Presumed Asymptomatic Carrier Transmission of COVID-19

COVID-19 Pandemic and Children: A Review

The severe respiratory disease COVID-19 (coronavirus disease 2019) was first reported in late December 2019 in Wuhan City, China. Soon thereafter, the World Health Organization (WHO) officially declared it a pandemic. The adult population is highly affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); however, infants and children are also not spared. Transmission in the pediatric population appears to be primarily from COVID-19-positive adults, largely from family contacts through droplets, direct contacts, and aerosols. There is also evidence of fecal-oral route of transmission. The incubation period of COVID-19 in children ranges from 2 to 10 days. Most children are asymptomatic. The most common symptoms amongst symptomatic children are fever and cough. Shortness of breath, sore throat, rhinorrhea, conjunctivitis, fatigue, and headache are other common symptoms. Diarrhea, vomiting, and abdominal pain are the common gastrointestinal symptoms that may be present with or without respiratory symptoms. Very few children are likely to develop severe disease.Supportive care is the mainstay of treatment. Though data are limited, antiviral therapies such as remdesivir, favipiravir, lopinavir/ritonavir, and other drugs like hydroxychloroquine/chloroquine have been used for severe COVID-19 cases, with remdesivir showing the greatest promise. A few children may develop an exaggerated immune response, characterized by exaggerated cytokine release and manifests with features similar to Kawasaki disease. The syndrome has been referred to by many names including pediatric inflammatory multisystem syndrome (PIMS) and more recently, as multisystem inflammatory syndrome in children (MIS-C); this life-threatening condition often requires a multidisciplinary team effort and use of immunomodulators.

Memory-based meso-scale modeling of Covid-19: County-resolved timelines in Germany

The COVID-19 pandemic has led to an unprecedented world-wide effort to gather data, model, and understand the viral spread. Entire societies and economies are desperate to recover and get back to normality. However, to this end accurate models are of essence that capture both the viral spread and the courses of disease in space and time at reasonable resolution. Here, we combine a spatially resolved county-level infection model for Germany with a memory-based integro-differential approach capable of directly including medical data on the course of disease, which is not possible when using traditional SIR-type models. We calibrate our model with data on cumulative detected infections and deaths from the Robert-Koch Institute and demonstrate how the model can be used to obtain county- or even city-level estimates on the number of new infections, hospitality rates and demands on intensive care units. We believe that the present work may help guide decision makers to locally fine-tune their expedient response to potential new outbreaks in the near future.

Vindication, virtue, and vitriol: A study of online engagement and abuse toward British MPs during the COVID-19 pandemic

COVID-19 has given rise to a lot of malicious content online, including hate speech, online abuse, and misinformation. British MPs have also received abuse and hate on social media during this time. To understand and contextualise the level of abuse MPs receive, we consider how ministers use social media to communicate about the pandemic, and the citizen engagement that this generates. The focus of the paper is on a large-scale, mixed-methods study of abusive and antagonistic responses to UK politicians on Twitter, during the pandemic from early February to late May 2020. We find that pressing subjects such as financial concerns attract high levels of engagement, but not necessarily abusive dialogue. Rather, criticising authorities appears to attract higher levels of abuse during this period of the pandemic. In addition, communicating about subjects like racism and inequality may result in accusations of virtue signalling or pandering by some users. This work contributes to the wider understanding of abusive language online, in particular that which is directed at public officials.

Coronavirus disease 2019 (COVID-19) surveillance system: Development of COVID-19 minimum data set and interoperable reporting framework

INTRODUCTION

The 2019 coronavirus disease (COVID-19) is a major global health concern. Joint efforts for effective surveillance of COVID-19 require immediate transmission of reliable data. In this regard, a standardized and interoperable reporting framework is essential in a consistent and timely manner. Thus, this research aimed at to determine data requirements towards interoperability.

MATERIALS AND METHODS

In this cross-sectional and descriptive study, a combination of literature study and expert consensus approach was used to design COVID-19 Minimum Data Set (MDS). A MDS checklist was extracted and validated. The definitive data elements of the MDS were determined by applying the Delphi technique. Then, the existing messaging and data standard templates (Health Level Seven-Clinical Document Architecture [HL7-CDA] and SNOMED-CT) were used to design the surveillance interoperable framework.

RESULTS

The proposed MDS was divided into administrative and clinical sections with three and eight data classes and 29 and 40 data fields, respectively. Then, for each data field, structured data values along with SNOMED-CT codes were defined and structured according HL7-CDA standard.

