title: Modelling death rates due to COVID-19: A Bayesian approach

text: Objective: To estimate the number of deaths in Peru due to COVID-19. Design: With a priori information obtained from the daily number of deaths due to CODIV-19 in China and data from the Peruvian authorities, we constructed a predictive Bayesian non-linear model for the number of deaths in Peru. Exposure: COVID-19. Outcome: Number of deaths. Results: Assuming an intervention level similar to the one implemented in China, the total number of deaths in Peru is expected to be 612 (95%CI: 604.3 - 833.7) persons. Sixty four days after the first reported death, the 99% of expected deaths will be observed. The inflexion point in the number of deaths is estimated to be around day 26 (95%CI: 25.1 - 26.8) after the first reported death. Conclusion: These estimates can help authorities to monitor the epidemic and implement strategies in order to manage the COVID-19 pandemic.


title: De eerste honderd opgenomen COVID-19-patiënten in het Elisabeth-Tweesteden Ziekenhuis./ [The first 100 COVID-19 patients admitted to the Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands]

text: Here we describe the characteristics of the first 100 laboratory confirmed COVID-19 patients admitted to the Elisabeth-Tweesteden Hospital (Tilburg, The Netherlands). The median age was 72 years, 67% was male, approximately 80% had co-morbidity, approximately 50% of which consisted of hypertension, cardiac and or pulmonary conditions and 25% diabetes. At admission 61% of patients had fever and about 50% presented at day 6 or more after onset of symptoms. At the time of writing 38 patients were discharged, 19 admitted to the intensive care unit (ICU) and 20 patients had died. The median age of ICU patients was 67 years and 63% had co-morbidity. The median time to discharge or to death was 6 and 5.5 days, respectively.


title: Coronavirus disease (COVID-19) prevention: Virtual classroom education for hand hygiene

text: Coronavirus disease (COVID-19), has spread rapidly in Asia, Europe, the Middle East and the Americas. Considering the recent outbreak of COVID-19, some precautionary measures have been announced, including campus class suspensions. Nursing campus courses have also been suspended, and there may be a learning gap between hand hygiene theory and clinical training for nursing students. A virtual classroom education approach may help address the learning gap by providing ongoing theoretical strengthening of hand hygiene during clinical nursing training. This editorial proposes a 3-step virtual classroom education approach to support nursing educators in online theoretical hand hygiene enhancement.


title: Correction: Facile synthesis of ultrathin Ni-MOF nanobelts for high-efficiency determination of glucose in human serum

text: Correction for 'Facile synthesis of ultrathin Ni-MOF nanobelts for high-efficiency determination of glucose in human serum' by Xiao Xiao et al., J. Mater. Chem. B, 2017, 5, 5234-5239, DOI: .


title: Norwegian Coronavirus Disease 2019 (NO COVID-19) Pragmatic Open label Study to assess early use of hydroxychloroquine sulphate in moderately severe hospitalised patients with coronavirus disease 2019: A structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: The hypothesis of the study is that treatment with hydroxychloroquine sulphate in hospitalised patients with coronavirus disease 2019 (Covid-19) is safe and will accelerate the virological clearance rate for patients with moderately severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when compared to standard care. Furthermore, we hypothesize that early treatment with hydroxychloroquine sulphate is associated with more rapid resolve of clinical symptoms as assessed by the National Early Warning Score 2 (NEWS2), decreased admission rate to intensive care units and mortality, and improvement in protein biomarker profiles (C-reactive protein, markers of renal and hepatic injury, and established cardiac biomarkers like cardiac troponin and B-type natriuretic peptide). TRIAL DESIGN: The study is a two-arm, open label, pragmatic randomised controlled group sequential adaptive trial designed to assess the effect on viral loads and clinical outcome of hydroxychloroquine sulphate therapy in addition to standard care compared to standard care alone in patients with established Covid-19. By utilizing resources already paid for by the hospitals (physicians and nurses in daily clinical practice), this pragmatic trial can include a larger number of patients over a short period of time and at a lower cost than studies utilizing traditional randomized controlled trial designs with an external study organization. The pragmatic approach will enable swift initiation of randomisation and allocation to treatment. PARTICIPANTS: Patients will be recruited from all inpatients at Akershus University Hospital, Lørenskog, Norway. Electronic real-time surveillance of laboratory reports from the Department of Microbiology will be examined regularly for SARS-CoV-2 positive subjects. All of the following conditions must apply to the prospective patient at screening prior to inclusion: (1) Hospitalisation; (2) Adults 18 years or older; (3) Moderately severe Covid-19 disease (NEWS2 of 6 or less); (4) SARS-CoV-2 positive nasopharyngeal swab; (5) Expected time of hospitalisation > 48 hours; and (6) Signed informed consent must be obtained and documented according to Good Clinical Practice guidelines of the International Conference on Harmonization, and national/local regulations. Patients will be excluded from participation in the study if they meet any of the following criteria: (1) Requiring intensive care unit admission at screening; (2) History of psoriasis; (3) Known adverse reaction to hydroxychloroquine sulphate; (4) Pregnancy; or (5) Prolonged corrected QT interval (>450 ms). Clinical data, including standard hospital biochemistry, medical therapy, vital signs, NEWS2, and microbiology results (including blood culture results and reverse transcriptase polymerase chain reaction [RT-PCR] for other upper airway viruses), will be automatically extracted from the hospital electronic records and merged with the study specific database. INTERVENTION AND COMPARATOR: Included patients will be randomised in a 1:1 ratio to (1) standard care with the addition of 400 mg hydroxychloroquine sulphate (PlaquenilTM) twice daily for seven days or (2) standard care alone. MAIN OUTCOMES: The primary endpoint of the study is the rate of decline in SARS-CoV-2 viral load in oropharyngeal samples as assessed by RT-PCR in samples collected at baseline, 48 and 96 hours after randomization and administration of drug for the intervention arm. Secondary endpoints include change in NEWS2 at 96 hours after randomisation, admission to intensive care unit, mortality (in-hospital, and at 30 and 90 days), duration of hospital admission, clinical status on a 7-point ordinal scale 14 days after randomization ([1] Death [2] Hospitalised, on invasive mechanical ventilation or extracorporeal membrane oxygenation [3] Hospitalised, on non-invasive ventilation or high flow oxygen devices [4] Hospitalized, requiring supplemental oxygen [5] Hospitalised, not requiring supplemental oxygen [6] Not hospitalized, but unable to resume normal activities [7] Not hospitalised, with resumption of normal activities), and improvement in protein biomarker profiles (C-reactive protein, markers of renal and hepatic injury, and established cardiac biomarkers like cardiac troponin and B-type natriuretic peptide) at 96 hours after randomization. RANDOMISATION: Eligible patients will be allocated in a 1:1 ratio, using a computer randomisation procedure. The allocation sequence has been prepared by an independent statistician. BLINDING (MASKING): Open label randomised controlled pragmatic trial without blinding, no active or placebo control. The virologist assessing viral load in the oropharyngeal samples and the statistician responsible for analysis of the data will be blinded to the treatment allocation for the statistical analyses. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): This is a group sequential adaptive trial where analyses are planned after 51, 101, 151 and 202 completed patients, with a maximum sample size of 202 patients (101 patients allocated to intervention and standard care and 101 patients allocated to standard care alone). TRIAL STATUS: Protocol version 1.3 (March 26, 2020). Recruitment of first patient on March 26, 2020, and 51 patients were included as per April 28, 2020. Study recruitment is anticipated to be completed by July 2020. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT04316377. Trial registered March 20, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


title: Coronavirus pandemic and colorectal surgery: practical advice based on the Italian experience

text: AIM: The current COVID-19 pandemic is challenging healthcare systems at a global level. We provide a practical strategy to reorganize pathways of emergency and elective colorectal surgery during the COVID-19 pandemic. METHOD: The authors, all from areas affected by the COVID-19 emergency, brainstormed remotely to define the key-points to be discussed. Tasks were assigned, concerning specific aspects of colorectal surgery during the pandemic, including the administrative management of the crisis in Italy. The recommendations (based on experience and on the limited evidence available) were collated and summarized. RESULTS: Little is known about the transmission of COVID-19, but it has shown a rapid spread. It is prudent to stop non-cancer procedures and prioritize urgent cancer treatment. Endoscopy and proctological procedures should be performed highly selectively. When dealing with colorectal emergencies, a conservative approach is advised. Specific procedures should be followed when operating on COVID-19-patients, using dedicated personal protective equipment and adhering to specific rules. Some policies are described, including minimally-invasive surgery. These policies outline the strict regulation of entry/ exit into theatres and operating building as well as advice on performing procedures safely to reduce risk of spreading the virus. It is likely that a reorganization of health system is required, both at central and local levels. A description of the strategy adopted in Italy is provided. CONCLUSION: Evidence on the management of patients needing surgery for colorectal conditions during the COVID-19 pandemic is currently lacking. Lessons learnt from healthcare professionals that have managed high volumes of surgical patients during the pandemic could be useful to mitigate some risks and reduce exposure to other patients, public and healthcare staff.


title: The interface between coronaviruses and host cell RNA biology: Novel potential insights for future therapeutic intervention

text: Coronaviruses, including SARS-Cov-2, are RNA-based pathogens that interface with a large variety of RNA-related cellular processes during infection. These processes include capping, polyadenylation, localization, RNA stability, translation, and regulation by RNA binding proteins or noncoding RNA effectors. The goal of this article is to provide an in-depth perspective on the current state of knowledge of how various coronaviruses interact with, usurp, and/or avoid aspects of these cellular RNA biology machineries. A thorough understanding of how coronaviruses interact with RNA-related posttranscriptional processes in the cell should allow for new insights into aspects of viral pathogenesis as well as identify new potential avenues for the development of anti-coronaviral therapeutics. This article is categorized under: RNA in Disease and Development > RNA in Disease.


title: Teleconsultation at a tertiary care government medical university during COVID-19 Lockdown in India - A pilot study

text: Purpose: COVID-19 related pan- India lockdown brought teleophthalmology to the forefront. The study ventures to understand the relevance of this modality in a government setup. The objective is to understand the feasibility, clinical profile and addressability of patients using teleconsultation in ophthalmology at a tertiary care government medical university during the COVID-19 Lockdown in India. Methods: An online survey targeting faculty members and resident doctors in a tertiary eye center in a government medical university in north India was conducted. Various aspects of teleconsultation were analyzed including the number and preferential mode of consultations, commonest complaints and diagnoses made. Frequency and factors mandating physical examination of patients was also analyzed. Results: The questionnaire was sent to 40 ophthalmologists of whom 38 responded. A total of 4880 teleconsultations were given. The commonest mode of communication was by WhatsApp messages (65.6%) and E-mail was the least preferred medium. More than 80% consultations were from previously seen patients. Red eye was the commonest presenting complaint (22.8%), followed by watering (18.7%) and foreign body sensation (14.5%). Computer vision syndrome was the commonest diagnosis (25.9%) followed by conjunctivitis (17.7%) and refractive error (17.7%). About 40% required physical examination, mostly due to uncertain diagnosis (22%) or inadequate response to prescribed treatment (19%). Conclusion: Teleconsultation was feasible in a government medical university for providing ophthalmic services during lockdown. WhatsApp was the preferred communication modality, computer vision syndrome was the most frequent tentative diagnosis and approximately 60% did not require in-person physical examination.


