title: Live cell imaging by 3-imino-(2-phenol)-1,8-naphthalimides: The effect of ex vivo hydrolysis

text: A series of 3-amino-N-substituted-1,8-naphthalimides and their salicylic Schiff base derivatives were synthesized. The structure of the obtained compounds was confirmed using 1H and 13C NMR, FT-IR spectroscopy and elemental analysis and COSY and HMQC for the representative molecules. The photophysical (UV-Vis, PL) and biological properties of all of the prepared compounds were studied. It was found that the amine with the n-hexyl group in EtOH had the highest PL quantum yield (Ð¤ = 85%) compared to the others. Moreover, the chelating properties of the azomethines with the n-hexyl group (1a, 1b, 1c) were tested against various cations (Al3+, Ba2+, Co2+, Cu2+, Cr3+, Fe2+, Fe3+, Mn2+, Ni2+, Pb2+, Sr2+ and Zn2+) in an acetonitrile, acetone and PBS/AC mixture. Compounds that contained the electron withdrawing groups (-Br, -I) had the ability to chelate most of the studied cations, while the unsubstituted derivative chelated only the trivalent cations such as Al3+, Cr3+ and Fe3+ in acetonitrile. The effect of the environment on the keto-enol tautomeric equilibrium was also demonstrated, especially in the case of the derivative with a bromine atom. The biological studies showed that the tested molecules had no cytotoxicity. Additionally, the ability to image intracellular organelles such as the mitochondria and endoplasmic reticulum was revealed. The crucial role of the hydrolysis of imines for cellular imaging was presented.


title: Overtone spectroscopy of v(C=O) stretching vibration of hexafluoroacetone: Experimental and ab initio determination of peak positions, absolute intensities, and band shapes

text: Infrared overtone spectra of the ν(Câ¯=â¯O) stretching vibration (ν1) of gaseous hexafluoroacetone ((CF3)2Câ¯=â¯O, HFA) were recorded in the spectral range of 7450-3300 cm-1 with a resolution of 0.1 cm-1. Experimental absolute IR intensities and vibrational band centers of the overtones 2ν1, 3ν1, 4ν1 of HFA were measured and compared with their ab initio counterparts, calculated by the second-order canonical vibrational perturbation theory (CVPT2). A hybrid potential energy surface (PES) was evaluated using the quantum-mechanical models MP2/cc-pVQZ for harmonic and MP2/cc-pVTZ for anharmonic parts. Cubic surfaces of dipole moment components were determined using the MP2/cc-pVTZ model. The predicted IR intensities for the first and second overtones reproduced the experimental values with a discrepancy of 6% and 9%, respectively. A weak Fermi resonance between the first overtone 2ν1 and combination tone ν1â¯+â¯ν2â¯+â¯ν8 was predicted. The appropriate model was employed for simulating the bands studied using: (i) the asymmetric-top vibration-rotational structure of the ν1 mode, (ii) the inhomogeneous band structure due to contributions of the vibrational states populated at the room temperature, and (iii) the homogeneous broadening of each vibration-rotation transition due to the intramolecular vibrational redistribution (IVR). The rotational and vibrational anharmonic constants were taken from the ab initio calculations, whereas the IVR data were obtained from the experimental data of Chekalin et al. (JPCA 2014, 118:955) with a time resolution of ≈100 fs. A good level of agreement of the predicted shapes of bands studied with experiment is achieved.


Treatment Recommendations for Persistent Smell and Taste Dysfunction Following COVID-19-The Coming Deluge


title: COVID 19 infection requires strengthening of the chronic care model: the impact on liver transplant practice at a high-volume center in Italy

text: Spreading of SARS-CoV-2 infection in Italy has challenged the practice of liver transplantation in an unprecedented way. We report on initiatives implemented at a high-volume transplant center to handle an anticipated increase in waiting list time, deferral of pre-transplant care and temporary postponement of routine post-transplant follow up. All of the strategies we implemented were derived from the chronic care model and based on productive interaction across healthcare professionals, communities, authorities and patients.


title: Utilization of deceased donors during a pandemic: argument against using SARS-CoV-2-positive donors

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become an unprecedented pandemic that has impacted society, disrupted hospital functions, strained health care resources, and impacted the lives of transplant professionals. Despite this, organ failure and the need for transplant continues throughout the United States. Considering the perpetual scarcity of deceased donor organs, Kates et al present a viewpoint that advocates for the utilization of coronavirus disease 2019 (COVID-19)-positive donors in selected cases. We present a review of the current literature that details the potential negative consequences of COVID-19-positive donors. The factors we consider include (1) the risk of blood transmission of SARS-CoV-2, (2) involvement of donor organs, (3) lack of effective therapies, (4) exposure of health care and recovery teams, (5) disease transmission and propagation, and (6) hospital resource utilization. While we acknowledge that transplant fulfills the mission of saving lives, it is imperative to consider the consequences not only to our recipients but also to the community and to health care workers, particularly in the absence of effective preventative or curative therapies. For these reasons, we believe the evidence and risks show that COVID-19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplant societies.


COVID-19 on the African continent


Radiographic examination of the chest and COVID-19


Lesiones musculoesqueléticas secundarias al ejercicio durante el confinamiento por la pandemia COVID-19./ Lesiones musculoesqueléticas secundarias al ejercicio durante el confinamiento por la pandemia COVID-19./ Musculoskeletal injuries secondary to exercise during confinement by the pandemic COVID-19


First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia (vol 395, pg 734, 2020)


First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia


title: An international multicentre study of protocols for liver transplantation during a pandemic: A case for quadripartite equipoise

text: BACKGROUND: The outbreak of Covid-19 has vastly increased the operational burden on healthcare systems worldwide. For patients with end-stage liver failure, liver transplantation is the only option. However, the strain on intensive care facilities caused by the pandemic is a major concern. There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources. METHODS: We performed an international multi-center study of transplant centers to understand the evolution of policies for transplant prioritization in response to the pandemic in March 2020. To describe the ethical tension arising in this setting, we propose a novel ethical framework, the Quadripartite Equipoise (QE) score, that is applicable to liver transplantation in the context of limited national resources. RESULTS: Seventeen large- and medium- sized liver transplant centers from twelve countries across four continents participated. Ten centers opted to limit transplant activity in response to the pandemic, favoring a "sickest-first" approach. Conversely, some larger centers opted to continue routine transplant activity in order to balance waiting list mortality. To model these and other ethical tensions, we computed a QE score using 4 factors - Recipient Outcome, Donor/Graft Safety, Waiting List Mortality and Healthcare Resources for seven countries. The fluctuation of the QE score over time accurately reflects the dynamic changes in the ethical tensions surrounding transplant activity in a pandemic. CONCLUSIONS: This four-dimensional model of Quadripartite Equipoise addresses the ethical tensions in the current pandemic. It serves as a universally applicable framework to guide regulation of transplant activity in response to the increasing burden on healthcare systems to allow greater global solidarity and transparency in these austere times.


title: Neutralization of SARS-CoV-2 spike pseudotyped virus by recombinant ACE2-Ig

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, at the end of 2019, and there are currently no specific antiviral treatments or vaccines available. SARS-CoV-2 has been shown to use the same cell entry receptor as SARS-CoV, angiotensin-converting enzyme 2 (ACE2). In this report, we generate a recombinant protein by connecting the extracellular domain of human ACE2 to the Fc region of the human immunoglobulin IgG1. A fusion protein containing an ACE2 mutant with low catalytic activity is also used in this study. The fusion proteins are then characterized. Both fusion proteins have a high binding affinity for the receptor-binding domains of SARS-CoV and SARS-CoV-2 and exhibit desirable pharmacological properties in mice. Moreover, the fusion proteins neutralize virus pseudotyped with SARS-CoV or SARS-CoV-2 spike proteins in vitro. As these fusion proteins exhibit cross-reactivity against coronaviruses, they have potential applications in the diagnosis, prophylaxis, and treatment of SARS-CoV-2.


Reducing onward spread of COVID-19 from imported cases: quarantine and 'stay at home' measures for travellers and returning residents to Singapore


Novel Coronavirus 2019 and Anesthesiology


title: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk during elective peri-operative care: a narrative review

text: The protection of healthcare workers from the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a paramount concern. SARS-CoV-2 is likely to remain endemic and measures to protect healthcare workers against nosocomial infection will need to be maintained. This review aims to inform the assessment and management of the risk of SARS-CoV-2 transmission to healthcare workers involved in elective peri-operative care. In the absence of data specifically related to the risk of SARS-CoV-2 transmission in the peri-operative setting, we explore the evidence-base that exists regarding modes of viral transmission, historical evidence for the risk associated with aerosol-generating procedures and contemporaneous data from the COVID-19 pandemic. We identify a significant lack of data regarding the risk of transmission in the management of elective surgical patients, highlighting the urgent need for further research.


Early Appearance of Coronavirus Disease 2019 Associated Pulmonary Infiltrates During Daily Radiotherapy Imaging for Lung Cancer


title: Prevention in COVID-19 time: from failure to future

text: The COVID-19 pandemic has developed as a consequence of sheer prevention failures, leading in many countries to a sizeable number of deaths and over-saturation of intensive care units. This triggered the imposition of generalisd quarantine ('lockdown') of variable stringency in different countries: with the decrease of the epidemic, the lockdown is now gradually relaxed and replaced by tight tracing and isolation of new cases and their contacts. Prevention, however, remains not a constant priority, as the objective may be avoidance of saturation of intensive care beds or more generally of healthcare facilities rather than the minimisation of the disease incidence. This combined with the fact that notwithstanding repeated warnings in past years the epidemic occurred as a surprise denotes a way of thinking in which prevention is an important option but not a guiding principle of choice and action within the health system. To modify this way of thinking and place prevention at the core of the system, non-negligible changes are required: they may become possible in light of emerging hazards like new viruses and climate change, huge economic costs of failed prevention and initial changes in the health system already induced by the COVID-19 epidemic.


title: Antiviral mechanisms of candidate chemical medicines and traditional Chinese medicines for SARS-CoV-2 infection

text: The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become a global pandemic. Up to now, numerous medicines have been applied or approved for the prevention and control of the virus infection. However, the efficiency of each medicine or combination is completely different or still unknown. In this review, we discuss the types, characteristics, antiviral mechanisms, and shortcomings of recommended candidate medicines for SARS-CoV-2 infection, as well as perspectives of the drugs for the disease treatment, which may provide a theoretical basis for drug screening and application.


