Nipah: The looming post-covid pandemic

First identified as a pathogen in Malaysia and Singapore in 1999, Nipah virus (NiV) caused nearly 300 human cases and over 100 fatalities. It also killed about 1 million pigs. Three years later (2002), it was reported in Pteropus bats in Malaysia, in Cambodia & Thailand, (2005), and as far as Madagascar (2007) and Ghana (2008). India (Kerala) reported its first human NiV-caused fatalities in September 2023. Taken together, these trends emphasize its public health threat. In humans, NiV infection initially leads to fever, headache, body aches and muscle pain, nausea and vomiting. The symptoms rapidly evolve into sore throat, cough and atypical pneumonia leading to severe respiratory distress. The cadre of NiV-induced pathology (Nipah disease, NiD) then includes severe dizziness and drowsiness, progressive alteration in cognition and consciousness, acute encephalitis and seizures. Public health protocols (e.g., mask-wearing, quarantine), essential to contain and control CoViD-19, seem insufficient to contain NiD spread because NiV transmission occurs primarily via direct contacts with body fluids of infected carriers, but presumably not by airborne transmission. As in the case of SARS-C0V2, health care providers (i.e., physicians, dentists, nurses, dental assistants) are greatest risks not only of contracting but of spreading NiV infection. NiV is a high-pathogenicity pathogen, against which, at present, we have no anti-viral medications or preventive vaccine. Taken together, the evidence to date heightens the threat of an upcoming NiD pandemic.

CoViD-19 effects on social-emotional development: Putative underlying mechanisms

Early childhood is the timely and critical period in the growth of the human being when the trajectory of children's holistic development is traced, and the foundation for their future as well-established and productive adults is set. The CoViD-19 pandemic produced profound changes in everyday life almost everywhere in the world. The personal, social and societal restrictions imposed during the CoViD-19 pandemic unquestionably blunted early childhood development by depriving young children from normal and healthy attachments through secure relationships with parents, teachers and peers. Furthermore, the public health measures enacted to counter the spread of the pandemic (e.g., mandatory masking, lockdown) contributed to a lack of social interactions essential for childhood development, and provoked perceptions of psycho-emotional stress (e.g., objective fear of the masked interlocutor, perceived fear of abandonment) in the children, which may have hampered critical periods of development. Based on theoretical foundation and our observations in the field, we propose that early intervention support may have a significant impact on the development of children victims of the effect of the CoViD-19 pandemic.

CoViD-19 effects on social-emotional development: impact of early intervention

Age-appropriate development of social and emotional skills is challenging to a child under standard conditions. The CoVID-19 pandemic has likely influenced the development of social, emotional, and communicative skills. Factors like prolonged lockdowns, restricted peer interactions, and mandatory mask-wearing may have hindered children's ability to learn facial expressions and nonverbal cues. The research evidence discussed in this paper confirms that proposition, and examines in further depth the potential impact of the CoViD-19 pandemic. We also discuss groundwork evidence-based early intervention (EI) practices designed to mitigate the negative effects these unprecedented circumstances may have led to, and how tele-medicine alternatives and Artificial intelligence (AI) can expedite interventional childhood plans. The role of bioinformatics is vital in the compilation and analysis of the vast research in this piece related to CoViD-19, serving as a profound search tool for future research endeavors focused on understanding the long term effects of the pandemic.

The IHI Rochester Report 2022 on Healthcare Informatics Research: Resuming After the CoViD-19

In 2020, the CoViD-19 pandemic spread worldwide in an unexpected way and suddenly modified many life issues, including social habits, social relationships, teaching modalities, and more. Such changes were also observable in many different healthcare and medical contexts. Moreover, the CoViD-19 pandemic acted as a stress test for many research endeavors, and revealed some limitations, especially in contexts where research results had an immediate impact on the social and healthcare habits of millions of people. As a result, the research community is called to perform a deep analysis of the steps already taken, and to re-think steps for the near and far future to capitalize on the lessons learned due to the pandemic. In this direction, on June 09th-11th, 2022, a group of twelve healthcare informatics researchers met in Rochester, MN, USA. This meeting was initiated by the Institute for Healthcare Informatics-IHI, and hosted by the Mayo Clinic. The goal of the meeting was to discuss and propose a research agenda for biomedical and health informatics for the next decade, in light of the changes and the lessons learned from the CoViD-19 pandemic. This article reports the main topics discussed and the conclusions reached. The intended readers of this paper, besides the biomedical and health informatics research community, are all those stakeholders in academia, industry, and government, who could benefit from the new research findings in biomedical and health informatics research. Indeed, research directions and social and policy implications are the main focus of the research agenda we propose, according to three levels: the care of individuals, the healthcare system view, and the population view.

