title: Beta regression with spatio-temporal effects as a tool for hospital impact analysis of initial phase epidemics: the case of COVID-19 in Spain

text: COVID-19 has put an extraordinary strain on medical staff around the world, but also on hospital facilities and the global capacity of national healthcare systems. In this paper, Beta regression is introduced as a tool to analyze the rate of hospitalization and the proportion of Intensive Care Unit admissions over both hospitalized and diagnosed patients, with the aim of explaining as well as predicting, and thus allowing to better anticipate, the impact on hospital resources during an early-phase epidemic. This is applied to the initial phase COVID-19 pandemic in Spain and its different regions from 20-Feb to 08-Apr of 2020. Spatial and temporal factors are included in the Beta distribution through a precision factor. The model reveals the importance of the lagged data of hospital occupation, as well as the rate of recovered patients. Excellent agreement is found for next-day predictions, while even for multiple-day predictions (up to 12 days), robust results are obtained in most cases in spite of the limited reliability and consistency of the data


title: Brief review of coronavirus for healthcare professionals February 10, 2020

text: A novel epidemic is challenging the global health care system Starting from probably November to December 2019, another Coronavirus entered the arena of human pathogens, to be then defined 2019- nCoV [ ]


title: Containing COVID-19 in China: AI and the robotic restructuring of future cities

text: COVID-19 has generated interest in the potential of urban robotics and automation to manage and police physical distancing and quarantine. This commentary examines the intersection between COVID-19 management strategies and the technological affordances of robotics, autonomous systems, and artificial intelligence (AI) in urban pandemic control. Examples from China illustrate the possibilities for urban robotics and automation in a new era of urban bio-(in)security.


title: Evaluation of "stratify and shield" as a policy option for ending the COVID-19 lockdown in the UK

text: Although population-wide lockdowns have been successful in slowing the COVID-19 epidemic, there is a consensus among disease modellers that keeping the load on critical care services within manageable limits will require an adaptive social distancing strategy, alternating cycles of relaxation and re-imposition until a vaccine is available. An alternative strategy that has been tentatively proposed is to shield the elderly and others at high risk of severe disease, while allowing immunity to build up in those at low risk until the entire population is protected. We examine the performance required from a classifier that uses information from medical records to assign risk status for a such a stratify-and-shield policy to be effective in limiting mortality when social distancing is relaxed. We show that under plausible assumptions about the level of immunity required for population-level immunity, the proportion shielded is constrained to be no more than 15% of the population. Under varying assumptions about the infection fatality ratio (from 0.1% to 0.4%) and the performance of the classifier (3 to 4.5 bits of information for discrimination), we calculate the expected number of deaths in the unshielded group. We show that with likely values of the performance of a classifier that uses information from age, sex and medical records, at least 80% of those who would die if unshielded would be allocated to the high-risk shielded group comprising 15% of the population. Although the proportion of deaths that would be prevented by effective shielding does not vary much with the infection fatality ratio, the absolute number of deaths in the unshielded varies from less than 10,000 if the infection fatality rate is 0.1% to more than 50,000 if the infection fatality rate is as high as 0.4%. For projecting the effect of an optimally applied stratify-and-shield policy, studies now under way should help to resolve key uncertainties: the extent to which infection confers immunity, the prevalence of immunity, the infection fatality ratio, and the performance of a classifier constructed using information from medical records. It is time to give serious consideration to a stratify-and-shield policy that could bring the COVID-19 epidemic to an end in a matter of months while restoring economic activity, avoiding overload of critical care services and limiting mortality.


title: Monocyte class switch and hyperinflammation characterise severe COVID-19 in type 2 diabetes

text: Background: Early in the COVID-19 pandemic type 2 diabetes (T2D) was marked as a risk factor of severe disease and mortality. Inflammation is central to the aetiology of both conditions where variations in immune responses have the potential to mitigate or aggravate disease course. Identifying at risk groups based on immuno-inflammatory signatures is valuable in directing personalised care and developing potential targets for precision therapy. Methods: This study characterised immunophenotypic variation associated with COVID-19 severity in type 2 diabetes. Broad-spectrum immunophenotyping quantified 15 leukocyte populations in peripheral circulation from a cohort of 45 hospitalised COVID-19 patients with and without type 2 diabetes. Results: Morphological anomalies in the monocyte pool, monocytopenia specific to quiescent monocytes, and a decreased frequency of cytotoxic lymphocytes were associated with severe COVID-19 in patients with type 2 diabetes requiring intensive care. An aggravated inflammatory gene expression profile, reminiscent of the type-1 interferon pathway, underlaid the immunophenotype associated with severe disease in T2D. Conclusion: Shifts in T-cell and monocyte dynamics underpin a maladaptive response to SARS-CoV-2. These alterations may impact type-1 interferon signalling which is the likely source of the hyperinflammation that increases voracity of COVID-19. These findings allow the identification of type 2 diabetic patients at risk of severe disease as well as providing evidence that the type-1 interferon pathway may be an actionable therapeutic target for future studies.


title: Spatial Correlation of Particulate Matter Pollution and Death Rate of COVID-19

text: The Coronavirus (COVID-19) epidemic, which was first reported in December 2019 in Wuhan, China, has caused 3,314 death as of March 31, 2020 in China. This study aimed to investigate the spatial associations of daily particulate matter (PM) concentrations with death rate of COVID-19 in China. We conducted a cross-sectional analysis to examine the spatial associations of daily PM2.5 and PM10 concentrations with death rate of COVID-19 in China through multiple linear regression method. We found that COVID-19 held higher death rates with increasing concentration of PM2.5 and PM10 levels in the spatial scale, which may affect the process of patients developed from mild to severe and finally influence the prognosis of COVID-19 patients.


title: Ophthalmology practice during the COVID-19 pandemic

text: OBJECTIVE: To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND ANALYSIS: Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice. RESULTS: A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety. CONCLUSION: Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.


title: The psychological distress and coping styles in the early stages of the 2019 coronavirus disease (COVID-19) epidemic in the general mainland Chinese population: a web-based survey

text: Background As the epidemic outbreak of 2019 coronavirus disease (COVID-19), general population may experience psychological distress. Evidence has suggested that negative coping styles may be related to subsequent mental illness. Therefore, we investigate the general population's psychological distress and coping styles in the early stages of the COVID-19 outbreak. Methods A cross-sectional battery of surveys was conducted from February 1-4, 2020. The Kessler 6 psychological distress scale, the simplified coping style questionnaire and a general information questionnaire were administered on-line to a convenience sample of 1599 in China. Spearman's correlation was used to measure the correlations among category variables. Results General population's psychological distress were significant differences based on age, marriage, epidemic contact characteristics, concern with media reports, and perceived impacts of the epidemic outbreak (all p <0.001) except gender (p=0.316). Those with a history of visiting Wuhan and a history of epidemics occurring in the community, more concern with media reports, perceived more severe impacts and negative coping style had a higher level of psychological distress, which was significantly positively correlated with a history of visiting Wuhan (r=0.548, p<0.001), a history of epidemics occurring in the community (r=0.219, p<0.001), and concern with media reports (r=0.192, p<0.001). Coping styles were significantly different across all category variables (all p <0.001), and negatively correlated with other category variables (all p<0.01) except age and marriage. Psychological distress was significantly negatively correlated with the coping style (r=-0.573, p<0.01). Conclusions In the early stages of COVID-19, general population with epidemic contact characteristics, excessive concern with media reports, and perceived more severe impacts have higher levels of psychological distress. Psychological distress was significantly negatively correlated with the coping style. Interventions should be implemented early, especially for those population with a high level of psychological distress and/or with a negative coping style.


title: Association between 2019-nCoV transmission and N95 respirator use

text: 2019-nCoV had caused pneumonia outbreak in Wuhan. Existing evidence have confirmed the human-to-human transmission of 2019-nCoV. We retrospectively collected infection data from 2 January to 22 January at six departments from Zhongnan Hospital of Wuhan University. In our study, we found N95 respirators, disinfection and hand washing can help to reduce the risk of 2019-nCoV infection in medical staffs. Our results call for re-emphasizing strict occupational protection code in battling this novel contagious disease. The risk of 2019-nCoV infection was higher in the open area than in the quarantined area. N95 may be more effective for 2019-nCoV infections.


title: Clinical characteristics of hospitalised patients with schizophrenia who were suspected to have coronavirus disease (COVID-19) in Hubei Province, China

text: BACKGROUND: Since the outbreak of COVID-19, no data have been available for hospitalised psychiatric patients who are suspected to have COVID-19. We performed a comprehensive investigation of the clinical features of hospitalised patients with schizophrenia with or without suspected COVID-19 in Hubei Province, China. AIM: To explore the clinical characteristics of hospitalised patients with schizophrenia with suspected COVID-19 in Hubei Province, China. METHODS: 21 hospitalised patients with schizophrenia with suspected COVID-19 (COVID-19 suspected group) in the isolation ward of a mental health hospital in Wuhan and 30 hospitalised patients with schizophrenia (clean group) in the general ward of another mental health hospital in Yichang were recruited. We retrospectively reviewed their clinical characteristics, laboratory findings and chest CT results before 21 February 2020. We also compared the emotional and mental symptoms between the two groups. RESULTS: Medical records revealed that 21 COVID-19 suspected patients were transferred to the isolation ward between 30 January 2020 and 15 February 2020. The mean age (SD) of COVID-19 suspected patients was 43.1 (2.6). 12 (57.1%) patients showed abnormalities on chest CT before onset of respiratory symptoms. 14 (66.7%) patients had psychiatric medications adjustment after detection of abnormal chest CT findings. By 21 February, one patient was confirmed to have COVID-19. Even though the remaining 20 (95.2%) were negative for at least two reverse transcription PCR tests, 11 (52.4%) patients met the diagnostic criteria for clinically confirmed cases. Compared with patients in the clean group, patients in the suspected COVID-19 group showed significantly higher stress, depression and anxiety levels and poorer sleep quality. CONCLUSION: Setting up an independent isolation ward for hospitalised psychiatric patients who are suspected to have symptoms of COVID-19 helped control the spread of the epidemic. Patients with schizophrenia suspected to have COVID-19 showed increased stress and mood and sleep disturbances, which should be appropriately managed.


