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2.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-336157

ABSTRACT

Timely and accurate detection of SARS-CoV-2 variants of concern (VOCs) is urgently needed for pandemic surveillance and control. However, current methods are limited by the low sensitivity, long turn-around time or high cost. Here, we report a nucleic acid testing-based method aiming to detect and discriminate SARS-CoV-2 VOCs by combining R T- R PA and C RISPR-Cas12a d etecting assays (RRCd). With a detection limit of 10 copies RNA/reaction, RRCd was validated in 204 clinical samples, showing 99% positive predictive agreement and 100% negative predictive agreement, respectively. Critically, using specific crRNAs, representatives of single nucleotide polymorphisms and small deletions in SARS-CoV-2 VOCs including N501Y, T478K and ΔH69-V70 were discriminated by RRCd, demonstrating 100% accuracy in clinical samples with C t < 33. The method completes within 65 min and could offer visible results without using any electrical devices, which may facilitate point-of-care testing of SARS-CoV-2 and its variants.

3.
Ther Adv Respir Dis ; 16: 17534666221091931, 2022.
Article in English | MEDLINE | ID: covidwho-1808190

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients with severe cases have received oxygen therapy through a high-flow nasal cannula (HFNC). OBJECTIVES: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk factors for HFNC failure. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of randomized controlled trials (RCTs) and observational studies of HFNC in patients with COVID-19 published in English from January 1st, 2020 to August 15th, 2021. The primary aim was to assess intubation, mortality, and failure rates in COVID-19 patients supported by HFNC. Secondary aims were to compare HFNC success and failure groups and to describe the risk factors for HFNC failure. RESULTS: A total of 25 studies fulfilled selection criteria and included 2851 patients. The intubation, mortality, and failure rates were 0.44 (95% confidence interval (CI): 0.38-0.51, I2 = 84%), 0.23 (95% CI: 0.19-0.29, I2 = 88%), and 0.47 (95% CI: 0.42-0.51, I2 = 56%), respectively. Compared to the success group, age, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, D-dimer, lactate, heart rate, and respiratory rate were higher and PaO2, PaO2/FiO2, ROX index (the ratio of SpO2/FiO2 to respiratory rate), ROX index after the initiation of HFNC, and duration of HFNC were lower in the failure group (all Ps < 0.05). There were also more smokers and more comorbidities in the failure group (all Ps < 0.05). Pooled odds ratios (ORs) revealed that older age (OR: 1.04, 95% CI: 1.01-1.07, P = 0.02, I2 = 88%), a higher white blood cell (WBC) count (OR: 1.06, 95% CI: 1.01-1.12, P = 0.02, I2 = 0%), a higher heart rate (OR: 1.42, 95% CI: 1.15-1.76, P < 0.01, I2 = 0%), and a lower ROX index(OR: 0.61, 95% CI: 0.39-0.95, P = 0.03, I2 = 93%) after the initiation of HFNC were all significant risk factors for HFNC failure. CONCLUSIONS: HFNC is an effective way of providing respiratory support in the treatment of COVID-19 patients. Older age, a higher WBC count, a higher heart rate, and a lower ROX index after the initiation of HFNC are associated with an increased risk of HFNC failure.


Subject(s)
COVID-19 , Respiratory Insufficiency , COVID-19/therapy , Cannula , Humans , Oxygen Inhalation Therapy/adverse effects , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Risk Factors
4.
BMC Pregnancy Childbirth ; 22(1): 317, 2022 Apr 13.
Article in English | MEDLINE | ID: covidwho-1789107

ABSTRACT

The SARS-CoV-2 pandemic is rapidly evolving and remains a major health challenge worldwide. With an increase in pregnant women with COVID-19 infection, we recognized an urgent need to set up a multidisciplinary taskforce to provide safe and holistic care for this group of women. In this review of practice in a tertiary hospital in Singapore, we discuss the key considerations in setting up an isolation maternity unit and our strategies for peripartum and postpartum care. Through teleconsultation, we involve these women and their families in the discussion of timing and mode of birth, disposition of babies after birth and safety of breastfeeding to enable them to make informed decisions and individualize their care.


