title: Guidelines and Recommendations for Patient Management, Surgical Activities, and Safety in the Maxillofacial Unit and Head and Neck Department During COVID-19 Pandemic

text: The recent pandemic has led to an unprecedented overload of sanitary systems around the world. Despite that a maxillofacial department is not a frontline specialty in the treatment of coronavirus disease 2019 infections, our department has found itself faced with numerous problems in keeping the care system active and efficient while ensuring safety for patients and healthcare professionals. Massive redistribution of health personnel was needed to improve prevention and personal safety measures. The education and training system has been kept active, giving residents a decisive role in managing the state of emergency response. This article outlines new guidelines for infection prevention: from clinical control, treatment processes, clinical management, protection, and disinfection of healthcare professionals.


COVID-19 Health Technology Governance, Epistemic Competence, and the Future of Knowledge in an Uncertain World


title: Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available. OBJECTIVE: We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation. METHODS: Patients with COVID-19 who were hospitalized from February 29 to April 9, 2020, were analyzed for baseline clinical and laboratory findings at admission and during the disease. Data from 89 evaluable patients were available for the purpose of analysis comprising an initial evaluation cohort (n = 40) followed by a temporally separated validation cohort (n = 49). RESULTS: We identified markers of inflammation, lactate dehydrogenase, and creatinine as the variables most predictive of respiratory failure in the evaluation cohort. Maximal IL-6 level before intubation showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. The respective AUC values for IL-6 and CRP levels in the evaluation cohort were 0.97 and 0.86, and they were similar in the validation cohort (0.90 and 0.83, respectively). The calculated optimal cutoff values during the course of disease from the evaluation cohort (IL-6 level > 80 pg/mL and CRP level > 97 mg/L) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure. CONCLUSION: The maximal level of IL-6, followed by CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP level to guide escalation of treatment in patients with COVID-19-related hyperinflammatory syndrome.


Convalescent plasma for COVID-19: Back to the future


title: COVID-19 and pregnancy - where are we now? A review

text: The new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.


title: The potential of putative zinc-binding motifs of haemagglutinin (HA) protein for categorization and prediction of pathogenicity of H5 subtypes of avian influenza virus

text: In the present study, we used the potential of bioinformatics and computational analysis to predict the existence and biological relevance of zinc finger (ZF) motifs in heamagglutinin (HA) protein of Avian Influenza (AI) virus. Sequence data of Avian Influenza (AI) viruses were retrieved from accessible databases (GenBank, GISAID, IRD) and analyzed for the existence, as well as functional prediction of the putative zinc finger or ''zinc-binding'' motif(s) of HA protein. It is hypothesized that the ZF motif(s) in HA of AI virus can be used as a ''novel'' biomarker for categorization of the virus and/or its virulence. As a model for analysis, we used the H5 subtypes of highly pathogenic, non-pathogenic and low pathogenic avian influenza (HPAI, NPAI and LPAI) viruses of H5N1 and H5N2 of avian and human origins. Interestingly, our method of characterization using the zinc-finger agrees with the existing classification in distinguishing between highly pathogenic and non-pathogenic or low pathogenic subtypes. The new method also clearly distinguished between low and non-pathogenic strains of H5N2 and H5N1 which are indistinguishable by the existing method that utilizes the sequence of the polybasic amino acids of the proteolytic cleavage site for pathogenicity. It is hypothesized that zinc through the activities of zinc-binding proteins modulates the virulence property of the viral subtypes. Our observation further revealed that only the HA protein among the eight encoded proteins of influenza viruses contain high numbers of Cys-His residues. It is expected that the information gathered from the analysis of the data will be useful to generate more research hypotheses/designs that will give further insight towards the identification and control of avian influenza virus through the molecular manipulation of zinc finger motifs present in viral HA protein.


Covid-19: Delays in attending emergency departments may have contributed to deaths of nine children


title: The Virtual Neurologic Exam: Instructional Videos and Guidance for the COVID-19 Era

text: OBJECTIVE: To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond. METHODS: The full neurologic examination is described with attention to components that can be performed virtually. RESULTS: A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations). CONCLUSIONS: During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.


The Adaptation of Management of Chronic Migraine Patients With Medication Overuse to the Suspension of Treatment Protocols During the COVID-19 Pandemic: Lessons From a Tertiary Headache Center in Milan, Italy


Refugee and migrant health in the COVID-19 response


Mass intake of hydroxychloroquine or chloroquine in the present context of the Covid-19 outbreak: Possible consequences in endemic malaria settings


title: In-silico approaches to detect inhibitors of the human severe acute respiratory syndrome coronavirus envelope protein ion channel

text: Recent outbreak of Coronavirus disease (COVID-19) pandemic around the world is associated with 'severe acute respiratory syndrome' (SARS-CoV2) in humans. SARS-CoV2 is an enveloped virus and E proteins present in them are reported to form ion channels, which is mainly associated with pathogenesis. Thus, there is always a quest to inhibit these ion channels, which in turn may help in controlling diseases caused by SARS-CoV2 in humans. Considering this, in the present study, authors employed computational approaches for studying the structure as well as function of the human 'SARS-CoV2 E' protein as well as its interaction with various phytochemicals. Result obtained revealed that α-helix and loops present in this protein experience random movement under optimal condition, which in turn modulate ion channel activity; thereby aiding the pathogenesis caused via SARS-CoV2 in human and other vertebrates. However, after binding with Belachinal, Macaflavanone E, and Vibsanol B, the random motion of the human 'SARS-CoV2 E' protein gets reduced, this, in turn, inhibits the function of the 'SARS-CoV2 E' protein. It is pertinent to note that two amino acids, namely VAL25 and PHE26, play a key role while interacting with these three phytochemicals. As these three phytochemicals, namely, Belachinal, Macaflavanone E & Vibsanol B, have passed the ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) property as well as 'Lipinski's Rule of 5s', they may be utilized as drugs in controlling disease caused via SARS-COV2, after further investigation.Communicated by Ramaswamy H. Sarma.


Challenges and Responsibilities in Caring for the Most Vulnerable During the COVID-19 Pandemic


Acute Respiratory Failure in COVID-19 Pneumoniae: The Best Interface for an Optimal Management. A South Italian Experience


title: High-flow cannulas will be required with current COVID-19 crisis, not only mechanical ventilators

text: COVID-19 is characterized by acute respiratory distress syndrome progression, which ranges from mild to severe. A percentage of critically ill patients will require endotracheal intubation and mechanical ventilation; therefore, Mexican engineers from different places have had the initiative of creating mechanical ventilators. Although artificial ventilator is one of the last resources for the most severely ill patients, there are patients who are on the verge of not meeting the criteria for intubation; if they are directly intubated, the opportunity for them to overcome the severe phase with high concentration supplemental oxygen would be be missed. Intubation per se induces lung damage, increases the risk of superinfection, and the number of days of ICU stay. Furthermore, non-selective use of artificial ventilators decreases the opportunity for patients who require a ventilator to survive and increases institutional care costs of both human and material resources.


The use of aspirated consonants during speech may increase the transmission of COVID-19


title: Construction of 5G intelligent medical service system in novel coronavirus pneumonia prevention and control/ 中华急诊医学杂志

text: Objective@#To analyze application fields of 5G communication technology in Corona Virus Disease 2019 (COVID-19) epidemic prevention and control, and build a 5G intelligent medical service system for COVID-19 epidemic prevention and control in China.@*Methods@#We collected and analyzed 5G technology application cases used in the fight against COVID-19 from December 2019 to February 2020: 5G + telemedicine application cases, 5G + negative pressure ambulance cases, 5G + remote monitoring cases, 5G + artificial intelligence cases, 5G + infrared thermography temperature detection cases, 5G + big data analysis cases for epidemic prevention and control.@*Results@#Through the analysis of 5G application cases in COVID-19 epidemic prevention and control, we found out the key elements of 5G intelligent medical service system in COVID-19 epidemic prevention and control. By optimizing and upgrading the internal service mode of the hospital, breaking the internal and external barriers, integrating internal and external resources, and strengthening 5G intelligent medical security, we can form a 5G intelligent medical service system for COVID-19 epidemic prevention and control, including application layer, technical service layer, network support layer and security system layer.@*Conclusion@#5G communication technology has the characteristics of faster speed, shorter time delay and denser capacity. In COVID-19 epidemic prevention and control work, it can further improve the efficiency of doctors' diagnosis, improve patients' medical experience, realize the remote sharing of high-quality medical resources and real-time information exchange, effectively block the spread of epidemic, alleviate the shortage of medical resources and medical staff, and make the epidemic prevention and control more efficient.


Call for Papers: The Pathophysiology of COVID-19 and SARS-CoV-2 Infection


title: Rapid implementation of virtual neurology in response to the COVID-19 pandemic

text: The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.


