title: COVID-19: conceptos clave para el cirujano./ COVID-19: conceptos clave para el cirujano./ COVID-19: Key Concepts for the Surgeon

text: In view of the current pandemic by SARS-CoV-2 it deems essential to understand the key concepts about the infection: its epidemiological origin, presentation, clinical course, diagnosis and treatment (still experimental in many cases). The knowledge about the virus is still limited, but as the pandemic progresses and the physiopathology of the disease is understood, new evidence is being massively published. Surgical specialists are facing an unprecedented situation: they must collaborate in the ER or medical wards attending these patients, while still needing to make decisions about surgical patients with probable COVID-19. The present narrative review aims to summarize the most relevant aspects and synthetize concepts on COVID-19 for surgeons.


Successful smallpox eradication: what can we learn to control COVID-19?


title: Epidemiological and Clinical Predictors of COVID-19

text: BACKGROUND: Rapid identification of COVID-19 cases, which is crucial to outbreak containment efforts, is challenging due to the lack of pathognomonic symptoms and in settings with limited capacity for specialized nucleic acid-based reverse transcription polymerase chain reaction (PCR) testing. METHODS: This retrospective case-control study involves subjects (7 to 98 years) presenting at the designated national outbreak screening centre and tertiary care hospital in Singapore for SARS-CoV-2 testing from January 26 to February 16, 2020. COVID-19 status was confirmed by PCR testing of sputum, nasopharyngeal swabs or throat swabs. Demographic, clinical, laboratory and exposure-risk variables ascertainable at presentation were analyzed to develop an algorithm for estimating the risk of COVID-19. Model development used Akaike's information criterion in a stepwise fashion to build logistic regression models, which were then translated into prediction scores. Performance was measured using receiver operating characteristics curves, adjusting for over-confidence using leave-out-one cross validation. RESULTS: The study population included 788 subjects, of whom 54 (6.9%) were SARS-CoV-2 positive and 734 (93.1%) were SARS-CoV-2 negative. The median age was 34 years and 407 (51.7%) were female. Using leave-out-one cross validation, all the models incorporating clinical tests (Models 1, 2 and 3) performed well with areas under the receiver operating characteristics curve (AUC) of 0.91, 0.88 and 0.88 respectively. In comparison, Model 4 had an AUC of 0.65. CONCLUSIONS: Rapidly ascertainable clinical and laboratory data could identify individuals at high risk of COVID-19 and enable prioritization of PCR-testing and containment efforts. Basic laboratory test results were crucial to prediction models.


title: Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China

text: OBJECTIVE: Patients with obesity are at increased risk of exacerbations from viral respiratory infections. However, the association of obesity with the severity of coronavirus disease 2019 (COVID-19) is unclear. We examined this association using data from the only referral hospital in Shenzhen, China. RESEARCH DESIGN AND METHODS: A total of 383 consecutively hospitalized patients with COVID-19 admitted from 11 January 2020 to 16 February 2020 and followed until 26 March 2020 at the Third People's Hospital of Shenzhen were included. Underweight was defined as a BMI <18.5 kg/m2, normal weight as 18.5-23.9 kg/m2, overweight as 24.0-27.9 kg/m2, and obesity as ≥28 kg/m2. RESULTS: Of the 383 patients, 53.1% were normal weight, 4.2% were underweight, 32.0% were overweight, and 10.7% were obese at admission. Obese patients tended to have symptoms of cough (P = 0.03) and fever (P = 0.06) compared with patients who were not obese. Compared with normal weight patients, those who were overweight had 1.84-fold odds of developing severe COVID-19 (odds ratio [OR] 1.84, 95% CI 0.99-3.43, P = 0.05), while those who were obese were at 3.40-fold odds of developing severe disease (OR 3.40, 95% CI 1.40-2.86, P = 0.007), after adjusting for age, sex, epidemiological characteristics, days from disease onset to hospitalization, presence of hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, liver disease, and cancer, and drug used for treatment. Additionally, after similar adjustment, men who were obese versus those who were normal weight were at increased odds of developing severe COVID-19 (OR 5.66, 95% CI 1.80-17.75, P = 0.003). CONCLUSIONS: In this study, obese patients had increased odds of progressing to severe COVID-19. As the severe acute respiratory syndrome coronavirus 2 may continue to spread worldwide, clinicians should pay close attention to obese patients, who should be carefully managed with prompt and aggressive treatment.


title: Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients

text: BACKGROUND: A patient's infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence. METHODS: The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed. RESULTS: In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0-62.0) years were analyzed. After in-hospital treatment, patients' inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0-4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients' urine specimens after throat swabs were negative. Using a multiple linear regression model (Fâ=â2.669, Pâ=â0.044, and adjusted Râ=â0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (tâ=â-2.699, Pâ=â0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs. 8.0 days, respectively; tâ=â2.550, Pâ=â0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs. 11 days, respectively; tâ=â4.631, Pâ<â0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (Pâ>â0.05). CONCLUSIONS: In brief, as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.


text: Background: A patient’s infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence Methods: The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively The reverse transcription polymerase chain reaction (RT-PCR) results for patients’oropharyngeal swab, stool, urine, and serum samples were collected and analyzed Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed Results: In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study In total, 28 (42 4%) women and 38 men (57 6%) with a median age of 44 0 (34 0–62 0) years were analyzed After in-hospital treatment, patients’inflammatory indicators decreased with improved clinical condition The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9 5 (6 0–11 0) days By February 10, 2020, 11 convalescent patients (16 7%) still tested positive for viral RNA from stool specimens and the other 55 patients’stool specimens were negative for 2019-nCoV following a median duration of 11 0 (9 0–16 0) days after symptom onset Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2 0 (1 0–4 0) days Results for only four (6 9%) urine samples were positive for viral nucleic acid out of 58 cases;viral RNA was still present in three patients’urine specimens after throat swabs were negative Using a multiple linear regression model ( F =2 669, P =0 044, and adjusted R 2 =0 122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients’stools ( t =-2 699, P =0 010) The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs 8 0 days, respectively;t =2 550, P =0 013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs 11 days, respectively;t =4 631, P <0 001) There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results ( P >0 05) Conclusions: In brief, as the clearance of viral RNA in patients’stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease The duration of RNA detection may relate to host cell immunity


title: Treatment options in people with COVID19: Selecting the best armamentarium against the novel virus

text: Novel coronavirus disease (COVID-19) infection is a global pandemic, of high infectivity, variable mortality, with currently no established treatment. This review summarizes different molecules which are being evaluated for COVID19 treatment. PubMed and Medline, search for articles published to March 2020 was done using terms "COVID19" OR "corona-virus 2019" OR "2019-nCoV" or "severe acute respiratory syndrome coronavirus" AND "treatment". As of today, we have >350 RCTs happening with different agents. COVID19 treatment agents can be broadly classified into immuno-modulators (prevent hyperimmune-activation and cytokine storm) and anti-viral therapies (prevent virus entry, replication or viricidal). Hydroxychloroquine/chloroquine, Interferon-l, glucocorticoids, interleukin antagonists, Ulinastatin, intravenous immunoglobulins, plasmapheresis are main immunomodulators showing initial positive outcomes. Umifenovir. Lopinavir/Ritonavir, Ribavirin, remdesivir and Ravipiravir are some of the major antiviral agents showing initial encouraging results. It may be concluded that the most successful regimen is going to be multi-drug therapy, a combination of immunomodulatory agent with anti-viral agent.


title: Dying still matters in the age of COVID-19

text: The ongoing COVID-19 pandemic is having a significant impact on people with palliative care needs.


Respuesta a la carta: Crisis sanitaria COVID-19: el papel de un cirujano./ Respuesta a la carta: Crisis sanitaria COVID-19: el papel de un cirujano./ Respond to the Letter: The COVID-19 Health Crisis: The Surgeon Role


title: Amantadine disrupts lysosomal gene expression: A hypothesis for COVID19 treatment

text: SARS-coronavirus 2 is the causal agent of the COVID-19 outbreak. SARS-Cov-2 entry into a cell is dependent upon binding of the viral spike (S) protein to cellular receptor and on cleavage of the spike protein by the host cell proteases such as Cathepsin L and Cathepsin B. CTSL/B are crucial elements of lysosomal pathway and both enzymes are almost exclusively located in the lysosomes. CTSL disruption offers potential for CoVID-19 therapies. The mechanisms of disruption include: decreasing expression of CTSL, direct inhibition of CTSL activity and affecting the conditions of CTSL environment (increase pH in the lysosomes). We have conducted a high throughput drug screen gene expression analysis to identify compounds that would downregulate the expression of CTSL/CTSB. One of the top significant results shown to downregulate the expression of the CTSL gene is amantadine (10uM). Amantadine was approved by the US Food and Drug Administration in 1968 as a prophylactic agent for influenza and later for Parkinson's disease. It is available as a generic drug. Amantadine in addition to downregulating CTSL appears to further disrupt lysosomal pathway, hence, interfering with the capacity of the virus to replicate. It acts as a lysosomotropic agent altering the CTSL functional environment. We hypothesize that amantadine could decrease the viral load in SARS-CoV-2 positive patients and as such it may serve as a potent therapeutic decreasing the replication and infectivity of the virus likely leading to better clinical outcomes. Clinical studies will be needed to examine the therapeutic utility of amantadine in COVID-19 infection.


