A Systems Approach To Preventing And Responding To COVID-19

EClinicalMedicine

Bradley, Declan Terence; Mansouri, Mariam Abdulmonem; Kee, Frank; Garcia, Leandro Martin Totaro

Introduction

A novel zoonotic coronavirus, SARS-CoV-2 has resulted in a pandemic of respiratory infection. COVID-19 has provoked restrictive infection control measures, social and economic disruption, and expressions of racism. Systems thinking can help policymakers understand and influence the spread of infection and its multifaceted consequences across the community since society is itself a complex adaptive system. It can provide a framework to look beyond the chain of infection and better understand the multiple implications of decisions and (in)actions in face of such a complex situation involving many interconnected factors. Causal loop diagrams (CLDs) are tools to depict the causal connections between components of a system, and illustrate how changes in one component cascade in changes in others and back to itself, via feedback loops, potentially affecting the status of the entire system.

Keywords

Epidemiology

SARS-CoV-2: A Storm is Raging

The Journal of Clinical Investigation

Pedersen, Savannah F.; Ho, Ya-Chi

Abstract

The pandemic coronavirus infectious disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe. In this issue of the JCI, Chen and colleagues compared the clinical and immunologic characteristics between moderate versus severe COVID-19. The authors found that respiratory distress on admission is associated with unfavorable outcomes. Increased cytokine levels (IL-6, IL-10 and TNFα), lymphopenia (in CD4+ and CD8+ T cells), and decreased IFNγ expression in CD4+ T cells are associated with severe COVID-19. Overall, this study characterized the cytokine storm in severe COVID-19 and provides insights into immune therapeutics and vaccine design.

Keywords

COVID-19, infection, anesthesia, safety

COVID-19 and the Renin-Angiotensin System

Kidney International Reports

Malha, Line; Mueller, Franco B.; Pecker, Mark S.; Mann, Samuel J.; August, Phyllis; Feig, Peter U.

Introduction

In late 2019, a coronavirus disease (COVID-19) leading to severe acute respiratory syndrome (SARS) started in China and has become a pandemic. The responsible virus has been designated SARS-CoV-2. The cellular receptor for SARS-CoV-2 is angiotensin-converting enzyme 2 (ACE2), a mostly membrane-bound homologue of angiotensin-converting enzyme(ACE) that has generated great interest in the interaction between COVID-19 and the renin-angiotensin system (RAS),1 as well as in the medicines commonly used to block the RAS. These agents, ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are widely used in the treatment of hypertension, heart failure, chronic kidney disease, and diabetes.

Keywords

Epidemiology

Anticoagulant Treatment Is Associated With Decreased Mortality In Severe Coronavirus Disease 2019 Patients With Coagulopathy

Journal of thrombosis and haemostasis : JTH

Tang, Ning; Bai, Huan; Chen, Xing; Gong, Jiale; Li, Dengju; Sun, Ziyong

Abstract

Background

A relatively high mortality of severe coronavirus disease 2019 (COVID‐19) is worrying, and the application of heparin in COVID‐19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated.

Methods

Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID‐19 in Tongji hospital were retrospectively analyzed. The 28‐day mortality between heparin users and nonusers were compared, as was a different risk of coagulopathy, which was stratified by the sepsis‐induced coagulopathy (SIC) score or D‐dimer result.

Results

There were 449 patients with severe COVID‐19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin) for 7 days or longer. D‐dimer, prothrombin time, and age were positively, and platelet count was negatively, correlated with 28‐day mortality in multivariate analysis. No difference in 28‐day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P = .910). But the 28‐day mortality of heparin users was lower than nonusers in patients with SIC score ≥4 (40.0% vs 64.2%, P = .029), or D‐dimer >6‐fold of upper limit of normal (32.8% vs 52.4%, P = .017).

Conclusions

Anticoagulant therapy mainly with low molecular weight heparin appears to be associated with better prognosis in severe COVID‐19 patients meeting SIC criteria or with markedly elevated D‐dimer.

Keywords

RCT; Clinical aspects, diagnosis, treatment

The Eye and COVID-19 Pandemic

Clinical journal of the American Society of Nephrology: CJASN

Hoenig, Leonard J.

 

Introduction

The excellent update on the COVID-19 pandemic by Darlenski and Tsankov1 notes that the conjunctiva is a potential entry point for the infection. With respect to the eye, the American Academy of Ophthalmology has just released an advisory on SARS-CoV-2 stating that there have been several reports to suggest that the virus can cause a mild follicular conjunctivitis.

Keywords

Epidemiology

Development Path and Urgency of further Strengthening Construction of Public Hospitals Based on Novel Coronavirus Pneumonia Treatment

Current Medical Science

Liao, Jia-Zhi; Wu, Jing

Summary

During the outbreak of novel coronavirus pneumonia (NCP) in Wuhan, public hospitals have played an important role in intensive care, case guidance and scheme optimization. At the same time, it also faces unprecedented challenges and tests. Based on the treatment of severe patients in Wuhan, combined with the treatment practice in Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, this paper puts forward the urgency of further strengthening the construction of public hospitals, discusses the feasible path for promoting the development of public hospitals, so as to meet the growing medical needs of the people, improve the ability to respond to major public health emergencies, and effectively guarantee the safety of people's lives and the promotion of a healthy China construction.

