported mutation in the Nsp2 gene, namely K489E. Epidemiologically-defined clusters displayed specific mutations, suggesting molecular signatures for strains coming from areas that were isolated during the lockdown. CONCLUSIONS: Romanian epidemic was initiated by multiple introductions from European countries followed by local transmissions. Different subtype distribution between northern and southern Romania was observed after two months of the pandemic. [Keywords]: romania;sars-cov-2;wgs;coronavirus;mutations;outbreak;pandemic;phylogenetic analysis

J Gen Intern Med

Comparing Associations of State Reopening Strategies with COVID-19 Burden.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied. OBJECTIVE: To estimate excess COVID-19 cases and deaths after reopening compared with trends prior to reopening for two groups of states: (1) states with an evidence-based reopening strategy, defined as reopening indoor dining after implementing a statewide mask mandate, and (2) states reopening indoor dining rooms before implementing a statewide mask mandate. DESIGN: Interrupted time series quasi-experimental study design applied to publicly available secondary data. PARTICIPANTS: Fifty United States and the District of Columbia. INTERVENTIONS: Reopening indoor dining rooms before or after implementing a statewide mask mandate. MAIN MEASURES: Outcomes included daily cumulative COVID-19 cases and deaths for each state. KEY RESULTS: On average, the number of excess cases per 100,000 residents in states reopening without masks is ten times the number in states reopening with masks after 8 weeks (643.1 cases; 95% confidence interval (CI) = 406.9, 879.2 and 62.9 cases; CI = 12.6, 113.1, respectively). Excess cases after 6 weeks could have been reduced by 90% from 576,371 to 63,062 and excess deaths reduced by 80% from 22,851 to 4858 had states implemented mask mandates prior to reopening. Over 50,000 excess deaths were prevented within 6 weeks in 13 states that implemented mask mandates prior to reopening. CONCLUSIONS: Additional mitigation measures such as mask use counteract the potential growth in COVID-19 cases and deaths due to reopening businesses. This study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. States should delay further reopening until mask mandates are fully implemented, and enforcement by local businesses will be critical for preventing potential future closures.

Journal Article

Kaufman, Brystana G;Whitaker, Rebecca;Mahendraratnam, Nirosha;Smith, Valerie A;McClellan, Mark B

10.1007/s11606-020-06277-0

[Title]: Comparing Associations of State Reopening Strategies with COVID-19 Burden. [Abstract]: BACKGROUND: The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied. OBJECTIVE: To estimate excess COVID-19 cases and deaths after reopening compared with trends prior to reopening for two groups of states: (1) states with an evidence-based reopening strategy, defined as reopening indoor dining after implementing a statewide mask mandate, and (2) states reopening indoor dining rooms before implementing a statewide mask mandate. DESIGN: Interrupted time series quasi-experimental study design applied to publicly available secondary data. PARTICIPANTS: Fifty United States and the District of Columbia. INTERVENTIONS: Reopening indoor dining rooms before or after implementing a statewide mask mandate. MAIN MEASURES: Outcomes included daily cumulative COVID-19 cases and deaths for each state. KEY RESULTS: On average, the number of excess cases per 100,000 residents in states reopening without masks is ten times the number in states reopening with masks after 8 weeks (643.1 cases; 95% confidence interval (CI) = 406.9, 879.2 and 62.9 cases; CI = 12.6, 113.1, respectively). Excess cases after 6 weeks could have been reduced by 90% from 576,371 to 63,062 and excess deaths reduced by 80% from 22,851 to 4858 had states implemented mask mandates prior to reopening. Over 50,000 excess deaths were prevented within 6 weeks in 13 states that implemented mask mandates prior to reopening. CONCLUSIONS: Additional mitigation measures such as mask use counteract the potential growth in COVID-19 cases and deaths due to reopening businesses. This study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. States should delay further reopening until mask mandates are fully implemented, and enforcement by local businesses will be critical for preventing potential future closures. [Keywords]:

Hum Genomics

Genetic variants of the human host influencing the coronavirus-associated phenotypes (SARS, MERS and COVID-19): rapid systematic review and field synopsis.

The COVID-19 pandemic has strengthened the interest in the biological mechanisms underlying the complex interplay between infectious agents and the human host. The spectrum of phenotypes associated with the SARS-CoV-2 infection, ranging from the absence of symptoms to severe systemic complications, raised the question as to what extent the variable response to coronaviruses (CoVs) is influenced by the variability of the hosts' genetic background.To explore the current knowledge about this question, we designed a systematic review encompassing the scientific literature published from Jan. 2003 to June 2020, to include studies on the contemporary outbreaks caused by SARS-CoV-1, MERS-CoV and SARS-CoV-2 (namely SARS, MERS and COVID-19 diseases). Studies were eligible if human genetic variants were tested as predictors of clinical phenotypes.An ad hoc protocol for the rapid review process was designed according to the PRISMA paradigm and registered at the PROSPERO database (ID: CRD42020180860). The systematic workflow provided 32 articles eligible for data abstraction (28 on SARS, 1 on MERS, 3 on COVID-19) reporting data on 26 discovery cohorts. Most studies considered the definite clinical diagnosis as the primary outcome, variably coupled with other outcomes (severity was the most frequently analysed). Ten studies analysed HLA haplotypes (1 in patients with COVID-19) and did not provide consistent signals of association with disease-associated phenotypes. Out of 22 eligible articles that investigated candidate genes (2 as associated with COVID-19), the top-ranked genes in the number of studies were ACE2, CLEC4M (L-SIGN), MBL, MxA (n = 3), ACE, CD209, FCER2, OAS-1, TLR4, TNF-alpha (n = 2). Only variants in MBL and MxA were found as possibly implicated in CoV-associated phenotypes in at least two studies. The number of studies for each predictor was insufficient to conduct meta-analyses.Studies collecting large cohorts from different ancestries are needed to further elucidate the role of host genetic variants in determining the response to CoVs infection. Rigorous design and robust statistical methods are warranted.

covid-19;coronavirus;genetic association;genetic susceptibility;genomic biomarker;genotype;human host;polymorphism

Journal Article;Meta-Analysis;Research Support, Non-U.S. Gov't;Review;Systematic Review

Di Maria, Emilio;Latini, Andrea;Borgiani, Paola;Novelli, Giuseppe

10.1186/s40246-020-00280-6

[Title]: Genetic variants of the human host influencing the coronavirus-associated phenotypes (SARS, MERS and COVID-19): rapid systematic review and field synopsis. [Abstract]: The COVID-19 pandemic has strengthened the interest in the biological mechanisms underlying the complex interplay between infectious agents and the human host. The spectrum of phenotypes associated with the SARS-CoV-2 infection, ranging from the absence of symptoms to severe systemic complications, raised the question as to what extent the variable response to coronaviruses (CoVs) is influenced by the variability of the hosts' genetic background.To explore the current knowledge about this question, we designed a systematic review encompassing the scientific literature published from Jan. 2003 to June 2020, to include studies on the contemporary outbreaks caused by SARS-CoV-1, MERS-CoV and SARS-CoV-2 (namely SARS, MERS and COVID-19 diseases). Studies were eligible if human genetic variants were tested as predictors of clinical phenotypes.An ad hoc protocol for the rapid review process was designed according to the PRISMA paradigm and registered at the PROSPERO database (ID: CRD42020180860). The systematic workflow provided 32 articles eligible for data abstraction (28 on SARS, 1 on MERS, 3 on COVID-19) reporting data on 26 discovery cohorts. Most studies considered the definite clinical diagnosis as the primary outcome, variably coupled with other outcomes (severity was the most frequently analysed). Ten studies analysed HLA haplotypes (1 in patients with COVID-19) and did not provide consistent signals of association with disease-associated phenotypes. Out of 22 eligible articles that investigated candidate genes (2 as associated with COVID-19), the top-ranked genes in the number of studies were ACE2, CLEC4M (L-SIGN), MBL, MxA (n = 3), ACE, CD209, FCER2, OAS-1, TLR4, TNF-alpha (n = 2). Only variants in MBL and MxA were found as possibly implicated in CoV-associated phenotypes in at least two studies. The number of studies for each predictor was insufficient to conduct meta-analyses.Studies collecting large cohorts from different ancestries are needed to further elucidate the role of host genetic variants in determining the response to CoVs infection. Rigorous design and robust statistical methods are warranted. [Keywords]: covid-19;coronavirus;genetic association;genetic susceptibility;genomic biomarker;genotype;human host;polymorphism

Clin Exp Rheumatol

COVID-19, cytokines and immunosuppression: what can we learn from severe acute respiratory syndrome?

A severe outbreak of coronavirus disease 2019 (COVID-19) emerged in China in December 2019, and spread so rapidly that more than 200,000 cases have so far been reported worldwide; on January 30, 2020, the WHO declared it the sixth public health emergency of international concern. The two previously reported coronavirus epidemics (severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome [MERS]) share similar pathogenetic, epidemiological and clinical features as COVID-19. As little is currently known about SARS-CoV-2, it is likely that lessons learned from these major epidemics can be applied to the new pandemic, including the use of novel immunosuppressive drugs.

Journal Article;Review

Sarzi-Puttini, Piercarlo;Giorgi, Valeria;Sirotti, Silvia;Marotto, Daniela;Ardizzone, Sandro;Rizzardini, Giuliano;Antinori, Spinello;Galli, Massimo

[Title]: COVID-19, cytokines and immunosuppression: what can we learn from severe acute respiratory syndrome? [Abstract]: A severe outbreak of coronavirus disease 2019 (COVID-19) emerged in China in December 2019, and spread so rapidly that more than 200,000 cases have so far been reported worldwide; on January 30, 2020, the WHO declared it the sixth public health emergency of international concern. The two previously reported coronavirus epidemics (severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome [MERS]) share similar pathogenetic, epidemiological and clinical features as COVID-19. As little is currently known about SARS-CoV-2, it is likely that lessons learned from these major epidemics can be applied to the new pandemic, including the use of novel immunosuppressive drugs. [Keywords]:

J Med Internet Res

Chinese Public's Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study.

BACKGROUND: Since January 2020, the coronavirus disease (COVID-19) swept over China and then the world, causing a global public health crisis. People's adoption of preventive and intervening behaviors is critical in curbing the spread of the virus. OBJECTIVE: The aim of this study is to evaluate Chinese people's adoption of health behaviors in responding to COVID-19 and to identify key determinants for their engagement. METHODS: An anonymous online questionnaire was distributed in early February 2020 among Mainland Chinese (18 years or older) to examine their engagement in preventive behaviors (eg, frequent handwashing, wearing masks, staying at home) and intervening behaviors (eg, advising family to wash hands frequently), and to explore potential determinants for their adoption of these health behaviors. RESULTS: Out of 2949 participants, 55.3% (n=1629) reported frequent engagement in preventive health behaviors, and over 84% (n=2493) performed at least one intervening health behavior. Greater engagement in preventive behaviors was found among participants who received higher education, were married, reported fewer barriers and greater benefits of engagement, reported greater self-efficacy and emotional support, had greater patient-centered communication before, had a greater media literacy level, and had greater new media and traditional media use for COVID-19 news. Greater engagement in intervening behaviors was observed among participants who were married, had lower income, reported greater benefits of health behaviors, had greater patient-centered communication before, had a lower media literacy level, and had a greater new media and traditional media use for COVID-19 news. CONCLUSIONS: Participants' engagement in coronavirus-related preventive and intervening behaviors was overall high, and the associations varied across demographic and psychosocial variables. Hence, customized health interventions that address the determinants for health behaviors are needed to improve people's adherence to coronavirus-related behavior guidelines.

covid-19;china;behavior;cross-sectional;health literacy;intervening health behaviors;prevention;preventive health behaviors;psychosocial

Journal Article

Niu, Zhaomeng;Wang, Tingting;Hu, Pengwei;Mei, Jing;Tang, Zhihan

10.2196/19995

[Title]: Chinese Public's Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study. [Abstract]: BACKGROUND: Since January 2020, the coronavirus disease (COVID-19) swept over China and then the world, causing a global public health crisis. People's adoption of preventive and intervening behaviors is critical in curbing the spread of the virus. OBJECTIVE: The aim of this study is to evaluate Chinese people's adoption of health behaviors in responding to COVID-19 and to identify key determinants for their engagement. METHODS: An anonymous online questionnaire was distributed in early February 2020 among Mainland Chinese (18 years or older) to examine their engagement in preventive behaviors (eg, frequent handwashing, wearing masks, staying at home) and intervening behaviors (eg, advising family to wash hands frequently), and to explore potential determinants for their adoption of these health behaviors. RESULTS: Out of 2949 participants, 55.3% (n=1629) reported frequent engagement in preventive health behaviors, and over 84% (n=2493) performed at least one intervening health behavior. Greater engagement in preventive behaviors was found among participants who received higher education, were married, reported fewer barriers and greater benefits of engagement, reported greater self-efficacy and emotional support, had greater patient-centered communication before, had a greater media literacy level, and had greater new media and traditional media use for COVID-19 news. Greater engagement in intervening behaviors was observed among participants who were married, had lower income, reported greater benefits of health behaviors, had greater patient-centered communication before, had a lower media literacy level, and had a greater new media and traditional media use for COVID-19 news. CONCLUSIONS: Participants' engagement in coronavirus-related preventive and intervening behaviors was overall high, and the associations varied across demographic and psychosocial variables. Hence, customized health interventions that address the determinants for health behaviors are needed to improve people's adherence to coronavirus-related behavior guidelines. [Keywords]: covid-19;china;behavior;cross-sectional;health literacy;intervening health behaviors;prevention;preventive health behaviors;psychosocial

J Investig Med

COVID-19 epidemic outside China: 34 founders and exponential growth.

COVID-19 raised tension both within China and internationally. Here, we used mathematical modeling to predict the trend of patient diagnosis outside China in future, with the aim of easing anxiety regarding the emergent situation. According to all diagnosis number from WHO website and combining with the transmission mode of infectious diseases, the mathematical model was fitted to predict future trend of outbreak. Daily diagnosis numbers from countries outside China were downloaded from WHO situation reports. The data used for this analysis were collected from January 21, 2020 and currently end at February 28, 2020. A simple regression model was developed based on these numbers, as follows: [Formula: see text], where [Formula: see text] is the total diagnosed patient till the i-th day and t=1 at February 1, 2020. Based on this model, we estimate that there were approximately 34 undetected founder patients at the beginning of the spread of COVID-19 outside China. The global trend was approximately exponential, with an increase rate of 10-fold every 19 days. Through establishment of this model, we call for worldwide strong public health actions, with reference to the experiences learned from China and Singapore.

disease management

Journal Article;Research Support, Non-U.S. Gov't

Li, Yi;Liang, Meng;Yin, Xianhong;Liu, Xiaoyu;Hao, Meng;Hu, Zixin;Wang, Yi;Jin, Li

10.1136/jim-2020-001491

[Title]: COVID-19 epidemic outside China: 34 founders and exponential growth. [Abstract]: COVID-19 raised tension both within China and internationally. Here, we used mathematical modeling to predict the trend of patient diagnosis outside China in future, with the aim of easing anxiety regarding the emergent situation. According to all diagnosis number from WHO website and combining with the transmission mode of infectious diseases, the mathematical model was fitted to predict future trend of outbreak. Daily diagnosis numbers from countries outside China were downloaded from WHO situation reports. The data used for this analysis were collected from January 21, 2020 and currently end at February 28, 2020. A simple regression model was developed based on these numbers, as follows: [Formula: see text], where [Formula: see text] is the total diagnosed patient till the i-th day and t=1 at February 1, 2020. Based on this model, we estimate that there were approximately 34 undetected founder patients at the beginning of the spread of COVID-19 outside China. The global trend was approximately exponential, with an increase rate of 10-fold every 19 days. Through establishment of this model, we call for worldwide strong public health actions, with reference to the experiences learned from China and Singapore. [Keywords]: disease management

Pediatr Pulmonol

Pediatric lung imaging features of COVID-19: A systematic review and meta-analysis.

