title: The Stanford Hall consensus statement for post-COVID-19 rehabilitation

text: The highly infectious and pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2, has emerged causing a global pandemic. Although COVID-19 predominantly affects the respiratory system, evidence indicates a multisystem disease which is frequently severe and often results in death. Long-term sequelae of COVID-19 are unknown, but evidence from previous CoV outbreaks demonstrates impaired pulmonary and physical function, reduced quality of life and emotional distress. Many COVID-19 survivors who require critical care may develop psychological, physical and cognitive impairments. There is a clear need for guidance on the rehabilitation of COVID-19 survivors. This consensus statement was developed by an expert panel in the fields of rehabilitation, sport and exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology and specialist pain, working at the Defence Medical Rehabilitation Centre, Stanford Hall, UK. Seven teams appraised evidence for the following domains relating to COVID-19 rehabilitation requirements: pulmonary, cardiac, SEM, psychological, musculoskeletal, neurorehabilitation and general medical. A chair combined recommendations generated within teams. A writing committee prepared the consensus statement in accordance with the appraisal of guidelines research and evaluation criteria, grading all recommendations with levels of evidence. Authors scored their level of agreement with each recommendation on a scale of 0-10. Substantial agreement (range 7.5-10) was reached for 36 recommendations following a chaired agreement meeting that was attended by all authors. This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post COVID-19 illness, for a target population of active individuals, including military personnel and athletes.


title: Accelerated infection testing at scale: a proposal for inference with single test on multiple patients

text: In pandemics or epidemics, public health authorities need to rapidly test a large number of individuals, both to determine the line of treatment as well as to know the spread of infection to plan containment, mitigation and future responses. However, the lack of adequate testing kits could be a bottleneck, especially in the case of unanticipated new diseases, such as COVID-19, where the testing technology, manufacturing capability, distribution, human skills and laboratories might be unavailable or in short supply. In addition, the cost of the standard PCR test is approximately USD 48, which is prohibitive for poorer patients and most governments. We address this bottleneck by proposing a test methodology that pools the sample from two (or more) patients in a single test. The key insight is that a single negative result from a pooled sample likely implies negative infection of all the individual patients. and It thereby rules out further tests for the patients. This protocol, therefore, requires significantly fewer tests. This may, however, result in somewhat increased false negatives. Our simulations show that combining samples from two patients with 7% underlying likelihood of infection implies that 36% fewer test kits are required, with 14% additional units of time for testing.


title: Development of a semi-structured, multifaceted, computer-aided questionnaire for outbreak investigation: e-Outbreak Platform

text: Aggressive tracing of contacts of confirmed cases is crucial to Taiwan's successful control of the early spread of COVID-19. As the pandemic lingers, an epidemiological investigation that can be conducted efficiently in a timely manner can help decrease the burden on the health personnel and increase the usefulness of such information in decision making. To develop a new tool that can improve the current practice of epidemiological investigation by incorporating new technologies in digital platform and knowledge graphs. To meet the various needs of the epidemiological investigation, we decided to develop an e-Outbreak Platform that provides a semi-structured, multifaceted, computer-aided questionnaire for outbreak investigation. There are three major parts of the platform: (1) a graphic portal that allows users to have an at-glance grasp of the functions provided by the platform and then choose the one they need; (2) disease-specific questionnaires that can accommodate different formats of the information, including text typing, button selection, and pull-down menu; and (3) functions to utilize the stored information, including report generation, statistical analyses, and knowledge graphs displaying contact tracing. When the number of outbreak investigation increases, the knowledge graphs can be extended to encompass other persons appearing in the same location at the same time, i.e., constituting a potential contact cluster. The information extracted can also be used to display the tracing on a map in animation. Overall, this system can provide a basis for further refinement that can be generalized to a variety of outbreak investigations.


title: Saudi association for the study of liver diseases and transplantation position statement on liver transplantation during the COVID-19 pandemic

text: The World Health Organization (WHO), on March 11th 2020, upgraded the status of the novel coronavirus disease (COVID-19) from epidemic to pandemic. Over two million individuals have been infected with SARS-CoV-2, the virus causing COVID-19, and as of April, 14th 2020, there were over 5000 confirmed cases in Saudi Arabia (SA). Many countries, including SA, have imposed major restrictions on travel, and everyday life, and the implications of these necessary changes are being felt in liver transplant (LT) centers in SA. Concerns remain that there is an increased risk for individuals over 65 years of age, with underlying medical conditions, or for those who are immunocompromised. Therefore, the Saudi Association for the Study of Liver Diseases and Transplantation (SASLT) established an urgent task force to launch a statement that can be utilized by LT centers as a guidance in the management of patients with advanced liver disease from the time of LT listing to the post-operative care of transplanted patients.


title: Estimation of the Epidemic Branching Factor in Noisy Contact Networks

text: Many fundamental concepts in network-based epidemic models depend on the branching factor, which captures a sense of dispersion in the network connectivity and quantifies the rate of spreading across the network. Moreover, contact network information generally is available only up to some level of error. We study the propagation of such errors to the estimation of the branching factor. Specifically, we characterize the impact of network noise on the bias and variance of the observed branching factor for arbitrary true networks, with examples in sparse, dense, homogeneous and inhomogeneous networks. In addition, we propose two estimators, by method-of-moments and bootstrap sampling. We illustrate the practical performance of our estimators through simulation studies and social contact networks in British secondary schools.


How to increase the SARS-CoV-2 detection rate through the nasopharyngeal swab?


The pandemic in pictures: how coronavirus is changing the world


title: COVID-19: Safe Guidelines for Breast Imaging During the Pandemic

text: During the COVID-19 pandemic, breast imaging must be performed using safe practices. Balancing the need to avoid delays in the diagnosis of breast cancer while avoiding infection requires careful attention to personal protective equipment and physical distancing and vigilance to maintain these practices. The Canadian Society of Breast Imaging/Canadian Association of Radiologists guideline for breast imaging during COVID-19 is provided based on priority according to risk of breast cancer and impact of delaying treatment. A review of the best practices is presented that allow breast imaging during COVID-19 to maximize protection of patients, technologists, residents, fellows, and radiologists and minimize spread of the infection. The collateral damage of delaying diagnosis of breast cancer due to COVID-19 should be avoided when possible.


title: Ethical implementation of 'immunity passports' during the COVID-19 pandemic

text: A number of countries are planning the use of 'immunity passports' as a way to ease restrictive measures and allow infected and recovered people to return to work during the COVID-19 pandemic. This paper brings together key scientific uncertainties regarding the use of serological tests to assure immune status and a public health ethics perspective to inform key considerations in the ethical implementation of immunity passport policies. Ill-conceived policies have the potential to cause severe unintended harms that could result in greater inequity, the stigmatization of certain sectors of society, and heightened risks and unequal treatment of individuals due to erroneous test results. Immunity passports could however be used to achieve collective benefits and benefits for specific populations besides facilitating economic recovery. We conclude that sector-based policies that prioritize access to testing based on societal need are likely to be fairer and logistically more feasible, while minimizing stigma and reducing incentives for fraud. Clear guidelines need to be set out for which sectors of society should be prioritized for testing, and rigorous mechanisms should be in place to validate test results and identify cases of re-infection.


title: RE: Acute Liver Failure (ALF) in Pregnancy: How Much Is Pregnancy-Related? Casey et al. Hepatology 2020 Jan 28[Online ahead of print DOI: 10.1002/hep.31144

text: I read with great interest the article "Acute Liver Failure (ALF) in Pregnancy: How Much Is Pregnancy-Related?" by Casey et al.1 An important contribution of the study is their result showing failure of the Swansea criteria to differentiate between AFLP and HELLP and other causes of ALF.


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

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


Covid-19 diagnostic imaging recommendations


title: Multivalue ethical framework for fair global allocation of a COVID-19 vaccine

text: The urgent drive for vaccine development in the midst of the current COVID-19 pandemic has prompted public and private organisations to invest heavily in research and development of a COVID-19 vaccine. Organisations globally have affirmed the commitment of fair global access, but the means by which a successful vaccine can be mass produced and equitably distributed remains notably unanswered. Barriers for low-income countries include the inability to afford vaccines as well as inadequate resources to vaccinate, barriers that are exacerbated during a pandemic. Fair distribution of a pandemic vaccine is unlikely without a solid ethical framework for allocation. This piece analyses four allocation paradigms: ability to develop or purchase; reciprocity; ability to implement; and distributive justice, and synthesises their ethical considerations to develop an allocation model to fit the COVID-19 pandemic.


title: COVID-19-associated Hemophagocytic Lymphohistiocytosis and Coagulopathy: Targeting the Duumvirate

text: CONTEXT: Preliminary data on coexistence of secondary hemophagocytic lymphohistiocytosis syndrome (HLH) and disseminated intravascular coagulation (DIC) in critically ill children with novel coronavirus disease (COVID-19) are emerging. Herein, we summarize the available literature and fill-in the gaps in this regard. EVIDENCE ACQUISITION: We have performed a literature search for articles in PubMed, EMBASE and Google Scholar databases till May 12, 2020, with following keywords: "COVID-19", "SARS-CoV-2", "HLH", "HScore", "coagulopathy", "D-dimer", "cytokine storm", "children" and "pediatrics" with interposition of Boolean operator "AND". RESULTS: Children presenting with moderate-severe COVID-19 and Kawasaki disease shock-like syndrome exhibit peripheral blood picture analogous to HLH. HScore, a validated tool to diagnose HLH, has been suggested to screen severe COVID-19 patients for cytokine storm. However, HScore faces certain limitations in this scenario. It may be more pragmatic to use 'high D-dimer' (> 3 µg/mL) instead of 'low fibrinogen' to facilitate early detection of cytokine storm. COVID-19 associated coagulopathy resembles hypercoagulable form of DIC with bleeding being rarely reported. Although the International Society on Thrombosis and Haemostasis (ISTH) interim guidance recommends low molecular weight heparin in all hospitalized patients, data is lacking in population below 14 years of age. However, in the presence of life-threatening thromboembolic event or symptomatic acro-ischemia, unfractionated heparin (UFH) should be used with caution. CONCLUSION: HScore can be used as a complement to clinical decision for initiating immunosuppression. Children with moderate-to-severe COVID-19, especially those with documented thrombocytopenia or chilblains, should be regularly monitored for coagulopathy.


