Machine Learning-based Voice Assessment for the Detection of Positive and Recovered COVID-19 Patients

Many virological tests have been implemented during the Coronavirus Disease 2019 (COVID-19) pandemic for diagnostic purposes, but they appear unsuitable for screening purposes. Furthermore, current screening strategies are not accurate enough to effectively curb the spread of the disease. Therefore, the present study was conducted within a controlled clinical environment to determine eventual detectable variations in the voice of COVID-19 patients, recovered and healthy subjects, and also to determine whether machine learning-based voice assessment (MLVA) can accurately discriminate between them, thus potentially serving as a more effective mass-screening tool. Three different subpopulations were consecutively recruited: positive COVID-19 patients, recovered COVID-19 patients and healthy individuals as controls. Positive patients were recruited within 10 days from nasal swab positivity. Recovery from COVID-19 was established clinically, virologically and radiologically. Healthy individuals reported no COVID-19 symptoms and yielded negative results at serological testing. All study participants provided three trials for multiple vocal tasks (sustained vowel phonation, speech, cough). All recordings were initially divided into three different binary classifications with a feature selection, ranking and cross-validated RBF-SVM pipeline. This brough a mean accuracy of 90.24%, a mean sensitivity of 91.15%, a mean specificity of 89.13% and a mean AUC of 0.94 across all tasks and all comparisons, and outlined the sustained vowel as the most effective vocal task for COVID discrimination. Moreover, a three-way classification was carried out on an external test set comprised of 30 subjects, 10 per class, with a mean accuracy of 80% and an accuracy of 100% for the detection of positive subjects. Within this assessment, recovered individuals proved to be the most difficult class to identify, and all the misclassified subjects were declared positive; this might be related to mid and short-term vocal traces of COVID-19, even after the clinical resolution of the infection. In conclusion, MLVA may accurately discriminate between positive COVID-19 patients, recovered COVID-19 patients and healthy individuals. Further studies should test MLVA among larger populations and asymptomatic positive COVID-19 patients to validate this novel screening technology and test its potential application as a potentially more effective surveillance strategy for COVID-19.

Associations between physical activity prior to infection and COVID-19 disease severity and symptoms: results from the prospective Predi-COVID cohort study

OBJECTIVE

To investigate if the physical activity (PA) prior to infection is associated with the severity of the disease in patients positively tested for COVID-19, as well as with the most common symptoms.

DESIGN

A cross-sectional study using baseline data from a prospective, hybrid cohort study (Predi-COVID) in Luxembourg. Data were collected from May 2020 to June 2021.

SETTING

Real-life setting (at home) and hospitalised patients.

PARTICIPANTS

All volunteers aged >18 years with confirmed SARS-CoV-2 infection, as determined by reverse transcription-PCR, and having completed the PA questionnaire (n=452).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was disease severity (asymptomatic, mild illness and moderate illness). The secondary outcomes were self-reported symptoms.

RESULTS

From the 452 patients included, 216 (48%) were female, the median (IQR) age was 42 (31-51) years, 59 (13%) were classified as asymptomatic, 287 (63%) as mild illness and 106 (24%) as moderate illness. The most prevalent symptoms were fatigue (n=294; 65%), headache (n=281; 62%) and dry cough (n=241; 53%). After adjustment, the highest PA level was associated with a lower risk of moderate illness (OR 0.37; 95% CI 0.14 to 0.98, p=0.045), fatigue (OR 0.54; 95% CI 0.30 to 0.97, p=0.040), dry cough (OR 0.55; 95% CI 0.32 to 0.96, p=0.034) and chest pain (OR 0.32; 95% CI 0.14 to 0.77, p=0.010).

CONCLUSIONS

PA before COVID-19 infection was associated with a reduced risk of moderate illness severity and a reduced risk of experiencing fatigue, dry cough and chest pain, suggesting that engaging in PA may be an effective approach to minimise the severity of COVID-19.

TRIAL REGISTRATION NUMBER

NCT04380987.

Clinical features of 375 COVID-19 cases imported from Russia through the Suifenhe port and countermeasures

Background and objectives

At present, the focus of the fighting against COVID-19 in China is shifting to strictly prevent the entrance of cases from abroad and disease transmission. Therefore, it is extremely urgent to better understand the clinical features of imported cases from overseas countries, which is conductive to formulate the corresponding countermeasures. This study aimed to describe the clinical features of COVID-19 cases imported from Russia through the Suifenhe port, in order to identify baseline and clinical data associated with disease progression and present corresponding countermeasures.

Methods

All COVID-19 cases imported from Russia through the Suifenhe port were included in this retrospective study. According to the “Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (seventh edition)”, imported COVID-19 cases were divided into asymptomatic infection, mild, moderate, severe, and critical groups. Baseline and clinical data, including age, gender, comorbidities, disease severity, symptoms at onset, body temperature, white blood cell (WBC) count, lymphocyte (LYMPH) count, lymphocyte percentage (LYM%), C-reactive protein (CRP), oxygenation index (OI), and the use therapeutic modalities were obtained on admission, and then compared between groups.

Results

A total of 375 COVID-19 cases imported from Russia through Suifenhe port were included, of whom the asymptomatic infection, mild, moderate, severe, and critical groups accounted for 4.0%, 13.9%, 75.5%, 5.3%, and 1.3%, respectively. The majority of the imported COVID-19 cases were men (61.9%) with a median age of 38.72 years who had no comorbidity (87.7%). Nearly one-third of them (33.1%) were asymptomatic at onset, and common initial symptoms included fever (36.5%), cough (36.0%), pharyngeal discomfort (12.3%), expectoration (8.0%), and chest tightness (5.3%). In total, 180 (48%) and 4 (1.1%) enrolled imported cases received nasal tube oxygen inhalation therapy and high-flow oxygen absorption, respectively; the remaining patients did not undergo oxygen therapy. The values of age, body temperature, WBC, LYMPH, LYM%, CRP, and OI were 38.72 ± 10.50, 35.10 ± 7.92, 5.59 ± 1.97, 1.67 ± 0.68, 31.05 ± 10.22, 8.00 ± 14.75, and 389.03 ± 74.07, respectively. Gender, age, LYMPH, LYM%, symptoms at onset, cough, fever, other rare symptoms, and oxygen therapy showed significant differences between groups (P = 0.036, < 0.001, < 0.001, < 0.001, < 0.001, < 0.001, < 0.001, = 0.045, < 0.001, respectively).

Conclusions

Compared with domestic confirmed patients, COVID-19 patients who arrived at China from Russia through the Suifenhe port had significantly different clinical features, and the differences in gender, age, LYMPH, LYM%, symptoms at onset, cough, fever, other rare symptoms, and oxygen therapy between groups were statistically significant. Therefore, detailed and comprehensive countermeasures were developed to manage and prevent another outbreak based on these clinical features.

Clinical Features and Laboratory Examination to Identify Severe Patients with COVID-19: A Systematic Review and Meta-Analysis

BACKGROUND

With the COVID-19 epidemic breakout in China, up to 25% of diagnosed cases are considered to be severe. To effectively predict the progression of COVID-19 via patients' clinical features at an early stage, the prevalence of these clinical factors and their relationships with severe illness were assessed.

METHODS

In this study, electronic databases (PubMed, Embase, Web of Science, and Chinese database) were searched to obtain relevant studies, including information on severe patients. Publication bias analysis, sensitivity analysis, prevalence, sensitivity, specificity, likelihood ratio, diagnosis odds ratio calculation, and visualization graphics were achieved through software Review Manager 5.3, Stata 15, Meta-DiSc 1.4, and R.

RESULTS

Data of 3.547 patients from 24 studies were included in this study. The results revealed that patients with chronic respiratory system diseases (pooled positive likelihood 6.07, 95% CI: 3.12-11.82), chronic renal disease (4.79, 2.04-11.25), cardiovascular disease (3.45, 2.19-5.44), and symptoms of the onset of chest tightness (3.8, 1.44-10.05), shortness of breath (3.18, 2.24-4.51), and diarrhea (2.04, 1.38-3.04) exhibited increased probability of progressing to severe illness. C-reactive protein, ratio of neutrophils to lymphocytes, and erythrocyte sedimentation rate increased a lot in severe patients compared to nonsevere. Yet, it was found that clinical features including fever, cough, and headache, as well as some comorbidities, have little warning value.

CONCLUSIONS

The clinical features and laboratory examination could be used to estimate the process of infection in COVID-19 patients. The findings contribute to the more efficient prediction of serious illness for patients with COVID-19 to reduce mortality.

