Potential for global spread of a novel coronavirus from China

Pentoxifylline decreases serum LDH levels and increases lymphocyte count in COVID-19 patients: Results from an external pilot study

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Pentoxifylline could be beneficial for the treatment of COVID-19.

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Serum lactate dehydrogenase and lymphocyte count are accessible biomarkers that correlate with the severity of COVID-19.

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Pentoxifylline treatment was associated with an increase in the lymphocyte count and decreased LDH levels.

We have previously hypothesized that pentoxifylline could be beneficial for the treatment of COVID-19 given its potential to restore the immune response equilibrium, reduce the impact of the disease on the endothelium and alveolar epithelial cells, and improve the circulatory function. Serum lactate dehydrogenase (LDH) and lymphocyte count are accessible biomarkers that correlate with the severity of COVID-19, the need for hospitalization, and mortality, reflecting the host immune response’s contribution to the seriousness of SARS-CoV-2 infection.

We carried out this external pilot study on 38 patients with moderate and severe COVID-19 to test the effect pentoxifylline on parameters such as LDH, lymphocyte count, days of hospitalization, mortality, and proportion of patients requiring intubation. Twenty-six patients were randomized to receive 400 mg of pentoxifylline t.i.d. plus standard therapy (pentoxifylline group), while the rest received the standard treatment (control group). Linear regression models were built for statistically significant parameters.

Pentoxifylline treatment was associated with a 64.25% increase (CI95% 11.83, 116.68) in lymphocyte count and a 29.61% decrease (CI95% 15.11, 44.10) in serum LDH. Although a trend towards reduced days of hospitalization, mortality, and proportion of patients requiring intubation was observed, no statistically significant difference was found for these parameters.

Our findings open the possibility of pentoxifylline being repositioned as a drug for COVID-19 treatment with the advantages of a proven safety profile, availability, and no risk of immunosuppression; however, this evidence needs to be confirmed in a pragmatic randomized controlled trial.

Computational Investigation of Structural Dynamics of SARS-CoV-2 Methyltransferase-Stimulatory Factor Heterodimer nsp16/nsp10 Bound to the Cofactor SAM

Recently, a highly contagious novel coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has emerged, posing a global threat to public health. Identifying a potential target and developing vaccines or antiviral drugs is an urgent demand in the absence of approved therapeutic agents. The 5'-capping mechanism of eukaryotic mRNA and some viruses such as coronaviruses (CoVs) are essential for maintaining the RNA stability and protein translation in the virus. SARS-CoV-2 encodes S-adenosyl-L-methionine (SAM) dependent methyltransferase (MTase) enzyme characterized by nsp16 (2'-O-MTase) for generating the capped structure. The present study highlights the binding mechanism of nsp16 and nsp10 to identify the role of nsp10 in MTase activity. Furthermore, we investigated the conformational dynamics and energetics behind the binding of SAM to nsp16 and nsp16/nsp10 heterodimer by employing molecular dynamics simulations in conjunction with the Molecular Mechanics Poisson-Boltzmann Surface Area (MM/PBSA) method. We observed from our simulations that the presence of nsp10 increases the favorable van der Waals and electrostatic interactions between SAM and nsp16. Thus, nsp10 acts as a stimulator for the strong binding of SAM to nsp16. The hydrophobic interactions were predominately identified for the nsp16-nsp10 interactions. Also, the stable hydrogen bonds between Ala83 (nsp16) and Tyr96 (nsp10), and between Gln87 (nsp16) and Leu45 (nsp10) play a vital role in the dimerization of nsp16 and nsp10. Besides, Computational Alanine Scanning (CAS) mutagenesis was performed, which revealed hotspot mutants, namely I40A, V104A, and R86A for the dimer association. Hence, the dimer interface of nsp16/nsp10 could also be a potential target in retarding the 2'-O-MTase activity in SARS-CoV-2. Overall, our study provides a comprehensive understanding of the dynamic and thermodynamic process of binding nsp16 and nsp10 that will contribute to the novel design of peptide inhibitors based on nsp16.

Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of São Paulo, Brazil

Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society. In this paper we modelled and simulated a test-trace-and-quarantine strategy to control the COVID-19 outbreak in the State of São Paulo, Brasil. The State of São Paulo failed to adopt an effective social distancing strategy, reaching at most 59% in late March and started to relax the measures in late June, dropping to 41% in 08 August. Therefore, São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic.

Two alternative strategies combined with economic evaluations were simulated. One strategy included indiscriminately testing the entire population of the State, reaching more than 40 million people at a maximum cost of 2.25 billion USD, that would reduce the total number of cases by the end of 2020 by 90%. The second strategy investigated testing only symptomatic cases and their immediate contacts – this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%.

The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st, it would have been possible to reduce the total number of cases by 90% at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts.

COVID-19: Oxidative Preconditioning as a Potential Therapeutic Approach

This Article summarizes the likely benefits of central nervous system oxidative preconditioning in the reduction of COVID-19 based on its putative pathogenesis. The current COVID-19 outbreak caused a pandemic with millions of infected patients and death cases worldwide. The clinical features of severe acute respiratory syndrome coronavirus (SARS-CoV) was initially linked with respiratory disorders, but recent studies have reported alterations of neurological and cerebrovascular functions in COVID-19 patients. The main viral infection features are related to cell death, inflammation, and cytokine generation, which can be associated with the dysregulation of redox systems or oxidative stress. However, until now, there is no available and effective therapeutic approach. Thus, it is necessary to search for care and adequate protection against the disease, especially for susceptible and vulnerable groups. Preconditioning, a well-known antioxidative stress and anti-inflammatory approach, is protective against many neurological age-related disorders. COVID-19 severity and morbidity have been observed in elderly patients. The aim of the present study is to elucidate the possible protective role of oxidative preconditioning in aged patients at high risk of developing severe COVID-19 complications.

Data-Driven Modeling for Different Stages of Pandemic Response

Some of the key questions of interest during the COVID-19 pandemic (and all outbreaks) include: where did the disease start, how is it spreading, who are at risk, and how to control the spread. There are a large number of complex factors driving the spread of pandemics, and, as a result, multiple modeling techniques play an increasingly important role in shaping public policy and decision-making. As different countries and regions go through phases of the pandemic, the questions and data availability also change. Especially of interest is aligning model development and data collection to support response efforts at each stage of the pandemic. The COVID-19 pandemic has been unprecedented in terms of real-time collection and dissemination of a number of diverse datasets, ranging from disease outcomes, to mobility, behaviors, and socio-economic factors. The data sets have been critical from the perspective of disease modeling and analytics to support policymakers in real time. In this overview article, we survey the data landscape around COVID-19, with a focus on how such datasets have aided modeling and response through different stages so far in the pandemic. We also discuss some of the current challenges and the needs that will arise as we plan our way out of the pandemic.