Economic globalization and the COVID-19 pandemic: global spread and inequalities

In just a few weeks, COVID-19 has become a global crisis and there is no longer any question of it being a major pandemic. The spread of the disease and the speed of transmission need to be squared with the forms and characteristics of economic globalization, disparities in development between the world's different regions and the highly divergent degree of their interconnectedness. Combining a geographic approach based on mapping the global spread of the virus with the collection of data and socio-economic variables, we drew up an OLS model to identify the impact of certain socio-economic factors on the number of cases observed worldwide. Globalization and the geography of economic relations were the main drivers of the spatial structuring and speed of the international spread of the COVID-19.

Are internship experiences during a pandemic related to students' commitment to nursing education? A cross-sectional study

BACKGROUND

The predominate role of internships on the retention of nursing students highlights the need to monitor internship experiences during a healthcare crisis like CoViD-19.

OBJECTIVES

To explore the relation between internships experiences during a pandemic and student nurses' commitment or intention-to-leave the nursing program; as well as the relation between internship experiences and commitment or intention-to-leave the nursing program.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study using a sample of 1.079 nursing students from18 nursing schools in Flanders, Belgium. Students from all study years were eligible to participate.

METHODS

Online self-reporting survey during the first CoViD-19 wave (April-May 2020). Regression analyses were used to explore the association with students' commitment or intention-to-leave.

RESULTS

Students reported high levels of study commitment (4.06; SD 0.66; range 1-5), and an overall low intention-to-leave (1.64; SD 0.83; range 1-5). No difference in commitment or intention-to-leave were seen between students who did or did not had internship experience during CoViD-19 period. Need-supportive experiences - indicating that students felt competent, related to the team, and could be themselves on internship - coincided with high commitment. Conversely, need-frustrating experiences - indicating that students felt insecure, unrelated, and controlled by the nursing team - increased intention-to-leave nursing education. Students who felt pressured for an internship during the first wave of the CoViD-19 crisis, had more doubts to continue nursing education, and an increased chance on drop-out.

CONCLUSIONS

We recommend nursing schools to assess student's motivation when making a substantiated decision concerning internships during a health crisis, as facing an imposed or subjective mandatory decision to go into clinical practice might lead to less commitment to the study program. For both teacher and staff mentors it is deemed important to discuss the internship climate with the student, in order to early identify need-frustrating issues during internship.

A telehealth intervention for ensuring continuity of care of pediatric obesity during the CoVid-19 lockdown in Italy

BACKGROUND AND AIMS

Restriction measures adopted during the Coronavirus Disease-19 pandemic favored unhealthy behaviors. Tele-health offered the opportunity to pursue alternative ways of chronic diseases management. This retrospective study sought to determine the effects of a telehealth counselling intervention during the lockdown to children and adolescents with obesity previously engaged in a family-based secondary care program in an outpatient clinic of South Italy.

METHODS AND RESULTS

117 out of 156 patients participated to the tele-health intervention. Participants underwent videocalls with each component of the multidisciplinary team to receive support in adopting adequate dietary habits and to practice exercise at home. They were included in a closed social group to watch age-adapted tutorials on healthy habits. 75 patients returned to the Center after the end of the lockdown, while only 7 patients who did not participate to the videocalls, took part to the follow-up. Body Mass Index and body composition were assessed in all these patients. BMI z score did not increase in both groups. However, a significant increase of fat mass was observed in the non-participating group (0.046), while the intervention group showed an increase of fat free mass (p < 0.000).

CONCLUSION

Notwithstanding the limited sample size, the telehealth intervention allowed the maintenance of baseline weight status in participants, with an increase of fat-free mass. As the CoViD-19 pandemic moves forward, the increasing adoption of the new technologies may help the continuity of care, even in pediatric obesity treatment.

[Progress through technology? Technology commitment, technical equipment and their relationship to studying from home]

Since the beginning of the Corona pandemic, students have had to rely more than ever on technology to manage their courses. So far, it is unclear what differential effects emerge from interindividual differences in technical equipment, and the willingness to use technology for coping with study requirements, and how both resources are related to student satisfaction with the learning media. Using structural equation models with survey data (N = 3332), we show that technical equipment and technology commitment explain interindividual differences in dealing with learning activities (ΔR2 = 0.11), study organization (ΔR2 = 0.16), and in satisfaction with digital learning media (ΔR2 = 0.13). Technical equipment and technology commitment prove to be of comparable relevance for coping with the study requirements investigated. In contrast, satisfaction with digital learning media appears to be linked more strongly to technical equipment. Our results extend the discourse currently taking place in higher education about good teaching and they highlight the need to adapt teaching and learning to student resources.