'COVID-19 pandemic' anxiety-induced Takotsubo cardiomyopathy


title: Lupus anticoagulant is frequent in patients with Covid-19: Response to Reply

text: We have recently published in the Journal of Thrombosis and Haemostasis the presence of lupus anticoagulant (LAC) at high frequency in Covid-19 patients (1). Different authors had confirmed these results (2). Connell and colleagues had discussed, in the Journal, technical points concerning LAC as well as anti-phospholipids (aPL) auto-antibodies detection (3).


title: Investigating APOE, APP-Aß metabolism genes and Alzheimer's disease GWAS hits in brain small vessel ischemic disease

text: Alzheimer's disease and small vessel ischemic disease frequently co-exist in the aging brain. However, pathogenic links between these 2 disorders are yet to be identified. Therefore we used Taqman genotyping, exome and RNA sequencing to investigate Alzheimer's disease known pathogenic variants and pathways: APOE Îµ4 allele, APP-Aß metabolism and late-onset Alzheimer's disease main genome-wide association loci (APOE, BIN1, CD33, MS4A6A, CD2AP, PICALM, CLU, CR1, EPHA1, ABCA7) in 96 early-onset small vessel ischemic disease Caucasian patients and 368 elderly neuropathologically proven controls (HEX database) and in a mouse model of cerebral hypoperfusion. Only a minority of patients (29%) carried APOE Îµ4 allele. We did not detect any pathogenic mutation in APP, PSEN1 and PSEN2 and report a burden of truncating mutations in APP-Aß degradation genes. The single-variant association test identified 3 common variants with a likely protective effect on small vessel ischemic disease (0.54>OR > 0.32, adj. p-value <0.05) (EPHA1 p.M900V and p.V160A and CD33 p.A14V). Moreover, 5/17 APP-Aß catabolism genes were significantly upregulated (LogFC > 1, adj. p-val<0.05) together with Apoe, Ms4a cluster and Cd33 during brain hypoperfusion and their overexpression correlated with the ischemic lesion size. Finally, the detection of Aß oligomers in the hypoperfused hippocampus supported the link between brain ischemia and Alzheimer's disease pathology.


title: Exploring the Active Compounds of Traditional Mongolian Medicine in Intervention of Novel Coronavirus (COVID-19) Based on Molecular Docking Method

text: Objective: This article intends to use molecular docking technology to find potential inhibitors that can respond to COVID-19 from active compounds in Mongolian medicine. Methods: Mongolian medicine with anti-inflammatory and antiviral effects is selected from Mongolian medicine prescription preparations. TCMSP, ETCM database and document mining methods were used to collect active compounds. Swiss TargetPrediction and SuperPred server were used to find targets of compounds with smiles number. Drugbank and Genecard database were used to collect antiviral drug targets. Then the above targets were compared and analyzed to screen out antiviral targets of Mongolia medicine. Metascape database platform was used to enrich and analyze the GO (Gene ontology) annotation and KEGG pathway of the targets. In view of the high homology of gene sequences between SARS-CoV-2 S-protein RBD domain and SARS virus, as well as their similarities in pathogenesis and clinical manifestations, we established SARS-CoV-2 S-protein model using Swiss-Model. The ZDOCK protein docking software was applied to dock the S-protein with the human angiotensin ACE2 protein to find out the key amino acids of the binding site. Taking ACE2 as the receptor, the molecular docking between the active ingredients and the target protein was studied by AutoDock molecular docking software. The interaction between ligand and receptor is applied to provide a choice for screening anti-COVID-19 drugs. Results: A total of 253 active components were predicted. Metascape analysis showed that key candidate targets were significantly enriched in multiple pathways related to different toxins. These key candidate targets were mainly derived from phillyrin and chlorogenic acid. Through the protein docking between S-protein and ACE2, it is found that Glu329/Gln325 and Gln42/Asp38 in ACE2 play an important role in the binding process of the two. The results of molecular docking virtual calculation showed that phillyrin and chlorogenic acid could stably combine with Gln325 and Gln42/Asp38 in ACE2, respectively, which hindered the combination between S- protein and ACE2. Conclusion: Phillyrin and chlorogenic acid can effectively prevent the combination of SARS-CoV-2 S-protein and ACE2 at the molecular level. Phillyrin and chlorogenic acid can be used as potential inhibitors of COVID-19 for further research and development.


title: Antibody responses against SARS-CoV-2 in COVID-19 patients

text: The emerging coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic, and brings formidable challenges to public health, society and the economy worldwide. Currently, the antibody responses against SARS-CoV-2 remains largely unknown. We herein estimated the longevity of specific antibodies against SARS-CoV-2, and reported that antibodies waned over substantially in COVID-19 patients after recovery. This article is protected by copyright. All rights reserved.


Face the COVID-19 emergency: measures applied in an Italian Dermatologic Clinic


Bioethics and informatics in medical studies during coronavirus disease 2019


Education and scientific dissemination during the COVID-19 pandemic


title: Propagation of epidemics along lines with fast diffusion

text: It has long been known that epidemics can travel along communication lines, such as roads. In the current COVID-19 epidemic, it has been observed that major roads have enhanced its propagation in Italy. We propose a new simple model of propagation of epidemics which exhibits this effect and allows for a quantitative analysis. The model consists of a classical $SIR$ model with diffusion, to which an additional compartment is added, formed by the infected individuals travelling on a line of fast diffusion. Exchanges between individuals on the line and in the rest of the domain are taken into account. A classical transformation allows us to reduce the proposed model to a system analogous to one we had previously introduced [5] to describe the enhancement of biological invasions by lines of fast diffusion. We establish the existence of a minimal spreading speed and we show that it may be quite large, even when the basic reproduction number $R_0$ is close to $1$. More subtle qualitative features of the final state, showing the important influence of the line, are also proved here.


title: Potential pharmacological agents for COVID-19

text: A novel coronavirus disease 2019 (COVID-19) infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) first emerged in December 2019 in Wuhan, China, has become a global pandemic. Currently, the management of COVID-19 infection is mainly supportive. Several clinical trials worldwide are evaluating several drugs approved for other indications, as well as multiple investigational agents for the treatment and prevention of COVID-19. Here, we give a brief overview of pharmacological agents and other therapies which are under investigation as treatment options or adjunctive agents for patients infected with COVID-19 and for chemoprophylaxis for the prevention of COVID-19 infection. At the time of writing this commentary, there is no peer-reviewed published evidence from randomized clinical trials of any pharmacological agents improving outcomes in COVID-19 patients. However, it was reported that remdesivir an investigational antiviral agent hastens clinical recovery, but a study is yet to be published in peer-reviewed medical journal.


title: Towards Characterizing COVID-19 Awareness on Twitter

text: The coronavirus (COVID-19) pandemic has significantly altered our lifestyles as we resort to minimize the spread through preventive measures such as social distancing and quarantine. An increasingly worrying aspect is the gap between the exponential disease spread and the delay in adopting preventive measures. This gap is attributed to the lack of awareness about the disease and its preventive measures. Nowadays, social media platforms (ie., Twitter) are frequently used to create awareness about major events, including COVID-19. In this paper, we use Twitter to characterize public awareness regarding COVID-19 by analyzing the information flow in the most affected countries. Towards that, we collect more than 46K trends and 622 Million tweets from the top twenty most affected countries to examine 1) the temporal evolution of COVID-19 related trends, 2) the volume of tweets and recurring topics in those trends, and 3) the user sentiment towards preventive measures. Our results show that countries with a lower pandemic spread generated a higher volume of trends and tweets to expedite the information flow and contribute to public awareness. We also observed that in those countries, the COVID-19 related trends were generated before the sharp increase in the number of cases, indicating a preemptive attempt to notify users about the potential threat. Finally, we noticed that in countries with a lower spread, users had a positive sentiment towards COVID-19 preventive measures. Our measurements and analysis show that effective social media usage can influence public behavior, which can be leveraged to better combat future pandemics.


