COVID-19 and telemedicine: Immediate action required for maintaining healthcare providers well-being

A critical analysis of the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies

The World Health Organization declared COVID-19 a global pandemic on the 11th of March 2020, but the world is still reeling from its aftermath. Originating from China, cases quickly spread across the globe, prompting the implementation of stringent measures by world governments in efforts to isolate cases and limit the transmission rate of the virus. These measures have however shattered the core sustaining pillars of the modern world economies as global trade and cooperation succumbed to nationalist focus and competition for scarce supplies. Against this backdrop, this paper presents a critical review of the catalogue of negative and positive impacts of the pandemic and proffers perspectives on how it can be leveraged to steer towards a better, more resilient low-carbon economy. The paper diagnosed the danger of relying on pandemic-driven benefits to achieving sustainable development goals and emphasizes a need for a decisive, fundamental structural change to the dynamics of how we live. It argues for a rethink of the present global economic growth model, shaped by a linear economy system and sustained by profiteering and energy-gulping manufacturing processes, in favour of a more sustainable model recalibrated on circular economy (CE) framework. Building on evidence in support of CE as a vehicle for balancing the complex equation of accomplishing profit with minimal environmental harms, the paper outlines concrete sector-specific recommendations on CE-related solutions as a catalyst for the global economic growth and development in a resilient post-COVID-19 world.

Dealing with lung cancer in the COVID-19 scenario (A review)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the coronavirus disease 2019 (COVID-19), first appeared in December 2019 in Wuhan (China) and quickly spread worldwide and has since been assigned a pandemic status. This affected the worlds' social interactions, including within medical practices, thus interfering with routine treatments for a variety of diseases including cancer. Different studies have addressed the fact that patients with cancer are often immunocompromised, making them more susceptible to infections. Since COVID-19 frequently causes respiratory distress, patients with lung cancer are considered to be a high-risk group. Genes that have been indicated to mediate viral entry into host cells such as angiotensin-converting enzyme 2 and transmembrane protease serine 2 are expressed in the lung tissue, a fact that could partially explain COVID-19 pathogenesis and lung involvement. Therefore, the current study offers a disease overview including molecular aspects behind the infection and provide a perspective on already published Chinese data plus recommendations for the management of lung cancer patients according to the two main lung cancer types and stages: non-small cell lung cancer and small cell lung cancer. This review aimed to add to the collective effort of selecting the most appropriate guidelines to follow for the treatment of these patients.

Assessment of patients with acute respiratory symptoms during the COVID-19 pandemic by Telemedicine: clinical features and impact on referral

Objective:

To characterize variables associated with referral to the emergency department following Telemedicine consultation during the COVID-19 pandemic.

Methods:

Cross-sectional retrospective study conducted between March and May 2020, with a sample of 500 adult patients. The inclusion criterion was the manifestation of respiratory symptoms, regardless of type.

Results:

The mean age of patients was 34.7±10.5 years, and 59% were women. Most patients (62.6%) perceived their own health status as malaise and some (41.4%) self-diagnosed COVID-19. Cough (74.4%), rhinorrhea (65.6%), sore throat (38.6%) and sneezing (20.6%) were the most common infection-related symptoms. Overall, 29.4% and 16% of patients reported dyspnea and chest pain, respectively. The Roth score was calculated for a sizeable number of patients (67.6%) and was normal, moderately altered or severely altered in 83.5%, 10.7% and 5.6% of patients, respectively. The percentage of suspected COVID-19 cases was 67.6%. Of these, 75% were managed remotely and only one quarter referred for emergency assessment.

Conclusion:

Telemedicine assessment is associated with reclassification of patient's subjective impression, better inspection of coronavirus disease 2019 and identification of risk patients. Referral is therefore optimized to avoid inappropriate in-person assessment, and low-risk patients can be properly guided. Telemedicine should be implemented in the health care system as a cost-effective strategy for initial assessment of acute patients.

Stress Reduction Techniques for Health Care Providers Dealing With Severe Coronavirus Infections (SARS, MERS, and COVID-19): A Rapid Review

OBJECTIVE

A rapid review was conducted to identify the most effective stress reduction techniques for health care providers dealing with patients infected with severe coronavirus (SARS, MERS, and COVID-19).

METHODS

PubMed, PsychInfo, Embase, and CINAHL databases were searched to identify relevant studies. Searches were restricted by date (2000 until present). All empirical quantitative and qualitative studies in which relaxation techniques of various types implemented on health care providers caring for patients during severe coronavirus pandemics and articles that consider the implementation of mental health care services considered to be pertinent, such as commentaries, were included.

RESULTS

Fourteen studies met the selection criteria, most of which were recommendations. Only one study described a digital intervention, and user satisfaction was measured. In the recommendations, both organizational and individual self-care interventions were suggested.

CONCLUSIONS

Further research is necessary to establish tailor-made effective stress reduction interventions for this population, during these challenging and particular times.

The battle against Coronavirus disease 2019 (COVID-19) in the Kingdom of Saudi Arabia. Public health perspective

Coronavirus disease 2019 (COVID-19) which was initially reported in the Chinese city of Wuhan has now spread unprecedented all over the world, including the Kingdom of Saudi Arabia (KSA). The World Health Organization declared this outbreak as a public health emergency of international concern during late January 2020 while the announcement of this viral infectious condition was made as COVID-19 disease during February 2020. As of late May 2020, the global death rate due to COVID-19 was 357,714 and 441 in KSA alone. This review provides an overview of COVID-19 and the public health measures adopted by KSA in the context of COVID-19.

The effect of Emotional Freedom Techniques on nurses' stress, anxiety, and burnout levels during the COVID-19 pandemic: A randomized controlled trial

Background and Objective

Infectious disease outbreaks pose psychological challenges to the general population, and especially to healthcare workers. Nurses who work with COVID-19 patients are particularly vulnerable to emotions such as fear and anxiety, due to fatigue, discomfort, and helplessness related to their high intensity work. This study aims to investigate the efficacy of a brief online form of Emotional Freedom Techniques (EFT) in the prevention of stress, anxiety, and burnout in nurses involved in the treatment of COVID patients.

Methods

The study is a randomized controlled trial. It complies with the guidelines prescribed by the Consolidated Standards of Reporting Trials (CONSORT) checklist. It was conducted in a COVID-19 department at a university hospital in Turkey. We recruited nurses who care for patients infected with COVID-19 and randomly allocated them into an intervention group (n = 35) and a no-treatment control group (n = 37). The intervention group received one guided online group EFT session.

Results

Reductions in stress (p < .001), anxiety (p < .001), and burnout (p < .001) reached high levels of statistical significance for the intervention group. The control group showed no statistically significant changes on these measures (p > .05).

