COVID-19

Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries*

GLOBAL PUBLIC HEALTH

Jody Heymann , Amy Raub, Willetta Waisath, Michael McCormack, Ross Weistroffer, Gonzalo Moreno, Elizabeth Wong and Alison Earle

ABSTRACT

Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.

KEYWORDS : COVID-19; infectious disease spread; paid sick leave; global policy analysis; workplace

A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19

Journal of Critical Care

Andrea Cortegiani, Giulia Ingoglia, Mariachiara Ippolito, Antonino Giarratano, Sharon Eina

Abstract

PurposeCOVID-19 (coronavirus disease 2019) is a public health emergency of international concern. As of this time, there is no known effective pharmaceutical treatment, although it is much needed for patient contracting the severe form of the disease. The aim of this systematic review was to summarize the evidence regarding chloroquine for the treatment of COVID-19.

Methods

PubMed, EMBASE, and three trial Registries were searched for studies on the use of chloroquine in patients with COVID-19.

Results

We included six articles (one narrative letter, one in-vitro study, one editorial, expert consensus paper, two national guideline documents) and 23 ongoing clinical trials in China. Chloroquine seems to be effective in limiting the replication of SARS-CoV-2 (virus causing COVID-19) in vitro.

Conclusions

There is rationale, pre-clinical evidence of effectiveness and evidence of safety from long-time clinical use for other indications to justify clinical research on chloroquine in patients with COVID-19. However, clinical use should either adhere to the Monitored Emergency Use of Unregistered Interventions (MEURI) framework or be ethically approved as a trial as stated by the World Health Organization. Safety data and data from high-quality clinical trials are urgently needed.

Keywords: SARS-CoV-2COVID-19ChloroquinePneumoniaCoronavirus

Breaking News ‘Don't You Think This Whole COVID-19 Thing is Overblown?’

Emergency Medicine
Volume 42, Issue 4A

Mosley, Mark

Introduction

I work in an emergency department in Wichita, KS. That may not matter, but it's important to have context. We have one confirmed case of COVID-19 (from a cruise ship) as I'm writing this on March 19. But we are testing hardly anyone—yet. Patients and friends ask several times a day, “Don't you think this whole thing is overblown?”.

Keywords

Clinical aspects, diagnosis, treatment

Breaking News: 16 Common-Sense Tips and Facts for Dealing with COVID-19

Emergency Medicine News
Volume 42 - Issue 4A 

Mosley, Mark

Introduction

Many of these suggestions are not new, but we need new vigilance in the wake of COVID-19.

1. Wash your hands with every entry into and exit from a room.

Wash your hands for 20 seconds. Think of something to say, sing, or pray that takes 20 seconds, or do three rounds of slow, deep meditative breathing. Water with soap may be better, especially if there is a sanitizer shortage. The virus has a lipid layer, so soap or alcohol that is 60% or higher breaks it down.

Keywords

Epidemiology

Artificial Intelligence and Machine Learning to Fight COVID-19

Physiological Genomics
Volume 52, Issue 4, April 2020, Pages 200-202

Alimadadi, Ahmad; Aryal, Sachin; Manandhar, Ishan; Munroe, Patricia B.; Joe, Bina; Cheng, Xi

Introduction

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (13), has become an unprecedented public health crisis. Coronavirus Resource Center at Johns Hopkins University of Medicine has reported a total of 23,638 deaths as worldwide COVID-19 infections surpass 500,000 (as of 5 PM EST on March 26, 2020). On March 16, 2020, the White House, collaborating with research institutes and tech companies, issued a call to action for global artificial intelligence (AI) researchers for developing novel text and data-mining techniques to assist COVID-19-related research.

Keywords

Artificial Intelligence, COVID-19, Machine Learning, SARS-CoV-2

Elevated Plasmin (Ogen) As A Common Risk Factor For COVID-19 Susceptibility

Physiological reviews
Volume 100, Issue 3, July 2020, Pages 1065-1075

Ji, Hong-Long; Zhao, Runzhen; Matalon, Sadis; Matthay, Michael A.