Decreased Mortality of COVID-19 With Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients With Hypertension: A Meta-Analysis


David Oliver: Covid-19 highlights the need for effective government communications


title: Evidence for host-dependent RNA editing in the transcriptome of SARS-CoV-2

text: The COVID-19 outbreak has become a global health risk, and understanding the response of the host to the SARS-CoV-2 virus will help to combat the disease. RNA editing by host deaminases is an innate restriction process to counter virus infection, but it is not yet known whether this process operates against coronaviruses. Here, we analyze RNA sequences from bronchoalveolar lavage fluids obtained from coronavirus-infected patients. We identify nucleotide changes that may be signatures of RNA editing: adenosine-to-inosine changes from ADAR deaminases and cytosine-to-uracil changes from APOBEC deaminases. Mutational analysis of genomes from different strains of Coronaviridae from human hosts reveals mutational patterns consistent with those observed in the transcriptomic data. However, the reduced ADAR signature in these data raises the possibility that ADARs might be more effective than APOBECs in restricting viral propagation. Our results thus suggest that both APOBECs and ADARs are involved in coronavirus genome editing, a process that may shape the fate of both virus and patient.


Single ventilator for multiple patients during COVID19 surge: matching and balancing patients


title: Gender equity and public health outcomes: The COVID-19 experience

text: This paper extends the growing research on the impact of gender equity on public health outcomes using the ongoing Covid-19 pandemic as its research setting. Specifically, it introduces a conceptual model incorporating the impact of gender equity and human development on women's representation in legislature and public health expenditure, and their combined impact with human environment (population density, aging population and urban population) on important public health outcomes in the Covid-19 context, including the total number of tests, diagnosed, active and critical cases, and deaths. Data from 210 countries shows support for many of the hypothesized relationships in the conceptual model. The results provide useful insights about the factors that influence the representation of women in political systems around the world and its impact on public health outcomes. The authors also discuss implications for public health policy-makers to ensure efficient and effective delivery of public health services in future.


COVID-19 convalescent plasma donor recruitment: beware the Faustian bargains


Elevated serum levels of S100A8/A9 and HMGB1 at hospital admission are correlated with inferior clinical outcomes in COVID-19 patients


title: A mechanistic model and therapeutic interventions for COVID-19 involving a RAS-mediated bradykinin storm

text: Neither the disease mechanism nor treatments for COVID-19 are currently known. Here we present a novel molecular mechanism for COVID-19 that provides therapeutic intervention points that can be addressed with existing FDA-approved pharmaceuticals. The entry point for the virus is ACE2, which is a component of the counteracting hypotensive axis of RAS, that produces the nonapeptide angiotensin1-9 from angiotensin I. Bradykinin is a potent, but often forgotten, part of the vasopressor system that induces hypotension and vasodilation 1, and is regulated by ACE and enhanced by angiotensin1-9 2. Here we perform a completely new analysis on gene expression data from cells of bronchoalveolar lavage samples from COVID-19 patients that were used to sequence the virus, but the host information was discarded 3. Comparison with lavage samples from controls identify a critical imbalance in RAS represented by decreased expression of ACE in combination with increases in ACE2, renin (REN) , angiotensin (AGT), key RAS receptors (AGTR2, AGTR1), kinogen (KNG) and the kallikrein enzymes (KLKB1, many of KLK-1-15) that activate it, and both bradykinin receptors (BDKRB1, BDKRB2). This very atypical pattern of the RAS is predicted to elevate bradykinin levels in multiple tissues and systems that will likely cause increases in vascular dilation, vascular permeability and hypotension. These bradykinin-driven outcomes explain many of the symptoms being observed in COVID-19.


title: Orchiepididymitis in a Boy with Covid-19

text: Coronavirus disease 2019 (COVID-19) symptoms in children are incompletely described. We present the first case of orchiepididymitis associated with COVID-19 in a boy and discuss pathways of testicular involvement by SARS-CoV2 virus. This case underlines the need for further study of the clinical presentation of pediatric COVID-19 and the potential association with nonrespiratory symptoms.


title: Rapid Direct Nucleic Acid Amplification Test without RNA Extraction for SARS-CoV-2 Using a Portable PCR Thermocycler

text: There is an ongoing worldwide coronavirus disease 2019 (Covid-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, confirmatory diagnosis is by reverse transcription polymerase chain reaction (RT-PCR), typically taking several hours and requiring a molecular laboratory to perform. There is an urgent need for rapid, simplified, and cost-effective detection methods. We have developed and analytically validated a protocol for direct rapid extraction-free PCR (DIRECT-PCR) detection of SARS-CoV-2 without the need for nucleic acid purification. As few as six RNA copies per reaction of viral nucleocapsid (N) gene from respiratory samples such as sputum and nasal exudate can be detected directly using our one-step inhibitor-resistant assay. The performance of this assay was validated on a commercially available portable PCR thermocycler. Viral lysis, reverse transcription, amplification, and detection are achieved in a single-tube homogeneous reaction within 36 min. This minimizes hands-on time, reduces turnaround-time for sample-to-result, and obviates the need for RNA purification reagents. It could enable wider use of Covid-19 testing for diagnosis, screening, and research in countries and regions where laboratory capabilities are limiting.


title: Lessons learned from the 2019-nCoV epidemic on prevention of future infectious diseases

text: Only a month after the outbreak of pneumonia caused by 2019-nCoV, more than forty-thousand people were infected. This put enormous pressure on the Chinese government, medical healthcare provider, and the general public, but also made the international community deeply nervous. On the 25th day after the outbreak, the Chinese government implemented strict traffic restrictions on the area where the 2019-nCoV had originated-Hubei province, whose capital city is Wuhan. Ten days later, the rate of increase of cases in Hubei showed a significant difference (p = 0.0001) compared with the total rate of increase in other provinces of China. These preliminary data suggest the effectiveness of a traffic restriction policy for this pandemic thus far. At the same time, solid financial support and improved research ability, along with network communication technology, also greatly facilitated the application of epidemic prevention measures. These measures were motivated by the need to provide effective treatment of patients, and involved consultation with three major groups in policy formulation-public health experts, the government, and the general public. It was also aided by media and information technology, as well as international cooperation. This experience will provide China and other countries with valuable lessons for quickly coordinating and coping with future public health emergencies.


title: COVID-19 Twitter Dataset with Latent Topics, Sentiments and Emotions Attributes

text: This resource paper describes a large dataset covering over 63 million coronavirus-related Twitter posts from more than 13 million unique users since 28 January to 1 July 2020. As strong concerns and emotions are expressed in the tweets, we analyzed the tweets content using natural language processing techniques and machine-learning based algorithms, and inferred seventeen latent semantic attributes associated with each tweet, including 1) ten attributes indicating the tweet's relevance to ten detected topics, 2) five quantitative attributes indicating the degree of intensity in the valence (i.e., unpleasantness/pleasantness) and emotional intensities across four primary emotions of fear, anger, sadness and joy, and 3) two qualitative attributes indicating the sentiment category and the most dominant emotion category, respectively. To illustrate how the dataset can be used, we present descriptive statistics around the topics, sentiments and emotions attributes and their temporal distributions, and discuss possible applications in communication, psychology, public health, economics and epidemiology.


How to Rapidly Determine First-in-Children Dosing for COVID-19 Therapeutics


Comment on Matricardi PM et al: The first, holistic immunological model of COVID-19: Implications for prevention, diagnosis, and public health measures


Mass masking in the COVID-19 epidemic: people need guidance


COVID-19 research: toxicological input urgently needed!


Pharmacological characteristics of patients infected with SARS-Cov-2 admitted to Intensive Care Unit in South of France


title: Description of a new species of Moenkhausia (Characiformes: Characidae) from the upper Paraguay basin, Central Brazil, with comments on its phylogenetic relationships

text: A new species of Moenkhausia is described from tributaries of the upper rio Sepotuba, Paraguay basin, Brazil. The new species is distinguished from its congeners by a combination of characters, including an inconspicuous oval-shaped vertically elongated humeral blotch, extending horizontally from third through five lateral-line scales, and vertically from third row above lateral line to first row below it, followed by a diffuse field of dark chromatophores in the flank, combined with a well-defined dark line at the base of the anal fin. Furthermore, the phylogenetic position of the new species is presented based on molecular data, showing a close relationship among species of Moenkhausia and Hemigrammus that have a well-defined dark line at the base of the anal fin. Until this moment, this species is only known from in the upper rio Sepotuba basin.(AU)


Viral infection-induced thrombosis, novel coronavirus


Urinalysis parameters for predicting severity in coronavirus disease 2019 (COVID-19)


COVID-19: A relationship to climate and environmental conditions?