title: Health literacy of inland population in the mitigation phase 3.2. of COVID-19's pandemic in Portugal - a descriptive cohort study

text: Background: COVID-19 is a respiratory disease transmitted through respiratory droplets with a high transmission rate. There's still no effective and approved antiretroviral treatment or vaccine, thus, preventive measures are the main key to contain this pandemic. Portugal is now in phase 3.2 of the mitigation of COVID-19, being imperative to understand the health literacy of our country and how to prevent the lack of information, through community empowerment. Material and methods: A cross-sectional study with a cohort from a primary care facility was conducted. We collected demographic and epidemiological data and carried out a questionnaire by phone call. Descriptive statistics and nonparametric tests were used to assess associations between the independent variables and the level of health literacy. The level of significance was set at p<0.05. Results: Our cohort includes 222 subjects (median age: 62 years old), mostly females (131), undergraduate (193) and with at least one risk factor for COVID-19 (144). Globally, younger individuals, females, graduates and the Non-Risk Group appear to have higher levels of health literacy, with some exceptions to this pattern. Conclusions: We observe a well-informed population. However, being a pandemic situation, we intend to identify and correct outliers/misconceptions. This work allows a perspective of the current state/pattern of health literacy as well as its possible predictors. Furthermore, this study makes aware of how relevant the specific communication approaches are. Further studies to understand the predictors of health literacy are necessary. Key-Words: COVID-19, pandemic, SARS-CoV2, Portugal, Health literacy.


The coronavirus outbreak


title: Global epidemiology, pathogenesis, immune response, diagnosis, treatment, economic and psychological impact, challenges, and future prevention of COVID-19: A scoping review

text: Background: Globally, the novel coronavirus, is a public health problem causing respiratory infections. Since the outbreak of severe acute and Middle East respiratory syndromes coronavirus was not reported to cause human infections. Now, it become an epidemic proportion with growing number of cases and deaths. Methods: A scoping review was conducted following the methodological framework. In this scoping review, 50 records published before 28 March, 2020 were included and discussed to better understand the current epidemiology, pathogenesis, immunological response, diagnosis, evasion mechanisms and suggested strategies to boost the immune system, challenges, treatment, and future preventions of the virus. PubMed, BioRxiv, MedRxiv, Global Health and google scholars were searched comprehensively for articles, preprints, grey literatures, reports, websites, conference proceedings and expert information. Studies conducted in human and published in the English language were included in the analysis. All the findings and statements of the review regarding the outbreak are based on published information as listed in citations. Results: We identified 360 records, of which 50 studies met the inclusion criteria. We synthesized the data from the included records and dig out the deep insights of them and pooled into this review. The burden of the outbreak is worsening due to overcrowding, presence of asymptomatic carriers, scarcity of test kits, the immune escaping ability of the virus and lack of awareness. Conclusions and recommendations: Due to the fast-spreading nature of COVID-19 the prevention and control strategies become challenging. It is imposing social, psychological, and socio-economic impacts. We recommended that following social distancing, isolation suspects, using personal protective equipment, health education and introducing handwashing practices, avoiding contact with animals, vaccine development and treatment for controlling and prevention.


title: Quantification of the Resilience and Vulnerability of HIV-1 Native Glycan Shield at Atomistic Detail

text: Dense surface glycosylation on the HIV-1 envelope (Env) protein acts as a shield from the adaptive immune system. However, the molecular complexity and flexibility of glycans make experimental studies a challenge. Here we have integrated high-throughput atomistic modeling of fully glycosylated HIV-1 Env with graph theory to capture immunologically important features of the shield topology. This is the first complete all-atom model of HIV-1 Env SOSIP glycan shield that includes both oligomannose and complex glycans, providing results which are physiologically more relevant than the previous models with uniform glycosylation. This integrated approach including quantitative comparison with cryo-electron microscopy data provides hitherto unexplored details of the native shield architecture and its difference from the high-mannose glycoform. We have also derived a measure to quantify the shielding effect over the antigenic protein surface that defines regions of relative vulnerability and resilience of the shield and can be harnessed for rational immunogen design.


title: Selective Nanotherapeutic Targeting of the Neutrophil Subset Mediating Inflammatory Injury

text: Inflammatory tissue injury such as acute lung injury (ALI) is a disorder that leads to respiratory failure, a major cause of morbidity and mortality worldwide. Excessive neutrophil influx is a critical pathogenic factor in the development of ALI. Here, we identify the subset of neutrophils that is responsible for ALI and lethality in polymicrobial sepsis. The pro-inflammatory neutrophil subpopulation was characterized by its unique ability to endocytose albumin nanoparticles (ANP), upregulation of pro-inflammatory cytokines and chemokines as well as the excessive production of reactive oxygen species (ROS) in models of endotoxemia and septicemia. ANP delivery of the drug piceatannol, a spleen tyrosine kinase (Syk) inhibitor, to the susceptible subset of neutrophils, prevented ALI and mortality in mice subjected to polymicrobial infection. Targeted inhibition of Syk in ANP-susceptible neutrophils had no detrimental effect on neutrophil-dependent host defense because the subset of ANPlow neutrophils effectively controlled polymicrobial infection. The results show that neutrophil heterogeneity can be leveraged therapeutically to prevent ALI without compromising host defense.


title: COVID-19: A Recommendation to Examine the Effect of Mouthrinses with β-Cyclodextrin Combined with Citrox in Preventing Infection and Progression

text: Considered to be a major portal of entry for infectious agents, the oral cavity is directly associated with the evolutionary process of SARS-CoV-2 in its inhalation of ambient particles in the air and in expectorations. Some new generations of mouth rinses currently on the market have ingredients that could contribute to lower the SARS-CoV-2 viral load, and thus facilitate the fight against oral transmission. If chlorhexidine, a usual component of mouth rinse, is not efficient to kill SARS-CoV-2, the use of a mouth rinses and/or with local nasal applications that contain β-cyclodextrins combined with flavonoids agents, such as Citrox, could provide valuable adjunctive treatment to reduce the viral load of saliva and nasopharyngeal microbiota, including potential SARS-CoV-2 carriage. We urge national agencies and authorities to start clinical trials to evaluate the preventive effects of βCD-Citrox therapeutic oral biofilm rinses in reducing the viral load of the infection and possibly disease progression.


title: Direct Measurement of Rates of Asymptomatic Infection and Clinical Care-Seeking for Seasonal Coronavirus

text: The pandemic potential of the novel coronavirus (nCoV) that emerged in Wuhan, China, during December 2019 is strongly tied to the number and contagiousness of undocumented human infections. Here we present findings from a proactive longitudinal sampling study of acute viral respiratory infections that documents rates of asymptomatic infection and clinical care seeking for seasonal coronavirus. We find that the majority of infections are asymptomatic by most symptom definitions and that only 4% of individuals experiencing a seasonal coronavirus infection episode sought medical care for their symptoms. These numbers indicate that a very high percentage of seasonal coronavirus infections are undocumented and provide a reference for understanding the spread of the emergent nCoV.


title: The landscape of lung bronchoalveolar immune cells in COVID-19 revealed by single-cell RNA sequencing

text: The novel coronavirus SARS-CoV-2, etiological agent of recently named Coronavirus infected disease (COVID-19) by WHO, has caused more than 2, 000 deaths worldwide since its emergency in Wuhan City, Hubei province, China, in December, 2019. The symptoms of COVID-19 varied from modest, mild to acute respiratory distress syndrome (ARDS), and the latter of which is generally associated with deregulated immune cytokine production; however, we currently know little as to the interplay between the extent of clinical symptoms and the compositions of lung immune microenvironment. Here, we comprehensively characterized the lung immune microenvironment with the bronchoalveolar lavage fluid (BALF) from 3 severe and 3 mild COVID-19 patients and 8 previously reported healthy lung controls through single-cell RNA sequence (scRNA-seq) combined with TCR-seq. Our data shows that monocyte-derived FCN1+ macrophages, whereas notFABP4+ alveolar macrophages that represent a predominant macrophage subset in BALF from patients with mild diseases, overwhelm in the severely damaged lungs from patients with ARDS. These cells are highly inflammatory and enormous chemokine producers implicated in cytokine storm. Furthermore, the formation of tissue resident, highly expanded clonal CD8+ T cells in the lung microenvironment of mild symptom patients suggests a robust adaptive immune response connected to a better control of COVID-19. This study first reported the cellular atlas of lung bronchoalveolar immune microenvironment in COVID-19 patients at the single-cell resolution, and unveiled the potential immune mechanisms underlying disease progression and protection in COVID-19.


title: Covid-19 nephropathy: What could pathologist say?

text: Implication for health policy/practice/research/medical education: The pathogenetic mechanism of renal involvement in coronavirus disease 19 (COVID-19) is still unclear. It is supposed to result from a combination of several contributing factors, such as state of dehydration, leading to pre-renal failure with acute tubular necrosis, toxic tubular damage, induced by cytokine storm or rhabdomyolysis, cytopathic action induced by the virus that invades ACE2- expressing kidney cells and drug-induced nephrotoxicity.


title: The far side of the COVID-19 epidemic curve: local re-openings based on globally coordinated triggers may work best

text: In the late stages of an epidemic, infections are often sporadic and geographically distributed. Spatially structured stochastic models can capture these important features of disease dynamics, thereby allowing a broader exploration of interventions. Here we develop a stochastic model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission amongst an interconnected group of population centres representing counties, municipalities and districts (collectively, ``counties''). The model is parameterized with demographic, epidemiological, testing, and travel data from the province of Ontario, Canada. We explore the effects of different control strategies after the epidemic curve has been flattened. We compare a local strategy of re-opening (and re-closing, as needed) schools and workplaces county-by-county according to triggers for county-specific infection prevalence, to a global strategy of province-wide re-opening and re-closing according to triggers for province-wide infection prevalence. We find that the local strategy results in far fewer person-days of closure but only slightly more coronavirus disease (COVID-19) cases, even under assumptions of high inter-county travel. However, both cases and person-days lost to closure rise significantly when county triggers are not coordinated by the province and when testing rates vary among counties. Finally, we show that local strategies can also do better in the early epidemic stage but only if testing rates are high and the trigger prevalence is low. Our results suggest that phased plans for re-opening economies on the far side of the COVID-19 epidemic curve should consider preceding larger-scale re-openings with coordinated local re-openings.