DISCUSSION AND CONCLUSION

The absence of effective and integrated system for COVID-19 surveillance can delay critical public health measures, leading to increased disease prevalence and mortality. The heterogeneity of reporting templates and lack of uniform data sets hamper the optimal information exchange among multiple systems. Thus, developing a unified and interoperable reporting framework is more effective to prompt reaction to the COVID-19 outbreak.

Sleep Disturbance and Psychological Profiles of Medical Staff and Non-Medical Staff During the Early Outbreak of COVID-19 in Hubei Province, China

OBJECTIVE

The outbreak of coronavirus disease 2019 (COVID-19) has considerably burdened the healthcare system in the Hubei Province, the most severely affected region in China. The aim of our study was to assess the psychological effects of COVID-19 epidemic on the healthcare workers in Hubei.

METHODS

A total of 2737 healthcare workers were sampled using a two-dimensional code shared online between Mar 4 and Mar 9, 2020. The questionnaires consisted of three elements: baseline characteristics, Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). The primary outcome variables were PQSI, anxiety and depression scores of non-medical staff, non-frontline medical staff and frontline medical staff. Binary logistical regression analyses were used to compare between respondents with and without sleep disturbance.

RESULTS

About 61.6% of the respondents reported sleep problems, 22.6% experienced anxiety, and 35% exhibited depressive symptoms. The prevalence of sleep disorders was higher among the frontline healthcare workers compared to the non-frontline and non-medical staff, while anxiety and depression were prevalent in the entire cohort. Logistic regression analysis identified medical occupation, family burden, bereavement, anxiety, and depression as significantly predictive of poor sleep quality.

CONCLUSIONS

Frontline medical staff are more vulnerable to sleep disturbances. Psychosocial interventions are needed to help allied healthcare personnel to better respond to COVID-19 and future outbreaks.

Real-life Management Strategy of COVID-19 Patients in Bangladesh with No Death: An Observational and Cohort Study

Background

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as pandemic by World Health Organization (WHO) with increasing morbidity (more than 4.6 million patients) and mortality (300,000 deaths). The world-wide target of management COVID-19 is to reduce complications with available management options; this become highly variable from country to country and even within different regions of the same country.

Aim and objective

This observational prospective study represents a single center study in which all patients in this cohort received almost similar medicines and care.

Materials and methods

All patients in this cohort (N: 32) were positive for SARS-CoV-2 by polymerase chain reaction (PCR) with variable presenting symptoms. The management strategy included Standard of Care (SoC) and administration of hydroxychloroquine and doxycycline. Out of 32 patients, 9 patients also received favipiravir. All patients were followed until they were discharged after negativity of SARS-CoV-2 confirmed by PCR on two consecutive occasions taken within 2 days.

Results

No death has been recorded in this cohort of 32 patients within the study period. The average hospital staying duration was 13.9 days with a range of 8–21 days. All patients were discharged with improvement of subjective symptoms and SARS-CoV-2 negativity. The vital signs (pulse, blood pressure) as well as and levels of electrolyte and blood counts were within normal and acceptable ranges at the time of discharge.

Conclusion

The study presented here provide and evidence of a real-life situation of management of limited numbers of COVID-19 patients at a tertiary center of Bangladesh. This study inspires optimism that proper diagnosis, establishment of effective inclusion and exclusion criteria, ensuring application of proper SoC with drugs available in Bangladesh may be a practical option for management of COVID-19 in the country.

How to cite this article

Huq AKMF, Rahman MF, Islam MA, et al. Real-life Management Strategy of COVID-19 Patients in Bangladesh with No Death: An Observational and Cohort Study. Euroasian J Hepato-Gastroenterol 2020;10(1):31–35.

Treatment of COVID-19 Patients at a Medical College Hospital in Bangladesh

Background and aim

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has induced a sense of panic around the world as the disease is highly contagious and has been spreading in full swing during last 5 months causing millions of COVID-19 patients and hundreds of thousands of deaths. Bangladesh, a country of 170 million people, is not an exception regarding COVID-19; it has reported several thousand COVID-19 patients with several hundred of deaths. This observational study has been planned to assess the scope and limitation of management strategy against COVID-19 patients in a medical college hospital of Bangladesh with available drugs in a real-life situation.

Materials and methods

All patients in this cohort (N: 33) were positive for SARS-CoV-2 by polymerase chain reaction (PCR) and they attended the hospital with variable presenting symptoms those ranged from cough and fever to respiratory distress and pneumonia. As per the protocol, the patients were regularly evaluated for several parameters of COVID-19-related pathology. Before discharge, they were checked for SARS-CoV-2 for 2 consecutive times. The management strategy included standard of care (SoC) and administration of hydroxychloroquine and azythromycin, available in Bangladesh.