Hispidin and Lepidine E: Two Natural Compounds and Folic Acid as Potential Inhibitors of 2019-novel Coronavirus Main Protease (2019- nCoVMpro), Molecular Docking and SAR Study

BACKGROUND

2019-nCoVis, a novel coronavirus was isolated and identified in 2019 in the city of Wuhan, China. On February 17, 2020 and according to the World Health Organization, 71, 429 confirmed cases worldwide were identified, among them 2162 new cases were recorded in the last 24 hours. One month later, the confirmed cases jumped to 179111, with 11525 new cases in the last 24 hours, with 7426 total deaths. No drug or vaccine is present at the moment for human and animal coronavirus.

METHODS

The inhibition of 3CL hydrolase enzyme provides a promising therapeutic principle for developing treatments against CoViD-19. The 3CLpro (Mpro) is known for involving in counteracting the host innate immune response.

RESULTS

This work presents the inhibitory effect of some natural compounds against 3CL hydrolase enzyme, and explains the main interactions in inhibitor-enzyme complex. Molecular docking study was carried out using Autodock Vina. By screening several molecules, we identified three candidate agents that inhibit the main protease of coronavirus. Hispidin, lepidine E, and folic acid are bound tightly in the enzyme, therefore strong hydrogen bonds have been formed (1.69-1.80Å) with the active site residues.

CONCLUSION

This study provides a possible therapeutic strategy for CoViD-19.

Impact of public health interventions to curb SARS-CoV-2 spread assessed by an evidence-educated Delphi panel and tailored SEIR model

AIM

To use a Delphi-panel-based assessment of the effectiveness of different non-pharmaceutical interventions (NPI) in order to retrospectively approximate and to prospectively predict the SARS-CoV-2 pandemic progression via a SEIR model (susceptible, exposed, infectious, removed).

METHODS

We applied an evidence-educated Delphi-panel approach to elicit the impact of NPIs on the SARS-CoV-2 transmission rate R₀ in Germany. Effectiveness was defined as the product of efficacy and compliance. A discrete, deterministic SEIR model with time step of 1 day, a latency period of 1.8 days, duration of infectiousness of 5 days, and a share of the total population of 15% assumed to be protected by immunity was developed in order to estimate the impact of selected NPI measures on the course of the pandemic. The model was populated with the Delphi-panel results and varied in sensitivity analyses.

RESULTS

Efficacy and compliance estimates for the three most effective NPIs were as follows: test and isolate 49% (efficacy)/78% (compliance), keeping distance 42%/74%, personal protection masks (cloth masks or other face masks) 33%/79%. Applying all NPI effectiveness estimates to the SEIR model resulted in a valid replication of reported occurrence of the German SARS-CoV-2 pandemic. A combination of four NPIs at consented compliance rates might curb the CoViD-19 pandemic.

CONCLUSION

Employing an evidence-educated Delphi-panel approach can support SARS-CoV-2 modelling. Future curbing scenarios require a combination of NPIs. A Delphi-panel-based NPI assessment and modelling might support public health policy decision making by informing sequence and number of needed public health measures.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10389-021-01566-2.

A compartment modeling approach to reconstruct and analyze gender and age-grouped CoViD-19 Italian data for decision-making strategies

BACKGROUND

Available national public data are often too incomplete and noisy to be used directly to interpret the evolution of epidemics over time, which is essential for making timely and appropriate decisions. The use of compartment models can be a worthwhile and attractive approach to address this problem. The present study proposes a model compartmentalized by sex and age groups that allows for more complete information on the evolution of the CoViD-19 pandemic in Italy.

MATERIAL AND METHODS

Italian public data on CoViD-19 were pre-treated with a 7-day moving average filter to reduce noise. A time-varying susceptible-infected-recovered-deceased (SIRD) model distributed by age and sex groups was then proposed. Recovered and infected individuals distributed by groups were reconstructed through the SIRD model, which was also used to simulate and identify optimal scenarios of pandemic containment by vaccination. The simulation started from realistic initial conditions based on the SIRD model parameters, estimated from filtered and reconstructed Italian data, at different pandemic times and phases. The following three objective functions, accounting for total infections, total deaths, and total quality-adjusted life years (QALYs) lost, were minimized by optimizing the percentages of vaccinated individuals in five different age groups.