title: Fitting and forecasting the trend of COVID-19 by SEIR + CAQ dynamic model

text: Objectives Fitting and forecasting the trend of COVID-19 epidemics Methods Based on SEIR dynamic model, considering the COVID-19 transmission mechanism, infection spectrum and prevention and control procedures, we developed SEIR + CAQ dynamic model to fit the frequencies of laboratory confirmed cases obtained from the government official websites The data from January 20, 2020 to February 7, 2020 were used to fit the model, while the left data between February 8-12 were used to evaluate the quality of forecasting Results According to the cumulative number of confirmed cases between January 29 to February 7, the fitting bias of SEIR + CAQ model for overall China (except for cases of Hubei province), Hubei province (except for cases of Wuhan city) and Wuhan city was less than 5% For the data of subsequent 5 days between February 8 to 12, which were not included in the model fitting, the prediction biases were less than 10% Regardless of the cases diagnosed by clinical examines, the numbers of daily emerging cases of China (Hubei province not included), Hubei Province (Wuhan city not included) and Wuhan city reached the peak in the early February Under the current strength of prevention and control, the total number of laboratory- confirmed cases in overall China will reach 80 417 till February 29, 2020, respectively Conclusions The proposed SEIR + CAQ dynamic model fits and forecasts the trend of novel coronavirus pneumonia well and provides evidence for decision making


title: Fitting and forecasting the trend of COVID-19 by SEIR+ CAQ dynamic model

text: Objectives;Fitting and forecasting the trend of COVID-19 epidemics ;;Methods;Based on SEIR dynamic model, considering the COVID-19 transmission mechanism, infection spectrum and prevention and control procedures, we developed SEIR+ CAQdynamic model to fit the frequencies of laboratory confirmed cases obtained from the government official websites The data from January 20, 2020 to February 7, 2020 were used to fit the model, while the left data between February 8-12 were used to evaluate the quality of forecasting ;;Results;According to the cumulative number of confirmed cases between January 29 to February 7, the fitting bias of SEIR+ CAQmodel for overall China (except for cases of Hubei province), Hubei province (except for cases of Wuhan city) and Wuhan city was less than 5% For the data of subsequent 5 days between February 8 to 12, which were not included in the model fitting, the prediction biases were less than 10% Regardless of the cases diagnosed by clinical examines, the numbers of daily emerging cases of China (Hubei province not included), Hubei Province (Wuhan city not included) and Wuhan city reached the peak in the early February Under the current strength of prevention and control, the total number of laboratory- confirmed cases in overall China will reach 80 417 till February 29, 2020, respectively ;;Conclusions;The proposed SEIR+ CAQdynamic model fits and forecasts the trend of novel coronavirus pneumonia well and provides evidence for decision making ;


Six months of coronavirus: the mysteries scientists are still racing to solve


Impact of a nationwide COVID-19 lockdown on acute coronary syndrome referrals


title: COVID_MTNet: COVID-19 Detection with Multi-Task Deep Learning Approaches

text: COVID-19 is currently one the most life-threatening problems around the world. The fast and accurate detection of the COVID-19 infection is essential to identify, take better decisions and ensure treatment for the patients which will help save their lives. In this paper, we propose a fast and efficient way to identify COVID-19 patients with multi-task deep learning (DL) methods. Both X-ray and CT scan images are considered to evaluate the proposed technique. We employ our Inception Residual Recurrent Convolutional Neural Network with Transfer Learning (TL) approach for COVID-19 detection and our NABLA-N network model for segmenting the regions infected by COVID-19. The detection model shows around 84.67% testing accuracy from X-ray images and 98.78% accuracy in CT-images. A novel quantitative analysis strategy is also proposed in this paper to determine the percentage of infected regions in X-ray and CT images. The qualitative and quantitative results demonstrate promising results for COVID-19 detection and infected region localization.


Masques contre le COVID : une evidence


Nigeria responds to COVID-19; first case detected in sub-Saharan Africa


title: Forecasting spatial, socioeconomic and demographic variation in COVID-19 health care demand in England and Wales

text: BACKGROUND: COVID-19 poses one of the most profound public health crises for a hundred years. As of mid-May 2020, across the world, almost 300,000 deaths and over 4 million confirmed cases were registered. Reaching over 30,000 deaths by early May, the UK had the highest number of recorded deaths in Europe, second in the world only to the USA. Hospitalization and death from COVID-19 have been linked to demographic and socioeconomic variation. Since this varies strongly by location, there is an urgent need to analyse the mismatch between health care demand and supply at the local level. As lockdown measures ease, reinfection may vary by area, necessitating a real-time tool for local and regional authorities to anticipate demand. METHODS: Combining census estimates and hospital capacity data from ONS and NHS at the Administrative Region, Ceremonial County (CC), Clinical Commissioning Group (CCG) and Lower Layer Super Output Area (LSOA) level from England and Wales, we calculate the number of individuals at risk of COVID-19 hospitalization. Combining multiple sources, we produce geospatial risk maps on an online dashboard that dynamically illustrate how the pre-crisis health system capacity matches local variations in hospitalization risk related to age, social deprivation, population density and ethnicity, also adjusting for the overall infection rate and hospital capacity. RESULTS: By providing fine-grained estimates of expected hospitalization, we identify areas that face higher disproportionate health care burdens due to COVID-19, with respect to pre-crisis levels of hospital bed capacity. Including additional risks beyond age-composition of the area such as social deprivation, race/ethnic composition and population density offers a further nuanced identification of areas with disproportionate health care demands. CONCLUSIONS: Areas face disproportionate risks for COVID-19 hospitalization pressures due to their socioeconomic differences and the demographic composition of their populations. Our flexible online dashboard allows policy-makers and health officials to monitor and evaluate potential health care demand at a granular level as the infection rate and hospital capacity changes throughout the course of this pandemic. This agile knowledge is invaluable to tackle the enormous logistical challenges to re-allocate resources and target susceptible areas for aggressive testing and tracing to mitigate transmission.


The burden of thrombotic complications in critically ill patients with COVID-19: charting the uncharted


Cultivating Deliberate Resilience During the Coronavirus Disease 2019 Pandemic


Public-private partnership: strategies for continuing urgent elective operative care during the COVID-19 pandemic


Prevention and Control of COVID-19 in Chronic Kidney Disease: Correspondence


title: Coronavirus Disease 2019 Pandemic Measures: Reports From a National Survey of 9,120 ICU Clinicians

text: IMPORTANCE: Recent reports identify that among hospitalized coronavirus disease 2019 patients, 30% require ICU care. Understanding ICU resource needs remains an essential component of meeting current and projected needs of critically ill coronavirus disease 2019 patients. OBJECTIVES: This study queried U.S. ICU clinician perspectives on challenging aspects of care in managing coronavirus disease 2019 patients, current and anticipated resource demands, and personal stress. DESIGN, SETTING, AND PARTICIPANTS: Using a descriptive survey methodology, an anonymous web-based survey was administered from April 7, 2020, to April 22, 2020 (email and newsletter) to query members of U.S. national critical care organizations. MEASUREMENTS AND MAIN RESULTS: Through a 16-item descriptive questionnaire, ICU clinician perceptions were assessed regarding current and emerging critical ICU needs in managing the severe acute respiratory syndrome coronavirus 2 infected patients, resource levels, concerns about being exposed to severe acute respiratory syndrome coronavirus 2, and perceived level of personal stress. A total of 9,120 ICU clinicians responded to the survey, representing all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more coronavirus disease 2019 cases. The 7,317 respondents who indicated their profession included ICU nurses (n = 6,731, 91.3%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 4.5%), physicians (n = 212, 2.9%), respiratory therapists (n = 31, 0.4%), and pharmacists (n = 30, 0.4%). A majority (n = 6,510, 88%) reported having cared for a patient with presumed or confirmed coronavirus disease 2019. The most critical ICU needs identified were personal protective equipment, specifically N95 respirator availability, and ICU staffing. Minimizing healthcare worker virus exposure during care was believed to be the most challenging aspect of coronavirus disease 2019 patient care (n = 2,323, 30.9%). Nurses report a high level of concern about exposing family members to severe acute respiratory syndrome coronavirus 2 (median score of 10 on 0-10 scale). Similarly, the level of concern reached the maximum score of 10 in ICU clinicians who had provided care to coronavirus disease 2019 patients. CONCLUSIONS: This national ICU clinician survey identifies continued concerns regarding personal protective equipment supplies with the chief issue being N95 respirator availability. As the pandemic continues, ICU clinicians anticipate a number of limited resources that may impact ICU care including personnel, capacity, and surge potential, as well as staff and subsequent family members exposure to severe acute respiratory syndrome coronavirus 2. These persistent concerns greatly magnify personal stress, offering a therapeutic target for professional organization and facility intervention efforts.


Reply: The Optimal Management of Electrodiagnostic Studies during COVID-19 Outbreak


Infection control protocol inside computed tomography suites during COVID-19 outbreak


title: Impact of the COVID-19 pandemic on interventional cardiology fellowship training in the New York metropolitan area: A perspective from the United States epicenter

text: BACKGROUND: The healthcare burden posed by the coronavirus disease 2019 (COVID-19) pandemic in the New York Metropolitan area has necessitated the postponement of elective procedures resulting in a marked reduction in cardiac catheterization laboratory (CCL) volumes with a potential to impact interventional cardiology (IC) fellowship training. METHODS: We conducted a web-based survey sent electronically to 21 Accreditation Council for Graduate Medical Education accredited IC fellowship program directors (PDs) and their respective fellows. RESULTS: Fourteen programs (67%) responded to the survey and all acknowledged a significant decrease in CCL procedural volumes. More than half of the PDs reported part of their CCL being converted to inpatient units and IC fellows being redeployed to COVID-19 related duties. More than two-thirds of PDs believed that the COVID-19 pandemic would have a moderate (57%) or severe (14%) adverse impact on IC fellowship training, and 21% of the PDs expected their current fellows' average percutaneous coronary intervention (PCI) volume to be below 250. Of 25 IC fellow respondents, 95% expressed concern that the pandemic would have a moderate (72%) or severe (24%) adverse impact on their fellowship training, and nearly one-fourth of fellows reported performing fewer than 250 PCIs as of March 1st. Finally, roughly one-third of PDs and IC fellows felt that there should be consideration of an extension of fellowship training or a period of early career mentorship after fellowship. CONCLUSIONS: The COVID-19 pandemic has caused a significant reduction in CCL procedural volumes that is impacting IC fellowship training in the NY metropolitan area. These results should inform professional societies and accreditation bodies to offer tailored opportunities for remediation of affected trainees.


title: Taking control amidst the chaos: Emotion regulation during the COVID-19 pandemic

text: The COVID-19 pandemic represents a major global health crisis that continues to threaten public health and safety. Although the pandemic is still unfolding, measures to reduce the spread of the virus have spawned significant challenges to people's current work as well as their careers more generally. In this commentary, we discuss the implications of COVID-19 for maintaining one's psychological well-being and employment security, and also managing family and work responsibilities. We also bring forth evidence from the emotion regulation literature to help mitigate the downstream negative consequences of COVID-19 on people's work lives. Finally, we offer several suggestions for future scholarly investigation into how this pandemic impacts vocational behavior.


Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic


title: What lies ahead: Elevated concerns for the ongoing suicide pandemic

text: The genesis and global spread of coronavirus disease 2019 (COVID-19) has resulted in significant health concerns amid societies that were ill-equipped for such a formidable opponent. The COVID-19 pandemic has illuminated systemic health disparities and weaknesses within our health care and political systems. With aggressive but necessary interventions to thwart the instantaneous reproduction number, we have simultaneously introduced risk factors for new and exacerbated mental health concerns. Suicide, an ongoing pandemic whose rates are higher than they have been in the past 50 years, is one of these concerns as we navigate COVID-19 deaths and fears surrounding its spread. This article aims to briefly describe in retrospect some of the historical pandemics and their downstream consequences as well as present what may lie ahead in terms of anxiety, depression, and suicidal behaviors. This applies not only to frontline health care workers but also the public at large, who may very well experience long-term stressor- and trauma-related consequences through ongoing exposure to a virus that is not only potentially fatal but may have taken the lives of loved ones. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: The hidden side of COVID-19 spread in Italy

text: Background. The paper concerns the SARS-CoV2 (COVID-19) pandemic that, starting from the end of February 2020, began spreading along the Italian peninsula, by first attacking small communities in north regions, and then extending to the center and south of Italy, including the two main islands. Objective. The creation of a forecast model that manages to alert the decision-making bodies and, in particular, the healthcare system, to hinder the emergence of any other pandemic outbreaks, or the arrival of subsequent pandemic waves. Methods. A new mathematical model to describe the pandemic is given. The model includes the class of undiagnosed infected people, and has a multi-region extension, to cope with the in-time and in-space heterogeneity of the epidemic. Results. We obtain a robust and reliable tool for the forecast of the total and active cases, which can be also used to simulate different scenarios. Conclusions. We are able to address a number of issues, such as assessing the adoption of the lockdown in Italy, started from 11 March 2020, and how to employ a rapid screening test campaign for containing the epidemic.


Latest updates on COVID-2019: A changing paradigm shift


title: Transcatheter mitral valve repair with MitraClip for severe mitral regurgitation and cardiogenic shock during the COVID-19 pandemic

text: Transcatheter mitral valve repair with MitraClip (Abbott) is largely an elective procedure. The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed challenges to health care systems; in many cases elective interventions have been curtailed. Patients with severe mitral regurgitation (MR) and cardiogenic shock are high-risk surgical candidates and at risk of a poor outcome without intervention. The American College of Cardiology (ACC) and the Society of Coronary Angiography and Interventions (SCAI) recently proposed joint guidance on triage of structural heart disease (SHD) interventions during the COVID-19 pandemic. We present two illustrative cases of severe MR and cardiogenic shock that were successfully treated with MitraClip amidst the COVID-19 pandemic with good outcomes at short term follow-up.


The pandemic is challenging China's breakneck race to the top of science


Positive result of Sars-Cov-2 in sputum from a cured patient with COVID-19


Smart learning for urology residents during the COVID-19 pandemic and beyond: insights from a nationwide survey in Italy


title: Nuklearmedizin zu Zeiten der SARS-CoV-2 Pandemie: 18F-FDG-PET/CT zur Visualisierung von COVID-19./ Nuclear medicine in SARS-CoV-2 pandemia: 18F-FDG-PET/CT to visualize COVID-19

text: The current outbreak of coronavirus SARS-CoV-2 has reached multiple countries worldwide. While the number of newly diagnosed cases and fatalities is rising quickly, far-reaching measures were enacted to prevent further spread. Diagnosis relies on clinical presentation, exposure history, PCR using specimens from the respiratory tract together with computed tomography (CT) imaging. One of the hallmarks of a critical course of COVID-19 is the development of severe acute respiratory distress syndrome (ARDS). As management of COVID-19 can be considered a multi-disciplinary approach involving various medical specialties, we here review the first 18F-FDG-PET/CT scans of COVID-19 to discuss how Nuclear Medicine could contribute to management of this disease.


title: Emerging Polynomial Growth Trends in COVID-19 Pandemic Data and Their Reconciliation with Compartment Based Models

text: We study the reported data from the COVID-19 pandemic outbreak in January - May 2020 in 119 countries. We observe that the time series of active cases in individual countries (the difference of the total number of confirmed infections and the sum of the total number of reported deaths and recovered cases) display a strong agreement with polynomial growth and at a later epidemic stage also with a combined polynomial growth with exponential decay. Our results are also formulated in terms of compartment type mathematical models of epidemics. Within these models the universal scaling characterizing the observed regime in an advanced epidemic stage can be interpreted as an algebraic decay of the relative reproduction number $R_0$ as $T_M/t$, where $T_M$ is a constant and $t$ is the duration of the epidemic outbreak. We show how our findings can be applied to improve predictions of the reported pandemic data and estimate some epidemic parameters. Note that although the model shows a good agreement with the reported data we do not make any claims about the real size of the pandemics as the relation of the observed reported data to the total number of infected in the population is still unknown.


title: Winds in Star Clusters Drive Kolmogorov Turbulence

text: Intermediate and massive stars drive fast and powerful isotropic winds that interact with the winds of nearby stars in star clusters and the surrounding interstellar medium (ISM). Wind-ISM collisions generate astrospheres around these stars that contain hot $T\sim 10^7$ K gas that adiabatically expands. As individual bubbles expand and collide they become unstable, potentially driving turbulence in star clusters. In this paper we use hydrodynamic simulations to model a densely populated young star cluster within a homogeneous cloud to study stellar wind collisions with the surrounding ISM. We model a mass-segregated cluster of 20 B-type young main sequence stars with masses ranging from 3--17 $M_{\odot}$. We evolve the winds for $\sim$11 kyrs and show that wind-ISM collisions and over-lapping wind-blown bubbles around B-stars mixes the hot gas and ISM material generating Kolmogorov-like turbulence on small scales early in its evolution. We discuss how turbulence driven by stellar winds may impact the subsequent generation of star formation in the cluster


Universal Screening for SARS-CoV-2 in Women Admitted for Delivery


SARS-CoV-2 in upper and lower airway samples of a laryngectomized patient: New insights and many lessons


title: Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic

text: The COVID-19 pandemic is impacting health systems worldwide. Maternity care providers must continue their core business in caring and supporting women, newborns and their families whilst also adapting to a rapidly changing health system environment. This article provides an overview of important considerations for supporting the emotional, mental and physical health needs of maternity care providers in the context of the unprecedented crisis that COVID-19 presents. Cooperation, planning ahead and adequate availability of PPE is critical. Thinking about the needs of maternity providers to prevent stress and burnout is essential. Emotional and psychological support needs to be available throughout the response. Prioritising food, rest and exercise are important. Healthcare workers are every country's most valuable resource and maternity providers need to be supported to provide the best quality care they can to women and newborns in exceptionally trying circumstances.


title: Estimating the burden of SARS-CoV-2 in France

text: France has been heavily affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and went into lockdown on 17 March 2020. Using models applied to hospital and death data, we estimate the impact of the lockdown and current population immunity. We find that 2.9% of infected individuals are hospitalized and 0.5% of those infected die (95% credible interval: 0.3 to 0.9%), ranging from 0.001% in those under 20 years of age to 8.3% in those 80 years of age or older. Across all ages, men are more likely to be hospitalized, enter intensive care, and die than women. The lockdown reduced the reproductive number from 2.90 to 0.67 (77% reduction). By 11 May 2020, when interventions are scheduled to be eased, we project that 3.5 million people (range: 2.1 million to 6.0 million), or 5.3% of the population (range: 3.3 to 9.3%), will have been infected. Population immunity appears to be insufficient to avoid a second wave if all control measures are released at the end of the lockdown.


title: Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19

text: BACKGROUND: A potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied. METHODS: We carried out a population-based case-control study in the Lombardy region of Italy. A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients' clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression. RESULTS: Among both case patients and controls, the mean (±SD) age was 68±13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex. CONCLUSIONS: In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.