title: Appendix Vaccination Schedules for Dogs and Cats

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title: Age- and sex-specific total mortality impacts of the early weeks of the Covid-19 pandemic in England and Wales: Application of a Bayesian model ensemble to mortality statistics

text: Background: The Covid-19 pandemic affects mortality directly through infection as well as through changes in the social, environmental and healthcare determinants of health. The impacts on mortality are likely to vary, in both magnitude and timing, by age and sex. Our aim was to estimate the total mortality impacts of the pandemic, by sex, age group and week. Methods: We developed an ensemble of 16 Bayesian models that probabilistically estimate the weekly number of deaths that would be expected had the Covid-19 pandemic not occurred. The models account for seasonality of death rates, medium-long-term trends in death rates, the impact of temperature on death rates, association of death rates in each week on those in preceding week(s), and the impact of bank holidays. We used data from January 2010 through mid-February 2020 (i.e., week starting 15th February 2020) to estimate the parameters of each model, which was then used to predict the number of deaths for subsequent weeks as estimates of death rates if the pandemic had not occurred. We subtracted these estimates from the actual reported number of deaths to measure the total mortality impact of the pandemic. Results: In the week that began on 21st March, the same week that a national lockdown was put in place, there was a >92% probability that there were more deaths in men and women aged [≥]45 years than would occur in the absence of the pandemic; the probability was 100% from the subsequent week. Taken over the entire period from mid-February to 8th May 2020, there were an estimated [~] 49,200 (44,700-53,300) or 43% (37-48) more deaths than would be expected had the pandemic not taken place. 22,900 (19,300-26,100) of these deaths were in females (40% (32-48) higher than if there had not been a pandemic), and 26,300 (23,800-28,700) in males (46% (40-52) higher). The largest number of excess deaths occurred among women aged >85 years (12,400; 9,300-15,300), followed by men aged >85 years (9,600; 7,800-11,300) and 75-84 years (9,000; 7,500-10,300). The cause of death assigned to the majority (37,295) of these excess deaths was Covid-19. There was nonetheless a >99.99% probability that there has been an increase in deaths assigned to other causes in those aged [≥]45 years. However, by the 8th of May, the all-cause excess mortality had become virtually equal to deaths assigned to Covid-19, and non-Covid excess deaths had diminished to close to zero, or possibly become negative, in all age-sex groups. Interpretation: The death toll of Covid-19 pandemic, in middle and older ages, is substantially larger than the number of deaths reported as a result of confirmed infection, and was visible in vital statistics when the national lockdown was put in place. When all-cause mortality is considered, the mortality impact of the pandemic on men and women is more similar than when comparing deaths assigned to Covid-19 as underlying cause of death.


title: The Impact of COVID-19 Pandemic on Spine Surgeons Worldwide

text: Study Design: Cross-sectional, international survey. Objectives: The current study addressed the multi-dimensional impact of COVID-19 upon healthcare professionals, particularly spine surgeons, worldwide. Secondly, it aimed to identify geographical variations and similarities. Methods: A multi-dimensional survey was distributed to surgeons worldwide. Questions were categorized into domains: demographics, COVID-19 observations, preparedness, personal impact, patient care, and future perceptions. Results: 902 spine surgeons representing 7 global regions completed the survey. 36.8% reported co-morbidities. Of those that underwent viral testing, 15.8% tested positive for COVID-19, and testing likelihood was region-dependent; however, 7.2% would not disclose their infection to their patients. Family health concerns were greatest stressor globally (76.0%), with anxiety levels moderately high. Loss of income, clinical practice and current surgical management were region-dependent, whereby 50.4% indicated personal-protective-equipment were not adequate. 82.3% envisioned a change in their clinical practice as a result of COVID-19. More than 33% of clinical practice was via telemedicine. Research output and teaching/training impact was similar globally. 96.9% were interested in online medical education. 94.7% expressed a need for formal, international guidelines to manage COVID-19 patients. Conclusions: In this first, international study to assess the impact of COVID-19 on surgeons worldwide, we identified overall/regional variations and infection rate. The study raises awareness of the needs and challenges of surgeons that will serve as the foundation to establish interventions and guidelines to face future public health crises.


title: Changes in premature birth rates during the Danish nationwide COVID-19 lockdown: a nationwide register-based prevalence proportion study

text: Objectives To explore the impact of COVID-19 lockdown on premature birth rates in Denmark Design Nationwide register-based prevalence proportion study. Participants 31,180 live singleton infants born in Denmark between March 12, and April 14, from 2015 to 2020 Main outcome measures The Main outcome measure was the odds ratio of premature birth, per preterm category, during the lockdown period compared with the calendar match period in the five previous years. Results A total of 31 180 newborns were included in the study period, of these 58 were born extremely premature (gestational age below 28 weeks). The distribution of gestational ages was significantly different (p = 0.004) during the lockdown period compared to the previous five years. The extremely premature birth rate during the lockdown was significantly lower than the corresponding mean rate for the same dates in the previous years (odds ratio 0.09 [95 % CI 0.01 - 0.04], p < 0.001). No significant difference between the lockdown and previous years was found for other gestational age categories. Conclusions The birth rate of extremely premature infants decreased significantly (~90 % reduction) during the Danish nationwide lockdown from a stable rate in the preceding five years. The reasons for this decrease are unclear. Identification of possible causal mechanisms might stimulate changes in clinical practice. Ideally, some cases of extreme prematurity are preventable which may decrease infant morbidity and mortality.


title: A systematic review to evaluate the clinical outcomes in COVID -19 patients on angiotensin converting enzyme inhibitors or angiotensin receptor blockers

text: Introduction: Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) share their target receptor site with the SARS-CoV-2 virus, that may cause ACE2 receptor upregulation which raised concerns regarding ACEI and ARB use in COVID-19 patients. However, many medical professional societies recommended their continued use given the paucity of clinical evidence but there is need for an updated systematic review of latest clinical studies. Methods: A search was conducted on PubMed, Google Scholar, EMBASE and various preprint servers for studies comparing clinical outcomes and mortality in COVID-19 patients on ACEI and/or ARB. Results: A total of eight studies were included in the review. There were conflicting findings reported in several studies as Meng J. et al, Liu Y. et al and Feng Y. reported that patients on ACE inhibitors/ARB had lower rates of severe outcomes whereas Richardson S. et al reported higher rates of invasive ventilation and intensive care unit (ICU) admissions in patients on ACE inhibitors/ARB as compared to non-users. However, Zhang P. et al found slightly higher rates of ICU admissions in patients on ACE inhibitors and ARB as compared to non-users. Similarly, there were conflicting results in the rate of mortality reported by the various clinical studies as well. Meng J. et al, Li J. et al and Zhang P. et al reported lower rates of mortality in ACE inhibitors/ARB users versus non-users whereas Guo J. et al reported higher rates of mortality in patients on ACE inhibitors/ARB as compared to non-users. Additionally, a large study conducted in New York by Richardson S. et al raised concerns with worse mortality outcomes in patients on ACEI/ ARB. Conclusion: It is concluded that ACEI and ARB should be continued in COVID-19 patients, albeit while exercising caution until larger clinical studies and randomized controlled trials confirm their safety. Additionally, the individual patient factors like ACE2 polymorphisms which might confer higher risk of adverse outcomes need to be evaluated further.


title: Investigating the genomic landscape of novel coronavirus (2019-nCoV) to identify non-synonymous mutations for use in diagnosis and drug design

text: Novel coronavirus has wrecked medical and health care facilities claiming ~5% death tolls globally. All efforts to contain the pathogenesis either using inhibitory drugs or vaccines largely remained futile due to a lack of better understanding of the genomic feature of this virus. In the present study, we compared the 2019-nCoV with other coronaviruses, which indicated that bat-SARS like coronavirus could be a probable ancestor of the novel coronavirus. The protein sequence similarity of pangolin-hCoV and bat-hCoV with human coronavirus was higher as compared to their nucleotide similarity denoting the occurrence of more synonymous mutations in the genome. Phylogenetic and alignment analysis of 591 novel coronaviruses of different clades from Group I to Group V revealed several mutations and concomitant amino acid changes. Detailed investigation on nucleotide substitution unfolded 100 substitutions in the coding region of which 43 were synonymous and 57 were of non-synonymous type. The non-synonymous substitutions resulting into 57 amino acid changes were found to be distributed over different hCoV proteins with maximum on spike protein. An important diamino acid change RG to KR was observed in ORF9 protein. Additionally, several interesting features of the novel coronavirus genome have been highlighted in respect to various other human infecting viruses which may explain extreme pathogenicity, infectivity and simultaneously the reason behind failure of the antiviral therapies. Summary This study presents a comprehensive phylogenetic analysis of SARS-CoV2 isolates to understand discrete mutations that are occurring between patient samples. This analysis will provide an explanation for varying treatment efficacies of different inhibitory drugs and a future direction towards a combinatorial treatment therapies based on the kind of mutation in the viral genome.


