SARS-CoV-2: What Do We Know So Far?

Acta physiologica (Oxford, England)

Khedkar, Pratik Hemant; Patzak, Andreas.

Introduction

We are living in times where a viral disease has brought normal life in much of the world to a halt. Named after its causative agent, coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus recently renamed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 manifests as dry cough, frequent fevers and in severe cases pneumonia. Older patients and patients with underlying comorbidities are at a higher risk of death. We are living in times where a viral disease has brought normal life in much of the world to a halt. Named after its causative agent, coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus recently renamed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 manifests as dry cough, frequent fevers and in severe cases pneumonia.

Keywords

COVID-19, SARS-CoV-2, Treatment

Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says

The European respiratory journal

Cohen, Jon.

To the Editor,

Chinese scientists at the front of that country’s outbreak of coronavirus disease 2019 (COVID-19) have not been particularly accessible to foreign media. Many have been overwhelmed trying to understand their epidemic and combat it, and responding to media requests, especially from journalists outside of China, has not been a top priority.

Science has tried to interview George Gao, director-general of the Chinese Center for Disease Control and Prevention (CDC), for 2 months. Last week he responded.

Keywords

COVID-19, SARS-CoV-2, Treatment

The Impact of COVID-19 on Radiology Trainees

Radiology

Alvin, Matthew D.; George, Elizabeth; Deng, Francis; Warhadpande, Shantanu; Lee, Susanna I.

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic is evolving rapidly in the United States, widely disrupting personal and professional life, including that of radiology trainees. Reducing the rate at which COVID-19 cases are diagnosed, so-called “flattening the curve,” is a goal both for the public to alleviate strain on the healthcare system, and for healthcare providers to stabilize our workforce. As residents and fellows at multiple institutions throughout the country working in both diagnostic and interventional radiology, the authors of this report provide an overview of major problems that our colleagues and training programs currently face and offer some potential solutions (Figure). We hope this report may serve as a starting point for radiology training programs to proactively assess the impact of the current pandemic on their resident and fellow trainees.

Keywords

Ethics, social science, economics

A Role For CT In COVID-19? What Data Really Tell Us So Far

The Lancet

Hope, Michael D.; Raptis, Constantine A.; Shah, Amar; Hammer, Mark M.; Henry, Travis S.

Introduction

Radiologists have watched the coronavirus disease 2019 (COVID-19) pandemic unfold, wondering if and how imaging could be useful for diagnosis. Perhaps imaging could aid in screening or accelerate the speed of diagnosis, especially with shortages of RT-PCR.

Some radiology literature suggests a pivotal role for CT. Ai and colleagues report on 1014 patients who received both RT-PCR and CT in Wuhan, China, during their epidemic. They found that 97% of cases with RT-PCR-confirmed diagnoses had CT findings of pneumonia, and conclude, “CT imaging has high sensitivity for diagnosis of COVID-19”. Other investigators are less optimistic. Inui and colleagues reviewed CT scans of 112 cases of RT-PCR-confirmed COVID-19 from the Diamond Princess cruise ship. Less than two-thirds (61%) of cases had lung opacities on CT; 20% of symptomatic patients had negative CTs.

Keywords

Clinical aspects, diagnosis, treatment

Dynamic Change Process Of Target Genes By RT-PCR Testing Of SARS-Cov-2 During The Course Of A Coronavirus Disease 2019 Patient

Clinica Chimica Acta
Volume 506, July 2020, Pages 172-175

Lv, Ding-feng; Ying, Qi-ming; Weng, Yue-song; Shen, Chi-bin; Chu, Jin-guo; Kong, Jing-ping; Sun, Ding-he; Gao, Xiang; Weng, Xing-bei; Chen, Xue-qin.

Abstract

We report the dynamic change process of target genes by RT-PCR testing of SARS-Cov-2 during the course of a COVID-19 patient: from successive negative results to successive single positive nucleocapsid gene, to two positive target genes (orf1ab and nucleocapsid) by RT-PCR testing of SARS-Cov-2, and describe the diagnosis, clinical course, and management of the case. In this case, negative results of RT-PCR testing was not excluded to diagnose a suspected COVID-19 patient, clinical signs and symptoms, other laboratory findings, and chest CT images should be taken into account for the absence of enough positive evidence. This case highlights the importance of successive sampling and testing SARS-Cov-2 by RT-PCR as well as the increased value of single positive target gene from pending to positive in two specimens to diagnose laboratory-confirmed COVID-19.

Keywords

Coronavirus, SARS-Cov-2, COVID-19, RT-PCR testing, Nucleocapsid

Undocumented U.S. Immigrants and Covid-19

New England Journal of Medicine

Page, Kathleen R.; Venkataramani, Maya; Beyrer, Chris; Polk, Sarah.

Introduction

In 2019, as the “public charge” rule made its tions, and separation of families case managers to disenroll their children from the Supplemental Nutrition Assistance Program (SNAP), fearing it would affect their chances of obtaining legal status in the future or lead to deportation. The new public charge rule, which went into effect on February 24, 2020, states that “aliens are inadmissible to the United States if they are unable to care for themselves without becoming public charges”

Keywords

Epidemiology

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