This research aimed at investigating the psychological impact of national quarantine in Italy, and the psychosocial factors that are may influence this impact. A convenience sample of 1569 people living in Italy responded to an online survey using virtual snowball sampling. The questionnaire included measures of mental health symptoms, well-being, worry about the epidemic of COVID-19, likelihood of infection, coping efficacy, trust in the institutional response to the epidemic of COVID-19, financial loss, perceived house size, and media exposure to COVID-19 outbreak. Gender (women), lower age, occupational status (employed), lower media exposure, higher worry, lower coping efficacy, lower trust in institutions, and negative attitudes toward quarantine measures predicted mental health symptoms. In addition, results showed that gender (men), higher age, socioeconomic status, occupational status (unemployed), higher coping efficacy and trust in institutions, and positive attitudes toward quarantine measures predicted well-being. The estimated prevalence of common mental disorders was 31.7% among men and 52.3% among women. The scores on well-being were significantly lower in the current study than in a previous validation study. The results of the study provided both theory and practical implications in understanding mental health and its psychosocial predictors during national quarantine.

Universal face mask use was recommended owing to the growing pandemic of the coronavirus disease (COVID-19). However, little is known about the public's compliance with mask-wearing behaviours. To evaluate the public's mask-wearing behaviours in the context of COVID-19. Cross-sectional study. Online survey from 6 April 2020 to 5 May 2020 in China. This study included 10,165 persons who lived in China, understood Chinese, and were not health care providers. Descriptive statistics were used to assess the public's mask-wearing behaviours. A binary logistic regression analysis was performed to identify the risk factors affecting the mask-wearing behaviours. Nearly all (99%) people wore a mask during the covid-19 pandemic, with most (73.3%) demonstrating good compliance with face mask use. However, 41.8% of the participants seldom cleaned their hands before putting on a face mask, and more than half (55.3%, 62.1%) of those who touched (n=8108, 79.8%) or adjusted (n=9356, 92.0%) their mask while using it failed to consistently wash their hands afterward. When removing a used mask, 7.6% of the participants discarded it into a garbage bin without a lid and 22.5% discarded it into a garbage bin in their reach regardless of presence of a lid. Participants reported wearing disposable medical masks (93.8%), followed by N95 respirators (26.2%), and cloth face masks (8.5%). Some participants wore multiple masks simultaneously (occasionally 26.5%, often 2.1%, always 1.5%). A total of 5,981 (58.8%) participants reported reusing disposable masks, with nearly two thirds (n=3923, 65.6%) indicating they would hang the used masks in well-ventilated places. More than one-third (37.6%) of the respondents did not replace mask when it had been used for more than 8 hours. Exposure to instructions on face mask use was the strongest predictor of good compliance (odds ratio=4.13, 95% confidential interval= 3.60-4.75, p=0.000). Other factors included specific situations, location, and gender. The influence of age needs further investigation. Most participants (76.4%) accessed information mainly via social media platforms. Nearly all people wore face mask and most of them used it properly during the COVID-19 pandemic. Hand hygiene before and during mask-wearing, choosing an appropriate type of face mask, reusing disposal face mask, and disposing of used face masks should be particularly emphasized in future evidence dissemination or behaviour-change interventions. Information on social media platforms for evidence dissemination and behaviour change may benefit the public the most, but this initiative requires further research to investigate its effectiveness.

National Institute for Health and Care Excellence (NICE) endorsed clinical frailty scale (CFS) to help with decision-making. However, this recommendation lacks an evidence basis and is controversial. This meta-analysis aims to quantify the dose-response relationship between CFS and mortality in COVID-19 patients, with a goal of supplementing the evidence of its use. We performed a systematic literature search from several electronic databases up until 8 September 2020. We searched for studies investigating COVID-19 patients and reported both (1) CFS and its distribution (2) CFS and its association with mortality. The outcome of interest was mortality, defined as clinically validated death or non-survivor. The odds ratio (ORs) will be reported per 1% increase in CFS. The potential for a non-linear relationship based on ORs of each quantitative CFS was examined using restricted cubic splines with a three-knots model. There were a total of 3817 patients from seven studies. Mean age was 80.3 (SD 8.2), and 53% (48-58%) were males. The pooled prevalence for CFS 1-3 was 34% (32-36%), CFS 4-6 was 42% (40-45%), and CFS 7-9 was 23% (21-25%). Each 1-point increase in CFS was associated with 12% increase in mortality (OR 1.12 (1.04, 1.20), p = 0.003; I This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.

The aims of this meta-analysis were to assess: 1) the prevalence of coronavirus disease 2019 (COVID-19) in hip fracture patients; 2) the associated mortality rate and risk associated with COVID-19; 3) the patient demographics associated with COVID-19; 4) time of diagnosis; and 5) length of follow-up after diagnosis of COVID-19. Searches of PubMed, Medline, and Google Scholar were performed in October 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms included "hip", "fracture", and "COVID-19". The criteria for inclusion were published clinical articles reporting the mortality rate associated with COVID-19 in hip fracture patients. In total, 53 articles were identified and following full text screening 28 articles satisfied the inclusion criteria. A total of 28 studies reported the mortality of COVID-19-positive patients, of which 21 studies reported the prevalence of COVID-19-positive patients and compared the mortality rate to COVID-19-negative patients. The prevalence of COVID-19 was 13% (95% confidence interval (CI) 11% to 16%) and was associated with a crude mortality rate of 35% (95% CI 32% to 39%), which was a significantly increased risk compared to those patients without COVID-19 (odds ratio (OR) 7.11, 95% CI 5.04 to 10.04; p < 0.001). COVID-19-positive patients were more likely to be male (OR 1.51, 95% CI 1.16 to 1.96; p = 0.002). The duration of follow-up was reported in 20 (71.4%) studies. A total of 17 studies reported whether a patient presented with COVID-19 (n = 108 patients, 35.1%) or developed COVID-19 following admission (n = 200, 64.9%), of which six studies reported a mean time to diagnosis of post-admission COVID-19 at 15 days (2 to 25). The prevalence of COVID-19 was 13%, of which approximately one-third of patients were diagnosed on admission, and was associated with male sex. COVID-19-positive patients had a crude mortality rate of 35%, being seven times greater than those without COVID-19. Due to the heterogenicity of the reported data minimum reporting standards of outcomes associated with COVID-19 are suggested. Cite this article:

COVID-19 is a highly contagious disease that has easily spread worldwide. Outpatient maintenance hemodialysis seems to entail an increased risk of contagion, and previous reports inform of increased mortality among this population. We retrospectively analyzed clinical and laboratory parameters, outcomes, and management once discharged of CKD-5D patients infected with SARS-CoV-2 from our health area. Out of the 429 CKD-5D population, 36 were diagnosed with SARS-CoV-2 infection (8%): 34 on in-center hemodialysis and 2 on peritoneal dialysis. Five were asymptomatic. The most common symptom was fever (70%), followed by dyspnea and cough. History of cardiovascular disease and elevation of LDH and C-reactive protein during admission were associated with higher mortality. Thirteen patients died (36%), 8 patients were admitted to an ICU, and survival was low (38%) among the latter. The mean time to death was 12 days. Most discharged patients got negative rRT-PCR in nasopharyngeal swabs within 26 days of diagnosis. However, there is a portion of cured patients that continue to have positive results even more than 2 months after the initial presentation. Patients on dialysis have an increased mortality risk if infected with SARS-CoV-2. Preventive measures have proven useful. Thus, proper ones, such as universal screening of the population and isolation when required, need to be generalized. Better de-isolation criteria are necessary to ensure an appropriate use of public health resources.

We examine the differential effect of gender, marital status, ethnicity, religion, education and employment status on mental health indicators (successful coping, stress & self-esteem) during COVID-19 lockdown in Nigeria. Applying a cross sectional approach, we administered an anonymised online questionnaire to select 353 individuals (

Ecuador is among the worst-hit countries in the world by the COVID-19 pandemic. In terms of confirmed deaths per million inhabitants, as of October 22, Ecuador ranks fourth in the Americas and ninth worldwide according to data from the World Health Organization. In this report we estimate excess deaths due to any cause in Ecuador since the start of the lockdown measures on March 17, 2020 until October 22, 2020. Estimates of excess deaths were calculated as the difference between the number of observed deaths from all causes and estimates of expected deaths from all causes. Expected deaths were estimated for the period March 17 to October 22, 2020 from forecasts of an ARIMA model of order (3,0,1) with drift which was applied to daily mortality data for the period January 1, 2014 to March 16, 2020. The number of all-cause excess deaths in Ecuador was estimated to be 36,922 (95% bootstrap confidence interval: 32,314-42,696) during the study period. The peak in all-cause excess mortality in Ecuador may have occurred on April 4, 2020, with 909 excess deaths. Our results suggest that the real impact of the pandemic in Ecuador was much worse than indicated by reports from national institutions. Estimates of excess mortality might provide a better approximation of the true COVID-19 death toll. These estimates might capture not only deaths directly attributable to the COVID-19 pandemic but also deaths from other diseases that resulted from indirect effects of the pandemic.

