Transmission of SARS-CoV2 and Strategies for Control of Infection: Lessons Learnt

Coronavirus has affected all spheres of human life;physical, mental, and social aspects to the limit which has never been experienced before. The major symptoms of COVID-19 infection are fever, cough, respiratory distress, loss of taste, loss of smell, body aches diarrhea, vomiting, and so on. Those having symptoms are tested for their COVID-19 infection status either by Rapid Antigen test or real-time polymerase chain reaction (RTPCR)/Gene Xpert method. Those found COVID-19 positive are shifted to COVID care centers or home isolation for 17 days. The epidemiological triad includes an agent (strains of SARS-CoV-2), host (immunocompromised person), environment (overcrowding, temperature, humidity, contaminated surfaces). Various strategies have been implemented from time to time to break the chain of transmission to contain the spread of infection. Various strategies at an individual level and the community level are implemented. Strategies such as wearing mask, frequent handwashing, maintaining a distance of minimum 2 m between two people, screening for risk factors, quarantine, isolation, surveillance, and contact tracing, defining high-risk areas into hotspots/containment zones or micro containment zones, issuing heating, ventilation, and air-conditioning guidelines, work from home and introduction of vaccine as prophylaxis for prevention against the infection were introduced by India as well as globally. The introduction of infection control measures has some good affects such as lowering air pollution level and controlling the unnecessary plight of the vehicle on roads but the people have faced some serious effects also such as, it pushed people more into poverty and more down in nutritional graph raising country rank in hunger index. Whatever the strategy be proposed it should be implemented keeping to view the pros and cons of each strategy. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.

Covid-19 mortality review: Current smokers Are under-represented and cannot be Explained by ethnicity alone

Aim To compare demographic information between COVID-19 related deaths and those who died of another cause to identify any significant patient factors that may be contributing to COVID-19 deaths. Methods A retrospective systematic review of all medical (acute, general internal, specialty and critical care) mortality was undertaken from 01/03/2020 until 01/07/2020 in a large inner-city hospital. The electronic medical record from both the hospital and GP (where available) were reviewed to identify demographic information with particular reference to characteristics thought to be associated with COVID-19 illness including age, gender, ethnicity and co-morbidities. Death certificate information was used to establish direct cause of death (part 1 a, b or c). Only deaths where death certification was available were included. Results Death certification was available for 279 deaths (median age 77 years;IQR 67-83;133 (48%) female;76 (27%) BAME;67 (24%) admitted to critical care). 121 (43%) died as a direct consequence of COVID-19 illness (median age 77 years;IQR 67-83;61 (50%) female;47 (39%) BAME;31 (26%) admitted to critical care). Non-Caucasian (BAME) ethnicity was associated with increased COVID-19 mortality (RR 1.67;95% CI 1.30-2.15;p 0.0015). BMI, COPD, hypertension, chronic kidney disease and renal replacement therapy were not independent risk factors for COVID-19 deaths compared to deaths by another cause (see table 1). In comparison, type 2 diabetes was stastically associated with COVID-19 deaths (RR 1.3;CI 1.01-1.71;p 0.045). Current smoking status was negatively associated with COVID-19 mortality (RR 0.33;95% CI 0.16-0.65;p 0.0015) with 5.8% current smokers in COVID-19 deaths compared to 23.7% in those who died of another cause. Smoking status was not available for 4 persons (1.4%). Conclusion In our cohort, there appears to be increased mortality from COVID-19 associated with BAME ethnicity and type 2 diabetes. The signal from current smoking status is interesting and cannot fully be explained by ethnicity alone and should prompt further research.

S5 COVID-19 mortality review: current smokers are under-represented and cannot be explained by ethnicity alone

S5 Table 1Commonest co-morbidities for certified deaths related and not related to COVID-19 illness March to July 2020ConclusionIn our cohort, there appears to be increased mortality from COVID-19 associated with BAME ethnicity and type 2 diabetes. The signal from current smoking status is interesting and cannot fully be explained by ethnicity alone and should prompt further research.

SARS-CoV-2 Detection in Gingival Crevicular Fluid.

Understanding the pathophysiology of the coronavirus disease 2019 (COVID-19) infection remains a significant challenge of our times. The gingival crevicular fluid being representative of systemic status and having a proven track record of detecting viruses and biomarkers forms a logical basis for evaluating the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The study aimed to assess gingival crevicular fluid (GCF) for evidence of SARS-CoV-2 in 33 patients who were deemed to be COVID-19 positive upon nasopharyngeal sampling. An attempt was also made to comparatively evaluate it with saliva in terms of its sensitivity, as a diagnostic fluid for SARS-CoV-2. GCF and saliva samples were collected from 33 COVID-19-confirmed patients. Total RNA was extracted using NucliSENS easyMAG (bioMérieux) and eluted in the elution buffer. Envelope gene (E gene) of SARS-CoV-2 and human RNase P gene as internal control were detected in GCF samples by using the TRUPCR SARS-CoV-2 RT qPCR kit V-2.0 (I) in an Applied Biosystems 7500 real-time machine. A significant majority of both asymptomatic and mildly symptomatic patients exhibited the presence of the novel coronavirus in their GCF samples. Considering the presence of SARS-CoV-2 RNA in the nasopharyngeal swab sampling as gold standard, the sensitivity of GCF and saliva, respectively, was 63.64% (confidence interval [CI], 45.1% to 79.60%) and 64.52% (CI, 45.37% to 80.77%). GCF was found to be comparable to saliva in terms of its sensitivity to detect SARS-CoV-2. Saliva samples tested positive in 3 of the 12 patients whose GCF tested negative, and likewise GCF tested positive for 2 of the 11 patients whose saliva tested negative on real-time reverse transcription polymerase chain reaction. The results establish GCF as a possible mode of transmission of SARS-CoV-2, which is the first such report in the literature, and also provide the first quantifiable evidence pointing toward a link between the COVID-19 infection and oral health.