COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period (Copy)

Annals of surgery

Aminian, Ali; Safari, Saeed; Razeghian-Jahromi, Abdolali; Ghorbani, Mohammad; Delaney, Conor P.

Abstract

Little is known about surgical practice in the initial phase of coronavirus disease 2019 (COVID-19) global crisis. This is a retrospective case series of 4 surgical patients (cholecystectomy, hernia repair, gastric bypass, and hysterectomy) who developed perioperative complications in the first few weeks of COVID-19 outbreak in Tehran, Iran in the month of February 2020. COVID-19 can complicate the perioperative course with diagnostic challenge and a high potential fatality rate. In locations with widespread infections and limited resources, the risk of elective surgical procedures for index patient and community may outweigh the benefit.

Keywords

Clinical aspects, diagnosis, treatment

Self-Reported Olfactory And Taste Disorders In SARS-Cov-2 Patients: A Cross-Sectional Study

Clinical Infectious Diseases: An Official Publication Of the Infectious Diseases Society of America

Giacomelli, Andrea; Pezzati, Laura; Conti, Federico; Bernacchia, Dario; Siano, Matteo; Oreni, Letizia; Rusconi, Stefano; Gervasoni, Cristina; Ridolfo, Anna Lisa; Rizzardini, Giuliano; Antinori, Spinello; Galli, Massimo 

Dear Editor,

We read with interest the paper by Wang et al [1] describing the clinical features of 69 patients with Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection in Wuhan, China. The authors provide a detailed description of major signs and symptoms of overt disease [2, 3], but fail to give an account of minor symptoms that may be present at earlier stage of the infection.

Keywords

COVID-19, SARS-CoV-2, Surge Capacity, Pandemics, Translational Science

Remote Treatment Delivery in Response to the COVID-19 Pandemic

Psychotherapy and Psychosomatics

Wright, Jesse H.; Caudill, Robert.

Introduction

Because containment efforts for the COVID-19 pandemic include social distancing, quarantine, and isolation, if indicated, health care providers are confronted with major challenges in delivery of care. As we write this editorial, the situation in the USA is extremely fluid with some clinics shuttering their doors and delivering services only via telephone, telemedicine, or other technologies; other clinics are continuing some face-to-face visits while moving toward the use of alternatives. Email channels among health care professionals are pulsing with questions about the use of telemedicine and other technologies.

Keywords

Clinical aspects, diagnosis, treatment

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

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

Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow

JMIR Mental Health

Torous, John; Jän Myrick, Keris; Rauseo-Ricupero, Natali; Firth, Joseph

Abstract

As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the world today must “flatten the curve” of spread of the virus, we argue that now is the time to “accelerate and bend the curve” on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further.

Keywords

Digital Health, Emergency Response, Telehealth, Apps

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

Management of Critically Ill Adults With COVID-19

JAMA

Poston, Jason T.; Patel, Bhakti K.; Davis, Andrew M.

Introduction

Infection Control and Testing
1. For health care workers performing aerosol-generating procedures (eg, endotracheal intubation, nebulized treatments, open suctioning) use of fitted respirator masks is recommended (N95 respirators, FFP2), instead of surgical masks, in addition to other personal protective equipment (PPE) (best practice statement).
2. For usual care of nonventilated patients, or for performing non–aerosolgenerating procedures on patients receiving mechanical ventilation, use of medical masks is recommended, instead of respirator masks, in addition to other PPE (weak recommendation, low-quality evidence [LQE]). 3. Diagnostic lower respiratory tract samples (endotracheal aspirates) are preferred over bronchial washings, bronchoalveolar lavage, and upper respiratory tract (nasopharyngeal or oropharyngeal) samples (weak recommendation, LQE).

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Can SARS-CoV-2 Infection Be Acquired In Utero?: More Definitive Evidence Is Needed

JAMA

Kimberlin, David W.; Stagno, Sergio

Introduction

Two articles reported in this issue of JAMA from separate research teams in China present details of 3 neonates who may have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in utero from mothers with coronavirus disease 2019 (COVID-19). Evidence for such transmission is based on elevated IgM antibody values in blood drawn from the neonates following birth. All infants also had elevated IgG antibody values and cytokine levels, although these may have crossed the placenta from the mother to the infant. No infant specimen had a positive reverse transcriptase–polymerase chain reaction test result, so there is not virologic evidence for congenital infection in these cases to support the serologic suggestion of in utero transmission. Nevertheless, the serologic data are provocative for a virus that is believed to be spread by respiratory secretions and—given the modeling showing that a significant percentage of the world’s population, many of them pregnant women, will be infected over the next weeks or months—it is one that deserves careful consideration. However, at this time, these data are not conclusive and do not prove in utero transmission.