Dearth of infectious diseases physicians as the USA faces a global pandemic


Command Suicidal Hallucination as Initial Presentation of Coronavirus Disease 2019 (COVID-19): A Case Report


title: Acro-ischemia in hospitalized COVID-19 patients

text: Dermatological manifestations of the Coronavirus Disease 2019 (COVID-19) may include unspecific macular erythematous rash, urticarial lesions and chickenpox-like vesicles1,2 . Acroischemic lesions have been described in two different types of COVID-19 patients. Firstly, critically ill patients with severe limb ischemia and secondly, paucisymptomatic young patients with chilblain-like lesions3 . The etiopathogenesis and clinical implications of these lesions remains unclear.


title: Synthetic Interventions

text: We develop a method to help quantify the impact different levels of mobility restrictions could have had on COVID-19 related deaths across nations. Synthetic control (SC) has emerged as a standard tool in such scenarios to produce counterfactual estimates if a particular intervention had not occurred, using just observational data. However, it remains an important open problem of how to extend SC to obtain counterfactual estimates if a particular intervention had occurred - this is exactly the question of the impact of mobility restrictions stated above. As our main contribution, we introduce synthetic interventions (SI), which helps resolve this open problem by allowing one to produce counterfactual estimates if there are multiple interventions of interest. We prove SI produces consistent counterfactual estimates under a tensor factor model. Our finite sample analysis shows the test error decays as $1/T_0$, where $T_0$ is the amount of observed pre-intervention data. As a special case, this improves upon the $1/\sqrt{T_0}$ bound on test error for SC in prior works. Our test error bound holds under a certain"subspace inclusion"condition; we furnish a data-driven hypothesis test with provable guarantees to check for this condition. This also provides a quantitative hypothesis test for when to use SC, currently absent in the literature. Technically, we establish the parameter estimation and test error for Principal Component Regression (a key subroutine in SI and several SC variants) under the setting of error-in-variable regression decays as $1/T_0$, where $T_0$ is the number of samples observed; this improves the best prior test error bound of $1/\sqrt{T_0}$. In addition to the COVID-19 case study, we show how SI can be used to run data-efficient, personalized randomized control trials using real data from a large e-commerce website and a large developmental economics study.


Les droits humains des enfants en situation de handicap en cas d'urgence sanitaire: le défi du COVID-19


COVID-19 Patients with Recent Influenza A/B Infection: A Retrospective Study


title: COVID-19 and the potential long-term impact on antimicrobial resistance

text: The emergence of the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has required an unprecedented response to control the spread of the infection and protect the most vulnerable within society. Whilst the pandemic has focused society on the threat of emerging infections and hand hygiene, certain infection control and antimicrobial stewardship policies may have to be relaxed. It is unclear whether the unintended consequences of these changes will have a net-positive or -negative impact on rates of antimicrobial resistance. Whilst the urgent focus must be on controlling this pandemic, sustained efforts to address the longer-term global threat of antimicrobial resistance should not be overlooked.


title: Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemic

text: Preliminary evidence suggests that climate may modulate the transmission of SARS-CoV-2. Yet it remains unclear whether seasonal and geographic variations in climate can substantially alter the pandemic trajectory, given high susceptibility is a core driver. Here, we use a climate-dependent epidemic model to simulate the SARS-CoV-2 pandemic probing different scenarios based on known coronavirus biology. We find that while variations in weather may be important for endemic infections, during the pandemic stage of an emerging pathogen the climate drives only modest changes to pandemic size. A preliminary analysis of non-pharmaceutical control measures indicates that they may moderate the pandemic-climate interaction via susceptible depletion. Our findings suggest, without effective control measures, strong outbreaks are likely in more humid climates and summer weather will not substantially limit pandemic growth.


title: Two-level modeling of quarantine

text: Continuum models of epidemics do not take into account the underlying microscopic network structure of social connections. This drawback becomes extreme during quarantine when most people dramatically decrease their number of social interactions, while others (like cashiers in grocery stores) continue maintaining hundreds of contacts per day. We formulate a two-level model of quarantine. On a microscopic level, we model a single neighborhood assuming a star-network structure. On a mesoscopic level, the neighborhoods are placed on a two-dimensional lattice with nearest neighbors interactions. The modeling results are compared with the COVID-19 data for several counties in Michigan (USA) and the phase diagram of parameters is identified.


title: Simulating social distancing measures in household and close contact transmission of SARS-CoV-2

text: We sought to evaluate contact rate reduction goals for household and close contacts and to provide preventive recommendations during the coronavirus pandemic. We applied an agent-based model to simulate the transmission dynamics of SARS-CoV-2 within household or close contacts through a social network of 150 nodes. there is no great difference in total infected people within modifications in number of links per node for networks with average number of links per node greater than three. For six nodes, total infected people are 149.85; for five nodes, 148.97; and for four nodes, 141.57. On the other hand, for three nodes, total infected are 82.39, for two nodes, 13.95; and for one node, 2.96. This model indicates a possible pitfall if social distancing measures are not stepwise suspended and close surveillance of cases are not provided, since the relationship between average links per node and number of infected people seems to be s-shaped, and not linear.


Covid-19: Low dose steroid cuts death in ventilated patients by one third, trial finds


title: Development and Implementation of a Clinician-Facing Prognostic Communication Tool for Patients With COVID-19 and Critical Illness

text: Effective prognostication for a novel disease presents significant challenges, especially given the stress induced during a pandemic. We developed a point-of-care tool to summarize outcome data for critically ill patients with COVID-19 and help guide clinicians through a thoughtful prognostication process. Two authors reviewed studies of outcomes of patients with critical illness due to COVID-19 and created a visual infographic tool based on available data. Survival data were supplemented by descriptions of best- and worst-case clinical scenarios. The tool also included prompts for clinician reflection designed to enhance awareness of cognitive biases that may affect prognostic accuracy. This online, open-source COVID-19 Prognostication Tool has been made available to all clinicians at our institution and is updated weekly to reflect evolving data. Our COVID-19 Prognostication Tool may provide a useful approach to promoting consistent and high-quality prognostic communication across a health care system.


title: Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

text: The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak poses a major challenge in the treatment decision-making of patients with cancer, who may be at higher risk of developing a severe and deadly SARS-CoV-2 infection compared with the general population. The health care emergency is forcing the reshaping of the daily assessment between risks and benefits expected from the administration of immune-suppressive and potentially toxic treatments. To guide our clinical decisions at the National Cancer Institute of Milan (Lombardy region, the epicenter of the outbreak in Italy), we formulated Coronavirus-adapted institutional recommendations for the systemic treatment of patients with gastrointestinal cancers. Here, we describe how our daily clinical practice has changed due to the pandemic outbreak, with the aim of providing useful suggestions for physicians that are facing the same challenges worldwide.


COVID-19 and people experiencing homelessness: challenges and mitigation strategies


title: Rethinking the role of hydroxychloroquine in the treatment of COVID-19

text: There are currently no proven or approved treatments for coronavirus disease 2019 (COVID-19). Early anecdotal reports and limited in vitro data led to the significant uptake of hydroxychloroquine (HCQ), and to lesser extent chloroquine (CQ), for many patients with this disease. As an increasing number of patients with COVID-19 are treated with these agents and more evidence accumulates, there continues to be no high-quality clinical data showing a clear benefit of these agents for this disease. Moreover, these agents have the potential to cause harm, including a broad range of adverse events including serious cardiac side effects when combined with other agents. In addition, the known and potent immunomodulatory effects of these agents which support their use in the treatment of auto-immune conditions, and provided a component in the original rationale for their use in patients with COVID-19, may, in fact, undermine their utility in the context of the treatment of this respiratory viral infection. Specifically, the impact of HCQ on cytokine production and suppression of antigen presentation may have immunologic consequences that hamper innate and adaptive antiviral immune responses for patients with COVID-19. Similarly, the reported in vitro inhibition of viral proliferation is largely derived from the blockade of viral fusion that initiates infection rather than the direct inhibition of viral replication as seen with nucleoside/tide analogs in other viral infections. Given these facts and the growing uncertainty about these agents for the treatment of COVID-19, it is clear that at the very least thoughtful planning and data collection from randomized clinical trials are needed to understand what if any role these agents may have in this disease. In this article, we review the datasets that support or detract from the use of these agents for the treatment of COVID-19 and render a data informed opinion that they should only be used with caution and in the context of carefully thought out clinical trials, or on a case-by-case basis after rigorous consideration of the risks and benefits of this therapeutic approach.