RESULTS

The developed SIRD model clearly highlighted those pandemic phases in which younger people, who had more contacts and lower mortality, infected older people, characterized by a significantly higher mortality, especially in males. Optimizing vaccination strategies yielded different results depending on the cost function used. As expected, to reduce total deaths, the suggested strategy was to vaccinate the older age groups, whatever the baseline scenario. In contrast, for QALYs lost and total infections, the optimal vaccine solutions strongly depended on the initial pandemic conditions: during phases of high virus diffusion, the model suggested to vaccinate mainly younger groups with a higher contact rate.

CONCLUSION

Because of the poor quality and insufficient availability of stratified public pandemic data, ad hoc information filtering and reconstruction procedures proved essential. The time-varying SIRD model, stratified by age and sex groups, provided insights and additional information on the dynamics of CoViD-19 infection in Italy, also supporting decision making for containment strategies such as vaccination.

Normal breathing releases SARS-CoV-2 into the air

This study tests the release of SARS-CoV-2 RNA into the air during normal breathing, without any sign of possible risk of contagion such as coughing, sneezing or talking. Five patients underwent oropharyngeal, nasopharyngeal and salivary swabs for real-time reverse transcriptase PCR (RT-PCR) detection of SARS-CoV-2 RNA. Direct SARS-CoV-2 release during normal breathing was also investigated by RT-PCR in air samples collected using a microbiological sampler. Viral RNA was detected in air at 1 cm from the mouth of patients whose oropharyngeal, nasopharyngeal and salivary swabs tested positive for SARS-CoV-2 RNA. In contrast, the viral RNA was not identified in the exhaled air from patients with oropharyngeal, nasopharyngeal and salivary swabs that tested negative. Contagion of SARS-CoV-2 is possible by being very close to the mouth of someone who is infected, asymptomatic and simply breathing.

Epistemic responsibilities in the COVID-19 pandemic: Is a digital infosphere a friend or a foe?

Digital technologies have a significant role in collecting, filtering and disseminating information, allowing for social, healthcare and economic activities even in the context of highly restrictive public health measures in the current COVID-19 pandemic. As personal contact is greatly reduced, they also create a shared informational landscape, allowing for a shared threat response. This is a difficult task, since truthfulness of content that leads to actionable knowledge is impossible to consistently validate. So, not only that curation of information is rarely congruent with pressing health issues, but digital spaces may also become fertile ground for misinformation and disinformation, contributing to the devastating effects of an infodemic.

Digital intermediaries are useful exactly because their representation of reality is not a true construct, but a result of purposely curated information. However, they are active, dynamic epistemological agents with their own logic and aim. In dealing with a pandemic, we should reconsider the ways how our digital informational landscapes are created and sustained. This urges us to consider ethical governance of digital data curation and dissemination, alongside forms of control of the truthfulness and reach of its content.

Some of the most fundamental issues in dealing with the COVID-19 pandemic, including the newly available vaccines are reliant on digital information and data sharing among experts, and the role of informing the general public. The need to create a reproducible, valid and truthful informational landscape is paramount, while allowing for free and rational, behavioral individual choices oriented toward preserving and promoting healthy behavior. These are issues at the heart of dealing with any pandemic, as well as a well-organized health care policy.

Influence of the CoViD-19 Pandemic on Mental Workload and Burnout of Fashion Retailing Workers in Spain

This study analyzed the levels of mental workload and the presence of burnout on a sample of fashion retailing workers from Spain and its relationship with the current CoViD-19 (Coronavirus disease-19) pandemic. We established a cross-sectional design. Participants (n = 360) answered an online survey including questions about sociodemographic data, perception of CoViD-19, CarMen-Q questionnaire (workload), and MBI (burnout syndrome). The survey campaign took place in October and November 2020. The results showed that participants exhibited deep concern about the CoViD-19 pandemic and its influence in the workplace. Although the mental workload was near the middle point of the scale, participants showed moderate to high burnout levels, revealing that the sample was at risk of experiencing higher burnout levels over time as the pandemic and associated economic crisis continued. The multiple regression analysis results indicated that environmental changes, work overload, somatic symptoms, insomnia, negative job expectations, and uncertainty constituted significant mental workload predictors. Insomnia, somatic symptoms, and negative job expectations constituted significant predictors for burnout. Differences between job positions and genders in mental workload and burnout were found. In conclusion, the uncertainty at work derived from the CoViD-19 pandemic harms fashion retailing workers' psychological well-being in Spain.