COVID-19: treating and managing severe cases


Impact of the COVID-19 pandemic on endoscopy practice: results of a cross-sectional survey from the New York metropolitan area


title: Education and the COVID-19 pandemic

text: The COVID-19 pandemic is a huge challenge to education systems. This Viewpoint offers guidance to teachers, institutional heads, and officials on addressing the crisis. What preparations should institutions make in the short time available and how do they address students' needs by level and field of study? Reassuring students and parents is a vital element of institutional response. In ramping up capacity to teach remotely, schools and colleges should take advantage of asynchronous learning, which works best in digital formats. As well as the normal classroom subjects, teaching should include varied assignments and work that puts COVID-19 in a global and historical context. When constructing curricula, designing student assessment first helps teachers to focus. Finally, this Viewpoint suggests flexible ways to repair the damage to students' learning trajectories once the pandemic is over and gives a list of resources.


Paracentral acute middle maculopathy and acute macular neuroretinopathy following SARS-CoV-2 infection


title: Postoperative fever in the time of COVID-19

text: Summary: Postoperative fever is common following orthopedic trauma surgery. As the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases in the community, migration into the acute care hospital setting intensifies, creating confusion when fever develops postoperatively. The transmission dynamics of SARS-CoV-2 make it difficult to adequately gauge and pinpoint risk groups with questionnaires at the time of hospital admission. This is particularly problematic when asymptomatic or presymptomatic patients infected with SARS-CoV-2 require urgent surgery and cannot be screened effectively. One approach is to treat every patient as though they were SARS-CoV-2-positive in preparation for surgery, but doing so could exacerbate shortages of personal protective equipment and staffing limitations. Uncertainty regarding the etiology of postoperative fever could be significantly reduced by universal SARS-CoV-2 testing of all surgical patients at the time of hospital admission in addition to routine screening, but testing capacity and a rapid turnaround time would be required.


title: COVID-19 in Singapore - a case series from primary care

text: As the coronavirus disease 2019 (COVID-19) pandemic worsens, early case detection is vital to limiting community spread. We describe our experiences with four COVID-19 cases at the polyclinics in January and February 2020. This retrospective case series highlights the challenges primary care clinicians face in the early identification of suspect cases based on clinical criteria only. To improve case detection, clinicians can sharpen their clinical acumen by keeping abreast with the latest COVID-19 developments and by maintaining a high state of vigilance.


title: Era of molecular diagnosis for pathogen identification of unexplained pneumonia, lessons to be learned

text: Unexplained pneumonia (UP) caused by a novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) emerged in China in late December 2019 and has infected more than 9000 cases by 31 January 2020. Shanghai reported the first imported case of COVID-19 (Coronavirus Disease 2019) in 20 January 2020. A combinative approach of real-time RT-PCR, CRISPR-based assay and metagenomic next-generation sequencing (mNGS) were used to diagnose this unexplained pneumonia patient. Real-time RT-PCR and CRISPR-based assay both reported positive. This sample belonged to Betacoronavirus and shared a more than 99% nucleotide (nt) identity with the Wuhan SARS-CoV-2 isolates. We further compared pros and cons of common molecular diagnostics in UP. In this study, we illustrated the importance of combining molecular diagnostics to rule out common pathogens and performed mNGS to obtain unbiased potential pathogen result for the diagnosis of UP.


Interpreting Diagnostic Tests for SARS-CoV-2


title: Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation

text: BACKGROUND: Coronavirus disease (COVID-19) has spread globally with far-reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well-being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction. OBJECTIVE: The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated. METHODS: Self-administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). Data will be collected at baseline (onset of SMS text messaging), the program midpoint (6 weeks), and the program endpoint (12 weeks). RESULTS: Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used. CONCLUSIONS: This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19292.


title: Challenges in Tuberculosis Clinical Trials in the Face of the COVID-19 Pandemic: A Sponsor's Perspective

text: The COVID-19 pandemic has caused unforeseen and extreme changes in societal and health system functioning not previously experienced in most countries in a lifetime. The impact of the pandemic on clinical trials can be especially profound given their complexities and operational requirements. The STREAM Clinical Trial is the largest trial for MDR-TB ever conducted. Currently operating in seven countries, the trial had 126 participants on treatment and 312 additional participants in active follow up as of March 31, 2020. Areas of particular concern during this global emergency include treatment continuity, supply chain management and participant safety monitoring. This commentary highlights some of the challenges faced due to the pandemic and the steps taken to protect the safety of trial participants and the integrity of the trial.


title: Timing of Community Mitigation and Changes in Reported COVID-19 and Community Mobility - Four U.S. Metropolitan Areas, February 26-April 1, 2020

text: Community mitigation activities (also referred to as nonpharmaceutical interventions) are actions that persons and communities can take to slow the spread of infectious diseases. Mitigation strategies include personal protective measures (e.g., handwashing, cough etiquette, and face coverings) that persons can use at home or while in community settings; social distancing (e.g., maintaining physical distance between persons in community settings and staying at home); and environmental surface cleaning at home and in community settings, such as schools or workplaces. Actions such as social distancing are especially critical when medical countermeasures such as vaccines or therapeutics are not available. Although voluntary adoption of social distancing by the public and community organizations is possible, public policy can enhance implementation. The CDC Community Mitigation Framework (1) recommends a phased approach to implementation at the community level, as evidence of community spread of disease increases or begins to decrease and according to severity. This report presents initial data from the metropolitan areas of San Francisco, California; Seattle, Washington; New Orleans, Louisiana; and New York City, New York* to describe the relationship between timing of public policy measures, community mobility (a proxy measure for social distancing), and temporal trends in reported coronavirus disease 2019 (COVID-19) cases. Community mobility in all four locations declined from February 26, 2020 to April 1, 2020, decreasing with each policy issued and as case counts increased. This report suggests that public policy measures are an important tool to support social distancing and provides some very early indications that these measures might help slow the spread of COVID-19.


Offline: CoHERE-a call for a post-pandemic health strategy


title: COVID-19 and comorbidities: A role for dipeptidyl peptidase 4 (DPP4) in disease severity?

text: The coronavirus disease 2019 (COVID-19) pandemic is caused by a novel betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), similar to SARS-CoV and Middle East respiratory syndrome (MERS-CoV), which cause acute respiratory distress syndrome and case fatalities. COVID-19 disease severity is worse in older obese patients with comorbidities such as diabetes, hypertension, cardiovascular disease, and chronic lung disease. Cell binding and entry of betacoronaviruses is via their surface spike glycoprotein; SARS-CoV binds to the metalloprotease angiotensin-converting enzyme 2 (ACE2), MERS-CoV utilizes dipeptidyl peptidase 4 (DPP4), and recent modeling of the structure of SARS-CoV-2 spike glycoprotein predicts that it can interact with human DPP4 in addition to ACE2. DPP4 is a ubiquitous membrane-bound aminopeptidase that circulates in plasma; it is multifunctional with roles in nutrition, metabolism, and immune and endocrine systems. DPP4 activity differentially regulates glucose homeostasis and inflammation via its enzymatic activity and nonenzymatic immunomodulatory effects. The importance of DPP4 for the medical community has been highlighted by the approval of DPP4 inhibitors, or gliptins, for the treatment of type 2 diabetes mellitus. This review discusses the dysregulation of DPP4 in COVID-19 comorbid conditions; DPP4 activity is higher in older individuals and increased plasma DPP4 is a predictor of the onset of metabolic syndrome. DPP4 upregulation may be a determinant of COVID-19 disease severity, which creates interest regarding the use of gliptins in management of COVID-19. Also, knowledge of the chemistry and biology of DPP4 could be utilized to develop novel therapies to block viral entry of some betacoronaviruses, potentially including SARS-CoV-2.


Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure


Clinical differentiation of anticoagulant and non-anticoagulant properties of heparin


From AACR 2020 (part 1)


title: Watch the coronavirus’ rampage through the body

text: Science’s COVID-19 reporting is supported by the Pulitzer Center SARS-CoV-2, the virus that causes COVID-19, can severely damage lungs, but in serious cases it doesn’t stop there—clinicians have observed bodywide damage because of the coronavirus As researchers begin to better understand the pathology of the disease, new treatments can be deployed to help save lives Clinicians see a range of impacts from COVID-19—from pulmonary embolisms to kidney damage


title: Effective nurse leadership in times of crisis

text: The emergence of coronavirus disease 2019 (COVID-19) has meant that nurse leaders need to respond rapidly and decisively to the demands and challenges of a pandemic in a context of increased staff shortages and limited resources. This article suggests essential leadership skills and characteristics that nurses can use to underpin effective leadership in a crisis, emphasising the importance of decision-making and emotional intelligence. It also addresses two important questions: 'what do leaders in a crisis need to do that differs from any other time?' and 'what does effective leadership look like in a crisis?'


title: Arbidol/IFN-α2b therapy for patients with corona virus disease 2019: a retrospective multicenter cohort study

text: The spread of COVID-19 is accelerating. At present, there is no specific antiviral drugs for COVID-19 outbreak. This is a multicenter retrospective cohort study of patients with laboratory-confirmed COVID-19 infection pneumonia from 3 hospitals in Hubei and Guangdong province, 141 adults (aged ≥18 years) without ventilation were included. Combined group patients were given Arbidol and IFN-α2b, monotherapy group patients inhaled IFN-α2b for 10-14 days. Of 141 COVID-19 patients, baseline clinical and laboratory characteristics were similar between combined group and monotherapy group, that 30% of the patients leucocytes counts were below the normal range and 36.4% of the patients experienced lymphocytopenia. The duration of viral RNA of respiratory tract in the monotherapy group was not longer than that in the combined therapy group. There was no significant differences between two groups. The absorption of pneumonia in the combined group was faster than that in the monotherapy group. We inferred that Arbidol/IFN - 2 b therapy can be used as an effective method to improve the COVID-19 pneumonia of mild patients, although it helpless with accelerating the virus clearance. These results should be verified in a larger prospective randomized environment.


