Spinal Anaesthesia For Patients With Coronavirus Disease 2019 And Possible Transmission Rates In Anaesthetists: Retrospective, Single-Centre, Observational Cohort Study

British Journal of Anaesthesia

Zhong, Qi; Liu, Yin Y.; Luo, Qiong; Zou, Yu F.; Jiang, Hai X.; Li, Hui; Zhang, Jing J.; Li, Zhen; Yang, Xin; Ma, Min; Tang, Li J.; Chen, Ying Y.; Zheng, Feng; Ke, Jian J.; Zhang, Zong Z.

 

Abstract

Background: The safety of performing spinal anaesthesia for both patients and anaesthetists alike in the presence of active infection with the novel coronavirus disease 2019 (COVID-19) is unclear. Here, we report the clinical characteristics and outcomes for both patients with COVID-19 and the anaesthetists who provided their spinal anaesthesia.

Methods: Forty-nine patients with radiologically confirmed COVID-19 for Caesarean section or lower-limb surgery undergoing spinal anaesthesia in Zhongnan Hospital, Wuhan, China participated in this retrospective study. Clinical characteristics and perioperative outcomes were recorded. For anaesthesiologists exposed to patients with COVID-19 by providing spinal anaesthesia, the level of personal protective equipment (PPE) used, clinical outcomes (pulmonary CT scans), and confirmed COVID-19 transmission rates (polymerase chain reaction [PCR]) were reviewed.

Results: Forty-nine patients with COVID-19 requiring supplementary oxygen before surgery had spinal anaesthesia (ropivacaine 0.75%), chiefly for Caesarean section (45/49 [91%]). Spinal anaesthesia was not associated with cardiorespiratory compromise intraoperatively. No patients subsequently developed severe pneumonia. Of 44 anaesthetists, 37 (84.1%) provided spinal anaesthesia using Level 3 PPE. Coronavirus disease 2019 infection was subsequently confirmed by PCR in 5/44 (11.4%) anaesthetists. One (2.7%) of 37 anaesthetists who wore Level 3 PPE developed PCR-confirmed COVID-19 compared with 4/7 (57.1%) anaesthetists who had Level 1 protection in the operating theatre (relative risk reduction: 95.3% [95% confidence intervals: 63.7–99.4]; P<0.01).

Conclusions: Spinal anaesthesia was delivered safely in patients with active COVID-19 infection, the majority of whom had Caesarean sections. Level 3 PPE appears to reduce the risk of transmission to anaesthetists who are exposed to mildly symptomatic surgical patients.

Keywords

Epidemiology

The Role of Emergency Radiology in COVID-19: From Preparedness to Diagnosis

Canadian Association of Radiologists Journal

Nasir, Muhammad Umer; Roberts, James; Muller, Nestor L.; Macri, Francesco; Mohammed, Mohammed F.; Akhlaghpoor, Shahram; Parker, William; Eftekhari, Arash; Rezaei, Susan; Mayo, John; Nicolaou, Savvas.

Abstract

Emergency trauma radiology, although a relatively new subspecialty of radiology, plays a critical role in both the diagnosis/triage of acutely ill patients, but even more important in providing leadership and taking the lead in the preparedness of imaging departments in dealing with novel highly infectious communicable diseases and mass casualties. This has become even more apparent in dealing with COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, first emerged in late 2019. We review the symptoms, epidemiology, and testing for this disease. We discuss characteristic imaging findings of COVID-19 in relation to other modern coronavirus diseases including SARS and MERS. We discuss roles that community radiology clinics, outpatient radiology departments, and emergency radiology departments can play in the diagnosis of this disease. We review practical methods to reduce spread of infections within radiology departments.

Keywords

COVID-19, emergency and trauma radiology, MERS, SARS, CT, preparedness

Antibody Responses To SARS-CoV-2 In Patients Of Novel Coronavirus Disease 2019

Clinical Infectious Diseases

Zhao, Juanjuan; Yuan, Quan; Wang, Haiyan; Liu, Wei; Liao, Xuejiao; Su, Yingying; Wang, Xin; Yuan, Jing; Li, Tingdong; Li, Jinxiu; Qian, Shen; Hong, Congming; Wang, Fuxiang; Liu, Yingxia; Wang, Zhaoqin; He, Qing; Li, Zhiyong; He, Bin; Zhang, Tianying; Fu, Yang; Ge, Shengxiang; Liu, Lei; Zhang, Jun; Xia, Ningshao; Zhang, Zheng.

