title: Dysregulation of immune response in patients with COVID-19 in Wuhan, China

text: BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China. METHODS: Demographic and clinical data of all confirmed cases with COVID-19 on admission at Tongji Hospital from January 10 to February 12, 2020, were collected and analyzed. The data of laboratory examinations, including peripheral lymphocyte subsets, were analyzed and compared between severe and non-severe patients. RESULTS: Of the 452 patients with COVID-19 recruited, 286 were diagnosed as severe infection. The median age was 58 years and 235 were male. The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough and myalgia. Severe cases tend to have lower lymphocytes counts, higher leukocytes counts and neutrophil-lymphocyte-ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils. Most of severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines. The number of T cells significantly decreased, and more hampered in severe cases. Both helper T cells and suppressor T cells in patients with COVID-19 were below normal levels, and lower level of helper T cells in severe group. The percentage of naïve helper T cells increased and memory helper T cells decreased in severe cases. Patients with COVID-19 also have lower level of regulatory T cells, and more obviously damaged in severe cases. CONCLUSIONS: The novel coronavirus might mainly act on lymphocytes, especially T lymphocytes. Surveillance of NLR and lymphocyte subsets is helpful in the early screening of critical illness, diagnosis and treatment of COVID-19.


title: Modulation of Hb-O2 affinity to improve hypoxemia in COVID-19 patients

text: This opinion paper aims at discussing the potential impact of modulating the Hb-O2 affinity by the nutritional supplement 5-HMF on patients affected by COVID-19. The paper describes the critical role of the oxygen affinity in hypoxemic COVID-19 patients and the potential positive effect of 5-HMF, a compound shown to increase the Hb-O2 affinity.


Management of Critically Ill Adults With COVID-19


Letter: Neurosurgical Patients' Management During the COVID-19 Pandemic-An Institutional Report From an African Neurosurgical Center


title: Proposing a fungal metabolite-Flaviolin as a potential inhibitor of 3CLpro of novel coronavirus SARS-CoV2 using docking and molecular dynamics

text: Here after performing docking and molecular dynamics of various small molecules derived as a secondary metabolite from fungi, we propose Flaviolin to act as potent inhibitor of 3-chymotrypsin (3C) like protease (3CLpro) of noval corona virus SARS-CoV2 responsible for pandemic condition caused by coronavirus disease 2019 (COVID-19).


Images in Clinical ECT: Immediate impact of COVID-19 on ECT Practice


title: When Public Health Crises Collide: Social Disparities and COVID-19

text: In To Have or to Be?, psychoanalyst Erich Fromm writes about pursuit after domination of nature, material abundance, and unlimited happiness, which made modern society become more interested in having than in being. Income, in his view, should not be as accentuated as to create different experiences of life for different groups [1]. Of the concepts that Fromm presents, the domination of nature, which facilitates zoonotic spillover events by increasing the overlap between the habitat of various species with that of humans [2-5], and the gap between the rich and the poor, which recently has become the widest in years [6], become particularly relevant in context of the COVID-19 pandemic.


Telemedicine and COVID-19: an Observational Study of Rapid Scale Up in a US Academic Medical System


title: Allelopathic bioactivity of fresh and infused aqueous extracts of Brazilian cherry (Eugenia uniflora L. ) on lettuce and maize/ Bioatividade alelopática de extrato aquoso fresco e infuso de pitangueira (Eugenia uniflora L. ) sobre alface e milho

text: This study aimed to analyse the allelopathic bioactivity of fresh and infused aqueous extracts of Brazilian cherry leaves on the germination of lettuce and the initial development of maize. Brazilian cherry leaves were used to prepare a fresh aqueous extract (200 g L-1) and an infused extract (100 g L-1), which were diluted to concentrations of 0.4, 0.8, 1.2, 1.6 or 2.0% w/v. The variables evaluated in lettuce were the germination rate (GR), germination time index (GTI), germination speed index (GSI) and root length (RL). To determine the effect on the initial development of maize, we measured the shoot (SL) and root (RL) length. The experimental design included a factorial 2 × 5 design (two extracts and five concentrations), in addition to a control treatment (no extract). In general, the allelopathic bioactivity differed between the fresh and infused extracts. The fresh extract was more phytotoxic for the GR and RL of lettuce. Some beneficial results were observed for the infused extract, including an increase in the RL of lettuce and SL of maize. These effects were dependent on the extract concentration. Thus, there is evidence that Brazilian cherry extracts have allelopathic bioactivity.(AU)


title: Cardiac Rehabilitation during the COVID-19 Era: Guidance on Implementing Virtual Care

text: Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared to centre-based programs. In order to minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation however can be daunting. Centres should initially focus on the collation, utilization and re-purposing of existing resources, equipment, and technology. Once established, programs should then focus on ensuring that quality indicators are met and care processes are protocolized. This should be followed by the development of sustainable VCR solutions to account for care gaps that existed prior to COVID-19, and to improve cardiac rehabilitation delivery moving forward. This article reviews the potential challenges and obstacles of this process and aims to provide pragmatic guidance to aid clinicians and administrators during this challenging time.


Response to "Dose Rationale for Favipiravir Use in Patients Infected With SARS-CoV-2"


title: Impact of COVID-19 on the mental health of surgeons and coping strategies

text: Unprecedented times call for extraordinary measures. While surgeons across the globe try to comprehend the evolving facade of the COVID-19 pandemic and improvise surgical practice to the best of their ability, the psychological impact of the stress on their own mental health and well-being has been underestimated. This paper aims to review the indirect and overt factors that may affect the mental health of a surgeon in the present circumstances. Furthermore, it will aim to highlight key coping mechanisms at an individual and institutional level, so as to mitigate the negative psychological impact on surgeons.


Guide to Understanding the 2019 Novel Coronavirus


Letter to the Editor "Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Neurological Surgery Care and Education; Our Experience from Iran"


SWAB team instead of SWAT team: Medical students as a frontline force during the COVID-19 pandemic


COVID-19 in gastroenterology and hepatology: Living with the realities of a historic 21st century pandemic


Safeguarding Dermatologist Attendings and Residents Amid the COVID-19 Pandemic: Focus on Special Populations


Safeguarding dermatologist attendings and residents amid the COVID-19 pandemic: Focus on special populations


title: Belatacept, kidney transplantation and COVID-19: successful management of the first reported case within the United Kingdom

text: Kidney transplant recipients may be at particular risk of acquiring SARS-CoV-2 infection with poor outcomes.1 In a recent case report 2 it was hypothesised that kidney transplant recipients on maintenance belatacept, a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) fusion protein, have a milder disease course due to belatacept mitigating the cytokine storm and resultant acute respiratory distress syndrome which have been linked to severity of COVID-19. 3 Here we present the first reported case in the United Kingdom of a kidney transplant patient on belatacept who on the contrary developed a severe COVID-19 pneumonia requiring intensive care admission and intubation.


Coronavirus Disease 19 Pandemic and Extracorporeal Therapies in Intensive Care: "Bis Peccare in Bello Non Licet"


title: Cash, cash conversion cycle, inventory and covid-19

text: In recent years, hospital cash balances and cash conversion has been largely stable in Washington State hospitals, with the only increase coming in terms of increasing inventory At current levels, cash is in short supply at many hospitals While increasing inventory would appear to be a good move in light of the COVID-19 pandemic, inventory is not a single generic item Hospital inventory is comprised of literally thousands of supplies and medications, only a few of which are critical Hospital financial viability could be threatened by insufficient liquidity


Call to Action: Announcing the Traditional, Complementary and Integrative Health and Medicine COVID-19 Support Registry


title: On Fast Multi-Shot COVID-19 Interventions for Post Lock-Down Mitigation

text: Fast intermittent lock-down intervals with regular period are suggested as a COVID-19 exit strategy from the widely adopted policy of total lock-down. Many proposed exit strategies have risks and uncertainties which could lead to a second wave of infection [1,2]. We demonstrate that our proposed policies have the potential to be a method of virus suppression, while at the same time allowing continued (albeit reduced) economic activity. Furthermore, these policies, while not eliminating the virus, can nevertheless be sustained over long periods of time, until a vaccine or treatment becomes available. The robustness of these policies stems from the fact that they are open loop methods; namely, lock-down periods are not triggered by measurements -- inevitably uncertain and delayed -- over short time scales such as hospital admissions, but rather are driven by predictable, high-frequency, periodic triggers in- and out- of lock-down. A slow and inherently robust outer supervisory feedback loop, based on measurements over longer time scales, is used to tune the parameters of the mitigation strategy. These methods can act alone, or can be used in combination with other mitigation strategies, to provide additional levels of effectiveness in their operation.


Erratum zu: Erhöhtes Risiko für tiefe Beinvenenthrombosen bei Intensivpatienten mit CoViD-19-Infektion?  Erste Daten./ [Erratum to: Increased risk of deep vein thrombosis in intensive care unit patients with CoViD-19 infections?-Preliminary data]


title: Safety at the Time of the COVID-19 Pandemic: How to Keep our Oncology Patients and Healthcare Workers Safe

text: The novel coronavirus, SARS-CoV-2, was first detected as a respiratory illness in December 2019 in Wuhan City, China. Since then, coronavirus disease 2019 (COVID-19) has impacted every aspect of our lives worldwide. In a time when terms such as social distancing and flattening the curve have become a part of our vernacular, it is essential that we understand what measures can be implemented to protect our patients and healthcare workers. Undoubtedly, healthcare providers have had to rapidly alter care delivery models while simultaneously acknowledging the crucial unknowns of how these changes may affect clinical outcomes. This special feature reviews strategies on how to mitigate transmission of COVID-19 in an effort to reduce morbidity and mortality associated with the disease for patients with cancer without infection, for patients with cancer with COVID-19 infection, and for the healthcare workers caring for them, while continuing to provide the best possible cancer care. [Editor's Note: This article includes the most current information available at time of publication; however, recommendations regarding public safety and practice may change rapidly in this situation. Individuals should get the most up to date information from the CDC website.].


