title: Nowhere to hide: The significant impact of coronavirus disease 2019 (COVID-19) measures on elite and semi-elite South African athletes

text: OBJECTIVES: To describe the perceptions of South African elite and semi-elite athletes on return to sport (RTS); maintenance of physical conditioning and other activities; sleep; nutrition; mental health; healthcare access; and knowledge of coronavirus disease 2019 (COVID-19). DESIGN: Cross- sectional study. METHODS: A Google Forms survey was distributed to athletes from 15 sports in the final phase (last week of April 2020) of the level 5 lockdown period. Descriptive statistics were used to describe player demographic data. Chi-squared tests investigated significance (p<0.05) between observed and expected values and explored sex differences. Post hoc tests with a Bonferroni adjustment were included where applicable. RESULTS: 67% of the 692 respondents were males. The majority (56%) expected RTS after 1-6 months. Most athletes trained alone (61%; p<0.0001), daily (61%; p<0.0001) at moderate intensity (58%; p<0.0001) and for 30-60min (72%). During leisure time athletes preferred sedentary above active behaviour (p<0.0001). Sleep patterns changed significantly (79%; p<0.0001). A significant number of athletes consumed excessive amounts of carbohydrates (76%; p<0.0001; males 73%; females 80%). Many athletes felt depressed (52%), and required motivation to keep active (55%). Most had access to healthcare during lockdown (80%) and knew proceedings when suspecting COVID-19 (92%). CONCLUSIONS: COVID-19 had physical, nutritional and psychological consequences that may impact on the safe RTS and general health of athletes. Lost opportunities and uncertain financial and sporting futures may have significant effects on athletes and the sports industry. Government and sporting federations must support athletes and develop and implement guidelines to reduce the risk in a COVID-19 environment.


title: Potential false-positive rate among the asymptomatic infected individuals’ in close contacts of COVID-19 patients

text: As the prevention and control of COVID-19continues to advance, the active nucleic acid test screening in the close contacts of the patients has been carrying out in many parts of China However, the false-positive rate of positive results in the screening has not been reported up to now But false positive rate during screening is important in COVID-19 control and prevention Methods: Point values and reasonable ranges of the indicators which impact the false-positive rate of positive results were estimated based on the information available to us at present The false-positive rate of positive results in the active screening was deduced, and univariate and multivariate-probabilistic sensitivity analyses were performed to understand the robustness of the findings Results: When the infection rate of the close contacts and the sensitivity and specificity of reported results were taken as the point estimates, the positive predictive value of the active screening was only 19 67%, in contrast, the false-positive rate of positive results was 80 33% The multivariate-probabilistic sensitivity analysis results supported the base-case findings, with a 75% probability for the false-positive rate of positive results over 47% Conclusions: In the close contacts of COVID-19 patients, nearly half or even more of the asymptomatic infected individuals reported in the active nucleic acid test screening might be false positives


title: [WITHDRAWN: Potential false-positive rate among the 'asymptomatic infected individuals' in close contacts of COVID-19 patients]

text: Editor office's response for Ahead of Print article withdrawn The article "Potential false-positive rate among the 'asymptomatic infected individuals' in close contacts of COVID-19 patients" was under strong discussion after pre-published. Questions from the readers mainly focused on the article's results and conclusions were depended on theoretical deduction, but not the field epidemiology data and further researches were needed to prove the current theory. Based on previous discussions, the article was decided to be offline by the editorial board from the pre-publish lists. Objective: As the prevention and control of COVID-19continues to advance, the active nucleic acid test screening in the close contacts of the patients has been carrying out in many parts of China. However, the false-positive rate of positive results in the screening has not been reported up to now. But to clearify the false-positive rate during screening is important in COVID-19 control and prevention. Methods: Point values and reasonable ranges of the indicators which impact the false-positive rate of positive results were estimated based on the information available to us at present. The false-positive rate of positive results in the active screening was deduced, and univariate and multivariate-probabilistic sensitivity analyses were performed to understand the robustness of the findings. Results: When the infection rate of the close contacts and the sensitivity and specificity of reported results were taken as the point estimates, the positive predictive value of the active screening was only 19.67%, in contrast, the false-positive rate of positive results was 80.33%. The multivariate-probabilistic sensitivity analysis results supported the base-case findings, with a 75% probability for the false-positive rate of positive results over 47%. Conclusions: In the close contacts of COVID-19 patients, nearly half or even more of the 'asymptomatic infected individuals' reported in the active nucleic acid test screening might be false positives.


title: Potential false-positive rate among the 'asymptomatic infected individuals’ in close contacts of COVID-19 patients

text: Objective@#As the prevention and control of COVID-19continues to advance, the active nucleic acid test screening in the close contacts of the patients has been carrying out in many parts of China However, the false-positive rate of positive results in the screening has not been reported up to now But to clearify the false-positive rate during screening is important in COVID-19 control and prevention @*Methods@#Point values and reasonable ranges of the indicators which impact the false-positive rate of positive results were estimated based on the information available to us at present The false-positive rate of positive results in the active screening was deduced, and univariate and multivariate-probabilistic sensitivity analyses were performed to understand the robustness of the findings @*Results@#When the infection rate of the close contacts and the sensitivity and specificity of reported results were taken as the point estimates, the positive predictive value of the active screening was only 19 67%, in contrast, the false-positive rate of positive results was 80 33% The multivariate-probabilistic sensitivity analysis results supported the base-case findings, with a 75% probability for the false-positive rate of positive results over 47% @*Conclusions@#In the close contacts of COVID-19 patients, nearly half or even more of the &apos;asymptomatic infected individuals’ reported in the active nucleic acid test screening might be false positives


Leveraging COVID-19-Inspired Changes to Advance Otolaryngology-Here to Stay


Shifting dermatology market strategies from cosmetics to moisturizers and sanitizers treatments in COVID-19 era


Lung Ultrasound and the COVID-19 "Pattern": Not All That Glitters Today Is Gold Tomorrow


title: Guidelines for therapy of patients with chronic myeloproliferative neoplasms during the novel coronavirus SARS-CoV2 pandemic

text: The novel coronavirus has swept across the world in 2020 and ushered a new era. In the current scenario, it is not clear how patients with myeloproliferative neoplasms (including chronic myelogenous leukemia) should be managed, considering the risk of therapy, the need for social distancing and the risk of untimely therapy discontinuation of delay. This guideline aims to give providers a sense of direction in order to better take care of patients and prioritize care.


title: Myeloma care adaptations in the UK during SARS-CoV-2 pandemic: challenges and measurable outcomes

text: Following the emergence of COVID-19 as a global pandemic, cancer clinicians have been faced with the challenge of continuing to manage patients, with limited data to inform practice (Poortmans et al 2020). Recently, a large prospective cohort study of 800 cancer patients diagnosed with symptomatic COVID-19 demonstrated a mortality rate of 28%, which was largely driven by age, co-morbidities and being a male (Lee et al 2020).


title: Adaptive Flexible Sialylated Nanogels as Highly Potent Influenza A Virus Inhibitors

text: Flexible multivalent 3D nanosystems that can deform and adapt onto the virus surface via specific ligand-receptor multivalent interactions can efficiently block virus adhesion onto the cell. We here report on the synthesis of a 250â nm sized flexible sialylated nanogel that adapts onto the influenza A virus (IAV) surface via multivalent binding of its sialic acid (SA) residues with hemagglutinin spike proteins on the virus surface. We could demonstrate that the high flexibility of sialylated nanogel improves IAV inhibition by 400 times as compared to a rigid sialylated nanogel in the hemagglutination inhibition assay. The flexible sialylated nanogel efficiently inhibits the influenza A/X31 (H3N2) infection with IC50 values in low picomolar concentrations and also blocks the virus entry into MDCK-II cells.


title: A primer on viral-associated olfactory loss in the era of COVID-19

text: Early reports have suggested that smell loss may be an early symptom associated with the pandemic known as coronavirus disease 2019 (COVID-19). The possibility that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might cause olfactory dysfunction is certainly plausible. Patients presenting to specialized smell clinics are commonly diagnosed with upper respiratory infection (URI)-associated olfactory loss and most are presumed to be viral related. In acute phases of infection, it is common to experience some smell loss as a result of nasal inflammation, mucosal edema, and obstruction of airflow into the olfactory cleft. In most cases, these episodes of smell loss are self-limiting and coincide with resolution of URI symptoms. However, in some cases the smell loss persists for months to years and this is presumed to occur through a more direct olfactory insult by the virus. It remains too early to know whether infection with SARS-CoV-2 causes persistent olfactory dysfunction. However, given the scale of this pandemic, if SARS-CoV-2 does cause chronic olfactory loss in even a small portion of those infected, then the overall population prevalence could be quite large. This review provides a brief, practical overview of viral-associated olfactory loss, realizing that evidence related to COVID-19 will likely not be clear for some time. Our goal is to highlight the existence and importance of this condition and provide information geared for both providers and patients. Practical suggestions regarding evaluation and treatment will be provided, realizing that there may be constraints on medical resources and the nature of this pandemic remains dynamic.


