Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures

COVID-19 wastewater epidemiology: a model to estimate infected populations

BACKGROUND

Wastewater-based epidemiology provides an opportunity for near real-time, cost-effective monitoring of community-level transmission of SARS-CoV-2. Detection of SARS-CoV-2 RNA in wastewater can identify the presence of COVID-19 in the community, but methods for estimating the numbers of infected individuals on the basis of wastewater RNA concentrations are inadequate.

METHODS

This is a wastewater-based epidemiology study using wastewater samples that were collected weekly or twice a week from three sewersheds in South Carolina, USA, between either May 27 or June 16, 2020, and Aug 25, 2020, and tested for SARS-CoV-2 RNA. We developed a susceptible-exposed-infectious-recovered (SEIR) model based on the mass rate of SARS-CoV-2 RNA in the wastewater to predict the number of infected individuals, and have also provided a simplified equation to predict this. Model predictions were compared with the number of confirmed cases identified by the Department of Health and Environmental Control, South Carolina, USA, for the same time period and geographical area.

FINDINGS

We plotted the model predictions for the relationship between mass rate of virus release and numbers of infected individuals, and we validated this prediction on the basis of estimated prevalence from individual testing. A simplified equation to estimate the number of infected individuals fell within the 95% confidence limits of the model. The rate of unreported COVID-19 cases, as estimated by the model, was approximately 11 times that of confirmed cases (ie, ratio of estimated infections for every confirmed case of 10·9, 95% CI 4·2-17·5). This rate aligned well with an independent estimate of 15 infections for every confirmed case in the US state of South Carolina.

INTERPRETATION

The SEIR model provides a robust method to estimate the total number of infected individuals in a sewershed on the basis of the mass rate of RNA copies released per day. This approach overcomes some of the limitations associated with individual testing campaigns and thereby provides an additional tool that can be used to inform policy decisions.

FUNDING

Clemson University, USA.

Integro-differential approach for modeling the COVID-19 dynamics - Impact of confinement measures in Italy

The COVID-19 pandemic has overwhelmed the life and security of most of the world countries, and especially of the Western countries, without similar experiences in the recent past. In a first phase, the response of health systems and governments was disorganized, but then incisive, also driven by the fear of a new and dramatic phenomenon. In the second phase, several governments, including Italy, accepted the doctrine of "coexistence with the virus" by putting into practice a series of containment measures aimed at limiting the dramatic sanitary consequences while not jeopardizing the economic and social stability of the country. Here, we present a new mathematical approach to modeling the COVID-19 dynamics that accounts for typical evolution parameters (i.e., virus variants, vaccinations, containment measurements). Reproducing the COVID-19 epidemic spread is an extremely challenging task due to the low reliability of the available data, the lack of recurrent patterns, and the considerable amount and variability of the involved parameters. However, the adoption of fairly uniform criteria among the Italian regions enabled to test and optimize the model in various conditions leading to robust and interesting results. Although the regional variability is quite large and difficult to predict, we have retrospectively obtained reliable indications on which measures were the most appropriate to limit the transmissibility coefficients within detectable ranges for all the regions. To complicate matters further, the rapid spread of the English variant has upset contexts where the propagation of contagion was close to equilibrium conditions, decreeing success or failure of a certain measure. Finally, we assessed the effectiveness of the zone assignment criteria, highlighting how the reactivity of the measures plays a fundamental role in limiting the spread of the infection and thus the total number of deaths, the most important factor in assessing the success of epidemic management.

COVID-19 wastewater epidemiology: a model to estimate infected populations

BACKGROUND

Wastewater-based epidemiology provides an opportunity for near real-time, cost-effective monitoring of community-level transmission of SARS-CoV-2. Detection of SARS-CoV-2 RNA in wastewater can identify the presence of COVID-19 in the community, but methods for estimating the numbers of infected individuals on the basis of wastewater RNA concentrations are inadequate.

METHODS

This is a wastewater-based epidemiology study using wastewater samples that were collected weekly or twice a week from three sewersheds in South Carolina, USA, between either May 27 or June 16, 2020, and Aug 25, 2020, and tested for SARS-CoV-2 RNA. We developed a susceptible-exposed-infectious-recovered (SEIR) model based on the mass rate of SARS-CoV-2 RNA in the wastewater to predict the number of infected individuals, and have also provided a simplified equation to predict this. Model predictions were compared with the number of confirmed cases identified by the Department of Health and Environmental Control, South Carolina, USA, for the same time period and geographical area.

FINDINGS

We plotted the model predictions for the relationship between mass rate of virus release and numbers of infected individuals, and we validated this prediction on the basis of estimated prevalence from individual testing. A simplified equation to estimate the number of infected individuals fell within the 95% confidence limits of the model. The rate of unreported COVID-19 cases, as estimated by the model, was approximately 11 times that of confirmed cases (ie, ratio of estimated infections for every confirmed case of 10·9, 95% CI 4·2-17·5). This rate aligned well with an independent estimate of 15 infections for every confirmed case in the US state of South Carolina.

INTERPRETATION

The SEIR model provides a robust method to estimate the total number of infected individuals in a sewershed on the basis of the mass rate of RNA copies released per day. This approach overcomes some of the limitations associated with individual testing campaigns and thereby provides an additional tool that can be used to inform policy decisions.

FUNDING

Clemson University, USA.

The journey of SARS-CoV-2 in human hosts: a review of immune responses, immunosuppression, and their consequences

Coronavirus disease 2019 (COVID-19) is a highly infectious viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory findings from a significant number of patients with COVID-19 indicate the occurrence of leukocytopenia, specifically lymphocytopenia. Moreover, infected patients can experience contrasting outcomes depending on lymphocytopenia status. Patients with resolved lymphocytopenia are more likely to recover, whereas critically ill patients with signs of unresolved lymphocytopenia develop severe complications, sometimes culminating in death. Why immunodepression manifests in patients with COVID-19 remains unclear. Therefore, the evaluation of clinical symptoms and laboratory findings from infected patients is critical for understanding the disease course and its consequences. In this review, we take a logical approach to unravel the reasons for immunodepression in patients with COVID-19. Following the footprints of the virus within host tissues, from entry to exit, we extrapolate the mechanisms underlying the phenomenon of immunodepression.

A qualitative study to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa

BACKGROUND

The coronavirus disease 2019 (COVID-19) is a novel virus that has rapidly spread across countries globally, and has been declared a pandemic by the World Health Organization (WHO). In South Africa, more that 1 million cases have been confirmed since case zero was detected in March 2020. South Africa is currently leading in the sub-Saharan African region in terms of COVID-19-related mortality and morbidity rates.

AIM

The aim of this study was to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa.

SETTING

The study was conducted at two selected primary health care facilities (a community health centre and satellite clinic) within a low-income rural context in KwaZulu-Natal, South Africa.

METHODS

A qualitative study was conducted to explore and describe perceptions and understanding of primary health care practitioners regarding the COVID-19 pandemic in KwaZulu-Natal (KZN), South Africa. Data were collected from a purposive sample of 15 participants at two different clinics situated in rural KZN, South Africa. Participants comprised of nurses, physiotherapists, pharmacists, community care givers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. An audiotape was used to collect data, which were transcribed verbatim. Data were analysed manually by thematic analysis following Tech's steps of data analysis.

RESULTS

Participants reported pre-pandemic and pandemic perceptions of fear, denial, expectancy and a perceived poor preparation for the COVID-19 outbreak. The findings also revealed participants' misperceptions regarding the nature of the COVID-19 pandemic and unrealistic expectations of occupational compensations for working during the outbreak.

CONCLUSION

The findings of this study suggest that primary health care practitioners generally have negative perceptions and understanding regarding the pandemic because of misinformation obtained from social media. Interventions to support health care practitioners are necessary to mitigate the potentially negative implications of health practitioners' misconceptions on service delivery and their mental health.

Epidemic size, trend and spatiotemporal mapping of SARS-CoV-2 using geographical information system in Alborz Province, Iran

BACKGROUND

The first confirmed cases of COVID-19 in Iran were reported in Qom city. Subsequently, the neighboring provinces and gradually all 31 provinces of Iran were involved. This study aimed to investigate the case fatility rate, basic reproductive number in different period of epidemic, projection of daily and cumulative incidence cases and also spatiotemporal mapping of SARS-CoV-2 in Alborz province, Iran.

METHODS

A confirmed case of COVID-19 infection was defined as a case with a positive result of viral nucleic acid testing in respiratory specimens. Serial interval (SI) was fitted by gamma distribution and considered the likelihood-based R0 using a branching process with Poisson likelihood. Seven days average of cases, deaths, doubling times and CFRs used to draw smooth charts. kernel density tool in Arc GIS (Esri) software has been employed to compute hot spot area of the study site.

