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

Expanded Umbilical Cord Mesenchymal Stem Cells (UC-MSCs) as a Therapeutic Strategy in Managing Critically Ill COVID-19 Patients: The Case for Compassionate Use

Pain physician
Volume 23, 2020, Issue 2, E71-e83

Atluri, S.; Manchikanti, L.; Hirsch, J. A..

Abstract

COVID-19 has affected the United States leading to a national emergency with health care and economic impact, propelling the country into a recession with disrupted lifestyles not seen in recent history. COVID-19 is a serious illness leading to multiple deaths in various countries including the United States. Several million Americans satisfy the Center for Disease Control and Prevention (CDC) criteria for being high risk. Unfortunately, the available supply of medical beds and equipment for mechanical ventilation are much less than is projected to be needed. The World Health Organization (WHO) and multiple agencies led by the CDC in the United States have attempted to organize intensive outbreak investigation programs utilizing appropriate preventive measures, evaluation, and treatment. The clinical spectrum of COVID-19 varies from asymptomatic forms to conditions encompassing multiorgan and systemic manifestations in terms of septic shock, and multiple organ dysfunction (MOD) syndromes. The presently approved treatments are supportive but not curative for the disease. There are multiple treatments being studied. These include vaccines, medications Remdesivir and hydroxychloroquine and potentially combination therapy. Finally, expanded umbilical cord mesenchymal stem cells or (UC-MSCs) may have a role and are being studied. The cure of COVID-19 is essentially dependent on the patients' own immune system. When the immune system is over activated in an attempt to kill the virus, this can lead to the production of a large number of inflammatory factors, resulting in severe cytokine storm. The cytokine storm may induce organ damage followed by the edema, dysfunction of air exchange, acute respiratory distress syndrome (ARDS), acute cardiac injury, and secondary infection, which may lead to death. Thus, at this point, the avoidance of the cytokine storm may be the key for the treatment of HCOV-19 infected patients.In China, where there was limited availability of effective modalities to manage COVID-19 several patients were treated with expanded UC-MSCs. Additionally, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care have reported guidelines to treat coronavirus patients with stem cells in the hope of decreasing the number of patients going to the ICU, and, also relatively quickly getting them out of ICU. In this manuscript, we describe the urgent need for various solutions, pathogenesis of coronavirus and the clinical evidence for treatment of COVID-19 with stem cells. The limited but emerging evidence regarding UC MSC in managing COVID-19 suggests that it might be considered for compassionate use in critically ill patients to reduce morbidity and mortality in the United States. The administration and Coronavirus Task Force might wish to approach the potential of expanded UC-MSCs as an evolutionary therapeutic strategy in managing COVID-19 illness with a 3-pronged approach: If proven safe and effective on a specific and limited basis...1. Minimize regulatory burden by all agencies so that critically ill COVID-19 patients will have access regardless of their financial circumstance.2. Institute appropriate safeguards to avoid negative consequences from unscrupulous actors.3. With proper informed consent from patients or proxy when necessary, and subject to accumulation of data in that cohort, allow the procedure to be initiated in critically ill patients who are not responding to conventional therapies.KEY WORDS: Coronavirus, COVID-19, cytokine storm, multiorgan failure, expanded umbilical cord mesenchymal stem cells.

Keywords

Coronavirus, COVID-19, cytokine storm, multiorgan failure, expanded umbilical cord mesenchymal stem cells

Serological and molecular findings during SARS-CoV-2 infection: the first case study in Finland, January to February 2020

Euro surveillance: European communicable disease bulletin

Haveri, A.; Smura, T.; Kuivanen, S.; Osterlund, P.; Hepojoki, J.; Ikonen, N.; Pitkapaasi, M.; Blomqvist, S.; Ronkko, E.; Kantele, A.; Strandin, T.; Kallio-Kokko, H.; Mannonen, L.; Lappalainen, M.; Broas, M.; Jiang, M.; Siira, L.; Salminen, M.; Puumalainen, T.; Sane, J.; Melin, M.; Vapalahti, O.; Savolainen-Kopra, C.