Response to: 'Monitoring of patients with systemic lupus erythematosus during the COVID-19 outbreak' by Holubar et al


title: Activity-based contact network scaling and epidemic propagation in metropolitan areas

text: Given the growth of urbanization and emerging pandemic threats, more sophisticated models are required to understand disease propagation and investigate the impacts of intervention strategies across various city types. We introduce a fully mechanistic, activity-based and highly spatio-temporally resolved epidemiological model which leverages on person-trajectories obtained from integrated mobility demand and supply models in full-scale cities. Simulating COVID-19 evolution in two full-scale cities with representative synthetic populations and mobility patterns, we analyze activity-based contact networks. We observe that transit contacts are scale-free in both cities, work contacts are Weibull distributed, and shopping or leisure contacts are exponentially distributed. We also investigate the impact of the transit network, finding that its removal dampens disease propagation, while work is also critical to post-peak disease spreading. Our framework, validated against existing case and mortality data, demonstrates the potential for tracking and tracing, along with detailed socio-demographic and mobility analyses of epidemic control strategies.


title: SARS-CoV-2 and bat RaTG13 spike glycoprotein structures inform on virus evolution and furin-cleavage effects

text: SARS-CoV-2 is thought to have emerged from bats, possibly via a secondary host. Here, we investigate the relationship of spike (S) glycoprotein from SARS-CoV-2 with the S protein of a closely related bat virus, RaTG13. We determined cryo-EM structures for RaTG13 S and for both furin-cleaved and uncleaved SARS-CoV-2 S; we compared these with recently reported structures for uncleaved SARS-CoV-2 S. We also biochemically characterized their relative stabilities and affinities for the SARS-CoV-2 receptor ACE2. Although the overall structures of human and bat virus S proteins are similar, there are key differences in their properties, including a more stable precleavage form of human S and about 1,000-fold tighter binding of SARS-CoV-2 to human receptor. These observations suggest that cleavage at the furin-cleavage site decreases the overall stability of SARS-CoV-2 S and facilitates the adoption of the open conformation that is required for S to bind to the ACE2 receptor.


title: Years of life lost due to the psychosocial consequences of COVID-19 mitigation strategies based on Swiss data

text: BACKGROUND: The pandemic caused by coronavirus disease 2019 (COVID-19) has forced governments to implement strict social mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies, however, carry a significant risk for mental health, which can lead to increased short-term and long-term mortality and is currently not included in modeling the impact of the pandemic. METHODS: We used years of life lost (YLL) as the main outcome measure, applied to Switzerland as an example. We focused on suicide, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in marital status, and social isolation, as these are known to increase YLL in the context of imposed restriction in social contact and freedom of movement. We stipulated a minimum duration of mitigation of 3 months based on current public health plans. RESULTS: The study projects that the average person would suffer 0.205 YLL due to psychosocial consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1% of the population, who will suffer an average of 9.79 YLL. CONCLUSIONS: The results presented here are likely to underestimate the true impact of the mitigation strategies on YLL. However, they highlight the need for public health models to expand their scope in order to provide better estimates of the risks and benefits of mitigation.


title: Performance of six SARS-CoV-2 immunoassays in comparison with microneutralisation

text: There is an urgent need for reliable high-throughput serological assays for the management of the ongoing COVID-19 pandemic. Preferably, the performance of serological tests for a novel virus should be determined with clinical specimens against a gold standard, i.e. virus neutralisation. We compared the performance of six commercial immunoassays for the detection of SARS-COV-2 IgG, IgA and IgM antibodies, including four automated assays [Abbott SARS-COV-2 IgG (CE marked), Diasorin Liaison® SARS-COV-2 S1/S2 IgG (research use only, RUO), and Euroimmun SARS-COV-2 IgG and IgA (CE marked)], and two rapid lateral flow (immunocromatographic) tests [Acro Biotech 2019-nCoV IgG/IgM (CE marked) and Xiamen Biotime Biotechnology SARS-COV-2 IgG/IgM (CE marked)] with a microneutralisation test (MNT). Two specimen panels from serum samples sent to Helsinki University Hospital Laboratory (HUSLAB) were compiled: the patient panel (N=70) included sera from PCR confirmed COVID-19 patients, and the negative panel (N=81) included sera sent for screening of autoimmune diseases and respiratory virus antibodies in 2018 and 2019. The MNT was carried out for all COVID-19 samples (70 serum samples, 62 individuals) and for 53 samples from the negative panel. Forty-one out of 62 COVID-19 patients showed neutralising antibodies.The specificity and sensitivity values of the commercial tests against MNT, respectively, were as follows: 95.1 %/80.5 % (Abbott Architect SARS-CoV-2 IgG), 94.9 %/43.8 % (Diasorin Liaison SARS-CoV-2 IgG; RUO), 68.3 %/87.8 % (Euroimmun SARS-CoV-2 IgA), 86.6 %/70.7 % (Euroimmun SARS-CoV-2 IgG), 74.4 %/56.1 % (Acro 2019-nCoV IgG), 69.5 %/46.3 % (Acro 2019-nCoV IgM), 97.5 %/71.9 % (Xiamen Biotime SARS-CoV-2 IgG), and 88.8 %/81.3 % (Xiamen Biotime SARS-CoV-2 IgM). This study shows variable performance values. Laboratories should carefully consider their testing process, such as a two-tier approach, in order to optimize the overall performance of SARS- CoV-2 serodiagnostics.


title: Survey on Knowledge and Psychological Crisis Related to COVID-19 among Nursing Staff: A Cross-sectional Study

text: BACKGROUND: Background: Since December 2019, the prevalence of COVID-19 is rapidly spreading in the world. Nurses play a key role in fighting this disease and are at risk of infection by coronavirus. Therefore, there is a urging need to assess their mental health condition and set up appropriate interventions to reduce the negative psychiatric outcomes. OBJECTIVE: The objective of this study was to evaluate the knowledge and psychological crisis related to COVID-19 among nursing staff, and to provide evidence for targeted training and psychological intervention. METHODS: This cross-sectional online survey study was performed in a class three grade A general hospital from a southwest province of China from March 1 to March 15, 2020. A self-designed questionnaire of COVID-19 related prevention and control knowledge and the Triages Assessment Form (TAF) were used to assess nursing staff's knowledge of COVID-19 and their degree of psychological crisis. SPSS 23.0 was applied to compute the collected data. RESULTS: A total of 979 nursing staff completed the questionnaire. The results showed that nursing staff have lower number of correct answers of continuous viral nucleic acid testing specifications (38.7%), debarment criteria (55.1%), and management measures for patients with suspected symptoms (72.8%). The overall score of the TAF was 7.0 (5.0-12.0), and there were statistical significance in scores between different types of personnel, years of work experience and department (P <.05). CONCLUSIONS: This study indicated that nursing staff have insufficient knowledge about COVID-19. Meanwhile, despite the psychological damage of nursing staff is slight, nurse manager must continue to monitor their mental health and take timely interventions.


Postacute Care Preparedness for COVID-19: Thinking Ahead


title: Latin American Scientists Join the Coronavirus Vaccine Race

text: Researchers fear that breakthroughs from abroad will be too slow or inequitably shared to benefit the global south Researchers fear that breakthroughs from abroad will be too slow or inequitably shared to benefit the global south


Latin American scientists join the coronavirus vaccine race: 'No one's coming to rescue us'


title: Covid-19 -- A simple statistical model for predicting ICU load in exponential phases of the disease

text: One major bottleneck in the ongoing Covid-19 pandemic is the limited number of critical care beds. Due to the dynamic development of infections and the time lag between when patients are infected and when a proportion of them enters an intensive care unit (ICU), the need for future intensive care can easily be underestimated. To derive future ICU load from reported infections, we suggest a simple statistical model that (1) accounts for time lags and (2) allows for making predictions depending on different future growth rates. We evaluate our model for public data from Berlin, Germany, by first estimating the model parameters (i.e., time lag and average stay in ICU) for March 2020 and then using an exponential model to predict the future ICU load for April and May 2020. Assuming an ICU rate of 5%, a time lag of 5 days and an average stay of 14 days in ICU provide the best fit of the data and is in accord with independent estimates. Our model is then used to predict future ICU load assuming a continued exponential phase with varying growth rates (0-15%). For example, based on our parameters the model predicts that the number of ICU patients at the end of May would be 246 if the exponential growth were to continue at a rate of 3%, 1,056 if the growth rate were 5% and 3,758 if the growth rate were 7%. The model can be adjusted as estimates of parameters develop and can thus also help to predict a potential exceedance of ICU capacity. Although our predictions are based on a small data set, disregard non-stationary dynamics, and have a number of assumptions, especially an exponential development of cases, our model is simple, robust, adaptable and can be up-dated when further data become available.


Illness perception, mood state and disease-related knowledge level of COVID-19 family clusters, Hunan, China


title: Lopinavir/ritonavir use in Covid-19 infection: is it completely non-beneficial?

text: Covid-19 infection caused by the novel coronavirus SARS-COV-2 continues to be a major global health challenge. Till date, no drug has been approved for the treatment of this infection. A number of medications have been proposed and there are ongoing clinical trials around the world to find a suitable treatment. A recent randomised control trial compared lopinavir/ritonavir with standard care among 199 patients with severe Covid-19 infection and concluded that there was no significant reduction in mortality rate with lopinavir/ritonavir. However, there are a few important lessons which may be learnt from the study apart from the statistical reduction in mortality rate. There was a numerical reduction in mortality rate, less intensive care unit stay and less complications in the lopinavir-ritonavir group. This article points out some of those important lessons with some suggestions for future clinical trials.


"Sorry ICU, I'm an Ophthalmologist!"


The fight against COVID-19: disinfection protocol and turning over of CleanSpace® HALO™ in a Singapore Hospital


title: Rapidly Bootstrapping a Question Answering Dataset for COVID-19

text: We present CovidQA, the beginnings of a question answering dataset specifically designed for COVID-19, built by hand from knowledge gathered from Kaggle's COVID-19 Open Research Dataset Challenge. To our knowledge, this is the first publicly available resource of its type, and intended as a stopgap measure for guiding research until more substantial evaluation resources become available. While this dataset, comprising 124 question-article pairs as of the present version 0.1 release, does not have sufficient examples for supervised machine learning, we believe that it can be helpful for evaluating the zero-shot or transfer capabilities of existing models on topics specifically related to COVID-19. This paper describes our methodology for constructing the dataset and presents the effectiveness of a number of baselines, including term-based techniques and various transformer-based models. The dataset is available at http://covidqa.ai/


Novel COronaVirus Disease 2019 (COVID-19) epidemic: What are the risks for systemic sclerosis patients?


A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia


title: Multi-patch epidemic models with general infectious periods

text: We study multi-patch SIR and SEIR models where individuals may migrate from one patch to another in either of the susceptible, exposed/latent, infectious and recovered states. We assume that infections occur locally with a rate that depends on the patch as well as the state of the various groups of individuals in the patch, and the infectious periods have a general distribution, and do not change as individuals migrate from one patch to another. The migration processes in either of the three states are assumed to be Markovian, and independent of the infectious periods. The rates of migration from one patch to another may be different due to the population density and the manner of migration (for example, transportation). We establish a functional law of large number (FLLN) and a function central limit theorem (FCLT) for the susceptible, exposed/latent, infectious and recovered processes. In the FLLN, the limit is determined by a set of Volterra integral equations. In the special case of deterministic infectious periods, the limit becomes an ODE with delay. In the FCLT, the limit is given by a set of stochastic Volterra integral equations driven by a sum of Brownian motion and a continuous Gaussian processes of a particular covariance structure.