"Sex in the time of COVID": clinical guidelines for STD management in an era of social distancing


Impact of coronavirus outbreak on psychological health


title: [Analysis of the clinical characteristics and early warning model construction of severe/critical coronavirus disease 2019 patients]

text: OBJECTIVE: To analyze the clinical characteristics of critical patients with coronavirus disease 2019 (COVID-19), build an early warning model for severe/critical type, and aim at providing reference for the prediction of severe/critical COVID-19. METHODS: The clinical data of COVID-19 patients treated in the Second People' Hospital of Fuyang City from January 20th to February 18th in 2020 were retrospective analyzed, including the demographic and epidemiological date, vital signs and hematology indexes, etc. on admission. Patients were divided into the normal type (set as normal group) and severe/critical type (set as severe group) according to the COVID-19 treatment plan classification standard published by National Health Commission of the People's Republic of China. The differences between two groups were compared, and the variables with statistical significance were incorporated in the multivariate binary unconditional Logistic regression analysis to screen the risk factors of severe/critical type. Risk factors were summarized to establish an early warning model, and the receiver operating characteristic (ROC) curve was carried out to evaluate the significance of the early warning model in the screening of critically COVID-19. RESULTS: A total of 155 patients with COVID-19 were admitted, including 125 patients of normal type and 30 patients of severe/critical type. (1) Compared with normal group, patients in severe group were older, and with higher proportion of basic diseases, higher body mass index (BMI), higher incidence of tachypnea, persistent high fever, peripheral blood oxygen saturation (SpO2) < 0.95, while the white blood cell count (WBC), CD4+T lymphocyte, CD8+T lymphocyte, lymphocyte count (LYM) were decreased obviously, the levels of interleukin-6 (IL-6), C-reactive protein (CRP) and serum amyloid a protein (SAA), and CT showed higher incidence of multi-pulmonary lobe lesions. There were no significant differences of gender, travel history from Wuhan, smoking history, shock index (SI) and CD4+/CD8+ ratio between the two groups. (2) Multivariate Logistic regression analysis showed that age ≥ 60 years old [odds ratio (OR) = 1.620, P = 0.031], combined with underlying diseases (OR = 1.521, P = 0.044), persistent high fever (OR = 2.469, P = 0.014), WBC < 2.0×109/L and/or LYM < 0.4×109/L (OR = 3.079, P = 0.006), pulmonary multilobar lesions (OR = 1.367, P = 0.047), and IL-6 ≥ 30 ng/L (OR = 2.426, P = 0.010) were the risk factors of severe/critical COVID-19. (3) The OR value corresponding to each risk factors were scored by rounding. Two points were scored for age ≥ 60 years old, with underlying diseases, persistent high fever and IL-6 ≥ 30 ng/L, 3 points for WBC < 2.0×109/L and/or LYM < 0.4×109/L, 1 point for pulmonary multilobar lesions, and totally calculated as early warning model scores. The early warning model score of the severe group was significantly higher than that of the normal group (9.33±2.79 vs. 5.04±2.38, t = 9.010, P = 0.001). (4) The ROC curve analysis showed the area under ROC curve (AUC) of early warning model on the early screening of severe/critical patients in COVID-19 was 0.944, and 95% confidence interval (95%CI) was 0.903-0.985; and the sensitivity and specificity were 93.3% and 72.0% respectively while the cut-off was 6.5. CONCLUSIONS: There are many differences between severe/critical and mild COVID-19 patients. The establishment of early warning model could help to screen severe/critical patients at an early stage, with certain significance for guiding treatment.


title: Informing emergency care for COVID-19 patients: The COVID-19 Emergency Department Quality Improvement Project protocol

text: OBJECTIVES: There is an urgency to support Australian ED clinicians with real-time tools as the COVID-19 pandemic evolves. The COVID-19 Emergency Department (COVED) Quality Improvement Project has commenced and will provide flexible and responsive clinical tools to determine the predictors of key ED-relevant clinical outcomes. METHODS: The COVED Project includes all adult patients presenting to a participating ED and meeting contemporary testing criteria for COVID-19. The dataset has been embedded in the electronic medical record and the COVED Registry has been developed. RESULTS: Outcomes measured include being COVID-19 positive and requiring intensive respiratory support. Regression methodology will be used to generate clinical prediction tools. CONCLUSION: This project will support EDs during this pandemic.


Covid-19: Return of Monday morning rush hour


title: Management of the difficult airway in the COVID-19 pandemic: Illustrative complex head and neck cancer scenario

text: BACKGROUND: This case highlights challenges in the assessment and management of the "difficult airway" patient in the SARS-CoV-2 (COVID-19) pandemic era. METHODS: A 60-year-old male with history of recent transoral robotic surgery resection, free flap reconstruction, and tracheostomy for p16+ squamous cell carcinoma presented with stridor and dyspnea 1 month after decannulation. Careful planning by a multidisciplinary team allowed for appropriate staffing and personal protective equipment, preparations for emergency airway management, evaluation via nasopharyngolaryngoscopy, and COVID testing. The patient was found to be COVID negative and underwent imaging which revealed new pulmonary nodules and a tracheal lesion. RESULTS: The patient was safely transorally intubated in the operating room. The tracheal lesion was removed endoscopically and tracheostomy was avoided. CONCLUSIONS: This case highlights the importance of careful and collaborative decision making for the management of head and neck cancer and other "difficult airway" patients during the COVID-19 epidemic.


The Risks of Prescribing Hydroxychloroquine in COVID-19-Infected Patients With Schizophrenia


title: A molecular modeling approach to identify effective antiviral phytochemicals against the main protease of SARS-CoV-2

text: The main protease of SARS-CoV-2 is one of the important targets to design and develop antiviral drugs. In this study, we have selected 40 antiviral phytochemicals to find out the best candidates which can act as potent inhibitors against the main protease. Molecular docking is performed using AutoDock Vina and GOLD suite to determine the binding affinities and interactions between the phytochemicals and the main protease. The selected candidates strongly interact with the key Cys145 and His41 residues. To validate the docking interactions, 100 ns molecular dynamics (MD) simulations on the five top-ranked inhibitors including hypericin, cyanidin 3-glucoside, baicalin, glabridin, and α-ketoamide-11r are performed. Principal component analysis (PCA) on the MD simulation discloses that baicalin, cyanidin 3-glucoside, and α-ketoamide-11r have structural similarity with the apo-form of the main protease. These findings are also strongly supported by root-mean-square deviation (RMSD), root-mean-square fluctuation (RMSF), radius of gyration (Rg), and solvent accessible surface area (SASA) investigations. PCA is also used to find out the quantitative structure-activity relationship (QSAR) for pattern recognition of the best ligands. Multiple linear regression (MLR) of QSAR reveals the R2 value of 0.842 for the training set and 0.753 for the test set. Our proposed MLR model can predict the favorable binding energy compared with the binding energy detected from molecular docking. ADMET analysis demonstrates that these candidates appear to be safer inhibitors. Our comprehensive computational and statistical analysis show that these selected phytochemicals can be used as potential inhibitors against the SARS-CoV-2.Communicated by Ramaswamy H. Sarma.


title: Viruses to fight other viruses: the influenza vaccine case

text: Undoubtedly, vaccination is one of the health interventions showing major impact on humankind. Vaccines remain one of the most effective and safest ways to tackle infections. The current coronavirus pandemic is not an exception, and we all hope that ongoing international efforts will succeed in developing a vaccine soon. In this scenario, the present work published in this edition of EMBO Molecular Medicine by Demminger and colleagues (Demminger et al, 2020) is timeliness to exemplify the steps needed to develop effective vaccines.


COVID-19: Time for precision epidemiology


title: Replication of SARS-CoV-2 in human respiratory epithelium

text: Currently, there are four seasonal coronaviruses associated with relatively mild respiratory tract disease in humans. However, there are also a plethora of animal coronaviruses, which have the potential to cross the species border. This regularly results in the emergence of new viruses in humans. In 2002 SARS-CoV emerged, to rapidly disappear in May 2003. In 2012 MERS-CoV was identified as a possible threat to humans, but its pandemic potential so far is minimal, as the human-to-human transmission is ineffective. The end of 2019 brought us information about the SARS-CoV-2 emergence, and the virus rapidly spread in 2020 causing an unprecedented pandemic.At present, the studies on the virus are carried out using a surrogate system based on the immortalized simian Vero E6 cell line. This model is convenient for diagnostics, but it has serious limitations and does not allow for the understanding of virus biology and evolution.Here we show that fully differentiated human airway epithelium cultures constitute an excellent model to study the infection with the novel human coronavirus SARS-CoV-2. We observed an efficient replication of the virus in the tissue, with the maximal replication at 2 days post-infection. The virus replicated in ciliated cells and was released apically.IMPORTANCE SARS-CoV-2 emerged by the end of 2019 to rapidly spread in 2020. At present, it is of utmost importance to understand the virus biology and to rapidly assess the potential of existing drugs and develop new active compounds. While some animal models for such studies are under development, most of the research is carried out in the Vero E6 cells. Here, we propose fully differentiated human airway epithelium cultures as a model for studies on the SARS-CoV-2.


title: Containment efficiency and control strategies for the Corona pandemic costs

text: The rapid spread of the Coronavirus (COVID-19) confronts policy makers with the problem of measuring the effectiveness of containment strategies and the need to balance public health considerations with the economic costs of a persistent lockdown. We introduce a modified epidemic model, the controlled-SIR model, in which the disease reproduction rate evolves dynamically in response to political and societal reactions. An analytic solution is presented. The model reproduces official COVID-19 cases counts of a large number of regions and countries that surpassed the peak of the outbreak. A single unbiased feedback parameter is extracted from field data and used to formulate an index that measures the efficiency of containment policies (the CEI index). CEI values for a range of countries are given. For two variants of the controlled-SIR model, detailed estimates of the total medical and socio-economic costs are evaluated over the entire course of the epidemic. Costs comprise medical care cost, the economic cost of social distancing, as well as the economic value of lives saved. Under plausible parameters, strict measures fare better than a hands-off policy. Strategies based on actual case numbers lead to substantially higher total costs than strategies based on the overall history of the epidemic.