The on-going global pandemic of coronavirus disease 2019 (COVID-19) caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been underway for about 11 months. Through November 20, 2020, 51 detection kits for SARS-CoV-2 nucleic acids (24 kits), antibodies (25 kits), or antigens (2 kits) have been approved by the National Medical Products Administration of China (NMPA). Convenient and reliable SARS-CoV-2 detection assays are urgently needed worldwide for strategic control of the pandemic. In this review, the detection kits approved in China are summarised and the three types of tests, namely nucleic acid, serological and antigen detection, which are available for the detection of COVID-19 are discussed in detail. The development of novel detection kits will lay the foundation for the control and prevention of the COVID-19 pandemic globally.

After one-month of oral treatment with traditional Chinese medicine decoction, without using other drugs, the lung inflammatory exudate, pulmonary fibrosis and quality of life of a 61-year-old female patient with corona virus disease 2019 (COVID-19) were significantly improved. No recurrence or deterioration of the patient's condition was found within seven weeks of treatment and follow-up, and no adverse events occurred, indicating that oral Chinese medicine decoction was able to improve the pulmonary inflammation and fibrosis in a patient recovering from COVID-19, but further research is still needed.

To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. Our cohort had median age of 61 (IQR 45-74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74-19.48), former (OR 8.06, CI 1.51-43.06) and current smoking status (OR 10.33, CI 1.43-74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11-0.96), procalcitonin (OR 1.27, CI 1.02-1.57), IL-6 (OR 1.17, CI 1.03-1.33), ferritin (OR 1.05, CI 1.005-1.11), LDH (OR 1.57, 95% CI 1.13-2.17) and CRP (OR 1.13, CI 1.06-1.21), were associated with IMV by univariate analysis. Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.

Eliminating disparities in the burden of COVID-19 requires equitable access to control measures across socio-economic groups. Limited research on socio-economic differences in mobility hampers our ability to understand whether inequalities in social distancing are occurring during the SARS-CoV-2 pandemic. We aim to assess how mobility patterns have varied across the United States during the COVID-19 pandemic, and identify associations with socio-economic factors of populations. We used anonymized mobility data from tens of millions of devices to measure the speed and depth of social distancing at the county level between February and May 2020, the period during which social distancing was widespread in the U.S. Using linear mixed models, we assessed the associations between social distancing and socio-economic variables, including the proportion of people below the poverty level, the proportion of Black people, the proportion of essential workers, and the population density. We find that the speed, depth, and duration of social distancing in the United States is heterogeneous. We particularly show that social distancing is slower and less intense in counties with higher proportions of people below the poverty level and essential workers; and in contrast, that social distancing is intense in counties with higher population densities and larger Black populations. Socio-economic inequalities appear to be associated with the levels of adoption of social distancing, potentially resulting in wide-ranging differences in the impact of COVID-19 in communities across the United States This is likely to amplify existing health disparities, and needs to be addressed to ensure the success of ongoing pandemic mitigation efforts.

Health inequities among people with HIV may be compounded by disparities in the prevalence of comorbidities associated with increased risk of severe illness from COVID-19. Complex sample survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States. We estimated prevalence of having ≥1 diagnosed comorbidity associated with severe illness from COVID-19 and prevalence differences (PD) by race/ethnicity, income level, and type of health insurance. We considered PDs ≥5 percentage points to be meaningful from a public health perspective. An estimated 37.9% (95% CI, 36.6 to 39.2) of adults receiving HIV care had ≥1 diagnosed comorbidity associated with severe illness from COVID-19. Compared with non-Hispanic Whites, non-Hispanic Blacks or African Americans were more likely (adjusted prevalence difference [APD], 7.8 percentage points [95% CI, 5.7 to 10.0]) and non-Hispanic Asians were less likely (APD, -13.7 percentage points [95% CI, -22.3 to -5.0]) to have ≥1 diagnosed comorbidity after adjusting for age differences. There were no meaningful differences between non-Hispanic Whites and adults in other racial/ethnic groups. Those with low income, were more likely to have ≥1 diagnosed comorbidity (PD, 7.3 percentage points [95% CI, 5.1 to 9.4]). Among adults receiving HIV care, non-Hispanic Blacks and those with low income were more likely to have ≥1 diagnosed comorbidity associated with severe COVID-19 Building health equity among people with HIV during the COVID-19 pandemic may require reducing the impact of comorbidities in heavily affected communities.

Coronavirus disease 2019 (COVID-19) is a novel viral infection that has led to a global pandemic. The clinical spectrum of COVID-19 has a wide range from asymptomatic disease to severe disease, including acute respiratory distress syndrome and death. The most common symptoms are fever, cough, myalgia, and fatigue. Diarrhea, headache, sore throat, and hemoptysis are rare symptoms. There is no patient with COVID-19 presenting with massive hemoptysis in the literature. Here we present a case series of 3 patients with COVID-19 who were admitted to the emergency department with massive hemoptysis without any other symptoms.

Coronavirus disease 2019 (COVID-19) has become a game changer in many aspects of clinical practice. Acute exacerbations of idiopathic pulmonary fibrosis (IPF) are known as serious events, which can reach a mortality rate of 50%, where viral infections may play a role. We describe the case of a 64-year-old male patient with a diagnosis of IPF under antifibrotic treatment for 1 year; the patient tested positive for COVID-19 with polymerase chain reaction test of the nasopharyngeal swab, and his chest computed tomography results were compatible with COVID-19 pneumonia described in the literature as well as the findings compatible with interstitial lung disease. The patient was successfully treated in the pulmonology ward according to official guidelines about COVID-19 along with antifibrotic treatment and required only a short course of oxygen therapy. We experienced no drug interactions, serious side effects, or complications during treatment. The patient was discharged after 1 week, and he is still in a good condition after 3 weeks. COVID-19 pneumonia in a patient with IPF who survived under antifibrotic treatment without serious deterioration is a new experience. Such cases will probably change our perspective in treating patients with IPF.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent that causes coronavirus disease, has been shown to infect several species. The role of domestic livestock and associated risks for humans in close contact with food production animals remains unknown for many species. Determining the susceptibility of pigs to SARS-CoV-2 is critical to a One Health approach to manage potential risk for zoonotic transmission. We found that pigs are susceptible to SARS-CoV-2 after oronasal inoculation. Among 16 animals, we detected viral RNA in group oral fluids and in nasal wash from 2 pigs, but live virus was isolated from only 1 pig. Antibodies also were detected in only 2 animals at 11 and 13 days postinoculation but were detected in oral fluid samples at 6 days postinoculation, indicating antibody secretion. These data highlight the need for additional livestock assessment to determine the potential role of domestic animals in the SARS-CoV-2 pandemic.

A meta-analysis was performed to evaluate the association of chronic kidney disease (CKD) and acute kidney injury (AKI) with the clinical prognosis of patients with coronavirus disease 2019 (COVID-19). The PubMed, EMBASE, Cochrane Library, medRxiv, Social Science Research Network, and Research Square databases (from December 1, 2019 to May 15, 2020) were searched to identify studies that reported the associations of CKD/AKI and disease severity/mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and meta-regression was performed. In total, 42 studies enrolling 8,932 participants were included in this meta-analysis. The quality of most included studies was moderate to high. Compared with patients without previously diagnosed CKD, those with CKD had a significantly increased risk of progressing to a severe condition (OR 2.31, 95% CI 1.64-3.24) or death (OR 5.11, 95% CI 3.36-7.77). Similarly, compared with patients without AKI, those with AKI had a significantly increased risk of progressing to a severe condition (OR 11.88, 95% CI 9.29-15.19) or death (OR 30.46, 95% CI 18.33-50.59). Compared with patients with previously diagnosed CKD, those with AKI were more likely to progress to a severe condition (pgroup < 0.001, I2 = 98.3%) and even to death (pgroup < 0.001, I2 = 96.5%). Age had a significant impact on the association between CKD and disease severity (p = 0.001) but had no impact on the associations between AKI and disease severity (p = 0.80), between CKD and mortality (p = 0.51), or between AKI and mortality (p = 0.86). Four important complications (cardiac injury, shock, acute respiratory distress syndrome, and liver injury) did not significantly affect the associations between CKD/AKI and disease severity/mortality, indicating that CKD/AKI may be independent clinical prognostic indicators for patients with COVID-19. In COVID-19 patients, CKD/AKI was associated with worse outcomes compared with those without CKD/AKI. AKI was associated with higher risks of severity and mortality than CKD.