Abstract

The first case of coronavirus disease (COVID-19) in Finland was confirmed on 29 January 2020. No secondary cases were detected. We describe the clinical picture and laboratory findings 3-23 days since the first symptoms. The SARS-CoV-2/Finland/1/2020 virus strain was isolated, the genome showing a single nucleotide substitution to the reference strain from Wuhan. Neutralising antibody response appeared within 9 days along with specific IgM and IgG response, targeting particularly nucleocapsid and spike proteins.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

The value of mitigating epidemic peaks of COVID-19 for more effective public health responses

Revista da Sociedade Brasileira de Medicina Tropical
Volume 53, e20200135

Villela, D. A. M.

Introduction

The emergence of SARS-Cov-2 virus in Wuhan, China, in December of 2019 led to a local epidemic that rapidly spread to multiple countries in the world, placing remarkable challenges in surveillance and control. In March 16th, 2020, WHO declared that the infection associated with SARS-Cov-2, named COVID-19, had spread to more than 100 countries, with more than 160,000 confirmed cases and more than 6,000 deaths globally

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

Correction To: COVID-19: A Novel Coronavirus And A Novel Challenge For Critical Care

Intensive Care Medicine

Arabi, Y. M.; Murthy, S.; Webb, S.

Introduction

The original version of this article unfortunately contained a mistake. There was an error in table one: in the last row, second column the part “Still being defined to” should be crossed out. The correct Table 1 can be found below. We apologize for the mistake.

Keywords

Clinical aspects, diagnosis, treatment

Dilemma of Organ Donation in Transplantation and The COVID-19 Pandemic

The Journal of Heart and Lung Transplantation

Woolley, Ann E.; Mehra, Mandeep R.

Abstract

In late 2019, the world began to confront the emergence of a novel coronavirus (SARS-CoV2) infection and its consequent disease manifestation of COVID-19. The virus spreads stealthily by transmission through asymptomatic carriers and is associated with a high rate of contagion, with a R0 of 2-3 (average number of people who will catch a disease from one infected person), a 19% rate of hospitalization and a case fatality rate (in those with a confirmed diagnosis) of 1-3.5%.1 Stages of severity for this illness have been described with death preferentially afflicting the elderly with underlying cardiovascular risk markers or disease.2 In late stages, COVID-19 overwhelms its host by an aberrant hyperinflammatory response with resultant cardio-pulmonary and multisystem failure. At this time a vaccine is awaited, and therapy targeting COVID-19 is largely derived from anecdotal experience based on empirical suggestions from limited in-vitro data.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Role of changes in SARS-CoV-2 spike protein in the interaction with the human ACE2 receptor: An in silico analysis

EXCLI journal
Volume 19, March 2020, pp 410-417

Ortega, J. T.; Serrano, M. L.; Pujol, F. H.; Rangel, H. R.

Abstract

Many human viral diseases are a consequence of a zoonotic event. Some of the diseases caused by these zoonotic events have affected millions of people around the world, some of which have resulted in high rates of morbidity/mortality in humans. Changes in the viral proteins that function as ligands of the host receptor may promote the spillover between species. The most recent of these zoonotic events that have caused an ongoing epidemic of high magnitude is the Covid-19 epidemics caused by SARS-CoV-2. The aim of this study was to determine the mutation(s) in the sequence of the spike protein of the SARS-CoV-2 that might be favoring human to human transmission. An in silico approach was performed, and changes were detected in the S1 subunit of the receptor-binding domain of spike. The observed changes have significant effect on SARS-CoV-2 spike/ACE2 interaction and produce a reduction in the binding energy, compared to the one of the Bat-CoV to this receptor. The data presented in this study suggest a higher affinity of the SARS-Cov-2 spike protein to the human ACE2 receptor, compared to the one of Bat-CoV spike and ACE2. This could be the cause of the rapid viral spread of SARS-CoV-2 in humans.

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Keywords

Comparative study, RCT; Clinical aspects, diagnosis, treatment

Potential therapeutic options for coronavirus disease 2019: using knowledge of past outbreaks to guide future treatment

Chinese medical journal

Lin, J.; Ouyang, J.; Peng, X. R.; Isnard, S.; Fombuena, B.; Routy, J. P.; Chen, Y. K.

Introduction

In December 2019, initial cases of the novel coronavirus (2019-nCov) infection, termed Coronavirus Disease 2019 (COVID-19), were first reported in Wuhan, China. In humans, infections with the human coronavirus 229E, OC43, NL63 and HKU1 usually result in mild, self-limiting upper respiratory tract infections. However, other variants have rapid transmission rates and can cause severe respiratory syndrome and death. These variants include severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and the current 2019-nCov…

Keywords

By Comparative study, RCT; Normative guidance; Clinical aspects, diagnosis, treatment; Epidemiology

Unrevealing sequence and structural features of novel coronavirus using in silico approaches: The main protease as molecular target

EXCLI journal
Volume 19, March 2020, pp 400-409

Ortega, J. T.; Serrano, M. L.; Pujol, F. H.; Rangel, H. R.

