Effect of awareness, quarantine and vaccination as control strategies on COVID-19 with Co-morbidity and Re-infection.

In this paper, a deterministic compartmental model is presented to assess the impact of vaccination and non-pharmaceutical interventions (social distance, awareness, face mask, and quarantine) on the transmission dynamics of COVID-19 with co-morbidity and re-infection. An expression for the basic reproduction number is then derived for this model. Theoretical analysis shows that the model exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity. But for the case of no re-infection, the model has a globally asymptotically stable disease-free equilibrium (DFE) when the basic reproduction number is less than unity. Furthermore, it is shown that in the case of no re-infection, a unique endemic equilibrium point (EEP) of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity. From the global sensitivity and uncertainty analysis, we have identified mask coverage, mask efficacy, vaccine coverage, vaccine efficacy, and contact rate as the most influential parameters influencing the spread of COVID-19. Numerical simulation results show that the use of effective vaccines with proper implementation of non-pharmaceutical interventions could lead to the elimination of COVID-19 from the community. Numerical simulations also suggest that the control strategy that ensures a continuous and effective mass vaccination program is the most cost-effective control strategy. The study also shows that in the presence of any co-morbidity and with the occurrence of re-infection, the disease burden may increase.

Survey on the use of general practice telehealth services for children during the COVID-19 pandemic.

In 2020, the Australian Government introduced temporary Medicare Benefits Schedule item numbers for GP telehealth consultations to combat the spread of the COVID-19 pandemic. Patient satisfaction has been positive; however, the paediatric cohort has not been sufficiently investigated. We aimed to explore the rates of satisfaction of paediatric patients undergoing telehealth compared with standard consultations, as well as looking at any barriers faced. We developed and distributed an online survey to eligible patients (or their guardian) aged 0-17years who underwent a general practice telehealth consultation between March 2020 and May 2020 at 12 participating medical centres in Perth. We received 68 total responses with 35 deemed complete. The mean (s.d.) age of participants was 8.22 (5.34) years. A total of 88.2% of participants indicated that the level of care provided via telehealth was equal to or better than a standard consultation. A total of 70.6% of patients reported no barriers faced, with the most common barrier being lack of examination (20.6%). This study describes high public satisfaction with telehealth GP consultations for paediatric patients, with a good level of patient outcomes and minimal barriers. There may be benefit to widespread and ongoing use of telehealth consultations for the paediatric population and the extension of the temporary Medicare Benefits Schedule items.

Atrial appendage angiotensin-converting enzyme-2, aging and cardiac surgical patients: a platform for understanding aging-related coronavirus disease-2019 vulnerabilities.

PURPOSE OF REVIEW: Hospitalizations for COVID-19 dramatically increase with age. This is likely because of increases in fragility across biological repair systems and a weakened immune system, including loss of the cardiorenal protective arm of the renin--angiotensin system (RAS), composed of angiotensin-converting enzyme-2 (ACE2)/angiotensin-(1--7) [Ang-(1--7)] and its actions through the Mas receptor. The purpose of this review is to explore how cardiac ACE2 changes with age, cardiac diseases, comorbid conditions and pharmaceutical regimens in order to shed light on a potential hormonal unbalance facilitating SARs-CoV-2 vulnerabilities in older adults. RECENT FINDINGS: Increased ACE2 gene expression has been reported in human hearts with myocardial infarction, cardiac remodeling and heart failure. We also found ACE2 mRNA in atrial appendage tissue from cardiac surgical patients to be positively associated with age, elevated by certain comorbid conditions (e.g. COPD and previous stroke) and increased in conjunction with patients' chronic use of antithrombotic agents and thiazide diuretics but not drugs that block the renin--angiotensin system. SUMMARY: Cardiac ACE2 may have bifunctional roles in COVID-19 as ACE2 not only mediates cellular susceptibility to SARS-CoV-2 infection but also protects the heart via the ACE2/Ang-(1--7) pathway. Linking tissue ACE2 from cardiac surgery patients to their comorbid conditions and medical regimens provides a unique latform to address the influence that altered expression of the ACE2/Ang-(1-7)/Mas receptor axis might have on SARs-CoV-2 vulnerability in older adults.

