title: Detection of SARS-COV-2 in Placental and Fetal Membrane Samples

text: Introduction: Since the first reports of the emergence of the novel coronavirus SARS-CoV-2 and its associated disease (COVID-19), concerns remain about whether the virus is transmissible in pregnant women from the mother to the fetus during either the antepartum period or the process of labor and delivery. One recent review reported that in a small number of cases, two PCR swabs of the placenta were sent in additional to neonatal and cord blood testing, and both placental PCR swabs were negative.1 Other studies have demonstrated the finding of SARS-CoV2 IgM in neonates born to mothers diagnosed with COVID-19 during pregnancy,2,3 findings that may indicate vertical transmission of the virus in utero. We report our experience with placental/membrane SARS-CoV2 RNA PCR swab results after delivery to a series of symptomatic mothers with confirmed COVID-19 infection in pregnancy. Methods: IRB approval was obtained. All pregnant patients diagnosed with COVID-19 who gave birth between March 1, 2020 and April 20, 2020 at NYU Langone Health were identified by a search of the electronic medical record. Charts were reviewed for documentation of SARS-CoV-2 RNA RT-PCR testing sent from either the placenta or membranes within 30 minutes following delivery. PCR testing for SARS-COV-2 was performed using the cobas SARS-CoV-2 assay (Roche) or the Cepheid Xpert Xpress assay. Placental swabs were obtained from the amniotic surface after clearing the surface of maternal blood (placental PCR). Membrane swabs were obtained from between the amnion and chorion after manual separation of the membranes (membrane PCR). Maternal COVID-19 illness was categorized as mild, severe, or critical.4 The time interval from maternal diagnosis of COVID-19 to delivery was calculated in days. Infants were tested with nasopharyngeal swabs for SARS-CoV-2 PCR between days of life 1 and 5 while hospitalized. Hospitalized infants were also assessed for clinical signs and symptoms, including fever, cough, and nasal congestion. Results: Of 32 COVID-19 positive pregnant patients who gave birth in this timeframe, placental or membrane swabs were sent from 11 patients (Table). Three of 11 swabs were positive. None of the infants tested positive for SARS-CoV2 on days of life 1 through 5, and none demonstrated symptoms of COVID-19 infection. Discussion: Of 11 placental or membrane swabs sent following delivery, 3 swabs were positive for SARS-CoV-2, all in women with moderate to severe COVID-19 illness at time of delivery. This is the first study to demonstrate the presence of SARS-CoV-2 RNA in placental or membrane samples. While there were no clinical signs of vertical transmission, our findings raise the possibility of intrapartum viral exposure. Given the mixing of maternal and fetal fluid and tissue at time of delivery, the origin of the detected SARS-CoV-2 RNA in our series is unclear. It may represent contamination from maternal blood, amniotic fluid, or COVID-19 infection of the membranes and amniotic sac. For those infants who were delivered vaginally, contamination with vaginal secretions is also a possible source, although prior studies on vaginal secretions have failed to demonstrate the presence of COVID-19.5,6Although all of our neonates tested negative in the first 5 days of life, many were born via cesarean deliveries with decreased length of exposure to these tissues, which may be associated with a decreased likelihood of vertical transmission. Additionally, nasopharyngeal testing immediately after delivery may not be the ideal approach to evaluate vertical transmission if exposure occurs at the time of delivery, as the virus may require a longer incubation period before these swabs convert to positive. In summary, the presence of viral RNA by RT-PCR in placenta/membranes at the time of delivery suggests the need for further research into the possibility of vertical transmission.


Proposed approach for reusing surgical masks in COVID-19 pandemic


title: Microencapsulated Insulin-Like Growth Factor-1 therapy improves cardiac function and reduces fibrosis in a porcine acute myocardial infarction model

text: Insulin-like growth factor-1 (IGF-1) has demonstrated beneficial effects after myocardial infarction (MI). Microencapsulation of IGF-1 could potentially improve results. We aimed to test the effect of an intracoronary (IC) infusion of microencapsulated IGF-1 in a swine acute MI model. For that purpose IC injection of a 10 ml solution of 5 × 106 IGF-1 loaded microspheres (MSPs) (n = 8, IGF-1 MSPs), 5 × 106 unloaded MSPs (n = 9; MSPs) or saline (n = 7; CON) was performed 48 hours post-MI. Left ventricular ejection fraction (LVEF), indexed ventricular volumes and infarct size (IS) were determined by cardiac magnetic resonance at pre-injection and 10 weeks. Animals were euthanized at 10 weeks, and myocardial fibrosis and vascular density were analysed. End-study LVEF was significantly greater in IGF-1 MSPs compared to MSPs and CON, while ventricular volumes exhibited no significant differences between groups. IS decreased over time in all groups. Collagen volume fraction on the infarct area was significantly reduced in IGF-1 MSPs compared to CON and MSPs. Vascular density analysis of infarct and border zones showed no significant differences between groups. In conclusion, the IC injection of 5 × 106 IGF-1 loaded MSPs in a porcine acute MI model successfully improves cardiac function and limits myocardial fibrosis, which could be clinically relevant.


Covid-19 and the rise of racism


title: Quarantine of the Covid-19 pandemic in suicide: A psychological autopsy

text: The epidemiology of suicide has identified numerous psychiatric and occupational risk factors. The circumstances surrounding a suicide are fundamental to determining whether its characteristics will play a crucial role in the decision-making process. The state of emergency arising from the Covid-19 pandemic has introduced a new element, given the general concern and feelings of alarm which are global. The most suitable forensic method to analyse these cases is the psychological autopsy. This study's purpose is to analyse the application of the psychological autopsy method to evaluate the impact of the pandemic where government lockdowns impose restrictions on personal freedom. We set out to consider how far this together with other factors may induce suicide. The literature does not as yet offer us a retrospective analysis of the influence of the global pandemic state on rates of suicide. Accordingly, we report a forensic case and examine the critical issues and problems in the management of these cases.


Reduction of childhood trauma during the COVID-19 Level 4 lockdown in New Zealand


title: RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

text: BACKGROUND: Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19. METHODS: We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded. The main outcomes of interest were in-hospital mortality and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation). FINDINGS: 96â032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14â888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide) and 81â144 patients were in the control group. 10â698 (11·1%) patients died in hospital. After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223-1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368-1·531), chloroquine (16·4%; 1·365, 1·218-1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273-1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935-2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106-5·983), chloroquine (4·3%; 3·561, 2·760-4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344-4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation. INTERPRETATION: We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19. FUNDING: William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital.


title: Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

text: Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage Bâ1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.


title: First Report of CR1 Polymorphisms and Soluble CR1 Levels Associated with Late Onset Alzheimer's Disease (LOAD) in Latin America

text: The CR1 gene has been widely studied in Alzheimer's disease (AD), since its first association with the disease in 2009. Even after 11 years of this discovery, the role of this gene in AD has not yet been fully elucidated and the association of its variants was not validated in Latin American populations. We genotyped five CR1 single nucleotide polymorphisms (SNPs rs6656401, rs3849266, rs2274567, rs4844610, and rs12034383) in up to 162 AD patients and 137 controls through PCR-SSP and iPLEX MassARRAY Platform (Sequenom), and measured soluble CR1 (sCR1) levels in plasma of 40 AD patients and 39 controls with an enzyme-linked immunosorbent assay (ELISA). Homozygosity for haplotype rs3849266*C_rs2274567*A (CA/CA genotype) was associated with susceptibility to AD (OR = 2.94, p = 0.018). Patients presented higher sCR1 levels in plasma than controls (p = 0.038). Furthermore, patients that carry the rs2274567*G allele (p.1208Arg) presented higher sCR1 levels than A/A (p.1208His/His) homozygotes (p = 0.036). This is the first study to validate the association of CR1 polymorphisms with late-onset Alzheimer's disease, as well as to evaluate sCR1 levels in a Latin American population. SNPs present in the regulatory and coding regions of this gene may be playing a key role in the observed association, probably by interfering in Aß plaques clearance. Inhibition may be due to the increase in local sCR1 levels observed in patients, which may result from polymorphisms leading to larger isoforms of CR1 and/or structural alterations of the protein that makes it less functional, as well as increased vesiculation of the molecules.


title: Erratum to: Bat origin of a new human coronavirus: there and back again

text: We miscalculated identities of several genes, and the corrected Table 1 should be as follows.


