mRNA-1273 boost after BNT162b2 vaccination generates comparable SARS-CoV-2-specific functional responses in naïve and COVID-19-recovered individuals.

Introduction: COVID-19 vaccines based on mRNA have represented a revolution in the biomedical research field. The initial two-dose vaccination schedule generates potent humoral and cellular responses, with a massive protective effect against severe COVID-19 and death. Months after this vaccination, levels of antibodies against SARS-CoV-2 waned, and this promoted the recommendation of a third vaccination dose. Methods: We have performed an integral and longitudinal study of the immunological responses triggered by the booster mRNA-1273 vaccination, in a cohort of health workers previously vaccinated with two doses of the BNT162b2 vaccine at University Hospital La Paz located in Madrid, Spain. Circulating humoral responses and SARS-CoV-2-specific cellular reactions, after ex vivo restimulation of both T and B cells (cytokines production, proliferation, class switching), have been analyzed. Importantly, all along these studies, the analyses have been performed comparing naïve and subjects recovered from COVID-19, addressing the influence of a previous infection by SARS-CoV-2. Furthermore, as the injection of the third vaccination dose was contemporary to the rise of the Omicron BA.1 variant of concern, T- and B-cell-mediated cellular responses have been comparatively analyzed in response to this variant. Results: All these analyses indicated that differential responses to vaccination due to a previous SARS-CoV-2 infection were balanced following the boost. The increase in circulating humoral responses due to this booster dropped after 6 months, whereas T-cell-mediated responses were more stable along the time. Finally, all the analyzed immunological features were dampened in response to the Omicron variant of concern, particularly late after the booster vaccination. Conclusion: This work represents a follow-up longitudinal study for almost 1.5 years, analyzing in an integral manner the immunological responses triggered by the prime-boost mRNA-based vaccination schedule against COVID-19.

Analysis of combined non-invasive respiratory support in the first six waves of the COVID-19 pandemic. Outcome according to the first respiratory support

Introduction COVID-19 can lead to acute respiratory failure (ARF) requiring admission to intensive care unit (ICU). This study analyzes COVID-19 patients admitted to the ICU, according to the initial respiratory support. Its main aim is to determine if the use of combination therapy: high-flow oxygen system with nasal cannula (HFNC) and non-invasive ventilation (NIV), is effective and safe in the treatment of these patients. Methods Retrospective observational study with a prospective database. All COVID-19 patients, admitted to the ICU, between March 11, 2020, and February 12, 2022, and who required HFNC, NIV, or endotracheal intubation with invasive mechanical ventilation (ETI-IMV) were analyzed. HFNC failure was defined as therapeutic escalation to NIV, and NIV failure as the need for ETI-IMV or death in the ICU. The management of patients with non-invasive respiratory support included the use of combined therapy with different devices. The study period included the first six waves of the pandemic in Spain. Results 424 patients were analyzed, of whom 12 (2.8%) received HFNC, 397 (93.7%) NIV and 15 (3.5%) ETI-IMV as first respiratory support. PaO2/FiO2 was 145 ± 30, 119 ± 26 and 117 ± 29 mmHg, respectively (p = 0.003). HFNC failed in 11 patients (91.7%), who then received NIV. Of the 408 patients treated with NIV, 353 (86.5%) received combination therapy with HFNC. In patients treated with NIV, there were 114 failures (27.9%). Only the value of SAPS II index (p = 0.001) and PaO2/FiO2 (p < 0.001) differed between the six analyzed waves, being the most altered values in the 3rd and 6th waves. Hospital mortality was 18.7%, not differing between the different waves (p = 0.713). Conclusions Severe COVID-19 ARF can be effectively and safely treated with NIV combined with HFNC. The clinical characteristics of the patients did not change between the different waves, only showing a slight increase in severity in the 3rd and 6th waves, with no difference in the outcome.