Pandemic and the PCMR


title: First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a pediatric dialysis unit

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a life-threatening respiratory condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was initially detected in China in December 2019. Currently, in Germany over 140,000 cases of COVID-19 are confirmed. Here we report a nosocomial outbreak of SARS-CoV-2 infections in the pediatric dialysis unit of the University Hospital of Münster (UHM). METHODS: Single-step real-time RT-PCR from nasopharyngeal swaps was used to diagnose the index patient and identify infected contacts. Epidemiological links were analyzed by patient interviews and chart reviews. In addition, each contact was assessed for exposure to the index case and monitored for clinical symptoms. Threshold cycle (Ct) values of all positive test results were compared between symptomatic and asymptomatic cases. RESULTS: Forty-eight cases were involved in this nosocomial outbreak. Nine contact cases developed laboratory confirmed COVID-19 infections. Two SARS-CoV-2 positive cases remained clinically asymptomatic. Eleven cases reported flu-like symptoms without positive results. Ct values were significantly lower in cases presenting typical COVID-19 symptoms, suggesting high viral shedding (p =0.007). CONCLUSION: Person-to-person transmission was at the heart of a hospital outbreak of SARS-CoV-2 between healthcare workers (HCWs) and patients in the pediatric dialysis unit at the UHM. Semi quantitative real-time RT-PCR results suggest that individuals with high viral load pose a risk to spread SARS-CoV-2 in the hospital setting. Our epidemiological observation highlights the need to develop strategies to trace and monitor SARS-CoV-2 infected HCWs in order to prevent COVID-19 outbreaks in the hospital setting.


title: System inference for the spatio-temporal evolution of infectious diseases: Michigan in the time of COVID-19

text: We extend the classical SIR model of infectious disease spread to account for time dependence in the parameters, which also include diffusivities. The temporal dependence accounts for the changing characteristics of testing, quarantine and treatment protocols, while diffusivity incorporates a mobile population. This model has been applied to data on the evolution of the COVID-19 pandemic in the US state of Michigan. For system inference, we use recent advances; specifically our framework for Variational System Identification (Wang et al., Comp. Meth. App. Mech. Eng., 356, 44-74, 2019; arXiv:2001.04816 [cs.CE]) as well as Bayesian machine learning methods.


title: A reflection on an adapted approach from face-to-face to telephone consultations in our Urology outpatient department during the COVID-19 pandemic - a pathway for change to future practice?

text: The sudden and unanticipated COVID-19 viral pandemic of 2020 and its profound impact on the NHS prompted an almost overnight change in the services we are able to offer our patients to fulfil clinical demands. From March 2020 we have changed outpatient appointments from face-to-face to telephone led consultations. We have performed an early review of this service to ensure its sustainability during the unknown duration of this current crisis and to establish its potential utility when normal services resume in the future. Our results show a patient satisfaction of 93% with 83% happy to have telephone follow-up in the future and a clinician satisfaction of 82% in adequacy of the telephone consultation in making a clinical decision. Telephone clinics are a safe and efficient alternative to face-to-face outpatient consultations for many patients, particularly non-complex benign follow-ups.


Syndrome de détresse respiratoire aiguë secondaire à une infection à SARS-CoV-2 chez un nourrisson./ [Acute respiratory distress syndrome secondary to SARS-CoV-2 infection in an infant]


Association of Black Race with Outcomes in COVID-19 Disease: A Retrospective Cohort Study


COVID 19: Will the 2020 Hajj pilgrimage and Tokyo Olympic Games be cancelled?


title: The characteristics of household transmission of COVID-19

text: BACKGROUND: Since December 2019, SARS-CoV-2 virus has extended to most parts of China with more than 80 thousand cases and to at least 100 countries with more than 60 thousand international cases by March 15, 2020. Here we applied household cohort study to determine the features of household transmission of COVID-19. METHODS: Total 105 index patients and 392 household contacts were enrolled. Both index patients and household members were inspected by SARS-CoV-2 RT-PCR. The information of all recruited people was extracted from medical records and confirmed or supplemented by telephone interviews. The baseline characteristics of index cases and contact patients were described. Secondary attack rates of SARS-CoV-2 to the contact members were computed and the risk factors for transmission within household were estimated. RESULTS: Secondary transmission of SARS-CoV-2 developed in 64 of 392 household contacts (16.3%). The secondary attack rate to children was 4% comparing with 17.1% to adults. The secondary attack rate to the contacts within the households with index patients quarantined by themselves since onset of symptoms was 0% comparing with 16.9% to the contacts without index patients quarantined. The secondary attack rate to contacts who were spouses of index cases was 27.8% comparing with 17.3% to other adult members in the households. CONCLUSION: The secondary attack rate of SARS-CoV-2 in household is 16.3%. Ages of household contacts and spouse relationship with index case are risk factors for transmission of SARS-CoV-2 within household. Quarantine of index patients at home since onset of symptom is useful to prevent the transmission of SARS-Co-2 within household.


title: The evidence of SARS-CoV-2 infection on ocular surface

text: This is a cross-sectional study of patients who received a COVID-19 diagnosis between December 30, 2019 and February 7, 2020 at Tongji Hospital. A total of 102 patients (48 Male [47%] and 54 Female [53%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) were confirmed to have COVID-19 by laboratory diagnosis with a SARS-CoV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis were identified from 72 patients with a laboratory confirmed COVID-19. Of those two patients, SARS-CoV-2 RNA fragments were found in ocular discharges by SARS-CoV-2 RT-PCR in only one patient. Our findings suspect the incidence of SARS-CoV-2 infection through the ocular surface is extremely low, while the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. To lower the SARS-CoV-2 nosocomial infection, all health care professionals should wear protective goggles. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-CoV-2.


COVID-19 outbreak and the practice of surgery: do we need to change?


title: Are Quaternary Ammonium Compounds, the Workhorse Disinfectants, Effective against Severe Acute Respiratory Syndrome-Coronavirus-2?

text: A novel virus named Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) emerged from Wuhan, China in late 2019. Since then, the virus has quickly spread worldwide, leading the World Health Organization to declare it as a pandemic; by the end of April 2020, the number of cases exceeded 3 million. Due to the high infectivity rate, SARS-CoV-2 is difficult to contain, making disinfectant protocols vital, especially for essential, highly trafficked areas such as hospitals, grocery stores, and delivery centers. According to the Centers for Disease Control and Prevention, best practices to slow the spread rely on good hand hygiene, including proper handwashing practices as well as the use of alcohol-based hand sanitizers. However, they provide warning against sanitizing products containing benzalkonium chloride (BAC), which has sparked concern in both the scientific community as well as the general public as BAC, a common quaternary ammonium compound (QAC), is ubiquitous in soaps and cleaning wipes as well as hospital sanitation kits. This viewpoint aims to highlight the outdated and incongruous data in the evaluation of BAC against the family of known coronaviruses and points to the need for further evaluation of the efficacy of QACs against coronaviruses.