Mobile Health Technology for Enhancing the COVID-19 Response in Africa: A Potential Game Changer?


Impact of Potential Physiological Changes due to COVID-19 Home Confinement on Athlete Health Protection in Elite Sports: a Call for Awareness in Sports Programming


title: Author Correction: Vitamin lipid nanoparticles enable adoptive macrophage transfer for the treatment of multidrug-resistant bacterial sepsis

text: An amendment to this paper has been published and can be accessed via a link at the top of the paper.


Spontaneous coronavirus disease 2019 (COVID-19)-associated luminal aortic thrombus


Lockdown and our national supply of blood products


title: Risk of hepatic failure in COVID-19 patients. A systematic review and meta-analysis

text: Liver injury has been reported to occur during the disease in severe cases. Therefore, this meta-analysis study aims to investigate the incidence of liver injury among published literature from 2019-Jan-01 to 2020-April-03 to provide an outline for further studies on the liver injury of COVID-19. Four databases including Pubmed, Embase, Web of Science, and the Scopus were searched for studies published from 2019-Jan-01 to 2020-April-03. Data analysis and drawing of charts were performed using the Comprehensive Meta-Analysis Software Version 2.2 (Biostat, USA). The search yielded 450 publications, of which 64 potentially eligible studies were identified for full-text review and 21 studies fulfilling the inclusion criteria remained. A total of 4191 COVID-19 patients were included in our meta-analysis. The pooled prevalence of liver injury was 19.5% (95% CI: 14.3-26.1). According to our results, there was significant heterogeneity among the 19 studies (X2 = 738.5; p < 0.001; I2 = 94.34%). Among 288 death cases, the pooled prevalence of liver injury was 22.8% (95% CI: 11.7-39.8). In summary, the COVID-19 disease itself can result in severe and even fatal respiratory diseases and even may lead to ARDS and multiple organ failure. The results of this systematic review highlight the importance of liver injury that may assist clinicians anywhere in the globe in controlling COVID-19-related infection and complications. Moreover, the prevalence of liver injury can be higher in severe cases than in mild cases.


title: Mobilizing the Trump Train: Understanding Collective Action in a Political Trolling Community

text: Political trolls initiate online discord not only for the lulz (laughs) but also for ideological reasons, such as promoting their desired political candidates. Political troll groups recently gained spotlight because they were considered central in helping Donald Trump win the 2016 US presidential election, which involved difficult mass mobilizations. Political trolls face unique challenges as they must build their own communities while simultaneously disrupting others. However, little is known about how political trolls mobilize sufficient participation to suddenly become problems for others. We performed a quantitative longitudinal analysis of more than 16 million comments from one of the most popular and disruptive political trolling communities, the subreddit /r/The\_Donald (T\D). We use T_D as a lens to understand participation and collective action within these deviant spaces. In specific, we first study the characteristics of the most active participants to uncover what might drive their sustained participation. Next, we investigate how these active individuals mobilize their community to action. Through our analysis, we uncover that the most active employed distinct discursive strategies to mobilize participation, and deployed technical tools like bots to create a shared identity and sustain engagement. We conclude by providing data-backed design implications for designers of civic media.


Considerations for Scaling Down Fetal Echocardiography During the COVID-19 Pandemic


A citizen's thoughts about COVID-19


Letter to the Editor: Risk Communication, Shared Responsibility, and Mutual Trust Are Matters: Real Lessons from Closure of Eunpyeong St. Mary's Hospital Due to Coronavirus Disease 2019 in Korea


title: Human Mobility during COVID-19 in the Context of Mild Social Distancing: Implications for Technological Interventions

text: The COVID-19 pandemic has brought both tangible and intangible damage to our society. Many researchers studied about its societal impacts in the countries that had implemented strong social distancing measures such as stay-at-home orders. Among them, human mobility has been studied extensively due to its importance in flattening the curve. However, mobility has not been actively studied in the context of mild social distancing. Insufficient understanding of human mobility in diverse contexts might provide limited implications for any technological interventions to alleviate the situation. To this end, we collected a dataset consisting of more than 1M daily smart device users in the third-largest city of South Korea, which has implemented mild social distancing policies. We analyze how COVID-19 shaped human mobility in the city from geographical, socio-economic, and socio-political perspectives. We also examine mobility changes for points of interest and special occasions such as transportation stations and the case of legislative elections. We identify a typology of populations through these analyses as a means to provide design implications for technological interventions. This paper contributes to social sciences through in-depth analyses of human mobility and to the CSCW community with new design challenges and potential implications.


Family medicine in times of 'COVID-19': A generalists' voice


Which intravascular access should we use in patients with suspected/confirmed COVID-19?


title: Knowledge, attitudes, risk perceptions, and practices of adults toward COVID-19: a population and field-based study from Iran

text: OBJECTIVES: To determine peoples' knowledge, attitudes, risk perceptions, and practices to provide policymakers pieces of field-based evidence and help them in the management of the COVID-19 epidemic. METHODS: This population-based survey was conducted using multi-stage stratified and cluster sampling in Shiraz, Iran. A total of 1331 persons were interviewed. The questionnaires were completed by face-to-face interviews. Univariable and multivariable (linear regression) data analyses were done using SPSS. RESULTS: The participants answered 63% of questions regarding knowledge, and 78% of questions regarding practice correctly. Only, 4.8% knew about common symptoms of COVID-19 and 7.3% about warning signs that require referral to hospitals. Males, lower educated people, and elders had a lower level of knowledge and poorer practices. Knowledge was also lower in the marginalized (socially deprived) people. Knowledge and practices' correlation was 37%. Overall, 43.6% considered themselves at high risk of COVID-19, and 50% considered it as a severe disease. This disease had negative effects on most participants' routine activities (69.1%). The participants preferred to follow the news from the national TV/Radio, social networks, and foreign satellite channels, respectively. CONCLUSIONS: Encouragement of people to observe preventive measures and decreasing social stress, especially among males, lower educated people, elders, and marginalized groups, are highly recommended.


New Early Warning Score: off-label approach for Covid-19 outbreak patient deterioration in the community


The next big threat to global health? 2019 novel coronavirus (2019-nCoV): What advice can we give to travellers? - Interim recommendations January 2020, from the Latin-American society for Travel Medicine (SLAMVI)


COVID-19 and benign intracranial hypertension: A case report


Update Alert: Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19? Living Practice Points From the American College of Physicians


title: Silencing the cytokine storm: the use of intravenous anakinra in haemophagocytic lymphohistiocytosis or macrophage activation syndrome

text: The term cytokine storm syndromes describes conditions characterised by a life-threatening, fulminant hypercytokinaemia with high mortality. Cytokine storm syndromes can be genetic or a secondary complication of autoimmune or autoinflammatory disorders, infections, and haematological malignancies. These syndromes represent a key area of interface between rheumatology and general medicine. Rheumatologists often lead in management, in view of their experience using intensive immunosuppressive regimens and managing cytokine storm syndromes in the context of rheumatic disorders or infection (known as secondary haemophagocytic lymphohistiocytosis or macrophage activation syndrome [sHLH/MAS]). Interleukin (IL)-1 is pivotal in hyperinflammation. Anakinra, a recombinant humanised IL-1 receptor antagonist, is licenced at a dose of 100 mg once daily by subcutaneous injection for rheumatoid arthritis, systemic juvenile idiopathic arthritis, adult-onset Still's disease, and cryopyrin-associated periodic syndromes. In cytokine storm syndromes, the subcutaneous route is often problematic, as absorption can be unreliable in patients with critical illness, and multiple injections are needed to achieve the high doses required. As a result, intravenous anakinra is used in clinical practice for sHLH/MAS, despite this being an off-licence indication and route of administration. Among 46 patients admitted to our three international, tertiary centres for sHLH/MAS and treated with anakinra over 12 months, the intravenous route of delivery was used in 18 (39%) patients. In this Viewpoint, we describe current challenges in the management of cytokine storm syndromes and review the pharmacokinetic and safety profile of intravenous anakinra. There is accumulating evidence to support the rationale for, and safety of, intravenous anakinra as a first-line treatment in patients with sHLH/MAS. Intravenous anakinra has important clinical relevance when high doses of drug are required or if patients have subcutaneous oedema, severe thrombocytopenia, or neurological involvement. Cross-speciality management and collaboration, with the generation of international, multi-centre registries and biobanks, are needed to better understand the aetiopathogenesis and improve the poor prognosis of cytokine storm syndromes.


Ethics in the Time of Coronavirus: Engaging the Conversation: In Reply to Hai and Colleagues


title: [The Key Role of Taiwanese Nurses in Combating COVID-19 Pandemic]

text: As the COVID-19 pandemic continues to rage worldwide, Taiwan has achieved outstanding performance in controlling the spread of the outbreak domestically, earning global appreciation. Nurses on the frontlines deserve much of the credit for the ongoing success in fighting against this outbreak in Taiwan. Taiwan's success to date is grounded in proactive preparedness and deployment by the government and effective teamwork among government agencies, medical institutions, enterprises, and the public. Comprehensive containment strategies and preparedness have allowed nurses to effectively perform their duties and combat the pandemic. Nurses safeguard the public's health a myriad of ways, including implementing quarantine measures at air and seaports, conducting fever screenings, delivering inpatient isolation treatments, performing case contact tracing, providing community care services, and operating special chartered-flight services. The Taiwan Nurses Association (TWNA) provides vital lead in this pandemic response, advocating for the safety, health and wellbeing of nurses; highlighting the contributions and value of nurses; and enhancing the professional image and status of nurses. Furthermore, through its global platform, TWNA shares with peer organizations worldwide the content and efficacy of actions taken by the national government, the contributions of healthcare workers, and the support and encouragement received from the public in COVID-19 containment to demonstrate values of Taiwan and nursing.