Levél a szerkesztoséghez


title: COVID-19: Wissensstand, Risikowahrnehmung und Umgang mit der Pandemie./ [COVID-19: Knowledge, risk perception and strategies for handling the pandemic]

text: INTRODUCTION: In order to stem the spread of an epidemic, widespread adherence to safety measures and their acceptance within the German population are of key importance. This survey examines the levels of knowledge and the perception of risk within the population and analyses implementation and adherence to the recommended and legally mandated safety measures in the early phase of the COVID-19-pandemic. METHODS: In March 2020, participants registered on the HeReCa-Online-Panel from Saxony-Anhalt, Berlin and Schleswig Holstein were invited to complete a 65 question survey. RESULTS: 1 048 respondents answered the questionnaire, which amounts to a response of 3.5%. 83% of respondents stated that they felt themselves to be well-informed or very well-informed concerning COVID-19 and the coronavirus. The majority of respondents reported fears for the well-being of family members (60%) or the health of the German population as a whole (45%); 79% reported concerns regarding adverse economic impacts. 79% of respondents have implemented individual protective measures, such as reducing social contacts and maintaining the recommended physical distance in public spaces. Most respondents regarded the government mandated safety measures as predominantly reasonable and appropriate. CONCLUSIONS: In the early phase of the pandemic, most people informed themselves of COVID-19 and started to take individual measures for risk reduction. Acceptance of governmental measures to stem the spread of the pandemic was high.


The impact of the COVID-19 pandemic on academic sleep medicine


Inactivated vaccine for SARS-CoV-2


title: Lung base CT findings in COVID-19 adult patients presenting with acute abdominal complaints: case series from a major New York City health system

text: OBJECTIVE: To describe demographic, clinical, and lung base CT findings in COVID-19 patients presenting with abdominal complaints. METHODS: In this retrospective study, 76 COVID-19 patients who underwent abdominal CT for abdominal complaints from March 1 to April 15, 2020, in a large urban multihospital Health System were included. Those with positive abdominal CT findings (n = 14) were then excluded, with 62 patients undergoing final analysis (30M/32F; median age 63 years, interquartile range (IQR) 52-75 years, range 30-90 years). Demographic and clinical data were extracted. CT lung base assessment was performed by a cardiothoracic radiologist. Data were compared between discharged and hospitalised patients using Wilcoxon or Fisher's exact tests. RESULTS: The majority of the population was non-elderly (56.4%, < 65 years) and most (81%) had underlying health conditions. Nineteen percent were discharged and 81% were hospitalised. The most frequent abdominal symptoms were pain (83.9%) and nausea/vomiting/anorexia (46.8%). Lung base CT findings included ground-glass opacities (95.2%) in a multifocal (95.2%) and peripheral (66.1%) distribution. Elevated laboratory values (when available) included C-reactive protein (CRP) (97.3%), D-dimer (79.4%), and ferritin (68.8% of males and 81.8% of females). Older age (p = 0.045), hypertension (p = 0.019), and lower haemoglobin in women (p = 0.042) were more frequent in hospitalised patients. There was no difference in lung base CT findings between discharged and hospitalised patients (p > 0.165). CONCLUSIONS: COVID-19 patients can present with abdominal symptoms, especially in non-elderly patients with underlying health conditions. Lung base findings on abdominal CT are consistent with published reports. Radiologists should be aware of atypical presentations of COVID-19. KEY POINTS: â¢ COVID-19 infected patients can present with acute abdominal symptoms, especially in non-elderly patients with underlying health conditions, and may frequently require hospitalisation (81%). â¢ There was no difference in lung base CT findings between patients who were discharged and those who were hospitalised. â¢ Lung base CT findings included multifocal and peripheral ground-glass opacities, consistent with published reports.


title: Ongoing Challenges Faced in the Global Control of COVID-19 Pandemic

text: The recent pandemic caused by SARS-CoV-2 has now spread worldwide and caused more than 51,000 deaths, by April 2nd 2020. As predicted, there are several obstacles for medical and governmental authorities to efficiently manage this respiratory illness. In spite of appropriated supplies, most hospitals are suffering from a scarcity of free beds, protective masks, sanitizing liquids and even ECMO machines for patients with severe cases. Defeating this pandemic is impossible without united and coordinated international attempts shaped by all countries of the world. We believe that an international scaled-determination is required to diminish the complex impacts of pandemic. The most important priorities are supposed to be i) The development of potential vaccine candidates to provide protection and interrupt the transmission of SARS-CoV-2, ii) To ensure enough supplies for hospitals and their homogeneous distribution among the countries with the worst number of severe cases, iii) There is a need for more studies to identify potential treatments that are effective for the control of this viral infection and iv) It is imperative to provide easy access to diagnostic kits for all countries affected by this pandemic. In the light of these suggestions, it would be recommendable to at least temporarily abandon the political checkouts in both national and international levels; therefore, all partners will be potentially able to efficiently enforce their strategies for the elimination of this unique threat to the human populations.


How Will COVID-19 Affect the Health Care Economy?


title: COVID-19 Pandemic: Survey of future use of personal protective equipment in optometric practice

text: PURPOSE: The aim of this project was to evaluate which personal protective equipment (PPE) eye care practitioners (ECP) will use during the next months and also what they will ask the patient to use in clinical practice. METHODS: A social-media survey was carried out, asking 257 optometrists and opticians in Germany, Austria and Switzerland (i) which PPE they intended to use in the future (after lockdown and before herd immunity and / or vaccine availability) and (ii) what they would ask the patient to do in terms of this. RESULTS: 75 % of the ECPs planned on wearing masks during refractions and 69 % when fitting contact lens. 62 % of the ECPs also expected their patients to wear masks in these tasks. This number is higher than for distance tasks such as fitting frames. Around 90 % of the ECPs would, in addition to hand washing, disinfect their hands and around 80 % expected their patients to do so too. Less than one third of ECPs favoured wearing safety spectacles, gloves and / or protective facial shields. 73 % planed on disinfecting frames after they would have been tried on by customers. CONCLUSIONS: In summary, most ECPs planed on continuing to use higher standards of PPE. Those, who intended to wear masks themselves, would ask their patients to also do so, combined with hand disinfection.


Correction: Insights from immuno-oncology: the Society for Immunotherapy of Cancer Statement on access to IL-6-targeting therapies for COVID-19


Rapid repurposing of drugs for COVID-19


Interventions for healthcare professionals taking care of COVID-19 patients (beyond vaccines). A systematic review


Neuroimmune correlates of the nervous system involvement of COVID-19: A commentary


title: Large-scale public venues as medical emergency sites in disasters: lessons from COVID-19 and the use of Fangcang shelter hospitals in Wuhan, China

text: Since the COVID-19 outbreak, Wuhan has adopted three methods of admitting patients for treatment: designated hospitals, newly built temporary hospitals and Fangcang shelter hospitals. It has been proven that converting large-scale public venues such as stadiums and exhibition centres into Fangcang shelter hospitals, which serve as hospitals for isolation, treatment and disease monitoring of patients with mild symptoms, is the most effective way to control virus transmission and reduce mortality. This paper presents some experiences learnt from treating COVID-19 in Wuhan, the first city to report the outbreak and which suffered from a shortage of emergency supplies, heavy workload among staff and a shortage of hospital beds during the early stages of the pandemic. The experiences include location, accessibility, spacious outdoor area, spacious indoor space, power supply, architectural layout design and partition isolation, ventilation, sewage, and problems in the construction and management of Fangcang shelter hospitals. During the COVID-19 pandemic, traditional approaches to disaster preparedness have demonstrated intrinsic problems, such as poor economic performance, inefficiency and lack of flexibility. Converting large-scale public venues into Fangcang shelter hospitals is an important means to rapidly improve the function of the city's healthcare system during a pandemic. This valuable experience in Wuhan will help other countries in their battle against the current COVID-19 pandemic and will also contribute to disaster preparedness and mitigation in the future.


Chloroquine and COVID-19: A western medical and scientific drift?


title: Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department

text: The 2019 coronavirus disease (COVID-19) has not appeared to affect children as severely as adults. However, approximately 1 month after the COVID-19 peak in New York City in April 2020, cases of children with prolonged fevers abruptly developing inflammatory shock-like states have been reported in Western Europe and the United States. This case series describes four previously healthy children with COVID-19 infection confirmed by serologic antibody testing, but negative by nasopharyngeal RT-PCR swab, presenting to the Pediatric Emergency Department (PED) with prolonged fever (5 or more days) and abrupt onset of hemodynamic instability with elevated serologic inflammatory markers and cytokine levels (IL-6, IL-8 and TNF-α). Emergency physicians must maintain a high clinical suspicion for this COVID-19 associated post-infectious cytokine release syndrome, with features that overlap with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS) in children with recent or current COVID-19 infection, as patients can decompensate quickly.