RATIONALE: Pediatric COVID-19 studies have been mostly restricted to case reports and small case series, which have prevented the identification of specific pediatric lung disease patterns in COVID-19. The overarching goal of this systematic review and meta-analysis is to provide the first comprehensive summary of the findings of published studies thus far describing COVID-19 lung imaging data in the pediatric population. METHODS: A systematic literature search of PubMed was performed to identify studies assessing lung-imaging features of COVID-19 pediatric patients (0-18 years). A single-arm meta-analysis was conducted to obtain the pooled prevalence and 95% confidence interval (95% CI). RESULTS: A total of 29 articles (n = 1026 children) based on chest computerized tomography (CT) images were included. The main results of this comprehensive analysis are as follows: (1) Over a third of pediatric patients with COVID-19 (35.7%, 95% CI: 27.5%-44%) had normal chest CT scans and only 27.7% (95% CI: 19.9%-35.6%) had bilateral lesions. (2) The most typical pediatric chest CT findings of COVID-19 were ground-glass opacities (GGO) (37.2%, 95% CI: 29.3%-45%) and the presence of consolidations or pneumonic infiltrates (22.3%, 95% CI: 17.8%-26.9%). (3) The lung imaging findings in children with COVID-19 were overall less frequent and less severe than in adult patients. (4) Typical lung imaging features of viral respiratory infections in the pediatric population such as increased perihilar markings and hyperinflation were not reported in children with COVID-19. CONCLUSION: Chest CT manifestations in children with COVID-19 could potentially be used for early identification and prompt intervention in the pediatric population.

sars-cov-2;lung ct scan;meta-analysis;pediatric covid-19

Journal Article;Meta-Analysis;Research Support, N.I.H., Extramural;Systematic Review

Nino, Gustavo;Zember, Jonathan;Sanchez-Jacob, Ramon;Gutierrez, Maria J;Sharma, Karun;Linguraru, Marius George

10.1002/ppul.25070

[Title]: Pediatric lung imaging features of COVID-19: A systematic review and meta-analysis. [Abstract]: RATIONALE: Pediatric COVID-19 studies have been mostly restricted to case reports and small case series, which have prevented the identification of specific pediatric lung disease patterns in COVID-19. The overarching goal of this systematic review and meta-analysis is to provide the first comprehensive summary of the findings of published studies thus far describing COVID-19 lung imaging data in the pediatric population. METHODS: A systematic literature search of PubMed was performed to identify studies assessing lung-imaging features of COVID-19 pediatric patients (0-18 years). A single-arm meta-analysis was conducted to obtain the pooled prevalence and 95% confidence interval (95% CI). RESULTS: A total of 29 articles (n = 1026 children) based on chest computerized tomography (CT) images were included. The main results of this comprehensive analysis are as follows: (1) Over a third of pediatric patients with COVID-19 (35.7%, 95% CI: 27.5%-44%) had normal chest CT scans and only 27.7% (95% CI: 19.9%-35.6%) had bilateral lesions. (2) The most typical pediatric chest CT findings of COVID-19 were ground-glass opacities (GGO) (37.2%, 95% CI: 29.3%-45%) and the presence of consolidations or pneumonic infiltrates (22.3%, 95% CI: 17.8%-26.9%). (3) The lung imaging findings in children with COVID-19 were overall less frequent and less severe than in adult patients. (4) Typical lung imaging features of viral respiratory infections in the pediatric population such as increased perihilar markings and hyperinflation were not reported in children with COVID-19. CONCLUSION: Chest CT manifestations in children with COVID-19 could potentially be used for early identification and prompt intervention in the pediatric population. [Keywords]: sars-cov-2;lung ct scan;meta-analysis;pediatric covid-19

Int J Mol Sci

Structural and Evolutionary Analysis Indicate That the SARS-CoV-2 Mpro Is a Challenging Target for Small-Molecule Inhibitor Design.

The novel coronavirus whose outbreak took place in December 2019 continues to spread at a rapid rate worldwide. In the absence of an effective vaccine, inhibitor repurposing or de novo drug design may offer a longer-term strategy to combat this and future infections due to similar viruses. Here, we report on detailed classical and mixed-solvent molecular dynamics simulations of the main protease (Mpro) enriched by evolutionary and stability analysis of the protein. The results were compared with those for a highly similar severe acute respiratory syndrome (SARS) Mpro protein. In spite of a high level of sequence similarity, the active sites in both proteins showed major differences in both shape and size, indicating that repurposing SARS drugs for COVID-19 may be futile. Furthermore, analysis of the binding site's conformational changes during the simulation time indicated its flexibility and plasticity, which dashes hopes for rapid and reliable drug design. Conversely, structural stability of the protein with respect to flexible loop mutations indicated that the virus' mutability will pose a further challenge to the rational design of small-molecule inhibitors. However, few residues contribute significantly to the protein stability and thus can be considered as key anchoring residues for Mpro inhibitor design.

covid-19;sars-cov;sars-cov-2;coronavirus;drug design;evolutionary analysis;ligand tracking approach;molecular dynamics simulations;small-molecule inhibitors

Journal Article

Bzowka, Maria;Mitusinska, Karolina;Raczynska, Agata;Samol, Aleksandra;Tuszynski, Jack A;Gora, Artur

10.3390/ijms21093099

[Title]: Structural and Evolutionary Analysis Indicate That the SARS-CoV-2 Mpro Is a Challenging Target for Small-Molecule Inhibitor Design. [Abstract]: The novel coronavirus whose outbreak took place in December 2019 continues to spread at a rapid rate worldwide. In the absence of an effective vaccine, inhibitor repurposing or de novo drug design may offer a longer-term strategy to combat this and future infections due to similar viruses. Here, we report on detailed classical and mixed-solvent molecular dynamics simulations of the main protease (Mpro) enriched by evolutionary and stability analysis of the protein. The results were compared with those for a highly similar severe acute respiratory syndrome (SARS) Mpro protein. In spite of a high level of sequence similarity, the active sites in both proteins showed major differences in both shape and size, indicating that repurposing SARS drugs for COVID-19 may be futile. Furthermore, analysis of the binding site's conformational changes during the simulation time indicated its flexibility and plasticity, which dashes hopes for rapid and reliable drug design. Conversely, structural stability of the protein with respect to flexible loop mutations indicated that the virus' mutability will pose a further challenge to the rational design of small-molecule inhibitors. However, few residues contribute significantly to the protein stability and thus can be considered as key anchoring residues for Mpro inhibitor design. [Keywords]: covid-19;sars-cov;sars-cov-2;coronavirus;drug design;evolutionary analysis;ligand tracking approach;molecular dynamics simulations;small-molecule inhibitors

Clin Infect Dis

Clinical Presentation and Outcomes of Pregnant Women with COVID-19: A Systematic Review and Meta-Analysis.

INTRODUCTION: Descriptions of coronavirus disease-2019 (COVID-19) have focused on the non-pregnant adult population. This study aims to describe the clinical characteristics and perinatal outcomes of COVID-19 in pregnancy. METHODS: We searched databases from December 2019 to April 30th, 2020. Eligible studies reported clinical characteristics, radiological findings and/or laboratory testing of pregnant women during infection. Data were pooled across studies using random-effects model. RESULTS: Twenty-four studies (136 women) were included. Most common symptoms were fever (62.9%) and cough (36.8%). Laboratory findings included elevated C-Reactive Protein (57%) and lymphocytopenia (50%). Ground-glass opacity was the most common radiological finding (81.7%). Preterm birth rate was 37.7% and cesarean delivery rate was 76%. There was one maternal death. There were two fetal COVID-19 cases. CONCLUSION: The clinical picture in pregnant women with COVID-19 did not differ from the non-pregnant population, however, the rate of preterm birth and cesarean delivery are considerably higher than international averages.

coronavirus;neonates;pregnant;transmission

Journal Article;Meta-Analysis;Systematic Review

Matar, Reem;Alrahmani, Layan;Monzer, Nasser;Debiane, Labib G;Berbari, Elie;Fares, Jawad;Fitzpatrick, Fidelma;Murad, Mohammad H

10.1093/cid/ciaa828

[Title]: Clinical Presentation and Outcomes of Pregnant Women with COVID-19: A Systematic Review and Meta-Analysis. [Abstract]: INTRODUCTION: Descriptions of coronavirus disease-2019 (COVID-19) have focused on the non-pregnant adult population. This study aims to describe the clinical characteristics and perinatal outcomes of COVID-19 in pregnancy. METHODS: We searched databases from December 2019 to April 30th, 2020. Eligible studies reported clinical characteristics, radiological findings and/or laboratory testing of pregnant women during infection. Data were pooled across studies using random-effects model. RESULTS: Twenty-four studies (136 women) were included. Most common symptoms were fever (62.9%) and cough (36.8%). Laboratory findings included elevated C-Reactive Protein (57%) and lymphocytopenia (50%). Ground-glass opacity was the most common radiological finding (81.7%). Preterm birth rate was 37.7% and cesarean delivery rate was 76%. There was one maternal death. There were two fetal COVID-19 cases. CONCLUSION: The clinical picture in pregnant women with COVID-19 did not differ from the non-pregnant population, however, the rate of preterm birth and cesarean delivery are considerably higher than international averages. [Keywords]: coronavirus;neonates;pregnant;transmission

BMC Res Notes

Age, source, and future risk of COVID-19 infections in two settings of Hong Kong and Singapore.

OBJECTIVE: To explore and compare the age, source and future risk of COVID-19 infection in Hong Kong SAR China and Singapore as of March 5, 2020. RESULTS: We find significant difference in age patterns of confirmed cases in these 2 localities early in the pandemic. CONCLUSION: We highlight the potential importance of population age structure in confirmed cases, which should be considered in evaluation of the effectiveness of control effort in different localities.

age structure;covid-19;hong kong;singapore

Journal Article

Zhu, Shuying;Tao, Jun;Gao, Huizhi;He, Daihai

10.1186/s13104-020-05178-z

[Title]: Age, source, and future risk of COVID-19 infections in two settings of Hong Kong and Singapore. [Abstract]: OBJECTIVE: To explore and compare the age, source and future risk of COVID-19 infection in Hong Kong SAR China and Singapore as of March 5, 2020. RESULTS: We find significant difference in age patterns of confirmed cases in these 2 localities early in the pandemic. CONCLUSION: We highlight the potential importance of population age structure in confirmed cases, which should be considered in evaluation of the effectiveness of control effort in different localities. [Keywords]: age structure;covid-19;hong kong;singapore

Arch Bone Jt Surg

Bone in the Time of Corona: Suggestions for Managing Pediatric Orthopaedics Conditions in a Resource-limited Environment during the COVID-19 Pandemic.

The outbreak of a novel coronavirus, referred to as coronavirus disease-19 (COVID-19), with its sentinel case in Wuhan, China, in December 2019, has spread rapidly around the globe. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a worldwide pandemic, which led to most countries implementing social distancing protocols. Most non-essential medical practices have been halted to direct resources to the facilities caring for patients with COVID infection. The pediatric orthopaedic practice is in a unique position, with the treatment of many conditions being treated by pediatric orthopedists being non-emergent, but time-sensitive. We hereby review the current literature and guidelines surrounding the practice change around the world and give recommendations regarding the practice of pediatric orthopaedics during the COVID pandemic.

covid-19;clubfoot;fractures;pediatric orthopaedics;pediatrics;sars-cov2

Journal Article;Review

Baghdadi, Soroush;Nabian, Mohammad Hossein;Baghdadi, Taghi

10.22038/ABJS.2020.47715.2340

[Title]: Bone in the Time of Corona: Suggestions for Managing Pediatric Orthopaedics Conditions in a Resource-limited Environment during the COVID-19 Pandemic. [Abstract]: The outbreak of a novel coronavirus, referred to as coronavirus disease-19 (COVID-19), with its sentinel case in Wuhan, China, in December 2019, has spread rapidly around the globe. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a worldwide pandemic, which led to most countries implementing social distancing protocols. Most non-essential medical practices have been halted to direct resources to the facilities caring for patients with COVID infection. The pediatric orthopaedic practice is in a unique position, with the treatment of many conditions being treated by pediatric orthopedists being non-emergent, but time-sensitive. We hereby review the current literature and guidelines surrounding the practice change around the world and give recommendations regarding the practice of pediatric orthopaedics during the COVID pandemic. [Keywords]: covid-19;clubfoot;fractures;pediatric orthopaedics;pediatrics;sars-cov2

Ann Med

Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry.

BACKGROUND: Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. METHODS: This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. RESULTS: Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. CONCLUSIONS: Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. KEY MESSAGE Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.

covid-19;sars-cov-2;diabetes;hyperglycaemia;mortality

Journal Article;Research Support, Non-U.S. Gov't

Carrasco-Sanchez, Francisco Javier;Lopez-Carmona, M feminine Dolores;Martinez-Marcos, Francisco Javier;Perez-Belmonte, Luis M;Hidalgo-Jimenez, Alicia;Buonaiuto, Veronica;Suarez Fernandez, Carmen;Freire Castro, Santiago Jesus;Luordo, Davide;Pesqueira Fontan, Paula Maria;Blazquez Encinar, Julio Cesar;Magallanes Gamboa, Jeffrey Oskar;de la Pena Fernandez, Andres;Torres Pena, Jose David;Fernandez Sola, Joaquim;Napal Lecumberri, Jose Javier;Amoros Martinez, Francisco;Guisado Espartero, Maria Esther;Jorge Ripper, Carlos;Gomez Mendez, Raquel;Vicente Lopez, Natalia;Roman Bernal, Berta;Rojano Rivero, Maria Gloria;Ramos Rincon, Jose Manuel;Gomez Huelgas, Ricardo

10.1080/07853890.2020.1836566

[Title]: Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. [Abstract]: BACKGROUND: Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. METHODS: This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. RESULTS: Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. CONCLUSIONS: Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. KEY MESSAGE Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes. [Keywords]: covid-19;sars-cov-2;diabetes;hyperglycaemia;mortality

Rev Peru Med Exp Salud Publica

Estimated conditions to control the covid-19 pandemic in peruvian pre- and post-quarantine scenarios.