Testing

One of the most striking reported symptoms in CoViD-19 is loss of smell and taste. The frequency of these impairments and their specificity as a potential central nervous system function biomarker are of great interest as a diagnostic clue for CoViD-19 infection as opposed to other similar symptomatologic diseases and because of their implication in viral pathogenesis. Here severe CoViD-19 was investigated by comparing self-report vs. testing of smell and taste, thus the objective severity of olfactory impairment and their possible correlation with other symptoms. Because a significant discrepancy between smell and taste testing vs. self-report results (p < 0.001) emerges in our result, we performed a statistical analysis highlighting disagreement among normosmia (p < 0.05), hyposmia, severe hyposmia, and anosmia (p < 0.001) and, in hypogeusia and severe hypogeusia, while no differences are observed in normogeusia and ageusia. Therefore, we analyzed the olfactory threshold by an objective test revealing the distribution of hyposmic (34%), severe hyposmic (48%), and anosmic (13%) patients in severe CoViD-19. In severe CoViD-19 patients, taste is lost in 4.3% of normosmic individuals, 31.9% of hyposmic individuals, 46.8% of severe hyposmic individuals, and 17% of anosmic individuals. Moreover, 95% of 100 CoViD-19 patients objectively tested were affected by smell dysfunction, while 47% were affected by taste dysfunction. Furthermore, analysis by objective testing also highlighted that the severity of smell dysfunction in CoViD-19 subjects did not correlate with age and sex. In conclusion, we report by objective testing that the majority of CoViD-19 patients report severe anosmia, that most of the subjects have olfactory impairment rather than taste impairment, and, finally, that the olfactory impairment correlate with symptom onset and hospitalization (p < 0.05). Patients who exhibit severe olfactory impairment had been hospitalized for about a week from symptom onset; double time has taken place in subjects with normosmia. Our results may be limited by the relatively small number of study participants, but these suggest by objective testing that hyposmia, severe hyposmia, and anosmia may relate directly to infection severity and neurological damage. The smell test assessment could be a potential screening symptom that might contribute to the decision to test suspected cases or guide quarantine instructions, further therapeutic approach, and evaluation of neurological damage.

An observation of the impact of CoViD-19 recommendation measures monitored through urban noise levels in central Stockholm, Sweden

Sweden stands out among the other European countries by the degree of restrictive measures taken towards handling the 2019 coronavirus outbreak, associated with the CoViD-19 pandemic. While several governments have imposed a nationwide total or partial lockdown in order to slow down the spread of the virus, the Swedish government has opted for a recommendation-based approach together with a few imposed restrictions. In the present contribution, the impact of this strategy will be observed through the monitored variation of the city noise levels during the associated period. The data used are recorded during a campaign of over a full year of noise level measurements at a building façade situated in a busy urban intersection in central Stockholm, Sweden. The noise level reductions, observed during the period of restrictions, are shown to be comparable to those found for the two most popular public holidays in Sweden with a peak reduction occurring during the first half of April 2020. Contrary to what has been recently discussed in public media, the spread of the virus, the recommendations, and the restrictions imposed during the ongoing pandemic clearly have had a significant effect on the transport and other human-related activities in Stockholm. In this unique investigation, the use of distributed acoustic sensors has thus shown to be a viable solution not only to enforce regulations but also to monitor the effectiveness of their implementation.

Autophagy Modulation in Lymphocytes From COVID-19 Patients: New Therapeutic Target in SARS-COV-2 Infection

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the novel coronavirus, causing coronavirus disease 2019 (COVID-19). During virus infection, several pro-inflammatory cytokines are produced, leading to the “cytokine storm.” Among these, interleukin (IL)-6, tumor necrosis factor‐α (TNF‐α), and IL-1β seem to have a central role in the progression and exacerbation of the disease, leading to the recruitment of immune cells to infection sites. Autophagy is an evolutionarily conserved lysosomal degradation pathway involved in different aspects of lymphocytes functionality. The involvement of IL-6, TNF‐α, and IL-1β in autophagy modulation has recently been demonstrated. Moreover, preliminary studies showed that SARS-CoV-2 could infect lymphocytes, playing a role in the modulation of autophagy. Several anti-rheumatic drugs, now proposed for the treatment of COVID-19, could modulate autophagy in lymphocytes, highlighting the therapeutic potential of targeting autophagy in SARS-CoV-2 infection.

Analysis of Commercial Hand Sanitisers amid CoViD-19: Are We Getting the Products that We Need?