Deployment of Information Technology to Facilitate Patient Care in the Isolation Ward during COVID-19 Pandemic


Medical care for spinal diseases during the COVID-19 pandemic


title: The Prediction of miRNAs in SARS-CoV-2 Genomes: hsa-miR Databases Identify 7 Key miRs Linked to Host Responses and Virus Pathogenicity-Related KEGG Pathways Significant for Comorbidities

text: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a member of the betacoronavirus family, which causes COVID-19 disease. SARS-CoV-2 pathogenicity in humans leads to increased mortality rates due to alterations of significant pathways, including some resulting in exacerbated inflammatory responses linked to the "cytokine storm" and extensive lung pathology, as well as being linked to a number of comorbidities. Our current study compared five SARS-CoV-2 sequences from different geographical regions to those from SARS, MERS and two cold viruses, OC43 and 229E, to identify the presence of miR-like sequences. We identified seven key miRs, which highlight considerable differences between the SARS-CoV-2 sequences, compared with the other viruses. The level of conservation between the five SARS-CoV-2 sequences was identical but poor compared with the other sequences, with SARS showing the highest degree of conservation. This decrease in similarity could result in reduced levels of transcriptional control, as well as a change in the physiological effect of the virus and associated host-pathogen responses. MERS and the milder symptom viruses showed greater differences and even significant sequence gaps. This divergence away from the SARS-CoV-2 sequences broadly mirrors the phylogenetic relationships obtained from the whole-genome alignments. Therefore, patterns of mutation, occurring during sequence divergence from the longer established human viruses to the more recent ones, may have led to the emergence of sequence motifs that can be related directly to the pathogenicity of SARS-CoV-2. Importantly, we identified 7 key-microRNAs (miRs 8066, 5197, 3611, 3934-3p, 1307-3p, 3691-3p, 1468-5p) with significant links to KEGG pathways linked to viral pathogenicity and host responses. According to Bioproject data (PRJNA615032), SARS-CoV-2 mediated transcriptomic alterations were similar to the target pathways of the selected 7 miRs identified in our study. This mechanism could have considerable significance in determining the symptom spectrum of future potential pandemics. KEGG pathway analysis revealed a number of critical pathways linked to the seven identified miRs that may provide insight into the interplay between the virus and comorbidities. Based on our reported findings, miRNAs may constitute potential and effective therapeutic approaches in COVID-19 and its pathological consequences.


Mental health and the SARS-CoV-2 pandemic


title: Dermatological insights from Google Trends: what does the public think is important during COVID-19 lockdown?

text: In the United Kingdom, Google is often the search engine used to explore information relating to many aspects of people's lives, including dermatological advice and information. The frequency of searching for particular terms could indicate the relative importance that the public assigns to various conditions and is dynamic, fluctuating in different societal contexts, such as during a pandemic.


title: Nonrelocatable Occupations at Increased Risk During Pandemics: United States, 2018

text: Objectives. To characterize which occupations in the United States could likely work from home during a pandemic such as COVID-19.Methods. I merged 2018 US Bureau of Labor Statistics (BLS) national employment and wage data with measures ranking the importance of computer use at work and the importance of working with or performing for the public from the BLS O*NET survey.Results. Approximately 25% (35.6 million) of US workers are employed in occupations (such as technology, administrative, financial, and engineering) that could be done from home; the remaining 75% work in occupations (including health care, manufacturing, retail, and food services) that are challenging to do from home.Conclusions. Most US workers are employed in occupations that cannot be done at home, putting 108.4 million workers at increased risk for adverse health outcomes related to working during a pandemic. These workers tend to be lower paid. The stress experienced by lower-income groups, coupled with job insecurity, could result in a large burden of mental health disorders in the United States in addition to increased cases of COVID-19 from workplace transmission. (Am J Public Health. Published online ahead of print June 18, 2020: e1-e7. doi:10.2105/AJPH.2020.305738).


text: Objectives. To characterize which occupations in the United States could likely work from home during a pandemic such as COVID-19.Methods. I merged 2018 US Bureau of Labor Statistics (BLS) national employment and wage data with measures ranking the importance of computer use at work and the importance of working with or performing for the public from the BLS O*NET survey.Results. Approximately 25% (35.6 million) of US workers are employed in occupations (such as technology, administrative, financial, and engineering) that could be done from home; the remaining 75% work in occupations (including health care, manufacturing, retail, and food services) that are challenging to do from home.Conclusions. Most US workers are employed in occupations that cannot be done at home, putting 108.4 million workers at increased risk for adverse health outcomes related to working during a pandemic. These workers tend to be lower paid. The stress experienced by lower-income groups, coupled with job insecurity, could result in a large burden of mental health disorders in the United States in addition to increased cases of COVID-19 from workplace transmission.


title: Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation: An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians

text: Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.


COVID-19-Compliant Strategies for Supporting Treatment Adherence Among People Living with HIV in Sub-Saharan Africa


title: Spatio-temporal predictive modeling framework for infectious disease spread

text: A novel predictive modeling framework for the spread of infectious diseases using high dimensional partial differential equations is developed and implemented. A scalar function representing the infected population is defined on a high-dimensional space and its evolution over all directions is described by a population balance equation (PBE). New infections are introduced among the susceptible population from non-quarantined infected population based on their interaction, adherence to distancing norms, hygiene levels and any other societal interventions. Moreover, recovery, death, immunity and all aforementioned parameters are modeled on the high-dimensional space. To epitomize the capabilities and features of the above framework, prognostic estimates of Covid-19 spread using a six-dimensional (time, 2D space, infection severity, duration of infection, and population age) PBE is presented. Further, scenario analysis for different policy interventions and population behavior is presented, throwing more insights into the spatio-temporal spread of infections across disease age, intensity and age of population. These insights could be used for science-informed policy planning.


title: Dynamic surveillance of SARS-CoV-2 shedding and neutralizing antibody in children with COVID-19

text: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and quickly spread globally. In this study, we investigated the characteristics of viral shedding from different sites and the neutralizing antibody (NAb) response during the acute and convalescent phases of nine children with COVID-19. SARS-CoV-2 was detected in their nasopharyngeal swabs (9/9, 100%), stool samples (8/9, 89%), and oropharyngeal swabs (3/9, 33%) but was not detected in their serum and urine samples. The median duration of viral shedding detected in nasopharyngeal swabs, oropharyngeal swabs, and stools was 13, 4, and 43 days respectively, and the maximum duration of viral shedding detected from stools was 46 days after discharge. In children, nasopharyngeal swabs appear to be a more sensitive specimen type for the diagnosis of COVID-19 compared with oropharyngeal swabs. Three of eight patients produced NAbs in the acute phase, and NAbs were detected in all eight patients with convalescent sera. The results of this study provide valuable information for the diagnosis and surveillance of COVID-19 and development of SARS-CoV-2 vaccines for use in children.


Prevention of SARS-CoV-2 infection in patients with decompensated cirrhosis


title: [Advances in the research of mechanism of pulmonary fibrosis induced by Corona Virus Disease 2019 and the corresponding therapeutic measures]

text: The Corona Virus Disease 2019 (COVID-19) outbroke in Wuhan, China in December 2019 and the severe acute respiratory syndrome (SARS) outbroke in Guangzhou, China in 2003 were caused by highly pathogenic coronaviruses with high homology. Since the 2019 novel coronavirus has strong transmissibility and progress rapidly. It has caused negative social effects and massive economic damage on a global scale. While there is currently no vaccine or effective drugs. Pulmonary fibrosis is a pulmonary disease with progressive fibrosis, which is the main factor leading to pulmonary dysfunction and quality of life decline in SARS survivors after recovery. Extensive epidemiological, viral immunological, and current clinical evidences support the possibility that pulmonary fibrosis may be one of the major complications in COVID-19 patients. Although there are no reports on the mechanism of COVID-19 inducing pulmonary fibrosis, based on the existing theoretical basis, we focus on the possible mechanism of COVID-19 sustained lung damaging, the key role of abnormal immune mechanism in the initiation and promotion of pulmonary fibrosis, and the corresponding therapeutic measures.


The COVID-19 pandemic, psychological stress during pregnancy, and risk of neurodevelopmental disorders in offspring: a neglected consequence


title: COVID-19 & Periodontitis: The cytokine connection

text: COVID-19 is now recognized as a pandemic throughout the world, leading to a scramble in order to gather knowledge as well as evidence regarding the 'novel' corona virus which causes this disease. Chemokines are a family of cytokines which are chemotactic in nature and cause the recruitment of cells of inflammation. Periodontitis has long been attributed to having its pathophysiology rooted in a cytokine response. The recent COVID-19 pandemic has been reported to have adverse outcomes related to the establishment of a cytokine storm, many of the components of which are common with the cytokine expression profile of periodontitis. This communication explores the connection between COVID-19 and periodontal disease through their cytokine connection to form a translational basis for recommending maintenance of oral hygiene in the COVID era and to red flag patients with periodontitis as having an increased risk of exhibiting COVID related adverse outcomes.


Molecular mechanisms for thrombosis risk in Black people: a role in excess mortality from COVID-19


title: Optimal Investing after Retirement Under Time-Varying Risk Capacity Constraint

text: This paper studies an optimal investing problem for a retiree facing longevity risk and living standard risk. We formulate the investing problem as a portfolio choice problem under a time-varying risk capacity constraint. We derive the optimal investment strategy under the specific condition on model parameters in terms of second-order ordinary differential equations. We demonstrate an endogenous number that measures the expected value to sustain the spending post-retirement. The optimal portfolio is nearly neutral to the stock market movement if the portfolio's value is higher than this number; but, if the portfolio is not worth enough to sustain the retirement spending, the retiree actively invests in the stock market for the higher expected return. Besides, we solve an optimal portfolio choice problem under a leverage constraint and show that the optimal portfolio would lose significantly in stressed markets. This paper shows that the time-varying risk capacity constraint has important implications for asset allocation in retirement.