Secondary attack rate and superspreading events for SARS-CoV-2


title: Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

text: OBJECTIVES: COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease. METHODS: Case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed. RESULTS: A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed. CONCLUSIONS: We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.


title: Efficacy and safety of Jinhua Qinggan granules for coronavirus disease 2019 (COVID-19): A protocol of a systematic review and meta-analysis

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome (SARS)-COV2 and represents the causative agent of a potentially fatal disease. Jinhua Qinggan granules has definite effect in treating COVID-19 patients, but it has not been systematically evaluated for efficacy and safety. METHODS: Retrieved the database, including the China National Knowledge Infrastructure (CNKI), Chinese Biomedical literature Database (CBM), Chinese Scientific and Journal Database (VIP), Wan Fang database, PubMed, and EMBASE. Evaluate methodological quality and judge risk of bias through the Cochrane manual. RevMan 5.3 and STATA 16.0 software were used to perform the meta-analysis. RESULTS: This study will provide high-quality evidence of Jinhua Qinggan granules for COVID-19. CONCLUSION: The conclusion of this study will provide evidence to determine whether Jinhua Qinggan granules is an effective treatment for COVID-19. PROSPERO REGISTRATION NUMBER: CRD42020182373.


Ark of Life and Hope: the role of the Cabin Hospital in facing COVID-19


International Mental Health perspectives on the novel coronavirus SARS-CoV-2 pandemic


title: Safety and immunogenicity of a parenteral trivalent P2-VP8 subunit rotavirus vaccine: a multisite, randomised, double-blind, placebo-controlled trial

text: BACKGROUND: A monovalent, parenteral, subunit rotavirus vaccine was well tolerated and immunogenic in adults in the USA and in toddlers and infants in South Africa, but elicited poor responses against heterotypic rotavirus strains. We aimed to evaluate safety and immunogenicity of a trivalent vaccine formulation (P2-VP8-P[4],[6],[8]). METHODS: A double-blind, randomised, placebo-controlled, dose-escalation, phase 1/2 study was done at three South African research sites. Healthy adults (aged 18-45 years), toddlers (aged 2-3 years), and infants (aged 6-8 weeks, ≥37 weeks' gestation, and without previous receipt of rotavirus vaccination), all without HIV infection, were eligible for enrolment. In the dose-escalation phase, adults and toddlers were randomly assigned in blocks (block size of five) to receive 30 µg or 90 µg of vaccine, or placebo, and infants were randomly assigned in blocks (block size of four) to receive 15 µg, 30 µg, or 90 µg of vaccine, or placebo. In the expanded phase, infants were randomly assigned in a 1:1:1:1 ratio to receive 15 µg, 30 µg, or 90 µg of vaccine, or placebo, in block sizes of four. Participants, parents of participants, and clinical, data, and laboratory staff were masked to treatment assignment. Adults received an intramuscular injection of vaccine or placebo in the deltoid muscle on the day of randomisation (day 0), day 28, and day 56; toddlers received a single injection of vaccine or placebo in the anterolateral thigh on day 0. Infants in both phases received an injection of vaccine or placebo in the anterolateral thigh on days 0, 28, and 56, at approximately 6, 10, and 14 weeks of age. Primary safety endpoints were local and systemic reactions (grade 2 or worse) within 7 days and adverse events and serious adverse events within 28 days after each injection in all participants who received at least one injection. Primary immunogenicity endpoints were analysed in infants in either phase who received all planned injections, had blood samples analysed at the relevant timepoints, and presented no major protocol violations considered to have an effect on the immunogenicity results of the study, and included serum anti-P2-VP8 IgA, IgG, and neutralising antibody geometric mean titres and responses measured 4 weeks after the final injection in vaccine compared with placebo groups. This trial is registered with ClinicalTrials.gov, NCT02646891. FINDINGS: Between Feb 15, 2016, and Dec 22, 2017, 30 adults (12 each in the 30 µg and 90 µg groups and six in the placebo group), 30 toddlers (12 each in the 30 µg and 90 µg groups and six in the placebo group), and 557 infants (139 in the 15 µg group, 140 in the 30 µg group, 139 in the 90 µg group, and 139 in the placebo group) were randomly assigned, received at least one dose, and were assessed for safety. There were no significant differences in local or systemic adverse events, or unsolicited adverse events, between vaccine and placebo groups. There were no serious adverse events within 28 days of injection in adults, whereas one serious adverse event occurred in a toddler (febrile convulsion in the 30 µg group) and 23 serious adverse events (four in placebo, ten in 15 µg, four in 30 µg, and five in 90 µg groups) occurred among 20 infants, most commonly respiratory tract infections. One death occurred in an infant within 28 days of injection due to pneumococcal meningitis. In 528 infants (130 in placebo, 132 in 15 µg, 132 in 30 µg, and 134 in 90 µg groups), adjusted anti-P2-VP8 IgG seroresponses (≥4-fold increase from baseline) to P[4], P[6], and P[8] antigens were significantly higher in the 15 µg, 30 µg, and 90 µg groups (99-100%) than in the placebo group (10-29%; p<0·0001). Although significantly higher than in placebo recipients (9-10%), anti-P2-VP8 IgA seroresponses (≥4-fold increase from baseline) to each individual antigen were modest (20-34%) across the 15 µg, 30 µg, and 90 µg groups. Adjusted neutralising antibody seroresponses in infants (≥2·7-fold increase from baseline) to DS-1 (P[4]), 1076 (P[6]), and Wa (P[8]) were higher in vaccine recipients than in placebo recipients: p<0·0001 for all comparisons. INTERPRETATION: The trivalent P2-VP8 vaccine was well tolerated, with promising anti-P2-VP8 IgG and neutralising antibody responses across the three vaccine P types. Our findings support advancing the vaccine to efficacy testing. FUNDING: Bill & Melinda Gates Foundation.


COVID-19: more evidence emerges


title: Detection of Unsuspected Coronavirus Disease 2019 Cases by Computed Tomography and Retrospective Implementation of the Radiological Society of North America/Society of Thoracic Radiology/American College of Radiology Consensus Guidelines

text: PURPOSE: The purpose of this article was to report the utility of computed tomography (CT) for detecting unsuspected cases of Coronavirus disease 2019 (COVID-19) and the utility of the Radiological Society of North America (RSNA)/Society of Thoracic Radiology (STR)/American College of Radiology (ACR) consensus guidelines for COVID-19 reporting. MATERIALS AND METHODS: A total of 22 patients of the 156 reverse transcriptase polymerase chain reaction confirmed COVID-19 patients who were hospitalized between March 27, 2020 and March 31, 2020 at our quaternary care academic medical center and who underwent CT imaging within 1 week of admission were included in this retrospective study. Demographics and clinical data were extracted from the electronic medical record system. Two thoracic radiologists independently categorized each CT study on the basis of RSNA/STR/ACR consensus guidelines. Disagreement in categorization was resolved by consensus discussion with a third thoracic radiologist. RESULTS: At the time of imaging, 16 patients (73%) were suspected of COVID-19, and 6 patients (27%) were not. Common symptoms at presentation were fever (73%), cough (77%), and gastrointestinal symptoms (59%). An overall 63% of suspected COVID-19 patients exhibited shortness of breath, whereas 0 unsuspected COVID-19 patients did (P=0.02). On the basis of the RSNA consensus guidelines, 68%, 18%, 9%, and 5% of studies were categorized as "typical appearance," "indeterminate appearance," "atypical appearance," and "negative for pneumonia," respectively. There was no difference of category distribution between suspected and unsuspected COVID-19 patients (P=0.20), with "typical appearance" being the most prevalent in both (69% vs. 67%, respectively). CONCLUSIONS: It is important to recognize imaging features of COVID-19 pneumonia even in unsuspected patients. Implementation of the RSNA/STR/ACR consensus guidelines may increase consistency of reporting and convey the level of suspicion for COVID-19 to other health care providers, with "typical appearance" especially warranting further attention.


title: When will the battle against novel coronavirus end in Wuhan: A SEIR modeling analysis

text: Background: Recent outbreak of 2019-nCoV in Wuhan raised serious public health concerns. By February 15, 2020 in Wuhan, the total number of confirmed infection cases has reached 37 914, and the number of deaths has reached 1123, accounting for 56.9% of the total confirmed cases and 73.7% of the total deaths in China. People are eager to know when the epidemic will be completely controlled and when people's work and life will be on the right track. Method: In this study we analyzed the epidemic dynamics and trend of 2019-nCoV in Wuhan by using the data after the closure of Wuhan city till February 12, 2020 based on the SEIR modeling method. Results: The optimal parameters were estimated as R0 = 1.44 (interquartile range: 1.40-1.47), TI = 14 (interquartile range = 14-14) and TE = 3.0 (interquartile range = 2.8-3.1). Based on these parameters, the number of infected individuals in Wuhan city may reach the peak around February 19 at about 47 000 people. Once entering March, the epidemic would gradually decline, and end around the late March. It is worth noting that the above prediction is based on the assumption that the number of susceptible population N = 200 000 will not increase. If the epidemic situation is not properly controlled, the peak of infected number can be further increased and the peak time will be a little postponed. It was expected that the epidemic would subside in early March, and disappear gradually towards the late March. Conclusions: The epidemic situation of 2019-nCoV in Wuhan was effectively controlled after the closure of the city, and the disease transmission index also decreased significantly. It is expected that the peak of epidemic situation would be reached in late February and end in March.


title: "Global Health": Time to Refocus while We still Have Time

text: Two decades of growing resource availability from agencies and foundations in wealthy countries has transformed approaches to health in poorly resourced nations. This progress looks increasingly unstable as climate change, social unrest, and, now, disruptive pandemics present threats not only to health but also to the mechanisms that manage it, and to funding itself. The growth in "global health" schools, technology development laboratories, nongovernmental organizations and multilateral institutions in donor countries has delivered not only successes but also disappointment, and reflect a paradigm that is in many ways contrary to the principles of population-based ownership that they espouse. Although the COVID-19 crisis has underlined the importance of health access and health service capacity, we may have a limited window of opportunity in which to rethink the current model and improve both efficiency and effectiveness. With a dose of humility, we may all benefit from studying our own rhetoric on human-centered design and applying these principles across global health to ensure that our approach is effective, efficient, and defensible.


