The Prevalence of Bacterial and Fungal Coinfections among Critically Ill COVID-19 Patients in the ICU in Jordan.

Background: Secondary bacterial and fungal coinfections have been reported among critically ill coronavirus disease-19 (COVID-19) patients and are associated with increased disease severity and mortality incidence (MI) rates. Aims: This study aimed to track bacterial and fungal coinfections among COVID-19 patients in the intensive care unit (ICU) and to assess the impact of these infections on disease prognosis and patient outcomes in Jordan. Materials and Methods: This was a single-center study that enrolled 46 ICU patients diagnosed with COVID-19. Microbiological and antimicrobial susceptibility results and inflammatory biomarker data were retrospectively analyzed. Results: The MI rate attributed to bacterial and fungal coinfections was 84.8%, and the highest rate was reported among patients older than 70 years (66.7%). The MI rate related to bacterial coinfections was 95.2%, whereas that of fungal coinfections was 4.8%. The most commonly isolated bacterium in the blood was a coagulase-negative staphylococcus (41%), followed by Klebsiella pneumoniae in nasopharyngeal swabs (34%) and Acinetobacter baumannii in sputum samples (31%). Candida species were the sole cause of fungal coinfections in the studied population. In particular, Candida albicans was isolated from 3% of patients with bacteremia, whereas Candida glabrata was isolated from 8% of nasopharyngeal swabs. Klebsiella pneumoniae was considered the major cause of upper respiratory tract infections (34%). Multifactorial infection was significantly associated with increased MI (p value <0.001). Conclusion: COVID-19 MI is associated with respiratory bacterial/fungal coinfections. The ability to predict bacterial and fungal coinfections in ICU patients may be crucial to their survival and prognosis.

Cognitive impairment in health care workers recovering from COVID-19 infection: a cross-sectional comparative study

Background The COVID-19 outbreak has infected people all over the world where many clinics are being constructed to diagnose and treat lingering symptoms or long COVID. Neurological and long-term cognitive consequences are very worrisome. Many of COVID-19’s neurological symptoms are likely the result of the body’s extensive immunological response to infection rather than the virus attacking the brain or nervous system directly. At the same time, the extent and type of COVID-19’s cognitive consequences are unknown. The goal of this study was to assess the cognitive functions of healthcare workers 2 weeks to 3 months after COVID-19 infection. Ninety-two healthcare workers participated in the study;32 were post-COVID-19 cases, and 60 were healthy people (the comparison group). The cognitive functions of the participants were assessed using the Addenbrooke’s Cognitive Examination (ACE-III) test, which evaluated attention, memory, language, and visuospatial skills, as well as the Arabic version of the Patient Health Questionnaire Anxiety GAD-7 and Depression Assessments PHQ-9. Results The study revealed that there was a highly significant direct correlation between post-infection with COVID-19 and scores of both anxiety and depression and an inverse correlation in the case of attention and memory. On the other hand, there is no statistical effect of post-COVID-19 on verbal fluency, language scores, and visio-spatial abilities. Using multiple linear regression, there was a powerful significant decrease effect of post-COVID-19 on memory scores controlling both anxiety and depression degrees (Beta = − 0.745, P < 0.001). Also, there was a strong negative correlation post-COVID-19 on attention scores controlling both anxiety and depression degrees (Beta = − 0.745, P < 0.001). Conclusions The study showed a strong negative effect of post-COVID-19 on the attention and memory of patients. Furthermore, both anxiety and depression scores increased significantly among the post-COVID-19 patients.

Promoting more future-ready anatomy education after the Covid-19 pandemic: A scoping review.