Telerehabilitation during COVID-19: Experiences in service delivery from South India


title: Structural variations and expression profiles of the SARS-CoV-2 host invasion genes in lung cancer

text: Recent days have seen growing evidence of cancer's susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and of the effect of genomic differences on the virus' entrance genes in lung cancer. Genetic confirmation of the hypotheses regarding gene expression and mutation pattern of target genes, including angiotensin-converting enzyme-2 (ACE2), transmembrane serine protease 2 (TMPRSS2), basigin (CD147/BSG) and paired basic amino acid cleaving enzyme (FURIN/PCSK3), as well as correlation analysis, was done in relation to lung adenocarcinoma (LUAD) and lung squamous carcinoma (LUSC) using in silico analysis. Not only were gene expression and mutation patterns detected, but also there were correlation and survival analysis between ACE2 and other target genes expression levels. The total genetic anomaly carrying rate of target genes, including ACE2, TMPRSS2, CD147/BSG, and FURIN/PCSK3, was determined as 8.1% and 21 mutations were detected, with 7 of these mutations having pathogenic features. p.H34N on the RBD binding residues for SARS-CoV-2 was determined in our LUAD patient group. According to gene expression analysis results, though the TMPRSS2 level was statistically significantly decreased in the LUSC patient group compared to healthy control, the ACE2 level was determined to be high in LUAD and LUSC groups. There were no meaningful differences in the expression of CD147 and FURIN genes. The challenge for today is building the assessment of genomic susceptibility to COVID-19 in lung cancer, requiring detailed experimental laboratory studies, in addition to in silico analyses, as a way of assessing the mechanism of novel virus invasion that can be used in the development of effective SARS-CoV-2 therapy.


When Physical Medicine and Rehabilitation Became Medicine-Life in the Time of Coronavirus Disease of 2019


Utilization and Appropriateness of Transthoracic Echocardiography in Response to the COVID-19 Pandemic


Sustainability of SARS-CoV-2 in aerosols: Should we worry about airborne transmission?


Olfactory Dysfunction in COVID-19: Diagnosis and Management


title: Guidance on diagnosis, prevention and treatment of thromboembolic complications in COVID-19: a position paper of the Brazilian Society of Thrombosis and Hemostasis and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy

text: Hemostatic abnormalities and thrombotic risk associated with coronavirus disease 2019 (COVID-19) are among the most discussed topics in the management of this disease. The aim of this position paper is to provide the opinion of Brazilian experts on the thromboprophylaxis and management of thrombotic events in patients with suspected COVID-19, in the sphere of healthcare in Brazil. To do so, the Brazilian Society of Thrombosis and Hemostasis (BSTH) and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH) have constituted a panel of experts to carefully review and discuss the available evidence about this topic. The data discussed in this document was reviewed by May 9, 2020. Recommendations and suggestions reflect the opinion of the panel and should be reviewed periodically as new evidence emerges.


COVID-19, vision, and fitness to drive


Palliative care: Essential support for patients with heart failure in the COVID-19 pandemic


title: COVID-19 Clinical trials: Quality matters more than quantity

text: Despite the ferment aroused in the scientific community by the COVID-19 outbreak and the over 11,000 papers listed in PubMed, published evidence on safe and effective drugs has not progressed yet at the same speed of the pandemic. However, clinical research is rapidly progressing, as shown by the hundreds of registered clinical trials on candidate drugs for COVID-19. Unfortunately, information on protocols of individual studies differs from registry to registry. Furthermore, study designs, criteria for stratification of patients and choice of outcomes are quite heterogeneous. All this makes data sharing and secondary analysis difficult. At last, small single centre studies and the use of drugs on a compassionate basis should be replaced by highly powered, multi-centre, multi-arm clinical trials, in order to provide the required evidence of safety and efficacy of novel or repurposed candidate drugs. Hopefully, the efforts of clinical researchers in the fight against the SARS Cov-2 will result into the identification of effective treatments. To make this possible, clinical research should be oriented by guidelines for more harmonized high-quality studies and by a united commitment of the scientific community to share personal knowledge and data. Allergists and clinical immunologists should have a leading role in this unprecedent challenge.


Susceptibility and prognosis of COVID-19 patients with cardiovascular disease


COVID-19 transmission through asymptomatic carriers is a challenge to containment


COVID-19 and essential pregnant worker policies


Coronavirus (COVID-19) infection-induced chilblains: A case report with histopathologic findings


A safe approach to surgery for pituitary and skull base lesions during the COVID-19 pandemic


title: Lithium as a candidate treatment for COVID-19: Promises and pitfalls

text: The pandemic of respiratory illness caused by a novel coronavirus (SARS-nCoV-2) is a global health crisis. Despite numerous preliminary results, there is as yet no treatment of proven efficacy for this condition. In this context, the pharmacological properties of lithium, better known as a treatment for mood disorders, merit closer examination. Lithium has shown in vitro efficacy at inhibiting the replication of coronaviruses responsible for gastrointestinal and respiratory diseases in animals. It has immunomodulatory properties that may be of additional benefit in moderating the host inflammatory response to the novel coronavirus (SARS-CoV-2). Furthermore, there is evidence that lithium may exert a protective action against upper respiratory infections and influenza-like illnesses in patients taking it for other indications. These promising reports must be balanced against the narrow therapeutic index and high risk of toxicity associated with lithium therapy, its documented interactions with several commonly used drugs, and the absence of evidence of its efficacy against coronaviruses responsible for human disease. Nevertheless, naturalistic studies of the risk of COVID-19 in patients already receiving lithium could provide indirect evidence of its efficacy, and understanding the putative antiviral and immune-regulatory mechanisms of lithium in models of SARS-CoV-2 infection may provide leads for the development of safer and more effective treatments with a specific action against COVID-19.


Thromboembolic events and apparent heparin resistance in patients infected with SARS-CoV-2


2019 Novel Coronavirus (2019-nCoV) Pneumonia


Public Education and Electronic Awareness of the New Coronavirus (COVID-19): Experiences From Iran


title: The Importance of Chest CT Scan in COVID-19

text: The coronavirus disease 2019 (COVID-19) is a highly transmissible acute respiratory disease that is caused by the Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2), a beta coronavirus first discovered in Wuhan, China, in late 2019. COVID-19 has been spreading swiftly globally, and as of March 2020, has been officially declared a pandemic by the World Health Organization (WHO). One of the challenges in managing COVID-19 is the identification of a swift, accessible, and reliable diagnostic modality that could serve as an alternative to a reverse-transcriptase polymerase chain reaction (RT-PCR). As of the writing of this paper, RT-PCR is still the recommended tool in diagnosing COVID-19, but the notion of a more prompt and accurate diagnostic tool is a possibility worth looking into. The objective of this case study is to investigate the importance and utility of chest computed tomography (CT) in the diagnosis of COVID-19, as increasing pieces of evidence suggest that chest CT could prove useful in the clinical pathway in diagnosing COVID-19.


Avoiding a new epidemic during a pandemic: The importance of assessing the risk of substance use disorders in the COVID-19 era


Portugal: fighting CoViD-19 in the edge of Europe


title: Expression of SARS-CoV-2 Receptor ACE2 and Coincident Host Response Signature Varies by Asthma Inflammatory Phenotype

text: BACKGROUND: Over 300 million people carry a diagnosis of asthma with data to suggest they are at higher risk for infection or adverse outcomes from SARS-CoV-2. Asthma is remarkably heterogenous and it is currently unclear how patient intrinsic factors may relate to COVID-19. OBJECTIVE: Identify and characterize subsets of asthmatics at increased risk for SARS-CoV-2 infection. METHODS: Participants from 2 large asthma cohorts were stratified using clinically relevant parameters to identify factors related to ACE2 expression within bronchial epithelium. ACE-2 correlated gene signatures were used to interrogate publicly available databases to identify upstream signaling events and novel therapeutic targets. RESULTS: Stratifying by Type 2 inflammatory biomarkers, we identified subjects who demonstrated low peripheral blood eosinophils accompanied by increased expression of the SARS-CoV-2 receptor ACE2 in bronchial epithelium. Genes highly correlated with ACE2 overlapped with Type 1 and 2 interferon signatures, normally induced by viral infections. T cell recruitment and activation within bronchoalveolar lavage cells of ACE2-high subjects was reciprocally increased. These patients demonstrated characteristics corresponding to risk factors for severe COVID-19, including male sex, history of hypertension, low peripheral blood and elevated BAL lymphocytes. CONCLUSION: ACE2 expression is linked to upregulation of viral response genes in a subset of Type-2 low asthmatics with characteristics resembling known risk factors for severe COVID-19. Therapies targeting the interferon family and T cell activating factors may therefore be of benefit in a subset of patients. CLINICAL IMPLICATION: Type-2 low asthmatics may be at increased risk for adverse outcome from COVID-19 and deserve increased vigilance upon developing symptoms.


