Clinical Characteristics and Clusters Analysis of 1009 COVID-19 Patients in Taiwan: A Registry Study (preprint)

Rationale, aims and objectives: The purpose of this study is to describe the symptoms and clusters characteristics of COVID-19 patients in Taiwan. Method: The Central Epidemic Command Center (CECC) from Taiwan CDC daily press release publications were extracted for patient demographic information (age, gender, case type and cluster) and the symptoms exhibited by the patients before diagnosis were collected. Results: A total of 1030 COVID-19 cases were reported in Taiwan up until the end of March 2021, of which 1009 patients had symptoms available. Of available patient data, 633 patients (62.74%) were symptomatic and 376 patients (37.26%) were asymptomatic, as classified in our study based on the published list of potential symptoms of COVID-19 by WHO. The most prevalent symptoms of our patients were coughing (29.33%), fever (26.56%) and nasal symptoms (20.22%). Our regression analysis found when the first detected patient of the cluster had a subjective sensation of feeling feverish, the number of infected cases in the cluster increased by 4.59 cases. Similarly, patients who experienced a slightly elevated body temperature or fever were associated with an increase of 2.37 and 0.35 cases in each cluster, respectively. Furthermore, increasing one new COVID-19 test per thousand population reduces 7.22 cases per cluster. Conclusions: The majority of reported cases in Taiwan were symptomatic. Symptoms which had the greatest number of patients overall were cough, fever, and nasal symptoms. It is our hope to help physicians to better diagnose current Taiwan COVID-19 patients, while aiding the government in stopping the spread of new cases.

COVID-19 Outbreak After 100 Days Without Community Transmission: Epidemiological Analysis of Factors Associated With Death (preprint)

Background: The SARS-CoV-2 pandemic has cost millions of deaths and lifelong consequences since December 2019. We attempted to evaluate the incidence, distribution, and risk factors associated with death after applying the social distance strategy to the second wave of SARS-CoV-2 in the Danang outbreak (July 2020), Vietnam. Methods: : We retrospectively reviewed the online Danang Hospital reports, gathering the epidemiological history of confirmed SARS-CoV-2 patients. We then conducted a descriptive analysis of Fisher's Phi Coefficient and Cramer's, along with multiple logistic regression models to test the effects of symptomatology and control measures performed by the Vietnamese government on transmission dynamics. The last report we examined was on August 29, 2020. Results: : 389 SARS-CoV-2 confirmed cases related to the Danang outbreak are included in our analysis with a mean age of 47.1 (SD = 18.4), involving 154 men and 235 women, 34 cases of death, and 355 were alive. The study showed significant results related to age, quarantine measures, previous negative SARS-CoV-2 test, and a range of symptoms, including shortness of breath and myalgia (p-value < 0.05). Our multiple-variable analysis suggested the significant risk of death was related to age, severe symptomology, undetected SARS-CoV-2 test results, and prior quarantined SARS-CoV-2 history. Conclusions: : Vietnamese authorities had implemented successful quarantine practices to control the SARS-CoV-2 outbreaks. However, this virus has shown dynamic spread beyond the ability of the country to control its transmission. Adequate screening, social distancing, and adequate care of the elderly and healthcare workers can lower the risk of future outbreaks.

The Efficacy and Adverse Effects of Favipiravir on COVID-19 Patients: A Systematic Review and Meta-Analysis of Published Clinical Trials and Observational Studies (preprint)