Results

Out of total 33 patients, 1 patient died at day 4 day after admission. Two patients developed severe complications and were referred to tertiary hospital in Dhaka (2 and 3 days after admission), the capital of Bangladesh, where they recovered and were discharged from hospital after being SARS-CoV-2 negative. The rest 30 patients were discharged from the medical college hospital after being negative for SARS-CoV-2 in two subsequent assessments and improvement of their COVID-related symptoms. The average hospital stay of these patients was 14.5 days with a range of 10-24 days.

Conclusion

It seems that most of the COVID-19 patients may be adequately managed by standard of care management with drug support. However, early diagnosis and hospitalization with adequate care may be important variables for better survival. These factors may be properly ensured if the patient burden remains at a palatable level in forthcoming days in Bangladesh.

How to cite this article

Bhuyan MAR, Al Mahtab M, Ashab E, et al. Treatment of COVID-19 Patients at a Medical College Hospital in Bangladesh. Euroasian J Hepato-Gastroenterol 2020;10(1):27-30.

Effects of control measures on the dynamics of COVID-19 and double-peak behavior in Spain

The COVID-19 disease significantly has threatened the human lives and economy. It is a dynamic system with transmission and control as factors. Modeling the dynamics of the spread of COVID-19 based on the reported data can predict the growing trend of such a disease. In this paper, the dynamic evolution of COVID-19 in Spain is studied, and a comprehensive SEIR model is adopted to fit the obtained clinical progressive data of COVID-19 in Spain. The transmission rate between the susceptible and the self-quarantine susceptible is made to be time-variant, which is reasonable. The equilibria are found, and the stability condition is given using the basic reproduction number and eigenvalues at the points. The effect on daily confirmed cases for the transmission rate from susceptible to the exposed population due to the currently exposed and infectious is extensively investigated. The risk of the easing of the control measure is investigated. The double-peak dynamic behavior of the COVID-19 system is observed. The second wave rebound shows that the daily confirmed cases of the second peak even much higher than the first peak.

Visitation restrictions: is it right and how do we support families in the NICU during COVID-19?

Although the COVID-19 pandemic has largely not clinically affected infants in neonatal intensive care units around the globe, it has affected how care is provided. Most hospitals, including their NICUs, have significantly reduced parental and family visitation privileges. From an ethical perspective, this restriction of parental visitation in settings where infectious risk is difficult to understand. No matter what the right thing to do is, NICUs are currently having to support families of their patients via different mechanisms. In this perspective, we discuss ways NICUs can support parents and families when they are home and when they are in the NICU as well as provide infants the support needed when family members are not able to visit.

Simulation-based estimation of the early spread of COVID-19 in Iran: actual versus confirmed cases

Understanding the state of the COVID-19 pandemic relies on infection and mortality data. Yet official data may underestimate the actual cases due to limited symptoms and testing capacity. We offer a simulation-based approach which combines various sources of data to estimate the magnitude of outbreak. Early in the epidemic we applied the method to Iran's case, an epicenter of the pandemic in winter 2020. Estimates using data up to March 20th, 2020, point to 916,000 (90% UI: 508 K, 1.5 M) cumulative cases and 15,485 (90% UI: 8.4 K, 25.8 K) total deaths, numbers an order of magnitude higher than official statistics. Our projections suggest that absent strong sustaining of contact reductions the epidemic may resurface. We also use data and studies from the succeeding months to reflect on the quality of original estimates. Our proposed approach can be used for similar cases elsewhere to provide a more accurate, early, estimate of outbreak state. © 2020 System Dynamics Society.

Self-Assessment Questionnaire for Efficient and Safe Evaluation of Patients with Mild COVID-19

As the outbreak of coronavirus disease 2019 continues and the number of confirmed cases requiring isolation increases, there is a need for a safe and efficient system to assess patients' condition. We developed and evaluated a self-assessment questionnaire consisting of 23 symptoms with linear-scale scores from 0 to 10. Patients were asked to indicate their worst score for each symptom daily, and medical personnel assessed clinical improvement or deterioration based on the changes in scores. Focused communication on severity of specific symptoms was the primary advantage for the clinicians, and a thorough check for their symptoms was helpful for patients.