The coronavirus disease 2019 (Covid-19) pandemic caused an abrupt transition from face-to-face to online anatomy teaching, learning, and assessment. Although online education has ensured the continuity of anatomy education during the pandemic, its implementation has been challenging, and its effectiveness has been questioned. Therefore, literature pertinent to online anatomy education during the pandemic is crucial to explain Covid-19's disruptions to this field. Accordingly, this scoping review explored changes, disruptions, and gaps in anatomy teaching and assessment during Covid-19 using an enhanced version of Arksey and O'Malley's six-stage protocol. Five online databases were searched for articles that described changes and disruptions in anatomy education. Three independent researchers were involved in titles, abstracts, and full texts screening, while another four researchers were independently involved in data extraction, charting, and synthesis. This review revealed six themes: immediate strategic plans and actions, teaching and learning changes, online assessment practice, students' and educators' receptivity and adaptability, online learning and assessment effects, and future directions. It also revealed four gaps: non-future-ready curricula, learning obstacles, administrative and teaching challenges, and online education ethical issues. The results were reported in tabular and narrative forms, following the PRISMA Extension for Scoping Reviews (PRISMA-ScR guidelines). Understanding the evolution and gaps in anatomy education during the Covid-19 pandemic will help anatomists design future-ready, adaptable curricula.

Impact of COVID-19 on medical education in different income countries: a scoping review of the literature.

The COVID-19 pandemic has disrupted medical education worldwide. Universities were forced to rapidly adapt to the evolving situation and develop methods of delivering curricula and assessments online. The purpose of this scoping review was to assess the impact of COVID-19 on medical education and investigate how this effect varies in different income countries. The methodology adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Key terms were searched in six electronic databases. Inclusion criteria included studies describing the effect of COVID-19 on undergraduate medical education in university and clinical settings, studies published post 1 December 2019 and studies published in English. A modified Johanna Briggs Institute data charting tool was used to extract data concerning study characteristics and outcomes. The initial search returned 298 articles. Following duplicate removal and article screening, 33 studies were included. The literature indicated that the pandemic had a negative effect on medical student education worldwide, in both high-income countries (HICs) and low- and middle-income countries (LMICs). A range of factors impacted students and educators, including new curriculum and assessment design, reduced patient contact, use of new technology and lack of infrastructure. However, LMICs encountered more arduous barriers such as lack of access to information technology infrastructure and support from national governments. COVID-19 has impeded medical education worldwide. Future research is needed to address barriers to providing medical education during a pandemic. LMICs need particular support as they have fewer resources and face greater challenges regarding this matter.

The Distribution and Determinants of COVID-19 in Sudan, 2020/2021: Analysis of Surveillance Data (preprint)

Background: Since the first case of COVID-19 in Sudan was reported in March 2020, the Federal Ministry of Health adopted an active surveillance system to collect and analyze information from the isolation centers and public and private laboratories about all suspected and confirmed COVID-19 cases. This study used the surveillance data to better understand the distribution and determinants of COVID-19 in Sudan and to construct a threshold level beyond which the dramatic surge may occur. Methods: Data of suspected and confirmed COVID-19 cases were extracted from the line list prepared by the Surveillance and Information Department at the Federal Ministry of Health after obtaining ethical approval from the National Ethics Committee. Data were cleaned, coded, and analyzed using SPSS version 21. Frequencies and proportions were used to describe data. A univariate logistic regression analysis was used to determine the association of variables with the positivity of COVID-19. Variables with p-values < 0.05 in the univariate logistic analyses were included in multivariable logistic regression to determine the adjusted odds ratios (ORs) and their 95% confidence interval (CI). A two-sided α of less than 0.05 (p < 0.05) was considered statistically significant.Results: Out of 48,545 suspected cases, 27,453 were positive. Four waves were seen, with a distinct explosion point of around 200 cases observed nationwide. Khartoum reported the highest number of cases. Of those tested positive, 16,444 (59.9%) were male and 11,009 (40.1%) were female. The mean (SD) age of cases was 41.1 (19.0) years with 21.6% of cases above 60 years. 14,780 (53.8%) of cases were asymptomatic. Fever, cough, shortness of breath, and loss of smell and taste were reported in 32.7%, 26.4%, 19.1 and 4.5% of confirmed cases, respectively. A total of 1,793 confirmed cases died; the case fatality rate was 6.5%. A considerable proportion of infection was reported among health workers. A univariate logistic regression analysis revealed that being symptomatic is significantly associated with testing negative for COVID-19 (odds ratio < 1). Conclusions: COVID-19 was widely spread in Sudan with more cases in Khartoum, the capital of Sudan. The country experienced four waves with an observable epidemic explosion point of around 200 positive cases per week nationwide. Around half of the patients were asymptomatic; however, fever, cough, and shortness of breath were the commonest symptoms. The CFR all through was 6.5%, with death having a strong association with age. Further studies are recommended to clarify the image, especially among health workers. The study also highlighted the need to improve the quality of surveillance data.