Conclusions

A single online group EFT session reduced stress, anxiety, and burnout levels in nurses treating COVID-19.

Association of Personal Protective Equipment with De Novo Headaches in Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Study

OBJECTIVES

 This study aimed to determine the association of personal protective equipment (PPE) usage with new-onset headaches and exacerbation of pre-existing headache disorders among healthcare workers at the frontlines during coronavirus disease 2019 (COVID-19) pandemic.

MATERIALS AND METHODS

 A descriptive cross-sectional survey was conducted across Pakistan in June-July 2020. The study was approved by Ethical Committee, Armed Forces Institute of Dentistry, Rawalpindi (IRB form no.905/Trg-ABP 1K2). A qualitative questionnaire was developed and was shared via different social networks. The questionnaire was closed when 241 responses were received.

STATISTICAL ANALYSIS

 Descriptive analysis was performed on demographic data. Chi-squared analysis was performed between demographic data and PPE-usage patterns among participants with or without de novo headaches. Univariable and multivariable logistic regression models were used to compare variables with the development of new-onset headaches. Chi-squared test was also performed between demographic data and other factors that may be causing new-onset headaches. A p-value < 0.05 was considered significant.

RESULTS

 A total of 241 healthcare workers participated, of which 68 participants (28.2%) reported de novo headaches since the start of the pandemic. Incidence of pre-existing headaches (odds ratio [OR] = 1.91; 95% confidence interval [CI]: 0.99-0.37; p = 0.049) was associated with new-onset headaches. Post hoc multivariable logistic regression analysis stated that incidence of pre-existing headaches (OR = 1.88; 95% CI: 0.94-3.78; p = 0.75) and age (OR = 2.21; 95% CI: 0.47-10.33; p = 0.36) was independently associated with new-onset PPE-induced headaches but was not statistically significant. Chi-squared analysis showed a statistically significant relationship between other factors (sleep deprivation, emotional stress, etc.) and department of activity, gender, and occupation (p < 0.05).

CONCLUSION

 Healthcare workers with previous history of pre-existing headaches were found to be more susceptible to PPE-induced headaches during COVID-19 pandemic. However, age and the department where the healthcare workers performed may also be risk factors.

The prevalence and risk factors of psychological disturbances of frontline medical staff in china under the COVID-19 epidemic: Workload should be concerned

BACKGROUND

To our best knowledge, this was the first time to investigate the prevalence and risk factors of psychological disturbances, including depression, anxiety, somatization symptoms, insomnia and suicide, among frontline medical staff, who were working with the COVID-10 infected patients directly.

METHODS

Patient Health Questionnaire Depression (PHQ-9), Generalized Anxiety Disorder Questionnaire scale (GAD-7), Symptom Check List-90 (SCL-90) somatization, Insomnia Severity Index (ISI), and the suicidal module of the Mini International Neuropsychiatric Interview were used for online survey.

RESULTS

A total of 606 frontline hospital staff and1099 general population were recruited. The prevalence of depression, anxiety, somatization symptoms, insomnia, and suicide risk in frontline medical staffs were 57.6%, 45.4%, 12.0%, 32.0% and 13.0%, respectively. Except for suicide risk, the prevalence of other psychological disorders in frontline medical staff were higher than those in general population (all p<0.01). Among the frontline medical staff, the daily working hours were associated with all psychological disturbance (all p<0.01), women with anxiety (p = 0.02), body mass index (BMI) with anxiety and insomnia (p = 0.02, p = 0.03). Age was negatively associated with depression, anxiety, and insomnia (all p<0.01). Finally, years of working and family income were negatively associated with suicide risk (p = 0.03, p<0.001).

CONCLUSION

Our study demonstrates that during the outbreak of COVID-19, the frontline medical staff are more likely to suffer from psychological disturbances than general population. It is noticeable that daily working hours are a risk factor for all measured psychological disturbances, and some other variables may be involved in certain psychological disturbances of frontline medical staff.

The mental health of healthcare workers in the COVID-19 pandemic: A systematic review

Purpose

The novel coronavirus 2019 (COVID-19) is widely spreading all over the world, causing mental health problems for most people. The medical staff is also under considerable psychological pressure. This study aimed to review all research carried out on the mental health status of health care workers (HCWs) to bring policymakers and managers' attention.

Methods

A literature search conducted through e-databases, including PubMed, EMBASE, Scopus, and Web of Science (WoS) from December 2019 up to April 12th 2020. All cross- sectional studies published in English which assessed the health workers' psychological well-being during the SARS-CoV-2 pandemic included. Study quality was analyzed using NHLBI Study Quality assessment tools.

Results

One hundred relevant articles were identified through systematic search; of which eleven studies were eligible for this review. Their quality score was acceptable. The lowest reported prevalence of anxiety, depression, and stress among HCWs was 24.1%, 12.1%, and 29.8%, respectively. In addition, the highest reported values for the aforementioned parameters were 67.55%, 55.89%, and 62.99%, respectively. Nurses, female workers, front-line health care workers, younger medical staff, and workers in areas with higher infection rates reported more severe degrees of all psychological symptoms than other health care workers. Moreover, vicarious traumatization in non-front-line nurses and the general public was higher than that of the front-line nurses.

Conclusion

During SARS-CoV-2 outbreak, the health care workers face aggravated psychological pressure and even mental illness. It would be recommended to the policymakers and managers to adopt the supportive, encouragement & motivational, protective, and training & educational interventions, especially through information and communication platform.

Implications of telehealth and digital care solutions during COVID-19 pandemic: a qualitative literature review

The coronavirus disease 2019 (COVID-19) pandemic has brought changes to the way medical care is delivered to keep health workers safe while simultaneously managing available resources. The well-being of patients and healthcare workers is crucial and has become a topic of debate as the world faces adjusts to the COVID-19 pandemic. Therefore, there is need to consider innovative methods of delivering medical care. Telehealth and digital health care which is the provision of medical care via Information Communication Technology (ICT) with highspeed telecommunications systems, has increasingly becoming popular in providing medical care services can be adopted to reduce infections during quarantine and social distancing practices. Specifically, by means of document and literature review this paper discusses the role of telehealth and digital care solutions, types and application of telehealth, and current policies for COVID-19. More importantly, findings from the article present the human, infrastructure, and institutional determinants that influence the adoption of telehealth and digital care solutions during the pandemic. The findings discuss how telehealth and digital care technologies can benefit the society. This study provides implications to informs medical staffs on the potential of digital technologies to provide support during and after the pandemic.

