On the issue of organizing medical care for the population and its resource provision during the pandemic of a new coronavirus infection (COVID-19) in the Russian Federation.

The outbreak of COVID-19 in December 2019 in Wuhan (PRC) and the subsequent global spread of the infection over several weeks, the emergence of new strains of the SARS-CoV-2 virus have made significant changes in the organization and activities of healthcare systems in most countries of the world. Purpose of the study. Conduct an analysis of infectious disease rates, individual indicators of the state and activities of the state and municipal healthcare systems of the Russian Federation before and during the COVID-19 pandemic — in the period 2019— 2020. Material and methods. As research materials, data from annual forms of federal statistical observation in the context of the Russian Federation Nos. 12, 14 and 30, as well as collections of statistical indicators of the Ministry of Health of Russia, were used. The main research methods are statistical, informational and analytical. Results. The study showed that in the period 2012—2019. Against the background of a decrease in infectious disease, the resource provision of the infectious service was gradually reduced. However, in the context of the COVID-19 pandemic, the load on this service has increased significantly. According to the results of testing for RNA, antigen and antibodies to SARS-CoV-2 in the conditions of medical organizations of the Ministry of Health of Russia in the country in 2020, about 5 million cases of COVID- 19 and almost 600 thousand cases of carriage of the pathogen were registered. Against the background of the COVID-19 pandemic, the number of visits to medical organizations providing medical care on an outpatient basis decreased by 17.6%, the level of hospitalization decreased by 16.0%, while the availability of beds did not change significantly, and in the structure of beds repurposed for the treatment of patients with COVID-19, more than 80% were therapeutic, surgical, neurological and gynecological beds. Against the background of a decrease in bed turnover, hospital mortality increased in a number of profiles, while mortality in infectious beds for patients with COVID-19 was at the level of the national average for the entire hospital bed stock. During the implementation of a number of measures, the decrease in the total number of nursing staff during the year was accompanied by an increase in the provision of the population with infectious disease doctors, general practitioners, anesthesiologists, resuscitators, radiologists, and epidemiologists. Conclusion. In the context of the ongoing COVID-19 pandemic, it is too early to draw conclusions, but, of course, the experience of combating it as part of the Russian Ministry of Health’s measures to organize medical care for the population determined the subsequent tasks for modernizing and improving the healthcare system and resource provision in terms of increasing the availability and quality of medical care. (English) [ FROM AUTHOR] Вспышка COVID-19 в декабре 2019 года в г. Ухань (КНР) и последующее глобальное распространение инфекции в течение нескольких недель, появление новых штаммов вируса SARS-CoV-2 внесли значительные изменения в организацию и деятельность систем здравоохранения большинства стран мира. Цель исследования. Провести анализ показателей инфекционной заболеваемости, отдельных показателей состояния и деятельности государственной и муниципальной систем здравоохранения Российской Федерации до и во время пандемии COVID-19 — за период 2019—2020 гг. Материал и методы. Ð’ качестве материалов исследования использованы данные годовых форм федерального статистического наблюдения в разрезе Российской Федерации â„–12, 14 и 30, а также сборники статистических показателей Минздрава России. Основные методы исследования — статистический, информационно-аналитический. Результаты. Исследование показало, что в период 2012—2019 гг. на фоне снижения инфекционной заболеваемости постепенно сокращалась ресурсная обеспеченность инфекционной службы. Вместе с тем в условиях пандемии COVID-19 нагрузка на данную службу существенно возросла. По результатам тестирования на РНК, антиген и антитела к SARS-CoV-2 в условиях медицинских организаций Минздрава России в стране в 2020 г. зарегистрировано около 5 млн случаев заболевания COVID-19 и почти 600 тыс. случаев носительства возбудителя. На фоне пандемии COVID-19 уменьшилась заболеваемость по обращаемости по большинству классов болезней, на 17,6% сократилось число посещений медицинских организаций, оказывающих медицинскую помощь в амбулаторных условиях, на 16,0% снизился уровень госпитализации, при этом обеспеченность коечным фондом существенно не изменилась, а в структуре коек, перепрофилированных для лечения пациентов с COVID-19, более 80% составили койки терапевтического, хирургического, неврологического и гинекологического профилей. На фоне уменьшения оборота койки по ряду профилей выросла госпитальная летальность, при этом летальность на инфекционныхкойках для пациентов с COVID-19 была на уровне среднероссийских значений по всему коечному фонду. Ð’ ходе реализации ряда мероприятий уменьшение общей численности среднего медицинского персонала в течение года сопровождалось ростом обеспеченности населения врачами-инфРкционистами, терапевтами, анестезиологамиреаниматологами, рентгенологами, эпидемиологами. Заключение. Ð’ условиях продолжающейся пандемии COVID-19 рано подводить итоги, но, безусловно, опыт борьбы с ней в рамках реализации Минздравом России мероприятий по организации медицинской помощи населению определил последующие задачи по модернизации и совершенствованию системы здравоохранения и ресурсного обеспечения в части повышения доступности и качества медицинской помощи. (Russian) [ FROM AUTHOR] Copyright of Profilakticheskaya Meditsina is the property of Media Sphere Publishing House 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.)