Clinical Characteristics of Covid-19 in China


title: The challenge of COVID-19 and hematopoietic cell transplantation; EBMT recommendations for management of hematopoietic cell transplant recipients, their donors, and patients undergoing CAR T-cell therapy

text: The new coronavirus SARS-CoV-2 has rapidly spread over the world causing the disease by WHO called COVID-19. This pandemic poses unprecedented stress on the health care system including programs performing allogeneic and autologous hematopoietic cell transplantation (HCT) and cellular therapy such as with CAR T cells. Risk factors for severe disease include age and predisposing conditions such as cancer. The true impact on stem cell transplant and CAR T-cell recipients in unknown. The European Society for Blood and Marrow Transplantation (EBMT) has therefore developed recommendations for transplant programs and physicians caring for these patients. These guidelines were developed by experts from the Infectious Diseases Working Party and have been endorsed by EBMT's scientific council and board. This work intends to provide guidelines for transplant centers, management of transplant candidates and recipients, and donor issues until the COVID-19 pandemic has passed.


title: Adding Colchicine to the Antiretroviral Medication - Lopinavir/Ritonavir (Kaletra) in Hospitalized Patients with Non-Severe Covid-19 Pneumonia: A Structured Summary of a Study Protocol for a Randomized Controlled Trial

text: OBJECTIVES: Colchicine is a well-known drug, which has been used for years to treat a wide range of rheumatic and inflammatory disorders. It helps break the cycle of inflammation through diverse mechanisms including reducing Intereukin-6, Interleukin-8, Tumour Necrosis Factor-alpha besides controlling oxidative stress pathways which all are important and pathologic components in the clinical course and outcome of patients infected with COVID-19. This study aims to assess the anti-inflammatory effects of colchicine in non-severe hospitalized COVID-19 patients. TRIAL DESIGN: Prospective, randomized (1:1 ratio), double blind study with parallel group design. PARTICIPANTS: Hospitalized patients with positive nasopharyngeal swab for COVID-19 infection (RT -PCR) and lung Computed tomography scan involvement compatible with COVID-19 pneumonia. The patients are not severely hypoxic, do not need intubation or invasive oxygenation. EXCLUSION CRITERIA: known hypersensitivity to colchicine; known hepatic failure; estimated glomerular filtration rate (eGFR)<30 ml/min/1.73m2 (by the CKD-EPI Creatinine Equation for Glomerular Filtration Rate (GFR) which estimates GFR based on serum creatinine. ; kidney transplant recipients, using Digoxin, QTc >450 msec. Participants will be recruited from inpatients at Labbafinejad Meidcal Center , Tehran, Iran. INTERVENTION AND COMPARATOR: Eligible enrolled patients will be randomized into two groups. Group A will receive the antiretroviral Lopinavir/Ritonavir (Kaletra) while group B will receive Lopinavir/Ritonavir (Kaletra) + Colchicine 1.5 mg loading then 0.5 mg twice daily orally. All patients in both groups will receive the same amounts of essential minerals, vitamins as antioxidants, and antibiotics. Patients of both groups will be treated under optimal treatment based on the CDC and WHO guidelines and national consensus proposed in Iran including the same dosages of Lopinavir/Ritonavir, antibiotics, trace elements and antioxidants while only in group-B patients Colchicine will be added on top of this protocol. MAIN OUTCOMES: Primary: Time for clinical improvement and lung CT score changes 14 days after treatment. Secondary: 14 days after treatment - C-Reactive Protein test x Neutrophil to Lymphocyte Ratio , Interleukin-6, malondialdehyde (MDA) levels reduction - Percentage of patients who require supplemental Oxygen - Mean hospital stay length RANDOMISATION: Patients will be allocated to each group (ratio 1:1) by using an online randomization tool: http://www.graphpad.com/quickcalcs/index.cfm BLINDING (MASKING): This will be a double-blind study in which participants and those assessing the final outcomes will be blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Regarding the pandemic crisis and our center capacity to hospitalize confirmed COVID-19 patients, a total of 80 patients was found to be logical to be randomized into two groups of 40- patients. TRIAL STATUS: Recruitment is ongoing. Recruitment began on 20/03/2020 and the date by which the recruitment is anticipated to be completed is 30/05/2020. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04360980, registered 24/04/2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


title: [Work flow of clinical microbiology laboratory under the outbreak of the novel coronavirus disease 2019]

text: The burn microbiology laboratory of the author's unit is a second-level biosafety laboratory, which is mainly responsible for handling clinical microbial samples from our department and other departments in the hospital. Since the outbreak of the coronavirus disease 2019, in order to ensure the normal development of daily work and the safety of medical staff, the microbiology laboratory has actively adjusted the daily work flow. The specific work flow is summarized as follows to provide reference for the safety protection of peer in clinical microbiology laboratory.


title: Emerging coronaviruses: Genome structure, replication, and pathogenesis

text: The recent emergence of a novel coronavirus (2019-nCoV), which is causing an outbreak of unusual viral pneumonia in patients in Wuhan, a central city in China, is another warning of the risk of CoVs posed to public health. In this minireview, we provide a brief introduction of the general features of CoVs and describe diseases caused by different CoVs in humans and animals. This review will help understand the biology and potential risk of CoVs that exist in richness in wildlife such as bats.


COVID-19: The race for a vaccine


A reply to Dr. Pan's and Dr. Wu's response: "Wuhan COVID-19 data - An example to show the importance of public health interventions to fight against the pandemic"


Seven days in medicine: 22-28 April 2020


Ultraviolet-based Biophotonic Technologies and COVID-19


title: SARS-CoV-2 and SARS-CoV: Virtual screening of potential inhibitors targeting RNA-dependent RNA polymerase activity (NSP12)

text: Since the outbreak of severe acute respiratory syndrome (SARS) in 2003, the harm caused by coronaviruses to the world cannot be underestimated. Recently, a novel coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) initially found to trigger human severe respiratory illness in Wuhan City of China in 2019, has infected more than six million people worldwide by 21 June 2020, and which has been recognized as a public health emergency of international concern as well. And the virus has spread to more than 200 countries around the world. However, the effective drug has not yet been officially licensed or approved to treat SARS-Cov-2 and SARS-Cov infection. NSP12-NSP7-NSP8 complex of SARS-CoV-2 or SARS-CoV, essential for viral replication and transcription, is generally regarded as a potential target to fight against the virus. According to the NSP12-NSP7-NSP8 complex (PDB ID: 7BW4) structure of SARS-CoV-2 and the NSP12-NSP7-NSP8 complex (PDB ID: 6NUR) structure of SARS-CoV, NSP12-NSP7 interface model, and NSP12-NSP8 interface model were established for virtual screening in the present study. Eight compounds (Nilotinib, Saquinavir, Tipranavir, Lonafarnib, Tegobuvir, Olysio, Filibuvir, and Cepharanthine) were selected for binding free energy calculations based on virtual screening and docking scores. All eight compounds can combine well with NSP12-NSP7-NSP8 in the crystal structure, providing drug candidates for the treatment and prevention of coronavirus disease 2019 and SARS.


title: When COVID-19 Crosses Paths with AIDS in the Homeless

text: The coronavirus disease of 2019 (COVID-19) pandemic has created new challenges and magnified existing ones for immunocompromised individuals who may be at risk for worse clinical outcomes. Severe COVID-19 has been associated with a hyperimmune response characterized by a surge in cytokine release defined as a cytokine release syndrome (CRS) (1). Among immunocompromised patients, the inability to mount an immune response may be protective against a poor outcome. This article is protected by copyright. All rights reserved.


A global needs assessment in times of a global crisis: world psychiatry response to the COVID-19 pandemic


Management of maternal resuscitation and category 1 cesarean delivery in a Covid-19 suspect parturient


title: The COVID-19 pandemic will have a long-lasting impact on the quality of cirrhosis care

text: The coronavirus disease 2019 (COVID-19) pandemic has shattered the meticulously developed processes by which we delivered quality care for patients with cirrhosis. Care has been transformed by the crisis, but enduring lessons have been learned. In this article, we review how COVID-19 will impact cirrhosis care. We describe how this impact unfolds over 3 waves; i) an intense period with prioritized high-acuity care with delayed elective procedures and routine care during physical distancing, ii) a challenging 'return to normal' following the end of physical distancing, with increased emergent decompensations, morbidity, and systems of care overwhelmed by the backlog of deferred care, and iii) a protracted period of suboptimal outcomes characterized by missed diagnoses, progressive disease and loss to follow-up. We outline the concrete steps required to preserve the quality of care provided to patients with cirrhosis. This includes an intensification of the preventative care provided to patients with compensated cirrhosis, proactive chronic disease management, robust telehealth programs, and a reorganization of care delivery to provide a full service of care with flexible clinical staffing. Managing the pandemic of a serious chronic disease in the midst of a global infectious pandemic is challenging. It is incumbent upon the entire healthcare establishment to be strong enough to weather the storm. Change is needed.


Invasive fungal diseases during COVID-19: We should be prepared


Mild or Moderate Covid-19


title: Impact of Public Health Interventions on Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Korea

text: BACKGROUND: COVID-19 was introduced in Korea early and experienced a large outbreak in mid-February. We aimed to review the public health interventions used during the COVID-19 outbreak and describe the impact on seasonal influenza activity in Korea. METHODS: National response strategies and public health interventions, along with daily COVID-19 confirmed cases in Korea were reviewed during the pandemic. National influenza surveillance data were compared between seven sequential seasons. Characteristics of each season, including the rate of influenza-like illness (ILI), duration of epidemic, date of termination of epidemic, distribution of influenza virus strain and hospitalization were analyzed. RESULTS: After various public health interventions including enforced public education on hand hygiene, cough etiquette and staying at home with respiratory symptoms, universal mask use in public places, refrain from non-essential social activities and school closure, the duration of the influenza epidemic in 2019/2020 decreased by 6-12 weeks and the influenza activity peak rated 49.8 ILI/1,000 visits compared to 71.9-86.2 ILI/1,000 visits of previous seasons. During the period of enforced social distancing from week 9 to 17 of 2020, influenza hospitalization cases were 11.9-26.9-fold lower compared with previous seasons. During the 2019/2020 season, influenza B accounted for only 4%, in contrast with previous seasons in which influenza B accounted for 26.6% to 54.9% of all cases. CONCLUSIONS: Efforts to activate high level national response not only led to a decrease in COVID-19, but also substantial decrease in seasonal influenza activity. Interventions applied to control COVID-19 may serve as useful strategies for prevention and control of influenza in upcoming seasons.


title: Safety and Efficacy of Bedside Peritoneal Dialysis Catheter Placement in the COVID-19 Era: Initial Experience at a New York City Hospital

text: INTRODUCTION: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in critically ill patients with COVID-19. Unparalleled numbers of patients with AKI and shortage of dialysis machines and operative resources prompted consideration of expanded use of urgent-start peritoneal dialysis (PD) and evaluation of the safety and efficacy of bedside surgical placement of PD catheters. STUDY DESIGN: Bedside, open PD catheter insertions were performed in early April 2020, at a large academic center in New York City. Patients with SARS-CoV-2 infection and AKI and ambulatory patients with chronic kidney disease and impending need for RRT were included. Detailed surgical technique is described. RESULTS: Fourteen catheters were placed at the bedside over 2 weeks, 11 in critically ill COVID-19 patients and three in ambulatory patients. Mean patient age was 61.9 years (43-83), and mean body mass index was 27.1 (20-37.6); four patients had prior abdominal surgery. All catheters were placed successfully without routine radiographic studies or intraoperative complications. One patient (7%) experienced primary nonfunction of the catheter requiring HD. One patient had limited intraperitoneal bleeding while anticoagulated, which was managed by mechanical compression of the abdominal wall and temporarily holding anticoagulation. All other catheters had an adequate function at 3-18 days of follow-up. CONCLUSIONS: Bedside placement of PD catheters is safe and effective in ICU and outpatient clinic settings. Our surgical protocols allowed for optimization of critical hospital resources, minimization of hazardous exposure to healthcare providers and a broader application of urgent-start PD in selected patients. Long-term follow-up is warranted.