SARS-CoV-2 and Streptococcus pneumoniae coinfection as a cause of severe pneumonia in an infant


title: Immunity-and-matrix-regulatory cells derived from human embryonic stem cells safely and effectively treat mouse lung injury and fibrosis

text: Lung injury and fibrosis represent the most significant outcomes of severe and acute lung disorders, including COVID-19. However, there are still no effective drugs to treat lung injury and fibrosis. In this study, we report the generation of clinical-grade human embryonic stem cells (hESCs)-derived immunity- and matrix-regulatory cells (IMRCs) produced under good manufacturing practice requirements, that can treat lung injury and fibrosis in vivo. We generate IMRCs by sequentially differentiating hESCs with serum-free reagents. IMRCs possess a unique gene expression profile distinct from that of umbilical cord mesenchymal stem cells (UCMSCs), such as higher expression levels of proliferative, immunomodulatory and anti-fibrotic genes. Moreover, intravenous delivery of IMRCs inhibits both pulmonary inflammation and fibrosis in mouse models of lung injury, and significantly improves the survival rate of the recipient mice in a dose-dependent manner, likely through paracrine regulatory mechanisms. IMRCs are superior to both primary UCMSCs and the FDA-approved drug pirfenidone, with an excellent efficacy and safety profile in mice and monkeys. In light of public health crises involving pneumonia, acute lung injury and acute respiratory distress syndrome, our findings suggest that IMRCs are ready for clinical trials on lung disorders.


[The protocol for prevention, diagnosis and treatment of liver injury in coronavirus disease 2019]


title: Ultra-Rapid Real-Time RT-PCR Method for Detecting Middle East Respiratory Syndrome Coronavirus Using a Mobile PCR Device, PCR1100

text: Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) is usually diagnosed through highly sensitive and specific genetic tests such as real-time reverse transcription polymerase chain reaction (RT-PCR). Currently, two real-time RT-PCR assays targeting the upE and ORF1a regions of the MERS-CoV genome are widely used, and these are the standard assays recommended by the World Health Organization (WHO). The MERS outbreaks to date suggest that rapid diagnosis and subsequent isolation of infected patients, particularly superspreaders, are critical for containment. However, conventional real-time RT-PCR assays require large laboratory instruments, and amplification takes approximately 2 h. These disadvantages limit rapid diagnosis. Here, an ultra-rapid real-time RT-PCR test was established comprising a multiplex assay for upE and ORF1a running on a mobile PCR1100 device. As few as five copies of the MERS-CoV RNA can be detected within 20 min using the standard WHO assays in the mobile PCR device, with the sensitivity and specificity being similar to those of a conventional real-time PCR instrument such as the LightCyler, thereby enabling timely intervention to control MERS-CoV infection.


title: Current development of COVID-19 diagnostics, vaccines and therapeutics

text: A novel coronavirus, designated as SARS-CoV-2, first emerged in Wuhan City, Hubei Province, China, in late December 2019. The rapidly increasing number of cases has caused worldwide panic. In this review, we describe some currently applied diagnostic approaches, as well as therapeutics and vaccines, to prevent, treat and control further outbreaks of SARS-CoV-2 infection.


MinIP technique may be helpful in diagnosing COVID-19


title: From guidance to practice: Promoting risk communication and community engagement for prevention and control of coronavirus disease (COVID-19) outbreak in China

text: Integrating risk communication and community engagement into the national public health emergency response is crucial. Considering the difficulties and challenges faced by China in the prevention and control of coronavirus disease (COVID-19) and based on interim guidelines from the World Health Organization, this article makes several recommendations addressing the outbreak in China. These include improvements in the internal governmental risk communication systems, enhancing the coordination between internal and partner governmental emergency management, and promoting public communication in response to societal concerns. Regarding these recommendations, we emphasize community engagement in joint prevention and control, confronting uncertainty and countering rumors effectively, and strengthening international cooperation and evidence-based decision making for prevention and control measures.


Surgical Considerations in Patients with COVID-19: What Orthopaedic Surgeons Should Know


title: Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes toward government, and well-being

text: The contagiousness and deadliness of COVID-19 have necessitated drastic social management to halt transmission. The immediate effects of a nationwide lockdown were investigated by comparing matched samples of New Zealanders assessed before (Nprelockdown = 1,003) and during the first 18 days of lockdown (Nlockdown = 1,003). Two categories of outcomes were examined: (a) institutional trust and attitudes toward the nation and government and (b) health and well-being. Applying propensity score matching to approximate the conditions of a randomized controlled experiment, the study found that people in the pandemic/lockdown group reported higher trust in science, politicians, and police, higher levels of patriotism, and higher rates of mental distress compared to people in the prelockdown prepandemic group. Results were confirmed in within-subjects analyses. The study highlights social connectedness, resilience, and vulnerability in the face of adversity and has applied implications for how countries face this global challenge. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Diagnostic Tests for SARS-CoV-2: Implications in Head and Neck Oncology


Preliminary Data Suggests That Biologics in Dermatology Are Not Associated With Adverse COVID-19 Outcomes


title: Phonon softening and higher-order anharmonic effect in the superconducting topological insulator SrxBi2Se3

text: We report the anharmonic effect of the Raman-scattering spectrum in the low-carrier density superconductor SrxBi2Se3, which is dominated by quartic term. Compared to the parent Bi2Se3, the superconducting SrxBi2Se3crystals show obvious phonon softening in the three optical phonon modes A1g1, Eg2, and A1g2. Based on the simulations by the Fano function, we present a compelling evidence of the enhanced electron-phonon coupling in SrxBi2Se3for its smaller asymmetric parameterq. Moreover, an anomalous broadening and intensity antiresonance in the characteristic Raman peaks were observed as the temperature decreased to around 160 K. Thus, the superconducting topological material SrxBi2Se3represents a counterintuitive example where the electron-phonon interaction is strengthened by the accumulation of electron carriers.


title: Modelo hospital de IFEMA. Implantación y puesta en marcha de su Servicio de Farmacia./ Ifema hospital model. Implementation and start-up of the Pharmacy Department

text: On the 20th of March 2020, triggered by the public health emergency declared, the Health Authorities in Madrid reported a legal instruction (Orden 371/2020) indicating the organization of a provisional hospital to admit patients with COVID-19 at the Trade Fair Institution (IFEMA). Several pharmacists working in the Pharmacy and Medical Devices Department of the Madrid Regional Health Service were called to manage the Pharmacy Department of the abovementioned hospital. Required permissions to set up a PD were here authorized urgently. Tackling human and material resources, and computer systems for drug purchase and electronic prescription, were some of the initial issues that hindered the pharmaceutical provision required for patients from the very day one. Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out through either drug stocks in the nursing units or individual patient dispensing for certain drugs. Moreover, safety issues related to prescription were considered, and as the electronic prescription was implemented we attained 100% prescriptions review and validation. The constitution of a multidisciplinary Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide, pres cription protocols, therapeutic equivalences, interactions, and drug dispensing circuits. The Pharmacy Department strategy was to ensure a very quick response to basic tasks keeping the aim to offer a pharmaceutical care of the highest quality whenever possible. Working under a health emergency situation, with many uncertainties and continuous pressure was a plight. However, the spirit of collaboration in and out of the Pharmacy Department was aligned with the whole hospital motivation to offer the highest quality of healthcare. These were possibly the keys to allow caring for almost 4,000 patients during the 42 days that the hospital lasted.


Effect of flow and cannula size on generated pressure during nasal high flow


title: Kerala's response to COVID-19

text: The response of Kerala state to COVID-19, led by the health department, was nested in larger social mobilization. Kerala has developed a strong government health system. Learning from managing the Nipah outbreaks, Kerala took effective prevention measures early. Local governments, actively involved in public health in Kerala, played an active role in controlling the epidemic and in cushioning the impact on the poor. Transparency in information and willingness of the government to take the people into confidence has contributed to enhancing trust in the government. These strengths will stand Kerala in good stead as it prepares to manage the next wave of COVID-19 infections.


Psychiatry in the COVID-19 Era


Cardiac safety and potential efficacy: two reasons for considering minocycline in place of azithromycin in COVID-19 management


title: Potent neutralizing antibodies from COVID-19 patients define multiple targets of vulnerability

text: The rapid spread of SARS-CoV-2 has a significant impact on global health, travel and economy. Therefore, preventative and therapeutic measures are urgently needed. Here, we isolated monoclonal antibodies from three convalescent COVID-19 patients using a SARS-CoV-2 stabilized prefusion spike protein. These antibodies had low levels of somatic hypermutation and showed a strong enrichment in VH1-69, VH3-30-3 and VH1-24 gene usage. A subset of the antibodies were able to potently inhibit authentic SARS-CoV-2 infection as low as 0.007 µg/mL. Competition and electron microscopy studies illustrate that the SARS-CoV-2 spike protein contains multiple distinct antigenic sites, including several receptor-binding domain (RBD) epitopes as well as non-RBD epitopes. In addition to providing guidance for vaccine design, the antibodies described here are promising candidates for COVID-19 treatment and prevention.


title: A Simple Prediction Model for the Development Trend of 2019-nCov Epidemics Based on Medical Observations

text: In order to predict the development trend of the 2019 coronavirus (2019-nCov), we established an prediction model to predict the number of diagnoses case in China except Hubei Province. From January 25 to January 29, 2020, we optimized 6 prediction models, 5 of them based on the number of medical observations to predicts the peak time of confirmed diagnosis will appear on the period of morning of January 29 from 24:00 to February 2 before 5 o'clock 24:00. Then we tracked the data from 24 o'clock on January 29 to 24 o'clock on January 31, and found that the predicted value of the data on the 3rd has a small deviation from the actual value, and the actual value has always remained within the range predicted by the comprehensive prediction model 6. Therefore we discloses this finding and will continue to track whether this pattern can be maintained for longer. We believe that the changes medical observation case number may help to judge the trend of the epidemic situation in advance.