Reply to Ruth Palan Lopez, PhD, GNP-BC


title: Characteristics of COVID-19 Near China's Epidemic Center

text: BACKGROUND: This study described and analyzed the age, gender, infection sources, and timing characteristics of the 416 confirmed cases in two cities near the center of China's COVID-19 outbreak. METHODS: This study used publicly available data to examine gender, age, source of infection, date returned from Hubei, date of disease onset, date of first medical visit, date of final diagnosis, and date of recovery of COVID-19 cases. RESULTS: Public-use data revealed similar risks of infection by age and that the numbers of new and final diagnoses of confirmed cases first increased, peaked at about two weeks, and then gradually decreased. The main sources of infection were firsthand or secondhand exposure in Hubei Province and contact with confirmed cases, which mostly involved contact with infected household members. The mean periods from disease onset to first medical visit, first visit to final diagnosis, and final diagnosis to recovery were 4.44, 3.18, and 13.42 days, respectively. CONCLUSIONS: The results suggest that the measures taken to control the rate of infection were effective. Prevention and control efforts should respond as quickly as possible, isolate and control activities of individuals leaving infected areas, and restrict household contact transmission.


title: Assessment of Coronavirus Disease 2019 Community Containment Strategies in Shenzhen, China

text: Importance: A new outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 in Wuhan, China, is spreading rapidly around the globe. Limited information on control in community settings is available. Objective: To detail measures enacted within a community to prevent the spread of coronavirus disease 2019 (COVID-19) and to evaluate the spread of COVID-19 associated with implementation of the program. Design, Setting, and Participants: This case series study details the implementation of prevention measures in a specific community setting among community-dwelling individuals exposed to or at risk of COVID-19 in Haiyu, Shenzhen, China, from January 23 to April 10, 2020. Exposures: Community containment strategies for tracking, quarantine, and management were strictly, cooperatively, and effectively implemented by a team that included a general practitioner, a community manager, and public safety bureau officials. Main Outcomes and Measures: Number of locally acquired cases with indirect links to confirmed COVID-19 cases. Diagnosis with COVID-19 was confirmed when throat swab samples tested positive for severe acute respiratory syndrome coronavirus 2 on reverse transcription-polymerase chain reaction. Results: Approximately 34â¯686 individuals live in Haiyu, including 2382 residents aged 65 years or older. Seven individuals with COVID-19 acquired outside the community (age, 20-70 years; 3 [42%] women) were moved from quarantine to a hospital for standard isolation treatment. A total of 20 people who were asymptomatic and who had had direct contact with these individuals were closely observed by health care workers at a nearby hotel. Additionally, 800 individuals considered to be at higher risk were moved from quarantine to home isolation for 14 days. There were no locally acquired cases of COVID-19 with indirect links reported in the Haiyu community from the time that the study began on January 23, 2020, to April 10, 2020. Conclusions and Relevance: These findings suggest that cooperation among the authorities of multiple sectors allowed for the implementation of preventive measures that were associated with limited community transmission.


Tocilizumab administration in patients with SARS-CoV-2 infection: Subcutaneous injection vs intravenous infusion


title: Medically Necessary Orthopaedic Surgery During the COVID-19 Pandemic: Safe Surgical Practices and a Classification to Guide Treatment

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) has rapidly evolved as a viral pandemic. Countries worldwide have been affected by the recent outbreak caused by the SARS (severe acute respiratory syndrome)-CoV-2 virus. As with prior viral pandemics, health-care workers are at increased risk. Orthopaedic surgical procedures are common in health-care systems, ranging from emergency to elective procedures. Many orthopaedic surgical procedures are life or limb-saving and cannot be postponed during the COVID-19 pandemic because of potential patient harm. Our goal is to analyze how orthopaedic surgeons can perform medically necessary procedures during the pandemic and to help guide decision-making perioperatively. METHODS: We performed a review of the existing literature regarding COVID-19 and prior viral outbreaks to help guide clinical practice in terms of how to safely perform medically necessary orthopaedic procedures during the pandemic for both asymptomatic patients and high-risk (e.g., COVID-19-positive) patients. We created a classification system based on COVID-19 positivity, patient health status, and COVID-19 prevalence to help guide perioperative decision-making. RESULTS: We advocate that only urgent and emergency surgical procedures be performed. By following recommendations from the American College of Surgeons, the Centers for Disease Control and Prevention, and the recent literature, safe orthopaedic surgery and perioperative care can be performed. Screening measures are needed for patients and perioperative teams. Surgeons and perioperative teams at risk for contracting COVID-19 should use appropriate personal protective equipment (PPE), including N95 respirators or powered air-purifying respirators (PAPRs), when risk of viral spread is high. When preparing for medically necessary orthopaedic procedures during the pandemic, our classification system will help to guide decision-making. A multidisciplinary care plan is needed to ensure patient safety with medically necessary orthopaedic procedures during the COVID-19 pandemic. CONCLUSIONS: Orthopaedic surgery during the COVID-19 pandemic can be performed safely when medically necessary but should be rare for COVID-19-positive or high-risk patients. Appropriate screening, PPE use, and multidisciplinary care will allow for safe medically necessary orthopaedic surgery to continue during the COVID-19 pandemic. LEVEL OF EVIDENCE: Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.


A rationale for blocking thromboinflammation in COVID-19 with Btk inhibitors


Acute stroke care during the COVID-19 pandemic: difficult, but not impossible!


title: The COVID-19 pandemic: implications for the cytology laboratory

text: The coronavirus disease 2019 (COVID-19) is a pandemic caused by the SARS-CoV-2 virus. The infection has predominantly respiratory transmission and is transmitted through large droplets or aerosols, and less commonly by contact with infected surfaces or fomites. The alarming spread of the infection and the severe clinical disease that it may cause have led to the widespread institution of social distancing measures. Because of repeated exposure to potentially infectious patients and specimens, health care and laboratory personnel are particularly susceptible to contract COVID-19. This review paper provides an assessment of the current state of knowledge about the disease and its pathology, and the potential presence of the virus in cytology specimens. It also discusses the measures that cytology laboratories can take to function during the pandemic, and minimize the risk to their personnel, trainees, and pathologists. In addition, it explores potential means to continue to educate trainees during the COVID-19 pandemic.


Addressing the Surgical Training Gaps Caused by the COVID-19 Pandemic: An Opportunity for Implementing Standards for Remote Surgical Training


Challenges for the female academic during the COVID-19 pandemic


title: The mental turmoil of hospital nurses in the COVID-19 pandemic

text: At this time, nurses within hospitals are working hard, but they potentially will have long-term mental health effects as a result of the 2019 novel coronavirus (COVID-19) pandemic. Both short-term interventions, such as daily huddles and debriefings, and long-term interventions, including follow-ups on the mental health of nurses, need to be implemented to prevent mental disorders among nurses during and after the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Successful treatment of severe COVID-19 pneumonia in a liver transplant recipient

text: Coronavirus disease 2019 (COVID-19) pandemic spreads rapidly and may be an increasing challenge for transplant community. Clinical data on COVID-19 infection in transplant population is very limited. Herein we presented the clinical course and outcome of a 50-year-old male post liver transplantation who contracted COVID-19, with subsequent infection of his wife. The process of illness was representative. A therapeutic regime with temporary immunosuppression withdrawal and systemic low-dose corticosteroid as principle was involved in the management of the patient which made him recover from severe COVID-19 pneumonia.


How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China


Mental health disorders


Safety and efficacy of early high-dose IV anakinra in severe COVID-19 lung disease


Public Reporting of COVID-19 Management


title: Proposed guidelines for screening of hyperglycemia in patients hospitalized with COVID-19 in low resource settings

text: BACKGROUND AND AIMS: The coronavirus disease 2019 (COVID-19) pandemic has immensely strained healthcare systems worldwide. Diabetes has emerged as a major comorbidity in a large proportion of patients infected with COVID-19 and is associated with poor health outcomes. We aim to provide a practical guidance on screening of hyperglycemia in persons without known diabetes in low resource settings. METHODS: We reviewed the available guidelines on this subject and proposed an algorithm based on simple measures of blood glucose (BG) which can be implemented by healthcare workers with lesser expertise in low resource settings. RESULTS: We propose that every hospitalized patient with COVID-19 infection undergo a paired capillary BG assessment (pre-meal and 2-h post-meal). Patients with pre-meal BG < 7.8 mmol/L (140 mg/dL) and post-meal BG < 10.0 mmol/L (180 mg/dL) may not merit further monitoring. On the other hand, those with one or more value above these thresholds should undergo capillary BG monitoring (pre-meals and 2 hours after dinner) for the next 24 hours. When two or more (≥50%) such values are significantly elevated [pre-meal ≥8.3 mmol/L (150 mg/dL) and post-meal ≥11.1 mmol/L (200 mg/dL)], pharmacotherapy should be immediately initiated. On the other hand, in patients with modest elevation of one or more values [pre-meal 7.8-8.3 mmol/L (140-150 mg/dL) and post-meal 10.0-11.1 mmol/L (180-200 mg/dL)], dietary modifications should be initiated and pharmacotherapy considered only if BG control remains suboptimal. CONCLUSION: We highlight strategies for screening of hyperglycemia in persons without known diabetes treated for COVID-19 infection in low resource settings. This guidance may well be applied to other settings in the near future.


SIR HELMET (Safety In Radiology HEalthcare Localised Metrological EnviromenT): a low-cost negative-pressure isolation barrier for shielding MRI frontline workers from COVID-19 exposure


title: The role of extracorporeal life support for patients with COVID-19: Preliminary results from a statewide experience

text: OBJECTIVE: There is a paucity of clinical data on critically ill patients with COVID-19 requiring extracorporeal life support. METHODS: A statewide multi-institutional collaborative for COVID-19 patients was utilized to obtain clinical data on the first 10 critically ill COVID-19 patients who required extracorporeal membrane oxygenation (ECMO). RESULTS: Of the first 10 patients that required ECMO for COVID-19, the age ranged from 31 to 62 years with the majority (70%) being men. Seven (70%) had comorbidities. The majority (80%) of patients had known sick contact and exposure to COVID-19 positive patients or traveled to pandemic areas inside the United States within the 2 weeks before symptom onset. None of the patients were healthcare workers. The most common symptoms leading to the presentation were high fever ≥103°F (90%), cough (80%) and dyspnea (70%), followed by fatigue and gastrointestinal symptoms (both 30%), myalgia, loss of taste, pleuritic chest pain, and confusion (all 10%). All patients had bilateral infiltrates on chest X-rays suggestive of interstitial viral pneumonia. All patients were cannulated in the venovenous configuration. Two (20%) patients were successfully liberated from ECMO support after 7 and 10 days, respectively, and one (10%) patient is currently on a weaning course. One patient (10%) died after 9 days on ECMO from multiorgan dysfunction. CONCLUSIONS: These preliminary multi-institutional data from a statewide collaborative offer insight into the clinical characteristics of the first 10 patients requiring ECMO for COVID-19 and their initial clinical course. Greater morbidity and mortality is likely to be seen in these critically ill patients with longer follow-up.


