Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China

Can Nanotechnology and Materials Science Help the Fight against SARS-CoV-2?

Since 2004, we have been developing nanomaterials with antimicrobial properties, the so-called nanoantimicrobials. When the coronavirus disease 2019 (COVID-19) emerged, we started investigating new and challenging routes to nanoantivirals. The two fields have some important points of contact. We would like to share with the readership our vision of the role a (nano)materials scientist can play in the fight against the COVID-19 pandemic. As researchers specifically working on surfaces and nanomaterials, in this letter we underline the importance of nanomaterial-based technological solutions in several aspects of the fight against the virus. While great resources are understandably being dedicated to treatment and diagnosis, more efforts could be dedicated to limit the virus spread. Increasing the efficacy of personal protection equipment, developing synergistic antiviral coatings, are only two of the cases discussed. This is not the first nor the last pandemic: our nanomaterials community may offer several technological solutions to challenge the ongoing and future global health emergencies. Readers' feedback and suggestions are warmly encouraged.

Fast spread of COVID-19 in Europe and the US suggests the necessity of early, strong and comprehensive interventions

The COVID-19 pandemic caused more than 800,000 infections and 40,000 deaths by the end of March 2020. However, some of the basic epidemiological parameters, such as the exponential epidemic growth rate and R0 are debated. We developed an inference approach to control for confounding factors in data collection, such as underreporting and changes in surveillance intensities, and fitted a mathematical model to infection and death count data collected from eight European countries and the US. In all countries, the early epidemic grew exponentially at rates between 0.19-0.29/day (epidemic doubling times between 2.4-3.7 days). This suggests a highly infectious virus with an R0 likely between 4.0 and 7.1. We show that similar levels of intervention efforts are needed, no matter the goal is mitigation or containment. Early, strong and comprehensive intervention efforts to achieve greater than 74-86% reduction in transmission are necessary.

Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study

OBJECTIVES

United States government scientists estimate that COVID-19 may kill tens of thousands of Americans. Many of the pre-existing conditions that increase the risk of death in those with COVID-19 are the same diseases that are affected by long-term exposure to air pollution. We investigated whether long-term average exposure to fine particulate matter (PM _2.5 ) is associated with an increased risk of COVID-19 death in the United States.

DESIGN

A nationwide, cross-sectional study using county-level data.

DATA SOURCES

COVID-19 death counts were collected for more than 3,000 counties in the United States (representing 98% of the population) up to April 22, 2020 from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center.

MAIN OUTCOME MEASURES

We fit negative binomial mixed models using county-level COVID-19 deaths as the outcome and county-level long-term average of PM _2.5 as the exposure. In the main analysis, we adjusted by 20 potential confounding factors including population size, age distribution, population density, time since the beginning of the outbreak, time since state issuance of the stay-at-home order, hospital beds, number of individuals tested, weather, and socioeconomic and behavioral variables such as obesity and smoking. We included a random intercept by state to account for potential correlation in counties within the same state. We conducted more than 68 additional sensitivity analyses.

RESULTS

We found that an increase of only 1 μg/m ³ in PM _2.5 is associated with an 8% increase in the COVID-19 death rate (95% confidence interval [CI]: 2%, 15%). The results were statistically significant and robust to secondary and sensitivity analyses.

CONCLUSIONS

A small increase in long-term exposure to PM _2.5 leads to a large increase in the COVID-19 death rate. Despite the inherent limitations of the ecological study design, our results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis. The data and code are publicly available so our analyses can be updated routinely.

COVID-19 and the Heart

Infection with the severe acute respiratory syndrome novel coronavirus produces a clinical syndrome known as 2019 novel coronavirus disease (COVID-19). When severe, COVID-19 is a systemic illness characterized by hyperinflammation, cytokine storm, and elevations of cardiac injury biomarkers. Here, we review what is known about the pathophysiology of COVID-19, its cardiovascular manifestations, and emerging therapeutic prospects. In this rapidly moving field, this review was comprehensive as of April 3, 2020.

Intervention Serology and Interaction Substitution: Modeling the Role of 'Shield Immunity' in Reducing COVID-19 Epidemic Spread

The COVID-19 pandemic has precipitated a global crisis, with more than 690,000 confirmed cases and more than 33,000 confirmed deaths globally as of March 30, 2020 [1-4]. At present two central public health control strategies have emerged: mitigation and suppression (e.g, [5]). Both strategies focus on reducing new infections by reducing interactions (and both raise questions of sustainability and long-term tactics). Complementary to those approaches, here we develop and analyze an epidemiological intervention model that leverages serological tests [6, 7] to identify and deploy recovered individuals as focal points for sustaining safer interactions via interaction substitution, i.e., to develop what we term 'shield immunity' at the population scale. Recovered individuals, in the present context, represent those who have developed protective, antibodies to SARS-CoV-2 and are no longer shedding virus [8]. The objective of a shield immunity strategy is to help sustain the interactions necessary for the functioning of essential goods and services (including but not limited to tending to the elderly [9], hospital care, schools, and food supply) while decreasing the probability of transmission during such essential interactions. We show that a shield immunity approach may significantly reduce the length and reduce the overall burden of an outbreak, and can work synergistically with social distancing. The present model highlights the value of serological testing as part of intervention strategies, in addition to its well recognized roles in estimating prevalence [10, 11] and in the potential development of plasma-based therapies [12-15].

Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro

An escalating pandemic by the novel SARS-CoV-2 virus is impacting global health and effective therapeutic options are urgently needed. We evaluated the in vitro antiviral effect of compounds that were previously reported to inhibit coronavirus replication and compounds that are currently under evaluation in clinical trials for SARS-CoV-2 patients. We report the antiviral effect of remdesivir, lopinavir, homorringtonine, and emetine against SARS-CoV-2 virus in Vero E6 cells with the estimated 50% effective concentration at 23.15 μM, 26.63 μM, 2.55 μM and 0.46 μM, respectively. Ribavirin or favipiravir that are currently evaluated under clinical trials showed no inhibition at 100 μM. Synergy between remdesivir and emetine was observed, and remdesivir at 6.25 μM in combination with emetine at 0.195 μM may achieve 64.9% inhibition in viral yield. Combinational therapy may help to reduce the effective concentration of compounds below the therapeutic plasma concentrations and provide better clinical benefits.

[SARS CoV-2/COVID-19: Evidence-Based Recommendation on Diagnosis and Therapy]

COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic with serious challenges to health systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 - 6 days; 5% of patients need intensive care therapy. Morbidity is about 1 - 2%. Protecting health care workers is of paramount importance in order to prevent hospital acquired infections. Therefore, during all procedures associated with aerosol production, a personal safety equipment consisting of a FFP2/FFP3 (N95) respiratory mask, gloves, safety glasses and a waterproof overall should be used. Therapy is based on established recommendations issued for patients with acute lung injury (ARDS). Lung protective ventilation, prone position, restrictive fluid management and an adequate management of organ failures are the mainstays of therapy. In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies evolve with ever increasing frequency; currently, however, there is no evidence based recommendation possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.

Why estimating population-based case fatality rates during epidemics may be misleading

Different ways of calculating mortality ratios during epidemics can yield widely different results, particularly during the COVID-19 pandemic. We formulate both a survival probability model and an associated infection duration-dependent SIR model to define individual- and population-based estimates of dynamic mortality ratios. The key parameters that affect the dynamics of the different mortality estimates are the incubation period and the length of time individuals were infected before confirmation of infection. We stress that none of these ratios are accurately represented by the often misinterpreted case fatality ratio (CFR), the number of deaths to date divided by the total number of infected cases to date. Using available data on the recent SARS-CoV-2 outbreaks and simple assumptions, we estimate and compare the different dynamic mortality ratios and highlight their differences. Informed by our modeling, we propose a more systematic method to determine mortality ratios during epidemic outbreaks and discuss sensitivity to confounding effects and errors in the data.

COVID 19 in INDIA: Strategies to combat from combination threat of life and livelihood

INDIA- As for reported in 360 COVID-19 cases (till March 22, 2020), seven people were died, and 23 people were treated successfully.¹ This virus can easily affect who having respiratory problem and especially who all have been aged older than sixty. Most of the affected peoples had reached India from different part of the world, as like of carrier. Owing to this, India made several precautionary measures to mitigate/neglect the disease in beginning stage, however, the denser population of country will not be simple to control the same for long time (community spread), if government will not incorporate the visionary strategies. Since attacked several nations have been worried mostly for their people life (health), despite that developing country like India with huge population should consider about the livelihood (for Below Poverty Line (BPL) people), equally with the life. This article will give insights to make effective strategy to culminate the world threat COVID-19 in India.

Age-related rhesus macaque models of COVID-19

BACKGROUND

Since December 2019, an outbreak of the Corona Virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) in Wuhan, China, has become a public health emergency of international concern. The high fatality of aged cases caused by SARS-CoV-2 was a need to explore the possible age-related phenomena with non-human primate models.

METHODS

Three 3-5 years old and two 15 years old rhesus macaques were intratracheally infected with SARS-CoV-2, and then analyzed by clinical signs, viral replication, chest X-ray, histopathological changes and immune response.