Keywords

Clinical aspects, diagnosis, treatment

Gastrointestinal Endoscopy During COVID-19 Pandemic

Journal of Gastroenterology and Hepatology

Ang, Tiing Leong

Abstract

Performing gastrointestinal (GI) endoscopy during the current COVID-19 pandemic is challenging. The ease of transmission at close proximity, especially in the context of aerosol generating procedures (AGP), raises the spectre of inadvertent healthcare worker (HCW) exposure and infection during GI endoscopy procedures, with further transmission to other HCW and patients, causing a nosocomial outbreak. Appropriate systematic processes must be put in place to enhance the safety of both HCW and patients, and limited resources must be utilized in a rationale manner. Although the practice of evidence-based medicine is advocated, objective scientific data may be lacking initially, and a judgment call has to be made. Even when key principles of safe practice are adhered to, specific approaches must be contextualized to actual needs on the ground.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

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

Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19

JAMA

Bourouiba, Lydia

Introduction

he current coronavirus disease 2019 (COVID-19) outbreak vividly demonstrates the burden that respiratory infectious diseases impose in an intimately connected world. Unprecedented containment and mitigation policies have been implemented in an effort to limit the spread of COVID-19, including travel restrictions, screening and testing of travelers, isolation and quarantine, and school closures.

Keywords

Coronavirus (COVID19), Infectious Diseases, Pulmonary Medicine, Public Health

Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn

JAMA

Dong, Lan; Tian, Jinhua; He, Songming; Zhu, Chuchao; Wang, Jian; Liu, Chen; Yang, Jing

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly infectious, with multiple possible routes of transmission Controversy exists regarding whether SARS-CoV-2 can be transmitted in utero from an infected mother to her infant before birth. A series of 9 pregnant women found no mother-child transmission. We report a newborn with elevated IgM antibodies to SARS-CoV-2 born to a mother with coronavirus disease 2019 (COVID-19).

Keywords

Clinical aspects, diagnosis, treatment

Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in China and Italy

Annals of Surgery

Zheng, Min Hua; Boni, Luigi; Fingerhut, Abe

Introduction

As elective operations are being canceled, and surgeons are called upon to perform only emergency or carcinological surgery, the precautions to take when operating on patients who are potentially or proven COVID-19 positive are of utmost importance. The novel coronavirus (2019-nCoV) outbreak hit China in the beginning of December 2019 and ignited the headlines a few days later. Unexpected, unprecedented, and radical modifications have profoundly shaken the world since then. The economic shutdown in China cleared the map of China viewed from the sky, the halt in travel, counseled first within the country, then internationally, was too late to stop the diffusion outside of China, and meanwhile has destroyed enterprises such as Flybe, while changing the economy of airlines and airports the world over.

Keywords

Clinical aspects, diagnosis, treatment

Cutaneous Manifestations In COVID-19: A First Perspective

Journal of the European Academy of Dermatology and Venereology

Recalcati, S.

Abstract

In December 2019 unexplained pneumonia cases were initially reported in Wuhan, China. The pathogen, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), was isolated from lower respiratory tract samples of infected patients and the resultant disease was termed as COVID‐19 (Coronavirus Disease 2019)1. By Feb 15, COVID‐19 has rapidly spread throughout China and across the world, until a pandemic condition was announced by March 11

Keywords

COVID-19, cutaneous manifestations, skin, cutaneous

Should Scientists Infect Healthy People with the Coronavirus to Test Vaccines?

Nature

Callaway, Ewen

Introduction

As hundreds of millions of people, maybe billions, avoid social contact to spare themselves and their communities from coronavirus, researchers are discussing a dramatic approach to research that could help end the pandemic: infecting a handful of healthy volunteers with the virus to rapidly test a vaccine.

Keywords

Clinical aspects, diagnosis, treatment

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