title: Impact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in Hong Kong, China

text: OBJECTIVE: To determine whether COVID-19 may adversely affect outcome of myocardial infarction (MI) patients in Hong Kong, China. BACKGROUND: The COVID-19 pandemic has infected thousands of people and placed enormous stress on healthcare system. Apart from being an infectious disease, it may affect human behavior and healthcare resource allocation which potentially cause treatment delay in MI. METHODS: This was a single center cross-sectional observational study. From November 1, 2019 to March 31, 2020, we compared outcome of patients admitted for acute ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) before (group 1) and after (group 2) January 25, 2020 which was the date when Hong Kong hospitals launched emergency response measures to combat COVID-19. RESULTS: There was a reduction in daily emergency room attendance since January 25, 2020 (group 1,327/day vs. group 2,231/day) and 149 patients with diagnosis of MI were included into analysis (group 1 N = 85 vs. group 2 N = 64). For STEMI, patients in group 2 tended to have longer symptom-to-first medical contact time and more presented out of revascularization window (group 1 27.8 vs. group 2 33%). The primary composite outcome of in-hospital death, cardiogenic shock, sustained ventricular tachycardia or fibrillation (VT/VF) and use of mechanical circulatory support (MCS) was significantly worse in group 2 (14.1 vs. 29.7%, p = .02). CONCLUSIONS: More MI patients during COVID-19 outbreak had complicated in-hospital course and worse outcomes. Besides direct infectious complications, cardiology community has to acknowledge the indirect effect of communicable disease on our patients and system of care.


title: Towards Optimization of Hydroxychloroquine Dosing in Intensive Care Unit COVID-19 Patients

text: Hydroxychloroquine (HCQ) appears to be a promising treatment for COVID-19. However, all ongoing clinical trials with HCQ use different dosing regimens, resulting on various concentrations PK studies are therefore needed to define the optimal dosing regimen.


title: Public Health Policy: COVID-19 Epidemic and SEIR Model with Asymptomatic Viral Carriers

text: We measure the effect of different public health regulations to the spread of COVID-19, based on a SEIRA model -- a SEIR model including asymptomatic transmissions. The cumulative confirmed cases and death show nonlinear positive relationship with the value of asymptomatic rate. Based on this model, we analyze the inhibit effects to COVID-19 of three types of public health policies, i.e. isolation of laboratory confirmed cases, general personal protection and quarantine (lock-down). The simulations conclude that the isolation display limited effects to the asymptomatic viral carriers. The general personal protection and quarantine perform similar effects when the their percentages of participants are same. When the total proportion of asymptomatic, mild symptomatic and neglected patients is 40%, only depends on isolation policy may lead to an additional 75% infections, compared with general personal protection or quarantine with an efficiency 80%. At end, we provide seven recommendations of public health intervention before and during an aerial transmitted epidemic (COVID-19).


title: Does active smoking worsen Covid-19?

text: Probably it does.


Atypical lung feature on chest CT in a lung adenocarcinoma cancer patient infected with COVID-19


Restricted family visiting in intensive care during COVID-19


Living donor liver transplants for sick recipients during COVID-19 pandemic-An experience from a tertiary center in India


Caution Needed on the Use of Chloroquine and Hydroxychloroquine for Coronavirus Disease 2019


title: Decline in acute upper gastrointestinal bleeding during Covid-19 pandemic after lockdown in Austria

text: Background and study aims COVID-19 disease has rapidly spread all over the world. The Austrian government has implemented a lockdown to contain further spread of this disease on March 16th. We investigated the effects of lockdown on acute upper gastrointestinal (GI) bleeding in Austria. Patients and methods We contacted 98 Austrian hospitals performing emergency endoscopies. The hospitals were asked to report upper GI endoscopies performed because of recent hematemesis, melena, or both and exhibiting endoscopically visible signs of bleeding. Investigated time points included three weeks before and after lockdown. Results 61% of Austrian hospitals and importantly all major state hospitals responded. 575 upper GI bleedings occurred in the three weeks before and 341 after lockdown (40.7% reduction). When comparing the first and last calendar week of investigation we observed an almost 55% decline in nonvariceal bleeding events (calendar week 9 versus 14: 196 versus 89) whereas rates of variceal hemorrhage did not change (calendar week 9 versus 14: 17 versus 15). Conclusions National lockdown resulted in a dramatic decrease in upper gastrointestinal bleeding events.


Diagnosis of SARS-CoV-2 infection based on CT scan vs RT-PCR: reflecting on experience from MERS-CoV


title: Are urologists in trouble by SARS-CoV-2? Reflexions and recommendations for specific interventions

text: OBJECTIVE: We aim to assess the risk of infection during urologic surgeries. Therefore possible hazards in tissue, blood, urine and aerosolized particles generated during surgery, are evaluated. Understanding the risk, recommendations for clinical practice are provided. MATERIALS AND METHODS: Review of available literature on urological and other surgical procedures in patients with virus infections such as HPV, HIV and hepatitis B and current publications on COVID-19. RESULTS: Several possible pathways for viral transmission appear in the literature. Recent groups detected SARS-CoV-2 in the urine and faeces, even after negative pharyngeal swabs. In addition, viral RNA can be detected in the blood and several tissues. During surgery, viral particles are released, aerosole-borne and present a certain risk for transmission and infection. However, there is currently no evidence on the exact risk for infection by the substances mentioned above. It remains unclear whether or not viral particles in the urine, blood or faeces are infectious. CONCLUSIONS: Whether SARS-CoV-2 can be transmitted by aerosols remains controversial. In any case, standard surgical masks offer inadequate protection from SARS-CoV-2. Full PPE including at least FFP-2 masks and safety goggles should be used. Aerosolized particles might remain for a longer time in the operation theatre and contaminate other surfaces, like floors or computer input devices. Therefore scrupulous hygiene and disinfection of surfaces must be carried out. To prevent aerosolization during laparoscopic interventions, the pneumoperitoneum should be evacuated with suction devices. The use of virus proof HEPA filters is recommended. Local separation of anesthesia/intubation and operation theatre can reduce the danger of viral transmission. Lumbar anaesthesia should be considered especially in endourology. Based on current knowledge, COVID-19 is no contraindication for acute urological surgery. If possible however, as european guideline committees recommend, non-emergency urological interventions should be postponed until negative SARS-CoV-2 tests become available.


Acute peritoneal dialysis in COVID-19


title: People experiencing homelessness: Their potential exposure to COVID-19

text: BACKGROUND: Insufficient housing quality is associated with stress and mental health impacts. Crowding, pollution, noise, inadequate lighting, lack of access to green spaces, and other environmental factors associated with slums can exacerbate mental health disorders, including depression, anxiety, violence, and other forms of social dysfunction. METHOD: The studies were identified using large-sized newspapers with international circulation. RESULTS: Experts say that people who sleep in shelters or on the streets already have lower life expectancy, suffer from addiction, and have underlying health conditions that put them at greater risk should they develop the virus. There are just so many competing and unmet needs, which makes it much harder for homeless to contend with all of this. If exposed, people experiencing homelessness might be more susceptible to illness or death due to the prevalence of underlying physical and mental medical conditions and a lack of reliable and affordable health care. Nevertheless, without an urgent solution, people experiencing homelessness will remain in limbo. CONCLUSIONS: Many people living on the streets already have a diminished health condition, higher rates of chronic illnesses or compromised immune systems, all of which are risk factors for developing a more serious manifestation of the coronavirus infection. Those suffering from mental illness may have difficulty in recognizing and responding to the threat of infection. Homeless people have less access to health care providers who could otherwise order diagnostic testing and, if confirmed, isolate them from others in coordination with local health departments.


title: COVID-19: Structural Predictions of Viral Success

text: Since the beginning of the 21st century, three coronaviruses have crossed the species barrier and caused serious human disease: severe acute respiratory syndrome coronavirus (SARS-CoV) in November 2002 [1, 2], Middle-East respiratory syndrome coronavirus (MERS-CoV) in 2012 [3, 4], and SARS-CoV-2 in 2019 [5, 6]. SARS-CoV-2 [7], initially called 2019-nCoV, is the etiological agent of COVID-19, a highly contagious infectious illness that was first reported in December 2019 in Wuhan, China and subsequently spread globally [8]. As of May 24, 2020, COVID-19 has caused >5,370,000 infections and >343,000 deaths worldwide [9].


Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review


COVID-19 and immunomodulator/immunosuppressant use in dermatology


Treatment approach in locally advanced rectal cancer during coronavirus (COVID-19) pandemic: long course or short course?


title: Early Experience Managing a High-Volume Academic Orthopaedic Department During the Coronavirus Pandemic in New York City

text: Our orthopaedic surgery department at Montefiore Medical Center and Albert Einstein College of Medicine, is located within the Bronx, a borough of New York City, and serves a densely-populated urban community. Since the beginning of the Coronavirus (COVID) outbreak in New York City the medical center was forced to rapidly adapt to the projected influx of critically ill patients. The aim of this report is to outline how our large academic orthopaedic surgery department adopted changes and alternative practices in response to the most daunting challenge to public health in our region in over a century. We hope that this report provides insight for others facing similar challenges.