Subject(s)
COVID-19 , Female , Humans , Pandemics/prevention & control , Pregnancy , Pregnant Women , SARS-CoV-2 , Tertiary Care Centers
5.
Nat Commun ; 13(1): 1788, 2022 04 04.
Article in English | MEDLINE | ID: covidwho-1773979

ABSTRACT

The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the generation of variants that may diminish host immune responses to vaccine formulations. Here we show a registered observational clinical trial (NCT04795414), we assess the safety and immunogenicity of the inactivated SARS-CoV-2 vaccine BBIBP-CorV in a cohort of 1006 vaccine recipients. No serious adverse events are observed during the term of the study. Detectable virus-specific antibody is measured and determined to be neutralizing in 698/760 (91.84%) vaccine recipients on day 28 post second vaccine dose and in 220/581 (37.87%) vaccine recipients on day 180 post second vaccine dose, whereas vaccine-elicited sera show varying degrees of reduction in neutralization against a range of key SARS-CoV-2 variants, including variant Alpha, Beta, Gamma, Iota, and Delta. Our work show diminished neutralization potency against multiple variants in vaccine-elicited sera, which indicates the potential need for additional boost vaccinations.


Subject(s)
COVID-19 Vaccines , COVID-19 , Antibodies, Viral , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , SARS-CoV-2/genetics
6.
Lancet Respir Med ; 10(6): 573-583, 2022 06.
Article in English | MEDLINE | ID: covidwho-1740330

ABSTRACT

BACKGROUND: Awake prone positioning has been broadly utilised for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure, but the results from published randomised controlled trials (RCTs) in the past year are contradictory. We aimed to systematically synthesise the outcomes associated with awake prone positioning, and evaluate these outcomes in relevant subpopulations. METHODS: In this systematic review and meta-analysis, two independent groups of researchers searched MEDLINE, Embase, PubMed, Web of Science, Scopus, MedRxiv, BioRxiv, and ClinicalTrials.gov for RCTs and observational studies (with a control group) of awake prone positioning in patients with COVID-19-related acute hypoxaemic respiratory failure published in English from Jan 1, 2020, to Nov 8, 2021. We excluded trials that included patients intubated before or at enrolment, paediatric patients (ie, younger than 18 years), or trials that did not include the supine position in the control group. The same two independent groups screened studies, extracted the summary data from published reports, and assessed the risk of bias. We used a random-effects meta-analysis to pool individual studies. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty and quality of the evidence. The primary outcome was the reported cumulative intubation risk across RCTs, and effect estimates were calculated as risk ratios (RR;95% CI). The analysis was primarily conducted on RCTs, and observational studies were used for sensitivity analyses. No serious adverse events associated with awake prone positioning were reported. The study protocol was prospectively registered with PROSPERO, CRD42021271285. FINDINGS: A total of 1243 studies were identified, we assessed 138 full-text articles and received the aggregated results of three unpublished RCTs; therefore, after exclusions, 29 studies were included in the study. Ten were RCTs (1985 patients) and 19 were observational studies (2669 patients). In ten RCTs, awake prone positioning compared with the supine position significantly reduced the need for intubation in the overall population (RR 0·84 [95% CI 0·72-0·97]). A reduced need for intubation was shown among patients who received advanced respiratory support (ie, high-flow nasal cannula or non-invasive ventilation) at enrolment (RR 0·83 [0·71-0·97]) and in intensive care unit (ICU) settings (RR 0·83 [0·71-0·97]) but not in patients receiving conventional oxygen therapy (RR 0·87 [0·45-1·69]) or in non-ICU settings (RR 0·88 [0·44-1·76]). No obvious risk of bias and publication bias was found among the included RCTs for the primary outcome. INTERPRETATION: In patients with COVID-19-related acute hypoxaemic respiratory failure, awake prone positioning reduced the need for intubation, particularly among those requiring advanced respiratory support and those in ICU settings. Awake prone positioning should be used in patients who have acute hypoxaemic respiratory failure due to COVID-19 and require advanced respiratory support or are treated in the ICU. FUNDING: OpenAI, Rice Foundation, National Institute for Health Research, and Oxford Biomedical Research Centre.