Video Conferencing Impact on Facial Appearance: Looking Beyond the COVID-19 Pandemic


title: Early characteristics of the COVID-19 outbreak predict the subsequent epidemic scope

text: OBJECTIVES: The mostly-resolved first wave of the COVID-19 epidemic in China provided a unique opportunity to investigate how the initial characteristics of the COVID-19 outbreak predict its subsequent magnitude. METHODS: We collected publicly available COVID-19 epidemiological data from 436 Chinese cities from 16th January-15th March 2020. Based on 45 cities that reported >100 confirmed cases, we examined the correlation between early-stage epidemic characteristics and subsequent epidemic magnitude. RESULTS: We identified a transition point from a slow- to a fast-growing phase for COVID-19 at 5.5 (95% CI, 4.6-6.4) days after the first report, and 30 confirmed cases marked a critical threshold for this transition. The average time for the number of confirmed cases to increase from 30 to 100 (time from 30-to-100) was 6.6 (5.3-7.9) days, and the average case-fatality rate in the first 100 confirmed cases (CFR-100) was 0.8% (0.2-1.4%). The subsequent epidemic size per million population was significantly associated with both of these indicators. We predicted a ranking of epidemic size in the cities based on these two indicators and found it highly correlated with the actual classification of epidemic size. CONCLUSIONS: Early epidemic characteristics are important indicators for the size of the entire epidemic.


title: Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia Region: A report from the Pediatric Oncology East and Mediterranean (POEM) Group

text: BACKGROUND: Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID-19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS: A 34-item survey focusing on barriers to pediatric oncology management during the COVID-19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID-19 cases and deaths were retrieved from the World Health Organization database. RESULTS: In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey. CONCLUSIONS: Mechanisms to approach childhood cancer treatment delivery during crises need to be re-evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease.


title: Coronavirus Disease 2019 (COVID-19): Clinical Perspectives and Ongoing Challenges

text: BACKGROUND: Emerging infectious diseases pose a great hazard to public health and the global economy A novel coronavirus, SARS-CoV-2, causing coronavirus disease 2019 (COVID-19), emerged from Wuhan, China, in December 2019 Since then, it has spread globally causing a global health emergency of inconceivable magnitude, with significant morbidity and mortality There is the need for clinicians and health care providers to understand and gain knowledge of the different aspects of the disease as it evolves OBJECTIVE: We reviewed existing literature on COVID-19 in order to present a synopsis of current understanding of the disease METHODS: Using PubMed, Embase and Medline, articles published between January and April 2020 on Coronavirus disease 2019 (COVID-19), and resources from World Health Organisation were analyzed in order to have an understanding of the clinical characteristics, transmission dynamics, virology, diagnostic possibilities, prevention, management approach, controversies and impact of COVID-19 on the healthcare workforce RESULTS: Our review revealed that COVID-19 patients present with a myriad of symptoms, ranging from mild to severe respiratory disease, which can often be fatal The mode of transmission via droplet infections makes it unduly contagious and difficult to control Currently, antiviral drugs or vaccines are being developed to manage this condition CONCLUSION: There is urgent need for potent antivirals and vaccine to manage those infected with COVID 19 and prevent infection Global efforts need to be unified in combating this public health emergency and flattening the curve of spread


Editorial: low population mortality from COVID-19 in countries south of latitude 35 degrees North-supports vitamin D as a factor determining severity. Authors' reply


title: Favorable COVID-19 course despite significant comorbidities in a ruxolitinib-treated patient with primary myelofibrosis

text: COVID-19 carries a high risk of severe disease course, particularly in patients with comorbidities. Therapy of severe COVID-19 infection has relied on supportive intensive care measures. More specific approaches including drugs that limit the detrimental "cytokine storm", such as Janus-activated kinase (JAK) inhibitors, are being discussed. Here, we report a compelling case of a 55-yo patient with proven COVID-19 pneumonia, who was taking the JAK1/2 inhibitor ruxolitinib in-label for co-existing primary myelofibrosis for 15 months prior to coronavirus infection. The patient had significant comorbidities, including chronic kidney disease, arterial hypertension, and obesity, and our previous cohort suggested that he was thus at high risk for acute respiratory distress syndrome (ARDS) and death from COVID-19. Since abrupt discontinuation of ruxolitinib may cause fatal cytokine storm and ARDS, ruxolitinib treatment was continued and was well tolerated, and the patient´s condition remained stable, without the need for mechanical ventilation or vasopressors. The patient became negative for SARS-CoV-2 and was discharged home after 15 days. In conclusion, our report provides clinical evidence that ruxolitinib treatment is feasible and can be beneficial in patients with COVID-19 pneumonia, preventing cytokine storm and ARDS.


title: Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020

text: Globally, approximately 170,000 confirmed cases of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) have been reported, including an estimated 7,000 deaths in approximately 150 countries (1). On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic (2). Data from China have indicated that older adults, particularly those with serious underlying health conditions, are at higher risk for severe COVID-19-associated illness and death than are younger persons (3). Although the majority of reported COVID-19 cases in China were mild (81%), approximately 80% of deaths occurred among adults aged ≥60 years; only one (0.1%) death occurred in a person aged ≤19 years (3). In this report, COVID-19 cases in the United States that occurred during February 12-March 16, 2020 and severity of disease (hospitalization, admission to intensive care unit [ICU], and death) were analyzed by age group. As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC, with multiple cases reported among older adults living in long-term care facilities (4). Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions or deaths were reported among persons aged ≤19 years. Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups.


Percutaneous Dilatational Tracheostomy in Coronavirus Disease 2019 Extracorporeal Membrane Oxygenation Patients: A Case Series


title: COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals

text: The novel coronavirus 2019, or COVID-19, infection has rapidly spread through the New York metropolitan area since the first reported case in the state on March 1, 2020. New York currently represents an epicenter for COVID-19 infection in the United States, with 84,735 cases reported as of April 2, 2020. We previously presented an early experience with seven COVID-positive patients in pregnancy, including two women who were diagnosed with COVID-19 following an asymptomatic initial presentation. We now describe a series of 43 test-confirmed cases of COVID-19 presenting to a pair of affiliated New York City hospitals over two weeks from March 13 to 27, 2020. Fourteen (32.6%) patients presented without any COVID-associated viral symptoms, and were identified either after developing symptoms during admission or following the implementation of universal testing for all obstetrical admissions on March 22. Of these, 10/14 (71.4%) developed symptoms or signs of COVID-19 infection over the course of their delivery admission or early after postpartum discharge. Of the other 29 (67.4%) patients who presented with symptomatic COVID-19 infection, three women ultimately required antenatal admission for viral symptoms, and an additional patient represented six days postpartum after a successful labor induction with worsening respiratory status that required oxygen supplementation. There were no confirmed cases of COVID-19 detected in neonates upon initial testing on the first day of life. Applying COVID-19 disease severity characteristics as described by Wu et al, 37 (86%) women possessed mild disease, four (9.3%) exhibited severe disease, and two (4.7%) developed critical disease; these percentages are similar to those described for non-pregnant adults with COVID-19 infections (about 80% mild, 15% severe, and 5% critical disease).


COVID-19 pandemic, healthcare providers' contamination and death: an international view


Treatment options for patients with HR+/HER2- advanced breast cancer during the COVID-19 pandemic: dose reduction of ribociclib does not diminish efficacy


title: The Doctor's Dilemma: lessons from GB Shaw in a modern pandemic COVID-19

text: In the current COVID 19 pandemic, the only treatments are supportive as no definitive pharmacological intervention is available. The heterogeneity of the immune response in different patient groups is clear with less severe illness in children. Understanding these disparities is particularly important as severely affected patients with COVID19 cannot always be predicted before they experience a cytokine storm and multiorgan dysfunction. Over 100 years ago, the concept of individualised immunotherapy was introduced by Sir Almroth Wright and immortalised in GB Shaw's play The Doctor's Dilemma. Shaw's play The Doctor's Dilemma explores the issues of private medical practice, equality of health care delivery, rationing of scarce resources (intensive care) and high-risk therapies. The play also describes the dilemma of rationing of resources and selecting the correct patient for new experimental therapies. Immunological theories of the time are now reflected in current understanding of inflammatory responses in sepsis and immunomodulation during the COVID19 pandemic.


title: A Discrete Probabilistic Approach to Dense Flow Visualization

text: Dense flow visualization is a popular visualization paradigm. Traditionally, the various models and methods in this area use a continuous formulation, resting upon the solid foundation of functional analysis. In this work, we examine a discrete formulation of dense flow visualization. From probability theory, we derive a similarity matrix that measures the similarity between different points in the flow domain, leading to the discovery of a whole new class of visualization models. Using this matrix, we propose a novel visualization approach consisting of the computation of spectral embeddings, i.e., characteristic domain maps, defined by particle mixture probabilities. These embeddings are scalar fields that give insight into the mixing processes of the flow on different scales. The approach of spectral embeddings is already well studied in image segmentation, and we see that spectral embeddings are connected to Fourier expansions and frequencies. We showcase the utility of our method using different 2D and 3D flows.


title: "The ancient and the new": is there an interaction between cytomegalovirus and SARS-CoV-2 infection?