title: A blueprint for the implementation of a validated approach for the detection of SARS-Cov2 in clinical samples in academic facilities

text: The COVID-19 pandemic is expanding at an unprecedented rate. As a result, diagnostic services are stretched to their limit, and there is a clear need for the provision of additional diagnostic capacity. Academic laboratories, many of which are closed due to governmental lockdowns, may be in a position to support local screening capacity by adapting their current laboratory practices. Here, we describe the process of developing a SARS-Cov2 diagnostic workflow in a conventional academic Containment Level 2 (CL2) laboratory. Our outline includes simple SARS-Cov2 deactivation upon contact, the methods for a quantitative real-time reverse transcriptase PCR (qRT-PCR) detecting SARS-Cov2, a description of process establishment and validation, and some considerations for establishing a similar workflow elsewhere. This was achieved under challenging circumstances through the collaborative efforts of scientists, clinical staff, and diagnostic staff to mitigate to the ongoing crisis. Within 14 days, we created a validated COVID-19 diagnostics service for healthcare workers in our local hospital. The described methods are not exhaustive, but we hope may offer support to other academic groups aiming to set up something comparable in a short time frame.


title: Study of the Dependence of Effective Reproduction Number of COVID-19 on the Temperature and Humidity: A Case Study with the Indian States

text: Corona Virus Disease 2019 (COVID-19) started in Wuhan province of China in November 2019 and within a short time, it was declared as a worldwide pandemic by World Health Organisation due to very fast worldwide spread of the virus. In the absence of any vaccine, various mitigation measures were used. In the past, the effect of temperature and humidity on the spread of the virus was studied for a very early phase of the data with mixed results. We are studying the impact of COVID-19 on the maximum temperature and relative humidity of a place using Indian states as test cases for SIR, SIRD, and SEIR models. We used a linear regression method to look for any dependency between effective reproduction number with maximum temperature and relative humidity. Most of the states show a correlation with the negative slope between the effective reproduction number with the maximum temperature and the relative humidity. It indicates that the effective reproduction number goes down as maximum temperature or relative humidity rise. But, the regression coefficient R2 is low for these correlations which means that the correlation is not strong.


title: 2019 novel coronavirus (2019-nCoV) and 2019-nCoV pneumonia/ 2019新型冠状病毒及其感染性肺炎

text: In the middle of December in 2019, a pneumonia outbreak caused by a new coronavirus, 2019 novel coronavirus (2019-nCoV), emerged in the populations in Wuhan city of China. The epidemic spreads rapidly and has been disseminated throughout the country and to 13 other counties in Asia, Europe, Oceania and North America. To accurately and deeply understand the biological characteristics, epidemiological features and pathogenicity of 2019-nCoV and related immunological characteristics, microbiological examinations and public protection measure, this study reviewed 2019-nCoV and 2019-nCoV pneumonia based on the newest relevant literatures and the newest version of National Diagnosis and Treatment Scheme of 2019-nCoV pneumonia.


title: ProgNet: Covid-19 prognosis using recurrent andconvolutional neural networks

text: Humanity is facing nowadays a dramatic pandemic episode with the Coronavirus propagation over all continents. The Covid-19 disease is still not well characterized, and many research teams all over the world are working on either ther- apeutic or vaccination issues. Massive testing is one of the main recommendations. In addition to laboratory tests, imagery- based tools are being widely investigated. Artificial intelligence is therefore contributing to the efforts made to face this pandemic phase. Regarding patients in hospitals, it is important to monitor the evolution of lung pathologies due to the virus. A prognosis is therefore of great interest for doctors to adapt their care strategy. In this paper, we propose a method for Covid-19 prognosis based on deep learning architectures. The proposed method is based on the combination of a convolutional and recurrent neural networks to classify multi-temporal chest X-ray images and predict the evolution of the observed lung pathology. When applied to radiological time-series, promising results are obtained with an accuracy rates higher than 92%.


title: Modelling COVID-19 using the Fundamentals of Fluid Dynamics

text: As of 21st May 2020, there have been 4.89M confirmed cases worldwide and over 323,000 deaths of people who have tested positive for SARS-CoV-2. The outbreak of COVID-19, has not only caused widespread morbidity and mortality, but has also led to a catastrophic breakdown in the global economy and unprecedented social disruption. To lessen the global health consequences of COVID-19, sweeping COVID-19 lockdown and quarantine measures have been imposed within many nations. These measures have significantly impacted the world's economy and in many cases has led to the loss of livelihood. Mathematical modeling of pandemics is of critical importance to understand the unfolding of transmission events and to formulate control measures. In this research letter, we have introduced a novel approach to forecasting epidemics like COVID-19. The proposed mathematical model stems from the fundamental principles of fluid dynamics, and can be utilized to make projections of the number of infected people. This unique mathematical model can be beneficial for predicting and designing potential strategies to mitigate the spread and impact of pandemics.


title: Provide and Protect the Essential Components

text: This article takes a look at the current educational climate during the worldwide COVID-19 pandemic, specifically the place that physical education has during this time. It explores the importance of maintaining standards-based learning and the essential components of physical education.


title: Serological surveys in Reunion Island of the first hospitalized patients revealed that long-lived immunoglobulin G antibodies specific against SARS-CoV2 virus are rapidly vanishing in severe cases

text: Both cellular and humoral immunities are critically important to control COVID19 infection but little is known about the kinetics of those responses and, in particular, in patients who will go on to develop a severe form of the disease over several weeks. We herein report the first set of data of our prospective cohort study of 90 hospitalized cases. Serological surveys were thoroughly performed over 2 month period by assessing IgG and IgM responses by immunofluorescence, immunoblot, Western blot and conventional ELISA using clinical RUN isolates of SARS-CoV-2 immobilized on 96 well plates. While the IgM and, unexpectedly, the IgG responses were readily detected early during the course of the disease (5-7 days post-first symptoms), our results (n=3-5 and over the full dilution set of the plasma 1/200 to 1/12800) demonstrated a significant decrease (over 2.5-fold) of IgG levels in severe (ICU) hospitalized patients (exemplified in patient 1) by WB and ELISA. In contrast, mild non-ICU patients had a steady and yet robust rise in their specific IgG levels against the virus. Interestingly, both responses (IgM and IgG) were initially against the nucleocapsid (50kDa band on the WB) and spreading to other major viral protein S and domains (S1 and S2. In conclusion, serological testing may be helpful for the diagnosis of patients with negative RT-PCR results and for the identification of asymptomatic cases. Moreover, medical care and protections should be maintained particularly for recovered patients (severe cases) who may remain at risk of relapsing or reinfection. Experiments to ascertain T cell responses but although their kinetics overtime are now highly warranted. All in all, these studies will help to delineate the best routes for vaccination.


title: Favipiravir for treating novel coronavirus (COVID-19) patients: protocol for a systematic review and meta-analysis of controlled trials

text: Introduction An outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was reported in Wuhan, China in mid-December 2019, and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Due to the unknown nature of the disease and the lack of specific drugs, several potential treatments were used for patients. This systematic review and meta-analysis will evaluate studies of the effects of Favipiravir in COVID-19 pneumonia. Methods and analysis We will search electronic databases including LitCovid hub, PubMed, Scopus, ISI web of Sciences, Cochrane, and Embase using keywords related to COVID-19 and Favipiravir. We will search the reference lists of all included studies and reviews. We will also search for clinical trial registries, such as clinicaltrial.gov for the ongoing clinical trials. Two investigators (MAZ and SH) will independently screen titles, abstracts, and full-text of included studies based on eligibility criteria. These investigators will also independently extract data and appraise the quality of studies. All potential discrepancies will be resolved through consultation with the third reviewer. Data synthesis will be conducted using the Review Manager software (version 5.3) or CMA (version 2). Statistical heterogeneity will be assessed using a standard I2 test. A funnel plot, Egger test, and Begg test will be used for asymmetry to explore possible publication bias. Ethics and dissemination The findings of this systematic review with proportional meta-analysis will help to identify the safety and efficacy of Favipiravir for COVID-19 patients. Knowledge gained from this research will also assist physicians in selecting better treatment options and developing a guideline in this field.


title: Intestinal Health – Key to Maximise Growth Performance in Livestock, Theo Niewold (Ed.), Wageningen Academic Publishers, Wageningen, The Netherlands (2015). 276 pp., Hardcover, Price: 89 €; 108.49 US$; £ 69.65; Hardback ISBN: 978-90-76998-91 6; e-book ISBN: 978-90-8686-792-9

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title: Neurophysiological Correlates of the Dunning-Kruger Effect

text: The Dunning-Kruger Effect (DKE) is a metacognitive phenomenon of illusory superiority in which individuals who perform poorly on a task believe they performed better than others, yet individuals who performed very well believe they under-performed compared to others. This phenomenon has yet to be directly explored in episodic memory, nor explored for reaction times or physiological correlates. We designed a novel method to elicit the DKE via a test of item recognition while electroencephalography (EEG) was recorded. Throughout the task, participants were asked to estimate the percentile in which they performed compared to others. Results revealed participants in the bottom 25th percentile overestimated their percentile, while participants in the top 75th percentile underestimated their percentile, exhibiting the classic DKE. Reaction time measures revealed a condition x group interaction whereby over-estimators responded faster than under-estimators when estimating being in the top percentile and responded slower when estimating being in the bottom percentile. Between-group EEG differences were evident between over-estimators and under-estimators during Dunning-Kruger responses, which revealed FN400-like effects of familiarity supporting differences for over-estimators from 400-600 ms, whereas ‘old-new’ memory ERP effects revealed a late parietal component (LPC) associated with recollection-based processing from 600-900 ms for under-estimators that was not evident for over-estimators. Findings suggest over- and under-estimators use differing cognitive processes when assessing their performance, such that under-estimators rely on recollection during memory and over-estimators draw upon excess familiarity when over-estimating their performance. Episodic memory thus appears to play a contributory role in metacognitive judgments of illusory superiority and inferiority. Graphical Abstract Event-related potentials (ERPS) were recorded for the Dunning-Kruger Effect as subjects made metacognitive judgments about performance on a memory task. Over- and Under-estimators exhibited a crossover interaction in response times when believing they did best and worst, respectively. A crossover pattern was also observed for ERPs: LPC signals of recollection were found for under-estimators, whereas familiarity-based FN400 effects were evident for over-estimators and correlated with estimates.