Deceased donor kidney transplant in a 70-year-old Jehovah's Witness patient: to transplant or not to transplant-a case report

While Jehovah's Witness (JW) patients refuse transfusions of blood or blood products, they are willing to accept renal allograft transplantation. We describe here a case of what we believe is the oldest (a 70-year-old) JW candidate to undergo a deceased donor kidney transplant reported in the literature. Prior to transplantation, discussions ensued amongst the multidisciplinary transplant team, weighing the potential benefits vs. risks of performing a kidney transplant on this patient due to her refusal (due to religion) to accept any blood transfusions or blood products combined with her advanced age and having longstanding insulin-dependent, type 2 diabetes mellitus with extensive peripheral vascular disease. Preoperatively, we believed that the odds were in favor of performing the kidney transplant safely without the need for any blood product usage. However, her post-operative course was complicated by severe anemia, which developed by post-transplant day 4. The anemia incapacitated the patient's physical and psychological state, creating medical, social and financial burdens on the patient, family, medical team and hospital. Both family and patient grew concerned about her overall condition. Blood transfusion was offered in order to improve her weakness and shortness of breath that developed due to the severe anemia, but the patient (along with her family) refused such treatment. During the 17 days of hospitalization, it was a continuous struggle between the transplant team, patient, and family for her to continue with the recovery process; at times we had even considered that performing the transplant had been a mistake. While organ transplantation can be performed safely in Jehovah's Witnesses, there are multiple factors seen in this particular case that warrant analyzing: (I) the potential use of stricter transplant exclusionary criteria, given the recipient's advanced age and preexisting co-morbidities, which likely increased her risk of developing severe anemia post-operatively, and (II) the recipient's emotional/psychological post-operative state of high anxiety, which developed while she was experiencing the severe anemia; in hindsight, her anxiety level may have been reduced if we had offered daily post-operative psychological counseling sessions. While the patient's allograft is currently doing well, we probably did not have strict enough criteria for proper selection of a JW candidate for kidney transplantation.

Distributions of time, place, and population of novel coronavirus disease 2019 (COVID-19) from January 20 to February 10, 2020, in China

Background and objective

Since December 2019, increasing cases of novel coronavirus disease 2019 (COVID-19) are being detected worldwide. The purpose of this paper is to provide a scientific reference for the global prevention and control of COVID-19.

Methods

General demographic characteristics, epidemiological history, and clinical symptoms of COVID-19 were collected that had been reported on the websites of multiple Municipal Health Commissions in China. We herein describe distributions in time, place, and population of COVID-19.

Results

As of midnight on February 10, 2020, the number of confirmed cases of COVID-19 in China was 42,638, and the province with the largest number of confirmed cases was Hubei (31,728), followed by Guangdong (1177), Zhejiang (1117), and Henan (1105) province. The number of cases and the speed of confirmed cases in provinces other than Hubei were more moderate than those of the Hubei province. The median (interquartile range) age of 1740 patients with COVID-19 was 44 (33, 54) years, with a range of 10 months to 89 years.

Conclusions

The COVID-19 epidemic should be considered a global threat and the steps for control include early diagnosis and treatment, as well as isolation.

Applicability of bedside ultrasonography for the diagnosis of deep venous thrombosis in patients with COVID-19 and treatment with low molecular weight heparin

PURPOSE

The aim of this study was to evaluate the applicability of bedside ultrasonography for the diagnosis of deep venous thrombosis (DVT) in patients infected with corona virus disease 2019 (COVID-19) with and without treatment with low molecular weight heparin (LMWH).

METHODS

We retrospectively analyzed the records of deceased and surviving patients in whom ultrasonography detected or not a DVT, and in whom LMWH was or not prescribed.

RESULTS

The incidence of DVT is higher in the deceased (33/35) than in the surviving (22/46) patients. LMWH was administered in a larger proportion of surviving (18/22) than of deceased (18/33) patients. D-dimer concentrations decreased in patients who received LMWH in both groups.

CONCLUSIONS

There was a high incidence of DVT in patients who succumbed to COVID-19. Bedside ultrasonography can detect the presence of DVT as early as possible and help assessing the risk of venous thromboembolism, allowing early and reasonable use of LMWH.

The influence of passenger air traffic on the spread of COVID-19 in the world

Countries in the world are suffering from COVID-19 and would like to control it. Thus, some authorities voted for new policies and even stopped passenger air traffic. Those decisions were not uniform, and this study focuses on how passenger air traffic might influence the spread of COVID-19 in the world. We used data sets of cases from the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University and air transport (passengers carried) from the World Bank. Besides, we computed Poisson, QuasiPoisson, Negative binomial, zero-inflated Poisson, and zero-inflated negative binomial models with cross-validation to make sure that our findings are robust. Actually, when passenger air traffic increases by one unit, the number of cases increases by one new infection.

[Distributions of time, place, and population of novel coronavirus disease 2019 (COVID-19) from January 20 to February 10, 2020, in China]

Background and objective

Since December 2019, increasing cases of novel coronavirus disease 2019 (COVID-19) are being detected worldwide. The purpose of this paper is to provide a scientific reference for the global prevention and control of COVID-19.

Methods

General demographic characteristics, epidemiological history, and clinical symptoms of COVID-19 were collected that had been reported on the websites of multiple Municipal Health Commissions in China. We herein describe distributions in time, place, and population of COVID-19.

Results

As of midnight on February 10, 2020, the number of confirmed cases of COVID-19 in China was 42,638, and the province with the largest number of confirmed cases was Hubei (31728), followed by Guangdong (1177), Zhejiang (1117), and Henan (1105) province. The number of cases and the speed of confirmed cases in provinces other than Hubei were more moderate than those of the Hubei province. The median (interquartile range) age of patients with COVID-19 was 44 (33, 54) years, with a range of 10 months to 89 years.

Conclusions

The COVID-19 epidemic should be considered a global threat and the steps for control include early diagnosis and treatment, as well as isolation.

Eltrombopag is a potential target for drug intervention in SARS-CoV-2 spike protein

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a current global threat for which there is an urgent need to search for an effective therapy. The transmembrane spike (S) glycoprotein of SARS-CoV-2 directly binds to the host angiotensin-converting enzyme 2 (ACE2) and mediates viral entrance, which is therefore considered as a promising drug target. Considering that new drug development is a time-consuming process, drug repositioning may facilitate rapid drug discovery dealing with sudden infectious diseases. Here, we compared the differences between the virtual structural proteins of SARS-CoV-2 and SARS-CoV, and selected a pocket mainly localizing in the fusion cores of S2 domain for drug screening. A virtual drug design algorithm screened the Food and Drug Administration-approved drug library of 1234 compounds, and 13 top scored compounds were obtained through manual screening. Through in vitro molecular interaction experiments, eltrombopag was further verified to possess a high binding affinity to S protein plus human ACE2 and could potentially affect the stability of the ACE2-S protein complex. Hence, it is worth further exploring eltrombopag as a potential drug for the treatment of SARS-CoV-2 infection.

A Body Tracking-Based Low-Cost Solution for Monitoring Workers' Hygiene Best Practices during Pandemics

Since its beginning at the end of 2019, the pandemic spread of the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) caused more than one million deaths in only nine months. The threat of emerging and re-emerging infectious diseases exists as an imminent threat to human health. It is essential to implement adequate hygiene best practices to break the contagion chain and enhance society preparedness for such critical scenarios and understand the relevance of each disease transmission route. As the unconscious hand-face contact gesture constitutes a potential pathway of contagion, in this paper, the authors present a prototype system based on low-cost depth sensors able to monitor in real-time the attitude towards such a habit. The system records people's behavior to enhance their awareness by providing real-time warnings, providing for statistical reports for designing proper hygiene solutions, and better understanding the role of such route of contagion. A preliminary validation study measured an overall accuracy of 91%. A Cohen's Kappa equal to 0.876 supports rejecting the hypothesis that such accuracy is accidental. Low-cost body tracking technologies can effectively support monitoring compliance with hygiene best practices and training people in real-time. By collecting data and analyzing them with respect to people categories and contagion statistics, it could be possible to understand the importance of this contagion pathway and identify for which people category such a behavioral attitude constitutes a significant risk.