Subject(s)
COVID-19 , Respiratory Insufficiency , COVID-19/complications , Child , Humans , Patient Positioning/methods , Prone Position , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Wakefulness
7.
9.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-325163

ABSTRACT

We assessed the safety and immunogenicity of an inactivated SARS-CoV-2 vaccine BBIBP-CorV, especially measured the resistance of four global variants of concern: Lineage B.1.1.7, Lineage B.1.351, Lineage P.1, and Lineage B.1.526 to neutralizing activity of vaccine-elicited sera. Among 1006 enrolled participants, no serious adverse event was reported within 28 days post-vaccination. Seroconversion of neutralizing antibodies was seen in 698 (91.84%) of 760 healthcare workers, and the geometric mean titres (GMTs) of neutralizing antibody titre was 62.68 (57.02–68.91) after the second immunization. We found that 57 (12.13%), 99 (20.97%), and 114 (24.26%) vaccine-elicited sera showed complete or partial loss of neutralizing activity against lineage B.1.1.7, lineage B.1.526, and lineage P.1, respectively, while 199 (42.34%) vaccine-elicited sera preserved neutralizing activity against lineage B.1.351, albeit at relatively low dilutions. These data indicated that humoral responses against SARS-CoV-2 could be effectively induced in vaccine recipients, although diminished neutralization potency against multiple variants was observed.

10.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-315533

ABSTRACT

Background: Current evidence from randomised controlled trials (RCTs) and systematic reviews on the use of interleukin-6 receptor (IL-6R) antagonists among patients with severe coronavirus disease 2019 (COVID-19) have yielded equivocal results. We conducted a meta-analysis of reconstructed individual participant data (IPD) from RCTs, in order to test the hypothesis that IL-6R antagonists lower mortality in severe COVID-19. Methods: We searched PubMed, Embase, Cochrane, Scopus and medRXiv from 1st December 2019 to 15th April 2021 for RCTs reporting on IL-6R antagonists in patients with severe COVID-19. Survival of individual patients was reconstructed from published Kaplan-Meier curves using a plot digitiser. Weibull mixture “cure” survival models were fitted to compare the overall survival and the “cured” fractions of the IL-6R antagonist and control arms. As a sensitivity analysis, we stratified our analysis according to the type and maximum dose of the IL-6R antagonist, and pooled the aggregate odds ratio (OR) for a cure from COVID-19. Secondary outcomes were analysed using a conventional two-stage meta-analysis, and include the pooled relative risk (RR) for secondary infections, and the pooled mean difference in ventilator-free days. The risk of bias was assessed using the Cochrane Risk-of-Bias Tool for RCTs, and overall certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Findings: 9 RCTs (6831 patients) reported on survival outcomes in COVID-19, of which data from 6 RCTs (6278 patients) was used for the reconstructed IPD meta-analysis. The fractions of “cured” patients who survived were estimated to be 74·0% and 67·9% in the IL-6R antagonist and control arms respectively, which corresponds to an absolute percentage increase in the fraction of COVID-19 survivors of +6·7% (95%-CI: 4·3% to 9·4%, p<0·0001) under an identity link. IL-6R antagonist use was associated with increased odds for a “cure” (OR: 1·22, 95%-CI: 1·09 to 1·38, p=0·0008), and a reduction in mortality (excess hazard ratio: 0·84, 95%-CI: 0·76 to 0·93, p=0·0004). This was also consistent with the conventional meta-analytic method (pooled OR for COVID-19 cure: 1·21, 95%-CI: 1·07 to 1·35, p=0·0015, high certainty). The number-needed-to-treat was 15·2 (95%-CI: 9·9 to 32·8). There was a significant reduction in the risk of secondary infections (RR: 0·83, 95%-CI: 0·68 to 1·01, p=0·058) or ventilator-free days (+0·08, 95%-CI: -0·10 to 0·26, p=0·37). Interpretation: IL-6R antagonists increase the chances of survival among patients with severe COVID-19 without the increased risk of secondary infections.Funding Statement: There was no funding source for this study.Declaration of Interests: All authors declare no competing interests.