[Ethical issues in primary care during the coronavirus (SARS-CoV-2) pandemic]

Las emergencias de salud pública, como la que estamos viviendo con la pandemia originada por el coronavirus SARS-CoV-2, han originado trágicas limitaciones de recursos que impiden salvar vidas. Provocan tensiones en la atención sanitaria centrada en el paciente como eje del sistema en condiciones normales, y en la misma atención sanitaria en situaciones de emergencia originadas en la COVID-19. En esta revisión abordamos algunos de los problemas asistenciales, organizativos y éticos que este escenario ha provocado en la atención primaria, como: cancelación de actividades programadas; escasa atención domiciliaria y seguimiento de pacientes ancianos, enfermos crónicos e inmovilizados; desabastecimiento de EPI y exposición al riesgo de los profesionales sanitarios, y finalmente los problemas asociados a la telemedicina y a la atención telefónica a los pacientes.

Industry 5.0: Potential Applications in COVID-19

Industry 5.0, the fifth industrial revolution, consists of smart digital information and manufacturing technologies. This industrial revolution generates effective processes and makes rapid improvement in industries and healthcare. Solutions to challenges posed by COVID-19 pandemic can be identified with the deployment of Industry 5.0-based technologies. It helps to provide personalized therapy and treatment processes to the COVID-19 patients if a detailed patient’s information is available. The aim of Industry 5.0 technologies is to create a smart healthcare environment with real-time capabilities. During the COVID-19 pandemic, these technologies can provide a remote monitoring system in healthcare. This paper identifies and studies major technologies of Industry 5.0 helpful for the COVID-19 pandemic. The supportive features of Industry 5.0 for the COVID-19 pandemic are discussed diagrammatically. Finally, we identified and studied significant challenges faced in the context of Industry 5.0 technologies for the COVID-19 pandemic. The literature revealed that this technological innovation allows a high personalization level to fulfill personal specific demands of the patient and doctors. These technologies play a significant role in making the life of doctors better. Further, doctors can use this technology to focus on critically infected patients and provide proper appropriate information regarding their better treatment. Moreover, Industry 5.0 technologies can help doctors and medical students for required medical training during this COVID-19 outbreak.

Satisfaction Survey of Patients and Medical Staff for Telephone-Based Telemedicine During Hospital Closing Due to COVID-19 Transmission

Introduction: Telephone-based telemedicine was temporarily permitted in Korea during the COVID-19 pandemic. The purpose of this study was to assess satisfaction with the telemedicine done during temporary hospital closing when in-person visits were not allowed due to in-hospital COVID-19 transmission. Methods: Survey questionnaires partially taken from a telehealth usability questionnaire (TUQ) were sent to 6,840 patients who used telephone-based telemedicine from February 24 to March 7, 2020. Questionnaires sent to patients and additionally created questionnaires to evaluate telemedicine were sent to medical staff (182 doctors and 138 nurses). Results: Response rates of patients and medical staff were 13.2% and 17.2%, respectively. Patients' satisfaction with telemedicine was significantly greater than medical staff's satisfaction for all five components taken from TUQ (all p = 0.000). In addition, created questionnaires showed good reliability, obtaining similar results between doctors and nurses (all p > 0.05). More than 85% of medical staff replied that telemedicine was needed in COVID-19, whereas more than 80% of them worried about incomplete assessment and communication of medical condition. Overall satisfaction with telemedicine by medical staff was 49.7%. The strength of telephone-based telemedicine was patients' convenience (53.4%). However, incomplete assessment of patients' condition (55.0%) was its weakness. Conclusion: Satisfaction with telephone-based telemedicine by patients was significantly greater than that by medical staff (doctors and nurses). Negative views for safety and inconvenience resulted in a greater proportion of dissatisfaction among medical staff. For safe application of telemedicine, medical staff insisted that developing a platform and creating guidelines should be needed.

The Effects of COVID-19 Among the Elderly Population: A Case for Closing the Digital Divide

The COVID-19 pandemic has had huge effects on the daily lives of most individuals in the first half of 2020. Widespread lockdown and preventative measures have isolated individuals, affected the world economy, and limited access to physical and mental healthcare. While these measures may be necessary to minimize the spread of the virus, the negative physical, psychological, and social effects are evident. In response, technology has been adapted to try and mitigate these effects, offering individuals digital alternatives to many of the day-to-day activities which can no longer be completed normally. However, the elderly population, which has been worst affected by both the virus, and the lockdown measures, has seen the least benefits from these digital solutions. The age based digital divide describes a longstanding inequality in the access to, and skills to make use of, new technology. While this problem is not new, during the COVID-19 pandemic it has created a large portion of the population suffering from the negative effects of the crisis, and unable to make use of many of the digital measures put in place to help. This paper aims to explore the increased negative effects the digital divide is having in the elderly population during the COVID-19 pandemic. It also aims to highlight the need for increased attention and resources to go toward improving digital literacy in the elderly, and the need to put in place measures to offer immediate solutions during the COVID-19 crisis, and solutions to close the digital divide for good in the long-term.

The characteristics of cancerous patients infected with COVID-19 in hospital setting

Purpose:

recently, Covid 19 as a fatal virus has been known as the cause of the pandemic. Different number of the mortality rate in various societies have been reported. However, it seems the underlying comorbidities increase the risk of mortality and the severity of presentation. In this study we evaluated the pattern of presentation of COVID-19 among cancerous patients in terms of severity.

Method:

Between 20^th February to 22nd April of 2020, in Taleghani Hospital as a COVID-19 referral hospital, among 214 hospitalized patients because of COVID-19. 41 patients revealed the cancer as a synchronous comorbidity. These patients based on the severity of COVID-19 infection presentation were divided to mild and severe groups. Then, the demographic characteristics, manifestation and laboratory data between these groups were compared.

Result:

about 19 (46.34%) of 41 cases were categorized as severe forms of COVID-19 with malignancy. The mean age of severe groups was significantly higher (P=0.00). Dyspnea (48.78%), cough (46.34%) and myalgia (24.39%) were the most common clinical features among cancerous patients with COVID-19. Diarrhea caused significant effects on severe form of presentation of COVID-19 infection (P=0.05). Hematological cancers were the most frequent types of cancer among these patients (46.34%).