Abstract

Background

The novel coronavirus SARS-CoV-2 is a newly emerging virus. The antibody response in infected patient remains largely unknown, and the clinical values of antibody testing have not been fully demonstrated.

Methods

A total of 173 patients with SARS-CoV-2 infection were enrolled. Their serial plasma samples (n=535) collected during the hospitalization were tested for total antibodies (Ab), IgM and IgG against SARS-CoV-2. The dynamics of antibodies with the disease progress was analyzed.

Results

Among 173 patients, the seroconversion rate for Ab, IgM and IgG was 93.1%, 82.7% and 64.7%, respectively. The reason for the negative antibody findings in 12 patients might due to the lack of blood samples at the later stage of illness. The median seroconversion time for Ab, IgM and then IgG were day-11, day-12 and day-14, separately. The presence of antibodies was <40% among patients within 1-week since onset, and rapidly increased to 100.0% (Ab), 94.3% (IgM) and 79.8% (IgG) since day-15 after onset. In contrast, RNA detectability decreased from 66.7% (58/87) in samples collected before day-7 to 45.5% (25/55) during day 15-39. Combining RNA and antibody detections significantly improved the sensitivity of pathogenic diagnosis for COVID-19 (p<0.001), even in early phase of 1-week since onset (p=0.007). Moreover, a higher titer of Ab was independently associated with a worse clinical classification (p=0.006).

Conclusions

The antibody detection offers vital clinical information during the course of SARS-CoV-2 infection. The findings provide strong empirical support for the routine application of serological testing in the diagnosis and management of COVID-19 patients.

Keywords

Epidemiology, antibody, SARS-CoV-2, COVID-19.

Base Protocol For Real Time Active Random Surveillance Of Coronavirus Disease (COVID-19) – Adapting Veterinary Methodology To Public Health

One Health

Foddai, Alessandro; Lubroth, Juan; Ellis-Iversen, Johanne

Abstract

The pandemic of new coronavirus disease COVID-19 is threatening our health, economy and life style. Collaborations across countries and sectors as a One Health World could be a milestone.

We propose a general protocol, for setting timely active random surveillance of COVID-19, at the human community level, with systematic repeated detection efforts. Strengths and limitations are discussed.

If considered applicable by public health, the protocol could evaluate the status of COVID-19 epidemics consistently and objectively.

Keywords

Keywords

Pandemic, New coronavirus, COVID-19, Active random surveillance

Reflections on Nursing Ingenuity During the COVID-19 Pandemic

The Journal of neuroscience nursing: journal of the American Association of Neuroscience Nurses

Newby, Jamison C.; Mabry, Madison C.; Carlisle, Byron A.; Olson, DaiWai M.; Lane, Blair E.

Abstract

Introduction: This reflections article provides insight toward nursing innovations to reduce the overuse of personal protective equipment while maintaining a safe environment for staff taking care of COVID-19 patients. The secondary aim of this paper to capitalize on recent advances in mass electronic communication through social media to encourage nurses across the globe to share their knowledge and expertise during this pandemic.The many innovations that have been implemented fall into 3 categories of: reducing unnecessary use of personal protective equipment (PPE), promoting staff safety and readiness, and reducing foot traffic.

Summary: These strategies are being shared to promote dissemination of innovative nursing interventions that will save lives during the COVID-19 pandemic.

Keywords

Clinical aspects, diagnosis, treatment

Quarantine Vehicle Scheduling for Transferring High-Risk Individuals in Epidemic Areas

International Journal of Environmental Research and Public Health 2020
Volume 17, Issue 7, March 2020, Page 2275

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

Abstract

In a large-scale epidemic outbreak, there can be many high-risk individuals to be transferred for medical isolation in epidemic areas. Typically, the individuals are scattered across different locations, and available quarantine vehicles are limited. Therefore, it is challenging to efficiently schedule the vehicles to transfer the individuals to isolated regions to control the spread of the epidemic. In this paper, we formulate such a quarantine vehicle scheduling problem for high-risk individual transfer, which is more difficult than most well-known vehicle routing problems. To efficiently solve this problem, we propose a hybrid algorithm based on the water wave optimization (WWO) metaheuristic and neighborhood search. The metaheuristic uses a small population to rapidly explore the solution space, and the neighborhood search uses a gradual strategy to improve the solution accuracy. Computational results demonstrate that the proposed algorithm significantly outperforms several existing algorithms and obtains high-quality solutions on real-world problem instances for high-risk individual transfer in Hangzhou, China, during the peak period of the novel coronavirus pneumonia (COVID-19).