Rapid and Sensitive Detection of COVID-19 Using CRISPR/Cas12a-based Detection with Naked Eye Readout, CRISPR/Cas12a-NER


title: COVID-19 and anosmia: A review based on up-to-date knowledge

text: The pandemic of Coronavirus Disease 2019 (COVID-19) has caused a vast disaster throughout the world. There is increasing evidence that olfactory dysfunction can present in COVID-19 patients. Anosmia can occur alone or can be accompanied by other symptoms of COVID-19, such as a dry cough. However, the pathogenic mechanism of olfactory dysfunction and its clinical characteristics in patients with COVID-19 remains unclear. Multiple cross-sectional studies have demonstrated that the incidence rate of olfactory dysfunction in COVID-19 patients varies from 33.9-68% with female dominance. Anosmia and dysgeusia are often comorbid in COVID-19 patients. Otolaryngologists should be mindful of the symptom of anosmia in outpatients so as not to delay the diagnosis of COVID-19. In this paper, we have reviewed the relevant knowledge based on up-to-date literature.


title: [Health protection guideline of passenger transport stations and transportation facilities during novel coronavirus pneumonia (NCP) outbreak]

text: During the coronavirus pneumonia (NCP) outbreak, the transportation industries are faced with the more burdensome tasks of outbreak prevention and control as well as ensuring smooth transportation. It is important to organize transportation in order to restore the order of production and life, ensure the normal economic and social operation, and control the outbreak in the whole society. From the perspective of health, this guideline puts forward technical requirements on the operation management, personnel requirements and health protection of passenger transportation places such as aviation, railway, subway, bus, taxi, ship, etc., which reduces the impact of the NCP outbreak on the transportation industry and personal health risks.


COVID-19 Response in Sub-Saharan Low-Resource Setting: Healthcare Soldiers Need Bullets.


title: Letter to the Editors: Additional Factors to Consider When Studying Liver Injury Indicators and Mortality in COVID-19 Patients

text: In a recent issue of Hepatology, Lei et al.(1) conducted a multicenter retrospective cohort study that included 5,771 adult patients with coronavirus disease 2019 (COVID-19) pneumonia in Hubei Province. The purpose of the study was to evaluate the relationships between liver injury indicators (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and total bilirubin [TBIL]) and mortality in COVID-19 patients. The authors considered the possibility that elevated liver injury indicators, particularly AST, are strongly associated with mortality risk. However, the association between liver injury indicators and mortality in COVID-19 patients should be interpreted cautiously in light of the following issues.


title: Indications and timing for tracheostomy in patients with SARS CoV2-related

text: BACKGROUND: The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial. PURPOSE: In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital. METHODS: 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. RESULTS: Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. CONCLUSION: In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.


title: A Stroke Care Model at an Academic, Comprehensive Stroke Center During the 2020 COVID-19 Pandemic

text: BACKGROUND AND PURPOSE: The COVID-19 pandemic has required the adaptation of hyperacute stroke care (including stroke code pathways) and hospital stroke management. There remains a need to provide rapid and comprehensive assessment to acute stroke patients while reducing the risk of COVID-19 exposure, protecting healthcare providers, and preserving personal protective equipment (PPE) supplies. While the COVID infection is typically not a primary cerebrovascular condition, the downstream effects of this pandemic force adjustments to stroke care pathways to maintain optimal stroke patient outcomes. METHODS: The University of California San Diego (UCSD) Health System encompasses two academic, Comprehensive Stroke Centers (CSCs). The UCSD Stroke Center reviewed the national COVID-19 crisis and implications on stroke care. All current resources for stroke care were identified and adapted to include COVID-19 screening. The adjusted model focused on comprehensive and rapid acute stroke treatment, reduction of exposure to the healthcare team, and preservation of PPE. AIMS: The adjusted pathways implement telestroke assessments as a specific option for all inpatient and outpatient encounters and accounts for when telemedicine systems are not available or functional. COVID screening is done on all stroke patients. We outline a model of hyperacute stroke evaluation in an adapted stroke code protocol and novel methods of stroke patient management. CONCLUSIONS: The overall goal of the model is to preserve patient access and outcomes while decreasing potential COVID-19 exposure to patients and healthcare providers. This model also serves to reduce the use of vital PPE. It is critical that stroke providers share best practices via academic and vetted social media platforms for rapid dissemination of tools and care models during the COVID-19 crisis.


title: Transmission of SARS-CoV-2 via fecal-oral and aerosols-borne routes: Environmental dynamics and implications for wastewater management in underprivileged societies

text: The advent of novel human coronavirus (SARS-CoV-2) and its potential transmission via fecal-oral and aerosols-borne routes are upcoming challenges to understand the fate of the virus in the environment. In this short communication, we specifically looked at the possibilities of these transmission routes based on the available literature directly related to the SARS-CoV-2 as well as on the closer phylogenetic relatives such as SARS-CoV-1. The available data suggest that, in addition to human-to-human contact, the virus may spread via fecal-oral and aerosols-borne routes. Existing knowledge states that coronaviruses have low stability in the environment due to the natural action of oxidants that disrupt the viral envelope. Previous recommended dosage of chlorination has been found to be not sufficient to inactivate SARS-CoV-2 in places where viral load is high such as hospitals and airports. Although there is no current evidence showing that coronaviruses can be transmitted through contaminated drinking water, there is a growing concern on the impact of the current pandemic wave on underprivileged societies because of their poor wastewater treatment infrastructures, overpopulation, and outbreak management strategies. More research is encouraged to trace the actual fate of SARS-CoV-2 in the environment and to develop/revise the disinfection strategies accordingly.


title: Impaired immune cell cytotoxicity in severe COVID-19 is IL-6 dependent

text: BACKGROUND: Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2. Anti-viral immune response is crucial to achieve pathogen clearance, however in some patients an excessive and aberrant host immune response can lead to an acute respiratory distress syndrome. The comprehension of the mechanisms that regulate pathogen elimination, immunity, and pathology is essential to better characterize disease progression and widen the spectrum of therapeutic options. METHODS: We performed a flow cytometric characterization of immune cells subsets from 30 COVID-19 patients and correlated these data with clinical outcomes. RESULTS: COVID-19 patients showed decreased numbers of circulating T, B and NK cells, and exhibited a skewing of CD8+ T cells towards a terminally differentiated/senescent phenotype. In agreement, T CD4+, T CD8+ but also NK cells displayed reduced anti-viral cytokine production capability. Moreover, a reduced cytotoxic potential was identified in COVID-19 patients, particularly in those that required intensive care. The latter group of patients showed also increased serum IL-6 levels, that correlated to the frequency of granzyme-expressing NK cells. Off-label treatment with tocilizumab restored the cytotoxic potential of NK cells. CONCLUSION: In conclusion, the association between IL-6 serum levels and the impairment of cytotoxic activity suggests the possibility that targeting this cytokine may restore anti-viral mechanisms. FUNDING: This study was supported by funds of Dept. of Experimental and Clinical Medicine of University of Florence (ex-60%) derived from Ministero dell'Istruzione, dell'Università e della Ricerca (Italy).


Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome Coronavirus Disease 2019 (COVID-19) Infection


title: [Comparison of epidemic characteristics between SARS in 2003 and COVID-19 in 2020 in Guangzhou]

text: Objective: By analyzing the epidemic characteristics and related indicators of SARS and COVID-19, to explore the reasons for the similarities and differences of the two epidemics, so as to provide reference for epidemic prevention and control. Methods: The general situation, clinical classification, activity history, contact history, family members' contact and incidence of the two infectious diseases in Guangzhou were collected and used to analyze the time characteristics, occupational characteristics, age characteristics and other key indicators of the two diseases, including the number of cases, composition ratio (%), mean, median, crude mortality, etc. Results: A total of 1 072 cases of SARS were included in the study. Three hundred and fifty three were severe cases with the incidence of 30.13%. Forty three cases of death were reported with a mortality rate of 4.01%. The average age was 46 years old, and 26.31% of the cases were medical staff. The interval time between first report to continuous zero reports was 129 days. As to COVID-19, a total of 346 cases were included. 58 of which were severe cases with the incidence of 16.67%. One case of death was reported with a mortality rate of 0.29%. The average age was 38 years old, and no hospital infection among medical staff was reported. The interval time between first report to continuous zero reports was 35 days. Conclusions: The prevention and control strategies for COVID-19 were more effective compared to that of SARS, and the emergency response procedures were worth to be evaluated and summarized.


title: [Discussion on early warning, prevention and control of emerging infectious diseases from a macroscopic perspective based on big data and effective distance model: enlightenment of COVID-19 epidemic data in China]

text: Objective: To provide a system for warning, preventing and controlling emerging infectious diseases from a macroscopic perspective, using the COVID-19 epidemic data and effective distance model. Methods: The dates of hospitalization/isolation treatment of the first confirmed cases of COVID-19 and the cumulative numbers of confirmed cases in different provinces in China reported as of 23 February, 2020 were collected. The Location Based Service (LBS) big data platform of "Baidu Migration" was employed to obtain the data of the proportion of the floating population from Wuhan to all parts of the country. Effective distance models and linear regression models were established to analyze the relationship between the effective distance and the arrival time of the epidemic as well as the number of cumulative confirmed cases at provincial and municipal levels. Results: The arrival time of the epidemic and the cumulative number of confirmed cases of COVID-19 had significant linear relationship at both provincial and municipal levels in China, and the regression coefficients of each linear model were significant (P<0.001). At the provincial level, the effective distance could explain about 71% of the variation of the model with arrival time along with around 90% of the variation for the model in the cumulative confirmed case magnitude; at the municipal level, the effective distance could explain about 66% of the variation for the model in arrival time, and about 85% of the variation of the model with the cumulative confirmed case magnitude. Conclusions: The fitting degree of the models are good. The LBS big data and effective distance model can be used to estimate the track, time and extent of epidemic spread to provide useful reference for early warning, prevention and control of emerging infectious diseases.


