Managing Oncology Services During a Major Coronavirus Outbreak: Lessons From the Saudi Arabia Experience

JCO Global Oncology
Volume 6, Page 518-524

g Jia, Xiaowen Hu, Feng Yang, Xin Song, Liyan Dong, Jingfei Zhang, Fachun Jiang and Ruqin G

Abstract

Outbreaks of infectious etiology, particularly those caused by a novel virus that has no known treatment or vaccine, may result in the interruption of medical care provided to patients with cancer and put them at risk for undertreatment in addition to the risk of being exposed to infection, a life-threatening event among patients with cancer. This article describes the approach used to manage patients with cancer during a large-scale Middle East respiratory syndrome-coronavirus hospital outbreak in Saudi Arabia to ensure continuity of care and minimize harm from treatment interruption or acquiring infection. The approach taken toward managing this high-risk situation (COVID-19) could be easily adopted by health care organizations and would be helpful to ensure readiness for the occurrence of future outbreaks of different infectious etiologies like those recent episodes of new coronavirus.

Keywords

Opinion piece; Clinical aspects, diagnosis, treatment

Responding to COVID-19: How to Navigate a Public Health Emergency Legally and Ethically

Hastings Center Report

Gostin, Lawrence O.; Friedman, Eric A.; Wetter, Sarah A.

Abstract

Few novel or emerging infectious diseases have posed such vital ethical challenges so quickly and dramatically as the novel coronavirus SARS-CoV-2. The World Health Organization declared a public health emergency of international concern and recently classified COVID-19 as a worldwide pandemic. As of this writing, the epidemic has not yet peaked in the United States, but community transmission is widespread. President Trump declared a national emergency as fifty governors declared state emergencies. In the coming weeks, hospitals ll become overrun, stretched to their capacities. When the health system becomes stretched beyond capacity, how can we ethically allocate scarce health goods and services? How can we ensure that marginalized populations can access the care they need? What ethical duties do we owe to vulnerable people separated from their families and communities? And how do we ethically and legally balance public health with civil liberties?

Keywords

COVID-19; allocation of scarce resources; civil liberties; crisis standards of care; novel coronavirus SARS-CoV-2; public health emergency; public health ethics

Stability Issues of RT-PCR Testing of SARS-CoV-2 for Hospitalized Patients Clinically Diagnosed with COVID-19

Journal of Medical Virology

Li, Yafang; Yao, Lin; Li, Jiawei; Chen, Lei; Song, Yiyan; Cai, Zhifang; Yang, Chunhua

Abstract

Abstract In this study, we collected a total of 610 hospitalized patients from Wuhan between Feb 2, 2020, and Feb 17, 2020. We reported a potentially high false negtive rate of RT-PCR testing for SARS-CoV-2 in the 610 hospitalized patients clinically diagnosed with COVID-19 during the 2019 outbreak. We also found that the RT-PCR results from several tests at different points were variable from the same patients during the course of diagnosis and treatment of these patients. Our results indicate that in addition to the emphasis on RT-PCR testing, clinical indicators such as CT images should also be used not only for diagnosis and treatment but also for isolation, recovery/discharge and transferring for hospitalized patients clinically diagnosed with COVID-19 during the current epidemic. These results suggested the urgent needs for standard of procedures(SOP) of sampling from different anatomic sites, sample transportation, optimization of RT-PCR, serology diagnosis/screening for SARS-CoV-2 infection, and distinct diagnosis from other respiratory diseases such as fluenza infections as well. This article is protected by copyright. All rights reserved.

Keywords

Clinical aspects, diagnosis, treatment

Prevention and control of SARS-CoV-2 (Covid-19) coronavirus infection in hemodialysis units

Salud publica de Mexico

Vega-Vega, Olynka; Arvizu-Hernández, Mauricio; Domínguez-Cherit, José Guillermo; Sierra-Madero, Juan; Correa-Rotter, Ricardo.

