SARS CoV2 RT-PCR cycle threshold (Ct) values and the risk of developing acute respiratory distress syndrome in patients with Covid19

Background. SARS-CoV-2 viral loads may aid in the risk stratification of patients with COVID-19. Methods. 486 patients tested positive for SARS Cov2 by real time RT-PCR were included in this study. All the tests were performed on nasopharyngeal swabs during the first week after symptom onset using Sansure Biotech™ SARS Cov2 real time RT-PCR kits. Patient's condition was monitored over a period of one month after the onset of symptoms. Results. The mean Ct value in the group of patients who developed acute respiratory distress syndrome (ARDS +) was 18.27 (95% CI: 17.43-19.10) while for the ARDS group it was 33.06 (95% CI: 32.77-33.34). Discussion. The Ct values in the group of patients who developed ARDS (ARDS +) were significantly lower than those observed in the ARDS- group. By setting a cut-off value, the determination Ct values (on a qualitative technique) from nasopharyngeal swabs performed during the first week after symptom onset will assist clinicians in risk-stratifying patients. Conclusion. Our data show that the determination of SARS CoV2 RTPCR cycle threshold values from nasopharyngeal swabs performed during the first week after symptom onset may aid in the risk stratification of patients with COVID-19

La phytothérapie et les produits naturels au secours de la médecine conventionnelle dans le traitement et la prévention de la COVID-19 / Herbal medicine and natural products to help conventional medicine in the treatment and prevention of COVID-19

Le monde vit actuellement une pandémie sans précédent liée à la maladie du coronavirus (COVID-19). Apparue d'abord dans le canton de Wuhan en Chine fin 2019, pratiquement plus aucun pays n'est épargné à ce jour. Cette maladie, d'origine zoonotique, est causée par le Coronavirus 2 responsable d'un syndrome respiratoire aigu sévère (SRAS-CoV2), elle peut entrainer dans certains cas de graves complications rénales, neurologiques et cardiaques et est responsable d'une mortalité considérable de par le monde au quotidien. Notre objectif à travers cette revue est de promouvoir l'effet des thérapies préventives et curatives, et de mettre en lumière les effets prophylactiques de certains produits naturels, accessibles à tous et peu coûteux en attendant la généralisation de la vaccination, pour endiguer cette pandémie. Pour cela, nous avons compilé les résultats d'études antérieures sur les effets antiviraux et anti-inflammatoires de certaines plantes et produits naturels sur les Coronavirus précédents et sur le virus de la grippe saisonnière. En effet, de nombreuses recherches ont prouvé l'efficacité de certains phytochimiques contre le SRAS-CoV et peuvent potentiellement contribuer à protéger contre la COVID-19. En plus de leur efficacité prouvée, les produits naturels présentent l'avantage d'être sûrs et fiables et pourraient contribuer grandement au contrôle de la pandémie.

The world is currently experiencing an unprecedented pandemic linked to the coronavirus disease (COVID-19). First appearing in Wuhan Township in China at the end of 2019, hardly any country has been spared to this day. This disease, of zoonotic origin, is caused by the coronavirus 2 responsible for a severe acute respiratory syndrome (SARS-CoV2). It can lead in some cases to serious renal, neurological and cardiac complications and is responsible for considerable mortality around the world on a daily basis. Our objective through this review is to promote the effect of preventive and curative therapies, and to highlight the prophylactic effects of certain natural products, accessible to all and inexpensive pending the generalization of vaccination, to stem this pandemic. To do this, we have compiled the results of previous studies on the antiviral and anti-inflammatory effects of certain plants and natural products on previous coronaviruses HAOUD K. et MELLALI S. (Phytothérapie et COVID-19) Page 80 and on the seasonal influenza virus. Indeed, a lot of research has proven the effectiveness of certain phytochemicals against SARS-CoV and can potentially help protect against COVID-19. In addition to their proven effectiveness, natural products have the advantage of being safe and reliable and could greatly contribute to the control of the pandemy.

