How should we implement radiotherapy for cancer patients in China during the endemic period of COVID-19?

Radiotherapy and Oncology
Volume 147, 2020, Pages 100-102

Wei, Wei; Jiang, Hao; Chen, Weipeng; Zhou, Yuling; Guo, Shuanshuan; Zhong, Guihua; Zhou, Huaili; Wang, Siyang; Zhang, Hongyu; Jiang, Wen; Liu, Zhi-gang.

Letter to the Editor

Since December 2019, an increasing number of cases of the2019 novel coronavirus disease (COVID-19) infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been identified in Wuhan, a large city of 11 million people in centralChina[1,2]. By February 19, 2020, the rapid spread of the virus had caused 74,280 cases and 2,009 deaths in China. Most cases were identified in Hubei Province, followed by bordering provinces, such as Guangdong Province, Henan Province, Hunan Province, and Anhui Province.

Keywords

COVID-19, SARS-CoV-2, Treatment

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

New England Journal of Medicine

McMichael, Temet M.; Currie, Dustin W.; Clark, Shauna; Pogosjans, Sargis; Kay, Meagan; Schwartz, Noah G.; Lewis, James; Baer, Atar; Kawakami, Vance; Lukoff, Margaret D.; Ferro, Jessica; Brostrom-Smith, Claire; Rea, Thomas D.; Sayre, Michael R.; Riedo, Francis X.; Russell, Denny; Hiatt, Brian; Montgomery, Patricia; Rao, Agam K.; Chow, Eric J.; Tobolowsky, Farrell; Hughes, Michael J.; Bardossy, Ana C.; Oakley, Lisa P.; Jacobs, Jesica R.; Stone, Nimalie D.; Reddy, Sujan C.; Jernigan, John A.; Honein, Margaret A.; Clark, Thomas A.; Duchin, Jeffrey S.

Abstract

BACKGROUND

Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

METHODS

After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

RESULTS

As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

CONCLUSIONS

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

Keywords

GERIATRICS/​AGING, INFECTIOUS DISEASE, VIRAL INFECTIONS, GLOBAL HEALTH, INFLUENZA

Clinical Characteristics of Covid-19 in China

The New England Journal of Medicine

Chen, Andre T. C.; Coura-Filho, George B.; Rehder, Marília H. H.

To the Editor,

According to the World Health Organization (WHO), the case definition for surveillance of returning travelers requires that they need to present with fever and at least one respiratory symptom to be considered as having suspected cases of coronavirus disease 2019 (Covid-19).1 In their article regarding 1099 patients with laboratory-confirmed Covid-19 at hospitals across China during the first 2 months of the pandemic, Guan et al. (Feb. 28 online publication, available at NEJM.org)2 present compelling data supporting the need for a reassessment of these criteria. The authors found that only 43.8% of the patients presented with fever on admission, although fever developed in 88.7% during hospitalization. That means that if those travelers were returning from affected areas, more than half would not be suspected of having Covid-19, which would result in undetected patients who can spread the virus. This issue may be particularly relevant in low-income countries with less structured health care systems, which could not provide adequate follow-up of these travelers.

Keywords

Clinical aspects, diagnosis, treatment

Covid-19: "Illogical" Lack Of Testing Is Causing Healthy Staff To Self-Isolate, BMA Chief Warns (Copy)

BMJ (Clinical research ed.)
Volume 369, March 2020, m1277-m1277

Iacobucci, Gareth.

Introduction

The absence of COVID-19 testing for NHS staff is causing huge workforce shortages by forcing doctors to self-isolate even if they do not have the virus, the head of the BMA has warned.

The government’s advice is for people with COVID-19 symptoms to stay at home for seven days, but for all other household members who remain well to isolate for 14 days. The BMA council chairman, Chaand Nagpaul, said that the lack of testing for staff was “counter-intuitive” as it was likely to be forcing more staff than necessary to stay away from hospitals and GP surgeries because they do not know if they are infected.

Keywords

Epidemiology

Experts' Request to the Spanish Government: Move Spain Towards Complete Lockdown

The Lancet

 Oriol Mitjà, Àlex Arenas, Xavier Rodó, Aurelio Tobias, Joe Brew, José M Benlloch

Introduction

We would like to express our concern about the limited capacity of actions taken by the Spanish Government to successfully control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak and end the exponential growth phase of new cases. The measures taken so far, consisting primarily of partial restriction mobility, are in the right direction, although some researchers have warned about the pressure placed on the building blocks of the health system.

