COVID-19 Australia: Epidemiology Report 80: Reporting period ending 22 October 2023

This is the eightieth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 23:59 Australian Eastern Daylight Time [AEST] 22 October 2023. It includes data on COVID-19 cases diagnosed in Australia and the international situation.

A Comparative Analysis of the Incidence of Pediatric Orbital Fractures Before and During the COVID-19 Pandemic in the Japanese Population

INTRODUCTION

 The aim of this study is to compare data on the incidence of pediatric orbital fractures before the onset of the coronavirus disease 2019 (COVID-19) pandemic and during the period of the pandemic in the Japanese population.

METHODS

This retrospective, single-center, observational study including 225 patients (226 sides) aged ≤ 18 years old diagnosed with orbital fracture was conducted in our institution from March 2017 to April 2023. The study compared the incidence of pediatric orbital fractures in the pre-pandemic period from March 2017 to March 2020 and during the pandemic from April 2020 to April 2023.

RESULTS

The most common cause of injury was sports in both groups (137 sides, 60.6%), and the ratio of causes of injury (P = 0.610) or between outdoor and indoor sports (P = 1.000) was not statistically different between the groups. Although the daily rate of patient consults was lowest during the country's state of emergency with priority preventative measures, the difference between pre-pandemic and pandemic was not statistically significant (P = 0.911).

CONCLUSION

Despite the restrictions mandated by the Japanese government during the COVID-19 pandemic, the physical activities of children did not significantly decline. Hence, the risk of pediatric orbital fractures remained the same.

Genetic and Epigenetic Determinants of COVID-19 Susceptibility: A Systematic Review

BACKGROUND

The molecular mechanisms regulating coronavirus pathogenesis are complex, including virus-host interactions associated with replication and innate immune control. However, some genetic and epigenetic conditions associated with comorbidities increase the risk of hospitalization and can prove fatal in infected patients. This systematic review will provide insight into host genetic and epigenetic factors that interfere with COVID-19 expression in light of available evidence.

METHODS

This study conducted a systematic review to examine the genetic and epigenetic susceptibility to COVID-19 using a comprehensive approach. Through systematic searches and applying relevant keywords across prominent online databases, including Scopus, PubMed, Web of Science, and Science Direct, we compiled all pertinent papers and reports published in English between December 2019 and June 2023.

RESULTS

The findings reveal that the host's HLA genotype plays a substantial role in determining how viral protein antigens are showcased and the subsequent immune system reaction to these antigens. Within females, genes responsible for immune system regulation are found on the X chromosome, resulting in reduced viral load and inflammation levels when contrasted with males. Possessing blood group A may contribute to an increased susceptibility to contracting COVID-19 as well as a heightened risk of mortality associated with the disease. The capacity of SARS-CoV-2 involves inhibiting the antiviral interferon (IFN) reactions, resulting in uncontrolled viral multiplication.

CONCLUSION

There is a notable absence of research into the gender-related predisposition to infection, necessitating a thorough examination. According to the available literature, a significant portion of individuals affected by the ailment or displaying severe ramifications already had suppressed immune systems, categorizing them as a group with elevated risk.

Intrahepatic Cholestasis of Pregnancy and Transaminitis in Women with COVID-19: A Case Series

Objective  The four initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pregnant women presenting at term gestation to our institution presented with transaminitis. Three of the four were diagnosed with intrahepatic cholestasis of pregnancy (IHCP). Growing evidence exists of an associated transaminitis in nonpregnant SARS-CoV-2 patients. However, there are limited data of hepatic involvement of SARS-CoV-2 in pregnancy, and no previous studies have assessed the association with IHCP in patients with coronavirus disease 2019 (COVID-19). Study Design  This was a retrospective, single-center case series of four consecutive pregnant women with a positive result for SARS-CoV-2 presenting with transaminitis in third trimester. Results  The clinical courses of four pregnant women with COVID-19 and transaminitis, three of four of whom were diagnosed with IHCP, are described. Testing for SARS-CoV-2 was done through a reverse transcription polymerase chain reaction test of a nasopharyngeal swab. Conclusion  As we await larger studies ascertaining the incidence of IHCP in SARS-CoV-2, this prevalence highlights the importance of diagnosing IHCP among women with COVID-19 as a potential etiology of transaminitis, as IHCP risks may be ameliorated with earlier delivery. Moreover, delineating a hepatobiliary association in pregnancy may provide further information about the mechanism of liver impairment in SARS-CoV-2 in all patients.

Effects of novel coronavirus Omicron variant infection on pregnancy outcomes: a retrospective cohort study from Guangzhou

Objective

Since 2022, Omicron has been circulating in China as a major variant of the novel coronavirus, but the effects of infection with Omicron variants on pregnant women and newborns are unknown. The purpose of this study was to determine the clinical characteristics of Omicron infection during pregnancy and its effect on pregnancy outcomes.

Methods

This study retrospectively analyzed the data of 93 confirmed cases of novel coronavirus infection and 109 non-infected patients admitted to the isolation ward of Guangdong Maternal and Child Health Hospital from December 1, 2022 to January 31, 2023, and statistically analyzed the clinical features of Omicron variant infection during pregnancy and its impact on pregnancy outcomes. Further effects of underlying diseases on Omicron infection in pregnant women were analyzed.

Results

The incubation period of COVID-19 infection was 0.99±0.86 days, 94.38% of patients had fever or other respiratory symptoms, the lymphocyte count in the infected group was lower than that in the uninfected group, and the lymphocyte count was further reduced in the patients with pregnancy complications or complications. Compared with the uninfected group, APTT and PT were prolonged, platelet count and fibrinogen were decreased in the infected group, all of which had statistical significance. COVID-19 infection during pregnancy increased the rate of cesarean section compared to uninfected pregnant patients, and COVID-19 infection in gestational diabetes resulted in a 4.19-fold increase in cesarean section rate. There was no statistically significant difference in gestational age between the two groups. The incidence of intrauterine distress, turbidity of amniotic fluid and neonatal respiratory distress were higher in the infection group. No positive cases of neonatal COVID-19 infection have been found.

Conclusion

The patients infected with omicron during pregnancy often have febrile respiratory symptoms with lymphocyopenia, but the incidence of severe disease is low. Both Omicron infection and gestational diabetes further increase the incidence of cesarean section, and this study found no evidence of vertical transmission of Omicron.

COVID-19 and beyond: leveraging artificial intelligence for enhanced outbreak control

COVID-19 has brought significant changes to our political, social, and technological landscape. This paper explores the emergence and global spread of the disease and focuses on the role of Artificial Intelligence (AI) in containing its transmission. To the best of our knowledge, there has been no scientific presentation of the early pictorial representation of the disease's spread. Additionally, we outline various domains where AI has made a significant impact during the pandemic. Our methodology involves searching relevant articles on COVID-19 and AI in leading databases such as PubMed and Scopus to identify the ways AI has addressed pandemic-related challenges and its potential for further assistance. While research suggests that AI has not fully realized its potential against COVID-19, likely due to data quality and diversity limitations, we review and identify key areas where AI has been crucial in preparing the fight against any sudden outbreak of the pandemic. We also propose ways to maximize the utilization of AI's capabilities in this regard.

Auxiliary screening COVID-19 by computed tomography

Background

The 2019 novel coronavirus (COVID-19) pandemic remains rampant in many countries/regions. Improving the positive detection rate of COVID-19 infection is an important measure for the control and prevention of this pandemic. This meta-analysis aims to systematically summarize the current characteristics of the computed tomography (CT) auxiliary screening methods for COVID-19 infection in the real world.

Methods

Web of Science, Cochrane Library, Embase, PubMed, CNKI, and Wanfang databases were searched for relevant articles published prior to 1 September 2022. Data on specificity, sensitivity, positive/negative likelihood ratio, area under curve (AUC), and diagnostic odds ratio (dOR) were calculated purposefully.

Results

One hundred and fifteen studies were included with 51,500 participants in the meta-analysis. Among these studies, the pooled estimates for AUC of CT in confirmed cases, and CT in suspected cases to predict COVID-19 diagnosis were 0.76 and 0.85, respectively. The CT in confirmed cases dOR was 5.51 (95% CI: 3.78-8.02). The CT in suspected cases dOR was 13.12 (95% CI: 11.07-15.55).

Conclusion

Our findings support that CT detection may be the main auxiliary screening method for COVID-19 infection in the real world.

