title: The epidemiology of reverse transmission of COVID-19 in Gansu Province, China

text: BACKGROUND: The transmission of COVID-19 is about to come under control within China, however, an emerging challenge to the Chinese authorities is reverse transmission due to COVID-19 patients/carriers evacuating from overseas to China. METHODS: We analysed the epidemiological characteristics of 311 Chinese citizens evacuated from Iran. All confirmed COVID-19 cases amongst the returnees were displayed by the spatial distribution pattern of the extent of COVID-19 infection. RESULTS: Characteristics that differed significantly amongst these returnees compared to the original infected cohorts in Gansu were mean age, occupation and sex. Differences observed between infected patients and non-patients amongst returnees were age, sex, race, occupation, the use of facemasks, and residential situation in Iran. The clinical features that were significantly related to infection were chill, shortness of breath, chest pain and nausea. Spatial distribution pattern analysis indicated that infected returnees had resided within Iranian provinces that had experienced high levels of COVID-19. The spatial distribution of the original homes of these returnees before departure for Iran demonstrated that returnees will largely return to northwest China, to regions that have only experienced low levels of infection within China. CONCLUSION: Blocking the reverse transmission of COVID-19 is critical in preventing a secondary outbreak of COVID-19.


title: [Analysis of baseline liver biochemical parameters in 324 cases with novel coronavirus pneumonia in Shanghai area]

text: Objective: To summarize the clinical characteristics and liver biochemical parameters of 324 cases admitted with novel coronavirus pneumonia in Shanghai area. Methods: Clinical data and baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia admitted to the Shanghai Public Health Clinical Center from January 20, 2020 to February 24, 2020 were retrospectively analyzed. Patients were divided into two groups based on the status of illness: mild type (mild and typical) and severe type (severe and critical).The differences in clinical data and baseline liver biochemical parameters of the two groups were described and compared. The t-test and Wilcoxon rank-sum test were used for measurement data. The enumeration data were expressed by frequency and rate, and chi-square test was used. Results: Of the 324 cases with novel coronavirus pneumonia, 26 were severe cases (8%), with median onset of 5 days, 20 cases were HBsAg positive (6.2%), and 70 cases (21.6%) with fatty liver, diagnosed with X-ray computed tomography. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), Î³-glutamyl transferase (GGT), total bilirubin (TBil), albumin(ALB) and international normalized ratio (INR) of 324 cases at baseline were 27.86 ± 20.02 U/L, 29.33 ± 21.02 U/L, 59.93 ± 18.96 U / L, 39.00 ± 54.44 U/L, 9.46 ± 4.58 µmol / L, 40.64 ± 4.13 g / L and 1.02 ± 0.10. Of which, ALT was > than the upper limit of normal (> ULN), accounting for 15.7% (51/324). ALT and AST > ULN, accounting for 10.5% (34/324). ALP > ULN, accounting for 1.2% (4/324). ALP and GGT > ULN, accounting for 0.9% (3/324). INR > ULN was lowest, accounting for 0.6% (2/324). There were no statistically significant differences (P > 0.05) in ALT [(21.5 vs. 26) U / L, P = 0.093], ALP [(57 vs.59) U/L, P = 0.674], and GGT [(24 vs.28) U/L, P = 0.101] between the severe group and the mild group. There were statistically significant differences in AST (23 U/L vs. 34 U/L, P < 0.01), TBil (10.75 vs. 8.05 µmol / L, P < 0.01), ALB (35.79 ± 4.75 vs. 41.07 ± 3.80 g/L, P < 0.01), and INR (1.00 vs. 1.04, P < 0.01). Conclusion: The baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia in Shanghai area was comparatively lower and the liverinjury degree was mild, and the bile duct cell damage was rare.


title: FDA-approved thiol-reacting drugs that potentially bind into the SARS-CoV-2 main protease, essential for viral replication

text: Emergent novel SARS-CoV-2 is responsible for the current pandemic outbreak of severe acute respiratory syndrome with high mortality among the symptomatic population worldwide. Given the absence of a current vaccine or specific antiviral treatment, it is urgent to search for FDA-approved drugs that can potentially inhibit essential viral enzymes. The inhibition of 3CLpro has potential medical application, due to the fact that it is required for processing of the first translated replicase polyproteins into a series of native proteins, which are essential for viral replication in the host cell. We employed an in silico approach to test if disulfiram, as well as its metabolites, and captopril could be used as potential antiviral drugs against COVID-19. We provide data on the potential covalent interaction of disulfiram and its metabolites with the substrate binding subsite of 3CLpro and propose a possible mechanism for the irreversible protease inactivation thought the reaction of the aforementioned compounds with the Cys145. Although, captopril is shown to be a potential ligand of 3CLpro, it is not recommended anti-COVID-19 therapy, due to the fact that it can induce the expression of the viral cellular receptor such as, angiotensin-converting enzyme ACE-2, and thus, making the patient potentially more susceptible to infection. On the other hand, disulfiram, an alcoholism-averting drug, has been previously proposed as an antimicrobial and anti-SARS and MERS agent, safe to use even at higher doses with low side effects, it is recommended to be tested for control of SARS-CoV-2 infection.Communicated by Ramaswamy H. Sarma.


Decreases in acute heart failure hospitalizations during COVID-19


Deceases in Acute Heart Failure Hospitalizations during COVID-19


title: COVID-19 in Colombia endpoints. Are we different, like Europe?

text: The infection by the new coronavirus (SARS-CoV-2) has taken the dimension of a pandemic, affecting more than 160 countries in a few weeks. In Colombia, despite the implementation of the rules established by the national government, exists an elevate concern both for mortality and for the limited capacity of the health system to respond effectively to the needs of patients infected. For Colombia, assuming a case fatality rate among people infected with SARS-CoV-2 of 0.6% (average data from the information reported for Latin American countries for March 18) (Table 1), the number of deaths, in one or two weeks, could be 16 and 243, respectively. These estimates differ markedly from those documented in countries such as Spain and Italy, in which COVID-19 case fatality rates exceed 8% (case of Italy) and from the percentage of patients who have required intensive care, which has ranged from 9% to 11% of patients in Mediterranean European countries. These differences could be explained due to: a) the percentage of the population at risk (individuals older than 60 years); b) a higher epidemiological exposure to viral respiratory infections associated with more frequent exposure to them, due to geographic and climatic conditions; c) less spread of the virus by location in the tropical zone; and d) earlier preventive measures to contain the spread of SARS-CoV-2 infection. Therefore, it is possible to establish that the situation in this country will be different from in European Mediterranean and that Colombia could have different endpoints from Spain and Italy.


title: How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection? A systematic review

text: OBJECTIVES: SARS-CoV-2 infection has now a global resonance. Data on how COVID-19 is affecting immunocompromised patients are however few. With our study we aimed to systematically review the current knowledge on SARS-CoV-2 cases in children and adults with immunosuppression, to evaluate outcomes in this special population. METHODS: A systematic review of literature was carried out to identify relevant articles, searching the EMBASE, Medline, and Google Scholar databases. Studies reporting data on pre-defined outcomes and related to immunosuppressed adults and children with SARS-CoV-2 were included. RESULTS: Sixteen relevant articles were identified with 110 immunosuppressed patients, mostly presenting cancer, along with transplantation and immunodeficiency. Cancer was more often associated with a more severe course, but not necessarily with a bad prognosis. Our data show that both children and adults with immunosuppression seem to have a favorable disease course, as compared to the general population. CONCLUSION: Immunosuppressed patients with COVID-19 seem to be few in relation to the overall figures, and to present a favorable outcome as compared to other comorbidities. This might be explained by a hypothetical protective role of a weaker immune response, determining a milder disease presentation and thus underdiagnosis. Nevertheless, surveillance on this special population should be encouraged.


title: LIPS method for the detection of SARS-CoV-2 antibodies to spike and nucleocapsid proteins

text: Profiling antibodies to SARS-CoV-2 can help to assess potential immune response after COVID-19 disease. Luciferase IP system (LIPS) assay is a sensitive method for quantitative detection of antibodies to antigens in their native conformation. We here describe LIPS to detect antibody responses to SARS-CoV-2 spike (S) and nucleocapsid (N) proteins in COVID-19 patients. The antibodies targeted both S and N fragments and gave a high assay sensitivity by identifying 26 out of 26 COVID-19 patients with N antigen or with three protein fragments when combined into a single reaction. The assay correlated well with ELISA method and was specific to COVID-19 as we saw no reactivity among uninfected healthy controls. Our results show that LIPS is a rapid and measurable method to screen antibody responses against SARS-CoV-2 antigens.


title: COVID-19 infection and treatment with hydroxychloroquine cause severe haemolysis crisis in a patient with glucose-6-phosphate dehydrogenase deficiency

text: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited genetic disorder caused by red cell enzymatic defects and is associated with haemolytic crisis when patients are exposed to oxidative agents (fava beans, drugs, infections). Hydroxychloroquine is suspected to trigger haemolytic crisis in G6PD-deficient patients, and off-label administration of this drug to patients infected with the novel coronavirus (SARS-CoV-2) could cause concern. We report here the first case of severe haemolytic crisis in a patient with G6PD deficiency, initiated by severe COVID-19 infection and hydroxychloroquine use. With worldwide spread of COVID-19, especially in regions with a high prevalence of G6PD deficiency, our case should alert physicians to this possible correlation.


