title: Modeling the epidemic dynamics and control of COVID-19 outbreak in China

text: Background: The coronavirus disease 2019 (COVID-19) is rapidly spreading in China and more than 30 countries over last two months. COVID-19 has multiple characteristics distinct from other infectious diseases, including high infectivity during incubation, time delay between real dynamics and daily observed number of confirmed cases, and the intervention effects of implemented quarantine and control measures. Methods: We develop a Susceptible, Un-quanrantined infected, Quarantined infected, Confirmed infected (SUQC) model to characterize the dynamics of COVID-19 and explicitly parameterize the intervention effects of control measures, which is more suitable for analysis than other existing epidemic models. Results: The SUQC model is applied to the daily released data of the confirmed infections to analyze the outbreak of COVID-19 in Wuhan, Hubei (excluding Wuhan), China (excluding Hubei) and four first-tier cities of China. We found that, before January 30, 2020, all these regions except Beijing had a reproductive number R > 1, and after January 30, all regions had a reproductive number R < 1, indicating that the quarantine and control measures are effective in preventing the spread of COVID-19. The confirmation rate of Wuhan estimated by our model is 0.0643, substantially lower than that of Hubei excluding Wuhan (0.1914), and that of China excluding Hubei (0.2189), but it jumps to 0.3229 after February 12 when clinical evidence was adopted in new diagnosis guidelines. The number of unquarantined infected cases in Wuhan on February 12, 2020 is estimated to be 3,509 and declines to 334 on February 21, 2020. After fitting the model with data as of February 21, 2020, we predict that the end time of COVID-19 in Wuhan and Hubei is around late March, around mid March for China excluding Hubei, and before early March 2020 for the four tier-one cities. A total of 80,511 individuals are estimated to be infected in China, among which 49,510 are from Wuhan, 17,679 from Hubei (excluding Wuhan), and the rest 13,322 from other regions of China (excluding Hubei). Note that the estimates are from a deterministic ODE model and should be interpreted with some uncertainty. Conclusions: We suggest that rigorous quarantine and control measures should be kept before early March in Beijing, Shanghai, Guangzhou and Shenzhen, and before late March in Hubei. The model can also be useful to predict the trend of epidemic and provide quantitative guide for other countries at high risk of outbreak, such as South Korea, Japan, Italy and Iran. Supplementary Materials: The supplementary materials can be found online with this article at 10.1007/s40484-020-0199-0.


Analysis of Gastrointestinal and Hepatic Manifestations of SARS-CoV-2 Infection in 892 Patients in Queens, NY


Cancer in intensive care unit patients with COVID-19


title: COVID-19 and Liver Dysfunction: a systematic review and meta-analysis of retrospective studies

text: BACKGROUND: Recently, Coronavirus Disease 2019 (COVID-19) pandemic is the most significant global health crisis. In this study, we conducted a meta-analysis to find the association between liver injuries and the severity of COVID-19 disease. METHODS: Online databases, including PubMed, Web of Science, Scopus, and Science direct, were searched to detect relevant publications up to April 16, 2020. Depending on the heterogeneity between studies, a fixed- or random-effects model was applied to pool data. Publication bias Egger's test was also performed. RESULTS: Meta-analysis of 20 retrospective studies (3428 patients), identified that patients with a severe manifestation of COVID-19 exhibited significantly higher levels of alanine aminotransferase, aspartate aminotransferase, and bilirubin values with prolonged prothrombin time. Furthermore, lower albumin level was associated with a severe presentation of COVID-19. CONCLUSION: Liver dysfunction was associated with a severe outcome of COVID-19 disease. Close monitoring of the occurrence of liver dysfunction is beneficial in early warning of unfavorable outcomes. This article is protected by copyright. All rights reserved.


New policy and regulation for a Radiology-Oncology Center at the time of Covid-19 outbreak in Tehran-Iran


Sports Health During the SARS-Cov-2 Pandemic


[2019 Novel Coronavirus, Angiotensin Converting Enzyme 2 and Cardiovascular Drugs]


title: The First Disease X is Caused by a Highly Transmissible Acute Respiratory Syndrome Coronavirus

text: Based on the announcement of the World Health Organization (WHO) in 2018, the Wuhan pneumonia caused by an unknown etiology should be recognized as the first Disease X. Later, the pathogen was identified to be a novel coronavirus denoted 2019-nCoV, which has 79.5% and 96% whole genome sequence identify to SARS-CoV and bat SARS-related coronavirus (SARSr-CoV-RaTG13), respectively, suggesting its potential bat origin. With high human-to-human transmission rate (R0), 2019-nCoV has quickly spread in China and other countries, resulting in 34,953 confirmed cases and 725 deaths as of 8 February 2020, thus calling for urgent development of therapeutics and prophylactics. Here we suggest renaming 2019-nCoV as "transmissible acute respiratory syndrome coronavirus (TARS-CoV)" and briefly review the advancement of research and development of neutralizing antibodies and vaccines targeting the receptor-binding domain (RBD) and viral fusion inhibitors targeting the heptad repeat 1 (HR1) domain in spike protein of 2019-nCoV.


Chloroquine and hydroxychloroquine for COVID-19: implications for cardiac safety


Progressive respiratory failure in COVID-19: a hypothesis


title: Antiviral activities of type I interferons to SARS-CoV-2 infection

text: There is an urgent need to identify antivirals to curtail the COVID-19 pandemic. Herein, we report the sensitivity of SARS-CoV-2 to recombinant human interferons α and ß (IFNα/ß). Treatment with IFN-α or IFN-ß at a concentration of 50 international units (IU) per milliliter reduces viral titers by 3.4 log or over 4 log, respectively, in Vero cells. The EC50 of IFN-α and IFN-ß treatment is 1.35 IU/ml and 0.76 IU/ml, respectively, in Vero cells. These results suggest that SARS-CoV-2 is more sensitive than many other human pathogenic viruses, including SARS-CoV. Overall, our results demonstrate the potential efficacy of human Type I IFN in suppressing SARS-CoV-2 infection, a finding which could inform future treatment options for COVID-19.


Coronavirus Disease 19 (COVID-19) during chemoradiation for locally advanced oropharyngeal squamous cell carcinoma (LA-OPSCC)


Mortality rate and gender differences in COVID-19 patients dying in Italy: A comparison with other countries


The Use of Nonsteroidal Anti-inflammatory Drugs in Urological Practice in the COVID-19 Era: Is "Safe Better than Sorry"?


title: Is Time to Intervention in the COVID-19 Outbreak Really Important? A Global Sensitivity Analysis Approach

text: Italy has been one of the first countries timewise strongly impacted by the COVID-19 pandemic. The adoption of social distancing and heavy lockdown measures is posing a heavy burden on the population and the economy. The timing of the measures has crucial policy-making implications. Using publicly available data for the pandemic progression in Italy, we quantitatively assess the effect of the intervention time on the pandemic expansion, with a methodology that combines a generalized susceptible-exposed-infectious-recovered (SEIR) model together with statistical learning methods. The modeling shows that the lockdown has strongly deviated the pandemic trajectory in Italy. However, the difference between the forecasts and real data up to 20 April 2020 can be explained only by the existence of a time lag between the actual issuance date and the full effect of the measures. To understand the relative importance of intervention with respect to other factors, a thorough uncertainty quantification of the model predictions is performed. Global sensitivity indices show that the the time of intervention is 4 times more relevant than quarantine, and eight times more important than intrinsic features of the pandemic such as protection and infection rates. The relevance of their interactions is also quantified and studied.


Early Challenges in Isolation and De-isolation of Children during the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic


title: The vaccine journey for COVID-19: a comprehensive systematic review of current clinical trials in humans

text: INTRODUCTION: Since December 2019, there has been an outbreak of a novel beta-coronavirus (SARS-CoV-2) in Wuhan, China. On March the 11th the World Health Organization (WHO) declared COVID-19 as a pandemic, with over 118,000 cases in more than 110 countries around the world. In response to the global coronavirus disease 2019 (COVID-19) emergency, clinical trial research assessing the efficacy and safety of experimental vaccines to prevent COVID-19 are emerging at an unprecedented rate. The aim of this systematic review is to summarize the preliminary experiences and ongoing clinical trials of the major candidates and challenges of the vaccine strategies in humans. EVIDENCE ACQUISITION: After a priori protocol registration with PROSPERO (181483), a systematic research of the published literature was conducted on 24 April 2020 using Medline (via PubMed), Embase (via Ovid), and WHO databases. Moreover, to explore the more recent literature we also searched the preprint server medRxiv. Finally, we scrutinized the Cochrane COVID-19 study register and the COVID-19 section of ClinicalTrials.gov database for identifying relevant ongoing clinical trials. Thereafter we selected the articles according to the PRISMA guidelines. Animal or in-vitro experimental studies were excluded. Moreover editorials, commentaries, abstracts, reviews, book chapters, and articles not in English were not included. EVIDENCE SYNTHESIS: Our search identified 1359 published papers, 478 pre-print articles and 367 ongoing clinical trials. Finally, only ten ongoing clinical trials met the inclusion criteria. Specifically, seven developed vaccines for the S protein of SARS-CoV-2 and three clinical trials assessed the protective role of BCG vaccine against COVID-19. The first group included phase I/II trials with different types of molecules (DNA or mRNA vaccine, bacterial plasmid or viral vectors), the latter were phase III/IV trials designed on the basis of a heterologous lymphocyte activation by the BCG vaccine. CONCLUSIONS: This new disease is pushing the scientific community to develop swiftly a safe and effective vaccine. Notwithstanding the limitations of our analysis, given by the absence of available results, we try to provide a comprehensive view of the ongoing clinical trials in humans. Our analysis reveals a worldwide effort of both scientists and enterprises to achieve one of the most challenging goals of our century.


title: How to Quantify and Interpret Treatment Effects in Comparative Clinical Studies of COVID-19

text: Clinical trials of treatments for coronavirus disease 2019 (COVID-19) draw intense public attention. More than ever, valid, transparent, and intuitive summaries of the treatment effects, including efficacy and harm, are needed. In recently published and ongoing randomized comparative trials evaluating treatments for COVID-19, time to a positive outcome, such as recovery or improvement, has repeatedly been used as either the primary or key secondary end point. Because patients may die before recovery or improvement, data analysis of this end point faces a competing risk problem. Commonly used survival analysis techniques, such as the Kaplan-Meier method, often are not appropriate for such situations. Moreover, almost all trials have quantified treatment effects by using the hazard ratio, which is difficult to interpret for a positive event, especially in the presence of competing risks. Using 2 recent trials evaluating treatments (remdesivir and convalescent plasma) for COVID-19 as examples, a valid, well-established yet underused procedure is presented for estimating the cumulative recovery or improvement rate curve across the study period. Furthermore, an intuitive and clinically interpretable summary of treatment efficacy based on this curve is also proposed. Clinical investigators are encouraged to consider applying these methods for quantifying treatment effects in future studies of COVID-19.