Reply: Potential role of Janus kinase inhibitors in COVID-19


title: Efficacy of auditory evoked potential follow-up in viral meningitis of infants

text: PURPOSE: To examine the rate of occurrence of hearing impairments among the infants who had recovered from viral meningitis under 1 year of age through auditory evoked potential (AEP) test and to investigate the efficacy of the follow-up AEP test in viral meningitis infants. METHODS: Two hundred twenty infants (440 ears) were examined through AEP test once, and 47 (94 ears) of them went back for a second examination and were diagnosed with viral meningitis. The first AEP tests were compared with the second results in 47 infants. I latency, V latency, I-III interpeak latency (IPL), and III-V IPL were checked. RESULTS: In the first AEP test conducted on 440 ears, the average values of I and V latency and I-III IPL were delayed as compared with normal values. The second AEP results were conducted on 47 infants 92.36 days after the first exam. I latency and V latency of second exam were improved significantly (p < 0.05), but I-III and III-V IPL showed no significant changes. Two hearing impaired patients (4 ears) were confirmed through chart reviews. CONCLUSION: The AEP test is a helpful study for early detection of hearing problem. However, in this study, AEP test was too sensitive in acute period, and later, the incidence rate of hearing impairment was relatively low. Therefore, age of onset, severity of neurologic symptom, and clinical examination must be considered before the AEP test.


title: Risk of SARS-CoV-2 transmission to medical staff and patients from an exposure to a COVID-19-positive ophthalmologist

text: PURPOSE: To evaluate the risk of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after exposure to a COVID-19+ physician in a retina clinic. METHODS: A retrospective observational study. Records of 142 patients and 11 staff members from a single retina clinic that were exposed to a COVID-19+ ophthalmologist were reviewed. All 153 individuals were placed in quarantine for 14 days. They were contacted after the quarantine period to inquire about symptoms consistent with COVID-19, and the results of diagnostic test for SARS-CoV-2 when performed. RESULTS: All patients (n = 142) were contacted successfully. The mean age was 72.8 ± 13.6 years; 54.2% (n = 77) were females. Twenty-three patients (16.2%) were exposed during an ophthalmic exam, 111 (78.2%) during intraocular injection, 4 (2.8%) underwent exam and injection, 3 (2.1%) underwent surgery, and one patient (0.7%) had laser photocoagulation. Half of the patients (50%; n = 71) were in contact with the COVID-19+ physician while he was symptomatic. Forty-four patients (31%) wore a mask on the day of their visit. 11.3% (n = 16) of the patients, and all involved staff had been tested for the virus and all were negative. One patient (0.7%) reported transient cough and sore throat, and the remaining 141 (99.3%) patients and 11 (100%) staff did not develop symptoms. CONCLUSIONS: Low risk for SARS-CoV-2 transmission in the ophthalmic setting was observed when universal safety measures such as social distancing, meticulous hand hygiene, enlarged breath shields, and mask wear during procedures were taken.


title: Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China

text: BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) was first found in Wuhan, China and soon was reported all around the world. METHODS: All confirmed cases with COVID-19 in Wenzhou from January 19 to February 20, 2020, were collected and analyzed. Of the 116 patients with COVID-19, 27 were diagnosed as severe cases. Among severe cases, 9 were treated in ICU. The data of blood routine examination were analyzed and compared among common patients (as common group), severe patients admitted to intensive care unit (as severe ICU group) and severe patients not admitted to ICU (as severe non-ICU group). The blood routine examination results were dynamically observed in the above groups after admission. RESULTS: Patients with COVID-19 have lower counts of leucocytes, lymphocytes, eosinophils, platelets, and hemoglobin, but have higher neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), which were compared with controls (P < 0.001). In severe ICU group, patients have the lowest count of lymphocytes, but the highest neutrophil count and NLR among the above three groups (all P values < 0.05); NLR and MLR indicators were combined for diagnostic efficacy analysis of severe COVID-19, and its area under the curve reached 0.925. The odds ratio of the delay in days to the start of the increase of eosinophil count for predicting the outcome of patients with severe COVID-19 was 2.291 after age adjusted. CONCLUSIONS: Patients with COVID-19 have abnormal peripheral blood routine examination results. Dynamic surveillance of peripheral blood system especially eosinophils is helpful in the prediction of severe COVID-19 cases.


Stand Together and Deliver: Challenges and Opportunities for Rheumatology Education During the COVID-19 Pandemic


Keeping Hospitals Safe During the COVID-19 Pandemic Finding inspiration in a father's credo


Covid-19: collateral damage of lockdown in India


Prioritizing Equity in a Time of Scarcity: The COVID-19 Pandemic


Virtual Reality as a Bridge in Palliative Care during COVID-19


title: The Strategic Alliance between Clinical and Molecular Science in the War against SARS-CoV-2, with the Rapid-Diagnostics Test as an Indispensable Weapon for Front Line Doctors

text: Our work concerns the actual problem of spread of SARS- CoV-2 outbreak which requires fast and correct as possible answer. In current scenario, the need of rapid answer put away the imperative of proper methodology. We focus on the serogical immunoassay for diagnosis of Covid-19 as an important weapon not only for diagnostic purpose, but also for epidemiologic one. The right equilibrium between high speed, low cost and accuracy is obtained with easy-to-use decentralized point-of-care test as the colloidal gold-based immunochromatographic strip assay which detects IgM and IgG antibodies directed against SARS-CoV-2. As our aim is to evaluate the efficacy of Covid-19 rapid tests and of serological assays in real-life settings, we designed a research protocol aimed to establish how to use correctly these diagnostics, taking into account the different possible clinical and epidemiological scenarios.


Mass quarantine measures in the time of COVID-19 pandemic: psychosocial implications for chronic skin conditions and a call for qualitative studies


title: Optimal Consumption with Reference to Past Spending Maximum

text: This paper studies an infinite horizon optimal consumption problem under exponential utility, together with non-negativity constraint on consumption rate and a reference point to the past consumption peak. The performance is measured by the distance between the consumption rate and a fraction $0\leq\lambda\leq 1$ of the historical consumption maximum. To overcome its path-dependent nature, the consumption running maximum process is chosen as an auxiliary state process that renders the value function two dimensional depending on the wealth variable $x$ and the reference variable $h$. The associated Hamilton-Jacobi-Bellman (HJB) equation is expressed in the piecewise manner across different regions to take into account constraints. By employing the dual transform and smooth-fit principle, the classical solution of the HJB equation is obtained in an analytical form, which in turn provides the feedback optimal investment and consumption. For $0<\lambda<1$, we are able to find four boundary curves $x_1(h)$, $\breve{x}(h)$, $x_2(h)$ and $x_3(h)$ for the wealth level $x$ that are nonlinear functions of $h$ such that the feedback optimal consumption satisfies: (i) $c^*(x,h)=0$ when $x\leq x_1(h)$; (ii) $0<c^*(x,h)<\lambda h$ when $x_1(h)<x<\breve{x}(h)$; (iii) $\lambda h\leq c^*(x,h)<h$ when $\breve{x}(h)\leq x<x_2(h)$; (iv) $c^*(x,h)=h$ but the running maximum process remains flat when $x_2(h)\leq x<x_3(h)$; (v) $c^*(x,h)=h$ and the running maximum process increases when $x=x_3(h)$. Similar conclusions can be made in a simpler fashion for two extreme cases $\lambda=0$ and $\lambda=1$. Numerical examples are also presented to illustrate some theoretical results and financial insights.


From SARS to COVID-19: the Singapore journey


title: Enhancing safety of laparoscopic surgery in COVID-19 era: clinical experience with low-cost filtration devices

text: BACKGROUND: Surgery in the era of the current COVID-19 pandemic has been curtailed and restricted to emergency and certain oncological indications, and requires special attention concerning the safety of patients and health care personnel. Desufflation during or after laparoscopic surgery has been reported to entail a potential risk of contamination from 2019-nCoV through the aerosol generated during dissection and/or use of energy-driven devices. In order to protect the operating room staff, it is vital to filter the released aerosol. METHODS: The assemblage of two easily available and low-cost filter systems to prevent potential dissemination of Coronavirus via the aerosol is described. RESULTS: Forty-nine patients underwent laparoscopic surgeries with the use of one of the two described tools, both of which proved to be effective in smoke evacuation, without affecting laparoscopic visualization. CONCLUSION: The proposed systems are cost-effective, easily assembled and reproducible, and provide complete viral filtration during intra- and postoperative release of CO2.