An epidemic of dengue virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infections occurred in Argentina during 2020. We describe the clinical characteristics and outcomes in a cohort of patients hospitalized because of co-infection. We retrospectively identified 13 patients from different hospitals in Buenos Aires who had confirmed infection with SARS-CoV-2 and dengue virus and obtained clinical and laboratory data from clinical records. All patients had febrile disease when hospitalized. Headache was a common symptom. A total of 8 patients had respiratory symptoms, 5 had pneumonia, and 3 had rash. Nearly all patients had lymphopenia when hospitalized. No patients were admitted to an intensive care unit or died during follow up. Co-infection with SARS-CoV-2 and dengue virus can occur in patients living in areas in which both viruses are epidemic. The outcome of these patients did not seem to be worse than those having either SARS-CoV-2 or dengue infection alone.

In this study, it was aimed to investigate the effects of lockdown measures implemented due to COVID-19 on aetiology, sociodemographic characteristics, and clinical status of burn cases. This study was carried out retrospectively at the Burn Unit of Dicle University Medical Faculty Hospital. The burn cases during the COVID-19 outbreak were compared with those of the previous 2 years. Statistical analyses were carried out using the IBM SPSS (Statistics Package for Social Sciences) Statistics 25. Descriptive statistics, independent samples t-test, Kolmogorov-Smirnov test, and Shapiro-Wilk test were used for data evaluation. Results were evaluated at 95% confidence interval and P < .05 significance level. It was determined that burn cases were reduced by half during the COVID-19 compared to the previous 2 years. Despite the increase in the number of third-degree burns and surgeries, it was determined that the length of hospital stay decreased by an average of two thirds. Hot liquids have been identified as the most important cause of burns in all years. New studies should be conducted in order to examine the social dimension of COVID-19 pandemic in burn cases and to prevent these cases completely. The short hospital stay preferred by clinicians after COVID-19 and possible problems that may arise should be investigated.

In light of the coronavirus disease-2019 (COVID-19) pandemic, how resources are managed and the critically ill are allocated must be reviewed. Although ethical recommendations have been published, strategies for dealing with overcapacity of critical care resources have so far not been addressed. Assess expert opinion for allocation preferences regarding the growing imbalance between supply and demand for medical resources. A 10-item questionnaire was developed and sent to the most prominent members of the European Society of Anaesthesiology and Intensive Care (ESAIC). Survey via a web-based platform. Respondents were members of the National Anaesthesiologists Societies Committee and Council Members of the ESAIC; 74 of 80 (92.5%), responded to the survey Responses were analysed thematically. The majority of respondents (83.8%), indicated that resources for COVID-19 were available at the time of the survey Of the representatives of the ESAIC governing bodies, 58.9% favoured an allocation of excess critical care capacity: 69% wished to make them available to supraregional patients, whereas 30.9% preferred to keep the resources available for the local population. Regarding the type of distribution of resources, 35.3% preferred to make critical care available, 32.4% favoured the allocation of medical equipment and 32.4% wished to support both options. The majority (59.5%) supported the implementation of a central European institution to manage such resource allocation. Experts in critical care support the allocation of resources from centres with overcapacity. The results indicate the need for centrally administered allocation mechanisms that are not based on ethically disputable triage systems. It seems, therefore, that there is wide acceptance and solidarity among the European anaesthesiological community that local medical and human pressure should be relieved during a pandemic by implementing national and international re-allocation strategies among healthcare providers and healthcare systems.

The role of healthcare worker hand hygiene in preventing healthcare associated infections (HCAI) is well established. There is less emphasis on the hand hygiene of hospitalised patient ; in the context of COVID-19 mechanisms to support it are particularly important. The purpose of this study was to establish if providing patient hand wipes, and a defined protocol for encouraging their use, was effective in improving the frequency of patient hand hygiene (PHH). Before and after study SETTING: General Hospital, United Kingdom. All adult patient admitted to six acute elderly care/rehabilitation hospital wards between July and October 2018. Baseline audit of PHH opportunities conducted over 6 weeks. Focus group with staff and survey of the public informed the development of a PHH bundle. Effect of bundle on PHH monitored by structured observation of HH opportunities over 12 weeks. During baseline 303 opportunities for PHH were observed; compliance with PHH was 13.2% (40/303; 95%CI 9.9-7.5). In the evaluation of PHH bundle 526 PHH opportunities were observed with HH occurring in 58.9% (310/526); an increase of 45.7% vs. baseline (95%CI 39.7-51.0%; p<0.001). Providing patient with multi-wipe packs of handwipes is a simple, cost-effective approach to increasing patient hand hygiene and reducing the risk of HCAI in hospital. Healthcare workers play an essential role in encouraging PHH.

Viral neutralization tests (VNTs) have long been considered old-fashioned tricks in the armamentarium of fundamental virology, with laboratory implementation for a limited array of viruses only. Nevertheless, they represent the most reliable surrogate of potency for passive immunotherapies, such as monoclonal or polyclonal antibody therapy. The recent interest around therapy with convalescent plasma or monoclonal antibodies for the Covid-19 pandemic has paralleled the revival of VNTs. We review here the available methods by dissecting variations for each fundamental component of the VNT (i.e., virus type and dose, replication-competent cell line, serum, and detection system).

COVID-19, a viral disease fatal yet preventable is caused by a newly identified β-corona virus. The people most vulnerable to this infection are the ones with a prior history of diseases, low immunity, or either too old or too young (particularly children and infants). In the context of the virus's impact on the pediatric age groups, this article highlights some of the challenges and guidelines on managing it. Pediatric groups, like everyone else, are highly vulnerable to the infection by COVID-19. The lower number of pediatric patients involved at the beginning of a pandemic does not necessarily mean that children are less vulnerable to the infection. However, the good news is that the disease usually has a mild course and appropriate prevention and oral health management in children can help to keep it at bay. Adherence to simple compliance and safety protocols can go a long way. For instance, in the course of some of the procedures performed by a pediatric dentist, there may be a risk of aerosols being generated, which in turn can lead to cross-infection making the patient vulnerable to contracting COVID-19. In such a situation, parents are advised to take good home-based care and take telemedicine consultation immediately. This article lays a concrete emphasis on reviewing the limited published literature that is specific to the pediatric population regarding epidemiology, pathogenesis, diagnosis, and treatment modalities of COVID-19. It analyzes the potential risk from COVID-19 associated with pediatric dental treatment. In addition, it presents a series of considerations on potential oral prevention strategies on the management of urgent and non-urgent dental procedures in a context of disease transference control. This literature review also gives an insight for the private practitioner to have healthier management in the pediatric fraternity during this highly contagious COVID-19 pandemic.

Medical students across the United Kingdom helped the National Health Service (NHS) with the increased workload caused by the COVID-19 pandemic. This study was conducted to better understand the implications of COVID-19 on the intricate relationship between the psychological wellbeing of students and working within the NHS. This was a cross-sectional, national UK study analysing the self-reported pandemic anxiety scale (PAS) of participants during the pandemic, using an online questionnaire. 25.2% of participants worked within the NHS. Working significantly reduced anxiety levels of participants. Concerns around the training and information provided on personal protective equipment (PPE) (OR 2.57, 95% CI OR: 1.93, 3.43) (p < 0.001) and Ethnicity (OR 2.15, 95% CI OR: 1.54, 2.99) (p < 0.001) were the most significant covariates affecting the likelihood of working. Working during the pandemic was influenced by age, ethnicity and information surrounding PPE. On average those who worked experienced less anxiety and were more cheerful and energetic.

Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children but serious complications may occur in conjunction with both acute infection and associated phenomena such as the multisystem inflammatory syndrome in children (MIS-C). Neurological symptoms, which have been predominantly reported in adults, range from mild headache to seizure, peripheral neuropathy, stroke, demyelinating disorders, and encephalopathy. Similar to respiratory and cardiac manifestations of COVID-19, neurological complications present differently based on age and underlying comorbidities. This review provides a concise overview of the neurological conditions seen in the context of COVID-19, as well as potential mechanisms and long-term implications of COVID-19 in the pediatric population from literature reviews and primary data collected at Morgan Stanley Children s Hospital in New York City.

Since December 2019, an outbreak of COVID-19 sweeping the world. Understanding the clinical and SARS-CoV-2 dynamic changes of mild and ordinary patients of COVID-19, so as to provide basis for the prevention and control of COVID-19.On February 1st, 2020, 16 SARS-CoV-2 RNA positive patients diagnosed in the same site in Beijing. The patients symptoms, signs, medication, and SARS-CoV-2 results were recorded.Of the 16 patients, 12 were female. Although they were infected at the same time in the same workplace, their clinical processes were very different and can be roughly divided into three different types: persistent sputum positive, persistent stool positive and persistent both positive. In 7 patients with mild clinical manifestations, the median days of SARS-CoV-2 RNA negative conversion in sputum samples were significantly later than those with obvious lung injury (27 days [range: 18 to 36]; 17 days, [range 6 to 25], P = .021). The negative conversion of SARS-CoV-2 RNA in stool was significant later than in sputum.There were various clinical manifestations after SARS-CoV-2 infection, even if they were infected by the same source of infection in the same place. The presence of SARS-CoV-2 virus RNA in stool samples was longer than that in respiratory tract.

The COVID-19 outbreak rapidly became a public health emergency and led to radical changes in patient management. From the start of the pandemic, we used electronic medical record-assisted telephone follow-up (E-TFU) of cancer survivors (CS) to minimize hospital exposure. The aim of this prospective study was to assess how breast cancer survivors (bCSs) perceived E-TFU. A 15-item survey was e-mailed to bCSs who had been managed with E-TFU. The responses were measured using Likert-like scales and were correlated with the main characteristics of the bCS using Pearson's test. One hundred thirty-seven of 343 bCSs (40%) completed the survey between March 9 and June 2, 2020. Their median age was 59 years. Although 80.3% of bCSs were satisfied with E-TFU, only 43.8% would like to have E-TFU in the future. A low educational level was correlated with higher COVID-19-related anxiety ( E-TFU was an important means of avoiding hospital contacts during the COVID-19 pandemic, and the majority of bCSs in the survey were satisfied with this procedure. Further studies are needed to investigate the implementation of telemedicine even outside an emergency situation.

We hypothesized that the currently implemented public health measures against COVID-19 might have a restraining effect on the transmission of other respiratory pathogens. In order to test that, we compared the prevalence of non-SARS-CoV-2 respiratory viruses and bacteria in hospitalized patients during April-August 2020, with those observed during the same time in three previous years. During April-August 2020 there was a notable decrease in the positive detection rates, with significant reduction in the detection of human metapneumovirus (0% vs mean 4.2%, p<0.001), parainfluenza 3 (0.61% vs mean 4.09%, p=0.007), adenovirus (0.60% vs mean 6.52%, p<0.001) and M. pneumoniae (0% vs mean 5.74%, p=0.001). Other respiratory bacteria were also detected in reduced numbers. Our findings argue for the broader impact of anti-COVID-19 measures on the transmission and prevalence of other respiratory pathogens, and may thus predict that a lower burden of these infections can be maintained, as long as public health control measures are utilized.

Investigating the spatial distribution characteristics of the coronavirus disease 2019 (COVID-19) and exploring the influence of environmental factors that drive it is the basis for formulating rational and efficient prevention and control countermeasures. Therefore, this study aims to analyze the spatial distribution characteristics of COVID-19 pandemic in Beijing and its relationship with the environmental factors Based on the incidences of new local COVID-19 cases in Beijing from June 11 to July 5, the spatial clustering characteristics of the COVID-19 pandemic in Beijing was investigated using spatial autocorrelation analysis. The relation between COVID-19 cases and environmental factors was assessed using the Spearman correlation analysis. Finally, geographically weighted regression (GWR) was applied to explore the influence of environmental factors on the spatial distribution of COVID-19 cases. The results showed that the development of COVID-19 pandemic in Beijing from June 11 to July 5 could be divided into two stages. The first stage was the outward expansion from June 11 to June 21, and the second stage (from June 22 to July 5) was the growth of the transmission in areas with existing previous cases. In addition, there was a ring of low value clusters around the Xinfadi market. This area was the key area for prevention and control. Population density and distance to Xinfadi market were the most critical factors that explained the pandemic development. The findings of this study can provide useful information for the global fighting against COVID-19.

There are no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers (HCW) are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia HCW and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. We searched government reports and websites and media reports to create a comprehensive line listing of Australian HCW infections and nosocomial outbreaks between January 25 We identified 36 hospital outbreaks or HCW infection reports between January 25 The study shows that HCW were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, HCW are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous HCW during an outbreak. The occurrence of hospital outbreaks even when community incidence was low highlights the high risk setting that hospitals present. Australia faced a resurgence of COVID-19 after the study period, with multiple hospital outbreaks. We recommend formal reporting of HCW infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for HCW.

The COVID-19 pandemic has highlighted the importance of social determinants of health in affecting health outcomes. Populations with high social risk are disproportionately impacted by the virus and its economic consequences. Primary care practices have a unique opportunity to implement interventions to mitigate their patients' unmet social needs, such as food and income insecurity. In this commentary, we outline key considerations for clinics implementing programs that identify and address patients' social needs in a way that promotes equity, quality, and sustainability. We provide examples from our own experience at a federally qualified health center.

The construction industry creates 1.3 trillion revenue each year in the United States. After Coronavirus (COVID-19) becoming a pandemic virus, many industries are shutting down and being on lockdown. This situation can lead to millions of people becoming unemployed and eventually causing a financial recession. Although the government and health organizations have issued guidelines to prevent the spread of the virus in the jobsites, there have not been any specific guidelines for construction industry workers. The contribution of this research is to develop a preliminary model and indicator of coronavirus (COVID-19) spread in the construction industry. This paper investigates the preliminary indexes, which can affect the spread of coronavirus in the construction industry. The developed model would act as a guide for stakeholders to take the most appropriate precautions in the jobsite with the available equipment and facilities.

Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians toward triaging scarce critical care resources in the COVID-19 pandemic. We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes toward triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used. The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65 percent), as well as fears of psychological distress if required to triage scarce resources (77 percent). Only 49 percent of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 versus 2.9/5 p = 0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 versus 4.0/5 p = 0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medicolegal protection, additional tools for therapeutic communications, and healthcare provider psychological support. There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.

Anxiety and stress like mental illnesses are the common outcomes of viral epidemics and pandemics. Novel coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) was first reported in Wuhan, China, and then spread all over the world in a short time. To highlight and discuss the impact of COVID-19 pandemic on mental or psychological health. Literature search and collection of the information were performed using PubMed, the reports from the World health organization, and the Center for disease control and prevention. COVID-19 infection has already been declared as a global pandemic, which in association with infodemic has increased the risk of psychiatric/psychological disorders. A large population of the world is prone to develop anxiety, depressive disorders, and other mental abnormalities. Therefore, timely psychological interventions and preventive strategies are required. Moreover, the infection has been reported to be linked with cerebrovascular conditions; therefore, patients with underlying cerebrovascular diseases should be given attention. COVID-19-mediated mental health complications and cerebrovascular conditions may cause a huge burden on healthcare communities in the future. Therefore, timely intervention and the development or application of preventive strategies are required to decrease the risk of neurological consequences.

As the world navigates the Coronavirus disease 2019 (COVID-19) pandemic, there is a growing need to assess its impact in patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). Patients with SLE are a unique population when considering the risk of contracting COVID-19 and infection outcomes. The use of systemic glucocorticoids and immunosuppressants, and underlying organ damage from SLE are potential susceptibility factors. Most patients with SLE have evidence of high type I IFN activity, which may theoretically act as an antiviral line of defense or contribute to the development of a deleterious hyperinflammatory response in COVID-19. Other immunopathogenic mechanisms of SLE may overlap with those described in COVID-19, and thus studies in SLE could provide some insight into immune responses occurring in severe cases of the viral infection. We reviewed the literature to date on COVID-19 in patients with SLE and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in those with autoimmune disease.