Monitoring environmental contamination caused by SARS-CoV-2 in a healthcare facility by using adenosine triphosphate testing


The fight to end tuberculosis must not be forgotten in the COVID-19 outbreak


¿BCG versus COVID-19?/ [BCG versus COVID-19?]


Life after COVID-19: preparing for changes in mental healthcare service demand


COVID-19 and neurologic manifestations: a still missing link and a call for neurologists


title: Epidemiological characteristics of COVID-19 patients in convalescence period

text: This study aimed to investigate the clinical characteristics and to analyse the epidemiological features of coronavirus disease 2019 (COVID-19) patients during convalescence. In this study, we enrolled 71 confirmed cases of COVID-19 who were discharged from hospital and transferred to isolation wards from 6 February to 26 March 2020. They were all employees of Zhongnan Hospital of Wuhan University or their family members of which three cases were <18 years of age. Clinical data were collected and analysed statistically. Forty-one cases (41/71, 57.7%) comprised medical faculty, young and middle-aged patients (aged â©½60 years) accounted for 81.7% (58/71). The average isolation time period for all adult patients was 13.8 ± 6.1 days. During convalescence, RNA detection results of 35.2% patients (25/71) turned from negative to positive. The longest RNA reversed phase time was 7 days. In all, 52.9% of adult patients (36/68) had no obvious clinical symptoms, and the remaining ones had mild and non-specific clinical symptoms (e.g. cough, sputum, sore throat, disorders of the gastrointestinal tract etc.). Chest CT signs in 89.7% of adult patients (61/68) gradually improved, and in the others, the lesions were eventually absorbed and improved after short-term repeated progression. The main chest CT manifestations of adult patients were normal, GGO or fibre streak shadow, and six patients (8.8%) had extrapulmonary manifestations, but there was no significant correlation with RNA detection results (r = -0.008, P > 0.05). The drug treatment was mainly symptomatic support therapy, and antibiotics and antiviral drugs were ineffective. It is necessary to re-evaluate the isolation time and standard to terminate isolation for discharged COVID-19 patients.


title: Keynesian models of depression. Supply shocks and the COVID-19 Crisis

text: The objective of this work is twofold: to expand the depression models proposed by Tobin and analyse a supply shock, such as the Covid-19 pandemic, in this Keynesian conceptual environment. The expansion allows us to propose the evolution of all endogenous macroeconomic variables. The result obtained is relevant due to its theoretical and practical implications. A quantity or Keynesian adjustment to the shock produces a depression through the effect on aggregate demand. This depression worsens in the medium/long-term. It is accompanied by increases in inflation, inflation expectations and the real interest rate. A stimulus tax policy is also recommended, as well as an active monetary policy to reduce real interest rates. On the other hand, the pricing or Marshallian adjustment foresees a more severe and rapid depression in the short-term. There would be a reduction in inflation and inflation expectations, and an increase in the real interest rates. The tax or monetary stimulus measures would only impact inflation. This result makes it possible to clarify and assess the resulting depression, as well as propose policies. Finally, it offers conflicting predictions that allow one of the two models to be falsified.


title: Hospital Preparedness for Outbreak at Patan Hospital: Lesson Learnt from COVID-19

text: Patan Academy of Health Sciences started preparedness for COVID-19 in response to increasing number of patient in neighboring country. Outbreak preparedness in resource limited setup is challenging. Despite this, preparedness was done in reference to WHO interim guidance utilizing best available resources. During this preparedness, one patient was isolated as suspected COVID-19. This paper presents level of preparedness achieved with the limited resources and the lesson learned while isolating the patient. Keywords: COVID-19; Disaster; hospital preparedness.


Public Health Interventions for COVID-19: Emerging Evidence and Implications for an Evolving Public Health Crisis


title: 2019 novel coronavirus (2019-nCoV) outbreak: A new challenge

text: OBJECTIVES: Following the public-health emergency of international concern (PHEIC) declared by the World Health Organization (WHO) on 30 January 2020 and the recent outbreak caused by 2019 novel coronavirus (2019-nCoV) [officially renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] in China and 29 other countries, we aimed to summarise the clinical aspects of the novelBetacoronavirus disease (COVID-19) and its possible clinical presentations together with suggested therapeutic algorithms for patients who may require antimicrobial treatment. METHODS: The currently available literature was reviewed for microbiologically confirmed infections by 2019-nCoV or COVID-19 at the time of writing (13 February 2020). A literature search was performed using the PubMed database and Cochrane Library. Search terms included 'novel coronavirus' or '2019-nCoV' or 'COVID-19'. RESULTS: Published cases occurred mostly in males (age range, 8-92 years). Cardiovascular, digestive and endocrine system diseases were commonly reported, except previous chronic pulmonary diseases [e.g. chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis] that were surprisingly underreported. Fever was present in all of the case series available, flanked by cough, dyspnoea, myalgia and fatigue. Multiple bilateral lobular and subsegmental areas of consolidation or bilateral ground-glass opacities were the main reported radiological features of 2019-nCoV infection, at least in the early phases of the disease. CONCLUSION: The new 2019-nCoV epidemic is mainly associated with respiratory disease and few extrapulmonary signs. However, there is a low rate of associated pre-existing respiratory co-morbidities.


title: The thromboembolism in COVID-19: the unsolved problem

text: INTRODUCTION: The recent Sars-Cov-2 pandemic (COVID-19) has led to growing research to explain the poor clinical prognosis in some patients. EVIDENCE ACQUISITION: While early observational studies highlighted the role of the virus in lung failure, in a second moment thrombosis emerged as a possible explanation of the worse clinical course in some patients. Despite initial difficulties in management of such patients, the constant increase of literature in the field is to date clarifying some questions from clinicians. However, several other questions need answer. EVIDENCE SYNTHESIS: A novel disease (Covid-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was responsible for thousands of hospitalizations for severe acute respiratory syndrome, with several cases of thrombotic complications due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. Covid-19 and hospitalizations for Covid-19 may carry several potential risk factors for thrombosis. Severe coagulation abnormalities may occur in almost all of the severe and critical ill COVID-19 cases. CONCLUSIONS: Despite a strong pathophysiological rationale, the evidences in literature are not enough to recommend an aggressive antithrombotic therapy in COVID- 19. However, it is our opinion that an early use, even at home at the beginning of the disease, could improve the clinical course.


title: COVID-19 and spontaneous singing to decrease loneliness, improve cohesion, and mental well-being: An Italian experience

text: Since March 2020, Italy has been in lockdown due to COVID-19, and individuals have missed all kinds of networking opportunities. Already in the 1st weeks of March, Italian cities' silence was broken by singing. The use of singing as a coping strategy as well as to improve the sense of cohesion is evident. Greater attention should be paid to the development of social cohesion and to social support in terms of social networks and the development of social capital. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019

text: Background/Aims: The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients. Methods: This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up. Results: Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients. Conclusions: Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.


title: Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative

text: BACKGROUND: The COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time. LOCAL PROBLEM: The Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH. METHODS: The COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles. RESULTS: Following the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6 weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected. CONCLUSIONS: This report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19. REGISTRATION: This project was submitted to the RNOH's Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).


Kronisk inflammatorisk tarmsykdom og covid-19


title: Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes

text: Recent reports have shown a strong association between obesity and the severity of COVID-19 infection, even in the absence of other comorbidities. After infecting the host cells, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause a hyperinflammatory reaction through the excessive release of cytokines, a condition known as "cytokine storm," while inducing lymphopenia and a disrupted immune response. Obesity is associated with chronic low-grade inflammation and immune dysregulation, but the exact mechanisms through which it exacerbates COVID-19 infection are not fully clarified. The production of increased amounts of cytokines such as TNFα, IL-1, IL-6, and monocyte chemoattractant protein (MCP-1) lead to oxidative stress and defective function of innate and adaptive immunity, whereas the activation of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome seems to play a crucial role in the pathogenesis of the infection. Endothelial dysfunction and arterial stiffness could favor the recently discovered infection of the endothelium by SARS-CoV-2, whereas alterations in cardiac structure and function and the prothrombotic microenvironment in obesity could provide a link for the increased cardiovascular events in these patients. The successful use of anti-inflammatory agents such as IL-1 and IL-6 blockers in similar hyperinflammatory settings, like that of rheumatoid arthritis, has triggered the discussion of whether such agents could be administrated in selected patients with COVID-19 disease.


