COVID-19 research and commentary

Please note that work published in MedRxiv are unrefereed preprints. Unrefereed preprints have not yet been peer-reviewed. They report new medical research that has yet to be evaluated and so should not be used to guide clinical practice. You can read more about the implications of this here: https://www.medrxiv.org/content/what-unrefereed-preprint 

We are grateful to the PHE COVID-19 Literature Digest Team for compiling and sharing the resources below. 

Diagnostics and Genomics

Date of publication

Title / URL

Journal / Publication type

Digest

02.04.2020

Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England

JMIR Public Health and Surveillance / Article

  • Established national RCGP RSC influenza surveillance system converted into one that can test effectiveness of COVID-19 containment policy. 
  • General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, the authors have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. 
  • Rapid sharing of this protocol should enable scientific critique and shared learning.

02.04.2020

A case of imported COVID-19 diagnosed by PCR-positive lower respiratory specimen but with PCR-negative throat swabs

Infectious Diseases  / Case report

  • Case study of a 35-year-old woman who presented with fever and travel history to Wuhan, China, but lacked respiratory symptoms.
  • CT scan revealed pneumonia but initial PCR test on throat swab was negative for SARS-CoV-2. 
  • On hospital day 5, PCR test on induced sputum was positive, but a second test on throat swab remained negative. 
  • Authors suggest that a lower respiratory tract specimen would aid better diagnosis, even in the absence of respiratory symptoms for patients with significant travel or exposure history.

02.04.2020

Gargle lavage as a safe and sensitive alternative to swab samples to diagnose COVID-19: a case report in Japan

Clinical infectious diseases / Letter

  • Case in which gargle lavage samples yielded a positive PCR result.  
  • For other respiratory pathogens, gargle lavage samples have been have been reported to be more sensitive than throat swab. Gargle lavage can be done by patients themselves without putting healthcare professionals at increased risk and so offer a safer and possibly more sensitive alternative or additional option for diagnosing COVID-19.

02.04.2020

Whole genome and phylogenetic analysis of two SARS-CoV-2 strains isolated in Italy in January and February 2020: additional clues on multiple introductions and further circulation in Europe

Eurosurveillance / Rapid communication

  • The authors characterised the full-genome sequence of two SARS-CoV-2 strains isolated from two patients diagnosed in Italy. 
  • The first patient was a Chinese tourist from Wuhan diagnosed at the end of January, who had visited Rome and not been in areas of Italy later found to be the initially affected areas of the epidemic in Lombardy. The second patient was an Italian person, with no apparent direct epidemiological link with China and who was diagnosed in the second half of February in Lombardy. 
  • The sequences presented are analysed in the context of other available genome sequences from Europe and elsewhere.

01.04.2020

Insights into The Codon Usage Bias of 13 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Isolates from Different Geo-locations

bioRxiv (not peer-reviewed) / Article

  • Analysed genome-wide codon usage patterns in 13 SARS-CoV-2 isolates from 13 different geo-locations (countries) by utilizing different CUB measurements.
  • The outcome of this study may help in understanding the underlying factors involved in the evolution of SARS-CoV-2 viruses and interactions with their host, also it may aid in vaccine design strategies.

31.03.2020

SARS-CoV-2 receptor and entry genes are expressed by sustentacular cells in the human olfactory neuroepithelium

bioRxiv (not peer-reviewed) / Article

  • Reports have indicated an association between SARS-CoV-2 infection and anosmia, suggesting an alteration not restricted to the respiratory tissue, but that might also include the olfactory sensory epithelium. This was explored by generating RNA-seq libraries from human neuroepithelium, in which the authors found significant expression of ACE2 and TMPRSS2. 
  • To determine whether specific cell types of this chemosensory tissue may coexpress both of the virus entry genes, they analysed a scRNA-seq dataset. They determined that sustentacular cells, which are in direct contact with the external world and maintain the integrity of olfactory sensory neurons, represents a prime candidate for SARS-CoV-2 infection via the nose, and possibly for SARS-CoV-2-induced anosmia.

31.03.2020

Virus-host interactome and proteomic survey of PMBCs from COVID-19 patients reveal potential virulence factors influencing SARS-CoV-2 pathogenesis

bioRxiv (not peer-reviewed) / Article

  • Integrated proteomics approach to systematically investigate intra-viral and virus-host interactomes for the identification of unrealized SARS-CoV-2 host targets and participation of cellular proteins in the response to viral infection using peripheral blood mononuclear cells (PBMCs) isolated from COVID-19 patients.
  • From the interactome, identified that non-structural protein nsp9 and nsp10 interact with NKRF, a NF-kB repressor, and may precipitate the strong IL-8/IL-6 mediated chemotaxis of neutrophils and overexuberant host inflammatory response observed in COVID-19 patients.

30.03.2020

Comparative genomics suggests limited variability and similar evolutionary patterns between major clades of SARS-Cov-2

bioRxiv (not peer-reviewed) / Article

  • Phylogenomic analysis of SARS-Cov-2 as available from publicly available repositories suggests the presence of 4 prevalent groups of viral episomes (super-clades), which are mostly associated with outbreaks in distinct geographic locations (China, USA and Europe).
  • Authors analysed more than 1100 complete, high quality SARS-Cov-2 genome sequences, and provide evidence for absence of distinct evolutionary patterns/signatures in genomes of currently known major clades of SARS-Cov-2. 
  • Evidence presented is strongly consistent with the notion that the biased geographic distribution of SARS-Cov-2 isolates should not be associated with adaptive evolution of this novel pathogen.

30.03.2020

Performance of VivaDiagTM COVID-19 IgM/IgG Rapid Test is inadequate for diagnosis of COVID-19 in acute patients referring to emergency room department

J Med Virol / Letter

  • Report results of a study performed in an emergency room department of a tertiary hospital in Northern Italy to validate VivaDiagTM COVID-19 IgM/IgG Rapid Test lateral flow immunoassay (LFIA) for the rapid diagnosis of COVID-19. 
  • Based on their results, VivaDiagTM COVID-19 IgM/IgG Rapid Test LFIA is not recommended for triage of patients with suspected COVID-19.

30.03.2020

ACE2 and TMPRSS2 variants and expression as candidates to sex and country differences in COVID-19 severity in Italy

medRxiv (not peer-reviewed) / Article

  • Prognostic markers for early identification of high-risk individuals are an urgent medical need. Authors searched for possible genetic components of peculiar severity of COVID-19 among Italians, by looking at expression levels and variants in ACE2 and TMPRSS2 genes, which are crucial for viral infection.
  • Exome and SNP array data from a large Italian cohort representative of Italy's population were used to compare the burden of rare variants and frequency of polymorphisms with European and East Asian populations. 
  • No significant evidence that ACE2 associated with disease severity/sex bias in Italian population, TMPRSS2 levels and genetic variants proved to be possible candidate disease modulators, contributing to the observed epidemiological data among Italian patients. 
  • Analysis suggests a role for TMPRSS2 variants and expression levels in modulating COVID-19 severity, a hypothesis that fosters a rapid experimental validation on large cohorts of patients with different clinical manifestations.

30.03.2020

The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2

Cardiovasc Res / Research letter

  • This study performed the first state-of-art single cell atlas of adult human heart, and revealed that pericytes with high expression of ACE2 might act as the target cardiac cell of SARS-CoV-2.

30.03.2020

Reply to: 'Interaction between RAAS inhibitors and ACE2 in the context of COVID-19'

Nat Rev Cardiol / Correspondence

30.03.2020

Diagnostic performance of chest CT to differentiate COVID-19 pneumonia in non-high-epidemic area in Japan

Jpn J Radiol / Special report

  • Evaluated the diagnostic performance of chest CT to differentiate COVID-19 pneumonia (n=29) in non-high-epidemic area in Japan.
  • All patients confirmed COVID-19 pneumonia had bilateral GGO- and peripheral-predominant lesions without airway abnormalities, mediastinal lymphadenopathy, and pleural effusion. The five CT criteria showed moderate to excellent diagnostic performance with area under the curves (AUCs) ranging 0.77-0.88 for R1 and 0.78-0.92 for R2. The criterion (e) showed the highest AUC.
  • CONCLUSION: Chest CT would play a supplemental role to differentiate COVID-19 pneumonia from other respiratory diseases presenting with similar symptoms in a clinical setting.

29.03.2020

The correlation between viral clearance and biochemical outcomes of 94 COVID-19 infected discharged patients

Inflammation Research / Original Research Article

  • This study evaluated the correlation between viral clearance and blood biochemical index of 94 discharged patients with COVID-19 infection in Shenzhen Third People's Hospital, enrolled from Jan 5 to Feb 13, 2020.
  • COVID-19 mRNA clearance ratio was identified significantly correlated with the decline of serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels. Furthermore, COVID-19 mRNA clearance time was positively correlated with the length of hospital stay in patients treated with either IFN-α + lopinavir/ritonavir or IFN-α + lopinavir/ritonavir + ribavirin. 
  • Conclusions: Therapeutic regimens of IFN-α + lopinavir/ritonavir and IFN-α + lopinavir/ritonavir + ribavirin might be beneficial for treatment of COVID-19. Serum LDH or CK decline may predict a favourable response to treatment of COVID-19 infection.

23.03.2020

A Genomic Perspective on The Origin and Emergence of SARSCoV-2

Cell / Commentary

  • The authors describe what genomic data reveals about the emergence SARS-CoV-2 and discuss the gaps in our understanding of its origins.

23.03.2020

Drive-Through Screening Center for COVID-19: a Safe and Efficient Screening System against Massive Community Outbreak

J Korean Med Sci / Article

  • The authors present the overall concept, advantages, and limitations of the COVID-19 DT screening centers.
  • The steps of the DT centers include registration, examination, specimen collection, and instructions - the entire service takes about 10 minutes for one testee without leaving his or her car.
  • Increased testing capacity over 100 tests per day and prevention of cross-infection between testees in the waiting space are the major advantages, while protection of staff from the outdoor atmosphere is challenging - it could be implemented in other countries to cope with the global COVID-19 outbreak and transformed according to their own situations.

23.03.2020

Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study

Lancet Infectious Diseases / Article

  • Posterior oropharyngeal saliva samples are a non-invasive specimen more acceptable to patients and health-care workers.
  • Unlike severe acute respiratory syndrome, patients with COVID-19 had the highest viral load near presentation, which could account for the fast-spreading nature of this epidemic.
  • This finding emphasises the importance of stringent infection control and early use of potent antiviral agents, alone or in combination, for high-risk individuals. Serological assay can complement RT-qPCR for diagnosis.

23.03.2020

Recommendations by the SEPD and AEG, both in general and on the operation of gastrointestinal endoscopy and gastroenterology units, concerning the current SARS-CoV-2 pandemic (March, 18)

Rev Esp Enferm Dig / Article

  • The presence of SARS-CoV-2 RNA in the faeces of patients infected with the virus, and occasionally in colonic biopsy samples, has been consistently documented.
  • In fact, viral elimination in the faeces may be more prolonged than viral identification in respiratory tract secretions.
  • Viral transmission may occur in asymptomatic individuals; however, as of this moment no information has been reported on the possibility of viral transmission, even to professionals, via this route

23.03.2020

Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection

Am J Respir Crit Care Med  /Case series

  • The study provides initial insights into the viral clearance kinetics and the ability of the virus to persist even after the resolution for as long as 8 days, which may pose a significant challenge in controlling the spread of the disease.

23.03.2020

SARS-CoV-2: virus dynamics and host response

Lancet Infectious Diseases / Comment

  • The high viral load during the early phase of illness suggests that patients could be most infectious during this period, and it might account for the high transmissibility of SARS-CoV-2.
  • The high viral load on presentation suggests that SARS-CoV-2 could be susceptible to emergence of antiviral resistance.
  • Age was associated with viral load in this study, which could explain the high degree of severe disease in older patients with SARS-CoV-2.

23.03.2020

AI-assisted CT imaging analysis for COVID-19 screening: Building and deploying a medical AI system in four weeks

medRxiv (not peer-reviewed) / Article

  • The authors present their experience in building and deploying an AI system that automatically analyses CT images to detect COVID-19 pneumonia features. Using 1,136 training cases (723 positives for COVID-19) from five hospitals, they were able to achieve a sensitivity of 0.974 and specificity of 0.922 on the test dataset, which included a variety of pulmonary diseases.  As of today, they have deployed the system in 16 hospitals, and it is performing over 1,300 screenings per day in China.

21.03.2020

Profiling Early Humoral Response to Diagnose Novel Coronavirus Disease (COVID-19)

Clinical Infectious Diseases / Accepted manuscript

  • The host humoral response against SARS-CoV-2 including IgA, IgM and IgG response were examined by using an ELISA based assay on the recombinant viral nucleocapsid protein.
  • Total 208 plasma samples were collected from 82 confirmed and 58 probable cases (qPCR negative but had typical manifestation).
  • Humoral response to SARS-CoV-2 can aid to the diagnosis of COVID-19, including subclinical cases.

21.03.2020

The potential added value of FDG PET/CT for COVID-19 pneumonia

European Journal of Nuclear Medicine and Molecular Imaging / Letter to the editor

  • As a non-invasive imaging method, FDG PET/CT plays an important role in evaluating inflammatory and infectious pulmonary diseases, monitoring disease progression and treatment effect, and improving patient management.

21.03.2020

RT-qPCR DETECTION OF SARS-CoV-2 RNA FROM PATIENT NASOPHARYNGEAL SWAB USING QIAGEN RNEASY KITS OR DIRECTLY VIA OMISSION OF AN RNA EXTRACTION STEP

bioRxiv (not peer-reviewed) / Article

  • The current shortage of RNA extraction kit (Qiagen QIAamp DSP Viral RNA Mini kit) during the COVID-19 pandemic has resulted in a severe bottleneck in testing capacity in the US.
  • To address this problem, the authors tested two alternative strategies: the use of alternative RNA extraction kits or a direct RT-qPCR assay that omits an RNA extraction step altogether. They report here that the RT-qPCR assay can be performed directly on patient sample material from a nasal swab, without the need for an RNA extraction step of any kind. Collectively, the findings provide viable options to circumvent supply chain issues in COVID-19 testing. Further, the ability to omit the RNA extraction step from RT-qPCR screening protocols would drastically ease supply chokepoints of COVID-19 screening and should be applicable throughout the world.
  • Findings are preliminary and based on a single pooled nasopharyngeal swab sample from two previously confirmed positive COVID-19 patients.

21.03.2020

COVID-19: Epidemiology, Evolution, and Cross-Disciplinary Perspectives

Trends in Microbiology / Review - corrected proof

  • 2019-nCoV isolated from patients shows limited sequence diversity, suggesting that the interspecies transmission event was very recent and that the source of the virus was focused, possibly a point-source event.
  • The amino acid sequence in the ACE2 receptor responsible for 2019-nCoV binding in farm animals and cats has only a few exchanges compared with the human receptor, suggesting that the species barrier for virus transmission is small.

20.03.2020

Single-cell transcriptome profiling an adult human cell atlas of 15 major organs

bioRxiv (not peer-reviewed) / Article

  • The adult human cell atlas (AHCA) reveals the inter- and intra-organ heterogeneity of cell characteristics and provides a useful resource to uncover key events during the development of human diseases such as the recent outbreak of coronavirus disease 2019 (COVID-19) in the context of heterogeneity of cells and organs.

20.03.2020

SARS-CoV-2 specific antibody responses in COVID-19 patients

MedRxiv (not peer-reviewed) / Article

  • The authors developed serological assays for the detection of SARS-CoV-2 neutralizing, spike- and nucleocapsid-specific antibodies.
  • Overall, the validated assays described here can be instrumental for the detection of SARS-CoV-2-specific antibodies for diagnostic, seroepidemiological and vaccine evaluation studies.

20.03.2020

Development and validation of a rapid single-step reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) system potentially to be used for reliable and high-throughput screening of COVID-19

MedRxiv (not peer-reviewed) / Article

  • The authors present a rapid RT-LAMP assay that could extend the capacity of laboratories to process 2.5 more clinical samples relative to qRT-PCR and potentially could be used for high-throughput screening purposes.

20.03.2020

The first-in-class peptide binder to the SARS-CoV-2 spike protein

bioRxiv (not peer-reviewed) / Article

  • This peptide binder to SARS-CoV-2-RBD provides new avenues for COVID-19 treatment and diagnostic modalities by blocking the SARS-CoV-2 spike protein interaction with ACE2 and thus precluding virus entry into human cells.

20.03.2020

Diagnostic Value of Chest CT in Coronavirus Disease 2019 (COVID-19)

Current medical imaging / Review

  • Editorial review of studies looking at chest CT in COVID-19 patients.
  • The overall chest imaging findings of COVID-19 presented by these studies are similar to those associated with coronavirus infection of severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV), the appearances of GGO and consolidation are typical manifestations of viral pneumonia.
  • Analysis of chest CT imaging findings by these studies, in particular, demonstrating the image pattern changes over time of disease onset, provides guidance for clinicians to manage patients effectively.

20.03.2020

Antibody responses to SARS-CoV-2 in COVID-19 patients: the perspective application of serological tests in clinical practice

medRxiv (not peer-reviewed) / Article

  • The authors investigated the profile of acute antibody response in COVID-19 patients, and provided proposals for the usage of antibody tests in clinical practice. They concluded that IgM and IgG should be detected simultaneously at the early phase of infection. The serological diagnosis criterion of seroconversion or the “≥ 4-fold increase in the IgG titer” is suitable for a majority of COVID-19 patients. Serologic tests are helpful for the diagnosis of SARS-CoV-2 infection in suspects and close contacts.

20.03.2020

Laboratory Diagnosis of Emerging Human Coronavirus Infections - The State of the Art

Emerging microbes & infections / Review article

  • Viral pneumonias typically do not result in the production of purulent sputum. Thus, a nasopharyngeal swab is usually the collection method used to obtain a specimen for testing. 
  • Nasopharyngeal specimens may miss some infections; a deeper specimen may need to be obtained by bronchoscopy.
  • Alternatively, repeated testing can be used because over time, the likelihood of the SARS-CoV-2 being present in the nasal-pharynx increases.
  • Several integrated, random-access, point-of-care molecular devices are currently under development for fast and accurate diagnosis of SARS-CoV-2 infections. These assays are simple, fast and safe and can be used in the local hospitals and clinics bearing the burden of identifying and treating patients.

20.03.2020

Reverse transcription loop-mediated isothermal amplification combined with nanoparticles-based biosensor for diagnosis of COVID-19

medRxiv (not peer-reviewed) / Article

  • A one-step reverse transcription loop-mediated isothermal amplification (RT-LAMP) coupled with nanoparticles-based biosensor (NBS) assay (RT-LAMP-NBS) was successfully established for rapidly and accurately diagnosing COVID-19.

20.03.2020

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

Virologica Sinica / Research letter

  • Summary of sequence analysis on the S protein of 2019-nCoV which has predicted a novel furin cleavage site at S1/S2 linkage. The ubiquitous expression of furin in different organs and tissues may be a reason for the high transmissibility and pathogenicity of 2019-nCoV observed in the current epidemic.
  • Findings were mainly based on bioinformatic analysis, so more laboratory studies on 2019-nCoV in cell and animal models are required.

20.03.2020

PRESCIENT: platform for the rapid evaluation of antibody success using integrated microfluidics enabled technology

Lab on a chip / Research article

  • Description of the development of PRESCIENT (Platform for the Rapid Evaluation of antibody SucCess using Integrated microfluidics ENabled Technology), a droplet microfluidic system that can enable high-throughput single-cell resolution identification of nAb repertoires elicited in response to viral infection.
  • The authors demonstrate PRESCIENT's ability to identify Abs that neutralize a model viral agent, Murine coronavirus (murine hepatitis virus), which causes high mortality rates in experimentally infected mice.