Palliative care (PC) and hospice services have experienced shortages prior to 2020 and during the initial phases of the current pandemic; more critical gaps are expected with future surges, much as scarcity in intensive care unit (ICU) services may recur during the COVID-19 pandemic. While ethical allocation of ventilators and ICU care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care (CSC) and ration these essential services to our communities.

Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory coronavirus 2 (SARS-COV-2) is a significant threat to global health security. Till date, no completely effective drug or vaccine is available to cure COVID-19. Therefore, an effective vaccine against SARS-COV-2 is crucially needed. This study was conducted to design an effective multiepitope based vaccine (MEV) against SARS-COV-2. Seven highly antigenic proteins of SARS-COV-2 were selected as targets and different epitopes (B-cell and T-cell) were predicted. Highly antigenic and overlapping epitopes were shortlisted. Selected epitopes indicated significant interactions with the HLA-binding alleles and 99.93% coverage of the world's population. Hence, 505 amino acids long MEV was designed by connecting 16 MHC class I and eleven MHC class II epitopes with suitable linkers and adjuvant. MEV construct was non-allergenic, antigenic, stable and flexible. Furthermore, molecular docking followed by molecular dynamics (MD) simulation analyses, demonstrated a stable and strong binding affinity of MEV with human pathogenic toll-like receptors (TLR), TLR3 and TLR8. Finally, MEV codons were optimized for its in silico cloning into Escherichia coli K-12 system, to ensure its increased expression. Designed MEV in present study could be a potential candidate for further vaccine production process against COVID-19. However, to ensure its safety and immunogenic profile, the proposed MEV needs to be experimentally validated.

This study aimed to investigate the anxiety levels of healthcare workers and to provide guidance on potential accurate social and psychological interventions for healthcare workers during the epidemic of COVID-19 in Zhejiang Province, China. Healthcare workers from five hospitals in Zhejiang Province were randomly selected into this study. Zung Self-Assessment Scale for Anxiety (SAS) was used to evaluate the anxiety status of the included 1637 healthcare workers. The total anxiety score of healthcare workers in Zhejiang Province was 30.85 ± 6.89. The univariate analysis showed that the anxiety level of healthcare workers was related to gender, education, occupation, physical condition, job risk coefficient, and with family members on the first-line combating COVID-19 (P <0.05). The multivariate analysis showed that physical condition and job risk coefficient were predictors of anxiety levels of healthcare workers. During the epidemic of COVID-19, 1637 healthcare workers generally had an increased tendency to have anxiety. Individualized assessment of the anxiety level of healthcare workers should be provided, and different interventions should be given based on the evaluation results.

An epidemic of COVID-19 broke out in Wuhan, China, since December 2019. The ordinary medical services were hindered. However, the emergency cases, including aneurysmal subarachnoid hemorrhage (aSAH), still required timely intervention. Thus, it provoked challenges to the routine management protocol. In this study, we summarized our experience in the emergency management of aSAH (Beijing Tiantan Protocol, BTP) in Beijing, China. Demographic, clinical, and imaging data of consecutive emergency aSAH patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and several detailed protocols. Neurological outcomes were evaluated by the modified Rankin Scale (mRS). A total of 127 aSAH were referred to our emergency department, and 42 (33.1%) underwent craniotomy clipping between January 20, 2020, and March 25, 2020. The incidence of preoperative hospitalized adverse events and the perioperative outcomes were similar (- 0.1, 95% CI - 1.0 to 0.8, P = 0.779) to the retrospective period last year (January 2019-March 2019). After the propensity score matching (PSM), there were still no statistical differences in prognostic parameters between the two groups. Eight (19.0%) of the 42 individuals were initially screened as preliminary undetermined COVID-19 cases, in which 2 of them underwent craniotomy clipping in the negative pressure operating room (OR). The prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission, and all showed negative. The false-negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (- 0.3, 95% CI - 1.4 to 0.9, P = 0.653). Our emergency surgery management protocol (BTP) is reliable for scheduling emergency aneurysm craniotomy clipping in non-major epidemic areas.

During the COVID-19 pandemic, hospital staff have experienced a variety of mental health challenges. European research on anxiety and stress among hospital workers during the pandemic is limited. This study aimed to describe the anxiety levels of Finnish hospital workers during the COVID-19 pandemic. The multidimensional, cross-sectional survey was distributed to all hospital staff working at two Finnish specialized medical care centres in the spring of 2020 ( The total mean GAD-7 score was 4.88, indicating normal anxiety levels. However, 30% ( Hospital staff experienced a variety of work-related stress and anxiety issues that should be visible to hospital administrators and policymakers alike. The anxiety is independent of whether the worker is directly involved in caring for or in any way coming into contact with COVID-19 patients. Key message Fifty-five percent of hospital staff have normal anxiety levels. The remaining workers may need targeted support interventions, and a smaller proportion (15%) are in danger of developing longer-term problems affecting their well-being. The anxiety experienced by hospital workers during the COVID-19 pandemic is more severe than that of the population on average. If the pandemic continues, the well-being of hospital staff may be widely threatened. Despite the different geographical locations and COVID-19 situations, hospital workers in Finland and China had similar anxiety levels. The anxiety is independent of whether staff are working in the front line of managing the COVID-19 pandemic or of the number of covid-19 patients admitted to the hospital. The hospital workers felt anxiety because they were facing a new situation which causes changes in their work and daily routine. Health care employers should engage in long-term follow-up as regards the personnel's recovery from the burden caused by the pandemic and from work in general. It is necessary to make easily attainable, flexibly delivered and cost-effective treatment interventions for anxiety available to hospital staff.

We describe the characteristics and short-term prognosis of in-patients with diabetes and COVID-19 admitted to a Belgian academic care center. We retrospective y reviewed the data on admission from patients with known or newly-diagnosed diabetes and confirmed COVID-19. First, survivors were compared to non-survivors to study the predictive factors of in-hospital death in patients with diabetes. Secondly, diabetic patients with SARS-CoV-2 pneumonia were matched for age and sex with non-diabetic patients with SARS-CoV-2 pneumonia, to study the prognosis and predictive factors of in-hospital death related to diabetes. Seventy-three diabetic patients were included. Mean age was 69 (±14) years. Women accounted for 52%. Most patients had type 2 diabetes (89.0%), long-term complications of hyperglycemia (59.1%), and hypertension (80.8%). The case-fatality rate (CFR) was 15%. Non-survivors had more severe pneumonia based on imaging (p 0.029) and were less often treated with metformin (p 0.036). In patients with SARS-CoV-2 pneumonia, CFR was 15.6% in diabetic (n = 64) and 25.0% in non-diabetic patients (n = 128), the difference being non-significant (p 0.194). Predictive factors of in-hospital death were elevated white blood cells count (HR 9.4, CI 1.50-58.8, p 0.016) and severe pneumonia on imaging (HR 25.0, CI 1.34-466, p 0.031) in diabetic patients, and cognitive impairment (HR 5.80, CI 1.61-20.9, p 0.007) and cardiovascular disease (HR 5.63, CI 1.54-20.6, p 0.009) in non-diabetic patients. In this monocentric cohort from Belgium, diabetic in-patients with COVID-19 had mostly type 2 diabetes, prevalent hyperglycemia-related vascular complications and comorbidities including hypertension. In this cohort, the CFR was not statistically different between patients with and without diabetes.

The outbreak of coronavirus disease 2019 (COVID-19) has been declared a pandemic. Although COVID-19 is caused by infection in the respiratory tract, extrapulmonary manifestations including dysregulation of the immune system and hepatic injury have been observed. Given the high prevalence of hepatitis B virus (HBV) infection in China, we sought to study the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HBV coinfection in patients. Blood samples of 50 SARS-CoV-2 and HBV coinfected patients, 56 SARS-CoV-2 mono-infected patients, 57 HBeAg-negative chronic HBV patient controls and 57 healthy controls admitted to Renmin Hospital of Wuhan University were collected in this study. Complete blood count and serum biochemistry panels including markers indicative of liver functions were performed. Cytokines including IFN-γ, TNF-α, IL-2, IL-4, IL-6 and IL-10 were evaluated. T cell, B cell and NK cell counts were measured using flow cytometry. SARS-CoV-2 and HBV coinfection did not significantly affect the outcome of the COVID-19. However, at the onset of COVID-19, SARS-CoV-2 and HBV coinfected patients showed more severe monocytopenia and thrombocytopenia as well as more disturbed hepatic function in albumin production and lipid metabolism. Most of the disarrangement could be reversed after recovery from COVID-19. While chronic HBV infection did not predispose COVID-19 patients to more severe outcomes, our data suggests SARS-CoV-2 and HBV coinfection poses a higher extent of dysregulation of host functions at the onset of COVID-19. Thus, caution needs to be taken with the management of SARS-CoV-2 and HBV coinfected patients.

Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of the Coronavirus disease-2019 (COVID-19). Accumulating data on patients with COVID-19-associated stroke have shed light on specificities concerning clinical presentation, neuroimaging findings, and outcome. Such specificities include a propensity towards large vessel occlusion, multi-territory stroke, and involvement of otherwise uncommonly affected vessels. Conversely, small-vessel brain disease, cerebral venous thrombosis, and intracerebral hemorrhage appear to be less frequent. Atypical neurovascular presentations were also described, ranging from bilateral carotid artery dissection to posterior reversible encephalopathy syndrome (PRES), and vasculitis. Cases presenting with encephalopathy or encephalitis with seizures heralding stroke were particularly challenging. The pathogenesis and optimal management of ischemic stroke associated with COVID-19 still remain uncertain, but emerging evidence suggest that cytokine storm-triggered coagulopathy and endotheliopathy represent possible targetable mechanisms. Some specific management issues in this population include the difficulty in identifying clinical signs of stroke in critically ill patients in the intensive care unit, as well as the need for a protected pathway for brain imaging, intravenous thrombolysis, and mechanical thrombectomy, keeping in mind that "time is brain" also for COVID-19 patients. In this review, we discuss the novel developments and challenges for the diagnosis and treatment of stroke in patients with COVID-19, and delineate the principles for a rational approach toward precision medicine in this emerging field.

Concerns have been expressed that some drugs may increase susceptibility to SARS-CoV-2 infection. In contrast, other drugs have generated interest as potential therapeutic agents. All adults aged ≥18 years who were tested for COVID-19 were included. Exposure was defined as a prescription of study drugs which would have been continued until 7 days prior to test for COVID-19 or later. The outcome measures were the diagnosis of COVID-19 and severe COVID-19. Disease risk score matching and multiple logistic regression was used. Matched claims and testing results were available for 219,961 subjects, of whom 7,341 (3.34%) were diagnosed with COVID-19. Patients were matched to 36,705 controls, and the subset of 878 patients of severe COVID-19 also matched with 1,927 mild-to-moderate patients. Angiotensin receptor blockers were not associated with either the diagnosis of COVID-19 (adjusted OR [aOR], 1.02; 95% confidence interval [CI], 0.90-1.15) or severe disease (aOR, 1.11; 95% CI, 0.87-1.42). The use of hydroxychloroquine was not associated with a lower risk for COVID-19 (aOR, 0.94; 95% CI, 0.53-1.66) or severe disease (aOR, 3.51; 95% CI, 0.76-16.22). In this national claims data-based case-control study, no commonly prescribed medications were associated with risk for COVID-19 infection or severity

Sudden smell and/or taste loss has been suggested to be an early marker of COVID-19 infection, with most findings based on self-report of sensory changes at a single time-point. To understand the onset, severity, and recovery of sensory changes with COVID-19 infection, this study will longitudinally track changes in chemosensory acuity among those suspected of COVID-19 infection, using standardised test stimuli that are self-administered over 28-days. In a prospective, case-controlled observational study, volunteers will be recruited when they present for COVID-19 screening (respiratory tract PCR; hereafter, swab test) and will initially complete a series of questionnaires to record their recent changes in smell and taste ability, followed by a brief standardized smell and taste test. Participants will receive a home-use smell and taste test kit to prospectively complete a daily self-assessment of their smell and taste acuity at their place of residence for up to 4-weeks, with all data collection submitted through online software. This study has been approved by the Domain Specific Review Board of the National Healthcare Group, Singapore, and is funded by the Biomedical Research Council Singapore COVID-19 Research Fund. Recruitment began on 23rd July 2020 and will continue through to 31st March 2021. As of 2nd October 2020, 69 participants have been recruited. To our knowledge, this study will be the first to collect longitudinal data on changes to smell and taste sensitivity related to clinically diagnosed COVID-19 infection, confirmed using PCR-swab test, in a population-based cohort. Findings will provide temporal insights on the onset, severity, and recovery of sensory changes with COVID-19 infection, the consistency of symptoms, and the frequency of full smell recovery among COVID-19 patients. This self-administered and cost-effective approach has many advantages over self-report questionnaire-based methods and provides a more objective measure of smell/taste changes associated with COVID-19 infection, and will encourage otherwise asymptomatic individuals who are potential spreaders of the virus to self-isolate and seek formal medical diagnosis if they experience a sudden change in sensory acuity. This broadened case finding can potentially help to control the pandemic and reduce the emergence of clusters of infections. Clinical Trial .gov NCT04492904. Registered on 27 July 2020, Retrospectively registered, version 1. DERR1-10.2196/24797.

The paucity of public health messages that directly address communities of color might contribute to racial and ethnic disparities in knowledge and behavior related to coronavirus disease 2019 (COVID-19). To determine whether physician-delivered prevention messages affect knowledge and information-seeking behavior of Black and Latinx individuals and whether this differs according to the race/ethnicity of the physician and tailored content. Randomized controlled trial (Registration: ClinicalTrials.gov, NCT04371419; American Economic Association RCT Registry, AEARCTR-0005789). United States, 13 May 2020 to 26 May 2020. 14 267 self-identified Black or Latinx adults recruited via Lucid survey platform. Participants viewed 3 video messages regarding COVID-19 that varied by physician race/ethnicity, acknowledgement of racism/inequality, and community perceptions of mask-wearing. Knowledge gaps (number of errors on 7 facts on COVID-19 symptoms and prevention) and information-seeking behavior (number of Web links demanded out of 10 proposed). 7174 Black (61.3%) and 4520 Latinx (38.7%) participants were included in the analysis. The intervention reduced the knowledge gap incidence from 0.085 to 0.065 (incidence rate ratio, [IRR], 0.737 [95% CI, 0.600 to 0.874]) but did not significantly change information-seeking incidence. For Black participants, messages from race/ethnic-concordant physicians increased information-seeking incidence from 0.329 (for discordant physicians) to 0.357 (IRR, 1.085 [CI, 1.026 to 1.145]). Participants' behavior was not directly observed, outcomes were measured immediately postintervention in May 2020, and online recruitment may not be representative. Physician-delivered messages increased knowledge of COVID-19 symptoms and prevention methods for Black and Latinx respondents. The desire for additional information increased with race-concordant messages for Black but not Latinx respondents. Other tailoring of the content did not make a significant difference. National Science Foundation; Massachusetts General Hospital; and National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

This study aimed to assess the knowledge of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. A total of 1,033 questionnaires were collected (273 dental students, 193 dental auxiliary personnel, 544 dentists). In all, 63.4% of the respondents worked in hospitals. Of all the respondents, 44.9%, 33.4%, and 21.7% worked in governmental clinics, academia, and the private sector, respectively. Overall knowledge of the incubation period and route of transmission of SARS-CoV-2 was consistent across all dental professions. Knowledge of hand-soap cleaning time was significantly different among dental professionals (p < 0.001). Dental professionals displayed significant disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of the respondents were reluctant to treat a suspected COVID-19 patient, and 92% of the participants believed that the mode of transmission was droplet inhalation. Fever, coughing, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of the participants. Dental professionals seem to be consistent regarding their knowledge of the incubation period of SARS-CoV-2. However, knowledge of viral survivability and recommended hand-soap washing time was significantly variable among the professionals. A high degree of apprehension toward suspected COVID-19 patients existed among all dental professionals. Pandemic-awareness campaigns are essential among healthcare providers.

