Forecasting the Temporal Evolution of COVID-19

COVID-19 epidemic has resulted in severe chaos across the globe. Complex frameworks can be investigated and studied using mathematical models, which are reliable and efficient. The objective of this research is to scrutinize the progression and prediction of parameters that evaluate the emergence and transmission of COVID-19 in the two most affected nations, i.e., the USA and India. Five models including the standard and hybrid epidemic models, viz, SIR (Susceptible-Infectious-Removed), SIRD (Susceptible-Infectious-Recovered-Death), SIRD with vaccination, SIRD with vital dynamics (i.e., including birth rate and death rate) and, SIRD with vital dynamics and vaccination have been developed. Worldwide statistics have been observed utilizing graphical layouts. Model evaluation measures such as Mean Absolute error (MAE), Mean-square error (MSE), and Root Mean Square Error (RMSE) for different parameters namely infection rate, recovery rate, and death rate have been estimated. © 2022 IEEE.

Forecasting the Temporal Evolution of COVID-19

COVID-19 epidemic has resulted in severe chaos across the globe. Complex frameworks can be investigated and studied using mathematical models, which are reliable and efficient. The objective of this research is to scrutinize the progression and prediction of parameters that evaluate the emergence and transmission of COVID-19 in the two most affected nations, i.e., the USA and India. Five models including the standard and hybrid epidemic models, viz, SIR (Susceptible-Infectious-Removed), SIRD (Susceptible-Infectious-Recovered-Death), SIRD with vaccination, SIRD with vital dynamics (i.e., including birth rate and death rate) and, SIRD with vital dynamics and vaccination have been developed. Worldwide statistics have been observed utilizing graphical layouts. Model evaluation measures such as Mean Absolute error (MAE), Mean-square error (MSE), and Root Mean Square Error (RMSE) for different parameters namely infection rate, recovery rate, and death rate have been estimated. © 2022 IEEE.

Modern Mortuary Complex Plan in Covid-19 Era

The COVID-19 pandemicis the most burning health emergency worldwide now a days and all health professionals are called to give support in the diagnosis, treatment of patients and management of dead bodies affected by this disease. Different modes of transmission of corona virus is well established, however aerosol generating procedure has significant importance for mortuary during autopsy. The risk of infection can be minimized by using standard universal precautions for autopsy dissection procedure, applying high bio-safety levels, using negative pressure and laminar flow system for ventilation, UV irradiation for sterilization, virtual autopsy etc. The aim can be achieved by constructing the mortuary complex in more planned way like area division, ventilation planning, environmental disinfection, individual protection, autopsy procedure, virtual autopsy, preservation and transportation of dead body and waste disposal management. The present manuscript describes in detail about modern mortuary complex during the pandemic era of covid-19 © 2022, Journal of Indian Academy of Forensic Medicine.All Rights Reserved.

Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis

OBJECTIVE: New-onset or persistent symptoms beyond after 4 weeks from COVID-19 are termed "long-COVID." Whether the initial severity of COVID-19 has a bearing on the clinicoradiological manifestations of long COVID is an area of interest. MATERIAL AND METHODS: We did an observational analysis of the long-COVID patients after categorizing them based on their course of COVID-19 illness into mild, moderate, and severe groups. The clinical and radiological profile was compared across these groups. RESULT(S): Out of 150 long-COVID patients recruited in the study, about 79% (118), 14% (22), and 7% (10) had a history of mild, moderate, and severe COVID-19, respectively. Fatigue (P = .001), breathlessness (P = .001), tachycardia (P = .002), tachypnea (P < .001), raised blood pressure (P < .001), crepitations (P = .04), hypoxia at rest (P < .001), significant desaturation in 6-minute walk test (P = .27), type 1 respiratory failure (P = .001), and type 2 respiratory failure (P = .001) were found to be significantly higher in the long-COVID patients with a history of severe COVID-19. These patients also had the highest prevalence of abnormal chest X-ray (60%) and honeycombing in computed tomography scan thorax (25%, P = .027). CONCLUSION(S): The course of long COVID bears a relationship with initial COVID-19 severity. Patients with severe COVID-19 are prone to develop more serious long-COVID manifestations.Copyright © Author(s).