RESULTS

The maximum-likelihood value of R0 was 2.88 (95%, CI: 2.57-3.23) in the early 14 days of epidemic. The case fatility rate for Alborz province (Iran) on March 10, was 8.33% (95%, CI:6.3-11), and by April 20, it had an increasing trend and reached 12.9% (95%,CI:11.5-14.4). The doubling time has been increasing from about two days and then reached about 97 days on April 20, 2020, which shows the slowdown in the spread rate of the disease. Also, from March 26 to April 2, 2020 the whole Geographical area of Karj city was almost affected by SARS-CoV-2.

CONCLUSIONS

The R0 of COVID-19 in Alborz province was substantially high at the beginning of the epidemic, but with preventive measures and public education and GIS based monitoring of the cases,it has been reduced to 1.19 within two months. This reduction highpoints the attainment of preventive measures in place, however we must be ready for any second epidemic waves during the next months.

Proof-of-concept trial of an amniotic fluid-derived extracellular vesicle biologic for treating high risk patients with mild-to-moderate acute COVID-19 infection

A pandemic brought on by COVID-19 has created a scalable health crisis. The search to help alleviate COVID-19-related complications through therapeutics has become a necessity. Zofin is an investigational, acellular biologic derived from full-term perinatal amniotic fluid that contains extracellular vesicles. Extracellular nanoparticles as such have been studied for their immunomodulatory benefits via cellular therapeutics and, if applied to COVID-19-related inflammation, could benefit patient outcome. Subjects (n = 8) experiencing mild-to-moderate COVID-19 symptoms were treated with the experimental intervention. Complete blood count, complete metabolic panel, inflammatory biomarkers, and absolute lymphocyte counts were recorded prior to and on days 4, 8, 14, 21, and 30 as markers of disease progression. Additionally, chest x-rays were taken of the patients prior to and on days 8 and 30. Patients experienced no serious adverse events. All COVID-19-associated symptoms resolved or became stable with no indication of disease worsening as found by patient and chest x-ray reports. Inflammatory biomarkers (CRP, IL-6, TNF- α ) and absolute lymphocyte counts improved throughout the study period. Findings from a proof-of-concept, expanded access trial for COVID-19 patients prove the acellular biologic is safe and potentially effective to prevent disease progression in a high-risk COVID-19 population with mild-to-moderate symptoms.

Investigation of the Relationship between the Perceived Public Transport Service Quality and Satisfaction: A PLS-SEM Technique

Public transportation (PT) service quality is recognized as a cornerstone of infrastructure development in many countries. Understanding the satisfaction level of public transport users towards provided service quality is vital. However, there is still a lack of research to identify the specific relationship between the experience of service quality and private vehicle (PV) users’ satisfaction. Therefore, this paper aimed to examine the different satisfaction attributes of PV users due to the COVID-19 pandemic and to make possible suggestions to policymakers on how to adapt to these changed attitudes. The paper highlights that some satisfaction issues became more significant, while the importance of others was mitigated due to the unusual circumstances. In this study, variance-based Partial Least Squares Structural Equation Modeling (PLS-SEM) was applied to test the proposed hypotheses. Further, Partial Least Squares Multi-Group Analysis (PLS-MGA) was conducted for investigating the perception of age and gender groups on the basis of gap analysis. An online panel and printed questionnaire survey were used to collect data in Budapest, Hungary in October and November 2020 during COVID-19 from the perception of 100 PV users. The findings show that perceived service quality and accessibility are statistically significant in the formation of PV users’ satisfaction but safety and security were not significantly related to satisfaction. Additionally, results from PLS-MGA reveal that there was a significant difference among gender and age groups in achieving satisfaction associated with safety and security. The conclusions of this study are not only beneficial for the theory of this field but also contribute to practice for policymakers in terms of providing better service with specific identification of how to encourage more private vehicle users to use public transportation.

Neurological complications and infection mechanism of SARS-COV-2

Currently, SARS-CoV-2 has caused a global pandemic and threatened many lives. Although SARS-CoV-2 mainly causes respiratory diseases, growing data indicate that SARS-CoV-2 can also invade the central nervous system (CNS) and peripheral nervous system (PNS) causing multiple neurological diseases, such as encephalitis, encephalopathy, Guillain-Barré syndrome, meningitis, and skeletal muscular symptoms. Despite the increasing incidences of clinical neurological complications of SARS-CoV-2, the precise neuroinvasion mechanisms of SARS-CoV-2 have not been fully established. In this review, we primarily describe the clinical neurological complications associated with SARS-CoV-2 and discuss the potential mechanisms through which SARS-CoV-2 invades the brain based on the current evidence. Finally, we summarize the experimental models were used to study SARS-CoV-2 neuroinvasion. These data form the basis for studies on the significance of SARS-CoV-2 infection in the brain.

Identification of Key Pathways and Genes in SARS-CoV-2 Infecting Human Intestines by Bioinformatics Analysis

COVID-19 is a serious infectious disease that has recently swept the world, and research on its causative virus, SARS-CoV-2, remains insufficient. Therefore, this study uses bioinformatics analysis techniques to explore the human digestive tract diseases that may be caused by SARS-CoV-2 infection. The gene expression profile data set, numbered GSE149312, is from the Gene Expression Omnibus (GEO) database and is divided into a 24-h group and a 60-h group. R software is used to analyze and screen out differentially expressed genes (DEGs) and then gene ontology (GO) term and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses are performed. In KEGG, the pathway of non-alcoholic fatty liver disease exists in both the 24-h group and 60-h group. STRING is used to establish a protein–protein interaction (PPI) network, and Cytoscape is then used to visualize the PPI and define the top 12 genes of the node as the hub genes. Through verification, nine statistically significant hub genes are identified: AKT1, TIMP1, NOTCH, CCNA2, RRM2, TTK, BUB1B, KIF20A, and PLK1. In conclusion, the results of this study can provide a certain direction and basis for follow-up studies of SARS-CoV-2 infection of the human digestive tract and provide new insights for the prevention and treatment of diseases caused by SARS-CoV-2.

Complex behavior of COVID-19's mathematical model

It is almost more than a year that earth has faced a severe worldwide problem called COVID-19. In December 2019, the origin of the epidemic was found in China. After that, this contagious virus was reported almost all over the world with different variants. Besides all the healthcare system attempts, quarantine, and vaccination, it is needed to study the dynamical behavior of this disease specifically. One of the practical tools that may help scientists analyze the dynamical behavior of epidemic disease is mathematical models. Accordingly, here, a novel mathematical system is introduced. Also, the complex behavior of this model is investigated considering different dynamical analyses. The results represent that some range of parameters may lead the model to chaotic behavior. Moreover, comparing the two same bifurcation diagrams with different initial conditions reveals that the model has multi-stability.

Prevalence of human pathogenic viruses in wastewater: A potential transmission risk as well as an effective tool for early outbreak detection for COVID-19

Millions of human pathogenic viral particles are shed from infected individuals and introduce into wastewater, subsequently causing waterborne diseases worldwide. These viruses can be transmitted from wastewater to human beings via direct contact and/or ingestion/inhalation of aerosols. Even the advanced wastewater treatment technologies are unable to remove pathogenic viruses from wastewater completely, posing a serious health risk. Recently, coronavirus disease 2019 (COVID-19) has been urged globally due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which has resulted in >4.1 million deaths until July 2021. A rapid human-to-human transmission, uncertainties in effective vaccines, non-specific medical treatments, and unclear symptoms compelled the world into complete lockdown, social distancing, air-travel suspension, and closure of educational institutions, subsequently damaging the global economy and trade. Although, few medical treatments, rapid detection tools, and vaccines have been developed so far to curb the spread of COVID-19; however, several uncertainties exist in their applicability. Further, the acceptance of vaccines among communities is lower owing to the fear of side effects such as blood-clotting and heart inflammation. SARS-CoV-2, an etiologic agent of COVID-19, has frequently been detected in wastewater, depicting a potential transmission risk to healthy individuals. Contrarily, the occurrence of SARS-CoV-2 in wastewater can be used as an early outbreak detection tool via water-based epidemiology. Therefore, the spread of SARS-CoV-2 through fecal-oral pathway can be reduced and any possible outbreak can be evaded by proper wastewater surveillance. In this review, wastewater recycling complications, potential health risks of COVID-19 emergence, and current epidemiological measures to control COVID-19 spread have been discussed. Moreover, the viability of SARS-CoV-2 in various environments and survival in wastewater has been reviewed. Additionally, the necessary actions (vaccination, face mask, social distancing, and hand sanitization) to limit the transmission of SARS-CoV-2 have been recommended. Therefore, wastewater surveillance can serve as a feasible, efficient, and reliable epidemiological measure to lessen the spread of COVID-19.