Pericarditis aguda secundaria a COVID-19./ Pericarditis aguda secundaria a COVID-19./ Acute pericarditis secondary to COVID-19


Coronavírus e o Coração | Um Relato de Caso sobre a Evolução da COVID-19 Associado à Evolução Cardiológica./ Coronavírus e o Coração | Um Relato de Caso sobre a Evolução da COVID-19 Associado à Evolução Cardiológica./ Coronavirus and the Heart | A Case Report on the Evolution of COVID-19 Associated with Cardiological Evolution


Modeling SARS-CoV-2 infection in mice


title: Do not forget interaction: Predicting fatality of COVID-19 patients using logistic regression

text: Amid the ongoing COVID-19 pandemic, whether COVID-19 patients with high risks can be recovered or not depends, to a large extent, on how early they will be treated appropriately before irreversible consequences are caused to the patients by the virus. In this research, we reported an explainable, intuitive, and accurate machine learning model based on logistic regression to predict the fatality rate of COVID-19 patients using only three important blood biomarkers, including lactic dehydrogenase, lymphocyte (%) and high-sensitivity C-reactive protein, and their interactions. We found that when the fatality probability produced by the logistic regression model was over 0.8, the model had the optimal performance in that it was able to predict patient fatalities more than 11.30 days on average with maximally 34.91 days in advance, an accumulative f1-score of 93.76% and and an accumulative accuracy score of 93.92%. Such a model can be used to identify COVID-19 patients with high risks with three blood biomarkers and help the medical systems around the world plan critical medical resources amid this pandemic.


title: Quality of primary health care in China: challenges and recommendations

text: China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.


title: SARS-CoV-2 can be detected in urine, blood, anal swabs, and oropharyngeal swabs specimens

text: PURPOSE: The purpose of this study was to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA) in urine and blood specimens, and anal and oropharyngeal swabs from patients with confirmed SARS-CoV-2 infection, and correlated positive results with clinical findings. METHODS: Patients with confirmed SARS-CoV-2 infections were included in this study. Patients' demographic and clinical data were recorded. Quantitative real-time polymerase chain reaction was used to detect SARS-CoV-2 RNA in urine and blood specimens, and anal and oropharyngeal swabs. The study is registered at ClinicalTrials.gov (No. NCT04279782, 19 February, 2020). RESULTS: SARS-CoV-2 RNA was present in all four specimen types, though not all specimen types were positive simultaneously. The presence of viral RNA was not necessarily predictive of clinical symptoms, for example, the presence of viral RNA in the urine did not necessarily predict urinary tract symptoms. CONCLUSIONS: SARS-CoV-2 can infect multiple systems, including the urinary tract. Testing different specimen types may be useful for monitoring disease changes and progression, and for establishing a prognosis.


The negative impact of comorbidities on the disease course of COVID-19


COVID-19 is milder in children possibly due to cross-immunity


title: Management of ophthalmic perioperative period during 2019 novel coronavirus disease outbreak/ 中华实验眼科杂志

text: Objective@#To explore the perioperative management and infection prevention methods for acute eye diseases during the outbreak of 2019 novel coronavirus disease (COVID-19).@*Methods@#Since the COVID-19 was included in the Class B infectious diseases and was managed according to Class A infectious diseases in China, 127 patients who underwent ophthalmic surgery were enrolled at First Affiliated Hospital of Army Military Medical University from January 21 to February 19,2020. The perioperative management according to the national epidemic prevention and control requirements was summarized, and the perioperative clinical management that should be taken during the epidemic prevention period were discussed.@*Results@#One hundred and twenty-seven patients underwent ophthalmic surgeries, including emergency surgery, daytime surgery and other surgeries for sight-threatening diseases. The methods of anesthesia included general anesthesia, local anesthesia and ocular superficial anesthesia. According to the national epidemic prevention and control requirements, epidemic screening for these patients and infectious managing measures were performed during the perioperative period, including the sterilization of relevant environment and equipments, the personal medical prevention and protection for medical staffs and patients, which made surealltheoperationswent smoothlyand safely. There were no 2019-nCoV infection, surgical-relative infection, crossing infection and operation-related complications occurred. Meanwhile, there were not COVID-19-related infection events of medical staffs. The air sampling compliance rate in the operating room, ward, examination and other areas was 100%.@*Conclusions@#During the prevention and control period of the epidemic of COVID-19, strict adherence to the prevention and control measures can effectively ensure the smooth implementation of the operation and the perioperative safety of medical staff and patients.


title: Serial interval in determining the estimation of reproduction number of the novel coronavirus disease (COVID-19) during the early outbreak ;Journal of Travel Medicine ;Oxford Academic

text: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China in the end of 2019, and soon spread oversea A comprehensive and timely review summarized the scientific research in estimating the basic reproduction number (R0) released from 1 January to 7 February 2020 [1] During the early outbreak, when the key epidemiological features of COVID-19 were uncovered, the R0 estimation largely relied on the growth rate of the epidemic curve and the estimation of the serial interval (SI) Here, we demonstrated that an overlarge SI would lead to overestimation of R0 We adopted the growing process proposed in [2] deterministically with a population of 11 million in Wuhan, 1 case initially onset on 5 December 2019 and a fixed step at 1 day We consider two values of the mean serial interval (SI) that are  SI at 4 6 days estimated based on 28 records of transmission chains [3], which was largely consistent with the SI estimate at 4 4 days based on 71 records [4];and  SI at 8 days, which was closer to the SI of the severe acute respiratory syndrome (SARS, 8 4 days), SI of the Middle East respiratory syndrome (MERS, 7 6 days) As for demonstration that a larger SI could lead to overestimation in R0, we conducted the simulation with two schemes that are  Scheme (I): R0 = 2, and SI = 4 6 days;and  Scheme (II): R0 = 2, 3, 4 and 3 3 as summarized in [1], and SI = 8 days We also compared the simulation results with the previous estimates of the cumulative number of COVID-19 infection in Wuhan In Fig 1, the simulation results of the scheme (I) had almost the same growing trends as those of scheme (II) with R0 = 3 3 Although a higher R0 could force the epidemic curve increasing rapidly, a shorter SI could increase iteration of transmission generation, i e , transmission may occur shortly post infection According to the simple approximated formula that R0 = exp(γ∙SI), where γ was the exponential growth rate calculated from the incidence data directly, a longer SI would lead to a higher R0 estimate theoretically With a shorter SI at 4 6 days, which was supported by richer datasets in [3, 4], the R0 of COVID-19 could be lower than previous estimates based on longer SI By using the growth rate (γ) at 0 15 per day, the R0 was found at 2 0 with SI at 4 6 days, whereas 3 3 with SI at 8 days Although the effects of public health control were ignored in this analysis, our model could be Downloaded from https://academic oup com/jtm/advance-article-abstract/doi/10 1093/jtm/taaa033/5803291 by guest on 13 March 2020 4 extended by introducing an effective reproduction number accounting for the effectiveness of the control measures, and we remarked this modification would not affect the main conclusion Furthermore, as pointed out in [3], provided that the SI of COVID-19 might be shorter than its incubation period, pre-symptomatic transmission may occur shortly after being infected [5] This implies that a fraction of transmissions cannot be prevented solely through isolating the symptomatic cases, since the time when contact tracing is conducted, they may have already been infectious and generated secondary cases Therefore, the effectively quarantine of suspected (and probable) cases, as well as close contacts, and timely contact tracing were crucial in successful outbreak mitigation


Serial interval in determining the estimation of reproduction number of the novel coronavirus disease (COVID-19) during the early outbreak


Prevalence of obesity among adult inpatients with COVID-19 in France


Cutaneous Clinico-Pathological Findings in three COVID-19-Positive Patients Observed in the Metropolitan Area of Milan, Italy


title: Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): A pooled analysis and review

text: Limited data exists to-date on the laboratory findings in children with COVID-19, warranting the conduction of this study, in which we pool the currently available literature data on the laboratory findings seen in children with mild and severe COVID-19. Following an extensive literature search, we identified 24 eligible studies, including a total of 624 pediatric cases with laboratory-confirmed COVID-19, which report data on 27 different biomarkers. We then performed a meta-analysis to calculate the pooled prevalence estimates (PPE) for these laboratory abnormalities in mild COVID-19. As data was too limited for children with severe COVID-19 to allow pooling, results were presented descriptively in a summary of findings table. Our data show an inconsistent pattern of change in the leukocyte index of mild and severe cases of COVID-19 in children. Specifically, changes in leukocyte counts were only observed in 32% of the mild pediatric cases (PPE: 13% increase, 19% decrease). In mild disease, creatine kinase-MB (CK-MB) was frequently elevated, with a PPE of 33%. In severe disease, c-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH) were frequently elevated. Based on data obtained from early COVID-19 studies, leukocyte indices in children appear inconsistent, differing from those reported in adults that highlight specific leukocyte trends. This brings into question the utility and reliability of such parameters in monitoring disease severity in the pediatric population. Instead, we suggest physicians to serially monitor CRP, PCT, and LDH to track the course of illness in hospitalized children. Finally, elevated CK-MB in mild pediatric COVID-19 cases is indicative of possible cardiac injury. This highlights the importance of monitoring cardiac biomarkers in hospitalized patients and the need for further investigation of markers such as cardiac troponin in future studies.