COVID-19: a user's guide, status of the art and an original proposal to terminate viral recurrence

The world is now entering its 9^th month of combat against a pandemic of deadly pneumonia. Started out from China in December 2019, the disease has been declared as caused by infection with a so far unknown RNA Coronavirus of the respiratory family, then named severe acute respiratory syndrome coronavirus SARS-CoV-2. In the absence of a vaccine, and with scientists still struggling for an effective therapy, COVID-19 (the SARS-dependent syndrome) carries up to now, a death toll of more than 590,000 (July 18,2020) undermining jobs and finance of contemporary society in all continents. Social distancing, the only measure hitherto shown to restrain virus spread, has been progressively loosened from May 2020 in some countries, leaving us in the fear of repeat attacks from the unchecked virus. We discuss the problem and propose to tentatively boost the antivirus cell machinery by using lab-made viral mimics to engage cell receptors.

Spatial analysis and GIS in the study of COVID-19. A review

This study entailed a review of 63 scientific articles on geospatial and spatial-statistical analysis of the geographical dimension of the 2019 coronavirus disease (COVID-19) pandemic. The diversity of themes identified in this paper can be grouped into the following categories of disease mapping: spatiotemporal analysis, health and social geography, environmental variables, data mining, and web-based mapping. Understanding the spatiotemporal dynamics of COVID-19 is essential for its mitigation, as it helps to clarify the extent and impact of the pandemic and can aid decision making, planning and community action. Health geography highlights the interaction of public health officials, affected actors and first responders to improve estimations of disease propagation and likelihoods of new outbreaks. Attempts at interdisciplinary correlation examine health policy interventions for the siting of health/sanitary services and controls, mapping/tracking of human movement, formulation of appropriate scientific and political responses and projection of spatial diffusion and temporal trends. This review concludes that, to fight COVID-19, it is important to face the challenges from an interdisciplinary perspective, with proactive planning, international solidarity and a global perspective. This review provides useful information and insight that can support future bibliographic queries, and also serves as a resource for understanding the evolution of tools used in the management of this major global pandemic of the 21 Century. It is hoped that its findings will inspire new reflections on the COVID-19 pandemic by readers.

Spatial analysis and GIS in the study of COVID-19. A review

This study entailed a review of 63 scientific articles on geospatial and spatial-statistical analysis of the geographical dimension of the 2019 coronavirus disease (COVID-19) pandemic. The diversity of themes identified in this paper can be grouped into the following categories of disease mapping: spatiotemporal analysis, health and social geography, environmental variables, data mining, and web-based mapping. Understanding the spatiotemporal dynamics of COVID-19 is essential for its mitigation, as it helps to clarify the extent and impact of the pandemic and can aid decision making, planning and community action. Health geography highlights the interaction of public health officials, affected actors and first responders to improve estimations of disease propagation and likelihoods of new outbreaks. Attempts at interdisciplinary correlation examine health policy interventions for the siting of health/sanitary services and controls, mapping/tracking of human movement, formulation of appropriate scientific and political responses and projection of spatial diffusion and temporal trends. This review concludes that, to fight COVID-19, it is important to face the challenges from an interdisciplinary perspective, with proactive planning, international solidarity and a global perspective. This review provides useful information and insight that can support future bibliographic queries, and also serves as a resource for understanding the evolution of tools used in the management of this major global pandemic of the 21 Century. It is hoped that its findings will inspire new reflections on the COVID-19 pandemic by readers.

Rapid in vitro assays for screening neutralizing antibodies and antivirals against SARS-CoV-2

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We have developed a rapid, accurate, and highly reproducible plaque reduction microneutralization (PRMNT) assay for SARS-CoV-2.

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Our PRMNT assay allows to identify and characterize antibodies with neutralizing activity against SARS-CoV-2.

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Likewise, our PRMNT assay can be used to find compounds with antiviral activity against SARS-CoV-2.

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The PRMNT assay can be developed using peroxidase or infrared staining readouts.

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Our PRMNT assay can be adapted to HTS settings to interrogate complex library of SARS-CoV-2 inhibitors.

Towards the end of 2019, a novel coronavirus (CoV) named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), genetically similar to severe acute respiratory syndrome coronavirus (SARS-CoV), emerged in Wuhan, Hubei province of China, and has been responsible for coronavirus disease 2019 (COVID-19) in humans. Since its first report, SARS-CoV-2 has resulted in a global pandemic, with over 10 million human infections and over 560,000 deaths reported worldwide at the end of June 2020. Currently, there are no United States (US) Food and Drug Administration (FDA)-approved vaccines and/or antivirals licensed against SARS-CoV-2. The high economical and health impacts of SARS-CoV-2 has placed global pressure on the scientific community to identify effective prophylactic and therapeutic treatments for SARS-CoV-2 infection and associated COVID-19 disease. While some compounds have been already reported to reduce SARS-CoV-2 infection and a handful of monoclonal antibodies (mAbs) have been described that neutralize SARS-CoV-2, there is an urgent need for the development and standardization of assays which can be used in high through-put screening (HTS) settings to identify new antivirals and/or neutralizing mAbs against SARS-CoV-2. Here, we described a rapid, accurate, and highly reproducible plaque reduction microneutralization (PRMNT) assay that can be quickly adapted for the identification and characterization of both neutralizing mAbs and antivirals against SARS-CoV-2. Importantly, our MNA is compatible with HTS settings to interrogate large and/or complex libraries of mAbs and/or antivirals to identify those with neutralizing and/or antiviral activity, respectively, against SARS-CoV-2.

The psychological impact of COVID-19 outbreak on medical staff and the general public

To assess the psychological effects of the novel coronavirus disease (COVID-19) on medical staff and the general public. During the outbreak of COVID-19, an internet-based questionnaire included The Self-rating Depression Scale (SDS), Perceived Stress Scale (PSS-10), and Impact of Event Scale-Revised (IES-R) was used to assess the impact of the pandemic situation on the mental health of medical staff and general population in Wuhan and its surrounding areas. Among the 1493 questionnaires completed, 827 (55.39%) of these were men, and 422 (28.27%) of these were medical personnel. The results suggest that the outbreak of COVID-19 has affected individuals significantly, the degree of which is related to age, sex, occupation and mental illness. There was a significant difference in PSS-10 and IES-R scores between the medical staff and the general population. The medical staff showed higher PSS-10 scores (16.813 ± 4.87) and IES-R scores (22.40 ± 12.12) compared to members of the general population PSS-10 (14.80 ± 5.60) and IES-R scores (17.89 ± 13.08). However, there was no statistically significant difference between the SDS scores of medical staff (44.52 ± 12.36) and the general public (43.08 ± 11.42). In terms of the need for psychological assistance, 50.97% of interviewees responded that they needed psychological counseling, of which medical staff accounted for 65.87% and non-medical staff accounted for 45.10%. During the ongoing COVID-19 outbreak, great attention should be paid to the mental health of the population, especially medical staff, and measures such as psychological intervention should be actively carried out for reducing the psychosocial effects.