Evidence of Coronavirus (CoV) Pathogenesis and Emerging Pathogen SARS-CoV-2 in the Nervous System: A Review on Neurological Impairments and Manifestations

The coronavirus disease 2019 (COVID-19) pandemic is an issue of global significance that has taken the lives of many across the world. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for its pathogenesis. The pulmonary manifestations of COVID-19 have been well described in the literature. Initially, it was thought to be limited to the respiratory system; however, we now recognize that COVID-19 also affects several other organs, including the nervous system. Two similar human coronaviruses (CoV) that cause severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) are also known to cause disease in the nervous system. The neurological manifestations of SARS-CoV-2 infection are growing rapidly, as evidenced by several reports. There are several mechanisms responsible for such manifestations in the nervous system. For instance, post-infectious immune-mediated processes, direct virus infection of the central nervous system (CNS), and virus-induced hyperinflammatory and hypercoagulable states are commonly involved. Guillain-Barré syndrome (GBS) and its variants, dysfunction of taste and smell, and muscle injury are numerous examples of COVID-19 PNS (peripheral nervous system) disease. Likewise, hemorrhagic and ischemic stroke, encephalitis, meningitis, encephalopathy acute disseminated encephalomyelitis, endothelialitis, and venous sinus thrombosis are some instances of COVID-19 CNS disease. Due to multifactorial and complicated pathogenic mechanisms, COVID-19 poses a large-scale threat to the whole nervous system. A complete understanding of SARS-CoV-2 neurological impairments is still lacking, but our knowledge base is rapidly expanding. Therefore, we anticipate that this comprehensive review will provide valuable insights and facilitate the work of neuroscientists in unfolding different neurological dimensions of COVID-19 and other CoV associated abnormalities.

COVID-19-related knowledge, risk perception, information seeking, and adherence to preventive behaviors among undergraduate students, southern Iran

Globally, the novel COVID-19 has been recognized as one of the most important pandemics and devastating diseases in human history, with many deaths and morbidities. In the absence of effective treatment and limited supply of COVID-19 vaccine, people must adhere to recommended preventive measures. This study aimed to determine the level of COVID-19 knowledge, perceived susceptibility, perceived severity, and health information-seeking and preventive behaviors as well as associated factors with preventive behaviors in a sample of Iranian students at Persian Gulf University. Data was collected using an online structured and validated questionnaire. Descriptive statistics, the Mann-Whitney U, Chi-square, and Spearman correlation tests were applied to analyze data. The significance level was set at P < 0.05. In total, 98% (319/325) of the participants completed the survey. A majority of participants were aware of the three main COVID-19 symptoms: fever, dry cough, and shortness of breath, while half of them were unaware of gastrointestinal problems caused by COVID-19. More than half of the subjects had a low perceived susceptibility and severity toward COVID-19. Most of the participants engaged in preventive behaviors and got COVID-19 information from social media and the Internet. Preventive behavior was associated with perceived susceptibility (P = 0.015), perceived severity (P = 0.014), and health information seeking (P < 0.001) of individuals toward COVID-19. The results of our research can help health authorities develop health promotion programs for student populations by providing baseline data.

COVID-19 Vaccines Global Information Management through Bibliometrics

Vaccination is nowadays the most used option to stem the covid-19 pandemic. The global impact of the pandemic has triggered an unprecedented frenzy for research axis related to COVID-19 vaccine. Since 2019, the volume of publications related to COVID-19 vaccines has swollen significantly. In this very dynamic context, it can be difficult to quickly access the state and orientations of the researches. Thus, the goal of this paper is to provide a quick, fast comprehensive science mapping of these researches through an information management bibliometric approach. We extracted 8 246 publications (up to July 08th 2021) related to COVID-19 and vaccination from a world-leading publisher-independent global citation database (Scopus). The Bibliometrix package was then used to perform a bibliometric review of all these documents. The most important connections between the main themes, publications, authors, institutions, countries, collaborations, and journals are being highlighted. Main implications for the Information System along with some future research directions are also presented.

Role of NLR, PLR, ELR and CLR in differentiating COVID-19 patients with and without pneumonia

OBJECTIVES

Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), eosinophil/lymphocyte ratio (ELR), and C-reactive protein (CRP)/lymphocyte ratio (CLR) are well-established inflammatory indices. This study aimed to examine whether NLR, PLR, MLR, ELR and CLR could differentiate coronavirus disease 2019 (COVID-19) patients with pneumonia from those of without.

METHODS

We retrospectively examined the laboratory parameters including CRP, D-dimer, procalcitonin and complete blood count of 306 COVID-19 patients (pneumonic = 152 and non-pneumonic = 154). NLR, PLR, MLR, ELR and CLR values of each patient were calculated. The ability of these indices to distinguish COVID-19 patients with and without pneumonia was determined by receiver operating characteristic (ROC) analysis.

RESULTS

NLR, PLR and CLR values were higher while ELR value was lower in pneumonic COVID-19 patients compared with patients with non-pneumonic COVID-19 infection. MLR value was similar in the two groups. NLR, PLR and CLR were positively correlated with CRP and procalcitonin. ELR was negatively correlated with CRP. The ROC analysis revealed that the optimal cut-off value of CLR for discriminating COVID-19 patients with pneumonia from those without pneumonia was 1.14 and the area under curve (AUC) for CLR was 0.731 (sensitivity = 81.5% and specificity = 55.6%), which was markedly higher than the AUCs of NLR (0.622), PLR (0.585) and ELR (0.613). However, no statistical differences were observed between AUC values of NLR, PLR and ELR (P > .05).

CONCLUSION

Our findings showed that NLR, PLR, ELR and CLR indices can be used in differentiating COVID-19 patients with or without pneumonia. Among them, the CLR index was the best predictor of pneumonia in COVID-19 patients.

Interferon-alpha or -beta facilitates SARS-CoV-2 pulmonary vascular infection by inducing ACE2

Severe viral pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by a hyperinflammatory state typified by elevated circulating pro-inflammatory cytokines, frequently leading to potentially lethal vascular complications including thromboembolism, disseminated intracellular coagulopathy and vasculitis. Though endothelial infection and subsequent endothelial damage have been described in patients with fatal COVID-19, the mechanism by which this occurs remains elusive, particularly given that, under naïve conditions, pulmonary endothelial cells demonstrate minimal cell surface expression of the SARS-CoV-2 binding receptor ACE2. Herein we describe SARS-CoV-2 infection of the pulmonary endothelium in postmortem lung samples from individuals who died of COVID-19, demonstrating both heterogeneous ACE2 expression and endothelial damage. In primary endothelial cell cultures, we show that SARS-CoV-2 infection is dependent on the induction of ACE2 protein expression and that this process is facilitated by type 1 interferon-alpha (IFNα) or -beta(β)—two of the main anti-viral cytokines induced in severe SARS-CoV-2 infection—but not significantly by other cytokines (including interleukin 6 and interferon γ/λ). Our findings suggest that the stereotypical anti-viral interferon response may paradoxically facilitate the propagation of COVID-19 from the respiratory epithelium to the vasculature, raising concerns regarding the use of exogenous IFNα/β in the treatment of patients with COVID-19.

A Multiallelic Molecular Beacon-Based Real-Time RT-PCR Assay for the Detection of SARS-CoV-2

Emerging infectious viruses have led to global advances in the development of specific and sensitive detection techniques. Viruses have an inherent potential to easily mutate, presenting major hurdles for diagnostics and requiring methods capable of detecting genetically diverse viral strains. One such infectious agent is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in December 2019 and has resulted in the global coronavirus disease 2019 (COVID-19) pandemic. This study presents a real-time reverse transcription PCR (RT-PCR) detection assay for SARS-CoV-2, taking into account its intrinsic polymorphic nature that arises due to genetic drift and recombination, as well as the possibility of continuous and multiple introductions of genetically nonidentical strains into the human population. This advance was achieved by using mismatch-tolerant molecular beacons designed to specifically detect the SARS-CoV-2 S, E, M, and N genes. These were applied to create a simple and reproducible real-time RT-PCR assay, which was validated using external quality control panels (QCMD: CVOP20, WHO: SARS-CoV-2-EQAP-01) and clinical samples. This assay was designed for high target detection accuracy and specificity and can also be readily adapted for the detection of other emerging and rapidly mutating pathogens.

Impact of COVID-19 pandemic on endoscopic retrograde cholangiopancreatography; a single center experience

Background COVID-19 pandemic has impacted several aspects of health care services worldwide. Our aim was to study its influence on the case volume, success rate and complication rate of ERCP. Method All patients who underwent ERCP one-year before and after applying COVID-19 safety measures at Qena university hospital were included. Data were collected from the patients' records, analyzed and compared. Result A total of 250 patients were subjected to ERCP between April 1, 2019 and March 31, 2021, mean age 52±18. There was 5% increase in case volume after applying COVID-19 safety measures than before (128 vs 122) and the total procedure time was significantly shorter (42 versus 46 minutes, p=0.04). The overall success rate and complication rate showed no significant difference. Procedure success significantly corelated to cannulation attempts and total procedure time in both groups, and serum bilirubin and cannulation time in patients before COVID-19, and ALP in patients after. ERCP related complications significantly correlated with cannulation attempts in both groups, and ALP, INR, cannulation time and total procedure time in patients before COVID-19, and platelets count and amylase after. Two patients were confirmed COVID-19 cases at the time of ERCP, therapeutic targets were achieved in both with smooth post-ERCP recovery. Three out of 9 ERCP team members have caught mild to moderate COVID-19 infection and recovered after receiving proper management. Conclusion Our result showed no negative impact of using COVID-19 safety measures and precautions on the case-volume, indications, overall outcome or complication rate of ERCP.