Launching a public statewide tele(oral)medicine service in Brazil during COVID-19 pandemic


title: Antiviral activity of lycorine against Zika virus in vivo and in vitro

text: The emergence and re-emergence of Zika virus (ZIKV), is a cause for international concern. These highly pathogenic arboviruses represent a serious health burden in tropical and subtropical areas worldwide. Despite these burdens, antiviral therapies do not exist, and inhibitors of ZIKV are therefore urgently needed. To elucidate the anti-ZIKV effect of lycorine, we used reverse transcription-quantitative real-time PCR (qRT-PCR), immunofluorescence, Westernwestern blot, and plaque forming assay to analyse viral RNA (vRNA), viral protein, progeny virus counts, and validated inhibitors in vitro using a variety of cell lines. Additionally, we found that lycorine acts post-infection according to time-of-addition assay, and inhibits RdRp activity. Lycorine protected AG6 mice against ZIKV-induced lethality by decreasing the viral load in the blood. Due to its potency and ability to target ZIKV infection in vivo and in vitro, lycorine might offer promising therapeutic possibilities for combatting ZIKV infections in the future.


EU guidance impedes humanitarian action to prevent COVID-19 in Syria


End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic


title: TraceSecure: Towards Privacy Preserving Contact Tracing

text: Contact tracing is being widely employed to combat the spread of COVID-19. Many apps have been developed that allow for tracing to be done automatically based off location and interaction data generated by users. There are concerns, however, regarding the privacy and security of users data when using these apps. These concerns are paramount for users who contract the virus, as they are generally required to release all their data. Motivated by the need to protect users privacy we propose two solutions to this problem. Our first solution builds on current"message based"methods and our second leverages ideas from secret sharing and additively homomorphic encryption.


title: Epidemiology, diagnosis, treatment, and future perspectives concerning SARS-COV-2: a review article

text: The present study aimed to review the epidemiology, clinical manifestation, laboratory diagnosis, treatment, and future perspectives related to COVID-19 infections. The following electronic databases were used searched: MEDLINE, SCIELO, and LILACS. It became clear that COVID-19 infections occur through exposure to the virus, and both the immunosuppressed and healthy population appear susceptible. The clinical course of COVID-19 is still not clear, although the SARS-CoV-2 infection seems to develop with mild, influenza-like symptoms in the vast majority of subjects, i.e., 10%-15% of COVID-19 patients. Since rRT-PCR tests serve as the gold standard method to confirm a SARS-CoV-2 infection, false-negative results could hinder the prevention and control of the epidemic, particularly considering the test plays a key role in the decision for continued isolated medical observation or discharge. Our findings also indicate that a radical increase in the identification and isolation of currently undocumented infections would be needed to fully control SARS-CoV2.


title: Probable Pangolin Origin of SARS-CoV-2 Associated with the COVID-19 Outbreak

text: An outbreak of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) began in the city of Wuhan in China and has widely spread worldwide. Currently, it is vital to explore potential intermediate hosts of SARS-CoV-2 to control COVID-19 spread. Therefore, we reinvestigated published data from pangolin lung samples from which SARS-CoV-like CoVs were detected by Liu et al. [1]. We found genomic and evolutionary evidence of the occurrence of a SARS-CoV-2-like CoV (named Pangolin-CoV) in dead Malayan pangolins. Pangolin-CoV is 91.02% and 90.55% identical to SARS-CoV-2 and BatCoV RaTG13, respectively, at the whole-genome level. Aside from RaTG13, Pangolin-CoV is the most closely related CoV to SARS-CoV-2. The S1 protein of Pangolin-CoV is much more closely related to SARS-CoV-2 than to RaTG13. Five key amino acid residues involved in the interaction with human ACE2 are completely consistent between Pangolin-CoV and SARS-CoV-2, but four amino acid mutations are present in RaTG13. Both Pangolin-CoV and RaTG13 lost the putative furin recognition sequence motif at S1/S2 cleavage site that can be observed in the SARS-CoV-2. Conclusively, this study suggests that pangolin species are a natural reservoir of SARS-CoV-2-like CoVs.


ECT in a time of COVID-19


Liver Stereotactic Ablative Radiotherapy: an Effective and Feasible Alternative to Surgery during the COVID-19 Pandemic


Reduction in cardiovascular emergency admissions in Monaco during the COVID-19 pandemic


title: Designing clinical trials for future space missions as a pathway to changing how clinical trials are conducted on Earth

text: OBJECTIVE: The project aims to build a framework for conducting clinical trials for long-term interplanetary missions to contribute to innovation in clinical trials on Earth, especially around patient involvement and ownership. METHODS: We conducted two workshops in which participants were immersed in the speculative scenario of an interplanetary mission in which health problems emerged that required medical trials to resolve. The workshops used virtual reality and live simulation to mimic a zero-gravity environment and visual perception shifts and were followed by group discussion. RESULTS: Some key aspects for the framework that emerged from the workshops included: (a) approaches to be inclusive in the management of the trial, (b) approaches to be inclusive in designing the research project (patient preference trials, n-of-1 trials, designing clinical trials to be part of a future prospective meta-analysis, etc), (c) balancing the research needs and the community needs (eg, allocation of the participants based on both research and community need), (d) ethics and partnerships (ethics and consent issues and how they relate to partnerships and relationships). CONCLUSION: In identifying some key areas that need to be incorporated in future planning of clinical trials for interplanetary missions, we also identified areas that are relevant to engaging patients in clinical trials on Earth. We will suggest using the same methodology to facilitate more in-depth discussions on specific aspects of clinical trials in aerospace medicine. The methodology can be more widely used in other areas to open new inclusive conversations around innovating research methodology.


Social Work Response Needed to the Challenge of COVID-19 for Aging People with Intellectual and Developmental Disabilties


title: Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020

text: We describe 2 cases in coronavirus disease patients in France involving presumed thrombotic stroke that occurred during ongoing anticoagulation treatment for atrial fibrillation stroke prophylaxis; 1 patient had positive antiphospholipid antibodies. These cases highlight the severe and unique consequences of coronavirus disease-associated stroke.


ACMT Position Statement: Medication Shortages During Coronavirus Disease Pandemic


title: The treatment and follow-up of "recurrence" with discharged COVID-19 patients: Data from Guizhou, China

text: We reported 20 cases of discharged COVID-19 patients whose RT-PCR test results showed "re-positive". After finding "re-positive ", these patients were admitted to hospital for the second time and were followed up until the end of May 2020. Methods: Record detailed treatment and follow-up process, and collect relevant data. The possible causes and potential clinical significance of this phenomenon are discussed. This article is protected by copyright. All rights reserved.


title: Treatment of Coronavirus Disease 2019 (COVID-19) Patients with Convalescent Plasma

text: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has spread globally, and no proven treatments are available. Convalescent plasma therapy has been used with varying degrees of success to treat severe microbial infections for >100 years. Patients (n = 25) with severe and/or life-threatening COVID-19 disease were enrolled at the Houston Methodist hospitals from March 28, 2020, to April 14, 2020. Patients were transfused with convalescent plasma, obtained from donors with confirmed severe acute respiratory syndrome coronavirus 2 infection who had recovered. The primary study outcome was safety, and the secondary outcome was clinical status at day 14 after transfusion. Clinical improvement was assessed on the basis of a modified World Health Organization six-point ordinal scale and laboratory parameters. Viral genome sequencing was performed on donor and recipient strains. At day 7 after transfusion with convalescent plasma, nine patients had at least a one-point improvement in clinical scale, and seven of those were discharged. By day 14 after transfusion, 19 (76%) patients had at least a one-point improvement in clinical status, and 11 were discharged. No adverse events as a result of plasma transfusion were observed. Whole genome sequencing data did not identify a strain genotype-disease severity correlation. The data indicate that administration of convalescent plasma is a safe treatment option for those with severe COVID-19 disease.


title: Obesity, the most common comorbidity in SARS-CoV-2: is leptin the link?

text: Overweight and obesity are major risk factors for diabetes, cardiovascular disease, and lung disease. These diseases are the most commonly reported health conditions that predispose individuals with SARS-CoV-2 infection to require hospitalization including intensive care unit admissions. The innate immune response is the host's first line of defense against a human coronavirus infection. However, most coronaviruses are armed with one strategy or another to overcome host antiviral defense, and the pathogenicity of the virus is related to its capacity to suppress host immunity. The multifaceted nature of obesity including its effects on immunity can fundamentally alter the pathogenesis of acute respiratory distress syndrome and pneumonia, which are the major causes of death due to SARS-CoV-2 infection. Elevated circulating leptin concentrations are a hallmark of obesity, which is associated with a leptin-resistant state. Leptin is secreted by adipocytes in proportion to body fat and regulates appetite and metabolism through signaling in the hypothalamus. However, leptin also signals through the Jak/STAT and Akt pathways, among others, to modulate T cell number and function. Thus, leptin connects metabolism with the immune response. Therefore, it seems appropriate that its dysregulation would have serious consequences during an infection. We propose that leptin may be the link between obesity and its high prevalence as a comorbidity of the SARS-CoV-2 infection. In this article, we present a synthesis of the mechanisms underpinning susceptibility to respiratory viral infections and the contribution of the immunomodulatory effects of obesity to the outcome.