Personal, professional, and psychological impact of the COVID-19 pandemic on hospital workers: A cross-sectional survey.

OBJECTIVES: We aimed to evaluate the personal, professional, and psychological impact of the COVID-19 pandemic on hospital workers and their perceptions about mitigating strategies. DESIGN: Cross-sectional web-based survey consisting of (1) a survey of the personal and professional impact of the COVID-19 pandemic and potential mitigation strategies, and (2) two validated psychological instruments (Kessler Psychological Distress Scale [K10] and Impact of Events Scale Revised [IES-R]). Regression analyses were conducted to identify the predictors of workplace stress, psychological distress, and post-traumatic stress. SETTING AND PARTICIPANTS: Hospital workers employed at 4 teaching and 8 non-teaching hospitals in Ontario, Canada during the COVID-19 pandemic. RESULTS: Among 1875 respondents (84% female, 49% frontline workers), 72% feared falling ill, 64% felt their job placed them at great risk of COVID-19 exposure, and 48% felt little control over the risk of infection. Respondents perceived that others avoided them (61%), reported increased workplace stress (80%), workload (66%) and responsibilities (59%), and 44% considered leaving their job. The psychological questionnaires revealed that 25% had at least some psychological distress on the K10, 50% had IES-R scores suggesting clinical concern for post-traumatic stress, and 38% fulfilled criteria for at least one psychological diagnosis. Female gender and feeling at increased risk due to PPE predicted all adverse psychological outcomes. Respondents favoured clear hospital communication (59%), knowing their voice is heard (55%), expressions of appreciation from leadership (55%), having COVID-19 protocols (52%), and food and beverages provided by the hospital (50%). CONCLUSIONS: Hospital work during the COVID-19 pandemic has had important personal, professional, and psychological impacts. Respondents identified opportunities to better address information, training, and support needs.

Factors that affect student engagement in online learning in health professions education.

BACKGROUND: Student engagement is vital in achieving learning outcomes and improving students' motivation, involvement, and attitudes toward learning. The aim of this study was to identify the factors that affect student engagement in online learning in medical and health science colleges. METHODS: A cross-sectional study was conducted among medical and health science students and faculty in May 2020. The Online Engagement Strategies Questionnaire was e-mailed to 370 students and 102 faculty members. The SPSS statistical software was used for the statistical analysis. Exploratory factor analysis was performed to identify the factors that affected the students' engagement in online learning. Composite scores were calculated for factors, separately for the student and faculty responses. Descriptive statistical analysis was performed for the student and faculty responses. RESULTS: The response rates of the students and faculty were 85.1% and 74.1%, respectively. The mean ages of the students and faculty were 20.6 and 44.6 years, respectively. Eighty-five percent of the faculty (n = 51) and 88.3% (n = 278) of the students found that the use of technology in proper communication was an important strategy to engage students in online learning. The factor analysis revealed agreement between the students and faculty regarding the factors that support student engagement in online learning. Techno-pedagogical skills were considered very important for faculty and important for students. For both faculty and students, self-directed learning skills were important, and peer-assisted learning (PAL) was fair symmetry. Nevertheless, collaborative learning (CL) was fairly symmetry to students and important to faculty. CONCLUSION: To enhance student engagement in online learning, faculty members should consider improving their techno-pedagogical skills. Moreover, by incorporating self-directed learning, CL and PAL will support student engagement. Finally, faculty development, updating of course design, and institutional policies are all required to support online learning.