Spinal anesthesia for Cesarean delivery in women with COVID-19 infection: questions regarding the cause of hypotension


Treatment adherence behaviours in rheumatic diseases during COVID-19 pandemic: a Latin American experience


title: Analysis of the evolution of the Sars-Cov-2 in Italy, the role of the asymptomatics and the success of Logistic model

text: In this letter we study the temporal evolution of the Sars-Cov-2 in Italy. The time window of the real data is between February 24 and March 25. After we upgrade the data until April 1.We perform the analysis with 4 different model and we think that the best candidate to describe correctly the italian situation is a generalized Logistic equation. We use two coupled differential equations that describe the evolution of the severe infected and the deaths. We have done this choice, because in Italy the pharyngeal swabs are made only to severe infected and so we have no information about asymptomatic people. An important observation is that the virus spreads between Regions with some delay; so we suggest that a different analysis region by region would be more sensible than that on the whole Italy. In particular the region Lombardia has a behaviour very fast with respect to the other ones. We show the behaviour of the total deaths and the total severe infected for Italy and five regions: Lombardia, Emilia Romagna, Veneto, Piemonte, Toscana. Finally we do an analysis of the peak and an estimation of how many lifes have been saved with the LockDown.


title: Environments, Behaviors, and Inequalities: Reflecting on the Impacts of the Influenza and Coronavirus Pandemics in the United States

text: In the past century, dramatic shifts in demographics, globalization and urbanization have facilitated the rapid spread and transmission of infectious diseases across continents and countries. In a matter of weeks, the 2019 coronavirus pandemic devastated communities worldwide and reinforced the human perception of frailty and mortality. Even though the end of this pandemic story has yet to unfold, there is one parallel that is undeniable when a comparison is drawn between the 2019 coronavirus and the 1918 influenza pandemics. The public health response to disease outbreaks has remained nearly unchanged in the last 101 years. Furthermore, the role of environments and human behaviors on the effect and response to the coronavirus pandemic has brought to light many of the historic and contemporaneous inequalities and injustices that plague the United States. Through a reflection of these pandemic experiences, the American burden of disparity and disproportionality on morbidity, mortality and overall social determinants of health has been examined. Finally, a reimagination of a post-coronavirus existence has also been presented along with a discussion of possible solutions and considerations for moving forward to a new and better normal.


title: AGILE-ACCORD: A Randomized, Multicentre, Seamless, Adaptive Phase I/II Platform Study to Determine the Optimal Dose, Safety and Efficacy of Multiple Candidate Agents for the Treatment of COVID-19: A structured summary of a study protocol for a randomised platform trial

text: OBJECTIVES: Phase I - To determine the optimal dose of each candidate (or combination of candidates) entered into the platform. Phase II - To determine the efficacy and safety of each candidate entered into the platform, compared to the current Standard of Care (SoC), and recommend whether it should be evaluated further in a later phase II & III platforms. TRIAL DESIGN: AGILE-ACCORD is a Bayesian multicentre, multi-arm, multi-dose, multi-stage open-label, adaptive, seamless phase I/II randomised platform trial to determine the optimal dose, activity and safety of multiple candidate agents for the treatment of COVID-19. Designed as a master protocol with each candidate being evaluated within its own sub-protocol (Candidate Specific Trial (CST) protocol), randomising between candidate and SoC with 2:1 allocation in favour of the candidate (N.B the first candidate has gone through regulatory approval and is expected to open to recruitment early summer 2020). Each dose will be assessed for safety sequentially in cohorts of 6 patients. Once a phase II dose has been identified we will assess efficacy by seamlessly expanding into a larger cohort. PARTICIPANTS: Patient populations can vary between CSTs, but the main eligibility criteria include adult patients (≥18 years) who have laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We will include both severe and mild-moderate patients defined as follows: Group A (severe disease) - patients with WHO Working Group on the Clinical Characteristics of COVID-19 infection 9-point ordinal scale of Grades 4 (hospitalised, oxygen by mask or nasal prongs), 5 (hospitalised, non-invasive ventilation or high flow oxygen), 6 (hospitalised, intubation and mechanical ventilation) or 7 (hospitalised, ventilation and additional organ support); Group B (mild-moderate disease) - ambulant or hospitalised patients with peripheral capillary oxygen saturation (SpO2) >94% RA. If any CSTs are included in the community setting, the CST protocol will clarify whether patients with suspected SARS-CoV-2 infection are also eligible. Participants will be recruited from England, North Ireland, Wales and Scotland. INTERVENTION AND COMPARATOR: Comparator is the current standard of care (SoC), in some CSTs plus placebo. Candidates that prevent uncontrolled cytokine release, prevention of viral replication, and other anti-viral treatment strategies are at various stages of development for inclusion into AGILE-ACCORD. Other CSTs will be added over time. There is not a set limit on the number of CSTs we can include within the AGILE-ACCORD Master protocol and we will upload each CST into this publication as each opens to recruitment. MAIN OUTCOMES: Phase I: Dose limiting toxicities using Common Terminology Criteria for Adverse Events v5 Grade ≥3 adverse events. Phase II: Agreed on a CST basis depending on mechanism of action of the candidate and patient population. But may include; time to clinical improvement of at least 2 points on the WHO 9-point category ordinal scale [measured up to 29 days from randomisation], progression of disease (oxygen saturation (SaO2) <92%) or hospitalization or death, or change in time-weighted viral load [measured up to 29 days from randomisation]. RANDOMISATION: Varies with CST, but default is 2:1 allocation in favour of the candidate to maximise early safety data. BLINDING (MASKING): For the safety phase open-label although for some CSTs may include placebo or SoC for the efficacy phase. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Varies between CSTs. However simulations have shown that around 16 participants are necessary to determine futility or promise of a candidate at a given dose (in efficacy evaluation alone) and between 32 and 40 participants are required across the dose-finding and efficacy evaluation when capping the maximum number of participants contributing to the evaluation of a treatment at 40. TRIAL STATUS: Master protocol version number v5 07 May 2020, trial is in setup with full regulatory approval and utilises several digital technology solutions, including Medidata's Rave EDC [electronic data capture], RTSM for randomisation and patient eConsent on iPads via Rave Patient Cloud. The recruitment dates will vary between CSTs but at the time of writing no CSTs are yet open for recruitment. TRIAL REGISTRATION: EudraCT 2020-001860-27 14th March 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: COVID-19: a collision of complement, coagulation and inflammatory pathways

text: COVID-19 is frequently accompanied by a hypercoagulable inflammatory state with microangiopathic pulmonary changes that can precede the diffuse alveolar damage characteristic of typical ARDS seen in other severe pathogenic infections. Parallels with systemic inflammatory disorders such as atypical haemolytic uraemic syndrome (aHUS) have implicated the complement pathway in the pathogenesis of COVID-19, and particularly the anaphylatoxins C3a and C5a released from cleavage of C3 and C5 respectively. C5a is a potent cell signalling protein that activates a cytokine storm - a hyper-inflammatory phenomenon - within hours of infection and the innate immune response. However, excess C5a can result in a pro-inflammatory environment orchestrated through a plethora of mechanisms, that propagates lung injury, lymphocyte exhaustion and an immune paresis. Furthermore, disruption of the homeostatic interactions between complement and extrinsic and intrinsic coagulation pathways contributes to a net pro-coagulant state in the microvasculature of critical organs. Fatal COVID-19 has been associated with a systemic inflammatory response accompanied by a pro-coagulant state and organ damage, particularly microvascular thrombi in the lungs and kidneys. Pathologic studies report strong evidence of complement activation. C5 blockade reduces inflammatory cytokines and their manifestations in animal studies, and has shown benefits in patients with aHUS, prompting investigation of this approach in the treatment of COVID-19. This review describes the role of the complement pathway and particularly C5a and its aberrations in highly pathogenic virus infections, and therefore its potential as a therapeutic target in COVID-19.


title: Direct and indirect impacts of high-tech industry development on CO2 emissions: empirical evidence from China

text: Vigorously developing high-tech industry has been considered to be an effective way to coordinate economic growth with excessive carbon dioxide (CO2) emissions. However, previous studies have not explored the heterogeneous impacts of high-tech industry on CO2 emissions in regions with different levels of high-tech industry development, and not distinguished the direct and indirect impacts. Based on STIRPAT model, this study investigates the impacts of high-tech industry development on CO2 emissions in China between 2005 and 2016. Adopting the K-medians cluster method, effects in regions with high, middle, and low levels of high-tech industry development are considered. Indirect effects of high-tech industry development on CO2 emissions by affecting industry structure upgrades and economic growth are explored. Empirical results illustrate a positive U-shaped nonlinear link between the level of high-tech industry development and CO2 emissions at the national level and regional (high, middle, and low) level. In terms of indirect impacts, high-tech industry development attenuates the reduction of CO2 emissions due to industry structure upgrades, and promotes economic growth to increase CO2 emissions slightly. The indirect impact intensity gradually decreases as the level of high-tech industry development decreases across three regions. Reasonable implications of our findings are proposed.


COVID-19: ICU delirium management during SARS-CoV-2 pandemic-pharmacological considerations


Simulation of Pool Testing to Identify Patients With Coronavirus Disease 2019 Under Conditions of Limited Test Availability


title: Epidemiology of the 2020 Pandemic of COVID-19 in the State of Texas: The First Month of Community Spread

text: The pandemic of novel Coronavirus (SARS-CoV-2) is currently spreading rapidly across the United States. We provide a comprehensive overview of COVID-19 epidemiology across the state of Texas, which includes vast rural & vulnerable communities that may be disproportionately impacted by the spread of this new disease. All 254 Texas counties were included in this study. We examined the geographic variation of COVID-19 from March 1 through April 8, 2020 by extracting data on incidence and case fatality from various national and state datasets. We contrasted incidence and case fatality rates by county-level demographic and healthcare resource factors. Counties which are part of metropolitan regions, such as Harris and Dallas, experienced the highest total number of confirmed cases. However, the highest incidence rates per 100,000 population were in found in counties of Donley (353.5), Castro (136.4), Matagorda (114.4) and Galveston (93.4). Among counties with greater than 10 cases, the highest CFR were observed in counties of Comal (10.3%), Hockley (10%), Hood (10%), and Castro (9.1%). Counties with the highest CFR (> 10%) had a higher proportion of non-Hispanic Black residents, adults aged 65 and older, and adults smoking, but lower number of ICU beds per 100,000 population, and number of primary care physicians per 1000 population. Although the urban areas of Texas account for the majority of COVID-19 cases, the higher case-fatality rates and low health care capacity in rural areas need attention.