Clinical and laboratory factors associated with coronavirus disease 2019 (Covid-19): A systematic review and meta-analysis

SARS Coronavirus-2 is one of the most widespread viruses globally during the 21st century, whose severity and ability to cause severe pneumonia and death vary. We performed a comprehensive systematic review of all studies that met our standardised criteria and then extracted data on the age, symptoms, and different treatments of Covid-19 patients and the prognosis of this disease during follow-up. Cases in this study were divided according to severity and death status and meta-analysed separately using raw mean and single proportion methods. We included 171 complete studies including 62,909 confirmed cases of Covid-19, of which 148 studies were meta-analysed. Symptoms clearly emerged in an escalating manner from mild-moderate symptoms, pneumonia, severe-critical to the group of non-survivors. Hypertension (Pooled proportion (PP): 0.48 [95% Confident interval (CI): 0.35-0.61]), diabetes (PP: 0.23 [95% CI: 0.16-0.33]) and smoking (PP: 0.12 [95% CI: 0.03-0.38]) were highest regarding pre-infection comorbidities in the non-survivor group. While acute respiratory distress syndrome (PP: 0.49 [95% CI: 0.29-0.78]), (PP: 0.63 [95% CI: 0.34-0.97]) remained one of the most common complications in the severe and death group respectively. Bilateral ground-glass opacification (PP: 0.68 [95% CI: 0.59-0.75]) was the most visible radiological image. The mortality rates estimated (PP: 0.11 [95% CI: 0.06-0.19]), (PP: 0.03 [95% CI: 0.01-0.05]), and (PP: 0.01 [95% CI: 0-0.3]) in severe-critical, pneumonia and mild-moderate groups respectively. This study can serve as a high evidence guideline for different clinical presentations of Covid-19, graded from mild to severe, and for special forms like pneumonia and death groups.

Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people

BACKGROUND

Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type.

METHODS AND FINDINGS

We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%-27%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value < 34 (N = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2-7 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. The resulting model (rounds 2-7) predicted PCR positivity in round 8 with area under the curve (AUC) of 0.77. The same 7 symptoms were selected as jointly predictive of B.1.1.7 infection in round 8, although when comparing B.1.1.7 with wild type, new persistent cough and sore throat were more predictive of B.1.1.7 infection while loss or change of sense of smell was more predictive of the wild type. The main limitations of our study are (i) potential participation bias despite random sampling of named individuals from the National Health Service register and weighting designed to achieve a representative sample of the population of England and (ii) the necessary reliance on self-reported symptoms, which may be prone to recall bias and may therefore lead to biased estimates of symptom prevalence in England.

CONCLUSIONS

Where testing capacity is limited, it is important to use tests in the most efficient way possible. We identified a set of 7 symptoms that, when considered together, maximize detection of COVID-19 in the community, including infection with the B.1.1.7 lineage.

Shielding of viruses such as SARS-Cov-2 from ultraviolet radiation in particles generated by sneezing or coughing: Numerical simulations of survival fractions

SARS-CoV-2 and other microbes within aerosol particles can be partially shielded from UV radiation. The particles refract and absorb light, and thereby reduce the UV intensity at various locations within the particle. Previously, we demonstrated shielding in calculations of UV intensities within spherical approximations of SARS-CoV-2 virions within spherical particles approximating dried-to-equilibrium respiratory fluids. The purpose of this paper is to extend that work to survival fractions of virions (i.e., fractions of virions that can infect cells) within spherical particles approximating dried respiratory fluids, and to investigate the implications of these calculations for using UV light for disinfection. The particles may be on a surface or in air. Here, the survival fraction (S) of a set of individual virions illuminated with a UV fluence (F, in J/m²) is assumed described by S(kF) = exp(-kF), where k is the UV inactivation rate constant (m²/J). The average survival fraction (S_p) of the simulated virions in a group of particles is calculated using the energy absorbed by each virion in the particles. The results show that virions within particles of dried respiratory fluids can have larger S_p than do individual virions. For individual virions, and virions within 1-, 5-, and 9-µm particles illuminated (normal incidence) on a surface with 260-nm UV light, the S_p = 0.00005, 0.0155, 0.22, and 0.28, respectively, when kF = 10. The S_p decrease to <10^-7, <10^-7, 0.077, and 0.15, respectively, for kF = 100. Results also show that illuminating particles with UV beams from widely separated directions can strongly reduce the S_p. These results suggest that the size distributions and optical properties of the dried particles of virion-containing respiratory fluids are likely important to effectively designing and using UV germicidal irradiation systems for microbes in particles. The results suggest the use of reflective surfaces to increase the angles of illumination and decrease the S_p. The results suggest the need for measurements of the S_p of SARS-CoV-2 in particles having compositions and sizes relevant to the modes of disease transmission.

An ensemble learning approach to digital corona virus preliminary screening from cough sounds

This work develops a robust classifier for a COVID-19 pre-screening model from crowdsourced cough sound data. The crowdsourced cough recordings contain a variable number of coughs, with some input sound files more informative than the others. Accurate detection of COVID-19 from the sound datasets requires overcoming two main challenges (i) the variable number of coughs in each recording and (ii) the low number of COVID-positive cases compared to healthy coughs in the data. We use two open datasets of crowdsourced cough recordings and segment each cough recording into non-overlapping coughs. The segmentation enriches the original data without oversampling by splitting the original cough sound files into non-overlapping segments. Splitting the sound files enables us to increase the samples of the minority class (COVID-19) without changing the feature distribution of the COVID-19 samples resulted from applying oversampling techniques. Each cough sound segment is transformed into six image representations for further analyses. We conduct extensive experiments with shallow machine learning, Convolutional Neural Network (CNN), and pre-trained CNN models. The results of our models were compared to other recently published papers that apply machine learning to cough sound data for COVID-19 detection. Our method demonstrated a high performance using an ensemble model on the testing dataset with area under receiver operating characteristics curve = 0.77, precision = 0.80, recall = 0.71, F1 measure = 0.75, and Kappa = 0.53. The results show an improvement in the prediction accuracy of our COVID-19 pre-screening model compared to the other models.

Ear, Nose, and Throat Manifestations of COVID-19 in Children

The article reviews and analyzes the different ear, nose, and throat (ENT)-related manifestations reported in coronavirus disease 2019 (COVID-19)-positive pediatric patients (age <18 years) in peer-reviewed and published literature. We searched the PubMed database using medical subject headings and associated key words, focusing on ENT symptoms in children with COVID-19. We included relevant published and peer-reviewed articles in English and excluded case reports and articles in press. There were 1,140 children positive for COVID-19 (56% boys) in the 23 studies included in this review. Although 11% of patients were asymptomatic, the most common symptoms reported were fever (48%) and cough (37%). Nasal symptoms (stuffy nose, nasal congestion, rhinorrhea) and sore throat occurred in about 22% of all patients. Otitis, dizziness, anosmia, and ageusia are hardly reported in children with COVID-19. Although fever and cough are the most common symptoms, ENT manifestations are frequently observed in pediatric patients with COVID-19. [Pediatr Ann. 2021;50(7):e277-e281.].

The COUGHVID crowdsourcing dataset, a corpus for the study of large-scale cough analysis algorithms

Cough audio signal classification has been successfully used to diagnose a variety of respiratory conditions, and there has been significant interest in leveraging Machine Learning (ML) to provide widespread COVID-19 screening. The COUGHVID dataset provides over 25,000 crowdsourced cough recordings representing a wide range of participant ages, genders, geographic locations, and COVID-19 statuses. First, we contribute our open-sourced cough detection algorithm to the research community to assist in data robustness assessment. Second, four experienced physicians labeled more than 2,800 recordings to diagnose medical abnormalities present in the coughs, thereby contributing one of the largest expert-labeled cough datasets in existence that can be used for a plethora of cough audio classification tasks. Finally, we ensured that coughs labeled as symptomatic and COVID-19 originate from countries with high infection rates. As a result, the COUGHVID dataset contributes a wealth of cough recordings for training ML models to address the world's most urgent health crises.

Clinical, Biochemical and Molecular Evaluations of Ivermectin Mucoadhesive Nanosuspension Nasal Spray in Reducing Upper Respiratory Symptoms of Mild COVID-19

BACKGROUND

Ivermectin is an FDA-approved broad-spectrum anti-parasitic agent that has been shown to inhibit SARS-CoV-2 replication in vitro.

OBJECTIVE

We aimed to assess the therapeutic efficacy of ivermectin mucoadhesive nanosuspension intranasal spray in treatment of patients with mild COVID-19.