Evaluation de la prise en charge des cas graves de COVID-19 aux soins intensifs dans un environnement à ressources limitées: expérience du centre de traitement des épidemies (CTE) d'Allada / NA

Introduction : Dans sa politique de riposte contre la pandémie liée à l'infection au SARS-COV2, le Bénin a opté pour la construction d'Hôpitaux dédiés exclusivement à la prise en charge des COVID19. Pendant la première vague de la pandémie en Afrique, les systèmes de santé n'étaient pas encore bien outillés pour faire face à cette pandémie. Nous vous rapportons l'expérience des soins intensifs du Centre de traitement des épidémies (CTE) d'ALLADA. Objectifs : évaluer la prise en charges des cas graves de COVID19 à l'USI du CTE ALLADA. Matériels et méthode : Il s'est agi d'une étude prospective, descriptive et analytique, réalisée aux soins intensifs du centre de traitement des épidémies d'ALLADA, du 1er juin au 31 Août 2020. Résultats : Quatre-vingt-quatorze malades étaient éligibles pour notre étude. L'âge moyen des malades était de 58,41 ans, le sex-ratio 1,61. Les comorbidités les plus représentatives étaient l'hypertension artérielle (70,21%), le diabète (31,91%), l'obésité morbide (21,28%) et l'asthme (15,96%). Selon le score de gravité adopté au Bénin, trente-six malades (38,30%) étaient classés cas graves grade3 et ont bénéficié d'une ventilation mécanique. La VNI était la technique de ventilation la plus utilisée (75% des cas). Le plateau technique était limité et les ressources humaines qualifiées insuffisantes. Les associations chloroquine/azithromycine ou lopinavir/ritonavir/ribavirine étaient les traitements spécifiques utilisés. La mortalité était de 27,66%. Conclusion : Malgré les conditions de travail difficiles, notamment le plateau technique limité et les ressources humaines qualifiées insuffisantes, les résultats obtenus après traitement des cas graves de COVID19 à l'USI du CTE ALLADA étaient encourageants

Introduction: To respond to the pandemic linked to the SARS-COV-2 infection, Benin has opted for the construction of hospitals dedicated exclusively to the treatment of COVID-19. During the first wave of the pandemic in Africa, health systems were not yet well equipped to deal with this pandemic. We here report the Intensive CareUnit (ICU) experience of the Epidemic Treatment Center of ALLADA (ETCA). Purpose: To assess the management of serious cases of COVID-19 in the ICU of ETCA. Materials and method: This was a prospective, descriptive and analytical study, carried out in the ICU of ETCA, from June 1 to August 31, 2020. Results: Ninety-four patients were eligible for our study. The average age of the patients was 58.41 years with a sex ratio of 1.61. The most representative comorbidities were arterial hypertension (70.21%), diabetes (31.91%), morbid obesity (21.28%) and asthma (15.96%). According to the severity score adopted in Benin, thirty-six patients (38.30%) were classified as severe grade III cases and received mechanical ventilation. Non-Invasive Ventilation (NIV) was the most used ventilation technique (75% of cases). The technical platform was limited and the qualified human resources were insufficient. Chloroquine/azithromycin or lopinavir / ritonavir/ribavirine were the specific treatments used. Mortality was 27.66%. Conclusion: Despite the difficult working conditions, especially the limited technical platform and insufficient qualified human resources, the results obtained after treatment of serious cases of COVID-19 at the ICU of ETCA were encouraging

Coronaviruses: a review of their properties and diversity

Human coronaviruses, which hitherto were causative agents of mild respiratory diseases of man, have recently become one of the most important groups of pathogens of humans the world over. In less than two decades, three members of the group, severe acute respiratory syndrome (SARS) coronavirus (CoV), Middle East respiratory syndrome (MERS)-CoV, and SARS-COV-2, have emerged causing disease outbreaks that affected millions and claimed the lives of thousands of people. In 2017, another coronavirus, the swine acute diarrhea syndrome (SADS) coronavirus (SADS-CoV) emerged in animals killing over 24,000 piglets in China. Because of the medical and veterinary importance of coronaviruses, we carried out a review of available literature and summarized the current information on their properties and diversity. Coronaviruses are single-stranded RNA viruses with some unique characteristics such as the possession of a very large nucleic acid, high infidelity of the RNA-dependent polymerase, and high rate of mutation and recombination in the genome. They are susceptible to a number of physical agents and several chemical agents used for disinfection procedures in hospitals and laboratories. They exhibit considerable genetic and host diversity, causing diseases of gastrointestinal and respiratory system in a wide range of vertebrate hosts including humans. The high prevalence of coronaviruses in domestic and wild animals, especially bats and birds, and the propensity for their genomes to undergo mutation and recombination may lead to emergence of new coronaviruses that could pose a serious threat to human and animal health