The pandemic of coronavirus: tackling the latest plague


Corona-Pandemie und Zukunft der ambulanten und stationären Urologie? : Subjektive Meinung aus einem "Hotspot"./ [Coronavirus pandemic and the future of outpatient and inpatient urology? : Subjective opinion from a "hotspot"]


Late onset of acral necrosis after SARS-CoV-2 infection resolution


Patients with diabetes are at higher risk for severe illness from COVID-19


title: Using Information Technology to Manage the COVID-19 Pandemic: Development of a Technical Framework Based on Practical Experience in China

text: BACKGROUND: The coronavirus disease (COVID-19) epidemic poses an enormous challenge to the global health system, and governments have taken active preventive and control measures. The health informatics community in China has actively taken action to leverage health information technologies for epidemic monitoring, detection, early warning, prevention and control, and other tasks. OBJECTIVE: The aim of this study was to develop a technical framework to respond to the COVID-19 epidemic from a health informatics perspective. METHODS: In this study, we collected health information technology-related information to understand the actions taken by the health informatics community in China during the COVID-19 outbreak and developed a health information technology framework for epidemic response based on health information technology-related measures and methods. RESULTS: Based on the framework, we review specific health information technology practices for managing the outbreak in China, describe the highlights of their application in detail, and discuss critical issues to consider when using health information technology. Technologies employed include mobile and web-based services such as Internet hospitals and Wechat, big data analyses (including digital contact tracing through QR codes or epidemic prediction), cloud computing, Internet of things, Artificial Intelligence (including the use of drones, robots, and intelligent diagnoses), 5G telemedicine, and clinical information systems to facilitate clinical management for COVID-19. CONCLUSIONS: Practical experience in China shows that health information technologies play a pivotal role in responding to the COVID-19 epidemic.


title: The role of digital mental health resources to treat trauma symptoms in australia during COVID-19

text: Demand for telehealth services with psychologists and other health professionals has increased during the COVID-19 pandemic, and as a result some members of the community are unable to access face-to-face assistance for trauma-related mental health issues. This has led to an increase in usage of alternative digital mental health options such as smartphone apps and other Internet-enabled assistance. The Australian Federal Government has promoted digital mental health options for many years, and it has a comprehensive architecture of digital resources in place, but will it be enough to deal with the expected rise in symptoms of trauma among the general population in the wake of COVID-19? (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19 Epidemic? An Analysis on All-Causes Mortality Data in Italy

text: Objective: Overall mortality is a relevant indicator of the population burden during an epidemic. It informs on both undiagnosed cases and on the effects of health system disruption. Methods: We aimed at evaluating the extent of the total death excess during the COVID-19 epidemic in Italy. Data from 4433 municipalities providing mortality reports until April 15th, 2020 were included for a total of 34.5 million residents from all Italian regions. Data were analyzed by region, sex and age, and compared to expected from 2015-2019. Results: In both genders, overall mortality was stable until February 2020 and abruptly increased from March 1st onwards. Within the municipalities studied, 77,339 deaths were observed in the period between March 1st to April 15th, 2020, in contrast to the 50,822.6 expected. The rate ratio was 1.11 before age 60 and 1.55 afterwards. Both sexes were affected. The excess was greater in the regions most affected by COVID-19 but always exceeded the deaths attributed to COVID-19. The extrapolation to the total Italian population suggests an excess of 45,033 deaths in the study period, while the number of COVID-19 deaths was 21,046. Conclusion: Our paper shows a large death excess during the COVID-19 epidemic in Italy; greater than the number attributed to it. Possible causes included both the undetected cases and the disruption of the Health Service organization. Timely monitoring of overall mortality based on unbiased nationwide data is an essential tool for epidemic control.


COVID-19 Epidemic: Possibility of Artificial Intelligence in Infection Control and Prevention


Five tips for moving teaching online as COVID-19 takes hold


title: The outbreak of COVID-19: An overview

text: In late December 2019, a previous unidentified coronavirus, currently named as the 2019 novel coronavirus#, emerged from Wuhan, China, and resulted in a formidable outbreak in many cities in China and expanded globally, including Thailand, Republic of Korea, Japan, United States, Philippines, Viet Nam, and our country (as of 2/6/2020 at least 25 countries). The disease is officially named as Coronavirus Disease-2019 (COVID-19, by WHO on February 11, 2020). It is also named as Severe Pneumonia with Novel Pathogens on January 15, 2019 by the Taiwan CDC, the Ministry of Health and is a notifiable communicable disease of the fifth category. COVID-19 is a potential zoonotic disease with low to moderate (estimated 2%-5%) mortality rate. Person-to-person transmission may occur through droplet or contact transmission and if there is a lack of stringent infection control or if no proper personal protective equipment available, it may jeopardize the first-line healthcare workers. Currently, there is no definite treatment for COVID-19 although some drugs are under investigation. To promptly identify patients and prevent further spreading, physicians should be aware of the travel or contact history of the patient with compatible symptoms.


COVID-19: The Underestimated Pandemic Impacting People With Diabetes


US Public Concerns About the COVID-19 Pandemic From Results of a Survey Given via Social Media


title: End-to-end automatic differentiation of the coronavirus disease 2019 (COVID-19) from viral pneumonia based on chest CT

text: PURPOSE: In the absence of a virus nucleic acid real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test and experienced radiologists, clinical diagnosis is challenging for viral pneumonia with clinical symptoms and CT signs similar to that of coronavirus disease 2019 (COVID-19). We developed an end-to-end automatic differentiation method based on CT images to identify COVID-19 pneumonia patients in real time. METHODS: From January 18 to February 23, 2020, we conducted a retrospective study and enrolled 201 patients from two hospitals in China who underwent chest CT and RT-PCR tests, of which 98 patients tested positive for COVID-19 (118 males and 83 females, with an average age of 42 years). Patient CT images from one hospital were divided among training, validation and test datasets with an 80%:10%:10% ratio. An end-to-end representation learning method using a large-scale bi-directional generative adversarial network (BigBiGAN) architecture was designed to extract semantic features from the CT images. The semantic feature matrix was input for linear classifier construction. Patients from the other hospital were used for external validation. Differentiation accuracy was evaluated using a receiver operating characteristic curve. RESULTS: Based on the 120-dimensional semantic features extracted by BigBiGAN from each image, the linear classifier results indicated that the area under the curve (AUC) in the training, validation and test datasets were 0.979, 0.968 and 0.972, respectively, with an average sensitivity of 92% and specificity of 91%. The AUC for external validation was 0.850, with a sensitivity of 80% and specificity of 75%. Publicly available architecture and computing resources were used throughout the study to ensure reproducibility. CONCLUSION: This study provides an efficient recognition method for coronavirus disease 2019 pneumonia, using an end-to-end design to implement targeted and effective isolation for the containment of this communicable disease.


title: Answering Questions on COVID-19 in Real-Time

text: The recent outbreak of the novel coronavirus is wreaking havoc on the world and researchers are struggling to effectively combat it. One reason why the fight is difficult is due to the lack of information and knowledge. In this work, we outline our effort to contribute to shrinking this knowledge vacuum by creating covidAsk, a question answering (QA) system that combines biomedical text mining and QA techniques to provide answers to questions in real-time. Our system leverages both supervised and unsupervised approaches to provide informative answers using DenSPI (Seo et al., 2019) and BEST (Lee et al., 2016). Evaluation of covidAsk is carried out by using a manually created dataset called COVID-19 Questions which is based on facts about COVID-19. We hope our system will be able to aid researchers in their search for knowledge and information not only for COVID-19 but for future pandemics as well.


title: Electrocardiographic features of patients with COVID-19 pneumonia

text: BACKGROUND: . The electrocardiographic (ECG) changes which may occur during hospitalization for COVID-19 have not yet been comprehensively assessed. PATIENTS AND METHODS: . We examined 50 patients admitted to hospital with proven COVID-19 pneumonia. At entry, all patients underwent a detailed clinical examination, 12-lead ECG, laboratory tests and arterial blood gas test. ECG was also recorded at discharge and in case of worsening clinical conditions. RESULTS: . Mean age of patients was 64 years and 72% were men. At baseline, 30% of patients had ST-T abnormalities, and 33% had left ventricular hypertrophy. During hospitalization, 26% of patients developed new ECG abnormalities which included atrial fibrillation, ST-T changes, tachy-brady syndrome, and changes consistent with acute pericarditis. One patient was transferred to intensive care unit for massive pulmonary embolism with right bundle branch block, and another for non-ST segment elevation myocardial infarction. Patients free of ECG changes during hospitalization were more likely to be treated with antiretrovirals (68% vs 15%, p = 0.001) and hydroxychloroquine (89% vs 62%, p = 0.026) versus those who developed ECG abnormalities after admission. Most measurable ECG features at discharge did not show significant changes from baseline (all p>0.05) except for a slightly decrease in Cornell voltages (13±6 vs 11±5 mm; p = 0.0001) and a modest increase in the PR interval. The majority (54%) of patients with ECG abnormalities had 2 prior consecutive negative nasopharyngeal swabs. ECG abnormalities were first detected after an average of about 30 days from symptoms' onset (range 12-51 days). CONCLUSIONS: . ECG abnormalities during hospitalization for COVID-19 pneumonia reflect a wide spectrum of cardiovascular complications, exhibit a late onset, do not progress in parallel with pulmonary abnormalities and may occur after negative nasopharyngeal swabs.


title: Short epidemiological overview of the current situation on COVID-19 pandemic in Southeast European (SEE) countries

text: We are living in times where a viral disease has brought normal life in much of the world to a halt. The novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) started in December 2019 in Wuhan, China initially and in a short time crossed the European borders. After mitigating the epidemic in China, Italy became one of the most COVID-19 affected countries worldwide. International travelers are important sources of infectious diseases and a possible source of epidemic. Due to its political, geographic, and cultural similarities, Italy is one of the main economic partners of Southeast European (SEE) countries. Our data show that infection in index cases in all 11 SEE countries was travel-related with Italy being a source country for 8/11 countries. After the first case identifications on February 25, the number of cases in SEE countries is continually rising reaching the total number of 15,612 with 565 fatal cases and overall case fatality ratio (CFR) of 3.6 (median 3.8, range 0.8-5.5) by April 10, 2020. At a time when the COVID-19 pandemic is approaching its peak, apart from the problems with treatment of the disease and care for critically ill patients, there are other equally important problems, such as organization of outbreak response, provision of health care, lack of hospital personnel, disruption of personal protective equipment supply chains and health care workers (HCWs) protection. But what is more important is the heroic behavior of the HCWs who are showing their humanity by disregarding their lives.