Abstract

The SARS-CoV-2 pandemic is of hich risk for patients on chronic hemodialysis due to their immunosuppressed state, advanced age, and the coexistence of significant comorbidities, in particular cardiovascular disease, diabetes mellitus, and others. Additionally, they constitute a closed conglomerate since they come to treatment regularly, spending hours in the treatment places, exposed to a possible acquisition of the infection. Finally, going to their treatment regularly prevents them from remaining in home isolation and with potential exposure. These recommendations summarize the interventions proposed by three international organizations and add some suggested by national experts, with the aim to early identify the patients and health personnel at risk and reducing the risk of infection.

Keywords

coronavirus infection; hemodialysis; pandemic; primary prevention; recommendations

Maternal Health Care Management During The Outbreak Of Coronavirus Disease 2019 (COVID-19)

Journal of Medical Virology

Chen, Yu; Li, Zhe; Zhang, Yuan-Yuan; Zhao, Wei-Hua; Yu, Zhi-Ying

Abstract

Coronavirus disease 2019 (COVID‐19) is a novel type of highly contagious pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Despite the strong efforts taken to control the epidemic, hundreds of thousands of people were infected worldwide by 11 March, and the situation was characterized as a pandemic by the World Health Organization. Pregnant women are more susceptible to viral infection due to immune and anatomic alteration, though hospital visits may increase the chance of infection, the lack of medical care during pregnancy may do more harm. Hence, a well‐managed system that allows pregnant women to access maternal health care with minimum exposure risk is desired during the outbreak. Here, we present the managing processes of three pregnant women who had fever during hospitalization in the gynecology or obstetrics department, and then, we further summarize and demonstrate our maternal health care management strategies including antenatal care planning, patient triage based on the risk level, admission control, and measures counteracting emergencies and newly discovered high‐risk cases at in‐patient department. In the meantime, we will explain the alterations we have done throughout different stages of the epidemic and also review relative articles in both Chinese and English to compare our strategies with those of other areas. Although tens of COVID‐19 cases were confirmed in our hospital, no nosocomial infection has occurred and none of the pregnant women registered in our hospital was reported to be infected.

Keywords

Clinical aspects, diagnosis, treatment

The Correlation Between Viral Clearance And Biochemical Outcomes Of 94 COVID-19 Infected Discharged Patients

Inflammation Research

Yuan, Jing; Zou, Rougrong; Zeng, Lijiao; Kou, Shanglong; Lan, Jianfeng; Li, Xiaohe; Liang, Yanhua; Ding, Xiaoyan; Tan, Guoyu; Tang, Shenghong; Liu, Lei; Liu, Yingxia; Pan, Yanchao; Wang, Zhaoqin

Abstract

Objective: This study aims to evaluate the correlation between viral clearance and blood biochemical index of 94 discharged patients with COVID-19 infection in Shenzhen Third People’s Hospital, enrolled from Jan 5 to Feb 13, 2020.
Methods: The clinical and laboratory fndings were extracted from the electronic medical records of the patients. The data were analysed and reviewed by a trained team of physicians. Information on clinical signs and symptoms, medical treatment, virus clearance, and laboratory parameters including interleukin 6 (IL-6) and C-reactive protein were collected.
Results: COVID-19 mRNA clearance ratio was identifed signifcantly correlated with the decline of serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels. Furthermore, COVID-19 mRNA clearance time was positively correlated with the length of hospital stay in patients treated with either IFN-α+lopinavir/ritonavir or IFN-α+lopinavir/ritonavir+ribavirin.
Conclusions: Therapeutic regimens of IFN-α+lopinavir/ritonavir and IFN-α+lopinavir/ritonavir+ribavirin might be benefcial for treatment of COVID-19. Serum LDH or CK decline may predict a favorable response to treatment of COVID-19 infection.

Keywords

COVID-19, Clearance ratio, LDH, CK

Maternity Protection-Also During The Corona Crisis

Medizinische Clink, Intensivmedizin und Notfallmedizin

Michels, Guido; Ochmann, Uta; Cranen, Rita.