A Patient with COVID-19 Presenting a False-Negative Reverse Transcriptase Polymerase Chain Reaction Result


title: COVID-19: Therapeutics and Their Toxicities

text: SARS-CoV-2 is a novel coronavirus that emerged in 2019 and is causing the COVID-19 pandemic. There is no current standard of care. Clinicians need to be mindful of the toxicity of a wide variety of possibly unfamiliar substances being tested or repurposed to treat COVID-19. The United States Food and Drug Administration (FDA) has provided emergency authorization for the use of chloroquine and hydroxychloroquine. These two medications may precipitate ventricular dysrhythmias, necessitating cardiac and electrolyte monitoring, and in severe cases, treatment with epinephrine and high-doses of diazepam. Recombinant protein therapeutics may cause serum sickness or immune complex deposition. Nucleic acid vaccines may introduce mutations into the human genome. ACE inhibitors and ibuprofen have been suggested to exacerbate the pathogenesis of COVID-19. Here, we review the use, mechanism of action, and toxicity of proposed COVID-19 therapeutics.


title: Flattening the curve in oncologic surgery: Impact of Covid-19 on surgery at tertiary care cancer center

text: INTRODUCTION: Covid-19 has ushered in drastic changes to the healthcare system in order to "flatten the curve"; in particular, surgical operations that can consume vital, limited resources, not to mention the risk to staff, anesthesiologists, and surgeons. However, under unique circumstances with diligent preparation, vital oncologic operations can be performed safely. METHODS: Prospective comparison of surgical cases during the pandemic from December 2019 to May 2020 to the correlating time frame from December 2018 to May 2019. RESULTS: A significant decline in case volume was not appreciated until the United States declared a national state of emergency, allowing patients with cancer to continue to undergo curative tumor resection until then (428.3 ± 51.5 vs 166.6 ± 59.8 cases/week; P < .001). The decrease was consistent with the mean case volume during the holidays (213.8 ± 76.8 vs 166.6 ± 59.8 case/week; P = .648). Evaluation of surgical subspecialties demonstrated a significant decrease for all subspecialties with the greatest decline in sarcoma (P = .002) and endocrine (P = .001) surgeries, while vascular (P = .004) and thoracic (P = .011) surgeries had the least. CONCLUSIONS: The novel coronavirus has drastically reduced oncologic operations, but with proper evaluation of patients and allocation of resources, surgery can be performed safely without compromising the aim to flatten the curve and control the coronavirus pandemic.


title: Spatiotemporal Dynamics, Nowcasting and Forecasting of COVID-19 in the United States

text: In response to the ongoing public health emergency of COVID-19, we investigate the disease dynamics to understand the spread of COVID-19 in the United States. In particular, we focus on the spatiotemporal dynamics of the disease, accounting for the control measures, environmental effects, socioeconomic factors, health service resources, and demographic conditions that vary from different counties. In the modeling of an epidemic, mathematical models are useful, however, pure mathematical modeling is deterministic, and only demonstrates the average behavior of the epidemic; thus, it is difficult to quantify the uncertainty. Instead, statistical models provide varieties of characterization of different types of errors. In this paper, we investigate the disease dynamics by working at the interface of theoretical models and empirical data by combining the advantages of mathematical and statistical models. We develop a novel nonparametric space-time disease transmission model for the epidemic data, and to study the spatial-temporal pattern in the spread of COVID-19 at the county level. The proposed methodology can be used to dissect the spatial structure and dynamics of spread, as well as to forecast how this outbreak may unfold through time and space in the future. To assess the uncertainty, projection bands are constructed from forecast paths obtained in bootstrap replications. A dashboard is established with multiple R shiny apps embedded to provide a 7-day forecast of the COVID-19 infection count and death count up to the county level, as well as a long-term projection of the next four months. The proposed method provides remarkably accurate short-term prediction results.


Experience from Malaysia During the COVID-19 Movement Control Order


Immunotherapy is a preferred option for oral cancer patients during COVID-19 pandemic?


title: Abnormal respiratory patterns classifier may contribute to large-scale screening of people infected with COVID-19 in an accurate and unobtrusive manner

text: Research significance: During the epidemic prevention and control period, our study can be helpful in prognosis, diagnosis and screening for the patients infected with COVID-19 (the novel coronavirus) based on breathing characteristics. According to the latest clinical research, the respiratory pattern of COVID-19 is different from the respiratory patterns of flu and the common cold. One significant symptom that occurs in the COVID-19 is Tachypnea. People infected with COVID-19 have more rapid respiration. Our study can be utilized to distinguish various respiratory patterns and our device can be preliminarily put to practical use. Demo videos of this method working in situations of one subject and two subjects can be downloaded online. Research details: Accurate detection of the unexpected abnormal respiratory pattern of people in a remote and unobtrusive manner has great significance. In this work, we innovatively capitalize on depth camera and deep learning to achieve this goal. The challenges in this task are twofold: the amount of real-world data is not enough for training to get the deep model; and the intra-class variation of different types of respiratory patterns is large and the outer-class variation is small. In this paper, considering the characteristics of actual respiratory signals, a novel and efficient Respiratory Simulation Model (RSM) is first proposed to fill the gap between the large amount of training data and scarce real-world data. Subsequently, we first apply a GRU neural network with bidirectional and attentional mechanisms (BI-AT-GRU) to classify 6 clinically significant respiratory patterns (Eupnea, Tachypnea, Bradypnea, Biots, Cheyne-Stokes and Central-Apnea). The proposed deep model and the modeling ideas have the great potential to be extended to large scale applications such as public places, sleep scenario, and office environment.


Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in the United States


title: Updating the diagnostic criteria of COVID-19 "suspected case" and "confirmed case" is necessary

text: On 6 February 2020, our team had published a rapid advice guideline for diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infection, and this guideline provided our experience and make well reference for fighting against this pandemic worldwide. However, the coronavirus disease 2019 (COVID-19) is a new disease, our awareness and knowledge are gradually increasing based on the ongoing research findings and clinical practice experience; hence, the strategies of diagnosis and treatment are also continually updated. In this letter, we answered one comment on our guideline and provided the newest diagnostic criteria of "suspected case" and "confirmed case" according to the latest Diagnosis and Treatment Guidelines for COVID-19 (seventh version) that issued by the National Health Committee of the People's Republic of China.


title: [Analysis of selective endoscopy results during the epidemic of coronavirus disease 2019 (COVID-19)]

text: Objective: To explore the necessity and safety of selective endoscopy to detect gastrointestinal (GI) malignancy during the outbreak of coronavirus disease 2019 (COVID-19). Methods: A retrospective cohort study was carried out to analyze the clinical data of selective endoscopy performed at the Endoscopic Center, Zhongshan Hospital of Fudan University from February 20 to March 6, 2020. Clinical data included epidemiological questionnaire, chief complaints, endoscopic findings and biopsy pathology results, etc. All medical staff had blood test for IgM/IgG antibodies of COVID-19. Patients and their families were followed up by phone to determine whether they were infected with COVID-19. Meanwhile, the clinical data of selective endoscopy during the same period from February 20 to March 6, 2019 were collected as the control group to compare the overall results of endoscopy examinations during the epidemic and the detection rate of GI malignancy. Results: A total of 911 patients underwent endoscopy in the epidemic period group, and a total of 5746 cases in the control group, which was 6.3 times over the epidemic period group. In the epidemic period group, 544 cases received gastroscopy and 367 cases received colonoscopy, while 3433 cases received gastroscopy and 2313 cases received colonoscopy in the control group, which were both 6.3 times of epidemic period group. Gastroscopy revealed that 39 patients (7.2%) were diagnosed with upper GI malignancies in the epidemic period group and 77 patients (2.2%) in the control group with significant difference (χ(2)=40.243, P<0.001). The detection rate of gastric cancer in these two groups was 3.3% (n=18) and 1.7% (n=59) respectively with significant difference (χ(2)=6.254,P=0.012). The detection rate of esophageal cancer was 3.7% (n=20) and 0.5% (n=18) respectively with significant difference (χ(2)=49.303,P<0.001). Colonoscopy revealed that colorectal cancer was found in 32 cases (8.7%) of the epidemic period group and 88 cases (3.8%) of the control group with significant difference (χ(2)=17.888, P<0.001). During the epidemic period, no infection of medical staff was found through the blood test of IgM/IgG antibodies on COVID-19. No patient and family members were infected with COVID-19 by phone follow-up. Conclusion: Compared with the same period in 2019, the number of selective endoscopy decreases sharply during the epidemic period, while the detection rate of various GI malignant tumors increases significantly, which indicates that patients with high-risk symptoms of GI malignancies should still receive endoscopy as soon as possible. Provided strict adherence to the epidemic prevention standards formulated by the state and professional societies, it is necessary to carry out clinical diagnosis and treatment as soon as possible.


The Courage to Return to Everyday Life at the Time of Covid-19: the Point of View of Inflammatory Bowel Disease Patients Needing Endoscopy


title: COVID-19 complicated by acute myocardial infarction with extensive thrombus burden and cardiogenic shock

text: A patient with coronavirus disease 19 (COVID-19) developed acute myocardial infarction (AMI) complicated by extensive coronary thrombosis and cardiogenic shock. She underwent percutaneous coronary intervention and placement of a mechanical circulatory support device but subsequently died from shock. This report illustrates the challenges in managing patients with COVID-19, AMI, and cardiogenic shock.


title: The 2019 novel coronavirus resource

text: An ongoing outbreak of a novel coronavirus infection in Wuhan, China since December 2019 has led to 31,516 infected persons and 638 deaths across 25 countries (till 16:00 on February 7, 2020). The virus causing this pneumonia was then named as the 2019 novel coronavirus (2019-nCoV) by the World Health Organization. To promote the data sharing and make all relevant information of 2019-nCoV publicly available, we construct the 2019 Novel Coronavirus Resource (2019nCoVR, https://bigd.big.ac.cn/ncov). 2019nCoVR features comprehensive integration of genomic and proteomic sequences as well as their metadata information from the Global Initiative on Sharing All Influenza Data, National Center for Biotechnology Information, China National GeneBank, National Microbiology Data Center and China National Center for Bioinformation (CNCB)/National Genomics Data Center (NGDC). It also incorporates a wide range of relevant information including scientific literatures, news, and popular articles for science dissemination, and provides visualization functionalities for genome variation analysis results based on all collected 2019-nCoV strains. Moreover, by linking seamlessly with related databases in CNCB/NGDC, 2019nCoVR offers virus data submission and sharing services for raw sequence reads and assembled sequences. In this report, we provide comprehensive descriptions on data deposition, management, release and utility in 2019nCoVR, laying important foundations in aid of studies on virus classification and origin, genome variation and evolution, fast detection, drug development and pneumonia precision prevention and therapy.