Effects of COVID-19 Lockdown on Managing Diabetes Mellitus Among Sudanese Insulin Pump Users, A Cross-Sectional Study (preprint)

Background: COVID-19 lockdown has affected diabetes management among the insulin pump users by changing their life style, affected their mental health, limited diabetes and insulin pump supplies and more difficult communication with the healthcare providers Objectives The aim of this research is to study the effects of COVID-19 lockdown on managing diabetes mellitus among Sudanese insulin pump users, Sudan (March- September 2020). Methodology: This is a descriptive cross-sectional community based study which was done in contact with Shimaa medical CO. LTD. 26 insulin pump users were chosen by total coverage and the data was collected throughout phone call interviews. All statistical analyses were performed using IBM SPSS Statistics software, version 20. Results The mean age of 22 participants was 25.3 ± 17.2 years, and the majorities (63.6%) were females. The average duration of diabetes was 6.9 ± 3.9 years, and the average duration of insulin pump use was 3 ± 1 years. Of the 22 patients (90.9%) used glucometer for monitoring blood sugar. 9 (40.9%) were less subjective to depression, 9 (40.9%) had moderate susceptibility to have depression. 8 patients (36.4%) reported weight gain, 12 patients (54.5%) reported no weight changes, while 2 patients (9.1%) reported weight loss. The level of physical activity decreased in 10 patients (45.5%), and the dietary habits remained unchanged in 50%. Moreover, participants who reported a decrease in physical activity levels were more likely to report weight gain (P = 0.004) compared with those who reported an increase in physical activity levels. Most of the patients have unchanged behaviors regarding experiencing hyper and hypoglycemic symptoms 45.5%, 72.7% respectively. Most of the patients have unchanged adherence to the insulin pump behaviors, carb counting (63.6%), bolus wizard during mealtime (68.2%), and bolus wizard for hyperglycemia correction (68.2%), self-monitoring of blood glucose (40.9%). (40.9%) of the patients had scheduled phone call appointments, 5 patients (22.7%) received virtual education (VE) from the insulin pump technician. 12 patients (54.5%) reported difficulty obtaining at least one type of insulin pump supply. Conclusion COVID-19 lock down has led to the decrease in physical activity with unchanged dietary habits. Getting the insulin pump supplies was difficult for most of the patient’s, and there was shortage and increase prices for diabetes care supplies. Telemedicine should be considered seriously to ease the communication between the patients and the health care providers.

Prevalence of depression and anxiety among male patients with COVID-19 in Lebsayyer Field Hospital, Qatar.

BACKGROUND: Depression and anxiety are major health problems found to be associated with various conditions. COVID-19 is a global pandemic that has a substantial effect on the worldwide population. This study aimed to assess the prevalence of depression and anxiety among male patients with COVID-19 and explore their relationship with participants' characteristics. METHODS: This cross-sectional study was conducted among expatriate male patients with COVID-19 admitted to Lebsayyer Field Hospital in Qatar with mild COVID-19 (according to World Health Organization classification) from July till August 2020. The sample size was calculated using Cochran's formula based on disease prevalence. All eligible patients were invited to participate until reaching 400 participants, who then completed an anonymous survey of sociodemographic questions, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 questionnaire, which are validated screening tools for depression and anxiety, respectively. RESULTS: Of the 400 participants, 148 (37.0%) and 77 (19.3%) reported depressive and anxiety symptoms, respectively. Depression was more prevalent among those 40-49 years old (p = 0.029), while anxiety was more prevalent among people aged  ≥ 50 (p = 0.456). Both depression (p = 0.009) and anxiety (p = 0.042) were more prevalent among Bangladeshi, followed by Filipino participants. Depression was more prevalent among those with the highest income (> 15,000 QR; p = 0.004), in contrast to anxiety, which was more prevalent among those with the lowest monthly income ( <  2,000 QR; p = 0.039). CONCLUSION: The prevalence of depressive and anxiety symptoms is high among the study participants. Associated factors identified by the study were unsteady income, poor self-rated health, living with family, Southeast Asian ethnicity, and age group of 40-49 years.

