Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series.

Saddle pulmonary embolism (SPE) is a rare type of pulmonary embolism that can lead to hemodynamic compromise causing sudden deaths. Due to a dearth of large prospective studies in this area, little is known regarding the epidemiology, and prognosis and factors affecting the latter for COVID-19-associated SPE. We aimed to describe COVID-19-associated SPE and quantify and compare mortality and factors affecting mortality among the cases. We included a total of 25 publications with a total of 35 cases. The average age was 45 ± 16.3 years with 11 females and 24 males. Dyspnoea (82.5%), orthopnoea (43.5%), and cough (43.5%) were the most common symptoms, and obstructive shock was present in five (21.7%) patients. The average reported oxygen (O2) saturation was 85.8% ± 11.9 mm Hg. Hypertension (26.1%), diabetes (21.7%), and deep vein thrombosis (21.7%) were the most commonly reported comorbidities. Right heart strain was recognized in seven (30%) patients on electroencephalogram (S1QIIITIII) and 12 (52.2%) patients on echocardiogram. Anticoagulation, thrombolysis, and percutaneous intervention were tried in 21 (91.3%), 13 (56.5%), and 6 (26.1%) cases, respectively. Despite the aggressive management, 2 of 25 (8.7%) patients died in our smaller case report cohort. We conclude that despite aggressive management modalities, the mortality of SPE remains high in COVID-19.

Assessment of different laboratory tests for the diagnosis of novel coronavirus infections

Rapid diagnosis of coronavirus disease 2019 (COVID-19)-infected patients is urgent in making decisions on public health measures. There are different types of diagnostic tests, such as quantitative PCR assay, antibody, and antigen-based and CRISPR-based tests, which detect genetic materials, viral proteins, or human antibodies in clinical samples. However, the proper test should be highly sensitive, quick, and affordable to address this life-threatening situation. This review article highlights the advantages and disadvantages of each test and compares its different features, such as sensitivity, specificity, and limit of detection to reach a reliable conclusion. Moreover, the FDA- authorized kits and studies' approaches toward these have been compared to provide a better perspective to the researchers.Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.

The Pediatric COVID-19 Registry in Kuwait: Methodology and Results of Pilot Phase.

OBJECTIVE: Establishing a pediatric COVID-19 registry in Kuwait (PCR-Q8) was deemed imperative during the pandemic to study children infected with severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) focusing on mode of presentation, therapeutic interventions, disease severity, and early outcomes. This manuscript describes the rapid establishment of the PCR-Q8 registry showcasing an infrastructure of the development process and presents the results of the pilot phase. SUBJECT AND METHODS: The registry was developed and implemented using the general key steps from a resource titled "Registries for Evaluating Patient Outcomes: A User's Guide" as a guide for best practice, experience from a previously established pediatric diabetes registry in Kuwait and several other COVID-19 registries developed globally. During the pilot phase, a convenience sample of 120 children was included, of whom 66 (55%) were male. RESULTS: Experience and expertise from other COVID-19 registries; guidance provided by the World Health Organization; and effective collaboration and cooperation between the stakeholders, study group, and data enterers during these challenging times were critical for the development and implementation of the registry. Our results were similar to international reports which showed that most children presented with mild disease (69.2%), majority (70.2%) had normal chest X-ray, and the most common symptom at presentation was fever (77%). CONCLUSION: We anticipate the development of PCR-Q8 to be a stepping-stone for more in-depth investigation of SARS-CoV-2 infection in children in Kuwait and for the establishment of other registries.

Evaluation of UVC Excimer Lamp (222 nm) Efficacy for Coronavirus Inactivation in an Animal Model.

The current pandemic caused by severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) has encouraged the evaluation of novel instruments for disinfection and lowering infectious pressure. Ultraviolet subtype C (UVC) excimer lamps with 222 nm wavelength have been tested on airborne pathogens on surfaces and the exposure to this wavelength has been considered safer than conventional UVC. To test the efficacy of UVC excimer lamps on coronaviruses, an animal model mimicking the infection dynamics was implemented. An attenuated vaccine based on infectious bronchitis virus (IBV) was nebulized and irradiated by 222 nm UVC rays before the exposure of a group of day-old chicks to evaluate the virus inactivation. A control group of chicks was exposed to the nebulized vaccine produced in the same conditions but not irradiated by the lamps. The animals of both groups were sampled daily and individually by choanal cleft swabs and tested usign a strain specific real time RT-PCR to evaluate the vaccine replication. Only the birds in the control group were positive, showing an active replication of the vaccine, revealing the efficacy of the lamps in inactivating the vaccine below the infectious dose in the other group.