Effectiveness of RCTs Pooling Evidence on Mesenchymal Stem Cell (MSC) Therapeutic Applications During COVID-19 Epidemic: A Systematic Review

Background

Global pandemic identified as coronavirus disease 2019 (COVID-19) has resulted in a variety of clinical symptoms, from asymptomatic carriers to those with severe acute respiratory distress syndrome (SARS) and moderate upper respiratory tract symptoms (URTS). This systematic review aimed to determine effectiveness of stem cell (SC) applications among COVID-19 patients.

Methods

Multiple databases of PubMed, EMBASE, Science Direct, Google Scholar, Scopus, Web of Science, and Cochrane Library were used. Studies were screened, chosen, and included in this systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flowchart diagram and PRISMA checklist. Included studies' quality was assessed employing Critical Appraisal Skills Programme (CASP) quality evaluation criteria for 14 randomized controlled trials (RCTs).

Results

Fourteen RCTs were performed between the years of 2020 to 2022, respectively, with a sample size n = 574 (treatment group (n = 318); control group (n = 256)) in multiple countries of Indonesia, Iran, Brazil, Turkey, China, Florida, UK, and France. The greatest sample size reported from China among 100 COVID-19 patients, while the lowest sample of 9 COVID-19 patients from Jakarta, Indonesia, and the patient's age ranges from 18 to 69 years. Studies applied to the type of SC were "Umbilical cord MSCs, MSCs secretome, MSCs, Placenta-derived MSCs, Human immature dental pulp SC, DW-MSC infusion, Wharton Jelly-derived MSCs". The injected therapeutic dose was 1 × 10⁶ cells/kg, 1 × 10⁷ cells/kg, 1 × 10⁵ cells/kg, and 1 million cells/kg as per the evidence from the different studies. Studies focused on demographic variables, clinical symptoms, laboratory tests, Comorbidities, respiratory measures, concomitant therapies, Sequential Organ Failure Assessment score, mechanical ventilation, body mass index, adverse events, inflammatory markers, and PaO₂/FiO₂ ratio were all recorded as study characteristics.

Conclusion

Clinical evidence on MSC's therapeutic applications during COVID-19 pandemic has proven to be a promising therapy for COVID-19 patient recovery with no consequences and applied as a routine treatment for challenging ailments.

Attitudes and behaviors on prevention and control of COVID-19 in a less developed village of Southwest China: a cross-sectional survey

Background

At present new epidemic has entered a stage of normalized management, but there is still sporadic distribution, public already had certain protective knowledge of coronavirus disease 2019 (COVID-19). G County of Liangshan Yi Autonomous Prefecture is located in the mountainous area of southwest Sichuan Province, which also is ethnic minorities and as national-level poverty-stricken areas, residents in the region to the migrant workers as the main economic source of personnel with high mobility. In order to ensure the resumption of work and production, the effective implementation of epidemic prevention measures has certain guiding significance for epidemic prevention and control and economic recovery. This study investigated and analyzed the status quo of villagers' attitudes and behaviors toward COVID-19 prevention and control in Liangshan Yi Autonomous Prefecture, providing evidence for COVID-19 prevention and control measures in the resumption of rural work and agricultural production.

Methods

Snowball sampling was used to survey 117 villagers from an impoverished village in Liangshan Yi Autonomous Prefecture on February 10-19, 2020. A total of 120 questionnaires were collected, the recovery rate is 97.5%. Based on literature review, a self-designed questionnaire on attitudes and behaviors related to COVID-19 prevention and control was designed, the expert validity score was 0.912, and Cronbach α coefficient was 0.903.

Results

The overall score for respondents' attitude toward COVID-19 prevention and control was 29.65±3.23, which was considered a good level. The total score for prevention and control behavior was 114.74±17.09, which was medium level. A statistically significant difference was found for the attitudes and behaviors of different ethnic groups toward epidemic prevention and control.

Conclusions

The people in this village had a positive attitude toward epidemic prevention and control, but there was still room for improvement in prevention and control behavior. Training on hand hygiene and wearing masks outside should be strengthened, and relevant training for ethnic minorities should be further strengthened.

Clinical efficacy analysis of paxlovid in children with hematological diseases infected with the omicron SARS-CoV-2 new variant

Objective

To summarize the clinical characteristics of children with hematological malignancies co-infected with novel coronavirus and explore the safety and effectiveness of Paxlovid treatment.

Methods

From December 10, 2022, to January 20, 2023, the clinical data of children with hematological diseases diagnosed with novel coronavirus infection in the outpatient and emergency department of the Seventh Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed.

Results

According to whether to give paxlovid or not, it is divided into group A (paxlovid group) and group B (non-paxlovid group). The length of fever was 1-6 days in group A and 0-3 days in group B. The viral clearance time was shorter in group A than in group B. The inflammatory indexes CRP and PCT were significantly higher in group A than in group B (P < 0.05). Twenty patients were followed up for 1 month after leaving the hospital, and there were 5 cases of reappearance of fever, 1 case of increased sleep, 1 case of physical fatigue and 1 case of loss of appetite within 2 weeks.

Conclusions

Paxlovid has no apparent adverse reactions in children 12 years old and younger with underlying hematological diseases infected with the new coronavirus. Focusing on the interaction between paxlovid and other drugs is necessary during the treatment.

The results of thrombectomy from the arteries of the lower extremities in patients infected with SARS-CoV-2 Omicron variant with different severity of respiratory failure

GOAL

Analysis of the results of thrombectomy from the arteries of the lower extremities in patients with COVID-19 against the background of different severity of respiratory failure.

MATERIALS AND METHODS

This retrospective, cohort, comparative study for the period from 05/01/2022 to 20/07/2022 included 305 patients with acute thrombosis of the arteries of the lower extremities against the background of the course of COVID-19 (SARS-CoV-2 Omicron variant). Depending on the type of oxygen support, 3 groups of patients were formed: group 1 (n = 168) - oxygen insufflation through nasal cannulas; group 2 (n = 92) - non-invasive lung ventilation; and group 3 (n = 45) - artificial lung ventilation.

RESULTS

Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5.3%, n = 9; group 2: 72.8%, n = 67; group 3: 100%, n = 45; p < 0.0001), rethrombosis (group 1 : 18.4%, n = 31; group 2: 69.5%, n = 64; group 3: 91.1%, n = 41; p < 0.0001), and limb amputations (group 1: 9.5%, n = 16; group 2: 56.5%, n = 52; group 3: 91.1%, n = 41; p < 0.0001) was recorded in group 3 (ventilated) patients.

CONCLUSION

In patients infected with COVID-19 and on artificial lung ventilation, a more aggressive course of the disease is noted, expressed in an increase in laboratory parameters (C-reactive protein, ferritin, interleukin-6, and D-dimer) of the degree of pneumonia (CT-4 in overwhelming number) and localization of thrombosis of the arteries of the lower extremities, mainly in the tibial arteries.

Age at SARS-CoV-2 infection and psychological and physical recovery among Chinese health care workers with severe COVID-19 at 28 months after discharge: A cohort study

Background

No prior study had reported the psychological and physical recovery of patients with COVID-19 2~3 years after discharge from the hospital. Moreover, it is not clear whether there is any difference in the health status of the patients with COVID-19 of different ages after discharge from the hospital.

Methods

Embedding in the "Rehabilitation Care Project for Medical Staff Infected with COVID-19" in China, this study included 271 health care workers (HCWs) with severe COVID-19. Their status of health-related quality of life, persistent symptoms, functional fitness and immune function at 28 months after discharge were followed, and compared according to tertiles of age at SARS-CoV-2 infection (group of younger (≤ 33 years); medium (34-42 years); and older (≥43 years)). Multivariate linear regression and multivariable adjusted logistic regression models were applied in investigating the associations of age at SARS-CoV-2 infection and outcomes.

Results

At 28 months after discharge, 76% of the HCWs with severe COVID-19 had symptom of fatigue/weakness; 18.7% of the HCWs with severe COVID-19 did not fully recover their functional fitness; the decrease of CD3+ T cells, CD8+ T cells and the increase of natural killer cells accounted for 6.6, 6.6, and 5.5%, respectively. Compared with the HCWs with severe COVID-19 in younger group, HCWs with severe COVID-19 in older group had lower scores regarding physical functioning, role physical, bodily pain and role emotional; HCWs with severe COVID-19 in older group had higher risk of cough, joint pain, hearing loss and sleep disorder; HCWs with severe COVID-19 in older group scored lower on flexibility test. The variance of relative numbers of CD3+ T cells, CD8+ T cells and natural killer cells among HCWs with severe COVID-19 of different age groups were significant.