OBJECTIVES: To determine the probability of controlling the outbreak of COVID-19 in Peru, in a pre- and post-quarantine scenario using mathematical simulation models. MATERIALS AND METHODS: Outbreak si mulations for the COVID-19 pandemic are performed, using stochastic equations under the following assumptions: a pre-quarantine population R0 of 2.7 or 3.5, a post-quarantine R0 of 1.5, 2 or 2.7, 18% or 40%, of asymptomatic positives and a maximum response capacity of 50 or 150 patients in the intensive care units. The success of isolation and contact tracing is evaluated, no other mitigation measures are included. RESULTS: In the pre-quarantine stage, success in controlling more than 80% of the simulations occurred only if the isolation of positive cases was implemented from the first case, after which there was less than 40% probability of success. In post-quarantine, with 60 positive cases it is necessary to isolate them early, track all of their contacts and decrease the R0 to 1.5 for outbreak control to be successful in more than 80% of cases. Other scenarios have a low probability of success. CONCLUSIONS: The control of the outbreak in Peru during pre-quarantine stage demanded requirements that were difficult to comply with, therefore quarantine was necessary; to successfully suspend it would require a significant reduction in the spread of the disease, early isolation of positives and follow-up of all contacts of positive patients.

Journal Article

Huamani, Charles;Timana-Ruiz, Raul;Pinedo, Jairo;Perez, Jhelly;Vasquez, Luis

10.17843/rpmesp.2020.372.5405

[Title]: Estimated conditions to control the covid-19 pandemic in peruvian pre- and post-quarantine scenarios. [Abstract]: OBJECTIVES: To determine the probability of controlling the outbreak of COVID-19 in Peru, in a pre- and post-quarantine scenario using mathematical simulation models. MATERIALS AND METHODS: Outbreak si mulations for the COVID-19 pandemic are performed, using stochastic equations under the following assumptions: a pre-quarantine population R0 of 2.7 or 3.5, a post-quarantine R0 of 1.5, 2 or 2.7, 18% or 40%, of asymptomatic positives and a maximum response capacity of 50 or 150 patients in the intensive care units. The success of isolation and contact tracing is evaluated, no other mitigation measures are included. RESULTS: In the pre-quarantine stage, success in controlling more than 80% of the simulations occurred only if the isolation of positive cases was implemented from the first case, after which there was less than 40% probability of success. In post-quarantine, with 60 positive cases it is necessary to isolate them early, track all of their contacts and decrease the R0 to 1.5 for outbreak control to be successful in more than 80% of cases. Other scenarios have a low probability of success. CONCLUSIONS: The control of the outbreak in Peru during pre-quarantine stage demanded requirements that were difficult to comply with, therefore quarantine was necessary; to successfully suspend it would require a significant reduction in the spread of the disease, early isolation of positives and follow-up of all contacts of positive patients. [Keywords]:

Iran J Allergy Asthma Immunol

Bradykinin as a Probable Aspect in SARS-Cov-2 Scenarios: Is Bradykinin Sneaking out of Our Sight?

The new virus SARS-CoV-2 is savagely spreading out over the world. The biologic studies show that the target receptor for the virus might be angiotensin-converting enzyme 2 (ACE2). This peptide is responsible for converting angiotensin II (Ang II), which is a profoundly active peptide, into Ang 1-7 with quite a balancing barbell function. It is emphasized that the direct target of the virus is ACE2 underlining the obvious difference with ACE. Nevertheless, we hypothesized that a back load build up effect on Ang II may usurp the ACE capacity and subsequently leave the bradykinin system unabated. We think there are clinical clues for dry cough and the presumed aggravating role of ACE inhibitors like captopril on the disease process. Thereby, we speculated that inhibition of bradykinin synthesis and/or blockade of bradykinin B2 receptor using Aprotinin/ecallantide and Icatibant, respectively, may hold therapeutic promise in severe cases and these molecules can be advanced to clinical trials.

angiotensin-converting enzyme 2;aprotinin;bradykinin;icatibant;sars-cov-2

Journal Article

Ghahestani, Seyed-Mohammad;Mahmoudi, Javad;Hajebrahimi, Sakineh;Sioofy-Khojine, Amir-Babak;Salehi-Pourmehr, Hanieh;Sadeghi-Ghyassi, Fatemeh;Mostafaei, Hadi

10.18502/ijaai.v19i(s1.r1).2850

[Title]: Bradykinin as a Probable Aspect in SARS-Cov-2 Scenarios: Is Bradykinin Sneaking out of Our Sight? [Abstract]: The new virus SARS-CoV-2 is savagely spreading out over the world. The biologic studies show that the target receptor for the virus might be angiotensin-converting enzyme 2 (ACE2). This peptide is responsible for converting angiotensin II (Ang II), which is a profoundly active peptide, into Ang 1-7 with quite a balancing barbell function. It is emphasized that the direct target of the virus is ACE2 underlining the obvious difference with ACE. Nevertheless, we hypothesized that a back load build up effect on Ang II may usurp the ACE capacity and subsequently leave the bradykinin system unabated. We think there are clinical clues for dry cough and the presumed aggravating role of ACE inhibitors like captopril on the disease process. Thereby, we speculated that inhibition of bradykinin synthesis and/or blockade of bradykinin B2 receptor using Aprotinin/ecallantide and Icatibant, respectively, may hold therapeutic promise in severe cases and these molecules can be advanced to clinical trials. [Keywords]: angiotensin-converting enzyme 2;aprotinin;bradykinin;icatibant;sars-cov-2

Molecules

The New Coronavirus (SARS-CoV-2): A Comprehensive Review on Immunity and the Application of Bioinformatics and Molecular Modeling to the Discovery of Potential Anti-SARS-CoV-2 Agents.

On March 11, 2020, the World Health Organization (WHO) officially declared the outbreak caused by the new coronavirus (SARS-CoV-2) a pandemic. The rapid spread of the disease surprised the scientific and medical community. Based on the latest reports, news, and scientific articles published, there is no doubt that the coronavirus has overloaded health systems globally. Practical actions against the recent emergence and rapid expansion of the SARS-CoV-2 require the development and use of tools for discovering new molecular anti-SARS-CoV-2 targets. Thus, this review presents bioinformatics and molecular modeling strategies that aim to assist in the discovery of potential anti-SARS-CoV-2 agents. Besides, we reviewed the relationship between SARS-CoV-2 and innate immunity, since understanding the structures involved in this infection can contribute to the development of new therapeutic targets. Bioinformatics is a technology that assists researchers in coping with diseases by investigating genetic sequencing and seeking structural models of potential molecular targets present in SARS-CoV2. The details provided in this review provide future points of consideration in the field of virology and medical sciences that will contribute to clarifying potential therapeutic targets for anti-SARS-CoV-2 and for understanding the molecular mechanisms responsible for the pathogenesis and virulence of SARS-CoV-2.

sars-cov-2;bioinformatics;drug discovery;infectious disease;innate immunity;molecular modeling;treatment

Journal Article;Review

Villas-Boas, Gustavo R;Rescia, Vanessa C;Paes, Marina M;Lavorato, Stefania N;Magalhaes-Filho, Manoel F de;Cunha, Mila S;Simoes, Rafael da C;Lacerda, Roseli B de;Freitas-Junior, Renilson S de;Ramos, Bruno H da S;Mapeli, Ana M;Henriques, Matheus da S T;Freitas, William R de;Lopes, Luiz A F;Oliveira, Luiz G R;Silva, Jonatas G da;Silva-Filho, Saulo E;Silveira, Ana P S da;Leao, Katyuscya V;Matos, Maria M de S;Fernandes, Jamille S;Cuman, Roberto K N;Silva-Comar, Francielli M de S;Comar, Jurandir F;Brasileiro, Luana do A;Santos, Jussileide N Dos;Oesterreich, Silvia A

10.3390/molecules25184086

[Title]: The New Coronavirus (SARS-CoV-2): A Comprehensive Review on Immunity and the Application of Bioinformatics and Molecular Modeling to the Discovery of Potential Anti-SARS-CoV-2 Agents. [Abstract]: On March 11, 2020, the World Health Organization (WHO) officially declared the outbreak caused by the new coronavirus (SARS-CoV-2) a pandemic. The rapid spread of the disease surprised the scientific and medical community. Based on the latest reports, news, and scientific articles published, there is no doubt that the coronavirus has overloaded health systems globally. Practical actions against the recent emergence and rapid expansion of the SARS-CoV-2 require the development and use of tools for discovering new molecular anti-SARS-CoV-2 targets. Thus, this review presents bioinformatics and molecular modeling strategies that aim to assist in the discovery of potential anti-SARS-CoV-2 agents. Besides, we reviewed the relationship between SARS-CoV-2 and innate immunity, since understanding the structures involved in this infection can contribute to the development of new therapeutic targets. Bioinformatics is a technology that assists researchers in coping with diseases by investigating genetic sequencing and seeking structural models of potential molecular targets present in SARS-CoV2. The details provided in this review provide future points of consideration in the field of virology and medical sciences that will contribute to clarifying potential therapeutic targets for anti-SARS-CoV-2 and for understanding the molecular mechanisms responsible for the pathogenesis and virulence of SARS-CoV-2. [Keywords]: sars-cov-2;bioinformatics;drug discovery;infectious disease;innate immunity;molecular modeling;treatment

Korean J Intern Med

Clinical characteristics of coronavirus disease 2019 patients with diarrhea in Daegu.

BACKGROUND/AIMS: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. METHODS: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. RESULTS: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. CONCLUSION: Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.

covid-19;diarrhea;mortality;shock, septic

Journal Article;Research Support, Non-U.S. Gov't

Kang, Min Kyu;Kim, Kyeong Ok;Kim, Min Cheol;Cho, Joon Hyun;Kim, Sung Bum;Park, Jung Gil;Kim, Kook Hyun;Lee, See Hyung;Jang, Byung Ik;Kim, Tae Nyeun

10.3904/kjim.2020.196

[Title]: Clinical characteristics of coronavirus disease 2019 patients with diarrhea in Daegu. [Abstract]: BACKGROUND/AIMS: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. METHODS: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. RESULTS: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. CONCLUSION: Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality. [Keywords]: covid-19;diarrhea;mortality;shock, septic

Diagnostics (Basel)

COVID-19 as a Vascular Disease: Lesson Learned from Imaging and Blood Biomarkers.

COVID-19, a disease initially thought to be prominently an interstitial pneumonia with varying degrees of severity, can be considered a vascular disease with regards to serious complications and causes of mortality. Quite recently, blood clots have emerged as the common factor unifying many of the symptoms initially attributed without an explanation to COVID-19. Cardiovascular biomarkers and particularly, D-dimer and troponin appear to be very powerful prognostic markers, signaling the need for earlier and more aggressive interventions and treatments in order to avoid and/or minimize arterial/venous thromboembolism and myocardial infarct. The ultrasound imaging patterns at both the lung and peripheral vascular level can also be very useful weapons that have the advantage of being able to monitor longitudinally the clinical picture, something that real-time PCR/nasopharyngeal swab is not able to do and that CT can only pursue with significant radiation exposure. A lesson learned in the early phase of the COVID-19 pandemic suggests quitting and starting again with targeted imaging and blood vascular biomarkers.

covid-19;d-dimer;sars-cov-2;contrast-enhanced ultrasound;deep vein thrombosis;ischemia;lung ultrasound;pulmonary embolism.;thrombosis;ultrasound;vascular biomarkers;venous thromboembolism

Editorial

Zamboni, Paolo

10.3390/diagnostics10070440

[Title]: COVID-19 as a Vascular Disease: Lesson Learned from Imaging and Blood Biomarkers. [Abstract]: COVID-19, a disease initially thought to be prominently an interstitial pneumonia with varying degrees of severity, can be considered a vascular disease with regards to serious complications and causes of mortality. Quite recently, blood clots have emerged as the common factor unifying many of the symptoms initially attributed without an explanation to COVID-19. Cardiovascular biomarkers and particularly, D-dimer and troponin appear to be very powerful prognostic markers, signaling the need for earlier and more aggressive interventions and treatments in order to avoid and/or minimize arterial/venous thromboembolism and myocardial infarct. The ultrasound imaging patterns at both the lung and peripheral vascular level can also be very useful weapons that have the advantage of being able to monitor longitudinally the clinical picture, something that real-time PCR/nasopharyngeal swab is not able to do and that CT can only pursue with significant radiation exposure. A lesson learned in the early phase of the COVID-19 pandemic suggests quitting and starting again with targeted imaging and blood vascular biomarkers. [Keywords]: covid-19;d-dimer;sars-cov-2;contrast-enhanced ultrasound;deep vein thrombosis;ischemia;lung ultrasound;pulmonary embolism.;thrombosis;ultrasound;vascular biomarkers;venous thromboembolism

J Med Virol

Predictive effects of IgA and IgG combination to assess pulmonary exudation progression in COVID-19 patients.

Our study intended to longitudinally explore the prediction effect of immunoglobulin A (IgA) on pulmonary exudation progression in COVID-19 patients. The serum IgA was tested with chemiluminescence method. Autoregressive moving average model was used to extrapolate the IgA levels before hospital admission. The positive rate of IgA and IgG in our cohort was 97% and 79.0%, respectively. In this study, the IgA levels peaks within 10-15 days after admission, while the IgG levels peaks at admission. We found that the time difference between their peaks was about 10 days. Viral RNA detection results showed that the positive rate in sputum and feces were the highest. Blood gas analysis showed that deterioration of hypoxia with the enlargement of pulmonary exudation area. And alveolar-arterial oxygen difference and oxygenation index were correlated with IgA and IgG. The results of biopsy showed that the epithelium of lung was exfoliated and the mucosa was edematous. In severe COVID-19 patients, the combination of IgA and IgG can predict the progress of pulmonary lesions and is closely related to hypoxemia and both also play an important defense role in invasion and destruction of bronchial and alveolar epithelium by SARS-CoV-2.

covid-19;iga;igg;prediction effects

Journal Article;Research Support, Non-U.S. Gov't

Xue, Mingshan;Zhang, Teng;Hu, Haisheng;Huang, Zhifeng;Zhen, Yingjie;Liang, Yueting;Zeng, Yifeng;Jin, Tengchuan;Zhou, Luqian;Zhang, Xiaohua D;Sun, Baoqing

10.1002/jmv.26437

[Title]: Predictive effects of IgA and IgG combination to assess pulmonary exudation progression in COVID-19 patients. [Abstract]: Our study intended to longitudinally explore the prediction effect of immunoglobulin A (IgA) on pulmonary exudation progression in COVID-19 patients. The serum IgA was tested with chemiluminescence method. Autoregressive moving average model was used to extrapolate the IgA levels before hospital admission. The positive rate of IgA and IgG in our cohort was 97% and 79.0%, respectively. In this study, the IgA levels peaks within 10-15 days after admission, while the IgG levels peaks at admission. We found that the time difference between their peaks was about 10 days. Viral RNA detection results showed that the positive rate in sputum and feces were the highest. Blood gas analysis showed that deterioration of hypoxia with the enlargement of pulmonary exudation area. And alveolar-arterial oxygen difference and oxygenation index were correlated with IgA and IgG. The results of biopsy showed that the epithelium of lung was exfoliated and the mucosa was edematous. In severe COVID-19 patients, the combination of IgA and IgG can predict the progress of pulmonary lesions and is closely related to hypoxemia and both also play an important defense role in invasion and destruction of bronchial and alveolar epithelium by SARS-CoV-2. [Keywords]: covid-19;iga;igg;prediction effects

BMC Public Health

Why crowding matters in the time of COVID-19 pandemic? - a lesson from the carnival effect on the 2017/2018 influenza epidemic in the Netherlands.