Trends of publications during COVID-19 pandemic


Contact Tracing to Manage COVID-19 Spread-Balancing Personal Privacy and Public Health


Modified Wake Forest Type Protective Shield for an Asymptomatic, COVID-19 Non-Confirmed Patient for Intubation Undergoing Urgent Surgery


title: Flight of the COVID-19 patient: experience with a Wuhan evacuee: a case report

text: BACKGROUND: Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, was declared a global pandemic by the World Health Organization in March 2020. CASE PRESENTATION: We report a case of a 51-year-old Chinese woman who was evacuated from Wuhan, China and diagnosed with coronavirus disease 2019 infection at a Southern California quarantine facility. Her clinical course was notable for high fevers, night sweats, productive cough, transient leukopenia, lymphopenia, thrombocytopenia, and transaminitis. Evolving hypoxia and infiltrates on chest imaging warranted the trial of an investigational antiviral drug - remdesivir. Our patient recovered and was discharged after 2 weeks of hospitalization. CONCLUSIONS: This case highlights our patient's clinical course, including diagnostic work-up, medical management, and challenges in defining non-infectivity in a relatively unknown disease.


Interleukin-6 blockade treatment for COVID-19 associated cytokine release syndrome in a patient with poorly controlled chronic myeloid leukaemia


Covid-19: Pandemic is having "severe" impact on non-communicable disease care, WHO survey finds


Rapid point-of-care antibody cassette tests for severe acute respiratory syndrome coronavirus 2: practical considerations


Gastrointestinal Complications in Critically Ill Patients With COVID-19


title: Preserving Radiology Resident Education During the COVID-19 Pandemic: The Simulated Daily Readout

text: RATIONALE AND OBJECTIVES: The educational value of the daily resident readout, a vital component of resident training, has been markedly diminished due to a significant decrease in imaging volume and case mix diversity. The goal of this study was to create a "simulated" daily readout (SDR) to restore the educational value of the daily readout. MATERIALS AND METHODS: To create the SDR the following tasks were performed; selection of cases for a daily worklist for each resident rotation, comprising a combination of normal and abnormal cases; determination of the correct number of cases and the appropriate mix of imaging modalities for each worklist; development of an "educational" environment consisting of separate "instances" of both our Picture Archive Communication System and reporting systems; and the anonymization of all of the cases on the worklists. Surveys of both residents and faculty involved in the SDR were performed to assess its effectiveness. RESULTS: Thirty-two residents participated in the SDR. The daily worklists for the first 20 days of the SDR included 3682 cases. An average of 480 cases per day was dictated by the residents. Surveys of the residents and the faculty involved in the SDR demonstrated that both agreed that the SDR effectively mimics a resident's daily work on rotations and preserves resident education during the Coronavirus Disease 2019 crisis. CONCLUSION: The development of the SDR provided an effective method of preserving the educational value of the daily readout experience of radiology residents, despite severe decreases in imaging exam volume and case mix diversity during the Coronavirus Disease 2019 pandemic.


title: Tracking the Twitter attention around the research efforts on the COVID-19 pandemic

text: The outbreak of the COVID-19 pandemic has been accompanied by a bulk of scientific research and related Twitter discussions. To unravel the public concerns about the COVID-19 crisis reflected in the science-based Twitter conversations, this study tracked the Twitter attention around the COVID-19 research efforts during the first three months of 2020. On the basis of nearly 1.4 million Twitter mentions of 6,162 COVID-19-related scientific publications, we investigated the temporal tweeting dynamic and the Twitter users involved in the online discussions around COVID-19-related research. The results show that the quantity of Twitter mentions of COVID-19-related publications was on rising. Scholarly-oriented Twitter users played an influential role in disseminating research outputs on COVID-19, with their tweets being frequently retweeted. Over time, a change in the focus of the Twitter discussions can be observed, from the initial attention to virological and clinical research to more practical topics, such as the potential treatments, the countermeasures by the governments, the healthcare measures, and the influences on the economy and society, in more recent times.


title: Materialism and dialectics of epidemic prevention and control: only by respecting science can we get twice the result with half the effort/ 中华危重病急救医学

text: The epidemic caused by 2019 novel coronavirus has been highly concerned by the international community including World Health Organization (WHO). This is an endless battle against human life and health. Never forget the past, the teacher of the future. When you think hard, draw inferences from one instance. Many phenomena and problems in the work of epidemic prevention, control and treatment are worthy of our deep reflection. We should use scientific thinking and dialectical materialism to make a practical and realistic summary. The purpose is to win the battle as soon as possible, and more importantly, to avoid repeating the same mistakes and prevent trouble before it happens.


title: Thoracic Anesthesia of Patients With Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the European Association of Cardiothoracic Anaesthesiology Thoracic Subspecialty Committee

text: The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.


Early evidence of pronounced brain involvement in fatal COVID-19 outcomes


title: It is time for a more cautious approach to surgical diathermy, especially in COVID-19 outbreak: A schematic review

text: Background: Many surgeons are unaware of the risks posed by the surgical diathermy. Apart from the numerous chemicals, surgical smoke had been shown to harbour intact bacterial and virus particles especially COVID-19 in the current time. Objective: To identify the inhalational, infectious, chemical, and mutagenic risks of surgical smoke and suggest evidence-based hazard reduction strategies. Also to cogitate on the very high risk of viral spread spread by the use of surgical diathermy in COVID-19 outbreak. Methods: A review of articles indexed for MEDLINE on PubMed using the keywords surgical smoke, diathermy, electrocautery, surgical smoke hazards, smoke evacuator, and guidelines for surgical smoke safety was performed. The review included evidences from 50 articles from the dermatology, surgery, infectious disease, obstetrics, and cancer biology literature. Results: There are risks associated with surgical smoke. Although some surgeons were aware, majority were not keen in the hazard reduction strategies. Conclusion: Many chemical and biological particles have been found in surgical smoke. It is highly recommended to follow the standardised guidelines for surgical smoke safety. Surgical smoke carries full virus particle(such as COVID-19 virus), it is strongly recommended to minimise or avoid electrocautery during the COVID-19 outbreak.


Urgent avenues in the treatment of COVID-19: Targeting downstream inflammation to prevent catastrophic syndrome


First experience of COVID-19 screening of health-care workers in England


title: COVID-19 outbreaks in U.S. immigrant detention centers: the urgent need to adopt CDC guidelines for prevention and evaluation

text: There have been several significant outbreaks of COVID-19 in federal immigrant detention centers, which lack clear and consistent guidelines across Department of Homeland Security (DHS) agencies to limit the spread of COVID-19. The Centers for Disease Control and Prevention (CDC) has issued detailed guidelines for the control, prevention, and evaluation of COVID-19 in detention facilities. While the DHS's Immigration and Customs Enforcement agency has stated that it complies with CDC recommendations, its policies significantly differ from these CDC guidelines, placing detainees at risk for contracting COVID-19. This submission urges the adoption of CDC guidelines across DHS-associated facilities. Such a policy change has the potential to protect and save the lives of the most vulnerable populations under the auspices of the federal government.


title: Coronavirus Detection and Analysis on Chest CT with Deep Learning

text: The outbreak of the novel coronavirus, officially declared a global pandemic, has a severe impact on our daily lives. As of this writing there are approximately 197,188 confirmed cases of which 80,881 are in"Mainland China"with 7,949 deaths, a mortality rate of 3.4%. In order to support radiologists in this overwhelming challenge, we develop a deep learning based algorithm that can detect, localize and quantify severity of COVID-19 manifestation from chest CT scans. The algorithm is comprised of a pipeline of image processing algorithms which includes lung segmentation, 2D slice classification and fine grain localization. In order to further understand the manifestations of the disease, we perform unsupervised clustering of abnormal slices. We present our results on a dataset comprised of 110 confirmed COVID-19 patients from Zhejiang province, China.


title: Annals On Call - Surge Modeling for COVID-19

text: [Figure: see text].


title: COVID-19 Pandemic: Experiences in China and Implications for its Prevention and Treatment Worldwide

text: The outbreak of COVID-19 due to SARS-CoV-2 originally emerged in Wuhan in December 2019. As of March 22, 2020, the disease spread to 186 countries, with at least 305,275 confirmed cases. Although there has been a decline in the spread of the disease in China, the prevalence of COVID-19 around the world remains serious despite containment efforts undertaken by national authorities and the international community. In this article, we systematically review the brief history of COVID-19 and its epidemic and clinical characteristics, highlighting the strategies used to control and prevent the disease in China, which may help other countries respond to the outbreak. This pandemic emphasizes the need to be constantly alert to shifts in both the global dynamics and the contexts of individual countries, making sure that all are aware of which approaches are successful for the prevention, containment and treatment of new diseases, and being flexible enough to adapt the responses accordingly.


title: COVID-19 Pandemic: Experiences in China and implications for its prevention and treatment worldwide

text: The outbreak of COVID-19 due to SARS-CoV-2 originally emerged in Wuhan in December, 2019. As of March 22, 2020, the disease had spread to 186 countries, with at least 305,275 confirmed cases. Although there has been a decline in the spread of the disease in China, the prevalence of COVID-19 around the world remains serious despite containment efforts undertaken by national authorities and the international community. In this article, we systematically review the brief history of COVID-19 and its epidemic and clinical characteristics, highlighting the strategies used to control and prevent the disease in China, which may help other countries respond to the outbreak. This pandemic emphasizes the need to be constantly alert to shifts in both the global dynamics and the contexts of individual countries, making sure that all are aware of which approaches are successful for the prevention, containment and treatment of new diseases, and being flexible enough to adapt the responses accordingly.


Dose Optimization of Hydroxychloroquine for COVID-19: Do Blood Concentrations Matter?


title: The Crucial Role of Nurses and Social Workers in Initiating End-of-Life Communication to Reduce Overtreatment in the Midst of the COVID-19 Pandemic

text: The large scale and rapid spread of the current COVID-19 pandemic has changed the way hospitals and other health services operate. Opportunities for patient-centered decision-making at the end of life are being jeopardized by a scarcity of health system resources. In response, the traditional doctor-initiated advanced care planning (ACP) for critical illness may also need to be readjusted. We propose nurse-led and allied health-led ACP discussions to ensure patient and family inclusion and understanding of the disease prognosis, prevention of overtreatment, and potential outcomes in crisis times. We highlight known barriers and list enablers, long-term and short-term opportunities to assist in the culture change.