Conclusion:

The elderly age, the positive chemotherapy history, diarrhea, cough, PLT and elevated CRP correlated with a severe form of this infection in malignant cases. (www.actabiomedica.it)

A cluster analysis of epidemiological and clinical factors associated with the accumulation process of the burden of COVID-19 in European countries

Background and aim of the work European COVID-19 statistics showed differentiation between mortality and new cases. Some studies suggested several factors including migration, cancer incidence, life expectancy and health system capacity maybe associated with differentiations. Up to now, impact of those factors in different European societies is not discussed and compared. Aim of the present study was to perform the cluster analysis in European countries in attention to clinical and epidemiological factors due to covid-19. Methods We collected some appropriate extreme data of COVID-19 to access the situations by ANOVA post-hoc test in 3 scenarios, as well as to estimate regression coefficients in simple linear regression, and a cluster analysis using average linkage. Covid-19 Statistics were considered in all analyses until April 24, 2020. Results Among 39 European countries, several countries reported highest rate of confirmed cases included of Italy (current statues=2270.52) and Spain (current status=2616.24). The highest rate of mortality was seen in France (current status=242.16), Italy (current status=305.52). Life expectancy (female) (P=0.01, 95%Cl=1521.27,15264.58), migration (P<0.001, 95%Cl=41.42,96.72) had significant association with confirmed cases and death. Overall cancer death (P<0.001, 95%Cl=0.36,0.68; P<0.001, 95%Cl=0.01,0.07) and lung cancer death (P<0.001, 95%Cl=1.97,3.56; P<0.001, 95%Cl=0.09,0.37) associated with confirmed cases and mortality, too. We were also determined 5 clusters which more than 30 countries were categorized in the first cluster. Conclusions Demographic factors, including population, life expectancy and migration, underlying disorders, such as several types of cancers, especially lung cancers lead to various distribution of COVID-19 in terms of prevalence and mortality, across European counties.

Lifestyle Acquired Immunity, Decentralized Intelligent Infrastructures, and Revised Healthcare Expenditures May Limit Pandemic Catastrophe: A Lesson From COVID-19

Throughout history, the human race has often faced pandemics with substantial numbers of fatalities. As the COVID-19 pandemic has now affected the whole planet, even countries with moderate to strong healthcare support and expenditure have struggled to contain disease transmission and casualties. Countries affected by COVID-19 have different demographics, socioeconomic, and lifestyle health indicators. In this context, it is important to find out to what extent these parametric variations are modulating disease outcomes. To answer this, this study selected demographic, socioeconomic, and health indicators e.g., population density, percentage of the urban population, median age, health expenditure per capita, obesity, diabetes prevalence, alcohol intake, tobacco use, case fatality of non-communicable diseases (NCDs) as independent variables. Countries were grouped according to these variables and influence on dependent variables e.g., COVID-19 positive tests, case fatality, and case recovery rates were statistically analyzed. The results suggested that countries with variable median age had a significantly different outcome on positive test rate (P < 0.01). Both the median age (P = 0.0397) and health expenditure per capita (P = 0.0041) showed a positive relation with case recovery. An increasing number of tests per 100 K of the population showed a positive and negative relationship with the number of positives per 100 K population (P = 0.0001) and the percentage of positive tests (P < 0.0001), respectively. Alcohol intake per capita in liter (P = 0.0046), diabetes prevalence (P = 0.0389), and NCDs mortalities (P = 0.0477) also showed a statistical relation to the case fatality rate. Further analysis revealed that countries with high healthcare expenditure along with high median age and increased urban population showed more case fatality but also had a better recovery rate. Investment in the health sector alone is insufficient in controlling the severity of the pandemic. Intelligent and sustainable healthcare both in urban and rural settings and healthy lifestyle acquired immunity may reduce disease transmission and comorbidity induced fatalities, respectively.

Covid-19 effects on the workload of Iranian healthcare workers

BACKGROUND

In this study, we aimed to evaluate the impact of the COVID-19 epidemic on the workload and mental health of Iranian medical staff using the General Health Questionnaire (GHQ-12) and NASA -Task Load Index (NASA-TLX) Questionnaire between March and April 2020, respectively.

METHODS

The present cross-sectional study was conducted from March 5th to April 5th, 2020. To evaluate the workload and mental health of participants NASA-TLX and GHQ-12 online questionnaires were distributed. Data were entered into software SPSS (Version 23) and T-test, ANOVA, Regression methods were used for data analysis.

RESULTS

Health workers who encountered COVID- 19 patients, were subjected to more task load compared to those who had no contact with COVID- 19 patients at the workplace (p <  0.001). In terms of the subscale score of NASA-TLX, nurses had more scores in mental pressure, physical pressure, time pressure (temporal), and frustration compared to the other jobs (p <  0.05). Moreover, nurses had significantly more workload compared to the other jobs.

CONCLUSIONS

Type of job, the shift of work, educational level, and facing COVID-19 affected the score of NASA-TLX. NASA-TLX scores were higher in nursing compared to the scores of other health staff groups. The results of this study indicate that the scores of NASA-TLX and GHQ-12 among staff who had contact with COVID-19 patients were significantly higher than those who did not face COVID-19 patients. We suggested that a comprehensive assistance should be provided to support the well-being of healthcare workers especially nurses and healthcare workers who treated COVID-19 patients.

Telemedicine Technologies for Confronting COVID-19 Pandemic: A Review

Telemedicine (TM) is used to treat patients in a remote location by using telecommunication technology. It exchanges the medical information and data from one location to another through advanced technological innovation. During this COVID-19 pandemic, there is a lockdown in almost all countries. TM is beneficial to healthcare to minimize social distance. This review paper briefs about TM and discusses how this technology works for the COVID-19 pandemic and its significant benefits. An extensive search is made on the known research engines of PubMed, SCOPUS, Google Scholar, and ResearchGate using the appropriate keywords to extract meaningful and relevant articles. Ten major applications of TM for COVID-19 are identified and discussed with a brief description of each provided. The major technological processes involved in TM, which create advancement in the medical field, are also discussed. This technology helps avoid visits to the doctor and hospital during the lockdown and provides a suitable treatment option. It collects the medical information and data, which can be helpful for better treatment of the patient. Telemedicine adopts virtualized treatment approaches for the patient. Now patients can receive better quality treatment without leaving their homes during COVID-19 lockdown.

Critical Considerations for Hepatopanceratobilliary Surgeries During COVID-19 Pandemic

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Virtual Urgent Care Quality and Safety in the Time of Coronavirus

Background

Telemedicine use rapidly increased during the COVID-19 pandemic. This study assessed quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the pandemic.

Methods

A retrospective cohort analysis was performed in a single health care network of VUC patients from March 1, 2020, through April 20, 2020. Researchers abstracted demographic data, comorbidities, VUC return visits, emergency department (ED) referrals and ED visits, dispositions, intubations, and deaths. The team also reviewed incomplete visits. For comparison, the study evaluated outcomes of non-admission dispositions from the ED: return visits with and without admission and deaths. We separately analyzed the effects of enhanced callback system targeting higher-risk patients with COVID-like illness during the last two weeks of the study period.

