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 Impact of COVID-19 on Radiation Oncology Clinics and Cancer Patients in the U.S

Advances in Radiation Oncology

Rivera, Amanda; Ohri, Nitin; Thomas, Evan; Miller, Robert; Knoll, Miriam A.

Background

In December 2019, Wuhan, China witnessed the outbreak of the novel coronavirus (SARS-CoV-2) that would soon become an international public health emergency and world pandemic.1 In the U.S., we are at a time where preparation for healthcare systems is critical. Given the rapidity with which the novel coronavirus (SARS-CoV-2) is spreading, we can expect an increased burden of cancer patients diagnosed with COVID-19 at oncology treatment clinics and a need to address this diagnosis. As of the date of this writing, the U.S.

Keywords

COVID-19, SARS-CoV-2, Treatment

The COVID-19 Pandemic And The Use Of MS Disease-Modifying Therapies

Multiple Sclerosis and Related Disorders

Giovannoni, Gavin; Hawkes, Chris; Lechner-Scott, Jeannette; Levy, Michael; Waubant, Emmanuelle; Gold, Julian

Introduction

Maria was distraught after reading about the ‘potential’ epidemic, yet to happen, and the horror stories on Facebook needing reassurance and certainty about what she should do. She requested an urgent appoint- ment to review her treatment plan. Maria was a 26-year-old woman with relapsing multiple sclerosis who had recently experienced brainstem relapse with double vision and ataxia despite treatment with pegylated interferon-beta for the last 18 months. A brain MRI performed one month prior had shown 16 new T2 lesions, four of which were enhancing. One of the enhancing lesions was at the pontomedullary junction and was certainly the cause of her relapse. Treatment was to be escalated to ocrelizumab with the first dose in a week's time. In view of the emerging coronavirus pandemic, she was questioning whether or not she should go ahead with ocrelizumab. This was despite only a handful of confirmed COVID-19 cases in the country and none in her town and region.

Keywords

Clinical aspects, diagnosis, treatment

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

Non-steroidal anti-inflammatory drugs and covid-19

BMJ
Volume 368, 2020, m1185-m1185

Little, Paul.

Introduction,

Extra risk is plausible on current balance of evidence Emerging evidence suggests that the most serious complications of covid-19 are sepsis and cardiovascular or respiratory complications. They occur predominantly in elderly people and those with underlying health conditions. Does use of non-steroidal anti-inflammatory drugs (NSAIDs) increase these risks? We don’t know for certain, but additional risks are plausible on the current balance of evidence.

Keywords

Clinical aspects, diagnosis, treatment

Early Antiviral Treatment Contributes to Alleviate the Severity and Improve the Prognosis of Patients With Novel Coronavirus Disease (COVID-19)

Journal of Internal Medicine

Wu, Jian; Li, Wei; Shi, Xiaowei; Chen, Zhongming; Jiang, Bin; Liu, Jun; Wang, Dawei; Liu, Chengyuan; Meng, Yiling; Cui, Leilei; Yu, Jiong; Cao, Hongcui; Li, Lanjuan

Abstract

Background

At present, the severity of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has been a focal point.

Methods

To assess the factors associated with severity and prognosis of patients infected with SARS‐CoV‐2, we retrospectively investigated the clinical, imaging and laboratory characteristics of confirmed 280 cases of novel coronavirus disease (COVID‐19) from 20 January to 20 February 2020.

Results

The median age of patients in the mild group was 37.55 years, whilst that in the severe group was 63.04 years. The proportion of patients aged over 65 years in the severe group was significantly higher than that of the mild group (59.04% vs. 10.15%, P < 0.05). 85.54% of severe patients had diabetes or cardiovascular diseases, which was significantly higher than that of the mild group (51.81% vs. 7.11%, P = 0.025; 33.73% vs. 3.05%, P = 0.042). Patients in the mild group experienced earlier initiation of antiviral treatment (1.19 ± 0.45 vs. 2.65 ± 1.06 days in the severe group, P < 0.001). Our study showed that comorbidity, time from illness onset to antiviral treatment and age >=65 were three major risk factors for COVID‐19 progression, whilst comorbidity and time from illness onset to antiviral treatment were two major risk factors for COVID‐19 recovery.