Keywords

novel coronavirus pneumonia, public hospital, epidemic prevention and control, public health emergency, construction

Is There an Association Between COVID-19 Mortality and the Renin-Angiotensin System—a Call for Epidemiologic Investigations

Clinical Infectious Diseases

Hanff, Thomas C.; Harhay, Michael O.; Brown, Tyler S.; Cohen, Jordana B.; Mohareb, Amir M. 

Abstract

Mortality from coronavirus disease 2019 (COVID-19) is strongly associated with cardiovascular disease, diabetes, and hypertension. These disorders share underlying pathophysiology related to the renin-angiotensin system (RAS) that may be clinically insightful. In particular, activity of the angiotensin-converting enzyme 2 (ACE2) is dysregulated in cardiovascular disease, and this enzyme is used by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to initiate the infection. Cardiovascular disease and pharmacologic RAS inhibition both increase ACE2 levels, which may increase the virulence of SARS-CoV-2 within the lung and heart. Conversely, mechanistic evidence from related coronaviruses suggests that SARS-CoV-2 infection may downregulate ACE2, leading to toxic overaccumulation of Angiotensin II that induces acute respiratory distress syndrome and fulminant myocarditis. RAS inhibition could mitigate this effect. With conflicting mechanistic evidence, we propose key clinical research priorities necessary to clarify the role of RAS inhibition in COVID-19 mortality that could be rapidly addressed by the international research community.

Keywords

COVID-19, SARS-CoV-2, Angiotensin-Converting Enzyme 2, Renin-Angiotensin System, Cardiovascular Disease

Safe Delivery for COVID-19 Infected Pregnancies

BJOG: An International Journal of Obstetrics & Gynaecology

Qi, Hongbo; Luo, Xin; Zheng, Yangxi; Zhang, Hua; Li, Jiafu; Zou, Li; Feng, Ling; Chen, Dunjin; Shi, Yuan; Tong, Chao; Baker, Philip N.

Abstract

Since December 2019, a new coronavirus (COVID-19) infection has rapidly become prevalent in central China1. On the basis of knowledge obtained from a previous coronavirus outbreak2, pregnant women are believed to be susceptible to this virus. Once a maternal infection of COVID-19 is suspected or confirmed, childbirth becomes complicated and challenging. Efficient obstetric treatment is required, and is key to optimizing the prognosis for both mother and child. Care should be taken in determination of the timing of delivery, assessment of the indications for caesarean section, preparation of the delivery room to prevent infection, choice of the type of anesthesia, and newborn management.

Keywords

COVID-19, infection, delivery, solutions

Detection of serum immunoglobulin M and immunoglobulin G antibodies in 2019-novel coronavirus infected cases from different stages

Chinese Medical Journal

Gao, Hui-Xia; Li, Ya-Nan; Xu, Zun-Gui; Wang, Yu-Ling; Wang, Hai-Bin; Cao, Jin-Feng; Yuan, De-Qin; Li, Li; Xu, Yi; Zhang, Zhi; Huang, Ying; Lu, Jian-Hua; Liu, Yu-Zhen; Dai, Er-Hei.

Abstract

To The Editor: The epidemic caused by 2019 novel coronavirus (2019-nCoV) has drawn public attention. Huge infected population and enormous economic loss make it the urgent public health event to deal with. Confirmatory test targeting virus RNA was established at the early stage of outbreak and then used for 2019-nCoV infection diagnosis. However, high risk of laboratory infection, high-qualified personnel and strict operation condition hampered its application into primary hospitals and community clinics. In this study, the serum immunoglobulin (Ig) M and IgG antibodies were detected in 2019-nCoV confirmed cases of different stages. Furthermore, three different immunological assays, chemiluminescent immunoassay (CLIA), gold immunochromatographic assay (GICA), and enzyme-linked immunosorbent assay (ELISA) were used for IgM and IgG detection.

Keywords

Clinical aspects, diagnosis, treatment

A Genomic Perspective on the Origin and Emergence of SARS-CoV-2

Cell

Zhang, Yong-Zhen; Holmes, Edward C.

Abstract

The ongoing pandemic of a new human coronavirus, SARS-CoV-2, has generated enormous global concern. We and others in China were involved in the initial genome sequencing of the virus. Herein, we describe what genomic data reveal about the emergence SARS-CoV-2 and discuss the gaps in our understanding of its origins.

