Potential for global spread of a novel coronavirus from China

Distance Learning during the COVID-19 Pandemic. A Comparison between European Countries

COVID-19 has shaped and changed our normalities, and, with the discovery of new variants, the long-COVID syndrome, and stress disorders, the end of the pandemic seems distant. The current scenario is impacting all aspects of our lives. In particular, many studies reported that the pandemic resulted in increased psychiatric disorders and grief-related symptoms in adolescents. The project developed between Italy and Slovenia investigated students’ experiences during the lockdown and, in particular, reported the perception of distanced learning, producing a transparent qualitative analysis that can inform future research and open to discussions on learning strategies. A survey was conducted with secondary school students in Southern Italy between 1 April and 31 May 2020 and in Central Slovenia between 16 March and 28 February 2021. Qualitative and quantitative data were collected based on students’ perception of distanced learning, via an online survey platform. The results focused on three main aspects: learning experience, relationships with peers and teachers, and anxiety levels. The data showed similarities and differences in the two cohorts and suggested strategies to improve education (e.g., with blended approaches) to prepare students, teachers, and tutors for the challenges of returning to classes. In particular, data showed that it is recommended to foster collaboration between EU countries and to work to prevent students’ social isolation.

Predictors of Persistence of Anxiety, Hyperarousal Stress, and Resilience During the COVID-19 Epidemic: A National Study in Iran

Background: The coronavirus pandemic can cause unprecedented global anxiety, and, in contrast, resilience can help the mental health of people in stressful situations. This study aimed to assess anxiety, hyperarousal stress, the resilience of the Iranian population, and their related factors during the coronavirus disease 2019 (COVID-19) epidemic. Methods: A cross-sectional study was conducted in 31 provinces in Iran between March 18 and 25, 2020. A four-part questionnaire, including the demographic information, the State-Trait Anxiety Inventory (STAI-y1-a 20-item standard questionnaire for obvious anxiety), the Connor-Davidson Resilience Scale (CD-RISC-a 25 item standard questionnaire), and the stress hyperarousal subscale from the Impact of Event Scale-Revised (IES-R), was used to collect data. The ordinal multivariable generalized estimating equation (GEE) model was used to identify correlates of the psychological factors mentioned above. The Fisher exact test was used to investigate the relationship between anxiety, stress, resilience, and the COVID-19 outbreak. All analyses were conducted with SPSS 26 and GIS 10.71. Results: The findings show that most people had moderate-to-severe anxiety (80.17%) and a high level of resilience (96.4%) during the COVID-19 epidemic. The majority of participants had a moderate level of stress (58.9%). The lowest and highest prevalences of psychiatric disorders were in Sistan and Baluchestan (3.14 cases per 100,000 people) and Semnan (75.9 cases per 100,000 people) provinces, respectively. Men and unmarried people were the only variables significantly associated with anxiety and resilience. Age, gender, and education were significantly associated with hyperarousal stress. Conclusion: The high and moderate levels of anxiety and stress in Iranians can have negative effects on the well-being and performance of the people and can lead to serious problems. Also, high resilience during negative life events (such as the COVID-19 pandemic) is associated with the well-being in the lives of people. The results of this study can be used in interventions and other psychological studies.

Learning from COVID-19: Infectious Disease Vulnerability Promotes Pro-Environmental Behaviors

Environmental problems, such as climate change, pollution, and environmental degradation, are important contributors to the spread of infectious diseases, such as COVID-19 and SARS. For instance, a greater concentration of ambient NO₂ was associated with faster transmission of the SARS-CoV-2 virus, which causes COVID-19. However, it remains unclear whether outbreaks of infectious diseases arouse individuals' concern on the need to protect the environment and therefore promote more pro-environmental behaviors. To this end, we examined the relationship between infectious disease vulnerability and pro-environmental behaviors using data from a cross-societal survey (N = 53 societies) and an experiment (N = 214 individuals). At both the societal and the individual levels, infectious disease vulnerability increased pro-environmental behaviors. At the societal level, this relationship was mediated by citizens' level of environmental concern. At the individual level, the relationship was mediated by empathy. The findings show that infectious disease vulnerability is conducive to pro-environmental behaviors.

The Effects of COVID-19 Risk Perception on Travel Intention: Evidence From Chinese Travelers

This study attempts to assess the relationship between risk perception, risk knowledge, and travel intentions of Chinese leisure travelers during the COVID-19 pandemic in the framework of social contagion and risk communication theories by analyzing a sample of 1,209 travelers through structural equation modeling (SEM) and path analysis. We used the process macro of Hayes to analyze the moderation effects of age, gender, and education between risk perception, media and interpersonal communication, and risk knowledge. It was found that travelers were more concerned about self-efficacy than severity. Risk perception of travelers predicts the information-seeking process of tourists. This process helps travelers to accumulate risk information that influences their travel intentions. Travelers give more importance to interpersonal (contagion) communication in making a traveling decision. Demographic factors influence traveling decision-making; women travelers were found to be more risk resilient than men. Young travelers seek information at low- and old travelers at high-risk levels. Marketing implications also provided.

Disinfection Measures during COVID-19 for Dental Operatories

Background:

In the dental health-care setups, the environmental object and surfaces are expected to be infected by the COVID virus wherein definite procedures are performed. Consequently, these objects and surfaces, particularly where COVID-19 patients are being treated, must be appropriately cleaned and sanitized to stop further spread.

Objective:

The present article is intended for providing protocols about the cleaning and disinfection of objects and surfaces in the circumstances of COVID-19 for Dental operatories.

Methods:

Studies evaluating the surface characteristics of the virus as well as effective disinfection measures have been documented.

Results:

Various chemicals in different concentrations have a virocidal effect. The devices introduced include used UV radiation and ozone.

Conclusion:

These changes in dental clinical practice are needed to save humanity by preventing further transmission of disease.

Study of Hearing Status in COVID-19 Patients: A Multicentered Review

To evaluate the hearing status of COVID-19 patients and compare with control group. Prospective study carried out in 9 institutes. The pure tone audiogram and impedance audiometry of COVID-19 patients performed initially and at 3 months follow up. The control group consisted COVID-19 negative individuals with no history of ear related diseases. The average of air and bone conduction threshold (AC and BC) were compared between the COVID-19 patients and control group using independent t-test with a p value of less than 0.05 considered significant. Total of 331 patients, age 32 ± 4.3 years, 66.7% males and 33.3% females were included in the study. There were 80 individuals in the control group. Aural symptoms were, tinnitus in 1.8%, aural fullness in 1.4%, hearing loss in 3. 9%, and ear ache in 1.8% were present initially, resolved at 3 months follow up. The impedance audiometry demonstrated type B and type C curve in 5.1% and 1.15% ears, and out of these 64.7% and 40% improved at 3 months follow up respectively. No significant difference observed between the average AC and BC of the COVID-19 patients and control group. The COVID-19 infection may present with aural symptoms; however, it was concluded that there was no significant difference in the hearing status of the COVID-19 positive patients in comparison to the control group. The presence of some changes in the normal functioning of the eustachian tube and middle ear in the COVID-19 infection was also highlighted.