COVID-19 outbreak among French firefighters, Marseille, France, 2020

We investigated a COVID-19 outbreak at a fire station in Marseille, France. Confirmed cases were defined as individuals with positive SARS-CoV-2 reverse transcription (RT)-PCR and/or neutralising antibodies. All 85 firefighters at work during the outbreak period were included after questioning and sampled for RT-PCR and viral neutralisation assay. Twenty-three firefighters were confirmed positive, 19 of them were symptomatic, and four asymptomatic cases were confirmed by virus neutralisation. A total of 22 firefighters had specific neutralising antibodies against SARS-CoV-2. Neutralising antibodies were found in four asymptomatic and 18 symptomatic cases. Eleven symptomatic cases had high titres (≥ 1:80). The earliest detection of neutralising antibodies was 7 days after symptom onset, and 80% had neutralising antibodies 15 days after onset. One viral culture was positive 13 days after onset. The attack rate was 27%. We identified two introductions of the virus in this outbreak, through a presymptomatic and a paucisymptomatic case. Asymptomatic cases were not the source of a third generation of cases, although they worked without wearing a mask, indicating that asymptomatic cases did not play a significant role in this outbreak. Management and strategy based on early research of clinical signs associated with self-quarantine was effective.

Characterization of SARS-CoV-2 East Java isolate, Indonesia

Background: Incidents of SARS-CoV-2 in East Java increased steadily, and it became the second epicenter in Indonesia. The COVID-19 pandemic caused a dire multisectoral crisis all around the world. This study investigates and characterizes local isolates from East Java, Indonesia.  

Methods: There were 54 patients suspected with SARS-COV-2 infection and 27 patients were COVID-19 positive. Virus isolates were obtained from COVID-19 inpatients’ nasopharyngeal swabs at the Dr Soetomo Teaching Hospital, Surabaya. There were only three isolates (#6, #11, #35) with good growth characteristics. Serial blind passage and cytopathic effect observation in the Vero E6 cell line were performed for virus isolation. Confirmation of the SARS-CoV-2 infection was proven by means of reverse transcriptase-polymerase chain reactions using SARS-CoV-2 specific primers, scanning electron microscopy, and scanning transmission electron microscopy examination. Whole genome sequencing was performed using ARTIC protocol. Furthermore, SARS-CoV-2 characterization was identified through a western blot using rabbit serum immunized with inactive SARS-CoV-2 vaccine and human natural COVID-19 infection serum.  

Results: Spike gene analysis of three samples (#6, #11, #35) found that the D614G mutation was detected in all isolates, although one isolate exhibited the D215Y and E484D mutation. Based on whole genome analysis, those three isolates were included in clade 20A, and two isolates were included in lineage B.1.6 with one isolate belongs to lineage B.1.4.7.  

Conclusion: Based on molecular characterization and immunogenicity of SARS-CoV-2 East Java, Indonesia showed high titer and it has mutation in some regions.

A Year Following the Onset of the COVID-19 Pandemic: Existing Challenges and Ways the Food Industry Has Been Impacted

The COVID-19 pandemic has created significant impacts for nearly all industrial and societal sectors in the world. As closures and social distancing mandates were implemented to help control the spread of the novel coronavirus designated as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the food industry was immensely affected. This review explores the effects of the COVID-19 pandemic on the food supply chain from a multi-disciplinary viewpoint and provides perspectives on the consequences on food safety and food security, a risk assessment on human–animal interactions, and considers logistical/protocol adjustments required for the food industry. While foodborne transmission of the novel coronavirus SARS-CoV-2 is not a significant factor for food safety as direct transmission of the virus through food products is not evident, food security has been significantly affected by the COVID-19 pandemic. The pandemic threatens food accessibility, especially for vulnerable populations of people, through its effects on food cost and infrastructure, food distribution and public transit access, and social inequities. Currently, global interest for COVID-19 is focused on human health and rightfully so, but adverse effects on the food supply chain are already evident and will likely continue to occur for several years after the pandemic is over, let alone if other global health pandemics of this magnitude surface in upcoming years. Uncertainties over the novel coronavirus have interrupted global trade and supply chains. The pandemic has underlined the importance of a robust and resilient food system, which presents an unprecedented challenge for competent authorities in upcoming years.

Recent advances in detection technologies for COVID-19

Corona Virus Disease 2019 (COVID-19) is a highly infectious respiratory illness that was caused by the SARS-CoV-2. It spread around the world in just a few months and became a worldwide pandemic. Quick and accurate diagnosis of infected patients is very important for controlling transmission. In addition to the commonly used Real-time reverse-transcription polymerase chain reaction (RT-PCR) detection techniques, other diagnostic techniques are also emerging endlessly. This article reviews the current diagnostic methods for COVID-19 and discusses their advantages and disadvantages. It provides an important reference for the diagnosis of COVID-19.

First COVID-19 cases with high secondary infection among health workers, Sana'a capital, April 2020: Lessons learned and future opportunities

OBJECTIVES

Confirm existence of COVID-19 outbreak, conduct contact tracing, and recommend control measures.

METHODS

Two COVID-19 cases in Sana'a Capital met the WHO case definition. Data were collected from cases and contacts who were followed for 14 days. Nasopharyngeal swabs were taken for confirmation by Polymerase Chain Reaction (PCR).

RESULTS

Two confirmed Yemeni male patients aged 20 and 40 years who had no travel history were admitted to hospital on 24 April 2020. Regarding the first patient, symptoms started on April 18th, 2020 then the patient improved and was discharged on May 5th, while the second patient's symptoms started on April 22nd but the patient died on April 29th, 2020. Both patients had 54 contacts, 17 (32%) were health workers (HWs). Four contacts (7%) were confirmed, two of them were HWs that needed hospitalization. The secondary attack rate (sAR) was 12% among HWs compared to 5% among other contacts.

CONCLUSIONS

First COVID-19 outbreak was confirmed among Yemeni citizens with a high sAR among HWs. Strict infection control among HWs should be ensured. Physical distancing and mask-wearing with appropriate disinfecting measures should be promoted especially among contacts. There is a need to strengthen national capacities to assess, detect, and respond to public health emergencies.

COVID-19 rhapsody: Rage towards advanced diagnostics and therapeutic strategy

The deadly global outbreak of coronavirus disease-2019 (COVID-19) has forged an unrivaled threat to human civilization. Contemplating its profuse impact, initial risk management and therapies are needed, as well as rapid detection strategies alongside treatments with existing drugs or traditional treatments to provide better clinical support for critical patients. Conventional detection techniques have been considered but do not sufficiently meet the current challenges of effective COVID-19 diagnosis. Therefore, several modern techniques including point-of-care diagnosis with a biosensor, clustered regularly interspaced short palindromic repeats (CRISPR)-associated proteins that function as nuclease (Cas) technology, next-generation sequencing, serological, digital, and imaging approaches have delivered improved and noteworthy success compared to that using traditional strategies. Conventional drug treatment, plasma therapy, and vaccine development are also ongoing. However, alternative medicines including Ayurveda, herbal drugs, homeopathy, and Unani have also been enlisted as prominent treatment strategies for developing herd immunity and physical defenses against COVID-19. All considered, this review can help develop rapid and simplified diagnostic strategies, as well as advanced evidence-based modern therapeutic approaches that will aid in combating the global pandemic.

Manifestations and mechanisms of central nervous system damage caused by SARS-CoV-2

The global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its threat to humans have drawn worldwide attention. The acute and long-term effects of SARS-CoV-2 on the nervous system pose major public health challenges. Patients with SARS-CoV-2 present diverse symptoms of the central nervous system. Exploring the mechanism of coronavirus damage to the nervous system is essential for reducing the long-term neurological complications of COVID-19. Despite rapid progress in characterizing SARS-CoV-2, the long-term effects of COVID-19 on the brain remain unclear. The possible mechanisms of SARS-CoV-2 injury to the central nervous system include: 1) direct injury of nerve cells, 2) activation of the immune system and inflammatory cytokines caused by systemic infection, 3) a high affinity of the SARS-CoV-2 spike glycoprotein for the angiotensin-converting enzyme ACE2, 4) cerebrovascular disease caused by hypoxia and coagulation dysfunction, and 5) a systemic inflammatory response that promotes cognitive impairment and neurodegenerative diseases. Although we do not fully understand the mechanism by which SARS-CoV-2 causes nerve injury, we hope to provide a framework by reviewing the clinical manifestations, complications, and possible mechanisms of neurological damage caused by SARS-CoV-2. With hope, this will facilitate the early identification, diagnosis, and treatment of possible neurological sequelae, which could contribute toward improving patient prognosis and preventing transmission.