Context, context, context: how has covid-19 changed implementation globally and how can we 'lock in' learning?


title: The impact of enhanced recovery on open and laparoscopic liver resections

text: Enhanced recovery after surgery programs (ERP) have been implemented in many surgical specialties. Their impact in liver surgery is poorly understood and approach-specific ERPs have not yet been assessed. This retrospective study aims to analyse the effect of such programs on liver resection. All patients undergoing liver resection at a tertiary referral centre between January 2009 and April 2019 were identified. Primary outcome was the length of stay (LOS), secondary outcomes were functional recovery, complications and readmission rates. Patients in the ERP with different protocols for open, laparoscopic, major and minor resections were compared to a historical cohort. Of 1056 patients, 644 were treated within the ERP. A comparable duration of hospital stay [7 days (IQR (interquartile range) 6-12) vs 7 days (IQR 5-9) p = 0.047] and faster functional recovery with fewer complications was found in the ERP group [94 (50.5%) vs 103 (35.9%) p < 0.002]. Those advantages were smaller after open minor compared to open major resection. In patients undergoing laparoscopic resection no differences were observed except for a lower readmission rate [21 (9.3%) vs 13 (3.6%) p = 0.005]. Multivariable analysis showed that laparoscopy was associated with a shorter LOS. ERPs offer significant advantages in open liver surgery. Those advantages are less evident after laparoscopic resection.


title: Distribution of the COVID-19 epidemic and correlation with population emigration from Wuhan, China

text: BACKGROUND: The ongoing new coronavirus pneumonia (Corona Virus Disease 2019, COVID-19) outbreak is spreading in China, but it has not yet reached its peak. Five million people emigrated from Wuhan before lockdown, potentially representing a source of virus infection. Determining case distribution and its correlation with population emigration from Wuhan in the early stage of the epidemic is of great importance for early warning and for the prevention of future outbreaks. METHODS: The official case report on the COVID-19 epidemic was collected as of January 30, 2020. Time and location information on COVID-19 cases was extracted and analyzed using ArcGIS and WinBUGS software. Data on population migration from Wuhan city and Hubei province were extracted from Baidu Qianxi, and their correlation with the number of cases was analyzed. RESULTS: The COVID-19 confirmed and death cases in Hubei province accounted for 59.91% (5806/9692) and 95.77% (204/213) of the total cases in China, respectively. Hot spot provinces included Sichuan and Yunnan, which are adjacent to Hubei. The time risk of Hubei province on the following day was 1.960 times that on the previous day. The number of cases in some cities was relatively low, but the time risk appeared to be continuously rising. The correlation coefficient between the provincial number of cases and emigration from Wuhan was up to 0.943. The lockdown of 17 cities in Hubei province and the implementation of nationwide control measures efficiently prevented an exponential growth in the number of cases. CONCLUSIONS: The population that emigrated from Wuhan was the main infection source in other cities and provinces. Some cities with a low number of cases showed a rapid increase in case load. Owing to the upcoming Spring Festival return wave, understanding the risk trends in different regions is crucial to ensure preparedness at both the individual and organization levels and to prevent new outbreaks.


title: High neutralizing antibody titer in intensive care unit patients with COVID-19

text: Coronavirus disease 2019 (COVID-19) has a wide spectrum of disease severity from mild upper respiratory symptoms to respiratory failure. The role of neutralizing antibody (NAb) response in disease progression remains elusive. This study determined the seroprevalence of 733 non-COVID-19 individuals from April 2018 to February 2020 in the Hong Kong Special Administrative Region and compared the neutralizing antibody (NAb) responses of eight COVID-19 patients admitted to the intensive care unit (ICU) with those of 42 patients not admitted to the ICU. We found that NAb against SARS-CoV-2 was not detectable in any of the anonymous serum specimens from the 733 non-COVID-19 individuals. The peak serum geometric mean NAb titer was significantly higher among the eight ICU patients than the 42 non-ICU patients (7280 [95% confidence interval (CI) 1468-36099]) vs 671 [95% CI, 368-1223]). Furthermore, NAb titer increased significantly at earlier infection stages among ICU patients than among non-ICU patients. The median number of days to reach the peak Nab titers after symptoms onset was shorter among the ICU patients (17.6) than that of the non-ICU patients (20.1). Multivariate analysis showed that oxygen requirement and fever during admission were the only clinical factors independently associated with higher NAb titers. Our data suggested that SARS-CoV-2 was unlikely to have silently spread before the COVID-19 emergence in Hong Kong. ICU patients had an accelerated and augmented NAb response compared to non-ICU patients, which was associated with disease severity. Further studies are required to understand the relationship between high NAb response and disease severity.


title: È guerra mondiale al CoViD-19. Decisiva la prima battaglia sul fronte dell'invasione virale contro l'exitus per polmonite interstiziale./ [It's world war at CoViD-19. The first battle on the front of the viral invasion against the exitus for interstitial pneumonia was decisive.]

text: An outbreak of a new coronavirus originating from Wuhan (China), responsible for a severe acute respiratory syndrome (SARS), called SARS-CoV-2, is causing a pandemic disease called CoViD-19 (Coronavirus Disease-19), although strict containment measures and restrictions on individual travel have been taken everywhere to hinder the spread of the virus. The clinical spectrum of this infection includes, in order of lesser to greater severity, asymptomatic viremia, paucisymptomatic forms, clinical conditions characterized by respiratory failure that needs mechanical ventilation and support in an intensive care unit, systemic manifestations of infection, septic shock, and multiple organ dysfunction syndromes. There is currently no vaccine to prevent CoViD-19, but the international scientific community is intensely focused on finding a vaccine that will prevent SARS-CoV-2 transmission. In the meanwhile, to prevent hospitals from risking collapse, it is crucial to stratify patients at high risk of poor lung progression, to find effective monitoring strategies, even at home, for the positive patients and/or those highly at risk of positivity of CoViD-19. Starting from the pathogenetic mechanisms involved in the development of this infection up to the clinical characteristics of the infected patients, in this review we tried to focus on the crucial points of the infection in combination with the appropriateness of the medical intervention. We aim to offer indications of therapeutic intervention that are timely and, as far as possible, effective, targeted to the individual patient in relation to age, clinical condition and comorbidities. An early diagnosis associated with an appropriate therapeutic action in the initial stages of the disease can reduce the progression of CoViD-19 towards interstitial pneumonia, thus interfering with the number of transfers to intensive care and lethality of the pandemic in progress.


Respiratory failure alone does not suggest central nervous system invasion by SARS-CoV-2


title: Personality traits are directly associated with anti-black prejudice in the United States

text: Modern psychological theories postulate that individual differences in prejudice are determined by social and ideological attitudes instead of personality. For example, the dual-process motivational (DPM) model argues that personality does not directly associate with prejudice when controlling for the attitudinal variables that capture the authoritarian-conservatism motivation and the dominance motivation. Previous studies testing the DPM model largely relied on convenience samples and/or European samples, and have produced inconsistent results. Here we examined the extent to which anti-black prejudice was associated with the Big Five personality traits and social and ideological attitudes (authoritarianism, social dominance orientation, political party affiliation) in two large probability samples of the general population (N1 = 3,132; N2 = 2,483) from the American National Election Studies (ANES). We performed structural equation modeling (SEM) to test the causal assumptions between the latent variables and used survey weights to generate estimates that were representative of the population. Different from prior theories, across both datasets we found that two personality traits, agreeableness and conscientiousness, were directly associated with anti-black prejudice when controlling for authoritarianism, social dominance orientation, and political party affiliation. We also found that a substantial part of the associations between personality traits and anti-black prejudice were mediated through those social and ideological attitudes, which might serve as candidates for prejudice-reduction interventions in the real world.


title: Assessment of serum lactate levels, blood glucose values and blood gas values in sheep, newborn lambs and placenta/ Avaliação da concentração de lactato sérico, glicemia e hemogasometria de ovelhas, cordeiros recém-nascidos e placenta

text: Newborn animals, in the fetal-to-neonatal transition, usually face several challenges in their first 24 hours, including issues with acid-base balance, glycemic levels and oxygenation. Difficulties to overcome such issues have caused several deaths among newborns. Therefore, studies have been carried out in order to evaluate them. The main purpose of this study is to evaluate the correlation between the serum lactate level in the mother, in the placenta and in the newborn. Moreover, the study measured the lactate level, blood glucose level and blood gas level in the first 24 hours. Tests were carried out right after birth, and at 4, 8, 12 and 24 hours after. Lactate levels were quite similar to the placental levels (p=0.991) which, in turn, were significantly different from the mother's (p=0.011). Results showed that, shortly after birth, the production of lactate in the placenta is part of the issue. Along the first 24 hours, the study observed a reduction of the levels of lactate in newborns; the levels were closer to the normal index levels for the species. Regarding the blood gas test results, we observed mild metabolic acidosis at birth; acid-base balance was completely stable at the end of the period.(AU)


title: An Innovative Way to Achieve Safe Lung Deflation During One-Lung Ventilation in a Potential Coronavirus Disease 2019 Patient: A Case Report

text: A novel coronavirus pandemic may be particularly hazardous to health care workers. Airway management is an aerosol-producing high-risk procedure. To minimize the production of airborne droplets, including pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from the endotracheal tube during procedures requiring lung deflation, we devised a technique to mitigate the risk of infection transmission to health care personnel.


title: A dissection of SARSCoV2 with clinical implications (Review)

text: We are being confronted with the most consequential pandemic since the Spanish flu of 19181920 to the extent that never before have 4 billion people quarantined simultaneously; to address this global challenge we bring to the forefront the options for medical treatment and summarize SARSCoV2 structure and functions, immune responses and known treatments. Based on literature and our own experience we propose new interventions, including the use of amiodarone, simvastatin, pioglitazone and curcumin. In mild infections (sore throat, cough) we advocate prompt local treatment for the nasopharynx (inhalations; aerosols; nebulizers); for moderate to severe infections we propose a triedandtrue treatment: the combination of arginine and ascorbate, administered orally or intravenously. The material is organized in three sections: i) Clinical aspects of COVID19; acute respiratory distress syndrome (ARDS); known treatments; ii) Structure and functions of SARSCoV2 and proposed antiviral drugs; iii) The combination of arginineascorbate.


