A Modified Portable Health Clinic System for Coronavirus Hotspot Areas (preprint)

This study applied the World Health Organization (WHO) guidelines to redesign the Portable Health Clinic (PHC), as a Remote Healthcare System (RHS), for the spread of COVID-19 containment. Additionally, the proposed system not only collects people data but also classifies the case according to the the main symptoms of coronavirus using the COVID-19 triage process (CT-process) based on the analysis of measurement readings taken from patients, where drones are used as a PHC platform and are equipped with the required sensors and essential COVID-19 medications for testing and treating people at their doorstep autonomously when a full curfew is imposed.

Non-Contact Smart Sensing of Physical Activities during Quarantine Period Using SDR Technology.

The global pandemic of the coronavirus disease (COVID-19) is dramatically changing the lives of humans and results in limitation of activities, especially physical activities, which lead to various health issues such as cardiovascular, diabetes, and gout. Physical activities are often viewed as a double-edged sword. On the one hand, it offers enormous health benefits; on the other hand, it can cause irreparable damage to health. Falls during physical activities are a significant cause of fatal and non-fatal injuries. Therefore, continuous monitoring of physical activities is crucial during the quarantine period to detect falls. Even though wearable sensors can detect and recognize human physical activities, in a pandemic crisis, it is not a realistic approach. Smart sensing with the support of smartphones and other wireless devices in a non-contact manner is a promising solution for continuously monitoring physical activities and assisting patients suffering from serious health issues. In this research, a non-contact smart sensing through the walls (TTW) platform is developed to monitor human physical activities during the quarantine period using software-defined radio (SDR) technology. The developed platform is intelligent, flexible, portable, and has multi-functional capabilities. The received orthogonal frequency division multiplexing (OFDM) signals with fine-grained 64-subcarriers wireless channel state information (WCSI) are exploited for classifying different activities by applying machine learning algorithms. The fall activity is classified separately from standing, walking, running, and bending with an accuracy of 99.7% by using a fine tree algorithm. This preliminary smart sensing opens new research directions to detect COVID-19 symptoms and monitor non-communicable and communicable diseases.

Disparities in critical care resources across Pakistan – findings from a national survey (preprint)

Background: In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in Intensive Care Units (ICUs) across Pakistan. An initial step in creating a plan towards strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.  Methods: To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was adapted from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.  Results: A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%).  We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model while 37.7% of hospitals did not have surge policies. On chi-square analysis, statistically significant differences (p<0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public-private and metropolitan-rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks. Conclusion: Pakistan has an underdeveloped critical care network with significant inequity between   public-private and metropolitan-rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.

Intelligent Non-Contact Sensing for Connected Health Using Software Defined Radio Technology

The unpredictable situation from the Coronavirus (COVID-19) globally and the severity of the third wave has resulted in the entire world being quarantined from one another again. Self-quarantine is the only existing solution to stop the spread of the virus when vaccination is under trials. Due to COVID-19, individuals may have difficulties in breathing and may experience cognitive impairment, which results in physical and psychological health issues. Healthcare professionals are doing their best to treat the patients at risk to their health. It is important to develop innovative solutions to provide non-contact and remote assistance to reduce the spread of the virus and to provide better care to patients. In addition, such assistance is important for elderly and those that are already sick in order to provide timely medical assistance and to reduce false alarm/visits to the hospitals. This research aims to provide an innovative solution by remotely monitoring vital signs such as breathing and other connected health during the quarantine. We develop an innovative solution for connected health using software-defined radio (SDR) technology and artificial intelligence (AI). The channel frequency response (CFR) is used to extract the fine-grained wireless channel state information (WCSI) by using the multi-carrier orthogonal frequency division multiplexing (OFDM) technique. The design was validated by simulated channels by analyzing CFR for ideal, additive white gaussian noise (AWGN), fading, and dispersive channels. Finally, various breathing experiments are conducted and the results are illustrated as having classification accuracy of 99.3% for four different breathing patterns using machine learning algorithms. This platform allows medical professionals and caretakers to remotely monitor individuals in a non-contact manner. The developed platform is suitable for both COVID-19 and non-COVID-19 scenarios.

Cardiac index is associated with oxygenation in COVID-19 acute respiratory distress syndrome.

Eleven participants with COVID-19 acute respiratory distress syndrome requiring mechanical ventilation underwent pulmonary artery catheterization for clinical indications. Clinical interventions or events concurrent with hemodynamic were recorded. Increased cardiac index was associated with worse hypoxemia. Modulation of cardiac index may improve hypoxemia in patients with COVID-19 acute respiratory distress syndrome.

