Case reports

Can China return to normalcy while keeping the coronavirus in check?

Science

Normile, Dennis

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Introduction

Life is almost back to normal in much of China. Shops, restaurants, bars, and offices are open for business. Manufacturing activity is picking up. Traffic once again jams the highways of major cities. Three quarters of China's workforce was back on the job as of 24 March, according to one company’s estimate. Wuhan, where the COVID-19 pandemic originated, is lagging, as is the rest of Hubei province but even there, the lockdown is due to lift 8 April. China has done what few believed was possible: bring a blazing epidemic of a respiratory virus to a virtual standstill. On 18 March, the country reported zero locally transmitted cases of COVID-19 for the first time. Since then, only 6 of such infections have been reported, only one of them in Wuhan. Now, the key question is: Can China keep it that way?

Keywords

Epidemiology

Iran confronts coronavirus amid a˜battle between science and conspiracy theories’

The European respiratory journal

Stone, Richard.

Introduction

When Mehdi Variji fell ill with COVID-19 in early March, he holed up in his apartment in Tehran, Iran, to ride it out. The comforts of home didn’t seem to help. As he grew short of breath and oxygen levels in his blood ebbed, Variji, a 43-year-old physician who ran Tehran’s 21st District Clinic, knew he faced a bleak prognosis. “I’m taking three medicines, but they are not working on me,” he said in a cellphone video he shot a few days before his death. A somber cellphone video shot on 20 March shows four gowned and masked workers preparing his grave in the courtyard of a shrine in his hometown, Sari. His wife and children stayed away because of the infection risk. It was just after midnight on Nowruz, the first day of the Persian new year and normally the beginning of a joyous festival.

Keywords

COVID-19, SARS-CoV-2, Treatment

Would everyone wearing face masks help us slow the pandemic?

Science

Servick, Kelly.

Introduction

As cases of coronavirus disease 2019 (COVID-19) ballooned last month, people in Europe and North America scrambled to get their hands on surgical masks to protect themselves. Health officials jumped in to discourage them, worried about the limited supply of masks for health care personnel. “Seriously people-STOP BUYING MASKS!” began a 29 February tweet from U.S. Surgeon General Jerome Adams. The World Health Organization and U.S. Centers for Disease Control and Prevention (CDC) have both said that only people with COVID-19 symptoms and those caring for them should wear masks. But some health experts, including the director of the Chinese Center for Disease Control and Prevention, think that’s a mistake. Health authorities in parts of Asia have encouraged all citizens to wear masks in public to prevent the spread of the virus, regardless of whether they have symptoms. And the Czech Republic took the uncommon step last week of making nose and mouth coverings mandatory in public spaces, prompting a grassroots drive to hand-make masks.

Keywords

COVID-19, SARS-CoV-2, Treatment

$100M in Dislocated Worker grants available

Federal Grants & Contracts
Volume 44, 2020, Issue

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About

The U.S. Department of Labor (DOL) has announced the availability of up to $100 million for Dislocated Worker Grants (DWGs) to help address the workforce‐related impacts of the public health emergency related to COVID‐19, also known as novel coronavirus.

“As Americans make sacrifices to combat the spread of coronavirus, President Trump's priority is to protect and sustain America's workers and their families,” U.S. Secretary of Labor Eugene Scalia said in a statement. “The availability of Dislocated Worker Grants will help states and communities strengthen their economies as we fight to slow the spread of the virus and regain our economic momentum.”

Covid-19: What Do Trainees Need To Know?

BMJ (Clinical Research ed.)
Volume 368, March 2020, m1276-m1276

Rimmer, Abi.