Why are women better protected from COVID-19: Clues for men? Sex and COVID-19


Taking the Longer View of COVID-19


Cancer Patient Care during COVID-19


Transient acute-onset tetraparesis in a COVID-19 patient


title: Neural Cellular Automata Manifold

text: Very recently, a deep Neural Cellular Automata (NCA)[1] has been proposed to simulate the complex morphogenesis process with deep networks. This model learns to grow an image starting from a fixed single pixel. In this paper, we move a step further and propose a new model that extends the expressive power of NCA from a single image to an manifold of images. In biological terms, our approach would play the role of the transcription factors, modulating the mapping of genes into specific proteins that drive cellular differentiation, which occurs right before the morphogenesis. We accomplish this by introducing dynamic convolutions inside an Auto-Encoder architecture, for the first time used to join two different sources of information, the encoding and cell's environment information. The proposed model also extends the capabilities of the NCA to a general purpose network, which can be used in a broad range of problems. We thoroughly evaluate our approach in a dataset of synthetic emojis and also in real images of CIFAR-10.


Investigation of a family outbreak of COVID-19 using systematic rapid diagnostic tests raises new questions about transmission


title: Incidence of New-Onset and Worsening Heart Failure Before and After the COVID-19 Epidemic Lockdown in Denmark: A Nationwide Cohort Study

text: BACKGROUND: The Danish government ordered a public lockdown on March 12, 2020, because of the coronavirus disease 2019 (COVID-19) pandemic. We investigated the immediate consequences of such a lockdown for patients with heart failure (HF). METHODS: Using the Danish nationwide administrative databases, we investigated the incidence of new-onset HF and hospitalizations for worsening HF before and after the lockdown (January 1 to March 11 versus March 12 to March 31) in 2020 versus 2019. We also investigated the mortality for all patients with HF and in COVID-19-infected patients with HF. RESULTS: Rates of new-onset HF between January 1 and March 11 were comparable for 2020 and 2019 (1.83 versus 1.78 per 10 000 person-years; P=0.19), while hospitalizations for worsening HF were slightly higher in 2020 versus 2019 (1.04 versus 0.93 per 1000 person-years; P=0.02). In the lockdown period, rates of new-onset HF diagnoses (1.26 versus 2.25 per 1000 person-years) and of hospitalizations for worsening HF (0.63 versus 0.99 per 1000 person-years) were significantly lower in 2020 versus 2019 (P for both, <0.0001). Mortality was similar before and after the national lockdown for the population with HF. We observed 90 HF patients with diagnosed COVID-19 infection, of whom 37% (95% CI, 23%-50%) died within 15 days. CONCLUSIONS: The number of patients hospitalized with worsening HF or diagnosed with new-onset HF was markedly reduced after lockdown but has not yet impacted mortality in HF patients at a population-based level. However, these data raise concerns for a potential undertreatment of HF currently that may impact prognosis in the longer term.


COVID-19: Quarantine and human rights


title: Current Therapies Under Investigation for COVID-19

text: In response to the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), researchers are expeditiously searching for antiviral treatments able to alleviate the symptoms of infection, which can be life-threatening. Here, we provide a general overview of what is currently known about the structure and characteristic features of SARS-CoV-2, some of which could potentially be exploited for the purposes of antiviral therapy and vaccine development. This mini-review also covers selected and noteworthy antiviral agents/supportive therapy out of hundreds of drugs that are being repurposed or tested as potential treatments for COVID-19, the disease caused by SARS-CoV.


title: Trend of respiratory pathogens during the COVID-19 epidemic

text: In Italy, the first SARS-CoV-2 infections were diagnosed in Rome, Lazio region, at the end of January 2020, but sustained transmission occurred later, since the end of February. From 1 February to 12 April 2020, 17,164 nasopharyngeal swabs were tested by real time PCR for the presence of SARS-CoV-2 at the Laboratory of Virology of National Institute for Infectious Diseases "Lazzaro Spallanzani" (INMI) in Rome. In the same period, coincident with the winter peak of influenza and other respiratory illnesses, 847 samples were analyzed by multiplex PCR assay for the presence of common respiratory pathogens. In our study the time trend of SARS-CoV-2 and that of other respiratory pathogens in the same observation period were analysed. Overall, results obtained suggest that the spread of the pandemic SARS-CoV-2 virus did not substantially affect the time trend of other respiratory infections in our region, highlighting no significant difference in rates of SARS-CoV-2 infection in patients with or without other respiratory pathogens. Therefore, in the present scenario of COVID-19 pandemic, differential diagnosis resulting positive for common respiratory pathogen(s) should not exclude testing of SARS-CoV-2.


title: Quant Bust 2020

text: We explain in a nontechnical fashion why dollar-neutral quant trading strategies, such as equities Statistical Arbitrage, suffered substantial losses (drawdowns) during the COVID-19 market selloff. We discuss: (i) why these strategies work during"normal"times; (ii) the market regimes when they work best; and (iii) their limitations and the reasons for why they"break"during extreme market events. An accompanying appendix (with a link to freely accessible source code) includes backtests for various strategies, which put flesh on and illustrate the discussion in the main text.


Can concomitant use of zinc and curcumin with other immunity-boosting nutraceuticals be the arsenal against COVID-19?


title: The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States

text: The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. While the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.


title: A case of COVID-19 in a patient with a univentricular heart post total cavopulmonary connection (Fontan) surgery

text: Coronavirus disease 2019 (COVID-19) has caused a global pandemic which has affected patients and healthcare systems around the world. Patients with underlying health conditions seem to be more severely affected. There are limited reports of patients with univentricular circulations and COVID 19; thus, we report a case of COVID-19 in a patient with a univentricular circulation.


COVID-19: extending or relaxing distancing control measures


Management of heart transplant candidates in the time of COVID-19 pandemic: Looking for answers


title: A Cautionary Tale of False-Negative Nasopharyngeal COVID-19 Testing

text: There remains diagnostic uncertainty regarding the sensitivity of reverse transcription polymerase chain reaction in detection of SARS-CoV-2 from nasopharyngeal specimens. We present a case where two nasopharyngeal specimens were negative, followed by a positive sputum sample. Serial testing for COVID-19 is indicated in patients with high pretest probability of disease.


title: Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence

text: The novel coronavirus, also known as SARS-Cov-2 or COVID-19 has become a worldwide threat and the major healthcare concern of the year 2020. Cancer research was directly affected by the emerging of this disease. According to some Chinese studies, cancer patients are more vulnerable to COVID-19 complications. This observation led many oncologists to change their daily practice in cancer care, without solid evidence and recommendations. Moreover, the COVID-19 manifestations as well as its diagnosis are particular in this special population. In this review paper we expose the challenges of cancer management in the era of SARS-CoV-2, the epidemiological, clinical, pathological and radiological characteristics of the disease in cancer patients and its outcomes on this population. Finally, we focus on strategies that are followed in cancer management with review of national and international guidelines.