Conclusions

This study demonstrated that older HCWs with severe COVID-19 recovered slower than those with younger age regarding health-related quality of life, persistent symptoms, functional fitness and immune function at 28 months after discharge. Effective exercise interventions regarding flexibility should be performed timely to speed their rehabilitation, especially among those with older age.

Development of an Antigen Detection Kit Capable of Discriminating the Omicron Mutants of SARS-CoV-2

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world, caused millions of deaths and a severe illness which poses a serious threat to human health.

OBJECTIVE

To develop an antigen detection kit that can identify Omicron novel coronavirus mutants.

METHODS

BALB/c mice were immunized with the nucleocapsid protein of SARS-CoV-2 Omicron mutant treated with β-propiolactone. After fusion of myeloma cells with immune cells, Elisa was used to screen the cell lines capable of producing monoclonal antibodies. The detection kit was prepared by colloidal gold immunochromatography. Finally, the sensitivity, specificity and anti-interference of the kit were evaluated by simulating positive samples.

RESULTS

The sensitivity of the SARS-CoV-2 antigen detection kit can reach 62.5 TCID₅₀/mL, and it has good inclusiveness for different SARS-CoV-2 strains. The kit had no cross-reaction with common respiratory pathogens, and its sensitivity was still not affected under the action of different concentrations of interferences, indicating that it had good specificity and stability.

CONCLUSION

In this study, monoclonal antibodies with high specificity to the N protein of the Omicron mutant strain were obtained by monoclonal antibody screening technology. Colloidal gold immunochromatography technology was used to prepare an antigen detection kit with high sensitivity to detect and identify the mutant Omicron strain.

Mega-scale desalination Efficacy (Reverse Osmosis, Electrodialysis, Membrane Distillation, MED, MSF) during COVID-19: Evidence from salinity, pretreatment methods, temperature of operation

The unprecedented situation of the COVID-19 pandemic heavily polluted water bodies whereas the presence of SARS-CoV-2, even in treated wastewater in every corner of the world is reported. The main aim of the present study is to show the effectiveness and feasibility of some well-known desalination technologies which are reverse osmosis (RO), Electrodialysis (ED), Membrane Distillation (MD), multi effect distillation (MED), and multi stage flashing (MSF) during the COVID-19 pandemic. Systems’ effectiveness against the novel coronavirus based on three parameters of nasopharynx/nasal saline-irrigation, temperature of operation and pretreatment methods are evaluated. First, based on previous clinical studies, it showed that using saline solution (hypertonic saline >0.9% concentration) for gargling/irrigating of nasal/nasopharynx/throat results in reducing and replication of the viral in patients, subsequently the feed water of desalination plants which has concentration higher than 3.5% (35000ppm) is preventive against the SARS-CoV-2 virus. Second, the temperature operation of thermally-driven desalination; MSF and MED (70-120°C) and MD (55-85°C) is high enough to inhibit the contamination of plant structure and viral survival in feed water. The third factor is utilizing various pretreatment process such as chlorination, filtration, thermal/precipitation softening, ultrafiltration (mostly for RO, but also for MD, MED and MSF), which are powerful treatment methods against biologically-contaminated feed water particularly the SARS-CoV-2. Eventually, it can be concluded that large-scale desalination plants during COVID-19 and similar situation are completely reliable for providing safe drinking water.

Clinical characteristics of patients infected with novel coronavirus wild strain, Delta variant strain and Omicron variant strain in Quanzhou: A real‑world study

This study aimed to investigate the clinical features of patients infected with novel coronavirus wild strains, Delta variant strains and Omicron variant strains to provide a reference for early clinical diagnosis and prognostic assessment. The demographic, clinical symptoms and ancillary examination data of 47 patients with novel coronavirus wild type strain infection, 18 with Delta variant infection and 20 with Omicron variant infection admitted to the First Hospital of Quanzhou affiliated with Fujian Medical University were collected and analyzed. The novel coronavirus wild strain and Delta strain were the predominant clinical types; patients infected with the Omicron strain were mainly asymptomatic. Fever and fatigue were the main clinical manifestations in the wild strain and Delta strain groups, whereas dry cough, nasal congestion, sore throat and fever were common clinical manifestations in the Omicron strain group. The Delta strain and Omicron variant groups had fewer comorbidities than the wild-type strain group, but no significant reduction was observed in the negative conversion time of nucleic acids. Significant differences were found in the neutrophil count/lymphocyte count ratio, lymphocyte count, eosinophil count, red blood cell count, hemoglobin level, erythrocyte sedimentation rate, C-reactive protein, prothrombin time, international normalized ratio and plasma D-dimer, PH, PaO₂, lactic acid and albumin levels among the three groups. Patients infected with the Omicron strain in Quanzhou presented with mild symptoms of the upper respiratory tract as the primary clinical manifestation and had few comorbidities and a good prognosis; however, the negative conversion time of the new coronavirus nucleic acid was still considerably long.

Neurological Complications in Post-COVID-19 Infected Patients: A Case Series

In December 2019, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the causative agent of coronavirus disease 2019 (COVID-19), emerged in China and quickly spread to other countries. COVID-19 infection can present in a variety of ways, ranging from mild upper respiratory illness with no symptoms to severe acute respiratory distress syndrome with multiorgan involvement and death. With increasing frequency, new associations and clinical complications, such as thrombotic states, mucormycosis, and others have been reported. Neurological complications can occur during infection, during the immediate recovery period, or as late sequel of infection in COVID-19. We present an intriguing case series of neurological complications following COVID-19 pneumonia.

Women's Experiences of Symptoms of Suspected or Confirmed COVID-19 Illness During the Pandemic

OBJECTIVE

To explore experiences of symptoms of suspected or confirmed COVID-19 illness among women using the CovidWatcher mobile citizen science app.

DESIGN

Convergent parallel mixed-methods design.

PARTICIPANTS

Twenty-eight self-identified women consented for follow-up after using CovidWatcher. Participants' ages ranged from 18 to 83 years old.

METHODS

We collected data via semistructured, virtual interviews and surveys: the COVID-19 Exposure and Family Impact Survey and Patient-Reported Outcomes Measurement Information System measures. We used directed content analysis to develop codes, categories, themes, and subthemes from the qualitative data and summarized survey data with descriptive statistics.

RESULTS

We derived five themes related to symptom experiences: (a) Physical Symptoms, (b) Mental Health Symptoms, (c) Symptom Intensity, (d) Symptom Burden, and (e) Symptom Trajectories. Subthemes reflected more nuanced experiences of suspected or confirmed COVID-19 disease. For those without COVID-19, anxiety and mental health symptoms were still present. Of those who attested to one of the PROMIS-measured symptoms, all but one had at least mild severity in one of their reported symptoms.

CONCLUSION

This study demonstrates the cross-cutting impact of the COVID-19 pandemic on individuals who identify as women. Future research and clinical practice guidelines should focus on alleviating physical and mental health symptoms related to the ongoing pandemic, regardless of COVID-19 diagnosis. Furthermore, clinicians should consider how patients can use symptom reconciliation apps and tracking systems.

Prolonged COVID-19 in a Multiple Sclerosis Patient Treated With Rituximab

Immunocompromised patients commonly present prolonged viral shedding of the novel coronavirus SARS-CoV-2, detected through reverse transcriptase-polymerase chain reaction (RT-PCR) in nasopharyngeal or oropharyngeal swabs. The detection and estimation of the viral load in patients with COVID-19 is of utmost importance, not only for the effective isolation of the patient but also from a therapeutic point of view. In the current study, we present the case of an immunocompromised patient receiving rituximab infusions for the treatment of multiple sclerosis who exhibited COVID-19 clinical symptomatology for an extended period of time along with prolonged viral shedding while at the same time being unable to organize sufficient humoral immunity. Despite being fully vaccinated and having suffered symptomatic SARS-CoV-2 infections, antibodies against the virus remained undetected. Clinical relapse of his symptoms led to the trialing of a multitude of therapeutic interventions in order to combat the disease, with an extended remdesivir regimen proving the most efficacious in the alleviation of his symptoms. This case demonstrates how immunocompromised COVID-19 patients should be regarded under a different scope when it comes to the diagnosis, management, and resolution of their SARS-CoV-2 infection.