Conclusions

The elderly and patients with underlying diseases are more likely to experience a severe progression of COVID‐19. It is recommended that timely antiviral treatment should be initiated to slow the disease progression and improve the prognosis.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

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

Potential Effects of Coronaviruses on the Cardiovascular System: A Review

JAMA Cardiology

Madjid, Mohammad; Safavi-Naeini, Payam; Solomon, Scott D.; Vardeny, Orly

Abstract

Importance:  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system.

Observations:  Coronavirus disease 2019 can cause a viral pneumonia with additional extrapulmonary manifestations and complications. A large proportion of patients have underlying cardiovascular disease and/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, and presence of comorbidities including hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. Acute cardiac injury determined by elevated high-sensitivity troponin levels is commonly observed in severe cases and is strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality.

Conclusions and Relevance:  Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. Extensive efforts are underway to find specific vaccines and antivirals against SARS-CoV-2. Meanwhile, cardiovascular risk factors and conditions should be judiciously controlled per evidence-based guidelines.

Keywords

Clinical aspects, diagnosis, treatment

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

JAMA Cardiology

Guo, Tao; Fan, Yongzhen; Chen, Ming; Wu, Xiaoyan; Zhang, Lin; He, Tao; Wang, Hairong; Wan, Jing; Wang, Xinghuan; Lu, Zhibing

Abstract

Importance  Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce.

Objective  To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19.

Design, Setting, and Participants  This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020.

Main Outcomes and Measures  Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels.

Result  Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P < .001) and N-terminal pro–brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P < .001). Plasma TnT and NT-proBNP levels during hospitalization (median [interquartile range (IQR)], 0.307 [0.094-0.600]; 1902.00 [728.35-8100.00]) and impending death (median [IQR], 0.141 [0.058-0.860]; 5375 [1179.50-25695.25]) increased significantly compared with admission values (median [IQR], 0.0355 [0.015-0.102]; 796.90 [401.93-1742.25]) in patients who died (P = .001; P < .001), while no significant dynamic changes of TnT (median [IQR], 0.010 [0.007-0.019]; 0.013 [0.007-0.022]; 0.011 [0.007-0.016]) and NT-proBNP (median [IQR], 352.20 [174.70-636.70]; 433.80 [155.80-1272.60]; 145.40 [63.4-526.50]) was observed in survivors (P = .96; P = .16). During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (41 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels. The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 25.6% (43 of 168).

Conclusions and Relevance  Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

JAMA

Shen, Chenguang; Wang, Zhaoqin; Zhao, Fang; Yang, Yang; Li, Jinxiu; Yuan, Jing; Wang, Fuxiang; Li, Delin; Yang, Minghui; Xing, Li; Wei, Jinli; Xiao, Haixia; Yang, Yan; Qu, Jiuxin; Qing, Ling; Chen, Li; Xu, Zhixiang; Peng, Ling; Li, Yanjie; Zheng, Haixia; Chen, Feng; Huang, Kun; Jiang, Yujing; Liu, Dongjing; Zhang, Zheng; Liu, Yingxia; Liu, Lei

Introduction

Importance  Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments.

Objective  To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Design, Setting, and Participants  Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation. All 5 were treated with convalescent plasma transfusion. The study was conducted at the infectious disease department, Shenzhen Third People's Hospital in Shenzhen, China, from January 20, 2020, to March 25, 2020; final date of follow-up was March 25, 2020. Clinical outcomes were compared before and after convalescent plasma transfusion.

Exposures  Patients received transfusion with convalescent plasma with a SARS-CoV-2–specific antibody (IgG) binding titer greater than 1:1000 (end point dilution titer, by enzyme-linked immunosorbent assay [ELISA]) and a neutralization titer greater than 40 (end point dilution titer) that had been obtained from 5 patients who recovered from COVID-19. Convalescent plasma was administered between 10 and 22 days after admission.

Main Outcomes and Measures  Changes of body temperature, Sequential Organ Failure Assessment (SOFA) score (range 0-24, with higher scores indicating more severe illness), Pao2/Fio2, viral load, serum antibody titer, routine blood biochemical index, ARDS, and ventilatory and extracorporeal membrane oxygenation (ECMO) supports before and after convalescent plasma transfusion.