Implication of COVID-19 in oral oncology practices in Brazil, Canada, and the United States


Rapid prototype feasibility testing with simulation: Improvements and updates to the Taiwanese "aerosol box"


Perspective on the COVID-19 Coronavirus Outbreak


title: Incidental CT Findings Suspicious for COVID-19-Associated Pneumonia on Nuclear Medicine Examinations: Recognition and Management Plan

text: Some patients undergoing routine SPECT/CT and PET/CT examinations during the COVID-19 pandemic may incidentally reveal findings of COVID-19-associated pneumonia (C-19AP) on localizing CT. It is critical for nuclear medicine physicians to develop diagnostic skills for timely recognition of typical findings of C-19AP on a localizing CT. Furthermore, it is our responsibility to know the optimal practices for safely isolating and managing such patients while protecting the staff, other patients at the facility, family and/or friend accompanying the patients, and the public in general from risky exposure to COVID-19 sources. We offer several steps following an encounter suspicious of C-19AP.


Immunotherapies for COVID-19: Restoring the immunity could be the priority


Medical Toxicology and COVID-19: Our Role in a Pandemic


title: Identification of potential inhibitors against SARS-CoV-2 by targeting proteins responsible for envelope formation and virion assembly using docking based virtual screening, and pharmacokinetics approaches

text: WHO has declared the outbreak of COVID-19 as a public health emergency of international concern. The ever-growing new cases have called for an urgent emergency for specific anti-COVID-19 drugs. Three structural proteins (Membrane, Envelope and Nucleocapsid protein) play an essential role in the assembly and formation of the infectious virion particles. Thus, the present study was designed to identify potential drug candidates from the unique collection of 548 anti-viral compounds (natural and synthetic anti-viral), which target SARS-CoV-2 structural proteins. High-end molecular docking analysis was performed to characterize the binding affinity of the selected drugs-the ligand, with the SARS-CoV-2 structural proteins, while high-level Simulation studies analyzed the stability of drug-protein interactions. The present study identified rutin, a bioflavonoid and the antibiotic, doxycycline, as the most potent inhibitor of SARS-CoV-2 envelope protein. Caffeic acid and ferulic acid were found to inhibit SARS-CoV-2 membrane protein while the anti-viral agent's simeprevir and grazoprevir showed a high binding affinity for nucleocapsid protein. All these compounds not only showed excellent pharmacokinetic properties, absorption, metabolism, minimal toxicity and bioavailability but were also remain stabilized at the active site of proteins during the MD simulation. Thus, the identified lead compounds may act as potential molecules for the development of effective drugs against SARS-CoV-2 by inhibiting the envelope formation, virion assembly and viral pathogenesis.


SARS-CoV-2 infection associated with spontaneous pneumothorax


Sedentariness and Physical Activity in Type 2 Diabetes mellitus during the COVID-19 Pandemic


Opportunities for international collaboration in COVID-19 mental health research


title: Measuring the Performance of Encrypted DNS Protocols from Broadband Access Networks

text: Until recently, DNS traffic was unencrypted, leaving users vulnerable to eavesdropping and tampering. In response to these privacy concerns, two protocols have been proposed: DNS-over-TLS (DoT) and DNS-over-HTTPS (DoH). Previous work has demonstrated that, in general, response times with popular DoT and DoH resolvers are marginally slower than conventional DNS, but sometimes faster on emulated lossy networks. However, these measurements were not taken from home networks, nor at scale from many vantage points. Furthermore, they do not capture performance on real networks with low bandwidth or high latency and packet loss. In this paper, we study the performance of encrypted DNS protocols and DNS from thousands of home networks in the United States, over one month in 2020. We perform these measurements from the homes of 2,768 participating panelists in the Federal Communications Commission's (FCC) Measuring Broadband America program. We find that, across the aggregate dataset, median DoT and DoH response times are as much as 7 ms and 23.2 ms slower than conventional DNS. We study the effects of latency, bandwidth, and heterogeneity between Internet service providers on DNS performance and find that latency had the most significant effect on response times, particularly for DoH. We also find that there can be significant variation in DNS performance between resolvers, with median query response times differing by as much as 23.7 ms.


Care for patients with ventricular assist devices and suspected COVID-19 infection


title: Assessment of SARS-CoV-2 serological tests for the diagnosis of COVID-19 through the evaluation of three immunoassays: Two automated immunoassays (Euroimmun and Abbott) and one rapid lateral flow immunoassay (NG Biotech)

text: BACKGROUND: The emergence of new SARS-CoV-2 has promoted the development of new serological tests that could be complementary to RT-PCR. Nevertheless, the assessment of clinical performances of available tests is urgently required as their use has just been initiated for diagnose. OBJECTIVES: The aim of this study was to assess the performance of three immunoassays for the detection of SARS-CoV-2 antibodies. METHODS: Two automated immunoassays (Abbott SARS-CoV-2 CLIA IgG and Euroimmun Anti-SARS-CoV-2 ELISA IgG/IgA assays) and one lateral flow immunoassay (LFIA NG-Test® IgG-IgM COVID-19) were tested. 293 specimens were analyzed from patients with a positive RT-PCR response, from patients with symptoms consistent with COVID-19 but exhibiting a negative response to the RT-PCR detection test, and from control group specimens. Days since symptoms onset were collected from clinical information sheet associated with respiratory tract samples. RESULTS: Overall sensitivity for IgG was equivalent (around 80 %) for CLIA, ELISA and LFIA. Sensitivity for IgG detection, >14 days after onset of symptoms, was 100.0 % for all assays. Overall specificity for IgG was greater for CLIA and LFIA (more than 98 %) compared to ELISA (95.8 %). Specificity was significantly different between IgA ELISA (78.9 %) and IgM LFIA (95.8 %) (pâ¯<â¯0.05). The best agreement was observed between CLIA and LFIA assays (97 %; kâ¯=â¯0.936). CONCLUSION: Excellent sensitivity for IgG detection was obtained >14 days after onset of symptoms for all immunoassays. Specificity was also excellent for IgG CLIA and IgG LFIA. Our study shows that NG-Test® is reliable and accurate for routine use in clinical laboratories.


title: What works and what does not work in response to COVID-19 prevention and control in Africa

text: Since the emergence of the COVID-19 pandemic in December 2019 in Wuhan, China, there have been nearly 6,663,304 confirmed cases of COVID-19, including 392,802 deaths, worldwide as of 10:00 CEST 06 June 2020. In Africa, 152,442 COVID-19 cases and 4334 deaths have been reported as of 02 June 2020. The five countries with the highest commutative number of cases in Africa are South Africa, Egypt, Nigeria, Algeria, and Ghana. Africa, and the rest of world, has had to swiftly undertake the necessary measures to protect the continent from irreversible effects of the COVID-19 pandemic that is claiming lives and destroying livelihoods. The lower number of COVID-19 cases in most African countries is attributed to inadequate health systems, low-to-absent testing capacity, poor reporting systems, and insufficient numbers of medical staff. The COVID-19 pandemic poses a great threat to most African countries, from cities to rural areas, and has created a strong demand on already scarce resources. Intense mobilization of additional resources is required to implement established emergency contingency measures. Measures to prevent the spread of COVID-19 include closure of borders and restricting movement of people within a country; this has resulted in the tourism sector being adversely affected by the loss of income. Cooperative prevention and control measures are one of the promising solutions to deplete the spread of COVID-19 on the continent.


Masques et COVID-19


title: ACE2 and TMPRSS2 variation in savanna monkeys (Chlorocebus spp.): Potential risk for zoonotic/anthroponotic transmission of SARS-CoV-2 and a potential model for functional studies

text: The COVID-19 pandemic, caused by the coronavirus SARS-CoV-2, has devastated health infrastructure around the world. Both ACE2 (an entry receptor) and TMPRSS2 (used by the virus for spike protein priming) are key proteins to SARS-CoV-2 cell entry, enabling progression to COVID-19 in humans. Comparative genomic research into critical ACE2 binding sites, associated with the spike receptor binding domain, has suggested that African and Asian primates may also be susceptible to disease from SARS-CoV-2 infection. Savanna monkeys (Chlorocebus spp.) are a widespread non-human primate with well-established potential as a bi-directional zoonotic/anthroponotic agent due to high levels of human interaction throughout their range in sub-Saharan Africa and the Caribbean. To characterize potential functional variation in savanna monkey ACE2 and TMPRSS2, we inspected recently published genomic data from 245 savanna monkeys, including 163 wild monkeys from Africa and the Caribbean and 82 captive monkeys from the Vervet Research Colony (VRC). We found several missense variants. One missense variant in ACE2 (X:14,077,550; Asp30Gly), common in Ch. sabaeus, causes a change in amino acid residue that has been inferred to reduce binding efficiency of SARS-CoV-2, suggesting potentially reduced susceptibility. The remaining populations appear as susceptible as humans, based on these criteria for receptor usage. All missense variants observed in wild Ch. sabaeus populations are also present in the VRC, along with two splice acceptor variants (at X:14,065,076) not observed in the wild sample that are potentially disruptive to ACE2 function. The presence of these variants in the VRC suggests a promising model for SARS-CoV-2 infection and vaccine and therapy development. In keeping with a One Health approach, characterizing actual susceptibility and potential for bi-directional zoonotic/anthroponotic transfer in savanna monkey populations may be an important consideration for controlling COVID-19 epidemics in communities with frequent human/non-human primate interactions that, in many cases, may have limited health infrastructure.


title: Determination of the optimal penetration factor for evaluating the invasion process of aerosols from a confined source space to an uncontaminated area

text: Due to the outbreak and spread of COVID-19, SARS-CoV-2 has been proven to survive in aerosols for hours. Virus-containing aerosols may intrude into an uncontaminated area from a confined source space under certain ventilated conditions. The penetration factor, which is the most direct parameter for evaluating the invasion process, can effectively reflect the penetration fraction of aerosols and the shielding efficiency of buildings. Based on the observed concentrations of aerosols combined with a widely used concentration model, four numerical calculations of the penetration factor are proposed in this study. A theoretical time-correction Pest was applied to a size-dependent Pavg by proposing a correction coefficient r, and the error analysis of the real-time P(t) and the derived Pd were also performed. The results indicated that Pavg supplied the most stable values for laboratory penetration simulations. However, the time-correction is of little significance under current experimental conditions. P(t) and Pd are suitable for rough evaluation under certain conditions due to the inevitability of particles detaching and re-entering after capture. The proposed optimal penetration factor and the error analysis of each method in this study can provide insight into the penetration mechanism, and also provide a rapid and accurate assessment method for preventing and controlling the spread of the epidemic.


title: Fast SARS-CoV-2 detection by RT-qPCR in preheated nasopharyngeal swab samples

text: OBJECTIVES: The gold-standard COVID-19 diagnosis relies on detecting SARS-CoV-2 using RNA purification and one-step retrotranscription and quantitative PCR (RT-qPCR). Based on the urgent need for high-throughput screening, we tested the performance of three alternative, simple and affordable protocols to rapidly detect SARS-CoV-2, bypassing the long and tedious RNA extraction step and reducing the time to viral detection. METHODS: We evaluated three methods based on direct nasopharyngeal swab viral transmission medium (VTM) heating before the RT-qPCR: a) direct without additives; b) in a formamide-EDTA (FAE) buffer, c) in a RNAsnapTM buffer. RESULTS: Although with a delay in cycle threshold compared to the gold-standard, we found consistent results in nasopharyngeal swab samples that were subject to a direct 70°C incubation for 10 min. CONCLUSIONS: Our findings provide valuable options to overcome any supply chain issue and help to increase the throughput of diagnostic tests, thereby complementing standard diagnosis.