Background: The burden of COVID-19 on healthcare systems worldwide requires an efficient treatment option. Favipiravir, a nucleoside analog, is a potential COVID-19 treatment. Therefore, this study aimed to evaluate the efficacy and adverse events of favipiravir in COVID-19 patients.Method: In our systematic review and meta-analysis, we performed searches of PubMed, Scopus, Embase, Web of Science, the Cochrane Library, Google Scholar, European PMC, Virtual Health Library, mRCT, ClinicalTrials.gov, SIGLE, the WHO COVID-19 research article database, Covid-evidence.org, and the iSearch COVID-19 Portfolio with the latest update on February 8 th , 2021. All types of studies in which favipiravir was used on COVID-19 patients were included and extracted by two independent authors. All studies underwent systematic review, data from controlled trials underwent meta-analysis. Our protocol was registered on PROSPERO as CRD42020206305.Findings: 145 studies (15 randomized controlled trials (RCTs), one non-RCT, 21 observational studies, two case series, and 106 case reports) were included. In comparison to standard of care (SOC), favipiravir showed a higher rate of viral clearance at day 5 (RR=1·49, p=0·03), defervescence at day 3 (RR=1·91, p<0·01), chest computed tomography (CT) improvement at day 14-15 (RR=1·40, p<0·01), and hospital discharge at day 10-11 (RR=1·31, p<0·01). Regarding adverse events, the favipiravir groups had higher rates of hyperuricemia (RR=9·42, p<0·01), but lower rates of nausea (RR=0·41, p<0·01) and vomiting (RR=0·09, p=0·02).Interpretation: Adding favipiravir to the standard of care provides better outcomes for COVID-19 patients. Pregnant and lactating women as well as a history of hyperuricemia or gouty arthritis should be noticed when using favipiravir. Using favipiravir could reduce the rate of nausea and vomiting for some patients.Registration Details: Registered on PROSPERO as CRD42020206305.Funding Information: Grant Asian clinical trial network construction project (Number JP20LK0201001J0001) by Japan Agency for Medical Research and Development (AMED).Declaration of Interests: We declare no competing interests.

Impacts of school closure due to COVID-19 on the mobility trend of Japanese citizens (preprint)

School closure was the only main control measure that Japan took into action from late February to late March in 2020. Accurate evaluation of how Japanese citizens responded to the impact of school closure remains a challenge. Data from the Google COVID-19 Community Mobility Report was used to analyze the mobility trend of Japanese citizens regarding six categories, including retail and recreation, grocery and pharmacy, parks, transit stations, workplace, and residential. The median percentage of mobility in all 47 prefectures of Japan was calculated during five periods of time, including one week before school closure, one week, two weeks, three weeks, and four weeks after school closure. There was a significant decline in the mobility trend of transit stations, grocery and pharmacy, parks, retail and recreation, and workplace at the moment after school closure compared to the prior period. Inversely, the mobility trend in staying at home remarkably increased following the implementation of school closure. Our study determined a significant change in the mobility trend of Japanese citizens before and after school closure. These data reflected the responsibility and the consciousness of Japanese citizens in mitigating COVID-19.

Case report: The first COVID-19 case among pregnant women at 21-week in Vietnam

This is the report of the first pregnant woman having COVID-19 in Vietnam. The patient was at 21 weeks of gestation and a high level of serum D-dimer and fibrinogen was observed from admission day to day 5.The patient had lived in Russia before returning to Vietnam where she was diagnosed with COVID-19. Clinical characteristics of this patient were described and there was no major derangement of laboratory parameters. She was asymptomatic when being diagnosed and then developed mild symptoms of COVID-19 after three days of admission. The patient was treated with lopinavir/ritonavir, ampicillin/sulbactam, and Lovenox and continued being hospitalized until April 25th, 2020.We presented the clinical picture of the first COVID-19 pregnant case in Vietnam. This case report highlighted the increased risk of developing coagulopathy even in mild and asymptomatic patients.