Abstract

Direct-acting antivirals are effective tools to control viral infections. SARS-CoV-2 is a coronavirus associated with the epidemiological outbreak in late 2019. Previous reports showed that HIV-1 protease inhibitors could block SARS-CoV main protease. Based on that and using an in silico approach, we evaluated SARS-CoV-2 main protease as a target for HIV-1 protease inhibitors to reveal the structural features related to their antiviral effect. Our results showed that several HIV inhibitors such as lopinavir, ritonavir, and saquinavir produce strong interaction with the active site of SARS-CoV-2 main protease. Furthermore, broad library protease inhibitors obtained from PubChem and ZINC (www.zinc.docking.org) were evaluated. Our analysis revealed 20 compounds that could be clustered into three groups based on their chemical features. Then, these structures could serve as leading compounds to develop a series of derivatives optimizing their activity against SARS-CoV-2 and other coronaviruses. Altogether, the results presented in this work contribute to gain a deep understanding of the molecular pharmacology of SARS-CoV-2 treatment and validate the use of protease inhibitors against SARS-CoV-2.

Keywords

Clinical aspects, diagnosis, treatment

Clinical and CT features of early-stage patients with COVID-19: a retrospective analysis of imported cases in Shanghai, China

The European respiratory journal

Yang, Shuyi; Shi, Yuxin; Lu, Hongzhou; Xu, Jianqing; Li, Feng; Qian, Zhiping; Hua, Xinyan; Ding, Xueting; Song, Fengxiang; Shen, Jie; Lu, Yang; Shan, Fei; Zhang, Zhiyong.

To the Editor,

Since December 2019, some patients with novel corona virus infectious disease (COVID-19) emerged in Wuhan, Hubei, China. The pathogen analysis discovered a new type of coronavirus from infected airway epithelial cells and named as sever acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). At the time of Chinese people were heading home for celebrating the Spring Festival, many latent cases left Wuhan, which led to the emergence of imported COVID-19 cases across the mainland of China and some other countries. Shanghai is one of the major cities with imported cases.

Keywords

COVID-19, SARS-CoV-2, Treatment

National Institute for the Infectious Diseases "L. Spallanzani", IRCCS. Recommendations for COVID-19 clinical management

Infectious Disease Reports
Volume 12, March 2020, Issue 1, 8543

Nicastri, E.; Petrosillo, N.; Bartoli, T. A.; Lepore, L.; Mondi, A.; Palmieri, F.; D'Offizi, G.; Marchioni, L.; Murachelli, S.; Ippolito, G.; Antinori, A.

Abstract

On January 9 2020, the World Health Organization (WHO) declared the identification, by Chinese Health authorities, of a novel coronavirus, further classified as SARS-CoV-2 responsible of a disease (COVID-19) ranging from asymptomatic cases to severe respiratory involvement. On March 9 2020, WHO declared COVID-19 a global pandemic. Italy is the second most affected country by COVID-19 infection after China. The "L. Spallanzani" National Institute for the Infectious Diseases, IRCCS, Rome, Italy, has been the first Italian hospital to admit and manage patients affected by COVID-19. Hereby, we show our recommendations for the management of COVID-19 patients, based on very limited clinical evidences; they should be considered as expert opinions, which may be modified according to newly produced literature data.

Keywords

COVID-19, SARS-CoV-2, Treatment

What Should Palliative Care's Response be to the COVID-19 Epidemic?

Journal of Pain and Symptom Management

Powell, Victoria D.; Silveira, Maria J.

To the Editor,

COVID-19 is anticipated to spread widely in the U.S. by the end of 2020.1 Widespread transmission of COVID-19 in the U.S. could translate into large numbers of people needing medical care at the same time. This will push many health systems to the point of rationing limited resources such as intensive care unit beds and life-sustaining machinery, as has occurred in Italy.2 Patients and their families at the peak of the pandemic will face symptoms, emotional distress, and decision making in the face of uncertainty and limited options. No one is more prepared to handle these needs than providers on palliative care consult teams. However, palliative care consult teams are themselves a limited resource. In this piece, we will outline the challenges palliative care consult services may face in this crisis and suggest some alternatives forward.