Digital Technology-Based Telemedicine for the COVID-19 Pandemic

In the year 2020, the coronavirus disease 2019 (COVID-19) crisis intersected with the development and maturation of several digital technologies including the internet of things (IoT) with next-generation 5G networks, artificial intelligence (AI) that uses deep learning, big data analytics, and blockchain and robotic technology, which has resulted in an unprecedented opportunity for the progress of telemedicine. Digital technology-based telemedicine platform has currently been established in many countries, incorporated into clinical workflow with four modes, including "many to one" mode, "one to many" mode, "consultation" mode, and "practical operation" mode, and has shown to be feasible, effective, and efficient in sharing epidemiological data, enabling direct interactions among healthcare providers or patients across distance, minimizing the risk of disease infection, improving the quality of patient care, and preserving healthcare resources. In this state-of-the-art review, we gain insight into the potential benefits of demonstrating telemedicine in the context of a huge health crisis by summarizing the literature related to the use of digital technologies in telemedicine applications. We also outline several new strategies for supporting the use of telemedicine at scale.

First molecular-based detection of SARS-CoV-2 virus in the field-collected houseflies

This is the first report of SARS-CoV-2 detection on field-collected Musca domestica housefly surface and tissue samples using the high-sensitive PCR assay which suggests the possible insect-borne transmission. The study was conducted in Shiraz city, southern Iran, in May and Jun 2020. Adult flies were sampled at the outdoor areas of two hospitals treating COVID-19 patients. Fly samples were first washed twice to remove the insect surface attached to SARS-CoV-2 virions. After that, the disinfected fly samples were homogenized. Fly surface washout and homogenate samples were tested using Taq Man real-time PCR assay for the SARS-CoV-2 virus. In a total of 156 houseflies, 75% of samples from the body washout samples were positive for SARS-CoV-2. Strikingly, 37% of the homogenized specimens were positive for the SARS-CoV-2, suggesting the possible infection of the insects or uptake of the virion to the insect metabolism. The other possibility is the houseflies up took the blood or blood fluids of the patients and the RNA of the SARS-CoV-2 survived in the insect body without replicating. Our preliminary findings suggest that the houseflies could transmit SARS-CoV-2 as a mechanical or biological vector especially during the warm seasons while increasing the population and activity of houseflies.

Development and application of a new framework for infectious disease management at the early stage of new epidemics: Taking COVID-19 outbreak in China as an example

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) rapidly spread across worldwide, posing a significant challenge to public health. Several shortcomings in the existing infectious disease management system were exposed during the pandemic, which hindered the control of the disease globally. To cope with this issue, we propose a window-period framework to reveal the general rule of the progression of management of infectious diseases and to help with decision making at the early stage of epidemics with a focus on healthcare provisions.

METHODS

The framework has two significant periods (dark-window period and bright-window period). Outbreak of COVID-19 in China was used as an example for the application of the framework.

RESULTS

The framework could reflect the progression of the epidemic objectively. The spread increased slowly in the dark-window period, but rocketed up in the bright-window period. The beginning of the bright-window period was the time when healthcare personnel were exposed to a substantially high risk of nosocomial infection. Additionally, proper and prompt preventive actions during the dark-window and bright-window periods were substantially important to reduce the future spreading of the disease.

CONCLUSIONS

It was recommended that when possible healthcare provisions should upgrade to the highest level of alert for the control of an unknown epidemic in the dark-window period, while countermeasures in the bright-window period could be accordingly adjusted with full exploration and considerations. The framework may provide some insights into how to accelerate the control of future epidemics promptly and effectively.

Analysis of 239 ordinary and severe cases of COVID-19: Clinical features and treatment

This study retrospectively analyzed the clinical characteristics of patients with new coronavirus infection (COVID-19) and summarizes the treatment experience. A total of 239 COVID-19 patients admitted to the Hajar Hospital, Aja University of Medical Science, Tehran, Iran from March 22, 2020 to May 18, 2020 were selected, including 176 cases in the ordinary group and 63 cases in the severe/critical group. We collected and compared the clinical data of the two groups of patients, including general conditions, clinical symptoms, signs, laboratory tests, lung CT imaging and prognosis, and analyzed the treatment plans of the two groups. The mean age of 239 COVID-19 patients was 48.1±17.6 years, including 132 males. Patients in the severe and critically ill groups were older than the normal group, with more males and more underlying diseases. The difference was statistically significant (p < 0.05). The lymphocyte (LYM) counts and albumin (ALB) counts of the severe and critically ill groups were more significantly lower than those of the normal group; while the percentage of neutrophils (NEU), C-reactive protein (CRP), D-dimer, and lactate The increase of lactate dehydrogenase (LDH) and urea nitrogen (BUN) was more significant, and the difference was statistically significant (p < 0.05). Patients in the severe and critically ill groups received more antiviral drugs, glucocorticoids, and nasal catheters than those in the normal group, and the difference was statistically significant (p < 0.05). Also, we observed that the most radiological finding was bilateral ground-glass opacity in both groups, however, the rate of typical abnormalities in both chest CT scan and chest x-ray was significantly higher in sever/critical group except air-bronchogram. Taken together, we showed that combination of oseltamivir and glucocorticosteroid such as dexamethasone was very effective in severe patients.

Modelling work- and non-work-based trip patterns during transition to lockdown period of COVID-19 pandemic in India

COVID-19 pandemic has significantly affected the transportation sector across the world. Implementation of lockdown (that includes restricted travel activities) is a prevention strategy executed by various governments to minimize the spread of COVID-19. India went into complete lockdown from 25th March 2020; however, change in commuter's travel behavior was observed from the third week of March (termed as transition to lockdown) due to pandemic fear. In total 1945 participants participated in the travel behaviour survey and their responses with respect to work-based and non-work-based trips during transition period were analysed to understand their adaptation towards COVID-19. The study also attempted to quantify the effects of influencing factors which can explain change in the commuters' travel behaviour. The findings revealed that one-year increment in traveller's age had 2% reduced probability of no travel during transition than pre-transition. For non-work-related travel, chances of lower travel frequency were significantly greater during the transition period as compared to pre-transition. Compared to the non-essential trips, the chances of reduced travel frequency for the essential trips were found to be lower by 92%. By examining these behavioural changes, the present study aims to assist the policymakers in understanding the dynamics of fluctuating travel demand with respect to trip purpose during pandemic situations like COVID-19.

Early Spread of COVID-19 in the Air-Polluted Regions of Eight Severely Affected Countries

COVID-19 escalated into a pandemic posing several humanitarian as well as scientific challenges. We here investigated the geographical character of the early spread of the infection and correlated it with several annual satellite and ground indexes of air quality in China, the United States, Italy, Iran, France, Spain, Germany, and the United Kingdom. The time of the analysis corresponded with the end of the first wave infection in China, namely June 2020. We found more viral infections in those areas afflicted by high PM 2.5 and nitrogen dioxide values. Higher mortality was also correlated with relatively poor air quality. In Italy, the correspondence between the Po Valley pollution and SARS-CoV-2 infections and induced mortality was the starkest, originating right in the most polluted European area. Spain and Germany did not present a noticeable gradient of pollution levels causing non-significant correlations. Densely populated areas were often hotspots of lower air quality levels but were not always correlated with a higher viral incidence. Air pollution has long been recognised as a high risk factor for several respiratory-related diseases and conditions, and it now appears to be a risk factor for COVID-19 as well. As such, air pollution should always be included as a factor for the study of airborne epidemics and further included in public health policies.

Incorporating dynamic flight network in SEIR to model mobility between populations

Current efforts of modelling COVID-19 are often based on the standard compartmental models such as SEIR and their variations. As pre-symptomatic and asymptomatic cases can spread the disease between populations through travel, it is important to incorporate mobility between populations into the epidemiological modelling. In this work, we propose to modify the commonly-used SEIR model to account for the dynamic flight network, by estimating the imported cases based on the air traffic volume and the test positive rate. We conduct a case study based on data found in Canada to demonstrate how this modification, called Flight-SEIR, can potentially enable (1) early detection of outbreaks due to imported pre-symptomatic and asymptomatic cases, (2) more accurate estimation of the reproduction number and (3) evaluation of the impact of travel restrictions and the implications of lifting these measures. The proposed Flight-SEIR is essential in navigating through this pandemic and the next ones, given how interconnected our world has become.