Abstract

Pregnant employees should be protected, particularly in crisis situations. The Maternity Protection Act states that employees are not allowed to have contact with infectious people, including people with SARS-CoV-2 infections; no new regulation is required here.

Keywords

Clinical aspects, diagnosis, treatment

Using Psychoneuroimmunity Against COVID-19

Brain, Behavior, and Immunity

Kim, Sung-Wan; Su, Kuan-Pin 

Abstract

The worldwide outbreak of coronavirus disease 2019 (COVID-19) raises concerns of widespread panic and anxiety in individuals subjected to the real or perceived threat of the virus. Compared to general populations, patients who are institutionalized in a closed unit are also very vulnerable to COVID-19 infection and complications. This crisis touched on difficult issues of not only psychiatric care and ethics, but also psychological impacts to psychiatric care givers. In this Viewpoint, we address both physical and biopsychosocial aspects of this infection, as well as the psychoneuroimmunity of preventive strategies of healthy lifestyle, regular exercise, balanced nutrition, quality sleep and a strong connection with people. Social distancing and wearing masks might help us from pathogen exposure, yet such these measures also prevent us from expressing compassion and friendliness. Therefore, all forms of psychological support should be routinely implemented not only to consider psychological resilience but also to enhance psychoneuroimmunity against COVID-19.

Keywords

Epidemiology

Covid-19 and the Digestive System

Journal of gastroenterology and hepatology

Wong, S. H.; Lui, R. N.; Sung, J. J.

Abstract

The novel coronavirus disease (COVID-19) is currently causing a major pandemic. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the Betacoronavirus genus that also includes the SARS-CoV and Middle East Respiratory Syndrome Coronavirus (MERS-CoV). While patients typically present with fever and a respiratory illness, some patients also report gastrointestinal symptoms such as diarrhoea, vomiting and abdominal pain. Studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and its viral receptor angiotensin converting enzyme 2 (ACE2) was found to be highly expressed in gastrointestinal epithelial cells. These suggest that SARS-CoV-2 can actively infect and replicate in the gastrointestinal tract. This has important implications to the disease management, transmission, and infection control. In this article, we review the important gastrointestinal aspects of the disease.

Keywords

COVID-19, coronavirus, pneumonia, gastrointestinal infection, diarrhoea

The effect of human mobility and control measures on the COVID-19 epidemic in China

Science (New York, N.Y.)

Kraemer, M. U. G.; Yang, C. H.; Gutierrez, B.; Wu, C. H.; Klein, B.; Pigott, D. M.; du Plessis, L.; Faria, N. R.; Li, R.; Hanage, W. P.; Brownstein, J. S.; Layan, M.; Vespignani, A.; Tian, H.; Dye, C.; Pybus, O. G.; Scarpino, S. V.

Abstract

The ongoing COVID-19 outbreak expanded rapidly throughout China. Major behavioral, clinical, and state interventions have been undertaken to mitigate the epidemic and prevent the persistence of the virus in human populations in China and worldwide. It remains unclear how these unprecedented interventions, including travel restrictions, affected COVID-19 spread in China. We use real-time mobility data from Wuhan and detailed case data including travel history to elucidate the role of case importation on transmission in cities across China and ascertain the impact of control measures. Early on, the spatial distribution of COVID-19 cases in China was explained well by human mobility data. Following the implementation of control measures, this correlation dropped and growth rates became negative in most locations, although shifts in the demographics of reported cases were still indicative of local chains of transmission outside Wuhan. This study shows that the drastic control measures implemented in China substantially mitigated the spread of COVID-19.

Keywords

COVID-19, Epidemic

Clinical Observation And Management Of COVID-19 Patients

Emerging Microbes & Infections
Volume 9, 2020, Issue 1,`pp 687-690

Li, T.; Lu, H.; Zhang, W.