Modeling the transmission dynamics of COVID-19 epidemic: a systematic review

The outbreak and rapid spread of COVID-19 has become a public health emergency of international concern. A number of studies have used modeling techniques and developed dynamic models to estimate the epidemiological parameters, explore and project the trends of the COVID-19, and assess the effects of intervention or control measures. We identified 63 studies and summarized the three aspects of these studies: epidemiological parameters estimation, trend prediction, and control measure evaluation. Despite the discrepancy between the predictions and the actuals, the dynamic model has made great contributions in the above three aspects. The most important role of dynamic models is exploring possibilities rather than making strong predictions about longer-term disease dynamics.

Protection of nephrology health professionals during the COVID-19 pandemic☆

The COVID-19 epidemic represents a special risk for kidney patients due to their comorbidities and advanced age, and the need for hemodialysis treatment in group rooms. It also represents a risk for professionals responsible for their attention. This manuscript contains a proposal for action to prevent infection of professionals in the Nephrology Services, one of the most valuable assets at the present time.

The Psychological Status and Self-Efficacy of Nurses During COVID-19 Outbreak: A Cross-Sectional Survey

A novel coronavirus pneumonia broke out and gradually developed into a global public health problem. Health care workers, especially nurses, suffered from great occupational pressure and psychological distress during the outbreak of infectious diseases. We performed a cross-sectional survey to investigate the psychological status and self-efficacy of nurses in public hospital during COVID-19 outbreak between 16th and 25th February 2020. A total of 223 nurses participated in this study. The prevalence of anxiety and depression symptoms was 40.8% (CI 95%: 34.4%-47.2%) and 26.4% (CI 95%: 20.6%-42.2%), respectively. There was no difference in the prevalence of anxiety symptoms among demographic variables. There was significant differences in the prevalence of depression symptoms according to professional titles (P = .020). The mean score of self-efficacy was 25.90 ± 7.55. The self-efficacy was negatively correlated with anxiety (r = -0.161, P < .05). The psychological status of nurses in public hospital during COVID-19 outbreak needs our attention. Improving nurses' self-efficacy in dealing with emerging infectious diseases may be helpful to their psychology.

Healthcare Workers in Brazil during the COVID-19 Pandemic: A Cross-Sectional Online Survey

Brazil is in a critical situation due to the COVID-19 pandemic. Healthcare workers that are in the front line face challenges with a shortage of personal protective equipment, high risk of contamination, low adherence to the social distancing measures by the population, low coronavirus testing with underestimation of cases, and also financial concerns due to the economic crisis in a developing country. This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The sample was randomly selected and a Google Forms questionnaire was sent by WhatsApp messenger. The survey comprised questions about jobs, income, workload, PPE, training for COVID-19 patient care, behavior and feelings during the pandemic. The number of jobs reduced for all healthcare workers in Brazil during the pandemic, but significantly more for dentists. The workload and income reduced to all healthcare workers. Most healthcare workers did not receive proper training for treating COVID-19 infected patients. Physicians and nurses were feeling more tired than usual. Most of the healthcare workers in all groups reported difficulties in sleeping during the pandemic. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists.

Comparative analysis of clinical characteristics, imaging and laboratory findings of different age groups with COVID-19

OBJECTIVE

This study aims to provide scientific basis for rapid screening and early diagnosis of the coronavirus disease 2019 (COVID-19) through analysing the clinical characteristics and early imaging/laboratory findings of the inpatients.

METHODS

Three hundred and three patients with laboratory-confirmed COVID-19 from the East Hospital of People's Hospital of Wuhan University (Wuhan, China) were selected and divided into four groups: youth (20-40 years, n = 64), middle-aged (41-60 years, n = 89), older (61-80 years, n = 118) and elderly (81-100 years, n = 32). The clinical characteristics and imaging/laboratory findings including chest computed tomography (CT), initial blood count, C-reactive protein [CRP]), procalcitonin (PCT) and serum total IgE were captured and analysed.

RESULTS

(1) The first symptoms of all age groups were primarily fever (76%), followed by cough (12%) and dyspnoea (5%). Beside fever, the most common initial symptom of elderly patients was fatigue (13%). (2) Fever was the most common clinical manifestation (80%), with moderate fever being the most common (40%), followed by low fever in patients above 40 years old and high fever in those under 40 years (35%). Cough was the second most common clinical manifestation and was most common (80%) in the middle-aged. Diarrhoea was more common in the middle-aged (21%) and the older (19%). Muscle ache was more common in the middle-aged (15%). Chest pain was more common in the youth (13%), and 13% of the youth had no symptoms. (3) The proportion of patients with comorbidities increased with age. (4) Seventy-one per cent of the patients had positive reverse transcription-polymerase chain reaction results and 29% had positive chest CT scans before admission to the hospital. (5) Lesions in all lobes of the lung were observed as the main chest CT findings (76%). (6) Decrease in lymphocytes and increase in monocytes were common in the patients over 40 years old but rare in the youth. Eosinophils (50%), red blood cells (39%) and haemoglobin (40%) decreased in all age groups. (7) The proportion of patients with CRP and PCT elevation increased with age. (8) Thirty-nine per cent of the patients had elevated IgE, with the highest proportion in the old (49%).