title: Impacts of the COVID-19 pandemic on labor market surveys at the German institute for employment research

text: The COVID-19 pandemic and associated government lockdown restrictions have fueled a high demand for survey data on how individuals and establishments are coping with the restrictions. However, the pandemic has also dramatically affected surveys themselves, forcing research institutes to adapt their fieldwork operations to the uncertain and evolving conditions. This paper documents the specific impacts of the pandemic on several ongoing surveys at the Institute for Employment Research in Germany, and describes how these impacts have been addressed. In addition, this paper summarizes efforts to rapidly develop new COVID-19 surveys to help meet the increasing demand for timely data about the effects of the Corona-Crisis on the labor market.


title: Modelling the epidemic 2019-nCoV event in Italy: a preliminary note

text: An analysis of the time evolution of the 2019-nCoV outbreak event in Italy is proposed and is based on the preliminary data at disposal (till March 11th, 2020) on one side, and on an epidemiological model recently used to describe the same epidemic event in the Wuhan region (February 2020) on the other side. The equations of the model include the description of compartments like Susceptible (S), exposed (E), infectious but not yet symptomatic (pre-symptomatic) (A), infectious with symptoms (I), hospitalized (H) and recovered (R). Further stratification includes quarantined susceptible (Sq), isolated exposed (Eq) and isolated infected (Iq) compartments. The equations are numerically solved for boundary (initial) conditions tuned on the Italian event. The role of quarantine is specifically emphasized and supports the strategies adopted providing a numerical description of the effects.


title: On a coupled time-dependent SIR models fitting with New York and New-Jersey states COVID-19 data

text: This article describes a simple Susceptible Infected Recovered (SIR) model fitting with COVID-19 data for the month of march 2020 in New York (NY) state. The model is a classical SIR, but is non-autonomous; the rate of susceptible people becoming infected is adjusted over time in order to fit the available data. The death rate is also secondarily adjusted. Our fitting is made under the assumption that due to limiting number of tests, a large part of the infected population has not been tested positive. In the last part, we extend the model to take into account the daily fluxes between New Jersey (NJ) and NY states and fit the data for both states. Our simple model fits the available data, and illustrates typical dynamics of the disease: exponential increase, apex and decrease. The model highlights a decrease in the transmission rate over the period which gives a quantitative illustration about how lockdown policies reduce the spread of the pandemic. The coupled model with NY and NJ states shows a wave in NJ following the NY wave, illustrating the mechanism of spread from one attractive hot spot to its neighbor. }


title: Detection of SARS-CoV-2 in Human Breast Milk

text: SARS-CoV-2 (CoV-2) is mainly transmitted in the human population during close contact and respiratory droplets. It is currently unclear, however, whether CoV-2 is shed into milk and may also be transmitted from infected mothers to newborns trough breast feeding. Two recent reviews on the topic (1,2) did not find evidence for CoV-2 in human milk. However, the number of breast milk samples analyzed so far is small and samples were taken only once from each mother (2).


title: EasyCOV : LAMP based rapid detection of SARS-CoV-2 in saliva

text: Covid-19 crisis showed us that rapid massive virus detection campaign is a key element in SARS-CoV-2 pandemic response. The classical RT-PCR laboratory platforms must be complemented with rapid and simplified technologies to enhance efficiency of large testing strategies. To this aim, we developed EasyCoV, a direct saliva RT-LAMP based SARS-CoV-2 virus detection assay that do not requires any RNA extraction step. It allows robust and rapid response under safe and easy conditions for healthcare workers and patients. EasyCov test was assessed under double blind clinical conditions (93 asymptomatic healthcare worker volonteers, 10 actively infected patients, 20 former infected patients tested during late control visit). EasyCov results were compared with classical laboratory RT-PCR performed on nasopharyngeal samples. Our results show that compared with nasopharyngeal laboratory RT-PCR, EasyCov SARS-CoV-2 detection test has a sensitivity of 72.7%. Measured on healthcare worker population the specificity was 95.7%. LAMP technology on saliva is clearly able to identify subjects with infectivity profile. Among healthcare worker population Easycov test detected one presymptomatic subject. Because it is simple, rapid and painless for patients, EasyCov saliva SARS-Cov-2 detection test may be useful for large screening of general population.


title: Almost sure convergence for the maximum and minimum of normal vector sequences

text: In this paper, we prove the almost sure convergences for the maximum and minimum of nonstationary and stationary standardized normal vector sequences under some suitable conditions.


title: Assessing the Impact of the COVID-19 Pandemic on Agricultural Production in Southeast Asia: Toward Transformative Change in Agricultural Food Systems

text: How will the COVID-19 pandemic affect the agriculture sector in Southeast Asia? Clearly, any disruptions in the agricultural food systems would create supply and demand shocks that would impact on the agriculture sector's immediate and long-term economic performance and food security contribution Overall, the COVID-19 pandemic during the first quarter of year 2020 is estimated to result in 3 11 percent or 17 03 million tons reduction in aggregate volume of agricultural production in Southeast Asia due to decline in agricultural farm labor affecting 100 77 million individuals This crisis could translate to 1 4 percent decrease in GDP of the Southeast Asian region, which is equivalent to USD 3 76 billion Ensuring a systemic transformation of the agricultural systems into resilient, sustainable, productive, and inclusive food systems would be crucial for the future of Southeast Asia


title: Pulmonary radiological change of COVID-19 patients with 99mTc-MDP treatment

text: Background: As increasing cases of COVID-19 around world, urgent need for effective COVID-19-specific therapeutic drugs is necessary; therefore, we conducted a pilot randomized-controlled study to evaluate the efficacy of 99mTc-MDP for COVID-19 therapeutic treatment. Methods: A total of 21 mild patients with COVID-19 were enrolled in this pilot RCT from February 2020 through March 2020, and then were assigned, in a 1:1 ratio, into control (11 patients) and 99mTc-MDP group (10 patients). Patients in the control group received routine treatment and patients assigned to the 99mTc-MDP group received a combination of routine treatment and an administration of 99mTc-MDP injection of 5ml/day. Both of the patients in the control and 99mTc-MDP groups were treated for 7 days with the primary end point of CT-based radiological pulmonary changes during 7-day follow-up. Findings: From baseline to the day 7, 8 (80%) of 10 mild patients in the 99mTc-MDP group had a significant radiological improvement in lung and a decline in inflammatory infiltration, whereas only 1 (9.1%) of 11 patients in the control group had a radiological improvement in lung. None of the patients in the 99mTc-MDP group had disease progression from mild to severe, as well as an inflammatory cytokine storm, and 2 mild patients (18.2%) in the control group developed severe. During days 7 through 14, the number of patients with radiological improvement in the 99mTc-MDP group remained consistent, and only 1 additional case (22%) in the control group were reported. Conclusion: In this randomized pilot study, 99mTc-MDP had an effective inhibitory effect on the inflammatory disease progression for the therapy of COVID-19, and it can accelerate the absorption of pulmonary inflammation in a short period of time during the process of treatment.


title: Estimating excess visual loss in people with neovascular age-related macular degeneration during the COVID-19 pandemic

text: Objectives: To report the reduction in new neovascular age-related macular degeneration (nAMD) referrals during the COVID-19 pandemic and estimate the impact of delayed treatment on visual outcomes at one year. Design: Retrospective clinical audit and simulation model. Setting: Multiple UK NHS ophthalmology centres. Participants: Data on the reduction in new nAMD referrals was obtained from four NHS Trusts in England comparing April 2020 to April 2019. To estimate the potential impact on one-year visual outcomes, a stratified bootstrap simulation model was developed drawing on an electronic medical records dataset of 20,825 nAMD eyes from 27 NHS Trusts. Main outcome measures: Simulated mean visual acuity and proportions of eyes with vision [≤]6/60, [≤]6/24 and [≥]6/12 at one year under four hypothetical scenarios: no treatment delay, 3, 6 and 9-month treatment delays. Estimated additional number of eyes with vision [≤]6/60 at one year nationally. Results: The number of nAMD referrals at four major eye treatment hospital groups based in England dropped on average by 72% (range 65 to 87%) in April 2020 compared to April 2019. Simulated one-year visual outcomes for 1000 nAMD eyes with a 3-month treatment delay suggested an increase in the proportion of eyes with vision [≤]6/60 from 15.5% (13.2 to 17.9) to 23.3% (20.7 to25.9), and a decrease in the proportion of eyes with vision [≥]6/12 (driving vision) from 35.1% (32.1 to 38.1) to 26.4% (23.8 to29.2). Outcomes worsened incrementally with longer modelled delays. Assuming nAMD referrals are reduced to this level at the national level for only one month, these simulated results suggest an additional 186-365 eyes with vision [≤]6/60 at one-year with even a short treatment delay. Conclusions: We report a large decrease in nAMD referrals during the first month of COVID-19 lockdown and provide an important public health message regarding the risk of delayed treatment. As a conservative estimate, a treatment delay of 3 months could lead to a >50% relative increase in the number of eyes with vision [≤]6/60 and 25% relative decrease in the number of eyes with driving vision at one year.


title: Inter-hospital communication and transfer practices during COVID-19 Pandemic in Karachi, Pakistan. A brief overview

text: OBJECTIVE: To discuss the referral mechanisms established for safe and expeditious inter-facility transfer of COVID 19 positive patients to ensure their referrals through establishing proper communication channels. METHODS: Mobile phone and WhatsApp based groups, administrated by The Indus Hospital were established in April 2020. Through detailed reports and frequent communication, factors like bed and ventilator availability across these facilities are shared. Weekly reports through zoom meetings updating the key stake holders, discussion of problems faced and planning for the week ahead are also done. RESULT: The establishment of these groups has been successful in ensuring referral to and from The Indus Hospital to various healthcare facilities across Karachi using appropriate ambulance services. CONCLUSION: The development of referral mechanisms is the need of the day that has been highlighted through the COVID 19 pandemic. It is our hope that these mechanisms are sustained after the pandemic and result in improvement in patient outcome through proper referrals.