Calculate the COVID-19 equation with the people's energy as key variable


title: Voluntary collective isolation as a best response to COVID-19 for indigenous populations? A case study and protocol from the Bolivian Amazon

text: Indigenous communities worldwide share common features that make them especially vulnerable to the complications of and mortality from COVID-19. They also possess resilient attributes that can be leveraged to promote prevention efforts. How can indigenous communities best mitigate potential devastating effects of COVID-19? In Bolivia, where nearly half of all citizens claim indigenous origins, no specific guidelines have been outlined for indigenous communities inhabiting native communal territories. In this Public Health article, we describe collaborative efforts, as anthropologists, physicians, tribal leaders, and local officials, to develop and implement a multiphase COVID-19 prevention and containment plan focused on voluntary collective isolation and contact-tracing among Tsimane forager-horticulturalists in the Bolivian Amazon. Phase 1 involves education, outreach, and preparation, and phase 2 focuses on containment, patient management, and quarantine. Features of this plan might be exported and adapted to local circumstances elsewhere to prevent widespread mortality in indigenous communities.


title: Hyponatremia: A Possible Immuno-Neuroendocrine Interface with COVID-19 in a Kidney Transplant Recipient

text: There is fast-emerging, cumulative clinical data on coronavirus disease 2019 (COVID-19) in kidney transplant recipients. Although respiratory tract symptoms are often the initial presentation among kidney transplant recipients who contract COVID-19, other clinical features which may indicate underlying SARS-CoV-2-related inflammation, such as gastrointestinal symptoms, are not uncommon. Hyponatremia can develop and may reflect underlying inflammation. Interferon-6 is an important pro-inflammatory cytokine involved in the pathogenesis of severe COVID-19 complications and may play a role in the inappropriately higher secretion of antidiuretic hormone leading to hyponatremia. This pathway is the so-called immuno-neuroendocrine interface. Hyponatremia in COVID-19 has been reported in a few case series of non-kidney transplant patients and only one reported kidney transplant recipient. However, the clinical course and prognostic value of hyponatremia in this population is not described in detail. We report a kidney transplant recipient who was infected with COVID-19 and exhibited severe hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion. Hyponatremia is one of the clinical presentations of COVID-19, although less common, and may occur more frequently in kidney transplant recipients. Thus the possible underlying immuno-neuroendocrine relationship related to the inflammatory process of COVID-19 leading to hyponatremia, and its prognostic value, are reviewed.


Nothing will ever be as before. Reflections on the COVID-19 epidemics by nephrologists in eleven countries


title: Haematological Cancers and the risk of severe COVID-19: Exploration and critical evaluation of the evidence to date

text: From the outset of the COVID-19 pandemic, patients and health care professionals have been concerned that a history of haematological malignancy will lead to an increased risk of severe COVID-19. This led to the UK government advising patients with blood cancers to shield, massive re-organisation of NHS haematology and cancer services, and changes in treatment plans for thousands of patients. Given the unknown effects that relaxation of social distancing measures will have on the infection rate, we review the evidence to date to see whether a history of haematological malignancy is associated with increased risk of COVID-19. Multivariable analysis of large population studies, taking other known risk factors into account do indicate that patients with haematological malignancy, especially those diagnosed recently are at increased risk of death with COVID-19 compared to the general population. The evidence that this risk is higher than for those with solid malignancies is conflicting. There is suggestive evidence from smaller cohort studies that those with myeloid malignancy may be at increased risk within the blood cancer population, but this needs to be confirmed on larger studies. Ongoing large collaborative efforts are required to gain further evidence regarding specific risk factors for severe complications of COVID-19.


COVID-19 y trombosis simultánea en dos arterias coronarias./ [COVID-19 and simultaneous thrombosis of two coronary arteries]


title: Pulmonary surfactant itself must be a strong defender against SARS-CoV-2

text: Pulmonary surfactant is considered to be one of the soaps. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the other enveloped viruses become very weak against surfactant. The SARS virus binds to angiotensin-converting enzyme (ACE2) receptor and causes pneumonia. In the lung, the ACE2 receptor sits on the top of lung cells known as alveolar epithelial type II (AE2) cells. These cells play an important role in producing surfactant. Pulmonary surfactant is believed to regulate the alveolar surface tension in mammalian lungs. To our knowledge, AE2 cells are believed to act as immunoregulatory cells; however, pulmonary surfactant itself has not been believed to act as a defender against the enveloped viruses. This study hypothesises that pulmonary surfactant may be a strong defender of enveloped viruses. Therefore, old coronaviruses merely cause pneumonia. On the contrary, new SARS-CoV-2 can suppress the production of surfactant that binds to the ACE2 of AE2 cells. The coronavirus can survive in the lung tissue because of the exhaustion of pulmonary surfactant.


title: COVID-19: a meta-analysis of diagnostic test accuracy of commercial assays registered in Brazil

text: The accuracy of commercially available tests for COVID-19 in Brazil remains unclear. We aimed to perform a meta-analysis to describe the accuracy of available tests to detect COVID-19 in Brazil. We searched at the Brazilian Health Regulatory Agency (ANVISA) online platform to describe the pooled sensitivity (Se), specificity (Sp), diagnostic odds ratio (DOR) and summary receiver operating characteristic curves (SROC) for detection of IgM/IgG antibodies and for tests using naso/oropharyngeal swabs in the random-effects models. We identified 16 tests registered, mostly rapid-tests. Pooled diagnostic accuracy measures [95%CI] were: (i) for IgM antibodies Se=82% [76-87]; Sp=97% [96-98]; DOR=168 [92-305] and SROC=0.98 [0.96-0.99]; (ii) for IgG antibodies Se=97% [90-99]; Sp=98% [97-99]; DOR=1994 [385-10334] and SROC=0.99 [0.98-1.00]; and (iii) for detection of SARS-CoV-2 by antigen or molecular assays in naso/oropharyngeal swabs Se=97% [85-99]; Sp=99% [77-100]; DOR=2649 [30-233056] and SROC=0.99 [0.98-1.00]. These tests can be helpful for emergency testing during the COVID-19 pandemic in Brazil. However, it is important to highlight the high rate of false negative results from tests which detect SARS-CoV-2 IgM antibodies in the initial course of the disease and the scarce evidence-based validation results published in Brazil. Future studies addressing the diagnostic performance of tests for COVID-19 in the Brazilian population are urgently needed.


title: Physical health among people with serious mental illness in the face of COVID-19: Concerns and mitigation strategies

text: COVID-19 can worsen the physical health of individuals with serious mental illness, a vulnerable group already facing physical health disparities. COVID-19 is further reducing access to physical health care due to shutdown of services deemed "non-urgent" and overcrowding of emergency services. Management of chronic diseases, highly prevalent in this group, is undermined due to exacerbation of psychiatric disorders, reduction in availability of social support, and worsening of negative social determinants of health. In this commentary, we discuss the challenges experienced by this group and offer mitigation strategies to reduce: (1) inequalities in access to physical health care; and (2) disruptions to the management of chronic physical conditions in the face of COVID-19. Recommendations include coordinated efforts by health authorities, primary and mental health care organizations, researchers, policymakers, and other stakeholders. These efforts should ensure equitable access to physical health care and implementation of innovative programs to protect the physical health of people with serious mental illness during and following the pandemic.


title: [Application of Reyanning Mixture in evaluating combining disease with syndrome of human coronavirus pneumonia with pestilence attacking lung syndrome]

text: In the previous research, our laboratory established a mouse model combining disease with syndrome of human coronavi-rus pneumonia with pestilence attacking the lung syndrome, based on the national traditional Chinese medicine clinical classification of Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Plan. In this study, a mouse model combining disease with syndrome of human coronavirus pneumonia with pestilence attacking the lung syndrome was used to evaluate the effectiveness of Reyanning Mixture to provide animal experimental support for clinical application. Mice were divided into normal group, 229 E infection group, cold-dampness group, cold-dampness+229 E infection group(the model group), Reyanning high and low dose groups. The cold-dampness group, cold-dampness+229 E infection group, two Reyanning groups were given cold and damp stimulation for 7 days. On the 5 th day, the 229 E infection group, cold-dampness+229 E infection group, and two Reyanning groups were infected with HCoV-229 E virus. Reyanning was administered for 3 days, starting from the day of infection. Blood was collected on the 4 th day and the lung tissue was dissected to calculate the lung index and inhibition rate; flow cytometry was used to detect the percentage of T and B lymphocytes in peripheral blood; RT-PCR was used to detect the nucleic acid virus load in lung tissue; ELISA was used to detect motilin and gastrin in serum, and inflammatory factors TNF-α, IFN-Î³, IL-6, IL-10 in lung tissue proteins. Reyanning Mixture could reduce the lung index(P<0.01) of coronavirus pneumonia mice with pestilence attacking the lung; it could significantly increase the percentage of CD8~+ T lymphocytes and CD4~+ T lymphocytes in peripheral blood of model mice(P<0.05, P<0.01). The low dose of Reyanning could effectively increase the percentage of total B lymphocytes(P<0.05), reduce virus load in lung tissue of model mice(P<0.01), reduce the levels of TNF-α, IFN-Î³, IL-6, IL-10 in the lung tissue of model mice(P<0.01), reduce the content of motilin in the serum of model mice(P<0.01). Reyanning Mixture convey a better effect in treating coronavirus pneumonia mice with pestilence attacking the lung. It manifested obvious effects in improving lung lesions, enhancing the gastrointestinal function of mice, improving the autoimmune function of mice, and reducing the expression of inflammatory factors in vivo, which could provide evidences for clinical research.