Keywords

Clinical aspects, diagnosis, treatment

Audio interview: Making decisions about testing and treatment for your patients

New England Journal of Medicine
Volume 382, Issue 11, March 2020, Page 1

Rubin, E. J.; Baden, L. R.; Morrissey, S.

Introduction

The rapid spread of SARS-CoV-2, a novel corona- virus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization.

Keywords

Epidemiology

Strategies for the prevention and management of coronavirus disease 2019

European Respiratory Journal

Guan, Wei-Jie; Chen, Rong-Chang; Zhong, Nan-Shan.

Introduction

Early protection, early identification, early diagnosis, and early isolation are crucial to combat with Covid-19 outbreaks Since the outbreak in Wuhan city in December 2019, there has been a surge of newly diagnosed cases with coronavirus disease 2019 (Covid-19) globally [1-4]. The total number has reached to 101,927 laboratory-confirmed cases as of March 8 th, 2020 [5]. An increasing number of countries have issued the alert of the highest level

Keywords

Transmission; control; prevention; therapy; laboratory testing

The 2019/2020 Novel Corona Virus Outbreak: An International Health Management Perspective

Open Public Health Journal
Volume 13, Issue 1, March 2020, Pages 52-54

Beck, M.; Tobin, D.

Introduction

On December 31, 2019 Chinese health authorities reported an outbreak of atypical pneumonia in Wuhan, the 12 million person capital of Hubei province [1]. On January 7, 2020 this outbreak was linked to a novel coronavirus epidemic known as Covid-19 (or 2019-nCoV caused by the virus SARS-CoV-2) [2]. The WHO declared the outbreak a Public Health Emergency of International Concern on January 30, 2020.

Keywords

Epidemiology

A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations

General psychiatry
Volume 33, March 2020, Issue 2, e100213

Qiu, J.; Shen, B.; Zhao, M.; Wang, Z.; Xie, B.; Xu, Y.

Abstract

The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people's lives. It has also triggered a wide variety of psychological problems, such as panic disorder, anxiety and depression. This study is the first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic.

Keywords

Epidemiology

AJN On The Web Clinical And High-Resolution CT Features Of The COVID-19 Infection: Comparison Of The Initial And Follow-Up Changes

AJN The American Journal of Nursing
Volume 120, Issue 3, March 2020, Page 13

Xiong, Ying; Sun, Dong; Liu, Yao; Fan, Yanqing; Zhao, Lingyun; Li, Xiaoming; Zhu, Wenzhen.

Abstract

Objectives: In late December, 2019, an outbreak of coronavirus disease (COVID-19) in Wuhan, China was caused by a novel coronavirus, newly named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to quantify severity of COVID-19 infection on High-Resolution CT and to determine its relationship with clinical parameters.

Materials and methods: From Jan 11, 2020, to Feb 5, 2020, the clinical, laboratory and HRCT features of 42 patients (26-75 years, 25 males) with COVID-19 were analyzed. The initial and follow-up CT obtained a mean of 4.5 days and 11.6 days from the illness onset were retrospectively assessed for the severity and progression of pneumonia. Correlations among clinical parameters, initial CT features and progression of opacifications were evaluated with Spearman correlation and linear regression analysis.

Results: Thirty-five (83%) patients exhibited a progressive process according to CT features during the early stage from onset. Follow-up CT findings showed progressive opacifications, consolidation, interstitial thickening, fibrous strips and air bronchograms, compared to initial CT (all p<0.05). Before regular treatments, there was a moderate correlation between the days from onset and sum score of opacifications (R=0.68, p<0.01). The C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase showed significantly positive correlation with the severity of pneumonia assessed on initial CT (R range 0.36-0.75, p<0.05). The highest temperature and the severity of opacifications assessed on initial CT were significantly related to the progression of opacifications on follow-up CT (p=0.001-0.04).

Conclusions: Patients with the COVID-19 infection usually presented with typical ground-grass opacities and other CT features, which showed significant correlations with some clinical and laboratory measurements. Follow-up CT images often demonstrated progressions during the early stage from illness onset.

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Keywords

COVID-19, SARS-CoV-2, viral pneumonia, clinical features, Computed Tomography, follow-up

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