title: Emergence of Institutional Antithrombotic Protocols for Coronavirus 2019

text: The coronavirus infection (COVID‐19), first identified in December 2019 in Wuhan, China, is a major public health crisis with new infections increasing exponentially worldwide. COVID‐19 is an acute infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) and has contributed to significant morbidity and mortality, including the development of coagulopathy. Similar thrombotic and thromboembolic events have occurred during other viral outbreaks, including severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS‐CoV), and influenza A H1N1.


title: Mutation landscape of SARS-CoV-2 reveals three mutually exclusive clusters of leading and trailing single nucleotide substitutions

text: The COVID-19 pandemic has spread across the globe at an alarming rate in the last four months. However, unlike any of the previous global outbreaks the availability of hundreds of SARS-CoV-2 sequences provides us with a unique opportunity to understand viral evolution in real time. We analysed 480 full-length (>29000 nt) sequences from the 1575 SARS-CoV-2 sequences available and identified 37 single-nucleotide substitutions occurring in >1% of the genomes. Majority of the substitutions were C to T or G to A. We identify C/Gs with an upstream TTT trinucleotide motif as hotspots for mutations in the SARS-CoV-2 genome. Interestingly, two of the 37 substitutions occur within highly conserved secondary structures in the 5’ and 3’ untranslated regions that are critical for the virus life cycle. Furthermore, clustering analysis revealed unique geographical distribution of SARS-CoV-2 variants defined by their mutation profile. Of note, we observed several co-occurring mutations that almost never occur individually. We define 3 mutually exclusive lineages (A1, B1 and C1) of SARS-CoV-2 which account for about three quarters of the genomes analysed. We identify lineage-defining leading mutations in the SARS-CoV-2 genome which precede the occurrence of sub-lineage defining trailing mutations. The identification of mutually exclusive lineage-defining mutations with geographically restricted patterns of distribution has potential implications for diagnosis, pathogenesis and vaccine design. Our work provides novel insights on the temporal evolution of SARS-CoV-2.


title: Estimating COVID-19 outbreak risk through air travel

text: Background: COVID-19 has spread rapidly across the globe during the first several months of 2020, creating a pandemic. Substantial, non-discriminatory limitations have been imposed on air travel to inhibit this spread. As the disease prevalence and incidence will decrease, more specific control measures will be sought so that commercial air travel can continue to operate yet not impose a high threat of COVID-19 resurgence. Methods: We use modelled global air travel data and population density estimates to analyse the risk posed by 1364 airports to initiate a COVID-19 outbreak. We calculate the risk using a probabilistic approach that considers the volume of air travelers between airports and the R0 of each location, scaled by population density. This exercise is performed globally as well as specifically for two potentially vulnerable locations: Africa and India. Results: We show that globally, many of the airports posing the highest risk are in China and India. An outbreak of COVID-19 in Africa is most likely to originate in a passenger travelling from Europe. On the other hand, the highest risk to India is from domestic travellers. Our results are robust to changes in the underlying epidemiological assumptions. Conclusions: Variation in flight volumes and destinations creates a non-uniform distribution of the risk different airports pose to resurgence of a COVID-19 outbreak. We suggest the method presented here as a tool for the estimation of this risk. Our method can be used to inform efficient allocation of resources, such as tests identifying infected passengers, so that they could be differentially deployed in various locations.


title: State-by-State prediction of likely COVID-19 scenarios in the United States and assessment of the role of testing and control measures

text: Due to the heterogeneity among the States in the US, predicting COVID-19 trends and quantitatively assessing the effects of government testing capability and control measures need to be done via a State-by-State approach. We develop a comprehensive model for COVID-19 incorporating time delays and population movements. With key parameter values determined by empirical data, the model enables the most likely epidemic scenarios to be predicted for each State, which are indicative of whether testing services and control measures are vigorous enough to contain the disease. We find that government control measures play a more important role than testing in suppressing the epidemic. The vast disparities in the epidemic trends among the States imply the need for long-term placement of control measures to fully contain COVID-19.


Understanding COVID-19 in children may provide clues to protect at-risk populations


title: The psychological effects of COVID-19 on frontline healthcare workers and how they are coping: a web-based, cross-sectional study from Pakistan

text: Background: High level stress is expected when crises starts affecting people's lives and communities which is witnessed in the past epidemics. Infectious diseases outbreaks like the ongoing COVID19 pandemic have negative impact on healthcare workers' (HCWs) mental health, which needs to be investigated. Therefore, we aimed to assess the psychological impact of COVID-19 on frontline HCWs and their coping strategies. Methods: A web-based, cross-sectional study was conducted among HCWs of the Punjab province of Pakistan. The generalized anxiety scale (GAD-7), patient health questionnaire (PHQ-9) and Brief-COPE were used to assess anxiety, depression and coping strategies of the respondents. Results: The mean age of respondents (N = 398) was 28.67 {+/-} 4.15 years, with majority of medical doctors (52%). The prevalence of anxiety and depression were 21.4% and 21.9%, respectively. There was no significant difference of anxiety and depression scores among doctors, nurses and pharmacists. Females had significantly higher anxiety (p = 0.003) and depression (p = 0.001) scores than males. Moreover, HCWs performing duties in COVID-19 ICU had significantly higher anxiety score than those from isolation wards (p = 0.020) and other departments (p = 0.014). Depression, not anxiety, score were higher among those who did not receive the infection prevention training. Most frequently adopted coping strategy was religious coping (5.98 {+/-} 1.73) followed by acceptance (5.59 {+/-} 1.55) and coping planning (4.91 {+/-} 1.85). Conclusion: A considerable proportion of HCWs are having generalized anxiety and depression during the ongoing COVID-19 pandemic. Our findings call for interventions to mitigate mental health risks in HCWs.


title: Repurposing low–molecular-weight drugs against the main protease of severe acute respiratory syndrome coronavirus 2

text: The coronavirus disease (COVID-19) pandemic caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected the global healthcare system. Drug repurposing is a feasible method for emergency treatment. As low–molecular-weight drugs have high potential to completely match interactions with essential SARS-CoV-2 targets, we propose a strategy to identify such drugs using the fragment-based approach. Herein, using ligand- and protein-observed fragment screening approaches, we identified niacin and hit 1 binding to the catalytic pocket of the main protease of the SARS-CoV-2 (Mpro), thereby modestly inhibiting the enzymatic activity of Mpro. Chemical shift perturbations induced by niacin and hit 1 indicate a partial overlap of their binding sites, i.e., the catalytic pocket of Mpro may accommodate derivatives with large molecular sizes. Therefore, we searched for drugs containing niacin or hit 1 pharmacophores and identified carmofur, bendamustine, triclabendazole, and emedastine; these drugs are highly capable of inhibiting protease activity. Our study demonstrates that the fragment-based approach is a feasible strategy for identifying low–molecular-weight drugs against the SARS-CoV-2 and other potential targets lacking specific drugs.


title: Effects of the COVID-19 crisis on survey ﬁeldwork: Experience and lessons from two major supplements to the U.S. Panel study of income dynamics

text: Two major supplements to the Panel Study of Income Dynamics (PSID) were in the field during the COVID-19 outbreak in the United States: the 2019 waves of the PSID Child Development Supplement (CDS-19) and the PSID Transition into Adulthood Supplement (TAS-19). Both CDS-19 and TAS-19 abruptly terminated all face-to-face fieldwork and, for TAS-19, shifted interviewers from working in a centralized call center to working from their homes. Overall, COVID-19 had a net negative effect on response rates in CDS-19 and terminated all home visits that represented an important study component. For TAS-19, the overall effect of Covid19 was uncertain, but negative. The costs were high of adapting to COVID-19 and providing paid time-off benefits to staff affected by the pandemic. Longitudinal surveys, such as CDS, TAS, and PSID, that span the pandemic will provide valuable information on its life course and intergenerational consequences, making ongoing data collection of vital importance.


title: An in vitro assessment of anti-SARS-CoV-2 activity of oral preparations of iodine complexes (RENESSANS)

text: Since the emergence of CoVID-19 pandemic in China in late 2019, scientists are striving hard to explore non-toxic, viable anti-SARS-CoV-2 compounds or medicines. We determined In Vitro anti-SARS-CoV-2 activity of oral formulations (syrup and capsule) of an Iodine-complex (Renessans). A monolayer of vero cells were exposed to SARS-CoV-2 in the presence and absence of different concentrations (equivalent to 50, 05 and 0.5 μg/ml of I2) of Renessans. Anti-SARS-CoV-2 activity of each of the formulation was assessed in the form of cell survival, SARS-CoV-2-specific cytopathic effect (CPE) and genome quantization. With varying concentrations of syrup and capsule, a varying rate of inhibition of CPE, cells survival and virus replication was observed. Compared to 0.5 μg/ml concentration of Renessans syrup, 5 and 50 μg/ml showed comparable results where there was a 100% cell survival, no CPEs and a negligible viral replication (ΔCT= 0.11 and 0.13, respectively). This study indicates that Renessans, containing iodine, may have potential activity against SARS-CoV-2 which needs to be further investigated in human clinical trials.


title: Agencies move grant review panels fully online

text: Several US federal agencies are taking all their grant review panels online for the first time in response to the COVID-19 pandemic The National Institutes of Health and the National Science Foundation are going exclusively online for their grant review meetings, at least for now So far, the NIH’s Center for Scientific Review, which oversees most grant review at the agency, has scheduled 281 online panels through August The agency expects that number to rise to almost 500 The agency was already running almost half of its meetings online, especially smaller ones, so “we’ve been able to quickly transition to all virtual,” says spokesperson Kristin Kramer At the NSF, the chemistry division has run meetings fully or partially online for 7 or 8 years Doing so allows a more diverse panel to participate, including those with travel, teaching, or family obligations or those on the West Coast, says Carol Bessel,


title: Viable circulating endothelial cells and their progenitors are increased in Covid-19 patients

text: During the course of Covid-19, the disease caused by the new Coronavirus SARS-CoV-2, thrombotic phenomena and/or diffuse vascular damage are frequent, and viral elements have been observed within endothelial cells. Circulating endothelial cells (CECs) and their progenitors (CEPs) are increased in cardiovascular, thrombotic, infectious and cancer diseases. Using a validated flow cytometry procedure, we found that viable CEPs/mL were significantly increased in Covid-19 patients compared to healthy controls. This increase was observed in patients with mild symptoms and not further augmented in patients with severe symptoms. In patients who recovered, CEPs decreased, but were in a range still significantly higher than normal controls. Regarding mature CECs, in Covid-19 patients their absolute number was similar to those observed in healthy controls, but the viable/apoptotic CEC ratio was significantly different. Both mild and severe Covid-19 patients had significantly more viable CECs compared to healthy controls. Patients who recovered had significantly less CECs/mL when compared to controls as well as to mild and severe Covid-19 patients. A positive correlation was found between the copies of SARS-CoV-2 RNA in the cellular fraction and apoptotic CEPs/mL in severe Covid-19 patients. These findings suggest that CECs and CEPs might be investigated as candidate biomarkers of endothelial damage in Covid-19 patients.