Need for Transparency and Reliable Evidence in Emergency Use Authorizations for Coronavirus Disease 2019 (COVID-19) Therapies


The basic reproduction number of novel coronavirus (2019-nCoV) estimation based on exponential growth in the early outbreak in China from 2019 to 2020: A reply to Dhungana


title: Usage of Chinese Herbs in Cancer Patients in Southern China: A Survey

text: OBJECTIVE: To study the use of Chinese medicine (CM) in cancer patients in southern China. METHODS: A total of 1,950 cancer patients finished questionnaires in four provinces in southern China. The survey included socio-demographic and clinical characteristics of participants, dosage forms, efficacy, and side effects. RESULTS: The study results showed that cancer patients with higher education (>12 years) were more likely to accept the treatment of Chinese herbs. There were 54.61% (1,065 cases) of patients chose Chinese herbs for the initial treatment and 14.46% (282 cases) chose Chinese herbs as monotherapy. Most patients (54.51%, 1,063 cases) continuously used CM for more than 6 months, and a few of them (212 cases) used CM for up to 3 years. All kinds of dosage forms of CM had been used, including CM decoction, CM patent prescription and CM injection. Concerning the efficacy in the view of patients, 40.31% (786 cases) believed that it would be effective to take Chinese herbs before they starting the anti-cancer treatment, and the percentage increased to 81.08% after 1-month CM treatment. The effect of Chinese herbs was mainly demonstrated by symptom relief and improvement of quality of life, and 8.31% (162 cases) of patients experienced control of tumor growth and decreased tumor markers. Furthermore, only 14.31% (279 cases) participants reported that they experienced side effects during CM treatment. CONCLUSION: This large scale investigation reflects the current situation of domestic CM usage objectively and comprehensively, which might provide new ways for cancer treatment.


title: Is it possible to suspend the spread of an epidemic infection? The dynamic Monte Carlo approach

text: We study a dynamics of the epidemiological infection spreading at different values of the risk factor $\beta$ (a control parameter) with the using of dynamic Monte Carlo approach (DMC). In our toy model, the infection transmits due to contacts of randomly moving individuals. We show that the behavior of recovereds critically depends on the $\beta$ value. For sub-critical values $\beta<\beta_{c}\sim 0.6$, the number of infected cases asymptotically converges to zero, such that for a moderate risk factor the infection may disappear with time. Our simulations shown that over time, the properties of such a system asymptotically become close to the critical transition in 2D percolation system. We also analyzed an extended system, which includes two additional parameters: the limits of taking on/off quarantine state. It is found that the early quarantine off does result in the irregular (with positive Lyapunov exponent) oscillatory dynamics of infection. If the lower limit of the quarantine off is small enough, the recovery dynamics acquirers a characteristic nonmonotonic shape with several damped peaks. The dynamics of infection spreading in case of the individuals with immunity is studied too.


Coping with the COVID-19 crisis in Sub-Saharan Africa: let us not leave older people behind!


title: United States should allow volunteers to be infected with coronavirus to test vaccines, lawmakers argue

text: Political support is building for regulators in the United States to embrace the controversial strategy of intentionally infecting volunteers with the virus that causes COVID-19 in order to test experimental vaccines Such human challenge trials could greatly accelerate the development of an effective vaccine, 35 members of the House of Representatives argue in a letter sent yesterday to the heads of the U S Food and Drug Administration (FDA) and its parent agency, the Department of Health and Human Services (HHS)


Evaluating the dermatology communities' public health response to COVID-19


The novel coronavirus (2019-nCoV) in pregnancy: What we need to know


Blood supply and transfusion support in southern Italy: findings during the first four weeks of the SARS-CoV-2 pandemic


Evaluation of COVID-19 infection in patients with Neuromyelitis optica spectrum disorder (NMOSD): A report from Iran


Videolaryngoscopy for tracheal intubation in patients with COVID-19


title: Crushing the curve, the role of national and international institutions and policy makers in COVID-19 pandemic

text: Nobody can be fully prepared to a pandemic. Of course there are signs of it, the scientists can predict, alarming speeches can be made. But there are always alarmist people around, maybe that is why sometimes even the most serious warnings may be not considered by the authorities on time. The first patients may be lost without a proper diagnosis. When everybody realizes that there may be a big problem in the horizon, sometimes it is too late. That is why it is very important to monitor contagious diseases and follow the warnings and releases of national and international disease control centers and other related organizations. China celebrated Lunar New Year with more than 40 thousand families on the 18 of January 2020. Nobody seem to be expecting this emerging new viral pneumonia outbreak appeared in Wuhan, in the last days of 2019, will break the chains and turn out to be a pandemic! But maybe this time it was not too late. There were four important pandemics within the last century: Spanish Flu, Hong Kong Flu, Asian Flu and Swine Flu. Each left different story behind. Millions of people had infected, hundreds, thousands of people died. This time, the Modern World had different tools to limit the SARS CoV2 outbreak. The national and international institutions of our globe were all communicating and taking precautions in a very fast manner than ever. However, this time, unexpectedly, the SARS-CoV-2 contagion was also faster. Besides the international organizations like WHO, UNESCO and UNICEF, the roles of local authorities, health ministries, disease control centers, health protection agencies, research centers and universities are all very important in different operational levels to control and survive from the pandemic. This paper will review the immediate response of different national and international institutions and authorities to COVID-19 pandemic.


Extracorporeal membrane oxygenation programs for COVID-19 in China


title: Part I. SARS-CoV-2 triggered 'PANIC' attack in severe COVID-19

text: The coronavirus disease 2019 (COVID-19) pandemic has produced a world-wide collapse of social and economic infrastructure, as well as constrained our freedom of movement. This respiratory tract infection is nefarious in how it targets the most distal and highly vulnerable aspect of the human bronchopulmonary tree, specifically, the delicate yet irreplaceable alveoli that are responsible for the loading of oxygen upon red cell hemoglobin for use by all of the body's tissues. In most symptomatic individuals, the disease is a mild immune-mediated syndrome, with limited damage to the lung tissues. About 20% of those affected experience a disease course characterized by a cataclysmic set of immune activation responses that can culminate in the diffuse and irreversible obliteration of the distal alveoli, leading to a virtual collapse of the gas-exchange apparatus. Here, in Part I of a duology on the characterization and potential treatment for COVID-19, we define severe COVID-19 as a consequence of the ability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to trigger what we now designate for the first time as a 'Prolific Activation of a Network-Immune-Inflammatory Crisis', or 'PANIC' Attack, in the alveolar tree. In Part II we describe an immunotherapeutic hypothesis worthy of the organization of a randomized clinical trial in order to ascertain whether a repurposed, generic, inexpensive, and widely available agent is capable of abolishing 'PANIC'; thereby preventing or mitigating severe COVID-19, with monumental ramifications for world health, and the global pandemic that continues to threaten it.


title: The changing patter of COVID-19 in China: A tempo-geographic analysis of the SARS-CoV-2 epidemic

text: BACKGROUND: Evaluating whether an infectious disease has reached a turning point is important for planning additional intervention efforts. This study aimed to analyze the changing patterns and the tempo-geographic features of the COVID-19 epidemic, to provide further evidence for real-time responses. METHODS: Daily data on COVID-2019 cases between 31st Dec. 2019 and 26th Feb. 2020 were collected and analyzed for Hubei and non-Hubei regions. Observed trends for new and cumulative cases were analyzed through joint-point regressions. Spatial analysis was applied to show the geographic distribution and changing pattern of the epidemic. RESULTS: By 26th Feb. 2020, 78,630 confirmed COVID-19 cases had been reported in China. In Hubei, an increasing trend (slope=221) was observed for new cases between 24th Jan. and February 7th Feb. 2020, after which a decline commenced (slope=-868). However, as the diagnosis criteria changed, a sudden increase (slope=5530) was observed on 12th Feb., which sharply decreased afterward (slope=-4898). In non-Hubei regions, the number of new cases increased from 20th Jan. to 3rd Feb. and started to decline afterward (slope=-53). The spatial analysis identified Chongqing, Guangzhou, Shenzhen, Changsha, Nanchang, Wenzhou, Shanghai, Xinyang, Jining, and Beijing as the hotspots outside of Hubei province in China. CONCLUSION AND RELEVANCE: The joint-point regression analysis indicated that the epidemic might have been under control in China, especially for regions outside of Hubei province. Further improvement in the response strategies based on these new patterns is needed.