Single cell RNA sequencing analysis did not predict hepatocyte infection by SARS-CoV-2


title: Impact of COVID-19 on surgical residency programs in Pakistan; A residents' perspective. Do programs need formal restructuring to adjust with the "new normal"? A cross-sectional survey study

text: BACKGROUND: Due to high-risk exposure of surgical residents to coronavirus, surgical residency programs have changed their training methods and working hours drastically. The purpose of this study is to find out the positive and negative impacts of the pandemic on surgical residency programs and on the lives of surgical residents. MATERIALS AND METHODS: A cross-sectional study was conducted on 112 surgical residents of a tertiary care hospital in Pakistan, with a mean age of 30.5 years from all the departments of surgery using a self-made, validated 40-point questionnaire comprising three sections. The last section also included modified Maslach Burnout inventory. RESULTS: Of all the residents, 97 (86.6%) stated that their surgical hands-on duration is adversely affected by the pandemic. As for clinical exposure, 92 (82.1%) trainees responded that their clinical exposure is affected too. Among all the subjects, 69 (61%) were concerned about transmitting it to their family members and 43 (38.4%) affirmed on being afraid of dying because of their direct exposure. On the brighter side, the average number of working hours per week for surgical residents were reduced from 81.10 ± 6.21 to 49.16 ± 6.25 (p < 0.001) due to the outbreak. Modified Maslach Burnout inventory score was 8.33 ± 2.34 after the outbreak, showing statistically significant reduction in burnout among the surgical residents (p < 0.001). CONCLUSION: The changes in the surgical residency programs amidst the pandemic has reduced the working hours, hands-on and clinical exposure of the surgical residents. Moreover, the situation has provided an opportunity to explore efficient methods of learning that can lead to lesser burnout. However, psychological burdens of surgical residents like fear of acquiring the infection should be appropriately addressed.


title: The optimal diagnostic methods for COVID-19

text: As the world continues to study and understand coronavirus disease (COVID-19), existing investigations and tests have been used to try and detect the virus to slow viral transmission and its global spread. A 'gold-standard' investigation has not yet been identified for detection and monitoring. Initially, computed tomography (CT) was the mainstay investigation as it shows the disease severity and recovery, and its images change at different stages of the disease. However, CT has been found to have limited sensitivity and negative predictive value in the early stages of the disease, and the value of its use has come under debate due to whether its images change the treatment plan, the risk of radiation, as well as its practicality with infection control. Therefore, there has been a shift to the use of other imaging modalities and tests, such as chest X-rays and ultrasound. Furthermore, the use of nucleic acid-based testing such as reverse-transcriptase polymerase chain reaction (RT-PCR) have proven useful with direct confirmation of COVID-19 infection. In this study, we aim to review and analyse current literature to compare RT-PCR, immunological biomarkers, chest radiographs, ultrasound and chest CT scanning as methods of diagnosing COVID-19.


title: SARS-CoV-2 Seroconversion in Humans: A Detailed Protocol for a Serological Assay, Antigen Production, and Test Setup

text: In late 2019, cases of atypical pneumonia were detected in China. The etiological agent was quickly identified as a betacoronavirus (named SARS-CoV-2), which has since caused a pandemic. Several methods allowing for the specific detection of viral nucleic acids have been established, but these only allow detection of the virus during a short period of time, generally during acute infection. Serological assays are urgently needed to conduct serosurveys, to understand the antibody responses mounted in response to the virus, and to identify individuals who are potentially immune to re-infection. Here we describe a detailed protocol for expression of antigens derived from the spike protein of SARS-CoV-2 that can serve as a substrate for immunological assays, as well as a two-stage serological enzyme-linked immunosorbent assay (ELISA). These assays can be used for research studies and for testing in clinical laboratories. © 2020 The Authors. Basic Protocol 1: Mammalian cell transfection and protein purification Basic Protocol 2: A two-stage ELISA for high-throughput screening of human serum samples for antibodies binding to the spike protein of SARS-CoV-2.


Violence against women during covid-19 pandemic restrictions


Purple Fingers and Toes


It is irrational to exclude vets from Covid-19 control


title: Seroepidemiologic Study Designs for Determining SARS-COV-2 Transmission and Immunity

text: Serologic studies are crucial for clarifying dynamics of the coronavirus disease pandemic. Past work on serologic studies (e.g., during influenza pandemics) has made relevant contributions, but specific conditions of the current situation require adaptation. Although detection of antibodies to measure exposure, immunity, or both seems straightforward conceptually, numerous challenges exist in terms of sample collection, what the presence of antibodies actually means, and appropriate analysis and interpretation to account for test accuracy and sampling biases. Successful deployment of serologic studies depends on type and performance of serologic tests, population studied, use of adequate study designs, and appropriate analysis and interpretation of data. We highlight key questions that serologic studies can help answer at different times, review strengths and limitations of different assay types and study designs, and discuss methods for rapid sharing and analysis of serologic data to determine global transmission of severe acute respiratory syndrome coronavirus 2.


Significant Applications of Big Data in COVID-19 Pandemic


title: Strengthening the core health research capacity of national health systems helps build country resilience to epidemics: a cross-sectional survey

text: Background: TDR, The Special Programme for Research and Training hosted at the World Health Organization, has long supported Low- and Middle-Income Countries in strengthening research capacity through three training programmes: the Postgraduate Training Scheme (PGTS), the Clinical Research and Development Fellowship (CRDF), and the Structured Operational Research Training InitiaTive (SORT IT). In the advent of the COVID-19 pandemic, we assessed whether those trained through these programmes were involved in the COVID-19 response and if so, in which area(s) of the emergency response they were applying their skills. Methods: From the records for each training programme, we identified the individuals who had completed training during the relevant timespan of each programme: 1999-2018 for the CRDF scheme, 2015-2020 for PGTS, and 2009-2019 for SORT-IT. Between March and April 2020, we sent trainees an online questionnaire by e-mail. Results: Out of 1254 trained, 1143 could be contacted and 699 responded to the survey. Of the latter, 411 were involved with the COVID-19 response, of whom 315 (77%) were applying their acquired skills in 85 countries. With some overlap between programmes, 84% of those trained through CRDF were applying their skills in 27 countries, 91% of those trained through PGTS were applying their skills in 19 countries, and through SORT IT, this was 73% in 62 countries. Skills were being applied in various areas of the emergency response, including: emergency preparedness, situation analysis/surveillance, infection control and clinical management, data generation, mitigating the effect of COVID on the health system, and research. Depending on the type of training programme, 26-74% were involved in implementation, operational or clinical research. Conclusion: Research training programmes build research capacity and equip health workers with transferable core competencies and skillsets prior to epidemics. This becomes invaluable in building health system resilience at a time of pandemics.


Building trust while influencing online COVID-19 content in the social media world


title: There are no best practices in a pandemic: Organ donation within the COVID-19 epicenter

text: LiveOnNY, the organ procurement organization (OPO) for the greater New York metropolitan area, suspended several best practices to manage the rising referrals of deaths from hospitals during the SARS-CoV-2 pandemic. On April 2, 2020 hospitals in the donor service area were notified that COVID-19 referrals should be deferred. Still, only 2% of referred patients to the OPO in April, 2020 were on ventilators and considered possible organ donors, versus a baseline of 11% in 2019. Few of these deaths were unrelated to COVID-19. Accordingly, organ donors declined to 10 in April (from 26 in March). Despite the exclusion of marginal donors and organs, the implementation of COVID-19 donor testing and the availability of local procurement surgeons, only 1 organ (a liver) was accepted by a transplant center outside of New York State and 8 organs (5 livers, 4 kidneys) were transplanted in state. 11 organs (1 liver, 10 kidneys) were discarded. Allocation was unsuccessful for 11 additional organs (1 liver, 4 kidneys, 4 hearts, 2 lungs). Despite the obstacles, organ donation remained an important model of collaboration and satisfaction for the healthcare community in the pandemic's U.S. epicenter. Declining COVID-19 deaths led to the resumption of the comprehensive referral policy on May 6, 2020, with improvement to 18 donors in May.


title: The most cited and co-cited COVID-19 articles: Knowledge base for rehabilitation team members

text: BACKGROUND: The COVID-19 outbreak pandemic is a situation without a tested action plan. Rehabilitation team members have been called for duty with new responsibilities in addition to their conventional roles in the healthcare system. The infectious disease specialists are updating the knowledge base in limited time in clinical settings. The number of articles in PubMed grows at an increasing rate. OBJECTIVE: The purpose of this study is to identify core COVID-19 articles by citation and co-citation network analysis in PMC subset of PubMed. METHODS: Citation and co-citation network analysis methods were used to identify core articles and knowledge base. RESULTS: COVID-19 terms query retrieved 15,387 articles in PubMed. These articles formed a citation network with 6,778 articles and 25,163 PMC-PubMed citations. The main article cluster in the co-citation network consists of 2,811 articles and 78,844 co-citations. CONCLUSIONS: The number of COVID-19 articles in PubMed is increasing at a very high rate. Citation and co-citation network analysis are advantageous techniques to identify knowledge base in a scientific discipline. These techniques may help rehabilitation specialists to identify core articles efficiently.