Death, Dying, and Dignity in the Time of the COVID-19 Pandemic


Dilemas terapéuticos en la enfermedad por SARS-CoV-2, un reto para la geriatría./ [Therapeutic dilemmas in SARS-CoV-2 disease, a challenge for geriatrics]


Subphenotyping ARDS in COVID-19 Patients: Consequences for Ventilator Management


The world is upside down; how coronavirus changes the way we care for our patients


Face masks for the public during the covid-19 crisis


Convalescent serum lines up as first-choice treatment for coronavirus


Quality of Ribonucleic Acid Extraction for Real-Time Reverse Transcription-PCR (rRT-PCR) of SARS-CoV-2: Importance of Internal Control Monitoring


Modifications to Dermatology Residency Education During the COVID-19 Pandemic


The impending storm: COVID-19, pandemics and our overwhelmed emergency departments


title: COVID-19: A case report from Bangladesh perspective

text: A 34-year-old man without any significant medical history or comorbidities, suddenly developed fever, and shortness of breath, thereby admitted to the emergency department of a tertiary care hospital, Dhaka, Bangladesh. He had neither a history of traveling to Coronavirus disease (COVID) prone areas nor a direct contact of COVID positive patients. His chest X-ray revealed ground-glass opacity in the right middle and lower zone of the lung. The first polymerase chain reaction (PCR) test on throat and nasal swabs for the COVID upon admission was negative. Based on the chest X-ray result, RT-PCR was done again resulted positive. The patient was primarily treated with chloroquine and azithromycin. On full recovery, he was discharged from the hospital on day 12, after two subsequent throat swab samples tested negative by PCR (24 hours apart). He was encouraged to maintain home quarantine for at least the next 14 days. SARS-CoV-2 RNA by swab remained negative and the blood sample shows the presence of antibody (both IgM and IgG) in his follow-up visit (after 7 days of hospital discharge).


title: Neurologic aspects of covid-19: a concise review

text: In addition to the conventional respiratory symptoms, patients with COVID-19 can exhibit neurological complications In this concise review, we aim to report the most frequent neurologic manifestations related to Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV2) infection SARS-CoV2 can reach the central nervous system from the bloodstream or olfactory pathway by binding ACE-2 receptor and the spike protein protease TMPRSS2 Headache is reported in more than 10% of affected patients and loss of smell and taste disturbance are reported in a slightly smaller percentage of cases Acute cerebrovascular events are diagnosed in less than 3% of COVID-19 patients, but those with more severe manifestations have cerebrovascular events in more than 6% of the cases, as reported by two retrospective studies from Italy and China Moreover, five cases of large-vessel stroke have been described in low-symptomatic COVID-19 patients aging less than 50 years suggesting that SARS-CoV2 can be associated with an increase of the risk of stroke in relatively young people Peripheral nerve diseases can be observed after an apparently uneventful SARS-CoV2 Based on a literature review, nine patients experienced Guillain-Barre syndrome (GBS) and 6 of these needed mechanical ventilation Two more cases have been described with Miller-Fisher syndrome or polyneuritis cranialis, both had rapidly resolving symptoms In conclusion, nervous system symptoms can be observed during SARS-CoV2 infection of which headache and smell and taste disturbance are the main symptoms reported Cerebrovascular complications can complicate the course of COVID-19 in apparently low-risk patients GBS is a life-threatening manifestation of COVID-19


Impact of a Global Pandemic on Health Technology Assessment


COVID-19-associated delayed posthypoxic necrotizing leukoencephalopathy


title: Seasonality of Respiratory Viral Infections

text: The seasonal cycle of respiratory viral diseases has been widely recognized for thousands of years, as annual epidemics of the common cold and influenza disease hit the human population like clockwork in the winter season in temperate regions. Moreover, epidemics caused by viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and the newly emerging SARS-CoV-2 occur during the winter months. The mechanisms underlying the seasonal nature of respiratory viral infections have been examined and debated for many years. The two major contributing factors are the changes in environmental parameters and human behavior. Studies have revealed the effect of temperature and humidity on respiratory virus stability and transmission rates. More recent research highlights the importance of the environmental factors, especially temperature and humidity, in modulating host intrinsic, innate, and adaptive immune responses to viral infections in the respiratory tract. Here we review evidence of how outdoor and indoor climates are linked to the seasonality of viral respiratory infections. We further discuss determinants of host response in the seasonality of respiratory viruses by highlighting recent studies in the field. Expected final online publication date for the Annual Review of Virology, Volume 7 is September 29, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.


title: Chilblains in children in the time of Covid-19: new evidence with serology assay

text: In a previous report in Pediatric Dermatology, we described chilblains-like lesions in four pediatric patients. From April 18 to May 10, 2020, 45 children presented to our Pediatric Dermatology department with similar acral lesions. The clinical appearance ranged from red to violaceous macules and dusky, purpuric plaques on the heels, soles and lateral margin of the feet, often accompanied by painful edema, consistent with chilblains.


title: [Investigation of transmission chain of a cluster COVID-19 cases]

text: Objective: To analyze of the transmission characteristics of a cluster of COVID-19 cases in Chongqing and evaluate the infectivity of COVID-19 in the incubation period. Methods: A retrospective survey was conducted by using unified questionnaire through field and telephone interviews among 129 close contacts of COVID-19 cases. The relationship of transmission was indicated by transmission chain, and the infectivity was analyzed by the contact history. Results: This cluster of COVID-19 cases occurred after a classmate party involving members in three families and work fellows in a factory (R(0)=3.8). The infection rate during the incubation period was 17.57%. On average, it was infectious three days before onset. There was significant difference in infection rate among different contact modes (χ(2)=15.10, P<0.01),There was significant difference in infection rate among single exposureswith different time length ( χ(2)=25.08, P<0.01). Conclusions: COVID-19 is highly infectious in the incubation period. The more confined the space is, the higher the risk is,and the longer the single exposure is, the higher the risk of transmission is. Indirect contact transmission still exists.


Offline: How to defeat political populism


title: Modeling COVID-19 and Its Impacts on U.S. Immigration and Customs Enforcement (ICE) Detention Facilities, 2020

text: U.S. Immigration and Customs Enforcement (ICE) facilities house thousands of undocumented immigrants in environments discordant with the public health recommendations to reduce the transmission of 2019 novel coronavirus (COVID-19). Using ICE detainee population data obtained from the ICE Enforcement and Removal Operations (ERO) website as of March 2, 2020, we implemented a simple stochastic susceptible-exposed-infected-recovered model to estimate the rate of COVID-19 transmission within 111 ICE detention facilities and then examined impacts on regional hospital intensive care unit (ICU) capacity. Models considered three scenarios of transmission (optimistic, moderate, pessimistic) over 30-, 60-, and 90-day time horizons across a range of facility sizes. We found that 72% of individuals are expected to be infected by day 90 under the optimistic scenario (R0 = 2.5), while nearly 100% of individuals are expected to be infected by day 90 under a more pessimistic (R0 = 7) scenario. Although asynchronous outbreaks are more likely, day 90 estimates provide an approximation of total positive cases after all ICE facility outbreaks. We determined that, in the most optimistic scenario, coronavirus outbreaks among a minimum of 65 ICE facilities (59%) would overwhelm ICU beds within a 10-mile radius and outbreaks among a minimum of 8 ICE facilities (7%) would overwhelm local ICU beds within a 50-mile radius over a 90-day period, provided every ICU bed was made available for sick detainees. As policymakers seek to rapidly implement interventions that ensure the continued availability of life-saving medical resources across the USA, they may be overlooking the pressing need to slow the spread of COVID-19 infection in ICE's detention facilities. Preventing the rapid spread necessitates intervention measures such as granting ICE detainees widespread release from an unsafe environment by returning them to the community.


title: Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain

text: BACKGROUND AND PURPOSE: Spain has been one of the countries heavily stricken by COVID-19. But this epidemic has not affected all regions equally. We analyzed the impact of the COVID-19 pandemic on hospital stroke admissions and in-hospital mortality in tertiary referral hospitals from North-West Spain. METHODS: Spanish multicenter retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. We recorded the number of patients admitted for ischemic stroke between 30 December 2019 and 3 May 2020, the number of IVT and EVT procedures, and in-hospital mortality. RESULTS: In the study period, 2737 patients were admitted with ischemic stroke. There was a decrease in the weekly mean admitted patients during the pandemic (124 vs. 173, p<0.001). In-hospital mortality of stroke patients increased significantly (9.9% vs. 6.5%, p = 0.003), but there were no differences in the proportion of IVT (17.3% vs. 16.1%, p = 0.405) or EVT (22% vs. 23%, p = 0.504). CONCLUSION: We found a decrease in the number of ischemic stroke admissions and an increase in in-hospital mortality during the COVID-19 epidemic in this large study from North-West Spain. There were regional changes within the network, not fully explained by the severity of the pandemic in different regions.


Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists


title: Incarceration And Its Disseminations: COVID-19 Pandemic Lessons From Chicago's Cook County Jail

text: Jails and prisons are major sites of novel coronavirus (SARS-CoV-2) infection. Many jurisdictions in the United States have therefore accelerated release of low-risk offenders. Early release, however, does not address how arrest and pre-trial detention practices may be contributing to disease spread. Using data from Cook County Jail, in Chicago, Illinois, one of the largest known nodes of SARS-CoV-2 spread, we analyze the relationship between jailing practices and community infections at the zip-code level. We find that jail cycling is a significant predictor of SARS-CoV-2 infection, accounting for 55 percent of the variance in case rates across zip codes in Chicago and 37 percent in Illinois. By comparison, jail cycling far exceeds race, poverty, public transit utilization, and population density as a predictor of variance. The data suggest that cycling through Cook County Jail alone is associated with 15.7 percent of all documented novel coronavirus disease (COVID-19) cases in Illinois and 15.9 percent in Chicago as of April 19, 2020. Our findings support arguments for reduced reliance on incarceration and for related justice reforms both as emergency measures during the present pandemic and as sustained structural changes vital for future pandemic preparedness and public health. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].