Keywords

Epidemiology

In Silico Assessment Of The Impact Of 2019 Novel Coronavirus (2019-Ncov) Genomic Variation On Published Real-Time Quantitative Polymerase Chain Reaction Detection Assays

Chinese Medical Journal

Fan, Hang; Zhang, Xiang-Li-Lan; Zhang, Ya-Wei; Huang, Yong; Teng, Yue; Guo, Yan; Mi, Zhi-Qiang; Yang, Rui-Fu; Song, Ya-Jun; Cui, Yu-Jun.

Abstract

In December 2019, a coronavirus disease 2019 (COVID-19) outbreak caused by the 2019 novel coronavirus (2019-nCoV) happened in Wuhan, China. Since then, it has spread to many countries and poses a world-wide public health threat. Real-time quantitative polymerase chain reaction (RT-qPCR) was recommended as an effective pathogen detection method and has played an important role in prevention and control of the current outbreak. Many research institutions have released their primer sets for RT-qPCR. However, the 2019- nCoV genome has evolved during the outbreak. If the variant sites were located in the primer regions, the efficiency of RT-qPCR would be reduced, thus possibly causing false negative results, and leading to unpredictable impact on the diagnosis of patients and the control of this outbreak. Therefore, a comprehensive investigation on 2019-nCoV genome variation is necessary to evaluate the effectiveness of current released RT-qPCR methods.

Keywords

Clinical aspects, diagnosis, treatment

Controversies about COVID-19 and anticancer treatment with immune checkpoint inhibitors

Immunotherapy

Bersanelli, Melissa.

Introduction

On 11 March, the WHO formally declared the corona virus disease-19 (COVID-19) outbreak a pandemic [1]. After the first cluster of cases emerged from Wuhan, in China, at the end of 2019, up today almost 287000 cases of infections from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been diagnosed across all five continents in the last few months

Keywords

anti-CTLA-4, anti-PD-1, anti-PD-L1, cancer patients, COVID-19, immune checkpoint inhibitors, immunotherapy, SARS-CoV-2, tocilizumab, viral infection

Coronavirus and the Responsibility of Plastic Surgeons

Plastic and Reconstructive Surgery - Global Open

Teven, Chad M.; Rebecca, Alanna

Introduction

The ongoing COVID-19 pandemic has massive implications both for our collective health and the state of our healthcare system. At the present time, the Johns Hopkins Coronavirus Resource Center has confirmed 181,587 total cases of COVID-19 infection and 7,139 total deaths (death rate 3.9%). By the time this letter reaches publication, both of these numbers are bound to have increased significantly. Of particular concern in regard to the current crisis are the high rates of critical illness and death related to contraction of the virus as well as the rate at which the outbreak has been spreading. Mizumoto and Chowell hypothesize a possible explanation for the severity of the epidemic may be associated with a faulty healthcare system.

Keywords

Ethics, social science, economics

COVID-19: protect great apes during human pandemics

Nature 
579, 7800, 497 (2020)

Gillespie, T. R.; Leendertz, F. H.

Correspondence

SARS-CoV-2, the coronavirus responsible for the current COVID-19 pandemic, is also a threat to our closest living relatives, the great apes. As leading experts in the conservation and health of these animals, we urge governments, conservation practitioners, researchers, tourism professionals and funding agencies to reduce the risk of introducing the virus into these endangered apes.

Keywords

COVID-19, SARS-CoV-2, Treatment, human pandemics

Care For Laboratory Animals During COVID-19 Crisis

Nature

Volume 579, Issue 7800, Page 497

Pullium, J. K.

Introduction

All US research programmes funded by Public Health Solutions in New York City or accredited by the nonprofit organization AAALAC International are required to have a care plan in place for laboratory animals in the event of a disaster. The COVID-19 pandemic could constitute such a disaster if it creates severe shortages in staffing and in supply chains.

Keywords

Reservoir

Lessons Learned During the COVID-19 Virus Pandemic

Journal of the American College of Surgeons

Sterpetti, Antonio V.

Introduction

Covid-19 is a new strain of coronavirus identified in China. Cases have now been detected in almost all countries in Asia, Australia, Europe, and North America. As of March 16, 2020, laboratories in Italy have diagnosed more than 27,000 people affected by the disease, with 2,158 deaths. Many infected patients do not have symptoms, so it is difficult to estimate the case fatality rate. In patients hospitalized for severe symptoms, the case fatality rate is around 15%.1-8 Elderly patients with severe comorbidities are at higher risk for mortality. Children and young adults rarely have symptoms, but they can carry the virus.

Keywords

Clinical aspects, diagnosis, treatment

Putting resiliency of a health system to the test: COVID-19 in Taiwan

Journal of the Formosan Medical Association

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

Introduction

On January 21 2020, Taiwan reported its first imported COVID-19 case returning from Wuhan whose history of disease has previously been described.1 From hard-learned lessons of severe acute respiratory syndrome (SARS) in 2003 (with 346 confirmed cases, 73 deaths),2 everyone on the island understand that this is a serious matter. Main reasons, of course, being our high population density, geographical location, and our close economic ties with epicenter of the outbreak.

Keywords

Epidemiology