Effects of COVID-19 lockdown on managing diabetes mellitus among Sudanese insulin pump users, A study from Sudan (preprint)

Background: COVID-19 lockdown has affected diabetes management among the insulin pump users by changing their life style, affected their mental health, limited diabetes and insulin pump supplies and more difficult communication with the healthcare providers Objectives: The aim of this research is to study the effects of COVID-19 lockdown on managing diabetes mellitus among Sudanese insulin pump users, Sudan Methods: : This study was a descriptive cross-sectional study, Community based in Shimaa medical CO. LTD. A 26 insulin pump users were chosen by total coverage and the data was collected throughout phone call interviews. All statistical analyses were performed using IBM SPSS Statistics software, version 20. Results: : The mean age of 22 participants was 25.3 ± 17.2 years, and the majority (63.6%) were females. The average duration of diabetes was 6.9 ± 3.9 years, and the average duration of insulin pump use was 3 ± 1 years. Of the 22 patients (90.9%) used glucometer for monitoring blood sugar. 9 (40.9%) were less subjective to depression, 9 (40.9%) had moderate susceptibility to have depression. Most of the patients have unchanged adherence to the insulin pump behaviours, carb counting (63.6%), boluswizard during mealtime (68.2%), and bolus wizard for hyperglycemia correction (68.2%), self-monitoring of blood glucose (40.9 %). (40.9%) of the patients had scheduled phone call appointments, 5 patients (22.7%) received virtual education (VE) from the insulin pump technician. 12 patients (54.5%) reported difficult obtaining at least one type of insulin pump supply. Conclusion: COVID-19 lock down has led to the decrease in physical activity with unchanged dietary habits. Getting the insulin pump supplies was difficult for most of the patient’s, and there was shortage and increase prices for diabetes care supplies. Telemedicine should be considered seriously to ease the communication between the patients and the health care providers.

COVID-Nets: deep CNN architectures for detecting COVID-19 using chest CT scans.

In this paper we propose two novel deep convolutional network architectures, CovidResNet and CovidDenseNet, to diagnose COVID-19 based on CT images. The models enable transfer learning between different architectures, which might significantly boost the diagnostic performance. Whereas novel architectures usually suffer from the lack of pretrained weights, our proposed models can be partly initialized with larger baseline models like ResNet50 and DenseNet121, which is attractive because of the abundance of public repositories. The architectures are utilized in a first experimental study on the SARS-CoV-2 CT-scan dataset, which contains 4173 CT images for 210 subjects structured in a subject-wise manner into three different classes. The models differentiate between COVID-19, non-COVID-19 viral pneumonia, and healthy samples. We also investigate their performance under three binary classification scenarios where we distinguish COVID-19 from healthy, COVID-19 from non-COVID-19 viral pneumonia, and non-COVID-19 from healthy, respectively. Our proposed models achieve up to 93.87% accuracy, 99.13% precision, 92.49% sensitivity, 97.73% specificity, 95.70% F1-score, and 96.80% AUC score for binary classification, and up to 83.89% accuracy, 80.36% precision, 82.04% sensitivity, 92.07% specificity, 81.05% F1-score, and 94.20% AUC score for the three-class classification tasks. We also validated our models on the COVID19-CT dataset to differentiate COVID-19 and other non-COVID-19 viral infections, and our CovidDenseNet model achieved the best performance with 81.77% accuracy, 79.05% precision, 84.69% sensitivity, 79.05% specificity, 81.77% F1-score, and 87.50% AUC score. The experimental results reveal the effectiveness of the proposed networks in automated COVID-19 detection where they outperform standard models on the considered datasets while being more efficient.

One year of SARS-CoV-2: Genomic characterization of COVID-19 outbreak in Qatar (preprint)

Qatar, a state that has a diverse population consisting mainly of foreign residents, has experienced a large COVID19 outbreak. In this study, we report on 2634 SARS-CoV-2 whole-genome sequences from infected patients in Qatar between March-2020 and March-2021, representing 1.5% of all positive cases in this period. Despite the restrictions on international travel, the viruses sampled from the populace of Qatar mirrored nearly the entire global population’s genomic diversity with nine predominant viral lineages that were sustained by local transmission chains and the emergence of mutations that are likely to have originated in Qatar. We reported an increased number of mutations and deletions in B.1.1.7 and B.1.351 lineages in a short period. These findings raise the imperative need to continue the ongoing genomic surveillance that has been an integral part of the national response to monitor the SARS-CoV-2 profile and re-emergence in Qatar.