Does androgen deprivation therapy protect against severe complications from COVID-19?


title: Estimating the impact of preventive quarantine with reverse epidemiology

text: The impact of mitigation or control measures on an epidemics can be estimated by fitting the parameters of a compartmental model to empirical data, and running the model forward with modified parameters that account for a specific measure. This approach has several drawbacks, stemming from biases or lack of availability of data and instability of parameter estimates. Here we take the opposite approach -- that we call reverse epidemiology. Given the data, we reconstruct backward in time an ensemble of networks of contacts, and we assess the impact of measures on that specific realization of the contagion process. This approach is robust because it only depends on parameters that describe the evolution of the disease within one individual (e.g. latency time) and not on parameters that describe the spread of the epidemics in a population. Using this method, we assess the impact of preventive quarantine on the ongoing outbreak of Covid-19 in Italy. This gives an estimate of how many infected could have been avoided had preventive quarantine been enforced at a given time.


title: [Strategy of dental clinics to cope with the epidemic period of infectious diseases based on the experience of corona virus disease outbreak]

text: The outbreak of corona virus disease (COVID-19) has raised concerns among dentists to develop strategies to prevent infection of dental equipment, materials, and patients during an epidemic period. Strategies following the National Laws and Standards of China and local standards of several provinces for controlling cross-infection and instituting protective measures for medical staff in dental clinics during an epidemic period are discussed. A proposal is put forth for dental clinics that will face similar situations in the future. Further research is warranted to address potential problems that will be encountered under such dire circumstances.


title: Strategy of dental clinics to cope with the epidemic period of infectious diseases based on the experience of corona virus disease outbreak/ 华西口腔医学杂志


Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019


title: Recommendations for respiratory rehabilitation in adults with COVID-19

text: Coronavirus disease-2019 (COVID-19) is a highly infectious respiratory disease that leads to respiratory, physical, and psychological dysfunction in patients. Respiratory rehabilitation is an important intervention as well as cure for clinical patients. With increased understanding of COVID-19 and the accumulation of clinical experience, we proposed recommendations for respiratory rehabilitation in adults with COVID-19 based on the opinions of frontline clinical experts involved in the management of this epidemic and a review of the relevant literature and evidence. Our recommendations are as follows: 1. for inpatients with COVID-19, respiratory rehabilitation would relieve the symptoms of dyspnea, anxiety, and depression and eventually improve physical functions and the quality of life; 2. for severe/critical inpatients, early respiratory rehabilitation is not suggested; 3. for patients in isolation, respiratory rehabilitation guidance should be conducted through educational videos, instruction manuals, or remote consultation; 4. assessment and monitoring should be performed throughout the respiratory rehabilitation process; 5. proper grade protection should be used following the present guidelines. These recommendations can guide clinical practice and form the basis for respiratory rehabilitation in COVID-19 patients.


Balancing Supply and Demand for Blood during the COVID-19 Pandemic


Prone Position and Lung Ventilation/Perfusion Matching in Acute Respiratory Failure Due to COVID-19


title: Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study

text: Background: The outbreak of COVID-19 has led to international concern. We aimed to establish an effective screening strategy in Shanghai, China, to aid early identification of patients with COVID-19. Methods: We did a multicentre, observational cohort study in fever clinics of 25 hospitals in 16 districts of Shanghai. All patients visiting the clinics within the study period were included. A strategy for COVID-19 screening was presented and then suspected cases were monitored and analysed until they were confirmed as cases or excluded. Logistic regression was used to determine the risk factors of COVID-19. Findings: We enrolled patients visiting fever clinics from Jan 17 to Feb 16, 2020. Among 53â617 patients visiting fever clinics, 1004 (1·9%) were considered as suspected cases, with 188 (0·4% of all patients, 18·7% of suspected cases) eventually diagnosed as confirmed cases. 154 patients with missing data were excluded from the analysis. Exposure history (odds ratio [OR] 4·16, 95% CI 2·74-6·33; p<0·0001), fatigue (OR 1·56, 1·01-2·41; p=0·043), white blood cell count less than 4â×â109 per L (OR 2·44, 1·28-4·64; p=0·0066), lymphocyte count less than 0·8â×â109 per L (OR 1·82, 1·00-3·31; p=0·049), ground glass opacity (OR 1·95, 1·32-2·89; p=0·0009), and having both lungs affected (OR 1·54, 1·04-2·28; p=0·032) were independent risk factors for confirmed COVID-19. Interpretation: The screening strategy was effective for confirming or excluding COVID-19 during the spread of this contagious disease. Relevant independent risk factors identified in this study might be helpful for early recognition of the disease. Funding: National Natural Science Foundation of China.


Covid-19: UK government writes off £13.4bn of hospital debts to ease pressures


Comparative seasonalities of influenza A, B and 'common cold' coronaviruses - setting the scene for SARS-CoV-2 infections and possible unexpected host immune interactions


title: Respiratory failure in patients infected with SARS-CoV-2

text: The management of patients with COVID-19-induced acute respiratory distress syndrome focuses on identifying the causes for respiratory failure and on following best practices for supportive care with oxygen supplementation and mechanical ventilation. In this patient population, appropriate measures need to be taken to prevent the spread of the coronavirus. Nearly 90% of COVID-19 patients admitted to the ICU need mechanical ventilation and most of these develop severe ARDS, which causes high morbidity and mortality. These patients need to be managed according to guidelines for the low-tidal-volume lung-protective ventilation. Practitioners also need to evaluate for other potential causes of respiratory failure.


Psychiatric emergency department volume during Covid-19 pandemic


title: Correction to: Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study

text: The authors regret a mistake in Table 1.


title: Discussion of digital gaming's impact on players' well-being during the COVID-19 lockdown

text: This research discusses how to utilise digital gaming to support the well-being of its users and sustain their physical and mental health during the COVID-19 lockdown in which people's activities are limited. The published academic literature that is written in English and available for access on online databases was reviewed to develop key take-aways and a framework for discussing how to enhance people's well-being in the COVID-19 lockdown. Interaction with other players in virtual communities has been found to have a positive influence on the mental health of those suffering from a lack of societal connection. A framework for further research has also been developed that focuses on the critical situation of the COVID-19 lockdown,as this is an urgent topic with a huge impact on our health.Some gaming service providers have been proactive in redesigning game programming to be suitable for the lockdown situation, and this enables players to enjoy physical activities even at home.


title: Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements)

text: Coronavirus-19 (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Risk of transmission may occur during endoscopy and the goal is to prevent infection among healthcare professionals while providing essential services to patients. Asia was the first continent to have a COVID-19 outbreak, and this position statement of the Asian Pacific Society for Digestive Endoscopy shares our successful experience in maintaining safe and high-quality endoscopy practice at a time when resources are limited. Sixteen experts from key societies of digestive endoscopy in Asia were invited to develop position statements, including patient triage and risk assessment before endoscopy, resource prioritisation and allocation, regular monitoring of personal protective equipment, infection control measures, protective device training and implementation of a strategy for stepwise resumption of endoscopy services after control of the COVID-19 outbreak.


2020 International Year of the Midwife - An unexpected challenge


Coronavirus disease 2019, Kawasaki disease, and multisystem inflammatory syndrome in children


title: Deep learning-based multi-view fusion model for screening 2019 novel coronavirus pneumonia: A multicentre study

text: PURPOSE: To develop a deep learning-based method to assist radiologists to fast and accurately identify patients with COVID-19 by CT images. METHODS: We retrospectively collected chest CT images of 495 patients from three hospitals in China. 495 datasets were randomly divided into 395 cases (80%, 294 of COVID-19, 101 of other pneumonia) of the training set, 50 cases (10%, 37 of COVID-19, 13 of other pneumonia) of the validation set and 50 cases (10%, 37 of COVID-19, 13 of other pneumonia) of the testing set. We trained a multi-view fusion model using deep learning network to screen patients with COVID-19 using CT images with the maximum lung regions in axial, coronal and sagittal views. The performance of the proposed model was evaluated by both the validation and testing sets. RESULTS: The multi-view deep learning fusion model achieved the area under the receiver-operating characteristics curve (AUC) of 0.732, accuracy of 0.700, sensitivity of 0.730 and specificity of 0.615 in validation set. In the testing set, we can achieve AUC, accuracy, sensitivity and specificity of 0.819, 0.760, 0.811 and 0.615 respectively. CONCLUSIONS: Based on deep learning method, the proposed diagnosis model trained on multi-view images of chest CT images showed great potential to improve the efficacy of diagnosis and mitigate the heavy workload of radiologists for the initial screening of COVID-19 pneumonia.


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


Letter from China


Telepsychiatry in the age of COVID: Some ethical considerations


To alert coinfection of COVID-19 and dengue virus in developing countries in the dengue-endemic area


title: Psychiatrist experience of remote consultations by telephone in an outpatient psychiatric department during the COVID-19 pandemic

text: OBJECTIVE: In response to the COVID-19 pandemic, there has been a shift globally from face-to-face consultations to remote consultations. In our department, remote consultations have taken in the form of telephone consultations. In this paper, we set out to study a group of Irish psychiatrists' experience of these consultations. METHODS: We identified recurrent themes in the existing literature on doctors' experience of telephone consultations with a view to determining the applicability of these themes to a group of Irish psychiatrists. A questionnaire was developed based on themes in the literature. This was sent to all psychiatrists working in a busy psychiatric service in Dublin. RESULTS: The questionnaire response rate was 72% (n = 26/35). Diagnostic challenges, the effect of phone consultation on the therapeutic alliance, challenges associated with the use of technology and ethical concerns were identified as issues. Flexibility in the working day and convenience were identified as possible benefits to telephone consultations. CONCLUSIONS: The group that participated in this research study identified a number of challenges to carrying out successful phone consultations. This study highlights the need at our clinical site for interventions to address the issues identified by staff. The findings also highlight the requirement for larger studies with stronger methodologies to determine the generalisability of our results.


title: Low- dose systemic steroids, an emerging therapeutic option for COVID-19 related urticaria

text: Dermatologists around the world are still doing their best to report more cutaneous manifestations of the emerging COVID-19 infection. New-onset acute or relapsing chronic urticaria may result from the body's overreacting inflammatory response to infection. The cytokine storm hits different organs in the body, including the skin, leading to activation and degranulation of mast cells with resultant urticaria. Low-dose systemic steroids combined with antihistamines can combat the COVID-19 inflammatory insult and play a role in the control of COVID-19 related severe urticarial attack.


title: The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study

text: The current international COVID-19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air-purifying respirators and powered air-purifying respirators during simulated difficult airway scenarios. Twenty-five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard or a powered respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq™; 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope; 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope; and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard tracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy allowed the shortest intubation times regardless of the respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered respirator group; however, noise levels were perceived to be significantly lower than in the standard respirator group. We conclude that standard and powered respirators do not significantly prolong simulated advanced intubation procedures.