Review of infective dose, routes of transmission and outcome of COVID-19 caused by the SARS-COV-2: comparison with other respiratory viruses.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is pandemic. Prevention and control strategies require an improved understanding of SARS-CoV-2 dynamics. We did a rapid review of the literature on SARS-CoV-2 viral dynamics with a focus on infective dose. We sought comparisons of SARS-CoV-2 with other respiratory viruses including SARS-CoV-1 and Middle East respiratory syndrome coronavirus. We examined laboratory animal and human studies. The literature on infective dose, transmission and routes of exposure was limited specially in humans, and varying endpoints were used for measurement of infection. Despite variability in animal studies, there was some evidence that increased dose at exposure correlated with higher viral load clinically, and severe symptoms. Higher viral load measures did not reflect coronavirus disease 2019 severity. Aerosol transmission seemed to raise the risk of more severe respiratory complications in animals. An accurate quantitative estimate of the infective dose of SARS-CoV-2 in humans is not currently feasible and needs further research. Our review suggests that it is small, perhaps about 100 particles. Further work is also required on the relationship between routes of transmission, infective dose, co-infection and outcomes.

Disinfection and sterilization methods to reuse face masks and respirators: A systematic review (preprint)

Background: In the context of COVID-19 pandemic, mask, or respirator wearing is considered one of the essential protection measures for healthcare workers to deal with infected patients. As the demand for face masks strongly increases during the pandemic leading to their shortages, our study aimed to review the current decontamination methods to reuse masks and respirators. Method: On May 18th, 2020, a systematic search for articles reported the methods of disinfection and sterilization for reusing surgical masks or respirators was conducted in eight electronic databases including PubMed, Scopus, Web of Science (ISI), Google Scholar, Cochrane, WHO Global Health Library (GHL), Clinicaltrials and Virtual Health Library (VHL). Manual search was further performed by screening references of included articles and relevant reviews and their related articles in PubMed and Google Scholar. We excluded unreliable extracted data, non-original or secondary research, not available full texts or abstract only. Results: There were 52 articles included in the qualitative synthesis. While hydrogen peroxide gas plasma (HPGP) (59%) degraded the mask filtration performance, vapor hydrogen peroxide (VHP) at varying concentrations and ethylene oxide (EtO) did not affect this. Moist heat incubation (MHI) (at 65 ± 5°C for 20 minutes) and microwave generated steam (MGS) (2 -3 minutes) caused > 4 log reduction of the H5N1 virus and did not degrade the mask filtration performance, while autoclave (at 121°C, 103 kPas) strongly affected this. The mask filtration efficacy was significantly reduced by ethanol 70% but recovered to 86% after the recharge process. Ultraviolet germicidal irradiation (UVGI) (4.32 – 7.2 J/cm2) showed good biocidal efficacy and no degradation of filtration performance but had a poor effect with a dose of 3J/cm2 and degraded the mask with a dose of 18 J/cm2. Conclusion: MHI and UVGI could be highly recommended decontamination methods for reusing masks. VHP could be considered but less effective due to the possible degradation in physical appearances. 

Cluster analysis of epidemiological characteristic features of confirmed cases with the novel coronavirus (COVID-19) outside China: a descriptive study (preprint)

Background: Novel coronavirus COVID-19 has caused significant global outbreaks outside China. Many countries have closed their borders with China and performed obligate protective procedures, however, this disease was still rising worldwide. In this report, we aim to identify transmission patterns from China to other countries, along with describing the disease control situation of countries. Methods: We retrospectively collected information about infected cases with COVID-19 from WHO situation reports, official notification websites of health ministries and reliable local newspapers from each country. Descriptive and cluster analysis was performed to describe the transmission characteristics while the logistic regression test was used to estimate the risk factors for the occurrence of an infected individual with an unknown source. Results: A total of 446 infected cases were recorded from 24 countries outside China until 12 February 2020, with the number of reported infected cases were doubled every 3.08 days (range from 2.6 to 3.9). Besides the spread from China, the transmission was originated from sub-endemic countries (Japan, Thailand, Singapore, Malaysia, France, German). Out of 6 countries got occurrence of an infected individual with unknown source and possible potential factors contributed to this occurrence was a time of epidemic circulating, number of patients and number of clusters when the occurrence still has not happened, and notably, the unreported situation of Chinese tourists information. Conclusions: The situational reports of each country about COVID-19 should be more detailed mentioning the transmissions routes with keeping contact tracing of the unknown cases to increase the control of this disease.