20.03.2020

The first-in-class peptide binder to the SARS-CoV-2 spike protein

bioRxiv (not peer-reviewed) / Article

  • Using molecular dynamics simulations based on the recently solved ACE2 and SARS-CoV-2-RBD co-crystal structure, the authors observed that the ACE2 peptidase domain (PD) α1 helix is important for binding SARS-CoV-2-RBD. Using automated fast-flow peptide synthesis, they chemically synthesized a 23-mer peptide fragment of the ACE2 PD α1 helix composed entirely of proteinogenic amino acids.
  • This peptide binder to SARS-CoV-2-RBD provides new avenues for COVID-19 treatment and diagnostic modalities by blocking the SARS-CoV-2 spike protein interaction with ACE2 and thus precluding virus entry into human cells.

20.03.2020

Crystal structure of SARS-CoV-2 main protease provides a basis for design of improved alpha-ketoamide inhibitors

Science / Article

  • The authors report the X-ray structures of the unliganded SARS-CoV-2 Mpro and its complex with an α-ketoamide inhibitor. This was derived from a previously designed inhibitor but with the P3-P2 amide bond incorporated into a pyridone ring to enhance the half-life of the compound in plasma.
  • Based on the structure, the authors developed the lead compound into a potent inhibitor of the SARS-CoV-2 Mpro. The pharmacokinetic characterization of the optimized inhibitor reveals a pronounced lung tropism and suitability for administration by the inhalative route.

20.03.2020

Is there a role for lung ultrasound during the COVID-19 pandemic?

Journal of ultrasound in medicine / Clinical letter

  • The authors argue that the current clinical evidence (although not yet represented in the literature), the theoretical bases of LUS in the aerated lung, and LUS findings of similar aspects in other pathologies (ARDS, flu virus pneumonia) strongly suggest a potential diagnostic accuracy of LUS that may be useful for various aspects of diagnosis and management of COVID-19 patients.

19.03.2020

Molecular Dynamics Simulations Indicate the SARS-CoV-2 Mpro Is Not a Viable Target for Small-Molecule Inhibitors Design

bioRxiv (not peer-reviewed) / Article

  • The authors compared Mpros from SARS-CoV-2 and SARS-CoV. Despite a high level of sequence similarity, the binding sites of analysed proteins show major differences in both shape and size indicating that repurposing SARS drugs for COVID-19 may be futile.

16.03.2020

Drive-Through Screening Center for COVID-19: a Safe and Efficient Screening System against Massive Community Outbreak

Journal of Korean Medical Science / Article

  • Drive-through screening centres have been implemented in Korea for safer and more efficient screening for COVID-19, and could be implemented in other countries.
  • This system may also evolve into a DT respiratory clinic, when rapid diagnostic kit, oral treatment options, and/or vaccines for COVID-19 are available in the future.
13.03.2020

Our experience with covid-19 patients has led to significant concerns over how they are identified and isolated

BMJ / Opinion

  • Any patient presenting to hospital in whom covid-19 enters the differential diagnosis should be tested on arrival.
  • Widespread availability of a rapid point-of-care assay for SARS-CoV-2 with high negative predictive value will also be crucial.
13.03.2020

Can lung US help critical care clinicians in the early diagnosis of Novel Coronavirus (COVID-19) pneumonia?

Radiology / Letter

  • The data are preliminary and further studies are necessary to confirm the role of lung US in the diagnosis and management of COVID-19 pneumonia, but the authors strongly recommend the use of bedside US for the early diagnosis of COVID-19 pneumonia in all the patients who presented to the emergency department with flu-like symptoms in novel COVID-19 era.
13.03.2020

Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, host–virus interaction, and proposed neurotropic mechanisms

ACS Chemical Neuroscience / Viewpoint

  • The authors investigate the density of the expression levels of ACE2 in the CNS, the host–virus interaction and relate it to the pathogenesis and complications seen in the recent cases resulting from the COVID-19 outbreak.
  • They also debate the need for a model for staging COVID-19 based on neurological tissue involvement.
13.03.2020

The establishment of reference sequence for SARS‐CoV‐2 and variation analysis

Journal of Medical Virology / Research article

  • The authors retrieved 95 full‐length genomic sequences of SARAS‐CoV‐2 strains from the NCBI and GISAID databases, established the reference sequence by conducting multiple sequence alignment and phylogenetic analyses, and analyzed sequence variations along the SARS‐CoV‐2 genome.
  • These findings suggest that there may be selective mutations in SARS‐COV‐2, and it is necessary to avoid certain regions when designing primers and probes.
13.03.2020

The potential chemical structure of anti‐SARS‐CoV‐2 RNA‐dependent RNA polymerase

Journal of Medical Virology / Short communication

  • In this study, the authors screened these chemical structures from traditional Chinese medicinal compounds proven to show anti‐viral activity in SARS‐CoV and the similar chemical structures through a molecular docking study to target RdRp of SARS‐CoV‐2, SARS‐CoV and MERS‐CoV.
  • The results suggest that theaflavin could be potential SARS‐CoV‐2 RdRp inhibitor for further study.
13.03.2020

An exclusive 42 amino acid signature in pp1ab protein provides insights into the evolutive history of the 2019 novel human‐pathogenic coronavirus (SARS‐CoV2)

Journal of Medical Virology / Short communication

  • In this short communication, the authors performed phylogenetic‐structural sequence analysis of pp1ab protein of SARS‐CoV2.
  • The analysis showed that the viral pp1ab has not changed in most isolates throughout the outbreak time, but interestingly a deletion of 8 aa in the virulence factor non‐structural protein 1 was found in a virus isolated from a Japanese patient that did not display critical symptoms.
  • While comparing pp1ab protein with other betacoronaviruses, they found a 42 amino acid signature that is only present in SARS‐CoV2 (AS‐SCoV2).
13.03.2020

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

Journal of Otorhinolaryngology Head and Neck Surgery / Chinese article

  • It was found that among all the upper respiratory sampling methods, nasopharyngeal aspirate (NPA) had a higher positive rate within 2 weeks of symptom onset, while combined nasal and oropharyngeal swabs (NS + OPS) was the least harmful to medical staff during sampling. We wish this review is helpful for the prevention of COVID-19.

01.08.2020

Genetic evolution analysis of 2019 novel coronavirus and coronavirus from other species

Infection, Genetics and Evolution / Letter to editor

  • The authors found the novel coronavirus was closely related to coronaviruses derived from five wild animals, including Paguma larvata, Paradoxurus hermaphroditus, Civet, Aselliscus stoliczkanus and Rhinolophus sinicus, and was in the same branch of the phylogenetic tree.
  • However, genome and ORF1a homology show that the virus is not the same coronavirus as the coronavirus derived from these five animals, whereas the virus has the highest homology with Bat coronavirus isolate RaTG13.

24.02.2020

Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study

The Lancet Infectious Diseases / Diagnostics, Radiology / Research

  • Describes the CT findings across different timepoints throughout the course of infection with SARS-CoV-2.
  • 81 patients admitted to hospital between Dec 20, 2019, and Jan 23, 2020, were retrospectively enrolled. The cohort included 42 (52%) men and 39 (48%) women, and the mean age was 49·5 years.
  • Found that COVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1–3 weeks.
  • Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia.

24.02.2020

COVID-19 pneumonia: what has CT taught us?

The Lancet Infectious Diseases / Diagnostics, Radiology / Comment

  • Discusses (CT) findings by Shi et al (above). States that:
  • Shi et al carefully evaluated the CT findings in a large cohort of patients with COVID-19 pneumonia, providing indirect evidence of the evolution of the CT changes with reference to the onset of symptoms.
  • More research is needed into the correlation of CT findings with clinical severity and progression, the predictive value of baseline CT or temporal changes for disease outcome, and the sequelae of acute lung injury induced by COVID-19.

24.02.2020

Viral load of SARS-CoV-2 in clinical samples

The Lancet Infectious Diseases / Correspondence

  • Reports findings from different types of clinical specimens collected from 82 infected individuals.
  • Serial samples (throat swabs, sputum, urine, and stool) from two patients in Beijing were collected daily after their hospitalisation Sputum samples generally showed higher viral loads than throat swab samples.
  • The authors also studied respiratory samples (nasal [n=1] and throat swabs [n=67], and sputum [n=42]) collected from 80 individuals at different stages of infection. Among the 30 pairs of throat swab and sputum samples available, viral loads were significantly correlated between the two sample types for days 1–3, days 4–7, and days 7–14.
  • Two individuals, who were under active surveillance showed positive results on RT-PCR a day before onset, suggesting that infected individuals can be infectious before them become symptomatic.
  • From 17 confirmed cases of SARS-CoV-2 infection, stool samples from nine (53%; days 0–11 after onset) were positive on RT-PCR analysis. Although the viral loads were less than those of respiratory samples, precautionary measures should be considered when handling faecal samples.

24.02.2020

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

JAMA / Viewpoint

  • The Chinese CDC recently published the largest case series to date of COVID-19 in mainland China (72 314 cases, updated through February 11, 2020).
  • This viewpoint summarizes key findings from this report and discusses emerging understanding of and lessons from the COVID-19 epidemic. Includes sections on:
  • Epidemiological characteristics of the COVID-19 outbreak.
  • Comparison of COVID-19 with SARS and MERS.
  • Response to the COVID-19 Epidemic.
  • Next steps.

 Note: this is a JAMA publication of the Chinese CDC Weekly case series published last week which we had previously circulated

17.02.2020

Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes

Emerging Microbes & Infections / Diagnostics / Research Article

  • Molecular diagnosis of 2019-nCoV is confirmed based on testing of oral swabs. Patients are released after two negative oral swab tests. However, many coronaviruses can also be transmitted through oral– faecal route.
  • This study investigated whether 2019-nCoV infected patients can also carry the virus in other organs like the intestine.
  • Conducted an investigation on patients in a local hospital who were infected with this virus. They found the presence of 2019-nCoV in anal swabs and blood as well, with more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby potential transmission through oral–faecal route.

Note: the paper is obviously written by individuals whom English is not their first language, it’s a rapid publication and although the sample number is small we thought worthy of inclusion

16.02.2020

The Proximal Origin of SARS-CoV-2

Preprint / Research Article

  • Investigated the origins and early evolution of SARS-CoV-2 from the comparative analysis of available genome sequence data. Deduced that:
  • It is improbable that SARS-CoV-2 emerged through laboratory manipulation of an existing SARS-related coronavirus (responding to a lot of social media rumours)
  • Given the similarity of SARS-CoV-2 to bat SARS-like CoVs, it is plausible that bats serve as reservoir hosts for SARS-CoV-2. It is important, however, to note that previous outbreaks of betacoronaviruses in humans involved direct exposure to animals other than bats, including civets (SARS) and camels (MERS), that carry viruses that are genetically very similar to SARS-CoV-1 or MERS-CoV, respectively. Viruses closely related to SARS-Cov-2 may be circulating in one or more animal species.
  • It is also possible that a progenitor to SARS-CoV-2 jumped from a non-human animal to humans, with the genomic features described above acquired through adaptation during subsequent human-to-human transmission. Once these adaptations were acquired it would enable the outbreak to take-off, producing a sufficiently large and unusual cluster of pneumonia cases to trigger the surveillance system that ultimately detected it.

13.02.2020

Clinical diagnosis of 8274 samples with 2019-novel coronavirus in Wuhan

medRxiv(not-peer reviewed) / Research Article

  • This study evaluated the testing methods for 2019-nCoV and co-infections.
  • Specimens from 8274 were tested using a fluorescence-based quantitative PCR kit distributed by the Chinese CDC (targets were two loci on the 2019-nCoV genome).  Also analysed 613 patients with fever who underwent multiple tests for 13 respiratory pathogens; 316 subjects were also tested for 2019-nCoV.
  • Findings among the 8274 subjects: 2745 (33.2%) had 2019-nCoV infection; 5277 (63.8%) showed negative results in the 2019-nCoV nucleic acid test; and in 252 cases (3.0%) because only one target was positive, the diagnosis was not definitive. Sixteen patients who originally had only one positive target were re-examined a few days later; 14 patients were finally defined as 2019-nCoV-positive, and 2 were finally defined as negative.
  • In the 316 patients with multiple respiratory pathogens, 104 were positive for 2019-nCov and 6/104 had co-infection with coronavirus (3/104), influenza A virus (2/104), rhinovirus (2/104), and influenza A H3N2 (1/104).
  • Importantly, 5.8% of 2019-nCoV infected had other pathogen infections.
    It is important to treat combined infections and perform rapid screening to avoid cross-contamination of patients. A test that quickly and simultaneously screens as many pathogens as possible is needed.
12/02/2020

Laboratory readiness and response for novel coronavirus (2019-nCoV) in expert laboratories in 30 EU/EEA countries, January 2020

Eurosurveillance / Rapid Communication
  • Timely detection of 2019-nCoV infection cases is crucial to interrupt the spread of this virus.
  • This study assessed the required expertise and capacity for molecular detection of 2019-nCoV in specialised laboratories in 30 European Union/European Economic Area (EU/EEA) countries.
  • Thirty-eight laboratories in 24 EU/EEA countries had diagnostic tests available by 29 January 2020.
  • A coverage of all EU/EEA countries was expected by mid-February.
  • Availability of primers/probes, positive controls and personnel were main implementation barriers
  Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP)

Medrxiv (not peer reviewed) / Research Paper

  • Explored the cellular immunity and cytokines status of NCP patients and to predict the correlation between the cellular immunity levels, cytokines and the severity of patients.
  • Found that low levels of CD4+T and CD8+T are common in severe NCP. IL-6 and IL-10 levels were higher in severe patients.
  • T cell subsets and cytokines can be used as one of the basis for predicting the transition from mild to severe. Large number of samples are still needed to confirm the "warning value" of CD4 + T, CD8 + T IL-6 and IL-10.
12/02/2020 Pre- and Posttreatment Chest CT Findings: 2019 Novel Coronavirus (2019-nCoV) Pneumonia

Radiology / Reviews and Commentary

  • A 46 yo woman presented to hospital with a 7-day history of fever without chills and rigor, nasal discharge, cough, and myalgia. Had stayed with a friend who had been diagnosed with 2019-nCoV in Wuhan, 5 days previously.
  • The patient’s pharyngeal swab was positive via RT-PCR for 2019-nCoV nucleic acid 2 days after hospitalization,
  • After 7 days of treatment, combined with interferon inhalation, the patient’s pharyngeal swab became negative for 2019-nCoV nucleic acid.
  • Outlines unenhanced chest CT results on admission, after 7 days of treatment and 13 days after admission.

 

12/02/2020 Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing

Radiology / Original Research

  • In this report, they present chest CT findings from five patients with 2019-nCoV infection who had initial negative RT-PCR results.
  • All five patients had typical imaging findings, including ground-glass opacity (GGO) (5/5) and/or mixed GGO and mixed consolidation (2/5).
  • After isolation for presumed 2019-nCoV pneumonia, all patients were eventually confirmed with 2019-nCoV infection by repeated swab tests.
  • A combination of repeated swab tests and CT scanning may be helpful when for individuals with high clinical suspicion of nCoV infection but negative RT-PCR screening.

 

12/02/2020 Consistent Detection of 2019 Novel Coronavirus in Saliva

Clinical Infectious Diseases / Research Paper

  • Tested saliva from 12 patients in Hong Kong with suspected 2019-nCoV infection (via RT-qPCR and viral culture), based on clinical and epidemiological criteria as outlined by the Centre for Health Protection of Hong Kong.
  • 2019-nCoV was detected in the self-collected saliva of 91.7% (11/12) of patients. Serial saliva viral load monitoring generally showed a declining trend. Viral cultures were positive for three patients, and negative for 2 patients.
  • Saliva is a promising non-invasive specimen for diagnosis, monitoring, and infection control in patients with 2019-nCoV infection.

 

09/02/2020

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

Science China Life Sciences / Research Paper

  • Report the epidemiological, clinical, laboratory, and radiological characteristics, as well as potential biomarkers for predicting disease severity in 2019-nCoV-infected patients in Shenzhen, China (12 cases).
  • All 12 patients developed pneumonia and half of them developed acute respiratory distress syndrome (ARDS).
  • The viral load of 2019-nCoV detected from patient respiratory tracts was positively linked to lung disease severity.
  • Age, viral load, lung injury score, and blood biochemistry indexes, albumin (ALB), C-reactive protein, lactate dehydrogenase, lymphocytes (%), and neutrophil (%), may be predictors of disease severity.
  • The Angiotensin II level in the plasma sample from 2019-nCoV infected patients was markedly elevated and linearly associated to viral load and lung injury.
  • Results suggest a number of potential diagnosis biomarkers and angiotensin receptor blocker (ARB) drugs for potential repurposing treatment of 2019-nCoV infection.

 

11.02.2020

Fusion Mechanism of 2019-nCoV and Fusion Inhibitors Targeting HR1 Domain in Spike Protein

Cellular & Molecular Immunology / Correspondence

  • Similar to SARS-CoV, 2019-nCoV belongs to lineage B betacoronavirus, and it has the ability to utilize human angiotensin-converting enzyme 2 (ACE2) as a receptor to infect human cells.
  • SARS-CoV spike (S) protein S2 subunit plays a key role in mediating virus fusion with and entry into the host cell, in which the heptad repeat 1 (HR1) and heptad repeat 2 (HR2) can interact to form six-helical bundle (6-HB), thereby bringing viral and cellular membranes in close proximity for fusion.
  • This study confirmed that 2019-nCoV S-HR1 and S-HR2 play key roles in mediating 2019-nCoV fusion with and entry into the host cell. 2019-nCoV may have similar membrane fusion mechanism as that of SARS-CoV.
  • Both 2019-nCoV-HR2P and EK1, the pan-CoV fusion inhibitor, exhibited potent inhibitory activity against S-mediated cell–cell fusion and 2019-nCoV pseudovirus infection, suggesting potential development of either 2019-nCoV-HR2P or EK1 peptide in nasal spray and inhalation formulations, respectively, to prevent and treat 2019-nCoV infection.

 

12/02/2020 The Global Spread of 2019-nCoV: A Molecular Evolutionary Analysis

Pathogens and Global Health / Research Paper

  • Provides a preliminary phylodynamic and phylogeographic analysis of 2019-nCoV.
  • A Maximum Clade Credibility tree was been built using the 29 available whole genome sequences of 2019-nCoV and two whole genome sequences that are highly similar sequences from Bat SARS-like Coronavirus available in GeneBank.  
  • Study describes the same population genetic dynamic underlying the SARS 2003 epidemic, and suggests the urgent need for the development of effective molecular surveillance strategies of Betacoronavirus among animals and Rhinolophus of the bat family.

10/02/2020

The first 2019 novel coronavirus case in Nepal

The Lancet Infectious Diseases / Correspondence

  • Case study of first case of 2019-nCoV presenting in Nepal.
  • 32 year old man presented with mild illness in Kathmandu hospital, and reported illness began 6 days before flying to Nepal from Wuhan, China.
  • No exposure to wet market in Wuhan was reported.
  • Throat swabs tested positive for 2019-nCoV.
  • Patient had overall mild disease, including cough, fever and mild breathing difficulty and recovered after 13 days.

10/02/2020

The spike glycoprotein of the new coronavirus 2019-nCoV contains a furin-like cleavage site absent in CoV of the same clade

Antiviral Research

  • Details of 2019-nCoV genome. Despite similarity to SARS-CoV genome, a furin-like cleavage site has been identified in the Spike protein of the 2019-nCoV, which is lacking in the other SARS-like CoVs.
  • This furin-like cleavage site may play a role in the viral life cycle and pathogenicity and therefore may be a target for treatment.
  • Anti-2019-nCoV therapeutics should include the evaluation of furin inhibitors.

07/02/2020

ACE2 expression by colonic epithelial cells is associated with viral infection, immunity and energy metabolism medRxiv (not peer reviewed) / Research Paper
  • Angiotensin-converting enzyme 2 (ACE2) is the receptor for SARS-CoV and has been suggested to be also the receptor for 2019-nCoV.
  • Suggest that ACE2 may play dual roles in mediating the susceptibility and immunity of 2019-nCoV infection.