Survey of ophthalmology in the time of COVID-19


title: Psychological well-being among older adults during the COVID-19 outbreak: a comparative study of the young-old and the old-old adults

text: The COVID-19 outbreak could be considered as an uncontrollable stressful life event. Lockdown measures have provoked a disruption of daily life with a great impact over older adults' health and well-being. Nevertheless, eudaimonic well-being plays a protective role in confronting adverse circumstances, such as the COVID-19 situation. This study aims to assess the association between age and psychological well-being (personal growth and purpose in life). Young-old (60-70 years) and old-old (71-80 years) community-dwelling Spaniards (N = 878) completed a survey and reported on their sociodemographic characteristics and their levels of health, COVID-19 stress-related, appraisal, and personal resources. Old-old did not evidence poorer psychological well-being than young-old. Age has only a negative impact on personal growth. The results also suggest that the nature of the COVID-19 impact (except for the loss of a loved one) may not be as relevant for the older adults' well-being as their appraisals and personal resources for managing COVID-related problems. In addition, these results suggest that some sociodemographic and health-related variables have an impact on older adults' well-being. Thus, perceived-health, family functioning, resilience, gratitude, and acceptance had significant associations with both personal growth and purpose in life. Efforts to address older adults' psychological well-being focusing on older adults' personal resources should be considered.


title: Extracellular HMGB1: a therapeutic target in severe pulmonary inflammation including COVID-19?

text: BACKGROUND: The 2019 novel coronavirus disease (COVID-19) causes for unresolved reasons acute respiratory distress syndrome in vulnerable individuals. There is a need to identify key pathogenic molecules in COVID-19-associated inflammation attainable to target with existing therapeutic compounds. The endogenous damage-associated molecular pattern (DAMP) molecule HMGB1 initiates inflammation via two separate pathways. Disulfide-HMGB1 triggers TLR4 receptors generating pro-inflammatory cytokine release. Extracellular HMGB1, released from dying cells or secreted by activated innate immunity cells, forms complexes with extracellular DNA, RNA and other DAMP or pathogen-associated molecular (DAMP) molecules released after lytic cell death. These complexes are endocytosed via RAGE, constitutively expressed at high levels in the lungs only, and transported to the endolysosomal system, which is disrupted by HMGB1 at high concentrations. Danger molecules thus get access to cytosolic proinflammatory receptors instigating inflammasome activation. It is conceivable that extracellular SARS-CoV-2 RNA may reach the cellular cytosol via HMGB1-assisted transfer combined with lysosome leakage. Extracellular HMGB1 generally exists in vivo bound to other molecules, including PAMPs and DAMPs. It is plausible that these complexes are specifically removed in the lungs revealed by a 40% reduction of HMGB1 plasma levels in arterial versus venous blood. Abundant pulmonary RAGE expression enables endocytosis of danger molecules to be destroyed in the lysosomes at physiological HMGB1 levels, but causing detrimental inflammasome activation at high levels. Stress induces apoptosis in pulmonary endothelial cells from females but necrosis in cells from males. CONCLUSION: Based on these observations we propose extracellular HMGB1 to be considered as a therapeutic target for COVID-19.


[Online learning-related visual impairment and preventive measures during the 2019 novel coronvirus outbreak]


title: Exogenous melatonin alleviates cadmium uptake and toxicity in apple rootstocks

text: To examine the potential roles of melatonin in cadmium (Cd) uptake, accumulation and detoxification in Malus plants, we exposed two different apple rootstocks varying greatly in Cd uptake and accumulation to either 0 or 30 µM Cd together with 0 or 100 µM melatonin. Cadmium stress stimulated endogenous melatonin production to a greater extent in the Cd-tolerant Malus baccata Borkh. than in the Cd-susceptible Malus micromalus 'qingzhoulinqin'. Melatonin application attenuated Cd-induced reductions in growth, photosynthesis and enzyme activity, as well as reactive oxygen species (ROS) and malondialdehyde accumulation. Melatonin treatment more effectively restored photosynthesis, photosynthetic pigments and biomass in Cd-challenged M. micromalus 'qingzhoulinqin' than in Cd-stressed M. baccata. Exogenous melatonin lowered root Cd2+ uptake, reduced leaf Cd accumulation, decreased Cd translocation factors and increased root, stem and leaf melatonin contents in both Cd-exposed rootstocks. Melatonin application increased both antioxidant concentrations and enzyme activities to scavenge Cd-induced ROS. Exogenous melatonin treatment altered the mRNA levels of several genes regulating Cd uptake, transport and detoxification including HA7, NRAMP1, NRAMP3, HMA4, PCR2, NAS1, MT2, ABCC1 and MHX. Taken together, these results suggest that exogenous melatonin reduced aerial parts Cd accumulation and mitigated Cd toxicity in Malus plants, probably due to the melatonin-mediated Cd allocation in tissues, and induction of antioxidant defense system and transcriptionally regulated key genes involved in detoxification.


Balancing Health and Economic Factors when Reopening Business in the Age of COVID-19


title: On the Alert for Cytokine Storm: Immunopathology in COVID-19

text: Poor outcomes in COVID-19 correlate with clinical and laboratory features of cytokine storm syndrome. Broad screening for cytokine storm and early, targeted antiinflammatory therapy may prevent immunopathology and could help conserve limited health care resources. While studies are ongoing, extrapolating from clinical experience in cytokine storm syndromes may benefit the multidisciplinary teams caring for patients with severe COVID-19.


Head and neck cancer cannot wait for this pandemic to end: Risks, challenges and perspectives of oral-maxillofacial surgeon during COVID-19


Reshaping neonatal intensive care units (NICUs) to avoid the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to high-risk infants


Psychosocial impact of COVID-19 outbreak on international students living in Hubei province, China


Surviving COVID-19: A disease tolerance perspective


title: Self-removing passive drain to facilitate postoperative care via telehealth during the COVID-19 pandemic

text: BACKGROUND: Telehealth postoperative visits are an attractive strategy to minimize exposure, especially during the SARS-CoV-2 (COVID-19) pandemic. The use of a surgical drain often prevents this minimal-exposure approach in that patients return to the outpatient clinic for drain removal. METHODS AND RESULTS: Following unilateral neck dissection, the customary closed-suction drain was replaced with a self-removing, passive drain dressing to facilitate same-day discharge and telehealth postoperative follow-up. The patient removed the dressing and drain at home during a telehealth visit on postoperative day 4 and she healed favorably without any signs of infection or seroma. CONCLUSIONS: When thoughtfully applied in the appropriate clinical context, small practice adaptations like this can facilitate telehealth solutions that diminish unnecessary exposure for patients, their caregivers, and health care staff.


Covid-19: Death rate in England and Wales reaches record high because of covid-19


title: A quantitative compendium of COVID-19 epidemiology

text: Accurate numbers are needed to understand and predict viral dynamics. Curation of high-quality literature values for the infectious period duration or household secondary attack rate, for example, is especially pressing currently because these numbers inform decisions about how and when to lockdown or reopen societies. We aim to provide a curated source for the key numbers that help us understand the virus driving our current global crisis. This compendium focuses solely on COVID-19 epidemiology. The numbers reported in summary format are substantiated by annotated references. For each property, we provide a concise definition, description of measurement and inference methods, and associated caveats. We hope this compendium will make essential numbers more accessible and avoid common sources of confusion for the many newcomers to the field such as using the incubation period to denote and quantify the latent period or using the hospitalization duration for the infectiousness period duration. This document will be repeatedly updated and the community is invited to participate in improving it.


Coronavirus outbreak is a symptom of Gaia's sickness


Younger patients with MAFLD are at increased risk of severe COVID-19 illness: A multicenter preliminary analysis


What's Important: What Is Our Role in the COVID-19 Pandemic?


title: The Percussive Effects of Pandemics and Disaster

text: In this special issue, we note the percussive - immediate, disruptive and urgent - effects of the coronavirus pandemic, while anticipating its longer term repercussions. As social institutions, global and local economies, political relations, and everyday social lives are being remade, we highlight the implications of this microbial infection and its virulence. In doing so, we illustrate how medical anthropology both illuminates the present and warns of COVID-19's unequal unfolding.


Myasthenic crisis in COVID-19


The COVID-19 Pandemic: A Family Affair


title: Time-dependent and time-independent SIR models applied to the COVID-19 outbreak in Argentina, Brazil, Colombia, Mexico and South Africa

text: We consider the SIR epidemiological model applied to the evolution of COVID-19 with two approaches. In the first place we fit a global SIR model, with time delay, and constant parameters throughout the outbreak, including the contagion rate. The contention measures are reflected on an effective reduced susceptible population $N_{eff}$. In the second approach we consider a time-dependent contagion rate that reflects the contention measures either through a step by step fitting process or by following an exponential decay. In this last model the population is considered the one of the country $N$. In the linear region of the differential equations, when the total population $N$ is large the predictions are independent of $N$. We apply these methodologies to study the spread of the pandemic in Argentina, Brazil, Colombia, Mexico, and South Africa for which the infection peaks are yet to be reached. In all of these cases we provide estimates for the reproduction and recovery rates. The scenario for a time varying contagion rate is optimistic, considering that reasonable measures are taken such that the reproduction factor $R_0$ decreases exponentially. The measured values for the recovery rate $\gamma$ are reported finding a universality of this parameter over various countries. We discuss the correspondence between the global SIR with effective population $N_{eff}$ and the evolution of the time local SIR.