Aortic floating thrombi with lower limb ischemia and renal infarct in COVID-19: A remote thromboembolic complication.

As the COVID-19 pandemic continues, its novel complications are being increasingly recognized, and new mechanisms of the disease are being unraveled. Aortic free-floating thrombus is exceptionally rare, and prompt diagnosis is vital to alleviate its detrimental end organ effects. We present a patient who was previously discharged owing to COVID-19 pneumonia, admitted with acute onset of lower limb pain, and was diagnosed with aortic free-floating thrombus ended up with embolic events. Clinicians should be aware of COVID-19-related thromboembolic complications, and close monitoring of patients with risk factors is vital for a timely and accurate diagnosis and management.

Prevalence, Psychological Responses and Associated Correlates of Depression, Anxiety and Stress in a Global Population, During the Coronavirus Disease (COVID-19) Pandemic.

Uncertainty and isolation have been linked to mental health problems. Uncertainty surrounding the COVID-19 pandemic has the potential to trigger mental health problems, which include anxiety, stress, and depression. This paper evaluates the prevalence, psychological responses, and associated correlates of depression, anxiety, and stress in a global population during the Coronavirus Disease (COVID-19) pandemic. A cross-sectional study design was adopted. 678 completed forms were collected during the COVID-19 quarantine/lockdown. An online questionnaire was designed and DASS-21 was used as the screening tool. A non-probability sampling technique strategy was applied. 50.9% of participants showed traits of anxiety, 57.4% showed signs of stress, and 58.6% exhibited depression. Stress, anxiety, and depression are overwhelmingly prevalent across the globe during this COVID-19 pandemic, and multiple factors can influence the rates of these mental health conditions. Our factorial analysis showed notable associations and manifestations of stress, anxiety, and depressive symptoms. People aged 18-24, females, and people in non-marital relationships experienced stress, anxiety, and depression. Separated individuals experienced stress and anxiety. Married people experienced anxiety. Single and divorced people experienced depression. Unemployed individuals experienced stress and depression. Students experienced anxiety and depression. Canada, the UK, and Pakistan are all countries that are experiencing stress and depression as a whole. An extended number of days in quarantine was associated with increased stress, anxiety, and depression. Family presence yielded lower levels of stress, anxiety, and depression. Lastly, lack of exercise was associated with increased stress, anxiety, and depression.

A Multicentered Study on Epidemiologic and Clinical Characteristics of 37 Neonates With Community-acquired COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) primarily affects adults and spares children, whereas very little is known about neonates. We tried to define the clinical characteristics, risk factors, laboratory, and imagining results of neonates with community-acquired COVID-19. METHODS: This prospective multicentered cohort study included 24 neonatal intensive care units around Turkey, wherein outpatient neonates with COVID-19 were registered in an online national database. Full-term and premature neonates diagnosed with COVID-19 were included in the study, whether hospitalized or followed up as ambulatory patients. Neonates without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were excluded. RESULTS: Thirty-seven symptomatic neonates were included. The most frequent findings were fever, hypoxemia, and cough (49%, 41%, 27%, respectively). Oxygen administration (41%) and noninvasive ventilation (16%) were frequently required; however, mechanical ventilation (3%) was rarely needed. Median hospitalization was 11 days (1-35 days). One patient with Down syndrome and congenital cardiovascular disorders died in the study period. C-reactive protein (CRP) and prothrombin time (PT) levels were found to be higher in patients who needed supplemental oxygen (0.9 [0.1-8.6] vs. 5.8 [0.3-69.2] p = 0.002, 11.9 [10.1-17.2] vs. 15.2 [11.7-18.0] p = 0.01, respectively) or who were severe/critical (1.0 [0.01-8.6] vs. 4.5 [0.1-69.2] p = 0.01, 11.7 [10.1-13.9] vs. 15.0 [11.7-18.0] p = 0.001, respectively). CONCLUSIONS: Symptomatic neonates with COVID-19 had high rates of respiratory support requirements. High CRP levels or a greater PT should alert the physician to more severe disease.