Re: Karl H. Pang, Diego M. Carrion, Juan Gomez Rivas, et al. The Impact of COVID-19 on European Health Care and Urology Trainees. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.04.042


title: Pulmonary Rehabilitation for Patients with Coronavirus Disease 2019 (COVID-19)

text: As a highly infectious respiratory tract disease, coronavirus disease 2019 (COVID-19) can cause respiratory, physical, and psychological dysfunction in patients. Therefore, pulmonary rehabilitation is crucial for both admitted and discharged patients of COVID-19. In this study, based on the newly released pulmonary rehabilitation guidelines for patients with COVID-19, as well as evidence from the pulmonary rehabilitation of patients with severe acute respiratory syndrome, we investigated pulmonary rehabilitation for patients with COVID-19 having complications, such as chronic pulmonary disease, and established an intelligent respiratory rehabilitation model for these patients.


Third year Dermatology Resident Anxiety in the Era of COVID-19


title: Criminal Justice-Involved Women Navigate COVID-19: Notes From the Field

text: In March-April, 2020, we communicated with a cohort of criminal justice-involved (CJI) women to see how they were navigating COVID-19, chronic illness, homelessness, and shelter-in-place orders in Oakland, Birmingham, and Kansas City. We report on conversations with N = 35 women (out of the cohort of 474 women) and our own observations from ongoing criminal justice involvement studies. Women reported barriers to protecting themselves given widespread unstable housing and complex health needs, though many tried to follow COVID-19 prevention recommendations. Women expressed dissatisfaction with the suspension of research activities, as the pandemic contributed to a heightened need for study incentives, such as cash, emotional support, and other resources. COVID-19 is illuminating disparities between those who can follow recommended actions to prevent infection and those who lack resources to do so. Concerted efforts are required to reduce inequities that put the 1.3 million U.S. women under criminal justice supervision at risk for infection and mortality.


title: Situación de la infección por SARS-CoV-2 en pacientes en tratamiento renal sustitutivo. Informe del Registro COVID-19 de la Sociedad Española de Nefrología (SEN)./ Situación de la infección por SARS-CoV-2 en pacientes en tratamiento renal sustitutivo. Informe del Registro COVID-19 de la Sociedad Española de Nefrología (SEN)./ [SARS-CoV-2 infection in patients on renal replacement therapy. Report of the COVID-19 Registry of the Spanish Society of Nephrology (SEN)]

text: INTRODUCTION: The recent appearance of the SARS-CoV-2 coronavirus pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation and due to their characteristics they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology. MATERIAL AND METHODS: The Registry began operating on March 18th, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. It is an online registry. Patients were diagnosed with SARS-CoV-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs, as well as in those who had undergone screening after some contact acquainted with another patient. RESULTS: As of April 11, the Registry had data on 868 patients, from all the Autonomous Communities. The most represented form of RRT is in-center hemodialysis (ICH) followed by transplant patients. Symptoms are similar to the general population. A very high percentage (85%) required hospital admission, 8% in intensive care units. The most used treatments were hydroxychloroquine, lopinavir-ritonavir, and steroids. Mortality is high and reaches 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less frequently lopinavir-ritonavir and steroids. Age and pneumonia were independently associated with the risk of death. CONCLUSIONS: SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on ICH, hospitalization rates are very high and mortality is high; age and the development of pneumonia are factors associated with mortality.


title: Addressing inequities in COVID-19 morbidity and mortality: research and policy recommendations

text: The COVID-19 pandemic is the greatest global public health crisis since the 1918 influenza outbreak. As of early June, the novel coronavirus has infected more than 6.3 million people worldwide and more than 1.9 million in the United States (US). The total number of recorded deaths due to COVID-19 are growing at an alarming rate globally (³383,000) and nationally (³109,000) Evidence is mounting regarding the heavier burden of COVID-19 infection, morbidity, and mortality on the underserved populations in the US. This commentary focuses on this global health pandemic and how mitigation of the virus relies heavily on health behavior change to slow its spread, highlighting how the pandemic specifically affects the most socially and economically disadvantaged populations in the US. The commentary also offers short, intermediate and long-term research and policy focused recommendations. Both the research and policy recommendations included in this commentary emphasize equity-driven: (1) research practices, including applying a social determinants and health equity lens on monitoring, evaluation, and clinical trials activities on COVID-19; and (2) policy actions, such as dedicating resources to prioritize high-risk communities for testing, treatment, and prevention approaches and implementing organizational, institutional, and legislative policies that address the social and economic barriers to overall well-being that these populations face during a pandemic. It is our hope that these recommendations will generate momentum in delivering timely, effective, and lifesaving changes.


title: A retrospective study on the epidemiological characteristics and establishment of an early warning system of severe COVID-19 patients

text: This paper estimates the magnitude of an informational friction limiting credit reallocation to firms during the 2007-2009 financial crisis. Because lenders rely on private information when deciding which relationship to end, borrowers looking for a new lender are adversely selected. I show how to identify private information separately from information common to all lenders but unobservable to the econometrician by using bank shocks within a discrete choice model of relationships. Quantitatively, these informational frictions seem too small to explain the credit crunch in the U.S. syndicated corporate loan market.


Coronavirus misinformation, and how scientists can help to fight it


title: A reaction-diffusion system to better comprehend the unlockdown: Application of SEIR-type model with diffusion to the spatial spread of COVID-19 in France

text: A reaction-diffusion model was developed describing the spread of the COVID-19 virus considering the mean daily movement of susceptible, exposed and asymptomatic individuals. The model was calibrated using data on the confirmed infection and death from France as well as their initial spatial distribution. First, the system of partial differential equations is studied, then the basic reproduction number, R0 is derived. Second, numerical simulations, based on a combination of level-set and finite differences, shown the spatial spread of COVID-19 from March 16 to June 16. Finally, scenarios of unlockdown are compared according to variation of distancing, or partially spatial lockdown.


title: Nanofiltration of growth media supplemented with human platelet lysates for pathogen-safe xeno-free expansion of mesenchymal stromal cells

text: BACKGROUND AIMS: Human platelet lysate can replace fetal bovine serum (FBS) for xeno-free ex vivo expansion of mesenchymal stromal cells (MSCs), but pooling of platelet concentrates (PCs) increases risks of pathogen transmission. We evaluated the feasibility of performing nanofiltration of platelet lysates and determined the impact on expansion of bone marrow-derived MSCs. METHODS: Platelet lysates were prepared by freeze-thawing of pathogen-reduced (Intercept) PCs suspended in 65% storage solution (SPP+) and 35% plasma, and by serum-conversion of PCs suspended in 100% plasma. Lysates were added to the MSC growth media at 10% (v/v), filtered and subjected to cascade nanofiltration on 35- and 19-nm Planova filters. Media supplemented with 10% starting platelet lysates or FBS were used as the controls. Impacts of nanofiltration on the growth media composition, removal of platelet extracellular vesicles (PEVs) and MSC expansion were evaluated. RESULTS: Nanofiltration did not detrimentally affect contents of total protein and growth factors or the biochemical composition. The clearance factor of PEVs was >3 log values. Expansion, proliferation, membrane markers, differentiation potential and immunosuppressive properties of cells in nanofiltered media were consistently better than those expanded in FBS-supplemented media. Compared with FBS, chondrogenesis and osteogenesis genes were expressed more in nanofiltered media, and there were fewer senescent cells over six passages. CONCLUSIONS: Nanofiltration of growth media supplemented with two types of platelet lysates, including one prepared from pathogen-reduced PCs, is technically feasible. These data support the possibility of developing pathogen-reduced xeno-free growth media for clinical-grade propagation of human cells.