Abstract

Three leading infectious disease experts in China were invited to share their bedside observations in the management of COVID-19 patients. Professor Taisheng Li was sent to Wuhan to provide frontline medical care. He depicts the clinical course of SARS-CoV-2 infection. Furthermore, he observes the significant abnormality of coagulation function and proposes that the early intravenous immunoglobulin and low molecular weight heparin anticoagulation therapy are very important. Professor Hongzhou Lu, a leader in China to try various anti-viral drugs, expresses concern on the quality of the ongoing clinical trials as most trials are small in scale and repetitive in nature, and emphasizes the importance of the quick publication of clinical trial results. Regarding the traditional Chinese medicine, Professor Lu suggests to develop a creative evaluation system because of the complicated chemical compositions. Professor Wenhong Zhang is responsible for Shanghai's overall clinical management of the COVID-19 cases. He introduces the team approach to manage COVID-19 patients. For severe or critically ill patients, in addition to the respiratory supportive treatment, timely multiorgan evaluation and treatment is very crucial. The medical decisions and interventions are carefully tailored to the unique characteristics of each patient.

Keywords

Clinical aspects, diagnosis, treatment

Cancer Care Delivery Challenges Amidst Coronavirus Disease - 19 (COVID-19) Outbreak: Specific Precautions for Cancer Patients and Cancer Care Providers to Prevent Spread (Copy)

Asian Pacific journal of cancer prevention : APJCP
Volume 21, Issue 3, March 2020, pg 569-573

Shankar, A.; Saini, D.; Roy, S.; Mosavi Jarrahi, A.; Chakraborty, A.; Bharti, S. J.; Taghizadeh-Hesary, F.

Abstract

Coronavirus outbreak has affected thousands of people in at least 186 countries which has affected the cancer care delivery system apart from affecting the overall health system. Cancer patients are more susceptible to coronavirus infection than individuals without cancer as they are in an immunosuppressive state because of the malignancy and anticancer treatment. Oncologists should be more attentive to detect coronavirus infection early, as any type of advanced cancer is at much higher risk for unfavorable outcomes. Oncology communities must ensure that cancer patients should spend more time at home and less time out in the community. Oncologists and other health care professionals involved in cancer care have a critical opportunity to communicate to their patients to pass on right information regarding practice modifications in view of COVID-19 outbreaks. Countries must isolate, test, treat and trace to control the coronavirus pandemic. There is a paucity of information on novel coronavirus infection and its impact on cancer patients and cancer care providers. To date, there is no scientific guideline regarding management of cancer patients in a background of coronavirus outbreak.

.

Keywords

Cancer, coronavirus, COVID-19- ublhoypatients

Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms

Gut

Jin, X.; Lian, J. S.; Hu, J. H.; Gao, J.; Zheng, L.; Zhang, Y. M.; Hao, S. R.; Jia, H. Y.; Cai, H.; Zhang, X. L.; Yu, G. D.; Xu, K. J.; Wang, X. Y.; Gu, J. Q.; Zhang, S. Y.; Ye, C. Y.; Jin, C. L.; Lu, Y. F.; Yu, X.; Yu, X. P.; Huang, J. R.; Xu, K. L.; Ni, Q.; Yu, C. B.; Zhu, B.; Li, Y. T.; Liu, J.; Zhao, H.; Zhang, X.; Yu, L.; Guo, Y. Z.; Su, J. W.; Tao, J. J.; Lang, G. J.; Wu, X. X.; Wu, W. R.; Qv, T. T.; Xiang, D. R.; Yi, P.; Shi, D.; Chen, Y.; Ren, Y.; Qiu, Y. Q.; Li, L. J.; Sheng, J.; Yang, Y.

Abstract

OBJECTIVE: The SARS-CoV-2-infected disease (COVID-19) outbreak is a major threat to human beings. Previous studies mainly focused on Wuhan and typical symptoms. We analysed 74 confirmed COVID-19 cases with GI symptoms in the Zhejiang province to determine epidemiological, clinical and virological characteristics.

