Clinics in diagnostic imaging (207). Coronavirus disease 2019 (COVID-19) atypical pneumonia

One Year on: An Overview of Singapore's Response to COVID-19-What We Did, How We Fared, How We Can Move Forward

Background-One year has passed since the first COVID-19 case in Singapore. This scoping review commemorates Singaporean researchers that have expanded the knowledge on this novel virus. We aim to provide an overview of healthcare-related articles published in peer-reviewed journals, authored by the Singapore research community about COVID-19 during the first year of the pandemic. Methods-This was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. It included healthcare-related articles about COVID-19 published between 23 January 2020 and 22 January 2021 with a Singapore-affiliated author. MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Google Scholar, and local journals were searched. The articles were screened independently by two reviewers. Results-The review included 504 articles. Most of the articles narrated the changes to hospital practice (210), while articles on COVID-19 pathology (94) formed most of the non-narrative papers. Publications on public health (61) and the indirect impacts to clinical outcomes (45) were other major themes explored by the research community. The remaining articles detailed the psychological impact of the pandemic (35), adaptations of medical education (30), and narratives of events (14). Conclusion-Amidst a resurgence of community cases involving variant COVID-19 strains, the resources from the research community will provide valuable guidance to navigate these uncertain times.

Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months

As of 27 October 2020, there have been 57,980 confirmed cases of COVID-19 in Singapore, with 28 fatalities. To summarise the Singapore experience in managing and containing COVID-19 based on available published data and from relevant sources, a review of literature using research databases such as PubMed and OVID Medline, along with non-peer-reviewed articles and other sources, was conducted with the search terms ‘COVID-19’ and ‘Singapore’. Research conducted in Singapore has provided insight into the clinical manifestations and period of infectivity of COVID-19, demonstrated evidence of pre-symptomatic transmission, linked infection clusters using serological tools, and highlighted aspects of hospital-based environmental contamination. It has also provided guidance for diagnostic testing and has described immune and virologic correlates with disease severity. Evidence of effectiveness of containment measures such as early border control, rigorous contact training, and calibrated social distancing measures have also been demonstrated. Singapore’s multipronged strategy has been largely successful at containing COVID-19 and minimising fatalities, but the risk of re-emergence is high. Keywords: Epidemiology, management, prevention, transmission

Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?

Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophila and Acinetobacter baumannii; Candida species and Aspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus. Influenza A was one of the most common co-infective viruses, which may have caused initial false-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory and imaging findings alone cannot help distinguish co-infection from SARS-CoV-2 infection. Newly developed syndromic multiplex panels that incorporate SARS-CoV-2 may facilitate the early detection of co-infection among COVID-19 patients. By contrast, clinicians cannot rule out SARS-CoV-2 infection by ruling in other respiratory pathogens through old syndromic multiplex panels at this stage of the COVID-19 pandemic. Therefore, clinicians must have a high index of suspicion for coinfection among COVID-19 patients. Clinicians can neither rule out other co-infections caused by respiratory pathogens by diagnosing SARS-CoV-2 infection nor rule out COVID-19 by detection of non-SARS-CoV-2 respiratory pathogens. After recognizing the possible pathogens causing co-infection among COVID-19 patients, appropriate antimicrobial agents can be recommended.

Detection of Coronavirus Disease (COVID-19) using Radiological Examinations

An outbreak of Coronavirus disease 2019 (COVID-19) occurred in China. The causative agent of COVID-19 is Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The disease rapidly spreads from China to the world by trading and traveling. Until April 24, 2020, approximately 2,544,792 cases were confirmed with 175,694 deaths throughout the world. The highest number of cases were identified from the United States of America (USA) whereas the mortality rate is high in Portugal. The diagnosis of COVID-19 is based on Computed Tomography Scanning (CT Scan) and Real-Time Reverse Transcription Polymerase Chain Reaction (qRT-PCR). Assessing the extension of pathology, the exact location of the area involved, and assessment of the disease severity makes CT scan superior to other modalities. This review shows that real-time polymerase chain reaction and imaging technology both play an important role in the diagnosis of COVID-19. However, imaging modalities have more importance in diagnosis and screening than qRT-PCR. The qRT-PCR was positive in 81.3% whereas CT scan abnormality was observed in 89.8%. Bilateral lobe (51.4%) abnormality was found more than a single lobe (21.5%) in COVID-19 infected patients. The CT scan reports show a high-level abnormality in right lower lung lobe than others in COVID-19 infected patients. The CT scan evaluates different manifestations such as the presence of ground-glass opacities, consolidations, crazy paying linear, cavitation, discrete nodules, pleural effusion, and lymphadenopathy. It is concluded that imaging technology especially CT scan and X-rays play an important role in the screening and diagnosis of COVID-19 infected patients in limited access to qRT-PCR regions. The common radiological manifestation was also determined, which will be helpful for the radiologist to diagnosed COVID-19 infected patients in the early stages. Follow up studies required regarding the radiological examinations.