The use of corticosteroids for COVID-19 infection

The SARS-CoV-2 pandemic is continuing relentlessly in many parts of the world and has resulted in the outpouring of literature on various aspects of the infection, including studies and recommendations regarding the optimal treatment of infected patients. Not surprisingly, the use of corticosteroids in the management of such patients has featured prominently in many of these publications. There is considerable debate in the literature as to the likely benefits, as well as the potential detrimental effects of corticosteroid therapy in general viral respiratory infections and, in particular, COVID-19 infections. While the definitive answer may need to await the results of ongoing randomised, controlled trials recent studies suggest that corticosteroid use in COVID-19 cases with hypoxaemia may benefit from low-dose corticosteroid therapy

Primary care management of the coronavirus (COVID-19)

South Africa is in the grip of a novel coronavirus pandemic (COVID-19). Primary care providers are in the frontline. COVID-19 is spread primarily by respiratory droplets contaminating surfaces and hands that then transmit the virus to another person's respiratory system. The incubation period is 2­9 days and the majority of cases are mild. The most common symptoms are fever, cough and shortness of breath. Older people and those with cardiopulmonary co-morbidities or immunological deficiency will be more at risk of severe disease. If people meet the case definition, the primary care provider should immediately adopt infection prevention and control measures. Diagnosis is made by a RT-PCR test using respiratory secretions, usually nasopharyngeal and oropharyngeal swabs. Mild cases can be managed at home with self-isolation, symptomatic treatment and follow-up if the disease worsens. Contact tracing is very important. Observed case fatality is between 0.5% and 4%, but may be overestimated as mild cases are not always counted. Primary care providers must give clear, accurate and consistent messages on infection prevention and control in communities and homes

COVID-19: Guidelines for pharmacists in South Africa

Since the outbreak of COVID-19, and its declaration as a pandemic by the World Health Organization (WHO), the reliance on pharmacists as one of the first points of contact within the healthcare system has been highlighted. This evidence-based review is aimed at providing guidance for pharmacists in community, hospital and other settings in South Africa, on the management of patients with suspected or confirmed coronavirus disease 2019, or COVID-19. The situation is rapidly evolving, and new evidence continues to emerge on a daily basis. This guidance document takes into account and includes newly available evidence and recommendations, particularly around the following aspects relating to COVID-19: • Epidemiology • The virus, its modes of transmission and incubation period • Symptom identification, including the differentiation between influenza, allergic rhinitis, sinusitis and COVID-19 • Social media myths and misinformation • Treatment guidelines and medicines that may need to be kept in stock • Treatment and prevention options, including an update on vaccine development • The case for and against the use of NSAIDs, ACE-inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19 • Interventions and patient counselling by the pharmacist. It is critical, though, that pharmacists access the most recent and authoritative information to guide their practice. Key websites that can be relied upon are: • World Health Organization (WHO): https://www.who.int/emergencies/diseases/novelcoronavirus-2019 • National Institute for Communicable Diseases (NICD): https://www.nicd.ac.za/diseasesa-z-index/covid-19/ • National Department of Health (NDoH): http://www.health.gov.za/index.php/ outbreaks/145-corona-virus-outbreak/465-corona-virus-outbreak; https://sacoronavirus. co.za/

The role of serological testing in the SARS-CoV-2 outbreak

Antibody tests for the novel coronavirus, SARS-CoV2, have been developed both as rapid diagnostic assays and for high-throughput formal serology platforms. Although these tests may be a useful adjunct to a diagnostic strategy, they have a number of limitations. Because of the antibody and viral dynamics of the coronavirus, their sensitivity can be variable, especially at early time points after symptom onset. Additional data are required on the performance of the tests in the South African population, especially with regard to development and persistence of antibody responses and whether antibodies are protective against reinfection. These tests may, however, be useful in guiding the public health response, providing data for research (including seroprevalence surveys and vaccine initiatives) and development of therapeutic strategies