DESIGN: COVID-19 hospital patients were admitted in the Zhejiang province from 17 January 2020 to 8 February 2020. Epidemiological, demographic, clinical, laboratory, management and outcome data of patients with GI symptoms were analysed using multivariate analysis for risk of severe/critical type. Bioinformatics were used to analyse features of SARS-CoV-2 from Zhejiang province. RESULTS: Among enrolled 651 patients, 74 (11.4%) presented with at least one GI symptom (nausea, vomiting or diarrhoea), average age of 46.14 years, 4-day incubation period and 10.8% had pre-existing liver disease. Of patients with COVID-19 with GI symptoms, 17 (22.97%) and 23 (31.08%) had severe/critical types and family clustering, respectively, significantly higher than those without GI symptoms, 47 (8.14%) and 118 (20.45%). Of patients with COVID-19 with GI symptoms, 29 (39.19%), 23 (31.08%), 8 (10.81%) and 16 (21.62%) had significantly higher rates of fever >38.5 degrees C, fatigue, shortness of breath and headache, respectively. Low-dose glucocorticoids and antibiotics were administered to 14.86% and 41.89% of patients, respectively. Sputum production and increased lactate dehydrogenase/glucose levels were risk factors for severe/critical type. Bioinformatics showed sequence mutation of SARS-CoV-2 with m(6)A methylation and changed binding capacity with ACE2.

CONCLUSION: We report COVID-19 cases with GI symptoms with novel features outside Wuhan. Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.

Keywords

Clinical aspects, diagnosis, treatment

Risk-adapted Treatment Strategy For COVID-19 Patients

International Journal of Infectious Diseases

Zhang, Min-Xia; Yan, Hong-Fan; Wu, Jia-Yu; Zheng, Yu-Jun

Abstract

Background: There are no clear expert consensus or guidelines on how to treat 2019 coronavirus disease (COVID-19). The objective of this study is to investigate the short-term effect of risk-adapted treatment strategy on patients with COVID-19. Methods: We collected the medical records of 55 COVID-19 patients for analysis. We divided these patients into mild, moderate and severe groups, and risk-adapted treatment approaches were given according to the illness severity. Results: Twelve patients were in mild group and 22 were in moderate group (non-severe group, n = 34), and 21 patients were in severe group. At the end of the first two weeks after admission, clinical manifestations had completely despeared in 31(91.2%)patients in non-severe group, and 18(85.7%) patients in severe group (p = 0.85). Both groups had a satisfied chest CT imaging recovery, which includes 22(64.7%) patients in non-severe group and 12(57.1%) patients in severe group recovered at least 50% of the whole leisions in the first week, and 28(82.4%) and 16(76.2%) recovered at least 75% in the second week, respectively. There were no significant differences in SARS-CoV-2 nucleic acid negativity (p = 0.92). There were also no significant differences in the levels of SARS-CoV-2-IgM and IgG antibody production between the two groups (p = 0.13, 0.62). There were 45 cases were discharged from the hospital, and no patients died at the time of this clinical analysis. Conclusions: Risk-adapted treatment strategy was associated with significant clinical manifestations alleviation and clinical imaging recovery. In severe COVID-19 patients, early and short-term use of lowdose methylprednisolone was beneficial and did not delay SARS-CoV-2 nucleic acid clearance and influence IgG antibody production.

Keywords

COVID-19, novel coronavirus pneumonia, risk-adapted treatment strategy, antiviral treatment, low-dose corticosteroid

Routes for COVID-19 importation in Brazil

Journal of travel medicine

Candido, D. D. S.; Watts, A.; Abade, L.; Kraemer, M. U. G.; Pybus, O. G.; Croda, J.; Oliveira, W.; Khan, K.; Sabino, E. C.; Faria, N. R.

Abstract

The global outbreak caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been declared a pandemic by the WHO. As the number of imported SARS-CoV-2 cases is on the rise in Brazil, we use incidence and historical air travel data to estimate the most important routes of importation into the country.