Post-vaccination infection rates and modification of COVID-19 symptoms in vaccinated UK school-aged children and adolescents: A prospective longitudinal cohort study.

Background: We aimed to explore the effectiveness of one-dose BNT162b2 vaccination upon SARS-CoV-2 infection, its effect on COVID-19 presentation, and post-vaccination symptoms in children and adolescents (CA) in the UK during periods of Delta and Omicron variant predominance. Methods: In this prospective longitudinal cohort study, we analysed data from 115,775 CA aged 12-17 years, proxy-reported through the Covid Symptom Study (CSS) smartphone application. We calculated post-vaccination infection risk after one dose of BNT162b2, and described the illness profile of CA with post-vaccination SARS-CoV-2 infection, compared to unvaccinated CA, and post-vaccination side-effects. Findings: Between August 5, 2021 and February 14, 2022, 25,971 UK CA aged 12-17 years received one dose of BNT162b2 vaccine. The probability of testing positive for infection diverged soon after vaccination, and was lower in CA with prior SARS-CoV-2 infection. Vaccination reduced proxy-reported infection risk (-80·4% (95% CI -0·82 -0·78) and -53·7% (95% CI -0·62 -0·43) at 14-30 days with Delta and Omicron variants respectively, and -61·5% (95% CI -0·74 -0·44) and -63·7% (95% CI -0·68 -0.59) after 61-90 days). Vaccinated CA who contracted SARS-CoV-2 during the Delta period had milder disease than unvaccinated CA; during the Omicron period this was only evident in children aged 12-15 years. Overall disease profile was similar in both vaccinated and unvaccinated CA. Post-vaccination local side-effects were common, systemic side-effects were uncommon, and both resolved within few days (3 days in most cases). Interpretation: One dose of BNT162b2 vaccine reduced risk of SARS-CoV-2 infection for at least 90 days in CA aged 12-17 years. Vaccine protection varied for SARS-CoV-2 variant type (lower for Omicron than Delta variant), and was enhanced by pre-vaccination SARS-CoV-2 infection. Severity of COVID-19 presentation after vaccination was generally milder, although unvaccinated CA also had generally mild disease. Overall, vaccination was well-tolerated. Funding: UK Government Department of Health and Social Care, Chronic Disease Research Foundation, The Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation and Alzheimer's Society, and ZOE Limited.

Impact of coronavirus disease 2019 (COVID-19) on Ear, Nose and Throat (ENT) surgery waitlists in regional centres

Background: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] impacted many aspects of healthcare in Australia, particularly already strained elective surgery waiting lists in regional areas. Elective operating was suspended throughout New South Wales (NSW) and Victoria (Vic) despite cases being predominantly located in metropolitan centres. The aim of this study was to quantify the effect of COVID-19 on patients' time spent on Ear, Nose and Throat (ENT) elective surgery waiting lists and the likelihood of breaching recommended waiting times. Methods: Elective ENT operating data was collected from Albury Wodonga Health (AWH) and Dubbo Health Service (DHS) between March 2019 and February 2021. Data was analysed based on the time period (March 2019-February 2020 = pre-COVID, March 2020-February 2021 = COVID) and priority category (1, 2 or 3 based on clinical urgency). Results: A total of 2,915 operations were recorded across the two sites during the study period. There were statistically significant increases in both the length of time spent on waiting lists as well as the likelihood of breaching recommended waiting times following the arrival of COVID-19. This was true for both sites as well as across all priority categories. Conclusions: This study demonstrated a significant increase on the length of time patients spent on elective surgery waiting lists as well as the likelihood of these patients breaching recommended surgery waiting times following COVID-19 pandemic. The shutdown of elective surgery due to the pandemic has had an unnecessarily large impact on regional areas where case numbers were initially low and local services are already stretched. During future waves, a region-specific response involving elective surgery shutdown is recommended, rather than a state-wide or nationwide approach. © 2022 Australian Journal of Otolaryngology. All rights reserved.

Adapting obstetric and neonatal services during the COVID-19 pandemic: a scoping review.