The CoViD-19 pandemic has caused a sudden spike in demand and production of hand sanitisers. Concerns are rising regarding the quality of such products, as the safeguard of consumers is a priority worldwide. We analyse here the ethanolic content of seven off-the-shelf hand sanitiser gels (two biocides and five cosmetics) from the Italian market, using gas chromatography. The WHO recommends that products containing ethanol should have 60-95% (v/v) alcohol. Four of the tested hand gels have ethanolic contents within the recommended range, while three products (all cosmetics) contain < 60% (v/v), i.e. 52.1% (w/w), ethanol. The product with the lowest alcoholic content has 37.1% w/w ethanol. Toxic methanol is not found in any of the hand sanitisers. We show, in addition, that products with the highest ethanolic content have generally greater antibacterial activity. In conclusion, all tested products are complying with the EU regulations, as the three "substandard" products are classified as cosmetics, whose purpose is cleaning and not disinfecting. Nevertheless, if such hand cleaners were inappropriately used as hand disinfectants, they might be ineffective. Thus, consumer safety relays on awareness and ability to distinguish between biocidal and cosmetics hand gels. The obtained results might sensitise the scientific community, health agencies and ultimately consumers towards the risks of using hand sanitisers of substandard alcoholic concentration. If the wrong product is chosen by consumers, public health can be compromised by the inappropriate use of "low-dosed" cosmetic gels as disinfectants, particularly during the period of the CoViD-19 pandemic.

Physical distancing reduced the incidence of influenza and supports a favorable impact on SARS-CoV-2 spread in Mexico

INTRODUCTION

Physical distancing preventive measures were implemented in Mexico as a response to the coronavirus disease 2019 (CoViD-19) pandemic. School closures occurred on March 16, 2020, in 10 out of 32 Mexican states, and one week later in the remaining states. Because the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the influenza virus have similar transmission mechanisms, we aimed to evaluate the impact of physical distancing on the incidence of influenza as a proxy of the impact on SARS-CoV-2 contagion.

METHODOLOGY

A national flu surveillance system was cross-sectionally analyzed and daily average percent changes (APCs) of incidence rates were calculated throught Poisson regression models.

RESULTS

Greater decreasing trends (APCs -8.8, 95% CI: -12.5, -4.5; vs. -6.0, 95% CI: -9.9, -2.0; p = 0.026) were documented in the states with earlier school closures and across age groups, suggesting that earlier implementation of physical distance results in reduced SARS-CoV-2 spread.

CONCLUSIONS

Physical distancing policies decrease the incidence of influenza infections in Mexico; its favorable impact on the spread of SARS-CoV-2 is commendable.

Location-aware systems or location-based services: a survey with applications to CoViD-19 contact tracking

With the CoViD-19 pandemic, location awareness technologies have seen renewed interests due to the numerous contact tracking mobile application variants developed, deployed, and discussed. For some, location-aware applications are primarily a producer of geospatial Big Data required for vital geospatial analysis and visualization of the spread of the disease in a state of emergency. For others, comprehensive tracking of citizens constitutes a dangerous violation of fundamental rights. Commercial web-based location-aware applications both collect data and-through spatial analysis and connection to services-provide value to users. This value is what motivates users to share increasingly private and comprehensive data. The willingness of users to share data in return for services has been a key concern with web-based variants of the technology since the beginning. With a focus on two privacy preserving CoViD-19 contact tracking applications, this survey walks through the key steps of developing a privacy preserving context-aware application: from types of applications and business models, through architectures and privacy strategies, to representations.

Diabetes and CoViD-19: Experience from the frontline of Internal Medicine wards in Italy

Available data suggest that the issue of CoViD-19 is particularly critical in patients with diabetes. In Italy, Internal Medicine (IM) wards have played a pivotal role in contrasting the spread of SARS-Cov2. During this pandemic, FADOI submitted a brief questionnaire to a group of its members acting as Head of IM units. Considering 38 units, 58% of beds dedicated to CoViD patients in CoViD Hospitals were in charge of IM, and globally cared for 6650 patients during a six-week period. Of these patients, 1264 (19%) had diabetes. Mortality rate in CoViD patients with or without diabetes were 20.5% and 14%, respectively (p < 0.001). Our survey seems to confirm that diabetes is a major comorbidity of CoViD-19, but it does not support an increased incidence of CoViD-19 infection in people with diabetes, if compared with the figures of patients with diabetes and hospitalized before the outbreak. On the other side, patients with diabetes appeared at a significantly increased risk of worse outcome. This finding underlines the importance of paying special attention to this patient population and its management.