Ancestral origin, antigenic resemblance and epidemiological insights of novel coronavirus (SARS-CoV-2): Global burden and Bangladesh perspective

SARS-CoV-2, a new coronavirus strain responsible for COVID-19, has emerged in Wuhan City, China, and continuing its global pandemic nature. The availability of the complete gene sequences of the virus helps to know about the origin and molecular characteristics of this virus. In the present study, we performed bioinformatic analysis of the available gene sequence data of SARS-CoV-2 for the understanding of evolution and molecular characteristics and immunogenic resemblance of the circulating viruses. Phylogenetic analysis was performed for four types of representative viral proteins (spike, membrane, envelope and nucleoprotein) of SARS-CoV-2, HCoV-229E, HCoV-OC43, SARS-CoV, HCoV-NL63, HKU1, MERS-CoV, HKU4, HKU5 and BufCoV-HKU26. The findings demonstrated that SARS-CoV-2 exhibited convergent evolutionary relation with previously reported SARS-CoV. It was also depicted that SARS-CoV-2 proteins were highly similar and identical to SARS-CoV proteins, though proteins from other coronaviruses showed a lower level of resemblance. The cross-checked conservancy analysis of SARS-CoV-2 antigenic epitopes showed significant conservancy with antigenic epitopes derived from SARS-CoV. Descriptive epidemiological analysis on several epidemiological indices was performed on available epidemiological outbreak information from several open databases on COVID-19 (SARS-CoV-2). Satellite-derived imaging data have been employed to understand the role of temperature in the environmental persistence of the virus. Findings of the descriptive analysis were used to describe the global impact of newly emerged SARS-CoV-2, and the risk of an epidemic in Bangladesh.

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.

Lymphocyte percentage and hemoglobin as a joint parameter for the prediction of severe and nonsevere COVID-19: a preliminary study

Background

Coronavirus disease 2019 (COVID-19) has spread rapidly around the world since December, 2019. This study aimed to identify parameters in routine blood tests that could be used to evaluate the severity of coronavirus disease 2019 (COVID-19) and, thus, assist with the clinical prediction of the extent of progression.

Methods

This retrospective study analyzed the epidemiological, clinical symptom, and laboratory examination data of 159 patients diagnosed with COVID-19. The percentage of lymphocytes (Lym%) and hemoglobin (HGB) were integrated into a joint parameter, Lym% & HGB, through binary logistic regression.

Results

Individually, Lym% and HGB decreased gradually with disease progression whereas the joint parameter Lym% & HGB increased gradually with disease progression. When Lym%, HGB, and Lym% & HGB were used to predict the severity of COVID-19, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.89, 0.79, and 0.92, respectively. The dynamic change curves showed that Lym% and HGB continued to decline while Lym% & HGB continued to increase with disease progression in patients with severe COVID. The change in Lym% & HGB was more prominent than those in Lym% and HBG.

Conclusions

The joint parameter Lym% & HGB could serve as an effective tool for differentiating severe and nonsevere COVID-19, and its sensitivity and specificity are higher than those of Lym% or HGB alone.

Telehealth tinnitus therapy during the COVID-19 outbreak in the UK: uptake and related factors

OBJECTIVE

The Audiology Department at the Royal Surrey County Hospital usually offers face-to-face audiologist-delivered cognitive behavioural therapy (CBT) for tinnitus rehabilitation. During COVID-19 lockdown, patients were offered telehealth CBT via video using a web-based platform. This study evaluated the proportion of patients who took up the offer of telehealth sessions and factors related to this.

DESIGN

Retrospective service evaluation.

STUDY SAMPLE

113 consecutive patients whose care was interrupted by the lockdown.

RESULTS

80% of patients accepted telehealth. The main reasons for declining were not having access to a suitable device and the belief that telehealth appointments would not be useful. Compared to having no hearing loss in the better ear, having a mild or moderate hearing loss increased the chance of declining telehealth by factors of 3.5 (p = 0.04) and 14.9 (p = 0.038), respectively. High tinnitus annoyance as measured via the visual analogue scale increased the chance of declining telehealth appointments by a factor of 1.4 (p = 0.019).

CONCLUSIONS

Although CBT via telehealth was acceptable to most patients, alternatives may be necessary for the 20% who declined. These tended to have worse hearing in their better ear and more annoying tinnitus.

The cytokine storm and COVID-19

Coronavirus disease 2019 (COVID‐19), which began in Wuhan, China, in December 2019, has caused a large global pandemic and poses a serious threat to public health. More than 4 million cases of COVID‐19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), have been confirmed as of 11 May 2020. SARS‐CoV‐2 is a highly pathogenic and transmissible coronavirus that primarily spreads through respiratory droplets and close contact. A growing body of clinical data suggests that a cytokine storm is associated with COVID‐19 severity and is also a crucial cause of death from COVID‐19. In the absence of antivirals and vaccines for COVID‐19, there is an urgent need to understand the cytokine storm in COVID‐19. Here, we have reviewed the current understanding of the features of SARS‐CoV‐2 and the pathological features, pathophysiological mechanisms, and treatments of the cytokine storm induced by COVID‐19. In addition, we suggest that the identification and treatment of the cytokine storm are important components for rescuing patients with severe COVID‐19.

SARS‐CoV‐2 is a highly pathogenic and transmissible coronavirus that primarily spreads through respiratory droplets and close contact.

A cytokine storm is associated with COVID‐19 severity and is also a crucial cause of death from COVID‐19.

Impaired acquired immune responses and uncontrolled inflammatory innate responses may be associated with the mechanism of the cytokine storm in COVID‐19.

Early control of the cytokine storm through therapies, such as immunomodulators and cytokine antagonists, is essential to improve the survival rate of patients with COVID‐19.

The COVID-19 Effect on the Immune System and Mitochondrial Dynamics in Diabetes, Obesity, and Dementia

The coronavirus disease 2019 (COVID-19) is a pandemic disease, originated in Wuhan City, China. It is caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) and its biology is still poorly understood. Currently, there are no vaccines and drugs/or agents that can reduce severity of this new disease. Recent data suggest that patients with age-related comorbidities, including cardiovascular disease, diabetes, obesity, hypertension, chronic kidney disease, and dementia are highly susceptible to severe respiratory illness due to coronavirus infection. Recent research also revealed that aged individuals with elevated baseline inflammation cause defects in T and B cells, leading to decreased body's immune response to viral infection. In the current article, we discuss the effects of SARS-CoV-2 on age-related chronic diseases, such as diabetes, obesity, and Alzheimer's disease. Our article also highlights the interaction between coronavirus and immune cells, and how COVID-19 alters mitochondrial activities in host cells. Based on new and compelling evidence, we propose that mitochondrial fission is inhibited while fusion is promoted, causing mitochondrial elongation and providing a receptive intracellular environment for viral replication in infected cells. Further research is still needed to understand the cross talk between viral replication in mitochondria and disease progression in patients with COVID-19.

Data-driven modeling for different stages of pandemic response

Some of the key questions of interest during the COVID-19 pandemic (and all outbreaks) include: where did the disease start, how is it spreading, who is at risk, and how to control the spread. There are a large number of complex factors driving the spread of pandemics, and, as a result, multiple modeling techniques play an increasingly important role in shaping public policy and decision making. As different countries and regions go through phases of the pandemic, the questions and data availability also changes. Especially of interest is aligning model development and data collection to support response efforts at each stage of the pandemic. The COVID-19 pandemic has been unprecedented in terms of real-time collection and dissemination of a number of diverse datasets, ranging from disease outcomes, to mobility, behaviors, and socio-economic factors. The data sets have been critical from the perspective of disease modeling and analytics to support policymakers in real-time. In this overview article, we survey the data landscape around COVID-19, with a focus on how such datasets have aided modeling and response through different stages so far in the pandemic. We also discuss some of the current challenges and the needs that will arise as we plan our way out of the pandemic.

Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients

BACKGROUND

There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting.

METHODS

We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI).

