ABSTRACT
Background The outbreak of coronavirus 2019 (COVID-19) which emerged in December 2019 spread rapidly and created a public health emergency. Geospatial records of case data are needed in real time to monitor and anticipate the spread of infection. Methods This study aimed to identify the emerging hotspots of COVID-19 using a geographic information system (GIS)-based approach. Data of laboratory-confirmed COVID-19 patients from March 15 to June 12, 2020, who visited the emergency department of a tertiary specialized academic hospital in Dubai were evaluated using ArcGIS Pro 2.5. Spatiotemporal analysis, including optimized hotspot analysis, was performed at the community level. Results The cases were spatially concentrated mostly over the inner city of Dubai. Moreover, the optimized hotspot analysis showed statistically significant hotspots (p < 0.01) in the north of Dubai. Waxing and waning hotspots were also observed in the southern and central regions of Dubai. Finally, there were nonsustaining hotspots in communities with a very low population density. Conclusion This study identified hotspots of COVID-19 using geospatial analysis. It is simple and can be easily reproduced to identify disease outbreaks. In the future, more attention is needed in creating a wider geodatabase and identifying hotspots with more intense transmission intensity.
ABSTRACT
BACKGROUND: Our understanding of the severe acute respiratory syndrome coronavirus 2 has evolved since the first reported cases in December 2019, and a greater emphasis has been placed on the hyper-inflammatory response in severely ill patients. The purpose of this study was to determine risk factors for mortality and the impact of anti-inflammatory therapies on survival. AIM: To determine the impact of various therapies on outcomes in severe coronavirus disease 2019 patients with a focus on anti-inflammatory and immune-modulating agents. METHODS: A retrospective analysis was conducted on 261 patients admitted or transferred to the intensive care unit in two community hospitals between March 12, 2020 and June 17, 2020. Totally 167 patients received glucocorticoid (GC) therapy. Seventy-three patients received GC alone, 94 received GC and tocilizumab, 28 received tocilizumab monotherapy, and 66 received no anti-inflammatory therapy. RESULTS: Patient survival was associated with GC use, either alone or with tocilizumab, and decreased vasopressor requirements. Delayed administration of GC was found to decrease the survival benefit of GC therapy. No difference in survival was found with varying anticoagulant doses, convalescent plasma, tocilizumab monotherapy; prone ventilation, hydroxychloroquine, azithromycin, or intravenous ascorbic acid use. CONCLUSION: This analysis demonstrated the survival benefit associated with anti-inflammatory therapy of GC, with or without tocilizumab, with the combination providing the most benefit. More studies are needed to assess the optimal timing of anti-inflammatory therapy initiation.
ABSTRACT
Zinc deficiency is linked to poor prognosis in COVID-19 patients while clinical trials with zinc demonstrate better clinical outcomes. The molecular targets and mechanistic details of the anti-coronaviral activity of zinc remain obscure. We show that zinc not only inhibits the SARS-CoV-2 main protease (Mpro) with nanomolar affinity, but also viral replication. We present the first crystal structure of the Mpro-Zn2+ complex at 1.9 Å and provide the structural basis of viral replication inhibition. We show that Zn2+ coordinates with the catalytic dyad at the enzyme active site along with two previously unknown water molecules in a tetrahedral geometry to form a stable inhibited Mpro-Zn2+ complex. Further, the natural ionophore quercetin increases the anti-viral potency of Zn2+. As the catalytic dyad is highly conserved across SARS-CoV, MERS-CoV and all variants of SARS-CoV-2, Zn2+ mediated inhibition of Mpro may have wider implications.