Results

A total of 18,278 unique adult patients completed 22,413 VUC visits. Separately, 718 patient-scheduled visits were incomplete; the majority were no-shows. The study found that 50.9% of all patients and 74.1% of patients aged 60 years or older had comorbidities. Of VUC visits, 6.8% had a subsequent VUC encounter within 72 hours; 1.8% had a subsequent ED visit. Of patients with enhanced follow-up, 4.3% were referred for ED evaluation. Mortality was 0.20% overall; 0.21% initially and 0.16% with enhanced follow-up (p = 0.59). Males and black patients were significantly overrepresented in decedents.

Conclusion

Appropriately deployed VUC services can provide a pragmatic strategy to care for large numbers of patients. Ongoing surveillance of operational, technical, and clinical factors is critical for patient quality and safety with this modality.

Anosmia: a missing link in the neuroimmunology of coronavirus disease 2019 (COVID-19)

Just before 2020 began, a novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), brought for humans a potentially fatal disease known as coronavirus disease 2019 (COVID-19). The world has thoroughly been affected by COVID-19, while there has been little progress towards understanding the pathogenesis of COVID-19. Patients with a severe phenotype of disease and those who died from the disease have shown hyperinflammation and were more likely to develop neurological manifestations, linking the clinical disease with neuroimmunological features. Anosmia frequently occurs early in the course of COVID-19. The prevalence of anosmia would be influenced by self-diagnosis as well as self-misdiagnosis in patients with COVID-19. Despite this, the association between anosmia and COVID-19 has been a hope for research, aiming to understand the pathogenesis of COVID-19. Studies have suggested differently probable mechanisms for the development of anosmia in COVID-19, including olfactory cleft syndrome, postviral anosmia syndrome, cytokine storm, direct damage of olfactory sensory neurons, and impairment of the olfactory perception center in the brain. Thus, the observation of anosmia would direct us to find the pathogenesis of COVID-19 in the central nervous system, and this is consistent with numerous neurological manifestations related to COVID-19. Like other neurotropic viruses, SARS-CoV-2 might be able to enter the central nervous system via the olfactory epithelium and induce innate immune responses at the site of entry. Viral replication in the nonneural olfactory cells indirectly causes damage to the olfactory receptor nerves, and as a consequence, anosmia occurs. Further studies are required to investigate the neuroimmunology of COVID-19 in relation to anosmia.

Telemedicine in Oral and Maxillo-Facial Surgery: An Effective Alternative in Post COVID-19 Pandemic

The aim of this work was to demonstrate the advantages of using telemedicine (TM) in the management of the outpatients with maxillofacial surgical pathologies during the COVID-19 pandemic. The study was conducted at the MaxilloFacial Surgery Unit of “Magna Graecia” University of Catanzaro, on two different groups of patients: a group of follow-up patients (A₁: patients in oncological follow-up after surgical treatment performed before the COVID-19 pandemic; A₂: suffering from chronic lesions such as precancerous lesions), and a group B of patients with first urgent visits (B₁: patients with suspected oncological pathology; B₂: patients with suspected urgent disease such as medication-related osteonecrosis of the jaws (MRONJ), odontogenic abscesses, temporomandibular joint (TMJ) dislocation, etc.). Participation in the study required possession of a smartphone with Internet access, e-mail and the use of a messaging service (WhatsApp or Telegram) to send photos and messages; completion by the patient of a COVID-19 screening questionnaire; submission of a satisfaction questionnaire by the doctors and patients. A total of 90 patients were included in this study. A high percentage of satisfaction emerged from the analysis of the satisfaction questionnaires of both patients and doctors.TM thus represents an excellent opportunity to improve accessibility to oncological and non-management activities, reducing the risk of Covid-19 dissemination and should be promoted and implemented in the post-pandemic era.

Angiotensin-converting enzyme 2 (ACE2) receptor and SARS-CoV-2: Potential therapeutic targeting

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a beta coronavirus that uses the human angiotensin-converting enzyme 2 (ACE2) receptor as a point of entry. The present review discusses the origin and structure of the virus and its mechanism of cell entry followed by the therapeutic potentials of strategies directed towards SARS-CoV2-ACE2 binding, the renin-angiotensin system, and the kinin-kallikrein system. SARS-CoV2-ACE2 binding-directed approaches mainly consist of targeting receptor binding domain, ACE2 blockers, soluble ACE2, and host protease inhibitors. In conclusion, blocking or manipulating the SARS-CoV2-ACE2 binding interface perhaps offers the best tactic against the virus that should be treated as a fundamental subject of future research.

Virtual care to increase military medical centre capacity in the primary health care setting: A prospective self-controlled pilot study of symptoms collection and telemedicine

INTRODUCTION

The Singapore Armed Forces (SAF) recognises the potential benefits and looks to harnessing telemedicine for primary health care services. In this prospective self-controlled pilot study, we aimed to evaluate the safety, efficiency and user satisfaction outcomes of virtual care (VC) at a military medical centre.

METHODS

Out of 320 patients seen during the study period, 28 were enrolled in this study and underwent on-premises VC, comprising digital symptoms collection and telemedicine in addition to the usual in-person physician consultation. Safety outcomes were measured based on the diagnostic concordance between physicians. Efficiency was measured based on consultation times, and user satisfaction was evaluated using a standard questionnaire.

RESULTS

There was a higher caseload of both upper respiratory infections and dermatological conditions in our population, in which telemedicine performed well. In terms of safety, telemedicine achieved a mean diagnostic concordance of 92.8% compared to in-person consultations. In terms of efficiency, consultation times were 26.2% - or 2 minutes and 15 seconds - shorter on average with telemedicine (p = 0.0488). User satisfaction was favourable, with 85.5% of patients satisfied with the VC experience.

DISCUSSION

This study has been invaluable in showing that on-premises telemedicine is a safe, efficient and effective means to extend and increase our surge capacity for primary health care. Our results have given us reasonable confidence to explore a larger-scale implementation in our network of military medical centres in the future.

COVID-19: Threat or Opportunity?

The COVID-19 pandemic is spreading quickly. Despite scientists’ best efforts all over the world, there is not a vaccine or definite treatment for it and the novel coronavirus remains a threat to humanity with far-reaching, and in many cases, irredeemable consequences for the economic, political, social-psychological , and cultural aspects of humans’ lives.(1)The quick transmission and fatality of the disease, absence of herd immunity, lack of or inequitable distribution of resources, e.g. Personal Protective Equipment ( PPE), and the existing challenges in the implementation of social distancing result in a daily increase in the number of victims and, consequently, an ever-expanding workload in healthcare systems worldwide. Moreover, the increasing mortality and morbidity of COVID-19 and lack of hospital beds and ventilators have led to healthcare provider’s exhaustion and burnout.(1,2) Healthcare providers, especially nurses are the most vulnerable group in the face of the current disaster. Unfortunately, In the world, many front-line experts have lost their lives.(3)

Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis

BACKGROUND

Health care workers (HCW) are at high risk of developing physical/mental health outcomes related to coronavirus syndromes. Nature and frequency of these outcomes are undetermined.