COVID-19 and flu, a perfect storm


Timely glucose monitoring-related potential risk of occupational exposure during the pandemic of COVID-19: A diabetologist's perspective


title: Development and Validation of a Rapid, Single-Step Reverse Transcriptase Loop-Mediated Isothermal Amplification (RT-LAMP) System Potentially to Be Used for Reliable and High-Throughput Screening of COVID-19

text: Objectives: Development and validation of a single-step and accurate reverse transcriptase loop-mediated isothermal amplification technique (RT-LAMP) for rapid identification of SARS-CoV-2 relative to commercial quantitative reverse transcriptase real-time PCR (qRT-PCR) assays to allow prompt initiation of proper medical care and containment of virus spread. Methods: Primers showing optimal in-silico features were subjected to analytical sensitivity and specificity to assess the limit of detection (LOD) and cross-reaction with closely- and distantly-related viral species, and clinically prominent bacterial and fungal species. In order to evaluate the clinical utility, our RT-LAMP was subjected to a large number of clinical samples, including 213 negative and 47 positive patients, relative to two commercial quantitative RT-PCR assays. Results: The analytical specificity and sensitivity of our assay was 100% and 500 copies/ml when serial dilution was performed in both water and sputum. Subjecting our RT-LAMP assay to clinical samples showed a high degree of specificity (99.5%), sensitivity (91.4%), positive predictive value (97.7%), and negative predictive value (98.1%) when used relative to qRT-PCR. Our RT-LAMP assay was two times faster than qRT-PCR and is storable at room temperature. A suspected case that later became positive tested positive using both our RT-LAMP and the two qRT-PCR assays, which shows the capability of our assay for screening purposes. Conclusions: We present a rapid RT-LAMP assay that could extend the capacity of laboratories to process two times more clinical samples relative to qRT-PCR and potentially could be used for high-throughput screening purposes when demand is increasing at critical situations.


Response to Letter to the editor: Lung Ultrasound in COVID-19 Patients - More Shadows Than Information - Letter to the Editor on the Article "W. LU et al. Ultraschall in Med. 2020 Apr 15"


title: Vaporization, bioactive formulations and a marine natural product: different perspectives on antivirals

text: This article examines three aspects of antivirals, such as hydroxychloroquine, chloroquine, and remdesvir, as they might relate to the treatment of a viral infection such as COVID-19: (i) the use of vaporization for the delivery of antivirals, with the bulk constituents having mild antiviral efficacy; (ii) the application of a marine natural product extract as opposed to a single molecule as an antiviral agent; and (iii) a counter intuitive approach to formulation that is, in part, based on delivering multiple species that fall into three categories: building blocks for the virus to accelerate replication; an energy source for the infected cell to boost its immune response; and the species that antagonize or provide toxicity to the virus.


title: Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study

text: BACKGROUND: Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. OBJECTIVE: The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. METHODS: We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. RESULTS: A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic. CONCLUSIONS: Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.


title: Nota T\'ecnica dos Modelos Implementados pelo Coletivo Covid19br para Proje\c{c}\~oes de Cen\'arios Futuros da Pandemia COVID-19 no Brasil

text: This technical note aims to provide a brief introduction to the projection models used by the group to project future scenarios for states and municipalities in real-time, according to the disease's behavior in previous days. However, the parameters can be modified by the user to design customized scenarios. The proposed model begins with the calculation of the basic reproduction number for the state or municipality based on the incidence of cases in the last 12 days. Once this is done, the epidemiological curve is projected using the SEIR compartmentalized epidemic model, in possession of this curve, part of the newly projected infected enter a simulation model for health systems in queuing theory, aiming to project future occupations and collapses.


title: Evaluation of SARS-CoV-2 viral RNA in fecal samples

text: The need for timely establishment of a complete diagnostic protocol of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is demanded worldwide. We selected 15 positive novel coronavirus disease 19 (COVID-19) patients with mild or no symptom. Initially, fecal samples were negative in the 67% (10/15) of the cases, while 33% (5/10) of the cases were positive. After serial virus RNA testing, 73% (11/15) of the cases resulted positive to fecal specimens. In particular, 15 days after the first positive respiratory specimens test, 6 fecal specimens became positive for SARS-CoV-2 RNA, while 13 respiratory test returned negative result. In conclusion, qRT-PCR assays of fecal specimens, is an important step to control infection, suggesting that samples remained positive for SARS-CoV-2 RNA longer time then respiratory tract samples. Our results enhance the recent knowledge on this emerging infectious disease and offer suggestions for a more complete diagnostic strategy.


title: 'Let us Help'-Why senior medical students are the next step in battling the COVID-19 Pandemic

text: As senior medical students in the UK, we read Dr Stein's letter on the novel coronavirus (COVID-19)2 and began wondering where we fit in, in this pandemic. As the government heads into a 'war footing',13 there is an increased need for medical staff. There is speculation of bringing back retired doctors, many of who fall into at-risk categories. With clinical placement and exams cancelled, we are determined to use our hard-earned skills in some way, to help in what is the biggest global emergency of our lifetime.


Telemedicine in cardiology in the time of coronavirus disease 2019: a friend that everybody needs


Infection Prevention and Control for Dental Settings During the COVID-19 Response


title: Can hyperimmune anti-CMV globulin substitute for convalescent plasma for treatment of COVID-19?

text: Information on treatment of COVID-19 infection in renal transplant recipients is scarce, especially in symptomatic patients and patients with recent major clinical events. This group of patients suffers from different opportunistic infections which may coexist with COVID-19. Currently available expert opinions suggest reduction of immunosuppression therapy for renal transplant recipients with symptomatic COVID-19 infection with either antiviral drugs, hydroxychloroquine and/or azithromycin. Inspired by our experience in treatment of CMV pneumonia and literature data on the potential benefit of convalescent plasma for treatment of different viral diseases we suggest use of the hyperimmune anti-CMV gamma globulins in addition to other available therapies. Besides the immunosuppression reduction which is supposed to be beneficial, immunoglobulins with their immunomodulatory effects and possible antiviral role, may increase a possibility for favorable outcome.


Mental Health Nurses are not quite 'all in this together': The struggle for equitable access to the Medicare Benefit Scheme


title: New onset of loss of smell or taste in household contacts of home-isolated SARS-CoV-2-positive subjects

text: PURPOSE: To estimate the prevalence of smell or taste impairment in household contacts of mildly symptomatic home-isolated SARS-CoV-2-positive patients. METHODS: Cross-sectional study based on ad hoc questions. RESULTS: Of 214 mildly symptomatic COVID-19 patients managed at home under self-isolation, 179 reported to have at least one household contact, with the total number of no study participants contacts being 296. Among 175 household contacts not tested for SARS-CoV-2 infection, 67 (38.3%) had SARS-CoV-2 compatible symptoms, 39 (22.3%) had loss of smell or taste with 7 (4.0%) having loss of smell or taste in the absence of other symptoms. The prevalence of smell or taste impairment was 1.5% in patients tested negative compared to 63.0% of those tested positive for SARS-CoV-2 (p < 0.001). CONCLUSION: Smell or taste impairment are quite common in not-tested household contacts of mildly symptomatic home-isolated SARS-CoV-2-positive patients. This should be taken into account when estimating the burden of loss of sense of smell and taste during COVID-19 pandemic, and further highlights the value of loss of sense of smell and taste as a marker of infection.


title: Automatic Detection of Coronavirus Disease (COVID-19) Using X-ray Images and Deep Convolutional Neural Networks

text: The 2019 novel coronavirus (COVID-19), with a starting point in China, has spread rapidly among people living in other countries, and is approaching approximately 12,245,417 cases worldwide according to the statistics of European Centre for Disease Prevention and Control. There are a limited number of COVID-19 test kits available in hospitals due to the increasing cases daily. Therefore, it is necessary to implement an automatic detection system as a quick alternative diagnosis option to prevent COVID-19 spreading among people. In this study, three different convolutional neural network based models (ResNet50, InceptionV3 and Inception-ResNetV2) have been proposed for the detection of coronavirus pneumonia infected patient using chest X-ray radiographs. ROC analyses and confusion matrices by these three models are given and analyzed using 5-fold cross validation. Considering the performance results obtained, it is seen that the pre-trained ResNet50 model provides the highest classification performance with 98% accuracy among other two proposed models (97% accuracy for InceptionV3 and 87% accuracy for Inception-ResNetV2).


title: A Deep Convolutional Neural Network for COVID-19 Detection Using Chest X-Rays

text: Purpose: We present image classifiers based on Dense Convolutional Networks and transfer learning to classify chest X-Ray images according to three labels: COVID-19, viral pneumonia and normal. Methods: We fine-tuned neural networks pretrained on ImageNet and applied a twice transfer learning approach, using NIH ChestX-Ray14 dataset as an intermediate step. We also suggested an output neuron keeping strategy. In order to clarify the modus operandi of the models, we used Layer-wise Relevance Propagation (LRP) to generate heatmaps. Results: We were able to reach state-of-the-art test accuracy (99.4%) and F1 Score (0.994). Twice transfer learning improved classification performances in the first half of the training process but, after many epochs, we could achieve the same results using common transfer learning. Output neuron keeping improved twice transfer learning performances. Although LRP showed that words on the X-Rays can influence the networks predictions, we discovered this had only a very small effect on accuracy. Conclusion: The state-of-the-art performances we achieved show that, with the help of artificial intelligence, chest X-Rays can become a cheap and accurate auxiliary method for COVID-19 diagnosis. heatmaps generated by LRP improve the interpretability of the deep neural networks and indicate an analytical path for future research on diagnosis.