title: Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations

text: Coronavirus disease 2019 (COVID-19) has had a significant impact on global healthcare services. In an attempt to limit the spread of infection and to preserve healthcare resources, one commonly used strategy has been to postpone elective surgery, whilst maintaining the provision of anaesthetic care for urgent and emergency surgery. General anaesthesia with airway intervention leads to aerosol generation, which increases the risk of COVID-19 contamination in operating rooms and significantly exposes the healthcare teams to COVID-19 infection during both tracheal intubation and extubation. Therefore, the provision of regional anaesthesia may be key during this pandemic, as it may reduce the need for general anaesthesia and the associated risk from aerosol-generating procedures. However, guidelines on the safe performance of regional anaesthesia in light of the COVID-19 pandemic are limited. The goal of this review is to provide up-to-date, evidence-based recommendations or expert opinion when evidence is limited, for performing regional anaesthesia procedures in patients with suspected or confirmed COVID-19 infection. These recommendations focus on seven specific domains including: planning of resources and staffing; modifying the clinical environment; preparing equipment, supplies and drugs; selecting appropriate personal protective equipment; providing adequate oxygen therapy; assessing for and safely performing regional anaesthesia procedures; and monitoring during the conduct of anaesthesia and post-anaesthetic care. Implicit in these recommendations is preserving patient safety whilst protecting healthcare providers from possible exposure.


title: Coronavirus3D: 3D structural visualization of COVID-19 genomic divergence

text: MOTIVATION: As the COVID-19 pandemics is spreading around the world, the SARS-CoV-2 virus is evolving with mutations that potentially change and fine-tune functions of the proteins coded in its genome. RESULTS: Coronavirus3D website integrates data on the SARS-CoV-2 virus mutations with information about 3D structures of its proteins, allowing users to visually analyze the mutations in their 3D context. AVAILABILITY: Coronavirus3D server is freely available at https://coronavirus3d.org.


title: Opioid Use Disorder and COVID-19: Crashing of the Crises

text: : The COVID19 crisis has created many additional challenges for patients with opioid use disorder, including those seeking treatment with medications for OUD. Some of these challenges include closure of substance use treatment clinics, focus of emergency departments on COVID-19 patients, social distancing and shelter in place orders affecting mental health, bystander overdose rescue, threats to income and supply of substances for people who use drugs. While the initial changes in regulation allowing buprenorphine prescribing by telehealth are welcomed by providers and patients, many additional innovations are required to ensure that additional vulnerabilities and hurdles created by this pandemic scenario do not further fan the flames of the opioid epidemic.


title: COVID-19 and picotechnology: Potential opportunities

text: Humanity's challenges are becoming increasingly difficult, and as these challenges become more advanced, the need for effective and intelligent action becomes more apparent. Meanwhile, the novel coronavirus disease (COVID-19) pandemic, which has plagued the world, could be considered as an opportunity to take a step toward the need for atomic engineering, compared to molecular engineering, as well as to accelerate this type of research. This approach, which can be expressed in terms of picotechnology, makes it possible to identify living cell types or in general, chemical and biological surfaces using their atomic arrays, and applied for early diagnosis even treatment of the disease.


title: New Biophysical Approaches Reveal the Dynamics and Mechanics of Type I Viral Fusion Machinery and Their Interplay with Membranes

text: Protein-mediated membrane fusion is a highly regulated biological process essential for cellular and organismal functions and infection by enveloped viruses. During viral entry the membrane fusion reaction is catalyzed by specialized protein machinery on the viral surface. These viral fusion proteins undergo a series of dramatic structural changes during membrane fusion where they engage, remodel, and ultimately fuse with the host membrane. The structural and dynamic nature of these conformational changes and their impact on the membranes have long-eluded characterization. Recent advances in structural and biophysical methodologies have enabled researchers to directly observe viral fusion proteins as they carry out their functions during membrane fusion. Here we review the structure and function of type I viral fusion proteins and mechanisms of protein-mediated membrane fusion. We highlight how recent technological advances and new biophysical approaches are providing unprecedented new insight into the membrane fusion reaction.


title: A Human Support Robot for the Cleaning and Maintenance of Door Handles Using a Deep-Learning Framework

text: The role of mobile robots for cleaning and sanitation purposes is increasing worldwide. Disinfection and hygiene are two integral parts of any safe indoor environment, and these factors become more critical in COVID-19-like pandemic situations. Door handles are highly sensitive contact points that are prone to be contamination. Automation of the door-handle cleaning task is not only important for ensuring safety, but also to improve efficiency. This work proposes an AI-enabled framework for automating cleaning tasks through a Human Support Robot (HSR). The overall cleaning process involves mobile base motion, door-handle detection, and control of the HSR manipulator for the completion of the cleaning tasks. The detection part exploits a deep-learning technique to classify the image space, and provides a set of coordinates for the robot. The cooperative control between the spraying and wiping is developed in the Robotic Operating System. The control module uses the information obtained from the detection module to generate a task/operational space for the robot, along with evaluating the desired position to actuate the manipulators. The complete strategy is validated through numerical simulations, and experiments on a Toyota HSR platform.


title: Gynecological prevention and control model based on ward rearrangement and zoning management in pandemic period of COVID-19

text: By 25th April 2020, the outbreak of COVID-19 caused 2719897 confirmed cases and 187705 deaths globally, remarkably more than Severe Acute Respiratory Syndrome (SARS) (8273 cases, 775 deaths) and Middle East Respiratory Syndrome (MERS) (1139 cases, 431 deaths) in 2003 and 2013, respectively. Gynecology is a specialty department with a large number of critical and severe patients. Consequently, it is of preeminent importance to formulate the in-patient management process. Rearranging the gynecological wards and managing ward partition, as well as the medical protection measures in specialized areas, are suitable for the current prevention and control for COVID-19 pandemic and the therapeutic requirements of patients. To effectively minimize nosocomial infections during the COVID- 19 pandemic period, our department implemented a novel prevention strategy based on the ward redesign and partition management. With this model, our department effectively protected the safety and health of patients and medical care staff from cross and nosocomial infection in the hospital. Now we would like to share the experience and strategies we implemented as following.


title: Guidance on Minimizing Risk of Drug-Induced Ventricular Arrhythmia During Treatment of COVID-19: A Statement from the Canadian Heart Rhythm Society

text: The COVID-19 pandemic has led to efforts at rapid investigation and application of drugs which may improve prognosis but for which safety and efficacy are not yet established. This document attempts to provide reasonable guidance for the use of antimicrobials which have uncertain benefit but may increase risk of QT interval prolongation and ventricular proarrhythmia, notably, chloroquine, hydroxychloroquine, azithromycin, and lopinavir/ritonavir. During the pandemic, efforts to reduce spread and minimize effects on health care resources mandate minimization of unnecessary medical procedures and testing. We recommend that the risk of drug proarrhythmia be minimized by 1) discontinuing unnecessary medications that may also increase the QT interval, 2) identifying outpatients who are likely to be at low risk and do not need further testing (no history of prolonged QT interval, unexplained syncope, or family history of premature sudden cardiac death, no medications that may prolong the QT interval, and/or a previous known normal corrected QT interval [QTc]), and 3) performing baseline testing in hospitalized patients or those who may be at higher risk. If baseline electrocardiographic testing reveals a moderately prolonged QTc, optimization of medications and electrolytes may permit therapy. If the QTc is markedly prolonged, drugs that further prolong it should be avoided, or expert consultation may permit administration with mitigating precautions. These recommendations are made while there are no known effective treatments for COVID-19 and should be revisited when further data on efficacy and safety become available.


title: Entwicklung und Implementierung eines Betriebskonzeptes in einer Universitätsaugenklinik im Rahmen der SARS-CoV-2-Pandemie./ [Development and implementation of an operational concept in a university eye hospital in the SARS-CoV-2 pandemic]

text: The SARS-CoV2 pandemic poses major challenges for the entire medical care system. Especially in maximum care clinical facilities, a higher exposure to potentially infectious patients or positively tested COVID-19 patients is to be expected. A hospital facility concept was developed in the Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany with the aim of achieving maximum patient safety with maximum employee protection. The current infection control hygiene recommendations of the Robert Koch Institute (RKI), the leading specialist association, were taken into consideration along with the existing hospital hygiene plan of the University Hospital Frankfurt am Main. Incorporated into the developmental process were the Institute for Medical Microbiology and Hospital Hygiene, the occupational medical service department and the board of the University Hospital Frankfurt am Main. The operational concept with individualized measures ensures that (i) the care of outpatients; (ii) the performance of outpatient operations; (iii) and the care of admitted patients and patients undergoing surgery are also guaranteed during the COVID-19 pandemic. All measures have been documented in writing in the clinic's internal quality manual and are thus accessible to all employees. The concept is regularly checked for functionality, so-called stress tests and hygiene inspections are carried out and improvements are made as necessary.