title: A Deep Q-learning/genetic Algorithms Based Novel Methodology For Optimizing Covid-19 Pandemic Government Actions

text: Whenever countries are threatened by a pandemic, as is the case with the COVID-19 virus, governments should take the right actions to safeguard public health as well as to mitigate the negative effects on the economy. In this regard, there are two completely different approaches governments can take: a restrictive one, in which drastic measures such as self-isolation can seriously damage the economy, and a more liberal one, where more relaxed restrictions may put at risk a high percentage of the population. The optimal approach could be somewhere in between, and, in order to make the right decisions, it is necessary to accurately estimate the future effects of taking one or other measures. In this paper, we use the SEIR epidemiological model (Susceptible - Exposed - Infected - Recovered) for infectious diseases to represent the evolution of the virus COVID-19 over time in the population. To optimize the best sequences of actions governments can take, we propose a methodology with two approaches, one based on Deep Q-Learning and another one based on Genetic Algorithms. The sequences of actions (confinement, self-isolation, two-meter distance or not taking restrictions) are evaluated according to a reward system focused on meeting two objectives: firstly, getting few people infected so that hospitals are not overwhelmed with critical patients, and secondly, avoiding taking drastic measures for too long which can potentially cause serious damage to the economy. The conducted experiments prove that our methodology is a valid tool to discover actions governments can take to reduce the negative effects of a pandemic in both senses. We also prove that the approach based on Deep Q-Learning overcomes the one based on Genetic Algorithms for optimizing the sequences of actions.


title: Development and Initial Validation of the COVID-19 Anxiety Scale

text: Background: Safeguarding the psychological well-being of the public is also an integral component of fighting COVID-19. However, there is limited availability of psychometric measures to document COVID-19-related anxiety among the general public. Objectives: This study was aimed at developing a validated scale to measure COVID-19-related anxiety. Methods: Three hundred and seven subjects from different gender, educational categories participated in the study. Exploratory factor analysis for the determination of factor structure, Pearson's correlation test, and Kruskal-Wallis ANOVA were employed in data analysis using SPSS version 20 software. Results: COVID-19 Anxiety Scale (CAS) demonstrated a two-component structure identified as: "fear of social interaction;" "illness anxiety." The final scale with seven items demonstrated good internal consistency reliability (Cronbach's Alpha 0.736). CAS exhibited good construct validity showing moderately negative correlation (Pearson's r = -0.417) with the self-rated mental health and resulted in higher scores among individuals with lower educational qualification (Kruskal-Wallis ANOVA χ2 [2, 303] = 38.01; P = 0.001). Conclusion: CAS is a rapidly administrable, valid, and reliable tool that can be used to measure COVID-19-related anxiety among the Indian population.


Teledentistry support in COVID-19 oral care


title: A Guide to Chatbots for COVID-19 Screening at Pediatric Health Care Facilities

text: The coronavirus disease 2019 (COVID-19) outbreak has required institutions to rapidly adapt to changing public health circumstances. The Centers for Disease Control and Prevention has encouraged health care facilities to explore novel health care delivery modes. However, many institutions may not be prepared to begin offering digital health and telehealth services. Chatbots are one digital health tool that can help evolve triage and screening processes in a scalable manner. Here, we present a decision-making and implementation framework for deploying COVID-19 screening chatbots at pediatric health care facilities.


Budgeting in the time of COVID-19


title: The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology

text: The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.


Spatial transmission of COVID-19 via public and private transportation in China


Presepsin as a predictive biomarker of severity in COVID-19: A case series


Combined treatment of tocilizumab and chloroquine on severe COVID-19: a case report


A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility


title: Prospects of Replication-Deficient Adenovirus Based Vaccine Development against SARS-CoV-2

text: The current appearance of the new SARS coronavirus 2 (SARS-CoV-2) and it quickly spreading across the world poses a global health emergency. The serious outbreak position is affecting people worldwide and requires rapid measures to be taken by healthcare systems and governments. Vaccinations represent the most effective strategy to prevent the epidemic of the virus and to further reduce morbidity and mortality with long-lasting effects. Nevertheless, currently there are no licensed vaccines for the novel coronaviruses. Researchers and clinicians from all over the world are advancing the development of a vaccine against novel human SARS-CoV-2 using various approaches. Herein, we aim to present and discuss the progress and prospects in the field of vaccine research towards SARS-CoV-2 using adenovirus (AdV) replication deficient-based strategies, with a comprehension that may support research and combat this recent world health emergency.


title: Epidemiological, clinical, and virological characteristics of 465 hospitalized cases of coronavirus disease 2019 (COVID-19) from Zhejiang province in China

text: BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated coronavirus disease (COVID-19) have spread throughout China. Previous studies predominantly focused on its place of origin, Wuhan, causing over estimation of the disease severity due to selection bias. We analyzed 465 confirmed cases in Zhejiang province to determine the epidemiological, clinical, and virological characteristics of COVID-19. METHODS: Epidemiological, demographic, clinical, laboratory, and management data from qRT-PCR confirmed COVID-19 patients from January 17, 2020, to January 31, 2020, were collected, followed by multivariate logistic regression analysis for independent predictors of severe/critical-type COVID-19 and bioinformatic analysis for features of SARS-CoV-2 from Zhejiang province. RESULTS: Among 465 COVID-19 patients, median age was 45 years, while hypertension, diabetes, and chronic liver disease were the most common comorbidities. History of exposure to the epidemic area was present in 170 (36.56%) and 185 (39.78%) patients were clustered in 77 families. Severe/critical-type of COVID-19 developed in 49 (10.54%) patients. Fever and cough were the most common symptoms, while diarrhea/vomiting was reported in 58 (12.47%) patients. Multivariate analysis revealed eight risk factors for severe/critical COVID-19. Glucocorticoids and antibiotics were administered to 60 (12.90%) and 218(46.88%) patients, respectively. Bioinformatics showed four single amino acid mutations and one amino acid position loss in SARS-CoV-2 from Zhejiang province, with more similarity to humans than to viruses. CONCLUSIONS: SARS-CoV-2 showed virological mutations and more human transmission in Zhejiang province, indicating considerable epidemiological and clinical changes. Caution in glucocorticoid and antibiotics use is advisable.


The Response of Women's Dermatologic Society and the International Journal of Women's Dermatology to the COVID-19 Pandemic


What Should Surgeons Do In Face of the COVID-19 Pandemic? A Beijing Experience


COVID-19 and the International Academy of Sex Research: We Will Be Back


title: Fast-track Innovation: Area Agencies on Aging Respond to the COVID-19 Pandemic

text: Millions of older Americans depend on services provided by Area Agencies on Aging to support their nutritional, social, and health needs. Social distancing requirements and the closure of congregate activities due to COVID-19 resulted in a rapid and dramatic shift in service delivery modes. Area Agencies on Aging were able to quickly pivot due to their long-standing expertise in community needs assessment and cross-sectoral partnerships. The federal Coronavirus relief measures also infused one billion dollars into the Aging Network. As the pandemic response evolves, Area Agencies on Aging are poised to be key partners in a transformed health system.


title: Is COVID-19 receiving ADE from other coronaviruses?

text: One of the most perplexing questions regarding the current COVID-19 coronavirus epidemic is the discrepancy between the severity of cases observed in the Hubei province of China and those occurring elsewhere in the world. One possible answer is antibody dependent enhancement (ADE) of SARS-CoV-2 due to prior exposure to other coronaviruses. ADE modulates the immune response and can elicit sustained inflammation, lymphopenia, and/or cytokine storm, one or all of which have been documented in severe cases and deaths. ADE also requires prior exposure to similar antigenic epitopes, presumably circulating in local viruses, making it a possible explanation for the observed geographic limitation of severe cases and deaths.


title: Social media and the new world of scientific communication during the COVID19 pandemic

text: The human and social toll of the COVID19 pandemic has already spurred several major public health 'lessons learned', and the theme of effective and responsible scientific communication is among them. We propose that Twitter has played a fundamental - but often precarious - role in permitting real-time global communication between scientists during the COVID19 epidemic, on a scale not seen before. Here, we discuss three key facets to Twitter-enabled scientific exchange during public health emergencies, including some major draw-backs. This discussion also serves as a succinct primer on some of the pivotal epidemiological analyses (and their communication) during the early phases of the COVID19 outbreak, as seen through the lens of a Twitter- feed.


Global health under fire: Trump and covid are just two of the threats


title: COVID-19 in solid organ transplant recipients: dynamics of disease progression and inflammatory markers in ICU and non-ICU admitted patients

text: BACKGROUND: COVID-19 infection varies in severity from minimal symptoms to critical illness associated with a hyperinflammatory response. Data on disease progression in immunosuppressed solid organ transplant (SOT) recipients are limited. METHODS: We examined the electronic medical records of all SOT recipients with COVID-19 from 12 Massachusetts hospitals between February 1st and May 6th, 2020. We analysed the demographics, clinical parameters, course and outcomes of illness in these patients. RESULTS: Of 52 COVID-19 positive SOT patients, 77% were hospitalized and 35% required ICU admission. Sixty nine percent of hospitalized patients had immunosuppression reduced, 6% developed suspected rejection. Co-infections occurred in 45% in ICU vs 5% in non-ICU patients (p=0.037). A biphasic pattern of evolution of laboratory tests was observed. In the first 5 days of illness, inflammatory markers were moderately increased. Subsequently, WBC, CRP, ferritin and D-dimer increased with increasing stay in the ICU, lymphocyte counts were similar. Five patients (16%) died. CONCLUSIONS: Our data indicate that SOT is associated with high rate of hospitalization, ICU admission and death from COVID-19 compared to data in the general population of patients with COVID-19. Despite reduction in immunosuppression, suspected rejection was rare. The clinical course and trend of laboratory biomarkers is biphasic with a later, pronounced peak in inflammatory markers seen in those admitted to an ICU. CRP is a useful marker to monitor disease progression in SOT.