Satisfaction with online learning in the new normal: perspective of students and faculty at medical and health sciences colleges.

Online learning has become the new normal in many medical and health science schools worldwide, courtesy of COVID-19. Satisfaction with online learning is a significant aspect of promoting successful educational processes. This study aimed to identify factors affecting student and faculty satisfaction with online learning during the new normal. Online questionnaires were emailed to students (n = 370) and faculty (n = 81) involved in online learning during the pandemic. The questionnaires included closed- and open-ended questions and were organised into two parts: socio-demographic information and satisfaction with online learning. Descriptive statistics were used to analyse the responses to the satisfaction scales. Students' and faculty responses to the open-ended questions were analysed using the thematic analysis method. The response rate was 97.8% for students and 86.4% for faculty. Overall satisfaction among students was 41.3% compared to 74.3% for faculty. The highest areas of satisfaction for students were communication and flexibility, whereas 92.9% of faculty were satisfied with students' enthusiasm for online learning. Technical problems led to reduced student satisfaction, while faculty were hampered by the higher workload and the required time to prepare the teaching and assessment materials. Study-load and workload, enhancing engagement, and technical issues (SWEET) were the themes that emerged from the thematic analysis as affecting student and faculty satisfaction. Adopting a combination synchronous and asynchronous approach, incorporating different applications to engage students, and timely feedback are imperative to increasing student satisfaction, while institutional support and organisational policy could enhance faculty satisfaction.

The influence of comorbidity on the severity of COVID-19 disease: systematic review and analysis (preprint)

A novel form of coronavirus disease (SARS-CoV-2) has spread rapidly across the world. This disease, originating in Wuhan, China, has become a global pandemic. What risk factors influence the severity of the disease is of considerable importance. This research is intended to offer a systematic review/meta-analysis for assessing how common clinical conditions and comorbidities correlate with COVID-19. The meta-analysis incorporated seven studies covering 4101 COVID-19 patients from Chinese hospitals who had their diagnosis confirmed through laboratory testing. The findings demonstrate that the most common comorbidities with the disease were COPD (2.53%, OR 3.24 [95% CI: 1.99-4.45], p< 0.0006), cardiovascular disease (10.76%, OR 2.89 [95% CI: 1.90-4.40], p <0.0001), coronary heart disease (5.52%, OR 2.97 [95% CI: 1.99-4.45], p <0.0001), diabetes (11.34%, OR 2.27, [95% CI: 1.46-3.53], p = 0.0003), and hypertension (22.07%, OR 2.43 [95% CI: 1.71-3.45], p <0.0001). No significant associations were found for disease severity with the comorbidities of kidney disease, liver disease, or cancer. The most frequently exhibited clinical symptoms were fever (74.52%, OR 1.37, 95% CI: 1.01-1.86, p = 0.04), cough (62.15%, OR 1.25, 95% CI: 0.97-1.60, p = 0.0823), myalgia/fatigue (38.77%, OR 1.31, 95% CI: 1.11-1.55, p = 0.0018), dyspnea (33.9%, OR 3.61, 95% CI: 2.57-5.06, p = <0.0001), respiratory failure/ARDS (20.6%, OR 11.46, 95% CI: 3.24-40.56, p = 0.0002), diarrhea (11.21%) and chest tightness/pain (16.82%, OR 2.17, 95% CI: 1.40-3.36, p = 0.0006). Meta-analysis also revealed that neither the duration of the incubation period nor current smoking status associated with disease severity.