COVID-19 antibody testing: from hype to immunological reality

The potential role for serological tests in the current COVID-19 pandemic has generated very considerable recent interest across many sectors worldwide, inter alia pathologists seeking additional weapons for their armoury of diagnostic tests; epidemiologists seeking tools to gain seroprevalence data that will inform improved models of the spread of disease; research scientists seeking tools to study the natural history of COVID-19 disease; vaccine developers seeking tools to assess vaccine efficacy in clinical trials; and companies and governments seeking tools to aid return-to-work decision-making. However, much of the local debate to date has centred on questions surrounding whether regulatory approval processes are limiting access to serological tests, and has not paused to consider the intrinsically limiting impact of underlying fundamental biology and immunology on where and how different COVID-19 serological tests can usefully be deployed in the response to the current pandemic. We review, from an immunological perspective, recent experimental evidence on the time-dependency of adaptive immune responses following SARS-CoV-2 infection and the impact of this on the sensitivity and specificity of COVID-19 antibody tests made at different time points post infection. We interpret this scientific evidence in terms of mooted clinical applications for current COVID-19 antibody tests in identifying acute infections, in confirming recent or past infections at the individual and population level, and in detecting re-infection and protective immunity. We conclude with guidance on where current COVID-19 antibody tests can make a genuine impact in the pandemic

The mechanics of setting up a COVID-19 response: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa

The COVID-19 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves

Transmission of respiratory viruses when using public ground transport: A rapid review to inform public health recommendations during the COVID-19 pandemic

In response to the COVID-19 pandemic, numerous countries worldwide declared national states of emergency and implemented interventions to minimise the risk of transmission among the public. Evidence was needed to inform strategies for limiting COVID-19 transmission on public transport. On 20 March 2020, we searched MEDLINE, CENTRAL, Web of Science and the World Health Organization's database of 'Global research on coronavirus disease (COVID-19)' to conduct a rapid review on interventions that reduce viral transmission on public ground transport. After screening 74 records, we identified 4 eligible studies. These studies suggest an increased risk of viral transmission with public transportation use that may be reduced with improved ventilation. International and national guidelines suggest the following strategies: keep the public informed, stay at home when sick, and minimise public transport use. Where use is unavoidable, environmental control, respiratory etiquette and hand hygiene are recommended, while a risk-based approach needs to guide the use of non-medical masks

Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SA government announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes

Criminalisation of transmission of SARS-CoV-2: A potential challenge to controlling the outbreak in South Africa

In March 2020, two cases of attempted murder were opened against people who had tested positive for COVID-19 and had not remained in quarantine. Criminal law has previously been used to criminalise intentional transmission of HIV in both South Africa (SA) and other countries. However, it has been found that criminalisation laws undermine public health and measures to control outbreaks by stigmatising those infected and deterring testing. This article explores whether SA's existing HIV criminalisation laws can be applied to the transmission of SARS-CoV-2, and the potential effect such measures could have on efforts to control the COVID-19 epidemic

Pandemics, professionalism and the duty of care: Concerns from the coalface

It is likely that the SARS-CoV-2 pandemic will affect a large part of the world's population and will last for several years. Many critical ethical issues have arisen in the healthcare context. While response from healthcare professionals to participating in the care of patients in the era of COVID-19 has generally been positive, there have also been disturbing experiences on the ground. The practice of medicine is a social contract with humanity. Challenges have arisen because the patient is both a victim and a vector of the coronavirus. All humans should have a natural instinct to care for those in need. Ethically and legally, healthcare professionals cannot be expected to assume a significant and unreasonable risk of harm. While fear is understandable, altruism and interest in serving the sick exemplify the value of solidarity. Social harms like stigmatisation and discrimination can occur. Concerns have been raised regarding protection of privacy and respect for rights of infected individuals. In the era of COVID-19, fear, misinformation and a detachment from one's calling put professionalism strongly to the test

Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis

Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus. Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185).Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35­18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90­5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality.The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75­51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20­21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICUmortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89­21.36). Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive

Efficient adaptive designs for clinical trials of interventions for COVID-19

The COVID-19 pandemic has led to an unprecedented response in terms of clinical research activity. An important part of this research has been focused on randomized controlled clinical trials to evaluate potential therapies for COVID-19. The results from this research need to be obtained as rapidly as possible. This presents a number of challenges associated with considerable uncertainty over the natural history of the disease and the number and characteristics of patients affected, and the emergence of new potential therapies. These challenges make adaptive designs for clinical trials a particularly attractive option. Such designs allow a trial to be modified on the basis of interim analysis data or stopped as soon as sufficiently strong evidence has been observed to answer the research question, without compromising the trial's scientific validity or integrity. In this paper we describe some of the adaptive design approaches that are available and discuss particular issues and challenges associated with their use in the pandemic setting. Our discussion is illustrated by details of four ongoing COVID-19 trials that have used adaptive design

Knowledge and attitude of physicians towards 2019 novel Coronavirus (COVID-19) pandemic: A cross sectional survey from Egypt

Background: Coronavirus disease 2019 (COVID-19) is a serious emerging public health issue and it has been identified as a major risk to human health in 2020. Egypt has more than 100 million population, of whom in poor economic conditions and with low education levels could be vulnerable to COVID-19 infection. Physicians are at the frontiers in battles against the emergence, spread, and control of COVID-19 pandemic. Research data are needed to develop evidence-based strategies to prepare health care systems to deal with the current epidemic. Aim: The aim of this study is to assess the level of knowledge and attitudes to COVID-19 pandemic among a group of Egyptian physicians. Methods: From March 15th to March 25th, 2020, we conducted a cross-sectional online survey using non-probability accessibility sampling technique. The structured questionnaire was distributed online through E-mails and social networks to identify the knowledge and attitude among a group of Egyptian physicians regarding COVID-19 pandemic. Result: The study included 256 physicians. Of the participants, 48% were males 49.6% were females. The mean of total score was (19.6±2.3) out of 23 gained mainly from the social media (50.7%). About 67% of the participants heard of Coronaviruses before this pandemic, 78.5% identified other Coronaviruses. All the participants correctly identified the incubation period and 81.6% correctly identified the typical clinical symptoms. Most of the participants (97.6%) could estimate the fatality of COVID-19. Approximately 95% of the respondents knew no vaccination and 88% correctly answered that no current specific treatment for COVID-19 available. Almost all 98% of the participants knew the recommended general infection control precautions. Most of the participants showed positive attitude, about (97%) agreed that health care workers must avail themselves of all information about the COVID-19. Conclusion: The finding of this survey indicating that, faced with the COVID-19 pandemic, this studied group of Egyptian physicians showed positive attitude and satisfactory knowledge about emerging COVID-19 infection. Recommendations: Although the Egyptian Ministry of Health (MOH) has taken several major steps to prepare the health care system to be ready dealing with COVID-19 pandemic, it is important to develop educational programs to ensure continuous updated knowledge of the physicians

Pre-exposure and Post-exposure new prophylactic treatments against COVID-19 in healthcare workers

The Severe Acute Respiratory Syndrome-related Coronavirus 2 or novel coronavirus (COVID-19) infection pandemic continues to spread. Since the outbreak of the COVID-19 in Wuhan (China), healthcare workers have been infected and are considered at high risk of contamination. Moreover, in addition to the physical effects of COVID-19, the pandemic results in important mental health issues among healthcare workers such as anxiety, stress, depression, and further nervous or mental disorders. Despite the increasing number of clinical trials aiming to develop vaccines or test antiviral molecules, till now no efficient anti- SARS-CoV-2 drugs have been validated. The COVID-19 pandemic led us to call for an urgent nutritional intervention model that should be established to prevent and/or reduce the negative impact of COVID-19 on healthcare workers. In the present paper, we suggest a safe nutritional supplementation of MgZn- B vitamins (B1, B6, B9, and B12) in healthcare workers as pre-exposure and post-exposure new prophylactic treatments. Furthermore, the paper reports the scientific arguments and the possible mechanisms by which the Mg-Zn- B vitamins supplementation may exert its beneficial effects in the healthcare workers facing the COVID-19 pandemic. Overall, the Mg-Zn- B vitamins supplementation would enhance the immune response against SARS-CoV2, prevent inflammatory processes and oxidative stress, fight or alleviate the COVID-19-related mental health issues, or even reduce the replication. Each element of the supplementation possesses important and promising effects contributing to the possible efficiency of the suggested Mg-ZnB vitamins supplementation in healthcare workers