Metabolic Reprogramming in SARS-CoV-2 Infection Impacts the Outcome of COVID-19 Patients.

Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection triggers inflammatory clinical stages that affect the outcome of patients with coronavirus disease 2019 (COVID-19). Disease severity may be associated with a metabolic imbalance related to amino acids, lipids, and energy-generating pathways. The aim of this study was to characterize the profile of amino acids and acylcarnitines in COVID-19 patients. A multicenter, cross-sectional study was carried out. A total of 453 individuals were classified by disease severity. Levels of 11 amino acids, 31 acylcarnitines, and succinylacetone in serum samples were analyzed by electrospray ionization-triple quadrupole tandem mass spectrometry. Different clusters were observed in partial least squares discriminant analysis, with phenylalanine, alanine, citrulline, proline, and succinylacetone providing the major contribution to the variability in each cluster (variable importance in the projection >1.5). In logistic models adjusted by age, sex, type 2 diabetes mellitus, hypertension, and nutritional status, phenylalanine was associated with critical outcomes (odds ratio=5.3 (95% CI 3.16-9.2) in the severe vs. critical model, with an area under the curve of 0.84 (95% CI 0.77-0.90). In conclusion the metabolic imbalance in COVID-19 patients might affect disease progression. This work shows an association of phenylalanine with critical outcomes in COVID-19 patients, highlighting phenylalanine as a potential metabolic biomarker of disease severity.

Association of the Transmembrane Serine Protease-2 (TMPRSS2) Polymorphisms with COVID-19.

SARS-CoV-2 uses the ACE2 receptor and the cellular protease TMPRSS2 for entry into target cells. The present study aimed to establish if the TMPRSS2 polymorphisms are associated with COVID-19 disease. The study included 609 patients with COVID-19 confirmed by RT-PCR test and 291 individuals negative for the SARS-CoV-2 infection confirmed by RT-PCR test and without antibodies anti-SARS-CoV-2. Four TMPRSS2 polymorphisms (rs12329760, rs2298659, rs456298, and rs462574) were determined using the 5'exonuclease TaqMan assays. Under different inheritance models, the rs2298659 (pcodominant2 = 0.018, precessive = 0.006, padditive = 0.019), rs456298 (pcodominant1 = 0.014, pcodominant2 = 0.004; pdominant = 0.009, precessive = 0.004, padditive = 0.0009), and rs462574 (pcodominant1 = 0.017, pcodominant2 = 0.004, pdominant = 0.041, precessive = 0.002, padditive = 0.003) polymorphisms were associated with high risk of developing COVID-19. Two risks (ATGC and GAAC) and two protectives (GAGC and GAGT) haplotypes were detected. High levels of lactic acid dehydrogenase (LDH) were observed in patients with the rs462574AA and rs456298TT genotypes (p = 0.005 and p = 0.020, respectively), whereas, high heart rate was present in patients with the rs462574AA genotype (p = 0.028). Our data suggest that the rs2298659, rs456298, and rs462574 polymorphisms independently and as haplotypes are associated with the risk of COVID-19. The rs456298 and rs462574 genotypes are related to high levels of LDH and heart rate.

Update on COVID-19 and histophysiology of the male reproductive system / Actualización sobre COVID-19 e histofisiología del sistema reproductor masculino

RESUMEN: La reciente pandemia de la COVID-19 ha sacudido a la sociedad teniendo una importante repercusión en el campo de la salud y de la investigación. Dada su relevancia, se han llevado a cabo estudios sobre los efectos del SARS-CoV-2 en la fisiología humana. En concreto, sobre la posible presencia y transmisión del virus a través del sistema reproductor masculino y su posible efecto en el éxito reproductivo. Conocer si la presencia del virus altera los órganos responsables del desarrollo y maduración de las células de la serie espermatogénica podría revelarnos su implicación en la calidad seminal. Por ello, nos planteamos esta revisión, con el fin de analizar las principales evidencias científicas sobre los efectos del SARS-CoV-2 en la histofisiología del sistema reproductor masculino y sobre la capacidad fecundante de los espermatozoides.