Licence: CC BY-NC-ND 4 0 Citation information: Arya, Rimanshee;Das, Amit;Prashar, Vishal;Kumar, Mukesh (2020): Potential inhibitors against papain-like protease of novel coronavirus (SARS-CoV-2) from FDA approved drugs ChemRxiv Preprint https://doi org/10 26434/chemrxiv 11860011 v2 The cases of 2019 novel coronavirus (SARS-CoV-2) infection have been continuously increasing ever since its outbreak in China last December Currently, there are no approved drugs to treat the infection In this scenario, there is a need to utilize the existing repertoire of FDA approved drugs to treat the disease The rational selection of these drugs could be made by testing their ability to inhibit any SARS-CoV-2 proteins essential for viral life-cycle We chose one such crucial viral protein, the papain-like protease (PLpro), to screen the FDA approved drugs in silico The homology model of the protease was built based on the SARS-coronavirus PLpro structure, and the drugs were docked in S3/S4 pockets of the active site of the enzyme In our docking studies, sixteen FDA approved drugs, including chloroquine and formoterol, was found to bind the target enzyme with significant affinity and good geometry, suggesting their potential to be utilized against the virus File list (1) download file view on ChemRxiv 2019-nCoV_final_draft2_ChemRxiv pdf (1 15 MiB) Abstract The cases of 2019 novel coronavirus (SARS-CoV-2) infection have been continuously increasing ever since its outbreak in China last December Currently, there are no approved drugs to treat the infection In this scenario, there is a need to utilize the existing repertoire of FDA approved drugs to treat the disease The rational selection of these drugs could be made by testing their ability to inhibit any SARS-CoV-2 proteins essential for viral life-cycle We chose one such crucial viral protein, the papain-like protease (PLpro), to screen the FDA approved drugs in silico The homology model of the protease was built based on the SARS-coronavirus PLpro structure, and the drugs were docked in S3/S4 pockets of the active site of the enzyme In our docking studies, sixteen FDA approved drugs, including chloroquine and formoterol, was found to bind the target enzyme with significant affinity and good geometry, suggesting their potential to be utilized against the virus


title: Structure Basis for Inhibition of SARS-CoV-2 by the Feline Drug GC376

text: The pandemic of SARS-CoV-2 coronavirus disease-2019 (COVID-19) caused by SARS-COV-2 continues to ravage many countries in the world. Mpro is an indispensable protein for viral translation in SARS-CoV-2 and a potential target in high-specificity anti-SARS-CoV-2 drug screening. In this study, to explore potential drugs for treating COVID-19, we elucidated the structure of SARS-CoV-2 Mpro and explored the interaction between Mpro and GC376, an antiviral drug used to treat a range of coronaviruses in Feline via inhibiting Mpro. The availability and safety of GC376 were proved by biochemical and cell experiments in vitro. We determined the structure of an important protein, Mpro, in SARS-CoV-2, and revealed the interaction of GC376 with the viral substrate and inhibition of the catalytic site of SARS-CoV-2 Mpro.


title: Study of Epidemiological Characteristics and In-silico Analysis of the Effect of Interventions in the SARS-CoV-2 Epidemic in India

text: After SARS-CoV-2 set foot in India, the Government took a number of steps to limit the spread of the disease in the country. This study involves assessing how the disease affected the population in the initial days of the epidemic. Data was collected from government-controlled and crowdsourced websites and analysed. Studying age and sex parameters of 413 Indian COVID-19 patients, the median age of the affected individuals was found to be 36 years (IQR, 25-54) with 20-39 years males being the most affected group. The number of affected males (66.34%) was more than that of the females (33.66%). Using Susceptible-Infected- Removed (SIR) model, the range of contact rate (β) of India was calculated and the role of public health interventions was assessed. If current contact rate continues, India may have 5583 to 13785 active cases at the end of 21 days lockdown.


title: Strict Lower Bound on the COVID-19 Fatality Rate in Overwhelmed Healthcare Systems

text: The Infection Fatality Rate (IFR) for COVID-19 is a poorly known, yet crucial, aspect of the disease. Counting only current deaths in a region and assuming everyone in that region is infected provides an absolute lower bound on the IFR. Using this estimator for New York City, Lombardy and Madrid yields strong bounds on the average IFR in overwhelmed health systems. Their combined 35,152 deaths implies IFR > 0.14% averaged over 25.1 million people. This is the best-case scenario and conclusively demonstrates that COVID-19 is more deadly than influenza. The actual value of the average COVID-19 IFR is likely to be higher than this bound.


title: Stability of SARS-CoV-2 Phylogenies

text: The SARS-CoV-2 pandemic has led to unprecedented, nearly real-time genetic tracing due to the rapid community sequencing response. Researchers immediately leveraged these data to infer the evolutionary relationships among viral samples and to study key biological questions, including whether host viral genome editing and recombination are features of SARS-CoV-2 evolution. This global sequencing effort is inherently decentralized and must rely on data collected by many labs using a wide variety of molecular and bioinformatic techniques. There is thus a strong possibility that systematic errors associated with lab-specific practices affect some sequences in the repositories. We find that some recurrent mutations in reported SARS-CoV-2 genome sequences have been observed predominantly or exclusively by single labs, co-localize with commonly used primer binding sites and are more likely to affect the protein coding sequences than other similarly recurrent mutations. We show that their inclusion can affect phylogenetic inference on scales relevant to local lineage tracing, and make it appear as though there has been an excess of recurrent mutation and/or recombination among viral lineages. We suggest how samples can be screened and problematic mutations removed. We also develop tools for comparing and visualizing differences among phylogenies and we show that consistent clade- and tree-based comparisons can be made between phylogenies produced by different groups. These will facilitate evolutionary inferences and comparisons among phylogenies produced for a wide array of purposes. Building on the SARS-CoV-2 Genome Browser at UCSC, we present a toolkit to compare, analyze and combine SARS-CoV-2 phylogenies, find and remove potential sequencing errors and establish a widely shared, stable clade structure for a more accurate scientific inference and discourse. Foreword We wish to thank all groups that responded rapidly by producing these invaluable and essential sequence data. Their contributions have enabled an unprecedented, lightning-fast process of scientific discovery---truly an incredible benefit for humanity and for the scientific community. We emphasize that most lab groups with whom we associate specific suspicious alleles are also those who have produced the most sequence data at a time when it was urgently needed. We commend their efforts. We have already contacted each group and many have updated their sequences. Our goal with this work is not to highlight potential errors, but to understand the impacts of these and other kinds of highly recurrent mutations so as to identify commonalities among the suspicious examples that can improve sequence quality and analysis going forward.


title: A cohort of patients with COVID-19 in a major teaching hospital in Europe

text: BACKGROUND Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the Madrid region. This article describes the first 2226 consecutive adult patients with COVID-19 admitted to the La Paz University Hospital in Madrid. METHODS Our cohort included all consecutively admitted patients who were hospitalized and who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from February 25th (first case admitted) to April 19th, 2020. Data was entered manually into an electronic case report form, which was monitored prior to the analysis. RESULTS We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients median age was 61 years; 51.8% were women. The most common comorbidity was arterial hypertension (41.3%). The most common symptoms on admission were fever (71.2%). The median time from disease onset to hospital admission was 6 days. Overall mortality was 20.7% and was higher in men (26.6% vs 15.1%). Seventy-five patients with a final outcome were transferred to the ICU (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. CONCLUSIONS We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male gender, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.


title: Using random testing in a feedback-control loop to manage a safe exit from the COVID-19 lockdown

text: We argue that frequent sampling of the fraction of infected people (either by random testing or by analysis of sewage water), is central to managing the COVID-19 pandemic because it both measures in real time the key variable controlled by restrictive measures, and anticipates the load on the healthcare system due to progression of the disease. Knowledge of random testing outcomes will (i) significantly improve the predictability of the pandemic, (ii) allow informed and optimized decisions on how to modify restrictive measures, with much shorter delay times than the present ones, and (iii) enable the real-time assessment of the efficiency of new means to reduce transmission rates. Here we suggest, irrespective of the size of a suitably homogeneous population, a conservative estimate of 15000 for the number of randomly tested people per day which will suffice to obtain reliable data about the current fraction of infections and its evolution in time, thus enabling close to real-time assessment of the quantitative effect of restrictive measures. Still higher testing capacity permits detection of geographical differences in spreading rates. Furthermore and most importantly, with daily sampling in place, a reboot could be attempted while the fraction of infected people is still an order of magnitude higher than the level required for a relaxation of restrictions with testing focused on symptomatic individuals. This is demonstrated by considering a feedback and control model of mitigation where the feed-back is derived from noisy sampling data.