More and more reports had observed the thrombosis in severe COVID-19 cases. The aim of this study was to evaluate the incidence of thromboembolism in mild/ moderate COVID-19. All of the patients had normal coagulation tests and had no overt thrombotic complications. It is important to screen the thrombotic status in mild/moderate COVID-19. From June 11 to July 8, 2020, 23 patients with mild/ moderate COVID-19 pneumonia consented to having a CTPA (CT pulmonary angiography) + CTV (CT venography) scans for the lung and extremity veins. Doppler ultrasound (DUS) was performed in all patients for screening. The incidence, clinical manifestations, laboratory examinations, imaging features and prognosis of patients with venous thromboembolism (VTE) were analyzed and compared with those COVID-19 pneumonia patients without VTE. 19 patients (82.6%) had VTE, mainly distal limb thrombosis. Only one of the VTE were screened by DUS, the other VTE were negative by DUS. All of the mild / moderate patients with VTE were screened by CTPA + CTV. The blood tests for inflammatory, coagulation and biochemistry parameters were all in normal scope except for the WBC and LDH. With CTV screening for DVT, we found the incidence of thrombosis in mild to moderate COVID-19 patients was soared to 82.6% (19/23). Screening for thrombosis is important in COVID-19. CTV is more sensitive than the DUS in detecting thrombosis. More research is needed to evaluate the significance of thrombosis in COVID-19 pneumonia.

To evaluate differences by race/ethnicity in clinical characteristics and outcomes among hospitalized patients with Covid-19 at Massachusetts General Hospital (MGH). The MGH Covid-19 Registry includes confirmed SARS-CoV-2-infected patients hospitalized at MGH and is based on manual chart reviews and data extraction from electronic health records (EHRs). We evaluated differences between White/Non-Hispanic and Hispanic patients in demographics, complications and 14-day outcomes among the N = 866 patients hospitalized with Covid-19 from March 11, 2020-May 4, 2020. Overall, 43% of patients hospitalized with Covid-19 were women, median age was 60.4 [IQR = (48.2, 75)], 11.3% were Black/non-Hispanic and 35.2% were Hispanic. Hispanic patients, representing 35.2% of patients, were younger than White/non-Hispanic patients [median age 51y; IQR = (40.6, 61.6) versus 72y; (58.0, 81.7) (p<0.001)]. Hispanic patients were symptomatic longer before presenting to care (median 5 vs 3d, p = 0.039) but were more likely to be sent home with self-quarantine than be admitted to hospital (29% vs 16%, p<0.001). Hispanic patients had fewer comorbidities yet comparable rates of ICU or death (34% vs 36%). Nonetheless, a greater proportion of Hispanic patients recovered by 14 days after presentation (62% vs 45%, p<0.001; OR = 1.99, p = 0.011 in multivariable adjusted model) and fewer died (2% versus 18%, p<0.001). Hospitalized Hispanic patients were younger and had fewer comorbidities compared to White/non-Hispanic patients; despite comparable rates of ICU care or death, a greater proportion recovered. These results have implications for public health policy and the design and conduct of clinical trials.

Certain Health Workers (HWs) may have inadequate knowledge and perceptions regarding COVID-19. As a result, they may not be completely aware of the danger/risk involved, which could impact their ability to control the spread of the virus. This systematic review aims to enhance HWs' knowledge and their perception of the spread risk of COVID-19 during the pandemic. A search was conducted in four databases (Medline, CINAHL, Scopus, and ScienceDirect) to locate peer-reviewed studies published in English between January 2020 and April 2020. Eventually, nine articles satisfied the inclusion criteria and were, therefore, included in the present study. Six of the aforementioned studies specifically investigated HWs' perception of risk. Apart from a study that indicated medium perception (min = 56.5%), all other studies found high levels of risk perception (

SARS Coronavirus 2 (SARS-CoV-2) emerged in late 2019, leading to the Coronavirus Disease 2019 (COVID-19) pandemic that continues to cause significant global mortality in human populations. Given its sequence similarity to SARS-CoV, as well as related coronaviruses circulating in bats, SARS-CoV-2 is thought to have originated in Chiroptera species in China. However, whether the virus spread directly to humans or through an intermediate host is currently unclear, as is the potential for this virus to infect companion animals, livestock, and wildlife that could act as viral reservoirs. Using a combination of surrogate entry assays and live virus, we demonstrate that, in addition to human angiotensin-converting enzyme 2 ( ACE2 , the Spike glycoprotein of SARS-CoV-2 has a broad host tropism for mammalian ACE2 receptors, despite divergence in the amino acids at the Spike receptor binding site on these proteins. Of the 22 different hosts we investigated, ACE2 proteins from dog, cat, and cattle were the most permissive to SARS-CoV-2, while bat and bird ACE2 proteins were the least efficiently used receptors. The absence of a significant tropism for any of the 3 genetically distinct bat ACE2 proteins we examined indicates that SARS-CoV-2 receptor usage likely shifted during zoonotic transmission from bats into people, possibly in an intermediate reservoir. Comparison of SARS-CoV-2 receptor usage to the related coronaviruses SARS-CoV and RaTG13 identified distinct tropisms, with the 2 human viruses being more closely aligned. Finally, using bioinformatics, structural data, and targeted mutagenesis, we identified amino acid residues within the Spike- ACE2 interface, which may have played a pivotal role in the emergence of SARS-CoV-2 in humans. The apparently broad tropism of SARS-CoV-2 at the point of viral entry confirms the potential risk of infection to a wide range of companion animals, livestock, and wildlife.

COVID-19, a respiratory viral disease causing severe pneumonia, also affects the heart and other organs. Whether its cardiac involvement is a specific feature consisting of myocarditis, or simply due to microvascular injury and systemic inflammation, is yet unclear and presently debated. Because myocardial injury is also common in other kinds of pneumonias, we investigated and compared such occurrence in severe pneumonias due to COVID-19 and other causes. We analysed data from 156 critically ill patients requiring mechanical ventilation in four European tertiary hospitals, including all n = 76 COVID-19 patients with severe disease course requiring at least ventilatory support, matched to n = 76 from a retrospective consecutive patient cohort of severe pneumonias of other origin (matched for age, gender, and type of ventilator therapy). When compared to the non-COVID-19, mortality (COVID-19 = 38.2% vs. non-COVID-19 = 51.3%, P = 0.142) and impairment of systolic function were not significantly different. Surprisingly, myocardial injury was even more frequent in non-COVID-19 (96.4% vs. 78.1% P = 0.004). Although inflammatory activity [C-reactive protein (CRP) and interleukin-6] was indifferent, d-dimer and thromboembolic incidence (COVID-19 = 23.7% vs. non-COVID-19 = 5.3%, P = 0.002) driven by pulmonary embolism rates (COVID-19 = 17.1% vs. non-COVID-19 = 2.6%, P = 0.005) were higher. Myocardial injury was frequent in severe COVID-19 requiring mechanical ventilation, but still less frequent than in similarly severe pneumonias of other origin, indicating that cardiac involvement may not be a specific feature of COVID-19. While mortality was also similar, COVID-19 is characterized with increased thrombogenicity and high pulmonary embolism rates.