England's Lockdown vs. Sweden's Herd Immunity: A Comparison of the Daily New COVID-19 Cases and Related Deaths Using Comparative Interrupted Time Series Analysis (preprint)

Background: There is a lack of empirical evidence that lockdowns decrease daily cases of COVID-19 and related mortality compared to herd immunity. England implemented a delayed lockdown on March 23, 2020, but Sweden did not. We aim to examine the effect of lockdown on daily COVID-19 cases and related deaths during the first 100 days post-lockdown.Methods: We compared daily cases of COVID-19 infection and related mortality in England and Sweden before and after lockdown intervention using a comparative-interrupted time series analysis.  The period included was from COVID-19 pandemic onset till June 30, 2020.Results: The adjusted-rate of daily COVID-19 infections was eight cases/10,000,000 person higher in England than Sweden before lockdown order (95% CI: 2-14, P=0.01). On the day of intervention (lagged lockdown), England had 693 more COVID-19 cases/10,000,000 person compared to Sweden (95% CI: 467-920, P<0.001). Compared to the pre-intervention period, the adjusted daily confirmed cases rate decreased by 19 cases/ 10,000,000 person compared to Sweden (95% CI: 13-26, P<0.001). There was a rate excess of 1.5 daily deaths/ 10,000,000 person in England compared to Sweden pre-intervention (95% CI: 1-2, P<0.001). The increased mortality rate resulted in 50 excess deaths/ 10,000,000 person related to COVID-19 in England compared to Sweden on the day of lockdown (95% CI: 30-71, P<0.001). Post-intervention, the rate of daily deaths in England decreased by two deaths/ 10,000,000 person compared to Sweden (95% CI: 1-3, P<0.001). During phases one and two of lockdown lifting in England, there was no rebound increase in daily cases or deaths compared to Sweden.  Conclusion: The lockdown order implemented in England on March 23, 2020, effectively decreased the daily new cases rate and related mortality compared to Sweden. There was no short-term increase in COVID-19 cases and related-deaths after the phases one and two of the lifting of restrictions in England compared to Sweden. This study provides empirical, comparative evidence that lockdowns slow the spread of COVID-19 in communities compared to herd immunity.  

England's Lockdown vs. Sweden's Herd Immunity: A Comparison of the Daily New COVID-19 Cases and Related Deaths Using Comparative Interrupted Time Series Analysis (preprint)

Background: There is a lack of empirical evidence that lockdowns decrease daily cases of COVID-19 and related mortality compared to herd immunity. England implemented a delayed lockdown on March 23, 2020, but Sweden did not. We aim to examine the effect of lockdown on daily COVID-19 cases and related deaths during the first 100 days post-lockdown. Methods: We compared daily cases of COVID-19 infection and related mortality in England and Sweden before and after lockdown intervention using a comparative-interrupted time series analysis. The period included was from COVID-19 pandemic onset till June 30, 2020. Results: The adjusted-rate of daily COVID-19 infections was eight cases/10,000,000 person higher in England than Sweden before lockdown order (95% CI: 2-14, P=0.01). On the day of intervention (lagged lockdown), England had 693 more COVID-19 cases/10,000,000 person compared to Sweden (95% CI: 467-920, P<0.001). Compared to the pre-intervention period, the adjusted daily confirmed cases rate decreased by 19 cases/ 10,000,000 person compared to Sweden (95% CI: 13-26, P<0.001). There was a rate excess of 1.5 daily deaths/ 10,000,000 person in England compared to Sweden pre-intervention (95% CI: 1-2, P<0.001). The increased mortality rate resulted in 50 excess deaths/ 10,000,000 person related to COVID-19 in England compared to Sweden on the day of lockdown (95% CI: 30-71, P<0.001). Post-intervention, the rate of daily deaths in England decreased by two deaths/ 10,000,000 person compared to Sweden (95% CI: 1-3, P<0.001). During phases one and two of lockdown lifting in England, there was no rebound increase in daily cases or deaths compared to Sweden. Conclusion: The lockdown order implemented in England on March 23, 2020, effectively decreased the daily new cases rate and related mortality compared to Sweden. There was no short-term increase in COVID-19 cases and related-deaths after the phases one and two of the lifting of restrictions in England compared to Sweden. This study provides empirical, comparative evidence that lockdowns slow the spread of COVID-19 in communities compared to herd immunity.

Broad beans (Vicia faba) and the potential to protect from COVID-19 coronavirus infection.

Due to its high linoleic acid concentration (41%), sesame oil has been proposed to have the potential to protect from COVID-19 coronavirus (SARS-CoV-2) infection, which was characterised by the World Health Organization as a pandemic in March 2020. Unsaturated fatty acids, in general, are active against some enveloped viruses, like COVID-19 coronavirus, due to the incorporation of the fatty acid into the lipid membrane of the viral envelope causing destabilisation of its bilayer. Broad beans (Vicia faba), grown in Northern Sudan, proved to incorporate high content of unsaturated fatty acids and in particular linoleic acid (46.41%). It forms a traditional meal in Sudan and in several Middle East countries. Hence, it is here recommended to be taken as the main meal in combination with sesame oil, as it is commonly practiced in Sudan. Theoretically, it has the potential to protect from COVID-19 coronavirus infections. This proposal needs to be confirmed by further experimental and clinical research.