SUMMARY: The recent COVID-19 pandemic has shaken up society, having a significant impact on the field of health and research. Given its relevance, studies have been performed on the effects of SARS-CoV-2 on human physiology. In particular, the possible presence and transmission of the virus through the male reproductive system could affect reproductive success. Knowing if the presence of the virus disrupts the organs responsible for the development and maturation of the cell lines involved in spermatogenesis could reveal its implications in sperm quality. For that reason, we proposed this review, in order to analyze the main scientific evidence on the effects of SARS-CoV-2 on the histophysiology of the male reproductive system and sperm fertilizing capacity.

Qualitative analysis of the twitter account of the Federation of Associations of Midwives of Spain

Introducción: Twitter es la red social con más usuarios en la que la Federación de Asociaciones de Matronas de España (FAME) publica contenido, y al estudiar su cuenta, podemos explicar las características y funcionamiento de la FAME, además de comprender sus intereses a través del análisis de contenido de sus publicaciones. Metodología: Se realizó un estudio cualitativo etnográfico para describir y explicar los elementos que integran el sistema de la red social construida a través de twitter por la FAME, teniendo en cuenta su evolución, estructura e interacciones a través de los tweets publicados. Resultados: Se obtuvieron 358 tweets, clasificados en tres matrices de codificación relacionadas con: Asociaciones de Matronas de España, Menciones de la cuenta de twitter de la FAME y Categorías de los tweets de la FAME. Discusión: La actividad social en twitter fue intensa en los primeros años y escasa en los últimos debido a la pandemia por COVID-19 a diferencia de la mayoría de asociaciones científicas. La FAME utiliza su cuenta para difundir información relacionada con la salud de las mujeres y la visibilidad de las matronas relacionándola con temas de actualidad. Conclusiones: Debido a su creciente impacto, las redes sociales deberían servir como sistemas de información entre ciencia y sociedad, y los profesionales deben conocer y utilizar este tipo de herramientas. Es necesario contar con fuentes de información que reflejen la salud de las mujeres y la FAME demostró su conocimiento de este hecho a través de sus tweets publicados durante el periodo analizado.Alternate :Introduction: Twitter is the social network with the most users in which the Federation of Associations of Midwives of Spain (FAME) publishes content, and by studying your account, we can explain the characteristics and operation of FAME, in addition to understanding their interests through of the content analysis of your publications. Methodology: A qualitative ethnographic study was carried out to describe and explain the elements that make up the social network system built by FAME through twitter, taking into account its evolution, structure and interactions through the published tweets. Results: 358 tweets were obtained, classified in three coding matrices related to: Associations of Midwives of Spain, Mentions of the FAME twitter account and Categories of the FAME tweets. Discussion: Social activity on Twitter was intense in the first years and scarce in the last due to the COVID-19 pandemic, unlike most scientific associations. FAME uses its account to disseminate information related to women's health and the visibility of midwives, relating it to current issues. Conclusions: Due to their growing impact, social networks should serve as information systems between science and society, and professionals should know and use these types of tools. It is necessary to have sources of information that reflect the health of women and the FAME demonstrated its knowledge of this fact through its tweets published during the period analyzed.

Use of the chroma key to study sperm morphology and physiology in virtual environments / Utilización de la herramienta chroma key para el estudio de la morfología y la fisiología espermática en entornos virtuales