11.
Symmetry ; 13(8):1535, 2021.
Article in English | ProQuest Central | ID: covidwho-1376975

ABSTRACT

Public key infrastructure (PKI) plays a fundamental role in securing the infrastructure of the Internet through the certification of public keys used in asymmetric encryption. It is an industry standard used by both public and private entities that costs a lot of resources to maintain and secure. On the other hand, identity-based cryptography removes the need for certificates, which in turn lowers the cost. In this work, we present a practical implementation of a hybrid PKI that can issue new identity-based cryptographic keys for authentication purposes while bootstrapping trust with existing certificate authorities. We provide a set of utilities to generate and use such keys within the context of an identity-based environment as well as an external environment (i.e., without root trust to the private key generator). Key revocation is solved through our custom naming design which currently supports a few scenarios (e.g., expire by date, expire by year and valid for year). Our implementation offers a high degree of interoperability by incorporating X.509 standards into identity-based cryptography (IBC) compared to existing works on hybrid PKI–IBC systems. The utilities provided are minimalist and can be integrated with existing tools such as the Enterprise Java Bean Certified Authority (EJBCA).

12.
Aging Male ; 24(1): 92-94, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1328899

ABSTRACT

Digital rectal examination (DRE) is routinely performed as part of a urology clinical assessment in patients with a clinical suspicion of prostate cancer. An abnormal DRE or a raised prostate specific antigen (PSA) level are part of the criteria for primary care referral to secondary care due to a suspicion of prostate cancer. The current Coronavirus-19 (COVID-19) pandemic has resulted in the rapid adoption of virtual consultations in the form of telephone or video consultations making clinical examination difficult. In the case of prostate cancer diagnostic pathways, often clinicians now rely on PSA measurements and MRI, where radiological services are available, without the requirement for a DRE. We discuss the limited role DRE has in the modern prostate cancer diagnostic pathway due to the widespread adoption of MRI particularly in the COVID-19 era.


Subject(s)
Digital Rectal Examination , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnosis , COVID-19 , Humans , Magnetic Resonance Imaging , Male , Prostatic Neoplasms/diagnostic imaging , SARS-CoV-2
13.
BMC Med Inform Decis Mak ; 21(1): 207, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1296596

ABSTRACT

BACKGROUND: Clinical risk prediction models (CRPMs) use patient characteristics to estimate the probability of having or developing a particular disease and/or outcome. While CRPMs are gaining in popularity, they have yet to be widely adopted in clinical practice. The lack of explainability and interpretability has limited their utility. Explainability is the extent of which a model's prediction process can be described. Interpretability is the degree to which a user can understand the predictions made by a model. METHODS: The study aimed to demonstrate utility of patient similarity analytics in developing an explainable and interpretable CRPM. Data was extracted from the electronic medical records of patients with type-2 diabetes mellitus, hypertension and dyslipidaemia in a Singapore public primary care clinic. We used modified K-nearest neighbour which incorporated expert input, to develop a patient similarity model on this real-world training dataset (n = 7,041) and validated it on a testing dataset (n = 3,018). The results were compared using logistic regression, random forest (RF) and support vector machine (SVM) models from the same dataset. The patient similarity model was then implemented in a prototype system to demonstrate the identification, explainability and interpretability of similar patients and the prediction process. RESULTS: The patient similarity model (AUROC = 0.718) was comparable to the logistic regression (AUROC = 0.695), RF (AUROC = 0.764) and SVM models (AUROC = 0.766). We packaged the patient similarity model in a prototype web application. A proof of concept demonstrated how the application provided both quantitative and qualitative information, in the form of patient narratives. This information was used to better inform and influence clinical decision-making, such as getting a patient to agree to start insulin therapy. CONCLUSIONS: Patient similarity analytics is a feasible approach to develop an explainable and interpretable CRPM. While the approach is generalizable, it can be used to develop locally relevant information, based on the database it searches. Ultimately, such an approach can generate a more informative CRPMs which can be deployed as part of clinical decision support tools to better facilitate shared decision-making in clinical practice.