title: Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender

text: BACKGROUND: The COVID-19 pandemic is having negative effects on societies' mental health. Both the pandemic and the measures taken to combat it can affect individuals' mental health. AIMS: The purpose of this study was to evaluate the levels of depression, anxiety and health anxiety in Turkish society during the COVID-19 pandemic, and to examine the factors affecting these. METHOD: The study was performed using an online questionnaire. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale (HADS) and the Health Anxiety Inventory (HAI). The effects on depression, anxiety and health anxiety levels of factors such as age, sex, marital status, living with an individual aged above 60, the presence of a new Coronavirus+ patient among friends or relatives, previous and current psychiatric illness and presence of accompanying chronic disease were then investigated. RESULTS: In terms of HADS cut-off points, 23.6% (n = 81) of the population scored above the depression cut-off point, and 45.1% (n = 155) scored above the cut-off point for anxiety. In regression analysis, female gender, living in urban areas and previous psychiatric illness history were found as risk factors for anxiety; living in urban areas was found as risk factor for depression; and female gender, accompanying chronic disease and previous psychiatric history were found as risk factors for health anxiety. CONCLUSION: The results of this cross-sectional study suggest that the groups most psychologically affected by the COVID-19 pandemic are women, individuals with previous psychiatric illness, individuals living in urban areas and those with an accompanying chronic disease. Priority might therefore be attached to these in future psychiatric planning.


title: COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs

text: In the Wuhan Province of China, in December 2019, the novel coronavirus 2019 (COVID-19) has caused a severe involvement of the lower respiratory tract leading to an acute respiratory syndrome. Subsequently, coronavirus 2 (SARS-CoV-2) provoked a pandemic which is considered a life-threatening disease. The SARS-CoV-2, a family member of betacoronaviruses, possesses single-stranded positive-sense RNA with typical structural proteins, involving the envelope, membrane, nucleocapsid and spike proteins that are responsible for the viral infectivity, and nonstructural proteins. The effectual host immune response including innate and adaptive immunity against SARS-Cov-2 seems crucial to control and resolve the viral infection. However, the severity and outcome of the COVID-19 might be associated with the excessive production of proinflammatory cytokines "cytokine storm" leading to an acute respiratory distress syndrome. Regretfully, the exact pathophysiology and treatment, especially for the severe COVID-19, is still uncertain. The results of preliminary studies have shown that immune-modulatory or immune-suppressive treatments such as hydroxychloroquine, interleukin (IL)-6 and IL-1 antagonists, commonly used in rheumatology, might be considered as treatment choices for COVID-19, particularly in severe disease. In this review, to gain better information about appropriate anti-inflammatory treatments, mostly used in rheumatology for COVID-19, we have focused the attention on the structural features of SARS-CoV-2, the host immune response against SARS-CoV-2 and its association with the cytokine storm.


title: [Left behind populations, COVID-19 and risks of health inequities : a guide of the local social-health network (Vaud, Switzerland)]

text: Since the emergence of the COVID-19 pandemic, the Confederation has referred to « vulnerable populations » over the age of 65 and/or with co-morbidities as potentially at risk This group should not overshadow other highly vulnerable populations such as forced migrants, people deprived of their liberty, and the homeless In the context of the current pandemic, there is a risk of increasing inequities in care among these populations In this practical article, we list the marginalized and disadvantaged left behind populations in the canton of Vaud and the issues of inequities in care in the context of the pandemic;we also present the implementation of procedures sometimes original, always inter-professional and interdisciplinary, specifying who the partners are and what the resources are for front-line caregivers


title: Left behind populations, COVID-19 and risks of health inequities : a guide of the local social-health network (Vaud, Switzerland)/ Populations precarisees, COVID-19 et risques diniquites en sante : guide du reseau socio-sanitaire vaudois

text: Since the emergence of the COVID-19 pandemic, the Confederation has referred to vulnerable populations over the age of 65 and/or with co-morbidities as potentially at risk This group should not overshadow other highly vulnerable populations such as forced migrants, people deprived of their liberty, and the homeless In the context of the current pandemic, there is a risk of increasing inequities in care among these populations In this practical article, we list the marginalized and disadvantaged left behind populations in the canton of Vaud and the issues of inequities in care in the context of the pandemic;we also present the implementation of procedures sometimes original, always inter-professional and interdisciplinary, specifying who the partners are and what the resources are for front-line caregivers Depuis lapparition de la pandemie du COVID-19, la Confederation evoque comme potentiellement a risque les populations vulnerables de plus de 65 ans et/ou presentant des comorbidites Ce groupe ne doit pas eclipser dautres populations en situation de grande vulnerabilite telles que les personnes issues de la migration forcee, celles privees de liberte, ainsi que les sans domicile fixe Dans cet article qui se veut pratique, nous enumerons differentes populations marginalisees du canton de Vaud et les enjeux diniquites dans les soins dans le cadre de la pandemie ;nous presentons egalement limplementation de procedures, parfois originales, toujours interprofessionnelles et interdisciplinaires, en precisant qui sont les partenaires et quelles sont les ressources pour les soignants de premiere ligne


COVID-19 and Schools Closure: Implications for School Nurses


title: Suggestions for the care of patients with liver disease during the Coronavirus 2019 pandemic

text: This document, written by the French Association for the Study of the Liver (AFEF) board, aims to provide information to physicians involved in the care of patients with liver disease during the Coronavirus disease (COVID-19) epidemic. These are not based on a systematic review of the literature and a rigorous evaluation using the GRADE method. These are recommendations based on feedback from China available in the form of original articles or letters - for which the scientific evidence is often modest - and the rules put forward by American (1) and European (Boettler et al, 2020) hepatology societies, the French National Digestive Cancer Thesaurus (Di Fiore et al., 2020) and the Francophone Transplantation Society (4). These suggestions require adjustment according to the geographical particularities of the epidemic, available standard procedures and access to local resources. This document will be updated as regularly as possible according to the evolution of our knowledge and characteristics on the epidemic.


Paediatric urology practice during COVID-19 pandemic


Clinical considerations for patients with diabetes in times of COVID-19 epidemic


Inimical effects of COVID-19 on surgical residency: Correspondence


ACE2 is on the X chromosome: could this explain COVID-19 gender differences?


title: The Impact of the COVID-19 "Infodemic" on Drug-Utilization Behaviors: Implications for Pharmacovigilance

text: The coronavirus disease 2019 (COVID-19) pandemic that hit the world in 2020 triggered a massive dissemination of information (an "infodemic") about the disease that was channeled through the print, broadcast, web, and social media. This infodemic also included sensational and distorted information about drugs that likely first influenced opinion leaders and people particularly active on social media and then other people, thus affecting choices by individual patients everywhere. In particular, information has spread about some drugs approved for other indications (chloroquine, hydroxychloroquine, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, favipiravir, and umifenovir) that could have led to inappropriate and therefore hazardous use. In this article, we analyze the rationale behind the claims for use of these drugs in COVID-19, the communication about their effects on the disease, the consequences of this communication on people's behavior, and the responses of some influential regulatory authorities in an attempt to minimize the actual or potential risks arising from this behavior. Finally, we discuss the role of pharmacovigilance stakeholders in emergency management and possible strategies to deal with other similar crises in the future.


title: Role of inflammatory markers in corona virus disease (COVID-19) patients: A review

text: IMPACT STATEMENT: In late 2019, a novel virus called SARS-CoV-2, expanded globally from Wuhan, China and was declared a pandemic on 11 March 2020 by the WHO. The mechanism of virus entry inside the host cell depends upon the cellular proteases including cathepsins, HAT, and TMPRSS2, which splits up the spike protein and causes further penetration. MERS coronavirus uses DPP4, while coronavirus HCoV-NL63 and SARS-CoV and SARS-CoV-2 employ ACE-2 as the key receptor. Cytokine storm syndrome was analyzed in critically ill nCOVID-19 patients and it is presented with high inflammatory mediators, systemic inflammation, and multiple organ failure. Among various inflammatory mediators, the level of interleukins (IL-2, IL-7, IL-10), G-CSF, MIP1A, MCP1, and TNF-α was reported to be higher in critically ill patients. Understanding this molecular mechanism of ILs, T cells, and dendritic cells will be helpful to design immunotherapy and novel drugs for the treatment of nCOVID-19 infection.


Letter to the Editor Regarding "Acute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic: From Trough of Disillusionment to Slope of Enlightenment"


title: Neurological manifestations and COVID-19: Experiences from a tertiary care center at the Frontline

text: OBJECTIVE: To report neurological manifestations seen in patients hospitalized with Coronavirus disease 2019 (COVID-19) from a large academic medical center in Chicago, Illinois. METHODS: We retrospectively reviewed data records of 50 patients with COVID-19 who were evaluated by the neurology services from March 1, 2020 - April 30, 2020. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the "Neuro first" group had neurological manifestations upon initial assessment, and the "COVID first" group developed neurological symptoms greater than 24 h after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms and diagnoses of both groups were analyzed. Statistical analysis was performed to compare the two groups. RESULTS: A total of 50 patients (48% African American and 24% Latino) were included in the analysis. Most common neurological manifestations observed were encephalopathy (n = 30), cerebrovascular disease (n = 20), cognitive impairment (n = 13), seizures (n = 13), hypoxic brain injury (n = 7), dysgeusia (n = 5), and extraocular movement abnormalities (n = 5). The "COVID-19 first" group had more evidence of physiologic disturbances on arrival with a more severe/critical disease course (83.3% vs 53.8%, p 0.025). CONCLUSION: Neurologic manifestations of COVID-19 are highly variable and can occur prior to the diagnosis of or as a complication of the viral infection. Despite similar baseline comorbidities and demographics, the COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses. Differently from previous studies, we noted a high percentage of African American and Latino individuals in both groups.