METHODS

This clinical trial included 114 patients diagnosed as mild COVID-19. Patients were divided randomly into two age and sex-matched groups; group A comprising 57 patients received ivermectin nanosuspension nasal spray twice daily plus the Egyptian protocol of treatment for mild COVID-19 and group B comprising 57 patients received the Egyptian protocol for mild COVID-19 only. Evaluation of the patients was performed depending on improvement of presenting manifestations, negativity of two consecutive pharyngeal swabs for the COVID-19 nucleic acid via rRT-PCR and assessments of hematological and biochemical parameters in the form of complete blood counts, C-reactive protein, serum ferritin and d-dimer which were performed at presentation and 7 days later.

RESULTS

Of the included patients confirmed with mild COVID-19, 82 were males (71.9%) and 32 females (28.1%) with mean age 45.1 ± 18.9. In group A, 54 patients (94.7%) achieved 2 consecutive negative PCR nasopharyngeal swabs in comparison to 43 patients (75.4%) in group B with P = 0.004. The durations of fever, cough, dyspnea and anosmia were significantly shorter in group A than group B, without significant difference regarding the duration of gastrointestinal symptoms. Duration taken for nasopharyngeal swab to be negative was significantly shorter in group A than in group B (8.3± 2.8 days versus 12.9 ± 4.3 days; P = 0.0001).

CONCLUSION

Local use of ivermectin mucoadhesive nanosuspension nasal spray is safe and effective in treatment of patients with mild COVID-19 with rapid viral clearance and shortening the anosmia duration.

CLINICALTRIALSGOV IDENTIFIER

NCT04716569; https://clinicaltrials.gov/ct2/show/NCT04716569.

Modeling of aerosol transmission of airborne pathogens in ICU rooms of COVID-19 patients with acute respiratory failure

The COVID-19 pandemic has generated many concerns about cross-contamination risks, particularly in hospital settings and Intensive Care Units (ICU). Virus-laden aerosols produced by infected patients can propagate throughout ventilated rooms and put medical personnel entering them at risk. Experimental results found with a schlieren optical method have shown that the air flows generated by a cough and normal breathing were modified by the oxygenation technique used, especially when using High Flow Nasal Canulae, increasing the shedding of potentially infectious airborne particles. This study also uses a 3D Computational Fluid Dynamics model based on a Lattice Boltzmann Method to simulate the air flows as well as the movement of numerous airborne particles produced by a patient's cough within an ICU room under negative pressure. The effects of different mitigation scenarii on the amount of aerosols potentially containing SARS-CoV-2 that are extracted through the ventilation system are investigated. Numerical results indicate that adequate bed orientation and additional air treatment unit positioning can increase by 40% the number of particles extracted and decrease by 25% the amount of particles deposited on surfaces 45s after shedding. This approach could help lay the grounds for a more comprehensive way to tackle contamination risks in hospitals, as the model can be seen as a proof of concept and be adapted to any room configuration.

Spontaneous coronary artery dissection in a patient with COVID-19

Supplemental Digital Content is available in the text.

Clinical characteristics, treatment, and prognosis of 74 2019 novel coronavirus disease patients in Hefei: A single-center retrospective study

Since December 2019, pneumonia caused by a novel coronavirus (SARS-CoV-2), namely 2019 novel coronavirus disease (COVID-19), has rapidly spread from Wuhan city to other cities across China. The present study was designed to describe the epidemiology, clinical characteristics, treatment, and prognosis of 74 hospitalized patients with COVID-19.Clinical data of 74 COVID-19 patients were collected to analyze the epidemiological, demographic, laboratory, radiological, and treatment data. Thirty-two patients were followed up and tested for the presence of the viral nucleic acid and by pulmonary computed tomography (CT) scan at 7 and 14 days after they were discharged.Among all COVID-19 patients, the median incubation period for patients and the median period from symptom onset to admission was all 6 days; the median length of hospitalization was 13 days. Fever symptoms were presented in 83.78% of the patients, and the second most common symptom was cough (74.32%), followed by fatigue and expectoration (27.03%). Inflammatory indicators, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of the intensive care unit (ICU) patients were significantly higher than that of the non-ICU patients (P < .05). However, 50.00% of the ICU patients had their the ratio of T helper cells to cytotoxic T cells (CD4/CD8) ratio lower than 1.1, whose proportion is much higher than that in non-ICU patients (P < .01).Compared with patients in Wuhan, COVID-19 patients in Anhui Province seemed to have milder symptoms of infection, suggesting that there may be some regional differences in the transmission of SARS-CoV-2 between different cities.

SARS-CoV-2 RNAaemia in children: An Iranian referral hospital-based study

Although severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA is generally detected in nasopharyngeal swabs, viral RNA can be found in other samples including blood. Recently, associations between SARS‐CoV‐2 RNAaemia and disease severity and mortality have been reported in adults, while no reports are available in pediatric patients with coronavirus disease 2019 (COVID‐19). The aim of this study was to evaluate the mortality, severity, clinical, and laboratory findings of SARS‐CoV‐2 RNA detection in blood in 96 pediatric patients with confirmed COVID‐19. Among all patients, 6 (6%) had SARS‐CoV‐2 RNAaemia. Out of the six patients with SARS‐CoV‐2 RNAaemia, four (67%) had a severe form of the disease, and two out of the 6 patients with SARS‐CoV‐2 RNAaemia passed away (33%). Our results show that the symptoms more commonly found in the cases of COVID‐19 in the study (fever, cough, tachypnea, and vomiting), were found at a higher percentage in the patients with SARS‐CoV‐2 RNAaemia. Creatine phosphokinase and magnesium tests showed significant differences between the positive and negative SARS‐CoV‐2 RNAaemia groups. Among all laboratory tests, magnesium and creatine phosphokinase could better predict SARS‐CoV‐2 RNAemia with area under the curve  levels of 0.808 and 0.748, respectively. In conclusion, 67% of individuals with SARS‐CoV‐2 RNAaemia showed a severe COVID‐19 and one‐third of the patients with SARS‐CoV‐2 RNAaemia passed away. Our findings suggest that magnesium and creatine phosphokinase might be considered as markers to estimate the SARS‐CoV‐2 RNAaemia.

Peering inside a cough or sneeze to explain enhanced airborne transmission under dry weather

High-fidelity simulations of coughs and sneezes that serve as virtual experiments are presented, and they offer an unprecedented opportunity to peer into the chaotic evolution of the resulting airborne droplet clouds. While larger droplets quickly fall-out of the cloud, smaller droplets evaporate rapidly. The non-volatiles remain airborne as droplet nuclei for a long time to be transported over long distances. The substantial variation observed between the different realizations has important social distancing implications, since probabilistic outlier-events do occur and may need to be taken into account when assessing the risk of contagion. Contrary to common expectations, we observe dry ambient conditions to increase by more than four times the number of airborne potentially virus-laden nuclei, as a result of reduced droplet fall-out through rapid evaporation. The simulation results are used to validate and calibrate a comprehensive multiphase theory, which is then used to predict the spread of airborne nuclei under a wide variety of ambient conditions.

Epidemiological and Clinical Characteristics of 217 Cases of COVID-19 in Jiangsu Province, China

BACKGROUND COVID-19 has become a worldwide epidemic disease and is a public health crisis. We aim to provide evidence for clinical diagnosis and assessment of severity by analyzing patients' clinical data and early laboratory results and exploring the correlation between laboratory results and clinical classification. MATERIAL AND METHODS We enrolled 283 cases of suspected and diagnosed COVID-19 from 16 hospitals in Jiangsu Province from January to April 2020. The routine laboratory blood examinations, T lymphocyte subsets, and biochemical and coagulation function among different populations were contrasted by t test and chi-square (χ²) test. RESULTS Cough, fever, and dyspnea could be helpful to diagnose COVID-19 infection (P<0.05). Patients who were older or had comorbidities tended to become severe and critical cases. Among all the patients, the most obvious abnormal laboratory results were higher neutrophil count, CRP, total bilirubin, BUN, CRE, APTT, PT, and D-dimer, and lower blood platelet and lymphocyte count. CD3⁺ T cell, CD4⁺ T cell, and CD8⁺ T cell counts gradually decreased with exacerbation of the disease (P<0.05). CONCLUSIONS Cough and fever were the most common symptom. Patients with comorbidities were in more serious condition. The detection of inflammatory indexes, coagulation function, lymphocyte subsets, and renal function can help diagnose and assess the severity of COVID-19.