Nonadherence to appropriate tidal volume and PEEP in children with pARDS at a single center.

BACKGROUND: Low tidal volume and adequate positive end-expiratory pressure (PEEP) are evidence-based approaches for pediatric acute respiratory distress syndrome (pARDS), however, data are limited regarding their use since pARDS guidelines were revised in 2015. OBJECTIVE: To identify prevalence of, and factors associated with, nonadherence to appropriate tidal volume and PEEP in children with pARDS. METHODS: Retrospective cohort study of children 1 month to <18 years with pARDS who received invasive mechanical ventilation from 2016 to 2018 in a single pediatric intensive care unit (PICU). RESULTS: At 24 h after meeting pARDS criteria, 48/86 (56%) patients received tidal volume ≤8 ml/kg of ideal body weight and 45/86 (52%) received appropriate PEEP, with 22/86 (26%) receiving both. Among patients ≥2 years of age, a lower proportion of patients with overweight/obesity (9/25, 36%) had appropriate tidal volume versus those in the normal or underweight category (16/22, 73%, p = 0.02). When FIO2 was ≥50%, PEEP was appropriate in 19/60 (32%) cases versus 26/26 (100%) with FIO2 < 50% (p < 0.0001). pARDS was documented in the progress note in 7/86 (8%) patients at 24 h. Severity of pARDS, documentation in the progress note, and other clinical factors were not significantly associated with use of appropriate tidal volume and PEEP, however pARDS was documented more commonly in patients with severe pARDS. CONCLUSIONS: In a single PICU in the United States, children with pARDS did not receive appropriate tidal volume for ideal body weight nor PEEP. Targets for improving tidal volume and PEEP adherence may include overweight patients and those receiving FIO2 ≥ 50%, respectively.

The Viability of Hematopoietic Progenitor Cell Grafts after Cryopreservation Does Not Predict Delayed Engraftment in Allogeneic Hematopoietic Stem Cell Transplantation.

OBJECTIVE: Due to the COVID-19 pandemic, more peripheral blood stem cell (PBSC) allogeneic grafts are being frozen and infused thawed. Our objective was to study the influence of graft viability on engraftment outcome in patients treated with PBSCs. METHODS: Using trypan blue stain, we compared total nucleated cell (TNC) viability of both fresh and thawed grafts in allogeneic PBSCs. RESULTS: The viability of thawed PBSC grafts median was 74%, and fresh was 99.0%. The median number of CD34 + cells/kg infused thawed was 6.3 × 106/kg and median time to neutrophil and platelet engraftment was 17.5 and 20 days. Median number of CD34 + cells/kg infused fresh was 5.1 × 106/kg and median time to neutrophil and platelet engraftment was 18 and 19 days. There were no statistically significant differences in the time to engraftment between the 2 groups. CONCLUSION: A low TNC viability of thawed PBSC grafts does not have an effect on time to neutrophil and platelet engraftment when more than 2.85 × 106 CD34 + cells/kg are infused.

Dynamics of novel COVID-19 in the presence of Co-morbidity.

A novel coronavirus (COVID-19) has emerged as a global serious public health issue from December 2019. People having a weak immune system are more susceptible to coronavirus infection. It is a double challenge for people of any age with certain underlying medical conditions including cardiovascular disease, diabetes, high blood pressure and cancer etc. Co-morbidity increases the probability of COVID-19 complication. In this paper a deterministic compartmental model is formulated to understand the transmission dynamics of COVID-19. Rigorous mathematical analysis of the model shows that it exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity. For the case of no re-infection it is shown that having the reproduction number less than one is necessary and sufficient for the effective control of COVID-19, that is, the disease free equilibrium is globally asymptotically stable when the reproduction threshold is less than unity. Furthermore, in the absence of reinfection, a unique endemic equilibrium of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity. Numerical simulations of the model, using data relevant to COVID-19 transmission dynamics, show that the use of efficacious face masks publicly could lead to the elimination of COVID-19 up to a satisfactory level. The study also shows that in the presence of co-morbidity, the disease increases significantly.