CoViD-19 epidemic follows the "kinetics" of enzymes with cooperative substrate binding

The Hill equation, which models the cooperative ligand-receptor binding equilibrium, turns out to be useful in modeling the progression of infectious disease outbreaks such as CoViD-19. The equation fits well the data for total and daily case numbers, allows tentative predictions for the half-point and end point of the epidemic, and presents a mathematical characterization of how social interventions "flatten the curve" of the disease progression.

Sedentary Behaviors and Physical Activity of Italian Undergraduate Students during Lockdown at the Time of CoViD-19 Pandemic

Background: From March to May 2020, lockdown measures were adopted in Italy to contain the epidemic of the novel Coronavirus. People were forced to restrict their movement and social contacts, therefore having a higher risk of inactivity. This study, carried out among Italian undergraduates, explored their sedentary and physical activities (PA) during the lockdown with respect to their previous habits. Methods: An electronic questionnaire was administered once to students attending three Italian universities after the end of lockdown. Results: A total of 1430 students (mean age 22.9 ± 3.5 years, 65.5% females) completed the questionnaire. All the sedentary behaviors increased significantly, and all the physical activities decreased significantly during the lockdown. Time spent using electronic devices showed the highest increase (+52.4 min/day), and walking the greatest decrease (-365.5 min/week). Being younger than 22 years old, female, and previously active, attending the universities of Naples and Rome and having at least one graduate parent were associated with the achievement of recommended levels of PA even during the lockdown. Conclusions: This study highlights the reduction of PA among Italian undergraduates in the course of home-confinement due to the CoViD-19 pandemic. The practice of adequate PA during the lockdown was mainly associated with the previous adoption of an active lifestyle. Promoting active lifestyles during the non-pandemic period may have had positive effects also in case of lockdown.

[Increased risk of deep vein thrombosis in intensive care unit patients with CoViD-19 infections?-Preliminary data]

Hintergrund

Die Inzidenz tiefer Beinvenenthrombosen (TVT) bei intensivpflichtigen CoViD-19-Patienten wurde bisher nur in wenigen Studien untersucht. Prospektive vergleichende Studien mit Non-CoViD-19-Intensivpatienten fehlen gänzlich.

Fragestellung

Die Inzidenz TVT bei an CoViD-19 erkrankten Intensivpatienten verglichen mit Non-CoViD-19-Patienten, die im selben Zeitraum auf den Intensivstationen des Universitätsklinikums Augsburg behandelt wurden, wurden erhoben. Zudem soll untersucht werden, welche Art der Antikoagulation zum Zeitpunkt des Auftretens der TVT bei CoViD-19-Patienten vorlag und inwiefern eine TVT bei diesem Patientengut mit einer erhöhten Letalität vergesellschaftet ist.

Material und Methoden

In der prospektiven Single-Center Studie wurden im Zeitraum vom 18.04.2020 bis 30.04.2020 20 SARS-CoV2-positive Patienten mit 20 Non-CoViD-Patienten auf Intensivstation bezüglich des Auftretens tiefer Beinvenenthrombosen verglichen. Hierzu wurden demographische Daten, Laborparameter und klinische Verläufe erfasst und ausgewertet.

Ergebnisse

Die Rate an TVT war im untersuchten Kollektiv bei Patienten mit SARS-CoV2 deutlich erhöht (CoViD-19-Patienten: 20 % vs. Non-CoViD-19-Patienten: 5 %). Sowohl das Vorliegen einer TVT sowie deutlich erhöhte D‑Dimer-Werte waren in der vorliegenden Studie mit erhöhter Letalität vergesellschaftet.

Diskussion

Wir empfehlen bei der stationären Aufnahme von Patienten mit SARS-CoV2-Verdacht oder Nachweis die Bestimmung der D‑Dimere und im Falle erhöhter Werte die großzügige Indikationsstellung zur Kompressionssonographie der tiefen Beinvenen. So können TVT früh erkannt und eine therapeutische Antikoagulation begonnen werden. Alle stationären CoViD-19-Patienten sollten eine Thromboseprophylaxe mit NMH erhalten. Weitere Studien zu Point-of-care-Methoden (TEG®, ROTEM®) zur Erkennung einer Hyperkoagulabilität bei SARS-CoV2 sind notwendig.