Results  All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion.

Conclusions and Relevance  In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Convalescent Plasma to Treat COVID-19: Possibilities and Challenges

JAMA

Roback, John D.; Guarner, Jeannette

Introduction

In this issue of JAMA, Shen et al report findings from a preliminary study of 5 severely ill patients with coronavirus disease 2019 (COVID-19) who were treated in the Shenzhen Third People's Hospital, China, using plasma from recovered individuals.1 All patients had severe respiratory failure and were receiving mechanical ventilation; 1 needed extracorporeal membrane oxygenation (ECMO) and 2 had bacterial and/or fungal pneumonia. Four patients without coexisting diseases received convalescent plasma around hospital day 20, and a patient with hypertension and mitral valve insufficiency received the plasma transfusion at day 10. The donor plasma had demonstrable IgG and IgM anti–SARS-CoV-19 antibodies and neutralized the virus in vitro cultures. Although these patients continued to receive antiviral treatment primarily with lopinavir/ritonavir and interferon, the use of convalescent plasma may have contributed to their recovery because the clinical status of all patients had improvement approximately 1 week after transfusion, as evidenced by normalization of body temperature as well as improvements in Sequential Organ Failure Assessment scores and Pao2/Fio2 ratio. In addition, the patients’ neutralizing antibody titers increased and respiratory samples tested negative for SARS-CoV-2 between 1 and 12 days after transfusion.

Keywords

Clinical aspects, diagnosis, treatment

Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality

JAMA Cardiology

Bonow, Robert O.; Fonarow, Gregg C.; O'Gara, Patrick T.; Yancy, Clyde W.

Introduction

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and a public health crisis of global proportions. As a medical community, we are actively engaged in a real-time data gathering mode to facilitate active learning and an expedited study of best practices of care. Although we are becoming more aware of the natural history of COVID-19, we have had scant information as of yet that addresses any unique risks of COVID-19 for those with underlying cardiovascular disease. Such information is of paramount importance as we now must begin to consider the potential for direct and indirect adverse effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the heart and especially so in those with already established heart disease.

Keywords

Clinical aspects, diagnosis, treatment

Covid-19: Lack of PPE in care homes is risking spread of virus, leaders warn

BMJ
Volume 368, 2020, m1280-m1280

Iacobucci, Gareth.

Introduction

A lack of access to personal protective equipment (PPE) and staff testing in care homes poses a major risk of covid-19 being spread, sector leaders have warned. Care homes have been identified as one of the biggest potential risks for virus spreading, owing to the number of elderly residents with underlying health conditions. At a health select committee hearing hosted remotely on 26 March, Sarah Pickup, the deputy chief executive of the Local Government Association, said that more equipment and testing was needed to protect both residents and workers.1 “Access to PPE is insufficient in the care sector,” she said, warning that people entering care homes on discharge from hospital could bring an infection.

Keywords

Clinical aspects, diagnosis, treatment; Ethics, social science, economics

Prevent loss of life by providing all NHS staff with WHO standard personal protective equipment

The European respiratory journal

Hero, Isabelle.

Introduction

As a retired consultant histopathologist with 40 years’ experience of working in the NHS, I am appalled that NHS staff are not being provided with adequate personal protective equipment (PPE). PPE that meets the standard set out by the World Health Organization is still today, 27 March 2020, not reaching many wards and clinics.1 2 All NHS staff need to be protected. All hospital departments, general practices, ambulances, and care homes need adequate PPE. We must prevent what happened in Italy.3-5 In the UK, six doctors and nurses are already fighting for their lives on ventilators, and one surgeon and a GP have already died from covid-19.6-10 And the battle has only just started. Please prevent the loss of numerous precious NHS staff through lack of PPE of WHO standard.

Keywords

Epidemiology

Practical Considerations In The Anaesthetic Management Of Patients During A COVID-19 Epidemic

The European respiratory journal

Ong, S.; Tan, T. Khee.

Abstract

We read with interest the excellent Association guidelines for the anaesthetic management of patients during a COVID-19 outbreak. We concur with these guidelines, which are not dissimilar to our hospital's protocols since Singapore reported its first case of COVID-19 on 23 January 2020. To date, there have been 226 confirmed cases in Singapore with no deaths reported. We are preparing for many more when community transmission becomes widespread and every patient presenting for surgery becomes a potential asymptomatic infected case. We would like to highlight additional anaesthetic considerations in this COVID-19 pandemic. Our discussion is limited to patients not known to be COVID infected.