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Public Health Responses to COVID-19 Outbreaks on Cruise Ships - Worldwide, February-March 2020

MMWR. Morbidity and mortality weekly report
Volume 69, March 2020, Issue 12, p 347-352

Moriarty, L. F.; Plucinski, M. M.; Marston, B. J.; Kurbatova, E. V.; Knust, B.; Murray, E. L.; Pesik, N.; Rose, D.; Fitter, D.; Kobayashi, M.; Toda, M.; Canty, P. T.; Scheuer, T.; Halsey, E. S.; Cohen, N. J.; Stockman, L.; Wadford, D. A.; Medley, A. M.; Green, G.; Regan, J. J.; Tardivel, K.; White, S.; Brown, C.; Morales, C.; Yen, C.; Wittry, B.; Freeland, A.; Naramore, S.; Novak, R. T.; Daigle, D.; Weinberg, M.; Acosta, A.; Herzig, C.; Kapella, B. K.; Jacobson, K. R.; Lamba, K.; Ishizumi, A.; Sarisky, J.; Svendsen, E.; Blocher, T.; Wu, C.; Charles, J.; Wagner, R.; Stewart, A.; Mead, P. S.; Kurylo, E.; Campbell, S.; Murray, R.; Weidle, P.; Cetron, M.; Friedman, C. R.

Abstract

An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged >/=65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

Keywords

Epidemiology

Current Knowledge About The Antivirals Remdesivir (GS-5734) And GS-441524 As Therapeutic Options For Coronaviruses

One Health
Volume 9, June 2020, 100128

Amirian, E. Susan; Levy, Julie K.

Abstract

Recent international epidemics of coronavirus-associated illnesses underscore the urgent medical and public health need for vaccine development and regulatory body approved therapies. In particular, the current coronavirus disease 2019 (COVID-19) pandemic has quickly intensified interest in developing treatment options to mitigate impact on human life. Remdesivir (GS-5734™) is a broad-spectrum antiviral drug that is now being tested as a potential treatment for COVID-19 in international, multi-site clinical trials. Currently available evidence about the antiviral effects of remdesivir against coronaviruses is primarily based on in vitro and in vivo studies (including some on a chemically related compound, GS-441524™), which have demonstrated largely favorable findings. As the pandemic progresses, information from human compassionate use cases will continue to accumulate before the clinical trials are concluded. It is imperative for public health practitioners and the One Health community to stay up to date on the most promising potential therapeutic options that are under investigation. Thus, the purpose of this review is to synthesize the knowledge to date about remdesivir as a therapeutic option for coronaviruses, with a special focus on information relevant to the One Health community.

Keywords

Remdesivir, GS-5734, Coronavirus, COVID-19, SARS-CoV-2, Compassionate use

Sicken Thy Neighbour: The Initial Trade Policy Response to COVID-19

The World Economy

Evenett, Simon J.

Introduction

In our interconnected world, whenever a global crisis occurs governments must decide whether discriminating against foreign suppliers is part of the solution? or whether foreign know-how and resources can be tapped for mutual advantage. Decisions to sacrifice open borders on the altar of some other goal are typically influenced by the steps? real or perceived? taken by other governments. At such times, written and unwritten international rules are tested, with consequences that can last well after the crisis dominated headlines. The COVID-19 pandemic is no exception.

Keywords

Ethics, social science, economics

Virology, Epidemiology, Pathogenesis, and Control of COVID-19

Viruses
Volume 12, Issue 4, Pages 372-372

Jin, Yuefei; Yang, Haiyan; Ji, Wangquan; Wu, Weidong; Chen, Shuaiyin; Zhang, Weiguo; Duan, Guangcai

Abstract

The outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China has been brought to global attention and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Scientific advancements since the pandemic of severe acute respiratory syndrome (SARS) in 2002~2003 and Middle East respiratory syndrome (MERS) in 2012 have accelerated our understanding of the epidemiology and pathogenesis of SARS-CoV-2 and the development of therapeutics to treat viral infection. As no specific therapeutics and vaccines are available for disease control, the epidemic of COVID-19 is posing a great threat for global public health. To provide a comprehensive summary to public health authorities and potential readers worldwide, we detail the present understanding of COVID-19 and introduce the current state of development of measures in this review. 