Analysis of Epidemiological and Clinical Characteristics of COVID-19 in Northwest Mexico and the Relationship Between the Influenza Vaccine and the Survival of Infected Patients

The first cases of unexplained pneumonia were reported in Wuhan, China, in December of 2019. Later, a novel coronavirus (SARS-CoV-2) was identified as the causal agent of pneumonia. This virus has since spread to more than 180 countries and has been declared a pandemic by the World Health Organization. Herein, we aimed to determine the epidemiological and clinical characteristics of symptomatic patients with coronavirus disease 2019 (COVID-19) and the relationship between the influenza vaccine with a lower risk of severe COVID-19 infection in the state of Sinaloa. We collected demographic and clinical data of 4,040 patients with acute respiratory infections across Sinaloa state hospitals from February 28 to May 15, 2020. The prevalence of COVID-19 among hospitalized patients with respiratory symptoms in Sinaloa showed 45.2% of men were more affected than women (p < 0.001), and people aged 40-49 years were the most affected. The main symptoms of COVID-19 infection were cough and fever (p < 0.001), while hypertension, obesity, and type 2 diabetes were the chronic diseases associated with COVID-19 than non-COVID-19 (p < 0.003). Healthcare workers were most likely to be infected compared to other occupations (p < 0.001). The general lethality rate was 14.1%, and males >62 years were the ones who had a higher lethality rate (p < 0.001); the aforementioned chronic diseases were related to higher lethality of COVID-19 (p < 0.001). Likewise, higher lethality was seen in housewives and patient retirees/pensioners compared with other occupations (p < 0.001). Finally, we found there was a relationship between influenza vaccination and a lower risk of severe COVID-19 infection and mortality (p < 0.001). These findings showed that healthcare workers, men >62 years with chronic diseases, and retired people were most affected. Furthermore, the influenza vaccine could decrease the severeness of COVID-19 cases.

Characteristics and outcomes of patients with COVID-19 in Hainan, South China

As an international tourist center, Hainan province includes both imported and local COVID-19 cases. This study aimed to investigate the clinical characteristics and outcomes of COVID-19 patients in Hainan, China.COVID-19 patients hospitalized in Hainan affiliated Hospital of Hainan Medical University in January to March 2020 were retrospectively assessed. Routine blood tests, blood gas analyses, and computed tomography imaging were performed within 24 hours. Virus nucleic acid was detected every other day. The patients were divided into local resident and traveler groups, and differences in clinical data as well as leukocyte, lymphocyte, and neutrophil levels were analyzed.A total of 70 patients aged 51.23 ± 13.54 years were assessed, including 16 local residents and 54 travelers. Of these, 55 cases (78.6%) had fever, 47 (67.1%) had cough and sputum, and 9 (12.9%) had chest dyspnea; 60 and 10 cases were mild/common and severe/critical, respectively. Sex, basic diseases, smoking history and drinking history, Charlson Comorbidity Index, symptoms, time of onset to admission, clinical severity, white blood cell count, lymphocyte count, neutrophil count, oxygen inhalation, mechanical ventilation, glucocorticoid therapy, treatment, admission to ICU, hospital stay, and mortality were similar between the 2 groups.The warm and humid climate of Hainan does not seem to significantly affect patient features and outcomes from COVID-19. Unnecessary travel to tourist areas should be avoided.

Clinical features and viral RNA shedding of imported and local cases with COVID-19 in Wenzhou, China

ABSTRACT

Wenzhou had the highest number of confirmed novel coronavirus 2019 (COVID-19) cases outside the Hubei province. The aim of this study was to identify the difference in clinical features and viral RNA shedding between the imported and local COVID-19 cases in Wenzhou.All patients with confirmed COVID-19 admitted to Wenzhou Sixth People's Hospital, Wenzhou Central Hospital Medical Group, from January 17 to February 11, 2020, were enrolled in this study. Data was analyzed and compared for the imported and local cases with regard to epidemiological, demographic, clinical, radiological features, and laboratory findings. Outcomes for the enrolled participants were followed up until May 7, 2020.Of the 136 cases, 50 were imported from Wuhan. The median age was 45 years and 73 (53.7%) were men. The most common symptoms at onset were fever (104 [76.5%]) and cough (85[62.5%]). Pleural effusion was more common among imported cases compared to local cases. The white blood cell count, neutrophil count, lymphocyte count and platelet count of the imported cases were significantly lower than those of the local cases, while the prothrombin time was significantly longer than that of the local cases. Severe and critically ill patients accounted for 15.4% and 2.9%, respectively. The median duration of SARS-CoV-2 RNA shedding from symptom onset was 26 days (IQR 17-32.3 days) and there were no significant differences in duration of viral RNA shedding between the two groups.The study findings suggest that imported cases from Wuhan were more likely to be severe compared to the local cases in Wenzhou. However, there was no difference between imported and local cases on the viral shedding among the COVID patients.

Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

BACKGROUND

The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection.

METHODS

An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19.

RESULTS

A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28).

CONCLUSION

The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease.

TRIAL REGISTRATION

Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082 .

Clinical and laboratory findings in COVID-19 adult hospitalized patients from Alborz province / Iran: comparison of rRT-PCR positive and negative

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) was emergency turned into global public health after the first patients were detected in Wuhan, China, in December 2019. The disease rapidly expanded and led to an epidemic throughout China, followed by the rising number of cases worldwide. Given the high prevalence of COVID-19, rapid and accurate diagnostic methods are immediately needed to identify, isolate and treat the patients as soon as possible, decreasing mortality rates and the risk of public contamination by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).

METHODS

This case-control study was conducted in two hospitals in Alborz Province in Iran. All recruited cases in this study were symptomatic adults hospitalized as COVID-19 patients with compatible Computed tomographic (CT) scan findings and available rRT-PCR results. The patients were recruited in this study. The patients were categorized into positive and negative rRT-PCR groups and evaluated for symptoms, initial vital signs, comorbidity, clinical and laboratory findings. Finally, the results were assessed by SPSS software.

RESULTS

Between March 5 to April 5, 2020, 164 symptomatic COVID-19 patients were studied. In total, there were 111 rRT-PCR positive (67.6%) and 53 rRT-PCR negative patients (32.4%). In terms of statistics, the frequency of symptoms revealed no difference, except for cough (P.V:0.008), dizziness (PV: 0.048), and weakness (P.V:0.022). Among initial vital signs, PR (P.V:0.041) and O2 Saturation (PV: 0.014) were statistically different between the two groups. Evaluation of comorbidities revealed no difference except for hyperlipidemia (P.V:0.024). In the comparison of laboratory findings, only WBC count (PV: 0.001), lymphocyte count (PV: 0.001), and Hb (P.V:0.008) were statistically different between the two groups.

CONCLUSION

In case of the negative rRT-PCR result, it is necessary to take a logical approach, and we recommended that the physician decides according to clinical manifestations, laboratory findings, and positive CT results.

Hemoptysis and a Newly Formed Lung Bulla in a Case of Convalescent COVID-19 Pneumonia

Coronavirus disease 2019 (COVID-19) is a novel infectious disease affecting the general population worldwide. A fever and cough are the common clinical presentations of COVID-19. In most of these patients, computed tomography (CT) shows bilateral peripheral ground-glass opacities. We herein report a case of hemoptysis and lung bulla in the convalescent phase of COVID-19. Based on the clinical observations, alveolar destruction was likely associated with hemoptysis and bulla formation. Therefore, we suggest the follow-up of COVID-19 patients whose clinical parameters indicate alveolar damage, even after their symptoms improve.

Updated experience of a tertiary pandemic center on 533 pregnant women with COVID-19 infection: A prospective cohort study from Turkey

OBJECTIVE

To investigate the clinical course and impact of coronavirus disease 2019 (COVID-19) infection on pregnant women.

METHODS

A prospective cohort study was conducted on pregnant women with confirmed COVID-19 infection. Demographic features, clinical characteristics, and perinatal outcomes were prospectively evaluated.

RESULTS

Of the 533 cases, 161 (30.2%) had co-morbidities and 165 (30.9%) were asymptomatic. Cough (n = 178, 33.4%) and myalgia (n = 168, 31.5%) were the leading symptoms. In total, 261 patients (48.9%) received COVID-19 therapy, 509 (95.5%) had mild disease, 7 (1.3%) were admitted to the intensive care unit (ICU), and invasive mechanical ventilation was necessary in 2 (0.4%) patients. Maternal mortality was observed in 2 (0.4%) cases. Of the patients, 297 (55.7%) were hospitalized, 39 (7.3%) had suspicious radiologic imaging findings, 66 (12.4) had pregnancy complications (preterm delivery [n =22, 4.1%] and miscarriage [n =12, 2.2%] were the most common pregnancy complications), 131 births occurred, and the cesarean section rate was 66.4%. All neonates were negative for COVID-19. The rate of admission to the neonatal ICU was 9.9%. One specimen of breast milk was positive for the infection.