Rapid antibody diagnostics for SARS-CoV-2 adaptive immune response

The emergence of a pandemic scale respiratory illness (COVID-19: coronavirus disease 2019) and the lack of the world's readiness to prevent its spread resulted in an unprecedented rise of biomedical diagnostic industries, as they took lead to provide efficient diagnostic solutions for COVID-19. However, these circumstances also led to numerous emergency use authorizations without appropriate evaluation that compromised standards, which could result in a larger than usual number of false-positive or false-negative results, leading to unwanted ambiguity in already confusing realities of the pandemic-hit closures of the world economy. This review is aimed at comparing the claimed or reported clinical sensitivity and clinical specificity of commercially available rapid antibody diagnostics with independently evaluated clinical performance results of the tests. Thereby, we not only present the types of modern antibody diagnostics and their working principles but summarize their experimental evaluations and observed clinical efficiencies to highlight the research, development, and commercialization issues with future challenges. Still, it must be emphasized that the serological or antibody tests do not serve the purpose of early diagnosis but are more suitable for epidemiology and screening populaces with an active immune response, recognizing convalescent plasma donors, and determining vaccine efficacy.

Factors influencing protective behavior in the post-COVID-19 period in China: a cross-sectional study

BACKGROUND

The study aimed to explore the factors influencing protective behavior and its association with factors during the post-COVID-19 period in China based on the risk perception emotion model and the protective action decision model (PADM).

METHODS

A total of 2830 valid questionnaires were collected as data for empirical analysis via network sampling in China. Structural equation modeling (SEM) was performed to explore the relationships between the latent variables.

RESULTS

SEM indicated that social emotion significantly positively affected protective behavior and intention. Protective behavioral intention had significant direct effects on protective behavior, and the direct effects were also the largest. Government trust did not have a significant effect on protective behavior but did have a significant indirect effect. Moreover, it was found that government trust had the greatest direct effect on social emotion. In addition, we found that excessive risk perception level may directly reduce people's intention and frequency of engaging in protective behavior, which was not conducive to positive, protective behavior.

CONCLUSION

In the post-COVID-19 period, theoretical framework constructed in this study can be used to evaluate people's protective behavior. The government should strengthen its information-sharing and interaction with the public, enhance people's trust in the government, create a positive social mood, appropriately regulate people's risk perception, and, finally, maintain a positive attitude and intent of protection.

COVID-19 Associated Mucormycosis: A Systematic Review from Diagnostic Challenges to Management

The coronavirus disease 2019 (COVID-19) outbreak has caused significant destruction, claiming over three million lives worldwide. Post SARS-COV-2 invasion, immunosuppression with hyperglycemia and elevated ferritin levels along with steroidal treatment creates a perfect storm for opportunistic infections. There is increasing evidence of mucormycosis co-infection in COVID-19 patients, during or post-treatment. A worse prognosis, a late diagnosis, and limited guidelines of screening and management of COVID-19 associated mucormycosis have made healthcare professionals fear an epidemic alongside a pandemic. This review geographically reports cases of COVID-19 associated mucormycosis (CAM), evaluates characteristics, clinical manifestations, and outcomes of mucormycosis in COVID-19 active or recovered patients. It further describes preventive strategies and recommendations for optimal management therapy that can be adopted worldwide to curtail an impending threat to the healthcare system.

Understanding Health Communication Through Google Trends and News Coverage for COVID-19: A Multinational Study in Eight Countries

Background

Due to the COVID-19 pandemic, health information related to COVID-19 has spread across news media worldwide. Google is among the most used internet search engines, and the Google Trends tool can reflect how the public seeks COVID-19–related health information during the pandemic.

Objective

The aim of this study was to understand health communication through Google Trends and news coverage and to explore their relationship with prevention and control of COVID-19 at the early epidemic stage.

Methods

To achieve the study objectives, we analyzed the public’s information-seeking behaviors on Google and news media coverage on COVID-19. We collected data on COVID-19 news coverage and Google search queries from eight countries (ie, the United States, the United Kingdom, Canada, Singapore, Ireland, Australia, South Africa, and New Zealand) between January 1 and April 29, 2020. We depicted the characteristics of the COVID-19 news coverage trends over time, as well as the search query trends for the topics of COVID-19–related “diseases,” “treatments and medical resources,” “symptoms and signs,” and “public measures.” The search query trends provided the relative search volume (RSV) as an indicator to represent the popularity of a specific search term in a specific geographic area over time. Also, time-lag correlation analysis was used to further explore the relationship between search terms trends and the number of new daily cases, as well as the relationship between search terms trends and news coverage.

Results

Across all search trends in eight countries, almost all search peaks appeared between March and April 2020, and declined in April 2020. Regarding COVID-19–related “diseases,” in most countries, the RSV of the term “coronavirus” increased earlier than that of “covid-19”; however, around April 2020, the search volume of the term “covid-19” surpassed that of “coronavirus.” Regarding the topic “treatments and medical resources,” the most and least searched terms were “mask” and “ventilator,” respectively. Regarding the topic “symptoms and signs,” “fever” and “cough” were the most searched terms. The RSV for the term “lockdown” was significantly higher than that for “social distancing” under the topic “public health measures.” In addition, when combining search trends with news coverage, there were three main patterns: (1) the pattern for Singapore, (2) the pattern for the United States, and (3) the pattern for the other countries. In the time-lag correlation analysis between the RSV for the topic “treatments and medical resources” and the number of new daily cases, the RSV for all countries except Singapore was positively correlated with new daily cases, with a maximum correlation of 0.8 for the United States. In addition, in the time-lag correlation analysis between the overall RSV for the topic “diseases” and the number of daily news items, the overall RSV was positively correlated with the number of daily news items, the maximum correlation coefficient was more than 0.8, and the search behavior occurred 0 to 17 days earlier than the news coverage.

Conclusions

Our findings revealed public interest in masks, disease control, and public measures, and revealed the potential value of Google Trends in the face of the emergence of new infectious diseases. Also, Google Trends combined with news media can achieve more efficient health communication. Therefore, both news media and Google Trends can contribute to the early prevention and control of epidemics.

Early Spatiotemporal Patterns and Population Characteristics of the COVID-19 Pandemic in Southeast Asia

This observational study aims to investigate the early disease patterns of coronavirus disease 2019 (COVID-19) in Southeast Asia, consequently providing historical experience for further interventions. Data were extracted from official websites of the WHO and health authorities of relevant countries. A total of 1346 confirmed cases of COVID-19, with 217 recoveries and 18 deaths, were reported in Southeast Asia as of 16 March 2020. The basic reproductive number (R0) of COVID-19 in the region was estimated as 2.51 (95% CI:2.31 to 2.73), and there were significant geographical variations at the subregional level. Early transmission dynamics were examined with an exponential regression model: y = 0.30e0.13x (p < 0.01, R2 = 0.96), which could help predict short-term incidence. Country-level disease burden was positively correlated with Human Development Index (r = 0.86, p < 0.01). A potential early shift in spatial diffusion patterns and a spatiotemporal cluster occurring in Malaysia and Singapore were detected. Demographic analyses of 925 confirmed cases indicated a median age of 44 years and a sex ratio (male/female) of 1.25. Age may play a significant role in both susceptibilities and outcomes. The COVID-19 situation in Southeast Asia is challenging and unevenly geographically distributed. Hence, enhanced real-time surveillance and more efficient resource allocation are urgently needed.

An algorithm for the robust estimation of the COVID-19 pandemic's population by considering undetected individuals

Due to the current COVID-19 pandemic, much effort has been put on studying the spread of infectious diseases to propose more adequate health politics. The most effective surveillance system consists of doing massive tests. Nonetheless, many countries cannot afford this class of health campaigns due to limited resources. Thus, a transmission model is a viable alternative to study the dynamics of the pandemic. The most used are the Susceptible, Infected and Removed type models (SIR). In this study, we tackle the population estimation problem of the A-SIR model, which takes into account asymptomatic or undetected individuals. By means of an algebraic differential approach, we design a model-free (no copy system) reduced-order estimation algorithm (observer) to determine the different non-measured population groups. We study two types of estimation algorithms: Proportional and Proportional-Integral. Both shown fast convergence speed, as well as a minimal estimation error. Additionally, we introduce random fluctuations in our analysis to represent changes in the external conditions and which result in poor measurements. The numerical results reveal that both model-free estimators are robust despite the presence of these fluctuations. As a point of reference, we apply the classical Luenberger type observer to our estimation problem and compare the results. Finally, we consider real data of infected individuals in Mexico City, reported from February 2020 to March 2021, and estimate the non-measured populations. Our work's main goal is to proportionate a simple and therefore, an accessible methodology to estimate the behavior of the COVID-19 pandemic from the available data, such that the competent authorities can propose more adequate health politics.