METHODS

PRISMA/MOOSE-compliant (PROSPERO-CRD42020180205) systematic review of Web of Science/grey literature until 15th April 2020, to identify studies reporting physical/mental health outcomes in HCW infected/exposed to Severe Acute Respiratory Syndrome -SARS-, Middle East Respiratory Syndrome -MERS-, Novel coronavirus -COVID-19-. Proportion random effect meta-analyses, I² statistic, quality assessment and sensitivity analysis.

RESULTS

115 articles were included (n=60,458 HCW, age 36.1±7.1, 77.1% female). Physical health outcomes: 75.9% HCW infected by SARS/MERS/COVID-19 reported fever (95%CI=65.9-83.7%, k=12, n=949), 47.9% cough (95%CI=39.2-56.8%, k=14, n=970), 43.6% myalgias (95%CI=31.9-56.0%, k=13, n=898), 42.3% chills (95%CI=20.2-67.9%, k=7, n=716), 41.2% fatigue (95%CI=18.2-68.8%, k=6, n=386), 34.6% headaches (95%CI=23.1-48.2%, k=11, n=893), 31.2% dyspnoea (95%CI=23.2-40.5%, k=12, n=1003), 25.3% sore throat (95%CI=18.8-33.2%, k=8, n=747), 22.2% nausea/vomiting (95%CI=14.9-31.8%, k=6, n=662), 18.8% diarrhoea (95%CI=11.9-28.4%, k=9, n=824). Mental health outcomes: 62.5% HCW exposed to SARS/MERS/COVID-19 reported general health concerns (95%CI=57.0-67,8%, k=2, n=2254), 43.7% fear (95%CI=33.9-54.0%, k=4, n=584), 37.9% insomnia (95%CI=30.9-45.5%, k=6, n=5067), 37.8% psychological distress (95%CI=28.4-48.2%, k=15, n=24,346), 34.4% burnout (95%CI=19.3-53.5%, k=3, n=1337), 29.0% anxiety features (95%CI=14.2-50.3%, k=6, n=9191), 26.3% depressive symptoms (95%CI=12.5-47.1%, k=8, n=9893), 20.7% post-traumatic stress disorder features (95%CI=13.2-31%, k=11, n=3826), 16.1% somatisation (95%CI=0.2-96.0%, k=2, n=2184), 14.0% stigmatisation feelings (95%CI=6.4-28.1%, k=2, n=411).

LIMITATIONS

Limited amount of evidence for some outcomes and suboptimal design in several studies included.

CONCLUSIONS

SARS/MERS/COVID-19 have a substantial impact on the physical and mental health of HCW, which should become a priority for public health strategies.

New Ways of Working and Public Healthcare Professionals’ Well-Being: The Response to Face the COVID-19 Pandemic

This research proposes analyzing the influence of new ways of working (NWW) on healthcare professional’s well-being and how these may affect work performance and public service motivation. These variables and relationships were important before COVID-19 pandemic, and everything points to the fact that during and after the pandemic their importance will be higher. To buffer the potential negative effects of implementing the NWW, both organizations and employees must identify personal (psychological capital) and job resources (inter-role conflict, psychological empowerment, meaning of work) capable of acting as effective moderators to promote employee well-being and avoid negative experiences at work. This paper aims to shed light on new ways of coping and adapting to uncertain job requirements such as those that have arisen during COVID-19. Moreover, it highlights the great changes that public healthcare needs to face to improve the quality of the service offered to society. It is urgent that public administrators and human resources managers design effective strategies and make effective decisions in which employee well-being and service quality are main priorities.

Experiences of healthcare providers of older adults with cancer during the COVID-19 pandemic

Objectives

Care for older adults with cancer became more challenging during the COVID-19 pandemic. We sought to examine healthcare providers' clinical barriers, patient questions, and overall experiences related to care delivery for these patients during the pandemic.

Materials and methods

Members of the Advocacy Committee of the Cancer and Aging Research Group along with the Association of Community Cancer Centers developed a 20-question survey for healthcare providers of older adults with cancer. Eligible participants were recruited by email sent through professional organizations' listservs, email blasts, and social media. This manuscript reports the qualitative data from the survey's three open-ended questions. Free text, open-ended survey items were analyzed by two independent coders for identification of common themes using NVivo software. Theme agreement was reached through consensus and count comparisons of participant responses were made.

Results

Healthcare system organizational challenges and meeting basic needs and support were commonly reported themes among respondents (n = 274). Barriers to care delivery included organizational challenges, patients' access to resources and support, concerns for patients' mental and physical health, and telehealth challenges. Respondents reported older adults were asking about their health and cancer care as well as access to basic needs and supports. Providers described worrying about patients' mental health, fear of personal safety, frustration in multi-level institutions, as well as experiencing positive leadership and communication.

Conclusion

Providers are faced with balancing their concerns for personal and patient safety. These findings demand resources and support allocation for older adults with cancer and healthcare providers during the COVID-19 pandemic.

COVID-19 and Music Therapists’ Employment, Service Delivery, Perceived Stress, and Hope: A Descriptive Study

In early 2020, the COVID-19 pandemic was declared, which impacted music therapists in terms of employment, service delivery, and mental health. However, the extent of changes within the profession was unknown. The purpose of this study was to determine the impact of the pandemic on the employment, service delivery, stress, and hope of music therapy professionals in the United States. Music therapists (N = 1,196) responded to a 51-item survey including questions related to employment and service delivery. The study also included the Adult Hope Scale and the Perceived Stress Scale-10 (PSS-10). Results indicated that many music therapists experienced changes in their positions, including a decrease in client contact hours and an increase in using alternative services, such as telehealth. Changes in service hours and delivery were higher for individuals who worked in private practice than for other settings. Primary respondent concerns included being a carrier of COVID-19, being isolated from loved ones, and income loss. Compared with prior general population samples from the United States, respondents reported higher levels of hope, with a majority of respondents also reporting a high level of hope for the profession. Respondents also indicated a moderate level of perceived stress on the PSS-10. Open response comments provided additional insights into the situational stressors and feelings of hope at this time in the pandemic. The results of this study indicate that music therapists adapted to service delivery changes and continued to provide services to clients, despite the many difficulties faced during the pandemic.