04.02.2020

Developing antibody tests for SARS-CoV-2

The Lancet / World Report

  • The demand for antibody tests is high in response to the pandemic.
  • Its most important current use, en masse, is to help inform public policy makers how many asymptomatic cases have occurred in a population.
  • Discussion of the development of antibody tests includes interviews with scientists.

 

Epidemiology and clinical

Date of publication

Title / URL

Journal / Publication type

Digest

03.04.2020

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020

MMWR. Morbidity and mortality weekly report / Article

  • Describes practices following identification of a case COVID-19 in a health care worker in a long term care facility in the USA.  76 of 82 residents were tested for SARS-CoV-2; 23 (30.3%) had positive test results with approx. half asymptomatic or presymptomatic. 
  • Symptom-based screening of care home residents might fail to identify all SARS-CoV-2 infections, and asymptomatic residents might contribute to SARS-CoV-2 transmission.

02.04.2020

COVID-19 in a Designated Infectious Diseases Hospital Outside Hubei Province, China

Allergy / Article

  • Describes the clinical characteristics of 298 COVID-19 patients outside the epicentre of Hubei province, China from Jan 11, 2020 to Feb 6, 2020 and followed until Mar 6, 2020.
  • 192(64.4%) cases had a fever as the initial symptom. Severe cases were associated with older age, underlying diseases, higher levels of C-reactive protein, interleukin-6, and erythrocyte sedimentation rate. 
  • Slower clearance of the virus was associated with higher risk of critical progression.
  • As of March 6, 2020, 268 (89.9%) patients were discharged and the overall case fatality ratio was 1.0%.

02.04.2020

Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China

Clinical infectious diseases / Article

  • Investigation of clinical and laboratory features and short-term outcomes of COVID-19 patients admitted to Wuhan University Zhongnan Hospital between January 3 and February 1, 2020.
  • 102 adult patients, median age 54 years and 48% were female. 
  • 34 patients (33.3%) were exposed to source of transmission in the hospital setting and 10 patients (9.8%) had a familial cluster. 
  • 18 patients were admitted to the ICU, and 17 patients died.
  • Those who survived were younger, more likely to be health care workers, less likely to suffer from comorbidities and less likely to suffer COVID-19 related complications. 
  • Patients who survived were less likely to have been admitted to ICU (14.1% vs. 35.3%).

02.04.2020

COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020

Emerging infectious diseases/ Research letter

  • Case study of 3 familial clusters of COVID-19 originating from an air-conditioned restaurant in Guangzhou, China. 
  • The airflow direction was consistent with droplet transmission. 
  • Restaurants should increase the distance between tables and improve ventilation to prevent the spread of SARS-COV-2.

02.04.2020

A Sentinel COVID-19 Case in Houston, Texas: Informing Frontline Emergency Department Screening and Preparedness

Journal of the American College of Emergency Physicians Open / Case Report

  • Describes a sentinel CoVID‐19 patient in Houston, Texas, who first presented on March 1, 2020. The patient did not meet criteria for a Person Under Investigation (PUI) as recommended by the Centres for Disease Control (CDC) at the time. This case has broad implications for emergency department screening and preparedness for CoVID‐19 and other future infectious diseases.

02.04.2020

Clinical characteristics of Non-ICU hospitalized patients with coronavirus disease 2019 and liver injury. A Retrospective study.

Liver International / Article

  • Retrospective study in Non-ICU Ward at Jinyintan Hospital from Feb 2, 2020 to Feb 23, 2020 to investigate the risk factors related to liver injury in the COVID-19 patients.
  • Of 79 COVID-19 patients, 31.6%, 35.4% and 5.1% COVID-19 patients had elevated levels of ALT, AST and bilirubin, respectively. 
  • Compared to controls, patients with liver injury had increased levels of white blood cell counts, neutrophils, CRP and CT score and had a longer length of stay.
  • Intense monitoring and evaluation of liver function in patients with severe pulmonary imaging lesions should be considered.

02.04.2020

Liver impairment in COVID-19 patients: a retrospective analysis of 115 cases from a single center in Wuhan city, China

Liver International / Letter

  • Retrospective, single-centre study with 115 confirmed cases of COVID-19 in Zhongnan hospital of Wuhan University from Jan 18 to Feb 22, 2020, to investigate the changes of liver function and its clinical significance.
  • Abnormalities of liver function indexes were common in COVID-19 patients but impairment of liver function was not a prominent feature and serious clinical consequences were not significant.

02.04.2020

Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome?

Rhinology / Special Report

  • Present a case report and case series as well as other evidence that there is an important fourth presenting syndrome, namely isolated sudden onset anosmia (ISOA), which should be considered highly suspicious for SARS-CoV-2.
  • Urge all healthcare practitioners with patients presenting with ISOA to treat these patients as possible COVID-19 positive with appropriate precautions and to avoid prescribing oral immunosuppressants in these cases.

02.04.2020

Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study

The Lancet Infectious Diseases / Article

  • Collected data on 8579 cases from 30 provinces laboratory-confirmed cases reported outside Hubei in mainland China.
  • The median age of cases was 44 years (33–56), with an increasing proportion of cases in younger age groups and in elderly people (i.e, aged >64 years) as the epidemic progressed. The mean time from symptom onset to hospital admission decreased from 4·4 days (95% CI 0·0–14·0) for the period of Dec 24 to Jan 27, to 2·6 days (0·0–9·0) for the period of Jan 28 to Feb 17. The mean incubation period for the entire period was estimated at 5·2 days (1·8–12·4) and the mean serial interval at 5·1 days (1·3–11·6). 
  • Estimated that the epidemic was self-sustained for less than 3 weeks, with mean Rt reaching peaks between 1·08 (95% CI 0·74–1·54) in Shenzhen city of Guangdong province and 1·71 (1·32–2·17) in Shandong province. 
  • The estimates of the incubation period and serial interval were similar, suggesting an early peak of infectiousness, with possible transmission before the onset of symptoms. The results also indicate that, as the epidemic progressed, infectious individuals were isolated more quickly, thus shortening the window of transmission in the community.

02.04.2020

Coronavirus disease 2019 (COVID-19): a clinical update

Frontiers of medicine / Review

  • Review of the literature on the epidemiology, clinical characteristics, diagnostics and latest advancements in treatment of COVID-19.

02.04.2020

Monitoring the COVID-19 epidemic in the context of widespread local transmission

The Lancet Respiratory Medicine / Comment

  • The availability of reliable surveillance platforms is crucial to monitor the COVID-19 epidemic in a timely manner and to respond with adequate control measures.
  • For COVID-19 surveillance purposes, the main objective is to detect changes in disease burden indicators that are more stable (in time or space). The main attribution of these indicators needs to be consistency, rather than validity.

02.04.2020

Post-donation COVID-19 identification in blood donors

Vox sanguinis / Commentary

  • Author presents experience of blood transfusions that support the evidence that SARS-CoV-2 is not transfusion-transmissible. In nine patients who received transfusions from donors who later tested positive for COVID-19, none tested positive for SARS-COV-2 nor developed symptoms.

02.04.2020

Cancer guidelines during the COVID-19 pandemic

The Lancet Oncology / News

  • This article includes links to several different cancer guidelines, including guidance on delivering radiotherapy and systemic cancer therapies.

31.03.2020

Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China

American Journal of Nephrology / Research article

  • Study aimed to explore the effects of SARS-CoV-2 infection on renal function through analysing the clinical data of 116 hospitalized COVID-19-confirmed patient
  • Acute kidney injury (AKI) was uncommon in COVID-19. SARS-CoV-2 infection does not result in AKI, or aggravate CKD in COVID-19 patients.

31.03.2020

Clinical features and outcomes of 2019 novel coronavirus-infected patients with high plasma BNP levels

medRxiv (not peer-reviewed) / Article

  • 34 patients with corona virus COVID-19 were included in the analysis. Ten patients had high plasma BNP level. 
  • Compared with patients with normal BNP, patients with high BNP were more likely to develop severe pneumonia, and receive tracheal cannula, invasive mechanical ventilation, continuous renal replacement therapy, extracorporeal membrane oxygenation, and be admitted to the intensive care unit.

31.03.2020

Blood glucose levels in elderly subjects with type 2 diabetes during COVID-19 outbreak: a retrospective study in a single center

medRxiv (not peer-reviewed) / Article

  • Investigated the changes of blood glucose levels in subjects aged 65 and above at  Fujian Provincial Hospital with type 2 diabetes (T2D) during COVID-19 outbreak.
  • 135 elderly subjects with T2D with baseline and follow-up fasting plasma glucose and 50 elderly subjects with T2D with baseline and follow-up HbA1c were analysed, respectively. The baseline and follow-up mean fasting plasma glucose were 7.08 and 7.48 mmol/L, respectively (P=0.008). The mean baseline and follow-up HbA1c were 7.2 and 7.4, respectively (P=0.158).
  • Elderly subjects with T2D had higher fasting plasma glucose levels during COVID-19 outbreak. We should pay more attention to the management of diabetics during public health emergencies.

31.03.2020

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

medRxiv (not peer-reviewed) / Article

  • The population-level case CFR associated with COVID-19 varies substantially, both across countries and within countries over time. Authors analysed the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates.
  • Use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, France, Germany, Italy, South Korea, Spain, and the United States. CFR for each country calculated at the latest data point and for Italy also over time. Demographic decomposition used to break the difference between CFRs into unique contributions arising from the age-structure of confirmed cases and the age-specific case-fatality.
  • CFRs vary from 0.7% in Germany and 1.6% in South Korea to 8.6% in Spain and 10.6% in Italy. The age-structure of detected cases can explain a substantial proportion of cross-country variation in the CFR. 
  • Findings support recommendations for data to be disaggregated by age, and potentially other variables, to facilitate a better understanding of population-level differences in CFRs. They also show the need for well-designed seroprevalence studies to ascertain the extent to which differences in testing regimes drive differences in the age-structure of detected cases.

31.03.2020

Coronavirus pandemic and Colorectal surgery: practical advice based on the Italian experience

Colorectal Disease / Article

  • Description of the strategy adopted in Italy for management of colorectal patients 
  • Some policies are described, including minimally-invasive surgery. It is likely that a reorganization of health system is required, both at central and local levels.

30.03.2020

Facing a disruptive threat: how can a nuclear medicine service be prepared for the coronavirus outbreak 2020?

Eur J Nucl Med Mol Imaging / Short communication

  • The authors describe the key considerations of policies and processes that have been implemented in their nuclear medicine service since the first case of COVID-19 was confirmed in Singapore General Hospital on 23 January 2020, up to the present time.

30.03.2020

Clinical and Transmission Characteristics of Covid-19 - A Retrospective Study of 25 Cases from a Single Thoracic Surgery Department

Curr Med Sci / Article

  • In this study, the authors analysed clinical and transmission features of 25 cases of Covid-19 from a single thoracic department, including 13 patients and 12 health care staff. By the end of follow-up date (Mar. 3, 2020), there were 16 non-severe cases (64%) and 9 severe cases (36%), 5 cases were dead (20%).
  • They found that COPD was significantly associated with severity and death (P=0.040, and P=0.038, respectively), and chest operation was significantly associated with death for Covid-19 patients (P=0.039). A potential "super spreader" may be the source of the transmission before the implementation of quarantine and comprehensive protection. 
  • It was concluded that Covid-19 is associated with poor prognosis for patients undergoing thoracic operation, especially for those with COPD. Implementation of comprehensive protective measures is important to control nosocomial infection.

30.03.2020

Fast nosocomial spread of SARS-CoV2 in a French geriatric unit Lyon Study Group on Covid-19 infection

Infect Control Hosp Epidemiol / Letter

  • Report the extremely fast spread of Covid-19 in a 24-bed geriatric unit in France. 
  • The fast spread of nosocomial covid-19 infection in this ward confirms the contagiousness of SARS-CoV2 in healthcare settings and the high mortality rates in this population. The existence of super-shedders has been suggested and could facilitate cluster emergence.

29.03.2020

Preparing an obstetric unit in the heart of the epidemic strike of COVID-19: quick reorganization tips

The Journal of Maternal-Fetal & Neonatal Medicine / Article

  • The purpose of this review is to suggest quick key points of strategies to implement in obstetric units without delay to respond to the oncoming wave, based on experience and feedback from the field. It is essential in an emergency situation to understand what is at stake and prepare maternity wards in the best possible way.

23.03.2020

Rising to the Challenge of the Novel SARS-coronavirus-2 (SARS-CoV-2): Advice for Pulmonary and Critical Care and an Agenda for Research

Am J Respir Crit Care Med / Editorial

  • We need to think about ways to move forward with a robust research agenda, which can be done with clinical and epidemiologic observations, use of new diagnostic testing tools, and clinical trials with new and repurposed therapies.
  • Some of the key priorities for research in the Pulmonary and Critical Care community are summarized.

23.03.2020

Nursing and the Novel Coronavirus: Risks and Responsibilities in a Global Outbreak

J Adv Nurs / Editorial

  • As one of the most trusted health professional groups, nurses also play a key role in providing public education on disease prevention and reducing the spread of misinformation around the outbreak.
  • There is a need for care coordination across public health departments, communities and healthcare systems that nurses are ideally suited to providing

23.03.2020

COVID-19: gastrointestinal symptoms and potential sources of 2019-nCoV transmission

Anaesthesiol Intensive Ther / Letter

  • In order to control the epidemic, every effort should be made to pay attention to the initial gastrointestinal symptoms of COVID-19 infection for early diagnosis and isolation of patients before the development of: pulmonary symptoms.
  • The exact mechanism of COVID-19-induced gastrointestinal symptoms remains largely elusive; however, ACE2-based strategies and TMPRSS2 inhibitors are the subject of current research

23.03.2020

COVID-19: A Global Transplant Perspective on Successfully Navigating a Pandemic

Am J Transplant / Viewpoint

  • A personal viewpoint representing different jurisdictions from around the world in order to outline the impact of the current COVID-19 pandemic on organ transplantation.
  • Based on collective experience, the authors discuss mitigation strategies such as donor screening, resource planning and a staged approach to transplant volume considerations as local resource issues demand

23.03.2020

Ventilatory Ratio in Hypercapnic Mechanically Ventilated Patients with COVID-19 Associated ARDS

Am J Respir Crit Care Med / Article

  • The authors found that hypercapnia was common in patients with COVID-19-associated ARDS while using low tidal volume ventilation.
  • VR was increased in these patients, which reflected increased pulmonary dead space and inadequacy of ventilation.
  • Clinicians must have a high index of suspicion for increased pulmonary dead space when COVID-19-related ARDS patients present with hypercapnia

23.03.2020

Mimics and chameleons of COVID-19

Swiss Med Wkly / Viewpoint

  • This article underlines the need for extensive testing and shows that the present policy of many government bodies to focus on patients at risk with specific symptoms is also limited by “chameleons”, such as patients with nonspecific symptoms.
  • As the true denominator is unknown, extending testing to patients presenting with possible COVID-19 mimics or chameleons should be considered.

23.03.2020

Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy

Jama / Viewpoint

  • The current data illustrate that Italy has a high proportion of older patients with confirmed COVID-19 infection and that the older population in Italy may partly explain differences in cases and case-fatality rates among countries.

23.03.2020

Lung Recruitability in SARS-CoV-2 Associated Acute Respiratory Distress Syndrome: A Single-center, Observational Study

Am J Respir Crit Care Med / Article

  • This data shows that lung recruitability can be assessed at the bedside even in a very constrained environment and is low in patients with COVID-19 induced ARDS.
  • The findings do not imply that all patients with SARSCoV-2 associated ARDS were poorly recruitable, and both the severity and management of these patients can remarkably differ among regions.

23.03.2020

The impact of COVID-19 on the provision of donor hematopoietic stem cell products worldwide: collateral damage

Bone Marrow Transplant / Correspondance

  • The currently accelerating rate of COVID-19 infection and the responses of governments and facilities have the potential to impact and interfere with the timely provision of hematopoietic stem cells that must cross national borders.
  • A number of strategies have been proposed to assist in navigating through these rapidly evolving difficulties
  • Organizations like World Marrow Donor Association could be vital to coordinate the urgent needs for cellular products

23.03.2020

High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

MedRxiv (not peer-reviewed) / Article

  • 82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who were returnees from Wuhan, 18.1% were asymptomatic.
  • The SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

23.03.2020

A COVID-19 Transmission within a family cluster by presymptomatic infectors in China

Clin Infect Dis / Case report

  • The authors report a COVID-19 family cluster caused by a presymptomatic case.
  • There were 9 family members, including 8 laboratory-confirmed with COVID-19, and a 6-year-old child had no evidence of infection - amongst the 8 patients, one adult and one 13-month-old infant were asymptomatic, one adult was diagnosed as having severe pneumonia.

23.03.2020

Coronavirus Disease 2019 (COVID-19) pandemic and pregnancy

American Journal of Obstetrics and Gynecology / Special report - in press

  • Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks.
  • To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission.
  • The authors present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcriptase polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission and maternal-fetal complications.

23.03.2020

The first infant case of COVID-19 acquired from a secondary transmission in Vietnam

Lancet Child & Adolescent Health / Case report

  • On Feb 11, 2020, a 3-month-old, female patient was received at Vietnam National Children's Hospital who was transferred from a local hospital.
  • The patient was a previously healthy full-term baby, without any complications experienced during pregnancy or her delivery.
  • She was exclusively breastfed and her immunisations were up to date.
  • As of Feb 19, despite close contact with the patient, the infant's mother did not present any symptoms and her repeated nasopharyngeal swabs were negative for SARS-CoV-2. All the other family members, including a 5-year-old boy, were also asymptomatic and tested negative.

23.03.2020

Systematic review of COVID-19 in children show milder cases and a better prognosis than adults

Acta Paediatr / Systematic Review

  • A systematic literature review was carried out to identify papers on COVID-19, using the Medline and EMBASE databases between 1 January and 18 March 2020 - the search identified 45 relevant scientific papers and letters.
  • The review showed that children have so far accounted for 1-5% of diagnosed COVID-19 cases, they often have milder disease than adults and deaths have been extremely rare.
  • Diagnostic findings have been similar to adults, with fever and respiratory symptoms being prevalent, but fewer children seem to have developed severe pneumonia - elevated inflammatory markers were less common in children and lymphocytopenia seemed rare.

23.03.2020

Forecasting ultra-early intensive care strain from COVID-19 in England

medRxiv (not peer-reviewed) / Article

  • On the basis of the modelling assumptions made, ICU occupancy is likely to increase dramatically in the the days following the time of modelling.
  • If the current exponential growth continues, 5 out of 7 commissioning regions will have more critically ill COVID-19 patients than there are ICU beds within two weeks.

23.03.2020

Fair Allocation of Scarce Medical Resources in the Time of Covid-19

N Engl J Med / Comment

  • Outlines 6 recommendations that should be used to develop guidelines for medical resource use that can be applied fairly and consistently across cases.
  • Such guidelines can ensure that individual doctors are never tasked with deciding unaided which patients receive life-saving care and which do not.
  • Guidelines should be provided at a higher level of authority, both to alleviate physician burden and to ensure equal treatment.

23.03.2020

The Toughest Triage — Allocating Ventilators in a Pandemic

N Engl J Med / Perspective

  • In the US, estimates show that the number of patients needing ventilation could range between 1.4 and 31 patients per ventilator.
  • The angst that clinicians may experience when asked to withdraw ventilators for reasons not related to the welfare of their patients should not be underestimated — it may lead to debilitating and disabling distress for some clinicians.
  • Creation and use of triage committees, informed by experience in the current pandemic and prior written recommendations, can help mitigate the enormous emotional, spiritual, and existential burden to which caregivers may be exposed.