CONCLUSION

The course of COVID-19 was mild in the majority of cases. However, increased rates of pregnancy complications and cesarean delivery were observed.

Epidemiological and clinical features in patients with coronavirus disease 2019 outside of Wuhan, China: Special focus in asymptomatic patients

OBJECTIVES

In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan City and rapidly spread across the world. The clinical characteristics of affected patients in different regions and populations may differ. Thus, this study aimed to identify the characteristics of the disease to provide an insight about the prevention and treatment of COVID-19.

METHODS

Data on the demographic characteristics and clinical findings of the patients admitted at the First Hospital of Changsha from January 1, 2020 to February 10, 2020 were assessed.

RESULTS

In this study, there were 8 (3.8%) asymptomatic, 21 (10.0%) mild upper respiratory tract infection (URTI), and 180 (86.1%) pneumonia cases. In total, 47 (22.5%) patients resided in Wuhan, and 45 (21.5%) had recently traveled to Wuhan before disease onset. Moreover, 19 (9.1%) had contact with people from Wuhan, and 69 (33.0%) were family cluster cases. The median incubation period was approximately 6.3 (range: 1.0-20.0) days. Fever and cough were the most common initial symptoms: 99 (49.3%) patients presented with fever, without cough; 59 (29.4%) with cough, without fever; and 33 (16.4%) with both fever and cough.

CONCLUSION

The symptoms of patients with COVID-19 were relatively mild outside Wuhan, and family cluster was a remarkable epidemic characteristic. Special attention should be paid to asymptomatic patients.

Airborne dispersion of droplets during coughing: a physical model of viral transmission

The Covid-19 pandemic has focused attention on airborne transmission of viruses. Using realistic air flow simulation, we model droplet dispersion from coughing and study the transmission risk related to SARS-CoV-2. Although this model defines most airborne droplets as 8-16 µm in diameter, we infer that larger droplets of 32-40 µm in diameter may potentially be more infectious due to higher viral content. Use of face masks is therefore recommended for both personal and social protection. We found social distancing effective at reducing transmission potential across all droplet sizes. However, the presence of a human body 1 m away modifies the aerodynamics so that downstream droplet dispersion is enhanced, which has implications on safe distancing in queues. At 1 m distance, we found that an average of 0.55 viral copies is inhaled for a cough at median loading, scalable up to 340 copies at peak loading. Droplet evaporation results in significant reduction in droplet counts, but airborne transmission remains possible even under low humidity conditions.

Intermittent High-Frequency Percussive Ventilation Therapy in 3 Patients with Severe COVID-19 Pneumonia

BACKGROUND High-frequency percussive ventilation (HFPV) is a method that combines mechanical ventilation with high-frequency oscillatory ventilation. This report describes 3 cases of patients with severe COVID-19 pneumonia who received intermittent adjunctive treatment with HFPV at a single center without requiring admission to the Intensive Care Unit (ICU). CASE REPORT Case 1 was a 60-year-old woman admitted to the hospital 14 days after the onset of SARS-CoV-2 infection symptoms, and cases 2 and 3 were men aged 65 and 72 years who were admitted to the hospital 10 days after the onset of SARS-CoV-2 infection symptoms. All 3 patients presented with clinical deterioration accompanied by worsening lung lesions on computed tomography (CT) scans after 21 days from the onset of symptoms. SARS-CoV-2 infection was confirmed in all patients by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay from nasal swabs. All 3 patients had impending respiratory failure when non-invasive intermittent HFPV therapy was initiated. After therapy, the patients had significant clinical improvement and visibly decreased lung lesions on followup CT scans performed 4-6 days later. CONCLUSIONS The 3 cases described in this report showed that the use of intermittent adjunctive treatment with HFPV in patients with severe pneumonia due to infection with SARS-CoV-2 improved lung function and may have prevented clinical deterioration. However, recommendations on the use of intermittent HFPV as an adjunctive treatment in COVID-19 pneumonia requires large-scale controlled clinical studies. In the pandemic context, with a shortage of ICU beds, avoiding ICU admission by using adjunctive therapies on the ward is a useful option.

Symptom Profiles and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA, 2020

To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how long each lasted. Among 128 hospitalized patients, commonly reported symptoms included fever (84%), fatigue (83%), cough (73%), and dyspnea (72%). Among 236 nonhospitalized patients, commonly reported symptoms included fatigue (90%), fever (83%), cough (83%), and myalgia (74%). The most commonly reported initial symptoms were cough (21%-25%) and fever (20%-25%). In multivariable analysis, vomiting, dyspnea, altered mental status, dehydration, and wheezing were significantly associated with hospitalization, whereas rhinorrhea, headache, sore throat, and anosmia or ageusia were significantly associated with nonhospitalization. General symptoms and upper respiratory symptoms occurred earlier in disease, and anosmia, ageusia, lower respiratory symptoms, and gastrointestinal symptoms occurred later. Symptoms should be considered alongside other epidemiologic factors in clinical and public health decisions regarding potential COVID-19 cases.

Meningoencephalitis associated with COVID-19: a systematic review

With the growing number of COVID-19 cases in recent times. significant set of patients with extra pulmonary symptoms has been reported worldwide. Here we venture out to summarize the clinical profile, investigations, and radiological findings among patients with SARS-CoV-2-associated meningoencephalitis in the form of a systemic review. This review was carried out based on the existing PRISMA (Preferred Report for Systematic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase, and Cochrane library and Preprint servers up till 30 June 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes "SARS-COV-2," "COVID-19," and "meningoencephalitis." All peer reviewed, case-control, case report, pre print articles satisfying our inclusion criteria were involved in the study. Quantitative data was expressed in mean ± SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p < 0.05 considered to be statistically significant. A total of 61 cases were included from 25 studies after screening from databases and preprint servers, out of which 54 of them had completed investigation profile and were included in the final analysis. Clinical, laboratory findings, neuroimaging abnormalities, and EEG findings were analyzed in detail. This present review summarizes the available evidences related to the occurrence of meningoencephalitis in COVID-19.

Investigation of the protection efficacy of face shields against aerosol cough droplets

Simple plastic face shields have numerous practical advantages over regular surgical masks. In light of the spreading COVID-19 pandemic, the potential of face shields as a substitution for surgical masks was investigated. In order to determine the efficacy of the protective equipment we used a cough simulator. The protective equipment considered was placed on a manikin head that simulated human breathing. Concentration and size distribution of small particles that reached the manikin respiration pathways during the few tens of seconds following the cough event were monitored. Additionally, water sensitive papers were taped on the tested protective equipment and the manikin face. In the case of frontal exposure, for droplet diameter larger than 3 μm, the shield efficiency in blocking cough droplets was found to be comparable to that of regular surgical masks, with enhanced protection for portions of the face that the mask does not cover. Additionally, for finer particles, down to 0.3 µm diameter, a shield blocked about 10 times more fine particles than the surgical mask. When exposure from the side was considered, the performance of the shield was found to depend dramatically on its geometry. While a narrow shield allowed more droplets and aerosol to penetrate in comparison to a mask under the same configuration, a slightly wider shield significantly improved the performance. The source control potential of shields was also investigated. A shield, and alternatively, a surgical mask, were placed on the cough simulator, while the breathing simulator, situated 60 cm away in the jet direction, remained totally exposed. In both cases, no droplets or particles were found in the vicinity of the breathing simulator. Conducted experiments were limited to short time periods after expiratory events, and do not include longer time ranges associated with exposure to suspended aerosol. Thus, additional evidence regarding the risk posed by floating aerosol is needed to establish practical conclusions regarding actual transmittance reduction potential of face shields and surgical face masks.

[Epidemiology, clinical manifestations and treatment of SARS-CoV-2 infection in children]

SARS-CoV-2 infection causes COVID-19. Most infected children have asymptomatic or mild clinical manifestations. A few develop serious illness, and the case fatality rate is lower than in adults. The most frequent symptoms are fever and cough. Studies indicate that children might be less susceptible to infection than adults as summarised in this review. Despite mild manifestation, some children experience a hyper-inflammatory response to SARS-CoV-2 infection called multisystem inflammatory syndrome, similarly to Kawasaki disease. The syndrome is still very rare, and the pathogenesis remains unknown.