title: A Recursive Bifurcation Model for Predicting the Peak of COVID-19 Virus Spread in United States and Germany

text: Prediction on the peak time of COVID-19 virus spread is crucial to decision making on lockdown or closure of cities and states. In this paper we design a recursive bifurcation model for analyzing COVID-19 virus spread in different countries. The bifurcation facilitates a recursive processing of infected population through linear least-squares fitting. In addition, a nonlinear least-squares fitting is utilized to predict the future values of infected populations. Numerical results on the data from three countries (South Korea, United States and Germany) indicate the effectiveness of our approach.


title: Social scientists scramble to study pandemic, in real time

text: If pandemic lockdowns have people feeling a bit like lab rats stuck in cages, in some ways that’s exactly what they are As the coronavirus touches on virtually every part of life around the globe, social scientists are rushing to suck up real-time data on how people are responding to the unfolding pandemic Economists are gathering data about supply chains Political scientists are scrutinizing how government responses track with ideology Psychologists are monitoring children in after-school programs Behavioral scientists are surveying thousands of people to see how they respond to information in a crisis


title: Is this beginning or the end of COVID-19 battle in India? A data-driven mathematical model-based analysis of outbreak

text: The India has experienced early and harshest lockdown in response to the outbreak from 25th March 2020. However, an accurate estimation of progression of spread of the infection and level of preparedness to combat this disease are urgently needed. Using a data-based mathematical model, our study has made predictions on the number of cases that are expected to rise in India till 14th June 2020. The epidemiological data of daily cases have been utilized from 25th March (i.e., the first day of lockdown) to 23rd April 2020. In the study, we have stimulated two possible scenarios (optimistic and pessimistic) for the prediction. As per the optimistic approach of modeling, COVID-19 may end in the first week of June 2020 with a total of 77,900 infected cases including 2,442 fatalities. However, the results under the pessimistic scenario are bit scary. The results show that a total of 283,300 infected cases with 10,180 fatalities till 14th June. To win the battle, 10 weeks of complete lockdown is much needed at least in the infected states and the union territories of India. Alternatively, the isolation of clusters (hotspot regions) is required if India wants resume some essential activities.


title: Pregnancy and COVID-19: What we need to know

text: Since the outbreak of the COVID-19 disease in wuhan china, the infection become a pandemic and a major public health concern all over the world. Pregnant women and their fetuses are at high risk of infectious disease outbreaks. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure during pregnancy. We need to further strengthen preventive measures amongst pregnant women against COVID-19, and to reinforce visit time and procedures in obstetric clinics and units with specialized infection control to limit the spread of the disease over the population especially the neonates.


title: IgG serology in health care and administrative staff populations from 7 hospital representative of different exposures to SARS-CoV-2 in Lombardy, Italy

text: Lombardy is one of the regions in Italy most affected by COVID-19. We assessed the diffusion of the virus via testing plasma anti-SARS-CoV-2 IgG antibodies in 3985 employees of 7 different hospitals, located across the Lombardy region in areas with different exposure to the epidemic. Subjects filled an anamnestic questionnaire to self-report on COVID-19 symptoms, co-morbidities, smoking, regular or smart-working, and the exposure to COVID-19-infected individuals. We show that the number of individuals exposed to the virus depended on the geographical area where the hospital was located and ranged between 3 to 43% which correlated with the incidence of COVID-19 in Lombardy. There was a higher prevalence of females than males positive for IgG, however the level of antibodies was similar, suggesting a comparable magnitude of the response. We observed 10% of IgG positive asymptomatic individuals and another 20% with one or two symptoms. 81% of individuals presenting both anosmia/ageusia and fever resulted SARS-CoV-2 infected. IgG positivity correlated with family contacts. In conclusion, the frequency of IgG positivity and SARS-CoV-2 infection is dependent on the geographical exposure to the virus and to extra-hospital exposure.


Lab Closures, Equipment Shortages, and Concerns About Patient Care: MS Neurologists and Researchers Share Their COVID-19 Experiences


title: Technology Enhanced Assessment (TEA) in COVID 19 Pandemic

text: Online teaching and learning is not a new phenomenon. For the last many years, it has been mainly used as a part of face to face teaching. Assessment is an essential part of teaching and learning, as it establishes the achievement of course learning outcomes by the students. Computer-based assessment is in place for a long time now, however, online assessments have been less practiced. This is because of the issues of validity, reliability and dishonesty. During the COVID 19 pandemic, the educational environment has taken a paradigm shift in many medical schools, both nationally and internationally. This situation demands a method of assessment that is safe, valid, reliable, acceptable, feasible and fair. This paper describes the different formats of online assessment and their application in formative and summative assessments during and after the COVID 19 pandemic.


title: Walking cadence affects the recruitment of the medial-lateral balance mechanisms

text: We have previously identified three balance mechanisms that young healthy adults use to maintain balance while walking. The three mechanisms are: 1) The lateral ankle mechanism, an active modulation of ankle inversion/eversion in stance; 2) The foot placement mechanism, an active shift of the swing foot placement; and 3) The push-off mechanism, an active modulation of the ankle plantarflexion angle during double stance. Here we seek to determine whether there are changes in neural control of balance when walking at different cadences and speeds. Twenty-one healthy young adults walked on a self-paced treadmill while immersed in a 3D virtual reality cave, and periodically received balance perturbations (bipolar galvanic vestibular stimulation) eliciting a perceived fall to the side. Subjects were instructed to match two cadences specified by a metronome, 110bpm (High) and 80bpm (Low), which led to faster and slower gait speeds, respectively. The results indicate that subjects altered the use of the balance mechanisms at different cadences. The lateral ankle mechanism was used more in the Low condition, while the foot placement mechanism was used more in the High condition. There was no difference in the use of the push-off mechanism between cadence conditions. These results suggest that neural control of balance is altered when gait characteristics such as cadence change, suggesting a flexible balance response that is sensitive to the constraints of the gait cycle. We speculate that the use of the balance mechanisms may be a factor resulting in well-known characteristics of gait in populations with compromised balance control, such as slower gait speed in older adults or higher cadence in people with Parkinson’s disease.


title: Die Anwendung der Traditionellen Chinesischen Medizin (TCM)/Akupunktur in der Therapie und Prävention von SARS-CoV-2-Infektionen: White Paper des Wissenschaftszentrums der deutschen Ärztegesellschaft für Akupunktur

text: There are currently numerous suggestions on the potential effectiveness of traditional Chinese medicine (TCM)/acupuncture in the treatment of SARS-CoV‑2 infections and their associated symptoms. These reflections are based on molecular virology and clinical investigations resulting from the SARS epidemic in 2002/2003. The antiviral properties of Chinese herbal medicine (CHM) against SARS-CoV‑2 have not yet been investigated in depth. Clinical data relies on studies conducted prior to the corona pandemic. Current data is limited to a few internationally published case reports and observational studies published in China. There is a promising number of ongoing registered clinical trials. Evidence regarding TCM treatments other than CHM is poor. Based on the available data, a combination of Western and TCM approaches in the Western Hemisphere seems justified only if all conventional treatments are exhausted.


title: NOx Emission Reduction and Recovery during COVID-19 in East China

text: Since its first confirmed case at the end of 2019, COVID-19 has become a global pandemic in three months with more than 1 4 million confirmed cases worldwide, as of early April 2020 Quantifying the changes of pollutant emissions due to COVID-19 and associated governmental control measures is crucial to understand its impacts on economy, air pollution, and society We used the WRF-GC model and the tropospheric NO2 column observations retrieved by the TROPOMI instrument to derive the top-down NOx emission change estimation between the three periods: P1 (January 1st to January 22nd, 2020), P2 (January 23rd, Wuhan lockdown, to February 9th, 2020), and P3 (February 10th, back-to-work day, to March 12th, 2020) We found that NOx emissions in East China averaged during P2 decreased by 50% compared to those averaged during P1 The NOx emissions averaged during P3 increased by 26% compared to those during P2 Most provinces in East China gradually regained some of their NOx emissions after February 10, the official back-to-work day, but NOx emissions in most provinces have not yet to return to their previous levels in early January NOx emissions in Wuhan, the first epicenter of COVID-19, had no sign of emission recovering by March 12 A few provinces, such as Zhejiang and Shanxi, have recovered fast, with their averaged NOx emissions during P3 almost back to pre-lockdown levels


title: Transmission characteristics of the COVID-19 outbreak in China: a study driven by data

text: The COVID-19 outbreak has been a serious public health threat worldwide. We use individually documented case descriptions of COVID-19 from China (excluding Hubei Province) to estimate the distributions of the generation time, incubation period, and periods from symptom onset to isolation and to diagnosis. The recommended 14-day quarantine period may lead to a 6.7% failure for quarantine. We recommend a 22-day quarantine period. The mean generation time is 3.3 days and the mean incubation period is 7.2 days. It took 3.7 days to isolate and 6.6 days to diagnose a patient after his/her symptom onset. Patients may become infectious on average 3.9 days before showing major symptoms. This makes contact tracing and quarantine ineffective. The basic reproduction number is estimated to be 1.54 with contact tracing, quarantine and isolation, mostly driven by super spreaders.


title: Reflection and Recovery from Psychosis during the Time of COVID-19: Adaptation in Psychotherapy in the United States/ La reflexión y la recuperación de la psicosis durante el COVID-19: adaptación en la psicoterapia de EE UU

text: ABSTRACT In response to the coronavirus (COVID-19) pandemic several adaptations have allowed us to continue to provide one form of recovery-oriented psychotherapy to persons with psychosis: Metacognitive Insight and Reflection Therapy (MERIT) These successful adaptations have included the incorporation of patients' experience of the pandemic and the exploration of challenges from temporary changes in therapy platforms to deepen reflections about patients' self-experience, their experience of intersubjectivity and their own agentic responses to psychosocial challenges


Romantic Love in the Age of COVID-19


Trendbericht Analytische Chemie


Expert consensus on clinical management of patients with emergent high-risk cardiovascular disease during the epidemic period of coronavirus disease 2019 in military hospitals/ 2019冠状病毒肺炎疫情期间军队医院心血管急危重症患者 临床管理原则专家共识