Keywords

SARS-CoV-2; COVID-19; epidemiology; pathogenesis; therapeutics

Consensus Guidelines For Managing The Airway In Patients With COVID-19

Anaesthesia

Cook, T. M.; El-Boghdadly, K.; McGuire, B.; McNarry, A. F.; Patel, A.; Higgs, A..

Abstract

Severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID-19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID-19. The advice in this document is designed to be adapted in line with local workplace policies.

Keywords

airway; anaesthesia; coronavirus; COVID-19; critical care; difficult airway; intubation

Might the Many Positive COVID19 Subjects in Italy Have Been Caused by Resident Bat-Derived Zoonotic β-Coronaviruses Instead of the Wuhan (China) Outbreak?

Journal of Medical Virology

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

To the Editor,

In a recent article by Lai et al, published on the Journal of Medical Virology, the authors attempted a mathematical reconstruction of the evolutionary dynamics of the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) outbreak occurred in Wuhan (China), by analyzing 52 SARS‐CoV2 genomes provided at GISAID on 4 February 2020. This evaluation is fundamental to make authorities aware about spreading characteristics of SARS‐CoV2 in the Italian population and to earn insightful clues about the presumptive hypothesis that the current viral spreading in Italy surely comes from a Wuhan‐borne genotype and/or a Chinese outbreak. The same authors concluded that the SARS‐CoV2 in Italy might be present at least since September and October 2019, much before the claimed Wuhan outbreak. According to the World Health Organization evaluation, SARS‐CoV2 outbreaks in Europe occurred much before in Germany and France respect to Italy. Therefore, it might be presumed that a significant proportion of Italians were infected by SARS‐CoV2 in times greatly preceding the Government dispositions upon the cases enumeration. The daily differences between cases in the highest emergence period, that is, 1 to 9 March 2020, plotted a linear rather than an exponential trend. As x increases (1 day each), y values (cases number) increases by the same amount (1.2 or +20%) (Shapiro‐Wilk's exp test P = .442857). This possibly suggests that rhinopharyngeal swabs are catching homogeneous clusters of cases from dating back homogeneously, normally distributed preinfected population, depending also on an established maximal number of analyzed swabs for the day.

Keywords

Clinical aspects, diagnosis, treatment

Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients

Radiology
201160

Wong, H. Y. F.; Lam, H. Y. S.; Fong, A. H.; Leung, S. T.; Chin, T. W.; Lo, C. S. Y.; Lui, M. M.; Lee, J. C. Y.; Chiu, K. W.; Chung, T.; Lee, E. Y. P.; Wan, E. Y. F.; Hung, F. N. I.; Lam, T. P. W.; Kuo, M.; Ng, M. Y.

Abstract

Background: Current COVID-19 radiological literature is dominated by CT and a detailed description of chest x-ray (CXR) appearances in relation to the disease time course is lacking.

Purpose: To describe the time course and severity of the CXR findings of COVID-19 and correlate these with real time reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-Cov-2 nucleic acid.

Materials and Methods: Retrospective study of COVID-19 patients with RT-PCR confirmation and CXRs admitted across 4 hospitals evaluated between January and March 2020. Baseline and serial CXRs (total 255 CXRs) were reviewed along with RT-PCRs. Correlation with concurrent CTs (total 28 CTs) was made when available. Two radiologists scored each CXR in consensus for: consolidation, ground glass opacity (GGO), location and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score.

Results: There were 64 patients (26 men, mean age 56+/-19 years). Of these, 58, 44 and 38 patients had positive initial RT-PCR (91%, [CI: 81-96%]), abnormal baseline CXR (69%, [CI: 56-80%]) and positive initial RT-PCR with abnormal baseline CXR (59 [CI:46-71%]) respectively. Six patients (9%) showed CXR abnormalities before eventually testing positive on RT-PCR. Sensitivity of initial RT-PCR (91% [95% CI: 83-97%]) was higher than baseline CXR (69% [95% CI: 56-80%]) (p = 0.009). Radiographic (mean 6 +/- 5 days) and virologic recovery (mean 8 +/- 6 days) were not significantly different (p= 0.33). Consolidation was the most common finding (30/64, 47%), followed by GGO (21/64, 33%). CXR abnormalities had a peripheral (26/64, 41%) and lower zone distribution (32/64, 50%) with bilateral involvement (32/64, 50%). Pleural effusion was uncommon (2/64, 3%). The severity of CXR findings peaked at 10-12 days from the date of symptom onset. Conclusion Chest x-ray findings in COVID-19 patients frequently showed bilateral lower zone consolidation which peaked at 10-12 days from symptom onset.