23.03.2020

Urology practice during COVID-19 pandemic

Minerva Urol Nefrol / Article

  • A panel of Italian urologists has agreed on possible strategies for the reorganization of urological routine practice and on a set of recommendations that should facilitate the process of rescheduling both surgical and outpatient activities during the COVID-19 pandemic and in the subsequent phases.
  • This document could be a valid tool to be used in routine clinical practice and, possibly, a cornerstone for further discussion on the topic also considering the further evolution of the COVID-19 pandemic.

23.03.2020

Dermatology staff participate in fight against Covid-19 in China

J Eur Acad Dermatol Venereol / Comment

  • In this paper the authors share their experiences in dealing with skin diseases in this special period and hope to provide some references for international colleagues in the COVID-19 epidemic situation.

22.03.2020

More awareness is needed for severe acute respiratory syndrome coronavirus 2019 transmission through exhaled air during non-invasive respiratory support: experience from China

The European respiratory journal / Letter

  • Exhaled air dispersion during non-invasive respiratory support may increase the risk of coronavirus transmission, and requires more attention from medical personnel and patients.

21.03.2020

Clinical Features and Treatment of COVID-19 Patients in Northeast Chongqing

Journal of Medical Virology / Research article

  • Epidemiological, clinical features, laboratory findings, radiological characteristics, treatment, and clinical outcomes of 135 patients in northeast Chongqing were collected and analysed in this study.

21.03.2020

Can COVID-19 present unusual GI symptoms?

Journal of Microbiology, Immunology and Infection /  Preprint - not peer-reviewed

  • A couple of weeks prior to the COVID-19 outbreak in Iran, the number of patients referred to the gastroenterology clinic in Shahid Beheshti Hospital in Qom increased unusually by 20%.
  • The patients (aged between 19–83 years, with a BMI of 17.5–22) exhibited various gastrointestinal (GI) symptoms, including epigastric pain, constipation, diarrhoea, nausea, vomiting, muscle pain, and melena; the patients did not respond to treatment with common therapeutic agents.
  • All patients with unusual GI symptoms, tested positive for SARS-CoV-2 and various forms of lung involvement were seen in the chest CT scans.

21.03.2020

[When COVID-19 encounters interstitial lung disease: challenges and management]

Chinese Journal of Tuberculosis and Respiratory Diseases / Chinese article

  • The lung injury and repair caused by COVID-19 has many similarities with the onset and progression of interstitial lung disease (ILD) .

21.03.2020

Loss of sense of smell as marker of COVID-19 infection

ENT UK / Letter

  • There is already good evidence from South Korea, China and Italy that significant numbers of patients with proven COVID-19 infection have developed anosmia/hyposmia.
  • Given the potential for COVID-19 to present with anosmia, and the reports that corticosteroid use may increase the severity of infection, we would advise against use of oral steroids in the treatment of new onset anosmia during the pandemic, particularly if it is unrelated to head trauma or nasal pathology (such as nasal polyps).
  • There is potential that if any adult with anosmia but no other symptoms was asked to self-isolate for seven days.

21.03.2020

Hospitals as health factories and the coronavirus epidemic

Journal of Nephrology / Editorial

  • A group of nephrologists, mainly from Lombardy, the Italian region most affected by the epidemics, proposes suggestions on the management of SARS-CoV-2 infection in the dialysis ward, one of the most vulnerable hospital wards
  • At a time when infectious diseases were the major cause of death, each disease was treated in a separate pavilion, with separate entrances and exits which made it possible to prevent contact between patients affected by different illnesses.

20.03.2020

Comparison of the coronavirus pandemic dynamics in Europe, USA and South Korea

MedRxiv (not peer-reviewed) / Article

  • The authors provide a simple method of data comparison that can be useful for both governmental organizations and anyone.

20.03.2020

A Tool to Early Predict Severe 2019-Novel Coronavirus Pneumonia (COVID-19) : A Multicenter Study using the Risk Nomogram in Wuhan and Guangdong, China

medRxiv (not peer-reviewed) / Article

  • The authors aimed to construct an effective model for the early identification of cases at high risk of progression to severe COVID-19.
  • The train cohort consisted of 189 patients, while the two independent validation cohorts consisted of 165 and 18 patients.
  • Among all cases, 72 (19.35%) patients developed severe COVID-19 and 107 (28.76%) patients had one of the following basic disease, including hypertension, diabetes, coronary heart disease, chronic respiratory disease, tuberculosis disease.
  • This risk stratification tool will enable better centralized management and early treatment of severe patients, and optimal use of medical resources via patient prioritization and thus significantly reduce mortality rates.

20.03.2020

Preliminary evidence that higher temperatures are associated with lower incidence of COVID-19, for cases reported globally up to 29th February 2020

medRxiv (not peer-reviewed) / Article

  • Using global gridded temperature data, and after adjusting for surveillance capacity and time since first imported case, the authors found that higher average temperature was strongly associated with lower COVID-19 incidence for temperatures of 1°C and higher.

20.03.2020

Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis

medRxiv (not peer-reviewed) / Article

  • The authors summarised and analysed the clinical characteristics and identify the predictors of disease severity and mortality. A total of 30 studies including 53000 patients with COVID-19 were included in this study.
  • The mean age was 49.8 years and 55.5% were male. The pooled incidence of severity and mortality were 20.2%  and 3.1%, respectively. The predictor for disease severity included old age, male , smoking and any comorbidity, especially chronic kidney disease, chronic obstructive pulmonary disease and cerebrovascular disease.
  • In terms of laboratory results, increased lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer and decreased blood platelet and lymphocytes count were highly associated with severe COVID-19. Meanwhile, old age, followed by cardiovascular disease  hypertension and diabetes were found to be independent prognostic factors for the COVID-19 related death.

20.03.2020

Coronaviruses and immunosuppressed patients. The facts during the third epidemic

Liver transplantation / Letter

  • Report of preliminary experience from the Papa Giovanni XXIII Hospital, Bergamo, Italy, in agreement with recent data from China, shows that, among patients in the follow-up for cirrhosis, transplantation, autoimmune liver disease, chemotherapy for hepatoblastoma, none developed a clinical pulmonary disease, despite some tested positive for SARS-CoV-2.
  • The experience made so far on Coronaviruses outbreaks suggests that immunosuppressed patients are not at increased risk of severe complications compared to the general population, both children and adults.

20.03.2020

The clinical characteristics of pneumonia patients co-infected with 2019 novel coronavirus and influenza virus in Wuhan, China

Journal of Medical Virology / Research article

  • Patients with both COVID-19 and influenza virus infection did not appear to show a more severe condition because based on the laboratory findings, imaging studies, and patient prognosis, they showed similar clinical characteristics as those patients with COVID-19 infection only.
  • It is worth noting that the symptoms of nasal tampon and pharyngalgia may be more prone to appear for those co-infection patients.

20.03.2020

Eleven Faces of Coronavirus Disease 2019

Allergy / Research article

  • Demographics, clinical manifestations, outcomes, key laboratory results, and radiological images of 11 COVID-19 patients are discussed to demonstrate the complexity of the COVID-19 profile with different clinical presentations.

20.03.2020

Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation?

American journal of transplantation / case report

  • Case report of a COVID-19 infection in a solid organ transplant recipient, in which the first clinical symptoms were of gastrointestinal viral disease and fever, which further progressed to respiratory symptoms in 48h.
  • In these high risk populations, protocols for screening for SARS-Cov2 may be needed to be re-evaluated.

20.03.2020

Clinical features in pediatric COVID-19

Pediatric pulmonology / Letter

  • The authors share observations from Thailand on clinical features in paediatric COVID-19 infection, concluding that early diagnosis of paediatric COVID‐19 in their setting might result in mild clinical presentation.

20.03.2020

COVID-19 in gastroenterology: a clinical perspective

Gut / Letter

  • As SARS-CoV2 spreads across all major continents, it is important that gastroenterologists remain vigilant for variant cases that mimic atypical pneumonia, gastroenteritis, viral hepatitis or dengue fever.
  • Another important consideration is endoscopy, which carries a risk of disease transmission if attending healthcare workers are not wearing appropriate personal protective equipment.

20.03.2020

Rhabdomyolysis as Potential Late Complication Associated with COVID-19

Emerging Infectious Diseases / Early release article - not final version

  • General muscle pain and fatigue are common symptoms of COVID-19, but clinicians should consider the diagnosis of rhabdomyolysis when patients have focal muscle pain and fatigue.
  • CK and myoglobin levels are important indexes for rhabdomyolysis; however, they are not tested routinely, so rhabdomyolysis is easily misdiagnosed.
  • The key to avoid acute renal failure from rhabdomyolysis is early detection and treatment with aggressive hydration

20.03.2020

Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe

Emerging Infectious Diseases / Early release article - not final version

  • Early infections with severe acute respiratory syndrome coronavirus 2 in Europe were detected in travellers from Wuhan, China, in January 2020. In 1 tour group, 5 of 30 members were ill; 3 cases were laboratory confirmed. In addition, a healthcare worker was infected. This event documents early importation and subsequent spread of the virus in Europe.

20.03.2020

Non-severe vs severe symptomatic COVID-19: 104 cases from the outbreak on the cruise ship “Diamond Princess” in Japan

medRxiv (not peer-reviewed) / Article

  • Analysed the difference between non-severe and severe cases with COVID-19 as a result of the mass infection on a cruise ship “Diamond Princess” in Japan (n=104). The high proportion of non-severe cases corrects the assessment of the trend of the outbreak. Consolidation on chest CT scan and lymphopenia were possible risk factors for deterioration of COVID-19 and contribute to the clinical management.

20.03.2020

Misguided drug advice for COVID-19

Science / Letter

  • In response to French Health Minister Olivier Véran's claim that anti-inflammatory drugs like ibuprofen or cortisone could aggravate the infection, the author outlines his arguments for uncertainty about this claim, based on the mechanism of action of NSAIDs. He concludes that people taking NSAIDs for other reasons should not stop doing so for fear of increasing their COVID-19 risk.

20.03.2020

Autopsy in suspected COVID-19 cases

Journal of clinical pathology / Guidance

  • Summary and interpretation of Royal College of Pathologists' autopsy guidelines for suspected COVID-19-related deaths.
  • It includes a description of hazard group 3 organisms to which SARS-CoV-2 has been assigned, a brief description of what is currently known about the pathological and autopsy findings in COVID-19, a summary of the recommendations for conducting autopsies in suspected COVID-19 cases and the techniques for making the diagnosis at autopsy.
  • It concludes by considering the clinicopathological correlation and notification of such cases.

20.03.2020

Hypothesis for potential pathogenesis of SARS-CoV-2 infection--a review of immune changes in patients with viral pneumonia

Emerging microbes & infections / Review article

  • This article reviews the immunological changes of coronaviruses like SARS, MERS and other viral pneumonia similar to SARS-CoV-2.

  • Combined with the published literature, the potential pathogenesis of COVID-19 is inferred, and the treatment recommendations for giving high-doses intravenous immunoglobulin and low-molecular-weight heparin anticoagulant therapy to severe type patients are proposed.

20.03.2020

Navigating Coronavirus Disease 2019 (Covid-19) in Physiatry: A CAN report for Inpatient Rehabilitation Facilities

PM & R : the journal of injury, function, and rehabilitation / Guidance

  • Guidance aiming to aid Physical Medicine and Rehabilitation specialists in acute Inpatient Rehabilitation Facilities (IRFs) to navigate patient care during this public health emergency. 

20.03.2020

Coronavirus disease 2019 (COVID-19) outbreak in Iran; actions and problems

Infection control and hospital epidemiology / Letter

  • Outlines the trajectory of COVID-19 spread in Iran
  • Describes official actions being taken to control infection
  • Identifies areas of concern such as inadequate infrastructure and resources, the wide distribution of the virus nationally, increased travel due to New Year (Nowruz) vacation

20.03.2020

Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres

Nephrology, dialysis, transplantation / Guidance

  • European Dialysis (EUDIAL) Working Group of ERA-EDTA  recommendations for the prevention, mitigation and containment in haemodialysis centres of the emerging COVID-19 pandemic.

20.03.2020

Will COVID-19 be a litmus test for post-Ebola Sub-Saharan Africa?

Journal of Medical Virology / Article

  • The 2014 Ebola outbreak in Sub-Saharan Africa (SSA) is used to highlight lessons learned and how these might apply to managing the COVID-19 pandemic, with advice for governments across 24 countries and warnings about inadequate healthcare infrastructure and public funding

20.03.2020

Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus Epidemic: An Experience in Hong Kong

JAMA otolaryngology-- head & neck surgery / Interview

  • Otolaryngologists are at particularly high risk when performing routine aerosol-generating procedures. This interview describes measures being taken to mitigate risk in a Hong Kong hospital.

20.03.2020

Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection

International journal of gynaecology and obstetrics / Guidance

  • Provides clinical management guidelines for novel coronavirus (COVID‐19) in pregnancy.

20.03.2020

COVID-19 (Coronavirus)

Lymphatic research and biology / Article

  • Guidelines for the Lymphatic Disease Community, focussing on common sense points and advising reference to CDC and NHS guidance

20.03.2020

Managing Cancer Care During the COVID-19 Pandemic: Agility and Collaboration Toward a Common Goal

Journal of the National Comprehensive Cancer Network : JNCCN / Special feature

  • Special Feature article highlighting the unique circumstances and challenges of cancer treatment amidst this global pandemic, and the importance of organizational structure, preparation, agility, and a shared vision for continuing to provide cancer treatment to patients in the face of uncertainty and rapid change.

20.03.2020

Practical laboratory considerations amidst the COVID-19 outbreak: early experience from Singapore

Journal of clinical pathology / Short report

  • This article presents one tertiary institution’s early experience with managing this emerging crisis and offers practical considerations for the preanalytical, analytical and postanalytical phases of laboratory testing in this cohort of patients.

16.03.2020

First Pediatric Case of Coronavirus Disease 2019 in Korea

Journal of Korean Medical Science / Case report

  • The authors report the first paediatric case of COVID-19 in Korea.
  • The 10-year-old girl was a close contact of her uncle and her mother who were confirmed to have COVID-19.
  • They discuss optimal strategy of self-quarantine and patient care in a negative isolation room for children.
14.03.2020

Coronavirus Disease 2019 (COVID-19): What we know?

Journal of Medical Virology / Review

  • The purpose of this review is primarily to review the pathogen, clinical features, diagnosis, and treatment of COVID-19, but also to comment briefly on the epidemiology and pathology based on the current evidences.
14.03.2020

Liver injury during highly pathogenic human coronavirus infections

Liver International / Review

  • In this review, the characteristics and mechanism of liver injury caused by SARS‐CoV, MERS‐CoV, as well as SARS‐CoV‐2 infection were summarized, which may provide help for further studies on the liver injury of COVID‐19.
13.03.2020

Bearing the brunt of covid-19: older people in low and middle income countries

BMJ / Editorial

  • An age perspective should be included explicitly in the development of national and global planning for covid-19, and a global expert group on older people should be formed to support with guidance and response to the virus in both residential facilities and home settings.
13.03.2020

Critical care utilization for the COVID-19 Outbreak in Lombardy, Italy: Early experience and forecast during an emergency response

JAMA / Viewpoint

  • This experience would suggest that only an ICU network can provide the initial immediate surge response to allow every patient in need for an ICU bed to receive one.
  • Health care systems not organized in collaborative emergency networks should work toward one now.
13.03.2020

Epidemiology of 2019 Novel Coronavirus Disease-19 in Gansu Province, China, 2020

Emerging Infectious Diseases / Early release article

  • Characteristics that differed significantly during the first and second waves of illness in Gansu Province were mean patient age, occupation, having visited epidemic areas, and mode of transportation.
  • Time from infection to illness onset for family clusters was shorter in Gansu Province than in Wuhan, consistent with shortened durations from onset to first medical visit or hospitalization.
13.03.2020

Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus 2019 pneumonia in Wuhan, China

JAMA Internal Medicine / Original investigation

  • Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020.
  • Risk for developing ARDS included factors consistent with immune activation; older age was associated with both ARDS development and death, likely owing to less robust immune responses.
13.03.2020

Initial clinical features of suspected Coronavirus Disease 2019 in two emergency departments outside of Hubei, China

Journal of Medical Virology / Research article

  • A total of 116 patients suspected of having COVID‐19 who presented to two emergency departments in Anhui for the first time between 24 January 2020 and 20 February 2020 were enrolled in the study.
  • No initial clinical feature was found to be specific to diagnosed patients, which could allow for early clinical diagnosis of COVID‐19 in EDs.
  • The authors recommend strict medical observation and quarantine of all patients suspected of having COVID‐19, either in the ED itself or in a dedicated quarantine facility, irrespective of initial clinical features, especially in under‐resourced regions without access to rapid nucleic acid amplification tests.
13.03.2020

COVID-19 Pandemic: Global epidemiological trends and China's subsequent preparedness and responses

PubMed / Chinese article

  • This study analyzed global COVID-19 epidemiological trends, examined impact of the pandemic on global health security, diplomacy, and social environment in China, and provided short- and long-term strategic policy recommendations for China's subsequent preparedness and responses.
13.03.2020

Epidemiological characteristics of confirmed COVID-19 cases in Tianjin

PubMed / Chinese article

  • Fever was the main symptom at the early phase of COVID-19 in Tianjin, and the local cluster cases accounted for high proportion in confirmed COVID-19 cases reported in Tianjin.
  • Severe illness was prone to occur in people with old age and multi underlying diseases.
  • Strict isolation of close contacts and intensive care of high-risk groups are the main measures to reduce the morbidity and case fatality of COVID-19.
11.03.2020

 

Report 8: Symptom progression of COVID-19

MRC Centre for Global Infectious Disease Analysis / Epidemiology and clinical / Report

  • The authors analysed clinical characteristics of cases in mainland China as well as case studies of individuals from Hong Kong, Japan, Singapore and South Korea.
  • The average time to presentation with pneumonia is 5.88 days, and may be linked to testing at hospitalisation; fever is often reported at onset (where the mean time to develop fever is 0.77 days).

23.02.2020

Clinical characteristics of 51 patients discharged from hospital with COVID-19 in Chongqing,China

medRxiv(not-peer reviewed) / Research Paper

  • Retrospective, single-centre case series of the 51 hospitalized patients with confirmed COVID-19 at Chongqing University Three Gorges Hospital in Chongqing, China, from January 20 to February 3, 2020.
  • The main results and indicators of epidemiology, demography, clinical manifestation, laboratory examination, imaging data and treatment data of 51 patients with covid-19 were collected and analysed.
    (Please note that English is probably not the authors’ first language so the written quality of this paper is poor in parts. Also the title is inaccurate as one of the 51 patients died (presumably in hospital))

22.02.2020

Clinical Features of Atypical 2019 Novel Coronavirus Pneumonia with an initially Negative RT-PCR Assay

Journal of Infection / Letter to the Editor

  • 58-year-old male was admitted to hospital with a 1-day history of fever, sore throat and fatigue 5 days after visiting Wuhan, China.
  • Chest CT images illustrated multiple patchy, cloud-like high-density shadows in the dorsal segment of the right lower lobe. Three RT-PCR assays of oropharyngeal swab specimens were negative for 2019-nCoV nucleic acid.
  • A repeat chest CT performed 4 days after admission displayed that the range of patchy turbidity high-density shadows in the lower lobe of the right lung was significantly enlarged, and turbidity high-density shadows also appeared in the outer zone of the left lower lobe. The fourth RT-PCR 2019-nCoV nucleic acid assay was positive.
  • With typical clinical presentation and a clear epidemiological history, 2019-nCoV infection may be strongly suspected when chest CT has the characteristics of viral pneumonia despite negative RT-PCR results.