SARSPLEX: Multiplex Serological ELISA with a Holistic Approach

Currently, there are over 602 million severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases and 6.4 million COVID-19 disease-related deaths worldwide. With ambitious vaccine strategies, reliable and accurate serological testing is needed to monitor the dynamics of the novel coronavirus pandemic and community immunity. We set out to improve serological testing of the immune response against SARS-CoV-2. We hypothesize that by multiplexing the serological diagnostic test kit (SARSPLEX) and screening for three antibodies, an even more robust diagnostic can be developed. A total of 293 sera were analyzed for IgM, IgG, or IgA immune reactions to the subunit 1 spike glycoprotein and the nucleocapsid protein in a standardized ELISA platform. Testing IgM, IgG, and IgA demonstrated high positive and negative agreements compared to RT-PCR and serology reference tests. Comparison with the pre-2019-CoV (n = 102) samples highlighted the specificity of this test kit and indicated that no unspecific binding, even with the summer flu patients (n = 44), was detected. In addition, SARSPLEX demonstrated to be a valuable occupational surveillance tool used in a functional medicine facility. With increased and broader testing, SARSPLEX will be a valuable tool in monitoring immunity and aid in prioritizing access to the SARS-CoV-2 vaccine for high-risk patients.

Prognostic Performance of Cystatin C in COVID-19: A Systematic Review and Meta-Analysis

Cystatin C is a specific biomarker of kidney function. We perform this meta-analysis to determine the association of Cystatin C with the COVID-19 severity. In this systematic review and meta-analysis, we searched PubMed, EMBASE, Cochrane library, and Web of Science for studies published until 2nd September 2022 that reported associations between Cystatin C levels and COVID-19 severity. The analysis was performed using a random-effects model to calculate pooled standard mean difference (SMD). Twenty-five studies were included in the meta-analysis. Pooled analysis showed statistically significant differences of Cystatin C levels among survive vs. decreased patients (0.998 ± 0.225 vs. 1.328 ± 0.475 mg/dL, respectively; SMD = -2.14; 95%CI: -3.28 to -1.01; p < 0.001). Cystatin C levels in COVID-19 severe vs. non-severe groups varied and amounted to 1.485 ± 1.191 vs. 1.014 ± 0.601 mg/dL, respectively (SMD = 1.81; 95%CI: 1.29 to 2.32; p < 0.001). Additionally, pooled analysis showed that Cystatin C levels in patients with acute kidney injury (AKI) was 1.562 ± 0.885 mg/dL, compared to 0.811 ± 0.108 mg/dL for patients without AKI (SMD = 4.56; 95%CI: 0.27 to 8.85; p = 0.04). Summing up, Cystatin C is a potentially very good marker to be used in the context of COVID-19 disease due to the prognosis of patients' serious condition, risk of AKI and mortality. In addition, Cystatin C could be used as a marker of renal complications in COVID-19 other than AKI due to the need to monitor patients even longer after leaving the hospital.

First reported cases of SARS-CoV-2 infection in pets in São Paulo, Brazil

Background and Aim

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global coronavirus pandemic (COVID-19) in humans in 2019. Although SARS-CoV-2 infection is primarily asymptomatic and transitory in companion animals, the role of these animals in the life cycle of the virus remains unclear. This study aimed to survey the first SARS-CoV-2 infection cases in pets, including a dog and three cats in São Paulo, Brazil.

Materials and Methods

We invited COVID-19-positive pet owners to participate in the survey and obtained nasal, oropharyngeal, and rectal swab samples from their pets. These samples were placed in vials and subjected to a real-time quantitative polymerase chain reaction. In addition, the owners answered an epidemiological questionnaire, and the pets underwent clinical examination and monitoring.

Results

Out of 49 sampled pets, 3/19 (15.8%) cats and 1/30 (3.3%) dogs tested positive, with wide variations in viral loads. Despite the limitations of size and non-randomized sampling, our results showed that cats are more susceptible than dogs to SARS-CoV-2 infection, presenting a cat: dog ratio of 4.8: 1. Only one cat presented mild and transitory respiratory symptoms.

Conclusion

Although SARS-CoV-2 infection was detected in pets in the largest South American city and the COVID-19 epicenter at the time, these first detected pet cases displayed either none or mild clinical signs.

Resilience related to novel coronavirus among doctors and undergraduate medical students-A study from India

BACKGROUND

There are no studies pertaining to resilience related to novel coronavirus focusing primarily on doctors and undergraduate medical students in India. The objectives of this survey were to assess the resilience and its various domains that are needed for dealing with novel coronavirus among doctors, interns, and undergraduate students and to see its correlation with various sociodemographic factors.

MATERIALS AND METHOD

An online cross-sectional survey was done among doctors and undergraduate medical students during the first COVID-19 wave from May 19, 2020 to June 8, 2020. A total of 434 responses were recorded during the study period. All the recorded full responses were considered for data analysis. Snowball sampling was used for this study. Resilience was assessed using three items, which were taken from the Brief Resilience Scale (BRS).

RESULT

Out of 434 responses, 51.7% (224/433) of the respondents were non-resilient. The presence of the elderly at home was significantly associated with poor resilience (P = 0.02). Resilience was not significantly associated with other socio-demographic factors. Younger respondents (P = 0.019) and females (P =0.0004) were of the opinion that they recovered late from stressful events. Elderly respondents (P = 0.003) and those with chronic illness (P = 0.008) reported that it is hard for them to snap back if something bad happens (P = 0.003).

CONCLUSIONS

More than half of the doctors and undergraduate medical students were found to be non-resilient, underscoring the urgent need to take steps to improve the resilience of this group of frontline workers.

Establishing an integrated prevention and control system to ensure zero nosocomial infections - an analysis of the logistics support in controlling nosocomial infections during the hospital's fight against the COVID-19 epidemic

AIM

To analyze the role of the logistics support services in nosocomial infection control during emergency periods, with a focus on job responsibilities including the organization of vehicle parking, supply of hospital meals, washing of medical bedding and clothing, disposal and management of medical sewage and waste, elevator services, disinfection of air conditioning systems, disinfection and cleaning of ambulances, management of hospital buildings, storage of sterilization supplies, reception and delivery of oxygen cylinders and protection of staff health as examples.

METHODS

The adjustment and optimization of the emergency support system and working mode as part of hospitals' response to major public emergencies were summarized, and the vital supporting role of the logistics support services in nosocomial infection control was analyzed.

RESULTS

The logistics support services played a crucial role in ensuring the high-performance operations of the hospitals and control of nosocomial infections, resulting in the excellent outcome of "zero infection" among hospital staff.

CONCLUSION

Establishing a safe, flexible and efficient system for the logistics support services is important in ensuring an effective response by hospitals to health emergencies.

High prevalence of SARS-CoV-2 detection and prolonged viral shedding in stools: A systematic review and cohort study

Objectives

Methods

Results

Conclusions

Preventive control strategy on second wave of Covid-19 pandemic model incorporating lock-down effect

This study presents an optimal control strategy through a mathematical model of the Covid-19 outbreak without lock-down. The pandemic model analyses the lock-down effect without control strategy based on the current scenario of second wave data to control the rapid spread of the virus. The pandemic model has been discussed with respect to the basic reproduction number and stability analysis of disease-free and endemic equilibrium. A new optimal control problem with treatment is framed to minimize the vulnerable situation of the second wave. This system is applied to study the effects of vaccines and treatment controls. Numerical solutions and the graphical presentation of the results predict the fate of India’s second wave situation on account of the control strategy. Lastly, a comparative study with control and without control has been analysed for the exposed phase, infective phase, and recovery phase to understand the effectiveness of the controls. This model is used to estimate the total number of infected and active cases, deaths, and recoveries in order to control the disease using this system and studying the effects of vaccines and treatment controls.

Missed nursing care in the COVID-19 pandemic in Iran

Background

Quality of care is one of the most critical issues in nursing care today. Moreover, all health care employees are responsible for providing support and high‐quality, safe care. However, nurses caring for COVID‐19 patients face problems such as unfamiliar work environments, exposure to the disease, lack of experience in their new positions, and close public and media attention. This study aimed to investigate missed nursing care and the reasons for missed nursing care during the coronavirus disease 2019 (COVID‐19) pandemic in Iran.