Keywords

Clinical aspects, diagnosis, treatment

The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19)

JAMA

Curtis, J. Randall; Kross, Erin K.; Stapleton, Renee D.

Introduction

The novel coronavirus disease 2019 (COVID-19) pandemic is challenging health care systems worldwide and raising important ethical issues, especially regarding the potential need for rationing health care in the context of scarce resources and crisis capacity. Even if capacity to provide care is sufficient, one priority should be addressing goals of care in the setting of acute life-threatening illness, especially for patients with chronic, life-limiting disease.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Perioperative Presentation of COVID-19 Disease in a Liver Transplant Recipient

Hepatology (Baltimore, Md.)

Qin, Juanjuan; Wang, Haitao; Qin, Xuan; Zhang, Peng; Zhu, Lihua; Cai, Jingjing; Yuan, Yufeng; Li, Hongliang.

Abstract

Coronavirus disease 2019 (COVID-19) is highly contagious. It may rapidly progress to acute respiratory distress syndrome (ARDS) and result in multiorgan dysfunction or death in some cases.((1,2)) Here, we report the case of a patient with hepatocellular carcinoma (HCC) who underwent liver transplantation and experienced COVID-19 infection during the perioperative period. This case may help clinicians by alerting them to potential COVID-19 infection in transplant recipients during the outbreak.

Keywords

Clinical aspects, diagnosis, treatment

How emergency departments prepare for virus disease outbreaks like COVID-19

European Journal of Emergency Medicine

Möckel, Martin; Bachmann, Ulrike; Behringer, Wilhelm; Pfäfflin, Frieder; Stegemann, Miriam Songa.

Introduction

Acute outbreaks of novel virus caused diseases like coronavirus disease 2019 (COVID-19) challenge the national and international healthcare systems and specifically the emergency departments (EDs) as patients, even if they have only mild symptoms, intuitively present in the ED once they fear to have a serious disease. Therefore, EDs need to prepare fast and effectively to address the challenge of walk-in patients who might transmit the virus SARSCoV-2 without displaying severe symptoms themselves, to protect personnel and vulnerable patient groups who are typically present in the ED at any time like patients with immunosuppression, chronic disease and older age. The outbreak of COVID-19 in Wuhan, China and the transmission to Europe is a typical example with some lessons learned for the ED. This early report reflects the situation from a German perspective including the capital city of Berlin.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

COVID-19: “A Tale of Two Epidemics” March 20, 2020

Disaster Medicine and Public Health Preparedness

James, James J.

Introduction

We are all too aware of the first epidemic - over 120,000 cases reported from well over a 100 countries with some 4,500 deaths and another 6,000+ severe or critical cases. Large outbreaks have occurred, and local medical facilities overwhelmed with many hospitals literally turned into war zones with medical personnel surrounded by suffering and death and having little at their disposal to combat the microscopic foe. From the perspective of the individual healthcare worker, trained in the ethos of individual care, this is a real and harrowing experience; for those not yet infected such images, well publicized in traditional and social media, naturally lead to feelings of concern and vulnerability. With widespread concern and alarm governments activate measures in an attempt to contain the epidemic. Such measures include quarantines, isolation, and travel restrictions in an effort to prevent introduction of the causative agent and/or its spread.

Keywords

Epidemiology

Simulation As A Tool For Assessing And Evolving Your Current Personal Protective Equipment: Lessons Learned During The Coronavirus Disease (COVID-19) Pandemic

Canadian Journal of Anaesthesia

Lockhart, Shannon L.; Naidu, Justen J.; Badh, Charanjit S.; Duggan, Laura V.

To the Editor

We believe that protection of the well-being of healthcare providers while maintaining a workforce sufficient to respond to the coronavirus disease (COVID19) are fundamental to pandemic planning. In this letter, we describe how our hospital used low-fidelity airway simulation to assess and evolve the personal protective equipment (PPE) used for airway management of patients with COVID-19.

Keywords

Clinical aspects, diagnosis, treatment