Introduction

Sarah Hallett, chair of the BMA junior doctors committee, answers questions on how the COVID-19 pandemic might affect trainees. This is an unprecedented situation for the NHS and it's likely that many staff, including junior doctors, will be asked to take on roles that may be unfamiliar or that they weren't expecting. We know that this is already happening in places where the pressure is being felt. Junior doctors shouldn't be asked to do anything outside of their own competence levels; if you have concerns about where you are being redeployed, you should raise this with your educational supervisor. When working in a different role, you should be supported and always know who you can escalate to. We would also expect any diversions for junior doctors to be for as short a time as possible. It's important, too, that once pressures ease, junior doctors can return to their training posts and trusts should do all they can to make sure this is the case.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Covid-19: "Illogical" Lack Of Testing Is Causing Healthy Staff To Self-Isolate, BMA Chief Warns (Copy)

BMJ (Clinical research ed.)
Volume 369, March 2020, m1277-m1277

Iacobucci, Gareth.

Introduction

The absence of COVID-19 testing for NHS staff is causing huge workforce shortages by forcing doctors to self-isolate even if they do not have the virus, the head of the BMA has warned.

The government’s advice is for people with COVID-19 symptoms to stay at home for seven days, but for all other household members who remain well to isolate for 14 days. The BMA council chairman, Chaand Nagpaul, said that the lack of testing for staff was “counter-intuitive” as it was likely to be forcing more staff than necessary to stay away from hospitals and GP surgeries because they do not know if they are infected.

Keywords

Epidemiology

Clinical Characteristics of Covid-19 in China

The New England Journal of Medicine

Chen, Andre T. C.; Coura-Filho, George B.; Rehder, Marília H. H.

To the Editor,

According to the World Health Organization (WHO), the case definition for surveillance of returning travelers requires that they need to present with fever and at least one respiratory symptom to be considered as having suspected cases of coronavirus disease 2019 (Covid-19).1 In their article regarding 1099 patients with laboratory-confirmed Covid-19 at hospitals across China during the first 2 months of the pandemic, Guan et al. (Feb. 28 online publication, available at NEJM.org)2 present compelling data supporting the need for a reassessment of these criteria. The authors found that only 43.8% of the patients presented with fever on admission, although fever developed in 88.7% during hospitalization. That means that if those travelers were returning from affected areas, more than half would not be suspected of having Covid-19, which would result in undetected patients who can spread the virus. This issue may be particularly relevant in low-income countries with less structured health care systems, which could not provide adequate follow-up of these travelers.

Keywords

Clinical aspects, diagnosis, treatment

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

New England Journal of Medicine

McMichael, Temet M.; Currie, Dustin W.; Clark, Shauna; Pogosjans, Sargis; Kay, Meagan; Schwartz, Noah G.; Lewis, James; Baer, Atar; Kawakami, Vance; Lukoff, Margaret D.; Ferro, Jessica; Brostrom-Smith, Claire; Rea, Thomas D.; Sayre, Michael R.; Riedo, Francis X.; Russell, Denny; Hiatt, Brian; Montgomery, Patricia; Rao, Agam K.; Chow, Eric J.; Tobolowsky, Farrell; Hughes, Michael J.; Bardossy, Ana C.; Oakley, Lisa P.; Jacobs, Jesica R.; Stone, Nimalie D.; Reddy, Sujan C.; Jernigan, John A.; Honein, Margaret A.; Clark, Thomas A.; Duchin, Jeffrey S.

Abstract

BACKGROUND

Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

METHODS

After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

RESULTS

As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

CONCLUSIONS

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

Keywords

GERIATRICS/​AGING, INFECTIOUS DISEASE, VIRAL INFECTIONS, GLOBAL HEALTH, INFLUENZA

COVID 19 and Intra Cerebral Hemorrhage: Causative or Coincidental

New Microbes and New Infections

Sharifi-Razavi, A.; Karimi, N.; Rouhani, N.

Introduction

Pneumonia appears to be the most manifestation of COVID 19, but some extra-pulmonary involvement such as gastrointestinal, cardiac and renal has been reported. According to limited clinical data about the virus behavior up to now, specially extra-pulmonary symptoms, we should be aware on possibility of initial cerebrovascular manifestations of COVID19.

Keywords

Epidemiology

Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says

The European respiratory journal

Cohen, Jon.

