COVID-19 and arrhythmia: An overview.

Arrhythmias in COVID-19 patients are associated with hypoxia, myocardial ischemia, cytokines, inflammation, electrolyte abnormalities, pro-arrhythmic or QT-prolonging medications, and underlying heart conditions such as severe congestive heart failure, inherited arrhythmia syndromes, or congenital heart conditions. In the pediatric population, multisystem inflammatory syndrome can lead to cardiac injury and arrhythmias. In addition, arrhythmias and cardiac arrests are most prevalent in the critically ill intensive care unit COVID-19 patient population. This review presents an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms, existing knowledge of pro-arrhythmic factors, and results from studies in adult and pediatric COVID-19 populations, and the clinical implications.

Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries.

BACKGROUND: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. METHODS: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. RESULTS: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a 'great-extent-of-confidence' in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. INTERPRETATION: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type.

Universal checklist for COVID-19 control measures: consensus via a Delphi method

Declaration/announcement of emergency status Launching a public website for guidelines and information Establishing a 'coronavirus task force'/ expert board Conducting training programmes Government financial assistance for citizens/taxpayers Equal protection for immigrants/foreigners Regulation and stabilisation of food prices and daily necessities Require company to pay full salary to quarantined/isolated people Financial support to frontline cleaners, toilet attendants and security employees Free testing Free treatment Production/procurement of supplies (such as surgical masks, gloves, ventilators, or goods) Enhance production of sanitisers Enhancing hospital capacities (beds) Designating which hospitals can receive COVID-19 patients Equipping university housings, hotels, sports stadiums or building temporary hospitals to be ready to receive patients Guidelines for treatment of COVID-19 Application of telemedicine Research: Established in-house PCR assay Development of quick test kits Successfully identifying SARS-CoV-2 genes Launching clinical trial treatment of COVID-19 Launching vaccination development Call for research related to epidemiology, prevention and control measures Call for development or reuse of efficient low cost of PPE and medical devices such as ventilators Call for development of a new treatment or new drug discovery, PPE and medical devices such as ventilators Call for non-academic industries to join the research or give funds Box 1. Prohibition of group gathering more than (x) number of people in public places Physical distancing from each other in public (2 metres between individuals) Closure of schools Working from home Shelter in place Closure of public areas Closure of services Closure of public transport Closure of city/area hotspots (separating areas, restriction of movement) Protection of vulnerable people (elderly, people with suppressed immunities or relevant comorbidities: hypertension, heart disease, kidney disease, liver disease, chronic respiratory disease, diabetes, obesity) Supporting e-learning for students/tele-workplace Preventive and containment measures: Universal checklist of COVID-19 control measures (Continued) Using a medical declaration when having respiratory symptoms or close contact with a new confirmed patient Isolation for all confirmed cases (F0) Disinfect the workplace of the newly detected patient Closure of workplace of the newly detected patient Isolation/quarantine for patients with respiratory symptoms (flu-like illness) Isolation/quarantine for suspected cases with negative RT-PCR (who had contact with confirmed patients or came from hotspots) Protection of hospitals at outpatient units Protection of healthcare workers Guidelines for each type of health worker to prevent crosstransmission Guidelines for performing aerosol generation Guidelines regarding reuse of masks/PPE for healthcare workers Guidelines on disposal of dead bodies Guidelines for home care Guidelines for community service (public transportation, food delivery, postal, volunteer services) Additional items:

Efficacy of face masks against respiratory infectious diseases: a systematic review and network analysis of randomized-controlled trials.

During the ongoing COVID-19 pandemic, face masks are among the most common and practical control measures used globally in reducing the risk of infection and disease transmission. Although several studies have investigated the efficacy of various face masks and respirators in preventing infection, the results have been inconsistent. Therefore, we performed a systematic review and network meta-analysis (NMA) of the randomized-controlled trials (RCTs) to assess the actual efficacy of face masks in preventing respiratory infections. We searched nine electronic databases up to July 2020 to find potential articles. We accepted trials reporting the protective efficacy of face masks against respiratory infections, of which the primary endpoint was the presence of respiratory infections. We used the ROB-2 Cochrane tool to grade the trial quality. We initially registered the protocol for this study in PROSPERO (CRD42020178516). Sixteen RCTs involving 17 048 individuals were included for NMA. Overall, evidence was weak, lacking statistical power due to the small number of participants, and there was substantial inconsistency in our findings. In comparison to those without face masks, participants with fit-tested N95 respirators were likely to have lesser infection risk (RR 0.67, 95% CI 0.38-1.19,P-score 0.80), followed by those with non-fit-tested N95 and non-fit-tested FFP2 respirators that shared the similar risk, (RR 0.73, 95% CI 0.12-4.36,P-score 0.63) and (RR 0.80, 95% CI 0.38-1.71,P-score 0.63), respectively. Next, participants who donned face masks with and without hand hygiene practices showed modest risk improvement alike (RR 0.89, 95% CI 0.67-1.17,P-score 0.55) and (RR 0.92, 95% CI 0.70-1.22,P-score 0.51). Otherwise, participants donning double-layered cloth masks were prone to infection (RR 4.80, 95% CI 1.42-16.27,P-score 0.01). Eleven out of 16 RCTs that underwent a pairwise meta-analysis revealed a substantially lower infection risk in those donning medical face masks (MFMs) than those without face masks (RR 0.83 95% CI 0.71-0.96). Given the body of evidence through a systematic review and meta-analyses, our findings supported the protective benefits of MFMs in reducing respiratory transmissions, and the universal mask-wearing should be applied-especially during the COVID-19 pandemic. More clinical data is required to conclude the efficiency of cloth masks; in the short term, users should not use cloth face masks in the outbreak hot spots and places where social distancing is impossible.

SARS-CoV-2-induced immunodysregulation and the need for higher clinical suspicion for co-infection and secondary infection in COVID-19 patients.

Cases of co-infection and secondary infection emerging during the current Coronavirus Disease-19 (COVID-19) pandemic are a major public health concern. Such cases may result from immunodysregulation induced by the SARS-CoV-2 virus. Pandemic preparedness must include identification of disease natural history and common secondary infections to implement clinical solutions.