RESUMEN: Uno de los retos en el uso de nuevas metodologías y tecnologías durante la crisis sanitaria causada por el virus SARS-CoV-2 ha sido mantener la motivación del alumnado en entornos virtuales. Por ello, el objetivo de este trabajo fue valorar la utilidad de materiales audiovisuales creados con chroma key en la metodología flipped classroom para impartir algunos conceptos teóricos en la asignatura de Biología del Desarrollo en el Grado en Biología de la Universidad de Alicante. Para ello, el profesorado de la asignatura elaboró vídeos utilizando la tecnología chroma key, los cuales fueron visualizados por parte del alumnado antes de las sesiones teóricas online. Durante dichas sesiones, el alumnado puso en práctica los conceptos comentados en los vídeos a través de la realización de actividades. La percepción del estudiantado sobre la metodología empleada se obtuvo mediante un cuestionario de opinión, en el cual el 90 % de los encuestados/as manifestaron que el uso combinado del flipped classroom con chroma key facilitaba el aprendizaje al adaptarse al ritmo y necesidades educativas de cada estudiante. Asimismo, destacaron que el uso de escenografía virtual con chroma key hizo más amena y atrayente la docencia online. En conclusión, el chroma key constituye una herramienta eficaz para realizar materiales educativos en flipped classroom que, además, resulta llamativo y motivador para el alumnado.

SUMMARY: One of the challenges in the use of new methodologies and technologies during the health crisis caused by the SARS-CoV-2 virus has been to keep students motivated in virtual environments. Therefore, the objective of this work was to assess the usefulness of audiovisual materials created with chroma key in the flipped classroom methodology to teach some theoretical concepts in the subject of Developmental Biology in the Degree in Biology at the University of Alicante. For this, the teaching staff of the subject produced videos using chroma key technology, which were viewed by the students before the online theoretical sessions. During these sessions, the students put into practice the concepts discussed in the videos by carrying out activities. The students' perception of the methodology used was obtained through an opinion questionnaire, in which 90 % of the respondents stated that the combined use of the flipped classroom with chroma key facilitated learning by adapting to the rhythm and educational needs of each student. They also highlighted that the use of virtual scenery with chroma key made online teaching more enjoyable and attractive. In conclusion, the chroma key is an effective tool for creating educational materials in the flipped classroom that is also attractive and motivating for students.

The rs8176740 T/A and rs512770 T/C Genetic Variants of the ABO Gene Increased the Risk of COVID-19, as well as the Plasma Concentration Platelets.

We conducted a case-control study in order to evaluate whether ABO gene polymorphisms were associated with a high risk of developing COVID-19 in a cohort of patients. Six ABO gene polymorphisms (rs651007 T/C, rs579459 T/C, rs495828 T/G, rs8176746 A/C, rs8176740 T/A, and rs512770 T/C) were determined using TaqMan genotyping assays in a group of 415 COVID-19 patients and 288 healthy controls. The distribution of rs651007 T/C, rs579459 T/C, rs495828 T/G, and rs8176746 A/C polymorphisms was similar in patients and healthy controls. Nonetheless, under co-dominant (OR = 1.89, pCCo-dominant = 6 × 10-6), recessive (OR = 1.98, pCRecessive = 1 × 10-4), and additive (OR = 1.36, pCAdditive = 3 × 10-3) models, the TT genotype of the rs8176740 T/A polymorphism increased the risk of developing COVID-19. In the same way, under co-dominant, recessive, and additive models, the TT genotype of the rs512770 T/C polymorphism was associated with a high risk of developing COVID-19 (OR = 1.87, pCCo-dominant = 2 × 10-3; OR = 1.87, pCRecessive = 5 × 10-4; and OR = 1.35, pCAdditive = 4 × 10-3, respectively). On the other hand, the GTC and GAT haplotypes were associated with a high risk of COVID-19 (OR = 5.45, pC = 1 × 10-6 and OR = 6.33, pC = 1 × 10-6, respectively). In addition, the rs8176740 TT genotype was associated with high-platelet plasma concentrations in patients with COVID-19. Our data suggested that the ABO rs512770 T/C and rs8176740 T/A polymorphisms increased the risk of developing COVID-19 and the plasma concentration of platelets.