Introduction

Patients with hypertension, diabetes, coronary heart disease, cerebrovascular illness, COPD, and kidney dysfunction have worse clinical outcomes when infected with SARS-CoV-2, for unknown reasons. The purpose of this review is to summarize the evidence for the existence of elevated plasmin(ogen) in COVID-19 patients with these comorbid conditions. Plasmin, and other proteases, may cleave a newly inserted furin site in the S protein of SARS-CoV-2, extracellularly, which increases its infectivity and virulence. Hyper-fibrinolysis associated with plasmin leads to elevated D-dimer in severe patients. The plasmin(ogen) system may prove a promising therapeutic target for combating COVID-19.

Keywords

Comorbidity, COVID-19, fibrinolysis, plasmin(ogen), SARS-CoV-2

Sound Science Before Quick Judgement Regarding RAS Blockade in COVID-19

Clinical journal of the American Society of Nephrology: CJASN

Matthew A. Sparks, Andrew South, Paul Welling, J. Matt Luther, Jordana Cohen, James Brian Byrd, Louise M. Burrell, Daniel Batlle, Laurie Tomlinson, Vivek Bhalla, Michelle N. Rheault, María José Soler, Sundar Swaminathan and Swapnil Hiremath 

Abstract

There has been much speculation in journals as well as social and traditional media about a link between popularly used classes of drugs that inhibit the renin-angiotensin system (RAS) and novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) infection or coronavirus disease 2019 (COVID-19) disease severity. After examining the available evidence, we advise that inhibitors of the RAS pathway should be continued in patients with COVID-19 who are taking these drugs for evidence-based indications. The putative link between SARS-CoV-2 angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) can be rationalized by the biology of virus entry. The spike protein of SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as a receptor to enter type II pneumocytes or enterocytes (and likely, other cells).

Keywords

angiotensinrenin angiotensin systemvirology, hypertension, ACE inhibitors, COVID-19, severe acute respiratory syndrome coronavirus 2, Renin-Angiotensin System, Angiotensin-Converting Enzyme Inhibitors

Protecting high-risk cardiac patients during the Covid-19 outbreak

Journal of Cardiothoracic and Vascular Anesthesia

Pisano, Antonio; Landoni, Giovanni; Zangrillo, Alberto

Abstract

In the effort to face the ongoing Coronavirus Disease 2019 (COVID-19) epidemic, which caused severe pneumonia requiring intensive care unit (ICU) admission in up to 15% of confirmed cases so far, many hospitals in Italy are setting up new ICUs, stopping nonurgent admissions, limiting the access to emergency rooms and wards, and providing separate pathways for suspected COVID-19 and other diseases. In parallel, it is mandatory to continue ensuring the provision of non-postponable treatments (eg, primary percutaneous coronary interventions or urgent/emergency cardiac surgical procedures).

Keywords

Clinical aspects, diagnosis, treatment

Assessment of health information about the prevention of COVID-19 on the Internet

JMIR Public Health and Surveillance

Hernández-García, Ignacio; Giménez-Júlvez, Teresa

Abstract

Background: The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users.

Objective: The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet.

Methods: On February 29, 2020, we performed a Google search with the terms "Prevention coronavirus," "Prevention COVID-19," "Prevención coronavirus," and "Prevención COVID-19". A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO).

Results: In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was "wash your hands frequently" (n=65, 81%). A less frequent recommendation was to "stay home if you feel unwell" (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as "wash your hands frequently" (OR 9.82), "cover your mouth and nose with your bent elbow or tissue when you cough or sneeze" (OR 4.59), or "stay home if you feel unwell" (OR 0.31).