BACKGROUND: To evaluate the association between crowding and transmission of viral respiratory infectious diseases, we investigated the change in transmission patterns of influenza and COVID-19 before and after a mass gathering event (i.e., carnival) in the Netherlands. METHODS: Information on individual hospitalizations related to the 2017/2018 influenza epidemic were accessed from Statistics Netherlands. The influenza cases were stratified between non-carnival and carnival regions. Distributions of influenza cases were plotted with time and compared between regions. A similar investigation in the early outbreak of COVID-19 was also conducted using open data from the Dutch National Institute for Public Health and the Environment. RESULTS: Baseline characteristics between non-carnival and carnival regions were broadly similar. There were 13,836 influenza-related hospitalizations in the 2017/2018 influenza epidemic, and carnival fell about 1 week before the peak of these hospitalizations. The distributions of new influenza-related hospitalizations per 100,000 inhabitants with time between regions followed the same pattern with a surge of new cases in the carnival region about 1 week after carnival, which did not occur in the non-carnival region. The increase of new cases for COVID-19 in the carnival region exceeded that in the non-carnival region about 1 week after the first case was reported, but these results warrant caution as for COVID-19 there were no cases reported before the carnival and social measures were introduced shortly after carnival. CONCLUSION: In this study, a mass gathering event (carnival) was associated with aggravating the spread of viral respiratory infectious diseases.

covid-19;epidemiology;influenza;mass gathering medicine

Journal Article

Chen, Qingui;Toorop, Myrthe M A;de Boer, Mark G J;Rosendaal, Frits R;Lijfering, Willem M

10.1186/s12889-020-09612-6

[Title]: Why crowding matters in the time of COVID-19 pandemic? - a lesson from the carnival effect on the 2017/2018 influenza epidemic in the Netherlands. [Abstract]: BACKGROUND: To evaluate the association between crowding and transmission of viral respiratory infectious diseases, we investigated the change in transmission patterns of influenza and COVID-19 before and after a mass gathering event (i.e., carnival) in the Netherlands. METHODS: Information on individual hospitalizations related to the 2017/2018 influenza epidemic were accessed from Statistics Netherlands. The influenza cases were stratified between non-carnival and carnival regions. Distributions of influenza cases were plotted with time and compared between regions. A similar investigation in the early outbreak of COVID-19 was also conducted using open data from the Dutch National Institute for Public Health and the Environment. RESULTS: Baseline characteristics between non-carnival and carnival regions were broadly similar. There were 13,836 influenza-related hospitalizations in the 2017/2018 influenza epidemic, and carnival fell about 1 week before the peak of these hospitalizations. The distributions of new influenza-related hospitalizations per 100,000 inhabitants with time between regions followed the same pattern with a surge of new cases in the carnival region about 1 week after carnival, which did not occur in the non-carnival region. The increase of new cases for COVID-19 in the carnival region exceeded that in the non-carnival region about 1 week after the first case was reported, but these results warrant caution as for COVID-19 there were no cases reported before the carnival and social measures were introduced shortly after carnival. CONCLUSION: In this study, a mass gathering event (carnival) was associated with aggravating the spread of viral respiratory infectious diseases. [Keywords]: covid-19;epidemiology;influenza;mass gathering medicine

Curr Opin Clin Nutr Metab Care

Nutrition in times of Covid-19, how to trust the deluge of scientific information.

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.

Journal Article;Review

Correia, Maria Isabel T D

10.1097/MCO.0000000000000666

[Title]: Nutrition in times of Covid-19, how to trust the deluge of scientific information. [Abstract]: PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals. [Keywords]:

Clin Microbiol Infect

Overall decrease in SARS-CoV-2 viral load and reduction in clinical burden: the experience of a hospital in northern Italy.

OBJECTIVES: In Italy the burden of patients with coronavirus disease 2019 (COVID-19) gradually decreased from March to the end of May. In this work we aimed to evaluate a possible association between the severity of clinical manifestations and viral load over time during the epidemiological transition from high-to low-transmission settings. METHODS: We reviewed the cases of COVID-19 diagnosed at the emergency room of our hospital, retrieving the proportion of patients admitted to the intensive care unit. A raw estimation of the viral load was done evaluating the Ct (cycle threshold) trend obtained from our diagnostic reverse transcriptase real-time PCR test. RESULTS: The proportion of patients requiring intensive care significantly decreased from 6.7% (19/281) in March to 1.1% (1/86) in April, and to none in May (Fisher's test p 0.0067). As for viral load, we observed a trend of Ct increasing from a median value of 24 (IQR 19-29) to 34 (IQR 29-37) between March and May, with a statistically significant difference between March and April (pairwise Wilcoxon test with stepdown Bonferroni adjustment for multiple testing, p 0.0003). CONCLUSIONS: We observed a reduction over time in the proportion of patients with COVID-19 requiring intensive care, along with decreasing median values of viral load. As the epidemiological context changes from high-to low-transmission settings, people are presumably exposed to a lower viral load which has been previously associated with less severe clinical manifestations.

covid-19;coronavirus;coronavirus disease 2019;sars-cov-2;viral load

Journal Article

Piubelli, Chiara;Deiana, Michela;Pomari, Elena;Silva, Ronaldo;Bisoffi, Zeno;Formenti, Fabio;Perandin, Francesca;Gobbi, Federico;Buonfrate, Dora

10.1016/j.cmi.2020.10.006

[Title]: Overall decrease in SARS-CoV-2 viral load and reduction in clinical burden: the experience of a hospital in northern Italy. [Abstract]: OBJECTIVES: In Italy the burden of patients with coronavirus disease 2019 (COVID-19) gradually decreased from March to the end of May. In this work we aimed to evaluate a possible association between the severity of clinical manifestations and viral load over time during the epidemiological transition from high-to low-transmission settings. METHODS: We reviewed the cases of COVID-19 diagnosed at the emergency room of our hospital, retrieving the proportion of patients admitted to the intensive care unit. A raw estimation of the viral load was done evaluating the Ct (cycle threshold) trend obtained from our diagnostic reverse transcriptase real-time PCR test. RESULTS: The proportion of patients requiring intensive care significantly decreased from 6.7% (19/281) in March to 1.1% (1/86) in April, and to none in May (Fisher's test p 0.0067). As for viral load, we observed a trend of Ct increasing from a median value of 24 (IQR 19-29) to 34 (IQR 29-37) between March and May, with a statistically significant difference between March and April (pairwise Wilcoxon test with stepdown Bonferroni adjustment for multiple testing, p 0.0003). CONCLUSIONS: We observed a reduction over time in the proportion of patients with COVID-19 requiring intensive care, along with decreasing median values of viral load. As the epidemiological context changes from high-to low-transmission settings, people are presumably exposed to a lower viral load which has been previously associated with less severe clinical manifestations. [Keywords]: covid-19;coronavirus;coronavirus disease 2019;sars-cov-2;viral load

Cell

A Therapeutic Non-self-reactive SARS-CoV-2 Antibody Protects from Lung Pathology in a COVID-19 Hamster Model.

The emergence of SARS-CoV-2 led to pandemic spread of coronavirus disease 2019 (COVID-19), manifesting with respiratory symptoms and multi-organ dysfunction. Detailed characterization of virus-neutralizing antibodies and target epitopes is needed to understand COVID-19 pathophysiology and guide immunization strategies. Among 598 human monoclonal antibodies (mAbs) from 10 COVID-19 patients, we identified 40 strongly neutralizing mAbs. The most potent mAb, CV07-209, neutralized authentic SARS-CoV-2 with an IC50 value of 3.1 ng/mL. Crystal structures of two mAbs in complex with the SARS-CoV-2 receptor-binding domain at 2.55 and 2.70 A revealed a direct block of ACE2 attachment. Interestingly, some of the near-germline SARS-CoV-2-neutralizing mAbs reacted with mammalian self-antigens. Prophylactic and therapeutic application of CV07-209 protected hamsters from SARS-CoV-2 infection, weight loss, and lung pathology. Our results show that non-self-reactive virus-neutralizing mAbs elicited during SARS-CoV-2 infection are a promising therapeutic strategy.

covid-19;sars-cov-2;autoreactivity;crystal structures;hamster model;monoclonal antibody;neutralizing antibody;post-exposure;self-antigens;self-reactivity

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't;Research Support, U.S. Gov't, Non-P.H.S.

Kreye, Jakob;Reincke, S Momsen;Kornau, Hans-Christian;Sanchez-Sendin, Elisa;Corman, Victor Max;Liu, Hejun;Yuan, Meng;Wu, Nicholas C;Zhu, Xueyong;Lee, Chang-Chun D;Trimpert, Jakob;Holtje, Markus;Dietert, Kristina;Stoffler, Laura;von Wardenburg, Niels;van Hoof, Scott;Homeyer, Marie A;Hoffmann, Julius;Abdelgawad, Azza;Gruber, Achim D;Bertzbach, Luca D;Vladimirova, Daria;Li, Lucie Y;Barthel, Paula Charlotte;Skriner, Karl;Hocke, Andreas C;Hippenstiel, Stefan;Witzenrath, Martin;Suttorp, Norbert;Kurth, Florian;Franke, Christiana;Endres, Matthias;Schmitz, Dietmar;Jeworowski, Lara Maria;Richter, Anja;Schmidt, Marie Luisa;Schwarz, Tatjana;Muller, Marcel Alexander;Drosten, Christian;Wendisch, Daniel;Sander, Leif E;Osterrieder, Nikolaus;Wilson, Ian A;Pruss, Harald

10.1016/j.cell.2020.09.049

[Title]: A Therapeutic Non-self-reactive SARS-CoV-2 Antibody Protects from Lung Pathology in a COVID-19 Hamster Model. [Abstract]: The emergence of SARS-CoV-2 led to pandemic spread of coronavirus disease 2019 (COVID-19), manifesting with respiratory symptoms and multi-organ dysfunction. Detailed characterization of virus-neutralizing antibodies and target epitopes is needed to understand COVID-19 pathophysiology and guide immunization strategies. Among 598 human monoclonal antibodies (mAbs) from 10 COVID-19 patients, we identified 40 strongly neutralizing mAbs. The most potent mAb, CV07-209, neutralized authentic SARS-CoV-2 with an IC50 value of 3.1 ng/mL. Crystal structures of two mAbs in complex with the SARS-CoV-2 receptor-binding domain at 2.55 and 2.70 A revealed a direct block of ACE2 attachment. Interestingly, some of the near-germline SARS-CoV-2-neutralizing mAbs reacted with mammalian self-antigens. Prophylactic and therapeutic application of CV07-209 protected hamsters from SARS-CoV-2 infection, weight loss, and lung pathology. Our results show that non-self-reactive virus-neutralizing mAbs elicited during SARS-CoV-2 infection are a promising therapeutic strategy. [Keywords]: covid-19;sars-cov-2;autoreactivity;crystal structures;hamster model;monoclonal antibody;neutralizing antibody;post-exposure;self-antigens;self-reactivity

Am J Perinatol

A Proposed Plan for Prenatal Care to Minimize Risks of COVID-19 to Patients and Providers: Focus on Hypertensive Disorders of Pregnancy.

Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 (0/7) weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 (0/7) weeks of gestation in the setting of preeclampsia with severe features. KEY POINTS: . Outbreak of novel coronavirus disease 2019 (COVID-19) warrants fewer office visits.. . Women should be classified for hypertension risk in pregnancy.. . Earlier delivery suggested with COVID-19 and hypertensive disorder..

Journal Article

Barton, John R;Saade, George R;Sibai, Baha M

10.1055/s-0040-1710538

[Title]: A Proposed Plan for Prenatal Care to Minimize Risks of COVID-19 to Patients and Providers: Focus on Hypertensive Disorders of Pregnancy. [Abstract]: Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 (0/7) weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 (0/7) weeks of gestation in the setting of preeclampsia with severe features. KEY POINTS: . Outbreak of novel coronavirus disease 2019 (COVID-19) warrants fewer office visits.. . Women should be classified for hypertension risk in pregnancy.. . Earlier delivery suggested with COVID-19 and hypertensive disorder.. [Keywords]:

Foods

Food and COVID-19: Preventive/Co-therapeutic Strategies Explored by Current Clinical Trials and in Silico Studies.

Foods, food ingredients, and their balanced consumption are recognized to have an important role in achieving or maintaining a state of wellbeing by acting as carriers of functional components and bioactive molecules. However, the potential contribution of foods to consumers' health has so far only been partially exploited. The rapidly evolving scenario of the coronavirus disease 2019 (COVID-19) pandemic is stimulating profound reflection on the relationships between food and the etiological agent, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, the status of knowledge regarding food as a possible defense/co-therapeutic strategy against the SARS-CoV-2 coronavirus is considered through the discussion of two main current lines of research. One line of research relates to the role of micronutrients, food components, and diets in the strengthening of the immune system through clinical trials; formulations could be developed as immune system enhancers or as co-adjuvants in therapies. The other line of research relates to investigation of the chemical interactions that specific food compounds can have with host or virus targets so as to interfere with the viral infective cycle of SARS-CoV-2. This line requires, as a first step, an in silico evaluation to discover lead compounds, which may be further developed through drug-design studies, in vitro and in vivo tests, and, finally, clinical trials to obtain therapeutic molecules. All of these promising strategies promote the role of food in preventive/co-therapeutic strategies to tackle the COVID-19 pandemic.

covid-19;sars-cov-2;food;immune system;in silico study;micronutrient clinical trial;protein interaction

Journal Article;Review

Di Matteo, Giacomo;Spano, Mattia;Grosso, Michela;Salvo, Andrea;Ingallina, Cinzia;Russo, Mariateresa;Ritieni, Alberto;Mannina, Luisa

10.3390/foods9081036

[Title]: Food and COVID-19: Preventive/Co-therapeutic Strategies Explored by Current Clinical Trials and in Silico Studies. [Abstract]: Foods, food ingredients, and their balanced consumption are recognized to have an important role in achieving or maintaining a state of wellbeing by acting as carriers of functional components and bioactive molecules. However, the potential contribution of foods to consumers' health has so far only been partially exploited. The rapidly evolving scenario of the coronavirus disease 2019 (COVID-19) pandemic is stimulating profound reflection on the relationships between food and the etiological agent, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, the status of knowledge regarding food as a possible defense/co-therapeutic strategy against the SARS-CoV-2 coronavirus is considered through the discussion of two main current lines of research. One line of research relates to the role of micronutrients, food components, and diets in the strengthening of the immune system through clinical trials; formulations could be developed as immune system enhancers or as co-adjuvants in therapies. The other line of research relates to investigation of the chemical interactions that specific food compounds can have with host or virus targets so as to interfere with the viral infective cycle of SARS-CoV-2. This line requires, as a first step, an in silico evaluation to discover lead compounds, which may be further developed through drug-design studies, in vitro and in vivo tests, and, finally, clinical trials to obtain therapeutic molecules. All of these promising strategies promote the role of food in preventive/co-therapeutic strategies to tackle the COVID-19 pandemic. [Keywords]: covid-19;sars-cov-2;food;immune system;in silico study;micronutrient clinical trial;protein interaction

Sci Total Environ

SARS-CoV-2 in the environment: Modes of transmission, early detection and potential role of pollutions.