Comparative analysis of non structural protein 1 of SARS-CoV2 with SARS-CoV1 and MERS-CoV: An in silico study

The recently emerged SARS-CoV2 caused a major pandemic of coronavirus disease (COVID-19). Non structural protein 1 (nsp1) is found in all beta coronavirus that cause severe respiratory disease. This protein is considered as a virulence factor and has an important role in pathogenesis. This study aims to elucidate the structural conformations of nsp1 to aid in the prediction of epitope sites and identification of important residues for targeted therapy against COVID-19. In this study, molecular modelling coupled with molecular dynamics simulations were performed to analyse the conformational landscape of nsp1 homologs of SARS-CoV1, SARS-CoV2 and MERS-CoV. Principal component analysis escorted by free energy landscape revealed that SARS-CoV2 nsp1 protein shows greater flexibility compared to SARS-CoV1 and MERS-CoV nsp1. Sequence comparison reveals that 28 mutations are present in SARS-CoV2 nsp1 protein compared to SARS-CoV1 nsp1. Several B-cell and T-cell epitopes were identified by an immunoinformatics approach. SARS-CoV2 nsp1 protein binds with the interface region of the palm and finger domain of POLA1 via hydrogen bonding and salt bridge interactions. Taken together, these in silico findings may help in the development of therapeutics specific against COVID-19.

Inflight transmission of COVID-19 based on experimental aerosol dispersion data

BACKGROUND

An issue of concern to the travelling public is the possibility of in-flight transmission of coronavirus disease 2019 (COVID-19) during long- and short-haul flights. The aviation industry maintains that the probability of contracting the illness is small based on reported cases, modelling and data from aerosol dispersion experiments conducted on-board aircraft.

METHODS

Using experimentally derived aerosol dispersion data for a B777-200 aircraft and a modified version of the Wells-Riley equation we estimate inflight infection probability for a range of scenarios involving quanta generation rate and face mask efficiency. Quanta generation rates were selected based on COVID-19 events reported in the literature while mask efficiency was determined from the aerosol dispersion experiments.

RESULTS

The MID-AFT cabin exhibits the highest infection probability. The calculated maximum individual infection probability (without masks) for a 2-hour flight in this section varies from 4.5% for the 'Mild Scenario' to 60.2% for the 'Severe Scenario' although the corresponding average infection probability varies from 0.1% to 2.5%. For a 12-hour flight, the corresponding maximum individual infection probability varies from 24.1% to 99.6% and the average infection probability varies from 0.8% to 10.8%. If all passengers wear face masks throughout the 12-hour flight, the average infection probability can be reduced by ~73%/32% for high/low efficiency masks. If face masks are worn by all passengers except during a one-hour meal service, the average infection probability is increased by 59%/8% compared to the situation where the mask is not removed.

CONCLUSIONS

This analysis has demonstrated that while there is a significant reduction in aerosol concentration due to the nature of the cabin ventilation and filtration system, this does not necessarily mean that there is a low probability or risk of in-flight infection. However, mask wearing, particularly high-efficiency ones, significantly reduces this risk.

SARS-CoV-2 outbreak in medical employees in a large urologic department: Spread, containment and outcome

BACKGROUND

The SARS-CoV-2 pandemic presents an unprecedented challenge to health care systems worldwide. Data on SARS-CoV-2 transmission in a hospital is rare and outbreaks among health care professionals are complex to control.

MATERIAL AND METHODS

Over the course of 6 consecutive weeks we recorded data on an exponential outbreak of SARS-CoV-2 within our department. We reconstructed the assumed route of the spread of infection, and the employees' acute and late symptoms. Increasing preventive measures (mandatory face masks, intense training in hygiene, physical distancing whenever possible, and termination of visits from outside the hospital) were implemented.

RESULTS

Within 6 weeks, 13 employees were tested positive for SARS-CoV-2. All individuals had a moderate course, not resulting in hospitalization. The majority of infections was discovered after testing contacts of known cases, prior to their onset of symptoms and was predominantly related to removal of face masks during breaks. Increasing preventive measures resulted in a decline and finally containment of transmission rates amongst the staff, confirmed by mass testing at week 6, with no further SARS-CoV-2 infection. Three individuals, all in their late 40s or older, have lasting or newly onset neurological symptoms 8 months after their infection.

CONCLUSIONS

Outbreaks of SARS-CoV-2 are particularly difficult to contain in a medical setting, where employees work in close physical proximity. Adherence to preventive measures, particularly face masks, seem to be effective.

Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19

Gastrointestinal (GI) symptoms, such as diarrhea, abdominal pain, vomiting, and anorexia, are frequently observed in patients with coronavirus disease 2019 (COVID-19). However, the pathophysiological mechanisms connecting these GI symptoms to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain elusive. Previous studies indicate that the entry of SARS-CoV-2 into intestinal cells leads to downregulation of angiotensin converting enzyme 2 (ACE2) receptors resulting in impaired barrier function. While intestinal ACE2 functions as a chaperone for the amino acid transporter B0AT1, the B0AT1/ACE2 complex within the intestinal epithelium acts as a regulator of gut microbiota composition and function. Alternations to the B0AT1/ACE2 complex lead to microbial dysbiosis through increased local and systemic immune responses. Previous studies have also suggested that altered serotonin metabolism may be the underlying cause of GI disorders involving diarrhea. The findings of elevated plasma serotonin levels and high fecal calprotectin in COVID-19 patients with diarrhea indicate that the viral infection evokes a systemic inflammatory response that specifically involves the GI. Interestingly, the elevated proinflammatory cytokines correlate with elevated serotonin and fecal calprotectin levels further supporting the evidence of GI inflammation, a hallmark of functional GI disorders. Moreover, the finding that rectal swabs of COVID-19 patients remain positive for SARS-CoV-2 even after the nasopharynx clears the virus, suggests that viral replication and shedding from the GI tract may be more robust than that of the respiratory tract, further indicating fecal-oral transmission as another important route of viral spread. This review summarized the evidence for pathophysiological mechanisms (impaired barrier function, gut inflammation, altered serotonin metabolism and gut microbiota dysbiosis) underlying the GI symptoms in patients with COVID-19.

COVID-19: breaking down a global health crisis

Coronavirus disease 2019 (COVID-19) is the second pandemic of the twenty-first century, with over one-hundred million infections and over two million deaths to date. It is a novel strain from the Coronaviridae family, named Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-CoV-2); the 7th known member of the coronavirus family to cause disease in humans, notably following the Middle East Respiratory syndrome (MERS), and Severe Acute Respiratory Distress Syndrome (SARS). The most characteristic feature of this single-stranded RNA molecule includes the spike glycoprotein on its surface. Most patients with COVID-19, of which the elderly and immunocompromised are most at risk, complain of flu-like symptoms, including dry cough and headache. The most common complications include pneumonia, acute respiratory distress syndrome, septic shock, and cardiovascular manifestations. Transmission of SARS-CoV-2 is mainly via respiratory droplets, either directly from the air when an infected patient coughs or sneezes, or in the form of fomites on surfaces. Maintaining hand-hygiene, social distancing, and personal protective equipment (i.e., masks) remain the most effective precautions. Patient management includes supportive care and anticoagulative measures, with a focus on maintaining respiratory function. Therapy with dexamethasone, remdesivir, and tocilizumab appear to be most promising to date, with hydroxychloroquine, lopinavir, ritonavir, and interferons falling out of favour. Additionally, accelerated vaccination efforts have taken place internationally, with several promising vaccinations being mass deployed. In response to the COVID-19 pandemic, countries and stakeholders have taken varying precautions to combat and contain the spread of the virus and dampen its collateral economic damage. This review paper aims to synthesize the impact of the virus on a global, micro to macro scale.