Conclusions: It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

The Cardiovascular Burden Of Coronavirus Disease 2019 (COVID-19) With A Focus On Congenital Heart Disease

International Journal of Cardiology

Tan, Weiyi; Aboulhosn, Jamil

Introduction

Coronavirus disease 2019 (COVID-19), caused by a novel betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in a cluster of patients presenting with pneumonia symptoms in Wuhan, China, in December of 2019. Over the past few months, COVID-19 has developed into a worldwide pandemic, with over 400,000 documented cases globally as of March 24, 2020. The SARS-CoV-2 virus is most likely of zoonotic origin, but has been shown to have effective human-to-human transmission. COVID-19 results in mild symptoms in the majority of infected patients, but can cause severe lung injury, cardiac injury, and death. Given the novel nature of COVID-19, no established treatment beyond supportive care exists currently, but extensive public-health measures to reduce person-to-person transmission of COVID-19 have been implemented globally to curb the spread of disease, reduce the burden on healthcare systems, and protect vulnerable populations, including the elderly and those with underlying medical comorbidities. Since this is an emerging infectious disease, there is, as of yet, limited data on the effects of this infection on patients with cardiovascular disease, particularly so for those with congenital heart disease. We summarize herewith the early experience with COVID-19 and consider the potential applicability to and implications for patients with cardiovascular disease in general and congenital heart disease in particular.

Keywords

Clinical aspects, diagnosis, treatment

Breaking News: Brace for Chloroquine Poisonings Because of the Coronavirus Pandemic

Emergency Medicine
Volume 42, Issue 4A

Gussow, Leon

Introduction

President Trump voiced enthusiasm in a March 19 press conference for using the drug chloroquine against the coronavirus, saying, “It's been around a long time, so if things don't go well, we know it won't kill anyone.”

Keywords

Clinical aspects, diagnosis, treatment

Response to the COVID-19 Epidemic: The Chinese Experience and Implications for Other Countries

International Journal of Environmental Research and Public Health 2020,
Volume 17, Issue 7, Page 2304

Liu, Wei; Yue, Xiao-Guang; Tchounwou, Paul B.

Abstract

The ongoing outbreak of the novel coronavirus disease (COVID-19) that occurred in China is rapidly spreading globally. China’s bond and strict containment measures have been proved (in practice) to significantly reduce the spread of the epidemic. This was obtained through the use of emergency control measures in the epidemic areas and the integration of resources from multiple systems, including business, community, technology, education, and transportation, across the country. In order to better understand how China has managed to reduce the public health and economic impacts of the COVID-19 epidemic, this editorial systematically reviews the specific measures for infection prevention and control of the disease. The best practices for COVID-19 eradication in China provide evidence-based strategies that could be replicated in other countries.

Keywords

COVID-19; epidemic, China, emergency control measures, public health

COVID-19, Rheumatic Diseases and Immunosuppressive Drugs: An Appeal For Medication Adherence

Rheumatology International 2020

Yun-Jung Kang

Dear Editor,

The novel coronavirus (SARS-CoV-2) outbreak has raised concerns among patients on chronic immunosuppressive therapy because of immune response to virus perceived to be lowered, possibly fuelling non-adherence behaviour. Indeed, high frequency of infection has been observed in patients with rheumatic diseases. Despite immunosuppressive agents and impaired immune function had been associated with increased risk of infection, it must be remembered that uncontrolled disease activity is among the most sensitive and specific independent predictors.

Keywords

Clinical Aspects, Diagnosis, Treatment

Roadblocks to Infection Prevention Efforts in Healthcare SARS-CoV-2/COVID-19 Response