The coronavirus disease 2019 (COVID-19) is spreading globally having a profound effect on lives of millions of people, causing worldwide economic disruption. Curbing the spread of COVID-19 and future pandemics may be accomplished through understanding the environmental context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and adoption of effective detection tools and mitigation policies. This article aims to examine the latest investigations on SARS-CoV-2 plausible environmental transmission modes, employment of wastewater surveillance for early detection of COVID-19, and elucidating the role of solid waste, water, and atmospheric quality on viral infectivity. Transmission of SARS-CoV-2 via faecal-oral or bio-aerosols lacks robust evidence and remains debatable. However, improper disinfection and defected plumbing systems in indoor environments such as hospitals and high-rise towers may facilitate the transport of virus-laden droplets of wastewater causing infection. Clinical and epidemiological studies are needed to present robust evidence that SARS-CoV-2 is transmissible via aerosols, though quantification of virus-laden aerosols at low concentrations presents a challenge. Wastewater surveillance of SARS-CoV-2 can be an effective tool in early detection of outbreak and determination of COVID-19 prevalence within a population, complementing clinical testing and providing decision makers guidance on restricting or relaxing movement. While poor air quality increases susceptibility to diseases, evidence for air pollution impact on COVID-19 infectivity is not available as infections are dynamically changing worldwide. Solid waste generated by households with infected individuals during the lockdown period may facilitate the spread of COVID-19 via fomite transmission route but has received little attention from the scientific community. Water bodies receiving raw sewage may pose risk of infection but this has not been investigated to date. Overall, our understanding of the environmental perspective of SARS-CoV-2 is imperative to detecting outbreak and predicting pandemic severity, allowing us to be equipped with the right tools to curb any future pandemic.

air pollution;covid-19;environmental context;modes of transmission;solid waste;wastewater-based epidemiology

Journal Article;Review

Al Huraimel, Khaled;Alhosani, Mohamed;Kunhabdulla, Shabana;Stietiya, Mohammed Hashem

10.1016/j.scitotenv.2020.140946

[Title]: SARS-CoV-2 in the environment: Modes of transmission, early detection and potential role of pollutions. [Abstract]: The coronavirus disease 2019 (COVID-19) is spreading globally having a profound effect on lives of millions of people, causing worldwide economic disruption. Curbing the spread of COVID-19 and future pandemics may be accomplished through understanding the environmental context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and adoption of effective detection tools and mitigation policies. This article aims to examine the latest investigations on SARS-CoV-2 plausible environmental transmission modes, employment of wastewater surveillance for early detection of COVID-19, and elucidating the role of solid waste, water, and atmospheric quality on viral infectivity. Transmission of SARS-CoV-2 via faecal-oral or bio-aerosols lacks robust evidence and remains debatable. However, improper disinfection and defected plumbing systems in indoor environments such as hospitals and high-rise towers may facilitate the transport of virus-laden droplets of wastewater causing infection. Clinical and epidemiological studies are needed to present robust evidence that SARS-CoV-2 is transmissible via aerosols, though quantification of virus-laden aerosols at low concentrations presents a challenge. Wastewater surveillance of SARS-CoV-2 can be an effective tool in early detection of outbreak and determination of COVID-19 prevalence within a population, complementing clinical testing and providing decision makers guidance on restricting or relaxing movement. While poor air quality increases susceptibility to diseases, evidence for air pollution impact on COVID-19 infectivity is not available as infections are dynamically changing worldwide. Solid waste generated by households with infected individuals during the lockdown period may facilitate the spread of COVID-19 via fomite transmission route but has received little attention from the scientific community. Water bodies receiving raw sewage may pose risk of infection but this has not been investigated to date. Overall, our understanding of the environmental perspective of SARS-CoV-2 is imperative to detecting outbreak and predicting pandemic severity, allowing us to be equipped with the right tools to curb any future pandemic. [Keywords]: air pollution;covid-19;environmental context;modes of transmission;solid waste;wastewater-based epidemiology

Infect Dis Health

SARS-CoV-2: The viral shedding vs infectivity dilemma.

Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over four million people worldwide. There are multiple reports of prolonged viral shedding in people infected with SARS-CoV-2 but the presence of viral RNA on a test does not necessarily correlate with infectivity. The duration of quarantine required after clinical recovery to definitively prevent transmission is therefore uncertain. In addition, asymptomatic and presymptomatic transmission may occur, and infectivity may be highest early after onset of symptoms, meaning that contact tracing, isolation of exposed individuals and social distancing are essential public health measures to prevent further spread. This review aimed to summarise the evidence around viral shedding vs infectivity of SARS-CoV-2.

covid-19;public health;sars-cov-2;transmission;virus shedding

Journal Article

Widders, Arabella;Broom, Alex;Broom, Jennifer

10.1016/j.idh.2020.05.002

[Title]: SARS-CoV-2: The viral shedding vs infectivity dilemma. [Abstract]: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over four million people worldwide. There are multiple reports of prolonged viral shedding in people infected with SARS-CoV-2 but the presence of viral RNA on a test does not necessarily correlate with infectivity. The duration of quarantine required after clinical recovery to definitively prevent transmission is therefore uncertain. In addition, asymptomatic and presymptomatic transmission may occur, and infectivity may be highest early after onset of symptoms, meaning that contact tracing, isolation of exposed individuals and social distancing are essential public health measures to prevent further spread. This review aimed to summarise the evidence around viral shedding vs infectivity of SARS-CoV-2. [Keywords]: covid-19;public health;sars-cov-2;transmission;virus shedding

Eur J Clin Invest

Efficacy of various treatment modalities for nCOV-2019: A systematic review and meta-analysis.

BACKGROUND: Several therapeutic agents have been investigated for treatment of novel coronavirus 2019 (nCOV-2019). We conducted a systematic review and meta-analysis to assess the efficacy of various treatment modalities in nCOV-2019 patients. METHODS: A literature search was conducted before 29 June 2020 in PubMed, Google Scholar and Cochrane library databases. A fixed-effect model was applied if I(2) < 50%, else results were combined using random-effect model. Risk ratio (RR) or standardized mean difference (SMD) along with 95% confidence interval (95% CI) was used to pool the results. Between-study heterogeneity was explored using influence and sensitivity analyses, and publication bias was assessed using funnel plots. Entire statistical analysis was conducted in R version 3.6.2. RESULTS: Fifty studies involving 15 in vitro and 35 clinical studies including 9170 nCOV-2019 patients were included. Lopinavir-ritonavir was significantly associated with shorter mean time to clinical recovery (SMD -0.32; 95% CI -0.57 to -0.06), remdesivir was significantly associated with better overall clinical recovery (RR 1.17; 95% CI 1.07 to 1.29), and tocilizumab was associated with less all-cause mortality (RR 0.38; 95% CI 0.16 to 0.93). Hydroxychloroquine was associated with longer time to clinical recovery and less overall clinical recovery. It additionally had higher all-cause mortality and more total adverse events. CONCLUSION: Our meta-analysis suggests that except in vitro studies, no treatment has shown overall favourable outcomes in nCOV-2019 patients. Lopinavir-ritonavir, remdesivir and tocilizumab may have some benefits, while hydroxychloroquine administration may cause harm in nCOV-2019 patients. Results from upcoming large clinical trials may further clarify role of these drugs.

humans;interventions;ncov-2019;novel coronavirus 2019;treatments

Comparative Study;Journal Article;Meta-Analysis;Systematic Review

Misra, Shubham;Nath, Manabesh;Hadda, Vijay;Vibha, Deepti

10.1111/eci.13383

[Title]: Efficacy of various treatment modalities for nCOV-2019: A systematic review and meta-analysis. [Abstract]: BACKGROUND: Several therapeutic agents have been investigated for treatment of novel coronavirus 2019 (nCOV-2019). We conducted a systematic review and meta-analysis to assess the efficacy of various treatment modalities in nCOV-2019 patients. METHODS: A literature search was conducted before 29 June 2020 in PubMed, Google Scholar and Cochrane library databases. A fixed-effect model was applied if I(2) < 50%, else results were combined using random-effect model. Risk ratio (RR) or standardized mean difference (SMD) along with 95% confidence interval (95% CI) was used to pool the results. Between-study heterogeneity was explored using influence and sensitivity analyses, and publication bias was assessed using funnel plots. Entire statistical analysis was conducted in R version 3.6.2. RESULTS: Fifty studies involving 15 in vitro and 35 clinical studies including 9170 nCOV-2019 patients were included. Lopinavir-ritonavir was significantly associated with shorter mean time to clinical recovery (SMD -0.32; 95% CI -0.57 to -0.06), remdesivir was significantly associated with better overall clinical recovery (RR 1.17; 95% CI 1.07 to 1.29), and tocilizumab was associated with less all-cause mortality (RR 0.38; 95% CI 0.16 to 0.93). Hydroxychloroquine was associated with longer time to clinical recovery and less overall clinical recovery. It additionally had higher all-cause mortality and more total adverse events. CONCLUSION: Our meta-analysis suggests that except in vitro studies, no treatment has shown overall favourable outcomes in nCOV-2019 patients. Lopinavir-ritonavir, remdesivir and tocilizumab may have some benefits, while hydroxychloroquine administration may cause harm in nCOV-2019 patients. Results from upcoming large clinical trials may further clarify role of these drugs. [Keywords]: humans;interventions;ncov-2019;novel coronavirus 2019;treatments

Eur Radiol

Relationship between clinical types and radiological subgroups defined by latent class analysis in 2019 novel coronavirus pneumonia caused by SARS-CoV-2.

OBJECTIVES: To investigate whether meaningful subgroups sharing the CT features of patients with COVID-19 pneumonia could be identified using latent class analysis (LCA) and explore the relationship between the LCA-derived subgroups and clinical types. METHODS: This retrospective review included 499 patients with confirmed COVID-19 pneumonia between February 11 and March 8, 2020. Subgroups sharing the CT features were identified using LCA. Univariate and multivariate logistic regression models were utilized to analyze the association between clinical types and the LCA-derived subgroups. RESULTS: Two radiological subgroups were identified using LCA. There were 228 subjects (45.69%) in class 1 and 271 subjects (54.31%) in class 2. The CT findings of class 1 were smaller pulmonary infection volume, more peripheral distribution, more GGO, more maximum lesion range </= 5 cm, a smaller number of lesions, less involvement of lobes, less air bronchogram, less dilatation of vessels, less hilar and mediastinal lymph node enlargement, and less pleural effusion than the CT findings of class 2. Univariate analysis demonstrated that older age, therapy, presence of fever, presence of hypertension, decreased lymphocyte count, and increased CRP levels were significant parameters associated with an increased risk for class 2. Multivariate analyses revealed that the patients with clinically severe type disease had a 1.97-fold risk of class 2 than the patients with clinically moderate-type disease. CONCLUSIONS: The demographic and clinical differences between the two radiological subgroups based on the LCA were significantly different. Two radiological subgroups were significantly associated with clinical moderate and severe types. KEY POINTS: * Two radiological subgroups were identified using LCA. * Older age, therapy, presence of fever, presence of hypertension, decreased lymphocyte count, and increased CRP levels were significant parameters with an increased risk for class 2 defined by LCA. * Patients with clinically severe type had a 1.97-fold higher risk of class 2 defined by LCA in comparison with patients showing clinically moderate-type disease.

coronavirus infections;pneumonia, latent class analysis;tomography, x-ray computed

Journal Article

Fang, Xu;Li, Xiao;Bian, Yun;Ji, Xiang;Lu, Jianping

10.1007/s00330-020-06973-9

[Title]: Relationship between clinical types and radiological subgroups defined by latent class analysis in 2019 novel coronavirus pneumonia caused by SARS-CoV-2. [Abstract]: OBJECTIVES: To investigate whether meaningful subgroups sharing the CT features of patients with COVID-19 pneumonia could be identified using latent class analysis (LCA) and explore the relationship between the LCA-derived subgroups and clinical types. METHODS: This retrospective review included 499 patients with confirmed COVID-19 pneumonia between February 11 and March 8, 2020. Subgroups sharing the CT features were identified using LCA. Univariate and multivariate logistic regression models were utilized to analyze the association between clinical types and the LCA-derived subgroups. RESULTS: Two radiological subgroups were identified using LCA. There were 228 subjects (45.69%) in class 1 and 271 subjects (54.31%) in class 2. The CT findings of class 1 were smaller pulmonary infection volume, more peripheral distribution, more GGO, more maximum lesion range </= 5 cm, a smaller number of lesions, less involvement of lobes, less air bronchogram, less dilatation of vessels, less hilar and mediastinal lymph node enlargement, and less pleural effusion than the CT findings of class 2. Univariate analysis demonstrated that older age, therapy, presence of fever, presence of hypertension, decreased lymphocyte count, and increased CRP levels were significant parameters associated with an increased risk for class 2. Multivariate analyses revealed that the patients with clinically severe type disease had a 1.97-fold risk of class 2 than the patients with clinically moderate-type disease. CONCLUSIONS: The demographic and clinical differences between the two radiological subgroups based on the LCA were significantly different. Two radiological subgroups were significantly associated with clinical moderate and severe types. KEY POINTS: * Two radiological subgroups were identified using LCA. * Older age, therapy, presence of fever, presence of hypertension, decreased lymphocyte count, and increased CRP levels were significant parameters with an increased risk for class 2 defined by LCA. * Patients with clinically severe type had a 1.97-fold higher risk of class 2 defined by LCA in comparison with patients showing clinically moderate-type disease. [Keywords]: coronavirus infections;pneumonia, latent class analysis;tomography, x-ray computed

Int J Infect Dis

Persistence of intestinal SARS-CoV-2 infection in patients with COVID-19 leads to re-admission after pneumonia resolved.