The rs8176740 T/A and rs512770 T/C Genetic Variants of the ABO Gene Increased the Risk of COVID-19, as well as the Plasma Concentration Platelets

We conducted a case-control study in order to evaluate whether ABO gene polymorphisms were associated with a high risk of developing COVID-19 in a cohort of patients. Six ABO gene polymorphisms (rs651007 T/C, rs579459 T/C, rs495828 T/G, rs8176746 A/C, rs8176740 T/A, and rs512770 T/C) were determined using TaqMan genotyping assays in a group of 415 COVID-19 patients and 288 healthy controls. The distribution of rs651007 T/C, rs579459 T/C, rs495828 T/G, and rs8176746 A/C polymorphisms was similar in patients and healthy controls. Nonetheless, under co-dominant (OR = 1.89, pCCo-dominant = 6 ×10−6), recessive (OR = 1.98, pCRecessive = 1 ×10−4), and additive (OR = 1.36, pCAdditive = 3 ×10−3) models, the TT genotype of the rs8176740 T/A polymorphism increased the risk of developing COVID-19. In the same way, under co-dominant, recessive, and additive models, the TT genotype of the rs512770 T/C polymorphism was associated with a high risk of developing COVID-19 (OR = 1.87, pCCo-dominant = 2 ×10−3;OR = 1.87, pCRecessive = 5 ×10−4;and OR = 1.35, pCAdditive = 4 ×10−3, respectively). On the other hand, the GTC and GAT haplotypes were associated with a high risk of COVID-19 (OR = 5.45, pC = 1 ×10−6 and OR = 6.33, pC = 1 ×10−6, respectively). In addition, the rs8176740 TT genotype was associated with high-platelet plasma concentrations in patients with COVID-19. Our data suggested that the ABO rs512770 T/C and rs8176740 T/A polymorphisms increased the risk of developing COVID-19 and the plasma concentration of platelets.

ACE and ACE2 Gene Variants Are Associated With Severe Outcomes of COVID-19 in Men.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current coronavirus disease 2019 (COVID-19) pandemic, affecting more than 219 countries and causing the death of more than 5 million people worldwide. The genetic background represents a factor that predisposes the way the host responds to SARS-CoV-2 infection. In this sense, genetic variants of ACE and ACE2 could explain the observed interindividual variability to COVID-19 outcomes. In order to improve the understanding of how genetic variants of ACE and ACE2 are involved in the severity of COVID-19, we included a total of 481 individuals who showed clinical manifestations of COVID-19 and were diagnosed by reverse transcription PCR (RT-PCR). Genomic DNA was extracted from peripheral blood and saliva samples. ACE insertion/deletion polymorphism was evaluated by the high-resolution melting method; ACE single-nucleotide polymorphism (SNP) (rs4344) and ACE2 SNPs (rs2285666 and rs2074192) were genotyped using TaqMan probes. We assessed the association of ACE and ACE2 polymorphisms with disease severity using logistic regression analysis adjusted by age, sex, hypertension, type 2 diabetes, and obesity. The severity of the illness in our study population was divided as 31% mild, 26% severe, and 43% critical illness; additionally, 18% of individuals died, of whom 54% were male. Our results showed in the codominant model a contribution of ACE2 gene rs2285666 T/T genotype to critical outcome [odds ratio (OR) = 1.83; 95%CI = 1.01-3.29; p = 0.04] and to require oxygen supplementation (OR = 1.76; 95%CI = 1.01-3.04; p = 0.04), in addition to a strong association of the T allele of this variant to develop critical illness in male individuals (OR = 1.81; 95%CI = 1.10-2.98; p = 0.02). We suggest that the T allele of rs2285666 represents a risk factor for severe and critical outcomes of COVID-19, especially for men, regardless of age, hypertension, obesity, and type 2 diabetes.