Hemorrhagic and thrombotic manifestations in the central nervous system in COVID-19: A large observational study in the Brazilian Amazon with a complete autopsy series

SARS-CoV-2 affects mainly the lungs, however, other manifestations, including neurological manifestations, have also been described during the disease. Some of the neurological findings have involved intracerebral or subarachnoid hemorrhage, strokes, and other thrombotic/hemorrhagic conditions. Nevertheless, the gross pathology of hemorrhagic lesions in the central nervous system has not been previously described in Brazilian autopsy cases. This study aimed to describe gross and microscopic central nervous system (CNS) pathology findings from the autopsies and correlate them with the clinical and laboratory characteristics of forty-five patients with COVID-19 from Manaus, Amazonas, Brazil. Forty-four patients were autopsied of which thirty-eight of these (86.36%) were positive by RT-PCR for COVID-19, and six (13.3%) were positive by the serological rapid test. Clinical and radiological findings were compatible with the infection. The patients were classified in two groups: presence (those who had hemorrhagic and/or thrombotic manifestations in the CNS) and absence (those who did not present hemorrhagic and/or thrombotic manifestations in the CNS). For risk assessment, relative risk and respective confidence intervals were estimated. Macroscopic or microscopic hemorrhages were found in twenty-three cases (52,27%). The postmortem gross examination of the brain revealed a broad spectrum of hemorrhages, from spots to large and confluent areas and, under microscopy, we observed mainly perivascular discharge. The association analyses showed that the use of corticosteroid, anticoagulant and antibiotic had no statistical significance with a risk of nervous system hemorrhagic manifestations. However, it is possible to infer a statistical tendency that indicates that individuals with diabetes had a higher risk for the same outcome (RR = 1.320, 95% CI = 0.7375 to 2.416, p = 0.3743), which was not observed in relation to other comorbidities. It is unknown whether the new variants of the virus can cause different clinical manifestations, such as those observed or indeed others. As a result, more studies are necessary to define clinical and radiologic monitoring protocols and strategic interventions for patients at risk of adverse and fatal events, such as the extensive hemorrhaging described here. It is imperative that clinicians must be aware of comorbidities and the drugs used to treat patients with COVID-19 to prevent CNS hemorrhagic and thrombotic events.

Measuring the impact of suspending Umrah, a global mass gathering in Saudi Arabia on the COVID-19 pandemic

Since the early days of the coronavirus (COVID-19) outbreak in Wuhan, China, Saudi Arabia started to implement several preventative measures starting with the imposition of travel restrictions to and from China. Due to the rapid spread of COVID-19, and with the first confirmed case in Saudi Arabia in March 2019, more strict measures, such as international travel restriction, and suspension or cancellation of major events, social gatherings, prayers at mosques, and sports competitions, were employed. These non-pharmaceutical interventions aim to reduce the extent of the epidemic due to the implications of international travel and mass gatherings on the increase in the number of new cases locally and globally. Since this ongoing outbreak is the first of its kind in the modern world, the impact of suspending mass gatherings on the outbreak is unknown and difficult to measure. We use a stratified SEIR epidemic model to evaluate the impact of Umrah, a global Muslim pilgrimage to Mecca, on the spread of the COVID-19 pandemic during the month of Ramadan, the peak of the Umrah season. The analyses shown in the paper provide insights into the effects of global mass gatherings such as Hajj and Umrah on the progression of the COVID-19 pandemic locally and globally.

Rhino-orbital-cerebral mucormycosis: fungal epidemic in a viral pandemic

Background

Treatment of coronavirus disease 2019 infection can result in immunosuppression. Rhino-orbital-cerebral mucormycosis is a frequent co-infection, even after recovery.

Methods

An ambispective interventional study was conducted of 41 coronavirus patients with rhino-orbital-cerebral mucormycosis at a tertiary care centre from March to May 2021.

Results

There were 28 males and 13 females with a mean age of 48.2 years (range, 21–68 years). Twelve had long-standing diabetes mellitus and 28 had been recently diagnosed. Thirty-six had received systemic corticosteroids for coronavirus disease 2019. Nasal signs were present in 95 per cent of patients, ophthalmic symptoms and signs in 87 per cent, palatal necrosis in 46.3 per cent, facial signs in 24.3 per cent, nerve palsies in 60.9 per cent, and intracranial involvement in 21.9 per cent. Treatment with amphotericin B was based on clinical features and co-morbidities. Endonasal debridement was performed in 51.2 per cent of patients, total maxillectomy in 14.6 per cent and orbital exenteration in 9.7 per cent. At the last follow up, 37 patients (90.24 per cent) were on antifungal therapy; 4 (9.75 per cent) did not survive.

Conclusion

Early detection may improve survival. Follow up of high-risk patients after coronavirus disease 2019 infection is paramount.

Artificial Intelligence Is Reshaping Healthcare amid COVID-19: A Review in the Context of Diagnosis & Prognosis

Preventing respiratory failure is crucial in a large proportion of COVID-19 patients infected with SARS-CoV-2 virus pneumonia termed as Novel Coronavirus Pneumonia (NCP). Rapid diagnosis and detection of high-risk patients for effective interventions have been shown to be troublesome. Using a large, computed tomography (CT) database, we developed an artificial intelligence (AI) parameter to diagnose NCP and distinguish it from other kinds of pneumonia and traditional controls. The literature was studied and analyzed from diverse assets which include Scopus, Nature medicine, IEEE, Google scholar, Wiley Library, and PubMed. The search terms used were 'COVID-19', 'AI', 'diagnosis', and 'prognosis'. To strengthen the overall performance of AI in COVID-19 diagnosis and prognosis, we segregated several components to perceive threats and opportunities, as well as their inter-dependencies that affect the healthcare sector. This paper seeks to pick out the crucial fulfillment of factors for AI with inside the healthcare sector in the Indian context. Using critical literature review and experts' opinion, a total of 11 factors affecting COVID-19 diagnosis and prognosis were detected, and we eventually used an interpretive structural model (ISM) to build a framework of interrelationships among the identified factors. Finally, the matrice d'impacts croisés multiplication appliquée á un classment (MICMAC) analysis resulted the driving and dependence powers of these identified factors. Our analysis will help healthcare stakeholders to realize the requirements for successful implementation of AI.

The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19

OBJECTIVE

This retrospective study aimed to determine the predictive values of the C-reactive protein (CRP)/albumin ratio (CAR), fibrinogen/albumin ratio (FAR), and neutrophil/lymphocyte ratio (NLR) parameters, which reflect the systemic inflammatory status, for the severity of COVID-19.

METHODS

A total of 188 patients diagnosed with COVID-19 were enrolled in this study. Among them, 118 were in the severe group, and 70 were in the non-severe group. Levels of albumin, CRP, D-dimer, procalcitonin, fibrinogen, and hemoglobin; leukocyte, neutrophil, lymphocyte, and monocyte counts; and the FAR, CAR, and NLR were compared between the two groups.

RESULTS

The CAR, FAR, and NLR values were significantly higher in the severe group compared to the non-severe group. CAR, FAR, and NLR were positively correlated with leukocyte and neutrophil counts and CRP, procalcitonin, and fibrinogen levels. On the other hand, they were inversely correlated with monocyte (except for NLR) and lymphocyte counts. Receiver operator characteristic analysis showed that the area under the curve (AUC) for CAR, FAR, and NLR was 0.841, 0.737, and 0.802, respectively.

CONCLUSIONS

Our investigation revealed that the CAR, FAR, and NLR indices can be used to predict the severity of COVID-19, among which CAR was the best predictor of severe COVID-19.

The mediating role of fear of COVID-19 in the relationship between intolerance of uncertainty and depression

OBJECTIVES

Living during the COVID-19 pandemic is characterized by the emergence of great uncertainty surrounding multiple aspects of daily life. This study explored the relationship between intolerance of uncertainty (IU) and depression, as well as the potential mediation effect of COVID-19-related fear.

DESIGN AND METHODS

A cross-sectional study was conducted through an online survey from 10 April until 13 April 2020, three weeks after a national lockdown had been imposed in Greece. The convenience sample used in this study consisted of 2,827 adults. Participants voluntarily provided sociodemographic data and completed the following scales: the Intolerance of Uncertainty Scale (IUS-12), the Fear of COVID-19 Scale (FCV-19S), and the Brief Patient Health Questionnaire (PHQ-9) Depression Scale.

RESULTS

Participants appeared to be moderately depressed [M = 14.75, SD = 4.52]. There was a significant indirect effect of IU to depressive symptoms ((.058), CI (0.051-0.066)). FCV-19S was tested as a mediator in the relationship between IUS-12 (independent variable) and PHQ-9 (dependent variable). Partial mediation of fear of COVID-19 was supported ((.54) (.41) = 13, CI (0.051-0.066), Sobel z-value = 14.93).

CONCLUSIONS

Depressive symptomatology affected study participants at a moderate level. IU was shown to be a significant predictor of depressive symptomatology with higher levels of IU being associated with more severe depressive symptoms. Fear of COVID-19 partially mediated this association. The mediation effect may be explained by the uncertainty around COVID-19-related health issues, which are reflected in the FCV-19S and cause worry and/or anxiety. Uncertainty related with other factors, such as the impact on the economy and education, not assessed by the FCV-19S, may explain part of the relationship between IU and depressive symptoms that is not mediated by FCV-19S.