title: Development and multicenter performance evaluation of fully automated SARS-CoV-2 IgM and IgG immunoassays

text: Objectives The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread globally. The laboratory diagnosis of SARS-CoV-2 infection has relied on nucleic acid testing; however, it has some limitations, such as low throughput and high rates of false negatives. Tests of higher sensitivity are needed to effectively identify infected patients. Methods This study has developed fully automated chemiluminescent immunoassays to determine IgM and IgG antibodies to SARS-CoV-2 in human serum. The assay performance has been evaluated at 10 hospitals. Clinical specificity was evaluated by measuring 972 hospitalized patients and 586 donors of a normal population. Clinical sensitivity was assessed on 513 confirmed cases of SARS-CoV-2 by RT-PCR. Results The assays demonstrated satisfied assay precision with coefficient of variation of less than 4.45%. Inactivation of specimen did not affect assay measurement. SARS-CoV-2 IgM showed clinical specificity of 97.33 and 99.49% for hospitalized patients and the normal population respectively, and SARS-CoV-2 IgG showed clinical specificity of 97.43 and 99.15% respectively. SARS-CoV-2 IgM showed clinical sensitivity of 82.54, 92.93, and 84.62% before 7 days, 7-14 days, and after 14 days respectively, since onset of symptoms, and SARS-CoV-2 IgG showed clinical sensitivity of 80.95, 97.98, and 99.15% respectively at the same time points above. Conclusions We have developed fully automated immunoassays for detecting SARS-CoV-2 IgM and IgG antibodies in human serum. The assays demonstrated high clinical specificity and sensitivity, and add great value to nucleic acid testing in fighting against the global pandemic of the SARS-CoV-2 infection.


title: Different scenarios in the Dynamics of SARS-Cov-2 Infection: an adapted ODE model

text: A mathematical model to calculate the transmissibility of SARS-Cov-2 in Wuhan City was developed and published recently by Tian-Mu Chen et al., Infectious Diseases of Poverty, 2020, https://doi.org/10.1186/s40249-020-00640-3. This paper improves this model in order to study the effect of different scenarios that include actions to contain the pandemic, such as isolation and quarantine of infected and at-risk people. Comparisons made between the different scenarios show that the progress of the infection is found to strongly depend on measures taken in each case. The particular case of Brazil was studied, showing the dynamics of the first days of the infection in comparison with the different scenarios contained in the model and the reality of the Brazilian health system was exposed, in front of each possible scenario. The relative evolution of the number of new infection and reported cases was employed to estimate a containment date of the pandemic. Finally, the basic reproduction number R0 values were estimated for each scenario, ranging from 4.04 to 1.12.


title: A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic

text: Challenging periods like the COVID-19 pandemic require fast and efficient adaptations of the healthcare system. It is vital that every patient has access to nutritional care as a part of primary healthcare services, even if social distancing measures are adopted. Therefore, we propose a simple remote nutritional screening tool and practical guidance for nutritional care in primary practice, and their implementation into telemedicine processes and digital platforms suitable for healthcare providers. The acronym for the tool is R-MAPP, as for Remote - Malnutrition APP, while the tool will be available also as an app. This protocol consists of two simple validated clinical tools for identifying nutritional risk and loss of muscle mass and function -Malnutrition Universal Screening Tool ('MUST') and SARC-F (5-item questionnaire: Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) - and additional practical guidance on nutritional interventions for family physicians.


Extracorporeal oxygenation and COVID-19 epidemic: is the membrane fail-safe to cross contamination?


Acral purpuric lesions associated with coagulation disorders during the COVID-19 pandemic


title: Potent Neutralizing Antibodies against SARS-CoV-2 Identified by High-Throughput Single-Cell Sequencing of Convalescent Patients' B Cells

text: The COVID-19 pandemic urgently needs therapeutic and prophylactic interventions. Here, we report the rapid identification of SARS-CoV-2-neutralizing antibodies by high-throughput single-cell RNA and VDJ sequencing of antigen-enriched B cells from 60 convalescent patients. From 8,558 antigen-binding IgG1+ clonotypes, 14 potent neutralizing antibodies were identified, with the most potent one, BD-368-2, exhibiting an IC50 of 1.2 and 15 ng/mL against pseudotyped and authentic SARS-CoV-2, respectively. BD-368-2 also displayed strong therapeutic and prophylactic efficacy in SARS-CoV-2-infected hACE2-transgenic mice. Additionally, the 3.8 Å cryo-EM structure of a neutralizing antibody in complex with the spike-ectodomain trimer revealed the antibody's epitope overlaps with the ACE2 binding site. Moreover, we demonstrated that SARS-CoV-2-neutralizing antibodies could be directly selected based on similarities of their predicted CDR3H structures to those of SARS-CoV-neutralizing antibodies. Altogether, we showed that human neutralizing antibodies could be efficiently discovered by high-throughput single B cell sequencing in response to pandemic infectious diseases.


title: AKI and Collapsing Glomerulopathy Associated with COVID-19 and APOL 1 High-Risk Genotype

text: BACKGROUND: Kidney involvement is a feature of COVID-19 and it can be severe in black patients. Previous research linked increased susceptibility to collapsing glomerulopathy, including in patients with HIV-associated nephropathy, to apo L1 (APOL1) variants that are more common in those of African descent. METHODS: To investigate genetic, histopathologic, and molecular features in six black patients with COVID-19 presenting with AKI and de novo nephrotic-range proteinuria, we obtained biopsied kidney tissue, which was examined by in situ hybridization for viral detection and by NanoString for COVID-19 and acute tubular injury-associated genes. We also collected peripheral blood for APOL1 genotyping. RESULTS: This case series included six black patients with COVID-19 (four men, two women), mean age 55 years. At biopsy day, mean serum creatinine was 6.5 mg/dl and mean urine protein-creatinine ratio was 11.5 g. Kidney biopsy specimens showed collapsing glomerulopathy, extensive foot process effacement, and focal/diffuse acute tubular injury. Three patients had endothelial reticular aggregates. We found no evidence of viral particles or SARS-CoV-2 RNA. NanoString showed elevated chemokine gene expression and changes in expression of genes associated with acute tubular injury compared with controls. All six patients had an APOL1 high-risk genotype. Five patients needed dialysis (two of whom died); one partially recovered without dialysis. CONCLUSIONS: Collapsing glomerulopathy in black patients with COVID-19 was associated with high-risk APOL1 variants. We found no direct viral infection in the kidneys, suggesting a possible alternative mechanism: a "two-hit" combination of genetic predisposition and cytokine-mediated host response to SARS-CoV-2 infection. Given this entity's resemblance with HIV-associated nephropathy, we propose the term COVID-19-associated nephropathy to describe it.


title: Judicious Use of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Diabetes on Coronavirus-19 Pandemic

text: Sodium glucose cotransporter-2 inhibitors (SGLT2i), a novel anti-diabetic drug blocks the reabsorption of glucose in proximal tubules of kidney, are demonstrated to have cardiovascular and renal benefits for people with diabetes. The benefits are associated with the significant increase of intrarenal angiotensin-converting enzyme II (ACE2) expression and blood volume contraction. However, the increased ACE2 may be detrimental to patients infected with the coronavirus infection 2019 (COVID-19), which is found to invades cells via the entry receptor of ACE2. Besides, SGLT2i induced natriuretic effect may also increase the risk of acute kidney injury and affect the hemodynamic stability during systemic infection disease. In the article, we explain the mechanisms why the use of SGLT2i in people with diabetes may lead to worse outcomes and suggest clinician to judiciously use it during COVID-19 pandemic.


COVID-19 convalescent plasma: phase 2


Adapting a Hospital-at-Home Care Model to Respond to New York City's COVID-19 Crisis


title: COVID-19's impact on private practice and academic dentistry in North America

text: The COVID-19 pandemic is a major public health crisis for countries around the world. In response to this global outbreak, the World Health Organization declared a public health emergency of international concern. Dental professionals are especially at high risk of contracting the COVID-19 virus due to the unique nature of dentistry, more specifically, exposure to aerosols and droplets. When it comes to dental emergencies, it was crucial to maintain urgent dental care services operational to help reduce the burden on our healthcare system and hospitals already under pressure. The COVID-19 pandemic has significantly impacted how dentistry is practiced in North America in both the private practice and academic settings. This article shares the perspectives of dentists practicing in private practice and clinician-researchers in academic dental institutions. More specifically, we discuss about measures implemented to minimize risks of disease transmission, challenges in emergency dental care, impact on patients, as well as impact on the professional and personal lives of the dental team during the COVID-19 crisis.


Experts' request to the Spanish Government: move Spain towards complete lockdown


Acute-on-chronic stress in the time of COVID-19: assessment considerations for vulnerable youth populations


Midwifery in the Time of COVID-19


What goes on board aircraft? Passengers include Aedes, Anopheles, 2019-nCoV, dengue, Salmonella, Zika, et al


title: Interaction of the spike protein RBD from SARS-CoV-2 with ACE2: Similarity with SARS-CoV, hot-spot analysis and effect of the receptor polymorphism

text: The spread of COVID-19 caused by the SARS-CoV-2 outbreak has been growing since its first identification in December 2019. The publishing of the first SARS-CoV-2 genome made a valuable source of data to study the details about its phylogeny, evolution, and interaction with the host. Protein-protein binding assays have confirmed that Angiotensin-converting enzyme 2 (ACE2) is more likely to be the cell receptor through which the virus invades the host cell. In the present work, we provide an insight into the interaction of the viral spike Receptor Binding Domain (RBD) from different coronavirus isolates with host ACE2 protein. By calculating the binding energy score between RBD and ACE2, we highlighted the putative jump in the affinity from a progenitor form of SARS-CoV-2 to the current virus responsible for COVID-19 outbreak. Our result was consistent with previously reported phylogenetic analysis and corroborates the opinion that the interface segment of the spike protein RBD might be acquired by SARS-CoV-2 via a complex evolutionary process rather than a progressive accumulation of mutations. We also highlighted the relevance of Q493 and P499 amino acid residues of SARS-CoV-2 RBD for binding to human ACE2 and maintaining the stability of the interface. Moreover, we show from the structural analysis that it is unlikely for the interface residues to be the result of genetic engineering. Finally, we studied the impact of eight different variants located at the interaction surface of ACE2, on the complex formation with SARS-CoV-2 RBD. We found that none of them is likely to disrupt the interaction with the viral RBD of SARS-CoV-2.


title: Laboratory Diagnosis of Coronavirus Disease-2019 (COVID-19)

text: The outbreak of Coronavirus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has threatened health worldwide. As of the end of 2020, there were nearly 10 million confirmed cases and nearly 5 million deaths associated with COVID-19. Rapid and early laboratory diagnosis of COVID-19 is the main focus of treatment and control. Molecular tests are the basis for confirmation of COVID-19, but serological tests for SARS-CoV-2 are widely available and play an increasingly important role in understanding the epidemiology of the virus and in identifying populations at higher risk for infection. Point-of-care tests have the advantage of rapid, accurate, portable, low cost and non-specific device requirements, which provide great help for disease diagnosis and detection. This review will discuss the performance of different laboratory diagnostic tests and platforms, as well as suitable clinical samples for testing, and related biosafety protection. This review shall guide for the diagnosis of COVID-19 caused by SARS-CoV-2.