Disaster Medicine and Public Health Preparedness

Popescu, Saskia

Abstract

The outbreak of a novel coronavirus, COVID-19, is challenging international public health and healthcare efforts. As hospitals work to acquire enough personal protective equipment and brace for potential cases, the role of infection prevention efforts and programs has become increasingly important. Lessons from the 2003 SARS-CoV outbreak in Toronto and 2015 MERS-CoV outbreak in South Korea have unveiled the critical role that hospitals play in outbreaks, especially of novel coronaviruses. Their ability to amplify the spread of disease can rapidly fuel transmission of the disease and often those failures in infection prevention and general hospital practices contribute to such events. While efforts to enhance infection prevention measures and hospital readiness are underway in the United States, it is important to understand why these programs were not able to maintain continued, sustainable levels of readiness. History has shown that infection prevention programs are primarily responsible for preparing hospitals and responding to biological events but face under-staffing and focused efforts defined by administrators. The current U.S. healthcare system though, is built upon a series of priorities that often view biopreparedness as a costly endeavor. Awareness of these competing priorities and the challenges infection prevention programs face when working to maintain biopreparedness is critical in adequately addressing this critical infrastructure in the face of an international outbreak.

Keywords

Epidemiology

A Randomized Trial Of Instructor-Led Training Versus Video Lesson In Training Health Care Providers In Proper Donning And Doffing Of Personal Protective Equipment

Disaster Medicine and Public Health Preparedness

Christensen, Liva; Rasmussen, Charlotte Schang; Benfield, Thomas; Franc, Jeffrey Michael

Abstract

Objective: This study compared live instructor-led training with video-based instruction in personal protective equipment (PPE) donning and doffing. It assessed the difference in performance between (1) attending 1 instructor-led training session in donning and doffing PPE at 1 month prior to assessment, and (2) watching training videos for 1 month.

Methods: This randomized controlled trial pilot study divided 21 medical students and junior doctors into 2 groups. Control group participants attended 1 instructor-led training session. Video group participants watched training videos demonstrating the same procedures, which they could freely watch again at home. After 1 month, a doctor performed a blind evaluation of performance using checklists.

Results: Nineteen participants were assessed after 1 month. The mean donning score was 84.8/100 for the instructor-led group and 88/100 for the video group; mean effect size was 3.2 (95% CI: -7.5 to 9.5). The mean doffing score was 79.1/100 for the instructor-led group and 73.9/100 for the video group; mean effect size was 5.2 (95% CI: -7.6 to 18).

Conclusion: Our study found no significant difference in donning and doffing scores between instructor-led and video lessons. Video training could be a fast and resource-efficient method of training in PPE donning and doffing in responding to the COVID-19 pandemic.

Keywords

personal protective equipment, coronavirus, video training, randomized trial

Herbal Medicine And Pattern Identification For Treating COVID-19: A Rapid Review Of Guidelines

Integrative Medicine Research
Volume 9, Issue 2, June 2020, 100407

Ang, Lin; Lee, Hye Won; Choi, Jun Yong; Zhang, Junhua; Lee, Myeong Soo

Introduction

Background:

Coronavirus disease 2019 (COVID-19) is pandemic and has caused illness to many people worldwide. This review aimed to summarize and analyze the herbal formulae provided by the guidelines for their pattern identifications (PIs) and compositions of herbs to treat patients with COVID-19.

Methods:

We searched 7 data sources for eligible traditional medicine guidelines up to March 6, 2020 and found a total of 28 traditional medicine guidelines that provide treatment measures for COVID-19.

Results:

Of the 28 guidelines, there were 26 government-issued Chinese guidelines and 2 Korean guidelines. After standardizing the terminology of the PIs and herbal formulae, there were 8 PIs and 23 herbal formulae for the mild stage, 11 PIs and 31 herbal formulae for the moderate stage, 8 PIs and 21 herbal formulae for the severe stage, and 6 PIs and 23 herbal formulae for the recovery stage in the Chinese guidelines. In the Korean guidelines, there were 4 PIs and 15 herbal formulae for the mild stage, 3 PIs and 3 herbal formulae for the severe stage, and 2 PIs and 2 herbal formulae for the recovery stage. In the frequency analysis of herbs, Glycyrrhizae Radix et Rhizoma was found to be the herb with the highest frequency of usage in the Chinese guidelines.