AGS COVID-19 Policy Brief Offers Roadmap to Government Action for a Critical Group During Pandemics: Older Adults in Nursing Homes


title: The COVID-19 pandemic, personal protective equipment and respirator: A narrative review

text: INTRODUCTION: The coronavirus disease 2019 pandemic has touched almost every continent. Personal protective equipment (PPE) is the final line of protection of healthcare workers (HCW). There is variation as well as controversy of infection control recommendation with regards to the use of PPE for HCW between institutions. The aim of this narrative review is to of examine and summarise the available evidence to guide recommendation for the safety of HCW. METHOD: A literature search was conducted on the PubMed, MedLine and Embase databases with the keywords "personal protective equipment," "COVID 19," "n95," "health care worker" and "mortality." RESULTS: SARS-nCoV-2 is highly contagious. About 3.5%-20% of HCW has been reported to be infected. The mortality ranges from 0.53% to 1.94%. PPE is part of the measure within a package of prevention and control of pandemic, rather than a replacement of. Respirators are more effective than masks in preventing aerosol transmission to HCWs. Extended use may be considered if guidelines are adhered. Powered air-purifying respirators if available should be used in high-risk procedures. CONCLUSION: Transmission of viruses is multimodal and in the setting of a novel pathogen with high case fatality with no proven effective interventions, PPE that affords the best protection should be available to HCWs.


title: Possible Bat Origin of Severe Acute Respiratory Syndrome Coronavirus 2

text: We showed that severe acute respiratory syndrome coronavirus 2 is probably a novel recombinant virus. Its genome is closest to that of severe acute respiratory syndrome-related coronaviruses from horseshoe bats, and its receptor-binding domain is closest to that of pangolin viruses. Its origin and direct ancestral viruses have not been identified.


title: Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth in Crisis Management

text: BACKGROUND: Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. OBJECTIVE: The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. METHODS: An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system's response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. RESULTS: The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. CONCLUSIONS: Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies.


title: The COVID-19 pandemic

text: In December 2019, an outbreak of pneumonia of unknown origin was reported in Wuhan, Hubei Province, China. Pneumonia cases were epidemiologically linked to the Huanan Seafood Wholesale Market. Inoculation of respiratory samples into human airway epithelial cells, Vero E6 and Huh7 cell lines, led to the isolation of a novel respiratory virus whose genome analysis showed it to be a novel coronavirus related to SARS-CoV, and therefore named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a betacoronavirus belonging to the subgenus Sarbecovirus. The global spread of SARS-CoV-2 and the thousands of deaths caused by coronavirus disease (COVID-19) led the World Health Organization to declare a pandemic on 12 March 2020. To date, the world has paid a high toll in this pandemic in terms of human lives lost, economic repercussions and increased poverty. In this review, we provide information regarding the epidemiology, serological and molecular diagnosis, origin of SARS-CoV-2 and its ability to infect human cells, and safety issues. Then we focus on the available therapies to fight COVID-19, the development of vaccines, the role of artificial intelligence in the management of the pandemic and limiting the spread of the virus, the impact of the COVID-19 epidemic on our lifestyle, and preparation for a possible second wave.


The role of serology for COVID-19 control: Population, kinetics and test performance do matter


Reproductive health under COVID-19 - challenges of responding in a global crisis


title: Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis

text: We suggest the use of MicroCLOTS (microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome) as a new name for severe pulmonary coronavirus disease 2019 (COVID-19) We hypothesise that, in predisposed individuals, alveolar viral damage is followed by an inflammatory reaction and by microvascular pulmonary thrombosis This progressive endothelial thromboinflammatory syndrome may also involve the microvascular bed of the brain and other vital organs, leading to multiple organ failure and death Future steps in the understanding of the disease and in the identification of treatments may benefit from this definition and hypothesised sequence of events


title: How Are Orthopaedic Surgery Residencies Responding to the COVID-19 Pandemic? An Assessment of Resident Experiences in Cities of Major Virus Outbreak

text: BACKGROUND: In response to COVID-19, American medical centers have enacted elective case restrictions, markedly affecting the training of orthopaedic residents. Residencies must develop new strategies to provide patient care while ensuring the health and continued education of trainees. We aimed to describe the evolving impact of COVID-19 on orthopaedic surgery residents. METHODS: We surveyed five Accreditation Council for Graduate Medical Education-accredited orthopaedic residency programs within cities highly affected by the COVID-19 pandemic about clinical and curricular changes. An online questionnaire surveyed individual resident experiences related to COVID-19. RESULTS: One hundred twenty-one resident survey responses were collected. Sixty-five percent of the respondents have cared for a COVID-19-positive patient. One in three reported being unable to obtain institutionally recommended personal protective equipment during routine clinical work. All programs have discontinued elective orthopaedic cases and restructured resident rotations. Most have shifted schedules to periods of active clinical duty followed by periods of remote work and self-isolation. Didactic education has continued via videoconferencing. DISCUSSION: COVID-19 has caused unprecedented changes to orthopaedic training; however, residents remain on the front lines of inpatient care. Exposures to COVID-19 are prevalent and residents have fallen ill. Programs currently use a variety of strategies to provide essential orthopaedic care. We recommend continued prioritization of resident safety and necessary training accommodations.


Case 22-2020: A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic


A pilot study on the perspectives of pediatric ophthalmologists and their patients towards online consultation during COVID-19 lockdown in India


title: COVID-19 Infection: Implications for Perioperative and Critical Care Physicians

text: Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19-associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19.


title: Management strategy of Novel coronavirus pneumonia in burn and wound care ward/ 中华烧伤杂志

text: The prevention and control of novel coronavirus pneumonia (NCP) has already entered a key period . The patients treated in the burn and wound care ward are susceptible to viral infection because of disease, age and other factors, so it is very important to manage the burn and wound care ward during the prevention and control of NCP epidemic. In this paper, combining with the key clinical problems of prevention and control in hospital during the epidemic period of NCP infection, medical evidence, and clinical and management experience, the author formulates prevention and control management strategy of the author’s unit in order to provide reference for prevention and control of burn and wound care ward.


title: Staffing Up For The Surge: Expanding The New York City Public Hospital Workforce During The COVID-19 Pandemic

text: Ascending to the peak of the novel coronavirus disease (COVID-19) pandemic in New York City, NYC Health + Hospitals (NYC H+H), the City's public health care system, rapidly expanded capacity across its 11 acute-care hospitals and three new field hospitals. To meet the unprecedented demand for patient care, NYC H+H redeployed staff to the areas of greatest need and redesigned recruiting, onboarding, and training processes. The hospital system engaged private staffing agencies, partnered with the U.S Department of Defense, and recruited volunteers throughout the country. A centralized onboarding team created a single-source portal for medical providers requiring credentialing and established new staff positions to increase efficiency. Using new educational tools focused on COVID-19 content, the hospital system trained 20,000 staff, including nearly 9,000 nurses, within a two-month period. Creation of multidisciplinary teams, frequent enterprise-wide communication, willingness to shift direction in response to changing needs, and innovative use of technology were the key factors that enabled the hospital system to meet its goals. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].


title: On the nonlinearity of a tuning fork

text: Tuning fork experiments at the undergraduate level usually only demonstrate a tuning fork's linear resonance. In this paper, we introduce an experiment that can be used to measure the nonlinear tuning curve of a regular tuning fork. Using double-grating Doppler interferometry, we achieve measurement accuracy within ten microns. With this experiment setup, we observe typical nonlinear behaviors of the tuning fork such as the softening tuning curve and jump phenomena. Our experiment is inexpensive and easy to operate. It provides an integrated experiment for intermediate-level students and a basis for senior research projects.


title: Neural Network aided quarantine control model estimation of COVID spread in Wuhan, China

text: In a move described as unprecedented in public health history, starting 24 January 2020, China imposed quarantine and isolation restrictions in Wuhan, a city of more than 10 million people. This raised the question: is mass quarantine and isolation effective as a social tool in addition to its scientific use as a medical tool? In an effort to address this question, using a epidemiological model driven approach augmented by machine learning, we show that the quarantine and isolation measures implemented in Wuhan brought down the effective reproduction number R(t) of the CoVID-19 spread from R(t)>1 to R(t)<1 within a month after the imposition of quarantine control measures in Wuhan, China. This ultimately resulted in a stagnation phase in the infected case count in Wuhan. Our results indicate that the strict public health policies implemented in Wuhan may have played a crucial role in halting down the spread of infection and such measures should potentially be implemented in other highly affected countries such as South Korea, Italy and Iran to curtail spread of the disease. Finally, our forecasting results predict a stagnation in the quarantine control measures implemented in Wuhan towards the end of March 2020; this would lead to a subsequent stagnation in the effective reproduction number at R(t)<1. We warn that immediate relaxation of the quarantine measures in Wuhan may lead to a relapse in the infection spread and a subsequent increase in the effective reproduction number to R(t)>1. Thus, it may be wise to relax quarantine measures after sufficient time has elapsed, during which maximum of the quarantined/isolated individuals are recovered.


Schutz von Patienten und medizinischem Personal vor COVID-19: Überlegungen für Praxis und ambulante Versorgung in der Kardiologie./ Protecting patients and healthcare personnel from COVID-19: considerations for practice and outpatient care in cardiology


Traqueobronquitis necrotizante con obstrucción del tubo endotraqueal en pacientes COVID-19./ [Necrotizing tracheobronchitis with endotracheal tube obstruction in COVID-19 patients]


#SendHelpNow: Mental wellness and virtual connection in the age of coronavirus


Approaching COVID-19-Bedside strategies for intensive care


title: How We Do It: Lessons on Outbreak Preparedness from the Cleveland Clinic

text: Disasters, including infectious disease outbreaks, are inevitable. Hospitals need to plan in advance to ensure that their systems can adapt to a rapidly changing environment if necessary. This review provides an overview of ten general principles that hospitals and healthcare systems should consider when developing disaster plans. The principles are consistent with an "all-hazards" approach to disaster mitigation. This approach is adapted to planning for a multiplicity of threats, but emphasizes highly relevant scenarios, such as the COVID-19 pandemic. We also describe specific ways these principles helped prepare our hospital for this pandemic. Key points include acting quickly, identifying and engaging key stakeholders early, providing accurate information, prioritizing employee safety and mental health, promoting a fully integrated clinical response, developing surge plans, preparing for ethical dilemmas, and having a cogent exit strategy for post disaster recovery.