To the Editor,

Chinese scientists at the front of that country’s outbreak of coronavirus disease 2019 (COVID-19) have not been particularly accessible to foreign media. Many have been overwhelmed trying to understand their epidemic and combat it, and responding to media requests, especially from journalists outside of China, has not been a top priority.

Science has tried to interview George Gao, director-general of the Chinese Center for Disease Control and Prevention (CDC), for 2 months. Last week he responded.

Keywords

COVID-19, SARS-CoV-2, Treatment

Dynamic Change Process Of Target Genes By RT-PCR Testing Of SARS-Cov-2 During The Course Of A Coronavirus Disease 2019 Patient

Clinica Chimica Acta
Volume 506, July 2020, Pages 172-175

Lv, Ding-feng; Ying, Qi-ming; Weng, Yue-song; Shen, Chi-bin; Chu, Jin-guo; Kong, Jing-ping; Sun, Ding-he; Gao, Xiang; Weng, Xing-bei; Chen, Xue-qin.

Abstract

We report the dynamic change process of target genes by RT-PCR testing of SARS-Cov-2 during the course of a COVID-19 patient: from successive negative results to successive single positive nucleocapsid gene, to two positive target genes (orf1ab and nucleocapsid) by RT-PCR testing of SARS-Cov-2, and describe the diagnosis, clinical course, and management of the case. In this case, negative results of RT-PCR testing was not excluded to diagnose a suspected COVID-19 patient, clinical signs and symptoms, other laboratory findings, and chest CT images should be taken into account for the absence of enough positive evidence. This case highlights the importance of successive sampling and testing SARS-Cov-2 by RT-PCR as well as the increased value of single positive target gene from pending to positive in two specimens to diagnose laboratory-confirmed COVID-19.

Keywords

Coronavirus, SARS-Cov-2, COVID-19, RT-PCR testing, Nucleocapsid

Undocumented U.S. Immigrants and Covid-19

New England Journal of Medicine

Page, Kathleen R.; Venkataramani, Maya; Beyrer, Chris; Polk, Sarah.

Introduction

In 2019, as the “public charge” rule made its tions, and separation of families case managers to disenroll their children from the Supplemental Nutrition Assistance Program (SNAP), fearing it would affect their chances of obtaining legal status in the future or lead to deportation. The new public charge rule, which went into effect on February 24, 2020, states that “aliens are inadmissible to the United States if they are unable to care for themselves without becoming public charges”

Keywords

Epidemiology

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020Weekly

MMWR Morb Mortal Weekly Rep

Kimball A, Hatfield KM, Arons M, et al.

Summary

What is already known about this topic? Once SARS-CoV-2 is introduced in a long-term care skilled nursing facility (SNF), rapid transmission can occur.
What is added by this report? Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.
What are the implications for public health practice? Symptom-based screening of SNF residents might fail to identify all SARS-CoV-2 infections. Asymptomatic and presymptomatic SNF residents might contribute to SARS-CoV-2 transmission. Once a facility has confirmed a COVID-19 case, all residents should be cared for using CDC-recommended personal protective equipment (PPE), with considerations for extended use or reuse of PPE as needed.

Keywords

Epidemiological study; Infection prevention and control

Strange Days

Medical Education

Eva, Kevin W.

Introduction

As people around the globe grapple with the COVID-19 pandemic it is difficult to know what to write in this space. Given publication lags, academic periodicals like Medical Education are a terrible place for "news" at the best of times. Our recently started release of "Accepted Articles" ensures this editorial will be made public in days rather than months, but the current situation is changing for many of us by the hour. With no capacity to know the future, the only claim I can make with confidence is that things are different now, when you're reading this text, relative to when it was written.

Keywords

Epidemiology

Preparedness and Lessons Learned from the Novel Coronavirus Disease

The International Journal of Occupational and Environmental Medicine
Volume 11, March 2020, Issue 2, pp 108-112

Gudi, S. K.; Tiwari, K. K.