How to overcome cardiovascular challenges in COVID-19 patients: a guide for common practice

The COVID-19 epidemic initially started in Wuhan, China in December 2019 due to SARS-CoV-2. SARS-CoV-2 is genetically similar to the bat beta-coronavirus genus, but the novel specie of this genus can infect humans. The most common clinical features of COVID-19 are fever, cough, myalgia, fatigue, expectoration, and dyspnea. The primary reported mortality rate was about 2-3% in China; however, it reached up to 10% among patients with underlying cardiovascular diseases. The primary epidemiological investigations showed a high prevalence of underlying cardiovascular diseases in more than 40% of infected patients. A high prevalence of hypertension, ischemic heart disease, and diabetes were reported among deceased patients in Italy. Previous experiments in different pandemic situations showed that the cardiovascular system has been affected in many ways. Previous studies on SARS-CoV and MERS-CoV reported that cardiovascular co-morbidities had a direct correlation with the risk of infection, the severity of disease, and the mortality rate. Therefore, brief and available protocols for controlling the negative effects of this novel respiratory infection on the cardiovascular system, especially in a high-risk populations with underlying cardiovascular conditions, is one of the most serious concerns among healthcare providers. Herein, we aimed to review the available data on the cardiac manifestation of COVID-19. Besides, we described useful maps for the better treatment of COVID-19 infection in patients with underlying cardiovascular conditions, as a high-risk group of patients.

Mental health consequences of the COVID-19 pandemic associated with social isolation

The 2019 coronavirus pandemic (COVID-19) is a public health emergency of international concern, which poses a major challenge to mental health as a result of its unprecedented impact in this 21st century. Research in past epidemics has revealed a deep and wide range of psychosocial consequences at the individual and collective level. There are multiple associated psychological disturbances, ranging from isolated symptoms to complex disorders with marked impairment of functionality, such as insomnia, anxiety, depression, and post-traumatic stress disorder. Therefore, it is necessary for mental health services to develop strategies that allow them to react skillfully and provide support to health workers and the affected population so as to reduce the psychological impact as well as the development of psychiatric symptoms. The purpose of this reflection article is to show the possible consequences on the mental health of the population as a result of social isolation due to the COVID-19 pandemic.

What COVID-19 can mean for people with hemophilia beyond the infection risk

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented global health crisis. To combat its effects, many governments have opted for strategies of social isolation that involve a radical change in people's behavior.

AREAS COVERED

For patients with hemophilia, the negative consequences of these measures can be greater, given they modify aspects of health care and lifestyles needed to counteract the adverse effects of hemophilia. The long-term consequences of the pandemic on patients with hemophilia are not well known. The aim of this special report is to show what COVID-19 could mean for this population, beyond the risk of infection.

EXPERT OPINION

Considerations of the clinical, care, therapeutic, physical, nutritional, mental health, pain, and disability aspects that might be affected are included. Strategies are also suggested to minimize the effects that these issues can have on patients' lives. Patients, health professionals, and society as a whole must work together to mitigate the effects of the pandemic on people with hemophilia.

Telecritical Care Clinical and Operational Strategies in Response to COVID-19

Background: The cororavirus disease 19 (COVID-19) pandemic has strained intensive care unit (ICU) material and human resources to global crisis levels. The risks of staffing challenges and clinician exposure are of significant concern. One resource, telecritical care (TCC), has the potential to optimize efficiency, maximize safety, and improve quality of care provided amid large-scale disruptions, but its role in pandemic situations is only loosely defined. Planning and Preparation Phase: We propose strategic initiatives by which TCC may act as a force multiplier for pandemic preparedness in response to COVID-19, utilizing a tiered approach for increasing surge capacity needs. The goals involved usage of TCC to augment ICU capacity, optimize safety, minimize personal protective equipment (PPE) use, improve efficiencies, and enhance knowledge of managing pandemic response. Implementation Phase: A phased approach utilizing TCC would involve implementing remote capabilities across the enterprise to accomplish the goals outlined. The hardware and software needed for initial expansion to cover 275 beds included $956,670 for mobile carts and $173,106 for home workstations. Team role deployment and bedside clinical care centering around TCC as critical care capacity expand beyond 275 beds. Surge capacity was not reached during early phases of the pandemic in the region, allowing refinement of TCC during subsequent pandemic phases. Conclusions: Leveraging TCC facilitated pandemic surge planning but required redefinition of typical ICU staffing models. The design was meant to workforce efficiencies, reduce PPE use, and minimize health care worker exposure risk, all while maintaining quality care standards through an intensivist-led model. As health care operations resumed and states reopened, TCC is being used to support shifts in volume and critical care personnel during the pandemic evolution. The lessons applied may help health care systems through variable phases of the pandemic.

Recomendaciones de la Asociación Colombiana de Medicina del Sueño para el ejercicio de la medicina del sueño en Colombia durante la pandemia por COVID-19

El lavado de manos frecuente, el uso obligatorio de mascarilla por parte de la población general en sitios públicos, el distanciamiento físico y social, y el confinamiento obligatorio de la mayoría de la población en sus casas son las medidas que hasta el momento han ayudado a frenar la propagación del nuevo coronavirus (SARS-CoV-2), causante de la actual pandemia por COVID-19. Sin embargo, la adopción de algunas de estas medidas ha generado retraso en el diagnóstico y tratamiento de diferentes enfermedades, incluyendo los trastornos del sueño, por lo que es urgente que los especialistas en medicina del sueño y los centros de sueño retomen sus actividades gradualmente, siempre que se implementen estrictos protocolos de bioseguridad que mitiguen el riesgo de contagio.En este contexto, y con el fin de ayudar a los somnólogos a reabrir los centros de sueño y reanudar los procedimientos allí realizados, la Asociación Colombiana de Medicina del Sueño propone en la presente reflexión una serie de recomendaciones para tener en cuenta durante el proceso de reactivación. Estas recomendaciones se basan en las estrategias de mitigación establecidas por las autoridades sanitarias del país, las directrices de la American Academy of Sleep Medicine, y la literatura disponible sobre el tema, la cual fue revisada luego de realizar una búsqueda en las bases de datos PubMed, SciELO y Google Scholar usando los términos “sleep” “sleep medicine” y “COVID19”.