Systematic Review on Outbreaks of SARS-CoV-2 on Cruise, Navy and Cargo Ships

The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.

An integrated framework for modelling quantitative effects of entry restrictions and travel quarantine on importation risk of COVID-19

OBJECTIVE

As the potential spread of COVID-19 sparked by imported cases from overseas will pose continuous challenges, it is essential to estimate the effects of control measures on reducing the importation risk of COVID-19. Our objective is to provide a framework of methodology for quantifying the combined effects of entry restrictions and travel quarantine on managing the importation risk of COVID-19 and other pandemics by leveraging different sets of parameters.

METHODS

Three major categories of control measures on controlling importation risk were parameterized and modelled by the framework: 1) entry restrictions, 2) travel quarantine, and 3) domestic containment measures. Integrating the parameterized intensity of control measures, a modified SEIR model was developed to simulate the case importation and local epidemic under different scenarios of global epidemic dynamics. A web-based tool was also provided to enable interactive visualization of epidemic simulation.

RESULTS

The simulated number of case importation and local spread modelled by the proposed framework of methods fitted well to the historical epidemic curve of China and Singapore. Based on the simulation results, the total numbers of infected cases when reducing 30% of visitor arrivals would be 88·4 (IQR 87·5-89·6) and 58·8 (IQR 58·3-59·5) times more than those when reducing 99% of visitor arrivals in mainland China and Singapore respectively, assuming actual time-varying R_t and travel quarantine policy. If the number of global daily new infections reached 100,000, 85%-91% of inbound travels should be reduced to keep the daily new infected number below 100 for a country with a similar travel volume as Singapore (daily 52,000 tourist arrivals in 2019). Whereas if the number was lower than 10,000, the daily new infected case would be less than 100 even with no entry restrictions.

DISCUSSIONS

We proposed a framework that first estimated the intensity of travel restrictions and local containment measures for countries since the first overseas imported case. Our approach then quantified the combined effects of entry restrictions and travel quarantine using a modified SEIR model to simulate the potential epidemic spread under hypothetical intensities of these control measures. We also developed a web-based system that enables interactive simulation, which could serve as a valuable tool for health system administrators to assess policy effects on managing the importation risk. By leveraging different sets of parameters, it could adapt to any specific country and specific type of epidemic.

CONCLUSIONS

This framework has provided a valuable tool to parameterize the intensity of control measures, simulate both the case importation and local epidemic, and quantify the combined effects of entry restrictions and travel quarantine on managing the importation risk.

Mathematical model for the mitigation of the economic effects of the Covid-19 in the Democratic Republic of the Congo

Since the apparition of the SRAS-Cov-2 in Wuhan in China, several countries have set diverse measures to stop its spread. Measures envisaged include national or local lockdown and travels ban. In the DRC, these measures have seriously prejudiced the economy of the country which is mainly informal. In this paper, a mathematical model for the spread of Covid-19 in Democratic Republic of Congo (DRC) taking into account the vulnerability of congolese economy is proposed. To mitigate the spreading of the virus no national lockdown is proposed, only individuals affected by the virus or suspicious are quarantined. The reproduction number for the Covid-19 is calculated and numerical simulations are performed using Python software. A clear advice for policymakers is deduced from the forecasting of the model.

Socioeconomic Conditioning of the Development of the COVID-19 Pandemic and Its Global Spatial Differentiation

The COVID pandemic very quickly became the world's most serious social and economic problem. This paper's focus is on the spatial aspect of its spread, with the aims being to point to spatial conditioning underpinning development of the pandemic, and to identify and assess possible socio-economic features exerting an impact on that. Particular attention has been paid to the percentage of positive tests for the presence of the coronavirus, as well as mortality due to the disease it causes. The statistics used relate to 102 countries, with the research for each extending from the time first cases of COVID-19 were reported through to 18 November 2020. The focus of investigation has been the stochastic co-occurrence of both a morbidity index and a mortality index, with intentionally selected socio-economic variables. Results have then been summarized through the classification of countries in relation to the two indices. Highest values relate to Latin America. A significant co-occurrence of morbidity and mortality with GDP per capita has been identified, as values for the indices are found to be lower in wealthier countries. The basic conclusion is that the dependency of the pandemic on environmental and socio-economic conditioning became more complex and ambiguous, while also being displaced gradually as concrete political decisions came to be taken.

Phytochemicals as potential drug candidates for targeting SARS CoV 2 proteins, an in silico study

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a member of the family Coronaviridae, and the world is currently witnessing a global pandemic outbreak of this viral disease called COVID-19. With no specific treatment regime, this disease is now a serious threat to humanity and claiming several lives daily. In this work, we selected 24 phytochemicals for an in silico docking study as candidate drugs, targeting four essential proteins of SARS-CoV-2 namely Spike glycoprotein (PDB id 5WRG), Nsp9 RNA binding protein (PDB id 6W4B), Main Protease (PDB id 6Y84), and RNA dependent RNA Polymerase (PDB id 6M71). After statistical validation, the results indicated that a total of 11 phytochemicals divided into two clusters might be used as potential drug candidates against SARS-CoV-2.

Chest CT Images for COVID-19: Radiologists and Computer-Based Detection

Background

Characteristic chest computed tomography (CT) manifestation of 2019 novel coronavirus (COVID-19) was added as a diagnostic criterion in the Chinese National COVID-19 management guideline. Whether the characteristic findings of Chest CT could differentiate confirmed COVID-19 cases from other positive nucleic acid test (NAT)-negative patients has not been rigorously evaluated.

Purpose

We aim to test whether chest CT manifestation of 2019 novel coronavirus (COVID-19) can be differentiated by a radiologist or a computer-based CT image analysis system.

Methods

We conducted a retrospective case-control study that included 52 laboratory-confirmed COVID-19 patients and 80 non-COVID-19 viral pneumonia patients between 20 December, 2019 and 10 February, 2020. The chest CT images were evaluated by radiologists in a double blind fashion. A computer-based image analysis system (uAI System, Lianying Inc., Shanghai, China) detected the lesions in 18 lung segments defined by Boyden classification system and calculated the infected volume in each segment. The number and volume of lesions detected by radiologist and computer system was compared with Chi-square test or Mann-Whitney U test as appropriate.

Results

The main CT manifestations of COVID-19 were multi-lobar/segmental peripheral ground-glass opacities and patchy air space infiltrates. The case and control groups were similar in demographics, comorbidity, and clinical manifestations. There was no significant difference in eight radiologist identified CT image features between the two groups of patients. There was also no difference in the absolute and relative volume of infected regions in each lung segment.

Conclusion

We documented the non-differentiating nature of initial chest CT image between COVID-19 and other viral pneumonia with suspected symptoms. Our results do not support CT findings replacing microbiological diagnosis as a critical criterion for COVID-19 diagnosis. Our findings may prompt re-evaluation of isolated patients without laboratory confirmation.

COVID-19 pandemic and its impact on dental students: A multi-institutional survey

Purpose/objectives

To investigate dental students’ perceptions and concerns regarding the COVID‐19 pandemic, their coping strategies and support resources, and their perceived stress levels.