Keywords

Epidemiology

Are certain drugs associated with enhanced mortality in COVID-19?

QJM: An International Journal of Medicine

Goldstein, Mark R.; Poland, Gregory A.; Graeber, Charles W.

Introduction

Prevalent comorbidities for the development of severe pneumonia requiring intensive care unit treatment, acute respiratory distress syndrome (ARDS), and death from Coronavirus disease 2019 (COVID-19) include hypertension, diabetes and cardiovascular disease [1,2]. We posit that drugs commonly used in the treatment of those comorbidities may actually increase the risk of severe pneumonia, ARDS and mortality in the setting of COVID-19; the drugs of primary concern include angiotensin receptor blockers (ARBs) used for blood pressure lowering and statins used for cholesterol lowering.

Keywords

COVID-19, SARS-CoV-2, Treatment

Ensuring Animal Welfare During Covid-19 Pandemic

Veterinary Record
Volume 186, Issue 12, Pages 389-389

Aitken, Maureen M.

Introduction

THE RCVS is providing useful advice for veterinary practitioners in the current coronavirus pandemic. However, I feel strongly that we, as veterinary professionals, must recognise the threats to animal welfare that would arise from animal owners being required to self isolate or be in quarantine. It is reassuring that at present ‘social distancing’ allows dog walking and horse riding. It is essential that ‘tending to animals’ should be recognised and clearly stated to be a valid reason for leaving one’s home.

Keywords

Ethics, social science, economics

Telemedicine Services Thrive During Covid-19

The Veterinary record
Volume 186, Issue 12, Pages 365-365

By Adele Waters

Abstract

Not all veterinary businesses are suffering a downturn in demand – or their fortunes – during the Covid-19 pandemic.

Quite the reverse for those offering the public access to telemedicine or remote first-line advice services – they appear to be positively thriving and competing for customers.

Last week, FirstVet, which provides on-demand video consultations with local, qualified vets throughout the UK, reported it has seen a 20 per cent week-on-week increase in pet owners using its video vet service between February and March due to self isolation and mandatory quarantine.

Meanwhile, Joii, a pet care app that offers video consultations with vets, said it had experienced ‘a substantial increase’ in users, with almost 30,000 people downloading or using the app in the past two months. The app has been trending at number 1 within the medical category in both Google Play and the Apple store…

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Molecular characterization of SARS-CoV-2 in the first COVID-19 cluster in France reveals an amino-acid deletion in nsp2 (Asp268Del)

Clinical Microbiology and Infection

Bal, Antonin; Destras, G.; Gaymard, Alexandre; Bouscambert-Duchamp, Maude; Valette, Martine; Escuret, Vanessa; Frobert, Emilie; Billaud, G.; Trouillet-Assant, Sophie; Cheynet, V.; Brengel-Pesce, Karen; Morfin, Florence; Lina, Bruno; Josset, Laurence 

To the Editor

In December 2019, a novel coronavirus emerged in China, causing outbreaks of pneumonia [1]. The virus was subsequently identified as a betacoronavirus and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is responsible for the coronavirus disease 2019 (COVID-19) pandemic which includes asymptomatic upper and lower respiratory tract infections. Among the first European cases of COVID-19, six were associated with a cluster of transmissions in the French Alps in late January 2020 [2]. The index case of this cluster travelled from Singapore to France and went back to the United Kingdom (UK) where he tested positive for SARS-CoV-2 on February 6th. Here, we aimed to investigate the French cases related to this cluster using metagenomic next-generation sequencing (mNGS) analysis.

Keywords

Virology, immunology

COVID 19 and Intra Cerebral Hemorrhage: Causative or Coincidental

New Microbes and New Infections

Sharifi-Razavi, A.; Karimi, N.; Rouhani, N.

Introduction

Pneumonia appears to be the most manifestation of COVID 19, but some extra-pulmonary involvement such as gastrointestinal, cardiac and renal has been reported. According to limited clinical data about the virus behavior up to now, specially extra-pulmonary symptoms, we should be aware on possibility of initial cerebrovascular manifestations of COVID19.

Keywords

Epidemiology

Consensus Guidelines For Managing The Airway In Patients With COVID-19

Anaesthesia

Cook, T. M.; El-Boghdadly, K.; McGuire, B.; McNarry, A. F.; Patel, A.; Higgs, A..

Abstract

Severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID-19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID-19. The advice in this document is designed to be adapted in line with local workplace policies.

Keywords

airway; anaesthesia; coronavirus; COVID-19; critical care; difficult airway; intubation

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