title: COVID-MobileXpert: On-Device COVID-19 Screening using Snapshots of Chest X-Ray

text: With the increasing demand for millions of COVID-19 screenings, Computed Tomography (CT) based test has emerged as a promising alternative to the gold standard RT-PCR test. However, it is primarily provided in hospital setting due to the need for expensive equipment and experienced radiologists. An accurate, rapid yet inexpensive test that is suitable for COVID-19 population screenings at mobile, urgent and primary care clinics is urgently needed. We present COVID-MobileXpert: a lightweight deep neural network (DNN) based mobile app that can use noisy snapshots of chest X-ray (CXR) for point-of-care COVID-19 screening. We design and implement a novel three-player knowledge transfer and distillation (KTD) framework including a pre-trained attending physician (AP) network that extracts CXR imaging features from large scale of lung disease CXR images, a fine-tuned resident fellow (RF) network that learns the essential CXR imaging features to discriminate COVID-19 from pneumonia and/or normal cases using a small amount of COVID-19 cases, and a trained lightweight medical student (MS) network that performs on-device COVID-19 screening. To accommodate the need for screening using noisy snapshots of CXR images, we employ novel loss functions and training schemes for the MS network to learn the robust imaging features for accurate on-device COVID-19 screening. We demonstrate the strong potential of COVID-MobileXpert for rapid deployment via extensive experiments with diverse MS network architecture, CXR imaging quality, and tuning parameter settings. The source code of cloud and mobile based models are available from https://github.com/xinli0928/COVID-Xray.


[Suggestions for emergency operation of otorhinolaryngology head and neck during the period of prevention and control of 2019 novel coronavirus]


title: Fish diversity in the cascade of reservoirs along the Paranapanema River, southeast Brazil

text: The Paranapanema River is a major tributary of the upper Paraná river basin. Eleven hydropower dams regulate its main course, but no study has investigated fish diversity in these impoundments at the basin-scale. The present study investigated spatial patterns of richness, composition, and abundance of native (non-migratory and migratory) and non-native fishes in the cascade of reservoirs along the Paranapanema River. The study is based on data collected from 34 independent studies conducted in nine reservoirs (47 samples). The compilation recorded 161 species, being 111 native (14 migratory) and 50 non-native. Total richness ranged between 56 and 112 species/reservoir, with a mean of 72 (49.9 non-migratory, 8.1 migratory and 14 non-native). The number of non-migratory species showed no spatial trend along the cascade system, but migratory and non-native richness increased toward downstream reaches. We also observed spatial variation in species composition along the cascade system, but some non-native fishes were widely distributed. Migratory fishes showed low relative abundance (usually < 10%), while non-native species were common and more abundant, especially in reservoirs downstream. Our results revealed a high diversity of fishes in the cascade of impoundments, but indicated that migratory fishes are rare, while non-native species are common or dominant.(AU)


Response to SARS-Covid-19-related visitor restrictions on labor and delivery wards in New York City


[Practice and Reflection on the Battle against COVID-19 by Guangdong Medical Aid Team in the city of Honghu]


title: Biochemical evidences for M1-, M17- and M18-like aminopeptidases in marine invertebrates from Cuban coastline

text: Metallo-aminopeptidases (mAPs) control many physiological processes. They are classified in different families according to structural similarities. Neutral mAPs catalyze the cleavage of neutral amino acids from the N-terminus of proteins or peptide substrates; they need one or two metallic cofactors in their active site. Information about marine invertebrate's neutral mAPs properties is scarce; available data are mainly derived from genomics and cDNA studies. The goal of this work was to characterize the biochemical properties of the neutral APs activities in eight Cuban marine invertebrate species from the Phyla Mollusca, Porifera, Echinodermata, and Cnidaria. Determination of substrate specificity, optimal pH and effects of inhibitors (1,10-phenanthroline, amastatin, and bestatin) and cobalt on activity led to the identification of distinct neutral AP-like activities, whose biochemical behaviors were similar to those of the M1 and M17 families of mAPs. Additionally, M18-like glutamyl AP activities were detected. Thus, marine invertebrates express biochemical activities likely belonging to various families of metallo-aminopeptidases.


Teaching Public Health Will Never Be the Same


title: Fate of respiratory droplets in tropical vs temperate environments and implications for SARS-CoV-2 transmission

text: The new pandemic of SARS-CoV-2 has shown stark differences in number of affected patients between countries in the tropics and those with temperate environments. Though there have been many theories on reasons for these differences, we hypothesise that this could be due to differences in the fate of respiratory droplets in the two environments. A simple understanding of the mechanics of droplet size, dispersion and displacement could help infection control and public health measures to minimize spread and mitigate the risk of people getting infected especially in hotspots like hospital environments or other closed spaces. This paper discusses the possibility of differences in number of infections and spread between different countries based on the spread of droplets.


Das MDK-Reformgesetz mit allen nachfolgenden Änderungen : In der Fassung des Zweiten Gesetzes zum Schutz der Bevölkerung bei einer epidemischen Lage von nationaler Tragweite./ [The MDK Reform Act with all subsequent amendments : As amended by the Second Act for the Protection of the Population in the Event of an Epidemic Situation of National Significance]


The Invisible Hand - Medical Care during the Pandemic


Online mental health services in Indonesia during the COVID-19 outbreak


In Reply: COVID-19 Infection Affects Surgical Outcome of Chronic Subdural Hematoma


Endonasal drilling may be employed safely in the COVID-19 era


COVID-19 disease in children: not as mild as we have been led to believe


title: Bioengineering tools to speed up the discovery and preclinical testing of vaccines for SARS-CoV-2 and therapeutic agents for COVID-19

text: This review provides an update for the international research community on the cell modeling tools that could accelerate the understanding of SARS-CoV-2 infection mechanisms and could thus speed up the development of vaccines and therapeutic agents against COVID-19. Many bioengineering groups are actively developing frontier tools that are capable of providing realistic three-dimensional (3D) models for biological research, including cell culture scaffolds, microfluidic chambers for the culture of tissue equivalents and organoids, and implantable windows for intravital imaging. Here, we review the most innovative study models based on these bioengineering tools in the context of virology and vaccinology. To make it easier for scientists working on SARS-CoV-2 to identify and apply specific tools, we discuss how they could accelerate the discovery and preclinical development of antiviral drugs and vaccines, compared to conventional models.


title: [Effectiveness of the contingency plan of the internal inflammatory disease unit before Covid-19 infection.]

text: OBJECTIVE: Decision making in hospitals, and especially in their own healthcare services, is hardly referenced in the literature During the pandemic period, healthcare services have put in place contingency plans to minimize the consequences of the coronavirus on professionals and patients However, the deployment of contingency plans and results are hardly shared, depriving other services of references to refute, compare or emulate the aforementioned plans The objective of this work was the description of the implementation and evaluation of Contingency Plans in the Covid-19 pandemic in a unit of inflammatory bowel disease of a Digestive Service in the Sanitary Area of Pontevedra and O Salnés METHODS: A team of managers and professionals adapted the 10 measures recommended by Deloitte to face a pandemic to the healthcare environment The measures were then formulated as a checklist From the Plan-Do-Check-Act improvement cycle, they were grouped into categories: risk management, organizational management and decision-making Finally, an external team carried out a qualitative evaluation of the implementation of the contingency plan carried out RESULTS: The Intestinal Inflammatory Disease Unit of the Digestive Service has obtained an assessment of compliance with the 10 recommended measures to confidently face a pandemic CONCLUSIONS: Sharing the deployment of the contingency plan and its results is useful to identify good practices This article shows a method to evaluate decision-making in pandemic situations The outcomes faces the The Intestinal Inflammatory Disease Unit in an excelent position


title: Effectiveness of the contingency plan of the internal inflammatory disease unit before Covid-19 infection./ Efectividad del plan de contingencia de la Unidad de Enfermedad Inflamatoria Intestinal ante la infeccion de Covid-19