Coronavirus Disease 2019 (COVID-19) in pediatric emergency. Presentation and disposition

Objectives:

To examine the demographics and common presentations of pediatric coronavirus disease 2019 patients in the emergency department (ED), as well as their contact with positive COVID-19 cases, return visits, and patients’ disposition from the ED.

Methods:

A retrospective chart review of confirmed cases of COVID-19 presenting to the Pediatric ED from March 2020 until June 2020 was conducted.

Results:

Fifty-two patients were identified, with a higher frequency of male patients. Forty-four (85%) patients were discharged from the ED, and 8 (15%) required admission. Three patients were admitted to the pediatric intensive care unit and 2 died, resulting in a mortality rate of 3.8%. The most frequent presentations were fever (85%), cough (48%), and diarrhea (23%).

Conclusion:

In our study, the second most affected system after the respiratory tract was the gastrointestinal tract, which was also the system responsible for the most return visits due to diarrhea. Coronavirus disease 2019 poses clinical and operational challenges given its variable clinical presentations.

Neurological features and outcome in COVID-19: dementia can predict severe disease

The COVID-19 pandemic has infected more than 22 million people worldwide. Although much has been learned about COVID-19, we do not know much about its neurological features and their outcome. This observational study was conducted on the patients of Imam Hossein Hospital, and 361 adult patients (214 males) with confirmed diagnosis of COVID-19 from March 5, 2020 to April 3, 2020, were enrolled. Data was gathered on age, sex, comorbidities, initial symptoms, symptoms during the disease course, neurological symptoms, and outcome. The mean age of the patients was 61.90 ± 16.76 years. The most common initial symptoms were cough, fever, and dyspnea. In 21 patients (5.8%), the initial symptom was neurological. History of dementia was associated with severe COVID-19 disease (odds ratio = 1.28). During the course of the disease, 186 patients (51.52%) had at least one neurological symptom, the most common being headache (109 [30.2%]), followed by anosmia/ageusia (69, [19.1%]), and dizziness (54, [15%]). Also, 31 patients had neurological complications (8.58%). Anosmia, ageusia, dizziness, and headache were associated with favorable outcome (P < 0.001), while altered mental status and hemiparesis were associated with poor outcome. The mortality rate of patients who had neurological complications was more than twice than that of patients without neurological complication (P = 0.008). Almost half of the patients experienced at least one neurological symptom, which may be the initial presentation of COVID-19. Dementia appears to be associated with severe COVID-19. Mortality was higher in patients with neurological complications, and these patients needed more intensive care.

A descriptive analysis of clinical characteristics of COVID-19 among healthcare workers in a district specialist hospital

INTRODUCTION

COVID-19 is a highly transmissible respiratory virus that has affected millions of people worldwide in the span of months. The burden of disease among healthcare workers (HCW) has not been well studied despite reports of infectivity and transmission around the world. Two HCW in Hospital Teluk Intan (HTI) contracted COVID-19 while attending a social event. They were in close proximity with colleagues upon returning to work, resulting in the spread of infection among other HCW in HTI.

OBJECTIVE

The objectives of this paper are to gain a better understanding of the key presenting symptoms of COVID-19 in HCWs in a district specialist hospital, to establish the proportion of symptomatic COVID-19 cases among HCWs and its severity and to determine the time taken from onset of symptoms or perceived exposure to diagnostic testing.

METHODOLOGY

This is a retrospective descriptive analysis of clinical characteristics of subjects infected with COVID-19 among HCW in HTI. Their demography and clinical characteristics were recorded.

RESULTS

There were 47 HCW in HTI who tested positive for COVID-19. The mean age of the patients was 37.5 years old. 7 patients (15.2%) had at least more than one comorbidity. Average duration of time from perceived close contact to onset of symptom was 4.5 days, while the mean duration of time from symptoms to first positive RT-PCR result was 3.4 days. Six patients (13.0%) were asymptomatic throughout, whereas 40 (87.0%) had at least one symptom prior to hospitalization. The most commonly reported symptoms were fever (65.2%), sore throat (39.1%) and cough (37.0%). In terms of severity of symptoms, the majority of patients experienced mild symptoms (Group 2, 52.2%). Two patients (4.3%) with multiple comorbidities had severe disease requiring ICU admission and mechanical ventilation. There were no mortalities, and the longest staying patient was hospitalized for 18 days. The high rates of infectivity among HCW in HTI can be attributed to working in close proximity while in the asymptomatic incubation phase, while no HCW directly involved in the care of COVID-19 positive patients were tested positive.

CONCLUSION

We report that HCW share similar clinical characteristics of COVID-19 infection as those of non HCW patients in earlier studies. The infection can spread rapidly within healthcare settings via close contacts among infected HCWs. As such, we advocate distancing when working and usage of personal protective equipment when treating patients with respiratory illness to reduce transmission of COVID-19.

Sociodemographic and clinical characteristics of the first cohort of COVID-19 recoveries at two national treatment centres in Accra, Ghana

INTRODUCTION

COVID-19 is a new disease, knowledge on the mode of transmission and clinical features are still evolving, new tests are being developed with inherent challenges regarding interpretation of tests results. There is generally, a gap in knowledge on the virus globally as the pandemic evolves and in Ghana, there is dearth of information and documentation on the clinical characteristics of the virus. With these in mind, we set out to profile the initial cohort of COVID-19 patients who recovered in Ghana.

METHODS

We reviewed clinical records of all confirmed cases of COVID-19 who had recovered from the two main treatment centres in Accra, Ghana. Descriptive data analysis was employed and presented in simple and relational tables. Independent t-test and ANOVA were used to determine differences in the mean age of the sexes and the number of days taken for the first and second retesting to be done per selected patient characteristics.

RESULTS

Of the 146 records reviewed, 54% were male; mean age of patients was 41.9 ± 17.5 years, nearly half were asymptomatic, with 9% being severely ill. The commonest presenting symptoms were cough (22.6%), headache (13%) and sore throat (11%) while the commonest co-morbidities were hypertension (25.3%), diabetes mellitus (14%) and heart disease (3.4%).

CONCLUSION

COVID-19 affected more males than females; nearly half of those infected were asymptomatic. Cough, headache and sore throat were the commonest symptoms and mean duration from case confirmation to full recovery was 19 days. Further research is required as pandemic evolves.

FUNDING

None declared.

Clinical features of COVID-19 in Ghana: symptomatology, illness severity and comorbid non-communicable diseases

OBJECTIVE

This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana.

METHODS

Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16.

RESULTS

Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD's count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)].

CONCLUSION

The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients.

FUNDING

None declared.

Epidemiological and clinical characteristics of 2019 novel coronavirus disease (COVID-19) in Jilin, China: A descriptive study

Coronavirus diseases 2019 (COVID-19) has become a global pandemic. To add to the scarce information on this disease, here, we investigated the epidemiological and clinical characteristics of 93 hospitalized patients with COVID-19 in Jilin, China from January 22 to March 15, 2020.We retrospectively investigated the demographic information, recent exposure history, clinical symptoms or signs, comorbidity, chest computed tomographic (CT) scan or X-ray results, laboratory test results, diagnostic classification, treatment, length of hospitalization, complications, and outcomes.Of the 93 patients, 54 were male and 39 female. More than half of these patients had a history of exposure to infected patients. The mean incubation period was 10.4 days in 87 patients, where the data was available. The 5 most common symptoms of illness onset were fever, cough, expectoration, fatigue, and dyspnea. One patient was asymptomatic. The imaging results were abnormal in majority of the patients. Almost one-third of the patients had lymphopenia. All patients received antiviral therapy, 84 patients were treated with antibiotics and 54 received different doses of the hormone for methylprednisolone. In addition, 72 patients used traditional Chinese medicine. Oxygen therapy, high nasal flow oxygen, non-invasive ventilator, invasive ventilator and extracorporeal membrane oxygenation (ECMO) were used symptomatically in different patients. Except 1 patient who died during treatment, all others were discharged.The average incubation time is prolonged in the present analysis, as compared to that in other reports. A few patients symptoms improved but CT exacerbated. Therefore, we suggest that close follow-up observation is still required after discharge.

Clinical and radiographic characteristics, management and short-term outcomes of patients with COVID-19 in Wenzhou, China

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an emerging viral disease. Here, we report the clinical features, management, and short-term outcomes of COVID-19 patients in Wenzhou, China, an area outside Wuhan.