Occupational risks for COVID-19 infection


COVID-19, Aging, and Mental Health: Lessons From the First Six Months


COVID-19, Climate Change, and the American Thoracic Society: A Shared Responsibility


A case series of children with Coronavirus Disease 2019: what have we learned?


Novel Coronavirus: What Neuroradiologists as Citizens of the World Need to Know


COVID-19 in pediatric hematopoietic stem cell transplantation: The experience of Spanish Group of Transplant (GETMON/GETH)


Die Corona-Krise und ihre Auswirkungen auf die Chirurgie./ [The Corona crisis and its consequences for surgery]


title: Feasibility and Acceptability of Inpatient Palliative Care E-Family Meetings During COVID-19 Pandemic

text: Family meetings are fundamental to the practice of palliative medicine and serve as a cornerstone of intervention on the inpatient palliative care consultation service. The COVID-19 pandemic disrupted the structure and process of in-patient family meetings, due to necessary but restrictive visitor policies that did not allow families to be present in the hospital. We describe implementation of telemedicine to facilitate electronic family (e-family) meetings to facilitate in-patient palliative care. Of 67 scheduled meetings and performed by the palliative care service, only 2 meetings were aborted for a 97% success rate of scheduled meetings occurring. On a five-point Likert-type scale, the average clinician rating of the e-family meeting overall quality was 3.18 (SD, 0.96). Of the 10 unique family participants that agreed to be interviewed, their overall ratings of the e-family meetings were high. Over 80% of respondent families participants reported that they agreed or strongly agreed that they were able to ask all of their questions, felt comfortable expressing their thoughts and feelings with the clinical team, felt like they understood the care their loved one received, and that the virtual family meeting helped them trust the clinical team. Of patients who were able to communicate 50% of family respondents reported that the e-family meeting helped them understand their loved one's thoughts and wishes.


COVID-19: Playing away the pandemic


title: Elevated serum aspartate aminotransferase level identifies patients with coronavirus disease 2019 and predicts the length of hospital stay

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a worldwide public health emergency. This study aimed to investigate the clinical significance of liver blood tests in COVID-19 patients. METHODS: The analysis included clinical data of 23 patients with suspected COVID-19 and 66 patients with confirmed COVID-19 from January 25 to February 20, 2020. The relationship between liver blood test results, liver condition (HBsAb positive, HBcAb positive, and fatty liver disease), and duration of hospital stay among COVID-19 patients was analyzed. RESULTS: The median hospital stay of COVID-19 patients was 6 days. Serum albumin (Alb) level was lower in patients with COVID-19 confirmed on admission than in patients with suspected COVID-19 (40.08 g/L vs 42.50 g/L, P = .016), while the level of aspartate aminotransferase (AST) was higher (23 U/L vs 18 U/L, P = .005). Abnormal results of liver blood tests in patients with COVID-19 included increased levels of alanine transaminase (ALT) (21.2%, 14 patients), AST (15.2%, 10 patients), and gamma-glutamyl transpeptidase (GGT) (22.7%, 15 patients). After 5-10 days of treatment, levels of Alb and AST in COVID-19 patients were significantly decreased (P < .001 and P = .027, respectively). Abnormal levels of Alb and AST in patients with COVID-19 were not associated with the liver condition (all P > .05). In addition, only levels of AST were positively correlated with the duration of hospital stay (r = .334, P = .007). CONCLUSION: Abnormal results of the liver blood test were found in COVID-19 patients. The COVID-19 patients on admission with the higher levels of AST might have longer hospital stays.


Audio Interview: New Data on Remdesivir in Covid-19


Multicenter analysis of clinical characteristics and outcomes in patients with COVID-19 who develop liver injury


title: Epidemiological and clinical characteristics of 671 COVID-19 patients in Henan Province, China

text: BACKGROUND: Despite many reports on the characteristics of coronavirus disease 2019 (COVID-19) in Wuhan, China, relatively little is known about the transmission features of COVID-19 outside Wuhan, especially at the provincial level. METHODS: We collected epidemiological, demographic, clinical, laboratory, radiological and occupation information, along with contact history, of 671 patients with laboratory-confirmed COVID-19 reported from January 23 to February 5, 2020, in Henan province, China. We described characteristics of these cases, compared the diagnostic accuracy and features of blood testing, computed tomography (CT) scans and X-rays, and analysed SARS-CoV-2 transmission sources and patients' occupations in Henan province. RESULTS: The mean age of patients in this case series was 43 years, 56.2% were male and 22.4% had coexisting medical disorders. The death rate was 0.3%. Fourteen patients did not show any symptoms. Lymphocyte percentage was associated with disease severity (χ2 = 6.71, P = 0.035) but had a large variation in each sample group. The mean time from illness onset to diagnosis was 5.6 days. A total of 330 patients had ever lived in or visited Wuhan, 150 had contact with confirmed cases, 323 had been to a hospital and 119 had been to a wet market. There were 33 patients who did not have a traceable transmission source, with 21.2% of these being farmers and 15.2% being workmen. CONCLUSIONS: Lymphocyte percentage was a sign of severe COVID-19 in general but was not a good diagnostic index. Longer time from illness onset to diagnosis was associated with higher COVID-19 severity, older age, higher likelihood of having coexisting cardiovascular diseases including hypertension, and being male. Farming was found to be a high-risk occupation in Henan province, China.


JEPM April 2020 - Avian & Exotic News


title: COVID in New York City, the epicenter: A New York University perspective and COVID in Duluth, the Bold North: A University of Minnesota perspective

text: In the first part of this dual commentary, perspectives are gathered from students at New York University. COVID in New York City is compared with the trauma of the World Trade Center. Triggers, racism, concerns, acts of kindness, and the future are considered for both. The second part of the commentary is written in juxtaposition to the New York City perspective by sharing the Upper Midwest experiences of this COVID-19 pandemic period, particularly in the small city of Duluth. Perspectives are gathered over time from students at the University of Minnesota, Duluth. The Minnesota stories are presented chronologically, from the declaration of the global pandemic to the beginning of the summer semester. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Effect of COVID-19 on the mental health care of older people in Canada


title: Role of a Habitat's Air Humidity in Covid-19 Mortality

text: Transient local over-dry environment might be a contributor and an explanation for the observed asynchronous local rises in Covid-19 mortality. We propose that a habitat's air humidity negatively correlate with Covid-19 morbidity and mortality, and support this hypothesis on the example of publicly available data from German federal states.


title: Role of a habitat's air humidity in Covid-19 mortality


title: A Guiding Principles Checklist for Otolaryngologic Surgery in the COVID-19 Era

text: The COVID-19 pandemic has had a dramatic impact on surgical workflows. There is an abundance of ever-changing information, and protocols are reflexively modified on a daily basis. As many otolaryngologic procedures are shown to have higher risk of viral transmission-so-called aerosol-generating procedures-it is imperative that multidisciplinary care teams be provided updated, timely, and consistent information. A single-page Guiding Principles surgical checklist was developed to discuss 7 key factors: patient information, staff wellness, risk minimization, prioritization, resource utilization, key society criteria, and communication. This was completed for every patient requiring otolaryngologic surgery and was distributed to the care teams involved. It provided the most information for those on the frontline and allowed for cogent pre-, intra-, and postoperative planning.


Staying Ahead of the Wave


title: Bloodstream infections in critically ill patients with COVID-19

text: BACKGROUND: Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS: This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were: (i) to assess the incidence rate of ICU-acquired BSI; (ii) to assess the cumulative risk of developing ICU-acquired BSI. RESULTS: Overall 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk, and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone, and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overall p for the dummy variable = 0.003). CONCLUSIONS: The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible proinflammatory dysregulation induced by SARS-CoV-2.


COVID-19 and cardiac implantable electronic device remote monitoring: crocodile tears or new opportunity?