 17.02.2020

The Epidemiological Characteristics of an Outbreak of 2019 Novel
Coronavirus Diseases (COVID-19) — China, 2020

China CDC Weekly / Vital Surveillances

  • This paper reports the results of a descriptive, exploratory analysis of all COVID-19 cases diagnosed as of February 11, 2020 - 72,314 patient records—44,672 (61.8%) confirmed cases, 16,186  (22.4%) suspected
    cases, 10,567 (14.6%)  clinically diagnosed  cases (Hubei Province only), and 889 asymptomatic cases (1.2%).  
  • Among confirmed cases, most were aged 30–79 years (86.6%), diagnosed in Hubei  (74.7%), and  considered mild (80.9%). 
  • A total of 1,023 deaths occurred among confirmed cases for an overall case fatality rate of 2.3%.
  • The COVID-19 spread outward from Hubei Province sometime after December 2019, and by February  11, 2020, 1,386 counties across all 31 provinces were affected. 
  • The  epidemic curve of onset of symptoms peaked around January 23–26, then began to decline leading  up to February 11. 
  • A total of 1,716 health workers have become infected and 5 have died (0.3%).
    (An alternative link to the paper is 
    https://github.com/cmrivers/ncov/blob/master/COVID-19.pdf as there are issues with the China CDC weekly website)
12/02/2020 Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records The Lancet / Article
  • Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia.
  • All nine patients had a caesarean section in their third trimester. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia. Three patients had increased aminotransferase concentrations.
  • None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in new-born babies.
  • Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested, and all samples tested negative for the virus.
  • The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy.
13/02/2020 COVID-19: what is next for public health? The Lancet / Comment

Lists next Steps for public health, some of which include:

  • Close monitoring of changes in epidemiology and Intensified active surveillance.
  • Continued evolution of enhanced communication strategies.
  • Preparation for resilience of health systems in all countries.
  • Development of serological tests that can estimate current and previous infections in general populations.
  • Continued research to understand the source and transmission routes.

 

13/02/2020 Epidemiological research priorities for public health control of the ongoing global novel coronavirus (2019-nCoV) outbreak Eurosurveillance / Editorial
  • In order to calibrate public health responses improved information on transmission dynamics, severity of the disease, immunity, and the impact of control and mitigation measures that have been applied to date is needed.
  • This paper outlines these elements and highlights priority areas within each.

 

12/02/2020 COVID-19, Australia: Epidemiology Report 2 Communicable  Diseases Intelligence /  Report
  • Second epidemiological report for COVID-19, reported in Australia as of 8th February 2020. 15 cases as of this date.
  • All 15 cases reported a travel history to China, and 12/15 had a travel history to Wuhan, Hubei Province, China.
  • All five Queensland cases were in a small tour group of nine people. The three Queensland cases reported this week are consistent with secondary transmission from the index Queensland case prior to isolation.
  • Isolation and quarantine actions undertaken for the Queensland cases appear to have successfully prevented further transmission from the isolated tour group.
  • Zero deaths were reported. Three days elapsed since the onset of illness in the latest confirmed case at the date of this report.

 

  Epidemiological and Clinical Characteristics of 17 Hospitalized Patients with 2019 Novel Coronavirus
Infections OutsideWuhan,China

Medrxiv (not peer reviewed) / Research Paper

  • Analysed data on the 17 confirmed cases in Dazhou to provide the epidemiologic characteristics of 2019-nCoV patients outside Wuhan.
  • Among them, 12 patients were still quarantined in the hospital and 5 patients were discharged. Compared with non-discharged NCP patients, the discharged 2019-nCoV patients were younger.
  • Discharged 2019-nCoV patients had a higher heart rate, lymphocytes levels and monocytes levels than non-discharged 2019-nCoV patients on admission to the hospital.
  • All 17 patients had abnormal increased C-reactive protein levels, and 16 patients had abnormal
    computed tomography images.
  • This study indicates that younger age, higher lymphocytes levels and monocytes levels at the diagnoses of 2019-nCoV may contributed to faster recovery and better therapeutic outcome

10/02/2020

Severity of 2019-novel coronavirus (nCoV) - report 4

Pre-publication, not peer reviewed (from Imperial)

  • Estimates of case fatality ratio (CFR) for 3 strata of 2019-nCoV infections:
  • Estimate for cases in Hubei, CFR to be 18% (95% credible interval: 11%-81%).
  • Estimate for travellers outside mainland China, CFR in the range 1.2-5.6% depending on the statistical methods, with substantial uncertainty around these central values.
  • Overall CFR in all infections (asymptomatic or symptomatic) of approximately 1% (95% confidence interval 0.5%-4%) (Using estimates of underlying infection prevalence in Wuhan/early epidemic in Hubei Province/cases reported outside mainland China).
  • It is important to note that the differences in these estimates does not reflect underlying differences in disease severity between countries.

10/02/2020

Critical care management of adults with community-acquired severe respiratory viral infection

Intensive Care Medicine

  • Summary of current clinical management of severe respiratory illness.
  • No antiviral therapies of proven efficacy at present for other RVIs other than influenza.
  • Several adjunctive pharmacologic interventions have been studied, and are presented in the paper, for their immunomodulatory effects, including macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-influenza immune plasma and vitamin C, however, none are recommended at present in severe RVIs.
  • Currently, supportive care is the mainstay for management as is evidence-based.
  • Need for data on supportive care and adjunctive pharmacologic therapy specifically for these patients.

09/02/2020

Clinical characteristics of 2019 novel coronavirus infection in China

medRxiv (not peer reviewed) / Clinical characteristics / Research

  • Authors extracted the data on 1,099 patients with laboratory-confirmed 2019-nCoV ARD from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020.
  • Radiologic findings are present among some patients with 2019-nCoV infection. The disease severity (including oxygen saturation, respiratory rate, blood leukocyte/lymphocyte count and chest X-ray/CT manifestations) predict poor clinical outcomes.

07/02/2020

Preparedness and vulnerability of African countries against introductions of 2019-nCoV medRxiv (not peer reviewed) / Research Paper
  • Evaluated the preparedness and vulnerability of African countries against their risk of importation of 2019-nCoV.
  • Countries at the highest importation risk (Egypt, Algeria, Republic of South Africa) have moderate to high capacity to respond to outbreaks. Countries at moderate risk (Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, Kenya) have variable capacity and high vulnerability.
  • Resources and intensified surveillance and capacity should be urgently prioritized towards countries at moderate risk that may be ill-prepared to face the importation and to limit onward transmission.

06/02/2020

2019-nCoV epidemic: what about pregnancies?

The Lancet / Correspondence

  • Of 12 pregnant women infected with SARS-CoV, 3 women died during pregnancy, 4 had a miscarriage, 2 had fetal growth restriction and 4 had preterm birth. Of 11 pregnant women infected with MERS-CoV, 10  presented with adverse outcomes. 3/11 neonates died.
  • 2019-nCoV seems to have a similar pathogenic potential as SARS-CoV and MERS-CoV, so recommend systematic screening of any suspected 2019-nCoV infection during pregnancy.

06/02/2020

Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV)

Eurosurveillance / Rapid Communication

  • This study evaluated the effectiveness of thermal passenger screening for 2019-nCoV infection at airport exit and entry to inform public health decision-making.
  • Concluded that airport screening is unlikely to detect a sufficient proportion of 2019-nCoV infected travellers to avoid entry of infected travellers.

06/02/2020

2019-nCoV in context: lessons learned?

The Lancet Planetary Health / Comment

  • The zoonotic or agricultural bridging of novel pathogens from domestic and captive wildlife needs urgent attention, along with attention to the human appetite for meat.
  • For coronavirus threats—need to substantially reduce the trade of risky species of wild caught animals for food or other purposes, and have a culturally sensitive ban on the sale of these animals in wet markets.

 

Infection control

Date of publication

Title / URL

Journal / Publication type

Digest

02.04.2020

Only strict quarantine measures can curb the coronavirus disease (COVID-19) outbreak in Italy, 2020

Eurosurveillance / Rapid communication

  • Investigated the extent of physical distancing needed to effectively control the outbreak in a lockdown situation in a small size town setting typical of Italy.
  • They specifically estimate the disease burden and the time required until the quarantine can be lifted, by taking into account the time spent by individuals in the public (i.e. outside of the home) and the household size.
  • Conclusion: If the lockdown in Italy is aimed at containment, close to 100% restriction of contact time within communities combined with prompt case detection and immediate isolation of infected persons need to be achieved.

02.04.2020

From China: hope and lessons for COVID-19 control

The Lancet Infectious Diseases / Comment

  • Outside the original epicentre of Hubei province, Zhang et al found that the effective reproduction number dropped below the critical threshold of 1 by the end of January, 2020, for nine heavily affected Chinese provinces or cities. 
  • This finding suggests significant slowing of local transmission. Importantly, these reductions were achieved in a matter of weeks from the first signs of local transmission in most provinces.

02.04.2020

Electronic Personal Protective Equipment: A Strategy to Protect Emergency Department Providers in the Age of COVID-19

Journal of the American Medical Informatics Association : JAMIA / Article

  • Authors define electronic personal protective equipment (ePPE) as an approach using telemedicine tools to perform electronic medical screening exams while satisfying EMTALA. The safety, legal, and technical factors necessary for implementing such a pathway are discussed. 
  • This approach has the potential to conserve PPE and protect providers while maintaining safe standards for medical screening exams in the ED for low risk patients in whom COVID-19 is suspected. ePPE has potential applicability to settings such as emergency medical services, medical wards, and intensive care units, where ePPE may facilitate more frequent patient contact while reducing staff exposure and conserving PPE.

02.04.2020

Stability of SARS-CoV-2 in different environmental conditions

The Lancet Microbe / Correspondence

  • Here, the authors report the stability of SARS-CoV-2 in different environmental conditions.
  • Measurements include: the stability of SARS-CoV2 at different temperatures, on different surfaces, and the viricidal effects of disinfectants.

02.04.2020

A risk-based approach is best for decision making on holding mass gathering events / Correspondence

The Lancet

  • Response to: https://doi.org/10.1016/S0140-6736(20)30754-6
  • Memish and colleagues, in their response to their Comment, perceive conflict between the current best practice risk management advice on physical distancing and the scientific evaluation of cancelling or continuing mass gathering events during the COVID-19 pandemic. Although the authors have already acknowledged the need to balance these two considerations in order to maintain public understanding and trust, they do not accept that conflict is inevitable as their approach requires all mass gatherings to be considered in context, including the prevailing advice on physical distancing and movement restrictions.
  • An open and transparent process to explicitly consider the risks of a mass gathering can, in fact, promote public confidence in the decision.

02.04.2020

Guidance COVID-19: infection prevention and control

gov.uk / guidance

This guidance outlines the infection prevention and control advice for health and social care providers involved in receiving, assessing and caring for patients who are a possible or confirmed case of COVID-19. It should be used in conjunction with local policies. On 2 April 2020, the main changes to previous guidance are:

  • Enhanced PPE recommendations for a wide range of health and social care contexts
  • Inclusion of individual and organisational risk assessment at local level to inform PPE use
  • Recommendation of single sessional (extended) use of some PPE items
  • Re-usable PPE can be used. Advice on suitable decontamination arrangements should be obtained from the manufacturer, supplier or local infection control
  • Guidance for when case status is unknown and SARS-CoV-2 is circulating at high levels
  • Recommendation on patient use of facemask

01.04.2020

Environment and Personal Protective Equipment Tests for SARS-CoV-2 in the Isolation Room of an Infant With Infection

Annals of Internal Medicine / Letters

  • Objective: To investigate environmental contamination and potential for transmission from an infant with COVID-19.
  • A 6-month-old infant was admitted for isolation in the authors hospital because both parents were in the isolation units of other hospitals for confirmed COVID-19. On admission, the infant was asymptomatic, but nasopharyngeal swabs confirmed COVID-19 infection with very high viral load. 
  • The investigation confirmed that a generally well infant with COVID-19 can contaminate the environment with PCR-detectable virus. Despite close physical contact with the infant during feeding, they did not detect any evidence of SARS-CoV-2 on the gown of the HCW.

30.03.2020

A RANDOMIZED TRIAL OF INSTRUCTOR-LED TRAINING VERSUS VIDEO LESSON IN TRAINING HEALTH CARE PROVIDERS IN PROPER DONNING AND DOFFING OF PERSONAL PROTECTIVE EQUIPMENT

Disaster Med Public Health Prep / Article

  • This study compared live instructor-led training in Personal Protective Equipment (PPE) donning and doffing with video-based instruction. It assessed the difference in performance between (i) attending one instructor-led training session in donning and doffing PPE one month prior to assessment, and (ii) watching training videos over the month. 
  • 19 participants were assessed after one month.
  • Found no significant difference in donning and doffing score between instructor-led and video lessons. Video training could be a fast and resource-efficient method of training in PPE donning and doffing in responding to the COVID-19 pandemic.

29.03.2020

Covid-19: Doctors are told not to perform CPR on patients in cardiac arrest

BMJ / News

  • Healthcare staff in the West Midlands have been told not to start chest compressions or ventilation in patients who are in cardiac arrest if they have suspected or diagnosed covid-19 unless they are in the emergency department and staff are wearing full personal protective equipment (PPE).
  • If a patient with suspected covid-19 is in cardiac arrest they should be given cardiac compressions and be ventilated only if they are in the emergency department and the person attending them is wearing aerosol generating procedures (AGP) PPE. That means wearing an FFP3 mask, full gown with long sleeves, gloves, and eye protection.

23.03.2020

An Imperative Need for Research on the Role of Environmental Factors in Transmission of Novel Coronavirus (COVID-19)

Environ Sci Technol / Viewpoint

  • The occurrence, survival, and behaviour of COVID-19 virus in environmental compartments should be determined, requiring the development of high-throughput, automatic techniques for virus monitoring.
  • To reduce the chance of infection, it is important to develop practical methods for large-scale disinfection treatment of COVID-19 virus in different environmental settings.

23.03.2020

Can a Paper-Based Device Trace COVID-19 Sources with Wastewater-Based Epidemiology?

Environ Sci Technol / Viewpoint

  • Utilizing wastewater-based epidemiology may provide an effective approach to predict the potential spread of COVID-19 infection by testing for infectious agents in wastewater
  • In the case of asymptomatic infections in the community or people are not sure whether they are infected or not, rapid and real-time community sewage detection through paper analytical devices can determine whether there are SARS-CoV-2 carriers in the area in a timely manner to enable rapid screening, quarantine, and prevention.

23.03.2020

COVID-19: mitigating transmission via wastewater plumbing systems

Lancet Global Health / Correspondence

  • The interconnectedness of the wastewater plumbing network can facilitate exposure to SARS-CoV-2 within, or even between, buildings.
  • This is of particular concern in high-risk transmission settings such as hospitals and health-care buildings.
  • In this piece, the authors provide a set of recommendations which will help to minimise the risk of transmission.

23.03.2020

Richard Lehman’s covid-19 reviews—23 March 2020

BMJ / Opinion

  • This piece highlights a number of key articles about optimal quarantine periods, improving adherence with quarantine, children with COVID-19.

23.03.2020

Scientific and ethical basis for social-distancing interventions against COVID-19

Lancet Infectious Diseases / Comment

  • In the absence of any pharmaceutical intervention, the only strategy against COVID-19 is to reduce mixing of susceptible and infectious people through early ascertainment of cases or reduction of contact.
  • The effectiveness and societal impact of quarantine and social distancing will depend on the credibility of public health authorities, political leaders, and institutions.
  • It is important that policy makers maintain the public's trust through use of evidence-based interventions and fully transparent, fact-based communication.

23.03.2020

Covid-19: Protecting Worker Health

Ann Work Expo Health / Editorial

  • There are many uncertainties around how transmission of respiratory infections like Covid-19 occur within workplace settings.
  • Research should seek to address the following questions - What is the relevant importance of inhaled exposure compared to surface contamination and hand-to-peri-oral routes in the transmission of Covid-19? How effective are different types of personal protective equipment in reducing both inhaled and surface transmission? What simple structural and behavioural changes in the workplace can be encouraged to reduce the risk of transmission

21.03.2020

COVID-19: protecting health-care workers

Lancet / Editorial

  • Adequate provision of PPE is just the first step; other practical measures must be considered, including cancelling non-essential events to prioritise resources; provision of food, rest, and family support; and psychological support.

21.03.2020

Prepare to adapt: Blood supply and transfusion support during the first 2 weeks of the 2019 Novel Coronavirus (COVID-19) pandemic affecting Washington State

Transfusion / Brief report

  • This brief report describes the response from the hospital, the regional blood centre, and the hospital‐based transfusion services to the events that took place in the community during the initial phases of the pandemic.

21.03.2020

Responding to the COVID-19 pandemic in complex humanitarian crises

International Journal for Equity in Health / Commentary

  • As the international community responds to SARS-CoV-2, public health authorities in humanitarian crises begin at a disadvantage to enact appropriate infection control to prevent transmission in healthcare settings, identify infectious cases, administer supportive care and novel treatments for the seriously ill, and trace contacts.
  • Interventions tailored to the needs of crisis-affected populations, delivered with transparent information, in the context of inclusive governance practices, are urgently needed in the global response to the COVID-19 pandemic.

20.03.2020

Rational use of face masks in the COVID-19 pandemic

Lancet: Respiratory Medicine / Comment

  • Recommendations on face masks vary across countries and the authors have seen that the use of masks increases substantially once local epidemics begin, including the use of N95 respirators (without any other protective equipment) in community settings.
  • Urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged.

20.03.2020

Letter to editor: Role of masks/respirator protection against 2019-novel coronavirus (COVID-19)

Infection control and hospital epidemiology / Letter

  • Summary of the evidence relating to the protective role of both N95 respirators and medical masks in other diseases, what is known so far about their role in protecting against COVID-19 infection, and discussion of their role in the fight against COVID-19

20.03.2020

Stopping the Spread of COVID-19

JAMA / Infographic

  • Infographic on infection control and brief behavioural information aimed at the general public

20.03.2020

Public health measures to slow community spread of COVID-19

The Journal of infectious diseases / Article

  • Given the evolving picture of the COVID-19 pandemic, the application of layered, multi faceted, location- and population-specific NPIs will need to be considered and initiated quickly to curb widespread transmission.
  • When NPIs are reactive to widespread transmission, instead of proactive to the potential for transmission, they often fail to reduce rates of illness. The types of proactive measures described by the authors were successful in mitigating the 1918/19 influenza pandemic and may be just as valuable almost a century later.

20.03.2020

Response and role of palliative care during the COVID-19 pandemic: a national telephone survey of hospices in Italy

medRxiv (not peer-reviewed) / Article

  • The hospice sector is capable of responding flexibly and rapidly to the COVID-19 pandemic.
  • Governments must urgently recognise the essential contribution of hospice and palliative care to the COVID-19 pandemic, and ensure these services are integrated into the health care system response.
  • Availability of personal protective equipment and setting-specific guidance is essential.

20.03.2020

How to improve adherence with quarantine: Rapid review of the evidence

medRxiv (not peer-reviewed) / Article

  • People vary in their adherence to quarantine during infectious disease outbreaks.
  • To improve this, public health officials should provide a timely, clear rationale for quarantine and information about protocols; emphasise social norms to encourage this altruistic behaviour; increase the perceived benefit that engaging in quarantine will have on public health; and ensure that sufficient supplies of food, medication and other essentials are provided.

19.03.2020

SOCRATES: An online tool leveraging a social contact data sharing initiative to assess mitigation strategies for COVID-19

medRxiv (not peer-reviewed) / Article

  • Using the online tool with the available social contact data, the authors illustrate that social distancing could have a considerable impact on reducing transmission for COVID-19.