RESULTS

Viral replication of nasopharyngeal swabs, anal swabs and lung in old monkeys was more active than that in young monkeys for 14 days after SARS-CoV-2 challenge. Monkeys developed typical interstitial pneumonia characterized by thickened alveolar septum accompanied with inflammation and edema, notably, old monkeys exhibited diffuse severe interstitial pneumonia. Viral antigens were detected mainly in alveolar epithelial cells and macrophages.

CONCLUSION

SARS-CoV-2 caused more severe interstitial pneumonia in old monkeys than that in young monkeys. Rhesus macaque models infected with SARS-CoV-2 provided insight into the pathogenic mechanism and facilitated the development of vaccines and therapeutics against SARS-CoV-2 infection.

Why individuals with cerebral palsy are at higher risk for respiratory complications from COVID-19

Respiratory dysfunction is a leading cause of morbidity and mortality in individuals with cerebral palsy (CP). In children and adults with CP, movement and physical function is always affected. Yet, many clinicians overlook potential for impaired movement and function of the diaphragm muscle (DIAm) in individuals with CP. Since individuals with pre-existing respiratory disorders are at greater risk for respiratory complications if they contract COVID-19, understanding potential risks to individuals with CP is important. In this review we present research on respiratory function and DIAm force generation in children with CP. We compare this clinical work to basic science research investigating phrenic motor neuron and DIAm motor unit dysfunction in an animal model with CP symptoms, the spa mouse. Finally, we integrate the clinical and basic science work in respiratory function in CP, discussing potential for individuals with CP to have severe respiratory symptoms from COVID-19.

School reopening during COVID-19 pandemic: Considering students with disabilities

Over 80% of the children in the world have had their education impacted by COVID-19. For children with disabilities who receive special education services, access to in-person education and other resources at school is particularly important. The American Academy of Pediatrics advocates for students to attend school in person, without specifics for how children with disabilities can safely return to school. To appropriately plan and accommodate children with disabilities we must prioritize safety, allow for adherence to the Individuals with Disabilities Education Act, and preserve essential school staff. The less cumbersome default of confining students with disabilities to home is not acceptable. We provide an outline describing why Individual Education Plans and 504 plans are important, how they are related to the COVID-19 pandemic, and recommendations for measures to help with safe return to school for children with disabilities.

Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality

The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries at any given time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, Germany, Italy, South Korea, Spain, the United States, and New York City. We calculate the CFR for each population at the latest data point and also for Italy, Germany, Spain, and New York City over time. We use demographic decomposition to break the difference between CFRs into unique contributions arising from the age-structure of confirmed cases and the age-specific case-fatality. In late June 2020, CFRs varied from 2.2% in South Korea to 14.0% in Italy. The age-structure of detected cases often explains more than two-thirds of cross-country variation in the CFR. In Italy, the CFR increased from 4.2% to 14.0% between March 9 and June 30, 2020, and more than 90% of the change was due to increasing age-specific case-fatality rates. The importance of the age-structure of confirmed cases likely reflects several factors, including different testing regimes and differences in transmission trajectories; while increasing age-specific case-fatality rates in Italy could indicate other factors, such as the worsening health outcomes of those infected with COVID-19. Our findings lend support to recommendations for data to be disaggregated by age, and potentially other variables, to facilitate a better understanding of population-level differences in CFRs. They also show the need for well-designed seroprevalence studies to ascertain the extent to which differences in testing regimes drive differences in the age-structure of detected cases.

Potential Novel Role of COVID-19 in Alzheimer's Disease and Preventative Mitigation Strategies

There are a number of potential implications for the field of Alzheimer's disease (AD) stemming from the global spread of SARS-CoV-2. Neuroinflammation is known to be a prominent feature of neurodegeneration and plays a major role in AD pathology. Immune response and excessive inflammation in COVID-19 may also accelerate the progression of brain inflammatory neurodegeneration, and elderly individuals are more susceptible to severe outcomes after SARS-CoV-2 infection. Individuals with type 2 diabetes (T2D) are at an increased risk for AD as well as severe outcomes after SARS-CoV-2 infection. Genetic and socioeconomic factors influencing the rates of T2D, AD, and COVID-19 severity may create an exceptionally high-risk profile for certain demographics such as African Americans and Hispanic Americans. Type I interferon response plays an important role in both host response to viral infection, as well as AD pathology and may be a sensible therapeutic target in both AD and COVID-19.