Methods

This cross‐sectional study included 135 nurses working in COVID‐19 units. Data were collected using the MISSCARE Survey. The significance level for the statistical tests was set at p < 0.05.

Results

Most of the participants were women and had a bachelor's degree in nursing. There was a lack of supportive and necessary care more than any other form of care. According to nurses, the most common reasons for missed care were urgent patient situations, inadequate staff, and an unexpected rise in patient volume and/or patient acuity on the unit.

Conclusion

Generally, the results showed that being positioned in a new situation and unfamiliarity with the disease had a significant impact—among nurses—on the amount of care provided. Managers can use this information to solve existing missed‐nursing‐care problems and contribute to improving the quality of care.

These results can be helpful in controlling missed nursing care and finding a more optimal solution for this problem; thus, we can improve the quality of care delivery and increase the satisfaction of nurses and patients. Additionally, an understanding of the kind of missing nursing care during a pandemic can positively enhance the management of similar situations in the future.

The prognostic role of interatrial block among COVID-19 patients hospitalized in medicine wards

INTRODUCTION

Some abnormal electrocardiographic findings were independently associated with increased mortality in patients admitted for COVID-19; however, no studies have focussed on the prognosis impact of the interatrial block (IAB) in this clinical setting. The aim of our study was to assess the prevalence and clinical implications of IAB, both partial and advanced, in hospitalized COVID-19 patients.

MATERIALS

We retrospectively evaluated 300 consecutive COVID-19 patients (63.22 ± 15.16 years; 70% males) admitted to eight Italian Hospitals from February 2020 to April 2020 who underwent twelve lead electrocardiographic recording at admission. The study population has been dichotomized into two groups according to the evidence of IAB at admission, both partial and advanced. The differences in terms of ARDS in need of intubation, in-hospital mortality and thromboembolic events (a composite of myocardial infarction, stroke and transient ischaemic attack) have been evaluated.

RESULTS

The presence of IAB was noticed in 64 patients (21%). In the adjusted logistic regression model, the partial interatrial block was found to be an independent predictor of ARDS in need of intubation (HR: 1.92; p: .04) and in-hospital mortality (HR: 2.65; p: .02); moreover, the advanced interatrial block was an independent predictor of thrombotic events (HR: 7.14; p < .001).

CONCLUSIONS

Among COVID-19 patients hospitalized in medical wards, the presence of interatrial block is more frequent than in the general population and it might be useful as an early predictor for increased risk of incident thrombotic events, ARDS in need of intubation and in-hospital mortality.

Risk assessment of novel coronavirus COVID-19 outbreaks in the border areas of southwest China

This study aimed to assess the risk of coronavirus disease 2019 in the border areas of southwest China, so as to provide guidance to targeted prevention and control measures in the border areas of different risk levels. We assessed the dependence of the risk of an outbreak in the southwest China from imported cases on key parameters such as the cumulative number of infectious diseases in the border area of southwest China in the past 3 years; the connectivity of the neighboring countries with China's Southwest border, including baseline travel numbers, travel frequencies, the effect of travel restrictions, and the length of borders with neighboring countries; the cumulative number of close contacts of coronavirus disease 2019 patients; (iv) the population density in border areas; the efficacy of control measures in border areas; experts estimated risks in border areas based on experience and then given a score; Spearman correlation and Logistic regression models were used to analyze the associated factors of novel coronavirus. According to the correlation of various factors, we assigned values to each parameter, calculated the risk score of each county, and then divided each county into high, medium, and low risk according to the sick score and took different control measure according to different risk levels. Finally, the total risk level was evaluated according to the Harvard disease risk index model. The number of infectious diseases in the past 3 years, travel numbers, travel frequencies, experts estimated risk score, effect of travel restrictions, and the number of close contacts were associated with the incidence of new coronary pneumonia. It is concluded that bilateral transportation convenience is a risk factor for new coronary pneumonia, (odds ratio = 9.23, 95% confidence interval, 1.99-42.73); the number of observers is a risk factor for new coronary pneumonia (odds ratio = 1.04, 95% confidence interval, 1.00-1.08). We found that in countries with travel numbers, travel frequencies, and experts' estimated risk scores were the influencing factors of novel coronavirus. The effect of travel restrictions and the cumulative number of close contacts of the case are risk factors for novel coronavirus.

Virology and immune dynamics reveal high household transmission of ancestral SARS-CoV-2 strain

BACKGROUND

Household studies are crucial for understanding the transmission of SARS-CoV-2 infection, which may be underestimated from PCR testing of respiratory samples alone. We aim to combine the assessment of household mitigation measures; nasopharyngeal, saliva, and stool PCR testing; along with mucosal and systemic SARS-CoV-2-specific antibodies, to comprehensively characterize SARS-CoV-2 infection and transmission in households.

METHODS

Between March and September 2020, we obtained samples from 92 participants in 26 households in Melbourne, Australia, in a 4-week period following the onset of infection with ancestral SARS-CoV-2 variants.

RESULTS

The secondary attack rate was 36% (24/66) when using nasopharyngeal swab (NPS) PCR positivity alone. However, when respiratory and nonrespiratory samples were combined with antibody responses in blood and saliva, the secondary attack rate was 76% (50/66). SARS-CoV-2 viral load of the index case and household isolation measures were key factors that determine secondary transmission. In 27% (7/26) of households, all family members tested positive by NPS for SARS-CoV-2 and were characterized by lower respiratory Ct values than low transmission families (Median 22.62 vs. 32.91; IQR 17.06-28.67 vs. 30.37-34.24). High transmission families were associated with enhanced plasma antibody responses to multiple SARS-CoV-2 antigens and the presence of neutralizing antibodies. Three distinguishing saliva SARS-CoV-2 antibody features were identified according to age (IgA1 to Spike 1, IgA1 to nucleocapsid protein (NP)), suggesting that adults and children generate distinct mucosal antibody responses during the acute phase of infection.

CONCLUSION

Utilizing respiratory and nonrespiratory PCR testing, along with the measurement of SARS-CoV-2-specific local and systemic antibodies, provides a more accurate assessment of infection within households and highlights some of the immunological differences in response between children and adults.

Short-Term Effect of the COVID-19 Pandemic on Suicidal Ideation

Background: Few studies have examined the effect of pandemics on suicide-related outcomes. Aims: We examined whether suicidal ideation levels among the general population changed owing to the COVID-19 pandemic by tracking individuals between January and April 2020. Method: We used a prospective observational longitudinal design (n = 6,683) and stratified sampling to conduct online surveys of the general adult population in Japan before (baseline) and during the pandemic (follow-up). Results: Suicidal ideation levels were significantly lower during than before the pandemic; however, the effect size was very small. Participants who were younger, with unstable employment, without children, with low income, and receiving psychiatric care were more likely to have higher suicidal ideation levels during the pandemic. Limitations: Because this was an Internet survey and subject to selection bias, the sample was not necessarily representative of the Japanese population. At the time of the survey, COVID-19 cases and deaths in Japan were relatively lower than in other developed countries. The dropout rate may have affected the results. Conclusion: Although the short-term impact of the COVID-19 pandemic on suicidal ideation is limited, relatively young and economically vulnerable individuals are more likely to show exacerbated suicidal ideation during the pandemic.

Mathematical Analysis of a COVID-19 Epidemic Model by Using Data Driven Epidemiological Parameters of Diseases Spread in India

This paper attempts to describe the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) via an epidemic model. This virus has dissimilar effects in different countries. The number of new active coronavirus cases is increasing gradually across the globe. India is now in the second stage of COVID-19 spreading, it will be an epidemic very quickly if proper protection is not undertaken based on the database of the transmission of the disease. This paper is using the current data of COVID-19 for the mathematical modeling and its dynamical analysis. We bring in a new representation to appraise and manage the outbreak of infectious disease COVID-19 through SEQIR pandemic model, which is based on the supposition that the infected but undetected by testing individuals are send to quarantine during the incubation period. During the incubation period if any individual be infected by COVID-19, then that confirmed infected individuals are isolated and the necessary treatments are arranged so that they cannot taint the other residents in the community. Dynamics of the SEQIR model is presented by basic reproduction number R ₀ and the comprehensive stability analysis. Numerical results are depicted through apt graphical appearances using the data of five states and India.