18.03.2020

Forecasting of COVID-19 Confirmed Cases in Different Countries with ARIMA Models

medRxiv (not peer-reviewed) / Article

  • The trend of South Korea was decreasing and will become stable in the near future. Iran and Italy had unstable trends. Mainland China and Thailand were successful in haltering COVID-19 epidemic.
  • Their protocol for quarantine should be investigated by other countries.
17.03.2020

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

New England Journal of Medicine / Letter

  • Evaluates the stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on various surfaces (cardboard, copper, plastic and stainless steel) and estimated their decay rates using a Bayesian regression model.
  • Stability of SARS-CoV-2 was similar to that of SARS-CoV-1 under the experimental circumstances tested.
14.03.2020

Limiting spread of COVID-19 from cruise ships: Lessons to be learnt from Japan

QJM: Monthly Journal of the Association of Physicians / Commentary

  • The reported development of a 15-minute blood-based Covid-1- test kit by Chinese scientists may help in future, if it is accurate and does not produce repeated false-negatives as the existing test does.
  • Similarly, creation of a purpose-built mass quarantine facility somewhere in Japan would be useful.
14.03.2020

COVID-19 and rationally layered social distancing

International Journal of Clinical Practice / Letter

  • It appears critical to implement social distancing in a rationally layered manner.
  • Young, healthy adults have a relatively lower risk of mortality, while individuals over their 60s, and particularly those in their 80s, have a disproportionately higher mortality risk.
  • Individuals with chronic, long-term conditions are at a higher risk of mortality.
  • It is imperative to support social interactions and social distancing interventions that are ideally positioned to protect everyone in a population and, at the same time, to more powerfully protect individuals from these highly susceptible groups.
13.03.2020

From containment to mitigation of COVID-19 in the US

JAMA / Viewpoint

  • Because SARS-CoV-2 is transmitted primarily by droplets, the proposed plan will focus on ensuring that reliable droplet precautions are used.
  • Key elements of a proposed plan for COVID-19 community spread mitigation in a Kaiser Permanente Northern California are highlighted.
13.03.2020

Consensus of Chinese experts on protection of skin and mucous membrane barrier for healthcare workers fighting against Coronavirus Disease 2019

Dermatologic Therapy / Article

  • Health professions preventing and controlling Coronavirus Disease 2019 are prone to skin and mucous membrane injury, which may cause acute and chronic dermatitis, secondary infection and aggravation of underlying skin diseases.
  • This is a consensus of Chinese experts on protective measures and advice on hand‐cleaning‐ and medical‐glove‐related hand protection, mask‐ and goggles‐related face protection, UV‐related protection, eye protection, nasal and oral mucosa protection, outer ear and hair protection.
13.03.2020

Impact of international travel and border control measures on the global spread of the novel 2019 coronavirus outbreak

Proceedings of the National Academy of Sciences of the United States of America / Research article

  • To contain the global spread of the 2019 novel coronavirus epidemic (COVID-19), border control measures, such as airport screening and travel restrictions, have been implemented in several countries.
  • These results show that these measures likely slowed the rate of exportation from mainland China to other countries, but are insufficient to contain the global spread of COVID-19.
13.03.2020

Involving antimicrobial stewardship programs in COVID-19 response efforts: All hands on deck

Infection Control & Hospital Epidemiology / Letter

  • The authors describe the need for hospital epidemiology programs to strongly consider integrating their Antimicrobial Stewardship Program (ASP) colleagues into disaster preparedness plans as well as identify a more formal role for stewards in their operations beyond the current COVID-19 outbreak.
13.03.2020

Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta‐analysis

Journal of Evidence-Based Medicine / Systematic review and meta-analysis

  • The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory‐confirmed influenza.
  • It suggests that N95 respirators should not be recommended for general public and nonhigh‐risk medical staff those are not in close contact with influenza patients or suspected patients.
13.03.2020

Interrupting transmission of COVID-19: lessons from containment efforts in Singapore

Journal of Travel Medicine / Accepted manuscript

  • In this article, the authors describe the combination of measures taken by Singapore to contain COVID-19 and share some early lessons learnt from the experience.
13.03.2020

A review of Coronavirus Disease-2019 (COVID-19)

The Indian Journal of Pediatrics / Review article

 
13.03.2020

What further should be done to control COVID-19 outbreaks in addition to cases isolation and contact tracing measures?

BMC Medicine / MedViews

  • Instead of asking whether case isolation and contact tracing measures are good enough, a more practical question might be: what further should be done by governments and communities to achieve effective control over outbreaks?
  • In the light that the strategies currently taken by China are beginning to prove effective, it would be of great interest to further discuss what can be learnt from their experience.

24.02.2020

Staff safety during emergency airway management for COVID-19 in Hong Kong

The Lancet Respiratory Medicine / Infection Control / Correspondence

  • Medical professionals caring for patients with COVID-19 are at high risk of contracting the infection.
  • This paper describes the approach of an ICU (North District Hospital, Sheung Shui, Hong Kong) to managing the risks to health-care staff, while maintaining optimal and high-quality care. Some details of this approach include:
  • Recommend that endotracheal intubation is done by an expert specialised in the procedure, and early intubation should be considered in a patient with deteriorating respiratory condition. For all cases, backup airway plans should be ready.
  • Recommend avoiding bag mask ventilation for as long as possible; and optimising preoxygenation with non-aerosol-generating means.

 

Transmission

Date of publication

 

Title / URL

Journal / Publication type Digest

24.02.2020

Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020

Emerging Infectious Diseases / Research Letter

  • Investigated a 2-family cluster of persons infected with SARS-CoV-2 in the city of Zhoushan in Zhejiang Province, China.
  • Identified 2 persons with confirmed cases of symptomatic COVID-19 after their exposure to a potentially presymptomatic person (traveller from the city of Wuhan in Hubei Province) who was later diagnosed with laboratory-confirmed COVID-19. These 2 persons later transmitted SARS-CoV-2 to 3 family members, who did not report symptoms at the time their SARS-CoV-2 infections were detected.

17.02.2020

The role of absolute humidity on transmission rates of the COVID-19 outbreak

medRxiv(not-peer reviewed) / Research Article

  • The role of absolute humidity in transmission of COVID-19 has not yet been established.
  • This study examined province-level variability of the basic reproductive numbers of COVID-19 across China.
  • Found that changes in weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in COVID-19 case counts without the implementation of extensive public health interventions.

17.02.2020

Passengers’ destinations from China: Low risk of Novel Coronavirus (2019-nCoV) transmission into Africa and South America

Cambridge University Press / Research Paper

  • Accepted in Epi & Infection – pre-publication
  • This study estimated the risk of transmission of 2019-nCoV through human passenger air flight from four major cities of China (Wuhan, Beijing, Shanghai, and Guangzhou) to the passengers’ destination countries.
  • Outside China, countries with higher risk of 2019-nCoV transmission are Thailand, Cambodia, Malaysia, Canada and United States of America, all of which reported at least one case.
  • In pan-Europe, United Kingdom, France, Russia, Germany and Italy, in Oceania, Australia had high risk, all of them reported at least one case.
  • In Africa and South America, the risk of transmission is very low with Ethiopia, South Africa, Egypt, Mauritius and Brazil showing similar risk of transmission compared to the risk of any of the countries where at least one case is detected.  

06/02/2020

2019-nCoV transmission through the ocular surface must not be ignored

The Lancet / Correspondence

  • On Jan 22, Guangfa Wang, reported that he was infected by 2019-nCoV during an inspection in Wuhan. He wore an N95 mask but did not wear anything to protect his eyes. Several days before the onset of pneumonia, he complained of redness of the eyes.
  • The respiratory tract is probably not the only transmission route for 2019-nCoV, and all ophthalmologists examining suspected cases should wear protective eyewear.

Treatment

Date of publication

Title / URL

Journal / Publication type

Digest

02.04.2020

Caution and clarity required in the use of chloroquine for COVID-19

The Lancet Rheumatology / Correspondence

  • Among the drugs being tested for COVID-19 in China is chloroquine, which was reported on Feb 4, 2020, to inhibit SARS-CoV-2 in vitro. The drug was rapidly pushed to clinical testing as an experimental treatment; on Feb 15, 2020, it was included in the sixth version of the COVID-19 treatment guidelines by the National Health Commission of the People's Republic of China.
  • This guideline established the use of chloroquine nationwide for patients with COVID-19, at a recommended adult dose of 500 mg twice per day for no more than 10 days.
  • The lethal dose of chloroquine in adults is about 5g, and in the human body is has a large volume of distribution with an elimination half-life of 20–60 days and a tendency to accumulate in metabolically active tissues at higher levels compared with the plasma concentration.
  • The potential toxicities of experimental treatments should be meticulously reported in peer-reviewed publications to avoid potentially misleading accounts and the risk of dangerous self-medication by the public.

02.04.2020

Chloroquine and hydroxychloroquine to treat COVID-19: between hope and caution

Clinical toxicology / Letter

  • While awaiting urgent, adequately powered, randomized trials to assess chloroquine/hydroxychloroquine-attributed benefits to treat COVID-19, these drugs should be prescribed cautiously, with initial cardiac evaluation in outpatients and daily ECG and twice-weekly residual blood concentration monitoring in hospitalized patients. If antimalarial drug effectiveness further disappoints, the onset of well-established drug-induced toxicity will not be forgiven.

02.04.2020

Respiratory Support for Adult Patients with COVID-19

Journal of the American College of Emergency Physicians Open / Concepts

  • This is a clinical review of non-invasive options to avert mechanical ventilation and ICU admission, and discusses their applicability in adult COVID-19 patients. 

02.04.2020

Global coalition to accelerate COVID-19 clinical research in resource-limited settings

The Lancet / Comment

  • Of the 332 COVID-19 related clinical trials, 188 are open for recruitment and 146 trials are preparing to recruit.
  • The distribution of these clinical trials is centred in the countries most affected by COVID-19 in the past 2 months, particularly China and South Korea, with high-income countries in Europe and North America planning most of the forthcoming trials. 
  • Very few trials are planned in Africa, south and southeast Asia, and central and South America.

02.04.2020

Converting gas-driven ventilators from oxygen to air

Anaesthesia / Correspondence

  • Shared advice from Devon based clinician:  
  • Identified that GE Healthcare anaesthetic machines (GE Healthcare, Amersham Place, Little Chalfont, UK) had a ventilator which was gas-driven, using oxygen, resulting in large amount of wasted oxygen. 
  • A simple procedure can make the switch from oxygen to air as the driving gas for the ventilators and requires no new additional parts and takes 45 min to complete per machine.

02.04.2020

The versatile heparin in COVID-19

Journal of thrombosis and haemostasis : JTH / Commentary

  • Coagulopathy in coronavirus infection has been shown to be associated with high mortality with high D-dimers being a particularly important marker for the coagulopathy.
  • In the latest paper the use of anticoagulant therapy with heparin was shown to decrease mortality as well. Especially in patients i) who have met the sepsis induced coagulopathy (SIC) criteria >/=4 (40.0% vs 64.2%, P=0.029) compared to those with SIC score <4 (29.0% vs 22.6%, P=0.419).or ii) with markedly elevated D-dimer (greater than six-fold at the upper limit of normal).

02.04.2020

Pivotal Role of Convalescent Plasma in Managing Emerging Infectious Diseases

Vox sanguinis / Commentary

  • Commentary on the role of convalescent plasma for COVID-19 treatment, including a review of existing evidence, potential hurdles in plasma collection and measures to mitigate risks to blood safety.

02.04.2020

Collecting and evaluating convalescent plasma for COVID-19 treatment: why and how

Vox sanguinis / Review

  • Review of the potential for plasma provided by COVID-19 convalescent patients for treatment.
  • Prior findings from SARS‐CoV-1 related pneumonia suggest convalescent plasma can reduce mortality, although formal proof of efficacy is still lacking. 
  • Clinical evaluation is need to assess if passive immunotherapy can reduce patient deterioration, and COVID‐19 mortality.

02.04.2020

In-silico approaches to detect inhibitors of the human severe acute respiratory syndrome coronavirus envelope protein ion channel

Journal of biomolecular structure & dynamics / Article

  • Authors employed computational approaches for studying the structure as well as function of the human "SARS-CoV2 E" protein as well as its interaction with various phytochemicals. 
  • Two amino acids, namely VAL25 and PHE26, play a key role while interacting with three phytochemicals. As these three phytochemicals, namely, Belachinal, Macaflavanone E & Vibsanol B, have passed the ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) property as well as "Lipinski's Rule of 5s", they may be utilized as drugs in controlling disease caused via SARS-COV2, after further investigation.

02.04.2020

Identification of Chymotrypsin-like Protease Inhibitors of SARS-CoV-2 Via Integrated Computational Approach

Journal of biomolecular structure & dynamics / Article

  • The functional importance of Chymotrypsin-like protease (3CL(pro)) in viral replication and maturation turns it into an attractive target for the development of effective antiviral drugs against SARS and other coronaviruses. The authors applied computational drug design methods to identify Chymotrypsin-like protease inhibitors from FDA approved antiviral drugs and their in-house database of natural and drug-like compounds of synthetic origin.
  • Three FDA approved drugs ( Remdesivir, Saquinavir and Darunavir) and two natural compounds (flavone and coumarine derivatives) were identified as promising hits.

31.03.2020

Characterization and treatment of SARS-CoV-2 in nasal and bronchial human airway epithelia

bioRxiv (not peer-reviewed) / Article

  • Authors used human reconstituted airway epithelial models of nasal or bronchial origin to characterize viral infection kinetics, tissue-level remodelling of the cellular ultrastructure and transcriptional immune signatures induced by SARS-CoV-2. 
  • Results underline the relevance of this model for the preclinical evaluation of antiviral candidates. Also evidence on the antiviral efficacy of remdesivir and the therapeutic potential of the remdesivir-diltiazem combination as a rapidly available option to respond to the current unmet medical need imposed by COVID-19.

31.03.2020

#VALUE!

Circulation / Article

  • Joint document from representatives of the HRS, ACC and AHA 
  • Describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities, provide guidance for managing invasive and non-invasive electrophysiology procedures, clinic visits and cardiac device interrogations. 
  • Discuss resource conservation and the role of tele-medicine in remote patient care along with management strategies for affected patients.

31.03.2020

Intranasal corticosteroids in allergic rhinitis in COVID-19 infected patients: An ARIA-EAACI statement

Allergy / Letter

  • Questionnaire to ARIA  database, 209 replies from 61 countries 
  • With  current  knowledge,  in  patients  with  COVID-19  infection,  intra-nasal  corticosteroid  (including  spray) can be continued in allergic rhinitis at the recommended dose
  • Stopping local intra-nasal corticosteroid is not advised. Suppression of the immune system has not been  proven and more sneezing after stopping means more spreading of the virus
  • These  recommendations  are  conditional  since  there  is  a  paucity  of  data  and  they  should  be  revised  regularly with new knowledge

29.03.2020

COVID-19 treatment by repurposing drugs until the vaccine is in sight

Drug Development Research / Commentary

  • Until such time that an effective vaccine is available for COVID-19 viral infection, one can repurpose known therapeutic drug molecules such as angiotensin receptor 2 blocker, a commonly used antihypertensive drug, to control COVID-19 virus from gaining entry into the host cell by blocking the angiotensin receptor. 
  • Clinical trials should also be undertaken to use statins, which are lipid-lowering drugs but have anti-inflammatory and immunomodulatory properties to prevent acute lung injury in COVID-19 infection.

23.03.2020

Identification of antiviral drug candidates against SARS-CoV-2 from FDA-approved drugs

bioRxiv (not peer-reviewed) / Article

  • The authors found 24 drugs which exhibited antiviral efficacy (0.1 µM <  IC50 < 10 µM) against SARS-CoV-2. In particular, two FDA-approved drugs - niclosamide and ciclesonide – were notable in some respects. These drugs will be tested in an appropriate animal model for their antiviral activities.

23.03.2020

An exploratory randomized, controlled study on the efficacy and safety of lopinavir/ritonavir or arbidol treating adult patients hospitalized with mild/moderate COVID-19 (ELACOI)

medRxiv (not peer-reviewed) / Article

  • This study was an exploratory randomized (2:2:1) and controlled one, exploring the efficacy and safety of lopinavir/ritonavir (LPV/r) or arbidol monotherapy treating mild/moderate COVID-19 patients.
  • Concluded that LPV/r or arbidol monotherapy seems to have little benefit for improving the clinical outcome of mild/moderate COVID-19. LPV/r might lead to more adverse events. Due to the limitation of small sample size, further verification is needed in the future.

23.03.2020

The feasibility of convalescent plasma therapy in severe COVID-19 patients: a pilot study

medRxiv (not peer-reviewed) / Article

  • In this study, ten severe patients confirmed by real-time viral RNA test were enrolled prospectively.
  • One dose of 200 mL convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents.
  • The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 days.
  • This study showed CP therapy was well-tolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases.

23.03.2020

Insights from nanomedicine into chloroquine efficacy against COVID-19

Nat Nanotechnol / Comment

  • Chloroquine — an approved malaria drug — is known in nanomedicine research for the investigation of nanoparticle uptake in cells.
  • There is cautious optimism that (hydroxy)chloroquine may have prophylactic and/or therapeutic effects against COVID-19, and understanding the mechanisms by which these drugs affect SARS-CoV-2 would be critical for optimizing and developing preventative and therapeutic strategies

20.03.2020

Effect of continuous renal replacement therapy on all-cause mortality in COVID-19 patients undergoing invasive mechanical ventilation: a retrospective cohort study

medRxiv (not peer-reviewed) / Article

  • Assessed the effect of continuous renal replacement therapy (CRRT) on all cause mortality in patients with COVID 19 undergoing invasive mechanical ventilation (n=36). Concluded that CRRT may be beneficial for the treatment of COVID 19 patients with invasive mechanical ventilation. Further prospective multicenter studies with larger sample sizes are required.

20.03.2020

SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19?

European heart journal / Article

  • Based on currently available data and in view of the overwhelming evidence of mortality reduction in cardiovascular disease, ACE-I and ARB therapy should be maintained or initiated in patients with heart failure, hypertension, or myocardial infarction according to current guidelines as tolerated, irrespective of SARS-CoV2.
  • Withdrawal of RAAS inhibition or pre-emptive switch to alternate drugs at this point seems not advisable, since it might even increase cardiovascular mortality in critically ill COVID-19 patients.

20.03.2020

Hiding in Plain Sight: an Approach to Treating Patients with Severe COVID-19 Infection

mBio / Commentary

  • The tissue receptor for COVID-19 is ACE2, and higher levels of ACE2 can protect against ARDS. Angiotensin receptor blockers and statins upregulate ACE2. Clinical trials are needed to determine whether this drug combination might be used to treat patients with severe COVID-19 infection.

20.03.2020

Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis

medRxiv (not peer-reviewed) / Article

  • The authors summarised and analysed the clinical characteristics and identify the predictors of disease severity and mortality. A total of 30 studies including 53000 patients with COVID-19 were included in this study.
  • The mean age was 49.8 years and 55.5% were male. The pooled incidence of severity and mortality were 20.2%  and 3.1%, respectively. The predictor for disease severity included old age, male , smoking and any comorbidity, especially chronic kidney disease, chronic obstructive pulmonary disease and cerebrovascular disease.
  • In terms of laboratory results, increased lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer and decreased blood platelet and lymphocytes count were highly associated with severe COVID-19. Meanwhile, old age, followed by cardiovascular disease  hypertension and diabetes were found to be independent prognostic factors for the COVID-19 related death.

20.03.2020

A brief review of antiviral drugs evaluated in registered clinical trials for COVID-19

medRxiv (not peer-reviewed) / Article

  • A review of currently registered clinical trials was performed on registries, including the Chinese (chictr.org.cn) and US (clinicaltrials.gov) databases to identify relevant studies up to March, 7th 2020. Out of the 353 studies identified, 115 clinical trials were selected for data extraction.

20.03.2020

COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression

The Journal of antimicrobial chemotherapy / Article

  • Chloroquine (CQ) exhibits a promising inhibitory effect on uncontrolled cytokine release but can cause severe side effects.
  • The authors propose that hydroxychloroquine (HCQ), which exhibits an antiviral effect highly similar to that of CQ, could serve as a better therapeutic approach. HCQ is likely to attenuate the severe progression of COVID-19, inhibiting the cytokine storm by suppressing T cell activation. It has a safer clinical profile and is suitable for those who are pregnant. It is cheaper and more readily available in China.
  • They herein strongly urge that clinical trials are performed to assess the preventive effects of HCQ in both disease infection and progression.