title: COVIDX-Net: A Framework of Deep Learning Classifiers to Diagnose COVID-19 in X-Ray Images

text: Background and Purpose: Coronaviruses (CoV) are perilous viruses that may cause Severe Acute Respiratory Syndrome (SARS-CoV), Middle East Respiratory Syndrome (MERS-CoV). The novel 2019 Coronavirus disease (COVID-19) was discovered as a novel disease pneumonia in the city of Wuhan, China at the end of 2019. Now, it becomes a Coronavirus outbreak around the world, the number of infected people and deaths are increasing rapidly every day according to the updated reports of the World Health Organization (WHO). Therefore, the aim of this article is to introduce a new deep learning framework; namely COVIDX-Net to assist radiologists to automatically diagnose COVID-19 in X-ray images. Materials and Methods: Due to the lack of public COVID-19 datasets, the study is validated on 50 Chest X-ray images with 25 confirmed positive COVID-19 cases. The COVIDX-Net includes seven different architectures of deep convolutional neural network models, such as modified Visual Geometry Group Network (VGG19) and the second version of Google MobileNet. Each deep neural network model is able to analyze the normalized intensities of the X-ray image to classify the patient status either negative or positive COVID-19 case. Results: Experiments and evaluation of the COVIDX-Net have been successfully done based on 80-20% of X-ray images for the model training and testing phases, respectively. The VGG19 and Dense Convolutional Network (DenseNet) models showed a good and similar performance of automated COVID-19 classification with f1-scores of 0.89 and 0.91 for normal and COVID-19, respectively. Conclusions: This study demonstrated the useful application of deep learning models to classify COVID-19 in X-ray images based on the proposed COVIDX-Net framework. Clinical studies are the next milestone of this research work.


Nursing research is coronavirus research


title: COVID-19 (Sars-cov 2/Koronavirüs-19) tedavisinde klinikte kullanilan geleneksel Çin tibbi bitkileri ve kardiyovasküler sisteme etkileri./ Traditional Chinese medicine practices used in COVID-19 (Sars-cov 2/Coronavirus-19) treatment in clinic and their effects on the cardiovascular system

text: OBJECTIVE: The aim of this study was to evaluate the effectiveness of plants used in the formulations of traditional Chinese medicine (TCM), which were also used in clinical trials to treat patients with the novel coronavirus COVID-19, and to assess their effects on the cardiovascular system. METHODS: A literature review of PubMed, ResearchGate, ScienceDirect, the Cochrane Library, and TCM monographs was conducted and the effects of the plants on the cardiovascular system and the mechanisms of action in COVID-19 treatment were evaluated. RESULTS: The mechanism of action, cardiovascular effects, and possible toxicity of 10 plants frequently found in TCM formulations that were used in the clinical treatment of COVID-19 were examined. CONCLUSION: TCM formulations that had been originally developed for earlier viral diseases have been used in COVID-19 treatment. Despite the effectiveness seen in laboratory and animal studies with the most commonly used plants in these formulations, the clinical studies are currently insufficient according to standard operating procedures. More clinical studies are needed to understand the safe clinical use of traditional plants.


Lessons from Influenza Outbreaks for Potential Impact of COVID-19 Outbreak on Hospitalizations, Ventilator Use, and Mortality Among Homeless Persons in New York State


Covid-19: Hancock is urged to make testing strategy clearer


Application of plasma exchange in association with higher dose CVVH in Cytokine Storm Complicating COVID-19


title: Thousands Of Lives Could Be Saved In The US During The COVID-19 Pandemic If States Exchanged Ventilators

text: It is thought that there are not enough mechanical ventilators in the United States for every patient who may need one during the novel coronavirus disease (COVID-19) pandemic. However, there has been no analysis that measures the potential magnitude of the problem or proposes a solution. In this article I combine the pandemic forecasting model used by the federal government with estimates of ventilator availability from the literature to assess the expected shortage under various scenarios. I then propose that the federal government organize a national effort for ventilators to be exchanged between states to take advantage of the intertemporal differences in demand peaks. I evaluate versions of this proposal, including use of the national stockpile, to estimate the potentially substantial number of lives that could be saved. In the absence of other viable solutions, the government should begin this effort in earnest, or else make preparations for such coordination should the country face another pandemic in the future.


Commentary: COVID-19 in patients with diabetes


title: Treatment of coronavirus disease 2019 in Shandong, China: a cost and affordability analysis

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is now a global public threat. Given the pandemic of COVID-19, the economic impact of COVID-19 is essential to add value to the policy-making process. We retrospectively conducted a cost and affordability analysis to determine the medical costs of COVID-19 patients in China, and also assess the factors affecting their costs. METHODS: This analysis was retrospectively conducted in Shandong Provincial Chest Hospital between 24 January and 16 March 2020. The total direct medical expenditures were analyzed by cost factors. We also assessed affordability by comparing the simulated out-of-pocket expenditure of COVID-19 cases relative to the per capita disposable income. Differences between groups were tested by student t test and Mann-Whitney test when appropriate. A multiple logistic regression model was built to determine the risk factors associated with high cost. RESULTS: A total of 70 COVID-19 patients were included in the analysis. The overall mean cost was USD 6827 per treated episode. The highest mean cost was observed in drug acquisition, accounting for 45.1% of the overall cost. Total mean cost was significantly higher in patients with pre-existing diseases compared to those without pre-existing diseases. Pre-existing diseases and the advanced disease severity were strongly associated with higher cost. Around USD 0.49 billion were expected for clinical manage of COVID-19 in China. Among rural households, the proportions of health insurance coverage should be increased to 70% for severe cases, and 80% for critically ill cases to avoid catastrophic health expenditure. CONCLUSIONS: Our data demonstrate that clinical management of COVID-19 patients incurs a great financial burden to national health insurance. The cost for drug acquisition is the major contributor to the medical cost, whereas the risk factors for higher cost are pre-existing diseases and severity of COVID-19. Improvement of insurance coverage will need to address the barriers of rural patients to avoid the occurrence of catastrophic health expenditure.


title: COVID-19 and Kawasaki syndrome: should we really be surprised?

text: A hyperinflammatory response to COVID-19 is being described in children. While this presents, and responds to management, similar to that of Kawasaki Disease it is being coined a new entity. But is it really? We explore how this phenomenon may be Kawasaki Disease with a new trigger.


Hidradenitis suppurativa: The importance of virtual outpatient care during COVID-19 pandemic


title: Effect of COVID-19 Pandemic on Oceans

text: The novel corona virus (COVID-19) has slowed down a lot of human activities in the world. A lockdown for a period of 2 months, due to the pandemic, was enough to cause a drop of 7% of the anthropogonic CO2 in the atmosphere. In addition to the world in general, the excess of the anthropogonic CO2 emission in the atmosphere has always been a threat to the oceans as well. Oceans play a key role to buffer the greenhouse effect, but in the process, it becomes warmer, more acidic, and less oxygenated. While there have already been investigations done on the effect of pandemic on atmosphere, the question what happens to oceans during the pandemic remains unanswered. The aim of this paper is to study the pandemic's effect and the resultant reduction in CO2 emissions on the productivity of the global oceans. Often Chlorophyll-a (Chl-a), Particulate organic and inorganic carbon (PIC:POC) and sea surface temperature(SST), are used to indicate the productivity of oceans. Herein, satellite-derived estimates of the aforementioned parameters are used. Based on these estimates, a drop in Chl-a (0.5 mgm-3) is observed off Alaska, North Europe,South China and Southeast USA during the pandemic. CO2 reduction of 123 MtCO2 during the pandemic in China might have caused reduction in mean Chl-a by around 5% (2.5 to 1.6 mgm-3). Reduction of Chl-a during the pandemic is mostly associated with the reduction of PIC:POC. The pandemic demonstrates noticeable effect on Chl-a and/or SST. A cooling response of 0.5 oC in mean SST is observed over most of the coastal areas, especially off Alaska,north Indian ocean and eastern Pacific. The decrease in the CO2 emissions in India by 30% during the pandemic translates into a drop of mean SST in the north Indian ocean by 5% (from 29.95 to 28.46 oC). All these suggest that maintaining global activities as sustainable as the pandemic period, can help to recover the oceans.


title: Cardiological Society of India: Document on acute MI care during COVID-19

text: The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.


title: Youth injury and parents' unemployment-the importance of socio-economic status and ethnicity context

text: BACKGROUND: Youth whose parents are unemployed have poorer health and well-being, including more injuries that result in hospitalization. The current study examined the possibility of an association of parents' employment status with youth injury and the interaction of this status with other socio-economic factors and ethnicity. METHODS: We distributed to adolescents aged 11-15 years, in class, the Israel Health Behavior in School-Aged Children Survey. We distinguished between any injury and severe injury, defining the latter as one necessitating the use of a cast, stitches and crutches or overnight hospitalization. RESULTS: Of 13 705 respondents, 6224 (45%) had an injury in the past year that required medical treatment and 1827 pupils (13.5%) reported severe injuries. The odds of any injury were 1.86 for boys as against girls (95% confidence interval [CI] 1.73-1.99), 0.80 for school grade (95% CI 0.78-0.82), 1.56 for Arabs vs. Jews (95% CI 1.43-1.70) and 1.10 for high Family Affluence Scale (FAS) vs. medium FAS (95% CI 1.01-1.21). Only in the low FAS group, when two parents were unemployed, the odds for severe injury was 1.36 (95% CI 1.03-1.78); when one or two parents were employed, the odds of severe child injury were the same (OR 1.13 and 95% CI 0.92-1.40). CONCLUSION: Factors that were found to increase the risk of injury among youth were parental unemployment, low socio-economic status and Arab ethnicity. The home environment was the most common place for injury.


title: Significant applications of virtual reality for COVID-19 pandemic

text: BACKGROUND AND AIMS: During COVID-19 pandemic, researchers are using innovative technologies for fast-tracking the development to end this menace. Virtual Reality (VR) also offers an imperative role for fighting this pandemic, through audiovisual-based virtual communication. METHODS: A brief study on Virtual Reality and its applications for the COVID-19 pandemic is carried out by employing keywords as Virtual reality or VR and COVID-19 from the databases of SCOPUS, Google Scholar, PubMed, Web of science Academia and ResearchGate. RESULTS: VR is beneficial for remote sites for exploring telemedicine, planning, treatment, and controlling of the infections by providing proper awareness to the people regarding this disease. CONCLUSIONS: VR technology develops a platform to reduce the face to face interaction of doctors with the infected COVID-19 patients. Through live video streaming, it helps to improve surveillance systems on the ongoing situation.