text: OBJECTIVE: Decision making in hospitals, and especially in their own healthcare services, is hardly referenced in the literature During the pandemic period, healthcare services have put in place contingency plans to minimize the consequences of the coronavirus on professionals and patients However, the deployment of contingency plans and results are hardly shared, depriving other services of references to refute, compare or emulate the aforementioned plans The objective of this work was the description of the implementation and evaluation of Contingency Plans in the Covid-19 pandemic in a unit of inflammatory bowel disease of a Digestive Service in the Sanitary Area of Pontevedra and O Salnes METHODS: A team of managers and professionals adapted the 10 measures recommended by Deloitte to face a pandemic to the healthcare environment The measures were then formulated as a checklist From the Plan-Do-Check-Act improvement cycle, they were grouped into categories: risk management, organizational management and decision-making Finally, an external team carried out a qualitative evaluation of the implementation of the contingency plan carried out RESULTS: The Intestinal Inflammatory Disease Unit of the Digestive Service has obtained an assessment of compliance with the 10 recommended measures to confidently face a pandemic CONCLUSIONS: Sharing the deployment of the contingency plan and its results is useful to identify good practices This article shows a method to evaluate decision-making in pandemic situations The outcomes faces the The Intestinal Inflammatory Disease Unit in an excelent position OBJETIVO: La toma de decisiones en los hospitales y en sus propios servicios asistenciales apenas esta referenciada en la literatura Durante el periodo de pandemia por Covid-19, los servicios asistenciales han puesto en marcha planes de contingencia para minimizar las consecuencias del coronavirus en los profesionales y pacientes Sin embargo, apenas se comparte el despliegue de esos planes de contingencia, ni sus resultados, privando de referencias para refutar, comparar o emular los citados planes a otros servicios asistenciales u hospitales El objetivo del trabajo fue la descripcion de la puesta en marcha de dichos planes ante la pandemia de Covid-19 en la Unidad de Enfermedad Inflamatoria Intestinal de un Servicio de Digestivo en el Area Sanitaria de Pontevedra e O Salnes (Galicia) METODOS: Un equipo de directivos y profesionales adaptaron al entorno sanitario las 10 medidas recomendadas por Deloitte para afrontar una pandemia A continuacion, se formularon las medidas como listado de comprobacion A partir del ciclo de mejora Plan-Do-Check-Act, se agruparon las 10 medidas en las siguientes categorias: gestion del riesgo, gestion organizacional y toma de decisiones Por ultimo, un equipo externo realizo una evaluacion cualitativa de la puesta en marcha del plan de contingencia realizado RESULTADOS: La Unidad de Enfermedad Inflamatoria Intestinal del Servicio de Digestivo realizo un plan de contingencia que presenta un cumplimiento de las 10 medidas recomendadas para hacer frente a la pandemia de Covid-19 con garantias CONCLUSIONES: Compartir el despliegue del plan de contingencia y sus resultados es util para identificar buenas practicas Este trabajo ofrece un metodo para evaluar las tomas de decisiones en los plantes de contingencia en situaciones de pandemia Los resultados situan a la Unidad de Enfermedad Inflamatoria Intestinal en el rango de la excelencia


title: A Commentary on Safety Precautions for Otologic Surgery during the COVID-19 Pandemic

text: There are insufficient data regarding the safety of otologic procedures in the setting of the coronavirus disease 2019 (COVID-19) pandemic. Given the proclivity for respiratory pathogens to involve the middle ear and the significant aerosolization associated with many otologic procedures, safety precautions should follow current recommendations for procedures involving the upper airway. Until preoperative diagnostic testing becomes standardized and readily available, elective cases should be deferred and emergent/urgent cases should be treated as high risk for COVID-19 exposure. Necessary otologic procedures on positive, suspected, or unknown COVID-19 status patients should be performed using enhanced personal protective equipment, including an N95 respirator and eye protection or powered air-purifying respirator (PAPR, preferred), disposable cap, disposable gown, and gloves. Powered instrumentation should be avoided unless absolutely necessary, and if performed, PAPR or sealed eye protection is recommended.


Case Report of a SARS-CoV-2 Infection in a Patient With Ulcerative Colitis on Tofacitinib


title: Investigation of Nosocomial SARS-CoV-2 Transmission from Two Patients to Health Care Workers Identifies Close Contact but not Airborne Transmission Events

text: OBJECTIVE: To describe the pattern of transmission of SARS-CoV-2 during 2 nosocomial outbreaks of COVID-19 with regard to the possibility of airborne transmission. DESIGN: Contact investigations with active case finding were used to assess the pattern of spread from 2 COVID-19 index patients. SETTING: A community hospital and university medical center in the United States, in February and March, 2020, early in the COVID-19 pandemic. PATIENTS: Two index patients and 421 exposed health care workers. METHODS: Exposed staff were identified by analyzing the EMR and conducting active case finding in combination with structured interviews. Staff were tested for COVID-19 by obtaining oropharyngeal/nasopharyngeal specimens, with RT-PCR testing to detect SARS-CoV-2. RESULTS: Two separate index patients were admitted in February and March 2020, without initial suspicion for COVID-19 and without contact or droplet precautions in place; both patients underwent several aerosol generating procedures in this context. A total of 421 health care workers were exposed in total, and the results of the case contact investigations identified 8 secondary infections in health care workers. In all 8 cases, the staff had close contact with the index patients without sufficient personal protective equipment. Importantly, despite multiple aerosol generating procedures, there was no evidence of airborne transmission. CONCLUSION: These observations suggest that, at least in a healthcare setting, a majority of SARS-CoV-2 transmission is likely to take place during close contact with infected patients through respiratory droplets, rather than by long-distance airborne transmission.


Potential inhibitors against 2019-nCoV coronavirus M protease from clinically approved medicines


Non-contact tonometer use during the COVID-19 pandemic


title: Assessment of Lockdown Effect in Some States and Overall India: A Predictive Mathematical Study on COVID-19 Outbreak

text: In the absence of neither an effective treatment or vaccine and with an incomplete understanding of the epidemiological cycle, Govt. has implemented a nationwide lockdown to reduce COVID-19 transmission in India. To study the effect of social distancing measure, we considered a new mathematical model on COVID-19 that incorporates lockdown effect. By validating our model to the data on notified cases from five different states and overall India, we estimated several epidemiologically important parameters as well as the basic reproduction number ($R_{0}$). Combining the mechanistic mathematical model with different statistical forecast models, we projected notified cases in the six locations for the period May 17, 2020, till May 31, 2020. A global sensitivity analysis is carried out to determine the correlation of two epidemiologically measurable parameters on the lockdown effect and also on $R_{0}$. Our result suggests that lockdown will be effective in those locations where a higher percentage of symptomatic infection exists in the population. Furthermore, a large scale COVID-19 mass testing is required to reduce community infection. Ensemble model forecast suggested a high rise in the COVID-19 notified cases in most of the locations in the coming days. Furthermore, the trend of the effective reproduction number ($R_{t}$) during the projection period indicates if the lockdown measures are completely removed after May 17, 2020, a high spike in notified cases may be seen in those locations. Finally, combining our results, we provided an effective lockdown policy to reduce future COVID-19 transmission in India.


title: Cardiac surgery in the time of the coronavirus

text: The current Covid-19 pandemic is a significant global health threat. The outbreak has profoundly affected all healthcare professionals, including heart surgeons. To adapt to these exceptional circumstances, cardiac surgeons had to change their practice significantly. We herein discuss the challenges and broad implications of the Covid-19 pandemic from the perspective of the heart surgeons.


title: Hercules: An Autonomous Logistic Vehicle for Contact-less Goods Transportation During the COVID-19 Outbreak

text: Since December 2019, the coronavirus disease 2019 (COVID-19) has spread rapidly across China. As at the date of writing this article, the disease has been globally reported in 100 countries, infected over 100,000 people and caused over 3,000 deaths. Avoiding person-to-person transmission is an effective approach to control and prevent the epidemic. However, many daily activities, such as logistics transporting goods in our daily life, inevitably involve person-to-person contact. To achieve contact-less goods transportation, using an autonomous logistic vehicle has become the preferred choice. This article presents Hercules, an autonomous logistic vehicle used for contact-less goods transportation during the outbreak of COVID-19. The vehicle is designed with autonomous navigation capability. We provide details on the hardware and software, as well as the algorithms to achieve autonomous navigation including perception, planning and control. This paper is accompanied by a demonstration video and a dataset, which are available here: https://sites.google.com/view/contact-less-transportation.


title: Pharmacotherapy in COVID-19; A narrative review for emergency providers

text: INTRODUCTION: The COVID-19 pandemic has been particularly challenging due to a lack of established therapies and treatment guidelines. With the rapid transmission of disease, even the off-label use of available therapies has been impeded by limited availability. Several antivirals, antimalarials, and biologics are being considered for treatment at this time. The purpose of this literature review is to synthesize the available information regarding treatment options for COVID-19 and serve as a resource for health care professionals. OBJECTIVES: This narrative review was conducted to summarize the effectiveness of current therapy options for COVID-19 and address the controversial use of non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). PubMed and SCOPUS were queried using a combination of the keywords "COVID 19," "SARS-CoV-2," and "treatment." All types of studies were evaluated including systematic reviews, case-studies, and clinical guidelines. DISCUSSION: There are currently no therapeutic drugs available that are directly active against SARS-CoV-2; however, several antivirals (remdesivir, favipiravir) and antimalarials (chloroquine, hydroxychloroquine) have emerged as potential therapies. Current guidelines recommend combination treatment with hydroxychloroquine/azithromycin or chloroquine, if hydroxychloroquine is unavailable, in patients with moderate disease, although these recommendations are based on limited evidence. Remdesivir and convalescent plasma may be considered in critical patients with respiratory failure; however, access to these therapies may be limited. Interleukin-6 (IL-6) antagonists may be used in patients who develop evidence of cytokine release syndrome (CRS). Corticosteroids should be avoided unless there is evidence of refractory septic shock, acute respiratory distress syndrome (ARDS), or another compelling indication for their use. ACE inhibitors and ARBs should not be discontinued at this time and ibuprofen may be used for fever. CONCLUSION: There are several ongoing clinical trials that are testing the efficacy of single and combination treatments with the drugs mentioned in this review and new agents are under development. Until the results of these trials become available, we must use the best available evidence for the prevention and treatment of COVID-19. Additionally, we can learn from the experiences of healthcare providers around the world to combat this pandemic.


title: Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic

text: With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic.


title: Optimal quarantine strategies for the COVID-19 pandemic in a population with a discrete age structure

text: The goal of this work is to study the optimal controls for the COVID-19 epidemic in Brazil. We consider an age-structured SEIRQ model with quarantine compartment, where the controls are the quarantine entrance parameters. We then compare the optimal controls for different quarantine lengths and distribution of the total control cost by assessing their respective reductions in deaths in comparison to the same period without quarantine. The best strategy provides a calendar of when to relax the isolation measures for each age group. Finally, we analyse how a delay in the beginning of the quarantine affects this calendar by changing the initial conditions.


title: Tor Vergata University-Hospital in the Beginning of COVID-19-Era: Experience and Recommendation for Breast Cancer Patients

text: COVID-19 has been officially declared as a pandemic by the WHO. Italy was the first European country to be strongly affected by this outbreak. All elective and health promotion activities were reduced. Accordingly, Italian Breast Units and breast cancer (BC) screening programs scaled down significantly their activities. The aim of this study was to evaluate measures that could potentially reduce the clinical impact of COVID-19 on BC patients. Temporary recommendations are needed that could assist specialists in preventing COVID-19 infection and optimizing resources for diagnosis and treatment of BC patients.