Mathematical Analysis of a COVID-19 Epidemic Model by Using Data Driven Epidemiological Parameters of Diseases Spread in India

This paper attempts to describe the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) via an epidemic model. This virus has dissimilar effects in different countries. The number of new active coronavirus cases is increasing gradually across the globe. India is now in the second stage of COVID-19 spreading, it will be an epidemic very quickly if proper protection is not undertaken based on the database of the transmission of the disease. This paper is using the current data of COVID-19 for the mathematical modeling and its dynamical analysis. We bring in a new representation to appraise and manage the outbreak of infectious disease COVID-19 through SEQIR pandemic model, which is based on the supposition that the infected but undetected by testing individuals are send to quarantine during the incubation period. During the incubation period if any individual be infected by COVID-19, then that confirmed infected individuals are isolated and the necessary treatments are arranged so that they cannot taint the other residents in the community. Dynamics of the SEQIR model is presented by basic reproduction number R 0 and the comprehensive stability analysis. Numerical results are depicted through apt graphical appearances using the data of five states and India.

Association of Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seroprevalence and State-Issued Nonpharmaceutical Interventions: United States, 1 August 2020 to 30 March 2021

BACKGROUND

We assess if state-issued nonpharmaceutical interventions (NPIs) are associated with reduced rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as measured through anti-nucleocapsid (anti-N) seroprevalence, a proxy for cumulative prior infection that distinguishes seropositivity from vaccination.

METHODS

Monthly anti-N seroprevalence during 1 August 2020 to 30 March 2021 was estimated using a nationwide blood donor serosurvey. Using multivariable logistic regression models, we measured the association of seropositivity and state-issued, county-specific NPIs for mask mandates, gathering bans, and bar closures.

RESULTS

Compared with individuals living in a county with all three NPIs in place, the odds of having anti-N antibodies were 2.2 (95% confidence interval [CI]: 2.0-2.3) times higher for people living in a county that did not have any of the 3 NPIs, 1.6 (95% CI: 1.5-1.7) times higher for people living in a county that only had a mask mandate and gathering ban policy, and 1.4 (95% CI: 1.3-1.5) times higher for people living in a county that had only a mask mandate.

CONCLUSIONS

Consistent with studies assessing NPIs relative to COVID-19 incidence and mortality, the presence of NPIs were associated with lower SARS-CoV-2 seroprevalence indicating lower rates of cumulative infections. Multiple NPIs are likely more effective than single NPIs.

The Role of Hematological Parameters in Predicting the Death of Hospitalized Patients with COVID-19

Background

The role of the hematologic indicators in the identification of severe or critical patients requires further investigation. In this study, we focused on predicting Covid-19 patients at risk of progression using blood parameters.

Materials and Methods

We performed a retrospective study including 444 patients with confirmed Covid-19. Hematological parameters were evaluated. The logistic regression analysis was performed with step-wise method with dependent variables such as intensive care units admission, partial pressure of oxygen saturation, and mortality. Also, independent variables such as hematological parameters, age and sex to assess variables that are likely to predict patients at risk of progression.

Results

Patients in intensive care units had significantly higher mean absolute neutrophil count than outpatients (P < 0.001). There was a statistically significant difference in the mean absolute lymphocyte count between dead and survived patients (P = 0.015). Multivariate analysis confirmed the positive association of the white blood cells (P < 0.001), absolute neutrophil count (P < 0.004), red cell distribution width (P < 0.001), and lactate dehydrogenase (P = 0.007) to be positively associated with the admission of Covid-19 patients in the intensive care units and the absolute monocyte count (P = 0.012, Odds ratios = 0.100, CI95% = 0.066-0.605) to be negatively associated with mortality.

Conclusion

Based on the results of our study, it is recommended to use hematological data to make clinical decisions and evaluate the patient's prognosis.

Mobile cabin hospital compulsory quarantine for mild patients can serve as an alternative treatment for COVID-19: the Chinese experience

OBJECTIVE

To explore the application value of mobile cabin hospitals in combating COVID-19 outbreak.

METHODS

The basic clinical data, the number of admission, CT scan, novel coronavirus nucleic acid testing results were collected and calculated. The operational elements of running this temporary hospital were reviewed from its construction to closing.

RESULTS

Wuhan Hanyang Mobile Cabin Hospital was transformed from Hall B1 of Wuhan International Expo Center. With a total of 930 beds in this temporary hospital, 1,028 patients were admitted, among them, 598 patients were cured, and 430 patients were transferred to designated hospitals in the special period. Totally, 1,206 mobile CT scan were conducted. 2,295 novel coronavirus nucleic acid tests were performed, among which, 1,032 tests showed two continuous negative results, 924 tests with one negative, while 302 tests with positive result (13.16%). No nosocomial infection of working staff was found due to the conduction of multiple measures. The patients' livelihoods were well safeguarded in mobile cabin hospitals.

CONCLUSION

The mobile cabin hospital compulsory quarantine for mild patients can serve as an alternative method to combat COVID-19.

Recent advances and clinical application in point-of-care testing of SARS-CoV-2

The novel coronavirus 2019 (COVID-19) caused by SARS-CoV-2 spread rapidly worldwide, posing a severe threat to public life and health. It is significant to realize rapid testing and timely control of epidemic situations under the condition of limited resources. However, laboratory-based standardized nucleic acid detection methods have a long turnaround time and high cost, so it is urgent to develop convenient methods for detecting COVID-19. This paper summarizes the point-of-care testing (POCT) developed for novel coronavirus from three aspects: nucleic acid extraction, nucleic acid amplification, and detection methods. This paper introduces a commercial real-time detection system that integrates the abovementioned three steps and the matters needing attention in use. The primary purpose of this review is to provide a reference for emergency response and rapid deployment of COVID-19 and some other emerging infectious diseases.

Perceived Self Efficacy in Implementing COVID-19 Preventive Measures Among Residents of Harari Regional State, Eastern Ethiopia: A Community-Based Cross-Sectional Study

Background

The COVID-19 outbreak has now become a major international public health concern and a major challenge for the entire world. Poor adherence to COVID-19 prevention measures continues to be a challenge in managing COVID-19 pandemics, including in Ethiopia. As a result, the current study sought to identify the determinants of community adherence to COVID-19 preventive measures among the adult population of Harari Regional State in Eastern Ethiopia.

Methods

A community-based cross-sectional study was conducted in Harari Regional State, Eastern Ethiopia from January 5 to 30, 2021. All adults above the age of 18 who lived in Harari Regional State's selected kebeles were eligible to participate in the study. A systematic random sampling method was used to select the study participants. The study included a total of 1,320 participants. Pre-tested, structured, and self-administered questionnaires were used to collect data, which was then analyzed using STATA version 16 software. The consent was obtained from each individual and concerned body. Binary logistic regression was used to find the correlation between community adherence to COVID-19 preventive measures and sociodemographic, knowledge, self-efficacy, and risk perception. A P-value of 0.05 was used as the statistical significance cut-off point.

Results

One thousand two hundred fifty-five (1,255) people took the survey, yielding a 95.1 % response rate. Adherence to COVID-19 preventive measures resulted in a mean cumulative score of 29.8. Six hundred eight (48.5%) of the participants had good adherence to COVID-19 preventive measures, whereas 647 (51.5%) did not. The researchers also discovered a statistically significant link between participants' residence, educational status, risk perception, income, and adherence to COVID-19 preventive measures.

Conclusion

Appropriate implementation of COVID-19 preventive measures among community members is required to manage or control pandemics and reduce health-related consequences associated with COVID-19 pandemics. The current study, on the other hand, discovered that nearly half of the study participants had poor adherence. As a result, in order to manage this pandemic, the relevant organizations, including the government and non-governmental organizations, must take appropriate and timely measures.

Changes in Preventive Behavior During the First 3 Months of the COVID-19 Outbreak in Iran

OBJECTIVES

Iran is facing a big challenge controlling the coronavirus disease 2019 (COVID-19) outbreak, and it is unclear to how individuals are engaging in preventive behaviors. This study aimed to investigate changes in preventive behaviors during the first 3 mo of the COVID-19 outbreak in Iran.

METHOD

This cross-sectional survey was conducted on 1477 adults aged 18 y and older in 31 provinces of Iran. Data were collected by an anonymous online questionnaire.