La práctica de la Cardiología ante la pandemia por COVID-19. Recomendaciones de la comunidad cardiológica mexicana./ Practice of Cardiology during COVID 19 pandemic. Recommendations of the Mexican Cardiology Community


title: Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia

text: BACKGROUND: Three months ago, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, and spread rapidly around the world. Severe novel coronavirus pneumonia (NCP) patients have abnormal blood coagulation function, but their venous thromboembolism (VTE) prevalence is still rarely mentioned. OBJECTIVES: To determine the incidence of VTE in patients with severe NCP. METHODS: In this study, 81 severe NCP patients in the intensive care unit (ICU) of Union Hospital (Wuhan, China) were enrolled. The results of conventional coagulation parameters and lower limb vein ultrasonography of these patients were retrospectively collected and analyzed. RESULTS: The incidence of VTE in these patients was 25% (20/81), of which 8 patients with VTE events died. The VTE group was different from the non-VTE group in age, lymphocyte counts, activated partial thromboplastin time (APTT), D-dimer, etc. If 1.5 µg/mL was used as the D-dimer cut-off value to predicting VTE, the sensitivity was 85.0%, the specificity was 88.5%, and the negative predictive value (NPV) was 94.7%. CONCLUSIONS: The incidence of VTE in patients with severe NCP is 25% (20/81), which may be related to poor prognosis. The significant increase of D-dimer in severe NCP patients is a good index for identifying high-risk groups of VTE.


title: [Large differences in excess mortality in March-May 2020 by country of birth in Sweden]

text: The Swedish strategy for dealing with covid-19 has been criticized for not accounting for difficulties of conducting voluntary social distancing in settings with household overcrowding, dependence on public transport and large proportion of service sector workers In such neighbourhoods there is typically a larger proportion of immigrants We compared all-cause-mortality data in Sweden by country of origin from 2020 and 2016-2019 and found large disparities The number of deaths among persons born in countries from which many refugees have migrated to Sweden in the last decades was 220% higher in March-May 2020 compared to the mean in 2016-2019 In contrast, there was no increased mortality among persons aged 40-64 years and a 19% increased number of deaths of those aged above 65 years born in Sweden, EU or North America during these three months These observations further illustrate the need for a dedicated and more diverse strategy in dealing with the covid-19 pandemic


title: SARS-CoV-2 and viral sepsis: observations and hypotheses

text: Since the outbreak of coronavirus disease 2019 (COVID-19), clinicians have tried every effort to understand the disease, and a brief portrait of its clinical features have been identified. In clinical practice, we noticed that many severe or critically ill COVID-19 patients developed typical clinical manifestations of shock, including cold extremities and weak peripheral pulses, even in the absence of overt hypotension. Understanding the mechanism of viral sepsis in COVID-19 is warranted for exploring better clinical care for these patients. With evidence collected from autopsy studies on COVID-19 and basic science research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV, we have put forward several hypotheses about SARS-CoV-2 pathogenesis after multiple rounds of discussion among basic science researchers, pathologists, and clinicians working on COVID-19. We hypothesise that a process called viral sepsis is crucial to the disease mechanism of COVID-19. Although these ideas might be proven imperfect or even wrong later, we believe they can provide inputs and guide directions for basic research at this moment.


title: A Robust Stochastic Method of Estimating the Transmission Potential of 2019-nCoV

text: The recent outbreak of a novel coronavirus (2019-nCoV) has quickly evolved into a global health crisis. The transmission potential of 2019-nCoV has been modelled and studied in several recent research works. The key factors such as the basic reproductive number, $R_{0}$, of the virus have been identified by fitting contagious disease spreading models to aggregated data. The data include the reported cases both within China and in closely connected cities over the world. In this paper, we study the transmission potential of 2019-nCoV from the perspective of the robustness of the statistical estimation, in light of varying data quality and timeliness in the initial stage of the outbreak. Sample consensus algorithm has been adopted to improve model fitting when outliers are present. The robust estimation enables us to identify two clusters of transmission models, both are of substantial concern, one with $R_0:8\sim14$, comparable to that of measles and the other dictates a large initial infected group.


title: Exploration and Discovery of the COVID-19 Literature through Semantic Visualization

text: We are developing semantic visualization techniques in order to enhance exploration and enable discovery over large datasets of complex networks of relations. Semantic visualization is a method of enabling exploration and discovery over large datasets of complex networks by exploiting the semantics of the relations in them. This involves (i) NLP to extract named entities, relations and knowledge graphs from the original data; (ii) indexing the output and creating representations for all relevant entities and relations that can be visualized in many different ways, e.g., as tag clouds, heat maps, graphs, etc.; (iii) applying parameter reduction operations to the extracted relations, creating"relation containers", or functional entities that can also be visualized using the same methods, allowing the visualization of multiple relations, partial pathways, and exploration across multiple dimensions. Our hope is that this will enable the discovery of novel inferences over relations in complex data that otherwise would go unnoticed. We have applied this to analysis of the recently released CORD-19 dataset.


title: Two clinical cases of Novel coronavirus pneumonia (NCP) in renal transplant recipients/ 中华器官移植杂志

text: Objective@#To explore the clinical features, diagnosis and prognosis of renal transplant recipients with NCP.@*Method@#The clinical data of 2 cases of kidney transplant recipients with NCP were retrospectively analyzed. Based onclinical manifestations, blood routine, inflammatory factors, cell immunity, chest CT andtherapeutic effects, the diagnosis and treatment of NCP in kidney transplant recipients (5th edition) were compared to that ofordinary NCP patients. Both recipients developed onset of low andmoderate fever, with no cough or fatigue at the initial stage. Blood routine indicated a normal range of leukocytes,buta significant decrease in lymphocyte counts, increased C-reactive protein (CRP) , and slightly higher procalcitonin (PCT) . The cellular immunity was extremely low, and the chest CT showed multiple patchy ground glass shadows in both lungs.@*Result@#After 1 week of onset, both patients had significant disease progression. The pathogenesis and imaging changes were highly similar tothatreported in ordinary NCP patients.Two patients were givensymptomatic supportive treatment by antiviral agents, stop uses ofimmunosuppression agents, small amount of hormone maintenance, intravenous drip of gamma globulin andrespiratory support toavoid secondary infections. At present, the condition of both patients is obviously improved, and renal function is stable. One of them has recovered and was discharged.@*Conclusion@#The clinical manifestations of NCP in renal transplant recipients were generally consistent with that of ordinary NCP patients. Although there is no established method for the treatment of NCP, it is effective by stopping uses of immunosuppressive agents, maintaining small and medium doses of hormones, actively restoring immunity, and providing respiratory support in a timely manner.


COVID-19: towards understanding of pathogenesis


title: Academic Emergency Medicine Physicians' Anxiety Levels, Stressors and Potential Stress Mitigation Measures during the Acceleration Phase of the COVID-19 Pandemic

text: OBJECTIVE: To assess anxiety and burnout levels, home life changes and measures to relieve stress of United States academic emergency medicine (EM) physicians during the COVID-19 pandemic acceleration phase. METHODS: We sent a cross-sectional email survey to all EM physicians at seven academic emergency departments. The survey incorporated items from validated stress scales and assessed perceptions and key elements in the following domains: numbers of suspected COVID-19 patients, availability of diagnostic testing, levels of home and workplace anxiety, severity of work burnout, identification of stressors, changes in home behaviors, and measures to decrease provider anxiety. RESULTS: 426 (56.7%) EM physicians responded. On a scale of 1-7 (1= not at all, 4 = somewhat, and 7=extremely), the median (interquartile range) reported effect of the pandemic on both work and home stress levels was 5 (4,6). Reported levels of emotional exhaustion/burnout increased from pre-pandemic median 3 (2,4) to since the pandemic started median 4 (3,6); difference in medians = 1.8 (95% confidence interval 1.7-1.9). Most physicians (90.8%) reported changing their behavior towards family and friends, especially by decreasing signs of affection (76.8%). The most commonly cited measures cited to alleviate stress/anxiety were increasing personal protective equipment availability (PPE), offering rapid COVID-19 testing at physician discretion, providing clearer communication about COVID-19 protocol changes, and assuring that physicians can take leave for care of family and self. CONCLUSIONS: During the acceleration phase, the COVID-19 pandemic has induced substantial workplace and home anxiety in academic EM physicians and their exposure during work has had a major impact on their home lives. Measures cited to decrease stress include enhanced availability of PPE, rapid turnaround testing at provider discretion, and clear communication about COVID-19 protocol changes.