An internet-based algorithm for diabetic foot infection during the COVID-19 pandemic


title: 2019 Novel Coronavirus: What Is Currently Known, Cardiovascular Implications and Management

text: From first cases reported on December 31, 2019, in Wuhan, Hubei-China, SARS-CoV2 has spread worldwide and finally the World Health Organization declared the pandemic status. We summarize what makes SARS-CoV2 different from previous highly pathogenic coronaviruses and why it is so contagious, with focus on its clinical presentation and diagnosis, which is mandatory to start the appropriate management and reduce the transmission. As far as infection pathophysiology is still not completely clarified, this review focuses also on the cardiovascular (CV) implication of COVID-19 and the capability of this virus to cause direct myocardial injury, myocarditis and other CV manifestations. Furthermore, we highlight the relationship between the virus, enzyme ACE2 and ACE inhibitors. Clinical management involves the intensive care approach with intubation and mechanical ventilation in the most serious cases and drug therapy with several apparently promising old and new molecules. Aim of this review is then to summarize what is actually known about the SARS-CoV2 and its cardiovascular implications.


title: Studies in humanized mice and convalescent humans yield a SARS-CoV-2 antibody cocktail

text: Neutralizing antibodies have become an important tool in treating infectious diseases. Recently, two separate approaches yielded successful antibody treatments for Ebola - one from genetically-humanized mice, and the other from a human survivor. Here, we describe parallel efforts using both humanized mice and convalescent patients to generate antibodies against the SARS-CoV-2 spike protein, yielding a large collection of fully-human antibodies that were characterized for binding, neutralization and three dimensional structure. Based on these criteria, we selected pairs of highly-potent individual antibodies that simultaneously bind the receptor-binding domain of the spike protein, providing ideal partners for a therapeutic antibody cocktail that aims to decrease the potential for virus escape mutants that might arise in response to selective pressure from a single antibody treatment.


title: Drug Development and Medicinal Chemistry Efforts toward SARS-Coronavirus and Covid-19 Therapeutics

text: The COVID-19 pandemic caused by SARS-CoV-2 infection is spreading at an alarming rate and has created an unprecedented health emergency around the globe. There is no effective vaccine or approved drug treatment against COVID-19 and other pathogenic coronaviruses. The development of antiviral agents is an urgent priority. Biochemical events critical to the coronavirus replication cycle provided a number of attractive targets for drug development. These include, spike protein for binding to host cell-surface receptors, proteolytic enzymes that are essential for processing polyproteins into mature viruses, and RNA-dependent RNA polymerase for RNA replication. There has been a lot of ground work for drug discovery and development against these targets. Also, high-throughput screening efforts have led to the identification of diverse lead structures, including natural product-derived molecules. This review highlights past and present drug discovery and medicinal-chemistry approaches against SARS-CoV, MERS-CoV and COVID-19 targets. The review hopes to stimulate further research and will be a useful guide to the development of effective therapies against COVID-19 and other pathogenic coronaviruses.


Rapid training of healthcare staff for protected cardiopulmonary resuscitation in the COVID-19 pandemic


COVID-19: How to Prepare for the Pandemic?


Frequent occurrence of CD19-negative relapse after CD19 CAR T and consolidation therapy in 14 TP53-mutated r/r B-ALL children


title: Residual Attention U-Net for Automated Multi-Class Segmentation of COVID-19 Chest CT Images

text: The novel coronavirus disease 2019 (COVID-19) has been spreading rapidly around the world and caused significant impact on the public health and economy. However, there is still lack of studies on effectively quantifying the lung infection caused by COVID-19. As a basic but challenging task of the diagnostic framework, segmentation plays a crucial role in accurate quantification of COVID-19 infection measured by computed tomography (CT) images. To this end, we proposed a novel deep learning algorithm for automated segmentation of multiple COVID-19 infection regions. Specifically, we use the Aggregated Residual Transformations to learn a robust and expressive feature representation and apply the soft attention mechanism to improve the capability of the model to distinguish a variety of symptoms of the COVID-19. With a public CT image dataset, we validate the efficacy of the proposed algorithm in comparison with other competing methods. Experimental results demonstrate the outstanding performance of our algorithm for automated segmentation of COVID-19 Chest CT images. Our study provides a promising deep leaning-based segmentation tool to lay a foundation to quantitative diagnosis of COVID-19 lung infection in CT images.


title: Excess cases of influenza-like illnesses synchronous with coronavirus disease (COVID-19) epidemic, France, March 2020

text: Several French regions where coronavirus disease (COVID-19) has been reported currently show a renewed increase in ILI cases in the general practice-based Sentinelles network. We computed the number of excess cases by region from 24 February to 8 March 2020 and found a correlation with the number of reported COVID-19 cases so far. The data suggest larger circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the French population than apparent from confirmed cases.


title: Model selection criteria for regression models with splines and the automatic localization of knots

text: In this paper we propose a model selection approach to fit a regression model using splines with a variable number of knots. We introduce a penalized criterion to estimate the number and the position of the knots where to anchor the splines basis. The method is evaluated on simulated data and applied to covid-19 daily reported cases for short-term prediction.


BCG-induced trained immunity: can it offer protection against COVID-19?


title: Epidemiologie und Kontrollmaßnahmen bei COVID-19./ [Epidemiology and control of COVID-19]

text: The Coronavirus Disease Pandemic 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2), started in December 2019 in China. SARS-CoV-2 is easily transmitted by droplet infection. After an incubation period of 1-14 days, COVID-19 shows a mild course in 80â% of observed cases and a severe course in 20â%, with a lethality rate of 0.3-5.8â%. Elderly people and people with underlying diseases have a higher risk of severe courses with mandatory ventilation. So far there are neither effective drugs nor vaccinations available, so only public health interventions such as physical distancing and hygiene measures on the one hand and targeted testing followed by isolation and quarantine measures on the other hand are available. China has shown that maximum use of these measures can control the epidemic. The further course and also the consequences for the global economy cannot be clearly predicted at present.


COVID-19 pandemic in India


Cancer surgery sustainability in the light of COVID-19 pandemic


title: Modelling the Extremes of Seasonal Viruses and Hospital Congestion: The Example of Flu in a Swiss Hospital

text: Viruses causing flu or milder coronavirus colds are often referred to as"seasonal viruses"as they tend to subside in warmer months. In other words, meteorological conditions tend to impact the activity of viruses, and this information can be exploited for the operational management of hospitals. In this study, we use three years of daily data from one of the biggest hospitals in Switzerland and focus on modelling the extremes of hospital visits from patients showing flu-like symptoms and the number of positive cases of flu. We propose employing a discrete Generalized Pareto distribution for the number of positive and negative cases, and a Generalized Pareto distribution for the odds of positive cases. Our modelling framework allows for the parameters of these distributions to be linked to covariate effects, and for outlying observations to be dealt with via a robust estimation approach. Because meteorological conditions may vary over time, we use meteorological and not calendar variations to explain hospital charge extremes, and our empirical findings highlight their significance. We propose a measure of hospital congestion and a related tool to estimate the resulting CaRe (Charge-at-Risk-estimation) under different meteorological conditions. The relevant numerical computations can be easily carried out using the freely available GJRM R package. The introduced approach could be applied to several types of seasonal disease data such as those derived from the new virus SARS-CoV-2 and its COVID-19 disease which is at the moment wreaking havoc worldwide. The empirical effectiveness of the proposed method is assessed through a simulation study.


How to survive from the threat of COVID-19, for rehabilitaion facilities with frequent heavy contact.


Letter to the Editor 'Scoping the Perplexing Effect of the COVID Pandemic in Nepal, and the Appraisal for Precautionary Measures from Its Lurking Aftermath'


Fighting the COVID-19 pandemic: An ophthalmologist's experience in an intensive care unit at the All India Institute of Medical Sciences


title: COVID-19 preventive measures showing an unintended decline in infectious diseases in Taiwan

text: Many communicable diseases may have contact, airborne, and/or droplets transmission. Following the COVID-19 outbreak, Taiwan government implemented the use of masks and sanitizer and other prevention measures, like social distancing for prevention. This public response may have likely contributed significantly to the decline in the outbreak of other infectious diseases.


Super-spreading events and contribution to transmission of MERS, SARS, and SARS-CoV-2 (COVID-19)


The Message of the Covid Pandemic


Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study


In Response to: In Reference to Anosmia and Ageusia: Common Findings in COVID-19 Patients


title: Clinical Risk Prediction with Temporal Probabilistic Asymmetric Multi-Task Learning

text: Although recent multi-task learning methods have shown to be effective in improving the generalization of deep neural networks, they should be used with caution for safety-critical applications, such as clinical risk prediction. This is because even if they achieve improved task-average performance, they may still yield degraded performance on individual tasks, which may be critical (e.g., prediction of mortality risk). Existing asymmetric multi-task learning methods tackle this negative transfer problem by performing knowledge transfer from tasks with low loss to tasks with high loss. However, using loss as a measure of reliability is risky since it could be a result of overfitting. In the case of time-series prediction tasks, knowledge learned for one task (e.g., predicting the sepsis onset) at a specific timestep may be useful for learning another task (e.g., prediction of mortality) at a later timestep, but lack of loss at each timestep makes it difficult to measure the reliability at each timestep. To capture such dynamically changing asymmetric relationships between tasks in time-series data, we propose a novel temporal asymmetric multi-task learning model that performs knowledge transfer from certain tasks/timesteps to relevant uncertain tasks, based on feature-level uncertainty. We validate our model on multiple clinical risk prediction tasks against various deep learning models for time-series prediction, which our model significantly outperforms, without any sign of negative transfer. Further qualitative analysis of learned knowledge graphs by clinicians shows that they are helpful in analyzing the predictions of the model. Our final code is available at https://github.com/anhtuan5696/TPAMTL.


title: [Contagiousness and secondary attack rate of 2019 novel coronavirus based on cluster epidemics of COVID-19 in Guangzhou]

text: Objective: To analyze the contagiousness and secondary attack rate of 2019 novel coronavirus in cluster epidemics in Guangzhou and provide evidence for the prevention and control of COVID-19. Methods: All the individuals identified to be infected with 2019-nCoV in Guangzhou, including confirmed cases and asymptomatic cases, were included and classified as imported cases and local cases. The first case of each cluster epidemic was defined as index case, and the number of subsequent infections was calculated to evaluate the contagiousness and secondary attack rate of 2019 novel coronavirus in the shortest incubation period of 1-3 days. Results: As of 18 February, 2020, a total of 349 cases of 2019-nCoV infection, including 339 confirmed cases (97.13%) and 10 asymptomatic cases (2.87%) were reported in Guangzhou. There were 68 clusters involving 217 2019-nCoV infection cases (210 confirmed cases and 7 asymptomatic cases). The median number of subsequent infections caused by an index case in a cluster epidemic was 3, among which 2 were confirmed cases and 1 was asymptomatic cases, respectively. The average number of contagiousness was 2.18 in shorted incubation period of 1-3 days (The average number of infected cases were 2.18 cases by the index case in a cluster epidemic), the average infection number in family members was 1.86, and the infection ratio of family member transmission was 85.32% (1.86/2.18). The secondary attack rate in close contacts with shortest incubation period of 1-3 days was 17.12%-18.99%, the secondary attack rate in family members was 46.11%-49.56%. Conclusions: The cluster epidemic of COVID-19 in Guangzhou mainly occurred in families, the contagiousness was high. It is necessary to strengthen the prevention and control to reduce the community transmission of COVID-19.