BACKGROUND: The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction. METHOD: Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations. RESULTS: We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options. INTERPRETATION: There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability.

Experimental and natural infections of severe acute respiratory syndrome-related coronavirus 2 in pets and wild and farm animals.

The severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has spread globally and has led to extremely high mortality rates. In addition to infecting humans, this virus also has infected animals. Experimental studies and natural infections showed that dogs have a low susceptibility to SARS-CoV-2 infection, whereas domesticated cats and other animals in the family Felidae, such as lions, tigers, snow leopards, and cougars, have a high susceptibility to viral infections. In addition, wild white-tailed deer, gorillas, and otters have been found to be infected by SARS-CoV-2. Furry farm animals, such as minks, have a high susceptibility to SARS-CoV-2 infection. The virus appears to spread among minks and generate several new mutations, resulting in increased viral virulence. Furthermore, livestock animals, such as cattle, sheep, and pigs, were found to have low susceptibility to the virus, whereas chicken, ducks, turkeys, quail, and geese did not show susceptibility to SARS-CoV-2 infection. This knowledge can provide insights for the development of SARS-CoV-2 mitigation strategies in animals and humans. Therefore, this review focuses on experimental (both replication and transmission) in vitro, ex vivo, and in vivo studies of SARS-CoV-2 infections in pets and in wild and farm animals, and to provide details on the mechanism associated with natural infection.

Complete remission of stage IV sinonasal small cell neuroendocrine carcinoma: A case report.

Sinonasal small cell carcinoma (SmCC) is a rare type of neoplasm. The current case report describes the case of a 30-year-old male patient with stage IV SmCC who underwent concurrent radiotherapy (RT) plus etoposide-cisplatin treatment. Positron emission tomography (PET)/computed tomography (CT) and fibroscopy examination showed complete remission at 3 months post-treatment. However, leptomeningeal metastasis (LM) occurred at 9 months. A literature search identified no previous case reports describing LM of SmCC. The patient was treated with concurrent RT plus irinotecan-gemcitabine. During the sixth cycle of irinotecan-gemcitabine, the patient required intensive care admission due to severe acute respiratory syndrome-related coronavirus 2-associated pneumonia. Following clearance of the pneumonia, LM was assessed using PET/CT and MRI at 3 months, which revealed a complete response to irinotecan-gemcitabine. In May 2021, the patient succumbed to LM following disease recurrence. The findings of this case report should encourage other authors to publish their treatment outcomes regarding SmCC. More clinical trials are required to achieve better results in terms of patient outcome.

SARS-CoV-2 Clinical Characteristics and Viral Shedding in Kuwait.

OBJECTIVES: We aimed to describe the clinical characteristics of SARS-CoV-2 infection and estimate viral shedding duration in respiratory specimens. METHODS: A retrospective cohort study was performed from February 25 to March 25, 2020. In Kuwait, all suspected coronavirus disease 2019 (COVID-19) cases, contacts of cases, and returning travelers were systematically tested for SARS-CoV-2 by RT-PCR. All infected persons, regardless of symptoms, were hospitalized and serially tested until they had two negative results. Descriptive statistics and regression analyses were performed. RESULTS: Two hundred seven cases of SARS-CoV-2 infection were included in this study. About half of the cases were asymptomatic and 1.9% died. The median time to negative RT-PCR was 22 days. Increasing age, ARDS, and low peripheral white blood cell count were associated with prolonged PCR positivity. CONCLUSION: Predictors for prolonged RT-PCR positivity included increasing age, ARDS, and low white blood cell count. The findings of this study may aid in better understanding of the epidemiology of SARS-CoV-2 infection and molecular testing dynamics.

Disentangling post-vaccination symptoms from early COVID-19.