The current reports of COVID-19 focus on the respiratory system, however, intestinal infections caused by SARS-CoV-2 are also worthy of attention. This paper reported persistence of intestinal SARS-CoV-2 infection leads to re-admission after pneumonia resolved in three cases with COVID-19.

covid-19;environmental sars-cov-2 contamination;intestinal infection;sars-cov-2;viral excretion of sars-cov-2

Case Reports

Wang, Xiaorong;Zhou, Yaya;Jiang, Nanchuan;Zhou, Qiong;Ma, Wan-Li

10.1016/j.ijid.2020.04.063

[Title]: Persistence of intestinal SARS-CoV-2 infection in patients with COVID-19 leads to re-admission after pneumonia resolved. [Abstract]: The current reports of COVID-19 focus on the respiratory system, however, intestinal infections caused by SARS-CoV-2 are also worthy of attention. This paper reported persistence of intestinal SARS-CoV-2 infection leads to re-admission after pneumonia resolved in three cases with COVID-19. [Keywords]: covid-19;environmental sars-cov-2 contamination;intestinal infection;sars-cov-2;viral excretion of sars-cov-2

BMJ Case Rep

Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.

haematology (incl blood transfusion);hypertension;liver disease;obstetrics and gynaecology;pregnancy

Case Reports;Journal Article

Ahmed, Irshad;Eltaweel, Nashwa;Antoun, Lina;Rehal, Anoop

10.1136/bcr-2020-237521

[Title]: Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection. [Abstract]: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy. [Keywords]: haematology (incl blood transfusion);hypertension;liver disease;obstetrics and gynaecology;pregnancy

Circ Arrhythm Electrophysiol

Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection.

BACKGROUND: The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine+/-azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death. METHODS: Hospitalized patients treated with chloroquine/hydroxychloroquine+/-azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death. RESULTS: Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6+/-24.9 versus 439.9+/-24.7 ms, P=0.834). The maximum corrected QT interval during treatment was significantly longer in the combination group versus the monotherapy group (470.4+/-45.0 ms versus 453.3+/-37.0 ms, P=0.004). Seven patients (3.5%) required discontinuation of these medications due to corrected QT interval prolongation. No arrhythmogenic deaths were reported. CONCLUSIONS: In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine+/-azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.

covid-19;qt prolongation;azithromycin;chloroquine;hydroxychloroquine;pandemic

Journal Article;Multicenter Study;Observational Study

Saleh, Moussa;Gabriels, James;Chang, David;Soo Kim, Beom;Mansoor, Amtul;Mahmood, Eitezaz;Makker, Parth;Ismail, Haisam;Goldner, Bruce;Willner, Jonathan;Beldner, Stuart;Mitra, Raman;John, Roy;Chinitz, Jason;Skipitaris, Nicholas;Mountantonakis, Stavros;Epstein, Laurence M

10.1161/CIRCEP.120.008662

[Title]: Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection. [Abstract]: BACKGROUND: The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine+/-azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death. METHODS: Hospitalized patients treated with chloroquine/hydroxychloroquine+/-azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death. RESULTS: Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6+/-24.9 versus 439.9+/-24.7 ms, P=0.834). The maximum corrected QT interval during treatment was significantly longer in the combination group versus the monotherapy group (470.4+/-45.0 ms versus 453.3+/-37.0 ms, P=0.004). Seven patients (3.5%) required discontinuation of these medications due to corrected QT interval prolongation. No arrhythmogenic deaths were reported. CONCLUSIONS: In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine+/-azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made. [Keywords]: covid-19;qt prolongation;azithromycin;chloroquine;hydroxychloroquine;pandemic

Eur Arch Otorhinolaryngol

In vitro comparison of surgical techniques in times of the SARS-CoV-2 pandemic: electrocautery generates more droplets and aerosol than laser surgery or drilling.

INTRODUCTION: Based on current knowledge, the SARS-CoV-2 is transmitted via droplet, aerosols and smear infection. Due to a confirmed high virus load in the upper respiratory tract of COVID-19 patients, there is a potential risk of infection for health care professionals when performing surgical procedures in this area. The aim of this study was the semi-quantitative comparison of ENT-typical interventions in the head and neck area with regard to particle and aerosol generation. These data can potentially contribute to a better risk assessment of aerogenic SARS-CoV-2-transmission caused by medical procedures. MATERIALS AND METHODS: As a model, a test chamber was created to examine various typical surgical interventions on porcine soft and hard tissues. Simultaneously, particle and aerosol release were recorded and semi-quantitatively evaluated time-dependently. Five typical surgical intervention techniques (mechanical stress with a passive instrument with and without suction, CO2 laser treatment, drilling and bipolar electrocoagulation) were examined and compared regarding resulting particle release. RESULTS: Neither aerosols nor particles could be detected during mechanical manipulation with and without suction. The use of laser technique showed considerable formation of aerosol. During drilling, mainly solid tissue particles were scattered into the environment (18.2 +/- 15.7 particles/cm(2)/min). The strongest particle release was determined during electrocoagulation (77.2 +/- 30.4 particles/cm(2)/min). The difference in particle release between electrocoagulation and drilling was significant (p < 0.05), while particle diameter was comparable. In addition, relevant amounts of aerosol were released during electrocoagulation (79.6% of the maximum flue gas emission during laser treatment). DISCUSSION: Our results demonstrated clear differences comparing surgical model interventions. In contrast to sole mechanical stress with passive instruments, all active instruments (laser, drilling and electrocoagulation) released particles and aerosols. Assuming that particle and aerosol exposure is clinically correlated to the risk of SARS-CoV-2-transmission from the patient to the physician, a potential risk for health care professionals for infection cannot be excluded. Especially electrocautery is frequently used for emergency treatment, e.g., nose bleeding. The use of this technique may, therefore, be considered particularly critical in potentially infectious patients. Alternative methods may be given preference and personal protective equipment should be used consequently.

aerosol;airborne infection;particle;sars-cov-2

Journal Article

Guderian, Daniela B;Loth, Andreas G;Weiss, Roxanne;Diensthuber, Marc;Stover, Timo;Leinung, Martin

10.1007/s00405-020-06330-y

[Title]: In vitro comparison of surgical techniques in times of the SARS-CoV-2 pandemic: electrocautery generates more droplets and aerosol than laser surgery or drilling. [Abstract]: INTRODUCTION: Based on current knowledge, the SARS-CoV-2 is transmitted via droplet, aerosols and smear infection. Due to a confirmed high virus load in the upper respiratory tract of COVID-19 patients, there is a potential risk of infection for health care professionals when performing surgical procedures in this area. The aim of this study was the semi-quantitative comparison of ENT-typical interventions in the head and neck area with regard to particle and aerosol generation. These data can potentially contribute to a better risk assessment of aerogenic SARS-CoV-2-transmission caused by medical procedures. MATERIALS AND METHODS: As a model, a test chamber was created to examine various typical surgical interventions on porcine soft and hard tissues. Simultaneously, particle and aerosol release were recorded and semi-quantitatively evaluated time-dependently. Five typical surgical intervention techniques (mechanical stress with a passive instrument with and without suction, CO2 laser treatment, drilling and bipolar electrocoagulation) were examined and compared regarding resulting particle release. RESULTS: Neither aerosols nor particles could be detected during mechanical manipulation with and without suction. The use of laser technique showed considerable formation of aerosol. During drilling, mainly solid tissue particles were scattered into the environment (18.2 +/- 15.7 particles/cm(2)/min). The strongest particle release was determined during electrocoagulation (77.2 +/- 30.4 particles/cm(2)/min). The difference in particle release between electrocoagulation and drilling was significant (p < 0.05), while particle diameter was comparable. In addition, relevant amounts of aerosol were released during electrocoagulation (79.6% of the maximum flue gas emission during laser treatment). DISCUSSION: Our results demonstrated clear differences comparing surgical model interventions. In contrast to sole mechanical stress with passive instruments, all active instruments (laser, drilling and electrocoagulation) released particles and aerosols. Assuming that particle and aerosol exposure is clinically correlated to the risk of SARS-CoV-2-transmission from the patient to the physician, a potential risk for health care professionals for infection cannot be excluded. Especially electrocautery is frequently used for emergency treatment, e.g., nose bleeding. The use of this technique may, therefore, be considered particularly critical in potentially infectious patients. Alternative methods may be given preference and personal protective equipment should be used consequently. [Keywords]: aerosol;airborne infection;particle;sars-cov-2

Clin Infect Dis

Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System.

BACKGROUND: Data on risk factors for COVID-19-associated hospitalization are needed to guide prevention efforts and clinical care. We sought to identify factors independently associated with COVID-19-associated hospitalizations. METHODS: U.S. community-dwelling adults (>/=18 years) hospitalized with laboratory-confirmed COVID-19 during March 1-June 23, 2020 were identified from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a multi-state surveillance system. To calculate hospitalization rates by age, sex, and race/ethnicity strata, COVID-NET data served as the numerator and Behavioral Risk Factor Surveillance System estimates served as the population denominator for characteristics of interest. Underlying medical conditions examined included hypertension, coronary artery disease, history of stroke, diabetes, obesity [BMI >/=30 kg/m 2], severe obesity [BMI>/=40 kg/m 2], chronic kidney disease, asthma, and chronic obstructive pulmonary disease. Generalized Poisson regression models were used to calculate adjusted rate ratios (aRR) for hospitalization. RESULTS: Among 5,416 adults, hospitalization rates were higher among those with >/=3 underlying conditions (versus without)(aRR: 5.0; 95%CI: 3.9, 6.3), severe obesity (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease (aRR:4.0; 95%CI: 3.0, 5.2), diabetes (aRR:3.2; 95%CI: 2.5, 4.1), obesity (aRR:2.9; 95%CI: 2.3, 3.5), hypertension (aRR:2.8; 95%CI: 2.3, 3.4), and asthma (aRR:1.4; 95%CI: 1.1, 1.7), after adjusting for age, sex, and race/ethnicity. Adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults aged >/=65, 45-64 (versus 18-44 years), males (versus females), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites). CONCLUSION: Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.

covid-19;epidemiology;hospitalization;risk factors;surveillance

Journal Article

Ko, Jean Y;Danielson, Melissa L;Town, Machell;Derado, Gordana;Greenlund, Kurt J;Daily Kirley, Pam;Alden, Nisha B;Yousey-Hindes, Kimberly;Anderson, Evan J;Ryan, Patricia A;Kim, Sue;Lynfield, Ruth;Torres, Salina M;Barney, Grant R;Bennett, Nancy M;Sutton, Melissa;Talbot, H Keipp;Hill, Mary;Hall, Aron J;Fry, Alicia M;Garg, Shikha;Kim, Lindsay

10.1093/cid/ciaa1419

[Title]: Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. [Abstract]: BACKGROUND: Data on risk factors for COVID-19-associated hospitalization are needed to guide prevention efforts and clinical care. We sought to identify factors independently associated with COVID-19-associated hospitalizations. METHODS: U.S. community-dwelling adults (>/=18 years) hospitalized with laboratory-confirmed COVID-19 during March 1-June 23, 2020 were identified from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a multi-state surveillance system. To calculate hospitalization rates by age, sex, and race/ethnicity strata, COVID-NET data served as the numerator and Behavioral Risk Factor Surveillance System estimates served as the population denominator for characteristics of interest. Underlying medical conditions examined included hypertension, coronary artery disease, history of stroke, diabetes, obesity [BMI >/=30 kg/m 2], severe obesity [BMI>/=40 kg/m 2], chronic kidney disease, asthma, and chronic obstructive pulmonary disease. Generalized Poisson regression models were used to calculate adjusted rate ratios (aRR) for hospitalization. RESULTS: Among 5,416 adults, hospitalization rates were higher among those with >/=3 underlying conditions (versus without)(aRR: 5.0; 95%CI: 3.9, 6.3), severe obesity (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease (aRR:4.0; 95%CI: 3.0, 5.2), diabetes (aRR:3.2; 95%CI: 2.5, 4.1), obesity (aRR:2.9; 95%CI: 2.3, 3.5), hypertension (aRR:2.8; 95%CI: 2.3, 3.4), and asthma (aRR:1.4; 95%CI: 1.1, 1.7), after adjusting for age, sex, and race/ethnicity. Adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults aged >/=65, 45-64 (versus 18-44 years), males (versus females), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites). CONCLUSION: Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions. [Keywords]: covid-19;epidemiology;hospitalization;risk factors;surveillance

Nan Fang Yi Ke Da Xue Xue Bao

[Supporting the battle against COVID-19 in E'zhou, Hubei Province: the experience of Guizhou medical team].

To suppress the rapid spread of coronavirus disease 2019 (COVID-19) in Hubei province, a medical rescue team consisting of 860 members was sent to E'zhou, one of the hard-hit cities in east Hubei. A total of 414 of the team members, whose core members were from Guizhou Medical University and its Affiliated Hospital, took over the full operation of Leishan hospital of E'zhou, a makeshift hospital built for treating COVID-19 patients. Under the instructions by the E'zhou Medical Team Front Command, the staff made quick responses to the surging number of patients with COVID-19 and rapidly formulated treatment plans based on the local conditions. The medical team efficiently carried out the operations and successfully completed the rescue mission. Herein the authors, as members of Guizhou Medical Team supporting COVID-19 containment in E'zhou, analyze and summarize the experiences of Guizhou Medical Team with the organization, implementation and logistic support of medical rescue operations, which may provide reference for future rescue missions in a similar scenario.

covid-19;hospital staffing;medical rescue;trans-regional

Journal Article

Zhang, Tao;Ran, Limei;Li, Kun;Liu, Jian;Chen, Li;Lu, Jinsong;Liang, Guiyou;Zuo, Shi

10.12122/j.issn.1673-4254.2020.03.12

[Title]: [Supporting the battle against COVID-19 in E'zhou, Hubei Province: the experience of Guizhou medical team]. [Abstract]: To suppress the rapid spread of coronavirus disease 2019 (COVID-19) in Hubei province, a medical rescue team consisting of 860 members was sent to E'zhou, one of the hard-hit cities in east Hubei. A total of 414 of the team members, whose core members were from Guizhou Medical University and its Affiliated Hospital, took over the full operation of Leishan hospital of E'zhou, a makeshift hospital built for treating COVID-19 patients. Under the instructions by the E'zhou Medical Team Front Command, the staff made quick responses to the surging number of patients with COVID-19 and rapidly formulated treatment plans based on the local conditions. The medical team efficiently carried out the operations and successfully completed the rescue mission. Herein the authors, as members of Guizhou Medical Team supporting COVID-19 containment in E'zhou, analyze and summarize the experiences of Guizhou Medical Team with the organization, implementation and logistic support of medical rescue operations, which may provide reference for future rescue missions in a similar scenario. [Keywords]: covid-19;hospital staffing;medical rescue;trans-regional

Rev Assoc Med Bras (1992)

Beyond ventilatory support: challenges in general practice and in the treatment of critically Ill children and adolescents with SARS-CoV-2 infection.

Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.

Journal Article;Review

Ferranti, Juliana Ferreira;Rodriguez, Isadora Souza;Motta, Emiliana;Johnston, Cintia;Carvalho, Werther Brunow de B;Delgado, Artur Figueiredo

10.1590/1806-9282.66.4.521

[Title]: Beyond ventilatory support: challenges in general practice and in the treatment of critically Ill children and adolescents with SARS-CoV-2 infection. [Abstract]: Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery. [Keywords]:

J Investig Med High Impact Case Rep

A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence.