The Impact of COVID-19 Pandemic on Obesity and Bariatric Surgery


title: Classification of COVID-19 patients from chest CT images using multi-objective differential evolution-based convolutional neural networks

text: Early classification of 2019 novel coronavirus disease (COVID-19) is essential for disease cure and control. Compared with reverse-transcription polymerase chain reaction (RT-PCR), chest computed tomography (CT) imaging may be a significantly more trustworthy, useful, and rapid technique to classify and evaluate COVID-19, specifically in the epidemic region. Almost all hospitals have CT imaging machines; therefore, the chest CT images can be utilized for early classification of COVID-19 patients. However, the chest CT-based COVID-19 classification involves a radiology expert and considerable time, which is valuable when COVID-19 infection is growing at rapid rate. Therefore, an automated analysis of chest CT images is desirable to save the medical professionals' precious time. In this paper, a convolutional neural networks (CNN) is used to classify the COVID-19-infected patients as infected (+ve) or not (-ve). Additionally, the initial parameters of CNN are tuned using multi-objective differential evolution (MODE). Extensive experiments are performed by considering the proposed and the competitive machine learning techniques on the chest CT images. Extensive analysis shows that the proposed model can classify the chest CT images at a good accuracy rate.


title: [Countermeasures and treatment for aortic acute syndrome with 2019 coronavirus disease]

text: The 2019 coronavirus disease(COVID-19) has cost a great loss to the health and economic property of Chines people. Under such a special circumstance, how to deal with such patients with acute aortic syndrome has become a serious challenge. Rapid diagnosis of concomitant COVID-19, safe and effective transportation, implementation of the interventional procedure, protection of vascular surgical team and postoperative management and follow-up of such patients have become urgent problems for us. Combined with the latest novel government documents, the literature and the experiences from Wuhan, we answered the above questions briefly and plainly. We also hope to inspire the national vascular surgeons to manage critical emergencies in vascular surgery and even routine vascular diseases with COVID-19, as a final point to limit the severe epidemic situation, and minimize the damage of COVID-19.


title: The Unique Impact of COVID-19 on Older Adults in Rural Areas

text: Older adults in rural areas of the U.S. face unique risks related to COVID-19. Rural areas are older, on average, than urban areas, and have more underlying health conditions and fewer economic resources. Rural health care is more limited, as is access to technology and online connectivity. Altogether, this puts rural older adults at risk of not only the virus, but of not being able to meet their health care, social, and basic needs. Rural/urban inequities, combined with within-rural inequities in health, health care, and financial resources cause particular challenges to health and well-being from COVID-19 for some older adults.


Reply to the letter concerning Kawasaki Disease and Covid-19


title: Artificial Intelligence Forecasting of Covid-19 in China

text: BACKGROUND An alternative to epidemiological models for transmission dynamics of Covid-19 in China, we propose the artificial intelligence (AI)-inspired methods for real-time forecasting of Covid-19 to estimate the size, lengths and ending time of Covid-19 across China. METHODS We developed a modified stacked auto-encoder for modeling the transmission dynamics of the epidemics. We applied this model to real-time forecasting the confirmed cases of Covid-19 across China. The data were collected from January 11 to February 27, 2020 by WHO. We used the latent variables in the auto-encoder and clustering algorithms to group the provinces/cities for investigating the transmission structure. RESULTS We forecasted curves of cumulative confirmed cases of Covid-19 across China from Jan 20, 2020 to April 20, 2020. Using the multiple-step forecasting, the estimated average errors of 6-step, 7-step, 8-step, 9-step and 10-step forecasting were 1.64%, 2.27%, 2.14%, 2.08%, 0.73%, respectively. We predicted that the time points of the provinces/cities entering the plateau of the forecasted transmission dynamic curves varied, ranging from Jan 21 to April 19, 2020. The 34 provinces/cities were grouped into 9 clusters. CONCLUSIONS The accuracy of the AI-based methods for forecasting the trajectory of Covid-19 was high. We predicted that the epidemics of Covid-19 will be over by the middle of April. If the data are reliable and there are no second transmissions, we can accurately forecast the transmission dynamics of the Covid-19 across the provinces/cities in China. The AI-inspired methods are a powerful tool for helping public health planning and policymaking.


Patterns of heart injury in COVID-19 and relation to outcome


Investigating hypothiocyanite against SARS-CoV-2


20/20 Foresight for 2020?


Evolving COVID-19 conundrum and its impact


title: Increased expression of CD8 marker on T-cells in COVID-19 patients

text: BACKGROUND: Cell-mediated immunity including T-cells (T helper and cytotoxic) plays an essential role in efficient antiviral responses against coronavirus disease-2019 (COVID-19). Therefore, in this study, we evaluated the ratio and expression of CD4 and CD8 markers in COVID-19 patients to clarify the immune characterizations of CD4 and CD8 T-cells in COVID-19 patients. METHODS: Peripheral blood samples of 25 COVID-19 patients and 25 normal individuals with similar age and sex as the control group were collected. White blood cells, platelets, and lymphocytes were counted and CD4 and CD8 T lymphocytes were evaluated by flow cytometry. RESULTS: The number of white blood cells, lymphocytes, and platelets were reduced significantly in COVID-19 patients (P < 0.05). The difference in CD4:CD8 ratio, CD4 T-cell frequency, CD8 T-cell frequency, and CD4 mean fluorescence intensity (MFI) was not significant between COVID-19 patients and healthy individuals (P > 0.05); however, the CD8 MFI increased significantly in COVID-19 infected patients (P < 0.05). CONCLUSION: Although, there is no significant difference in the ratio of CD4 to CD8 between two groups, the expression level of CD8 in COVID-19 patients was significantly higher than the normal individuals. This result suggested that the cellular immune responses triggered by COVID-19 infection were developed through overexpression of CD8 and hyperactivation of cytotoxic T lymphocytes.


title: Clinical trials for the prevention and treatment of COVID-19: current state of play

text: Since coronavirus disease 2019 (COVID-19) emerged in Wuhan, China in December 2019 and spread around the world, over 1100 clinical studies have been registered globally on clinical trials registries, including over 500 randomised controlled trials. Such rapid development and launch of clinical trials is impressive but presents challenges, including the potential for duplication and competition. There is currently no known effective treatment for COVID-19. In order to focus on those studies most likely to influence clinical practice, we summarise the 31 currently registered randomised trials with a target sample size of at least 1000 participants. We have grouped these trials into four categories: prophylaxis; treatment of outpatients with mild COVID-19; treatment of hospitalised patients with moderate COVID-19; and treatment of hospitalised patients with moderate or severe disease. The most common therapeutic agent being trialled currently is hydroxychloroquine (24 trials with potential sample size of over 25 000 participants), followed by lopinavir-ritonavir (seven trials) and remdesevir (five trials) There are many candidate drugs in pre-clinical and early phase development, and these form a pipeline for future large clinical trials if current candidate therapies prove ineffective or unsafe.


title: Psychosocial Reactions to Plagues in the Cultural History of Medicine: A Medical Humanities Approach

text: The aim of this work is to elucidate psychosocial reactions to plagues by analyzing three landmark descriptions from different eras: Thucydides' description of the plague of Athens (430 BC) in The History of the Peloponnesian War, Giovanni Boccaccio's description of the plague in Florence (1348) in The Decameron, and Albert Camus' description in The Plague (1947). Using a narrative inquiry, we found psychosocial reactions to be complex and ambivalent and could discern several coping strategies. We propose that this knowledge can help psychiatrists and other healthcare professionals during the ongoing COVID-19 pandemic.


title: Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study

text: BACKGROUND: In December 2019, the coronavirus disease 2019 (COVID-19) emerged in Wuhan city and spread rapidly throughout China and the world. In this study, we aimed to describe the clinical course and outcomes of older patients with COVID-19. METHODS: This is a retrospective investigation of hospitalized older patients with confirmed COVID-19 at Zhongnan Hospital of Wuhan University from January 1, 2020, to February 10, 2020. RESULTS: In total, 203 patients were diagnosed with COVID-19, with a median age of 54 years (interquartile range, 41-68; range, 20-91 years). Men accounted for 108 (53.2%) of the cases, and 55 patients (27.1%) were >65 years of age. Among patients who were 65 years and older, the mortality rate was 34.5% (19/55), which was significantly higher than that of younger patients at 4.7% (7/148). Common symptoms of older patients with COVID-19 included fever (94.5%; n=52), dry cough (69.1%; n=38), and chest distress (63.6%; n=35). Compared with young patients, older patients had more laboratory abnormalities and comorbidities. Through a multivariate analysis of the causes of death in older patients, we found that males, comorbidities, time from disease onset to hospitalization, abnormal kidney function, and elevated procalcitonin levels were all significantly associated with death. CONCLUSIONS: In the recent outbreak of COVID-19, our local hospital in Wuhan found that patients aged 65 and older had greater initial comorbidities, more severe symptoms, and were more likely to experience multi-organ involvement and death, as compared with younger patients.