Face Mask Detection using an Automated Hybrid Deep Learning Method in the COVID Scenario

Currently, in light of the health catastrophe due to the COVID-19 which has been unfolding all over the world. Wearing a defensive mask has ended up a substitute normal. Face recognition technology is most commonly implemented for surveillance and other applications. Traditional machine learning classifiers as well as deep transfer learning classifiers have been used to accomplish the face mask detection mechanism. In this paper, two hybrid deep learning models MobileNetV2-SVM and MobilNetV2-KNN has been proposed for the task of face mask detection. The models involve two processes: feature extraction and classification. For initialization, the MobileNetV2 pre-trained weights from ImageNet were employed, and during training, data augmentation and resampling were applied. By integrating the model with an SVM classifier and a KNN classifier, the model is further refined, creating hybrid models that are effective in terms of processing. The Kaggle dataset of 45000 images (22582 images are masked and 23423 images that are unmasked) of the proposed model/system is trained using MobilenetV2 and classified using SVM and K-NN algorithm in different models. Various machine learning frameworks were used like pandas, TensorFlow, Keras and NumPy. The accuracy achieved by the SVM model is 98.17% and 95.22% accuracy are achieved by using the K-NN classifier. © 2022 IEEE.

Comparison of Clinical Outcome between Immunocompetent and Immunocompromised Children Aged 1 to 12 Years Admitted with Acute COVID-19 Infection - A Retrospective Review

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created havoc in adults and children. Immunocompromised children are considered a high-risk group for the extreme manifestation of coronavirus disease 2019 (COVID-19) infection. There are conflicting reports on the outcome of SARS-CoV-2 disease in immunocompromised children. We aimed to find the difference in clinical outcomes of COVID-19 infection between immunocompetent and immunocompromised children. This includes a retrospective chart review of children admitted with COVID-19 infection in a tertiary care pediatric hospital in Northern India from March 1, 2021, to May 31, 2021. There were 35 COVID-19-positive children aged 1 to 12 years admitted during the study period. The study participants were divided into two groups: immunocompetent and immunocompromised patients. The clinical features, laboratory parameters, treatment needs, and outcomes in both groups were compared. Among 35 patients enrolled, 17 were immunocompromised and 18 were immunocompetent. The median duration of hospital stay, clinical features, laboratory parameters, severity of illness, treatment needs, and outcomes were comparable between the two groups. Immunocompromised children are not at a higher risk of severe COVID-19 manifestation compared to immunocompetent children.

Driving through sustainable systems: a Study of Air Quality Index of Delhi during COVID-19 Pandemic

The impact of lockdown during covid-19 pandemic on air quality in terms of pollution was investigated in the Delhi/NCR region in this study. The National Air Quality Index (NAQI) uses air quality data for six pollutant measures (PM10, PM2.5, SO2, CO, NO2 and O3) from monitoring stations across the megacity to demonstrate the spatial pattern of air quality before and during the lockdown period due to pandemic. The objective of this study is to investigate the interrelationship among the various parameters the Pearson’s correlation analysis was conducted. The results found were able to demonstrate that during lockdown air quality was significantly improved. It was also found that among other pollutants, level of NO2 and CO have also declined during- lockdown phase. It was observed that during this period of lockdown, the air quality index on maximum number of days was found to be good and satisfactory in Delhi that was the clear indication of an improvement in air quality due to a reduction in pollution and emissions of vehicles and industries. It can be implemented to further work on parameters to improve the air quality in future.

REAL-WORLD IMPLEMENTATION OF THE CYTOSPONGE TEST IN SECONDARY CARE FOR PATIENTS AT RISK OF EARLY OESOPHAGEAL CANCER

Introduction The CytospongeTM test is a non-endoscopic method to collect cells from the oesophagus and test for biomarkers of early oesophageal cancer and its precancerous form, Barrett's oesophagus. The real-world implementation pilots of the Cytosponge has been accelerated in response to the COVID-19 pandemic. At the onset of the pandemic, when endoscopy services were paused, guidelines from the British Society of Gastroenterology were updated to recommend the use of alternatives including the Cytosponge. In December 2020, NICE published a Medtech Innovation Briefing for use of the Cytosponge test as a triage tool for endoscopy to identify people at risk of oesophageal cancer. Aims & methods Implementation pilots were launched within the NHS in England and Scotland, as well as the Innovate UK-funded research project, Project DELTA. The Cytosponge test was offered to two patient cohorts as an alternative to endoscopy: (1) patients already diagnosed with Barrett's Oesophagus, and so in need of routine surveillance;and (2) patients referred from primary care with reflux symptoms. Samples were received, processed and analysed at the ISO 15189:2012 accredited laboratory at Cyted. Pathology reports were issued with TFF3, p53 and atypia biomarker results and clinical recommendations. Any reports positive for p53/atypia biomarkers were double reported. Here, we evaluate the real-world laboratory metrics for the Cytosponge test in secondary care. Results Between August 2020 and November 2021, Cytosponge tests were delivered to 5373 patients at 48 hospitals across England and Scotland. For 4842 diagnostic reports issued by mid-November, 2807 patients had Barrett's Oesophagus and 2034 reflux symptoms. For Barrett's surveillance, 2629 (93.7%) of patient samples had sufficient cellular material for analysis, including sampling the gastric cardia. Of these 324 (12.3%) exhibited cellular atypia (including uncertain significance), dysplasia, or aberrant p53 expression. These patients were recommended to have an endoscopy. Patients without evidence of atypia/dysplasia/p53 were recommended surveillance by Cytosponge or endoscopy after the recommended interval by clinical guidelines. In the symptomatic reflux cohort, 1854 (91.2%) patient samples had sufficient cellular material for analysis, including sampling the gastric cardia. Of these 185 (10.0%) exhibited intestinal metaplasia corroborated by TFF3 expression and a further 44 (2.4%) exhibited atypia/ dysplasia/p53. These patients were recommended to have an endoscopy. Otherwise, patients were recommended management according to symptoms. Discussion A high-quality centralised laboratory service has enabled accelerated real-world implementation of the Cytosponge in the secondary care setting. This has enabled triage and care of patients who have not been able to access endoscopy during the COVID-19 pandemic.