RESULTS

We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12-0.41, p < 10^-3) with a corresponding area under curve (AUC) of 0.91 (95% CI: 0.85-0.98). HI significantly differed between patients with and without prehospital intubation (1.0 ± 1.0 vs. 3.6 ± 1.8, respectively; p < 10^-3). ROC curve analysis defined the optimal HI threshold as 1.3. Bivariate analysis revealed that HI <1.3 was significantly, positively associated with prehospital intubation (OR, 38.38; 95% CI: 11.57-146.54; p < 10^-3). Multivariate logistic regression analysis demonstrated that prehospital intubation was significantly associated with HI (adjusted odds ratio (ORa), 0.20; 95% CI: 0.06-0.45; p < 10^-3) and HI <3 (ORa, 51.08; 95% CI: 7.83-645.06; p < 10^-3). After adjustment for confounders, the ORa between HI <1.3 and prehospital intubation was 3.6 (95% CI: 1.95-5.08; p < 10^-3).

CONCLUSION

An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results.

Coronavirus Disease 2019-COVID-19

SUMMARYIn recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs). Recently, a new type of viral infection emerged in Wuhan City, China, and initial genomic sequencing data of this virus do not match with previously sequenced CoVs, suggesting a novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility of other routes should not be ruled out. Compared to diseases caused by previously known human CoVs, COVID-19 shows less severe pathogenesis but higher transmission competence, as is evident from the continuously increasing number of confirmed cases globally. Compared to other emerging viruses, such as Ebola virus, avian H7N9, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 has shown relatively low pathogenicity and moderate transmissibility. Codon usage studies suggest that this novel virus has been transferred from an animal source, such as bats. Early diagnosis by real-time PCR and next-generation sequencing has facilitated the identification of the pathogen at an early stage. Since no antiviral drug or vaccine exists to treat or prevent SARS-CoV-2, potential therapeutic strategies that are currently being evaluated predominantly stem from previous experience with treating SARS-CoV, MERS-CoV, and other emerging viral diseases. In this review, we address epidemiological, diagnostic, clinical, and therapeutic aspects, including perspectives of vaccines and preventive measures that have already been globally recommended to counter this pandemic virus.

Coronavirus Disease 2019-COVID-19

SUMMARYIn recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs). Recently, a new type of viral infection emerged in Wuhan City, China, and initial genomic sequencing data of this virus do not match with previously sequenced CoVs, suggesting a novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility of other routes should not be ruled out. Compared to diseases caused by previously known human CoVs, COVID-19 shows less severe pathogenesis but higher transmission competence, as is evident from the continuously increasing number of confirmed cases globally. Compared to other emerging viruses, such as Ebola virus, avian H7N9, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 has shown relatively low pathogenicity and moderate transmissibility. Codon usage studies suggest that this novel virus has been transferred from an animal source, such as bats. Early diagnosis by real-time PCR and next-generation sequencing has facilitated the identification of the pathogen at an early stage. Since no antiviral drug or vaccine exists to treat or prevent SARS-CoV-2, potential therapeutic strategies that are currently being evaluated predominantly stem from previous experience with treating SARS-CoV, MERS-CoV, and other emerging viral diseases. In this review, we address epidemiological, diagnostic, clinical, and therapeutic aspects, including perspectives of vaccines and preventive measures that have already been globally recommended to counter this pandemic virus.

Coronavirus Disease 2019-COVID-19

SUMMARYIn recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs). Recently, a new type of viral infection emerged in Wuhan City, China, and initial genomic sequencing data of this virus do not match with previously sequenced CoVs, suggesting a novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility of other routes should not be ruled out. Compared to diseases caused by previously known human CoVs, COVID-19 shows less severe pathogenesis but higher transmission competence, as is evident from the continuously increasing number of confirmed cases globally. Compared to other emerging viruses, such as Ebola virus, avian H7N9, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 has shown relatively low pathogenicity and moderate transmissibility. Codon usage studies suggest that this novel virus has been transferred from an animal source, such as bats. Early diagnosis by real-time PCR and next-generation sequencing has facilitated the identification of the pathogen at an early stage. Since no antiviral drug or vaccine exists to treat or prevent SARS-CoV-2, potential therapeutic strategies that are currently being evaluated predominantly stem from previous experience with treating SARS-CoV, MERS-CoV, and other emerging viral diseases. In this review, we address epidemiological, diagnostic, clinical, and therapeutic aspects, including perspectives of vaccines and preventive measures that have already been globally recommended to counter this pandemic virus.

Prehospital management of acute respiratory distress in suspected COVID-19 patients

BACKGROUND

In December 2019, coronavirus disease (COVID-19) emerged in China and became a world-wide pandemic in March 2020. Emergency services and intensive care units (ICUs) were faced with a novel disease with unknown clinical characteristics and presentations. Acute respiratory distress (ARD) was often the chief complaint for an EMS call. This retrospective study evaluated prehospital ARD management and identified factors associated with the need of prehospital mechanical ventilation (PMV) for suspected COVID-19 patients.

METHODS

We included 256 consecutive patients with suspected COVID-19-related ARD that received prehospital care from a Paris Fire Brigade BLS or ALS team, from March 08 to April 18, 2020. We performed multivariate regression to identify factors predisposing to PMV.

RESULTS

Of 256 patients (mean age 60 ± 18 years; 82 (32%) males), 77 (30%) had previous hypertension, 31 (12%) were obese, and 49 (19%) had diabetes mellitus. Nineteen patients (7%) required PMV. Logistic regression observed that a low initial pulse oximetry was associated with prehospital PMV (ORa = 0.86, 95%CI: 0.73-0.92; p = 0.004).

CONCLUSIONS

This study showed that pulse oximetry might be a valuable marker for rapidly determining suspected COVID-19-patients requiring prehospital mechanical ventilation. Nevertheless, the impact of prehospital mechanical ventilation on COVID-19 patients outcome require further investigations.

The Global Health Security index and Joint External Evaluation score for health preparedness are not correlated with countries' COVID-19 detection response time and mortality outcome

Global Health Security Index (GHSI) and Joint External Evaluation (JEE) are two well-known health security and related capability indices. We hypothesised that countries with higher GHSI or JEE scores would have detected their first COVID-19 case earlier, and would experience lower mortality outcome compared to countries with lower scores. We evaluated the effectiveness of GHSI and JEE in predicting countries' COVID-19 detection response times and mortality outcome (deaths/million). We used two different outcomes for the evaluation: (i) detection response time, the duration of time to the first confirmed case detection (from 31st December 2019 to 20th February 2020 when every country's first case was linked to travel from China) and (ii) mortality outcome (deaths/million) until 11th March and 1st July 2020, respectively. We interpreted the detection response time alongside previously published relative risk of the importation of COVID-19 cases from China. We performed multiple linear regression and negative binomial regression analysis to evaluate how these indices predicted the actual outcome. The two indices, GHSI and JEE were strongly correlated (r = 0.82), indicating a good agreement between them. However, both GHSI (r = 0.31) and JEE (r = 0.37) had a poor correlation with countries' COVID-19-related mortality outcome. Higher risk of importation of COVID-19 from China for a given country was negatively correlated with the time taken to detect the first case in that country (adjusted R2 = 0.63-0.66), while the GHSI and JEE had minimal predictive value. In the negative binomial regression model, countries' mortality outcome was strongly predicted by the percentage of the population aged 65 and above (incidence rate ratio (IRR): 1.10 (95% confidence interval (CI): 1.01-1.21) while overall GHSI score (IRR: 1.01 (95% CI: 0.98-1.01)) and JEE (IRR: 0.99 (95% CI: 0.96-1.02)) were not significant predictors. GHSI and JEE had lower predictive value for detection response time and mortality outcome due to COVID-19. We suggest introduction of a population healthiness parameter, to address demographic and comorbidity vulnerabilities, and reappraisal of the ranking system and methods used to obtain the index based on experience gained from this pandemic.