RESULT

Overall, engagement in preventive behaviors was relatively acceptable, and more than 45% of subjects always carried out all preventive behaviors. Engaging in all preventive behaviors had a peak in the second month and obviously declined during third month. Engagement in some preventive behaviors, such as "wearing a face mask" and "keeping a safe distance from others," was observed less than other behaviors. There was a statistically significant difference in the engagement in preventive behaviors by gender and occupation (P < 0.001).

CONCLUSIONS

Although engagement in preventive behaviors was relatively acceptable for the first 2 mo of the outbreak, it has declined gradually. This is a warning for public health decision makers. COVID-19 is still a crucial issue in Iran, and it is necessary that government decision be based on the fact that Iranian people must live with a coronavirus for months, with full caution and compliance toward all preventive care protocols.

Prediction of putative potential siRNAs for inhibiting SARS-CoV-2 strains, including variants of concern and interest

Aim: To predict siRNAs as a therapeutic intervention for highly infectious new variants of SARS-CoV-2. Methods: Conserved coding sequence regions of 11 SARS-CoV-2 proteins were used to construct siRNAs through sampling of metadata comprising 214,256 sequences. Results: Predicted siRNAs S1: 5′-UCAUUGAGAAAUGUUUACGCA-3′ and S2: 5′-AAAGACAUCAGCAUACUCCUG-3′ against RdRp of SARS-CoV-2 satisfied all the stringent filtering processes and showed good binding characteristics. The designed siRNAs are expected to inhibit viral replication and transcription of various coronavirus strains encompassing variants of concern and interest. Conclusion: The predicted siRNAs are expected to be potent against SARS-CoV-2, and following in vitro and in vivo validations may be considered as potential therapeutic measures.

Interest in Home Birth During the COVID-19 Pandemic: Analysis of Google Trends Data

Introduction

Nearly all (94%‐99%) pregnant persons in developed countries search for pregnancy‐related information online. The advent of the novel coronavirus disease 2019 (COVID‐19) and the associated restrictions in hospital policies may have pushed pregnant persons in the United States to consider giving birth at home to achieve their desired birth experience.

Methods

Google Trends is an open, rich source of real‐time, anonymized, relative data on disease patterns and population behavior that provides data in the form of search volume index (SVI): the search volume for a queried term relative to overall search volume for a given time frame and geographic location. The SVI is normalized to a scale of 0 to 100. After the World Health Organization declared COVID‐19 a pandemic on March 11, 2020, Google Trends was queried on February 21, 2021, for the search term home birth with location set to the United States and the time frame March 11, 2019 to February 21, 2021.

Results

The median SVI for home birth during nominally pre‐COVID‐19 baseline (weeks of March 17, 2019 to March 8, 2020) was relatively constant at 43 (range, 25‐56) and increased sharply to 77 during the week of March 15, to 86 during the week of March 22, and peaked at 100 during the week of March 29, 2020. The SVI declined substantially in the following weeks but remained significantly elevated compared with baseline levels. During the approximate 2‐year period of query, the states with the highest SVI values (≥80) were Arkansas, Washington, Montana, and Georgia.

Discussion

Interest in home birth spiked in the United States immediately after COVID‐19 was declared a pandemic and remained significantly elevated thereafter. These results have implications for caregivers and health systems to ensure safe pregnancies and childbirths through the resolution of the ongoing pandemic.

Clinical Outcome of Hospitalized COVID-19 Patients with History of Atrial Fibrillation

Background and objectives: Pre-existing atrial fibrillation (AF) is a frequent comorbidity in hospitalized patients with COVID-19; however, little is still known about its prognostic role in infected patients. The aim of our study was to evaluate whether the pre-existing AF as comorbidity would contribute to increase the risk for severe forms of COVID-19, worse prognosis, or even higher mortality. Materials and Methods: We retrospectively evaluated all consecutive COVID-19 patients admitted to the emergency department of nine Italian Hospitals from 1 March to 30 April 2020.The prevalence and the type of pre-existing AF have been collected. The correlation between the history and type of AF and the development of severe ARDS and in-hospital mortality has been evaluated. Results: In total, 467 patients (66.88 ± 14.55 years; 63% males) with COVID-19 were included in the present study. The history of AF was noticed in 122 cases (26.1%), of which 12 (2.6%) with paroxysmal, 57 (12.2%) with persistent and 53 (11.3%) with permanent AF. Among our study population, COVID-19 patients with AF history were older compared to those without AF history (71.25 ± 12.39 vs. 65.34 ± 14.95 years; p < 0.001); however, they did not show a statistically significant difference in cardiovascular comorbidities or treatments. Pre-existing AF resulted in being independently associated with an increased risk of developing severe ARDS during the hospitalization; in contrast, it did not increase the risk of in-hospital mortality. Among patients with AF history, no significant differences were detected in severe ARDS and in-hospital mortality between patients with permanent and non-permanent AF history. Conclusions: Pre-existing AF is a frequent among COVID-19 patients admitted to hospital, accounting up to 25% of cases. It is independently associated with an increased risk of severe ARDS in hospitalized COVID-19 patients; in contrast, it did not affect the risk of death. The type of pre-existing AF (permanent or non-permanent) did not impact the clinical outcome.

Research and Prospect Analysis of Sports Consumption Willingness Based on Public Health Emergencies

In 2020, the sudden outbreak of coronavirus disease 2019 (COVID-19) has had a great impact on the health and life of people all over the world, and the sports industry is facing unprecedented challenges due to its participation and strong clustering. Based on the questionnaire survey, literature analysis, and other research methods, this study introduces the stimulus-organism-response (SOR) theory, takes the sports and consumption of Kunshan citizens as the research subject, and draws lessons from the structural equation model (SEM) to build a theoretical model of sports consumption characteristics and future consumption willingness. The results of empirical analysis show that physical sports consumption has been greatly affected by the epidemic, but because people realize the importance of sports, the willingness of residents to consume sports increases, and the venue and other factors affect the ornamental and participating sports consumption willingness decreases. At the same time, the restrictive factors, such as lower educational background, increased age, and lack of time, make the sports consumption willingness of this characteristic group significantly lower than that of other citizens. This study puts forward some suggestions for relevant government departments to improve the sports consumption willingness of citizens. In order to expand the development prospect of sports industry from a long-term perspective, it can provide reference for the development of sports consumption.

Effect of Coronary Artery Disease on COVID-19-Prognosis and Risk Assessment: A Systematic Review and Meta-Analysis

Coronary artery disease (CAD) is the leading cause of death worldwide. Patients with pre-existing CAD were shown to have a more severe course of COVID-19, but this association has not been clarified. We performed a meta-analysis to determine the association between CAD and COVID-19 outcomes. We searched Scopus, Medline (PubMed), Web of Science, Embase, and Cochrane databases up to 2 November 2021. There were 62 studies with a total population of 49,286 patients included in the meta-analysis. CAD occurrence in survivor vs. non-survivor groups varied and amounted to 9.2% vs. 22.9%, respectively (OR = 0.33; 95%CI: 0.29 to 0.39; I² = 70%; p < 0.001). CAD was also associated with increased severity of COVID-19 disease and was (10.8% vs. 5.6%, respectively, for severe vs. non-severe groups (OR = 2.28; 95%CI: 1.59 to 3.27; I² = 72%; p < 0.001). The role of history of CAD in mortality and severe condition in COVID-19 presents itself as prominent-although a risk of bias in retrospective trials needs to be assessed, in case of our meta-analysis the statistically significant results when it comes to higher mortality among patients with CAD compared to non-CAD patients, a more severe condition observed in patients with CAD, and a visibly more frequent admission to intensive care unit in patients with CAD, it seems that an incidence of cardiovascular events plays a role in COVID-19 prognosis.

Influenza-Like Illness Among Personnel Responding to U.S. Quarantine of Cruise Ship Passengers Exposed to SARS-CoV-2

OBJECTIVES

Before community transmission of COVID-19 was recognized in the United States, cruise ship passengers with high risk for exposure to SARS-CoV-2 were repatriated and quarantined. We describe cases of influenza-like illness (ILI) among responders.

METHODS

We reviewed situation reports and responder illness reports to characterize ill responders, including illness onset date, symptoms, fever, diagnostic tests, potential breaches in PPE use, and return to work status.