Hand sanitisers amid CoViD-19: A critical review of alcohol-based products on the market and formulation approaches to respond to increasing demand

The world is facing a medical crisis amid the CoViD-19 pandemic and the role of adequate hygiene and hand sanitisers is inevitable in controlling the spread of infection in public places and healthcare institutions. There has been a great surge in demand for hand sanitisation products leading to shortages in their supply. A consequent increase of substandard products in the market has raised safety concerns. This article, therefore, presents a critical review of hand sanitation approaches and products available on the market in light of the scientific evidence available to date. This review also provides a range of hand sanitisation product formulations, and manufacturing instructions to allow for extemporaneous preparations at the community and hospital pharmacies during this urgent crisis. In addition, this emergent situation is expected to continue, hence hand sanitisers will be in demand for an extended time, and the availability and purchase of substandard products on the market create an ongoing safety concern. Therefore, this article shall also provide various commercial organisations, interested in stepping forward the production and marketing of hand sanitisers, with a guide on the development of products of standardised ingredients and formulations.

Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy

(1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19-69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.

Epidemiology of CoViD-19 Pandemic: Recovery and mortality ratio around the globe

Coronavirus Disease 2019 (CoViD-19) is the third type of coronavirus disease after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) that appears in human population from the past two decades. It is highly contagious and rapidly spread in the human population and compelled global public health institutions on high alert. Due to genetic similarity of this novel coronavirus 2019 with bat virus its emergence from bat to humans is possible. The virus survive in the droplets of coughing and sneezing and spread around the large areas through infected person resulting in its rapid spread among people. Clinical symptoms of CoViD-19 include fever, dry cough, dyspnea, loose stool, nausea and vomiting. The present review discuss the origin of CoViD-19, its rapid spread, mortality rate and recoveries ratio around the world. Since its origin from Wuhan, the CoViD-19 spread very rapidly all across the countries, on April 17, 2020 this disease has affected 210 countries of the globe. The data obtained showed over 2.4 million confirmed cases of CoViD-19. Higher mortality rate was found in Algeria and Belgium as 15% and 13.95%, respectively. Lower mortality rate was found in Qatar 0.17% and Singapore 0.2%. Recovery versus deceased ratio showed that recovery was 68, 59 and 35 times higher than the death in Singapore, Qatar and Thailand respectively. It is concluded that 2019-novel corona virus is a zoonotic pathogen similar to MERS and SARS. Therefore, a barrier should be maintained between and across the human, household and wild animals to avoid such pandemics.

Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a "Red Zone" Area in Northern Italy

Since February 20, 2020, in Italy, we have been confronting the dramatic challenge of the SARS-CoV-2 outbreak, which has completely overthrown our medical practice. We report our experience as an IBD center in Lombardia, the most affected region in Italy.

Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy

The Coronavirus-associated disease, that was first identified in 2019 in China (CoViD-19), is a pandemic caused by a bat-derived beta-coronavirus, named SARS-CoV2. It shares homology with SARS and MERS-CoV, responsible for past outbreaks in China and in Middle East. SARS-CoV2 spread from China where the first infections were described in December 2019 and is responsible for the respiratory symptoms that can lead to acute respiratory distress syndrome. A cytokine storm has been shown in patients who develop fatal complications, as observed in past coronavirus infections. The management includes ventilatory support and broad-spectrum antiviral drugs, empirically utilized, as a targeted therapy and vaccines have not been developed. Based upon our limited knowledge on the pathogenesis of CoViD-19, a potential role of some anti-rheumatic drugs may be hypothesized, acting as direct antivirals or targeting host immune response. Antimalarial drugs, commonly used in rheumatology, may alter the lysosomal proteases that mediates the viral entry into the cell and have demonstrated efficacy in improving the infection. Anti-IL-1 and anti-IL-6 may interfere with the cytokine storm in severe cases and use of tocilizumab has shown good outcomes in a small cohort. Baricitinib has both antiviral and anti-inflammatory properties. Checkpoints inhibitors such as anti-CD200 and anti-PD1 could have a role in the treatment of CoViD-19. Rheumatic disease patients taking immunosuppressive drugs should be recommended to maintain the chronic therapy, prevent infection by avoiding social contacts and pausing immunosuppressants in case of infection. National and international registries are being created to collect data on rheumatic patients with CoViD-19.

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CoViD-19 is a pandemic caused by SARS-CoV2, that can lead to acute respiratory distress syndrome.

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Antimalarial drugs, anti-IL-1 and anti-IL-6 may be used in severe cases targeting the cytokine storm induced by CoViD-19.

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Recommendations for rheumatic disease patients include the prevention of infection by avoiding social contacts.

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Patients should also continue their ongoing therapy except in the case of overt infection.