Emergency Medicine
Volume 42, Issue 4A
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?”.
Clinical aspects, diagnosis, treatment
Emergency Medicine News
Volume 42 - Issue 4A
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.
Epidemiology
Physiological Genomics
Volume 52, Issue 4, April 2020, Pages 200-202
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.
Artificial Intelligence, COVID-19, Machine Learning, SARS-CoV-2
Physiological reviews
Volume 100, Issue 3, July 2020, Pages 1065-1075
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.
Comorbidity, COVID-19, fibrinolysis, plasmin(ogen), SARS-CoV-2
Clinical journal of the American Society of Nephrology: CJASN
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).
angiotensinrenin angiotensin systemvirology, hypertension, ACE inhibitors, COVID-19, severe acute respiratory syndrome coronavirus 2, Renin-Angiotensin System, Angiotensin-Converting Enzyme Inhibitors
Journal of Cardiothoracic and Vascular Anesthesia
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).
Clinical aspects, diagnosis, treatment
Disaster Medicine and Public Health Preparedness
27 March 2020, pp. 1-33
Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health care system with challenges that have limited science to guide the staff, stuff and structure surge response.
This study reviewed the available surge science literature specifically to guide an Emergency Department's surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident (MCI) surge capability apply to the process to expand COVID-19 Pandemic surge structure response?
The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as grey, literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the Emergency Department team's COVID-19 surge structural response.
COVID-19, SARS-CoV-2, Surge Capacity, Pandemics, Translational Science
JMIR Public Health and Surveillance
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.
Clinical aspects, diagnosis, treatment; Epidemiology
Annals of Emergency Medicine
Volume 75, Issue 4, April 2020, Page 556.
Since the emergence of a cluster of patients with pneumonia caused by a novel coronavirus (COVID-19) in Wuhan, Hubei, China, in December 2019, emergency departments (EDs) in China have instituted special measures to manage patients with potential exposure to the virus. We describe our initial experience in managing the current outbreak caused by COVID-19…
Epidemiology
International Journal of Cardiology
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.
Clinical aspects, diagnosis, treatment
Emergency Medicine
Volume 42, Issue 4A
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.”
Clinical aspects, diagnosis, treatment
International Journal of Environmental Research and Public Health 2020,
Volume 17, Issue 7, Page 2304
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.
COVID-19; epidemic, China, emergency control measures, public health
Science & Education
In late February 2019, when the Covid-19 crisis began to spread across South Korea, my doctoral student Wonyong Park was there for his data collection in secondary schools. Unphased by the growing national epidemic at the time, he remarked: “As a Cambridge student, Newton once had to return home due to the plague outbreak in England, during which he made his greatest discoveries! However, as the situation develops, I promise I’ll keep healthy and make this time most useful for me.” Now, about a month later, the entire planet finds itself in the midst of a pandemic
Epidemiology
Infection Control & Hospital Epidemiology
Our healthcare system faces an unprecedented strain as it struggles with the coronavirus disease 2019 (COVID-19) pandemic. With cases now reported in 53 states and territories, community spread is either already occurring or imminent in most localities. Most healthcare systems are experiencing limited access to diagnostic tests accompanied by delays in test results of more than 24 hours.1 Trials to assess potential treatments are underway, with mounting difficulty in acquiring agents as the demand for them increases.
Clinical aspects, diagnosis, treatment
Disaster Medicine and Public Health Preparedness
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.
Epidemiology
J Korean Med Sci
Volume 35, Issue 12, e136
Novel corona virus (SARS -CoV-2) has provided us with not only losses but also gains in Korea.
Cartoon Editorial
Clinical aspects, diagnosis, treatment; Epidemiology
Disaster Medicine and Public Health Preparedness
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.
personal protective equipment, coronavirus, video training, randomized trial
Gastrointestinal Endoscopy
We have read with great interest the paired articles on SARS-CoV-2/Novel Coronavirus19 (COVID-19) in this issue of Gastrointestinal Endoscopy. The first is entitled “Coronavirus (COVID-19) outbreak: what the department of endoscopy should know” by Repici et al, 1 which describes the Italian experience, and the second is “Considerations in performing endoscopy during the COVID-19 pandemic” by Soetikno et al, 2 which is drawn largely from the Hong Kong experience. We would like to congratulate the authors for their development and rigorous account of the endoscopic practices they have successfully used to minimize infection of endoscopy staff while providing essential services in this high-risk environment. We would also like to share a U.S. hospital perspective gained from our experience contending with numerous COVID-19 cases following the Biogen conference in Boston, Massachusetts.
Clinical aspects, diagnosis, treatment
Brain, Behavior, & Immunity - Health
On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus COVID-19 a pandemic. There are patients in psychiatric hospitals in China who have been infected with COVID-19, however, the knowledge and attitudes of psychiatric hospital staff towards infectious diseases and their willingness to work during the COVID-19 outbreak has not yet been investigated. This study was performed to assess the knowledge and attitudes of medical staff in two Chinese mental health centers during the COVID-19 outbreak. We included 141 psychiatrists and 170 psychiatric nurses in the study. We found that during the COVID-19 epidemic, 89.51% of the medical staff of the psychiatric hospitals studied had extensive knowledge of COVID-19, and 64.63% of them received the relevant training in hospitals. Furthermore, about 77.17% of participants expressed a willingness to care for psychiatric patients suffering from COVID-19 virus infection. Independent predictors of willingness to care for patients included advanced training and experience of caring for patients with COVID-19. In conclusion, this study suggests that increased attention should be paid to the knowledge and attitudes of medical staff at psychiatric hospitals during the COVID-19 outbreak.
COVID-19, Knowledge, Attitudes, Psychiatrists, Nurses
Expert Review of Anti-infective Therapy
Dr Hadi: Artificial intelligence (AI) is one of the means or avenues to understand the virus and develop preventative and control measures. This includes but is not limited to: the usage of mathematical modeling to understand virus transmission, structural biology to determine virus structure and develop vaccines, computational biology to understand virus evolution, as well as docking studies to screen for drugs and inhibitors
COVID19, Artificial Intelligence, In-silico, Vaccines, Emerging Diseases