Subject(s)
Clinical Decision-Making , Electronic Health Records , Humans , Logistic Models , Singapore , Support Vector Machine
14.
Cancers (Basel) ; 13(13)2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1288807

ABSTRACT

External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle-Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited.

15.
World J Urol ; 39(12): 4295-4303, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1241604

ABSTRACT

PURPOSE: The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era. METHOD: The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared. RESULTS: Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43-0.86, p < 0.001). CONCLUSION: Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered.


Subject(s)
COVID-19/prevention & control , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/mortality , Kidney Neoplasms/surgery , Time-to-Treatment , COVID-19/epidemiology , COVID-19/transmission , Carcinoma, Renal Cell/pathology , Communicable Disease Control , Humans , Kidney Neoplasms/pathology , Nephrectomy , Survival Rate
16.
Ther Adv Respir Dis ; 15: 17534666211009407, 2021.
Article in English | MEDLINE | ID: covidwho-1199884

ABSTRACT

BACKGROUND AND AIMS: The application of prone positioning with acute hypoxemic respiratory failure (AHRF) or acute respiratory distress syndrome (ARDS) in non-intubation patients is increasing gradually, applying prone positioning for more high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) patients. This meta-analysis evaluates the efficacy and tolerance of prone positioning combined with non-invasive respiratory support in patients with AHRF or ARDS. METHODS: We searched randomized controlled trials (RCTs) (prospective or retrospective cohort studies, RCTs and case series) published in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 1 July 2020. We included studies that compared prone and supine positioning with non-invasive respiratory support in awake patients with AHRF or ARDS. The meta-analyses used random effects models. The methodological quality of the RCTs was evaluated using the Newcastle-Ottawa quality assessment scale. RESULTS: A total of 16 studies fulfilled selection criteria and included 243 patients. The aggregated intubation rate and mortality rate were 33% [95% confidence interval (CI): 0.26-0.42, I2 = 25%], 4% (95% CI: 0.01-0.07, I2 = 0%), respectively, and the intolerance rate was 7% (95% CI: 0.01-0.12, I2 = 5%). Prone positioning increased PaO2/FiO2 [mean difference (MD) = 47.89, 95% CI: 28.12-67.66; p < 0.00001, I2 = 67%] and SpO2 (MD = 4.58, 95% CI: 1.35-7.80, p = 0.005, I2 = 97%), whereas it reduced respiratory rate (MD = -5.01, 95% CI: -8.49 to -1.52, p = 0.005, I2 = 85%). Subgroup analyses demonstrated that the intubation rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 34% and 21%, respectively; and the mortality rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 6% and 0%, respectively. PaO2/FiO2 and SpO2 were significantly improved in COVID-19 patients and non-COVID-19 patients. CONCLUSION: Prone positioning could improve the oxygenation and reduce respiratory rate in both COVID-19 patients and non-COVID-19 patients with non-intubated AHRF or ARDS.The reviews of this paper are available via the supplemental material section.