METHODS

Patients admitted to the Infectious Diseases Department of Ruian People's Hospital in Wenzhou, from January 21 to February 7, 2020, were recruited. Medical data on epidemiological history, demographics, clinical characteristics, laboratory tests, chest computerized tomography (CT) examination, treatment, and short-term outcomes were retrospectively reviewed. Blood biochemistry and routine tests were examined using standard methods and automatic machines. CT examination was performed several times during hospitalization as necessary.

RESULTS

A total of 67 confirmed COVID-19 cases were diagnosed; 64 (95.4%) were common cases and three (4.5%) were severe cases. The most common symptoms at admission were fever (86.6%), cough (77.6%), productive cough (52.2%), chest distress (17.9%), and sore throat (11.9%), followed by diarrhea (7.4%), headache (7.4%), shortness of breath (6.0%), dizziness (4.5%), muscular soreness (4.5%), and running nose (4.5%). Thirty patients (47.8%) had increased C-reactive protein levels. The CT radiographs at admission showed abnormal findings in 54 (80.6%) patients. The patients were treated mainly by oxygen therapy and antiviral drugs. By March 3, 2020, all 67 patients completely recovered and had negative nucleic acid tests. The patients were discharged from the hospital and transferred to a medical observation isolation center for further observation.

CONCLUSION

Cases of COVID-19 in Wenzhou are milder and have a better prognosis, compared to those in Wuhan. Timely and appropriate screening, diagnosis, and treatment are the key to achieve good outcomes.

Serum Protein Profiling Reveals a Landscape of Inflammation and Immune Signaling in Early-stage COVID-19 Infection

Coronavirus disease 2019 (COVID-19) is a highly contagious infection and threating the human lives in the world. The elevation of cytokines in blood is crucial to induce cytokine storm and immunosuppression in the transition of severity in COVID-19 patients. However, the comprehensive changes of serum proteins in COVID-19 patients throughout the SARS-CoV-2 infection is unknown. In this work, we developed a high-density antibody microarray and performed an in-depth proteomics analysis of serum samples collected from early COVID-19 (n = 15) and influenza (n = 13) patients. We identified a large set of differentially expressed proteins (n = 132) that participate in a landscape of inflammation and immune signaling related to the SARS-CoV-2 infection. Furthermore, the significant correlations of neutrophil and lymphocyte with the CCL2 and CXCL10 mediated cytokine signaling pathways was identified. These information are valuable for the understanding of COVID-19 pathogenesis, identification of biomarkers and development of the optimal anti-inflammation therapy.

Modeling the load of SARS-CoV-2 virus in human expelled particles during coughing and speaking

Particle size is an essential factor when considering the fate and transport of virus-containing droplets expelled by human, because it determines the deposition pattern in the human respiratory system and the evolution of droplets by evaporation and gravitational settling. However, the evolution of virus-containing droplets and the size-dependent viral load have not been studied in detail. The lack of this information leads to uncertainties in understanding the airborne transmission of respiratory diseases, such as the COVID-19. In this study, through a set of differential equations describing the evolution of respiratory droplets and by using the SARS-CoV-2 virus as an example, we investigated the distribution of airborne virus in human expelled particles from coughing and speaking. More specifically, by calculating the vertical distances traveled by the respiratory droplets, we examined the number of viruses that can remain airborne and the size of particles carrying these airborne viruses after different elapsed times. From a single cough, a person with a high viral load in respiratory fluid (2.35 × 109 copies per ml) may generate as many as 1.23 × 105 copies of viruses that can remain airborne after 10 seconds, compared to 386 copies of a normal patient (7.00 × 106 copies per ml). Masking, however, can effectively block around 94% of the viruses that may otherwise remain airborne after 10 seconds. Our study found that no clear size boundary exists between particles that can settle and can remain airborne. The results from this study challenge the conventional understanding of disease transmission routes through airborne and droplet mechanisms. We suggest that a complete understanding of the respiratory droplet evolution is essential and needed to identify the transmission mechanisms of respiratory diseases.

Clinical characteristics, laboratory findings, radiographic signs and outcomes of 61,742 patients with confirmed COVID-19 infection: A systematic review and meta-analysis

INTRODUCTION

In the current time where we face a COVID-19 pandemic, there is no vaccine or effective treatment at this time. Therefore, the prevention of COVID-19 and the rapid diagnosis of infected patients is crucial.

METHOD

We searched all relevant literature published up to February 28, 2020. We used Random-effect models to analyze the appropriateness of the pooled results.

RESULT

Eighty studies were included in the meta-analysis, including 61,742 patients with confirmed COVID-19 infection. 62.5% (95% CI 54.5-79, p < 0.001) of patients had a history of recent travel endemic area or contact with them. The most common symptoms among COVID-19 infected patients were fever 87% (95% CI 73-93, p < 0.001), and cough 68% (95% CI 55.5-74, p < 0.001)), respectively. The laboratory analysis showed that thrombocytosis was present in 61% (95% CI 41-78, p < 0.001) CRP was elevated in 79% (95% CI 65-91, p < 0.001), and lymphopenia in 57.5% (95% CI 42-79, p < 0.001). The most common radiographic signs were bilateral involvement in 81% (95% CI 62.5-87, p < 0.001), consolidation in 73.5% (95% CI 50.5-91, p < 0.001), and ground-glass opacity 73.5% (95% CI 40-90, p < 0.001) of patients. Case fatality rate (CFR) in <15 years old was 0.6%, in >50 years old was 39.5%, and in all range group was 6%.

CONCLUSIONS

Fever and cough are the most common symptoms of COVID-19 infection in the literature published to date. Thombocytosis, lymphopenia, and increased CRP were common lab findings although most patients included in the overall analysis did not have laboratory values reported. Among Chinese patients with COVID-19, rates of hospitalization, critical condition, and hospitalization were high in this study, but these findings may be biased by reporting only confirmed cases.

Clinical characteristics of 194 cases of COVID-19 in Huanggang and Taian, China

PURPOSE

We aimed to report the clinical characteristics of 194 cases coronavirus disease-19 (COVID-19) in Huanggang, Hubei and Taian, Shandong.

METHODS

We retrospectively investigated the clinical, laboratory characteristics and CT imaging of confirmed cases of COVID-19 from January 22 to February 28, 2020 in Huanggang Central Hospital and The Second Affiliated Hospital of Shandong First Medical University. Real time PCR was used to detect the new coronavirus in respiratory samples. Immunohistochemical staining was used to detect the expressions of ACE2 in tissues.

RESULTS

Among the 194 patients infected with COVID-19, 108 patients were male, with a median age of 48.3 years. The average preclinical period was 7.44 day. Except for 37 severe or critically ill patients, the rest of the 157 patients exhibited mild or moderate symptoms. 190 (97.94%) patients were confirmed during the three times nucleic acid test. The main clinical symptom of the patients were fever, sore throat and cough, which accounted for 146 cases (75.26%), 98 (50.52%) and 86 cases (44.33%), respectively. 30 patients (15.46%) showed liver dysfunction. Imaging examination showed that 141 patients (72.68%) showed abnormal density shadow, while 53 cases (27.32%) had no obvious abnormality in the parenchyma of both lungs. Up to now, 109 cases have been discharged from the hospital, and 9 patients died. The ACE2 expression levels were up-regulated in patients of severe type and critically ill type.

CONCLUSION

Clinical symptoms, laboratory tests and CT imaging should be combined for comprehensive analysis to diagnose COVID-19. ACE2 may be the receptor of COVID-19.

Efficacy of masks and face coverings in controlling outward aerosol particle emission from expiratory activities

The COVID-19 pandemic triggered a surge in demand for facemasks to protect against disease transmission. In response to shortages, many public health authorities have recommended homemade masks as acceptable alternatives to surgical masks and N95 respirators. Although mask wearing is intended, in part, to protect others from exhaled, virus-containing particles, few studies have examined particle emission by mask-wearers into the surrounding air. Here, we measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators, even without fit-testing, reduce the outward particle emission rates by 90% and 74% on average during speaking and coughing, respectively, compared to wearing no mask, corroborating their effectiveness at reducing outward emission. These masks similarly decreased the outward particle emission of a coughing superemitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. In contrast, shedding of non-expiratory micron-scale particulates from friable cellulosic fibers in homemade cotton-fabric masks confounded explicit determination of their efficacy at reducing expiratory particle emission. Audio analysis of the speech and coughing intensity confirmed that people speak more loudly, but do not cough more loudly, when wearing a mask. Further work is needed to establish the efficacy of cloth masks at blocking expiratory particles for speech and coughing at varied intensity and to assess whether virus-contaminated fabrics can generate aerosolized fomites, but the results strongly corroborate the efficacy of medical-grade masks and highlight the importance of regular washing of homemade masks.