Direct Medical Costs of Four Vaccine-Preventable Infectious Diseases in Older Adults in Spain

Objective Protection against vaccine-preventable diseases is especially relevant in older adults due to age-related decline in immunity (immunosenescence). However, adult vaccination remains a challenge with overall low coverage rates, which has an impact on both the patients who have these diseases and the health care system in terms of resource use and costs derived. This study aimed to estimate the direct economic impact of herpes zoster, pneumococcal disease, influenza and pertussis in Spanish adults 45 years and older. Methods Data from 2015 were extracted from two Spanish public databases: the Minimum Basic Data Set for Hospitalisations and the Clinical Database of Primary Care. Codes from the International Classification of Diseases and the International Classification of Primary Care were used to identify and classify the diseases analysed. The variables extracted and calculated were hospitalisation (cases, percentage, length of stay, costs, mortality), primary care (cases, percentage, costs) and referrals (cases, percentage, costs). Results were presented for the age groups 45–64 years, 65–74 years, > 74 years and all ages. Results In adults 45 years and older, total costs amounted to €134.1 million in 2015 (i.e. 63.9% of the total direct costs for all age groups): 44.4% due to pneumococcal disease, 39.5% due to influenza, 16.0% due to herpes zoster and 0.1% due to pertussis. Hospitalisations represented 58.1% (€77.9 million) of the total costs, with 15,910 admissions, 144,752 days of hospitalisation and 1170 deaths. Primary care registered 566,556 visits with a cost of €35.0 million, and 269,186 referrals with a cost of €21.1 million. Conclusion The direct economic burden of herpes zoster, pneumococcal disease, influenza and pertussis in adults 45 years and older was high in Spain, and may be underestimated as it only considered medical assistance and not other applicable direct or indirect costs. Increasing vaccination rates in adults may potentially reduce the economic burden derived from these diseases, although future cost-effectiveness analysis including other disease-related costs, vaccination costs and vaccination effectiveness would be needed. Graphical

Spatial effects and institutional quality in the demand for international tourism. An application to COVID-19 impact

This paper analyses the determinants of the tourism demand, following an approach which innovates in a) using spatial models applying a well-founded specification selection process b) exploring the effects of two types of institutions, corruption and Rule of Law, and c) assessing the spillover effects of the COVID-19 shock on the international tourism demand in Portugal and Spain. The study is conducted using a sample of 109 countries for the period 1995-2018. It shows that tourism shocks in neighbouring countries, and particularly the coronavirus pandemic, significantly affect tourism demand in the host country with the same sign as the shock itself, and that the Rule of Law of the destination country influences positively on tourists' inflow. Corruption does not seem to have significant effects on the tourist demand of the host country. From these results, we derive that national governments should provide fair and transparent legal frameworks that generate security for potential tourists. Moreover, national authorities of neighbouring countries are advised to cooperate in both promoting tourism and adopting coordinated actions against negative external shocks that hit them symmetrically, such as COVID-19.

Cellular and humoral functional responses after BNT162b2 mRNA vaccination differ longitudinally between naive and subjects recovered from COVID-19.

We have analyzed BNT162b2 vaccine-induced immune responses in naive subjects and individuals recovered from coronavirus disease 2019 (COVID-19), both soon after (14 days) and later after (almost 8 months) vaccination. Plasma spike (S)-specific immunoglobulins peak after one vaccine shot in individuals recovered from COVID-19, while a second dose is needed in naive subjects, although the latter group shows reduced levels all along the analyzed period. Despite how the neutralization capacity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mirrors this behavior early after vaccination, both groups show comparable neutralizing antibodies and S-specific B cell levels late post-vaccination. When studying cellular responses, naive individuals exhibit higher SARS-CoV-2-specific cytokine production, CD4+ T cell activation, and proliferation than do individuals recovered from COVID-19, with patent inverse correlations between humoral and cellular variables early post-vaccination. However, almost 8 months post-vaccination, SARS-CoV-2-specific responses are comparable between both groups. Our data indicate that a previous history of COVID-19 differentially determines the functional T and B cell-mediated responses to BNT162b2 vaccination over time.

