Covid-19: Medical Students And FY1 Doctors To Be Given Early Registration To Help Combat Covid-19

BMJ (Clinical research ed.)
Volume 368, March 2020, m1268-m1268

Harvey, Anna.

Introduction

Final year medical students are to be offered early provisional registration and foundation year 1 (FY1) doctors early full registration with the General Medical Council to help staffing levels during the covid-19 pandemic, a joint statement from regulatory and training bodies released on 25 March says.

The statement from the UK health departments, the GMC, Health Education England, NHS Education for Scotland, Health Education and Improvement Wales, the Northern Ireland Medical and Dental Training Agency, and the Medical Schools Council states that final year medical students who have been deemed by their medical school to have met the GMC’s outcomes for graduates can graduate early.

Keywords

COVID-19, SARS-CoV-2, Treatment

Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China

Psychological Medicine
March 2020 , pp. 1-7

Bo, Hai-Xin; Li, Wen; Yang, Yuan; Wang, Yu; Zhang, Qinge; Cheung, Teris; Wu, Xinjuan; Xiang, Yu-Tao.

Body

The novel coronavirus disease (COVID-19) epidemic, which is believed to be originated from Wuhan, China at the end of 2019, has been rapidly transmitted globally. With the increasing number of infected cases and deaths, many patients experienced both physical sufferings and great psychological distress. In China, a range of guidelines and expert consensus have been developed by health authorities and academic associations. Crisis mental health interventions, such as online education and counseling services, have been widely adopted nationwide.(Liu et al., 2020) According to the treatment guidelines in China, COVID-19 patients need to be treated in isolated infectious hospitals. Due to social isolation, perceived danger, uncertainty, physical discomfort, medication side effects, fear of virus transmission to others, and overwhelming negative news portrayal in mass media coverage, patients with COVID-19 may experience loneliness, anger, anxiety, depression, and insomnia, and posttraumatic stress symptoms,(Wu, Chan, & Ma, 2005; Xiang et al., 2020) which could negatively affect individuals’ social and occupational functioning, and quality of life.(Monson, Caron, McCloskey, & Brunet, 2017; North et al., 2002) To date, no studies on the pattern of posttraumatic stress symptoms among COVID-19 patients have been reported.

Keywords

Ethics, social science, economics

CSC Expert Consensus on Principles of Clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 Epidemic

Circulation

Han, Yaling; Zeng, Hesong; Jiang, Hong; Yang, Yuejin; Yuan, Zuyi; Cheng, Xiang; Jing, Zhicheng; Liu, Bin; Chen, Jiyan; Nie, Shaoping; Zhu, Jianhua; Li, Fei; Ma, Changsheng.

Introduction

The coronavirus disease 2019 (COVID-19) outbreak in China commenced in Wuhan in December, 2019. The virus spread rapidly due to its robust capacity for human-to-human transmission, long incubation period, and asymptomatic infection characteristics. In the early stages of the outbreak, it was inferred that the nosocomial infection rate could reach 41% without rapid intervention [1]. On January 20, 2020, the Chinese National Health Commission announced that COVID-19 had been included in the list of Class B infectious diseases categorized by the Chinese Law on the Prevention and Control of Infectious Diseases, and should be managed as a Class A infectious disease (for categorization and management principles of infectious diseases, please see Supplemental material I). Strict quarantine measures have been undertaken in Hubei province and other regions of China.

Keywords

Clinical aspects, diagnosis, treatment

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

Covid-19: Hospitals Brace For Disaster As US Surpasses China In Number Of Cases

BMJ (Clinical Research ed.)
Volume 368, 2020, m1278-m1278

Dyer, Owen.

Introduction

The US has become the country with the most confirmed cases of covid-19 with 86 762 diagnoses on the morning of 27 March—more than China or Italy—and 1306 deaths. The rise in cases is steeper in the US than in any other large country. Almost half of US cases are in the state of New York while neighbouring New Jersey has the second-most cases. Texas and some other states now require people coming from New York to self-quarantine. But there are multiple cases in every US state and every sizeable city, with prominent clusters in New Orleans, Detroit, Chicago, Miami, Atlanta, and the Denver region.

Keywords

Epidemiology

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

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020Weekly

MMWR Morb Mortal Weekly Rep

Kimball A, Hatfield KM, Arons M, et al.