BACKGROUND: Identifying and testing individuals likely to have SARS-CoV-2 is critical for infection control, including post-vaccination. Vaccination is a major public health strategy to reduce SARS-CoV-2 infection globally. Some individuals experience systemic symptoms post-vaccination, which overlap with COVID-19 symptoms. This study compared early post-vaccination symptoms in individuals who subsequently tested positive or negative for SARS-CoV-2, using data from the COVID Symptom Study (CSS) app. METHODS: We conducted a prospective observational study in 1,072,313 UK CSS participants who were asymptomatic when vaccinated with Pfizer-BioNTech mRNA vaccine (BNT162b2) or Oxford-AstraZeneca adenovirus-vectored vaccine (ChAdOx1 nCoV-19) between 8 December 2020 and 17 May 2021, who subsequently reported symptoms within seven days (N=362,770) (other than local symptoms at injection site) and were tested for SARS-CoV-2 (N=14,842), aiming to differentiate vaccination side-effects per se from superimposed SARS-CoV-2 infection. The post-vaccination symptoms and SARS-CoV-2 test results were contemporaneously logged by participants. Demographic and clinical information (including comorbidities) were recorded. Symptom profiles in individuals testing positive were compared with a 1:1 matched population testing negative, including using machine learning and multiple models considering UK testing criteria. FINDINGS: Differentiating post-vaccination side-effects alone from early COVID-19 was challenging, with a sensitivity in identification of individuals testing positive of 0.6 at best. Most of these individuals did not have fever, persistent cough, or anosmia/dysosmia, requisite symptoms for accessing UK testing; and many only had systemic symptoms commonly seen post-vaccination in individuals negative for SARS-CoV-2 (headache, myalgia, and fatigue). INTERPRETATION: Post-vaccination symptoms per se cannot be differentiated from COVID-19 with clinical robustness, either using symptom profiles or machine-derived models. Individuals presenting with systemic symptoms post-vaccination should be tested for SARS-CoV-2 or quarantining, to prevent community spread. FUNDING: UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK National Institute for Health Research, UK Medical Research Council and British Heart Foundation, Chronic Disease Research Foundation, Zoe Limited.

Comparison of Estimated Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence Through Commercial Laboratory Residual Sera Testing and a Community Survey.

We compared severe acute respiratory syndrome coronavirus 2 seroprevalence estimated from commercial laboratory residual sera and a community household survey in metropolitan Atlanta during April and May 2020 and found these 2 estimates to be similar (4.94% vs 3.18%). Compared with more representative surveys, commercial sera can provide an approximate measure of seroprevalence.

Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study.

Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76-98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on chest X-ray (CXR)), and systemic inflammation in CARDS patients by survivorship and to identify baseline characteristics associated with survival after prone ventilation. The study cohort included 23 patients with moderate-to-severe CARDS who received prone ventilation for ≥16 h/day and was segmented by living status: living (n = 6) and deceased (n = 17). Immediately after prone ventilation, PaO2/FiO2 improved by 108% (p < 0.03) for the living and 150% (p < 3 × 10-4) for the deceased. However, the 48 h change in lung infiltrate severity in gravity-dependent lung zones was significantly better for the living than for the deceased (p < 0.02). In CXRs of the lower lungs before prone ventilation, we observed 5 patients with confluent infiltrates bilaterally, 12 patients with ground-glass opacities (GGOs) bilaterally, and 6 patients with mixed infiltrate patterns; 80% of patients with confluent infiltrates were alive vs. 8% of patients with GGOs. In conclusion, our small study indicates that CXRs may offer clinical utility in selecting patients with moderate-to-severe CARDS who will benefit from prone ventilation. Additionally, our study suggests that lung infiltrate severity may be a better indicator of patient disposition after prone ventilation than PaO2/FiO2.

SARS-CoV-2 RT-PCR test results across symptomatic COVID-19 cases in Auckland, New Zealand, February-June 2020.

ABSTRACT: During the first wave of COVID-19 transmission in New Zealand, a review of RT-PCR testing in all symptomatic cases reported in the Auckland Region found 74% of test results to have been positive. Detection rate was superior for nasopharyngeal swabs than for oropharyngeal samples, and highest one week after symptom onset. Certain symptom presentations may associate with these cases returning negative results, with dyspnoea reported by a greater proportion of cases who tested negative.

Mefloquine, a Potent Anti-severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2) Drug as an Entry Inhibitor in vitro.