Epidemiological surveillance of common respiratory viruses in patients with suspected COVID-19 in Southwest China

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the peak season of common respiratory viral infections. However, the clinical symptoms of most SARS-CoV-2 infected patients are not significantly different from those of common respiratory viral infections. Therefore, knowing the epidemiological patterns of common respiratory viruses may be valuable to improve the diagnostic and therapeutic efficacy of patients with suspected COVID-19, especially in Southwest China (a mild epidemic area).

METHODS

A total of 2188 patients with clinically suspected of COVID-19 in Southwest China were recruited from January 21 to February 29, 2020. Nasopharyngeal swabs, throat swabs and sputum specimens were collected to detect SARS-CoV-2 by using real-time reverse transcription-polymerase chain reaction (RT-PCR) and other 12 viruses via PCR fragment analysis combined with capillary electrophoresis. Clinical characteristics and laboratory test findings were acquired from electronic medical records. All data were analyzed to unravel the epidemiological patterns.

RESULTS

Only 1.1% (24/2188) patients with suspected COVID-19 were eventually confirmed to have SARS-CoV-2 infection, and the most frequently observed symptoms were fever (75.0%, 18/24) and cough (20.8%, 5/24). The overall detection rate of other respiratory pathogens was 10.3% (226/2188). Among them, human rhinovirus (3.2%, 71/2188), human parainfluenza viruses (1.6%, 35/2188), influenza B virus (1.2%, 26/2188) and mycoplasma pneumonia (1.2%, 26/2188) were the predominantly detected pathogens in this study. Moreover, the co-infection was observed in 22 specimens. Notably, one COVID-19 case had a coexisting infection with human parainfluenza virus (4.2%, 1/24) and bocavirus was the most common virus tending to occur in co-infection with other respiratory pathogens.

CONCLUSIONS

This study reveals the epidemiological features of common respiratory viruses and their clinical impact during the ongoing outbreak of COVID-19 in a mild epidemic area. The findings highlight the importance of understanding the transmission patterns of the common respiratory virus in COVID-19 regions, which can provide information support for the development of appropriate treatment plans and health policies, while eliminating unnecessary fear and tension.

Clinical and Epidemiological Features of 46 Children <1 Year Old With Coronavirus Disease 2019 in Wuhan, China: A Descriptive Study

The number of coronavirus disease 2019 (COVID-19) cases has exceeded 10 million. However, little is known about the epidemiology and clinical characteristics of COVID-19 infants. We collected medical information of 46 confirmed patients (<1 year old) and retrospectively analyzed epidemiological history, clinical symptoms, and laboratory test results. The median age was 5 (interquartile range, 2-7) months. Sixteen cases had fever and 27 cases had cough. Moderate disease was present in 40 cases and cardiac injury occurred in 38 cases, following by liver dysfunction in 20 cases and lymphocytosis in no cases. Of all infant patients, 2 received invasive mechanical ventilation and 1 died with multiple organ dysfunction syndrome.

Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis

INTRODUCTION

COVID-19 is an emerging infectious disease. The study about features of this infection could be very helpful in better knowledge about this infectious disease. The current systematic review and meta-analysis were aimed to estimate the prevalence of clinical symptoms of COVID-19 in a systematic review and meta-analysis.

METHODS

A systematic review using Medline/PubMed, Scopus, and Google scholar has been conducted. In the current systematic review and meta-analysis, the articles published in the period January 1, 2020, to April 2, 2020, written in English and reporting clinical symptoms of COVID-19 was reviewed. To assess, the presence of heterogeneity, the Cochran's Q statistic, the I2 index, and the tau-squared test were used. Because of significant heterogeneity between the studies the random-effects model with 95% CI was used to calculate the pooled estimation of each symptom prevalence.

RESULTS

The most common symptoms in COVID-19 patients include: Fever 81.2% (95% CI: 77.9-84.4); Cough: 58.5% (95% CI: 54.2-62.8); Fatigue 38.5% (95% CI: 30.6-45.3); Dyspnea: 26.1% (95% CI: 20.4-31.8); and the Sputum: 25.8% (95% CI: 21.1-30.4). Based on the meta-regression results, the sample size used in different studies did not have a significant effect on the final estimate value (P > 0.05).

CONCLUSIONS

Considering the main symptoms of COVID-19 such as Fever, Cough, Fatigue, and Dyspnea can have a key role in early detection of this disease and prevent the transmission of the disease to other people.

Preliminary CT findings of coronavirus disease 2019 (COVID-19)

OBJECTIVES

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This paper aims to examine the CT imaging characteristics of COVID-19.

METHODS

We evaluated CT images obtained between 10 January 2019 and 16 February 2020 at Taihe Hospital. Scans were conducted 2-6 times per patient and the re-testing interval was 2-7 days. Ninety-five patients with positive SARS-CoV-2 nucleic acid test results were included in this study and we retrospectively analysed their CT imaging characteristics.

RESULTS

Ninety-five patients underwent 2-3 SARS-CoV-2 nucleic acid tests and received a definitive diagnosis of COVID-19. Fifty-three were male and 42 were female, and their mean age was 42 ± 12 years (range: 10 months to 81 years). Sixty-nine patients (72.6%) experienced fever, fatigue, and dry cough, while 15 (15.8%) had poor appetite and fatigue, and 11 (11.6%) had a dry cough and no fever. On CT imaging, early stage patients (n = 53, 55.8%) showed peripheral subpleural ground-glass opacities; these were mainly local patches (22/53, 41.5%), while some lesions were accompanied by interlobular septal thickening. Thirty-four (35.8%) patients were classified in the 'progression stage' based on CT imaging; these patients typically showed lesions in multiple lung segments and lobes (21/34，61.8%), and an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows(30.5%). Two patients (2.1%) showed a severe presentation on CT. These showed diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening and air bronchograms, entire lung involvement with a "white lung" presentation, and mild pleural effusion. Six patients in remission (6.3%), visible lesion absorption, fibrotic lesions. Based on clinical signs, 71 (74.7%), 22 (23.2%), and 2 (2.1%) patients had mild or moderate, severe, and critical disease, respectively. Within the follow-up period, 93 patients recovered and were discharged, including the 53 early stage patients and 34 progression stage patients. The length of hospitalisation was 7-28 days (mean: 10 ± 3.5 days). On discharge, lesions were significantly reduced in area and had in many cases completely disappeared, while slight pulmonary fibrosis was present in some patients. One severe stage patient was still hospitalised at the end of the follow-up period and the other severe stage patient died. The overall mortality rate was 1.05%.

CONCLUSIONS

Understanding the CT imaging characteristics of COVID-19 is important for early lesion detection, determining the nature of lesions, and assessing disease severity.

Dynamic changes in clinical and CT characteristics of COVID-19 cases with different exposure histories: a retrospective study

BACKGROUND

To assess the dynamic changes in clinical and CT characteristics of COVID-19 patients with different epidemiology histories.

METHODS

Fifty-three discharged COVID-19 patients were enrolled at Beijing YouAn Hospital, Capital Medical University, between January 21 and March 10, 2020. Spearman correlation analysis was performed between CT scores and laboratory indicators. Patients were divided into the Wuhan group (lived in or with travel to Wuhan, numbering 30 cases) and non-Wuhan group (close contacts or unknown exposure, totaling 23 cases). The CT and laboratory findings were compared between and within groups during the clinical process.

RESULTS

Fever (88.7%), cough (64.2%), fatigue (34%), and abnormal laboratory indicators, including lymphopenia, reduced albumin, albumin/globulin (A/G), and elevated C-reactive protein (CRP), were mainly observed. Subpleural ground-glass opacities (86.8%) were usually detected at admission. The CT scores were highly correlated with lymphocytes, CRP, albumin, and A/G at initial and follow-ups (all p < 0.05). Four days after admission, most patients (66.7% Wuhan, 47.8% non-Wuhan) showed progression, and the CT scores of Wuhan significantly increased (p = 0.015). Eight days after admission, the vast majority of patients (69.2% Wuhan, 100% non-Wuhan, p = 0.006) presented improvement, and the CT scores of non-Wuhan were significantly lower than Wuhan (p = 0.006). Pneumonia was completely absorbed in most patients 2-4 weeks after discharge.

CONCLUSIONS

CT plays a crucial role in the early diagnosis and monitoring of changes in COVID-19. Lymphocytes, CRP, albumin, and A/G are expected to predict disease severity and prognosis. Viral pathogenicity in non-endemic areas may be weaker than core-infected areas. In most patients, lung lesions can disappear around 4 weeks after discharge.