Promoting healthy movement behaviours among children during the COVID-19 pandemic


Psychosocial Stress Contagion in Children and Families During the COVID-19 Pandemic


title: On a maximum of nearest-neighbor random walk with asymptotically zero drift on lattice of positive half line

text: Consider a nearest-neighbor random walk with certain asymptotically zero drift on the positive half line. Let $M$ be the maximum of an excursion starting from $1$ and ending at $0.$ We study the distribution of $M$ and characterize its asymptotics, which is quite different from those of simple random walks.


title: Perspectives on how to navigate cancer surgery in the breast, head and neck, skin, and soft tissue tumor in limited-resource countries during COVID-19 pandemic

text: The rapidly spreading coronavirus infection (COVID-19) worldwide has contracted all aspects of health systems. Developing countries that mostly have a weaker healthcare system and insufficient resources are likely to be the most hardly affected by the pandemic. Cancers are frequently diagnosed in late stages with higher case-fatality rates compared to those in high-income countries. Delayed diagnosis, lack of cancer awareness, low adherence to treatment, and unequal or limited access to treatment are among the challenging factors of cancer management in developing countries. Elective cancer surgeries are often considered to be postponed during COVID-19 pandemic to preserve valuable hospital resources such as personal protection equipment, hospital bed, intensive care unit capacity, and manpower to screen and treat the affected individuals. However, specific considerations to defer cancer surgery in developing countries might need to be carefully adjusted to counterbalance between preventing COVID-19 transmission and preserving patients 'long-term life expectancy and quality of life.


title: Environmental and decontamination issues for human coronaviruses and their potential surrogates

text: Pandemic coronavirus disease-2019 (COVID-19) gives ample reason to generally review coronavirus (CoV) containment. For establishing some preliminary views on decontamination and disinfection, surrogate CoVs have commonly been assessed. This review serves to examine the existing science in regard to CoV containment generically and then to translate these findings into timely applications for COVID-19. There is widespread dissemination of CoVs in the immediate patient environment, and CoVs can potentially be spread via respiratory secretions, urine, and stool. Interpretations of the spread however must consider whether studies examine for viral RNA, virus viability by culture, or both. Presymptomatic, asymptomatic, and post-14 day virus excretion from patients may complicate the epidemiology. Whereas droplet spread is accepted, there continues to be controversy over the extent of possible airborne spread and especially now for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CoVs are stable in body secretions and sewage at reduced temperatures. In addition to temperature, dryness or relative humidity, initial viral burden, concomitant presence of bioburden, and the type of surface can all affect stability. Generalizing, CoVs can be susceptible to radiation, temperature extremes, pH extremes, peroxides, halogens, aldehydes, many solvents, and several alcohols. Whereas detergent surfactants can have some direct activity, these agents are better used as complements to a complex disinfectant solution. Disinfectants with multiple agents and adverse pH are more likely to be best active at higher water temperatures. Real-life assessments should be encouraged with working dilutions. The use of decontamination and disinfection should be balanced with considerations of patient and caregiver safety. Processes should also be balanced with considerations for other potential pathogens that must be targeted. Given some CoV differences and given that surrogate testing provides experimental correlates at best, direct assessments with SARS-CoV, Middle East respiratory syndrome-related coronavirus (MERS-CoV), and SARS-CoV-2 are required.


title: Environmental and Decontamination Issues for Human Coronaviruses and Their Potential Surrogates

text: Pandemic COVID-19 gives ample reason to generally review coronavirus (CoV) containment. For establishing some preliminary views on decontamination and disinfection, surrogate CoVs have commonly been assessed. This review serves to examine the existing science in regards to CoV containment generically and then to translate these findings into timely applications for COVID-19. There is widespread dissemination of CoVs in the immediate patient environment, and CoVs can potentially be spread via respiratory secretions, urine, and stool. Interpretations of the spread however must consider whether studies examine for viral RNA, virus viability by culture, or both. Pre-symptomatic, asymptomatic, and post-fourteen day virus excretion from patients may complicate the epidemiology. Whereas droplet spread is accepted, there continues to be controversy over the extent of possible airborne spread and especially now for SARS-CoV-2. CoVs are stable in body secretions and sewage at reduced temperatures. In addition to temperature, dryness or relative humidity, initial viral burden, concomitant presence of bioburden, and the type of surface can all affect stability. Generalizing, CoVs can be susceptible to radiation, temperature extremes, pH extremes, peroxides, halogens, aldehydes, many solvents, and several alcohols. Whereas detergent surfactants can have some direct activity, these agents are better used as complements to a complex disinfectant solution. Disinfectants with multiple agents and adverse pH are more likely to be best active at higher water temperatures. Real-life assessments should be encouraged with working dilutions. The use of decontamination and disinfection should be balanced with considerations of patient and caregiver safety. Processes should also be balanced with considerations for other potential pathogens that must be targeted. Given some CoV differences and given that surrogate testing provides experimental correlates at best, direct assessments with SARS-CoV, MERS-CoV, and SARS-CoV-2 are required. This article is protected by copyright. All rights reserved.


title: Aerosol generating procedures and infective risk to healthcare workers: SARS-CoV-2 - the limits of the evidence

text: The transmission behaviour of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still being defined. It is likely that it is transmitted predominantly by droplets and direct contact and it is possible that there is at least opportunistic airborne transmission. In order to protect healthcare staff adequately is necessary that we establish whether aerosol generating procedures (AGPs) increase the risk of transmission of SARS-CoV-2. Where we do not have evidence relating to SARS-CoV-2, guidelines for safely conducting these procedures should consider what risk procedures would have of transmitting related pathogens. Currently there is very little evidence detailing the transmission of SARS-CoV-2 associated with any specific procedures. Regarding aerosol generating procedures and respiratory pathogens in general, there is still a large knowledge gap that will leave clinicians unsure what risk they are putting themselves in when offering these procedures. This review aimed to summarise the evidence (and gaps in evidence) around AGPs and SARS-CoV-2.


Use of drape/patient covering during potentially aerosolizing procedures


Which interventions work best in a pandemic?


COVID-19 in kidney transplant recipients


title: V-, U-, L-, or W-shaped recovery after COVID? Insights from an Agent Based Model

text: We discuss the impact of a Covid-like shock on a simple toy economy, described by the Mark-0 Agent-Based Model that we developed and discussed in a series of previous papers. We consider a mixed supply and demand shock, and show that depending on the shock parameters (amplitude and duration), our toy economy can display V-shaped, U-shaped or W-shaped recoveries, and even an L-shaped output curve with permanent output loss. This is due to the existence of a self-sustained"bad"state of the economy. We then discuss two policies that attempt to moderate the impact of the shock: giving easy credit to firms, and the so-called helicopter money, i.e. injecting new money into the households savings. We find that both policies are effective if strong enough, and we highlight the potential danger of terminating these policies too early. While we only discuss a limited number of scenarios, our model is flexible and versatile enough to allow for a much wider exploration, thus serving as a useful tool for the qualitative understanding of post-Covid recovery. We provide an on-line version of the code at https://gitlab.com/sharma.dhruv/markovid .


title: Break in the Stroke Chain of Survival Due to COVID-19

text: BACKGROUND AND PURPOSE: Emergency measures to treat patients with coronavirus 2019 (COVID-19) and contain the outbreak is the main priority in each of our hospitals; however, these measures are likely to result in collateral damage among patients with other acute diseases. Here, we investigate whether the COVID-19 pandemic affects acute stroke care through interruptions in the stroke chain of survival. METHODS: A descriptive analysis of acute stroke care activity before and after the COVID-19 outbreak is given for a stroke network in southern Europe. To quantify the impact of the pandemic, the number of stroke code activations, ambulance transfers, consultations through telestroke, stroke unit admissions, and reperfusion therapy times and rates are described in temporal relationship with the rising number of COVID-19 cases in the region. RESULTS: Following confinement of the population, our stroke unit activity decreased sharply, with a 25% reduction in admitted cases (mean number of 58 cases every 15 days in previous months to 44 cases in the 15 days after the outbreak, P<0.001). Consultations to the telestroke network declined from 25 every 15 days before the outbreak to 7 after the outbreak (P<0.001). The increasing trend in the prehospital diagnosis of stroke activated by 911 calls stopped abruptly in the region, regressing to 2019 levels. The mean number of stroke codes dispatched to hospitals decreased (78% versus 57%, P<0.001). Time of arrival from symptoms onset to stroke units was delayed >30 minutes, reperfusion therapy cases fell, and door-to-needle time started 16 minutes later than usual. CONCLUSIONS: The COVID-19 pandemic is disruptive for acute stroke pathways. Bottlenecks in the access and delivery of patients to our secured stroke centers are among the main challenges. It is critical to encourage patients to continue seeking emergency care if experiencing acute stroke symptoms and to ensure that emergency professionals continue to use stroke code activation and telestroke networks.