SARS-CoV-2 Proteins Induce Endotoxin Tolerance Hallmarks: A Demonstration in Patients with COVID-19.

According to a large number of reported cohorts, sepsis has been observed in nearly all deceased patients with COVID-19. We and others have described sepsis, among other pathologies, to be an endotoxin tolerance (ET)-related disease. In this study, we demonstrate that the culture of human blood cells from healthy volunteers in the presence of SARS-CoV-2 proteins induced ET hallmarks, including impairment of proinflammatory cytokine production, low MHC class II (HLA-DR) expression, poor T cell proliferation, and enhancing of both phagocytosis and tissue remodeling. Moreover, we report the presence of SARS-CoV-2 blood circulating proteins in patients with COVID-19 and how these levels correlate with an ET status, the viral RNA presence of SARS-CoV-2 in plasma, as well as with an increase in the proportion of patients with secondary infections.

Genesis of Antibiotic Resistance LXII: Mitigation of Antibiotic Resistant Bacterial Pathogen(s) (ARBP) / Clinical Persisters (cPrs) (ARBP - cPrs) herded Pandemic by Effective Preventive Measures

An inspiration for an analysis of plausible of Pandemic impelled by Antibiotic Resistant (AR) infectious diseases (PARID) was derived from the observations during Covid-19 pandemic from February 2020 on till the time of submission of this work and also from a colloquium on the role of multiple socioeconomic factors impinging on pathophysiological factors (lymphatic system functions) contributing for the plausible sixth mass extinction. We have formulated three prong approach namely, (focusing on reducing the antibiotic footprint, drug resistance index - resistance map DRI-RM, implementation of antibiotic stewardship) I: Prevention, II: Treatment (Clinical care), and III: Rehabilitation of cohort with or without comorbidity. Here, we present a multitude of mitigation strategies as a part of I: Prevention: Non-Pharm. Intervention: i. establishment of internet site/home page for issuing and monitoring a national alert for lockdown /followed by a 48 ? 72-hour mandatory preparatory process for stay home / shelter-in order simultaneous call center for guidelines and concerted effort in undertaking the contact tracing of the infected person sustaining quarantine / social isolation, ii. hand washing for 20 seconds before and after work, preparing food, dining, sneezing, coughing, iii. avoid crowds / close contact with sick people, iv. avoid community gathering (not more than 5, no cinemas, conferences, beauty salons), v drink adequate amount of water, vi Wear personal protection equipment while maintaining six feet during the rationing or going to the groceries hospitals or other life demanding event activities then demands demanding activities and see being informed by the local city states national global morbidity and mortality data on a daily basis, vii disinfect the surface of frequent contacts (door knob, toilet seat, dining table, electronic devices namely phone, computers, tv remotes, viii Avoid shaking hands, ix Stay home while taking a short walk in the lawn maintaining 6 feet distance with other person, x Decontaminate arriving from work or unknowingly touching an infected/sick patient by taking shower, washing clothes, xi Avoid touching your face, xii Avoid non-essential travels including the hot zones from where the disease started spreading, xiii Isolate the Footwear before entering the house, xiv No personal handkerchief, xv Decontaminate the personal jewelries, xvi Preferably vegetarian food, if not well cooked meat diet, and xvii Avoid unnecessary trips domestic / aboard / cruses) and well-coordinated pause in stay-home/shelter-in laws. Prophyl. Meas : DDX of the clinically recorded signs and symptoms of infectious diseases, plasma therapy, medically supervised implementation of vaccine campaigns as needed, stock pile of vaccines at each health care centers. Taken together, effective implementation of aforesaid mitigation measures, PARID would be improbable to impart a vile mortality rate. However, the plausibility of a higher morbidity rate of asymptomatic carrier with an array of comorbidity requiring concerted integrative approach for rehabilitation.