Methods

A customized 19‐item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress

Results

A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID‐19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went “smoothly with some troubles” for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID‐19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores

Conclusion

Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.

Impact of weather on COVID-19 transmission in south Asian countries: An application of the ARIMAX model

We aimed to examine the impact of weather on COVID-19 confirmed cases in South Asian countries, namely, Afghanistan, Bangladesh, India, Pakistan, and Sri Lanka. Data on daily confirmed cases, together with weather parameters, were collected from the first day of COVID confirmed cases in each country to 31 August 2020. The weather parameters were Rainfall (mm), relative humidity (%), maximum and minimum temperature (°C), surface pressure (kPa), maximum air pollutants matter PM 2.5 (μg/m³) and maximum wind speed (m/s). Data were analyzed for each investigated countries separately by using the Autoregressive Integrated Moving Average with Explanatory Variables (ARIMAX) model. We found that maximum wind speed had significant negative impact on COVID-19 transmission in India (-209.45, 95% confidence interval (CI): -369.13, -49.77) and Sri Lanka (-2.77, 95% CI: -4.77, -0.77). Apart from India, temperature had mixed effects (i.e., positive or negative) in four countries in South Asia. For example, maximum temperature had negative impact (-30.52, 95% CI: -60.24, -0.78) in Bangladesh and positive impact (5.10, 95% CI: 0.06, 10.14) in Afghanistan. Whereas rainfall had negative effects (-48.64, 95% CI: -80.17, -17.09) in India and mixed effects in Pakistan. Besides, maximum air pollutants matter PM 2.5 was negatively associated with the confirmed cases of COVID-19. In conclusion, maximum wind speed, rainfall, air pollutants (maximum PM 2.5) and temperature are four variables that could play a vital role in the transmission of COVID-19. Although there is a mixed conclusion regarding weather parameters and COVID-19 transmission, we recommend developing environmental policies regarding the transmission of COVID-19 in South Asian countries.

Airborne Infections and Emergency Surgery: The COVID-19 Pandemic Perspective

COVID-19 which emerged in Wuhan, China has rapidly spread all over the globe and the World Health Organisation has declared it a pandemic. COVID-19 disease severity shows variation depending on demographic characteristics like age, history of chronic illnesses such as cardio-vascular/renal/respiratory disease; pregnancy; immune-suppression; angiotensin converting enzyme inhibitor medication use; NSAID use etc but the pattern of disease spread is uniform - human to human through contact, droplets and fomites. Up to 3.5% of health care workers treating COVID-19 contact an infection themselves with 14.8% of these infections severe and 0.3% fatal. The situation has spread panic even among health care professionals and the cry for safe patient care practices are resonated world-wide. Surgeons, anesthesiologists and intensivists who very frequently perform endotracheal intubation, tracheostomy, non-invasive ventilation and manual ventilation before intubation are at a higher odds ratio of 6.6, 4.2, 3.1 and 2.8 respectively of contacting an infection themselves. Elective surgery is almost always deferred in fever/infection scenarios. A surgeon and an anesthesiologist can anytime encounter a situation where in a COVID-19 patient requires an emergency surgery. COVID-19 cases requiring surgery predispose anesthesiologists and surgeons to cross-infection threats. This paper discusses, the COVID-19 precautionary outlines which has to be followed in the operating room; personal protective strategies available at present; methods to raise psychological preparedness of medical professionals during a pandemic; conduct of anesthesia in COVID-19 cases/suspect cases; methods of decontamination after conducting a surgery for COVID-19 case in the operating room; and post-exposure prophylaxis for medical professionals.

Rising summer temperatures do not reduce the reproduction number of COVID-19

Data analysis on the spread of COVID-19 in Bushehr, one of the warmest provinces of Iran, indicates that rising summer temperatures do not reduce the reproduction number and the spread of COVID-19.

Challenges facing users of hearing aids during the COVID-19 pandemic

OBJECTIVES

To explore the difficulties and obstacles of hearing-technology users during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

Descriptive, cross-sectional study.

STUDY SAMPLE

Individuals with permanent hearing loss (n = 278) answered a questionnaire designed to identify potential obstacles caused by using hearing aids during the COVID-19 pandemic, along with the reasons and deleterious effects associated with the devices. Each category reflected challenges in communicating, learning, and working during the pandemic. Different response categories were compared using descriptive and inferential statistics.

RESULTS

The duration of daily device usage before the imposed lockdown was significantly higher than that during (Z = -2.01, p < 0.05), potentially attributable to the pandemic-induced difficulties faced by hearing-technology users. Such challenges include the shortage of batteries for hearing devices, limited access to repair or programming services of said devices and accessories, termination of speech therapy sessions, and obstacles to employment and education.

CONCLUSIONS

Among audiologists, efficiency and professionalism are required to educate the public and private health sectors regarding the prevalent challenges and their harmful impact on hearing-technology users during the COVID-19 pandemic. To overcome these issues, awareness of telepractice and its importance in providing audiological services to hard of hearing individuals should be raised.

Teleconsultation and Teletreatment Protocol to Diagnose and Manage Patients with Benign Paroxysmal Positional Vertigo (BPPV) during the COVID-19 Pandemic

Introduction  Telehealth consists in the application of technology to provide remote health service. This resource is considered safe and effective and has attracted an exponential interest in the context of the COVID pandemic. Expanded to dizzy patients, it would be able to provide diagnosis and treatment, minimizing the risk of disease transmission. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. The diagnosis typically rests on the description of the symptoms along with the nystagmus observed at a well-established positional testing.

Objectives  The aim of the present study was to propose a teleconsultation and teletreatment protocol to manage patients with BPPV during the COVID-19 pandemic.

Methods  Specialists in the vestibular field met through remote access technologies to discuss the best strategy to manage BPPV patients by teleconsultation and teletreatment system. Additionally, several scientific sources were consulted. Technical issues, patient safety, and clinical assessment were independently analyzed. All relevant information was considered in order to design a clinical protocol to manage BPPV patients in the pandemic context.

Results  Teleconsultation for BPPV patients requires a double way (video and audio) digital system. An adapted informed consent to follow good clinical practice statements must be considered. The time, trigger and target eye bedside examination (TiTRaTe) protocol has proven to be a valuable first approach. The bow and lean test is the most rational screening maneuver for patients with suspected positional vertigo, followed by most specific maneuvers to diagnostic the sub-variants of BPPV.

Conclusion  Although with limited evidence, teleconsultation and teletreatment are both reasonable and feasible strategies for the management of patients with BPPV in adverse situations for face-to-face consultation.

COVID-19 and climatic factors: A global analysis

BACKGROUND

It is unknown if COVID-19 will exhibit seasonal pattern as other diseases e.g., seasonal influenza. Similarly, some environmental factors (e.g., temperature, humidity) have been shown to be associated with transmission of SARS-CoV and MERS-CoV, but global data on their association with COVID-19 are scarce.

OBJECTIVE

To examine the association between climatic factors and COVID-19.

METHODS

We used multilevel mixed-effects (two-level random-intercepts) negative binomial regression models to examine the association between 7- and 14-day-lagged temperature, humidity (relative and absolute), wind speed and UV index and COVID-19 cases, adjusting for Gross Domestic Products, Global Health Security Index, cloud cover (%), precipitation (mm), sea-level air-pressure (mb), and daytime length. The effects estimates are reported as adjusted rate ratio (aRR) and their corresponding 95% confidence interval (CI).