Food Delivery Service During Social Distancing: Proactively Preventing or Potentially Spreading Coronavirus Disease-2019?


The Baffling Case of Ischemic Stroke Disappearance from the Casualty Department in the COVID-19 Era


Dual protection for day care procedures: Need in Coronavirus Disease 2019 (COVID-19) pandemic


COVID-19: The personal and professional impact of one case


title: Improving Preparedness for and Response to Coronavirus Disease 19 (COVID-19) in Long-Term Care Hospitals in the Korea

text: Clusters of coronavirus disease 2019 (COVID-19) in long-term care facilities (LTCFs) have been widely reported in the Korea and around the world. COVID-19 has a high mortality rate, and older patients and those with underlying diseases are at particularly high risk of being infected. Outbreaks in LTCFs, where many high-risk patients reside, result in the occupation of beds meant for severely ill patients and even death in many patients. Long-term care hospitals (LTCH) are major LTCFs in Korea. Therefore, it is very important to protect patients in LTCHs from COVID-19. The reality is that preparedness for COVID-19 in LTCHs is inadequate, and there are barriers to improvements in preparedness. Through institutional improvement and policy support, the government should help healthcare personnel and LTCHs improve installation and raise the level of knowledge of infection prevention and control. With these improvement, prevention, surveillance, and screening for COVID-19 should be done and a response system to the COVID-19 outbreak should be established. There are many challenges that must be overcome to meet the goals proposed in this article. This may be possible only with a spirit of solidarity and cooperation of government, public and private healthcare facilities.


Acral purpuric lesions (erythema multiforme type) associated with thrombotic vasculopathy in a child during the COVID-19 pandemic


Skin-to-Skin Care and COVID-19


Operational Recommendations for the Attention and Prevention of Sars-cov-2 Infection at Interventional Bronchoscopy Units


title: Concerns of Frontline Doctors in India during COVID-19: A Cross-Sectional Survey

text: A rapid cross-sectional survey was conducted across India among frontline allopathic doctors to know their prime concerns. Four hundred and five responses were received from 16 states and 3 union territories. Among doctors working in COVID-dedicated hospitals, 56.18% are formally trained for the same, and 40.5% of these are satisfied with the training. 47.3% of these have personal protective equipment (PPE) kits, 35.1% have no PPE kits, and 17.6% are not aware of their availability. 31.1% of doctors reported attending to COVID suspects without PPE. 58.1% of institutions have a dedicated task force, 20.3% do not, whereas 21.6% of doctors are not aware of such a task force. Only 21.6% of the participants consider their institution to be fully prepared for COVID. After performing COVID duties, 45.9% are being provided with an alternative place of stay, whereas only 16.2% have been quarantined. In non-COVID institutions, 82.4% of doctors are using protective gear, of these 35.2% procured them on their own.


title: Advances in COVID-19: the virus, the pathogenesis, and evidence-based control and therapeutic strategies

text: Since the outbreak of the COVID-19 pandemic in early December 2019, 81 174 confirmed cases and 3242 deaths have been reported in China as of March 19, 2020. The Chinese people and government have contributed huge efforts to combat this disease, resulting in significant improvement of the situation, with 58 new cases (34 were imported cases) and 11 new deaths reported on March 19, 2020. However, as of March 19, 2020, the COVID-19 pandemic continues to develop in 167 countries/territories outside of China, and 128 665 confirmed cases and 5536 deaths have been reported, with 16 498 new cases and 817 new deaths occurring in last 24 hours. Therefore, the world should work together to fight against this pandemic. Here, we review the recent advances in COVID-19, including the insights in the virus, the responses of the host cells, the cytokine release syndrome, and the therapeutic approaches to inhibit the virus and alleviate the cytokine storm. By sharing knowledge and deepening our understanding of the virus and the disease pathogenesis, we believe that the community can efficiently develop effective vaccines and drugs, and the mankind will eventually win this battle against this pandemic.


Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding "Zoom Fatigue"


Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China


Electron microscopy of SARS-CoV-2: a challenging task


title: The 2019 Novel Coronavirus Outbreak - A Global Threat

text: The 2019 Novel Corona virus infection (COVID 19) is an ongoing public health emergency of international significance. There are significant knowledge gaps in the epidemiology, transmission dynamics, investigation tools and management. In this article, we review the available evidence about this disease. Every decade has witnessed the evolution of a new coronavirus epidemic since the last three decades. The varying transmission patterns, namely, nosocomial transmission and spread through mildly symptomatic cases is an area of concern. There is a spectrum of clinical features from mild to severe life threatening disease with major complications like severe pneumonia, ARDS, acute cardiac injury and septic shock. Presence of bilateral ground glass opacity and consolidation on imaging in appropriate clinical background should raise a suspicion about COVID 19. Poor prognostic factors include Multilobular infiltration on chest imaging, Lymphopenia, Bacterial co-infection, Smoking history, Chronic medical conditions like Hypertension and age >60 years (MuLBSTA score). Diagnosis is confirmed with PCR based testing of appropriate respiratory samples. Management is primarily supportive, with newer antivirals (lopinavir ritonavir and Remdesivir) under investigation. Role of steroids is still inconclusive. Standard infection control and prevention techniques should be followed. Vigilant screening of suspected cases and their contacts is important. Isolation of symptomatic cases and home quarantine of asymptomatic contacts is recommended. To conclude, controlling this highly transmissible disease requires international co-ordination.


title: Optimizing testing policies for detecting COVID-19 outbreaks

text: The COVID-19 pandemic poses challenges for continuing economic activity while reducing health risk to individuals and preventing uncontrolled outbreaks. These challenges can be mitigated by extensive testing. We study testing policies that optimize a fixed budget of tests within a single institution (e.g., business, school, nursing home, etc.) by varying the number of batches that the tests are split into. We prove that, in an exponential spread model and for reasonable parameter values, the expected size of an outbreak at initial detection is smaller when random subgroups of the population are tested frequently, as opposed to periodic testing of the entire population. We also simulate the effect of different policies in a network SEIR model taking into account factors such as variable connectivity between individuals, incubation period, and inaccurate testing results. We show that under a broad set of early-outbreak scenarios, given a certain budget of tests, increasing testing frequency of random samples of the population will reduce the societal risk, defined as the number of infection opportunities until first detection. For example, testing a quarter of the institution members every week is generally better than testing the entire institution every month. In fact, in many settings, sufficiently frequent testing (combined with mitigation once an outbreak is detected) can decrease the risk even compared to the baseline when the institution is closed and testing is not conducted. The bottom-line is a simple policy prescription for institutions: distribute the total tests over several batches instead of using them all at once.


The Value and Ethics of Using Technology to Contain the COVID-19 Epidemic


title: Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge

text: The novel coronavirus 2019 (COVID-19) is clinically characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for a high number of patients needing mechanical ventilation or intensive care units treatment and for the elevated mortality risk. A link between COVID-19 and multiorgan failure may be dependent on the fact that most COVID-19 patients are complicated by pneumonia, which is known to be associated with early changes of clotting and platelet activation and artery dysfunction; these changes may implicate in thrombotic-related events such as myocardial infarction and ischemic stroke. Recent data showed that myocardial injury compatible with coronary ischemia may be detectable in SARS-CoV-2 patients and laboratory data exploring clotting system suggest the presence of a hypercoagulation state. Thus, we performed a systematic review of COVID-19 literature reporting measures of clotting activation to assess if changes are detectable in this setting and their relationship with clinical severity. Furthermore, we discussed the biologic plausibility of the thrombotic risk in SARS-CoV-2 and the potential use of an antithrombotic treatment.


title: Attainment of Herd Immunity: Mathematical Modelling of Survival Rate

text: We study the influence of the rate of the attainment of herd immunity (HI), in the absence of an approved vaccine, on the vulnerable population. We essentially ask the question: how hard the evolution towards the desired herd immunity could be on the life of the vulnerables? We employ mathematical modelling (chemical network theory) and cellular automata based computer simulations to study the human cost of an epidemic spread and an effective strategy to introduce HI. Implementation of different strategies to counter the spread of the disease requires a certain degree of quantitative understanding of the time dependence of the outcome. In this paper, our main objective is to gather understanding of the dependence of outcome on the rate of progress of HI. We generalize the celebrated SIR model (Susceptible-Infected-Removed) by compartmentalizing the susceptible population into two categories- (i) vulnerables and (ii) resilients, and study dynamical evolution of the disease progression. We achieve such a classification by employing different rates of recovery of vulnerables vis-a-vis resilients. We obtain the relative fatality of these two sub-categories as a function of the percentages of the vulnerable and resilient population, and the complex dependence on the rate of attainment of herd immunity. Our results quantify the adverse effects on the recovery rates of vulnerables in the course of attaining the herd immunity. We find the important result that a slower attainment of the HI is relatively less fatal. However, a slower progress towards HI could be complicated by many intervening factors.


