COVID-19 as many-faced Janus. On the classification of a new coronavirus infection

The spectrum of the clinical manifestations in patients with COVID-19 varies from asymptomatic to severe forms of the disease leading to death. The most commonly affected in patients with COVID-19 system is the respiratory system, but other organ systems can also be affected by the virus. We propose a classification of the clinical forms of COVID-19, which includes: acute respiratory infection (affecting only the upper respiratory tract);pneumonia: without ARF, with ARF;anosmia/parosmia/ cacosmia;cerebral form (meningitis, meningoencephalitis);gastrointestinal form, including hepatitis;oligosymptomatic form/ asymptomatic form;combined forms. Sepsis, septic (infectious-toxic) shock;DIC, thrombosis and thromboembolism are proposed to be considered as complications of the underlying disease. Present classification can help clinicians to diagnose COVID-19 at an early stage, identify atypical infection forms, and assign appropriate treatment. © 2021, Dynasty Publishing House. All rights reserved.

Low Rates of Bacterial Co-infection in Hospitalized Patients with COVID-19

Background. The rate of bacterial co-infection in inpatients with COVID-19 is unknown, however, patients who are hospitalized with COVID-19 often receive antibiotics for community-acquired bacterial pneumonia (CABP). Reducing unnecessary antibiotic usage in this population is important to prevent adverse effects and slow the development of antimicrobial resistance. Methods. We performed a retrospective chart review on patients admitted to our health system between March and May 2020 with confirmed COVID-19 by nasopharyngeal PCR. We reviewed patients with positive cultures from urine, blood, sputum, and sterile sites. Positive cultures were reviewed to determine if they represented a true infection versus a contaminant or colonization. Patients with true infections were categorized as having a co-infection (CI) if the positive culture was collected within 48 hours of initial positive SARS-CoV-2 PCR test. Additional data was collected on patient demographics, types of infections, organisms grown, and antibiotic usage. Results. 902 patients were admitted with positive SARS-CoV-2 tests during the study period. Of these, 47 patients (5.2%) had a bacterial CI. Some patients had more than one CI, with 53 total CIs identified. The median age of patients with CI was 66 years old (39 - 90). Tables 1 and 2 describe patient characteristics and infections. A subgroup analysis on types of bacteria was done on the 20 patients with a respiratory CI, who accounted for 2.2% of all COVID-positive patients admitted during the study period. In these infections, Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae were the most common organisms, accounting for 60%, 15%, and 10% infections, respectively. Conclusion. The overall rate of CIs in patients admitted with COVID-19 was low. Some of these CIs may represent an "incidentally positive" COVID-19 test if a patient presented with one infection and had asymptomatic carriage of SARS-CoV-2 when community prevalence was high. Further analysis is needed to evaluate specific risk factors for co-infection.

Description of Super-infections in Hospitalized Patients with COVID-19

Background. The rate of bacterial and fungal super-infections (SI) in inpatients with COVID-19 is unknown. In this study, we aimed to identify and describe patients that developed secondary infections while hospitalized with COVID-19. Methods. We performed a retrospective chart review on patients admitted to our health system between March and May 2020 with confirmed COVID-19 by nasopharyngeal PCR. We reviewed patients with positive cultures from urine, blood, sputum, and sterile sites. Patients with positive cultures had cases reviewed to determine if they represented a true infection, defined by CDC criteria. SIs were defined as infections that occurred at least 48 hours or longer after the initial positive SARSCoV-2 test. Additional data was collected on patient demographics, COVID-related therapies, types of infections, and outcomes. Results. 902 patients were admitted with COVID-19 during our study period. Of these, 52 patients (5.8%) developed a total of 82 SIs. Tables 1 and 2 describe patient and infection characteristics. Patients identified as having a SI were admitted for a median of 30 days;56% had mortality, and 39% of remaining patients were readmitted within 90 days. Conclusion. Overall, the rate of SIs in patients admitted with COVID-19 is low. These patients had a long length of stay, which may be either a cause of SI or an effect. Further analysis with matched COVID-positive control patients who do not develop SIs is needed to evaluate the risk of development of SIs in relation to presenting respiratory status, COVID-related therapies, and other patient-specific factors.