The Crucible of War: Innovation in a Pandemic


Reply to Siniorakis et al., "COVID-19 Interference with Renin-Angiotensin System in the Context of Heart Failure"


title: mEBAL: A Multimodal Database for Eye Blink Detection and Attention Level Estimation

text: This work presents mEBAL, a multimodal database for eye blink detection and attention level estimation. The eye blink frequency is related to the cognitive activity and automatic detectors of eye blinks have been proposed for many tasks including attention level estimation, analysis of neuro-degenerative diseases, deception recognition, drive fatigue detection, or face anti-spoofing. However, most existing databases and algorithms in this area are limited to experiments involving only a few hundred samples and individual sensors like face cameras. The proposed mEBAL improves previous databases in terms of acquisition sensors and samples. In particular, three different sensors are simultaneously considered: Near Infrared (NIR) and RGB cameras to capture the face gestures and an Electroencephalography (EEG) band to capture the cognitive activity of the user and blinking events. Regarding the size of mEBAL, it comprises 6,000 samples and the corresponding attention level from 38 different students while conducting a number of e-learning tasks of varying difficulty. In addition to presenting mEBAL, we also include preliminary experiments on: i) eye blink detection using Convolutional Neural Networks (CNN) with the facial images, and ii) attention level estimation of the students based on their eye blink frequency.


Olfactory and gustatory dysfunction caused by SARS-CoV-2: Comparison with cases of infection with influenza and other viruses


Acute Kidney Injury in COVID-19 Pandemic


title: The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2

text: BACKGROUND: Face mask usage by the healthy population in the community to reduce risk of transmission of respiratory viruses remains controversial. We assessed the effect of community-wide mask usage to control coronavirus disease 2019 (COVID-19) in Hong Kong Special Administrative Region (HKSAR). METHODS: Patients presenting with respiratory symptoms at outpatient clinics or hospital wards were screened for COVID-19 per protocol. Epidemiological analysis was performed for confirmed cases, especially persons acquiring COVID-19 during mask-off and mask-on settings. The incidence of COVID-19 per million population in HKSAR with community-wide masking was compared to that of non-mask-wearing countries which are comparable with HKSAR in terms of population density, healthcare system, BCG vaccination and social distancing measures but not community-wide masking. Compliance of face mask usage in the HKSAR community was monitored. FINDINGS: Within first 100 days (31 December 2019 to 8 April 2020), 961 COVID-19 patients were diagnosed in HKSAR. The COVID-19 incidence in HKSAR (129.0 per million population) was significantly lower (p<0.001) than that of Spain (2983.2), Italy (2250.8), Germany (1241.5), France (1151.6), U.S. (1102.8), U.K. (831.5), Singapore (259.8), and South Korea (200.5). The compliance of face mask usage by HKSAR general public was 96.6% (range: 95.7% to 97.2%). We observed 11 COVID-19 clusters in recreational 'mask-off' settings compared to only 3 in workplace 'mask-on' settings (pâ¯=â¯0.036 by Chi square test of goodness-of-fit). CONCLUSION: Community-wide mask wearing may contribute to the control of COVID-19 by reducing the amount of emission of infected saliva and respiratory droplets from individuals with subclinical or mild COVID-19.


title: Recommendations for the organization of electrophysiology and cardiac pacing services during the COVID-19 pandemic : Latin American Heart Rhythm Society (LAHRS) in collaboration with: Colombian College Of Electrophysiology, Argentinian Society of Cardiac Electrophysiology (SADEC), Brazilian Society Of Cardiac Arrhythmias (SOBRAC), Mexican Society Of Cardiac Electrophysiology (SOMEEC)

text: COVID-19 is a rapidly evolving public health emergency that has largely impacted the provision of healthcare services around the world. The challenge for electrophysiology teams is double; on one side preventing disease spread by limiting all nonessential face-to-face interactions, but at the same time ensuring continued care for patients who need it. These guidelines contain recommendations regarding triaging in order to define what procedures, device checks and clinic visits can be postponed during the pandemic. We also discuss best practices to protect patients and healthcare workers and provide guidance for the management of COVID-19 patients with arrhythmic conditions.


Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19


title: Mobilidade urbana e o acesso ao Sistema Único de Saúde para casos suspeitos e graves de Covid-19 nas vinte maiores cidades do Brasil

text: A iminência da crise do sistema de saúde causada pela Covid-19 exige inúmeras ações emergenciais Entre estas, é essencial para o planejamento dos serviços de saúde ter um diagnóstico de quais áreas das cidades têm menos acesso a equipamentos de saúde, e quais são os hospitais que poderão ter maior sobrecarga de demanda por internações Esta nota técnica tem como objetivos: (1) estimar quantas são e onde moram as pessoas mais vulneráveis com maior dificuldade de acessar equipamentos de saúde;e (2) apontar quais são os estabelecimentos de saúde que poderão ter maior estrangulamento de demanda, considerando-se sua capacidade de oferta de leitos de unidades de tratamento intensivo (UTIs) Este trabalho analisou a capacidade de suporte do SUS, apresentando estimativas da quantidade de leitos de UTI/respiradores por pessoa de cada hospital nos maiores municípios do Brasil Os resultados apontam que os maiores municípios do Brasil têm um número de leitos de UTI adulto com respiradores disponíveis ao SUS muito próximo do mínimo desejável, segundo o Ministério da Saúde No entanto, esse valor pode ficar muito abaixo do necessário para lidar com um grande crescimento da demanda de internações, mesmo caso os cenários mais otimistas de propagação da Covid-19 no Brasil se confirmem Os resultados apontam uma situação ainda mais preocupante nas periferias dos grandes centros urbanos, onde, via de regra, a baixa oferta de equipamentos de saúde, combinada com piores condições de urbanização e de renda, aumentam o potencial de propagação da Covid-19 diante de uma baixa capacidade de atendimento do sistema de saúde Esses resultados podem ajudar a identificar quais unidades de saúde poderiam receber aportes de recursos suplementares para ampliação de sua capacidade Uma análise mais detalhada desses resultados poderia apontar também quais são os bairros das cidades onde a construção de hospitais de campanha seria mais eficaz quanto ao aumento do acesso da população aos serviços de saúde


title: The spike glycoprotein of the new coronavirus 2019-nCoV contains a furin-like cleavage site absent in CoV of the same clade

text: In 2019, a new coronavirus (2019-nCoV) infecting Humans has emerged in Wuhan, China. Its genome has been sequenced and the genomic information promptly released. Despite a high similarity with the genome sequence of SARS-CoV and SARS-like CoVs, we identified a peculiar furin-like cleavage site in the Spike protein of the 2019-nCoV, lacking in the other SARS-like CoVs. In this article, we discuss the possible functional consequences of this cleavage site in the viral cycle, pathogenicity and its potential implication in the development of antivirals.


title: Pandemics and psychiatry: Repositioning research in context of COVID-19

text: The current Covid-19 pandemic is posing an unprecedented threat to global well-being and its mental health consequences are just becoming understood. While the crisis has led to a temporary halt in a lot of ongoing or planned psychiatric research, this pandemic is a natural experiment that can help the field to repurpose research to better understand the causes, presentations and outcome trajectories as well as treatments in psychiatry. Inter-disciplinary collaborations between researchers are needed to rapidly develop and share the emerging new knowledge of the mental health implications of Covid-19, This will help mount an effective response to the current as well as future pandemics.


title: Prediction of repurposed drugs for treating lung injury in COVID-19

text: Coronavirus disease (COVID-19) is an infectious disease discovered in 2019 and currently in outbreak across the world. Lung injury with severe respiratory failure is the leading cause of death in COVID-19, brought by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there still lacks efficient treatment for COVID-19 induced lung injury and acute respiratory failure. Inhibition of Angiotensin-converting enzyme 2 (ACE2) caused by spike protein of SARS-CoV-2 is the most plausible mechanism of lung injury in COVID-19. We propose two candidate drugs, COL-3 (a chemically modified tetracycline) and CGP-60474 (a cyclin-dependent kinase inhibitor), for treating lung injuries in COVID-19, based on their abilities to reverse the gene expression patterns in HCC515 cells treated with ACE2 inhibitor and in human COVID-19 patient lung tissues. Further bioinformatics analysis shows that twelve significantly enriched pathways (P-value<0.05) overlap between HCC515 cells treated with ACE2 inhibitor and human COVID-19 patient lung tissues, including signaling pathways known to be associated with lung injury such as TNF signaling, MAPK signaling and Chemokine signaling pathways. All these twelve pathways are targeted in COL-3 treated HCC515 cells, in which genes such as RHOA, RAC2, FAS, CDC42 have reduced expression. CGP-60474 shares eleven of twelve pathways with COL-3 with common target genes such as RHOA. It also uniquely targets genes related to lung injury, such as CALR and MMP14. In summary, this study shows that ACE2 inhibition is likely part of the mechanisms leading to lung injury in COVID-19, and that compounds such as COL-3 and CGP-60474 have the potential as repurposed drugs for its treatment.


Non-evidence-based platelet transfusions for protocol eligibility


We must not forget the most disadvantaged people facing the COVID-19 crisis


Kidney Involvement in COVID-19: Need for Better Definitions