Risk assessment of acquiring SARS-CoV-2 infection among employees of a tertiary cancer care center

Objectives: Continuation of health-care facilities for non-COVID illness during the SARS-CoV-2 pandemic is mired with apprehension of infection to health care workers (HCWs). The lack of facilities can result in dire outcomes for patients of NCDs such as cancer. The Objective of this paper is to assess the risk of running a healthcare facility during the pandemic. Material and Methods: A retrospective analysis was carried out at a tertiary cancer hospital to understand the quantum of risk to HCWs while providing care to patients of cancer and to SARS-CoV-2 patients, within the same set-up with optimal segregation. Data were collected for 6 weeks during which attendance, exposure, and infection status of doctors and nurses were recorded along with comorbidities.

Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C)

Objective To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. Methods This comparative cross-sectional study was done at a tertiary care teaching institute. We enrolled all hospitalized children aged 1 month-18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. Results During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. MIS-C with shock was seen in 15 cases (44%), MIS-C without shock in 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients [100.2 (85.1) vs 16.9 (29.3) mg/dL] (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Mean hospital stay (patient days) was longer in MIS- C compared to dengue fever (8.6 vs 6.5 days;P=0.014). Conclusions Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

Emergency Department Management and Outcomes of COVID-19 Acute Hypoxemic Respiratory Failure During the New York City Surge

Study Objectives: Delays in intensive care unit (ICU) admission for critically ill patients are associated with worse outcomes, but the effect of “boarding” during the COVID-19 pandemic has not been well characterized. This study describes the emergency department (ED)-based care for patients presenting with COVID-19-related acute hypoxemic respiratory failure (AHRF) to five hospitals in a large, academic health system during the initial surge in New York City, examining both respiratory modality choice and settings. For those managed with noninvasive respiratory support, we also aimed to explore the association between ED boarding time and patient morbidity and mortality. Methods: We conducted a retrospective cohort study of ED patients presenting from 3/1/2020 to 7/10/2020 with COVID-19-related AHRF and requiring ICU admission at any time during their hospitalization. Patient demographics, comorbidities, severity of illness (Mortality Probability Model III on admission), clinical course, including the use, settings (initial and changes), and duration of respiratory support modalities (ie, noninvasive ventilation [NIV], high flow nasal cannula [HFNC], invasive mechanical ventilation [IMV]), as well as hospital site, were collected through validated electronic query and standardized manual chart abstraction. AHRF severity was defined using a PaO2/FiO2 ratio (PF): 200-300 (mild), 100-199 (moderate), and <100 (severe). For patients without a PaO2, the PF was imputed using SpO2/FiO2 ratio using previously validated non-linear conversion. Boarding was defined as the time interval from ED request for admission to ED departure. The primary outcome was a composite outcome of ICU admission, intubation, or mortality within 48 hours of ED arrival. Descriptive analyses stratified by boarding duration and AHRF were completed. Multivariable logistic regression modelling was used to determine the association between ED boarding and the primary outcome. Results: A total of 679 ED patients with COVID-19 AHRF required ICU admission during the study period. They were managed with low flow oxygen only (261, 38.4%), or with NIV (120, 17.7%), HF (51, 7.5%), and/or IMV (99, 14.6%), with setting ranges detailed in Table 1. Of the patients with a known PF ratio (N=418), 110 (26.35%) had mild, 34 (5.0%) had moderate, and 274 (40.4%) had severe AHRF. Of these patients, 279 (41.1%) had a change documented to their settings, with increased likelihood of adjustments with longer boarding time (p<0.001) and higher AHRF severity (p<0.001). Median boarding duration across all site was 9.5 hours (IQR 5.3-16.9 hours) with site variation. AHRF severity and support modality were not associated with differences of boarding time (p = 0.77 and p=0.54). Controlling for age, sex, race, and severity of illness, boarding time was not associated with worse patient outcomes in 48 hours (OR 0.85, 95% CI 0.67-1.08, p=0.17) Conclusion: During the COVID-19 pandemic, critically ill patients presented to the ED and boarded for long periods of time, requiring prolonged ventilatory management. Despite the surge state and resource limitations, boarding times did not worsen post-ED outcomes for patients managed with non-invasive modalities. [Formula presented]

Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C)

OBJECTIVE: To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. METHODS: This comparative cross-sectional study was done at tertiary care teaching institute. We enrolled all hospitalized children aged 1 month - 18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. RESULTS: During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. Of 34 cases, MIS-C with shock was seen in 15 cases (44%), MIS-C without shock, 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Conjunctival injection and swelling of hand and feet were more commonly seen in MIS-C. Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients, than dengue fever patients [100.2 (85.1) vs 16.9 (29.3) mg/dL (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Need for mechanical ventilation was significantly more in MIS-C cases. Mean hospital stay was longer in MIS- C patients days compared to dengue fever (8.6 vs 6.5 days;P=0.014). CONCLUSION: Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

Cardiovascular disease and severe hypoxemia are associated with higher rates of non-invasive respiratory support failure in COVID-19 pneumonia

RATIONALE Acute hypoxemic respiratory failure (AHRF) is the major complication of coronavirus disease 2019 (COVID-19), yet optimal respiratory support strategies are uncertain. We aimed to describe outcomes with highflow oxygen delivered through nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) in COVID-19 AHRF and identify individual factors associated with non-invasive respiratory support failure. METHODS We conducted a retrospective cohort study of hospitalized adults with COVID-19 within a large academic health system in New York City early in the pandemic to describe outcomes with HFNC and NIPPV. Patients were categorized into the HFNC cohort if they received HFNC but not NIPPV, whereas the NIPPV cohort included patients who received NIPPV with or without HFNC. We described rates of HFNC and NIPPV success, defined as live discharge without endotracheal intubation (ETI). Further, using Fine-Gray sub-distribution hazard models, we identified demographic and patient characteristics associated with HFNC and NIPPV failure, defined as the need for ETI and/or in-hospital mortality. RESULTS Of the 331 patients in the HFNC cohort, 154 (46.5%) patients were successfully discharged without requiring ETI. Of the 177 (53.5%) who experienced HFNC failure, 100 (56.5%) required ETI and 135 (76.3%) patients ultimately died. Among the 747 patients in the NIPPV cohort, 167 (22.4%) patients were successfully discharged without requiring ETI, and 8 (1.1%) were censored. Of the 572 (76.6%) patients who failed NIPPV, 338 (59.1%) required ETI and 497 (86.9%) ultimately died. In adjusted models, significantly increased risk of HFNC and NIPPV failure was observed among patients with co-morbid cardiovascular disease (sub-distribution hazard ratio (sHR) 1.82;95% confidence interval (CI), 1.17-2.83 and sHR 1.40;95% CI 1.06-1.84, respectively). Conversely, a higher oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) at HFNC and NIPPV initiation was associated with reduced risk of failure (sHR, 0.32;95% CI 0.19-0.54, and sHR 0.34;95% CI 0.21-0.55, respectively). CONCLUSIONS A subset of patients with COVID-19 AHRF was effectively managed with non-invasive respiratory modalities and achieved successful hospital discharge without requiring ETI. Notably, patients with co-morbid cardiovascular disease and more severe hypoxemia experienced lower success rates with both HFNC and NIPPV. Identification of specific patient factors may help inform more selective use of non-invasive respiratory strategies, and allow for a more personalized approach to the management of COVID-19 AHRF in pandemic settings.