The COVID-19 Pandemic led to the implementation of worldwide restrictive measures to reduce social contact and viral spread. These measures have been reported to have a negative effect on physical activity (PA). Studies of PA during the pandemic have primarily used self -reported data. The single academic study that used tracked data did not report on demographics. The present study aimed to explore patterns of smartphone tracked activity before, during and immediately after lockdown in the UK, and examine differences by sociodemographic characteristics and prior levels of PA. Tracked longitudinal weekly minutes of physical activity were captured using the BetterPoints smartphone app between January and June 2020. Data was plotted by week, demographics and activity levels at baseline. Non-parametric tests of difference were used to assess mean and median weekly minutes of activity at significant points, before, during and as lockdown was eased. Changes over time by demographics (age, gender, Index of Multiple Deprivation, baseline activity levels) were examined using generalised estimating equations (GEEs). There were 5395 users with mean age of 41 (SD 12), 61% were female. At baseline, 26% of users were inactive, 23% fairly active and 51% active. There was a relatively even spread across deprivation deciles (31% in the least deprived deciles and 23% in the most). We found significant changes in PA from the week before the first case of COVID-19 was announced (baseline), to the week that social distancing restrictions were relaxed (Friedman test: χ2(2) = 2331, p < 0.001.) By the first full week of lockdown, the median change in PA was 57 minutes less than baseline. This represents a 37% reduction in weekly minutes of PA. Overall, 63% of people decreased their level of activity between baseline and first week of COVID-19 restrictions. Younger people showed more PA before lockdown but the least PA after lockdown. In contrast, the over-65s appeared to remain more active throughout and increased their activity levels as soon as lockdown was eased. Levels of physical activity among those classed as active at baseline showed a larger drop compared with those considered to be fairly active or inactive. Socioeconomic group and gender did not appear to be associated with changes in PA. Our tracked physical activity data suggests a significant drop in PA during the UK's COVID-19 lockdown. Significant differences by age group and prior PA levels suggests that the Government's response to COVID-19 needs to be sensitive to these individual differences and react accordingly. Specifically, it should consider the impact on younger age groups, encourage everyone to increase their PA and not assume that people will recover prior levels of PA on their own.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new strain of virus in the Coronavirus family that has not been previously identified. Since SARS-CoV-2 is a new virus, everyone is at risk of catching the Coronavirus disease 2019 (Covid-19). No one has immunity to the virus. Despite this, misconceptions about specific groups of people who are immune to Covid-19 emerged with the onset of the pandemic. This paper explores South African communities' misconceptions about who is most vulnerable to Covid-19. A rapid qualitative assessment was conducted remotely in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Recruitment of study participants took place through established relationships with civil society organizations and contacts made by researchers. In total, 60 key informant interviews and one focus group discussion was conducted. Atlas.ti.8 Windows was used to facilitate qualitative data analysis. The qualitative data was coded, and thematic analysis used to identify themes. The results show a high level of awareness and knowledge of the transmission and prevention of SARS-CoV-2. Qualitative data revealed that there is awareness of elderly people and those with immunocompromised conditions being more vulnerable to catching Covid-19. However, misconceptions of being protected against the virus or having low or no risk were also evident in the data. We found that false information circulated on social media not only instigated confusion, fear and panic, but also contributed to the construction of misconceptions, othering and stigmatizing responses to Covid-19. The study findings bring attention to the importance of developing communication materials adapted to specific communities to help reduce misconceptions, othering and stigmatization around Covid-19.

Porcine epidemic diarrhea virus (PEDV) is an enteric swine coronavirus. Recent PEDV eruption in East Asian and North American countries made it notorious and caused huge economic losses to the porcine industry. Nonstructural protein 13 (nsp13) is a nucleic acid helicase/NTPase that plays a critical role in viral gene transcription and viral replication. To investigate the function of nsp13 in the context of PEDV infection, here, PEDV nsp13 gene was amplified and cloned into pET28a/pET30a/pGEX-6P-1 expression vectors. The recombinant his-tagged nsp13 and GST-tagged nsp13 were expressed. Purified his-tagged nsp13 from pET28a-nsp13 vectors was chosen for immunization. Three monoclonal antibodies (mAbs) named 5A9, 5C7, and 5G7 were identified from the hybridoma cells, and were characterized by Western blot analysis and immunofluorescent assay, which demonstrated high specificity of these three mAbs with pCAGGS-HA-nsp13. All three mAbs belong to IgG1+ kappa subclass. However, only mAb 5A9 could effectively and specifically recognize PEDV expressing nsp13. Furthermore, the generated antibody against nsp13 could be applied to investigate nsp13 function during PEDV replication.

The coronavirus disease (COVID-19) pandemic has greatly altered peoples' daily lives, and it continues spreading as a crucial concern globally. Knowledge, attitudes, and practices (KAP) toward COVID-19 are related to individuals' adherence to government measures. This study evaluated KAP toward COVID-19 among university students in Japan between May 22 and July 16, 2020, via an online questionnaire, and it further investigated the associated determining KAP factors. Among the eligible respondents (n = 362), 52.8% were female, 79.0% were undergraduate students, 32.9% were students whose major university subjects were biology-related, 35.4% were from the capital region, and 83.7% were Japanese. The overall KAP of university students in Japan was high. All respondents (100%) showed they possessed knowledge on avoiding enclosed spaces, crowded areas, and close situations. Most respondents showed a moderate or higher frequency of washing their hands or wearing masks (both at 96.4%). In addition, 68.5% of respondents showed a positive attitude toward early drug administration. In the logistic regressions, gender, major subjects, education level, nationality, residence, and psychological factors (private self-consciousness and extroversion) were associated with knowledge or attitudes toward COVD-19 (p < 0.05). In the logistic and multiple linear regressions, capital regions, high basic knowledge, high information acquisition, correct information explanations contributed positively to preventative action (p < 0.05). Non-capital regions, male gender, non-bio-backgrounds, high public self-consciousness, high advanced knowledge, incorrect information explanations, and high extroversion contributed negatively to self-restraint (p < 0.05). Moreover, self-restraint was decreasing over time. These findings clarify the Japanese university students' KAP and the related factors in the early period of the COVID-19 pandemic, and they may help university managers, experts, and policymakers control the future spread of COVID-19 and other emerging infections.

The intestinal microbiota comprises diverse fungal and viral components, in addition to bacteria. These microbes interact with the immune system and affect human physiology. Advances in metagenomics have associated inflammatory and autoimmune diseases with alterations in fungal and viral species in the gut. Studies of animal models have found that commensal fungi and viruses can activate host-protective immune pathways related to epithelial barrier integrity, but can also induce reactions that contribute to events associated with inflammatory bowel disease. Changes in our environment associated with modernization and the COVID-19 pandemic have exposed humans to new fungi and viruses, with unknown consequences. We review the lessons learned from studies of animal viruses and fungi commonly detected in the human gut and how these might affect health and intestinal disease.

The WHO has declared a SARS-CoV-2 pandemic. During a pandemic, the researches aimed at finding the new treatments for SARS-CoV-2 become relevant. The review focuses on studies of androgens and antiandrogens in this disease. Since the beginning of the COVID-19 epidemic, it has been noted that men have more severe forms of infection and higher mortality. The main cause of both the severity of the disease and the high mortality of men from COVID-19 are associated with androgens. It was found that patients receiving androgen deprivation are less likely to become infected and easily tolerate COVID-19. The researchers explain the effect of the therapy by the effect on the TMPRSS2 protein. It was found that both TMPRSS2 expression and a more severe course of coronavirus infection are observed in men with hyperandrogenism - androgenic alopecia, acne, excessive facial hair growth and increased skin oiliness. In this regard, some researchers suggest to use androgen deprivation for men at high risk of developing COVID-19. Steroid and non-steroidal antiandrogens are used for androgen deprivation. At the same time, obtaned scientific data on the relationship of severe forms and mortality of COVID-19 with low testosterone levels leads to a hypothesis about the possibility of a positive effect not of androgen devrivation therapy but of androgen replacement therapy in case of hypogonadism have diagnosed. These studies have not been completed recently, and data on the effectiveness and safety of antiandrogens and androgens in the treatment of a new coronavirus infection require clarification.

Emerging highly transmissible viral infections such as SARS-CoV-2 pose a significant global threat to human health and the economy. Since its first appearance in December 2019 in the city of Wuhan, Hubei province, China, SARS-CoV-2 infection has quickly spread across the globe, with the first case reported on the Africa continent, in Egypt on February 14

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) expresses a multifunctional papain-like proteinase (PLpro), which mediates the processing of the viral replicase polyprotein. Inhibition of PLpro has been shown to suppress the viral replication. This study aimed to explore new anti-PLpro candidates by applying virtual screening based on GRL0617, a known PLpro inhibitor of SARS coronavirus (SARS-CoV). The three-dimensional (3D) structure of SARS-CoV-2 PLpro was built by homology modeling, using SARS-CoV PLpro as the template. The model was refined and studied through molecular dynamic simulation. AutoDock Vina was then used to perform virtual screening where 50 chemicals with at least 65% similarity to GRL0617 were docked with the optimized SARS-CoV-2 PLpro. In this screening, 5-(aminomethyl)-2-methyl-

In a recent publication in this journal Eleftheriou et al. proposed inhibitors of dipeptidyl peptidase-4 (DPP-4) to be functional inhibitors of the main protease (M pro ) of SARS-CoV-2. Their predictions prompted the authors to suggest linagliptin, a DPP-4 inhibitor and approved anti-diabetes drug, as a repurposed drug candidate against the ongoing COVID-19 pandemic. We used an enzymatic assay measuring inhibition of M pro catalytic activity in the presence of four different commercially available gliptins (linagliptin, sitagliptin, alogliptin and saxagliptin) and several structural analogues of linagliptin to study binding of DPP-4 inhibitors to M pro and their functional activity. We show here that DPP-4 inhibitors like linagliptin, other gliptins and structural analogues are inactive against M pro .