The influence of comorbidity on the severity of COVID-19 disease: A scoping review and meta-analysis (preprint)

Background: A novel form of coronavirus disease (SARS-CoV-2) has spread rapidly across the world. What risk factors influence the severity of the disease is of considerable importance. Objectives: This research offers a systematic review and meta-analysis of the correlation between common clinical conditions and comorbidities and the severity of COVID-19. Methodology: Two independent researchers searched Europe PMC, Google Scholar, and PubMed databases for articles related to influence comorbidities have on the progress of the disease. A search engine was also created to screen a further 59,000 articles in COVID-19 Open Research Dataset (CORD-19). Random-effects modeling was used to pool 95% confidence intervals (CIs) and odds ratios (ORs). The significance of all comorbidities and clinical conditions to the severity of the disease was evaluated by employing machine-learning techniques. Publication bias was assessed by using funnel-plots and Egger’s-test. Heterogeneity was tested using I2. Results: The meta-analysis incorporated 12 studies spanning 4,101 confirmed COVID-19 patients who were admitted to Chinese hospitals. The prevalence of the most commonly associated co-morbidities and their corresponding odds ratio for disease severity were as follows: coronary heart disease (OR 2.97 [CI: 1.99-4.45], p < 0.0001), cancer (OR 2.65 [CI: 1.12-6.29], p < 0.03), cardiovascular disease (OR 2.89 [CI: 1.90-4.40], p < 0.0001), COPD (OR 3.24 [CI: 1.66-6.32], p = 0.0), and kidney disease (OR 2.2.4 [CI: 1.01-4.99], p = 0.05) with low or moderate level of heterogeneity. The most frequently exhibited clinical symptoms recorded during the course of admission were fever (OR 1.37 [CI: 1.01-1.86], p = 0.04), myalgia/fatigue (OR 1.31 [CI: 1.11-1.55], p = 0.0018), and dyspnea (OR 3.61, [CI: 2.57-5.06], p = <0.0001). No significant associations between disease severity and liver disease, smoking habits, and other clinical conditions, such as a cough, respiratory/ARDS, diarrhea or chest tightness/pain were found. The meta-analysis also revealed that the incubation period was positively associated with disease severity. Conclusion: Existing comorbidities, including COPD, cardiovascular disease, and coronary heart disease, increase the severity of COVID-19. Some studies found a statistically significant association between comorbidities such as diabetes and hypertension and disease severity. However, these studies may be biased due to substantial heterogeneity.

The estimations of the COVID-19 incubation period: a systematic review of the literature (preprint)

BackgroundA novel coronavirus (COVID-19) has taken the world by storm. The disease has spread very swiftly worldwide. A timely clue which includes the estimation of the incubation period among COVID-19 patients can allow governments and healthcare authorities to act accordingly. Objectivesto undertake a review and critical appraisal of all published/preprint reports that offer an estimation of incubation periods for COVID-19. Eligibility criteriaThis research looked for all relevant published articles between the dates of December 1, 2019, and April 25, 2020, i.e. those that were related to the COVID-19 incubation period. Papers were included if they were written in English, and involved human participants. Papers were excluded if they were not original (e.g. reviews, editorials, letters, commentaries, or duplications). Sources of evidenceCOVID-19 Open Research Dataset supplied by Georgetowns Centre for Security and Emerging Technology as well as PubMed and Embase via Arxiv, medRxiv, and bioRxiv. Charting methodsA data-charting form was jointly developed by the two reviewers (NZ and EA), to determine which variables to extract. The two reviewers independently charted the data, discussed the results, and updated the data-charting form. Results and conclusionsscreening was undertaken 44,000 articles with a final selection of 25 studies referring to 18 different experimental projects related to the estimation of the incubation period of COVID-19. The majority of extant published estimates offer empirical evidence showing that the incubation period for the virus is a mean of 7.8 days, with a median of 5.01 days, which falls into the ranges proposed by the WHO (0 to 14 days) and the ECDC (2 to 12 days). Nevertheless, a number of authors proposed that quarantine time should be a minimum of 14 days and that for estimates of mortality risks a median time delay of 13 days between illness and mortality should be under consideration. It is unclear as to whether any correlation exists between the age of patients and the length of time they incubate the virus.