Clinical and epidemiological significance of Diarrhea in children with COVID-19

Objective. To show the clinical and epidemiological significance of diarrhea and SARS-CoV-2 excretion in the feces of COVID-19 patients in children. Patients and methods. 42 case histories of children with COVID-19 hospitalized and examined by PCR for SARS-CoV-2 RNA in nasal and oropharyngeal swabs, as well as in feces were ana-lyzed. Design: retrospective analysis of patient medical records. Results. It was shown that watery diarrhea was observed in 2.4% of children with verified COVID-19, vomiting and abdominal pain – in 4.8%. In the blood test, lymphocytosis prevailed. In all the examined patients, SARS-CoV-2 RNA was detected not only in nasal and oropharyngeal swabs, but also in feces, while in 4.8% of children, the virus was excreted in feces for a longer time than in the respiratory tract. In the epidemiological history of 100% of patients, there was no indication of contact with a patient with acute diarrhea. Conclusion. These facts indicate that, despite the infrequently registered diarrhea in COVID-19 in childhood, the detection of SARS-CoV-2 RNA in the feces of a significant number of such patients may have important clinical and epidemiological significance, contributing to the fecaloral transmission of this infection, which requires additional study due to the small number and incon-sistency of currently known data.

Commanding Curiosity from the Couch: MSL Remote Operations, Challenges, and Path Ahead

This paper describes how the Mars Science Laboratory (MSL) project prepared for and successfully began Curiosity rover Mars operations from their homes in response to the COVID-19 work-from-home orders. In a very short period, the team developed procedures and executed a remote operations readiness test in parallel with the team's support for nominal operations. Continuing regular rover operations with an entirely remote team had not previously been considered feasible due to a variety of factors. These included both the human factors, such as multiple concurrent person-to-person interactions of the uplink planning team, as well as technical factors, such as reliance on powerful workstations dedicated to graphically intensive software tools used for planning. The test was conducted on March 12, 2020, with both the downlink and uplink teams successfully simulating a near full planning day. The JPL administration announced the transition to mandatory telework on Monday, March 16. MSL stood down the uplink planning originally scheduled for the next day while downlink continued monitoring the rover. Full operations then resumed per schedule with nearly the entire operations team teleworking on Friday, March 20, during which the team planned rover activities for three Martian days (sols). These activities included the successful drilling of the "Edinburgh" rock target, a highly complex robotic arm contact science activity. As of October 1, 2020, the Mars Science Laboratory mission operations team has conducted 88 remote tactical uplink shifts for a total of 190 sols of planned rover activity, which accounts for more than 6% of the mission to date. In this period the rover has completed four drilling campaigns and driven over 1160 meters towards its next major science target - a sulfate bearing geologic unit at the foot of Mount Sharp. Success has not been without its challenges. Many of these have been addressed while others will remain in some form until the team can safely return to JPL, which in turn is the largest challenge for the future.

Commanding Curiosity from the Couch: MSL Remote Operations, Challenges, and Path Ahead

This paper describes how the Mars Science Laboratory (MSL) project prepared for and successfully began Curiosity rover Mars operations from their homes in response to the COVID-19 work-from-home orders. In a very short period, the team developed procedures and executed a remote operations readiness test in parallel with the team's support for nominal operations. Continuing regular rover operations with an entirely remote team had not previously been considered feasible due to a variety of factors. These included both the human factors, such as multiple concurrent person-to-person interactions of the uplink planning team, as well as technical factors, such as reliance on powerful workstations dedicated to graphically intensive software tools used for planning. The test was conducted on March 12, 2020, with both the downlink and uplink teams successfully simulating a near full planning day. The JPL administration announced the transition to mandatory telework on Monday, March 16. MSL stood down the uplink planning originally scheduled for the next day while downlink continued monitoring the rover. Full operations then resumed per schedule with nearly the entire operations team teleworking on Friday, March 20, during which the team planned rover activities for three Martian days (sols). These activities included the successful drilling of the 'Edinburgh' rock target, a highly complex robotic arm contact science activity. As of October 1, 2020, the Mars Science Laboratory mission operations team has conducted 88 remote tactical uplink shifts for a total of 190 sols of planned rover activity, which accounts for more than 6% of the mission to date. In this period the rover has completed four drilling campaigns and driven over 1160 meters towards its next major science target - a sulfate bearing geologic unit at the foot of Mount Sharp. Success has not been without its challenges. Many of these have been addressed while others will remain in some form until the team can safely return to JPL, which in turn is the largest challenge for the future. © 2021 IEEE.