Patient and public involvement in the post COVID era


title: The consequences of COVID-19 for gastroenterology nursing

text: Jennie Burch, Head of Gastrointestinal Nurse Education, St Mark's Hospital, London (jburch1@nhs.net), discusses the ramifications of coronavirus and the guidelines available to professionals working in gastroenterology.


title: On the airborne aspect of COVID-19 coronovirus

text: It is a widely accepted view that COVID 19 is either transmitted via surface contamination or via close contact of an un-infected person with an infected person. Surface contamination usually happens when infected water droplets from exhalation/sneeze/cough of COVID sick person settle on nearby surfaces. To curb this, social distancing and good hand hygiene advise is advocated by World health Organization (WHO). We argue that COVID 19 coronovirus can also be airborne in a puff cloud loaded with infected droplets generated by COVID sick person. An elementary calculation shows that a $5~\mu m$ respiratory infected droplet can remain suspended for about 9.0 minutes and a $2~\mu m$ droplet can remain suspended for about an hour! And social distancing advise of 3 feet by WHO and 6 feet by CDC (Centers for Disease Control and Prevention) may not be sufficient in some circumstances as discussed in the text.


title: Impact of intracellular hemin on N-type inactivation of voltage-gated K+ channels

text: N-type inactivation of voltage-gated K+ channels is conferred by the N-terminal "ball" domains of select pore-forming α subunits or of auxiliary ß subunits, and influences electrical cellular excitability. Here, we show that hemin impairs inactivation of K+ channels formed by Kv3.4 α subunits as well as that induced by the subunits Kvß1.1, Kvß1.2, and Kvß3.1 when coexpressed with α subunits of the Kv1 subfamily. In Kvß1.1, hemin interacts with cysteine and histidine residues in the N terminus (C7 and H10) with high affinity (EC50 100 nM). Similarly, rapid inactivation of Kv4.2 channels induced by the dipeptidyl peptidase-like protein DPP6a is also sensitive to hemin, and the DPP6a mutation C13S eliminates this dependence. The results suggest a common mechanism for a dynamic regulation of Kv channel inactivation by heme/hemin in N-terminal ball domains of Kv α and auxiliary ß subunits. Free intracellular heme therefore has the potential to regulate cellular excitability via modulation of Kv channel inactivation.


title: Cardiac injuries in patients with coronavirus disease 2019: Not to be ignored

text: OBJECTIVE: To describe the clinical features of coronavirus disease 2019 (COVID-19). METHODS: We recruited 73 patients with COVID-19 [49 men and 24 women; average age: 58.36 years (SD: 14.31)] admitted to the intensive care unit of Wuhan Jinyintan Hospital from December 30, 2019 to February 16, 2020. Demographics, underlying diseases, and laboratory test results on admission were collected and analyzed. Data were compared between survivors and non-survivors. RESULTS: The non-survivors were older (65.46 [SD 9.74]vs 46.23 [12.01]) and were more likely to have chronic medical illnesses. Non-survivors tend to develop more severe lymphopenia, with higher C-reactive protein, interleukin-6, D-dimer, and hs-Troponin I(hs-TnI) levels. Patients with elevated hs-TnI levels on admission had shorter duration from symptom onset to death. Increased hs-TnI level was related to dismal prognosis. Death risk increased by 20.8% when the hs-TnI level increased by one unit. After adjusting for inflammatory or coagulation index, the independent predictive relationship between hs-TnI and death disappeared. CONCLUSIONS: Cardiac injury may occur at the early stage of COVID-19, which is associated with high mortality. Inflammatory factor cascade and coagulation abnormality may be the potential mechanisms of COVID-19 combined with cardiac injury.


At the heart of COVID-19


title: A model of underground ridership during the severe outbreaks of the SARS epidemic in a modern city

text: The outbreaks of the severe acute respiratory syndrome (SARS) epidemic in 2003 resulted in unprecedented impacts on people's daily life. One of the most significant impacts to people is the risk of contacting SARS while engaging daily routine activity. In this work we use data from daily underground ridership in Taipei and daily reported SARS cases in Taiwan to model the dynamics of the public underground usage during the wax and wane of the SARS period. We found that for each reported SARS case there is an immediate loss of about 1200 underground ridership. These loss rates propagate to the following days with an e-folding decay time of about 28 days, reflecting the public perception on the risk of contacting SARS disease when travelling with the underground system. About 50% of daily ridership was lost during the peak of the 2003 SARS period, compared with the loss of 80% daily ridership during the closure of the underground system after Typhoon Nari, the loss of 50-70% ridership due to the closure of the governmental offices and schools during typhoon periods, and the loss of 60% daily ridership during Chinese New Year holidays.


title: Together we stand: Suicide risk and suicide prevention among Israeli older adults during and after the COVID-19 world crisis

text: The outbreak of COVID-19 has increased potential risks for depression and suicide among older adults. In this paper, we discuss the specific risk factors and current status of older adults in Israel in light of the COVID-19 crisis. Following that, we suggest establishing relevant and effective measures for suicide assessment, intervention, and prevention to avert experiences of loneliness, thwarted belongingness, and perceived burdensomeness and thus prevent suicides during and after the crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the Central Nervous System

text: Emerging evidence indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), can cause neurological complications. We provide a brief overview of these recent observations and discuss some of their possible implications. In particular, given the global dimension of the current pandemic, we highlight the need to consider the possible long-term impact of COVID-19, potentially including neurological and neurodegenerative disorders.


What is the role of rheumatologists in the era of COVID-19?


Asynchronous teledermatology in medical education: Lessons from the COVID-19 pandemic


title: Development of an inactivated vaccine candidate for SARS-CoV-2

text: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in an unprecedented public health crisis. Because of the novelty of the virus, there are currently no SARS-CoV-2-specific treatments or vaccines available. Therefore, rapid development of effective vaccines against SARS-CoV-2 are urgently needed. Here, we developed a pilot-scale production of PiCoVacc, a purified inactivated SARS-CoV-2 virus vaccine candidate, which induced SARS-CoV-2-specific neutralizing antibodies in mice, rats, and nonhuman primates. These antibodies neutralized 10 representative SARS-CoV-2 strains, suggesting a possible broader neutralizing ability against other strains. Three immunizations using two different doses, 3 or 6 micrograms per dose, provided partial or complete protection in macaques against SARS-CoV-2 challenge, respectively, without observable antibody-dependent enhancement of infection. These data support the clinical development and testing of PiCoVacc for use in humans.


title: Examining the Impact of COVID-19 Lockdown in Wuhan and Lombardy: A Psycholinguistic Analysis on Weibo and Twitter

text: Many countries are taking strict quarantine policies to prevent the rapid spread of COVID-19 (Corona Virus Disease 2019) around the world, such as city lockdown. Cities in China and Italy were locked down in the early stage of the pandemic. The present study aims to examine and compare the impact of COVID-19 lockdown on individuals' psychological states in China and Italy. We achieved the aim by (1) sampling Weibo users (geo-location = Wuhan, China) and Twitter users (geo-location = Lombardy, Italy); (2) fetching all the users' published posts two weeks before and after the lockdown in each region (e.g., the lockdown date of Wuhan was 23 January 2020); (3) extracting the psycholinguistic features of these posts using the Simplified Chinese and Italian version of Language Inquiry and Word Count (LIWC) dictionary; and (4) conducting Wilcoxon tests to examine the changes in the psycholinguistic characteristics of the posts before and after the lockdown in Wuhan and Lombardy, respectively. Results showed that individuals focused more on "home", and expressed a higher level of cognitive process after a lockdown in both Wuhan and Lombardy. Meanwhile, the level of stress decreased, and the attention to leisure increased in Lombardy after the lockdown. The attention to group, religion, and emotions became more prevalent in Wuhan after the lockdown. Findings provide decision-makers timely evidence on public reactions and the impacts on psychological states in the COVID-19 context, and have implications for evidence-based mental health interventions in two countries.


Pakistan's Combat and Comeback Against COVID-19


Heart Failure in the COVID-19 Pandemic: Where Has All New York's Congestion Gone?


Nurses responding to the World Health Organization (WHO) priority for emergency care systems for universal health coverage


title: COSRE: Community Exposure Risk Estimator for the COVID-19 Pandemic

text: Due to the complexities of virus genotypes and the stochastic contacts in human society, it is a big challenge to estimate the potential risks of getting exposed to a widely spreading virus. To allow the public to be aware of the exposure risks in their daily activities, we proposed a birthday-paradox-based probability model and implement it into a web-based system named COSRE for estimating community exposure risks of public gathering during a pandemic. The exposure risk means the probability of people meeting potential COVID hosts in public places like grocery stores, gyms, libraries, restaurants, coffee shops, office suits, etc. The model has three inputs: the real-time potential active patients, the population in local communities, and the customer counts in the room. With COSRE, people can explore the possible impacts of the pandemic by doing spatiotemporal analysis, e.g., moving through time and testing a different number of people to see the changes of risks as the pandemic unfolds. The system has the potential to advance our ability to know the accurate exposure risks in various communities and allow us to make plans with improved preparedness and precise responses for the pandemic. We use spatial analysis tools and drew the county-level exposure risks of the United States from April 1 to May 15. The experiment shows that the estimation model is very promising to assist people to be more specifically precise about their safety control in daily routine and social lives and help businesses to dynamically adjust their COVID-19 policies to accelerate their recovery.


title: Coronavirus disease (COVID-19) in a paucisymptomatic patient: epidemiological and clinical challenge in settings with limited community transmission, Italy, February 2020

text: Data concerning the transmission of the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in paucisymptomatic patients are lacking. We report an Italian paucisymptomatic case of coronavirus disease 2019 with multiple biological samples positive for SARS-CoV-2. This case was detected using the World Health Organization protocol on cases and contact investigation. Current discharge criteria and the impact of extra-pulmonary SARS-CoV-2 samples are discussed.


title: Breast radiotherapy under COVID-19 pandemic resource constraints -- approaches to defer or shorten treatment from a Comprehensive Cancer Center in the United States

text: Introduction: Breast radiotherapy accounts for a significant proportion of patient volume in contemporary radiation oncology practice. In the setting of anticipated resource constraints and widespread community infection with SARS-CoV-2 during the COVID-19 pandemic, measures for balancing both infectious and oncologic risk among patients and providers must be carefully considered. Here, we present evidence-based guidelines for omitting or abbreviating breast cancer radiotherapy, where appropriate, in an effort to mitigate risk to patients and optimize resource utilization. Methods: Multidisciplinary breast cancer experts at a high-volume comprehensive cancer center convened contingency planning meetings over the early days of the COVID-19 pandemic to review the relevant literature and establish recommendations for the application of hypofractionated and abbreviated breast radiation regimens. Results: Substantial evidence exists to support omitting radiation among certain favorable risk subgroups of breast cancer patients and for abbreviating or accelerating regimens among others. For those who require either whole-breast or post-mastectomy radiation, with or without coverage of the regional lymph nodes, a growing body of literature supports various hypofractionated approaches that appear safe and effective. Conclusion: In the setting of a public health emergency with the potential to strain critical healthcare resources and place patients at infection risk, the parsimonious application of breast radiotherapy may alleviate a significant clinical burden without compromising long term oncologic outcomes. The judicious and personalized use of immature study data may be warranted in the setting of a competing mortality risk from this widespread pandemic.