Corona Virus: Global Pandemic Causing World-Wide Shutdown


Thromboelastometry and D-Dimer Elevation in Coronavirus-2019


title: Older Adults and Covid-19: The Most Vulnerable, the Hardest Hit

text: Older adults in the United States have been the age group hardest hit by the Covid pandemic. They have suffered a disproportionate number of deaths; Covid patients eighty years or older on ventilators had fatality rates higher than 90 percent. How could we have better protected older adults? Both the popular press and government entities blamed nursing homes, labeling them "snake pits" and imposing harsh fines and arduous new regulations. We argue that this approach is unlikely to improve protections for older adults. Rather than focusing exclusively on acute and critical resources, including ventilators, a plan that respected the best interests of older adults would have also supported nursing homes, a critical part of the health care system. Better access to protective equipment for staff members, early testing of staff members and patients, and enhanced means of communication with families were what was needed. These preventive measures would have offered greater benefit to the oldest members of our population than the exclusive focus on acute care.


title: Identification of an Epidemiological Model to Simulate the COVID-19 Epidemic using Robust Multi-objective Optimization and Stochastic Fractal Search

text: Traditionally, the identification of parameters in the formulation and solution of inverse problems considers that models, variables and mathematical parameters are free of uncertainties. This aspect simplifies the estimation process, but does not consider the influence of relatively small changes in the design variables in terms of the objective function. In this work, the SIDR (Susceptible, Infected, Dead and Recovered) model is used to simulate the dynamic behavior of the novel coronavirus disease (COVID-19), and its parameters are estimated by formulating a robust inverse problem, that is, considering the sensitivity of design variables. For this purpose, a robust multi-objective optimization problem is formulated, considering the minimization of uncertainties associated to the estimation process and the maximization of the robustness parameter. To solve this problem, the Multi-objective Stochastic Fractal Search algorithm is associated with the Effective Mean concept for the evaluation of robustness. The results obtained considering real data of the epidemic in China demonstrate that the evaluation of the sensitivity of the design variables can provide more reliable results.


Driving forces for COVID-19 clinical trials using chloroquine: the need to choose the right research questions and outcomes


title: What comes after the ICU?

text: Some people with covid-19 need ventilation. Those who survive this will need a lot of physical and mental rehabilitation, finds Clare Wilson.


title: Prolonged confusional state as first manifestation of COVID-19

text: A 77-year-old gentleman, normally fit and well, was admitted with acute confusion. On admission, Glasgow Coma Scale (GCS) was 14/15, vital signs were within the normal limits and bilateral crepitation at the lung base. Head CT scan was normal. CXR showed some air space opacification. Investigations revealed hyponatraemia, raised CRP, and positive for COVID-19. Treated with antibiotics and intravenous saline, sodium returned to normal. Delirium remained unchanged 4 weeks post-incidence. Neurological manifestations were documented in patients with COVID-19; however no report has shown delirium as a primary manifestation. This case illustrates acute confusion may be the only presenting symptom of COVID-19 without overt lung disease.


title: Research with older people in a world with COVID-19: identification of current and future priorities, challenges and opportunities

text: Older people are disproportionately affected by the COVID-19 pandemic, which has had a profound impact on research as well as clinical service delivery. This commentary identifies key challenges and opportunities in continuing to conduct research with and for older people, both during and after the current pandemic. It shares opinions from responders to an international survey, a range of academic authors and opinions from specialist societies. Priorities in COVID-19 research include its specific presentation in older people, consequences for physical, cognitive and psychological health, treatments and vaccines, rehabilitation, supporting care homes more effectively, the impact of social distancing, lockdown policies and system reconfiguration to provide best health and social care for older people. COVID-19 research needs to be inclusive, particularly involving older people living with frailty, cognitive impairment or multimorbidity, and those living in care homes. Non-COVID-19 related research for older people remains of critical importance and must not be neglected in the rush to study the pandemic. Profound changes are required in the way that we design and deliver research for older people in a world where movement and face-to-face contact are restricted, but we also highlight new opportunities such as the ability to collaborate more widely and to design and deliver research efficiently at scale and speed.


Digital Smartphone Tracking for COVID-19: Public Health and Civil Liberties in Tension


Safer through surgery: American Society for Metabolic and Bariatric Surgery statement regarding metabolic and bariatric surgery during the COVID-19 pandemic


Regulators split on antimalarials for COVID-19


title: Isodeoxyelephantopin, a sesquiterpene lactone from Elephantopus scaber Linn., inhibits pro-inflammatory mediators' production through both NF-κB and AP-1 pathways in LPS-activated macrophages

text: Isodeoxyelephantopin (IDET) has been identified as an anti-tumor natural constituent whose anti-tumor activity and mechanism have been widely investigated. Since the occurrence and development of cancer usually accompany with inflammation, and tumor signaling shares many components with inflammation signaling, the agents with anti-tumor activity are likely to possess anti-inflammation potential. Thus, the current study aims to demonstrate the anti-inflammatory activity along with the underlying mechanism of IDET in lipopolysaccharide (LPS)-primed macrophages. By using Griess method and ELISA, we found that in both bone marrow derived macrophages and alveolar macrophage cell line, IDET, at relatively low concentrations (0.75, 1.5 and 3 µM), could inhibit LPS-induced expression of various pro-inflammatory mediators including nitric oxide (NO) generated by inducible nitric oxide synthase (iNOS), interleukin (IL)-6, monocyte chemotactic protein-1 (MCP-1) and IL-1ß. Meanwhile, in activated MH-S cells, the inhibitory action of IDET on mRNA expression levels of these cytokines was also detected using qPCR. Mechanistically, the effects of IDET on two key inflammatory signalings, nuclear factor-κB (NF-κB) and activator protein-1 (AP-1) pathways, were determined in LPS-activated MH-S cells by reporter gene along with western blot assays. On the one hand, IDET suppressed NF-κB signaling via down-regulating phosphorylation and degradation of inhibitor of NF-κB (IκB)-α and the subsequent p65 translocation. On the other hand, IDET dampened AP-1 signaling through attenuating phosphorylation of both c-jun N-terminal kinase 1/2 (JNK1/2) and extracellular signal regulated kinase 1/2 (ERK1/2). Our study indicates that IDET might be a promising constituent from the anti-inflammatory herb Elephantopus scaber Linn. in mitigating inflammatory conditions, especially respiratory inflammation.


title: Developing a guidance resource for managing delirium in patients with Covid-19

text: As the Covid-19 pandemic escalates worldwide it is apparent that many patients with more severe illness will also experience delirium. These patients pose a particular challenge in the application of optimal care due to issues with infectious risk, respiratory compromise and potential interactions between medications that can be used to manage delirium with antiviral and other treatments used for Covid-19. We describe a guidance resource adapted from existing guidelines for delirium management that has been tailored to the specific challenge of managing delirium in patients with Covid-19 infection. Issues around the assessment and treatment of these patients are examined and distilled into a simple (one-paged guidance resource that can assist clinicians in managing suspected delirium.


Case-finding: Fast, Available, and Efficient Font-line Diagnostics for SARS-CoV-2


Interleukin-6 and Severity of COVID-19 Patients in Hefei, China


Slit-lamp evaluation during SARS-CoV-2 pandemic: safety first!


First CRISPR test for the coronavirus approved in the United States


title: Investiagation of possible mechanism of eye transmission of SARS-CoV-2 based on SARS-CoV/ 国际眼科杂志(Guoji Yanke Zazhi)

text: @#SARS-CoV-2 has been spreading rapidly since its outbreak in December 2019.Understanding its epidemiological characteristics, especially cutting off transmission routes, is crucial to controlling the spread of the disease. In the study of transmission pathway, the issue of whether SARS-CoV-2 is transmitted through ocular surface tissue has also aroused concerns, but there are still no clinically confirmed cases and laboratory evidence of its infection through ocular surface tissue. New research suggests that the SARS-CoV-2 belongs to the same genus as SARS coronavirus(SARS-CoV), and that it enters cells in the same way as SARS-CoV. This paper reviews the research on SARS-CoV to investigate the possible mechanism of eye transmission of SARS-CoV-2.


title: Primer design for quantitative real-time PCR for the emerging Coronavirus SARS-CoV-2

text: In December 2019, a new coronavirus disease (COVID-19) outbreak occurred in Wuhan, China. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which is the seventh coronavirus known to infect humans, is highly contagious and has rapidly expanded worldwide since its discovery. Quantitative nucleic acid testing has become the gold standard for diagnosis and guiding clinical decisions regarding the use of antiviral therapy. However, the RT-qPCR assays targeting SARS-CoV-2 have a number of challenges, especially in terms of primer design. Primers are the pivotal components of a RT-qPCR assay. Once virus mutation and recombination occur, it is difficult to effectively diagnose viral infection by existing RT-qPCR primers. Some primers and probes have also been made available on the WHO website for reference. However, no previous review has systematically compared the previously reported primers and probes and described how to design new primers in the event of a new coronavirus infection. This review focuses on how primers and probes can be designed methodically and rationally, and how the sensitivity and specificity of the detection process can be improved. This brief review will be useful for the accurate diagnosis and timely treatment of the new coronavirus pneumonia.


title: Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

text: BACKGROUND: In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. METHODS: In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. FINDINGS: Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. INTERPRETATION: The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. FUNDING: National Key R&D Program of China.


title: Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis

text: OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a new respiratory and systemic disease which needs quick identification of potential critical patients. This meta-analysis aimed to explore the relationship between lymphocyte count and the severity of COVID-19. METHODS: A comprehensive systematic literature search was carried out to find studies published from December 2019 to 22 March 2020 from five databases. The language of literatures included English and Chinese. Mean difference (MD) of lymphocyte count in COVID-19 patients with or without severe disease and odds ratio (OR) of lymphopenia for severe form of COVID-19 was evaluated with this meta-analysis. RESULTS: Overall 13 case-series with a total of 2282 cases were included in the study. The pooled analysis showed that lymphocyte count was significantly lower in severe COVID-19 patients (MD -0.31×109/L; 95%CI: -0.42 to -0.19×109/L). The presence of lymphopenia was associated with nearly threefold increased risk of severe COVID-19 (Random effects model, OR=2.99, 95% CI: 1.31-6.82). CONCLUSIONS: Lymphopenia is a prominent part of severe COVID-19 and a lymphocyte count of less than 1.5×109/L may be useful in predicting the severity clinical outcomes.


title: Oral ulceration and blistering in patients with COVID-19

text: Design Case series.Introduction The most common signs and symptoms of SARS-CoV-2 infection include headache, sore throat, hyposmia, hypogeusia, diarrhoea, dyspnoea and pneumonia. Dermatological manifestations have also been reported but few authors have documented oral signs and symptoms. Methods Three cases are reported where oral ulceration or blistering is found in patients with confirmed or suspected COVID-19.Results One patient had serologically confirmed COVID-19, whilst the remaining two cases were only suspected. Two patients reported pain from the palate, whilst the third reported in the tongue. The first two patients had lesions affecting keratinised tissue consistent with herpes simplex lesions but with no history of herpetic infection. The third patient had lesions compatible with erythema multiforme.Conclusions The authors suggest a link between COVID-19 and oral ulceration and blistering, but acknowledge these signs may often go undetected due to a lack of intraoral examination during hospital admission.