Keywords

Coronavirus, brazil, disease outbreaks, severe acute respiratory syndrome, air travel, pandemics, sars-cov-2, covid-19

Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy

American journal of obstetrics and gynecology

Dashraath, P.; Jing Lin Jeslyn, W.; Mei Xian Karen, L.; Li Min, L.; Sarah, L.; Biswas, A.; Arjandas Choolani, M.; Mattar, C.; Lin, S. L.

Abstract

The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome 2 (SARS-CoV-2) virus, is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2 - 2.5, indicating that 2 - 3 persons will be infected from an index patient. A serious public health emergency, it is particularly deadly in vulnerable populations and communities in which healthcare providers are insufficiently prepared to manage the infection. As of March 16, 2020, there are more than 180,000 confirmed cases of COVID-19 worldwide, with over 7,000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious two weeks after cessation of symptoms. The substantial morbidity and socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns and border closures. Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks. To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure in the gravida. Furthermore, the pregnancy bias towards T-helper 2 (Th2) system dominance which protects the fetus, leaves the mother vulnerable to viral infections, which are more effectively contained by the Th1 system. These unique challenges mandate an integrated approach to pregnancies affected by SARS-CoV-2. Here we present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcriptase polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission and maternal-fetal complications. We discuss the latest options in antiviral therapy and vaccine development, including the novel use of chloroquine in the management of COVID-19. Fetal surveillance, in view of the predisposition to growth restriction and special considerations during labor and delivery are addressed. Additionally, we focus on keeping frontline obstetric care providers safe while continuing to provide essential services. Our clinical service model is built around the principles of workplace segregation, responsible social distancing, containment of cross-infection to healthcare providers, judicious use of personal protective equipment and telemedicine. Our aim is to share a framework which can be adopted by tertiary maternity units managing pregnant women in the flux of a pandemic while maintaining the safety of the patient and healthcare provider at its core.

Keywords

Normative guidance; Epidemiology

COVID-19, SARS And MERS: Are They Closely Related?

Clinical Microbiology and Infection

Petrosillo, Nicola; Viceconte, Giulio; Ergonul, Onder; Ippolito, Giuseppe; Petersen, Eskild 

Abstract

Background

The 2019 novel coronavirus (SARS-CoV-2) is a new human coronavirus which is spreading with epidemic features in China and other Asian countries with cases reported worldwide. This novel Coronavirus Disease (COVID-19) is associated with a respiratory illness that may cause severe pneumonia and acute respiratory distress syndrome (ARDS). Although related to the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS), COVID-19 shows some peculiar pathogenetic, epidemiological and clinical features which have not been completely understood to date.

Objectives

We provide a review of the differences in terms of pathogenesis, epidemiology and clinical features between COVID-19, SARS and MERS.

Sources

The most recent literature in English language regarding COVID-19 has been reviewed and extracted data have been compared with the current scientific evidence about SARS and MERS epidemics.

Content

COVID-19 seems not to be very different from SARS regarding its clinical features. However, it has a fatality rate of 2.3%, lower than SARS (9.5%) and much lower than MERS (34.4%). It cannot be excluded that because of the COVID-19 less severe clinical picture it can spread in the community more easily than MERS and SARS. The actual basic reproductive number (R0) of COVID-19 (2-2.5) is still controversial. It is probably slightly higher than the R0 of SARS (1.7-1.9) and higher than MERS (<1),. The gastrointestinal route of transmission of SARS-CoV-2, which has been also assumed for SARS-CoV and MERS-CoV, cannot be ruled out and needs to be further investigated.

Implications

There is still much more to know about COVID-19, especially as concerns mortality and capacity of spreading on a pandemic level. Nonetheless, all of the lessons we learned in the past from SARS and MERS epidemics are the best cultural weapons to face this new global threat.