Coronavirus disease 2019 (COVID-19) has caused serious public health, social, and economic damage worldwide and effective drugs that prevent or cure COVID-19 are urgently needed. Approved drugs including Hydroxychloroquine, Remdesivir or Interferon were reported to inhibit the infection or propagation of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), however, their clinical efficacies have not yet been well demonstrated. To identify drugs with higher antiviral potency, we screened approved anti-parasitic/anti-protozoal drugs and identified an anti-malarial drug, Mefloquine, which showed the highest anti-SARS-CoV-2 activity among the tested compounds. Mefloquine showed higher anti-SARS-CoV-2 activity than Hydroxychloroquine in VeroE6/TMPRSS2 and Calu-3 cells, with IC50 = 1.28 µM, IC90 = 2.31 µM, and IC99 = 4.39 µM in VeroE6/TMPRSS2 cells. Mefloquine inhibited viral entry after viral attachment to the target cell. Combined treatment with Mefloquine and Nelfinavir, a replication inhibitor, showed synergistic antiviral activity. Our mathematical modeling based on the drug concentration in the lung predicted that Mefloquine administration at a standard treatment dosage could decline viral dynamics in patients, reduce cumulative viral load to 7% and shorten the time until virus elimination by 6.1 days. These data cumulatively underscore Mefloquine as an anti-SARS-CoV-2 entry inhibitor.

SARS-CoV-2 Infection in Pregnant Women: Neuroimmune-Endocrine Changes at the Maternal-Fetal Interface.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has devastating effects on the population worldwide. Given this scenario, the extent of the impact of the disease on more vulnerable individuals, such as pregnant women, is of great concern. Although pregnancy may be a risk factor in respiratory virus infections, there are no considerable differences regarding COVID-19 severity observed between pregnant and nonpregnant women. In these circumstances, an emergent concern is the possibility of neurodevelopmental and neuropsychiatric harm for the offspring of infected mothers. Currently, there is no stronger evidence indicating vertical transmission of SARS-CoV-2; however, the exacerbated inflammatory response observed in the disease could lead to several impairments in the offspring's brain. Furthermore, in the face of historical knowledge on possible long-term consequences for the progeny's brain after infection by viruses, we must consider that this might be another deleterious facet of COVID-19. In light of neuroimmune interactions at the maternal-fetal interface, we review here the possible harmful outcomes to the offspring brains of mothers infected by SARS-CoV-2.

Comparison and clinical characteristics of COVID-19 between January and February 2020 in Wuhan, China.

BACKGROUND: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) continues to make a deadly impact on human life all over the world. Therefore, we aimed to analyze the changes in clinical characteristics of coronavirus disease 2019 (COVID-19) patients over time. METHODS: We recruited 896 patients who were admitted to the Renmin Hospital of Wuhan University between 30th January 2020 and 16st March 2020. We conducted a retrospective study collecting clinical characteristics, radiologic and laboratory findings, treatments administered, and clinical outcomes in the patients. The data collected were compared between patients with onset of illness in January 2020 and patients with onset of illness in February 2020, in Wuhan, China. Categorical data and non-normally distributed continuous data were examined by the χ2 test and the Mann-Whitney-Wilcoxon test respectively, and the Kaplan-Meier plot was used to analyze survival data. Univariate and multivariate logistic regression methods were used to explore the risk factors associated with in-hospital death. RESULTS: A total of 896 patients were enrolled; the median age was 60 (range, 47-69) years, 685 (76.5%) were categorized into group A (patients with onset of illness in January 2020), and 211 (23.5%) were categorized into group B (patients with onset of illness in February 2020). Compared with group B, group A had a higher incidence of fever (P<0.001), and a lower rate of asymptomatic individuals (P<0.001). Group A patients had a higher incidence of neutrophilia (P=0.043), an elevated D-dimer (P<0.001), and an increased lactate dehydrogenase (LDH) (P=0.002), but a lower incidence of a normal computed tomography (CT) scan (P=0.001). CD3 cell counts (P=0.015) and CD4 cell counts (P=0.04) were significantly reduced in group A patients. Critically ill patients were less frequent (P=0.005) and patients with milder disease were more common (P=0.001) in group B. The fatality rate was significantly less in group B patients (P=0.028). Multivariate regression indicated that older age (odds ratio 1.086, 95% CI: 1.061-1.111, per year increase; P<0.001) increased the risk of in-hospital death. Female sex (odds ratio 0.523, 95% CI: 0.316-0.865; P=0.012) and being in group B (odds ratio 0.423, 95% CI: 0.212-0.844; P=0.015) significantly decreased the risk of in-hospital death. CONCLUSIONS: The condition of patients with onset of illness in January was more serious than that of patients with onset of illness in February 2020. The time of onset of illness was an independent risk factor for in-hospital death comparing January and February 2020. Changing pathogenicity of SARS-CoV-2 and improved healthcare may have contributed to the results, however, more basic research is required to support this hypothesis.