Predictors of pre-icu duration and its association with mortality in COVID-19 infection: A secondary analysis of the stop-covid registry

Rationale: High patient volume and limited ICU resources associated with the COVID-19 pandemic have exacerbated ICU capacity strain, leading to longer pre-ICU lengths-of-stay (LOS). We examined the patient- and hospital-level predictors of pre-ICU LOS, and the association of pre-ICU LOS on in-hospital mortality for patients with COVID-19. Methods: Data were derived from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID), a multicenter cohort study of critically ill adults with COVID-19 admitted to 68 US hospitals. All patients had a minimum of 28-day follow-up;those discharged from hospital were presumed alive. The primary outcome was pre-ICU LOS, dichotomized into brief (≤1 day) vs. prolonged (>1 day). We constructed a multivariate mixed effects model, adjusting for patient factors (e.g., demographics, comorbidities, and pre-hospital symptom duration) and hospital factors (pre-COVID ICU beds number, countylevel case rates of COVID-19 (number of cases per 100,000 residents), and the hospital site itself) to determine predictors of pre-ICU LOS. Using 1:3 propensity score matching for pre-ICU period, we used multivariate mixed effect modelling to examine the association between pre-ICU LOS and in-hospital mortality. Results: A total of 4738 patients with complete data were admitted to the ICU, 36.6% were female, with median age 62 years (IQR 52-71). The majority (85.5%) were admitted from the ED or wards, with 62.5% classified as having a brief pre- ICU LOS. While demographics and co-morbidities (cancer, diabetes, and end-stage renal disease) were not associated with pre-ICU LOS, pre-existing lung disease (OR 1.33, 95% CI 1.02-1.74) was a patient-level predictor of a brief pre-ICU LOS as compared to a prolonged LOS. Having more available ICU beds (>100 vs. 0-48 ICU beds, OR 1.41, 95% CI 1.03-1.92) was a hospital-level predictor of a brief pre-ICU LOS. More patients were intubated at the time of ICU arrival in the prolonged pre-ICU LOS group, compared to the brief LOS group (64.6% vs. 59.2%, p≤0.001). In the mixed model, propensity matched for pre-ICU LOS, and adjusted for patient/hospital characteristics, differential pre-ICU LOS was not predictive of in-hospital mortality (OR 1.22, 95%CI 0.81-1.87), though oxygen support modality was associated with mortality. Conclusion: Patient- and hospital-level factors, such as ICU capacity, had an impact on pre-ICU duration, with more patients requiring a higher level of oxygen support at ICU arrival if admitted later in their course. However, once adjusting for clinical and hospital factors, pre-ICU LOS was not associated with in-hospital mortality.

Convalescent plasma therapy: Treatment option for SARS-CoV-2 infection

The number of corona virus cases is steeply increasing day by day worldwide. According to WHO, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection is managed by preventing infection, detection of cases, providing supportive care, and monitoring. No specific options (antiviral, monoclonal antibody or vaccine) are available for controlling and treatment of the COVID-19 infection, Convalescent plasma (CP) therapy becomes the first available option to treat this pandemic situation according to the successful use of plasma therapy in a historical corona virus outbreak. Plasma obtained from COVID-19 recovered patients is used as prophylaxis therapy or as a therapeutic option. Plasma collection, preparation, and administration requires a proper procedure to enhance its productivity. Preparation of plasma with adequate neutralizing antibody titer becomes challenging. CP therapy may provide antiviral and immunomodulatory effect to SARS-CoV-2 infected patients by controlling overactive immune system such as cytokine storm, Th1/Th17 ratio, and hypercoagulable state. Based on the available case studies data, the administration of CP is proven to be beneficial in treating critically ill patients of SARS-CoV-2 infection. Passive antibody transfusion may reduce viral load with no severe adverse reaction and provide passive immunity against the virus. However, further well-designed clinical trials are needed to establish true clinical efficacy and safety of plasma therapy.

The role of ace2 receptor and its age related immunity in covid-19

World is facing the Coronavirus pandemic, which is resulting in large number of deaths and economic burden to the society. SARS-CoV-2 is the causative agent for COVID-19 infection. SARS-CoV-2 is a single stranded RNA molecule which enters the human through ACE2 receptor. ACE2 is widely expressed in the human tissues, primarily in the heart, kidney and testis and secondarily in the lungs, blood vessels and colon. Therefore, SARS-CoV-2 can infect the lungs and other organs as well leading to multiple organ damage. ACE2 receptor regulates the Renin Angiotensin System (RAS). Therefore, increasing SARS-CoV-2 infection decreases ACE2 receptor and results in dysfunction of RAS, imbalance of blood pressure and inflammation of airways. This provide direct link between the ACE2 receptor and COVID-19 infection. ACE2 expression and immune response may fluctuate throughout the life of human which accounts for variation of disease severity. ACE2 level decreases with age i.e. children have higher expression of ACE2 as compared to the older people and children also possess strong innate immunity leading to early control of the infection comparing to older people. Hence, children are found to be less susceptible to COVID19 infection then the older ones. The difference in ACE2 expression and host immune response to SARS-CoV-2 infection can explain the severity of disease progression in different age, gender and race.