The COVID-19 Pandemic Is a Battle Against Disease, Fear, and Misinformation


title: Endocrine significance of SARS-CoV-2's reliance on ACE2

text: The current COVID-19 pandemic is the most disruptive event in the last 50 years with global impact on healthcare and world economies. It is caused by SARS-CoV-2, a coronavirus that uses angiotensin converting enzyme 2 (ACE2), as an entry point to the cells. ACE2 is a transmembrane carboxypeptidase and member of the renin-angiotensin system. This mini-review, summarizes the main findings regarding ACE2 expression and function in endocrine tissues. We discuss rapidly evolving knowledge on the potential role of ACE2 and SARS coronaviruses in endocrinology and the development of diabetes mellitus, hypogonadism, pituitary and thyroid diseases.


title: The possible of immunotherapy for COVID-19: A systematic review

text: The novel coronavirus (2019-nCoV) is an emerging pathogen that was first described in late December 2019 and causes a severe respiratory infection in humans. Since the outbreak of COVID-19, international attention has raised to develop treatment and control options such as types of immunotherapies. The immunotherapy is an effective method for fighting against similar viral infections such as SARS-CoV, and MERS-CoV. These methods include several types of vaccines, monoclonal antibody candidates, and etc. This systematic review article was designed to evaluate the existing evidence and experience related to immunotherapy for 2019-nCoV. Web of Science (ISI), PubMed, and Scopus databases were used to search for suitable keywords such as 2019-nCoV, novel coronavirus, Immunotherapy, interleukin, vaccine and the related words for relevant publications up to 24.3.2020. The present systematic review was performed based on PRISMA protocol. Data extraction and quality valuation of articles were performed by two reviewers. 51 articles were the results of the search and based on the inclusions and exclusions criteria, 7 articles were included in the final review. As a conclusion of these studies demonstratedthat although no serious research has been done on this subject at the time of writing this article, similar studies on the related viruses showed notable results. So immunotherapy for this virus can also be a suitable option.


The coronavirus disease 2019 pandemic: telemedicine in elderly patients with type 2 diabetes


AIDS Activism and Coronavirus Vaccine Challenge Trials


COVID-19 in Cameroon: a crucial equation to resolve


Statin therapy in COVID-19 infection: much more than a single pathway


title: Amantadine Treatment for People with COVID-19

text: SARS-Cov-2, whose symptoms include difficulty swallowing, coughing, diarrhea, and breathing failure, has caused the loss of many lives around the world. In the absence of a vaccine or medication to help prevent or decrease the effects of the disease, we suggest that amantadine may reduce the effects of COVID-19.


title: Follow-up studies in COVID-19 recovered patients - is it mandatory?

text: The novel Coronavirus disease 2019 (COVID-19) is an illness caused due to Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The World Health Organization (WHO) has declared this outbreak a global health emergency and as on April 24, 2020, it has spread to 213 countries, with 25,91,015 confirmed cases and 742,855 cases have been recovered from COVID-19. In this dreadful situation our team has already published an article in the Science of the Total Environment, which elaborates the various aspects of the SARS-CoV-2 infection. In this situation, it is imperative to understand the possible outcome of COVID-19 recovered patients and determine if they have any other detrimental illnesses by longitudinal analysis to safeguard their life in future. It is necessary to follow-up these recovered patients and performs comprehensive assessments for detection and appropriate management towards their psychological, physical, and social realm. This urges us to suggest that it is highly important to provide counselling, moral support as well as a few recommended guidelines to the recovered patients and society to restore to normalcy. Epidemiological, clinical and immunological studies from COVID-19 recovered patients are particularly important to understand the disease and to prepare better for potential outbreaks in the future. Longitudinal studies on a larger cohort would help us to understand the in-depth prognosis as well as the pathogenesis of COVID-19. Also, follow-up studies will help us provide more information for the development of vaccines and drugs for these kinds of pandemics in the future. Hence, we recommend more studies are required to unravel the possible mechanism of COVID-19 infection and the after-effects of it to understand the characteristics of the virus and to develop the necessary precautionary measures to prevent it.


title: Epidemiology of COVID-19 in an Urban Dialysis Center

text: BACKGROUND: During the coronavirus disease 2019 (COVID-19) epidemic, many countries have instituted population-wide measures for social distancing. The requirement of patients on dialysis for regular treatment in settings typically not conducive to social distancing may increase their vulnerability to COVID-19. METHODS: Over a 6-week period, we recorded new COVID-19 infections and outcomes for all adult patients receiving dialysis in a large dialysis center. Rapidly introduced control measures included a two-stage routine screening process at dialysis entry (temperature and symptom check, with possible cases segregated within the unit and tested for SARS-CoV-2), isolated dialysis in a separate unit for patients with infection, and universal precautions that included masks for dialysis nursing staff. RESULTS: Of 1530 patients (median age 66 years; 58.2% men) receiving dialysis, 300 (19.6%) developed COVID-19 infection, creating a large demand for isolated outpatient dialysis and inpatient beds. An analysis that included 1219 patients attending satellite dialysis clinics found that older age was a risk factor for infection. COVID-19 infection was substantially more likely to occur among patients on in-center dialysis compared with those dialyzing at home. We observed clustering in specific units and on specific shifts, with possible implications for aspects of service design, and high rates of nursing staff illness. A predictive epidemic model estimated a reproduction number of 2.2; cumulative cases deviated favorably from the model from the fourth week, suggesting that the implemented measures controlled transmission. CONCLUSIONS: The COVID-19 epidemic affected a large proportion of patients at this dialysis center, creating service pressures exacerbated by nursing staff illness. Details of the control strategy and characteristics of this epidemic may be useful for dialysis providers and other institutions providing patient care.


title: Environmental contamination by SARS-CoV-2 of an imported case during incubation period

text: We collected environmental surface samples prior to and after disinfection of a quarantine room to evaluate the stability of SARS-CoV-2 during the incubation period of an imported case traveling to Qingdao, China. Overall, 11 of 23 (47.8%) of the first batch of environmental surface samples (within 4 h after case confirmation) were tested positive for SARS-CoV-2. Whereas only 2 of 23 (8.7%) of the second batch of environmental samples (after first disinfection) were tested positive for SARS-CoV-2. The majority of samples from the bedroom (70%) were positive for SARS-CoV-2, followed by 50% of samples from the bathroom and that of 33% from the corridor. The inner walls of toilet bowl and sewer inlet were the most contaminated sites with the highest viral loads. SARS-CoV-2 was widely distributed on object surfaces in a quarantine room of a later diagnosed COVID-19 case during the incubation period. Proper disinfection is crucial to minimize community transmission of this highly contagious virus.


title: Atmospheric CO$_2$ and total electricity production before and during the nation-wide restriction of activities as a consequence of the COVID-19 pandemic

text: In this paper, we analysed real-time measurements of atmospheric CO$_2$ with total electricity production and nation-wide restrictions phases due to the novel coronavirus COVID-19 pandemic, and its effects on atmospheric CO$_2$ concentrations. A decline of 3.7% in the global energy demand at about 150 million tonnes of oil equivalent (Mtoe) in the first quarter (Q1), of 2020 was recorded, as compared to the same first quarter (Q1), of 2019, due to the cutback on global economic activities. Our results showed that: 1) electricity production for the same period in the years 2018, 2019, and 2020, shrunk at an offset of about 9.20%, which resulted in the modest reduction of about (-1.79%), in the atmospheric CO$_2$, to that of 2017-2018 CO$_2$ level; 2) a non-seasonal abrupt; but brief, atmospheric CO$_2$ decrease by about 0.85% in mid-February 2020, could be due to the Phase 1 movement restrictions in China. The results showed that, the reduction in electricity production is significant to the short-term variability of atmospheric CO$_2$. It also highlights the significant contributions from China to the atmospheric CO$_2$, which suggests that, without the national restriction of activities, CO$_2$ concentration are set to exceed 2019 by 1.79%, but it quickly decreased due to the lockdown, and sustained the reduction for two consecutive months. The results underscore the atmospheric CO$_2$ reductions on the monthly time scale that can be achieved, if electricity production from combustible sources were slashed, which could be useful for cost-benefit analyses of the reduction in electricity production from combustible sources, and the impact of these reduction to the atmospheric CO$_2$.