Commentary: COVID-19 and diabetes


title: Lest We Forget: A Dataset of Coronavirus-Related News Headlines in Swiss Media

text: We release our COVID-19 news dataset, containing more than 10,000 links to news articles related to the Coronavirus pandemic published in the Swiss media since early January 2020. This collection can prove beneficial in mining and analysis of the reaction of the Swiss media and the COVID-19 pandemic and extracting insightful information for further research. We hope this dataset helps researchers and the public deliver results that will help analyse the pandemic and potentially lead to a better understanding of the events.


Covid-19: death rate is 0.66% and increases with age, study estimates


The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19


[Which sampling method for the upper respiratory tract specimen should be taken to diagnose patient with COVID-19?]


title: Addressing the rheumatology workforce shortage: A multifaceted approach

text: A significant challenge facing the field of rheumatology is the projected gap between the growing demand for rheumatologists and the available workforce. In order to improve access to care, augmenting the rheumatology workforce is required. Herein we discuss potential solutions to the anticipated workforce shortage, including 1) expanding the training of rheumatology physicians; 2) increasing nurse practitioner, physician assistant and pharmacist utilization in rheumatology practice; 3) growing the use of telemedicine; and 4) reducing burnout in order to retain practicing rheumatologists. Building on the existing literature in these areas, we propose a multifaceted approach to addressing the rheumatology workforce shortage.


title: Animal-based food systems are unsafe: SARS-CoV-2 fosters the debate on meat consumption

text: The current pandemic restarts a debate on permanently banning wildlife consumption in an effort to prevent further public health threats. In this commentary, we offer two ideas to enhance the discussion on foodborne zoonotic diseases in food systems. First, we focus on the probable consequences that the loss of access to wildlife could cause to the status of food and nutrition security of many people in developing countries that rely on bushmeat to subsist. Second, we argue that all animal-based food systems, especially the ones based on intensive husbandry, present food safety threats. To ban the access to bushmeat without a rational analysis of all human meat production and consumption in the global animal-based food system will not help us to prevent future outbreaks.


title: Explainable deep learning models in medical image analysis

text: Deep learning methods have been very effective for a variety of medical diagnostic tasks and has even beaten human experts on some of those. However, the black-box nature of the algorithms has restricted clinical use. Recent explainability studies aim to show the features that influence the decision of a model the most. The majority of literature reviews of this area have focused on taxonomy, ethics, and the need for explanations. A review of the current applications of explainable deep learning for different medical imaging tasks is presented here. The various approaches, challenges for clinical deployment, and the areas requiring further research are discussed here from a practical standpoint of a deep learning researcher designing a system for the clinical end-users.


Managing Change in the Aftermath of a Pandemic


title: Using Photo Modeling Based 3DGRSL to Promote the Sustainability of Geo-Education, a case study from China

text: In earth science education, observation of field geological phenomena is very important. Due to China's huge student population, it is difficult to guarantee education fairness and teaching quality in field teaching. Specimens are indispensable geo-education resources. However, the specimen cabinet or picture specimen library has many limitations and it is difficult to meet the internet-spirit or geo-teaching needs. Based on photo modeling, this research builds a 3D Geo-Resource Sharing Library (3DGRSL) for Geo-Education. It uses the Cesium engine and data-oriented distributed architecture to provide the educational resources to many universities. With Browser/Server (B/S) architecture, the system can realize multi-terminal and multi-scenario access of mobile phones, tablets, VR, PC, indoor, outdoor, field, providing a flexible and convenient way for preserving and sharing scientific information about geo-resources. This makes sense to students who cannot accept field teaching in under-funded colleges, and the ones with mobility problems. Tests and scoring results show that 3DGRSL is a suitable solution for displaying and sharing geological specimens. Which is of great significance for the sustainable use and protection of geoscience teaching resources, the maintenance of the right to fair education, and the construction of virtual simulation solutions in the future.


title: Mobility patterns of the Portuguese population during the COVID-19 pandemic

text: SARS-CoV-2 emerged in late 2019. Since then, it has spread to several countries, becoming classified as a pandemic. So far, there is no definitive treatment or vaccine, so the best solution is to prevent transmission between individuals through social distancing. However, it is difficult to measure the effectiveness of these distancing measures. Therefore, this study uses data from Google COVID-19 Community Mobility Reports to try to understand the mobility patterns of the Portuguese population during the COVID-19 pandemic. In this study, the Rt value was modeled for Portugal. Also, the changepoint was calculated for the population mobility patterns. Thus, the change in the mobility pattern was used to understand the impact of social distancing measures on the dissemination of COVID-19. As a result, it can be stated that the initial Rt value in Portugal was very close to 3, falling to values close to 1 after 25 days. Social isolation measures were adopted quickly. Furthermore, it was observed that public transport was avoided during the pandemic. Finally, until the emergence of a vaccine or an effective treatment, this will be the new normal and it must be understood that new patterns of mobility, social interaction, and hygiene must be adapted to this new reality.


title: The impact of the great economic crisis on mental health care in Italy

text: The great economic crisis in 2008 has affected the welfare of the population in countries such as Italy. Although there is abundant literature on the impact of the crisis on physical health, very few studies have focused on the causal implications for mental health and health care. This paper, therefore, investigates the impact of the recent economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy and assesses whether there are heterogeneous effects across areas with distinct levels of income. We exploit 9-year (2007-2015) panel data on hospital discharges, which is merged with employment and income composition at the geographic units that share similar labour market structures. Linear and dynamic panel analysis are used to identify the causal effect of rising unemployment rate on severe mental illness admissions per 100,000 residents to account for time-invariant heterogeneity. We further create discrete income levels to identify the potential socioeconomic gradients behind this effect across areas with different economic characteristics. The results show a significant impact of higher unemployment rates on admissions for severe mental disorders after controlling for relevant economic factors, and the effects are concentrated on the most economically disadvantaged areas. The results contribute to the literature of spatio-temporal variation in the broader determinants of mental health and health care utilisation and shed light on the populations that are most susceptible to the effects of the economic crisis.


title: Reply to Letter to the Editor: COVID-19-Related Liver Injury and Clinical Outcomes: Does It Really Exist?

text: We appreciate Philips and colleagues' interest in our report on the associations between liver injury markers and coronavirus 2019 (COVID-19) mortality.(1) They raised the question regarding the application of liver injury markers. However, several of their interpretations of our results are misleading or incorrect. We understand that use of aspartate aminotransferase (AST) in isolation cannot comprehensively characterize liver injury.


title: The basic reproduction number of SARS-CoV-2 in Wuhan is about to die out, how about the rest of the World?

text: The virologically confirmed cases of a new coronavirus disease (COVID-19) in the world are rapidly increasing, leading epidemiologists and mathematicians to construct transmission models that aim to predict the future course of the current pandemic. The transmissibility of a virus is measured by the basic reproduction number ( R0 ), which measures the average number of new cases generated per typical infectious case. This review highlights the articles reporting rigorous estimates and determinants of COVID-19 R0 for the most affected areas. Moreover, the mean of all estimated R0 with median and interquartile range is calculated. According to these articles, the basic reproduction number of the virus epicentre Wuhan has now declined below the important threshold value of 1.0 since the disease emerged. Ongoing modelling will inform the transmission rates seen in the new epicentres outside of China, including Italy, Iran and South Korea.


title: Probing the sensitivity to leptonic $\delta_{CP}$ in presence of invisible decay of $\nu_3$ using atmospheric neutrinos

text: One of the main neutrino oscillation parameters whose value has not been determined very precisely is the leptonic $\delta_{CP}$ phase. Since neutrinos have a tiny but finite mass they can undergo decay both visibly and invisibly. The effect of invisible decay of the third mass eigen state $\nu_3$ on the sensitivity to $\delta_{CP}$ is analysed here using atmospheric neutrino and anti-neutrino events. Effects of detector resolutions and systematic uncertainties are studied to identify the optimum resolutions and efficiencies required by a detector to obtain a significant sensitivity even in presence of decay.


Covid-19: Mental health consequences of pandemic need urgent research, paper advises


title: 'All In': a pragmatic framework for COVID-19 testing and action on a global scale

text: Current demand for SARS-CoV-2 testing is straining material resource and labor capacity around the globe. As a result, the public health and clinical community are hindered in their ability to monitor and contain the spread of COVID-19. Despite broad consensus that more testing is needed, pragmatic guidance toward realizing this objective has been limited. This paper addresses this limitation by proposing a novel and geographically agnostic framework (the 4Ps framework) to guide multidisciplinary, scalable, resource-efficient, and achievable efforts toward enhanced testing capacity. The 4Ps (Prioritize, Propagate, Partition, and Provide) are described in terms of specific opportunities to enhance the volume, diversity, characterization, and implementation of SARS-CoV-2 testing to benefit public health. Coordinated deployment of the strategic and tactical recommendations described in this framework has the potential to rapidly expand available testing capacity, improve public health decision-making in response to the COVID-19 pandemic, and/or to be applied in future emergent disease outbreaks.