20.03.2020

PREDICTING THE EVOLUTION OF COVID-19 IN PORTUGAL USING AN ADAPTED SIR MODEL PREVIOUSLY USED IN SOUTH KOREA FOR THE MERS OUTBREAK

medRxiv (not peer-reviewed) / Article

  • Compared the efficacy and safety of favipiravir and arbidol to treat COVID-19 patients on 7 day′s clinical recovery rate. In ordinary COVID-19 patients untreated with antiviral previously, favipiravir can be considered as a preferred treatment because of its′ higher 7 day′s clinical recovery rate and more effectively reduced incidence of fever, cough except some antiviral-associated adverse effects.

20.03.2020

An orally bioavailable broad-spectrum antiviral inhibits SARS-CoV-2 and multiple endemic, epidemic and bat coronavirus

bioRxiv (not peer-reviewed) / Article

  • The authors show that the ribonucleoside analog Beta-D-N4-hydroxycytidine (NHC, EIDD-1931) has broad spectrum antiviral activity against SARS-CoV 2, MERS-CoV, SARS-CoV, and related zoonotic group 2b or 2c Bat-CoVs, as well as increased potency against a coronavirus bearing resistance mutations to another nucleoside analog inhibitor. The potency of NHC/EIDD-2801 against multiple coronaviruses, its therapeutic efficacy, and oral bioavailability in vivo, all highlight its potential utility as an effective antiviral against SARS-CoV-2 and other future zoonotic coronaviruses.
16.03.2020

COVID-19: consider cytokine storm syndromes and immunosuppression

Lancet / Correspondence

  • Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome.
  • The authors recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality.
13.03.2020

Combination of western medicine and Chinese traditional patent medicine in treating a family case of COVID-19 in Wuhan

Frontiers in Medicine / Treatment / Case report

  • The authors report the first family case of coronavirus disease 2019 (COVID-19) confirmed in Wuhan and treated using the combination of western medicine and Chinese traditional patent medicine Shuanghuanglian oral liquid (SHL).
  • The authors describe the identification, diagnosis, clinical course, and management of three cases from a family, suggests the expected therapeutic effects of SHL on COVID-19, and warrants further clinical trials.
13.03.2020

The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status

Military Medical Research / Treatment /  Review

  • Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation.
  • The authors summarise the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID-19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.
13.03.2020

The convalescent sera option for containing COVID-19

The Journal of Clinical Investigation / Treatment / Viewpoint

  • This Viewpoint argues that human convalescent serum is an option for prevention and treatment of COVID-19 disease that could be rapidly available when there are sufficient numbers of people who have recovered and can donate immunoglobulin-containing serum.
13.03.2020

Soluble angiotensin-converting enzyme 2: a potential approach for coronavirus infection therapy?

Clinical Science / Treatment / Correspondence

  • The authors explain the connection between the SARS-CoV, SARS-CoV-2, ACE2 and the rationale for soluble ACE2 as a potential therapy.
13.03.2020

COVID-19: An update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative Chinese–Western medicine for the management of 2019 Novel Coronavirus Disease

The American Journal of Chinese Medicine / Article

  • The authors reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine.
  • Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19.

17.02.2020

Potent Binding of 2019 Novel Coronavirus Spike Protein by a SARS Coronavirus-Specific Human Monoclonal Antibody

Emerging Microbes & Infections / Letter

  • This study reports for the first time that a SARS-CoV-specific human monoclonal antibody, CR3022, could potently bind with 2019-nCoV receptor-binding domain (RBD). The epitope of CR3022 does not overlap with the ACE2 binding site within 2019-nCoV RBD.
  • These results suggest that CR3022 may have the potential to be developed as candidate therapeutics, alone or in combination with other neutralizing antibodies, for the prevention and treatment of 2019-nCoV infections.

10/02/2020

Therapeutic options for the 2019 novel coronavirus (2019-nCoV)

Nature Reviews Drug Discovery / comment

  • Therapeutic options in response to the 2019-nCoV outbreak are urgently needed.
  • Authors discuss the potential for repurposing existing antiviral agents to treat 2019-nCoV, some of which are already moving into clinical trials.

06/02/2020

Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury The Lancet / Treatment / Review
  • Summary of clinical outcomes of corticosteroid therapy for MERS, SARS, Flu & RSV.
  • Concluded that corticosteroid treatment should not be used for the treatment of 2019-nCoV-induced lung injury or shock outside of a clinical trial.

 

Social Sciences

Date of publication

Title / URL

Journal / Publication type

Digest

04.04.2020

Redefining vulnerability in the era of COVID-19

The Lancet / Editorial

  • Vulnerable groups of people are those that are disproportionally exposed to risk, but who is included in these groups can change dynamically. A person not considered vulnerable at the outset of a pandemic can become vulnerable depending on the policy response. 
  • The strategies most recommended to control the spread of COVID-19—social distancing and frequent handwashing—are not easy for the millions of people who live in highly dense communities with precarious or insecure housing, and poor sanitation and access to clean water. 
  • While responding to COVID-19, policy makers should consider the risk of deepening health inequalities. If vulnerable groups are not properly identified, the consequences of this pandemic will be even more devastating.

02.04.2020

Why inequality could spread COVID-19

The Lancet Public Health / Comment

  • The inequitable response to COVID-19 is already evident. Healthy life expectancy and mortality rates have historically been markedly disproportionate between the richest and poorest populations. 
  • The full effects of COVID-19 are yet to be seen, while the disease begins to spread across the most fragile settings, including conflict zones, prisons, and refugee camps. 
  • As the global economy plunges deeper into an economic crisis and government bailout programmes continue to prioritise industry, scarce resources and funding allocation decisions must aim to reduce inequities rather than exacerbate them.

02.04.2020

COVID-19 and experiences of moral injury in front-line key workers

Occupational medicine / Editorial

  • COVID-19 pandemic may lead to increased 'moral injury' in UK front line key workers; a type of psychological distress resulting from actions, or the lack of them, which violate one’s moral or ethical code. 
  • The condition can contribute to the development of mental health problems, including depression, PTSD and anxiety.
  • A lack of resources may mean workers are unable to adequately care for those they are responsible for which may result in great suffering or a loss of life.

02.04.2020

Monitoring behavioural insights related to COVID-19

The Lancet / Correspondence

  • A critical element in reducing transmission of the virus is rapid and widespread behavioural change. Evidence shows that a perceived lack of consistency, competence, fairness, objectivity, empathy, or sincerity in crisis response in the public could lead to distrust and fear.
  • Conversely, when the public perceives measures as having these characteristics, as well as being easily understood and communicated through trusted and accessible channels, and when the necessary services are available, people are able to make informed choices, protect themselves, and comply with recommended practices.

02.04.2020

The impact of unplanned school closure on children’s social contact: rapid evidence review

Eurosurveillance / Review

  • Rapid review format discusses the impact of school closures on children's interaction with others outside the home and factors associated with contact outside the home.
  • This review of 19 papers found that all studies reported children leaving the home during the closure period and/or being looked after by non-household members, thereby having social contact with others they could potentially infect if they themselves were infected. There was some evidence that continuing to engage in social contact during school closures may be related to older child age, parental disagreement with closure and potentially infection status.
  • Further research is needed to identify how best to ensure that children are incentivised to stay at home during a school closure.

02.04.2020

Critical health literacy and the COVID-19 crisis

Health promotion international / Letter

  • Letter discussing the need to build critical health literacy in the population in light of the COVID-19 pandemic, so individuals can reflect on complex health issues and critically assess information available. Included in forward thinking should be efforts to strengthen values and attitudes of collective responsibility to reduce carelessness and prevent over-reactions.

02.04.2020

Understanding coronavirus disease (COVID-19) risk perceptions among the public to enhance risk communication efforts: a practical approach for outbreaks, Finland, February 2020

Eurosurveillance / Rapid communication

  • In February 2020, The Finnish Institute for Health and Welfare (THL) initiated a practical exercise to analyse risk perceptions and trust towards public authorities in the context of coronavirus disease (COVID-19). 
  • The process allows qualitative data collection and analysis in real time, based on social media posts and emails from the public. Its objective is to inform risk communication efforts on weekly basis.
  • The information can be used to help identify appropriate responses and communication strategies to COVID-19 related topics of public interest. This paper describes the methodology and the results of the first 3 weeks of the exercise.

02.04.2020

The COVID-19 pandemic: we are all in this together

Clinical infectious diseases / Letter

  • Letter discussing how stigma, discrimination and misinformation is effecting responses to the COVID-19 pandemic, and the need for a unified response globally rather than an “us against them mentality.”

02.04.2020

Achieve Research Continuity During Social Distancing by Rapidly Implementing Individual and Group Videoconferencing with Participants: Key Considerations, Best Practices, and Protocols

AIDS and behavior / Note

  • The authors describe methodology to continue social and behavioural research with individuals and group participants during social distancing, including use of videoconferencing and phone-based interactions. Best practices, key considerations, examples from the field, and sample protocols are presented to ease transition for ongoing studies and maximize the potential of videoconferencing.

31.03.2020

Knowledge and behaviors toward COVID-19 among U.S. residents during the early days of the pandemic

medRxiv (not peer-reviewed) / Article

  • This survey is one of the first attempts to study determinants of knowledge and behaviours in response to the COVID-19 pandemic in the U.S; tests hypothesis that knowledge of COVID-19 influences participation in different behaviours including self-reports of purchasing more goods than usual, attending large gatherings, and using medical masks.
  • A national, coordinated effort at pandemic response may ensure better compliance with behavioural recommendations to address this public health emergency.

30.03.2020

Health psychology and the coronavirus (COVID-19) global pandemic: A call for research

Br J Health Psychol / Editorial

  • Despite similarities with previous pandemics and a rapid response by the scientific community to understand COVID‐19 and reduce its global impact, there is still much that we do not know, especially given the novel features of COVID‐19, and governments varying responses to the crisis worldwide. There is therefore an urgent need for health psychology research.

23.03.2020

COVID-19 and medical education

Lancet Infectious Diseases / Correspondence

  • In one Chinese medical school, online problem-based learning techniques were implemented to complete the curricula; these methods proved incredibly popular, to the extent that they were applied in subsequent years.

23.03.2020

That discomfort you're feeling is grief

Harvard Business Review / Perspective

  • Harvard Business School staff discuss the content they’re commissioning in this harrowing time of a pandemic and how they can help people. They also talked about how they were feeling.

23.03.2020

The Role of Telehealth in Reducing the Mental Health Burden from COVID-19

Telemed J E Health / Commentary

  • While there is growing awareness of mortality rates associated with COVID-19, we should also be cognizant of the impact on mental health—both on a short- and a long-term basis.
  • Telemental health services are perfectly suited to this pandemic situation—giving people in remote locations access to important services without increasing risk of infection.

23.03.2020

Public Mental Health Crisis during COVID-19 Pandemic, China

Emerg Infect Dis / Research Letter

  • China has been implementing emergency psychological crisis interventions to reduce the negative psychosocial impact on public mental health, but challenges exist.
  • Public mental health interventions should be formally integrated into public health preparedness and emergency response plans

23.03.2020

Coronavirus research

European Commission / Research resources

  • Research projects and initiatives to tackle the spread of coronavirus and preparedness for other outbreaks.
  • A better understanding of COVID-19 and its spread is essential in order to detect the disease, treat and protect patients and ultimately control the epidemic.
  • The European Commission has been at the forefront of supporting research and coordination European and global research efforts, including preparedness for pandemics.

23.03.2020

The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure

Health Psychol / Comment

  • The authors review research suggesting that repeated media exposure to community crisis can lead to increased anxiety, heightened stress responses that can lead to downstream effects on health, and misplaced health-protective and help-seeking behaviors that can overburden health care facilities and tax available resources.

23.03.2020

Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based measures

Eur J Clin Invest / Commentary

  • Proper communication and optimal decision-making is an ongoing challenge, as data evolve.
  • The challenge is compounded, however, by exaggerated information which can lead to inappropriate actions.
  • It is important to differentiate promptly the true epidemic from an epidemic of false claims and potentially harmful actions.

23.03.2020

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

JAMA Network Open / Original investigation

  • In this survey of 1,257 heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.

23.03.2020

Social Media and Emergency Preparedness in Response to Novel Coronavirus

Jama / Viewpoint

  • More than 100 years ago, a global pandemic affected more than 500 million people worldwide - today, in the midst of another public health emergency, some lessons from history demonstrate the importance of understanding how information spreads and individuals interact.
  • Integrating social media as an essential tool in preparedness, response, and recovery can influence the response to COVID-19 and future public health threats.

23.03.2020

How might the social stigma around covid-19 perpetuate the spread of disease?

BMJ / Opinion

  • The first thing people can do is to limit the adverse effects of social stigma is to acknowledge its presence and its potential role in the spread of coronavirus.
  • Furthermore, the media must take accountability for the dissemination of misleading and sensationalist headlines, which encourage this stigmatisation.

20.03.2020

Scientometric Trends for Coronaviruses and Other Emerging Viral Infections

bioRxiv (not peer-reviewed) / Article

  • The authors demonstrate that the research volume of emerging infectious diseases is very high after an outbreak and drops drastically upon the containment of the disease.
  • This can yield inadequate research and limited investment in gaining a full understanding of novel coronavirus management and prevention.
  • Independent of the outcome of the current COVID-19 outbreak, we believe that measures should be taken to encourage sustained research in the field.

20.03.2020

Supporting Clinicians During the COVID-19 Pandemic

Annals of internal medicine / Opinion

  • Opinion piece examining best practice to support maintaining the resilience of clinicians during a crisis such as COVID-19

20.03.2020

Knowledge and Perceptions of COVID-19 Among the General Public in the United States and the United Kingdom: A Cross-sectional Online Survey

Annals of internal medicine / research letter

  • A total of 2986 and 2988 adults residing in the United States and United Kingdom, respectively, completed a questionnaire assessing assess knowledge and perceptions about COVID-19.
  • Although participants generally had good knowledge of the main mode of disease transmission and common symptoms, the survey identified several important misconceptions on how to prevent acquisition of COVID-19, including beliefs in falsehoods that have circulated on social media.
  • A substantial proportion of participants also expressed an intent to discriminate against individuals of East Asian ethnicity for fear of acquiring COVID-19.

20.03.2020

Report 10: Public Response to UK Government Recommendations on COVID-19: Population Survey, 17-18 March 2020

Imperial College / Report

  • To capture public sentiment towards these recommendations, a YouGov survey was commissioned by the Patient Experience Research Centre (PERC), Imperial College London.
  • The survey was completed by 2,108 UK adults between the dates of 17th – 18th March 2020.
  • Hand washing (63%), avoiding persons with symptoms (61%), and covering your sneeze (53%) were more likely to be perceived as ‘very effective’ measures to prevent COVID-19 spread than common social distancing measures (avoiding going out (31%), to work (23%), to shops (16%) or to schools (19%).

20.03.2020

Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China

Medical science monitor / Article

  • During a period of individual self-isolation during the COVID-19 virus epidemic in central China, increased social capital improved sleep quality by reducing anxiety and stress

20.03.2020

Covid-19: control measures must be equitable and inclusive

BMJ (Clinical research ed.) / Editorial

  • Discusses the needs of vulnerable groups in the response to COVID-19, including inclusive messaging, free testing provision, equitable sharing of health resources, and employment rights

20.03.2020

COVID-19: Vulnerability and the power of privilege in a pandemic

Health promotion journal of Australia / Editorial

  • Discusses the role of health promotion during pandemics, with a focus on the importance of coordination in key messaging between various sectors.
  • Considers how pandemics can impact vulnerable populations.

26.02.2020

Caring for persons in detention suffering with mental illness during the Covid-19 outbreak

Forensic Science International: Mind and Law

  • The authors urge that governments take into account special needs of people in confined closed spaces, and make recommendations for achieving this.
  • It should not be forgotten that psychiatric and psychological care must not just be provided to affected individuals among the general population, but also to vulnerable groups such as people in detention, homes, and asylum centers.
  • Those who survive the infection may experience survivor guilt and those who experience loss of loved ones may experience grief.
12/02/2020

Toning down the 2019-nCoV media hype—and restoring hope

The Lancet Respiratory Medicine / Media and Communication / Comment
  • Since the first announcement of the outbreak, the news and social media hype has been unprecedented.
  • The proliferation of internet-based health news might encourage selection of media and academic research articles that overstate the strength of causal inference.
  • The media should focus on having altruistic intentions and develop dialogue with the appropriate authorities to protect global health security through effective amiable partnerships.
  • They should highlight vaccine development efforts as well as educational and public health measures that are being put in place to prevent the spread of infection.

 

12.02.2020 Anti-Chinese sentiment during the 2019-nCoV outbreak The Lancet / Racism / Correspondence
  • The rampant spread of 2019-nCoV has stirred panic and an unwelcoming sentiment towards Chinese people across the world.
  • Anti-Chinese sentiment in Hong Kong was exacerbated by the government's delayed public health response.
  • As a result, some of the public health precautionary strategies are self-initiated by the community in attempts to influence the government's policies.
  • Public health measures, however well intended, can be tainted by sentiment that is fuelled with prejudice against a certain group of people.
  • If left unexamined, this sentiment could give rise to measures that do not target the real issue accurately and adequately, undermining the effectiveness of any interventions.

10/02/2020

Coronaphobia: Fear and the 2019-nCoV Outbreak

Journal of Anxiety Disorders / Editorial

  • Data from recent public opinion polls show that 2019-nCoV is having psychological impact on the general public, including in low risk countries including Canada and USA.
  • The fear of 2019-nCoV is likely to be due to its novelty and the uncertainties about how bad the current outbreak might become.
  • More research is needed to understand the relationship between coronaphobia and coronavirus-related xenophobia.

08/02/2020

Offline: 2019-nCoV—“A desperate plea”

The Lancet / Comment

  • What is life like for those quarantined in Chinese cities? Contains email extracts from someone quarantined in China. Email was titled “A desperate plea from an ordinary citizen in China”.

 

Miscellaneous

Date of publication

Title / URL

Journal / Publication type

Digest

02.04.2020

Communication Skills in the Age of COVID-19

Annals of Internal medicine / Ideas and Opinions

  • Comment on the impact of COVID-19 in revealing challenges that clinicians already face in communicating with patients about serious illness.
  • Clinicians are confronted with new communication tasks not faced before, including proactive COVID-19 planning for at risk patients, facilitating virtual goodbyes between family members, and explaining decisions around scarce resources.
  • Clinicians lacking training in evidence-based methods to communicate with patients with serious illness may particularly struggle

02.04.2020

Collision of the COVID-19 and Addiction Epidemics

Annals of Internal medicine / Ideas and Opinions

  • Comment on the impact of COVID-19 and social distancing on those with substance use disorders (SUD).
  • Those with SUD or recovering may be particularly susceptible to COVID-19 and associated complications, struggle to access care, and be uniquely challenged by social distancing measures.
  • Many risks of the current pandemic to persons with SUD are indirect, such as housing instability and incarceration.

02.04.2020

An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19

Annals of Internal medicine / Ideas and Opinions

  • Strategies to address disruptions in medication access facing persons with opioid use disorder plus reduce in-person contact with health care providers for treatment assessments and to manage changes in care.

02.04.2020

Flattening the Curve for Incarcerated Populations - Covid-19 in Jails and Prisons

New England Journal of Medicine / Perspective

  • Practical steps to operationalize a response for incarcerated populations.

02.04.2020

Governmental Public Health Powers During the COVID-19 Pandemic: Stay-at-home Orders, Business Closures, and Travel Restrictions

JAMA / Viewpoint

  • To limit cross-border spread, more than a dozen states in the USA have issued mandatory quarantines for interstate travellers. Some models suggest physical distancing would have to persist for 3 months to mitigate the peak effects on health systems and could be required on an intermittent basis for 12 to 18 months. 
  • This article discusses what legal powers governments have, the role of the courts, and how public health can be balanced with personal and economic rights.