In Response to COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review


Trump claims public health warnings on covid-19 are a conspiracy against him


Covid-19: adverse mental health outcomes for healthcare workers


title: Managing COVID-19 Pandemic without Destructing the Economy

text: We analyze an approach to managing the COVID-19 pandemic without shutting down the economy while staying within the capacity of the healthcare system. We base our analysis on a detailed heterogeneous epidemiological model, which takes into account different population groups and phases of the disease, including incubation, infection period, hospitalization, and treatment in the intensive care unit (ICU). We model the healthcare capacity as the total number of hospital and ICU beds for the whole country. We calibrate the model parameters to data reported in several recent research papers. For high- and low-risk population groups, we calculate the number of total and intensive care hospitalizations, and deaths as functions of time. The main conclusion is that countries, which enforce reasonable hygienic measures on time can avoid lockdowns throughout the pandemic provided that the number of spare ICU beds per million is above the threshold of about 100. In countries where the total number of ICU beds is below this threshold, a limited period quarantine to specific high-risk groups of the population suffices. Furthermore, in the case of an inadequate capacity of the healthcare system, we incorporate a feedback loop and demonstrate that quantitative impact of the lack of ICU units on the death curve. In the case of inadequate ICU beds, full- and partial-quarantine scenarios outcomes are almost identical, making it unnecessary to shut down the whole economy. We conclude that only a limited-time quarantine of the high-risk group might be necessary, while the rest of the economy can remain operational.


COVID-19 pandemic, infodemic and the role of eHealth literacy


To consider or not antimalarials as a prophylactic intervention in the SARS-CoV-2 (COVID-19) pandemic


Serum IgA, IgM, and IgG responses in COVID-19


Coexistent COVID-19 pneumonia and pulmonary embolism: challenges in identifying dual pathology


title: Preliminary estimation of the novel coronavirus disease (COVID-19) cases in Iran: A modelling analysis based on overseas cases and air travel data

text: As of March 1, 2020, Iran had reported 987 novel coronavirus disease (COVID-19) cases, including 54 associated deaths. At least six neighboring countries (Bahrain, Iraq, Kuwait, Oman, Afghanistan, and Pakistan) had reported imported COVID-19 cases from Iran. In this study, air travel data and the numbers of cases from Iran imported into other Middle Eastern countries were used to estimate the number of COVID-19 cases in Iran. It was estimated that the total number of cases in Iran was 16 533 (95% confidence interval: 5925-35 538) by February 25, 2020, before the UAE and other Gulf Cooperation Council countries suspended inbound and outbound flights from Iran.


Letter to the editor regarding "How to avoid nosocomial spread during tracheostomy for Covid-19 patients"


Specific Considerations for Pediatric, Fetal, and Congenital Heart Disease Patients and Echocardiography Service Providers during the 2019 Novel Coronavirus Outbreak: Council on Pediatric and Congenital Heart Disease Supplement to the Statement of the American Society of Echocardiography: Endorsed by the Society of Pediatric Echocardiography and the Fetal Heart Society


title: A SARS-CoV-2 familial cluster infection reveals asymptomatic transmission to children

text: Information on SARS-CoV-2 asymptomatic infection and infectivity in children is limited. In this study, we aimed to report the epidemiological and clinical characteristics of a familial cluster infection including children with SARS-CoV-2. On February 1, 2020, two children(case 1 and case 2), an 8-year-old girl and a 9-year-old boy, were admitted to the isolation ward in Xiangyang Central Hospital, Hubei province, China, with the diagnosis of COVID-19. Before admission, they had been staying at home with their father and never contacted with any confirmed patients except their mother (case 3) who returned from Wuhan on January 22. Both case 1 and case 2 got mild symptoms. Case 3 did not develop any symptoms until February 6, 2020, with an asymptomatic period of 15 days. She was transferred to ICU and administered multiple treatment according to the disease progression and chest CT manifestations. Her nucleic acid test turned positive until Feb 21, 2020, 15 days after symptoms onset, 30 days after her return from Wuhan. Our data showed that patients with SARS-CoV-2 may have the ability to transmit during their asymptomatic period even with the negative of viral nucleic acid in pharyngeal swabs.


title: Sickle Cell Trait and The Potential Risk of Severe Coronavirus Disease 2019- A Mini-Review

text: Coronavirus Disease 2019 (COVID-19) pandemic is a rapidly evolving public health problem. The severity of COVID-19 cases reported hitherto has varied greatly from asymptomatic to severe pneumonia and thromboembolism with subsequent mortality. An improved understanding of risk factors for adverse clinical outcomes may shed some light on novel personalized approaches to optimize clinical care in vulnerable populations. Emerging trends in the United States suggest possibly higher mortality rates of COVID-19 amongst African Americans, although detailed epidemiological study data is pending. Sickle Cell Disease (SCD) disproportionately affect Black/African Americans in the United States as well as forebearers from sub-Saharan Africa, the Western Hemisphere (South America, the Caribbean, and Central America) and some Mediterranean countries. The carrier frequency for SCD is high amongst African Americans. This article underscores the putative risks that may be associated with COVID-19 pneumonia in sickle cell trait as well as potential opportunities for individualized medical care in the burgeoning era of personalized medicine.


title: Self-reported alteration of sense of smell or taste in patients with COVID-19: a systematic review and meta-analysis on 3563 patients

text: BACKGROUND: Emerging reports suggest that new onset of smell or taste loss are potential early clinical markers of SARS-CoV-2 infection, but it remains unclear as to what extent. Therefore, the purpose of this study is to systematically assess the prevalence of self-reported altered sense of smell or taste in patients with confirmed SARS-CoV-2 infection, overcoming the limitations of individual studies by meta-analysis of pooled data. METHODS: The databases Medline, Embase, Web of Science, Scopus and MedRxiv's set were searched from inception to the 4th May 2020. This study was conducted following the PRISMA checklist. RESULTS: 18 studies met the eligibility criteria out of the 171 initially screened citations. The overall prevalence of alteration of the sense of smell or taste was 47% , but estimates were 31% and 67% in severe and mild-to-moderate symptomatic patients, respec- tively. The loss of smell and taste preceded other symptoms in 20% of cases and it was concomitant in 28%. CONCLUSIONS: Based on this meta-analysis, we recommend self-isolation and testing, where possible, for patients complaining smell or taste impairment during COVID-19 pandemic in order to prevent spread of disease and propose the inclusion of loss of smell and taste as recognized symptoms of SARS-CoV-2 in the World Health Organization and other relevant regulatory body's lists.


title: Successful intravenous immunoglobulin treatment in severe COVID-19 pneumonia

text: We describe a 42-year old woman, admitted to our Department after 15 days of persistence of respiratory failure and treated with infusion of intravenous immunoglobulin with a successful outcome.


title: COVID -19 and the state of African neurology

text: Expectations of Africa having high rates of infection and death from COVID-19 have, as yet, not materialised. At the time of writing, all 54 countries have officially reported COVID-19 cases; 123,724 people have tested positive for the disease and 3,668 people have died. The reasons for such low levels may be due, in part, to countries rapid responses: South Africa declared a national state of disaster and implemented a nationwide lockdown before even its first death was reported and likewise Uganda suspended all public gatherings before the country reported its first case. In Ethiopia-where the first case was reported March 13-the office of the Prime Minister announced that schools, sporting events, and public gatherings should be suspended for 15 days, on March 16. In Addis Ababa, on April 8, the Council of Ministers declared a 5-month long state of emergency.


title: The impact of undetected cases on tracking epidemics: the case of COVID-19

text: One of the key indicators used in tracking the evolution of an infectious disease isthe reproduction number. This quantity is usually computed using the reportednumber of cases, but ignoring that many more individuals may be infected (e.g.asymptomatics). We propose a statistical procedure to quantify the impact of un-detected infectious cases on the determination of the effective reproduction number. Our approach is stochastic, data-driven and not relying on any compartmentalmodel. It is applied to the COVID-19 case in eight different countries and all Italianregions, showing that the effect of undetected cases leads to estimates of the effective reproduction numbers larger than those obtained only with the reported cases by factors ranging from two to ten. Our findings urge caution about deciding when and how to relax containment measures based on the value of the reproduction number.


title: Psychological health during the coronavirus disease 2019 pandemic outbreak

text: BACKGROUND: The current ongoing pandemic outbreak of COVID-19 (Coronavirus Disease 2019) has globally affected 213 countries and territories with more than 2.5 million confirmed cases and thousands of casualties. The unpredictable and uncertain COVID-19 outbreak has the potential of adversely affecting the psychological health on individual and community level. Currently all efforts are focused on the understanding of epidemiology, clinical features, mode of transmission, counteract the spread of the virus, and challenges of global health, while crucially significant mental health has been overlooked in this endeavor. METHOD: This review is to evaluate past outbreaks to understand the extent of adverse effects on psychological health, psychological crisis intervention, and mental health management plans. Published previous and current articles on PubMed, EMBASE, Google Scholar, and Elsevier about psychological impact of infectious diseases outbreaks and COVID-19 has been considered and reviewed. COMMENTS: COVID-19 is leading to intense psychosocial issues and comprising mental health marking a secondary health concern all around the world. Globally implementing preventive and controlling measures, and cultivating coping and resilience are challenging factors; modified lifestyle (lockdown curfew, self-isolation, social distancing and quarantine); conspiracy theories, misinformation and disinformation about the origin, scale, signs, symptoms, transmission, prevention and treatment; global socioeconomic crisis; travel restrictions; workplace hazard control; postponement and cancellation of religious, sports, cultural and entertainment events; panic buying and hoarding; incidents of racism, xenophobia, discrimination, stigma, psychological pressure of productivity, marginalization and violence; overwhelmed medical centers and health organizations, and general impact on education, politics, socioeconomic, culture, environment and climate - are some of the risk factors to aggravate further problems.