Chest computed tomography (CT) findings and semiquantitative scoring of 60 patients with coronavirus disease 2019 (COVID-19): A retrospective imaging analysis combining anatomy and pathology

In this study, we ascertained the chest CT data of 60 patients admitted to 3 hospitals in Chongqing with confirmed COVID-19. We conducted anatomical and pathological analyses to elucidate the possible reasons for the distribution, morphology, and characteristics of COVID-19 in chest CT. We also shared a semiquantitative scoring of affected lung segments, which was recommended by our local medical association. This scoring system was applied to quantify the severity of the disease. The most frequent imaging findings of COVID-19 were subpleural ground glass opacities and consolidation; there was a significant difference in semiquantitative scores between the early, progressive, and severe stages of the disease. We conclude that the chest CT findings of COVID-19 showed certain characteristics because of the anatomical features of the human body and pathological changes caused by the virus. Therefore, chest CT is a valuable tool for facilitating the diagnosis of COVID-19 and semiquantitative scoring of affected lung segments may further elucidate diagnosis and assessment of disease severity. This will assist healthcare workers in diagnosing COVID-19 and assessing disease severity, facilitate the selection of appropriate treatment options, which is important for reducing the spread of the virus, saving lives, and controlling the pandemic.

COVID-19 in Children: Clinical Characteristics and Follow-Up Study

Since December 2019, the coronavirus disease 2019 (COVID-19) has spread globally. But the clinical symptoms and detailed follow-up of children with COVID-19 infection are lacking. Here, we conducted a retrospective study including children with confirmed COVID-19. We recorded patients’ epidemiological, clinical features, and follow-up data after discharging in order to improve the awareness and treatment of children with COVID-19.

Assessment of Epidemiological Determinants of COVID-19 Pandemic Related to Social and Economic Factors Globally

The COVID-19 pandemic has manifested more than a health crisis and has severely impacted on social, economic, and development crises in the world. The relationship of COVID-19 with countries’ economic and other demographic statuses is an important criterion with which to assess the impact of this current outbreak. Based on available data from the online platform, we tested the hypotheses of a country’s economic status, population density, the median age of the population, and urbanization pattern influence on the test, attack, case fatality, and recovery rates of COVID-19. We performed correlation and multivariate multinomial regression analysis with relative risk ratio (RRR) to test the hypotheses. The correlation analysis showed that population density and test rate had a significantly negative association (r = −0.2384, p = 0.00). In contrast, the median age had a significant positive correlation with recovery rate (r = 0.4654, p = 0.00) and case fatality rate (r = 0.2847, p = 0.00). The urban population rate had a positive significant correlation with recovery rate (r = 0.1610, p = 0.04). Lower-middle-income countries had a negative significant correlation with case fatality rate (r= −0.3310, p = 0.04). The multivariate multinomial logistic regression analysis revealed that low-income countries are more likely to have an increased risk of case fatality rate (RRR = 0.986, 95% Confidence Interval; CI = 0.97−1.00, p < 0.05) and recovery rate (RRR = 0.967, 95% CI = 0.95–0.98, p = 0.00). The lower-income countries are more likely to have a higher risk in case of attack rate (RRR = 0.981, 95% CI = 0.97–0.99, p = 0.00) and recovery rate (RRR = 0.971, 95% CI = 0.96–0.98, p = 0.00). Similarly, upper middle-income countries are more likely to have higher risk in case of attack rate (RRR = 0.988, 95% CI = 0.98–1.0, p = 0.01) and recovery rate (RRR = 0.978, 95% CI = 0.97–0.99, p = 0.00). The low- and lower-middle-income countries should invest more in health care services and implement adequate COVID-19 preventive measures to reduce the risk burden. We recommend a participatory, whole-of-government and whole-of-society approach for responding to the socio-economic challenges of COVID-19 and ensuring more resilient and robust health systems to safeguard against preventable deaths and poverty by improving public health outcomes.

Impact of physical distancing due to novel coronavirus (SARS-CoV-2) on daily travel for work during transition to lockdown

The outbreak of COVID-19 pandemic has resulted in change in both commute and personal travel patterns. Though, in India, lockdown was implemented from 25th March 2020, due to self-awareness and pandemic risk perception, change in commuter behavior was observed from the beginning of March 2020. The period from 15th to 24th March 2020 is considered as the transition phase of COVID-19 outbreak in India (i.e., between no lockdown and lockdown period). This study attempts to use a decision tree approach to investigate the modal preference of 1542 commuters in association with socio-economic and travel characteristics, and safety perceptions with respect to public and private modes during transition to lockdown due to COVID-19 in India. About 41% of commuters stopped traveling during the transition to lockdown phase, 51.3% were using the same mode of transport and 5.3% of commuters shifted from public to private mode. The study findings reported different interactions of factors influencing the decision to use public or private modes of transport for daily commuting during pandemic situations like COVID-19. Interestingly, safety perceptions (associated with personal health) of commuters did not play a significant role in their mode choice behavior during the transition phase. Though people perceived public transportation as unsafe over personal vehicle use, the actual commute patterns did not validate this due to a possible reason that commuters do not have enough alternative modes. Given the uncertainties in the decision making of the commuters regarding their travel behavior due to physical distancing, the insights from this study are important to policymakers and local transport authorities to understand the change in travel patterns.

Association between weather data and COVID-19 pandemic predicting mortality rate: Machine learning approaches

Nowadays, a significant number of infectious diseases such as human coronavirus disease (COVID-19) are threatening the world by spreading at an alarming rate. Some of the literatures pointed out that the pandemic is exhibiting seasonal patterns in its spread, incidence and nature of the distribution. In connection to the spread and distribution of the infection, scientific analysis that answers the questions whether the next summer can save people from COVID-19 is required. Many researchers have been exclusively asked whether high temperature during summer can slow down the spread of the COVID-19 as it has with other seasonal flues. Since there are a lot of questions that are unanswered right now, and many mysteries aspects about the COVID-19 that is still unknown to us, in-depth study and analysis of associated weather features are required. Moreover, understanding the nature of COVID-19 and forecasting the spread of COVID-19 request more investigation of the real effect of weather variables on the transmission of the COVID-19 among people. In this work, various regressor machine learning models are proposed to extract the relationship between different factors and the spreading rate of COVID-19. The machine learning algorithms employed in this work estimate the impact of weather variables such as temperature and humidity on the transmission of COVID-19 by extracting the relationship between the number of confirmed cases and the weather variables on certain regions. To validate the proposed method, we have collected the required datasets related to weather and census features and necessary prepossessing is carried out. From the experimental results, it is shown that the weather variables are more relevant in predicting the mortality rate when compared to the other census variables such as population, age, and urbanization. Thus, from this result, we can conclude that temperature and humidity are important features for predicting COVID-19 mortality rate. Moreover, it is indicated that the higher the value of temperature the lower number of infection cases.