RESULTS

Data from 206 countries/regions (until April 20, 2020) with ≥100 reported cases showed no association between COVID-19 cases and 7-day-lagged temperature, relative humidity, UV index, and wind speed, after adjusting for potential confounders, but a positive association with 14-day-lagged temperature and a negative association with 14-day-lagged wind speed. Compared to an absolute humidity of <5 g/m³, an absolute humidity of 5-10 g/m³ was associated with a 23% (95% CI: 6-42%) higher rate of COVID-19 cases, while absolute humidity >10 g/m³ did not have a significant effect. These findings were robust in the 14-day-lagged analysis.

CONCLUSION

Our results of higher COVID-19 cases (through April 20) at absolute humidity of 5-10 g/m³ may be suggestive of a 'sweet point' for viral transmission, however only controlled laboratory experiments can decisively prove it.

Modelling airport catchment areas to anticipate the spread of infectious diseases across land and air travel

Air travel is an increasingly important conduit for the worldwide spread of infectious diseases. However, methods to identify which airports an individual may use to initiate travel, or where an individual may travel to upon arrival at an airport is not well studied. This knowledge gap can be addressed by estimating airport catchment areas: the geographic extent from which the airport derives most of its patronage. While airport catchment areas can provide a simple decision-support tool to help delineate the spatial extent of infectious disease spread at a local scale, observed data for airport catchment areas are rarely made publicly available. Therefore, we evaluated a probabilistic choice behavior model, the Huff model, as a potential methodology to estimate airport catchment areas in the United States in data-limited scenarios. We explored the impact of varying input parameters to the Huff model on estimated airport catchment areas: distance decay exponent, distance cut-off, and measures of airport attractiveness. We compared Huff model catchment area patterns for Miami International Airport (MIA) and Harrisburg International Airport (MDT). We specifically compared our model output to observed data sampled for MDT to align model parameters with an established, observed catchment area. Airport catchment areas derived using the Huff model were highly sensitive to changes in model parameters. We observed that a distance decay exponent of 2 and a distance cut-off of 500 km represented the most realistic spatial extent and heterogeneity of the MIA catchment area. When these parameters were applied to MDT, the Huff model produced similar spatial patterns to the observed MDT catchment area. Finally, our evaluation of airport attractiveness showed that travel volume to the specific international destinations of interest for infectious disease importation risks (i.e., Brazil) had little impact on the predicted choice of airport when compared to all international travel. Our work is a proof of concept for use of the Huff model to estimate airport catchment areas as a generalizable decision-support tool in data-limited scenarios. While our work represents an initial examination of the Huff model as a method to approximate airport catchment areas, an essential next step is to conduct a quantitative calibration and validation of the model based on multiple airports, possibly leveraging local human mobility data such as call detail records or online social network data collected from mobile devices. Ultimately, we demonstrate how the Huff model could be potentially helpful to improve the precision of early warning systems that anticipate infectious disease spread, or to incorporate when local public health decision makers need to identify where to mobilize screening infrastructure or containment strategies at a local level.

Co-infection in patients with hypoxemic pneumonia due to COVID-19 in Reunion Island

This study aimed to evaluate the incidence of co-infection with different types of pathogens in patients with hypoxemic pneumonia due to coronavirus disease 2019 (COVID-19) in Reunion Island.This observational study using a prospectively collected database of hypoxemic pneumonia due to COVID-19 cases was conducted at Félix Guyon University Hospital in Reunion Island, France.Between 18 March 2020 and 15 April 2020, 156 patients were admitted to our hospital for COVID-19. A total of 36 patients had hypoxemic pneumonia (23.1%) due to COVID-19. Thirty of these cases (83.3%) were imported by travelers returning mainly from metropolitan France and Spain. Patients were screened for co-infection with other pathogens at admission: 31 (86.1%) by multiplex polymerase chain reaction (PCR) and 16 (44.4%) by cytobacteriological examination of sputum culture. Five patients (13.9%) were found to have co-infection: 1 with influenza virus A H1N1 (pdm09) associated with Branhamella catarrhalis, 1 with Streptococcus pneumoniae associated with Haemophilus influenzae, 1 with Human Coronavirus 229E, 1 with Rhinovirus, and 1 with methicillin-susceptible Staphylococcus aureus. Patients with co-infection had higher D-dimer levels than those without co-infection (1.36 [1.34-2.36] μg/mL vs 0.63 [0.51-1.12] μg/mL, P = .05).The incidence of co-infection in our cohort was higher than expected (13.9%). Three co-infections (with influenza virus A(H1N1) pdm09, Streptococcus pneumoniae, and Staphylococcus aureus) required specific treatment. Patients with hypoxemic pneumonia due to COVID-19 should be screened for co-infection using respiratory cultures or multiplex PCR. Whilst our study has a number of limitations, the results from our study suggest that in the absence of screening, patients should be commenced on treatment for co-infection in the presence of an elevated D-dimer.

Panoramic and Personalised Intelligent Healthcare Mode

Although the development of national conditions and the increase in health risk factors undoubtedly pose a huge challenge to China’s medical health and labour security system, these simultaneously promote the elevation and transformation of national healthcare consciousness. Given that the current disease diagnosis and treatment models hardly satisfy the growing demand for medical and health care in China, based on the theory of healthcare and basic laws of human physiological activities, and combined with the characteristics of the information society, this paper presents a panoramic and personalised intelligent healthcare mode that is aimed at improving and promoting individual health. The basic definition and conceptual model are provided, and its basic characteristics and specific connotations are elaborated in detail. Subsequently, an intelligent coordination model of daily time allocation and a dynamic optimisation model for healthcare programmes are proposed. The implementation of this mode is explicitly illustrated with a practical application case. It is expected that this study will provide new ideas for further healthcare research and development.

Cabin crew health and fitness-to-fly: Opportunities for re-evaluation amid COVID-19

Aircrew fitness-to-fly is among the elements that make aviation the safest form of long-distance transport. The health of cabin crew is a crucial determinant in carrying out safety-related duties. 'Fitness-to-fly' is associated with defined workplace conditions, for which airlines have a legal duty to ensure fitness for employment. We explored the literature on fitness-to-fly to obtain a pragmatic assessment of the challenges for aeromedical examinations. Regulations promulgated by aviation regulatory authorities and airline-internal policies have similar status and meaning, yet there is no harmonised approach internationally, and an inability to conform periodic medical assessments to actual operational fitness. The COVID-19 pandemic has highlighted the need to better understand fitness-to-fly criteria. Fitness-to-fly measures are mainly based on self-reported data and there is a need for a 'safety' factor for self-reports. Aeromedical evaluations should evolve from meeting medical standards to include pandemics as an element of the overall risk of aircraft operations. Re-evaluating criteria for fitness-to-fly assessment will further the goal of linking research to the actual needs of public health decisionmakers. If airlines are to resume operations at pre-pandemic levels, they must demonstrate to the public and public health agencies that fitness-to-fly assessment is appropriate and effective.

Toracostomía con colocación de tubo torácico en decúbito prono durante la pandemia de COVID-19

El síndrome respiratorio agudo severo causado por el coronavirus SARS-CoV-2 lleva a padecer insuficiencia respiratoria e hipoxemia grave y requiere la implementación de ventilación mecánica invasiva, además de estrategias como la posición en decúbito prono para mejorar la oxigenación arterial. Las complicaciones extrapulmonares como neumotórax espontáneo, neumomediastino o derrame pleural complican su manejo, en especial en posición de decúbito prono. La toracostomía con colocación de sonda pleural es el tratamiento de primera línea; este procedimiento conlleva un riesgo elevado de contagio por la generación de aerosoles, además del riesgo de lesión pulmonar durante la inserción del drenaje pleural debido a la posición en decúbito prono. Informamos un caso de infección por SARS-CoV-2 con asistencia ventilatoria mecánica complicada con neumotórax espontáneo que requirió colocar drenaje pleural cuando el paciente se encontraba en posición de decúbito prono. Describimos la técnica, que no se encuentra descrita en la literatura.