title: Corona virus versus existence of human on the earth: A computational and biophysical approach

text: SARS-CoV-2 has a positive sense RNA genome of 29.9 kb in size, showing high sequence similarity to the BAT-CoV, SARS-CoV, MERS-CoV. SARS-CoV-2 is composed of 14 open reading frames (ORFs), which encodes for a total of 27 proteins divided into structural and non-structural proteins (NSPs). The fundamental structural protein-encoding genes are a spike protein (S) gene, envelope protein (E) gene, a membrane protein (M) gene, and a nucleocapsid protein (N) gene. They make about 33% of the entire genome and are vital for the viral life cycle. Rest 67% is distributed among different NSPs (such as Mpro, helicase, and RNA-dependent RNA polymerase) encoding genes across the ORFs, which are involved in virus-cell receptor interactions during viral entry. Researchers are trying to formulate vaccines, therapeutic antibodies or protein-targeted antiviral drugs to control the spread. This review proceeds stepwise through the COVID-19 outbreak, structural and genomic organization, entry mechanism, pathogenesis, and finally highlighting the essential proteins involved at each step that might be potential targets for drug discovery. Currently, approved treatment modalities consist of only supportive care and oxygen supplementation. This review is established on the current knowledge that has expanded on structural motifs and topology of proteins and their functions.


Rethinking Regional Neurologic Care in the Coronavirus Disease 2019 Era


title: La pandemia de Coronavirus SARS-CoV-2 (COVID-19): Situación actual e implicaciones para México

text: The Coronavirus pandemic (COVID-19) is one of the most devastating in this century It originated in China in December 2019 caused by the SARS-Cov-2 virus, and in less than a month it had been classified as an "International Public Health Emergency" To date there are nearly 3 million people infected and more than 250,000 deaths caused by the disease worldwide Initially it affects the respiratory tract with atypical pneumonia and in severe cases it produces systemic inflammation with cytokine storm that can cause rapid deterioration with circulatory and respiratory failure, coagulopathy and a lethality rate of approximately 7% In Mexico, the first case was detected in February 2020, and to date there are 26,616 confirmed cases and 2,961 deaths throughout the country The low number of diagnostic tests conducted in our country clearly underestimates the real incidence and impact of the disease The most affected groups are those with risk factors such as age over 60, presence of hypertension, diabetes or cardiovascular disease Of the confirmed cases, 15% are healthcare workers There is no specific treatment or vaccine yet, so it is important to have hygiene, social isolation and personal protection measures Health, social and economic consequences could have great impact in the near future


title: Plasma from donors recovered from the new Coronavirus 2019 as therapy for critical patients with COVID-19 (COVID-19 plasma study): a multicentre study protocol

text: Since the end of 2019, a new coronavirus strain has been reported in the Chinese province of Wuhan, indicated as 2019-nCoV or SARS-CoV-2. In February 2020, the first case of transmission on Italian soil was reported. On March 09, 2020, at the time of protocol design, the Italian Ministry of Health reported 10,149 people who had contracted the virus; of these, 8514 were positive, of which 5038 were hospitalized with symptoms (59.2%) and 877 in intensive care (10.3%), while the remaining 2599 were in home isolation; 631 were deceased (6.2%) and 1004 healed (9.9%). To date there are no studies in the literature that demonstrate its feasibility and efficacy in the context of the worldwide SARS-CoV-2 epidemic. Based upon the little existing evidence, we planned to assess the efficacy of the infusion of hyperimmune plasma in COVID-19 patients in a one-arm proof-of-concept clinical trial. The primary objective of our study is to evaluate the efficacy of the administration of plasma taken from convalescent donors of COVID-19 to critically ill patients with COVID-19 in terms of their survival. Death from any cause will be considered. The main limit of this study is its one-arm proof-of-concept design with only 43 patients enrolled. However, in the absence of previous evidence, larger and/or randomized trials did not appear to be ethically acceptable. Moreover, the results from this study, if encouraging, will allow us to plan further informed large clinical trials. Trial registration: NCT04321421 March 23, 2020.


Hypofractionated radiotherapy in patients with non-melanoma skin cancer in the post COVID-19 era: Time to reconsider its role for most patients


title: Initial psychological impact of COVID-19 and its correlates in Indian Community: An online (FEEL-COVID) survey

text: BACKGROUND: The pandemic of Corona Virus (COVID-19) hit India recently; and the associated uncertainty is increasingly testing psychological resilience of the masses. When the global focus has mostly been on testing, finding a cure and preventing transmission; people are going through a myriad of psychological problems in adjusting to the current lifestyles and fear of the disease. Since there is a severe dearth of researches on this issue, we decided to conduct an online survey to evaluate its psychological impact. METHODS: From 26th to 29th March an online survey (FEEL-COVID) was conducted using principles of snowballing, and by invitation through text messages to participate. The survey collected data on socio-demographic and clinical variables related to COVID-19 (based on the current knowledge); along with measuring psychological impact with the help of Impact of Event-revised (IES-R) scale. RESULTS: There were a total of 1106 responses from around 64 cities in the country. Out of these 453 responses had at least one item missing; and were excluded from the analysis. The mean age of the respondents was around 41 years with a male female ratio of 3:1 and around 22% respondents were health care professionals. Overall approximately one third of respondents had significant psychological impact (IES-R score > 24). Higher psychological impact was predicted with younger age, female gender and comorbid physical illness. Presence of physical symptoms and contact history predicted higher psychological impact, but did not reach statistical significance. CONCLUSION: During the initial stages of COVID-19 in India, almost one-third respondents had a significant psychological impact. This indicates a need for more systematic and longitudinal assessment of psychological needs of the population, which can help the government in formulating holistic interventions for affected individuals.


Reply to "Vascular Changes Detected With Thoracic CT in Coronavirus Disease (COVID-19) Might Be Significant Determinants for Accurate Diagnosis and Optimal Patient Management"


title: Insurance status and level of education predict disparities in receipt of treatment and survival for anal squamous cell carcinoma

text: INTRODUCTION: Anal squamous cell carcinoma (ASCC) is relatively rare, but its incidence and mortality have been steadily climbing in marginalized populations. We explored the impact of insurance status, education, and income on survival and receipt of chemoradiation therapy. METHODS: We included patients with ASCC from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Socioeconomic variables included insurance status, level of education, income, and unemployment rate. Cox proportional hazards and multivariate logistic regression were used to determine predictors of survival and receipt of chemoradiation. RESULTS: We included a total of 10,868 cases of ASCC. The median age was 55, 10.4 % were black, and 65.4 % were female. Overall, 74.1 % of patients received combination chemoradiation. In multivariate analysis, poorer survival was found for Medicaid (HR 1.52, 95 % CI 1.34-1.74) and uninsured (HR 1.68, 95 % CI 1.35-2.10) patients, and for communities with the lowest rates of high school education (HR 1.17, 95 % CI 1.02-1.38), lowest income (HR 1.29, 95 % CI 1.08-1.54), and highest unemployment (HR 1.21, 95 % CI 1.03-1.40). Patients were less likely to receive combination treatment if they were black (OR 0.76, 95 % CI 0.55-0.92), had Medicaid insurance (OR 0.54, 95 % CI 0.33-0.88) or lower education (OR 0.59, 95 % CI 0.46-0.76). CONCLUSION: Insurance status, level of education, income, and employment impact survival and receipt of treatment in patients with ASCC. Identifying high risk patients and developing targeted interventions to improve access to treatment is integral to reducing these disparities and improving cancer survival.


Covid-19: Doctors should be alert for signs of myocardial injury, says NICE


title: Usefulness and safety of remote continuous glucose monitoring for a severe COVID-19 patient with diabetes

text: Diabetes is associated with mortality and severity of COVID-19. Protecting against infection in healthcare workers at high risk of COVID-19 are critical. This report investigates the usefulness and safety of remote continuous glucose monitoring in a patient with diabetes and severe interstitial pneumonia caused by the coronavirus disease. The Dexcom G4 Platinum continuous glucose monitoring system® was used to monitor blood glucose levels from outside the patient's isolation room. Continuous insulin infusion rates and boluses were determined based on the patient's blood glucose levels. Real-time continuous glucose monitoring made it possible to track blood glucose trends and prevent dramatic variations in blood glucose, although the rate of insulin infusion changed dynamic. Furthermore, the need for healthcare workers to enter the isolation room was minimized because the Dexcom G4 Platinum continuous glucose monitoring system can evaluate from a distance of up to 6.0 meters.


title: Effective lockdown and role of hospital-based COVID-19 transmission in some Indian states: An outbreak risk analysis

text: There are several reports in India that indicate hospitals and quarantined centers are COVID-19 hotspots. In the absence of efficient contact tracing tools, Govt. and the policymakers may not be paying attention to the risk of hospital-based transmission. To explore more on this important route and its possible impact on lockdown effect, we developed a mechanistic model with hospital-based transmission. Using daily notified COVID-19 cases from six states (Maharashtra, Delhi, Madhya Pradesh, Rajasthan, Gujarat, and Uttar Pradesh) and overall India, we estimated several important parameters of the model. Moreover, we provided an estimation of the basic ($R_{0}$), the community ($R_{C}$), and the hospital ($R_{H}$) reproduction numbers for those seven locations. To obtain a reliable forecast of future COVID-19 cases, a BMA post-processing technique is used to ensemble the mechanistic model with a hybrid statistical model. Using the ensemble model, we forecast COVID-19 notified cases (daily and cumulative) from May 3, 2020, till May 20, 2020, under five different lockdown scenarios in the mentioned locations. Our analysis of the mechanistic model suggests that most of the new COVID-19 cases are currently undetected in the mentioned seven locations. Furthermore, a global sensitivity analysis of four epidemiologically measurable \&controllable parameters on $R_{0}$ and as well on the lockdown effect, indicate that if appropriate preventive measures are not taken immediately, a much larger COVID-19 outbreak may trigger from hospitals and quarantined centers. In most of the locations, our ensemble model forecast indicates a substantial percentage of increase in the COVID-19 notified cases in the coming weeks in India. Based on our results, we proposed a containment policy that may reduce the threat of a larger COVID-19 outbreak in the coming days.