PRACTITIONER POINTS

Intolerance of uncertainty is related to depressive symptomatology, and fear of COVID-19 explains part of the relation. Fear of COVID-19 indicates worry and anxiety related to health issues. Psychotherapeutic interventions enhancing individuals' capacity to endure uncertainty could be beneficial. Provision of simple and clear information by the authorities should be a priority issue.

Evaluation of invasive ventilation rate and comorbidities, clinical signs and lab findings among COVID-19 patients

The severity of COVID-19 has been to be associated with comorbidities. It is defined as the presentation of severe respiratory dysfunction or failure, leading to the need for ventilation and mortality. The aim of this study is the evaluate the factors predicting the rate of invasive ventilation among these patients. This retrospective study involved 317 COVID-19 patients referred to (XXX) Hospital in Qom, Iran. The following data were obtained for all the patients: demographic parameters, comorbidities, need for mechanical ventilation, signs and symptoms and lab findings. The results from the demographic data of the study indicated that the need for mechanical ventilation is significantly associated with advanced age, p = 0.001. Additionally, hypertension, leukopenia and blood urea nitrogen to creatinine ratio p = 0.008. p = 0.042 and p < 0.001, respectively, are significantly associated with an increased need for mechanical ventilation. Malignancy, diabetes, asthma, chronic obstructive pulmonary disease, headache, fever, platelet count, prothrombin time, c-reactive protein, erythrocyte sedimentation rate and creatinine phosphatase were not significantly different in the two groups, p > 0.05. Prediction of the extent of severity among COVID-19 patients using clinical parameters and comorbidities prepare medical practitioners and health care centres to take immediate measurements and reduce the burden of the scarcity of health supplies and care.

Thiol level and total oxidant/antioxidant status in patients with COVID-19 infection

Background

Accumulating evidence suggests that oxidative stress is closely related to the pathogenesis and severity of COVID-19 infection. Here, we attempted to compare thiol, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) levels between COVID-19 patients who need and do not need intensive care unit (ICU) support, and determine whether these markers could be used as predictors of ICU admission.

Methods

We recruited 86 patients with COVID-19 infection and classified them into two groups according to the level of care: ICU group (n = 40) and non-ICU group (n = 46). Thiol, TAS, TOS, and OSI levels were determined and compared between the two groups.

Results

The levels of thiol and TAS in serum were markedly lower in ICU patients than in the non-ICU patients. On the contrary, TOS and OSI levels were markedly higher. Inflammatory markers, including white blood cell, neutrophil, C-reactive protein, procalcitonin, and ferritin, were negatively correlated with the thiol and TAS, and positively correlated with the TOS and OSI. We determined that areas under the ROC curve for thiol, TAS, TOS, and OSI were 0.799, 0.778, 0.713, and 0.780, respectively.

Conclusions

Our results revealed that the increase in oxidative stress and decrease in antioxidant levels in COVID-19-infected patients were associated with worsening of disease. Thiol, TAS, TOS, and OSI parameters can be used to distinguish between ICU patients and those who do not, among which thiol was the best predictor of ICU requirement.

Ultrasound Studies of COVID-19-Positive Patients and Patient Under Investigation: Pandemic Experience of Body Imaging Division at a Tertiary Medical Center

ABSTRACT

This retrospective study shares our departmental experience of screening of ultrasound (US) requests, triaging of studies, and abbreviated US protocols implemented during the COVID-19 pandemic. For US studies requested in April and May 2020, the following data were collected: type of study, indication, COVID-19 status (positive or patient under investigation [PUI]), decision to perform study, US findings, and location of patient. A total of 196 US studies in 150 patients were included. The median age of patients was 60 years (female: 46.7% [70/150]). At the time of study request, 83 patients (55.3%) were COVID-19-positive and 67 (44.7%) were PUI, of which 8 (11.9%) tested positive after waiting for test result. The most frequently requested study was venous extremity Doppler (51%), followed by right upper quadrant (20.4%), renal (11.7%), and liver duplex (6.6%). After radiologist screening and triage of US requests, 156 studies were performed (79.6%), 15 were postponed until COVID test result (7.6%), and 40 were not performed after discussion with ordering provider (20.4%). Notably, 40.1% of studies performed on COVID-19-positive patients yielded pathological findings, most frequently deep venous thrombosis (18.1%), medical renal disease (7.6%), and gall bladder sludge (5.7%). Abbreviated US protocols were used in 29.4% of studies. In conclusion, US study screening and triage played an important role to optimize care of COVID-19 patients and PUIs.

Stroke Associated with SARS-CoV-2 Infection and its Pathogenesis: A Systematic Review

INTRODUCTION

The change of stroke incidence during the COVID-19 pandemic period and the proposed mechanisms of the relationship between SARS-CoV-2 and stroke is reviewed.

METHODS

Web of Science, PMC/Medline, and Scopus databases were searched until July 2020 without time and language limitations. After quality assessment, 22 articles were included in this study.

RESULTS

Based on the results, it is impossible to conclude any definite relationship between the rising or decreasing stroke frequency or the shift in the ischemic and hemorrhagic ratio and SARS-CoV-2 infection. However, it appears that SARS-CoV-2 infection has some correlation with stroke. The supposed mechanisms for the SARS-CoV-2-related hemorrhagic stroke include 1) SARS-CoV-2-related vasculopathy with the endothelial damage of small vessels, 2) viral infection-induced platelet dysfunction or thrombocytopenia, and 3) activation of the proinflammatory cascade leading to coagulopathy. The helpful strategies are receiving therapeutic anticoagulation for high D-dimer or a known thrombus due to SARS-CoV-2 infection, as well as using extracorporeal membrane oxygenation (ECMO) in some patients. Furthermore, the possible mechanisms for the SARS-CoV-2-related ischemic stroke include 1) dysregulation of angiotensin-converting enzyme 2 (a key host cellular receptor for SARSCoV-2)-related physiologic functions, 2) endothelial cell damages, 3) thrombo-inflammation, and 4) coagulopathy and coagulation abnormalities related to SARS-CoV-2 infection.

CONCLUSION

A better understanding of the SARS-CoV-2 pathogenesis and its relation to neurologic abnormalities such as stroke can help to design new therapeutic approaches.

Relationship between chest computed tomography findings and clinical conditions of coronavirus disease (COVID-19): A multicentre experience

AIMS

This study aimed to investigate the clinical and chest computed tomography (CT) features associated with clinical parameters for coronavirus disease (COVID-19) in the capital of Turkey, Ankara.

MATERIALS AND METHODS

Epidemiological, clinical features, laboratory findings and radiological characteristics of 1563 hospitalised patients with COVID-19 in Ankara were collected, reviewed and analysed in this study. The risk factors associated with disease severity were investigated.

RESULTS

Non-severe (1214; 77.7%) and severe cases (349; 22.3%) were enrolled in the study. Compared with the non-severe group, the severe group were significantly older and had more comorbidities (ie, hypertension, diabetes mellitus, cardiovascular disease and chronic kidney disease). Smoking was more common in the severe group. Severe patients had higher respiratory rates and higher incidences of cough and dyspnoea compared with non-severe patients. Compared with the non-severe patients, the severe patients had increased C-reactive protein (CRP), procalcitonin, neutrophil to lymphocyte ratio (NLR) and CRP/albumin ratio and decreased albumin. The occurrence rates of consolidation, subpleural sparing, crazy-paving pattern, cavity, halo sign, reversed halo sign, air bronchogram, pleural thickening, micronodule, subpleural curvilinear line and multilobar and bilateral involvement in the CT finding of the severe patients were significantly higher than those of the non-severe patients.

CONCLUSIONS

Many factors are related to the severity of COVID-19, which can help clinicians judge the severity of the patient and evaluate the prognosis. This cohort study revealed that male sex, age (≥55 years), patients with any comorbidities, especially those with cardiovascular disease, dyspnoea, increased CRP, D-dimer and NLR, and decreased lymphocyte count and CT findings of consolidation and multilobar involvement were predictors of severe COVID-19.

Exploring short term spatio-temporal pattern of PM2.5 and PM10 and their relationship with meteorological parameters during COVID-19 in Delhi

Present study aims to examine the impact of lockdown on spatio-temporal concentration of PM2.5 and PM10 - categorized and recorded based on its levels during pre-lockdown, lockdown and unlock phases while noting the relationship of these levels with meteorological parameters (temperature, wind speed, relative humidity, rainfall, pressure, sun hour and cloud cover) in Delhi. To aid the study, a comparison was made with the last two years (2018 to 2019), covering the same periods of pre-lockdown, lockdown and unlock phases of 2020. Correlation analysis, linear regression (LR) was used to examine the impact of meteorological parameters on particulate matter (PM) concentrations in Delhi, India. The findings showed that (i) substantial decline of PM concentration in Delhi during lockdown period, (ii) there were substantial seasonal variation of particulate matter concentration in city and (iii) meteorological parameters have close associations with PM concentrations. The findings will help planners and policy makers to understand the impact of air pollutants and meteorological parameters on infectious disease and to adopt effective strategies for future.