Exploratory study of existing approaches for analyzing epidemics

The outbreak of epidemic diseases such as COVID-19, H1N1 swine flu, Ebola, and dengue has caused different communities to raise their apprehension over preventing and controlling the infectious diseases, as well as determining methods to diminish the disease propagation percentage. Epidemics are generally contiguous in which the number of cases increases at a very rapid rate. It often results in loss of lives as it affects the respiratory tract and lungs and even causes multiorgan failure. Hence, it is imperative to analyze the spread of any virus to make strategies for situational awareness and intervention. Researchers and medical practitioners have actively performed many studies to model the behavior of viruses with varied perspectives. These studies have guided in analyzing the pattern and speed of virus spread. This chapter presents an exploratory study on the existing approaches, such as classical epidemic approaches and Machine Learning approaches, useful for studying the outbreak patterns of epidemics. Besides, the chapter highlights the available epidemics datasets and describes the varied visualization charts that can help in understanding the patterns of virus spread.

A critical COVID-19 patient managed with timely evaluation, early prone positioning ventilation, and a multi-pronged pharmacotherapy

There is not yet a standard drug regimen for the treatment of coronavirus disease 2019 (COVID-19) patients. Here, we summarize our experience and successful treatment plan with a critical COVID-19 patient who required mechanical ventilation (MV). A 56-year-old man presented with a fever, cough, and dyspnea. He had not been to a medium/high risk epidemic area in the past year and had no family history of a disease cluster. COVID-19 was suspected based on clinical symptoms and radiologically detected ground-glass lung changes in the context of a normal white blood cell count (WBCC) and lymphocyte fraction (L%). A diagnosis of COVID-19 was confirmed by nucleic acid testing. Initially, he was started on noninvasive ventilation (NIV). Because his respiratory distress worsened over the following 2 h, he was transitioned to mechanical ventilation (MV), placed in prone positioning 12 h/day, and given a multi-pronged pharmacotherapy regimen that included an antiviral cocktail (lopinavir/ritonavir plus α-interferon), an immunity enhancer (thymosin α1), an anti-coagulant to prevent thrombosis (heparin). He was given an antibiotic to treat an opportunistic nosocomial infection. The patient has recovered well. The regimen applied in this case of timely evaluation, early prone positioning with MV, and a multi-pronged pharmacotherapy may be an effective strategy for patients with critical COVID-19, particularly with respect to preventing life-threatening worsening of the illness.

Coronavirus pandemic versus temperature in the context of Indian subcontinent: a preliminary statistical analysis

The novel coronavirus (COVID-19) has unleashed havoc across different countries and was declared a pandemic by the World Health Organization. Since certain evidences indicate a direct relationship of various viruses with the weather (temperature in particular), the same is being speculated about COVID-19; however, it is still under investigation as the pandemic is advancing the world over. In this study, we tried to analyze the spread of COVID-19 in the Indian subcontinent with respect to the local temperature regimes from March 9, 2020, to May 27, 2020. To establish the relation between COVID-19 and temperature in India, three different ecogeographical regions having significant temperature differences were taken into consideration for the analysis. We observed that except Maharashtra, Rajasthan and Kashmir showed a significantly positive correlation between the number of COVID-19 cases and the temperature during the period of study. The evidences based on the results presented in this research lead us to believe that the increasing temperature is beneficial to the COVID-19 spread, and the cases are going to rise further with the increasing temperature over India. We, therefore, conclude that the existing data, though limited, suggest that the spread of COVID-19 in India is not explained by the variation of temperature alone and is most likely driven by a host of other factors related to epidemiology, socioeconomics and other climatic factors. Based on the results, it is suggested that temperature should not be considered as a yardstick for planning intervention strategies for controlling the COVID-19 pandemic.

The Risk Factors for the Exacerbation of COVID-19 Disease: A Case-control Study

AIMS AND OBJECTIVES

To investigate the factors associated with the exacerbations of COVID-19.

BACKGROUND

At present, COVID-19 is prevalent in the world, seriously endangering the property and life safety of people around the world. Currently, there are many reports on the clinical features, complications and risk factors of death of COVID-19, but there are few reports on the factors associated with the exacerbation of COVID-19.

DESIGN

Case-control Study.

METHODS

Patients with COVID-19 were recruited from four designated hospitals for novel coronavirus pneumonia in Xiangyang City, Hubei Province from January to April 2020. The patients were divided into disease exacerbation group (n = 53) and disease stabilisation group (n = 265) according to the disease progression during hospitalisation. Univariate analysis and multivariate logistic regression were used to identify the factors associated with the exacerbation of COVID-19. The research was reported according to STROBE statement.

RESULTS

Univariate analysis showed there were significant differences in gender, age, hypertension, heart disease, kidney disease, white blood cell count, percentage of neutrophil, percentage of lymphocyte, C-reactive protein, lactate dehydrogenase, total protein, albumin, creatinine, calcium ion, rate of erythrocyte sedimentation, cough, expectoration, chest tightness, gastrointestinal discomfort and dyspnoea between the two groups. The variables with p < 0.05 in the aforementioned difference analysis were included in binary logistic regression analysis, which showed that age, hypertension history, chest tightness, percentage of neutrophil, percentage of lymphocyte, lactate dehydrogenase and creatinine were independent factors associated with COVID-19 disease exacerbation.

CONCLUSION

Clinicians may warn the exacerbation of COVID-19 facing above risk factors and associated characteristics, and adjust the diagnosis and treatment plan to delay the disease progression, reduce complications and mortality and improve the prognosis of patients.

RELEVANCE TO CLINICAL PRACTICE

Patients with certain risk factors associated with COVID-19 diseases exacerbation should be observed and targeted by using effective early interventions.

COVID-19 healthcare demand and mortality in Sweden in response to non-pharmaceutical mitigation and suppression scenarios

Background

While the COVID-19 outbreak in China now appears suppressed, Europe and the USA have become the epicentres, both reporting many more deaths than China. Responding to the pandemic, Sweden has taken a different approach aiming to mitigate, not suppress, community transmission, by using physical distancing without lockdowns. Here we contrast the consequences of different responses to COVID-19 within Sweden, the resulting demand for care, intensive care, the death tolls and the associated direct healthcare related costs.

Methods

We used an age-stratified health-care demand extended SEIR (susceptible, exposed, infectious, recovered) compartmental model for all municipalities in Sweden, and a radiation model for describing inter-municipality mobility. The model was calibrated against data from municipalities in the Stockholm healthcare region.

Results

Our scenario with moderate to strong physical distancing describes well the observed health demand and deaths in Sweden up to the end of May 2020. In this scenario, the intensive care unit (ICU) demand reaches the pre-pandemic maximum capacity just above 500 beds. In the counterfactual scenario, the ICU demand is estimated to reach ∼20 times higher than the pre-pandemic ICU capacity. The different scenarios show quite different death tolls up to 1 September, ranging from 5000 to 41 000, excluding deaths potentially caused by ICU shortage. Additionally, our statistical analysis of all causes excess mortality indicates that the number of deaths attributable to COVID-19 could be increased by 40% (95% confidence interval: 0.24, 0.57).