text: The SARS-CoV-2 pandemic represents one of the greatest infectious challenges to humanity in recent history. One of the striking features of infection is the heterogeneous clinical response with worse outcomes observed in older patients and those with underlying health conditions. To date the potential impact of previous infection history has been poorly investigated as a potential determinant of risk. Cytomegalovirus (CMV), a persistent herpesvirus infection whose prevalence increases with age, is a major modulator of immune function and several observations suggest that infection might act to influence clinical outcome following SARS-CoV-2 infection. In particular, CMV is associated with the acceleration of immune senescence and has been linked to a range of cardiovascular and metabolic disorders. This review addresses mechanisms by which cytomegalovirus infection may act to worsen the clinical outcome of SARS-CoV-2 infection, discusses how these potential links could be investigated, and assesses the potential significance of any findings that emerge.


title: Review article: COVID-19 and liver disease-what we know on 1st May 2020

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), became a global threat to human health. Liver impairment has been frequently reported as a common manifestation, although its clinical significance is still unclear, particularly in patients with underlying chronic liver disease (CLD). AIMS: To summarise the changes in liver function tests during SARS-CoV-2 infection and the impact of COVID-19 in patients with underlying CLD. METHODS: A literature review using online database PubMed was done using the search terms "SARS-CoV-2", "COVID-19", "liver", "cirrhosis" and "liver transplantation". RESULTS: COVID-19 is frequently associated with different degrees of abnormal liver function tests, most notably transaminases, which are usually transitory and of mild degree. Available evidence suggests that liver injury may result from direct pathogenic effect by the virus, systemic inflammation or toxicity from commonly used drugs in this subset of patients. SARS-CoV-2 infection in children is associated with minimal or no increase in liver enzymes, thus the presence of abnormal liver function tests should trigger evaluation for underlying liver diseases. Although it seems that patients with CLD are not at greater risk for acquiring the infection, those with cirrhosis, hepatocellular carcinoma, non-alcoholic fatty liver disease, autoimmune liver diseases or liver transplant may have a greater risk for severe COVID-19. CONCLUSIONS: Abnormal liver function tests during the course of COVID-19 are common, though clinically significant liver injury is rare. Further research is needed focusing on the effect of existing liver-related comorbidities on treatment and outcome of COVID-19.


Understanding Observational Treatment Comparisons in the Setting of Coronavirus Disease 2019 (COVID-19)


Lessons from the present: Intraoperative neurophysiological monitoring organization during the COVID-19 pandemic in Lombardy, northern Italy


title: Incorporating Geographic Information Science and Technology in Response to the COVID-19 Pandemic

text: Incorporating geographic information science and technology (GIS&T) into COVID-19 pandemic surveillance, modeling, and response enhances understanding and control of the disease. Applications of GIS&T include 1) developing spatial data infrastructures for surveillance and data sharing, 2) incorporating mobility data in infectious disease forecasting, 3) using geospatial technologies for digital contact tracing, 4) integrating geographic data in COVID-19 modeling, 5) investigating geographic social vulnerabilities and health disparities, and 6) communicating the status of the disease or status of facilities for return-to-normal operations. Locations and availability of personal protective equipment, ventilators, hospital beds, and other items can be optimized with the use of GIS&T. Challenges include protection of individual privacy and civil liberties and closer collaboration among the fields of geography, medicine, public health, and public policy.


title: Changes of EEG phase synchronization and EOG signals along the use of steady state visually evoked potential-based brain computer interface

text: The steady-state visual evoked potential (SSVEP)-based brain computer interface (BCI) has demonstrated relatively high performance with little user training, and thus becomes a popular BCI paradigm. However, due to the performance deterioration over time, its robustness and reliability appear not sufficient to allow a non-expert to use outside laboratory. It would be thus helpful to study what happens behind the decreasing tendency of the BCI performance. This paper explores the changes of brain networks and electrooculography (EOG) signals to investigate the cognitive capability changes along the use of the SSVEP-based BCI. The EOG signals are characterized by the blink amplitudes and the speeds of saccades, and the brain networks are estimated by the instantaneous phase synchronizations of electroencephalography (EEG) signals. Experimental results revealed that the characteristics derived from EOG and brain networks have similar trends which contain two stages. At the beginning, the blink amplitudes and the saccade speeds start to reduce. Meanwhile, the global synchronizations of the brain networks are formed quickly. These observations implies that the cognitive decline along the use of the SSVEP-based BCI. Then, the EOG and the brain networks related characteristics demonstrate a slow recovery or relatively stable trend. This study could be helpful for a better understanding about the depreciation of the BCI performance as well as its relationship with the brain networks and the EOG along the use of the SSVEP-based BCI.


title: Lineamientos que refuerzan el cuidado integral de salud en el Primer Nivel de Atención en el contexto de la pandemia COVID-19/ Guidelines that reinforce comprehensive health care at the First Level of Care in the context of the COVID-19 pandemic

text: El documento contiene los lineamientos que refuerzan el cuidado integral de salud por curso de vida y con un enfoque de derechos humanos e interculturalidad en el Primer Nivel de Atención en el contexto de la pandemia y el aislamiento social obligatorio por COVID-19


Surgical Decision Making in the Era of COVID-19: A New Set of Rules


title: A case series of COVID-19 patients with chronic hepatitis B virus infection

text: Previous studies reported that coronavirus disease 2019 (COVID-19) was likely to result in liver injury. However, few studies reported the impacts of COVID-19 on liver function in patients with chronic liver diseases. We aimed to describe a case series of COVID-19 patients with chronic hepatitis B virus (HBV) infection. Confirmed hospitalized COVID-19 patients from hospitals in 10 cities of Jiangsu province, China were retrospectively included between January 18, 2020, and February 26, 2020. Demographic information, epidemiologic data, clinical features and treatment data were extracted from medical records. Seven COVID-19 patients with chronic HBV infection were included. Six (85.7%) patients were male. The patients aged from 33 years to 49 years. Two patients had HBV-related cirrhosis. One patients (14.3%) were positive for serum hepatitis B virus e antigen. On admission, 1 (14.3%) patients had mildly elevated ALT level (>40 U/L) and 1 (14.3%) had elevated AST level (>40 U/L). The serum albumin level and platelet counts were decreased in 2 patients with HBV-related liver cirrhosis. Three (42.9%) patients had elevated ALT level and 2 (28.6%) patients had elevated AST level in hospitalization. However, the peak ALT and AST level during hospitalization was 51 U/L and 44 U/L, respectively. As of February 29, 2020, all patients were discharged. No patient was admitted to the intensive care units or developed liver failure during hospitalization. The abnormalities of liver function are not uncommon on COVID-19 patients with chronic HBV infection in our case series. However, no patient developed severe liver-related complications during hospitalization. This article is protected by copyright. All rights reserved.


title: The Story of #GetMePPE and GetUsPPE.org - Rapidly Deploying Digital Tools for Better Healthcare

text: UNSTRUCTURED: Physicians, nurses, and other healthcare providers initiated the #GetMePPE movement on Twitter to spread awareness of the shortage of personal protective equipment (PPE) during the COVID-19 pandemic. Dwindling supplies, such as face masks, gowns and goggles, and inadequate production to meet increasing demands, has left healthcare workers and patients at risk. The momentum of this Twitter hashtag resulted in a petition to urge public officials to address the PPE shortage through increased funding and production. Simultaneously, GetUsPPE.org was launched by a collaborative of physicians and software engineers to develop a digital platform for the donation, request, and distribution of multi-modal sources of PPE. GetUsPPE.org and #GetMePPE merged in an attempt to combine public engagement and advocacy on social media with the coordination of PPE donation and distribution. Within ten days, over 1800 hospitals and PPE suppliers were registered in a database that allowed for the rapid coordination and distribution of scarce and in-demand materials. One month after its launch, the organization has distributed hundreds of thousands of items of PPE and built a database of over 6,000 PPE requesters[1] The call for action on social media and the rapid development of this digital tool created a productive channel for the public to contribute to the healthcare response to COVID-19 in meaningful ways. #GetMePPE and GetUsPPE.org were able to mobilize individuals and organizations outside of the healthcare system to address the unmet needs of the medical community. The success of GetUsPPE.org demonstrates the potential of digital tools as a platform for larger healthcare institutions (table 1) to rapidly address urgent issues in healthcare. In this manuscript, we outline this process and discuss key factors determining success.