CONCLUSION

The clinical characteristics and imaging/laboratory findings of COVID-19 patients vary in different age groups. Personalised criteria should be formulated according to different age groups in the early screening and diagnosis stage.

Are official confirmed cases and fatalities counts good enough to study the COVID-19 pandemic dynamics? A critical assessment through the case of Italy

As the COVID-19 outbreak is developing the two most frequently reported statistics seem to be the raw confirmed case and case fatalities counts. Focusing on Italy, one of the hardest hit countries, we look at how these two values could be put in perspective to reflect the dynamics of the virus spread. In particular, we find that merely considering the confirmed case counts would be very misleading. The number of daily tests grows, while the daily fraction of confirmed cases to total tests has a change point. It (depending on region) generally increases with strong fluctuations till (around, depending on region) 15-22 March and then decreases linearly after. Combined with the increasing trend of daily performed tests, the raw confirmed case counts are not representative of the situation and are confounded with the sampling effort. This we observe when regressing on time the logged fraction of positive tests and for comparison the logged raw confirmed count. Hence, calibrating model parameters for this virus's dynamics should not be done based only on confirmed case counts (without rescaling by the number of tests), but take also fatalities and hospitalization count under consideration as variables not prone to be distorted by testing efforts. Furthermore, reporting statistics on the national level does not say much about the dynamics of the disease, which are taking place at the regional level. These findings are based on the official data of total death counts up to 15 April 2020 released by ISTAT and up to 10 May 2020 for the number of cases. In this work, we do not fit models but we rather investigate whether this task is possible at all. This work also informs about a new tool to collect and harmonize official statistics coming from different sources in the form of a package for the R statistical environment and presents the "COVID-19 Data Hub."

A Cross-Sectional Study of Psychological Status in Different Epidemic Areas in China After the COVID-19 Outbreak

Background: The outbreak of coronavirus disease 2019 in Wuhan, Hubei Province, China has seriously affected people's mental health. We aimed to assess the psychological impact of the coronavirus disease 2019 on health care workers and non-health care workers in three different epidemic areas in China and to identify independent risk factors. Methods: We surveyed 1,020 non-health care workers and 480 health care workers in Wuhan, other cities in Hubei except Wuhan and other provinces in China except Hubei. Results: Health care workers in Hubei had higher levels of anxiety and depression than non-health care workers (p < 0.05), but there was no such difference in other provinces in China except Hubei (p > 0.05). Compared with other regions, health care workers in Wuhan was more anxious (p < 0.05), and this anxiety may be caused by concerns about occupational exposure and wearing protective clothing for a long time daily; health care workers in Hubei had more obvious depression (p < 0.05), which may be associated with long days participating in epidemic work and wearing protective clothing for a long time daily. Meanwhile, 62.5% of health care workers were proud of their work. The anxiety and depression of non-health care workers in Wuhan were also the most serious. Conclusions: In Wuhan, where the epidemic is most severe, levels of anxiety and depression seem to be higher, especially among health care workers. This information may help to better prepare for future events.

Predisposing risk factors for COVID-19 infection: A case-control study

BACKGROUND

The Covid-19 epidemic in 2019 has created many public health problems. Literature that focuses on the risk factors of this issue is limited especially in developing countries. This study proposed to examine the risk factors of COVID-19 infection in the west area of Iran.

METHODS

This case-control study was conducted from February to April 2020 in Nahavand county, western Iran. Cases were all patients who were coronavirus positive and, the controls included people who had clinical signs consistent with COVID-19, but their test results were negative. Two controls were selected for every case. Multivariate logistic regression was applied to evaluate the effects of epidemiological aspects on the incidence of COVID-19.

RESULTS

Significant risk factors for COVID-19 infection based on the multivariable logistic regression model were male gender (OR=1.82, P=0.0.15), age group over 60 years (OR=2.04, P=0.017), living in urban areas (OR=1.79, P=0.018), being married (OR=2.08, P=0.022), having history of contact with the corona patients (OR=5.61, P=0.009), and comorbidities (OR=1.78, P=0.031).

CONCLUSION

This study highlighted the factors associated with the occurrence of COVID-19 infection. These findings may help guide recommendations for the protection of high-risk groups.