title: Risk factors for disease progression in hospitalized patients with COVID-19: a retrospective cohort study

text: Background: To investigate the risk factors related to aggravation and clinical outcomes in coronavirus disease 2019 (COVID-19) patients.Methods: We performed a retrospective study on the risk factors for disease progression of cases with COVID-19. Based on the clinical types, the patients were divided into a progression group and an improvement group. Multivariable logistic regression and ROC curve analysis were performed to explore the risk factors for disease progression.Results: A total of 101 patients were included in this study; diseases progression occurred in 17 patients, 84 patients improved, 6 were transferred to intensive care unit (ICU), and 5 died. The mean time to obtain negative nucleic acid results was 12.5 ± 5.0 days. Multivariate logistic analysis indicated that age (OR, 0.104; p = .002), C-reactive protein (CRP) (OR, 0.093; p < .001) and lymphocyte count (OR, 3.397; p = .022) were risk factors for disease progression. ROC curve analysis revealed that the AUC of age, CRP and lymphocyte count for disease progression were 0.873, 0.911 and 0.817, respectively.Conclusions: Older age increased CRP and decreased lymphocyte count resulted in potential risk factors for COVID-19 progression. This may be helpful in identifying patients whose condition worsens at an early stage.


Safety fears over drug hyped to treat the coronavirus spark global confusion


title: Effective Wavelength Range in Photobiomodulation for Tooth Movement Acceleration in Orthodontics: A Systematic Review

text: Objective: The present systematic review aims to establish an effective range of low-level laser therapy wavelengths to accelerate tooth movement in orthodontic treatments. Materials and methods: The electronic literature search was carried out in the following databases: PubMed, ISI Web of Science, Scopus, and Cochrane randomized controlled trials (RCTs). The protocol (CRD42019117648) was registered in PROSPERO. Results: According to PRISMA guidelines and after applying the inclusion criteria, nine RCTs were included. Three blind reviewers independently assessed the methodological quality and evidence level of selected articles. Evidence level classification was established according to the recommendations of SIGN 50 (Scottish Intercollegiate Guidelines Network 2012) and was high quality being ++, acceptable +, low quality -, unacceptable -, reject 0. Conclusions: The majority of RCTs related to accelerating the tooth movement in orthodontic treatments are ideally between 780 and 830 nm wavelengths. The average increase in speed movement calculated as a percentage of the control group in nine studies is 24%. Further studies are necessary to establish the exact dosimeter in photobiomodulation during orthodontic movement.


title: Virtual Screening of Plant Metabolites against Main protease, RNA-dependent RNA polymerase and Spike protein of SARS-CoV-2: Therapeutics option of COVID-19

text: Covid-19, a serious respiratory complications caused by SARS-CoV-2 has become one of the global threat to human healthcare system. The present study evaluated the possibility of plant originated approved 117 therapeutics against the main protease protein (MPP), RNA-dependent RNA polymerase (RdRp) and spike protein (S) of SARS-CoV-2 including drug surface analysis by using molecular docking through drug repurposing approaches. The molecular interaction study revealed that Rifampin (-16.3 kcal/mol) were topmost inhibitor of MPP where Azobechalcone were found most potent plant therapeutics for blocking the RdRp (-15.9 kcal /mol) and S (-14.4 kcal/mol) protein of SARS-CoV-2. After the comparative analysis of all docking results, Azobechalcone, Rifampin, Isolophirachalcone, Tetrandrine and Fangchinoline were exhibited as the most potential inhibitory plant compounds for targeting the key proteins of SARS-CoV-2. However, amino acid positions; H41, C145, and M165 of MPP played crucial roles for the drug surface interaction where F368, L371, L372, A375, W509, L514, Y515 were pivotal for RdRP. In addition, the drug interaction surface of S proteins also showed similar patterns with all of its maximum inhibitors. ADME analysis also strengthened the possibility of screened plant therapeutics as the potent drug candidates against SARS-C with the highest drug friendliness.


title: Laparoscopic Pneumoperitoneum Escape and Contamination during Surgery using the Airseal Insufflation System: Video Vignette

text: Unanticipated behaviours of the Airseal Insufflation and Access System (Conmed, NY, USA), in the public domain since 2017, have been recently restated by the manufacturer in light of the COVID19 pandemic and widespread concerns regarding aerosolization hazards during surgery. The associated video illustrates this device's tendency for intra-abdominal gas effluvium to be continually blown into the operating room during use as well as the phenomenon of air entrainment (i.e. the tendency for room air to be sucked into the abdomen) during high pressure intraoperative suctioning. We used a combination of assessment technologies in a high-fidelity simulation model (fresh porcine cadaver) as well as during clinical surgery to examine gas flow through the Airseal 12mm valve-less trocar with the Airseal IFS carbon dioxide (CO2 ) insufflator in Airseal mode.


Is Gradual and Controlled Approach to Herd Protection a Valid Strategy to Curb the COVID-19 Pandemic?


title: Comprehensive characterization of mainstream marijuana and tobacco smoke

text: Recent increases in marijuana use and legalization without adequate knowledge of the risks necessitate the characterization of the billions of nanoparticles contained in each puff of smoke. Tobacco smoke offers a benchmark given that it has been extensively studied. Tobacco and marijuana smoke particles are quantitatively similar in volatility, shape, density and number concentration, albeit with differences in size, total mass and chemical composition. Particles from marijuana smoke are on average 29% larger in mobility diameter than particles from tobacco smoke and contain 3.4× more total mass. New measurements of semi-volatile fractions determine over 97% of the mass and volume of the particles from either smoke source are comprised of semi-volatile compounds. For tobacco and marijuana smoke, respectively, 4350 and 2575 different compounds are detected, of which, 670 and 536 (231 in common) are tentatively identified, and of these, 173 and 110 different compounds (69 in common) are known to cause negative health effects through carcinogenic, mutagenic, teratogenic, or other toxic mechanisms. This study demonstrates striking similarities between marijuana and tobacco smoke in terms of their physical and chemical properties.


title: Choices

text: We need to make choices on a daily basis in our practice of medical oncology. In regular times, these choices are evidence-based and backed by science. However, during emergency situations like the current COVID pandemic, these choices are not just tougher to make, but come with the added burden of inadequate evidence to base them on. We attempt to discuss the various issues involved in making difficult choices.


title: Estimating the basic reproduction number of COVID-19 in Wuhan, China/ 中华流行病学杂志

text: Objective@#The number of confirmed and suspected cases of the COVID-19 in Hubei province is still increasing. However, the estimations of the basic reproduction number of COVID-19 varied greatly across studies. The objectives of this study are 1) to estimate the basic reproduction number (R0) of COVID-19 reflecting the infectiousness of the virus and 2) to assess the effectiveness of a range of controlling intervention.@*Method@#The reported number of daily confirmed cases from January 17 to February 8, 2020 in Hubei province were collected and used for model fit. Four methods, the exponential growth (EG), maximum likelihood estimation (ML), sequential Bayesian method (SB) and time dependent reproduction numbers (TD), were applied to estimate the R0.@*Result@#Among the four methods, the EG method fitted the data best. The estimated R0 was 3.49 (95% CI: 3.42-3.58) by using EG method. The R0 was estimated to be 2.95 (95%CI: 2.86-3.03) after taking control measures.@*Conclusion@#In the early stage of the epidemic, it is appropriate to estimate R0 using the EG method. Meanwhile, timely and effective control measures were warranted to further reduce the spread of COVID-19.


title: [Estimating the basic reproduction number of COVID-19 in Wuhan, China]

text: Objective: The number of confirmed and suspected cases of the COVID-19 in Hubei province is still increasing. However, the estimations of the basic reproduction number of COVID-19 varied greatly across studies. The objectives of this study are 1) to estimate the basic reproduction number (R(0)) of COVID-19 reflecting the infectiousness of the virus and 2) to assess the effectiveness of a range of controlling intervention. Methods: The reported number of daily confirmed cases from January 17 to February 8, 2020 in Hubei province were collected and used for model fit. Four methods, the exponential growth (EG), maximum likelihood estimation (ML), sequential Bayesian method (SB) and time dependent reproduction numbers (TD), were applied to estimate the R(0). Results: Among the four methods, the EG method fitted the data best. The estimated R(0) was 3.49 (95%CI: 3.42-3.58) by using EG method. The R(0) was estimated to be 2.95 (95%CI: 2.86-3.03) after taking control measures. Conclusions: In the early stage of the epidemic, it is appropriate to estimate R(0) using the EG method. Meanwhile, timely and effective control measures were warranted to further reduce the spread of COVID-19.


title: Response to COVID-19 pandemic: Beyond medical education in Brazil

text: We received a response to our Editorial from a group in Brazil that raised valuable concerns about the struggles in transforming medical education in low-income countries. Here, we address the concerns they raised that reinforce the global need for a "Coalition for Medical Education."


Role of mask/respirator protection against SARS-CoV-2


COVID-19 online surveys need to follow standards and guidelines: Comment on "does COVID-19 pandemic affect sexual behavior? A cross-sectional, cross-national online survey" and "binge watching behavior during COVID 19 pandemic: A cross-sectional, cross-national online survey"- authors' reply


Emergence of a novel coronavirus causing respiratory illness from Wuhan, China