Understanding of COVID-19 based on current evidence

The changing landscape of SARS-CoV-2: Implications for the maternal-infant dyad

The COVID-19 pandemic represents the greatest challenge to date faced by the medical community in the 21st century. The rate of rapid dissemination, magnitude of viral contagiousness, person to person transmission at an asymptomatic phase of illness pose a unique and dangerous challenge for all patients, including neonatal and obstetric patients. Although scientific understanding of the pathophysiology of the disease, nature of transmission, and efficacy of mitigation strategies is growing, neither a cure or vaccine have been developed. While COVID-19 is primarily a disease of older patients, infection is now seen across all age demographics with reports of illness in pregnant patients and infants. Altered hormone status and predominance of Th-2 immune helper cells may result in increased predisposition to SARS-CoV-2. Case reports of pregnant patients demonstrate a clinical presentation comparable to non-pregnant adults, but evidence of vertical transmission to the fetus is controversial. Neonatal reports demonstrate an inconsistent and non-specific phenotype, and it is often difficult to separate COVID-19 from the underlying conditions of prematurity or bacterial infection. The development of international registries to enable risk profiling of COVID-19 positive pregnant mothers and/or their offspring may facilitate the development of enhanced mitigation strategies, medical treatments and effective vaccinations.

Knowledge of Latin American gastroenterologists and endoscopists regarding SARS-CoV-2 infection☆

Introduction

After the World Health Organization declared the COVID-19 outbreak a pandemic, the number of patients with confirmed SARS-CoV-2 infection (COVID-19) has increased exponentially, and gastroenterologists and other specialists most likely will be involved in the care of those patients.

Aim

To evaluate the knowledge Latin American gastroenterologists and endoscopists (staff physicians and residents) have about the characteristics of COVID-19, as well as the prevention measures to be taken during endoscopic procedures.

Materials and methods

We conducted a cross-sectional study that included gastroenterologists and endoscopists from 9 Latin American countries. An electronic questionnaire was applied that was designed to evaluate the knowledge of symptoms, risk groups for severe disease, prevention measures, and the reprocessing of endoscopes utilized in patients with COVID-19.

Results

Information was obtained from 133 physicians. Ninety-five percent of them correctly identified the most frequent symptoms of the virus, and 60% identified the 3 risk groups for severe disease. Sixty-six percent of those surveyed did not consider it necessary to use standard precautions during endoscopic procedures, and 30% did not consider contact precautions necessary. Forty-eight percent of the participants surveyed were not familiar with the protocol for reprocessing the endoscopes utilized in patients with COVID-19.

Conclusion

The majority of the gastroenterologists and endoscopists surveyed were familiar with the signs and symptoms of COVID-19 and the populations at risk for complications. There was a lack of knowledge about prevention measures (during clinical care and endoscopic procedures) and the reprocessing of endoscopic equipment by 70% and 48%, respectively, of those surveyed. Dissemination and teaching strategies that increase the knowledge of specific biosafety measures must be carried out.

Emergency reconstruction of large general hospital under the perspective of new COVID-19 prevention and control

OBJECTIVE

To summarize the successful experience of timely crisis management, correct measures, and successful display of the hospital image in the First Affiliated Hospital of Zhejiang University (FAHZU), to improve the ability of emergency response.

METHODS

The FAHZU, as the earliest designated hospital, accomplished the transformation from general hospital to infectious disease hospital under the guiding ideology of centralized patients, centralized experts, centralized resources, and centralized treatment with measures to transfer the Zhijiang campus hospitalized patients quickly, complete the space layout, create diagnosis and treatment space, streamline logistics, and transform logistics facilities within 48 h. As of 5 March, the hospital had admitted 104 patients.

RESULTS

Of the severe cases in Zhejiang province 95% underwent centralized treatment with the goal of zero deaths for severely ill patients, zero misdiagnoses for infected patients, and zero infections for medical staff, and this served as a reference for large medical institutions regarding how to manage such a public health emergency.

CONCLUSION

The successful cases of FAHZU provided a valuable experience for large medical institutions on how to address public health emergencies and how to carry out diagnosis and treatment and streamline the layout and related facilities in emergency reconstruction.

COVID-19 infections and fatalities developments: empirical evidence for OECD countries and newly industrialized economies

This paper presents empirical results on coronavirus infection and fatality rates from cross-country regressions for OECD economies and a sample of middle- and high-income countries. We include environmental, economic, medical, and policy variables in our analysis to explain the number of corona cases and deaths per million. We find a significant positive impact of local air pollution on infection rates in the whole sample and on fatality rates for OECD countries. Obesity rates have a positive effect on cases and deaths across the different estimation equations. The strategy of aiming to achieve herd immunity has a significant positive effect on infections as well as on death rates. The first affected countries have significantly higher mortality rates, revealing the lack of experience and medical capacity to deal with the pandemic in an initial phase. Postponing – and fighting - the pandemic could save lives in many countries and generate considerable economic benefits. Other medical and policy variables discussed in the public sphere do not show a significant impact in the regression analysis. Our results suggest that improving air quality and fighting obesity helps reduce the negative effects of a coronavirus pandemic significantly. Policy options for fighting a second epidemic wave should take into account the results from this study in order to optimize global epidemic policy.

Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study

BACKGROUND

An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan, Hubei, China. People of all ages are susceptible to SARS-CoV-2 infection. No information on severe pediatric patients with COVID-19 has been reported. We aimed to describe the clinical features of severe pediatric patients with COVID-19.

METHODS

We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU), Wuhan Children's Hospital from January 24 to February 24. We collected information including demographic data, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of the patients with severe COVID-19.

RESULTS

The onset age of the eight patients ranged from 2 months to 15 years; six were boys. The most common symptoms were polypnea (8/8), followed by fever (6/8) and cough (6/8). Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six. Laboratory findings revealed normal or increased whole blood counts (7/8), increased C-reactive protein, procalcitonin and lactate dehydrogenase (6/8), and abnormal liver function (4/8). Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8), increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-γ (2/8). Treatment modalities were focused on symptomatic and respiratory support. Two critically ill patients underwent invasive mechanical ventilation. Up to February 24, 2020, three patients remained under treatment in ICU, the other five recovered and were discharged home.

CONCLUSIONS

In this series of severe pediatric patients in Wuhan, polypnea was the most common symptom, followed by fever and cough. Common imaging changes included multiple patch-like shadows and ground-glass opacity; and a cytokine storm was found in these patients, which appeared more serious in critically ill patients.

A retrospective analysis of the effect of the intervention of Arogya Kashayam in COVID-19 positive cases in Madhya Pradesh

Introduction:

Coronavirus disease (COVID-19) is a newly identified strain of corona virus that causes illness ranging from the clinical features similar to the common cold to a fatal condition due to severe respiratory failure. According to the WHO, there have been more than 26.3 million confirmed COVID-19 cases in more than 190 countries to date. In light of the outbreak, various treatment modalities have been considered, including traditional medicine, which has been widely used in the pandemic of severe acute respiratory syndrome (SARS) and H₁N₁ influenza. Ayurveda contributes a measurable ratio in the world’s traditional practices. As per the guideline of directorate of AYUSH, Government of Madhya Pradesh, cases of COVID-19 were intervened with ArogyaKashayam (AK-20), a decoction prepared from the herbs at 88 COVID Care Centers (CCC) across the state.

Aim:

To evaluate retrospectively, the effect of the intervention of AK-20 in COVID-19 positive cases as stand alone or in combination with hydroxychloroquine (HCQ) administered at CCC in Madhya Pradesh.

Materials and Methods:

It is a retrospective study with 4432 COVID-19 reverse transcription–polymerase chain reaction (RTPCR) tested positive cases including 2750 males and 1682 females between 5 and 80 years of age. All the cases were intervened with AK-20 as stand alone or in combination with HCQ. Moreover, these patients were also given Zinc and Vitamin C simultaneously. The intervention of AK-20 was made through the district level government AYUSH machinery, and the related data were collected in specially designed case report form. The data were analyzed retrospectively, and outcomes included the RTPCR testing or asymptomatic discharge from the CCC as per the prevailing ICMR guidelines.

Results:

The present study reveals that out of 4432 COVID-19 RTPCR-positive cases, 2817 (63.56%) received HCQ with AK-20 and 1615 cases (36.43%) received AK-20 as a stand alone treatment. Among the cases that received HCQ and AK-20, 2681 cases (94.17%) recovered completely in an average of 6.8 days and among those who were on standalone AK-20, 1502 cases (93.00%) recovered completely in the same average days. The Chi-square test showed that both the groups were equally effective (P < 0.01; F = 0.3764).

Conclusion:

The retrospective analysis showed that the treatment practices of AK-20 standalone or in combination with HCQ applied in COVID-19 positive cases at CCC in Madhya Pradesh were effective against SARS coronavirus 2 disease. A significant number of cases was tested negative or asymptomatically discharged from both the groups of interventions. Moreover, AK-20 alone has shown statistically equal results to that when used in combination with HCQ therapy.

The first community outbreak of COVID-19 in Viet Nam: description and lessons learned

Objective

At the time of this study, the prevention of novel coronavirus disease 2019 (COVID-19) relied solely on nonpharmaceutical interventions. Implementation of these interventions is not always optimal and, consequently, several cases were imported into non-epidemic areas and led to large community outbreaks. This report describes the characteristics of the first community outbreak of COVID-19 in Viet Nam and the intensive preventive measures taken in response.

Methods

Cases were detected and tested for SARS-CoV-2 by real-time reverse transcriptase polymerase chain reaction. Contact tracing and active surveillance were conducted to identify suspected cases and individuals at risk. Clinical symptoms were recorded using a standardized questionnaire.

Results

In Vinh Phuc province from 20 January to 3 March 2020, there were 11 confirmed cases among 158 suspected cases and 663 contacts. Nine of the confirmed cases (81.8%) had mild symptoms at the time of detection and two (18.2%) were asymptomatic; none required admission to an intensive care unit. Five prevention and control measures were implemented, including quarantining a community of 10 645 individuals for 20 days. The outbreak was successfully contained as of 13 February 2020.

Discussion

In the absence of specific interventions, the intensive use of combined preventive measures can mitigate the spread of COVID-19. The lessons learned may be useful for other communities.