Abstract

In a short span, a novel coronavirus (SARS-CoV-2) has captured global consciousness by significantly affecting the day-to-day life of humans and emerged as a public health emergency. Undoubtedly, it indicates that lessons learnt from the past epidemics of coronaviruses such as the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), had not enough and thus left us ill-prepared to deal with the challenges that COVID-19 pandemic is currently posing. Currently, as a global pandemic, COVID-19 poses major challenges and thus forcing the entire world to lockdown. However, the disease has prepared humankind in facing such outbreaks at present as well as in the future. Besides, it has also taught numerous lessons that are worth considering and implementing to make the world a better reality.

Keywords

Epidemiology

How emergency departments prepare for virus disease outbreaks like COVID-19

European Journal of Emergency Medicine

Möckel, Martin; Bachmann, Ulrike; Behringer, Wilhelm; Pfäfflin, Frieder; Stegemann, Miriam Songa.

Introduction

Acute outbreaks of novel virus caused diseases like coronavirus disease 2019 (COVID-19) challenge the national and international healthcare systems and specifically the emergency departments (EDs) as patients, even if they have only mild symptoms, intuitively present in the ED once they fear to have a serious disease. Therefore, EDs need to prepare fast and effectively to address the challenge of walk-in patients who might transmit the virus SARSCoV-2 without displaying severe symptoms themselves, to protect personnel and vulnerable patient groups who are typically present in the ED at any time like patients with immunosuppression, chronic disease and older age. The outbreak of COVID-19 in Wuhan, China and the transmission to Europe is a typical example with some lessons learned for the ED. This early report reflects the situation from a German perspective including the capital city of Berlin.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Tracking COVID-19 Responsibly

The Lancet

Muhareb, Rania; Giacaman, Rita.

Introduction

As of March 25, 2020, WHO's online coronavirus disease 2019 (COVID-19) situation dashboard reveals that the pandemic spans 195 countries and territories with 375 498 cases. With this rapid expansion of the pandemic comes a growing need to ensure that accurate and credible information is accessible to public health authorities, researchers, and the wider public. This has prompted WHO, institutions, and individuals to develop online tools to track the spread of the pandemic. Although WHO's emergency preparedness is informed by established principles of international law,

1 the multiplicity of actors has the potential to create confusion and barriers to accessing reliable and consistent data. These actors’ categorisation of countries and territories, which could be subject to geopolitical considerations, remains unaccountable to affected populations.

Keywords

Epidemiology

Reacquainting Cardiology with Mechanical Ventilation in Response to the COVID-19 Pandemic

JACC: Case Reports

Gage, Ann; Higgins, Andrew; Lee, Ran; Panhwar, Muhammad Siyab; Kalra, Ankur

Introduction

Reports from countries struck by the coronavirus disease 2019 (COVID-19) pandemic have consistently highlighted physician shortages and the utilization of physicians not specifically trained in critical care to care for COVID-19 patients. Given the significant overlap between cardiology and critical care, cardiologists may be among the first physicians asked to step in to fill this shortage. If and when this occurs, a basic framework for recognition of acute respiratory failure, acute respiratory distress syndrome (ARDS), and initial ventilator management is imperative. The following is a brief review of ARDS and an overview of ventilator management designed to help ensure physician comfort and patient safety.

Keywords

Clinical aspects, diagnosis, treatment

Race to find COVID-19 treatments accelerates

Science (New York, N.Y.)
Volume 367, 2020, Issue 6485, P 1412-1413

Kupferschmidt, K.; Cohen, J.

Abstract

With cases of the new coronavirus disease 2019 (COVID-19) climbing steeply everywhere from Madrid to Manhattan , overwhelming one hospital after another and pushing the global death toll past 17,000, the sprint to find treatments has dramatically accelerated. Drugs that stop the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could save the lives of severely ill patients, protect health care workers and others at high risk of infection, and reduce the time patients spend in hospital beds.

Keywords

Clinical aspects, diagnosis, treatment