02.04.2020

Fangcang shelter hospitals: a novel concept for responding to public health emergencies

The Lancet / Health Policy

  • Fangcang shelter hospitals are a novel public health concept. The authors document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). 
  • Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.

02.04.2020

The 3 Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will

JMIR Public Health and Surveillance / Editorial

  • The authors describe the rationale for three priority areas to stop the COVID-19 pandemic:  1) coordinated and consistent stay-at-home orders across multiple jurisdictions, including potential nation-wide mandates 2) rapid scale-up of SARS-CoV-2 testing 3) improving healthcare capacity to respond.

02.04.2020

Covid-19 and Health Care's Digital Revolution

The New England journal of medicine / Perspective

  • Perspective piece on the need to increase use of digital health in all health care systems to support response to COVID-19, and suggested actions.

02.04.2020

Thinking Globally, Acting Locally — The U.S. Response to Covid-19

New England Journal of Medicine /  Perspective

  • Suggests that national leadership in an epidemic response only works if it is evidence-based.
  • Discussion of lessons already learned from COVID-19, in the United States.

02.04.2020

Covid-19 and Health Care’s Digital Revolution

New England Journal of Medicine / Perspective

  • The authors suggest that the United States' health care system is ill equipped to deal with this pandemic due to its analogue nature.
  • New remote service options are needed, including: video, text, email, mobile phone applications, wearable devices and "chatbots". 
  • Hospital-at-home care should be an option for otherwise stable patients with newly diagnosed SARS-CoV-2 infections and for early discharge of patients admitted to hospitals.
  • An emergency update of privacy and communication regulation is needed to accompany these new digital services, including for payment models.

02.04.2020

Declining Public Health Protections within Autocratic Regimes: Impact on Global Public Health Security, Infectious Disease Outbreaks, Epidemics, and Pandemics

Prehospital and disaster medicine / Article

  • Paper describing the impact of autocratic regimes and leaders on public health response, with a review of a cross section of autocratic nations currently experiencing the impact of COVID-19 as an example of how these regimes have global impact.

02.04.2020

Medical student involvement in the COVID-19 response

The Lancet / Correspondence

  • The paradoxical dual role of medical students is that, as the future health-care workforce, they potentially form part of a health-care system's response to public health emergencies but, conversely, are considered non-essential in clinical delivery and might be restricted from clinical learning.
  • Some medical schools have cancelled training, whereas others encourage clinical placements. Both represent a loss of essential learning opportunities.

02.04.2020

COVID-19: the current situation in Afghanistan

The Lancet Global Health / Correspondence

  • Although the health-care system in Afghanistan has improved over the past 17 years, the authors question its preparedness for a prompt and functional response to the COVID-19 outbreak.

23.03.2020

Are We Ready for Coronavirus Disease 2019 Arriving at Schools?

J Korean Med Sci / Opinion

  • At this moment, we do not have strong evidence to guide decisions on durations of school closures and how various durations will effect public health.
  • A few days of closure is reasonable in response to school-based cases of COVID-19 for decontamination and contact tracing; while medium to longer lengths of closure (4–8 weeks) may be considered as part of a broader community mitigation strategy

23.03.2020

Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade

Nephron / Article

  • A review of the most recent findings on the effects of SARS-CoV-2 infection on kidney diseases, including acute kidney injury, and the potential effects of ARBs on the outcomes of patients with COVID-19

23.03.2020

Ethics Committee Reviews of Applications for Research Studies at 1 Hospital in China During the 2019 Novel Coronavirus Epidemic

Jama / Research Letter

  • All new applications for COVID-19–related studies and meeting minutes from February 2 through March 7, 2020 were examined, categorized by study type, approval rate and review time determined, and issues in research proposals and informed consent forms summarised.
  • During the outbreak, ethics committee review of COVID-19 studies at 1 hospital were conducted within a few days, more quickly than the 27 ethical reviews organized by the Médecins Sans Frontières ethics review board during the Ebola crisis, with a mean time of 12.4 days to provide a review after the initial request

23.03.2020

COVID-19 and the crisis of national development

Nat Hum Behav / Viewpoint

  • The global practice of monetizing ecosystems to further national economic development has laid fertile ground for the COVID-19 pandemic and others like it

21.03.2020

Respiratory disease and virus shedding in rhesus macaques inoculated with SARS-CoV-2

bioRxiv (not peer-reviewed) / Article

  • The authors show that SARS-CoV-2 causes respiratory disease in infected rhesus macaques, with disease lasting 8-16 days. Pulmonary infiltrates, a hallmark of human disease, were visible in lung radiographs of all animals. High viral loads were detected in swabs from the nose and throat of all animals as well as in bronchoalveolar lavages; in one animal the authors observed prolonged rectal shedding.
  • Taken together, the rhesus macaque recapitulates moderate disease observed in the majority of human cases. The establishment of the rhesus macaque as a model of COVID-19 will increase our understanding of the pathogenesis of this disease and will aid development and testing of medical countermeasures.

20.03.2020

Roles of meteorological conditions in COVID-19 transmission on a worldwide scale

medRxiv (not peer-reviewed) / Article

  • The authors examined the relationships of meteorological variables with the severity of the outbreak on a worldwide scale.

20.03.2020

A framework for identifying regional outbreak and spread of COVID-19 from one-minute population-wide surveys

medRxiv (not peer-reviewed) / Article

  • The authors propose that daily population-wide surveys that assess the development of symptoms caused by the virus could serve as a strategic and valuable tool for identifying such clusters to inform epidemiologists, public health officials, and policymakers. Show preliminary results from a survey of over 38,000 Israelis and call for an international consortium to extend this concept in order to develop predictive models.

20.03.2020

Seasonality of Respiratory Viral Infections

Annual review of virology / Early release article - not final version

  • Review of evidence of how outdoor and indoor climates are linked to the seasonality of viral respiratory infections.
  • Discussion of determinants of host response in the seasonality of respiratory viruses by highlighting recent studies in the field.

20.03.2020

Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

Journal of telemedicine and telecare / Research article

  • Examines the role of telehealth in emergency responses, highlighting advantages and limitations and calling for the development of a telehealth strategy to deal with global and national emergency responses, built on the premise that telehealth becomes a mainstream component of our health system.
13.03.2020

Better use of data and digital offer rapid opportunities to address covid-19

BMJ / Opinion

  • In the Oxford DataLab we informally assembled a small team of clinicians and digital health experts to think through urgent actions to improve our use of digital technologies during the current crisis, and actions to start implementing in preparation for future pandemics.
  • This post briefly summarises our suggestions and links to the full document: but its main purpose is to flag the urgent need for swift progress on digital in the NHS, and more sophisticated open discussion around the tools, systems, and culture towards digital technology across the health service.
13.03.2020

Covid-19: Older adults and the risks of misinformation

BMJ / Opinion

  • Research in political misinformation has shown that older adults in the US aged 65 and older were more likely to share fake news on social media as compared to other groups.
  • Efforts to address exposure to and sharing of misinformation during covid-19 thus need urgent attention, with a particular focus on making sure that at risk and vulnerable populations have access to accurate information that is tailored for them.

24.02.2020

Chinese medical staff request international medical assistance in fighting against COVID-19

The Lancet Global Health / Working Conditions, Seeking Assistance / Correspondence

  • The authors went to Wuhan, China, to support the local nurses in their fight against the COVID-19 infection. They are asking nurses and medical staff from countries around the world to come to China, to help in this battle. This correspondence outlines some of the challenges faced by the medical staff in Wuhan, some of which include:
  • As a result of wearing an N95 respirator for extended periods of time and layers of protective equipment, some nurses now have pressure ulcers on their ears and forehead.
  • In order to save energy and the time it takes to put on and take off protective clothing, they avoid eating and drinking for 2 hours before entering the isolation ward. Some nurses have fainted due to hypoglycaemia and hypoxia.
  • In addition to the physical exhaustion, they are also suffering psychologically.

17.02.2020

Pathological findings of COVID-19 associated with acute respiratory distress syndrome

The Lancet Respiratory Medicine  / Case Report

  • Investigated the pathological characteristics of a single patient who died from severe infection with SARS-CoV-2, by obtaining biopsy samples at autopsy.
  • Outlines disease onset, progression and treatment given to the patient before death.
  • The right lung showed signs indicative of acute respiratory distress syndrome (ARDS). The left lung tissue displayed signs suggestive of early-phase ARDS. X-ray images showed rapid progression of pneumonia and some differences between the left and right lung.
  • The liver biopsy specimens showed moderate microvascular steatosis and mild lobular and portal activity, indicating the injury could have been caused by either SARS-CoV-2 infection or drug-induced liver injury. There were no obvious histological changes seen in heart tissue, suggesting that SARS-CoV-2 infection might not directly impair the heart.  
  • The pathological features of COVID-19 greatly resemble those seen in SARS and MERS coronavirus infection.

17.02.2020

Timely research papers about COVID-19 in China

The Lancet / Correspondence

  • As of Feb 3, 2020, just 23 Chinese-language papers on COVID-19 were published.
  • Many of the research papers about COVID-19 in international journals were written by researchers in China, which led to great concerns because these findings cannot directly benefit frontline health professionals and policy makers because of the language barrier.
  • A recent statement by the Ministry of Science and Technology of China encouraged researchers to focus their efforts on epidemic prevention and to publish their results in Chinese.
  • Broad dissemination in both Chinese and English will accomplish the goals of communicating timely and crucial findings to the international scientific community, while also disseminating this information to health-care workers on the frontline who need to understand the epidemiological and clinical features of COVID-19.

17.02.2020

Challenges of coronavirus disease 2019

The Lancet Infectious Diseases / Editorial

  • Outlines the challenges faced with the COVID-19 outbreak.
  • While health systems in high-income countries would be stretched by the COVID-19 outbreak, the most devastating effects would be in countries with weak health systems, ongoing conflicts, or existing infectious disease epidemics. In these countries, it is imperative to rapidly detect and contain the virus at points of entry to prevent community transmission and health systems from being overwhelmed.
  • There is an urgent need to develop effective diagnostics, therapeutics, and vaccines
  • Social media and sensationalist reporting are challenging outbreak response efforts.

17.02.2020

Challenges of coronavirus disease 2019

The Lancet Infectious Diseases / Editorial

  • Outlines the challenges faced with the COVID-19 outbreak.
  • While health systems in high-income countries would be stretched by the COVID-19 outbreak, the most devastating effects would be in countries with weak health systems, ongoing conflicts, or existing infectious disease epidemics. In these countries, it is imperative to rapidly detect and contain the virus at points of entry to prevent community transmission and health systems from being overwhelmed.
  • There is an urgent need to develop effective diagnostics, therapeutics, and vaccines
  • Social media and sensationalist reporting are challenging outbreak response efforts.
12/02/2020 What are the risks of COVID-19 infection in pregnant women? The Lancet / Comment
  • Previous studies have shown that SARS during pregnancy is associated with a high incidence of adverse maternal and neonatal complications.
  • However, pregnant women with COVID-19 infection in the Chen et al study had fewer adverse maternal and neonatal complications and outcomes than would be anticipated for those with SARS-CoV-1 infection.
  • There is no reliable evidence as of yet available to support the possibility of vertical transmission of COVID-19 infection from the mother to the baby.
  • Because of the small number of cases analysed and the short duration of the study period, more follow-up studies should be done to further evaluate the safety and health of pregnant women and new-born babies who develop COVID-19 infection.

 

12/02/2020 Caution on Kidney Dysfunctions of 2019-nCoV Patients Medrxiv (not peer reviewed) / Research Paper
  • Report an ongoing case study on kidney functions in 59 patients infected by 2019-nCoV (including 28 diagnosed as severe cases and 3 deaths).
  • 63% (32/51) of the patients exhibited proteinuria, indicative of renal impairment. 19% (11/59) and 27% (16/59) of the patients had an elevated level of plasma creatinine and urea nitrogen respectively. The computerized tomography (CT) scan showed radiographic abnormalities of the kidneys in 100% (27/27) of the patients.
  • Strongly suggest exercising a high degree of caution in monitoring the kidney functions of 2019-nCoV patients and, very importantly, that applying potential interventions including continuous renal replacement therapies (CRRT) for protecting kidney functions as early as possible, particular for those with plasma creatinine rising, is key to preventing fatality.

 

08/02/2020

What next for the coronavirus response?

The Lancet / World Report

  • Outlines recommendations by the WHO, which include: to support countries with weaker health systems; accelerate development of vaccines, therapeutics, and diagnostics; combat the spread of rumours/misinformation etc..

 

Modelling

Date of publication

Title / URL

Journal / Publication type

Digest

23.03.2020

Prudent public health intervention strategies to control the coronavirus disease 2019 transmission in India: A mathematical model-based approach

Indian J Med Res / Pre-Print Article

  • The objectives of this study were to find out if it was possible to prevent, or delay, the local outbreaks of COVID-19 through restrictions on travel from abroad and if the virus has already established in-country transmission, to what extent would its impact be mitigated through quarantine of symptomatic patients.
  • Port-of-entry-based entry screening of travellers with suggestive clinical features and from COVID-19-affected countries, would achieve modest delays in the introduction of the virus into the community - acting alone, however, such measures would be insufficient to delay the outbreak by weeks or longer.

23.03.2020

Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study

Lancet Infectious Diseases / Article

  • The authors adapted an influenza epidemic simulation model to estimate the likelihood of human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a simulated Singaporean population.
  • Implementing the combined intervention of quarantining infected individuals and their family members, workplace distancing, and school closure once community transmission has been detected could substantially reduce the number of SARS-CoV-2 infections.

23.03.2020

Assessing the potential impacts of COVID-19 in Brazil: Mobility, Morbidity and Impact to the Health System

medRxiv (not peer-reviewed) / Article

  • The authors explore the most likely routes of spread of COVID-19 through Brazil, from the already exposed cities, according to human mobility statistics. The resulting maps should help authorities in their efforts to prioritize actions and if resource allocation to mitigate the effects of the pandemic.

23.03.2020

From a single host to global spread. The global mobility based modelling of the COVID-19 pandemic implies higher infection and lower detection rates than current estimates

medRxiv (not peer-reviewed) / Article

  • The authors propose a set of parameters for the first COVID-19 Global Epidemic and Mobility Model (GLEaM). The parameters that successfully model the pandemic are: the basic reproduction number R​ 0​, ~4·4; a latent non-infectious period of 1·1. days followed by 4·6 days of the presymptomatic infectious period; the probability of developing severe symptoms, 0·01; the probability of being diagnosed when presenting severe symptoms of 0·6; the probability of diagnosis for cases with mild symptoms or asymptomatic, 0·001. Also, the higher the testing rate per country, the lower the discrepancy between data (diagnosed cases) and model.

21.03.2020

Building a COVID-19 Vulnerability Index

medRxiv (not peer-reviewed) / Article

  • While information specific to COVID-19 is limited, a model using complications due to other upper respiratory infections can be used as a proxy to help identify those individuals who are at the greatest risk. The authors present the results for three models predicting such complications, with each model having varying levels of predictive effectiveness at the expense of ease of implementation.

20.03.2020

Estimating Spot Prevalence of COVID-19 from Daily Death Data in Italy

medRxiv (not peer-reviewed) / Article

  • This model predicts that when the first 3 infected cases had been identified by Italian authorities there were already nearly 30 cases in Italy, and by the 24th of February 2020 only 0.5% cases had been detected and confirmed by Italian authorities.
  • While official statistics had 132 confirmed case the authors believe a more accurate estimate would be closer to 26000. With a case-doubling period of about 2.5 days.

20.03.2020

Estimating the Risks from COVID-19 Infection in Adult Chemotherapy Patients

medRxiv (not peer-reviewed) / Article

  • The authors develop a simple model to estimate the potential harms in patients undergoing chemotherapy during a COVID outbreak.
  • They use data from randomised trials to estimate benefit across a range of curative and palliative settings, and address the balance of benefit against the risk of harm.
  • They then use those data to estimate the impact on national chemotherapy delivery patterns.

20.03.2020

Extended SIR prediction of the epidemics trend of COVID-19 in Italy and compared with Hunan, China

medRxiv (not peer-reviewed) / Article

  • Using time-series data of COVID-19 from Jan 22, 2020 to Mar 16, 2020, the authors found that Italy's current strict measures can effectively prevent the further spread of COVID-19 and should be maintained.
  • Necessary strict public health measures should be implemented as soon as possible in other European countries with a high number of COVID-19 cases.

20.03.2020

Pandemic dynamics of COVID-19 using epidemic stage, instantaneous reproductive number and pathogen genome identity (GENI) score: modeling molecular epidemiology

medRxiv (not peer-reviewed) / Article

  • The authors calculated an instantaneous country-specific R at different stages of outbreaks and formulated a novel metric for infection dynamics using viral genome sequences to capture gaps in untraceable transmission. Integrating epidemiology with genome sequencing allows evidence-based dynamic disease outbreak tracking with predictive evidence.

14.03.2020

Expected impact of school closure and telework to mitigate COVID-19 epidemic in France: Report 8

EPIcx lab / Report

  • Numerical results show that school closure alone would have limited benefit in reducing the peak incidence (less than 10% reduction with 8-week school closure for regions in the early phase of the epidemic).
  • When coupled with 25% adults teleworking, 8-week school closure would be enough to delay the peak by almost 2 months with an approximately 40% reduction of the case incidence at the peak.
13.03.2020

 

Case-fatality risk estimates for COVID-19 calculated by using a lag time for fatality 

Emerging Infectious Diseases / Early release article - not final version

  • Given the residual uncertainties, health sector decision-makers and disease modelers probably should consider a broad range of 0.25%–3.0% for COVID-19 case-fatality risk estimates.
  • The higher values could be more appropriate in resource poor settings where the quality of hospital and intensive care might be constrained.
13.03.2020

Estimating risk for death from 2019 Novel Coronavirus Disease, China, January-February 2020

Emerging Infectious Diseases / Early release article - not final version

  • Because the risk for death from COVID-19 is probably associated with a breakdown of the healthcare system in the absence of pharmaceutical interventions (i.e., vaccination and antiviral drugs), enhanced public health interventions (including social distancing measures, quarantine, enhanced infection control in healthcare settings, and movement restrictions), as well as enhanced hygienic measures in the general population and an increase in healthcare system capacity, should be implemented to rapidly contain the epidemic.

24.02.2020

Estimated effectiveness of symptom and risk screening to prevent the spread of COVID-19

eLife / Research Paper

  • Traveller screening is being used to limit further spread of COVID-19 following its recent emergence, and symptom screening has become a ubiquitous tool in the global response.
  • This study estimates the impact of different screening programs given current knowledge of key COVID-19 life history and epidemiological parameters.
  • Concludes that even under best-case assumptions, that screening will miss more than half of infected people. Breaking down the factors leading to screening successes and failures, they find that most cases missed by screening are fundamentally undetectable, because they have not yet developed symptoms and are unaware they were exposed. 

14.02.2020

A spatial model of CoVID-19 transmission in England and Wales: early spread and peak timing

medRxiv(not-peer reviewed) / Research Article

  • Adapted an existing national-scale metapopulation model to capture the spread of CoVID-19 in England and Wales.
  • Used 2011 census data to capture population sizes and population movement, together with parameter estimates from the current outbreak in China.
  • Predict that a CoVID-19 outbreak will peak 126 to 147 days (~4 months) after the start of person-to-person transmission in England and Wales in the absence of controls, assuming biological parameters remain unchanged.

10/02/2020

Feasibility of controlling 2019-nCoV outbreaks by isolation of cases and
contacts

Pre-publication, not peer reviewed (from LSHTM)

  • Developed a stochastic transmission model to quantify the potential effectiveness of contact tracing and isolation of cases to control a 2019 nCoV-like pathogen.
  • Results:  in most scenarios contact tracing and case isolation alone is unlikely to control a new outbreak of 2019-nCov within three months.
  • The probability of control decreases with longer delays from symptom onset to isolation, fewer cases ascertained by contact tracing, and increasing transmission before symptoms