Adapting to Uncertainty: Nursing Responsiveness to COVID-19


UpdatesMental support for health care professionals essential during the COVID-19 pandemic


Letter: Surgical Management of Brain Tumor Patients in the COVID-19 Era


title: The Impact of Response Measures on COVID-19-Related Hospitalization and Death Rates in Germany and Switzerland

text: We assess the impact of COVID-19 response measures implemented in Germany and Switzerland on cumulative COVID-19-related hospitalization and death rates. Our analysis exploits the fact that the epidemic was more advanced in some regions than in others when certain lockdown measures came into force, based on measuring health outcomes relative to the region-specific start of the epidemic and comparing outcomes across regions with earlier and later start dates. When estimating the effect of the relative timing of measures, we control for regional characteristics and initial epidemic trends by linear regression (Germany and Switzerland), doubly robust estimation (Germany), or synthetic controls (Switzerland). We find for both countries that a relatively later exposure to the measures entails higher cumulative hospitalization and death rates on region-specific days after the outbreak of the epidemic, suggesting that an earlier imposition of measures is more effective than a later one. For Germany, we also evaluate curfews (as introduced in a subset of states) based on cross-regional variation. We do not find any effects of curfews on top of the federally imposed contact restriction that banned groups of more than 2 individuals. Finally, an analysis of mobility patterns in Switzerland shows an immediate behavioral effect of the lockdown in terms of reduced mobility.


Positive effects of COVID-19 control measures on pneumonia prevention


title: Developing an ultra-efficient microsatellite discoverer to find structural differences between SARS-CoV-1 and Covid-19

text: Motivation: Recently, the outbreak of Coronavirus-Covid-19 has forced the World Health Organization to declare a pandemic status. A genome sequence is the core of this virus which interferes with the normal activities of its counterparts within humans. Analysis of its genome may provide clues toward the proper treatment of patients and the design of new drugs and vaccines. Microsatellites are composed of short genome subsequences which are successively repeated many times in the same direction. They are highly variable in terms of their building blocks, number of repeats, and their locations in the genome sequences. This mutability property has been the source of many diseases. Usually the host genome is analyzed to diagnose possible diseases in the victim. In this research, the focus is concentrated on the attacker's genome for discovery of its malicious properties. Results: The focus of this research is the microsatellites of both SARS and Covid-19. An accurate and highly efficient computer method for identifying all microsatellites in the genome sequences is discovered and implemented, and it is used to find all microsatellites in the Coronavirus-Covid-19 and SARS2003. The Microsatellite discovery is based on an efficient indexing technique called K-Mer Hash Indexing. The method is called Fast Microsatellite Discovery (FMSD) and it is used for both SARS and Covid-19. A table composed of all microsatellites is reported. There are many differences between SARS and Covid-19, but there is an outstanding difference which requires further investigation. Availability: FMSD is freely available at https://gitlab.com/FUM_HPCLab/fmsd_project, implemented in C on Linux-Ubuntu system. Software related contact: hossein_savari@mail.um.ac.ir.


title: Identifying Radiological Findings Related to COVID-19 from Medical Literature

text: Coronavirus disease 2019 (COVID-19) has infected more than one million individuals all over the world and caused more than 55,000 deaths, as of April 3 in 2020. Radiological findings are important sources of information in guiding the diagnosis and treatment of COVID-19. However, the existing studies on how radiological findings are correlated with COVID-19 are conducted separately by different hospitals, which may be inconsistent or even conflicting due to population bias. To address this problem, we develop natural language processing methods to analyze a large collection of COVID-19 literature containing study reports from hospitals all over the world, reconcile these results, and draw unbiased and universally-sensible conclusions about the correlation between radiological findings and COVID-19. We apply our method to the CORD-19 dataset and successfully extract a set of radiological findings that are closely tied to COVID-19.


title: On the problem of biological form

text: Embryonic development, which inspired the first theories of biological form, was eventually excluded from the conceptual framework of the Modern Synthesis as irrelevant. A major question during the last decades has centred on understanding whether new advances in developmental biology are compatible with the standard view or whether they compel a new theory. Here, I argue that the answer to this question depends on which concept of morphogenesis is held. Morphogenesis can be conceived as (1) a chemically driven or (2) a mechanically driven process. According to the first option, genetic regulatory networks drive morphogenesis. According to the second, morphogenesis results from an invariant tendency of embryonic tissues to restore changes in mechanical stress. While chemically driven morphogenesis allows an extension of the standard view, mechanically driven morphogenesis would deeply transform it. Which of these hypotheses has wider explanatory power is unknown. At present, the problem of biological form remains unsolved.


title: No deleterious effect of lockdown due to COVID-19 pandemic on glycaemic control, measured by glucose monitoring, in adults with type 1 diabetes

text: BACKGROUND: The COVID-19 pandemic has forced the health public authorities to impose extraordinary policies to limit the virus spread. Lockdown has been recognized as an effective measure to minimise the risk of infection. The effect of this extreme and prolonged situation on glycaemic control in people with type 1 diabetes (T1D) is unknown. Continuous glucose monitoring (CGM) and Flash glucose monitoring (FGM) allow health care professionals to remotely monitored sensor glucose levels. The aim of the study was to evaluate the effect of lockdown on glycaemic control in adults with T1D. METHODS: People with T1D on multiple daily insulin injections and using CGM or FGM were included. Sensor data from the 2 weeks before the start of the COVID-19 lockdown and from the 2 weeks after 5 weeks of consecutive lockdown were compared. RESULTS: 147 subjects were selected (age: 39±14 years (15-80), 54% male (n=80), diabetes duration: 18±11 years). Forty six percent (n=68) were CGM users and 54% (n=79) FGM users. Estimated HbA1c was reduced from 57±11 mmol/l to 55±11 mmol/l (7.38±1.0% to 7.16±1.0%), (p<0.001). Time 70-180 mg/dl was increased from 60.3±16.0 to 62.8±17.0 (p=0.009). Time >180 mg/dl and >250 mg/dl were reduced from 36.0±17.2 to 32.6±17.5 (p<0.001) and from 11.9±11.8 to 9.4±10.3%, (p=0.001), respectively. Time in hypoglycaemia remained unchanged. Estimated HbA1c and time in range 70-180 mg/dl showed an improvement in 62% (n=91) of the subjects. Sensor use (93%) and coefficient of variation (36%) remained unchanged. CONCLUSION: No deterioration in glycaemic control was found as a result of lockdown due to the COVID-19 pandemic.


title: Elevation of liver fibrosis index FIB-4 is associated with poor clinical outcomes in patients with COVID-19

text: BACKGROUND AND AIMS: COVID-19 is a potentially severe disease caused by the recently described SARS-CoV-2. Whether liver fibrosis might be a relevant player in the natural history of COVID-19 is currently unknown. We aimed to evaluate the association between FIB-4 and the risk of progression to critical illness in middle-aged patients with COVID-19. METHODS: multicenter, retrospective study with prospective follow-up of 160 middle-aged (35 to 65 years) patients with COVID-19. FIB-4, clinical and biochemical variables were collected at baseline. FIB-4 ≥2.67 defined patients with risk for advanced liver fibrosis. Through multivariate logistic regression and bootstrap analysis, independent predictors of intensive care unit admission for mechanical ventilation were identified. RESULTS: risk for advanced fibrosis was estimated in 28.1% of patients. Patients with FIB-4 ≥2.67 required more frequently mechanical ventilation (37.8% vs 18.3%; p= 0.009). In multivariate analysis, FIB-4 ≥2.67 (OR 3.41; 95% CI 1.30-8.92), cardiovascular risk factors (OR 5.05; 95% CI: 1.90-13.39), previous respiratory diseases (OR 4.54; 95% CI: 1.36-15.10) and C-reactive protein (OR 1.012; 95% CI: 1.006-1.017) increased significantly the risk of ICU admission. Bootstrap confirmed FIB-4 as an independent risk factor. CONCLUSIONS: in middle-aged patients with COVID-19, FIB-4 may have a relevant prognostic role. The link between liver fibrosis and the natural history of COVID-19 should be evaluated in future studies.


title: Tracking of Infused Mesenchymal Stem Cells in Injured Pulmonary Tissue in Atm-Deficient Mice

text: Pulmonary failure is the main cause of morbidity and mortality in the human chromosomal instability syndrome Ataxia-telangiectasia (A-T). Major phenotypes include recurrent respiratory tract infections and bronchiectasis, aspiration, respiratory muscle abnormalities, interstitial lung disease, and pulmonary fibrosis. At present, no effective pulmonary therapy for A-T exists. Cell therapy using adipose-derived mesenchymal stromal/stem cells (ASCs) might be a promising approach for tissue regeneration. The aim of the present project was to investigate whether ASCs migrate into the injured lung parenchyma of Atm-deficient mice as an indication of incipient tissue damage during A-T. Therefore, ASCs isolated from luciferase transgenic mice (mASCs) were intravenously transplanted into Atm-deficient and wild-type mice. Retention kinetics of the cells were monitored using in vivo bioluminescence imaging (BLI) and completed by subsequent verification using quantitative real-time polymerase chain reaction (qRT-PCR). The in vivo imaging and the qPCR results demonstrated migration accompanied by a significantly longer retention time of transplanted mASCs in the lung parenchyma of Atm-deficient mice compared to wild type mice. In conclusion, our study suggests incipient damage in the lung parenchyma of Atm-deficient mice. In addition, our data further demonstrate that a combination of luciferase-based PCR together with BLI is a pivotal tool for tracking mASCs after transplantation in models of inflammatory lung diseases such as A-T.