Keywords

Normative guidance; Clinical aspects, diagnosis, treatment

Special Attention To Nurses’ Protection During The COVID-19 Epidemic

Critical Care

Huang, Lishan; Lin, Guanwen; Tang, Li; Yu, Lingna; Zhou, Zhilai

 

Abstract

As of March 8, 2020, the novel coronavirus disease 2019 (COVID-19) had caused 80,815 human infections and 3073 deaths in China, including more than 3000 infections among medical staff. Guangdong Second Provincial General Hospital (Guangzhou, Guangdong Province, China), a provincial emergency hospital, has treated more than 35 confirmed cases of COVID-19 and more than 260 suspected cases. Most of nurses’ work involves direct contact with patients. As nurses have high vulnerability to COVID-19, it is necessary to establish hospital-specific protocols to reduce the risk of nurses’ infection in interactions with COVID-19 patients. Our hospital has maintained a “zero nurse infection” rate while battling SARS in 2003 and during the present COVID-19 epidemic. The following are the key measures implemented in our hospital.

Keywords

Clinical aspects, diagnosis, treatment

Organ-protective Effect of Angiotensin-converting Enzyme 2 and its Effect on the Prognosis of COVID-19

Journal of Medical Virology

Cheng, Hao; Wang, Yan; Wang, Gui-Qiang

Abstract

This article reviews the correlation between angiotensin-converting enzyme 2 (ACE2) and severe risk factors for coronavirus disease 2019 (COVID-19) and the possible mechanisms. ACE2 is a crucial component of the renin-angiotensin system (RAS). The classical RAS ACE-Ang II-AT1R regulatory axis and the ACE2-Ang 1-7-MasR counter-regulatory axis play an essential role in maintaining homeostasis in humans. ACE2 is widely distributed in the heart, kidneys, lungs, and testes. ACE2 antagonizes the activation of the classical RAS system and protects against organ damage, protecting against hypertension, diabetes, and cardiovascular disease. Similar to SARS-CoV, SARS-CoV-2 also uses the ACE2 receptor to invade human alveolar epithelial cells. Acute respiratory distress syndrome (ARDS) is a clinical high-mortality disease, and ACE2 has a protective effect on this type of acute lung injury. Current research shows that the poor prognosis of patients with COVID-19 is related to factors such as sex (male), age (>60 years), underlying diseases (hypertension, diabetes, and cardiovascular disease), secondary ARDS, and other relevant factors. Because of these protective effects of ACE2 on chronic underlying diseases and ARDS, the development of spike protein-based vaccine and drugs enhancing ACE2 activity may become one of the most promising approaches for the treatment of COVID-19 in the future.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

SARS-CoV-2 Infection Presenting With Hematochezia

Médecine et Maladies Infectieuses

Li, Guotao; Zhao, Xingpeng; Dong, Zhihui; Wang, Huirui

Abstract

Background: COVID-19 is a new infectious disease, for which there is currently no treatment. It is therefore necessary to explore biomarkers to determine the extent of lung lesions and disease severity.

Objective: We aimed to assess the usefulness of CRP levels in the early stage of COVID-19 and to correlate them with lung lesions and severe presentation.

Methods: Confirmed cases of COVID-19 were selected at the Fever Unit in two regions of Guizhou, China. On admission CRP levels were collected, and the diameter of the largest lung lesion was measured in the most severe lung lesion by lung CT scan. Differences in the diameter and CRP levels were compared in the following groups of patients: mild group, moderate group, severe group, and critical group.

Result: CRP levels and the diameter of the largest lung lesion in the moderate group were higher than those in the mild group (Mann-Whitney test = −2.647, −2.171, P ˂ 0.05), those in the severe group were higher than those in the moderate group (Mann-Whitney test = 0.693, −2.177, P ˂ 0.05), and those in the critical group were higher than those in the severe group (Mann-Whitney test = −0.068, −1.549, P ˂ 0.05). The difference was statistically significant. CRP levels were positively correlated with the diameter of lung lesion and severe presentation (correlation coefficient = 0.873, 0.734, P ˂ 0.001).

Conclusion: In the early stage of COVID-19 CRP levels were positively correlated with lung lesions and could reflect disease severity.

Keywords

COVID-19; Clinical symptoms; SARS-CoV-2.

The Italian COVID-19 Outbreak: Experiences And Recommendations From Clinical Practice

Anaesthesia

Sorbello, M.; El-Boghdadly, K.; Di Giacinto, I.; Cataldo, R.; Esposito, C.; Falcetta, S.; Merli, G.; Cortese, G.; Corso, R. M.; Bressan, F.; Pintaudi, S.; Greif, R.; Donati, A.; Petrini, F.