Crystal structures of SARS-CoV-2 ADP-ribose phosphatase: from the apo form to ligand complexes

Among 15 nonstructural proteins (Nsps), the newly emerging Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) encodes a large, multidomain Nsp3. One of its units is the ADP-ribose phosphatase domain (ADRP; also known as the macrodomain, MacroD), which is believed to interfere with the host immune response. Such a function appears to be linked to the ability of the protein to remove ADP-ribose from ADP-ribosylated proteins and RNA, yet the precise role and molecular targets of the enzyme remain unknown. Here, five high-resolution (1.07-2.01 Å) crystal structures corresponding to the apo form of the protein and its complexes with 2-(N-morpholino)ethanesulfonic acid (MES), AMP and ADP-ribose have been determined. The protein is shown to undergo conformational changes to adapt to the ligand in the manner previously observed in close homologues from other viruses. A conserved water molecule is also identified that may participate in hydrolysis. This work builds foundations for future structure-based research on ADRP, including the search for potential antiviral therapeutics.

The psychosocial effects of being quarantined following exposure to COVID-19: A qualitative study of Lebanese health care workers

BACKGROUND

Since the outbreak of the novel Coronavirus (COVID-19), health care professionals in Lebanon have been diligently serving as the frontline of defense. In the light of challenging economic and political circumstances, putting their community wellbeing as a priority, and abiding by quarantine and strict infection control measures, health care professionals risk both their physical and mental wellbeing.

OBJECTIVE

The aim of this study is to explore the psychosocial effects of being quarantined following exposure to COVID-19 among Lebanese health care professionals.

METHOD

An exploratory qualitative research design was employed, where semi-structured interviews were carried out involving a sample of 13 Lebanese health care providers working at various COVID-19 units.

RESULTS

The qualitative analysis has revealed four themes namely 'Fears of contracting and spreading the virus', 'Conflict between professional duty and family obligation', 'Stigma of being infected', and 'Inadequate or inaccurate information'.

CONCLUSION

COVID-19 quarantine has been posing intense psychological challenges among Lebanese health care workers which are worsened at times by the economic instability; thus, health care policymakers are urged to take proper action nationwide to alleviate longlisting implications and support the health care providers in fulfilling their mission.

Airport risk of importation and exportation of the COVID-19 pandemic

On March 11, 2020, the Director-General of the World Health Organization (WHO) characterized the spread of the coronavirus disease, COVID-19, as a pandemic on the basis of "alarming levels of spread and severity, and by the alarming levels of inaction." Hence, it is urgent and imperative to evaluate the risk of COVID-19 for as many global locations as possible. This study calculates the relative risk of the importation and exportation of the COVID-19 virus. The study's most important contribution is the calculation of the overall relative risk of the importation and exportation of COVID-19 from every airport in local municipalities around the world, based on global spatial and mapping information. Three scenarios of air travel restriction are considered, and the change in the risk of importation and exportation of COVID-19 is calculated. The relative risk of importation and exportation of COVID-19 clearly shows that not only China, Europe, Middle East, and East Asia, but also the U.S., Australia, and countries in northeast Asia and Latin America are subject to risk. Further, a larger reduction in air travel through airports in a large part of the cumulative incidence area would lead to a gradual decrease in the risk flow. Importantly, the exportation risk of the disease from some airports in China, Iran, and European countries has a higher global spread than the importation risk during the pandemic stage. Therefore, every airport, or government with airports in their jurisdiction, should implement strict countermeasures. It is also indispensable for these countries to undertake countermeasures for COVID-19, such as home quarantine within each country and restricting infected or suspected individuals from flying on airplanes.

Geographic Correlation between the Number of COVID-19 Cases and the Number of Overseas Travelers in Japan, Jan-Feb, 2020

Since the coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019, it has rapidly spread worldwide, and the number of cases is also increasing in Japan. The number of COVID-19 cases in Japan in the early stages was not uniform, and cases were largely concentrated in several prefectures. There was a strong, positive correlation between the distribution of COVID-19 cases and the number of foreign travelers as well as Chinese travelers, at prefectural level, with coefficients of 0.68 (P < 0.0001) and 0.60 (P < 0.0001), respectively. Moreover, phylogenetic tree analysis revealed that all the registered SARS-CoV-2 detected from January 23 to February 29, 2020, belonged to Chinese lineage, while those detected in March 2020 belonged to American and European lineages. Only 14 (20.3%) were infected outside Japan; however, the majority of the cases (79.7%) were infected domestically. In conclusion, a higher number of COVID-19 cases were identified in prefectures with more Chinese travelers, supporting the importance of enforcing policies that restrict the entry of overseas travelers to control COVID-19 spread. These findings highlight the risk of secondary transmission in the community caused by apparent or silently imported cases.

The dark cloud with a silver lining: Assessing the impact of the SARS COVID-19 pandemic on the global environment

The Severe Acute Respiratory Syndrome-Coronavirus Disease 2019 (COVID-19) pandemic caused by a novel coronavirus known as SARS-CoV-2 has caused tremendous suffering and huge economic losses. We hypothesized that extreme measures of partial-to-total shutdown might have influenced the quality of the global environment because of decreased emissions of atmospheric pollutants. We tested this hypothesis using satellite imagery, climatic datasets (temperature, and absolute humidity), and COVID-19 cases available in the public domain. While the majority of the cases were recorded from Western countries, where mortality rates were strongly positively correlated with age, the number of cases in tropical regions was relatively lower than European and North American regions, possibly attributed to faster human-to-human transmission. There was a substantial reduction in the level of nitrogen dioxide (NO₂: 0.00002 mol m^-2), a low reduction in CO (<0.03 mol m^-2), and a low-to-moderate reduction in Aerosol Optical Depth (AOD: ~0.1-0.2) in the major hotspots of COVID-19 outbreak during February-March 2020, which may be attributed to the mass lockdowns. Our study projects an increasing coverage of high COVID-19 hazard at absolute humidity levels ranging from 4 to 9 g m^-3 across a large part of the globe during April-July 2020 due to a high prospective meteorological suitability for COVID-19 spread. Our findings suggest that there is ample scope for restoring the global environment from the ill-effects of anthropogenic activities through temporary shutdown measures.

Interplay of global multi-scale human mobility, social distancing, government interventions, and COVID-19 dynamics

This work quantifies mobility changes observed during the different phases of the pandemic world-wide at multiple resolutions -- county, state, country -- using an anonymized aggregate mobility map that captures population flows between geographic cells of size 5 km ² . As we overlay the global mobility map with epidemic incidence curves and dates of government interventions, we observe that as case counts rose, mobility fell and has since then seen a slow but steady increase in flows. Further, in order to understand mixing within a region, we propose a new metric to quantify the effect of social distancing on the basis of mobility.Taking two very different countries sampled from the global spectrum, We analyze in detail the mobility patterns of the United States (US) and India. We then carry out a counterfactual analysis of delaying the lockdown and show that a one week delay would have doubled the reported number of cases in the US and India. Finally, we quantify the effect of college students returning back to school for the fall semester on COVID-19 dynamics in the surrounding community. We employ the data from a recent university outbreak (reported on August 16, 2020) to infer possible R _eff values and mobility flows combined with daily prevalence data and census data to obtain an estimate of new cases that might arrive on a college campus. We find that maintaining social distancing at existing levels would be effective in mitigating the extra seeding of cases. However, potential behavioral change and increased social interaction amongst students (30% increase in R _eff ) along with extra seeding can increase the number of cases by 20% over a period of one month in the encompassing county. To our knowledge, this work is the first to model in near real-time, the interplay of human mobility, epidemic dynamics and public policies across multiple spatial resolutions and at a global scale.