title: Impact of Rumors and Misinformation on COVID-19 in Social Media

text: The coronavirus disease 2019 (COVID-19) pandemic has not only caused significant challenges for health systems all over the globe but also fueled the surge of numerous rumors, hoaxes, and misinformation, regarding the etiology, outcomes, prevention, and cure of the disease. Such spread of misinformation is masking healthy behaviors and promoting erroneous practices that increase the spread of the virus and ultimately result in poor physical and mental health outcomes among individuals. Myriad incidents of mishaps caused by these rumors have been reported globally. To address this issue, the frontline healthcare providers should be equipped with the most recent research findings and accurate information. The mass media, healthcare organization, community-based organizations, and other important stakeholders should build strategic partnerships and launch common platforms for disseminating authentic public health messages. Also, advanced technologies like natural language processing or data mining approaches should be applied in the detection and removal of online content with no scientific basis from all social media platforms. Furthermore, these practices should be controlled with regulatory and law enforcement measures alongside ensuring telemedicine-based services providing accurate information on COVID-19.


title: COViD-19: Face Mask Effectiveness, Hand Sanitizer Shortages, and Rapid Medication Therapy Trials

text: The COVID-19 pandemic is a rapidly evolving phenomenon that presents serious practical challenges and complex clinical considerations for health care workers, health care administrators, and policy formulators. The Senior Care Pharmacist carries periodic updates addressing matters relevant to pharmacotherapeutics and pharmacy practice as these relate to the care of older people in the time of the pandemic. The brief news items that are provided here are not intended to be substitutes for a careful and comprehensive consideration of the issues involved, but rather, they serve to provide initial awareness of concepts and to stimulate more complete situational analysis.


title: Marked T cell activation, senescence, exhaustion and skewing towards TH17 in patients with COVID-19 pneumonia

text: The immune system of patients infected by SARS-CoV-2 is severely impaired. Detailed investigation of T cells and cytokine production in patients affected by COVID-19 pneumonia are urgently required. Here we show that, compared with healthy controls, COVID-19 patients' T cell compartment displays several alterations involving naïve, central memory, effector memory and terminally differentiated cells, as well as regulatory T cells and PD1+CD57+ exhausted T cells. Significant alterations exist also in several lineage-specifying transcription factors and chemokine receptors. Terminally differentiated T cells from patients proliferate less than those from healthy controls, whereas their mitochondria functionality is similar in CD4+ T cells from both groups. Patients display significant increases of proinflammatory or anti-inflammatory cytokines, including T helper type-1 and type-2 cytokines, chemokines and galectins; their lymphocytes produce more tumor necrosis factor (TNF), interferon-Î³, interleukin (IL)-2 and IL-17, with the last observation implying that blocking IL-17 could provide a novel therapeutic strategy for COVID-19.


Anaesthesia preparedness for COVID-19 pandemic readiness: a medication preservation strategy


title: Measuring the effectiveness of an automated text messaging active surveillance system for COVID-19 in the south of Ireland, March to April 2020

text: We report the effectiveness of automated text messaging for active surveillance of asymptomatic close contacts of coronavirus disease (COVID-19) cases in the Cork/Kerry region of Ireland. In the first 7 weeks of the COVID-19 outbreak, 1,336 close contacts received 12,421 automated texts. Overall, 120 contacts (9.0%) reported symptoms which required referral for testing and 35 (2.6%) tested positive for COVID-19. Non-response was high (n = 2,121; 17.1%) and this required substantial clinical and administrative resources for follow-up.


title: [Significance and operation mode of moxibustion intervention for the group under quarantine after close contact with COVID-19]

text: On the base of the idea of traditional Chinese medicine as "disease prevention", the mode and the protocol of the moxibustion intervention for the group under quarantine after close contact with coronavirus disease 2019 (COVID-19) were explored. The group under quarantine after close contact with COVID-19 was taken as the subjects. By the non-contact physician-patient communication network platform co-developed by China Association of Acupuncture-Moxibustion, Hunan Provincial Association of Acupuncture-Moxibustion, Data Center of China Academy of Chinese Medical Sciences and Yuge Medicine Company, an exploratory randomized controlled trial was designed. A total of 100 cases were included and randomized into a moxibustion group and a conventional intervention group, 50 cases in each one. In the moxibustion group, moxibustion intervention was used. In the conventional intervention group, the conventional observation was adopted without moxibusiton intervention applied. The outcomes included the symptoms changes, e.g. anxiety, emotional disturbance, fatigue, headache and diarrhea, as well as whether quarantine release and the case confirmed or not, etc. The results were evaluated before intervention, in 14 days of intervention and 2 weeks after intervention separately. In this research, on the base of internet plus technology and with the internet communication platform adopted, through mobile phone WeChat App, it was to implement the subject screen, the random allocation and the instruction of moxibustion intervention as well as the quality control of patient's diary and data collection. It is anticipated that the significance and the implementation mode of moxibustion intervention can be assessed preliminarily for the group under quarantine after close contact with COVID-19.


title: A Conceptual Discussion about R0 of SARS-COV-2 in Healthcare Settings

text: To date, no specific estimate of R0 for SARS-CoV-2 is available for healthcare settings. Using inter-individual contact data, we highlight that R0 estimates from the community cannot translate directly to healthcare settings, with pre-pandemic R0 values ranging 1.3-7.7 in three illustrative healthcare institutions. This has implications for nosocomial Covid-19 control.


Paediatric ethical issues during the COVID-19 pandemic are not just about ventilator triage


Gustatory dysfunctions in COVID-19 patients: possible involvement of taste renin-angiotensin system (RAS)


title: National Outreach of Telepalliative Medicine Volunteers for a New York City Safety Net System COVID-19 Pandemic Response

text: The coronavirus disease 2019 surge in New York City created an increased demand for palliative care (PC) services. In staff-limited settings such as safety net systems, and amid growing reports of health care worker illness, leveraging help from less-affected areas around the country may provide an untapped source of support. A national social media outreach effort recruited 413 telepalliative medicine volunteers (TPMVs). After expedited credentialing and onboarding of 67 TPMVs, a two-week pilot was initiated in partnership with five public health hospitals without any previous existing telehealth structure. The volunteers completed 109 PC consults in the pilot period. Survey feedback from TPMVs and on-site PC providers was largely positive, with areas of improvement identified around electronic health record navigation and continuity of care. This was a successful, proof of concept, and quality improvement initiative leveraging TPMVs from across the nation for a PC pandemic response in a safety net system.


After the COVID 19 outbreak in Italy: What have we learnt?


title: An assessment of United States dermatology practices during the COVID-19 outbreak

text: Objectives: The COVID-19 outbreak is a serious threat to public health and social distancing on the part of individuals can help contain the epidemic. It is unknown if dermatologists are assisting with the public health officials' recommendations for social distancing by closing their practice or limiting their practice to the treatment of emergency conditions. This study examines the activity level of dermatology practices during the United States COVID-19 outbreak.Methods: We performed scripted phone calls to 60 dermatology practices in six different counties in the United Stated during the COVID-19 outbreak. We assessed if practices are open and if they are serving patients with urgent and non-urgent conditions.Results: Of the 60 dermatologists selected for the study, 55 were successfully contacted (92% contact rate). Of these practices, 29 (53%) were open, 17 (31%) were only seeing urgent patients and 9 (16%) were closed. New York, New York had 2 (20%) open offices which was the lowest proportion of any county (p = .04). Counties with higher prevalence had fewer open offices (p < .01, R2 = .7).Conclusions: Many practices have restricted their level of operation especially in higher areas of COVID-19 prevalence, likely to help facilitate social distancing.


title: Evaluation of the RealStar® SARS-CoV-2 RT-PCR kit RUO performances and limit of detection

text: BACKGROUND: The use of efficient, reliable and sensitive PCR assays is a cornerstone in the race to contain the SARS-CoV-2 pandemic. In this work we performed an independent evaluation of the RealStar® SARS-CoV-2 RT-PCR Kit Researh Use Only (Altona) for SARS-CoV-2 detection. METHODS: A comparative limit of detection (LoD) assessment was performed between RealStar® SARS-CoV-2 and the currently WHO recommended RT-PCR (WHO-PCR) workflow using a quantified clinical sample. Assessment of the RealStar® SARS-CoV-2 assay was also performed using 83 primary clinical samples in comparison with the WHO-PCR. RESULTS: The RealStar® SARS-CoV-2 demonstrated a slightly higher sensitivity than the WHO recommended assay with a limit of detection at 625 copies/mL instead of 1250 copies/mL for the WHO-PCR in our conditions. The overall percent agreement between RealStar® SARS-CoV-2 and WHO-PCR on 83 clinical samples was 97.6 % (81/83) with a sensitivity at 97.8 % (45/46) and specificity at 97.3 % (36/37). No cross reaction was encountered for the other human coronaviruses (HKU1, OC43, NL63, 229E). CONCLUSIONS: In this comparison of the RealStar® SARS-CoV-2 assay with the reference WHO assay, we observed a slightly better sensitivity of the RealStar® assay. It provides a robust option for all molecular biology laboratories, with a strong real-life LoD and is compatible with various real-time PCR platforms.


title: COVID-19 and the male susceptibility: the role of ACE2, TMPRSS2 and the androgen receptor

text: COVID-19 is the pandemic that hit the world starting December 2019. Recent studies and international statistics have shown an increased prevalence, morbidity as well as mortality of this disease in male patients compared to female patients. The aim of this brief communication is to describe the pathophysiology of this sex-discrepancy, based on the infectivity mechanism of the coronavirus including the Angiotensin-Converting Enzyme 2 (ACE2), the Type II transmembrane Serine Protease (TMPRSS2), and the androgen receptor. This could help understand the susceptibility of urological patients, especially those receiving androgen deprivation therapy for prostate cancer, and testosterone replacement therapy.