Conclusion

The results of this study highlight the impact of different combinations of non-pharmaceutical interventions, especially moderate physical distancing in combination with more effective isolation of infectious individuals, on reducing deaths, health demands and lowering healthcare costs. In less effective mitigation scenarios, the demand on ICU beds would rapidly exceed capacity, showing the tight interconnection between the healthcare demand and physical distancing in the society. These findings have relevance for Swedish policy and response to the COVID-19 pandemic and illustrate the importance of maintaining the level of physical distancing for a longer period beyond the study period to suppress or mitigate the impacts from the pandemic.

Countries of origin of imported COVID-19 cases into China and measures to prevent onward transmission

From 11 March to 6 July 2020, a total of 268 imported cases of COVID-19 from abroad were confirmed in Guangzhou. 74% of the imported cases were detected during customs inspection and 19% under centralized quarantine. We advocate for legally enforced quarantine and monitoring of quarantined persons.

Navigating the risks of flying during COVID-19: a review for safe air travel

RATIONALE FOR REVIEW

With air travel restarting, there has been much discourse about the safety of flying during the pandemic. In travel medicine, risk assessment includes estimating baseline risk to the traveller, recognizing factors that may modify that risk, considering the role of interventions to decrease that risk and accounting for a traveller's perception and tolerance of risk. The goals of this review are to identify the in-flight transmission risks of commercial air travel, provide recommendations about the risks of flying during the pandemic and propose strategies to mitigate the spread of COVID-19.

KEY FINDINGS

The airline industry has taken a layered approach to increase passenger safety through effective onboard ventilation, extended ventilation at the gate, boarding and deplaning strategies, improved aircraft disinfection and pre-flight screening such as temperature checks and COVID-19 testing. Proximity to an index case may contribute to the risk of transmission more than the seat type or location. The use of face masks has significantly reduced onboard transmission, and mandatory in-flight mask-wearing policies are being enforced. Innovations such as digital health passports may help standardize screening entry requirements at airports and borders, allowing for a safer return to travel.

RECOMMENDATIONS

In-flight transmission of SARS-CoV-2 is a real risk, which may be minimized by combining mitigation strategies and infection prevention measures including mandatory masking onboard, minimizing unmasked time while eating, turning on gasper airflow in-flight, frequent hand sanitizing, disinfecting high touch surfaces, promoting distancing while boarding and deplaning, limiting onboard passenger movement, implementing effective pre-flight screening measures and enhancing contact tracing capability. Assessing risk is a cornerstone of travel medicine. It is important to evaluate the multiple factors contributing to the cumulative risk of an individual traveller during the COVID-19 pandemic and to employ a multi-pronged approach to reduce that risk.

Strategies at points of entry to reduce importation risk of COVID-19 cases and reopen travel

BACKGROUND

With more countries exiting lockdown, public health safety requires screening measures at international travel entry points that can prevent the reintroduction or importation of the severe acute respiratory syndrome-related coronavirus-2. Here, we estimate the number of cases captured, quarantining days averted and secondary cases expected to occur with screening interventions.

METHODS

To estimate active case exportation risk from 153 countries with recorded coronavirus disease-2019 cases and deaths, we created a simple data-driven framework to calculate the number of infectious and upcoming infectious individuals out of 100 000 000 potential travellers from each country, and assessed six importation risk reduction strategies; Strategy 1 (S1) has no screening on entry, S2 tests all travellers and isolates test-positives where those who test negative at 7 days are permitted entry, S3 the equivalent but for a 14 day period, S4 quarantines all travellers for 7 days where all are subsequently permitted entry, S5 the equivalent for 14 days and S6 the testing of all travellers and prevention of entry for those who test positive.

RESULTS

The average reduction in case importation across countries relative to S1 is 90.2% for S2, 91.7% for S3, 55.4% for S4, 91.2% for S5 and 77.2% for S6. An average of 79.6% of infected travellers are infectious upon arrival. For the top 100 exporting countries, an 88.2% average reduction in secondary cases is expected through S2 with the 7-day isolation of test-positives, increasing to 92.1% for S3 for 14-day isolation. A substantially smaller reduction of 30.0% is expected for 7-day all traveller quarantining, increasing to 84.3% for 14-day all traveller quarantining.

CONCLUSIONS

The testing and isolation of test-positives should be implemented provided good testing practices are in place. If testing is not feasible, quarantining for a minimum of 14 days is recommended with strict adherence measures in place.

The impact of human mobility networks on the global spread of COVID-19

Human mobility networks are crucial for a better understanding and controlling the spread of epidemics. Here, we study the impact of human mobility networks on the COVID-19 onset in 203 different countries. We use exponential random graph models to perform an analysis of the country-to-country global spread of COVID-19. We find that most countries had similar levels of virus spreading, with only a few acting as the main global transmitters. Our evidence suggests that migration and tourism inflows increase the probability of COVID-19 case importations while controlling for contiguity, continent co-location and sharing a language. Moreover, we find that air flights were the dominant mode of transportation while male and returning travellers were the main carriers. In conclusion, a mix of mobility and geography factors predicts the COVID-19 global transmission from one country to another. These findings have implications for non-pharmaceutical public health interventions and the management of transborder human circulation.

Virus strain from a mild COVID-19 patient in Hangzhou represents a new trend in SARS-CoV-2 evolution potentially related to Furin cleavage site

The mutations in the SARS-CoV-2 virus genome during COVID-19 dissemination are unclear. In 788 COVID-19 patients from Zhejiang province, we observed decreased rate of severe/critical cases compared with patients in Wuhan. For mechanisms exploration, we isolated one strain of SARS-CoV-2 (ZJ01) from a mild COVID-19 patient. Thirty-five specific gene mutations were identified. Phylogenetic and relative synonymous codon usage analysis suggested that ZJ01 may be a potential evolutionary branch of SARS-CoV-2. We classified 54 global virus strains based on the base (C or T) at positions 8824 and 28247 while ZJ01 has T at both sites. The prediction of the Furin cleavage site (FCS) and sequence alignment indicated that the FCS may be an important site of coronavirus evolution. ZJ01 mutations identified near the FCS (F1-2) caused changes in the structure and electrostatic distribution of the S surface protein, further affecting the binding capacity of Furin. Single-cell sequencing and ACE2-Furin co-expression results confirmed that the Furin expression was especially higher in glands, liver, kidneys, and colon. The evolutionary pattern of SARS-CoV-2 towards FCS formation may result in its clinical symptom becoming closer to HKU-1 and OC43 caused mild flu-like symptoms, further showing its potential in differentiating into mild COVID-19 subtypes.

Controlling Cytokine Storm Is Vital in COVID-19

Corona virus disease 2019 (COVID-19) has caused a global outbreak and severely posed threat to people's health and social stability. Mounting evidence suggests that immunopathological changes, including diminished lymphocytes and elevated cytokines, are important drivers of disease progression and death in coronavirus infections. Cytokine storm not only limits further spread of virus in the body but also induces secondary tissue damage through the secretion of large amounts of active mediators and inflammatory factors. It has been determined that cytokine storm is a major cause of deaths in COVID-19; therefore, in order to reverse the deterioration of severe and critically ill patients from this disease, the cytokine storm has become a key therapeutic target. Although specific mechanisms of the occurrences of cytokine storms in COVID-19 have not been fully illuminated, hyper-activated innate immune responses, and dysregulation of ACE2 (angiotensin converting enzyme 2) expression and its downstream pathways might provide possibilities. Tailored immunoregulatory therapies have been applied to counteract cytokine storms, such as inhibition of cytokines, corticosteroids, blood purification therapy, and mesenchymal stem cell therapy. This review will summarize advances in the research of cytokine storms induced by COVID-19, as well as potential intervention strategies to control cytokine storms.