Subject(s)
COVID-19/complications , Patient Positioning , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/therapy , SARS-CoV-2 , COVID-19/mortality , Humans , Intubation, Intratracheal , Oxygen/blood , Prone Position , Respiration
17.
Asian Spine J ; 15(2): 164-171, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1191223

ABSTRACT

STUDY DESIGN: An original article describing a comprehensive methodology for making a traditional spine surgery clinic telemedicineready in terms of logistical considerations and workflow. PURPOSE: The aim of this study is to promote the use of telemedicine via videoconferencing to reduce human exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and reduce the risk of coronavirus disease 2019 (COVID-19) transmission at outpatient clinics. OVERVIEW OF LITERATURE: The COVID-19 pandemic is the biggest healthcare crisis in the 21st century. Until a vaccine is developed or herd immunity against SARS-CoV-2 is achieved, social distancing to avoid crowding is an important strategy to reduce disease transmission and resurgence. Telemedicine has already been applied in the field of orthopedics with encouraging results. METHODS: We reviewed the evidence behind telemedicine and described our clinical protocol, patient selection criteria, and workflow for telemedicine. We discussed a simple methodology to convert pre-existing traditional clinic resources into telemedicine tools, along with future challenges. RESULTS: Our methodology was successfully and easily applied in our clinical practice, with a streamlined workflow allowing our spine surgery service to implement telemedicine as a consultation modality in line with the national recommendations of social distancing. CONCLUSIONS: Telemedicine was well incorporated into our outpatient practice using the above workflow. We believe that the use of telemedicine via videoconferencing can become part of the new normal and a safe strategy for healthcare systems as both a medical and an economic countermeasure against COVID-19.

19.
Virus Evol ; 7(1): veaa102, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1145192

ABSTRACT

Analysis of genetic sequence data from the SARS-CoV-2 pandemic can provide insights into epidemic origins, worldwide dispersal, and epidemiological history. With few exceptions, genomic epidemiological analysis has focused on geographically distributed data sets with few isolates in any given location. Here, we report an analysis of 20 whole SARS- CoV-2 genomes from a single relatively small and geographically constrained outbreak in Weifang, People's Republic of China. Using Bayesian model-based phylodynamic methods, we estimate a mean basic reproduction number (R 0) of 3.4 (95% highest posterior density interval: 2.1-5.2) in Weifang, and a mean effective reproduction number (Rt) that falls below 1 on 4 February. We further estimate the number of infections through time and compare these estimates to confirmed diagnoses by the Weifang Centers for Disease Control. We find that these estimates are consistent with reported cases and there is unlikely to be a large undiagnosed burden of infection over the period we studied.

20.
Atmosphere ; 12(2):184, 2021.
Article in English | MDPI | ID: covidwho-1055014

ABSTRACT

Restrictions on human activities remarkably reduced emissions of air pollutants in China during the COVID-19 lockdown periods. However, distinct responses of O3 concentrations were observed across China. In the Beijing–Tianjin–Hebei (BTH) and Yangtze River Delta (YRD) regions, O3 concentrations were enhanced by 90.21 and 71.79% from pre-lockdown to lockdown periods in 2020, significantly greater than the equivalent concentrations for the same periods over 2015–2019 (69.99 and 43.62%, p <0.001). In contrast, a decline was detected (−1.1%) in the Pearl River Delta (PRD) region. To better understand the underlying causes for these inconsistent responses across China, we adopted the least absolute shrinkage and selection operator (Lasso) and ordinary linear squares (OLS) methods in this study. Statistical analysis indicated that a sharp decline in nitrogen dioxide (NO2) was the major driver of enhanced O3 in the BTH region as it is a NOx-saturated region. In the YRD region, season-shift induced changes in the temperature/shortwave radiative flux, while lockdown induced declines in NO2, attributable to the rise in O3. In the PRD region, the slight drop in O3 is attributed to the decreased intensity of radiation. The distinct regimes of the O3 response to the COVID-19 lockdown in China offer important insights into different O3 control strategies across China.

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