Conclusion:

This review can be used as guidance for the traditional medicine treatment of COVID-19. Clinical evidence is needed in the future to evaluate the efficacy of traditional medicine.

Keywords

Clinical aspects, diagnosis, treatment

The Cytokine Release Syndrome (CRS) Of Severe COVID-19 And Interleukin-6 Receptor (IL-6R) Antagonist Tocilizumab May Be The Key To Reduce The Mortality

International Journal of Antimicrobial Agents

Zhang, Chi; Wu, Zhao; Li, Jia-Wen; Zhao, Hong; Wang, Gui-Qiang

Abstract

Since December 2019, a viral pneumonia (COVID-19) from Wuhan, China has swept the world. Although the case fatality rate is not high, the number of people infected is large, and there are still a large number of patients dying. With the collation and publication of more and more clinical data, a large number of data suggest that there are mild or severe cytokine storms in severe patients, which is also an important cause of death. Therefore, the treatment of cytokine storm has become an important part of rescuing severe patients. Interleukin-6 (IL-6) plays an important role in cytokine release syndrome (CRS). If it can block the signal transduction pathway of IL-6, it is expected to become a new method for the treatment of severe patients. Tocilizumab is a blocker of IL-6R, which can effectively block IL-6 signal transduction pathway. So, tocilizumab is likely to become an effective drug for patients with severe COVID-19.

Keywords

COVID-19, Cytokine release syndrome, Tocilizumab

Coronavirus Disease 2019 (COVID-19): Current Status And Future Perspective

International Journal of Antimicrobial Agents

Li, Heng; Liu, Shang-Ming; Yu, Xiao-Hua; Tang, Shi-Lin; Tang, Chao-Ke

Abstract

Coronavirus disease 2019 (COVID-19) originated in the city of Wuhan, Hubei Province, Central China, and has spread quickly to 72 countries to date. COVID-19 is caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [previously provisionally known as 2019 novel coronavirus (2019-nCoV)]. At present, the newly identified SARS-CoV-2 has caused a large number of deaths with tens of thousands of confirmed cases worldwide, posing a serious threat to public health. However, there are no clinically approved vaccines or specific therapeutic drugs available for COVID-19. Intensive research on the newly emerged SARS-CoV-2 is urgently needed to elucidate the pathogenic mechanisms and epidemiological characteristics and to identify potential drug targets, which will contribute to the development of effective prevention and treatment strategies. Hence, this review will focus on recent progress regarding the structure of SARS-CoV-2 and the characteristics of COVID-19, such as the aetiology, pathogenesis and epidemiological characteristics.

Keywords

COVID-19, SARS-CoV-2, 2019-nCoV, Coronavirus, Pneumonia

Recent Progress In Understanding 2019 Novel Coronavirus (SARS-Cov-2) Associated With Human Respiratory Disease: Detection, Mechanisms And Treatment

International Journal of Antimicrobial Agents

Kang, Shuntong; Peng, Wenyao; Zhu, Yuhao; Lu, Shiyao; Zhou, Min; Lin, Wei; Wu, Wenfang; Huang, Shu; Jiang, Liping; Luo, Xuan; Deng, Meichun

ABSTRACT

Viral respiratory diseases such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) always pose a severe threat to people. First identified in late December 2019, a novel coronavirus (2019-nCoV; SARS-CoV-2) has affected many provinces in China and multiple countries worldwide. The viral outbreak has aroused panic and a public-health emergency around the world, and the number of infections continues to rise. However, the causes and consequences of the pneumonia remain unknown. To effectively implement epidemic prevention, early identification and diagnosis are critical to disease control. Here we scrutinise a series of available studies by global scientists on the clinical manifestations, detection methods and treatment options for the disease caused by SARS-CoV-2, named coronavirus disease 2019 (COVID-19), and also propose potential strategies for preventing the infection.

Keywords

2019 novel coronavirus, 2019-nCoV, SARS-CoV-2, Mechanism, Treatment, Detection