Abstract

Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019 (COVID-19). Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We report the impact of the COVID-19 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including safe oxygen therapy, airway management, personal protective equipment and non-technical aspects of caring for patients diagnosed with COVID-19. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.

Keywords

COVID-19; critical care; tracheal intubation; ventilation

Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)

JAMA Cardiology

Inciardi, Riccardo M.; Lupi, Laura; Zaccone, Gregorio; Italia, Leonardo; Raffo, Michela; Tomasoni, Daniela; Cani, Dario S.; Cerini, Manuel; Farina, Davide; Gavazzi, Emanuele; Maroldi, Roberto; Adamo, Marianna; Ammirati, Enrico; Sinagra, Gianfranco; Lombardi, Carlo M.; Metra, Marco

Introduction

Importance  Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Objective  To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms.

Design, Setting, and Participant  This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course.

Exposure  Cardiac involvement with COVID-19.

Main Outcomes and Measures  Detection of cardiac involvement with an increase in levels of N-terminal pro–brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging.

Results  An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptase–polymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization.

Conclusions and Relevance  This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

The Role of the Global Health Development/Eastern Mediterranean Public Health Network and the Eastern Mediterranean Field Epidemiology Training Programs in Preparedness for COVID-19

JMIR public health and surveillance
Volume 6, Issue 1, e18503

Al Nsour, M.; Bashier, H.; Al Serouri, A.; Malik, E.; Khader, Y.; Saeed, K.; Ikram, A.; Abdalla, A. M.; Belalia, A.; Assarag, B.; Baig, M. A.; Almudarra, S.; Arqoub, K.; Osman, S.; Abu-Khader, I.; Shalabi, D.; Majeed, Y.

Abstract

The World Health Organization (WHO) declared the current COVID-19 a public health emergency of international concern on January 30, 2020. Countries in the Eastern Mediterranean Region (EMR) have a high vulnerability and variable capacity to respond to outbreaks. Many of these countries addressed the need for increasing capacity in the areas of surveillance and rapid response to public health threats. Moreover, countries addressed the need for communication strategies that direct the public to actions for self- and community protection. This viewpoint article aims to highlight the contribution of the Global Health Development (GHD)/Eastern Mediterranean Public Health Network (EMPHNET) and the EMR's Field Epidemiology Training Program (FETPs) to prepare for and respond to the current COVID-19 threat. GHD/EMPHNET has the scientific expertise to contribute to elevating the level of country alert and preparedness in the EMR and to provide technical support through health promotion, training and training materials, guidelines, coordination, and communication. The FETPs are currently actively participating in surveillance and screening at the ports of entry, development of communication materials and guidelines, and sharing information to health professionals and the public. However, some countries remain ill-equipped, have poor diagnostic capacity, and are in need of further capacity development in response to public health threats. It is essential that GHD/EMPHNET and FETPs continue building the capacity to respond to COVID-19 and intensify support for preparedness and response to public health emergencies.

Keywords

COVID-19, Outbreak, Preparedness, Response, Public health 

Use Of In Situ Simulation To Evaluate The Operational Readiness Of A High Consequence Infectious Disease Intensive Care Unit

The European respiratory journal

Fregene, T. E.; Nadarajah, P.; Buckley, J. F.; Bigham, S.; Nangalia, V.

Abstract

On 30 January 2020, the World Health Organization declared that the outbreak of a coronavirus disease-2019 (COVID-19) was a Public Health Emergency of International Concern. The WHO guidance states that patients with COVID-19 should be managed by staff wearing appropriate personal protective equipment; however, working whilst wearing personal protective equipment is unfamiliar to many healthcare professionals. We ran high-fidelity, in situ simulation of high-risk procedures on patients with COVID-19 in a negative-pressure side room on our intensive care unit. Our aim was to identify potential problems, to test the robustness of our systems and to inform modification of our standard operating procedures for any patients with COVID-19 admitted to our intensive care unit. The simulations revealed several important latent risks and allowed us to put corrective measures in place prior to the admission of patients with COVID-19. We recommend that staff working in clinical areas expected to receive patients with COVID-19 conduct in situ simulation in order to detect their own unique risks and aid in the creation of local guidelines of management of patients with COVID-19.

Keywords

COVID-19; coronavirus; intensive care medicine; simulation