A Multicenter Prospective Registry Study of Lung Transplant Recipients Hospitalized with COVID-19

Purpose Outcomes of lung transplant recipients (LTR) hospitalized for COVID-19 and comparisons to non-lung solid organ transplant recipients (SOTR) are incompletely described. Methods Using a multicenter prospective registry of SOTR, we examined 28-day outcomes (mortality [primary outcome], intensive care unit (ICU) admission, mechanical ventilation, and bacterial pneumonia) among both LTR and non-lung SOTR hospitalized with laboratory-confirmed COVID-19 diagnosed between March 1, 2020 and September 21, 2020. Data were analyzed using Stata (StataCorp, College Station, TX);chi-square tests were used to compare categorical variables and multivariable logistic regression was used to assess risk factors for mortality. Results The cohort included 72 LTR and 392 non-lung SOTR (Table 1). Overall, 28-day mortality trended higher in LTR vs. non-lung SOTR (27.8% vs. 19.9%, P=0.136). Other 28-day outcomes were similar between LTR and non-lung SOTR: ICU admission (45.8% vs. 39.1%, P=0.28), mechanical ventilation (32.9% vs. 31.1%, P=0.78), and bacterial pneumonia (15.3% vs. 8.2%, P=0.063). Congestive heart failure, diabetes, age >65 years, and obesity (BMI >= 30) were independently associated with mortality in non-lung SOTR, but not in LTR (Table 2). Conclusion In this large prospective cohort comparing lung and non-lung SOTR hospitalized for COVID-19, there were high but not significantly different rates of short-term morbidity and mortality. Baseline comorbidities appeared to drive mortality in non-lung SOTR but not LTR. Further studies are needed to identify risk factors for mortality among LTR.

Ensuring the safety of personnel in radiology departments during the COVID-19 epidemic

Health care workers are at high risk of coronavirus infection due to direct contact with patients and the predominant airborne COVID- 19 transmission route. Radiographers are among the first-line medical personnel to come into contact with patients who have fallen ill. Lack of a technician directly affects the radiology departments’ performance, as it requires either a search for a new employee or a radiologist to perform the examination, which slows down work and increases the risk of stopping the department. Objective. To estimate the change in the proportion of dropped out radiographers after the department division into «clean» and «dirty» zones. Material and methods. Radiographers and other medical personnel performing patient positioning (aides) were included in the study. Dropped out employees were divided into three groups: Group 1 - radiographers before the implementation of outpatient CTcenters (working in the scan room and control room at the same time from 01.02.20 to 10.04.20);Group 2 - radiographers in outpatient CT centers (did not contact patients, working in the control room, a «clean» area, from 11.04.20 to 24.06.20);Group 3 - aides (welcomed and positioned the patients on the CT table, working in the scan room, a «dirty» area, from 11.04.20 to 24.06.20). The study included medical staff in Moscow city outpatient clinics, working in computer tomography rooms from 01.02.20 to 24.06.20. We excluded outpatient CT centers employees where Group 2 had contact with Group 3 (automatically contaminating the second group) or incomplete data points from the study. Results. Before the pandemic, 90 radiographers (71 women and 19 men, mean age 52.97±5.31 years) worked in outpatient CT rooms. The total number of nursing staff during the pandemic was 201 people. In Group 2, the share of temporary leaves was 8.7%. In Groups 1 and 3, it was 42.2 and 38.8%, respectively. As a result, the proportion of dropped out radiographers after the introduction of outpatient CT centers decreased by 33.5% compared to the period before the deployment of outpatient CT centers. Conclusion. Changes in the workflow of the radiology departments during the COVID-19 pandemic led to a justified increase in the number of CT room staff by introducing aides, termination of radiographers’ contacts with patients to reduce the risk of infection, a decrease of the department shutdown risk, and also served as a basis for increasing the capacity by splitting the functionality of a single unit, which usually rests on the shoulders of a single employee. © 2020, Media Sphera Publishing Group. All rights reserved.