Coronavirus disease 2019 (COVID-19) caused by a novel human coronavirus has led to a tsunami of viral illness across the globe, originating from Wuhan, China. Although the value and effectiveness of extracorporeal membrane oxygenation (ECMO) in severe respiratory illness from COVID-19 remains unclear at this time, there is emerging evidence suggesting that it could be utilized as an ultimate treatment in appropriately selected patients not responding to conventional care. We present a case of a 32-year-old COVID-19 positive male with a history of diabetes mellitus who was intubated for severe acute respiratory distress syndrome (ARDS). The patient's hypoxemia failed to improve despite positive pressure ventilation, prone positioning, and use of neuromuscular blockade for ventilator asynchrony. He was evaluated by a multidisciplinary team for considering ECMO for refractory ARDS. He was initiated on venovenous ECMO via dual-site cannulation performed at the bedside. Although his ECMO course was complicated by bleeding, he showed a remarkable improvement in his lung function. ECMO was successfully decannulated after 17 days of initiation. The patient was discharged home after 47 days of hospitalization without any supplemental oxygen and was able to undergo active physical rehabilitation. A multidisciplinary approach is imperative in the initiation and management of ECMO in COVID-19 patients with severe ARDS. While ECMO is labor-intensive, using it in the right phenotype and in specialized centers may lead to positive results. Patients who are young, with fewer comorbidities and single organ dysfunction portray a better prognosis for patients in which ECMO is utilized.

ards;covid-19;ecmo;acute respiratory distress syndrome;extracorporeal membrane oxygenation

Case Reports;Journal Article

Rajdev, Kartikeya;Farr, Lyndie A;Saeed, Muhammad Ahsan;Hooten, Rorak;Baus, Joseph;Boer, Brian

10.1177/2324709620957778

[Title]: A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence. [Abstract]: Coronavirus disease 2019 (COVID-19) caused by a novel human coronavirus has led to a tsunami of viral illness across the globe, originating from Wuhan, China. Although the value and effectiveness of extracorporeal membrane oxygenation (ECMO) in severe respiratory illness from COVID-19 remains unclear at this time, there is emerging evidence suggesting that it could be utilized as an ultimate treatment in appropriately selected patients not responding to conventional care. We present a case of a 32-year-old COVID-19 positive male with a history of diabetes mellitus who was intubated for severe acute respiratory distress syndrome (ARDS). The patient's hypoxemia failed to improve despite positive pressure ventilation, prone positioning, and use of neuromuscular blockade for ventilator asynchrony. He was evaluated by a multidisciplinary team for considering ECMO for refractory ARDS. He was initiated on venovenous ECMO via dual-site cannulation performed at the bedside. Although his ECMO course was complicated by bleeding, he showed a remarkable improvement in his lung function. ECMO was successfully decannulated after 17 days of initiation. The patient was discharged home after 47 days of hospitalization without any supplemental oxygen and was able to undergo active physical rehabilitation. A multidisciplinary approach is imperative in the initiation and management of ECMO in COVID-19 patients with severe ARDS. While ECMO is labor-intensive, using it in the right phenotype and in specialized centers may lead to positive results. Patients who are young, with fewer comorbidities and single organ dysfunction portray a better prognosis for patients in which ECMO is utilized. [Keywords]: ards;covid-19;ecmo;acute respiratory distress syndrome;extracorporeal membrane oxygenation

Immunity

Lessons for COVID-19 Immunity from Other Coronavirus Infections.

A key goal to controlling coronavirus disease 2019 (COVID-19) is developing an effective vaccine. Development of a vaccine requires knowledge of what constitutes a protective immune response and also features that might be pathogenic. Protective and pathogenic aspects of the response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not well understood, partly because the virus has infected humans for only 6 months. However, insight into coronavirus immunity can be informed by previous studies of immune responses to non-human coronaviruses, common cold coronaviruses, and SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). Here, we review the literature describing these responses and discuss their relevance to the SARS-CoV-2 immune response.

Journal Article;Research Support, N.I.H., Extramural;Review

Sariol, Alan;Perlman, Stanley

10.1016/j.immuni.2020.07.005

[Title]: Lessons for COVID-19 Immunity from Other Coronavirus Infections. [Abstract]: A key goal to controlling coronavirus disease 2019 (COVID-19) is developing an effective vaccine. Development of a vaccine requires knowledge of what constitutes a protective immune response and also features that might be pathogenic. Protective and pathogenic aspects of the response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not well understood, partly because the virus has infected humans for only 6 months. However, insight into coronavirus immunity can be informed by previous studies of immune responses to non-human coronaviruses, common cold coronaviruses, and SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). Here, we review the literature describing these responses and discuss their relevance to the SARS-CoV-2 immune response. [Keywords]:

J Clin Hypertens (Greenwich)

Influence of blood pressure control and application of renin-angiotensin-aldosterone system inhibitors on the outcomes in COVID-19 patients with hypertension.

Hypertension is proved to be associated with severity and mortality in coronavirus disease 2019 (COVID-19). However, little is known about the effects of pre-admission and/or in-hospital antihypertension treatments on clinical outcomes. Thus, this study aimed to investigate the association between in-hospital blood pressure (BP) control and COVID-19-related outcomes and to compare the effects of different antihypertension treatments. This study included 2864 COVID-19 patients and 1628 were hypertensive. Patients were grouped according to their BP during hospitalization and records of medication application. Patients with higher BP showed worse cardiac and renal functions and clinical outcomes. After adjustment, subjects with pre-admission usage of renin-angiotensin-aldosterone system (RAAS) inhibitors (HR = 0.35, 95%CI 0.14-0.86, P = .022) had a lower risk of adverse clinical outcomes, including death, acute respiratory distress syndrome, respiratory failure, septic shock, mechanical ventilation, and intensive care unit admission. Particularly, hypertension patients receiving RAAS inhibitor treatment either before (HR = 0.35, 95%CI 0.13-0.97, P = .043) or after (HR = 0.18, 95%CI 0.04-0.86, P = .031) admission showed a significantly lower risk of adverse clinical outcomes than those receiving application of other antihypertensive medicines. Furthermore, consecutive application of RAAS inhibitors in COVID-19 patients with hypertension showed better clinical outcomes (HR = 0.10, 95%CI 0.01-0.83, P = .033) than non-RAAS inhibitors users. We revealed that COVID-19 patients with poor BP control during hospitalization had worse clinical outcomes. Compared with other antihypertension medicines, RAAS inhibitors were beneficial for improving clinical outcomes in COVID-19 patients with hypertension. Our findings provide direct evidence to support the administration of RAAS inhibitors to COVID-19 patients with hypertension before and after admission.

covid-19;raas inhibitors;antihypertensive medicine;blood pressure;clinical outcomes;hypertension

Journal Article

Chen, Renzheng;Yang, Jie;Gao, Xubin;Ding, Xiaohan;Yang, Yuanqi;Shen, Yang;He, Chunyan;Xiang, Hedong;Ke, Jingbin;Yuan, Fangzhengyuan;Cheng, Ran;Lv, Hailin;Li, Ping;Zhang, Limin;Liu, Chuan;Tan, Hu;Huang, Lan

10.1111/jch.14038

[Title]: Influence of blood pressure control and application of renin-angiotensin-aldosterone system inhibitors on the outcomes in COVID-19 patients with hypertension. [Abstract]: Hypertension is proved to be associated with severity and mortality in coronavirus disease 2019 (COVID-19). However, little is known about the effects of pre-admission and/or in-hospital antihypertension treatments on clinical outcomes. Thus, this study aimed to investigate the association between in-hospital blood pressure (BP) control and COVID-19-related outcomes and to compare the effects of different antihypertension treatments. This study included 2864 COVID-19 patients and 1628 were hypertensive. Patients were grouped according to their BP during hospitalization and records of medication application. Patients with higher BP showed worse cardiac and renal functions and clinical outcomes. After adjustment, subjects with pre-admission usage of renin-angiotensin-aldosterone system (RAAS) inhibitors (HR = 0.35, 95%CI 0.14-0.86, P = .022) had a lower risk of adverse clinical outcomes, including death, acute respiratory distress syndrome, respiratory failure, septic shock, mechanical ventilation, and intensive care unit admission. Particularly, hypertension patients receiving RAAS inhibitor treatment either before (HR = 0.35, 95%CI 0.13-0.97, P = .043) or after (HR = 0.18, 95%CI 0.04-0.86, P = .031) admission showed a significantly lower risk of adverse clinical outcomes than those receiving application of other antihypertensive medicines. Furthermore, consecutive application of RAAS inhibitors in COVID-19 patients with hypertension showed better clinical outcomes (HR = 0.10, 95%CI 0.01-0.83, P = .033) than non-RAAS inhibitors users. We revealed that COVID-19 patients with poor BP control during hospitalization had worse clinical outcomes. Compared with other antihypertension medicines, RAAS inhibitors were beneficial for improving clinical outcomes in COVID-19 patients with hypertension. Our findings provide direct evidence to support the administration of RAAS inhibitors to COVID-19 patients with hypertension before and after admission. [Keywords]: covid-19;raas inhibitors;antihypertensive medicine;blood pressure;clinical outcomes;hypertension

Am J Mens Health

Men and COVID-19: A Pathophysiologic Review.

Coronaviruses are single-stranded ribonucleic acid viruses that can cause illnesses in humans ranging from the common cold to severe respiratory disease and even death.In March 2020, the World Health Organization declared the 2019 novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the first pandemic. Compared to women, most countries with available data report that men with COVID-19 have greater disease severity and higher mortality. Lab and animal data indicate that men respond differently to the SARS-CoV-2 infection, offering possible explanations for the epidemiologic observations. The plausible theories underlying these observations include sex-related differences in angiotensin-converting enzyme 2 receptors, immune function, hormones, habits, and coinfection rates.In this review we examine these factors and explore the rationale as to how each may impact COVID-19. Understanding why men are more likely to experience severe disease can help in developing effective treatments, public health policies, and targeted strategies such as early recognition and aggressive testing in subgroups.

covid-19;men;sar-cov-2;coronavirus;crisis;pandemic;pathology;public health

Comparative Study;Journal Article;Review

Lipsky, Martin S;Hung, Man

10.1177/1557988320954021

[Title]: Men and COVID-19: A Pathophysiologic Review. [Abstract]: Coronaviruses are single-stranded ribonucleic acid viruses that can cause illnesses in humans ranging from the common cold to severe respiratory disease and even death.In March 2020, the World Health Organization declared the 2019 novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the first pandemic. Compared to women, most countries with available data report that men with COVID-19 have greater disease severity and higher mortality. Lab and animal data indicate that men respond differently to the SARS-CoV-2 infection, offering possible explanations for the epidemiologic observations. The plausible theories underlying these observations include sex-related differences in angiotensin-converting enzyme 2 receptors, immune function, hormones, habits, and coinfection rates.In this review we examine these factors and explore the rationale as to how each may impact COVID-19. Understanding why men are more likely to experience severe disease can help in developing effective treatments, public health policies, and targeted strategies such as early recognition and aggressive testing in subgroups. [Keywords]: covid-19;men;sar-cov-2;coronavirus;crisis;pandemic;pathology;public health

Redox Biol

The cholesterol metabolite 27-hydroxycholesterol inhibits SARS-CoV-2 and is markedly decreased in COVID-19 patients.

There is an urgent need to identify antivirals against the coronavirus SARS-CoV-2 in the current COVID-19 pandemic and to contain future similar emergencies early on. Specific side-chain cholesterol oxidation products of the oxysterols family have been shown to inhibit a large variety of both enveloped and non-enveloped human viral pathogens. Here we report on the in vitro inhibitory activity of the redox active oxysterol 27-hydroxycholesterol against SARS-CoV-2 and against one of the common cold agents HCoV-OC43 human coronavirus without significant cytotoxicity. Interestingly, physiological serum levels of 27-hydroxycholesterol in SARS-CoV-2 positive subjects were significantly decreased compared to the matched control group, reaching a marked 50% reduction in severe COVID-19 cases. Moreover, no correlation at all was observed between 24-hydroxycholesterol and 25-hydroxycholesterol serum levels and the severity of the disease. Opposite to that of 27-hydroxycholesterol was the behaviour of two recognized markers of redox imbalance, i.e. 7-ketocholesterol and 7beta-hydroxycholesterol, whose serum levels were significantly increased especially in severe COVID-19. The exogenous administration of 27-hydroxycholesterol may represent in the near future a valid antiviral strategy in the worsening of diseases caused by present and emerging coronaviruses.

27-hydroxycholesterol;covid-19;cholesterol;coronavirus;hcov-oc43;oxysterols;sars-cov-2

Journal Article;Research Support, Non-U.S. Gov't

Marcello, Alessandro;Civra, Andrea;Milan Bonotto, Rafaela;Nascimento Alves, Lais;Rajasekharan, Sreejith;Giacobone, Chiara;Caccia, Claudio;Cavalli, Roberta;Adami, Marco;Brambilla, Paolo;Lembo, David;Poli, Giuseppe;Leoni, Valerio

10.1016/j.redox.2020.101682

[Title]: The cholesterol metabolite 27-hydroxycholesterol inhibits SARS-CoV-2 and is markedly decreased in COVID-19 patients. [Abstract]: There is an urgent need to identify antivirals against the coronavirus SARS-CoV-2 in the current COVID-19 pandemic and to contain future similar emergencies early on. Specific side-chain cholesterol oxidation products of the oxysterols family have been shown to inhibit a large variety of both enveloped and non-enveloped human viral pathogens. Here we report on the in vitro inhibitory activity of the redox active oxysterol 27-hydroxycholesterol against SARS-CoV-2 and against one of the common cold agents HCoV-OC43 human coronavirus without significant cytotoxicity. Interestingly, physiological serum levels of 27-hydroxycholesterol in SARS-CoV-2 positive subjects were significantly decreased compared to the matched control group, reaching a marked 50% reduction in severe COVID-19 cases. Moreover, no correlation at all was observed between 24-hydroxycholesterol and 25-hydroxycholesterol serum levels and the severity of the disease. Opposite to that of 27-hydroxycholesterol was the behaviour of two recognized markers of redox imbalance, i.e. 7-ketocholesterol and 7beta-hydroxycholesterol, whose serum levels were significantly increased especially in severe COVID-19. The exogenous administration of 27-hydroxycholesterol may represent in the near future a valid antiviral strategy in the worsening of diseases caused by present and emerging coronaviruses. [Keywords]: 27-hydroxycholesterol;covid-19;cholesterol;coronavirus;hcov-oc43;oxysterols;sars-cov-2

Radiol Res Pract

Computed Tomography (CT) Imaging Features of Patients with COVID-19: Systematic Review and Meta-Analysis.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious disease, and its first outbreak was reported in Wuhan, China. A coronavirus disease (COVID-19) causes severe respiratory distress (ARDS). Due to the primary involvement of the respiratory system, chest CT is strongly recommended in suspected COVID-19 cases, for both initial evaluation and follow-up. Objective: The aim of this review was to systematically analyze the existing literature on CT imaging features of patients with COVID-19 pneumonia. Methods: A systematic search was conducted on PubMed, Embase, Cochrane Library, Open Access Journals (OAJ), and Google Scholar databases until April 15, 2020. All articles with a report of CT findings in COVID-19 patients published in English from the onset of COVID-19 outbreak to April 20, 2020, were included in the study. Result: From a total of 5041 COVID-19-infected patients, about 98% (4940/5041) had abnormalities in chest CT, while about 2% have normal chest CT findings. Among COVID-19 patients with abnormal chest CT findings, 80% (3952/4940) had bilateral lung involvement. Ground-glass opacity (GGO) and mixed GGO with consolidation were observed in 2482 (65%) and 768 (18%) patients, respectively. Consolidations were detected in 1259 (22%) patients with COVID-19 pneumonia. CT images also showed interlobular septal thickening in about 691 (27%) patients. Conclusion: Frequent involvement of bilateral lung infections, ground-glass opacities, consolidation, crazy paving pattern, air bronchogram signs, and intralobular septal thickening were common CT imaging features of patients with COVID-19 pneumonia.