RESULTS

Among 339 responders, nine (3%) reported ILI. No breaches in PPE were reported. Three responders with ILI were tested for both SARS-CoV-2 infection and influenza A; none tested positive for SARS-CoV-2 infection and two tested positive for influenza A.

CONCLUSIONS

Despite an outbreak of ILI among responders, none were diagnosed with COVID-19, suggesting preventive measures in place might have been sufficient to prevent responders from SARS-CoV-2 exposure.

Healthcare use and RT-PCR testing during the first wave of the COVID-19 pandemic in Japan

BACKGROUND

Rapid testing, tracing, and isolation among symptomatic patients are the standard for controlling the COVID-19. However, during spring 2020, Japan employed a RT-PCR test policy by using a guideline, which was used for the public to visit hospitals or clinics when they had mild symptoms for 4 days or longer ("4-day rule") among low-risk patients. It is unknown of patients' experience of healthcare use and testing during the period under the guideline. Thus, we investigated the healthcare visiting and testing among patients who developed cold-like symptoms during the period.

METHODS

Our survey was conducted online in September 2020 to a nationally representative sample of adults throughout Japan. We investigated the public's understanding of the guideline. In addition, we asked their experience with healthcare use and testing if they had noticed new-onset cold-like symptoms.

RESULTS

Of 2,137 people surveyed, 1,698 (79.5%) recognized the guidelines, but 422 people (19.7%) misunderstood. There were 144 (6.7% of 2,137 people) who developed cold-like symptoms, and many of them experienced difficulties in getting through telephone calls to a public health center, and 25 (17% of 144 people) visited healthcare institutions. Of these 25 symptomatic patients, 15 (60%) could not receive testing because of decisions by physicians (14 patients) or a local public health center (1 patient).

CONCLUSION

There was a low use of healthcare and testing among symptomatic patients during the first wave of the pandemic in Japan. Testing capacity should be increased to provide effective care for patients with suspected COVID-19 in Japan.

Aftermath histopathological findings of 2019 novel Coronavirus (COVID-19) pneumonia

Background

There have been several studies describing clinicoradiological features of the novel coronavirus SARS-CoV-2 infection. It seems that we still should know more about pathological features in the different stages of this infection.

Case presentation

A 77 year-old man with cough and respiratory distress was admitted to the intensive care unit.  Real-time PCR on nasopharyngeal swab was done for him and it was positive for SARS-CoV-2.He was treated with oxygen therapy, hydroxychloroquine and antibiotic therapy and was discharged from the hospital with brief improvement of clinical symptoms. However, due to persistent dyspnea, the patient was admitted to the hospital again and throracotomy and wedge biopsy were performed for about 3 months from the onset of symptoms.

Conclusion

Pathological examination revealed diffuse alveolar damage, fibroblastic hyperplasia, infiltration of inflammatory cells and hyaline membrane formation.

Negative Nasopharyngeal SARS-CoV-2 PCR Conversion in Response to Different Therapeutic Interventions

Background

The current management practices for patients with COVID-19 consist of infection prevention and supportive care. We aimed to explore the association between negative nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) clearance and different therapeutic interventions.

Methods

This study is a retrospective cohort study of 93 patients who were admitted to a tertiary hospital in Saudi Arabia with a PCR confirmed diagnosis of COVID-19. There were three intervention subgroups (group A) (n = 45), which included those who received chloroquine or hydroxychloroquine (HCQ) only (A1), those who received chloroquine or HCQ in combination with azithromycin (A2), and those who received chloroquine or HCQ in combination with antiviral drugs with or without azithromycin (A3), as well as one supportive care group (group B) (n = 48). The primary and secondary endpoints were achieving negative SARS-CoV-2 nasopharyngeal PCR samples within five and 12 days from the start of the intervention, respectively.

Results

A median time of three days (interquartile range (IQR): 2.00-6.50) is needed from the time of starting the intervention/supportive care to the first negative PCR sample. There was no statistically significant difference neither between the percentage of patients in the intervention group and the supportive care group who achieved the primary or secondary endpoint nor in the median time needed to achieve the first negative PCR sample (p > 0.05).

Conclusion

Prescribing antimalarial medications was not shown to shorten the disease course nor to accelerate the negative PCR conversion rate.

Children and Adolescents' Psychological Well-Being Became Worse in Heavily Hit Chinese Provinces during the COVID-19 Epidemic

In light of the novel coronavirus’s (COVID-19’s) threat to public health worldwide, we sought to elucidate COVID-19’s impacts on the mental health of children and adolescents in China. Through online self-report questionnaires, we aimed to discover the psychological effects of the pandemic and its associated risk factors for developing mental health symptoms in young people.

We disseminated a mental health survey through online social media, WeChat, and QQ in the five Chinese provinces with the most confirmed cases of COVID-19 during the late stage of the country-wide lockdown. We used a self-made questionnaire that queried children and adolescents aged 6 to 18 on demographic information, psychological status, and other lifestyle and COVID-related variables.

A total of 17,740 children and adolescents with valid survey data participated in the study. 10,022 (56.5%), 11,611 (65.5%), 10,697 (60.3%), 6868 (38.7%), and 6225 (35.1%) participants presented, respectively, more depressive, anxious, compulsive, inattentive, and sleep-related problems compared to before the outbreak of COVID-19. High school students reported a greater change in depression and anxiety than did middle school and primary school students. Despite the fact that very few children (0.1%) or their family members (0.1%) contracted the virus in this study, the psychological impact of the pandemic was clearly profound. Fathers’ anxiety appeared to have the strongest influence on a children’s psychological symptoms, explaining about 33% of variation in the child’s overall symptoms. Other factors only explained less than 2% of the variance in symptoms once parents’ anxiety was accounted for.

The spread of COVID-19 significantly influenced the psychological state of children and adolescents in participants’ view. It is clear that children and adolescents, particularly older adolescents, need mental health support during the pandemic. The risk factors we uncovered suggest that reducing fathers’ anxiety is particularly critical to addressing young people’s mental health disorders in this time.

Ischemic stroke associated with novel coronavirus 2019: a report of three cases

INTRODUCTION

There is limited evidence about the neurological manifestations of COVID-19 in infected patients. In this report, we describe three patients with ischemic stroke associated with COVID-19 infection.

METHODS

We report 3 cases of adult patients with ischemic stroke and novel coronavirus 2019 infection. Case 1 is an 88-year-old female with acute left hemiplegia and right peripheral facial paresis that she had a fever along with stroke symptoms. Case 2 is an 85-year-old female with left hemiplegia and drowsiness who had a weakness, asthenia, and dry cough 3 days before appearing stroke signs. Case 3 is a 55-year-old male with acute Broca's aphasia and right hemiplegia who experience fever and respiratory problems 3 days after admission.

RESULTS

The clinical symptoms of infected patients with COVID-19 have been associated with severe symptoms of ischemic stroke. Two patients were admitted to the ICU. RT-PCR of the oropharyngeal sample was positive in three cases. All patients had the involvement of large cerebral arteries.

CONCLUSION

The mechanism by which COVID-19 causes ischemic stroke is unknown but it is likely by production inflammatory cytokines or direct infection of cerebral arteries. Therefore, regarding the current situation of the COVID-19 pandemic, it is indispensable that the possible diagnosis of COVID-19 vasculopathy is considered in all ischemic strokes of unclear etiology.

Reactivation of Pulmonary Tuberculosis in a Patient With COVID-19: Case Report and Review of Literature

Given COVID-19 rise in populations with high burden of tuberculosis infection, the interplay between COVID-19 and tuberculosis reactivation needs further investigation. We report a case of a 64-year-old man who developed acute respiratory distress syndrome due to severe COVID-19 infection. He was managed with intubation, prone-position mechanical ventilation, inhaled nitric oxide, and methylprednisolone 40 mg intravenous twice daily for 5 days. He developed unexplained persistent fever and leukocytosis that failed to respond to empiric broad-spectrum antibacterial, antifungal agents, and a 3-day course of intravenous methylprednisolone 1000 mg for possible usual interstitial pneumonitis. His endotracheal aspiration samples tested positive for Mycobacterium tuberculosis, and antituberculosis regimen was started. The patient died as result of decision to withdraw life support. This report establishes the clinical picture of a tuberculosis reactivation in a COVID-19 patient. The complex interaction between COVID-19, steroids, and tuberculosis is a clinical dilemma of great significance.