ABSTRACT
The novel coronavirus SARS-CoV-2, which emerged in late 2019, has since spread around the world and infected hundreds of millions of people with coronavirus disease 2019 (COVID-19). While this viral species was unknown prior to January 2020, its similarity to other coronaviruses that infect humans has allowed for rapid insight into the mechanisms that it uses to infect human hosts, as well as the ways in which the human immune system can respond. Here, we contextualize SARS-CoV-2 among other coronaviruses and identify what is known and what can be inferred about its behavior once inside a human host. Because the genomic content of coronaviruses, which specifies the virus's structure, is highly conserved, early genomic analysis provided a significant head start in predicting viral pathogenesis and in understanding potential differences among variants. The pathogenesis of the virus offers insights into symptomatology, transmission, and individual susceptibility. Additionally, prior research into interactions between the human immune system and coronaviruses has identified how these viruses can evade the immune system's protective mechanisms. We also explore systems-level research into the regulatory and proteomic effects of SARS-CoV-2 infection and the immune response. Understanding the structure and behavior of the virus serves to contextualize the many facets of the COVID-19 pandemic and can influence efforts to control the virus and treat the disease. IMPORTANCE COVID-19 involves a number of organ systems and can present with a wide range of symptoms. From how the virus infects cells to how it spreads between people, the available research suggests that these patterns are very similar to those seen in the closely related viruses SARS-CoV-1 and possibly Middle East respiratory syndrome-related CoV (MERS-CoV). Understanding the pathogenesis of the SARS-CoV-2 virus also contextualizes how the different biological systems affected by COVID-19 connect. Exploring the structure, phylogeny, and pathogenesis of the virus therefore helps to guide interpretation of the broader impacts of the virus on the human body and on human populations. For this reason, an in-depth exploration of viral mechanisms is critical to a robust understanding of SARS-CoV-2 and, potentially, future emergent human CoVs (HCoVs).Copyright © 2021 Rando et al.
ABSTRACT
Aims: Recruitment to Randomised Controlled Trials (RCTs) has traditionally been the domain of Research Nurses. Due to the unprecedented pressures of the COVID pandemic, the majority of Research Nurses have been redeployed to other clinical roles, or those still working within research have had to focus on COVID-related projects. This has left existing surgical trials struggling to recruit. We report on our experience of engaging Specialist Nurses without a research background as well as Consultants and Trainees to support surgical research in these challenging circumstances. Method: The Sunflower RCT was first opened to recruitment in August 2019 at our trust. The recruitment was led by single Research Nurse, but the delegation log included a range of Consultants, Trainees, and Specialist Nurses. Due to the COVID pandemic, recruitment was paused from March 2020 and restarted in July 2020. Data were collected on recruitment until January 2021. Results: In the seven months before the recruitment pause, 80 patients were recruited (average 11 per month), with the highest proportion of recruits by the sole Research Nurse. Following the recruitment pause, a further 45 patients were recruited (average 7.5 per month). These patients were recruited by Consultants (20, 44%), Specialist Nurses (12, 27%), Trainees (7, 16%), Research Nurse (3, 7%) and postal consents (3, 7%). Conclusions: We have demonstrated that surgical research activity can be maintained even with minimal Research Nurse recruitment by engaging all members of the surgical team, especially utilising Specialist Nurses, who may not commonly be approached for such a role.
ABSTRACT
Regional resilience refers to an immanent condition for facing multiple risks on a permanent basis, both episodic and incremental. These risks are not only linked to natural disasters and climate change, but also to poverty and inequality of access to services such as health, and personal safety. This article considers the underlying conditions that shape regional resilience in Chile, based on inter-regional and intra-regional comparisons in the Metropolitan Region of Santiago and the Region of Araucanía. Instead of viewing resilience in terms of an ability to counter a single risk, the article highlights the fact that risks are multiple and overlapping over time and generated at different scales. Municipal level data on poverty, health, and public finances in the two regions reveal the contrasting underlying inequalities that point to regional mosaics of resilience rather than homogeneity. Different threats are superposed on these preexisting conditions of resilience. The article refers to three in particular: the 2010 Chilean earthquake (episodic);climate change (episodic and incremental);and the Covid-19 pandemic (episodic). The findings point to high levels of urban versus rural differentiation, and also high differentiation within the Santiago Metropolitan Area based on socio-economic conditions. This regional mosaic of underlying structural conditions suggests that regional resilience can be enhanced by engaging with structural socio-spatial inequalities rather than a focus on managing risks via siloed, threat-by-threat responses. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.