Covid-19: UK starts social distancing after new model points to 260 000 potential deaths


title: Disposable Isolation Device to Reduce COVID-19 Contamination During CT Scanning

text: RATIONALE AND OBJECTIVES: The use of chest computed tomography (CT) in the era of the COVID-19 pandemic raises concern regarding the transmission risks to patients and staff caused by CT room contamination. Meanwhile the Center for Disease Control guidance for air exchange in between patients may heavily impact workflows. To design a portable custom isolation device to reduce imaging equipment contamination during a pandemic. MATERIALS AND METHODS: Center for Disease Control air exchange guidelines and requirements were reviewed. Device functional requirements were outlined and designed. Engineering requirements were reviewed. Methods of practice and risk mitigation plans were outlined including donning and doffing procedures and failure modes. Cost impact was assessed in terms of CT patient throughput. RESULTS: CT air exchange solutions and alternatives were reviewed. Multiple isolation bag device designs were considered. Several designs were custom fabricated, prototyped and reduced to practice. A final design was tested on volunteers for comfort, test-fit, air seal, and breathability. Less than 14 times enhanced patient throughput was estimated, in an ideal setting, which could more than counterbalance the cost of the device itself. CONCLUSION: A novel isolation bag device is feasible for use in CT and might facilitate containment and reduce contamination in radiology departments during the COVID Pandemic.


title: Impacto de la pandemia por SARS-CoV-2 sobre la actividad y profesionales de un Servicio de Cirugía General y del Aparato Digestivo en un hospital terciario./ Impacto de la pandemia por SARS-CoV-2 sobre la actividad y profesionales de un Servicio de Cirugía General y del Aparato Digestivo en un hospital terciario./ SARS-CoV-2 pandemic on the activity and professionals of a General Surgery and Digestive Surgery Service in a tertiary hospital

text: INTRODUCTION: The rapid spread of SARS-CoV-2 infection has led to a radical reorganization of healthcare resources. Surgical Departments need to adapt to this change. METHODS: We performed a prospective descriptive observational study of the incidence of COVID-19 in patients and surgeons of a General Surgical Department in a high prevalence area, between the 1st and 31st of March 2020. RESULTS: Patients: The incidence of SARS-CoV-2 infection in elective surgery patients was 7% (mean age 59.5 years). All survived. Of 36 patients who underwent emergency surgery, two of them were SARS-CoV-2 positive and one was clinically highly suspicious of COVID-19 (11.1%). All three patients died of respiratory failure (mean age 81 years). Surgeons: There were a total of 12 confirmed SARS-CoV-2+ cases among the surgical department staff (24.4%) (8 out of 34 consultants and 4 out of 15 residents). Healthcare activity: The average number of daily emergency surgical interventions declined from 3.6 in February to 1.16 in March. 42% of the patients who underwent emergency surgery had peritonitis upon presentation. CONCLUSIONS: The fast pace of COVID-19 pandemia should alert surgical departments of the need of adopting early measures to ensure the safety of patients and staff.


title: Initial CT imaging characters of an imported family cluster of COVID-19

text: The objective of this report is to better understand the initial CT imaging spectrum and the relationship between clinical characteristics and initial CT imaging features of an imported family cluster cases involving 7 laboratory-confirmed COVID-19 patients. We find that initial CT findings of 4 patients were positive within one week after the onset of symptoms and 1 patient was negative before the onset of symptoms. Two asymptomatic patients had typical CT abnormalities. The initial CT imaging manifestations are mainly peripheral or subpleural ground-glass opacities and ground-glass with consolidation. Our report is of potential guiding value for the initial CT screening of imported familial cluster cases since the imported cases have an identified time of infection.


Children with cancer in the time of COVID-19: An 8-week report from the six pediatric onco-hematology centers in Lombardia, Italy


title: The accuracy of auditory spatial judgments in the visually impaired is dependent on sound source distance

text: Blindness leads to substantial enhancements in many auditory abilities, and deficits in others. It is unknown how severe visual losses need to be before changes in auditory abilities occur, or whether the relationship between severity of visual loss and changes in auditory abilities is proportional and systematic. Here we show that greater severity of visual loss is associated with increased auditory judgments of distance and room size. On average participants with severe visual losses perceived sounds to be twice as far away, and rooms to be three times larger, than sighted controls. Distance estimates for sighted controls were most accurate for closer sounds and least accurate for farther sounds. As the severity of visual impairment increased, accuracy decreased for closer sounds and increased for farther sounds. However, it is for closer sounds that accurate judgments are needed to guide rapid motor responses to auditory events, e.g. planning a safe path through a busy street to avoid collisions with other people, and falls. Interestingly, greater visual impairment severity was associated with more accurate room size estimates. The results support a new hypothesis that crossmodal calibration of audition by vision depends on the severity of visual loss.


title: A Comparative Study of Chest Computed Tomography Features in Young and Older Adults With Corona Virus Disease (COVID-19)

text: OBJECTIVE: To analyze the most common computed tomography (CT) findings of pneumonia caused by new coronavirus in younger patients (60 and younger) and older adults (older than 60). MATERIALS AND METHODS: The chest CT images of 72 symptomatic patients with corona virus disease (COVID-19) were analyzed retrospectively, including 44 younger patients (47.5±8.7 y old) and 28 older patients (68.4±6.0 y old). CT findings including density (pure ground-glass opacities, ground-glass opacities with consolidation, consolidation), the number of lobes involved, lesion distribution, and the main accompanying signs were analyzed and compared. RESULTS: Characteristic CT findings included the lobes of bilateral lung extensively involved, ground-glass opacity and ground-glass opacity with consolidation in the peripheral area, sometimes accompanied by interlobular septal thickening, and subpleural line and pleural thickening. Compared with the younger group, the proportion of extensive involvement of lung lobes was higher in the elderly group (71.4% vs. 36.4%, P=0.009), and subpleural line and pleural thickening were more likely to occur (50.0% vs. 25.0%, and 71.4% vs. 40.9%, P=0.030 and 0.011, respectively). CONCLUSION: Elderly and younger patients with corona virus disease have some common CT features, but older patients are more likely to have extensive lung lobe involvement, and subpleural line and pleural thickening. These differentiated characteristics may be related to the progress and prognosis of the disease.


title: Associations of Clinical Characteristics and Treatment Regimens with Viral RNA Shedding Duration in Patients with COVID-19

text: OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) has become a global pandemic, but the factors influencing viral RNA shedding remain unclear to inform optimal control strategies. METHODS: The clinical course and viral RNA shedding pattern of 267 consecutive symptomatic COVID-19 patients admitted to the hospital from January 20, 2020 to March 15, 2020 were retrospectively evaluated. RESULTS: The median viral RNA shedding duration was 12 days (interquartile range, 8-16 d) after the onset of illness. Of the 267 patients included in this study, 65.2% had viral RNA cleared within 14 days, 88.8% within 21 days, and 94.4% within 28 days. Older age (hazard ratio [HR], 0.99; 95% confidence interval [CI]: 0.98-1.00; P = 0.04), time lag from illness onset to hospital admission (HR, 0.91; 95% CI: 0.88-0.94; P < 0.001), diarrhea (HR, 0.59; 95% CI: 0.36-0.96; P = 0.036), corticosteroid treatment (HR, 0.60; 95% CI: 0.39-0.94; P = 0.024), and lopinavir/ritonavir use (HR, 0.70; 95% CI: 0.52-0.94; P = 0.014) were significantly independently associated with prolonged viral RNA shedding. CONCLUSIONS: Early detection and timely hospital admission may be warranted for symptomatic COVID-19 patients, especially for older patients and patients with diarrhea. Corticosteroid treatment is associated with prolonged viral RNA shedding and should be used with caution. Lopinavir/ritonavir use may be associated with prolonged viral RNA shedding in non-severe patients; further randomized controlled trials are needed to confirm this finding.


title: Analytical and numerical investigation of the airflow in face masks used for protection against COVID-19 virus -- implications for mask design and usage

text: The use of face masks for the general public has been suggested in literature as a means to decrease virus transmission during the global COVID-19 pandemic. However, literature findings indicate that most mask designs do not provide reliable protection. This paper investigates the hypothesis that the impaired protection is mainly due to imperfect fitting of the masks, so that airflow, which contains virus-transporting droplets, can leak through gaps into or out of the mask. The fluid dynamics of face masks are investigated via analytical and numerical computations. The results demonstrate that the flow can be satisfactorily predicted by simplified analytical 1D-flow models, by efficient 2D-flow simulations and by 3D-flow simulations. The present results show that already gap heights larger than 0.1mm can result in the mask not fulfilling FFP2 or FFP3 standards, and for gap heights of ca. 1mm most of the airflow and droplets may pass through the gap. The implications of these findings are discussed and improvements to existing mask designs are suggested.


title: COVID-19-related strokes in adults below 55 years of age: a case series

text: BACKGROUND: Coronavirus infection is a novel respiratory disease affecting people across the world. Although the majority of patients present with fever, dyspnea, cough, or myalgia, various signs and symptoms have been reported for this disease. Recently, neurological symptoms have been noticed in patients with COVID-19 with unknown etiology. However, the occurrence of strokes in young and middle aged patients with COVID-19 is not fully explained. METHODS: In this series, six patients younger than 55 years of age with diagnosis of stroke and a confirmed diagnosis of COVID-19 were evaluated for symptoms, lab data, imaging findings, and outcomes from March 2020 to the end of April 2020 from all stroke cases in a tertiary academic hospital. Patients older than 55 and all others who had evidence of cardiac abnormalities (arrhythmia/valvular) were excluded. RESULTS: Fever, myalgia, cough, and dyspnea were the most common clinical symptoms noted in 66.66% (4/6), 66.66% (4/6), 50% (3/6), and 50% (3/6) of the patients, respectively. The mean ± standard deviation (SD) of National Institutes of Health Stroke Scale (NIHSS) for the patient was 10.16 ± 7.13 (ranged 5-24). The most involved area was middle cerebral artery (MCA) (five in MCA versus one in basal ganglia) and the majority of our patients had a low lung involvement score (mean ± SD: 13.16 ± 6.49 out of 24). Finally, one patient was deceased and rest discharged. CONCLUSION: Stroke may be unrelated to age and the extent of lung involvement. However, different factors may play roles in co-occurrence of stroke and COVID-19 and its outcome. Future studies with long-term follow-up and more cases are needed to assess prognostic factors.