COVID-19 vaccine development pipeline gears up


title: Patients with cancer in the COVID-19 era: the clinical trial issue

text: Coronavirus disease 2019 (COVID-19) hospital reorganization may result in reduced ability for the hospital to fully use its armamentarium for battling cancer. Thus different therapeutic modalities have been recommended. During the pandemic, despite regulatory agencies' recommendations, several considerations and doubts remain for oncologic clinical trials. Considering patients who had been enrolled before the pandemic, and who plan to take the study medication, the situation becomes complicated. These patients should undergo monitoring visits, blood sampling, questionnaire, physical examination, and drug and radiation administration. To avoid deviations from the protocol and trial discontinuation, follow-up should be performed regularly, in concordance with safety guidelines. Here we report several considerations.


Impact of COVID-19 on endoscopy trainees: an international survey


title: National Response to COVID-19 in the Republic of Korea and Lessons Learned for Other Countries

text: In the first two months of the COVID-19 pandemic, the Republic of Korea (South Korea) had the second highest number of cases globally yet was able to dramatically lower the incidence of new cases and sustain a low mortality rate, making it a promising example of strong national response. We describe the main strategies undertaken and selected facilitators and challenges in order to identify transferable lessons for other countries working to control the spread and impact of COVID-19. Identified strategies included early recognition of the threat and rapid activation of national response protocols led by national leadership; rapid establishment of diagnostic capacity; scale-up of measures for preventing community transmission; and redesigning the triage and treatment systems, mobilizing the necessary resources for clinical care. Facilitators included existing hospital capacity, the epidemiology of the COVID-19 outbreak, and strong national leadership despite political changes and population sensitization due to the 2015 Middle East respiratory syndrome-related coronavirus (MERS-CoV) epidemic. Challenges included sustaining adequate human resources and supplies in high-caseload areas. Key recommendations include (1) recognize the problem, (2) establish diagnostic capacity, (3) implement aggressive measures to prevent community transmission, (4) redesign and reallocate clinical resources for the new environment, and (5) work to limit economic impact through and while prioritizing controlling the spread and impact of COVID-19. South Korea's strategies to prevent, detect, and respond to the pandemic represent applicable knowledge that can be adopted by other countries and the global community facing the enormous COVID-19 challenges ahead.


Interleukin-6 levels in children developing SARS-CoV-2 infection


title: Coronavirus disease-2019: A tocsin to our aging, unfit, corpulent, and immunodeficient society

text: Acute and chronic respiratory illnesses cause widespread morbidity and mortality, and this class of illness now includes the novel coronavirus severe acute respiratory syndrome that is causing coronavirus disease-2019 (COVID-19). The world is experiencing a major demographic shift toward an older, obese, and physically inactive populace. Risk factor assessments based on pandemic data indicate that those at higher risk for severe illness from COVID-19 include older males, and people of all ages with obesity and related comorbidities such as hypertension and type 2 diabetes. Aging in and of itself leads to negative changes in innate and adaptive immunity, a process termed immunosenescence. Obesity causes systemic inflammation and adversely impacts immune function and host defense in a way that patterns immunosenescence. Two primary prevention strategies to reduce the risk for COVID-19 at both the community and individual levels include mitigation activities and the adoption of lifestyle practices consistent with good immune health. Animal and human studies support the idea that, in contrast to high exercise workloads, regular moderate-intensity physical activity improves immunosurveillance against pathogens and reduces morbidity and mortality from viral infection and respiratory illnesses including the common cold, pneumonia, and influenza. The odds are high that infectious disease pandemics spawned by novel pathogens will continue to inflict morbidity and mortality as the world's population becomes older and more obese. COVID-19 is indeed a wake-up call, a tocsin, to the world that primary prevention countermeasures focused on health behaviors and hygiene demand our full attention and support.


title: Herd Immunity: Understanding COVID-19

text: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease, COVID-19, has demonstrated the devastating impact of a novel, infectious pathogen on a susceptible population. Here, we explain the basic concepts of herd immunity and discuss its implications in the context of COVID-19.


title: An outbreak of gastroenteritis by emerging norovirus GII.2[P16] in a kindergarten in Kota Kinabalu, Malaysian Borneo

text: Outbreaks of diarrhea in kindergartens are underreported and frequently go unnoticed in developing countries. To better understand the etiology this study was performed during an outbreak of diarrhea in a kindergarten in Sabah, Malaysia. Outbreak investigation was performed according to the standard procedures. In this outbreak a total of 34 (36.5%) children and 4 (30.8%) teachers suffered from gastroenteritis. Stool samples from seven children and 13 teachers were tested for rotavirus and norovirus. During the investigation stool samples were collected and sent in cold chain to the laboratory. The samples were subjected to rotavirus enzyme linked immunosorbent assay, and reverse transcription PCR for norovirus. All samples were negative for rotavirus but positive for norovirus. To determine the genogroup and genotype of norovirus, nucleotide sequencing of the amplicons was performed. All norovirus from the outbreak was of genotype GII.2[16]. To determine the relatedness of the strains phylogenetic analysis was done using neighbor-joining method. Phylogenetically these strains were highly related to GII.2[P16] noroviruses from China and Japan. This study provided evidence that a diarrheal outbreak in a kindergarten was caused by GII.2[P16] norovirus which is an emerging strain in East Asia and Europe.


Expanding the definition of covid-19 deaths will show the true effect of the pandemic


title: The nexus between COVID-19, temperature and exchange rate in Wuhan city: New findings from partial and multiple wavelet coherence

text: This study attempts to document the nexus between weather, COVID-19 outbreak in Wuhan and the Chinese economy. We used daily average temperature (hourly data), daily new confirmed cases of COVID-19 in Wuhan, and RMB (Chinese currency) exchange rate to represent the weather, COVID-19 outbreak and the Chinese economy, respectively. The methodology of Wavelet Transform Coherence (WTC), Partial Wavelet Coherence (PWC) and Multiple Wavelet Coherence (MWC) is employed to analyze the daily data collected from 21st January 2020 to 31st March 2020. The results have revealed a significant coherence between the series at different time-frequency combinations. The overall results suggest the insignificance of an increase in temperature to contain or slow down the new COVID-19 infections. The RMB exchange rate and the COVID-19 showed an out phase coherence at specific time-frequency spots suggesting a negative but limited impact of the COVID-19 outbreak in Wuhan on the Chinese export economy. Our results are contrary to many earlier studies which suggest a significant role of temperature in slowing down the COVID-19 spread. These results can have important policy implications for the containment of COVID-19 spread and macro-economic management with respect to changes in the weather.


Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern


title: Recomendaciones de salud laboral para socorristas ante emergencias acuáticas en la era Covid-19: prevención, rescate y reanimación./ [Occupational health recommendations for lifeguards in aquatic emergencies in the Covid-19 era: prevention, rescue and resuscitation.]

text: Severe acute respiratory syndrome (SARS-CoV-2), which causes coronavirus disease 2019 (Covid-19), is highly contagious. Lifeguards are the first line of response in aquatic emergencies and they will suffer a strong exposure to risk this first summer of the Covid-19 era, so their occupational health must be rethought in their professional practice during the new normal. The main public health measure to prevent drowning is prevention, but when this fails and assistance or rescue is required, in most interventions, distancing will not be possible. The limitation of personal protective equipment (PPE) for rescue is a reality that must be known and that can affect the health of the lifeguard. A review of the current literature aimed at avoiding or minimizing the risk of contagion in the interventions carried out by rescuers in the Covid-19 era was performed. This article provides structured information on the prevention of contagion in lifeguards, the potential risks, the available PPE, and the recommendations for its proper use during rescue or prehospital care in aquatic settings.


title: Changes in electricity demand pattern in Europe due to COVID-19 shutdowns

text: The article covers electricity demand shift effects due to COVID-19 shutdowns in various European countries. We utilize high-dimensional regression techniques to exploit the structural breaks in demand profiles due to the shutdowns. We discuss the findings with respect to coronavirus pandemic progress and regulatory measures of the considered countries.


title: COVID-19 detection using Residual Attention Network an Artificial Intelligence approach

text: Coronavirus Disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2). The virus transmits rapidly, it has a basic reproductive number ($R_0$) of $2.2-2.7$. In March, 2020 the World Health Organization declared the COVID-19 outbreak a pandemic. Effective testing for COVID-19 is crucial to controlling the outbreak since infected patients can be quarantined. But the demand for testing outstrips the availability of test kits that use Reverse Transcription Polymerase Chain Reaction (RT-PCR). In this paper, we present a technique to detect COVID-19 using Artificial Intelligence. Our technique takes only a few seconds to detect the presence of the virus in a patient. We collected a dataset of chest X-ray images and trained several popular deep convolution neural network-based models (VGG, MobileNet, Xception, DenseNet, InceptionResNet) to classify chest X-rays. Unsatisfied with these models we then designed and built a Residual Attention Network that was able to detect COVID-19 with a testing accuracy of 98\% and a validation accuracy of 100\%. Feature maps of our model show which areas within a chest X-ray are important for classification. Our work can help to increase the adaptation of AI-assisted applications in clinical practice.


A framework for nosocomial transmission of emerging coronaviruses


Sustaining essential healthcare in Africa during the COVID-19 pandemic


SARS-CoV-2 on the neural battleground


Life in a post-pandemic world: What to expect of anxiety-related conditions and their treatment


Responding to COVID-19 pandemic: Why a strong health system is required