Letter to the editors in response to: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic (Cure et al.)


title: Neutrophil Extracellular Traps (NETs) Contribute to Immunothrombosis in COVID-19 Acute Respiratory Distress Syndrome

text: COVID-19 affects millions of patients worldwide with clinical presentation ranging from isolated thrombosis to acute respiratory distress syndrome (ARDS) requiring ventilator support. Neutrophil extracellular traps (NETs) originate from decondensed chromatin released to immobilize pathogens and can trigger immunothrombosis. We studied the connection between NETs and COVID-19 severity and progression. We conducted a prospective cohort study of COVID-19 patients (n=33) with age- and sex-matched controls (n=17). We measured plasma myeloperoxidase (MPO)-DNA complexes (NETs), Platelet Factor 4, RANTES, and selected cytokines. Three COVID-19 lung autopsies were examined for NETs and platelet involvement. We assessed NET formation ex vivo in COVID-19 neutrophils and in healthy neutrophils incubated with COVID-19 plasma. We also tested the ability of neonatal NET-Inhibitory Factor (nNIF) to block NET formation induced by COVID-19 plasma. Plasma MPO-DNA complexes increased in COVID-19 with intubation (P<0.0001) and death as outcome (P<0.0005). Illness severity correlated directly with plasma MPO-DNA complexes (P=0.0360), while PaO2/FiO2 correlated inversely(P=0.0340). Soluble and cellular factors triggering NETs were significantly increased in COVID-19 and pulmonary autopsies confirmed NET-containing microthrombi with neutrophil-platelet infiltration. Finally, COVID-19 neutrophils ex vivo displayed excessive NETs at baseline and COVID-19 plasma triggered NET formation which was blocked by nNIF. Thus, NETs triggering immunothrombosis may, in part, explain the prothrombotic clinical presentations in COVID-19 and NETs may represent targets for therapeutic intervention.


title: Incubation period of the coronavirus disease 2019 (COVID-19) in Busan, South Korea

text: The assessment of the incubation period, which is the period between the infection and the illness onset, is essential to identify the sufficient isolation period for infectious diseases. In South Korea, a few cases of the coronavirus disease 2019 (COVID-19) were identified after the 14-day self-quarantine program, and the length of this quarantine has raised controversial issues for the Korean public health professionals. We estimated the COVID-19 incubation period using the log-normal distribution from publicly available data. The data were obtained from the press release of the Busan city department of public health and news reports. We collected and analysed information for 47 patients with a median age of 30. We estimated that the median incubation period was three days (95% Confidence Interval, 0.6-8.2). We also did not find any significant difference in the incubation period between males and females. Our findings indicate that a 14-day self-quarantine program should be sufficient to prevent spreading in the infection of suspected individuals with COVID-19 in the community.


title: AI Surveillance during Pandemics: Ethical Implementation Imperatives

text: Artificial intelligence surveillance can be used to diagnose individual cases, track the spread of Covid-19, and help provide care. The use of AI for surveillance purposes (such as detecting new Covid-19 cases and gathering data from healthy and ill individuals) in a pandemic raises multiple concerns ranging from privacy to discrimination to access to care. Luckily, there exist several frameworks that can help guide stakeholders, especially physicians but also AI developers and public health officials, as they navigate these treacherous shoals. While these frameworks were not explicitly designed for AI surveillance during a pandemic, they can be adapted to help address concerns regarding privacy, human rights, and due process and equality. In a time where the rapid implementation of all tools available is critical to ending a pandemic, physicians, public health officials, and technology companies should understand the criteria for the ethical implementation of AI surveillance.


Impact of COVID-19 public health interventions on influenza incidence in Thailand


title: Best interests versus resource allocation: could COVID-19 cloud decision-making for the cognitively impaired?

text: The COVID-19 pandemic is putting the NHS under unprecedented pressure, requiring clinicians to make uncomfortable decisions they would not ordinarily face. These decisions revolve primarily around intensive care and whether a patient should undergo invasive ventilation. Certain vulnerable populations have featured in the media as falling victim to an increasingly utilitarian response to the pandemic-primarily those of advanced years or with serious existing health conditions. Another vulnerable population potentially at risk is those who lack the capacity to make their own care decisions. Owing to the pandemic, there are increased practical and normative challenges to following the requirements of the Mental Capacity Act 2005. Both capacity assessments and best interests decisions may prove more difficult in the current situation. This may create a more paternalistic situation in decisions about the care of the cognitively impaired which is at risk of taking on a utilitarian focus. We look to these issues and consider whether there is a risk of patients who lack capacity to make their own care decisions being short-changed.


title: Examining the incubation period distributions of COVID-19 on Chinese patients with different travel histories

text: INTRODUCTION: Current studies estimated a general incubation period distribution of COVID-19 based on early-confirmed cases in Wuhan, and have not examined whether the incubation period distribution varies across population segments with different travel histories. We aimed to examine whether patients infected by community transmission had extended incubation periods than the early generation patients who had direct exposures to Wuhan. METHODOLOGY: Based on 4741 patient case reports from municipal centers of disease control by February 21, 2020, we calculated the incubation periods of 2555 patients with clear epidemiological survey information and illness development timeline. All patients were categorized into five groups by their travel histories. Incubation period distributions were modeled for each group by the method of the posterior Weibull distribution estimation. RESULTS: Adults aged 30 to 59 years had the most substantial proportion of confirmed cases in China. The incubation period distribution varied slightly across patient groups with different travel histories. Patients who regularly lived in Wuhan and left to other locations before January 23, 2020 had the shortest posterior median value of 7.57 days for the incubation period, while the incubation periods for persons affected by local community transmission had the largest posterior median of incubation periods, 9.31 days. CONCLUSIONS: The median incubation period for all patients infected outside Wuhan was 9 days, a bit of more extended than the early estimated 5-day incubation period that was based on patients in Wuhan. Our findings may imply the decreases of virulence of the COVID-19 virus along with intergenerational transmission.


Improved Prognosis in Cystic Fibrosis: Consideration for Intensive Care during the COVID-19 Pandemic


Culture and COVID-19: Observations From an Italian American Nurse


title: The psychological impact of COVID-19 pandemic on physicians in Saudi Arabia: A cross-sectional study

text: Background/Aim: COVID-19 pandemic exposed physicians to extraordinary stress and made them vulnerable to various types of psychological illnesses. The aim of this study was to evaluate the impact that the COVID-19 pandemic had on the psychological well-being of physicians. Materials and Methods: We performed a cross-sectional, survey-based study, targeting physicians in Saudi Arabia during the COVID-19 pandemic. The primary outcome was to assess the psychological impact that the pandemic had on physicians by using a questionnaire that was previously designed and used by Reynold's et al. to survey Canadians during the SARS outbreak in 2003. The questionnaire assessed respondents' understanding of the rationale for quarantine, quarantine behaviors (including difficulties and compliance), as well as socio-economic and psychological impacts through answers that are based on a Likert scale. We also assessed the possible risk factors for psychological disorders related to the pandemic. Results: The study included 529 physicians from various regions in Saudi Arabia. The enrolled physicians were practicing different specialties and branches in medicine. We classified them based on their workplace in relation to COVID-19 exposure to: COVID-19 designated center vs. non-COVID-19 designated centers. Furthermore, we subdivided the physicians who work in COVID-19 designated centers to those who work in high-risk areas such as ER, ICU and COVID-19 isolation wards and other areas as low-risk areas. The most common feelings reported by the physicians during the pandemic were: worry (357, 67.5%), isolation (301, 56.9%) and fear (263, 49.7%). According to logistic regression analysis, physicians older than age 60 were less likely to feel isolated (OR = 0.08, 95% CI = 0.01-0.96, P = 0.05), female physicians were more likely to experience fear (OR = 2.96, 95% CI = 1.20 - 7.27, P = 0.02) and worry (OR = 2.87,95% CI = 1.23 - 6.69, P = 0.02), while physicians with a previous exposure to similar traumatic events were less likely to experience fear (OR = 0.24, 0.10 - 0.64, P = 0.004) during the COVID-19 pandemic. Conclusions: The COVID-19 pandemic had a negative psychological effect on physicians in Saudi Arabia. Gender, age, and previous exposure to similar traumatic events were predictive of psychological reactions to the pandemic in this population.


title: Incorporating Video Visits into Ophthalmology Practice: A Retrospective Analysis and Patient Survey to Assess Initial Experiences and Patient Acceptability at an Academic Eye Center

text: INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has led to rapid adoption of teleophthalmology to deliver eyecare remotely. The purpose of our study was to assess the implementation and patient acceptability of video consultation for outpatient ophthalmic care at our institution. METHODS: We conducted a retrospective, cross-sectional analysis and patient survey of adult patients who completed a virtual video visit at our institution from 18 March 18 through to 27 April 2020. All video visit encounters were assessed for patient characteristics, diagnoses, management, and follow-up outcomes. Patients were surveyed for their feedback on acceptability and utility of their virtual video consultation. RESULTS: A total of 219 patients (mean age 55 years; range 21-89 years) completed 231 video visit encounters at our department over a 6-week period, of whom 118 were women (54%). About half of these encounters were acute visits (102 visits, 47%). The most common diagnosis of these visits was postoperative state (20 visits, 9% of the total), followed by conjunctivitis (16 visits, 7%), and keratitis (14 visits, 6%). The most common management decisions were medication prescription (102 visits, 46%) or reassurance (86 visits, 39%), while 17 video visit patients (8%) were escalated to an urgent, in-person evaluation. Ninety-two patients completed a follow-up survey (42% response rate), of whom 45 (49%) indicated that they might have delayed seeking care during this pandemic in the absence of a virtual video option. Seventy-two (78%) reported that they would consider participating in a video visit as an alternative to an office-based encounter in the future, and the overall video visit experience was rated highly, with a weighted mean Likert scale rating of 4.3 out of 5 (Cronbach's α = 0.88). CONCLUSION: Virtual video visits may be used to manage a range of ophthalmic complaints. Patients participating in this survey found such video visits acceptable and timesaving, and the majority would consider using video consultations for future eyecare encounters.