How and When Does Inclusive Leadership Curb Psychological Distress During a Crisis? Evidence From the COVID-19 Outbreak

Traumatic events such as a pandemic shatter the assumption of the workplace as a safe place. Nurses face risks of life-threatening infection, which can create psychological distress. Quality of care for infected patients depends on mental well-being of nurses which calls for research on predictors of stress among health care workers. Responding to a call for research on the effects of leadership styles on psychological distress during traumatic events, this paper uses the theoretical lens of social exchange theory and contributes to literature on relationships between inclusive leadership, psychological distress, work engagement, and self-sacrifice. Participants of this cross sectional study included 497 registered nurses from five hospitals in Wuhan. Data were collected with temporal separation through an online questionnaire. Partial least-squares structural equation modeling was used to analyze data. Results show inclusive leadership has a significant negative relationship with psychological distress. Work engagement mediates this relationship, and nurses’ self-sacrificial behavior moderates it. Findings indicate inclusive leadership style serves as a sustainable mechanism to reduce psychological distress during pandemics. It can operationalize the delivery of mental health support in real-time in work settings. Results provide empirical support for social exchange theory through high work engagement to help control psychological distress among nurses.

Speech-Language Pathology Guidance for Tracheostomy During the COVID-19 Pandemic: An International Multidisciplinary Perspective

Purpose As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to frontline health care workers. When caring for patients with tracheostomy, speech-language pathologists have significant exposure to mucosal surfaces, secretions, and aerosols that may harbor the SARS-CoV-2 virus. This tutorial provides guidance on practices for safely performing patient evaluation and procedures, thereby reducing risk of infection. Method Data were collated through review of literature, guidelines, and consensus statements relating to COVID-19 and similar high-consequent infections, with a focus on mitigating risk of transmission to health care workers. Particular emphasis was placed on speech-language pathologists, nurses, and other allied health professionals. A multinational interdisciplinary team then analyzed findings, arriving at recommendations through consensus via electronic communications and video conference. Results Reports of transmission of infection to health care workers in the current COVID-19 pandemic and previous outbreaks substantiate the need for safe practices. Many procedures routinely performed by speech-language pathologists have a significant risk of infection due to aerosol generation. COVID-19 testing can inform level of protective equipment, and meticulous hygiene can stem spread of nosocomial infection. Modifications to standard clinical practice in tracheostomy are often required. Personal protective equipment, including either powered air-purifying respirator or N95 mask, gloves, goggles, and gown, are needed when performing aerosol-generating procedures in patients with known or suspected COVID-19 infection. Conclusions Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and safety of the health care team. Careful adherence to best practices can significantly reduce risk of infectious transmission.

Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic

As the novel coronavirus disease 2019 (COVID-19) continues to spread across countries, the need for innovative measures to provide high-quality patient care and manage its spread has become more imperative. Software-based systems such as medical software applications could provide valuable suggestion on health-related information to physicians towards improving quality of life, especially for outpatients (e.g., elderly, immunosuppressed, pregnant women). The use of telemedicine and virtual software offers promising potential in the fight against COVID-19. Accordingly, by means of expedited literature and document review, this paper provides implication on the opportunities, application, and challenges of telemedicine and existing virtual software currently adopted as suitable initiatives for reducing the spread of COVID-19. More importantly, findings present factors that impact adoption of telemedicine. The findings suggest that telemedicine and virtual software are capable of decreasing emergency room visits, safeguarding healthcare resources, and lessening the spread of COVID-19 by remotely treating patients during and after the COVID-19 pandemic.

An Internet of Things Approach to Contact Tracing—The BubbleBox System

The COVID-19 pandemic exploded at the beginning of 2020, with over four million cases in five months, overwhelming the healthcare sector. Several national governments decided to adopt containment measures, such as lockdowns, social distancing, and quarantine. Among these measures, contact tracing can contribute in bringing under control the outbreak, as quickly identifying contacts to isolate suspected cases can limit the number of infected people. In this paper we present BubbleBox, a system relying on a dedicated device to perform contact tracing. BubbleBox integrates Internet of Things and software technologies into different components to achieve its goal—providing a tool to quickly react to further outbreaks, by allowing health operators to rapidly reach and test possible infected people. This paper describes the BubbleBox architecture, presents its prototype implementation, and discusses its pros and cons, also dealing with privacy concerns.

Coronavirus Disease 2019 (COVID-19) and Neurosurgery: Literature and Neurosurgical Societies Recommendations Update

BACKGROUND

Since January 2020, when the pathogen causing the coronavirus disease was identified in humans, the literature on coronavirus disease 2019 (COVID-19) has grown exponentially to more than 4000 publications. There is the need to provide an update for each single medical discipline, including neurosurgery, to be used by single professionals or to be distributed through the neurosurgical community and to be used by governments in designing new scenario of care.

METHODS

A review of the MEDLINE database was performed on April 13, 2020. Search terms included "COVID-19," "neurosurgery," and "surgery." A review of documents published on the webpage of the WFNS (World Federation of Neurosurgical Societies) and of the 5 continental associations of neurosurgical societies, AANS (American Association of Neurological Surgeons), AASNS (Asian Australasian Society of Neurological Surgeons), CAANS (Continental Association of African Neurosurgical Societies), EANS (European Association of Neurosurgical Societies), and FLANC (Latin American Federation of Neurosurgical Societies), representing the 119 national neurosurgical societies around the world, was performed.

RESULTS

The literature search yielded 38 results that were manually reviewed. Fourteen manuscripts were considered eligible. They described suggestions and considerations to optimize care of neurosurgical patients, editorials on operational models, perspectives from neurosurgical departments, letters to the editor describing experiences on how to help medical staff to be prepared in advance for pandemic situations, and descriptions of regional or departmental models and/or organizational schemes. The webpages of the searched societies reported a total of 57 documents.

CONCLUSIONS

The neurosurgical scientific community has promptly reacted to the COVID-19 outbreak by producing a growing number of documents that could serve as guidance for neurosurgeons all over the world. Neurosurgical societies will represent the key institutions for guiding the neurosurgical community to overcome the COVID-19 crisis.

A global respiratory perspective on the COVID-19 pandemic: commentary and action proposals

The novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. The World Health Organization (WHO) declared the COVID-19 outbreak a pandemic on 11 March, 2020, demanding effective national and global mitigation measures, strong public health response and coordination. To date, the SARS-CoV-2 pandemic has affected over 5 million individuals worldwide with an overall 7.02% (median 3.41%, ranges 0.06% to 31.25%) case fatality ratio (European Center for Disease Prevention and Control dashboard: www.ecdc.europa.eu , as of 22 May, 2020) [3]. This ratio may be overstated since it is based primarily on hospitalised or notified cases.

This paper offers practical and feasible actions to be implemented at patient, healthcare provider and community level to combat COVID-19 while attending, maintaining and strengthening ongoing health management in people with lung diseases https://bit.ly/30yNyhP