Climate change, Covid-19, preparedness, and consciousness


title: Cataloguing the response by emergency veterinary hospitals during the COVID-19 pandemic via weekly surveys

text: BACKGROUND: The COVID-19 pandemic has presented veterinary emergency hospitals with unique challenges. Rapid online surveys represent an efficient way of collating responses to rapidly shifting circumstances. METHODS: Fifty, 24-h small animal emergency veterinary hospital representatives were recruited to participate in weekly surveys in April 2020 to catalog changes due to COVID-19 pandemic. KEY FINDINGS: The majority of emergency veterinary hospitals surveyed reported significant changes to day-to-day operations as a result of the COVID-19 pandemic. SIGNIFICANCE: Reporting of weekly survey results provides useful information on how emergency veterinary hospitals with similar challenges are responding to the COVID-19 pandemic.


title: Gene signatures of SARS-CoV/SARS-CoV-2-infected ferret lungs in short- and long-term models

text: Coronaviruses (CoVs) consist of six strains, and the severe acute respiratory syndrome coronavirus (SARS-CoV), newly found coronavirus (SARS-CoV-2) has rapidly spread leading to a global outbreak. The ferret (Mustela putorius furo) serves as a useful animal model for studying SARS-CoV/SARS-CoV-2 infection and developing therapeutic strategies. A holistic approach for distinguishing differences in gene signatures during disease progression is lacking. The present study discovered gene expression profiles of short-term (3 days) and long-term (14 days) ferret models after SARS-CoV/SARS-CoV-2 infection using a bioinformatics approach. Through Gene Ontology (GO) and MetaCore analyses, we found that the development of stemness signaling was related to short-term SARS-CoV/SARS-CoV-2 infection. In contrast, pathways involving extracellular matrix and immune responses were associated with long-term SARS-CoV/SARS-CoV-2 infection. Some highly expressed genes in both short- and long-term models played a crucial role in the progression of SARS-CoV/SARS-CoV-2 infection, including DPP4, BMP2, NFIA, AXIN2, DAAM1, ZNF608, ME1, MGLL, LGR4, ABHD6, and ACADM. Meanwhile, we revealed that metabolic, glucocorticoid, and reactive oxygen species-associated networks were enriched in both short- and long-term infection models. The present study showed alterations in gene expressions from short-term to long-term SARS-CoV/SARS-CoV-2 infection. The current result provides an explanation of the pathophysiology for post-infectious sequelae and potential targets for treatment.


title: A self-supervised neural-analytic method to predict the evolution of COVID-19 in Romania

text: Analysing and understanding the transmission and evolution of the COVID-19 pandemic is mandatory to be able to design the best social and medical policies, foresee their outcomes and deal with all the subsequent socio-economic effects. We address this important problem from a computational and machine learning perspective. More specifically, we want to statistically estimate all the relevant parameters for the new coronavirus COVID-19, such as the reproduction number, fatality rate or length of infectiousness period, based on Romanian patients, as well as be able to predict future outcomes. This endeavor is important, since it is well known that these factors vary across the globe, and might be dependent on many causes, including social, medical, age and genetic factors. We use a recently published improved version of SEIR, which is the classic, established model for infectious diseases. We want to infer all the parameters of the model, which govern the evolution of the pandemic in Romania, based on the only reliable, true measurement, which is the number of deaths. Once the model parameters are estimated, we are able to predict all the other relevant measures, such as the number of exposed and infectious people. To this end, we propose a self-supervised approach to train a deep convolutional network to guess the correct set of Modified-SEIR model parameters, given the observed number of daily fatalities. Then, we refine the solution with a stochastic coordinate descent approach. We compare our deep learning optimization scheme with the classic grid search approach and show great improvement in both computational time and prediction accuracy. We find an optimistic result in the case fatality rate for Romania which may be around 0.3% and we also demonstrate that our model is able to correctly predict the number of daily fatalities for up to three weeks in the future.


Is low dose radiation therapy a potential treatment for COVID-19 pneumonia?


title: Beveridgean Unemployment Gap

text: This paper proposes a new method to estimate the unemployment gap (the actual unemployment rate minus the efficient rate). While lowering unemployment puts more people into work, it forces firms to post more vacancies and devote more resources to recruiting. This unemployment-vacancy tradeoff, governed by the Beveridge curve, determines the efficient unemployment rate. Accordingly, the unemployment gap can be measured from three sufficient statistics: the elasticity of the Beveridge curve, cost of recruiting, and social cost of unemployment. In the United States the unemployment gap is countercyclical, reaching 1.5--6.5 percentage points in slumps. Thus the US labor market appears inefficient---especially inefficiently slack in slumps.


title: Disinfection technology of hospital wastes and wastewater: Suggestions for disinfection strategy during coronavirus Disease 2019 (COVID-19) pandemic in China

text: Hospitals are important sources of pollutants resulted from diagnostic, laboratory and research activities as well as medicine excretion by patients, which include active component of drugs and metabolite, chemicals, residues of pharmaceuticals, radioactive markers, iodinated contrast media, etc. The discharge of hospital wastes and wastewater, especially those without appropriate treatment would expose the public in danger of infection. In particular, under the Coronavirus Disease 2019 (COVID-19) pandemic context in China, it is of great significance to reduce the health risks to the public and environment. In this study, technologies of different types of hospital wastes and wastewater disinfection have been summarized. Liquid chlorine, sodium hypochlorite, chlorine dioxide, ozone, and ultraviolet irradiation disinfection are commonly used for hospital wastewater disinfection. While incineration, chemical disinfection, and physical disinfection are commonly used for hospital wastes disinfection. In addition, considering the characteristics of various hospital wastes, the classification and selection of corresponding disinfection technologies are discussed. On this basis, this study provides scientific suggestions for management, technology selection, and operation of hospital wastes and wastewater disinfection in China, which is of great significance for development of national disinfection strategy for hospital wastes and wastewater during COVID-19 pandemic.


title: Blood pressure trend in hospitalized adult dengue patients

text: BACKGROUND: Monitoring of blood pressure is an important part of management of dengue illness. Large scale studies of temporal trend of blood pressure in adult dengue are lacking. In this study, we examined the differences in time trend of systolic (SBP) and diastolic blood pressure (DBP) in patients with and without severe dengue (SD), dengue hemorrhagic fever (DHF) and pre-existing hypertension, and elderly versus non-elderly patients. METHODS: We studied a retrospective cohort from 2005 to 2008 of 6,070 hospitalized adult dengue patients confirmed by polymerase chain reaction or clinical criteria plus positive dengue serology. Dengue severity was defined according to World Health Organization 1997 and 2009 guidelines. We used Bayesian hierarchical Markov models to compare the daily mean SBP and DBP between different subgroups. Analysis was conducted by day of defervescence (denoted as day 0), and day of illness onset (denoted as day 1) respectively. RESULTS: SBP decreased to a nadir during the critical phase before defervescence and was significantly lower for patients with SD or DHF, compared with patients without SD or DHF. DBP increased marginally more for patients with SD or DHF in the critical phase before defervescence. By day of defervescence, comparison of patients with and without SD showed significant difference in SBP from day -6 to day +6, except days +1, +3 and +5, and similarly in DBP except days 0, and +4 to +6. Comparison of patients with and without DHF showed significant difference in SBP from day -6 to day -1, but for DBP, significant difference was noted from day -6 to day +6, except day -2 to day 0. By day of illness, SBP differed significantly between patients with and without SD from illness days 1 to 10, and DBP from illness days 7 to 12. Between patients with and without DHF, SBP differed significantly on illness days 1, 2, 4 to 7, while DBP from days 7 to 12. On analysis by days of defervescence or by days of illness, elderly patients and those with hypertension showed consistently higher SBP and DBP throughout their hospitalization, as compared with their younger and non-hypertensive counterparts. CONCLUSION: In SD or DHF, SBP decreased to a nadir around the day of defervescence, and recovered to a level exceeding that in febrile phase by days 2 or 3 post-defervescence. Elderly patients and patients with pre-existing hypertension maintained higher SBP and DBP throughout the duration of dengue infection.


title: Role of esophageal manometry and 24-h pH testing in patients with refractory reflux symptoms

text: BACKGROUND: A proportion of patients with gastroesophageal reflux disease (GERD) do not respond to proton pump inhibitor (PPI) therapy. AIM OF THE STUDY: To determine the findings on high-resolution esophageal manometry (HREM) and 24-h pH recording in patients with typical GERD symptoms, refractory to PPI treatment. METHODS: Retrospective analysis of prospectively maintained database of patients referred for HREM and 24-h pH recording was done. We selected patients who were referred for evaluation of refractory GERD symptoms despite > 8 weeks of at least once-daily PPI treatment. Details noted were demographic profile, upper gastrointestinal endoscopy report, HREM findings and 24-h pH findings. RESULTS: Ninety-six patients had symptoms of GERD that were refractory to PPI therapy. Seven patients (7.1%) were diagnosed having diseases mimicking GERD: eosinophilic esophagitis (n=2), supragastric belching (n=4) and rumination (n=1). After excluding these patients and those with insufficient data, the final study cohort included 82 cases. Fifty patients (61%) had normal motility. Major motility disorders were detected in 8 (9.75%) patients: achalasia cardia (6) and distal esophageal spasm (2). Ineffective esophageal motility was noted in 24 patients. A total of 74 patients underwent 24-h pH testing. Significant acid reflux with good symptom correlation was noted in 56 patients. Eighteen patients did not have significant acid reflux (Johnson-DeMeester score < 14.7): hypersensitive esophagus (12) and functional heartburn (6). CONCLUSION: Fifty-six patients (68.3%) had definite diagnosis of GERD and 31.7% (26) had non-GERD conditions like motility disorders, functional heartburn and hypersensitive esophagus.


title: An Investigation of COVID-19 Spreading Factors with Explainable AI Techniques

text: Since COVID-19 was first identified in December 2019, various public health interventions have been implemented across the world. As different measures are implemented at different countries at different times, we conduct an assessment of the relative effectiveness of the measures implemented in 18 countries and regions using data from 22/01/2020 to 02/04/2020. We compute the top one and two measures that are most effective for the countries and regions studied during the period. Two Explainable AI techniques, SHAP and ECPI, are used in our study; such that we construct (machine learning) models for predicting the instantaneous reproduction number ($R_t$) and use the models as surrogates to the real world and inputs that the greatest influence to our models are seen as measures that are most effective. Across-the-board, city lockdown and contact tracing are the two most effective measures. For ensuring $R_t<1$, public wearing face masks is also important. Mass testing alone is not the most effective measure although when paired with other measures, it can be effective. Warm temperature helps for reducing the transmission.