Geolocated Twitter social media data to describe the geographic spread of SARS-CoV-2

Openly available, geotagged Twitter data from 2013 to 2015 was used to estimate the 2019–2020 human mobility patterns in and outside of China to predict the spatiotemporal spread of severe acute respiratory syndrome coronavirus 2. Countries with the highest number of visiting Twitter users outside of China were the USA, Japan, UK, Germany and Turkey. A high correlation was observed when comparing country-level Twitter user visits and reported cases.

The effectiveness of full and partial travel bans against COVID-19 spread in Australia for travellers from China during and after the epidemic peak in China

BACKGROUND

Australia implemented a travel ban on China on 1 February 2020, while COVID-19 was largely localized to China. We modelled three scenarios to test the impact of travel bans on epidemic control. Scenario one was no ban; scenario two and three were the current ban followed by a full or partial lifting (allow over 100 000 university students to enter Australia, but not tourists) from the 8th of March 2020.

METHODS

We used disease incidence data from China and air travel passenger movements between China and Australia during and after the epidemic peak in China, derived from incoming passenger arrival cards. We used the estimated incidence of disease in China, using data on expected proportion of under-ascertainment of cases and an age-specific deterministic model to model the epidemic in each scenario.

RESULTS

The modelled epidemic with the full ban fitted the observed incidence of cases well, predicting 57 cases on March 6th in Australia, compared to 66 observed on this date; however, we did not account for imported cases from other countries. The modelled impact without a travel ban results in more than 2000 cases and about 400 deaths, if the epidemic remained localized to China and no importations from other countries occurred. The full travel ban reduced cases by about 86%, while the impact of a partial lifting of the ban is minimal and may be a policy option.

CONCLUSIONS

Travel restrictions were highly effective for containing the COVID-19 epidemic in Australia during the epidemic peak in China and averted a much larger epidemic at a time when COVID-19 was largely localized to China. This research demonstrates the effectiveness of travel bans applied to countries with high disease incidence. This research can inform decisions on placing or lifting travel bans as a control measure for the COVID-19 epidemic.

Estimating COVID-19 outbreak risk through air travel

BACKGROUND

Substantial limitations have been imposed on passenger air travel to reduce transmission of severe acute respiratory syndrome coronavirus 2 between regions and countries. However, as case numbers decrease, air travel will gradually resume. We considered a future scenario in which case numbers are low and air travel returns to normal. Under that scenario, there will be a risk of outbreaks in locations worldwide due to imported cases. We estimated the risk of different locations acting as sources of future coronavirus disease 2019 outbreaks elsewhere.

METHODS

We use modelled global air travel data and population density estimates from locations worldwide to analyse the risk that 1364 airports are sources of future coronavirus disease 2019 outbreaks. We use a probabilistic, branching-process-based approach that considers the volume of air travelers between airports and the reproduction number at each location, accounting for local population density.

RESULTS

Under the scenario we model, we identify airports in East Asia as having the highest risk of acting as sources of future outbreaks. Moreover, we investigate the locations most likely to cause outbreaks due to air travel in regions that are large and potentially vulnerable to outbreaks: India, Brazil and Africa. We find that outbreaks in India and Brazil are most likely to be seeded by individuals travelling from within those regions. We find that this is also true for less vulnerable regions, such as the United States, Europe and China. However, outbreaks in Africa due to imported cases are instead most likely to be initiated by passengers travelling from outside the continent.

CONCLUSIONS

Variation in flight volumes and destination population densities creates a non-uniform distribution of the risk that different airports pose of acting as the source of an outbreak. Accurate quantification of the spatial distribution of outbreak risk can therefore facilitate optimal allocation of resources for effective targeting of public health interventions.

The Lived Experience of Nurses Caring for Patients with COVID-19 in Iran: A Phenomenological Study

OBJECTIVE

This study aimed to explore the lived experiences of nurses caring for patients with COVID-19 in Iran.

METHODS

This study was a descriptive phenomenology. Sampling was purposefully performed, and participants were selected in terms of the inclusion criteria. Data were collected through semi-structured interviews using the WhatsApp mobile messaging application. Colaizzi's method was used to analyse the data. The criteria introduced by Lincoln and Guba were used for the study rigour.

RESULTS

The data were obtained from 12 nurses caring for patients with COVID-19. The mean age of the participants was 29.41 years (SD = 2.72) with a mean work experience of 6.75 years (SD = 2.52). Three main themes and six subthemes were identified: mental condition (subthemes included "anxiety and stress" and "fear"), emotional condition (subthemes included "suffering and affliction" and "waiting for death"), and care context (subthemes included "turmoil" and "lack of support and equipment").

CONCLUSION

The results of this study show that nurses working in the wards and care centres designated for patients with COVID-19 are experiencing mental and emotional distress and are working in inadequate professional conditions.

[Ocular manifestations of coronavirus infection COVID-19 (clinical observation)]

This paper describes possible clinical ocular manifestations of novel coronavirus infection COVID-19. Two clinical cases of conjunctivitis are examined. Due to the lack of ophthalmological approaches to the treatment of such patients, different management tactics are given based on the severity of local and systemic disease manifestations. Our research and practical management of these conditions showed the toxic and allergic nature of ocular surface manifestations in patients with COVID-19. Such cases are proposed to be treated similar to the conjunctivitis of "unclear origin" with components from antiviral and anti-allergic therapies.

Clinical characteristics of patients with uremia undergoing maintenance hemodialysis complicated with COVID-19

This study aimed to evaluate the onset characteristics of patients with uremia undergoing maintenance hemodialysis complicated with COVID-19, so as to improve the understanding, diagnosis, and treatment.26 cases were confirmed cases of COVID-19. Confirmed patients with COVID-19 undergoing maintenance hemodialysis in the blood purification center were recruited. The general data of patients, including age, sex, duration of dialysis, and basic diseases, were analyzed. The clinical features included fever, respiratory symptoms, and gastrointestinal symptoms. The items for laboratory tests included blood routine examination, liver function, C-reactive protein, procalcitonin, creatine kinase, creatine kinase-MB, markers of myocardial injury, B-type natriuretic peptide, D-dimer, and so forth. The imaging examinations referred mainly to computed tomography imaging findings of the lungs.Twenty-one cases were complicated with chronic basic diseases, such as hypertension or diabetes. In terms of clinical manifestations, 13 cases had fever, which was close to the number of cases without fever (13 cases). The respiratory symptoms included dry cough (19 cases), shortness of breath (9 cases), fatigue (11 cases), and so forth. Further, 15 patients had hypoxemia, indicating more severe patients. Sore throat (2 cases) was not significant, and a few patients reported gastrointestinal symptoms (3 cases). The results of blood routine examination showed decreased absolute lymphocyte count (0.7 ± 0.4 × 10∼9/L), lower hemoglobin level (105.2 ± 20 g/L), and normal absolute neutrophil count 4.2 (3.0, 5.9) × 10∼9/L. Of the inflammatory indexes, procalcitonin was 0.69 (0.24, 2.73) ng/mL; C reactive protein was 17.2 (5.2, 181.6) mg/L, which was higher than normal. Blood biochemistry revealed lower albumin level (38.0 ± 4.0 g/L) and higher troponin 0.11(0.035, 6.658) ng/mL and myoglobin levels (538.5 ± 240.5 ng/mL), suggesting myocardial injury.The patients with uremia and confirmed COVID-19 undergoing maintenance hemodialysis are more common in males. Although the proportion of fever patients is 50%, the proportion of hypoxemia patients is high (58%). With poor cardiac function. They were prone to respiratory failure complicated with heart failure. According to the onset characteristics of this population, early diagnosis and treatment could help reduce the risk of developing a critical illness and control the spread of the COVID-19 epidemic.