Keywords

Coronavirus, COVID-19, Emerging infections, MERS, SARS

Monitoring Transmissibility and Mortality of COVID-19 in Europe

International Journal of Infectious Diseases

Yuan, Jing; Li, Minghui; Lv, Gang; Lu, Z. Kevin

Abstract

Objectives: As a global pandemic is inevitable, real-time monitoring of transmission is vital for containing the spread of COVID-19. The main objective was to report real-time effective reproduction numbers (R(t)) case fatality rate (CFR).

Methods: Data were mainly obtained from WHO website, up to 9 March 2020. R(t) was estimated by exponential growth rate (EG) and time dependent (TD) methods. “R0” package in R was employed to estimate R(t) by fitting the existing epidemic curve. Both naïve CFR (nCFR) and adjust CFR (aCFR) were estimated.

Results: In EG method, R(t) was 3.27 [3.17-3.38] for Italy, 6.32 [5.72-6.99] for France, 6.07 [5.51- 6.69] for Germany, 5.08 [4.51-5.74] for Spain. With TD method, the R value for March 9 was 3.10 [2.21-4.11] for Italy, 6.56 [2.04-12.26] for France, 4.43 [1.83-7.92] for Germany, and 3.95 [0-10.19] for Spain.

Conclusions: This study provides important findings on an early outbreak of COVID-19 in Europe. Due to the recent rapid increase in new cases of COVID-19, real-time monitoring of the transmissibility and mortality in Spain and France is a priority.

Keywords

COVID-19, effective reproduction numbers, Control, Europe

An Ounce of Prevention: Coronavirus (COVID-19) and Mass Gatherings

Cureus
Volume 12, Issue 3, 27345

Escher, A. R., Jr.

Abstract

Widespread, non-stop, and often sensational coverage of the coronavirus (COVID-19) has caught many governments flat-footed in efforts to protect the health and safety of their citizens. In response to the current global health event, the World Health Organization (WHO) declared COVID-19 a pandemic. Mass gatherings present a historic challenge in protecting the health and safety of attendees. The majority of the prominent mass gatherings are religious in nature. Global sporting events, such as the Olympics and the World Cup, pose unique health risks to attendees and host nations. Deferment or cancellation of such mass gatherings may exert an extraordinary economic loss to the host nation. Universal adoption of best practices for infection control is the surest way for governments to prepare for mass gatherings. In these uncertain times, it is up to intergovernmental organizations to be the voice of reason.

Keywords

COVID-19, Epidemiology

Risk of COVID-19 importation to the Pacific islands through global air travel

Epidemiology & Infection
Volume 148 / 2020

A. T. Craig, A. E. Heywood and J. Hall

Abstract

On 30 January 2020, WHO declared coronavirus (COVID-19) a global public health emergency. As of 12 March 2020, 125 048 confirmed COVID-19 cases in 118 countries had been reported. On 12 March 2020, the first case in the Pacific islands was reported in French Polynesia; no other Pacific island country or territory has reported cases. The purpose of our analysis is to show how travelers may introduce COVID-19 into the Pacific islands and discuss the role robust health systems play in protecting health and reducing transmission risk. We analyse travel and Global Health Security Index data using a scoring tool to produce quantitative estimates of COVID-19 importation risk, by departing and arriving country. Our analysis indicates that, as of 12 March 2020, the highest risk air routes by which COVID-19 may be imported into the Pacific islands are from east Asian countries (specifically, China, Korea and Japan) to north Pacific airports (likely Guam, Commonwealth of the Northern Mariana Islands or, to a less extent, Palau); or from China, Japan, Singapore, the United States of America or France to south Pacific ports (likely, Fiji, Papua New Guinea, French Polynesia or New Caledonia). Other importation routes include from other east Asian countries to Guam, and from Australia, New Zealand and other European countries to the south Pacific. The tool provides a useful method for assessing COVID-19 importation risk and may be useful in other settings.

Keywords

Coronavirus, COVID-19, Pacific islands, surveillance, travel