ZINC USE IS ASSOCIATED WITH IMPROVED OUTCOMES IN COVID-19: RESULTS FROM THE CRUSH-COVID REGISTRY

B Introduction: b Previous work has shown correlations of zinc deficiency and poor outcomes in COVID-19 patients.i Little is known, however, about the use of zinc supplementation and its potential benefits in hospitalized COVID-19 positive individuals. B Conclusions: b Zinc use may be associated with improved clinical outcomes in hospitalized COVID-19 patients. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Global survey-based assessment of lifestyle changes during the COVID-19 pandemic.

Along with the major impact on public health, the COVID-19 outbreak has caused unprecedented concerns ranging from sudden loss of employment to mental stress and anxiety. We implemented a survey-based data collection platform to characterize how the COVID-19 pandemic has affected the socio-economic, physical and mental health conditions of individuals. We focused on three broad areas, namely, changes in social interaction during home confinement, economic impact and their health status. We identified a substantial increase in virtual interaction among individuals, which might be a way to alleviate the sudden unprecedented mental health burden, exacerbated by general awareness about viral infections or other manifestations associated with them. The majority of participants (85%) lived with one or more companions and unemployment issues did not affect 91% of the total survey takers, which was one of the crucial consequences of the pandemic. Nevertheless, measures such as an increased frequency of technology-aided distant social interaction, focus on physical fitness and leisure activities were adopted as coping mechanisms during this period of home isolation. Collectively, these metrics provide a succinct and informative summary of the socio-economic and health impact of the COVID-19 pandemic on the individuals. Findings from our study reflect that continuous surveillance of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide. Given the limitations of analyzing the large number of variables, we have made the raw data publicly available on the OMF ME/CFS Data Center server to facilitate further analyses (https://igenomed.stanford.edu/dataset/survey-study-on-lifestyle-changes-during-covid-19-pandemic).

A decentralised point-of-care testing model to address inequities in the COVID-19 response.

The COVID-19 pandemic is growing rapidly, with over 37 million cases and more than 1 million deaths reported by mid-October, 2020, with true numbers likely to be much higher in the many countries with low testing rates. Many communities are highly vulnerable to the devastating effects of COVID-19 because of overcrowding in domestic settings, high burden of comorbidities, and scarce access to health care. Access to testing is crucial to globally recommended control strategies, but many communities do not have adequate access to timely laboratory services. Geographic dispersion of small populations across islands and other rural and remote settings presents a key barrier to testing access. In this Personal View, we describe a model for the implementation of decentralised COVID-19 point-of-care testing in remote locations by use of the GeneXpert platform, which has been successfully scaled up in remote Aboriginal and Torres Strait Islander communities across Australia. Implementation of the decentralised point-of-care testing model should be considered for communities in need, especially those that are undertested and socially vulnerable. The decentralised testing model should be part of the core global response towards suppressing COVID-19.

Microfluidic Point-of-Care Testing: Commercial Landscape and Future Directions.

Point-of-care testing (POCT) allows physicians to detect and diagnose diseases at or near the patient site, faster than conventional lab-based testing. The importance of POCT is considerably amplified in the trying times of the COVID-19 pandemic. Numerous point-of-care tests and diagnostic devices are available in the market including, but not limited to, glucose monitoring, pregnancy and infertility testing, infectious disease testing, cholesterol testing and cardiac markers. Integrating microfluidics in POCT allows fluid manipulation and detection in a singular device with minimal sample requirements. This review presents an overview of two technologies - (a.) Lateral Flow Assay (LFA) and (b.) Nucleic Acid Amplification - upon which a large chunk of microfluidic POCT diagnostics is based, some of their applications, and commercially available products. Apart from this, we also delve into other microfluidic-based diagnostics that currently dominate the in-vitro diagnostic (IVD) market, current testing landscape for COVID-19 and prospects of microfluidics in next generation diagnostics.