Journal Article;Review

Awulachew, Ephrem;Diriba, Kuma;Anja, Asrat;Getu, Eyob;Belayneh, Firehiwot

10.1155/2020/1023506

[Title]: Computed Tomography (CT) Imaging Features of Patients with COVID-19: Systematic Review and Meta-Analysis. [Abstract]: Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious disease, and its first outbreak was reported in Wuhan, China. A coronavirus disease (COVID-19) causes severe respiratory distress (ARDS). Due to the primary involvement of the respiratory system, chest CT is strongly recommended in suspected COVID-19 cases, for both initial evaluation and follow-up. Objective: The aim of this review was to systematically analyze the existing literature on CT imaging features of patients with COVID-19 pneumonia. Methods: A systematic search was conducted on PubMed, Embase, Cochrane Library, Open Access Journals (OAJ), and Google Scholar databases until April 15, 2020. All articles with a report of CT findings in COVID-19 patients published in English from the onset of COVID-19 outbreak to April 20, 2020, were included in the study. Result: From a total of 5041 COVID-19-infected patients, about 98% (4940/5041) had abnormalities in chest CT, while about 2% have normal chest CT findings. Among COVID-19 patients with abnormal chest CT findings, 80% (3952/4940) had bilateral lung involvement. Ground-glass opacity (GGO) and mixed GGO with consolidation were observed in 2482 (65%) and 768 (18%) patients, respectively. Consolidations were detected in 1259 (22%) patients with COVID-19 pneumonia. CT images also showed interlobular septal thickening in about 691 (27%) patients. Conclusion: Frequent involvement of bilateral lung infections, ground-glass opacities, consolidation, crazy paving pattern, air bronchogram signs, and intralobular septal thickening were common CT imaging features of patients with COVID-19 pneumonia. [Keywords]:

Clin Appl Thromb Hemost

Methodological Issues and Controversies in COVID-19 Coagulopathy: A Tale of Two Storms.

Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in ECMO devices, all in the face of prophylactic and sometimes even therapeutic anti-coagulation, are frequent features of COVID-19 coagulopathy. The trials available to guide clinicians are methodologically limited. There are several unresolved controversies including 1) Should all hospitalized patients with COVID-19 receive prophylactic anti-coagulation? 2) Which patients should have their dosage escalated to intermediate dose? 3) Which patients should be considered for full-dose anti-coagulation even without a measurable thromboembolic event and how should that anti-coagulation be monitored? 4) Should patients receive post-discharge anti-coagulation? 5) What thrombotic issues are related to the various medications being used to treat this coagulopathy? 6) Is anti-phospholipid anti-body part of this syndrome? 7) How do the different treatments for this disease impact the coagulation issues? The aims of this article are to explore these questions and interpret the available data based on the current evidence.

Journal Article;Review

Berkman, Samuel A;Tapson, Victor F

10.1177/1076029620945398

[Title]: Methodological Issues and Controversies in COVID-19 Coagulopathy: A Tale of Two Storms. [Abstract]: Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in ECMO devices, all in the face of prophylactic and sometimes even therapeutic anti-coagulation, are frequent features of COVID-19 coagulopathy. The trials available to guide clinicians are methodologically limited. There are several unresolved controversies including 1) Should all hospitalized patients with COVID-19 receive prophylactic anti-coagulation? 2) Which patients should have their dosage escalated to intermediate dose? 3) Which patients should be considered for full-dose anti-coagulation even without a measurable thromboembolic event and how should that anti-coagulation be monitored? 4) Should patients receive post-discharge anti-coagulation? 5) What thrombotic issues are related to the various medications being used to treat this coagulopathy? 6) Is anti-phospholipid anti-body part of this syndrome? 7) How do the different treatments for this disease impact the coagulation issues? The aims of this article are to explore these questions and interpret the available data based on the current evidence. [Keywords]:

J Biomol Struct Dyn

In silico exploration of small-molecule alpha-helix mimetics as inhibitors of SARS-COV-2 attachment to ACE2.

The novel coronavirus, SARS-CoV-2, has infected more than 10 million people and caused more than 502,539 deaths worldwide as of June 2020. The explosive spread of the virus and the rapid increase in the number of cases require the immediate development of effective therapies and vaccines as well as accurate diagnosis tools. The pathogenesis of the disease is triggered by the entry of SARS-CoV-2 via its spike protein into ACE2-bearing host cells, particularly pneumocytes, resulting in overactivation of the immune system, which attacks the infected cells and damages the lung tissue. The interaction of the SARS-CoV-2 receptor binding domain (RBD) with host cells is primarily mediated by the N-terminal helix of ACE2; thus, inhibition of the spike-ACE2 interaction may be a promising therapeutic strategy for blocking the virus entry into host cells. In this paper, we used an in-silico approach to explore small-molecule alpha-helix mimetics as inhibitors that may disrupt the attachment of SARS-CoV-2 to ACE2. First, the RBD-ACE2 interface in the 6M0J structure was studied by the MM-GBSA decomposition module of the HawkDock server, which led to the identification of two critical target regions in the RBD. Next, two virtual screening experiments of 7236 alpha-helix mimetics from ASINEX were conducted on the above regions using the iDock tool, which resulted in 10 candidates with favorable binding affinities. Finally, the stability of RBD complexes with the top-two ranked compounds was further validated by 100 ns of molecular dynamics simulations. Communicated by Ramaswamy H. Sarma.

ace2;covid-19;coronavirus;md simulation;sars-cov-2;spike;treatment;virtual screening;alpha-helix mimetics

Journal Article

Hakmi, Mohammed;Bouricha, E L Mehdi;Akachar, Jihane;Lmimouni, Badreddine;El Harti, Jaouad;Belyamani, Lahcen;Ibrahimi, Azeddine

10.1080/07391102.2020.1830175

[Title]: In silico exploration of small-molecule alpha-helix mimetics as inhibitors of SARS-COV-2 attachment to ACE2. [Abstract]: The novel coronavirus, SARS-CoV-2, has infected more than 10 million people and caused more than 502,539 deaths worldwide as of June 2020. The explosive spread of the virus and the rapid increase in the number of cases require the immediate development of effective therapies and vaccines as well as accurate diagnosis tools. The pathogenesis of the disease is triggered by the entry of SARS-CoV-2 via its spike protein into ACE2-bearing host cells, particularly pneumocytes, resulting in overactivation of the immune system, which attacks the infected cells and damages the lung tissue. The interaction of the SARS-CoV-2 receptor binding domain (RBD) with host cells is primarily mediated by the N-terminal helix of ACE2; thus, inhibition of the spike-ACE2 interaction may be a promising therapeutic strategy for blocking the virus entry into host cells. In this paper, we used an in-silico approach to explore small-molecule alpha-helix mimetics as inhibitors that may disrupt the attachment of SARS-CoV-2 to ACE2. First, the RBD-ACE2 interface in the 6M0J structure was studied by the MM-GBSA decomposition module of the HawkDock server, which led to the identification of two critical target regions in the RBD. Next, two virtual screening experiments of 7236 alpha-helix mimetics from ASINEX were conducted on the above regions using the iDock tool, which resulted in 10 candidates with favorable binding affinities. Finally, the stability of RBD complexes with the top-two ranked compounds was further validated by 100 ns of molecular dynamics simulations. Communicated by Ramaswamy H. Sarma. [Keywords]: ace2;covid-19;coronavirus;md simulation;sars-cov-2;spike;treatment;virtual screening;alpha-helix mimetics

Int J Environ Res Public Health

Hospital and Population-Based Evidence for COVID-19 Early Circulation in the East of France.

BACKGROUND: Understanding SARS-CoV-2 dynamics and transmission is a serious issue. Its propagation needs to be modeled and controlled. The Alsace region in the East of France has been among the first French COVID-19 clusters in 2020. METHODS: We confront evidence from three independent and retrospective sources: a population-based survey through internet, an analysis of the medical records from hospital emergency care services, and a review of medical biology laboratory data. We also check the role played in virus propagation by a large religious meeting that gathered over 2000 participants from all over France mid-February in Mulhouse. RESULTS: Our results suggest that SARS-CoV-2 was circulating several weeks before the first officially recognized case in Alsace on 26 February 2020 and the sanitary alert on 3 March 2020. The religious gathering seems to have played a role for secondary dissemination of the epidemic in France, but not in creating the local outbreak. CONCLUSIONS: Our results illustrate how the integration of data coming from multiple sources could help trigger an early alarm in the context of an emerging disease. Good information data systems, able to produce earlier alerts, could have avoided a general lockdown in France.

covid-19;sars-cov-2;emerging infectious disease;epidemic surveillance;epidemic threshold

Journal Article

Gerbaud, Laurent;Guiguet-Auclair, Candy;Breysse, Franck;Odoul, Josephine;Ouchchane, Lemlih;Peterschmitt, Jonathan;Dezfouli-Desfer, Camille;Breton, Vincent

10.3390/ijerph17197175

[Title]: Hospital and Population-Based Evidence for COVID-19 Early Circulation in the East of France. [Abstract]: BACKGROUND: Understanding SARS-CoV-2 dynamics and transmission is a serious issue. Its propagation needs to be modeled and controlled. The Alsace region in the East of France has been among the first French COVID-19 clusters in 2020. METHODS: We confront evidence from three independent and retrospective sources: a population-based survey through internet, an analysis of the medical records from hospital emergency care services, and a review of medical biology laboratory data. We also check the role played in virus propagation by a large religious meeting that gathered over 2000 participants from all over France mid-February in Mulhouse. RESULTS: Our results suggest that SARS-CoV-2 was circulating several weeks before the first officially recognized case in Alsace on 26 February 2020 and the sanitary alert on 3 March 2020. The religious gathering seems to have played a role for secondary dissemination of the epidemic in France, but not in creating the local outbreak. CONCLUSIONS: Our results illustrate how the integration of data coming from multiple sources could help trigger an early alarm in the context of an emerging disease. Good information data systems, able to produce earlier alerts, could have avoided a general lockdown in France. [Keywords]: covid-19;sars-cov-2;emerging infectious disease;epidemic surveillance;epidemic threshold

Int J Spine Surg

Remote Virtual Spinal Evaluation in the Era of COVID-19.

Background: With the COVID-19 pandemic disrupting many facets of our society, physicians and patients have begun using telemedicine as a platform for the delivery of health care. One of the challenges in implementing telemedicine for the spine care provider is completing a comprehensive spinal examination. Currently, there is no standardized methodology to complete a full spinal examination through telemedicine. Methods: We propose a novel, remote spinal examination methodology that is easily implemented through telemedicine, where the patient is an active participant in the successful completion of his or her examination. This type of examination has been validated in a neurology setting. To facilitate the telemedicine visit, we propose that video instruction be shared with the patient prior to the telemedicine visit to increase the efficacy of the examination. Results: Since the issuance of stay-at-home order across the states, many spine practices around the country have rapidly adopted and increased their telemedicine program to continue provide care for patients during COVID-19 pandemic. At a tertiary academic center in a busy metropolitan area, nearly 700 telemedicine visits were successfully conducted during a 4-week period. There were no remote visits being done prior to the shutdown. Conclusions: Implementation of our proposed remote spinal examination has the potential to serve as a guideline for the spine care provider to efficiently assess patients with spine disease using telemedicine. Because these are only suggestions, providers should tailor examination to each individual patient's needs. Level of Evidence: V. Clinical Relevance: It is likely that physicians will incorporate telemedicine into health care delivery services even after the COVID-19 pandemic subsides because of telemedicine's efficiency in meeting patient needs. Using the standard maneuvers provided in our study, spine care providers can perform a nearly comprehensive spine examination through telemedicine. Further studies will be needed to validate the reproducibility and reliability of our methodology.

motor examination;neurologic examination;neurosurgery;orthopedics;spine examination;spine surgery;telemedicine;virtual clinic;virtual spine evaluation

Journal Article

Yoon, Jang W;Welch, Rachel L;Alamin, Todd;Lavelle, William F;Cheng, Ivan;Perez-Cruet, Mick;Fielding, Louis C;Sasso, Rick C;Linovitz, R J;Kim, Kee D;Welch, William C

10.14444/7057

[Title]: Remote Virtual Spinal Evaluation in the Era of COVID-19. [Abstract]: Background: With the COVID-19 pandemic disrupting many facets of our society, physicians and patients have begun using telemedicine as a platform for the delivery of health care. One of the challenges in implementing telemedicine for the spine care provider is completing a comprehensive spinal examination. Currently, there is no standardized methodology to complete a full spinal examination through telemedicine. Methods: We propose a novel, remote spinal examination methodology that is easily implemented through telemedicine, where the patient is an active participant in the successful completion of his or her examination. This type of examination has been validated in a neurology setting. To facilitate the telemedicine visit, we propose that video instruction be shared with the patient prior to the telemedicine visit to increase the efficacy of the examination. Results: Since the issuance of stay-at-home order across the states, many spine practices around the country have rapidly adopted and increased their telemedicine program to continue provide care for patients during COVID-19 pandemic. At a tertiary academic center in a busy metropolitan area, nearly 700 telemedicine visits were successfully conducted during a 4-week period. There were no remote visits being done prior to the shutdown. Conclusions: Implementation of our proposed remote spinal examination has the potential to serve as a guideline for the spine care provider to efficiently assess patients with spine disease using telemedicine. Because these are only suggestions, providers should tailor examination to each individual patient's needs. Level of Evidence: V. Clinical Relevance: It is likely that physicians will incorporate telemedicine into health care delivery services even after the COVID-19 pandemic subsides because of telemedicine's efficiency in meeting patient needs. Using the standard maneuvers provided in our study, spine care providers can perform a nearly comprehensive spine examination through telemedicine. Further studies will be needed to validate the reproducibility and reliability of our methodology. [Keywords]: motor examination;neurologic examination;neurosurgery;orthopedics;spine examination;spine surgery;telemedicine;virtual clinic;virtual spine evaluation