Delayed presentation and increased prevalence of proliferative vitreoretinopathy for primary rhegmatogenous retinal detachments presenting during the COVID-19 pandemic lockdown


Letter to the editor: Neuroleptic malignant syndrome in COVID-19 patients by Soh et al


title: Proximity: a recipe to break the outbreak

text: We present a mobile app solution to help the containment of an epidemic outbreak by keeping track of possible infections in the incubation period. We consider the particular case of an infection which primarily spreads among people through proximal contact, via respiratory droplets. This smartphone application will work offline and will be able to detect other devices in close proximity and list all the interactions in an anonymous and encrypted way. If an app user is tested positive and so is certified as infected, the application notifies immediately the potential contagion to the devices in the list and suggests to start a voluntary quarantine and undergo a medical test. We believe this solution may be useful in particular in the current COVID-19 pandemic and moreover could be used to prevent similar events in the future.


The Social, Economic and Sanitary Impact of COVID-19 Pandemic


title: Serum KL-6 concentrations as a novel biomarker of severe COVID-19

text: Severe acute respiratory syndrome coronavirus 2-induced direct cytopathic effects against type I and II pneumocytes mediate lung damage. Krebs von den Lungen-6 (KL-6) is mainly produced by damaged or regenerating alveolar type II pneumocytes. This preliminary study analyzed serum concentrations of KL-6 in patients with coronavirus disease (COVID-19) to verify its potential as a prognostic biomarker of severity. Twenty-two patients (median age [interquartile range] 63 [59-68] years, 16 males) with COVID-19 were enrolled prospectively. Patients were divided into mild-moderate and severe groups, according to respiratory impairment and clinical management. KL-6 serum concentrations and lymphocyte subset were obtained. Peripheral natural killer (NK) cells/µL were significantly higher in nonsevere patients than in the severe group (P = .0449) and the best cut-off value was 119 cells/µL. KL-6 serum concentrations were significantly higher in severe patients than the nonsevere group (P = .0118). Receiver operating characteristic analysis distinguished severe and nonsevere patients according to KL-6 serum levels and the best cut-off value was 406.5 U/mL. NK cell analysis and assay of KL-6 in serum can help identify severe COVID-19 patients. Increased KL-6 serum concentrations were observed in patients with severe pulmonary involvement, revealing a prognostic value and supporting the potential usefulness of KL-6 measurement to evaluate COVID-19 patients' prognosis.


Rational hand hygiene during the coronavirus 2019 (COVID-19) pandemic


title: COVID in NYC: What We Could Do Better

text: New York City hospitals expanded resources to an unprecedented extent in response to the COVID pandemic. Thousands of beds, ICU beds, staff members, and ventilators were rapidly incorporated into hospital systems. Nonetheless, this historic public health disaster still created scarcities and the need for formal crisis standards of care. These were not available to NY clinicians because of the state's failure to implement, with or without revision, long-standing guidance documents intended for just such a pandemic. The authors argue that public health plans for disasters should be well-funded and based on available research and expertise. Communities should insist that political representatives demonstrate responsible leadership by implementing and updating as needed, crisis standards of care. Finally, surge requirements should address the needs of both those expected to survive and those who will not, by expanding palliative care and other resources for the dying.


title: Is hesperidin essential for prophylaxis and treatment of COVID-19 Infection?

text: SARS-CoV-2 or COVID-19 is representing the major global burden that implicated more than 4.7 million infected cases and 310 thousand deaths worldwide in less than 6 months. The prevalence of this pandemic disease is expected to rise every day. The challenge is to control its rapid spread meanwhile looking for a specific treatment to improve patient outcomes. Hesperidin is a classical herbal medicine used worldwide for a long time with an excellent safety profile. Hesperidin is a well-known herbal medication used as an antioxidant and anti-inflammatory agent. Available shreds of evidence support the promising use of hesperidin in prophylaxis and treatment of COVID 19. Herein, we discuss the possible prophylactic and treatment mechanisms of hesperidin based on previous and recent findings. Hesperidin can block coronavirus from entering host cells through ACE2 receptors which can prevent the infection. Anti-viral activity of hesperidin might constitute a treatment option for COVID-19 through improving host cellular immunity against infection and its good anti-inflammatory activity may help in controlling cytokine storm. Hesperidin mixture with diosmin co-administrated with heparin protect against venous thromboembolism which may prevent disease progression. Based on that, hesperidin might be used as a meaningful prophylactic agent and a promising adjuvant treatment option against SARS-CoV-2 infection.


title: [Case of Recurrent Breast Cancer with BRCA2 Mutation Successfully Treated with Olaparib Therapy]

text: A 70-year-old woman was diagnosed with cT2N2M0 left triple negative breast cancer. She received neoadjuvant chemotherapy. Around 30 months after the surgery, she developed carcinomatous pericardial tamponade, carcinomatous pleurisy, and metastatic thyroid cancer due to the breast cancer. Around the same time, a BRCA2 mutation was confirmed. Thus, olaparib therapy was started. Around 45 days after the start of olaparib administration, the therapeutic effect was cPR. The treatment remains effective even after approximately 1 year.


Comments on: Tool kit for survival: How to run and manage ophthalmic practices during the difficult time of COVID-19 crisis


title: Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis

text: Background As coronavirus disease 2019 (COVID-19) pandemic rages on, there is urgent need for identification of clinical and laboratory predictors for progression towards severe and fatal forms of this illness. In this study we aimed to evaluate the discriminative ability of hematologic, biochemical and immunologic biomarkers in patients with and without the severe or fatal forms of COVID-19. Methods An electronic search in Medline (PubMed interface), Scopus, Web of Science and China National Knowledge Infrastructure (CNKI) was performed, to identify studies reporting on laboratory abnormalities in patients with COVID-19. Studies were divided into two separate cohorts for analysis: severity (severe vs. non-severe and mortality, i.e. non-survivors vs. survivors). Data was pooled into a meta-analysis to estimate weighted mean difference (WMD) with 95% confidence interval (95% CI) for each laboratory parameter. Results A total number of 21 studies was included, totaling 3377 patients and 33 laboratory parameters. While 18 studies (n = 2984) compared laboratory findings between patients with severe and non-severe COVID-19, the other three (n = 393) compared survivors and non-survivors of the disease and were thus analyzed separately. Patients with severe and fatal disease had significantly increased white blood cell (WBC) count, and decreased lymphocyte and platelet counts compared to non-severe disease and survivors. Biomarkers of inflammation, cardiac and muscle injury, liver and kidney function and coagulation measures were also significantly elevated in patients with both severe and fatal COVID-19. Interleukins 6 (IL-6) and 10 (IL-10) and serum ferritin were strong discriminators for severe disease. Conclusions Several biomarkers which may potentially aid in risk stratification models for predicting severe and fatal COVID-19 were identified. In hospitalized patients with respiratory distress, we recommend clinicians closely monitor WBC count, lymphocyte count, platelet count, IL-6 and serum ferritin as markers for potential progression to critical illness.


Combating COVID-19: East meets West


Practical indications for management of patients candidate to Interventional and Intraoperative Radiotherapy (Brachytherapy, IORT) during COVID-19 pandemic - A document endorsed by AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy Working Group


title: Systemic immunosuppressive therapy for inflammatory skin diseases in children: Expert consensus-based guidance for clinical decision-making during the COVID-19 pandemic

text: BACKGROUND/OBJECTIVES: The COVID-19 pandemic has raised questions about the approach to management of systemic immunosuppressive therapies for dermatologic indications in children. Change to: Given the absence of data to address concerns related to SARS-CoV-2 infection and systemic immunosuppressive therapies in an evidence-based manner, a Pediatric Dermatology COVID-19 Response Task Force (PDCRTF) was assembled to offer time-sensitive guidance for clinicians. METHODS: A survey was distributed to an expert panel of 37 pediatric dermatologists on the PDCRTF to assess expert opinion and current practice related to three primary domains of systemic therapy: initiation, continuation, and laboratory monitoring. RESULTS: Nearly all respondents (97%) reported that the COVID-19 pandemic had impacted their decision to initiate immunosuppressive medications. The majority of pediatric dermatologists (87%) reported that they were pausing or reducing the frequency of laboratory monitoring for certain immunosuppressive medications. In asymptomatic patients, continuing therapy was the most popular choice across all medications queried. The majority agreed that patients on immunosuppressive medications who have a household exposure to COVID-19 or test positive for new infection should temporarily discontinue systemic and biologic medications, with the exception of systemic steroids, which may require tapering. CONCLUSIONS: The ultimate decision regarding initiation, continuation, and laboratory monitoring of immunosuppressive therapy during the pandemic requires careful deliberation, consideration of the little evidence available, and discussion with families. Consideration of an individual's adherence to COVID-19 preventive measures, risk of exposure, and the potential severity if infected must be weighed against the dermatological disease, medication, and risks to the patient of tapering or discontinuing therapies.