Impact of Mass Screening on the Number of Confirmed Cases, Recovered Cases, and Deaths Due to COVID-19 in Iran: An Interrupted Time Series Analysis.

BACKGROUND: Mass screening for the coronavirus disease 2019 (COVID-19) began in Iran on March 23, 2020, with the purpose of improving early detection of patients for their own health and to prevent onward transmission to others. In this study, we evaluated the impact of the change towards mass screening on new cases reported, cases recovered, and deaths due to COVID-19. METHODS: This study analyzed the daily reports on the number of new cases confirmed by polymerase chain reaction (PCR) testing, cases recovered, and deaths due to COVID-19 provided to the Ministry of Health and Medical Education of Iran. Changes in trends on these outcomes were evaluated using interrupted time series analysis. RESULTS: From February 19 to May 6, 2020, a total of 519544 COVID-19 tests were done and 101650 diagnoses were made (case/ test ratio 19.6%). For the same period, 6418 deaths due to COVID-19 were reported (case fatality ratio 6.3%). The number of cases detected increased significantly over the period of scale-up of mass screening (P=0.003), as did the number of recovered cases (P=0.001). The number of deaths due to COVID-19 did not change before versus after mass screening. CONCLUSION: Following the scale-up of mass screening for COVID-19 in Iran, the rate of new cases detected and reported recovered accelerated significantly. Mass screening is likely to have detected many mild and asymptomatic cases that were infectious. Our data support the role that mass screening, coupled with isolation and contract tracing, can have in slowing the COVID-19 epidemic.

Comprehensive review on the prevailing COVID-19 therapeutics and the potential of repurposing SARS-CoV-1 candidate drugs to target SARS-CoV-2 as a fast-track treatment and prevention option.

The recent seemingly uncontrollable pandemic caused by the novel severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has been able to spread quickly due to the non-availability of effective antivirals or vaccines. The virus has structural and non-structural proteins that are considered as possible targets. Receptor recognition is the critical determinant and preliminary phase of viral infection to enter the host cell and causes tissue tropism. We have conducted a comprehensive review of relevant publication on in vitro, in silico, in vivo and clinical evaluation of drug candidates ranging from broad-spectrum antivirals to natural molecules targeted towards viral spike protein in addition to evaluate their suitability as therapies based on an analysis of the similarities between SARS-CoV-1 and SARS-CoV-2. In general, antiviral targets are based on two strategies, either targeting the host or the host's immune cell. We have reviewed the available details on the SARS-CoV-2 strain's host-viral binding sites entry mechanism, alongside recently tested effective antivirals. The hypothesis of this review may provide clear insight for researchers and physicians who are struggling to narrow down scientific options to control the current pandemic. Overall, we found that the promising efficacious drug candidates reported against SARS-CoV-1 could be considered for drug repurposing; this might help to identify a potential drug for therapeutic measures and development of vaccine for COVID-19.

Medicinal Plants as Sources of Active Molecules Against COVID-19.

The Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) or novel coronavirus (COVID-19) infection has been declared world pandemic causing a worrisome number of deaths, especially among vulnerable citizens, in 209 countries around the world. Although several therapeutic molecules are being tested, no effective vaccines or specific treatments have been developed. Since the COVID-19 outbreak, different traditional herbal medicines with promising results have been used alone or in combination with conventional drugs to treat infected patients. Here, we review the recent findings regarding the use of natural products to prevent or treat COVID-19 infection. Furthermore, the mechanisms responsible for this preventive or therapeutic effect are discussed. We conducted literature research using PubMed, Google Scholar, Scopus, and WHO website. Dissertations and theses were not considered. Only the situation reports edited by the WHO were included. The different herbal products (extracts) and purified molecules may exert their anti-SARS-CoV-2 actions by direct inhibition of the virus replication or entry. Interestingly, some products may block the ACE-2 receptor or the serine protease TMPRRS2 required by SARS-CoV-2 to infect human cells. In addition, natural products were shown to inhibit the SARS-CoV-2 life-cycle related proteins such as papain-like or chymotrypsin-like proteases. In conclusion, we suggest that natural products could be used alone or in combination as alternative medicines to treat/prevent COVID-19 infection. Moreover, their structures may offer clues for the development of anti-SARS-CoV-2 drugs.