Effects of control measures on the dynamics of COVID-19 and double-peak behavior in Spain

The COVID-19 disease significantly has threatened the human lives and economy. It is a dynamic system with transmission and control as factors. Modeling the dynamics of the spread of COVID-19 based on the reported data can predict the growing trend of such a disease. In this paper, the dynamic evolution of COVID-19 in Spain is studied, and a comprehensive SEIR model is adopted to fit the obtained clinical progressive data of COVID-19 in Spain. The transmission rate between the susceptible and the self-quarantine susceptible is made to be time-variant, which is reasonable. The equilibria are found, and the stability condition is given using the basic reproduction number and eigenvalues at the points. The effect on daily confirmed cases for the transmission rate from susceptible to the exposed population due to the currently exposed and infectious is extensively investigated. The risk of the easing of the control measure is investigated. The double-peak dynamic behavior of the COVID-19 system is observed. The second wave rebound shows that the daily confirmed cases of the second peak even much higher than the first peak.

Regression Models Predicting the Number of Deaths from the New Coronavirus Infection

Predicting the development of epidemic infection caused by the COVID-19 coronavirus is a matter of the utmost urgency for health care and effective anti-epidemic measures. Given the rapidly changing initial information and the ambiguous quality of data coming from various sources, it is important to quickly optimize the existing prognostic models by using more sophisticated algorithms.

The aim of the study is to test the originally developed mathematical algorithms for predicting the development of the COVID-19 epidemic process.

The Resilience of Social Service Providers and Families of Children With Autism or Development Delays During the COVID-19 Pandemic-A Community Case Study in Hong Kong

Background: Hong Kong is one of the earliest cities to have hampered by the COVID-19. When preventive public health measures are enforced, specific groups, who have already been facing inequality before the outbreak, are likely to become more overlooked and vulnerable. Aim: This community case study aims to describe the additional needs of families of children with autism spectrum disorder and other developmental issues, as well as unexpected difficulties and challenges social service professionals encountered when delivering service and their solutions toward these challenges. Methods: A focus group with 10 professionals providing the Caregiver Skills Training Program was conducted. Results: Poor families of vulnerable children were found to be challenged, more than average, in finding daily necessities during the initial stage of the outbreak. Most vulnerable children displayed additional problematic behaviors and emotional problems during the quarantine. The social service professionals addressed the family needs by providing tangible resources and offering online training, workshops, and programs to meet their needs. Several important lessons were learned. First, technology know-how on conducting online training, workshop, and program could be a challenge to some social service professionals and the parents. Second, the professionals reported that they made huge efforts to produce guidelines in protecting services users' privacy, to equip themselves with necessary skills in executing privacy-protection measures, and to keep exploring for safer alternatives. Third, providing tele-services in online mode represented a different interaction pattern between social service professionals and service users, especially in the recruitment processes and group dynamics. Conclusion: In comparison with other cities, Hong Kong has responded to the COVID-19 efficiently and effectively based on the citizen's strict adherence to behavioral advice and the innovative altruistic efforts from the multi-sectors in the community.

Coronavirus Infection Among Children and Adolescents

Coronavirus infection is a global emergency. Over the past few months, there is a rapid increase in the number of cases and deaths due to coronavirus infection. It has been observed that elderly individuals and those with medical co-morbidities are maximally affected. In children and adolescents, coronavirus infection has low mortality as well as the severity of symptoms are less. Children and adolescents with immunocompromised state, malnutrition, medical co-morbidities and poor hygiene are at higher risk of contracting coronavirus infection. Minimizing this risk factors and adopting appropriate prevention measures will be helpful in limiting the spread of infection as there is no specific treatment and immunization available to date to address this serious issue. This chapter highlights the issues and challenges of coronavirus infection in children and adolescents.

Epidemic model of COVID-19 outbreak by inducing behavioural response in population

COVID-19 has spread around the world since December 2019, creating one of the greatest pandemics ever witnessed. According to the current reports, this is a situation when people need to be more careful and take the precaution measures more seriously, unless the condition may become even worse. Maintaining social distances and proper hygiene, staying at isolation or adopting the self-quarantine method are some of the common practices that people should use to avoid the infection. And the growing information regarding COVID-19 and its symptoms help the people to take proper precautions. In this present study, we consider an SEIRS epidemiological model on COVID-19 transmission which accounts for the effect of an individual's behavioural response due to the information regarding proper precautions. Our results indicate that if people respond to the growing information regarding awareness at a higher rate and start to take the protective measures, then the infected population decreases significantly. The disease fatality can be controlled only if a large proportion of individuals become immune, either by natural immunity or by a proper vaccine. In order to apply the latter option, we need to wait until a safe and proper vaccine is developed and it is a time-taking process. Hence, in the latter part of the work, an optimal control problem is considered by implementing control strategies to reduce the disease burden. Numerical figures show that the control denoting behavioural response works with higher intensity immediately after implementation and then gradually decreases with time. Further, the control policy denoting hospitalisation of infected individuals works with its maximum intensity for quite a long time period following a sudden decrease. As, the implementation of the control strategies reduce the infected population and increase the recovered population, so, it may help to reduce the disease transmission at this current epidemic situation.