Summary

What is already known about this topic? Once SARS-CoV-2 is introduced in a long-term care skilled nursing facility (SNF), rapid transmission can occur.
What is added by this report? Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.
What are the implications for public health practice? Symptom-based screening of SNF residents might fail to identify all SARS-CoV-2 infections. Asymptomatic and presymptomatic SNF residents might contribute to SARS-CoV-2 transmission. Once a facility has confirmed a COVID-19 case, all residents should be cared for using CDC-recommended personal protective equipment (PPE), with considerations for extended use or reuse of PPE as needed.

Keywords

Epidemiological study; Infection prevention and control

Strange Days

Medical Education

Eva, Kevin W.

Introduction

As people around the globe grapple with the COVID-19 pandemic it is difficult to know what to write in this space. Given publication lags, academic periodicals like Medical Education are a terrible place for "news" at the best of times. Our recently started release of "Accepted Articles" ensures this editorial will be made public in days rather than months, but the current situation is changing for many of us by the hour. With no capacity to know the future, the only claim I can make with confidence is that things are different now, when you're reading this text, relative to when it was written.

Keywords

Epidemiology

COVID-19 positive test result from private hospital laboratory, neglecting on reporting and problem on national infection control

Gastrointestinal Endoscopy

Thompson, Christopher C.; Shen, Lin; Lee, Linda S.

To the Editor,

The new coronavirus disease (COVID-19) is a new global public health problem. It already affects more than 140 countries around the world. Thailand is the second country in the timeline of disease pandemic [1]. The infection occurs since early January 2020 and COVID-19 is still uncontrollable problem. The Thai Ministry of Public Health tried several methods for counteracting the disease outbreak. As a legal control, COVID-19 is included into the national list of infectious disease under surveillance. The laws note that when a medical center detects this disease, an official report to governmental Center of Disease Control has to done within 3 hours. If one violates this legal control, there will be punishment.

Keywords

Infection prevention and control

Necessitating Repeated Chest CT In COVID-19 Pneumonia

Journal of the Formosan Medical Association

Li, Meng; Zhang, Li-Jing; Tian, Gui-Hua; Hao, Xue-Zeng

Introduction

An outbreak of novel coronavirus, severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2) began in Wuhan, China, has spread rapidly. The disease caused by SARS CoV-2 was named as coronavirus disease 2019 (COVID-19) by the World Health Organization. Chest computed tomography (CT) is easily available and is highly strongly recommended for screening patients for rapid confirmation of SARS-CoV-2 infected COVID-19. We report a case with COVID-19 pneumonia which has outlined the main patterns of evolution seen on CT imaging though real-time fluorescence polymerase chain reaction results were negative for a total of four times.

Keywords

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

Preparedness and Lessons Learned from the Novel Coronavirus Disease

The International Journal of Occupational and Environmental Medicine
Volume 11, March 2020, Issue 2, pp 108-112

Gudi, S. K.; Tiwari, K. K.

Abstract

In a short span, a novel coronavirus (SARS-CoV-2) has captured global consciousness by significantly affecting the day-to-day life of humans and emerged as a public health emergency. Undoubtedly, it indicates that lessons learnt from the past epidemics of coronaviruses such as the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), had not enough and thus left us ill-prepared to deal with the challenges that COVID-19 pandemic is currently posing. Currently, as a global pandemic, COVID-19 poses major challenges and thus forcing the entire world to lockdown. However, the disease has prepared humankind in facing such outbreaks at present as well as in the future. Besides, it has also taught numerous lessons that are worth considering and implementing to make the world a better reality.

Keywords

Epidemiology

Guidance Needed For Singlehanded Gps To Deal With Covid-19 Pandemic

BMJ
Volume 368, 2020, m1261-m1261

O'Dowd, Adrian.

Introduction

Singlehanded GPs are worried about what will happen to their practice patients if they themselves become ill with the covid-19 virus and have to self-isolate, it has emerged.

The situation has been highlighted by a case of a husband and wife GP, both older than 70, who each have their own singlehanded practices in Nottingham.

Doctors Noble Vinayakumar Phillips and Naomi Phillips have sought, unsuccessfully so far, to secure assurances over what will happen to their patients if they both have to self-isolate.

Officials say practices should have been informed about how they can support each other, make better use of technology, and have access to “buddying” arrangements for practices with major staff absences.

Keywords

COVID-19, SARS-CoV-2, Treatment

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