Impact of nonpharmacological COVID-19 interventions in hospitalizations for childhood pneumonia in Brazil

BACKGROUND AND OBJECTIVE

The knowledge about the impact of the nonpharmacological measures to control the COVID-19 pandemic can give insight into ways in which they can also be applied for other respiratory diseases. To assess the impact of containment measures of the COVID-19 pandemic on pneumonia hospitalizations in children from 0 to 14 years of age in Brazil.

METHODS

Data from hospital admissions for pneumonia were obtained from the Department of Informatics of Brazilian Public Health System database in the period of 2015-2020 and analyzed by macroregions and age groups. To evaluate the effect of containment measures, on the incidence of pneumonia, the absolute reduction and relative reduction were calculated by analyzing the subsets 2015-2019 vs. 2020.

RESULTS

Comparing the subsets of April-August 2015-2019 vs. April-August 2020 for Brazil (total), there was an significant reduction in the average incidence of hospitalizations, with numbers ranging from -82% [IRR 0.17 (0.14-0.21)] for <4 years (prepandemic 741.8/100,000 vs. pandemic 132.7/100.000), -83% [IRR 0.17 (0.10-0.27)] for 5-9 years (prepandemic 113.6/100,000 vs. pandemic 19.6/100.000), -77% [IRR 0.23 (0.11-0.46)] for 10-14 (prepandemic 42.0/100,000 vs. pandemic 9.8/100.000) and -82% [IRR 0.18 (0.15-0.21)] for all children ≤14 years (prepandemic 897.4/100,000 vs. pandemic 162.1/100.000).

CONCLUSION

We found a significant decrease in cases of all cause pneumonia in children under 14 years and especially in the age group <9 years during the COVID-19 pandemic, which may be associated with the nonpharmacological measures applied to control the SARS-CoV-2.

Hepatitis C Virus Protease Inhibitors Show Differential Efficacy and Interactions with Remdesivir for Treatment of SARS-CoV-2 In Vitro

Antivirals targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could improve treatment of COVID-19. We evaluated the efficacy of clinically relevant hepatitis C virus (HCV) NS3 protease inhibitors (PIs) against SARS-CoV-2 and their interactions with remdesivir, the only direct-acting antiviral approved for COVID-19 treatment. HCV PIs showed differential potency in short-term treatment assays based on the detection of SARS-CoV-2 spike protein in Vero E6 cells. Linear PIs boceprevir, telaprevir, and narlaprevir had 50% effective concentrations (EC₅₀) of ∼40 μM. Among the macrocyclic PIs, simeprevir had the highest (EC₅₀, 15 μM) and glecaprevir the lowest (EC₅₀, >178 μM) potency, with paritaprevir, grazoprevir, voxilaprevir, vaniprevir, danoprevir, and deldeprevir in between. Acyclic PIs asunaprevir and faldaprevir had EC₅₀s of 72 and 23 μM, respectively. ACH-806, inhibiting the HCV NS4A protease cofactor, had an EC₅₀ of 46 μM. Similar and slightly increased PI potencies were found in human hepatoma Huh7.5 cells and human lung carcinoma A549-hACE2 cells, respectively. Selectivity indexes based on antiviral and cell viability assays were highest for linear PIs. In short-term treatments, combination of macrocyclic but not linear PIs with remdesivir showed synergism in Vero E6 and A549-hACE2 cells. Longer-term treatment of infected Vero E6 and A549-hACE2 cells with 1-fold EC₅₀ PI revealed minor differences in the barrier to SARS-CoV-2 escape. Viral suppression was achieved with 3- to 8-fold EC₅₀ boceprevir or 1-fold EC₅₀ simeprevir or grazoprevir, but not boceprevir, in combination with 0.4- to 0.8-fold EC₅₀ remdesivir; these concentrations did not lead to viral suppression in single treatments. This study could inform the development and application of protease inhibitors for optimized antiviral treatments of COVID-19.

What it takes to save lives: An assessment of water, sanitation, and hygiene facilities in temporary COVID-19 isolation and treatment centers of Southern Ethiopia: A mixed-methods evaluation

Background

Quality water, sanitation, and hygiene facilities act as barricades to the transmission of COVID-19 in health care facilities. These facilities ought to also be available, accessible, and functional in temporary treatment centers. Despite numerous studies on health care facilities, however, there is limited information on the status of WASH facilities in such centers.

Methods

The assessment of health care facilities for the COVID-19 response checklist and key informant interviews, were used for data collection. 35 treatment centers in Southern Ethiopia were surveyed. Eightkey informants were interviewed to gain an understanding of the WASH conditions in the treatment centers. The Quantitative data was entered using EPI-INFO 7 and exported to SPSS 20 for analysis. Results are presented using descriptive statistics. Open Code 4.02 was used for the thematic analysis of the qualitative data.

Results

Daily water supply interruptions occurred at 27 (77.1%) of the surveyed sites. Only 30 (85.72%) had bathrooms that were segregated for personnel and patients, and only 3 (3.57%) had toilets that were handicapped accessible. 20(57.2%) of the treatment centers did not have a hand hygiene protocol that satisfied WHO guidelines. In terms of infection prevention and control, 16 (45.71%) of the facilities lacked adequate personal protective equipment stocks. Between urban and rural areas, there was also a significant difference in latrine maintenance, hand hygiene protocol design and implementation, and incineration capacity.

Conclusion

The results reveal crucial deficiencies in the provision of WASH in the temporary COVID-19 treatment centers. Efforts to improve WASH should offer priority to hygiene service interventions to minimize the risk of healthcare-acquired infections. The sustainable provision of hygiene services, such as hand washing soap, should also be given priority.

Self-collected unstimulated saliva, oral swab, and nasopharyngeal swab specimens in the detection of SARS-CoV-2

OBJECTIVES

The presence of SARS-CoV-2 virus in the saliva of patients infected with COVID-19 has been confirmed by several studies. However, the use of saliva for the diagnosis of COVID-19 remains limited, because of the discrepancies in the results, which might be due to using different saliva sampling methods. The purpose of this study was to compare the consistency of SARS-CoV-2 detection using two different saliva sampling methods (oral swab and unstimulated saliva) to that of the standard nasopharyngeal swab.

METHODS

Fifty-five subjects were recruited from a pool of COVID-19 inpatient at the Hospital Israelita Albert Einstein (HIAE), Brazil. Nasopharyngeal swab, oral swab, and self-collected unstimulated saliva samples were examined for SARS-CoV-2 using RT-PCR.

RESULTS

Self-collected unstimulated saliva demonstrated 87.3% agreement in the detection of SARS-CoV-2 virus as compared with the nasopharyngeal swab, while oral swab displayed 65.9% agreement when compared to nasopharyngeal swab and 73% when compared to self-collected unstimulated saliva.

CONCLUSION

Unstimulated self-collected saliva samples have shown a higher agreement with the nasopharyngeal swab samples for SARS-COV-2 detection than that obtained when using oral swab samples.

CLINICAL RELEVANCE

This study compares the accuracy of COVID-19 test using different saliva sampling methods to that of nasopharyngeal swab. Given the need for a simple self-applied test that can be performed at home, our findings support the efficacy of self-collected unstimulated saliva samples in the diagnosis of SARS-CoV-2 infection, alleviating the demands for swab supplies, personal protective equipment, and healthcare personnel.

Newly Diagnosed Diabetes in Patients with COVID-19: Different Types and Short-Term Outcomes

A great global concern is currently focused on the coronavirus disease 2019 (COVID-19) pandemic and its associated morbidities. The goal of this study was to determine the frequency of newly diagnosed diabetes mellitus (DM) and its different types among COVID-19 patients, and to check the glycemic control in diabetic cases for three months. After excluding known cases of DM, 570 patients with confirmed COVID-19 were studied. All participants were classified as non-diabetic or newly discovered diabetic. According to hemoglobin A1c (HbA1c) and fasting insulin, newly discovered diabetic patients were further classified into pre-existing DM, new-onset type 1 DM, and new-onset type 2 DM. Glycemic control was monitored for three months in newly diagnosed diabetic patients. DM was diagnosed in 77 patients (13.5%); 12 (2.1%) with pre-existing DM, 7 (1.2%) with new-onset type 1 DM, and 58 (10.2%) with new-onset type 2 DM. Significantly higher rates of severe infection and mortality (p < 0.001 and p = 0.046) were evident among diabetic patients. Among survived diabetic patients (n = 63), hyperglycemia and the need for anti-diabetic treatment persisted in 73% of them for three months. COVID-19 was associated with a new-onset of DM in 11.4% of all participants and expression of pre-existing DM in 2.1% of all participants, both being associated with severe infection. COVID-19 patients with newly diagnosed diabetes had high risk of mortality. New-onset DM persisted for at least three months in more than two-thirds of cases.