Student mental health in the midst of the COVID-19 pandemic: A call for further research and immediate solutions


title: Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: an early report on the Italian general population

text: The outbreak of COVID-19 is severely affecting mental health worldwide, although individual response may vary. This study aims to investigate the psychological distress perceived by the Italian general population during the early phase of the COVID-19 pandemic, and to analyze affective temperament and adult attachment styles as potential mediators. Through an online survey, we collected sociodemographic and lockdown-related information and evaluated distress, temperament, and attachment using the Kessler 10 Psychological Distress Scale (K10), the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire short version (TEMPS-A) and the Attachment Style Questionnaire (ASQ). In our sample (n = 500), 62% of the individuals reported no likelihood of psychological distress, whereas 19.4% and 18.6% displayed mild and moderate-to-severe likelihood. Cyclothymic (OR: 1.24; p < 0.001), depressive (OR: 1.52; p < 0.001) and anxious (OR: 1.58; p = 0.002) temperaments, and the ASQ "Need for approval" (OR: 1.08; p = 0.01) were risk factors for moderate-to-severe psychological distress compared to no distress, while the ASQ "Confidence" (OR: 0.89; p = 0.002) and "Discomfort with closeness" were protective (OR: 0.92; p = 0.001). Cyclothymic (OR: 1.17; p = 0.008) and depressive (OR: 1.32; p = 0.003) temperaments resulted as risk factors in subjects with moderate-to-severe psychological distress compared to mild distress, while the ASQ "Confidence" (OR: 0.92; p = 0.039) and "Discomfort with closeness" (OR: 0.94; p = 0.023) were protective. Our data indicated that a relevant rate of individuals may have experienced psychological distress following the COVID-19 outbreak. Specific affective temperament and attachment features predict the extent of mental health burden. To the best of our knowledge, these are the first data available on the psychological impact of the early phase of the COVID-19 pandemic on a sizeable sample of the Italian population. Moreover, our study is the first to investigate temperament and attachment characteristics in the psychological response to the ongoing pandemic. Our results provide further insight into developing targeted intervention strategies.


Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines: Setting Expectations Appropriately


title: No infectious risk of COVID-19 patients with long-term fecal 2019-nCoV nucleic acid positive

text: OBJECTIVE: It has recently been reported that some COVID-19 patients have long-term positive fecal nucleic acid after discharging from the hospital with negative nucleic acid in the respiratory tract, but it is unclear whether COVID-19 patients with positive long-term fecal nucleic acid tests have the risk of self-infection. PATIENTS AND METHODS: From January 25, 2020 to March 9, 2020, 5 COVID-19 patients with negative respiratory tract nucleic acid and positive fecal nucleic acid were observed and studied to explore whether these patients can re-infect themselves. Five patients with COVID-19 accompanied by diarrhea as the main gastrointestinal symptoms were carefully observed through clinical symptoms, imaging and other auxiliary examinations. The RT-PCR technology was used to continuously detect fecal and respiratory viral nucleic acids. The IgM antibody was detected on the 7th day of admission and IgM/IgG at the time of discharge. RESULTS: All 5 patients had symptoms of fever and diarrhea upon admission. The fecal nucleic acid was positive, as well as the throat swab was positive. All COVID-19 patients had positive IgM antibodies on the 7th day of admission and positive IgM and IgG at the time of discharge, and there were no abnormalities in the gastrointestinal examination on discharge. All 5 fecal nucleic acid tests were positive at the time of discharge. After continuous dynamic follow-up for 3-15 days, no clinical symptoms recurred, and the last nucleic acid test was negative. CONCLUSIONS: There is no risk of self-infection for COVID-19 patients with long-term 2019-nCoV nucleic acid positive in feces.


title: On the crucial role of multilingual biomedical databases in epidemic events (SARS-CoV-2 analysis)

text: The need for multilingual biomedical databases was already pointed out by different authors. They argue about the need for making translations available in other languages and centralized access to regional databases and that one should not disregard citations in other languages. This fact could not be any more real in the current situation regarding the novel coronavirus. When considering treatment, diagnosis and prevention, around 44% of the articles in PubMed were written in Chinese. This prompts the urgent need for quality automatic translation to make such extremely valuable information available to medical personnel in as many languages as possible. We also point out that the community should also make efforts to guarantee editorial quality and to follow the best practices in editing and publishing. This is of critical importance as well, such that the content is properly scrutinized before being published.


Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19


title: Using the Coronavirus Pandemic as an Opportunity to Address the Use of Human Milk and Breastfeeding as Lifesaving Medical Interventions

text: Health care providers should use this current pandemic as an opportunity educate the public about the importance of human milk and breastfeeding as lifesaving medical interventions.


Excess mortality in men and women in Massachusetts during the COVID-19 pandemic


title: [The impact of Covid-19 pandemic on breastfeeding and birth care. The importance of recovering good practices.]

text: The SARS-CoV-2 pandemic has had a major impact on birth care and lactation The lack of knowledge regarding the transmission mechanisms and the potential risks for the mother and the newborn, even when the vertical transmission of the virus has not been demonstrated, has led to the abandonment of practices such as skin-to-skin and the early initiation of breastfeeding (BF), which offer great benefits for maternal and child health Taking into account the available scientific evidence and the protective effect of BF, the World Health Organization (WHO), and other organisms recommend, in cases of suspected or confirmed SARS-CoV-2 infection of the mother, maintaining mother-child contact and BF, adopting preventive measure procedures to minimize the risk of contagion These measures include hand hygiene, before and after contact with the newborn and the use of a mask If a temporary separation of mother and child is required, it is recommended to feed the newborn with expressed breast milk The presence of IgA antibodies against SARS-CoV-2 has been confirmed in the milk of infected women, so BF could reduce the clinical impact of the disease in the infant, if it becomes infected


The impact of COVID-19 pandemic on ophthalmological emergency department visits


Community Health Workers: The Authors Reply


The Myriad Ways in Which COVID-19 Revealed Character


AMD Management During the COVID-19 Pandemic


title: Negligence, trauma and nervous shock

text: Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers whether nurses who have suffered psychological trauma because of the negligent handling of the COVID-19 outbreak can claim compensation.


title: Special report: Prevalence of selected underlying health conditions among active component Army service members with coronavirus disease 2019, 11 February-6 April 2020

text: The novel coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) is exhibiting widespread community transmission throughout most of the world. Previous reports have evaluated the risk of serious illness in civilians diagnosed with COVID-19; however, similar reports have not been compiled for the Army active component (AC) population. COVID-19 has been a reportable condition for the Department of Defense since 5 February 2020, and, as of the morning of 6 April, a total of 873 cases were reported to the Disease Reporting System internet from Army installations. Of these cases, a total of 219 (25.1%) were identified as Army AC service members. The majority of these cases did not require hospitalization (n=207; 94.5%). The most common comorbidities present in nonhospitalized cases included other chronic illnesses (43.5%), neurologic disorders (24.6%), and obesity (21.7%). Overall, 12 cases (5.5%) required hospitalization. Hospitalized cases had a history of obesity (58.3%), neurologic disorder (50.0%), other chronic illnesses (41.7%), and hypertension (25.0%). No comorbidities were present among 27.1% (n=56) of nonhospitalized cases and 25.0% (n=3) of hospitalized cases.


June editorial :viewing the gathering storm


title: Coronavirus disease 2019 (COVID-19): two case reports from a family cluster

text: The coronavirus disease 2019 (COVID-19) is a new infectious disease, firstly appeared in Wuhan city and has rapidly spread to 114 countries outside China, which is receiving worldwide attention. As two important means of examination, computed tomography (CT) and real-time reverse transcription polymerase chain reaction (RT-PCR) have always been controversial in the clinical diagnosis of COVID-19 pneumonia. Here, we report a family cluster case of a father and a son diagnosed as COVID-19 at our hospital, and described the clinical manifestations, laboratory results, CT changes, diagnosis and treatment strategy of these two patients. Focus on the value of these two methods in the diagnosis and treatment of diseases, as well as their respective deficiencies. For patient 1 (father), the efficacy of RT-PCR is not satisfactory either in terms of diagnosis or follow-up, which may cause misdiagnosis and delay treatment. For patient 2 (son), the clinical symptoms were not obvious, but CT imaging clearly displayed dynamic changes of the lung lesions. Meanwhile, the two patients respectively underwent five chest CT examinations during their hospitalization and discharge follow-up, showing the potential harm of radiation. Therefore, in clinical work, doctors should make full use of the advantages of CT and RT-PCR, and take other measures to make up for their disadvantages.


Why is COVID-19 so mild in children?


Severe Covid-19


title: Outcomes of Elective Major Cancer Surgery During COVID 19 at Tata Memorial Centre: Implications for Cancer Care Policy

text: BACKGROUND: Overburdened systems and concerns of adverse outcomes have resulted in deferred cancer surgeries with devastating consequences. In this COVID pandemic, the decision to continue elective cancer surgeries, and their subsequent outcomes, are sparsely reported from hotspots. METHODS: A prospective database of the Department of Surgical Oncology was analysed from March 23rd to April 30th, 2020. FINDINGS: Four hundred ninety-four elective surgeries were performed (377 untested and 117 tested for Covid 19 before surgery). Median age was 48 years with 13% (n = 64) above the age of 60 years. Sixty-eight percent patients were American Society of Anaesthesiology (ASA) grade I. As per surgical complexity grading, 71 (14·4%) cases were lower grade (I-III) and 423 (85.6%) were higher grade complex surgeries (IV - VI).Clavien-Dindo ≥ grade III complications were 5.6% (n = 28) and there were no postoperative deaths. Patients >60 years documented 9.3% major complications compared to 5.2% in <60 years (P = 0.169). The median hospital stay was 1 to 9 days across specialties.Postoperatively, 26 patients were tested for COVID 19 and 6 tested positive. They all had higher grade surgeries but none required escalated or intensive care treatment related to COVID infection. INTERPRETATION: A combination of scientific and administrative rationale contributed to favorable outcomes after major elective cancer surgeries. These results support the continuation of elective major cancer surgery in regions with Covid 19 trends similar to India.