Detection of SARS-CoV-2 in young children attending day-care centres in Belgium, May 2020 to February 2022.

Presence of SARS-CoV-2 was monitored in nasopharyngeal samples from young children aged 6-30 months attending day-care centres (DCCs) in Belgium from May 2020-February 2022. SARS-CoV-2 carriage among DCC children was only detected from November 2021, after emergence of Delta and Omicron variants, in 9 of the 42 DCCs screened. In only one DCC, two children tested positive for SARS-CoV-2 at the same sampling time point, suggesting limited transmission of SARS-CoV-2 in Belgian DCCs among young children during the studied period.

Risk assessment of COVID-19 infection for subway commuters integrating dynamic changes in passenger numbers.

The COVID-19 global pandemic has had a significant impact on mass travel. We examined the risk of transmission of COVID-19 infection between subway commuters using the Susceptible Exposed Infected Recovered (SEIR) model. The model considered factors that may influence virus transmission, namely subway disinfection, ventilation capacity, average commuter spacing, single subway journey time, COVID-19 transmission capacity, and dynamic changes in passenger numbers. Based on these parameters, above a certain threshold (25 min), the risk of infection for susceptible people increased significantly as journey time increased. Average distance between commuters and levels of ventilation and disinfection were also important influencing factors. Meanwhile, the model also indicated that the risk of infection varied at different times of the day. Therefore, this paper recommends strengthening ventilation and disinfection in the carriages and limiting the time of single journeys, with an average distance of at least 1 m between passengers. In this light, subway commuters need to take proactive precautions to reduce their risk of COVID-19 infection. Also, the results show the importance of managing subway stations efficiently during epidemic and post-epidemic eras.

A Pilot study screening bank currency in community circulation for potential carriage of SARS-CoV-2: how safe handling the currency is?

Purpose: Currency seems to represent an important vehicle for transmission of pathogenic microorganisms, thus a potential in affecting the public health. Digital transactions are more common in developed countries;however, handling cash currency is still very common in many countries including Bahrain. A recent study from Australia reported that SARS-CoV-2 may survive for 28 days on smooth surfaces (including banknotes), however the study was purely experimental and done in controlled laboratory environment. There were worldwide speculations suggesting the possible transmission of SARS-CoV-2 infection through currency notes. A recent study from Bangladesh reported presence of SARS-CoV-2 in approximately 7% of currency samples collected from the community. No such study has been performed on Bahraini currency, so the present study was proposed to screen the cash currency in circulation in Bahrain for the possible presence of SARS-CoV-2. Method: We collected notes and coins of Bahraini currency and a few of Saudi riyals from different public sources of currency exchange. Two time points were selected for collection when percentage of tested positive cases was on its peak. All the samples were tested for the presence of SARS-CoV-2 antigen with rapid antigen detection kit and qRT-PCR method. For initial validation, 5 samples each of potential SARS-CoV-2 RNAs extracted from known positive cases and 5 samples of extracted RNA from known negative persons were tested by rapid antigen detection kit and qRT-PCR. The results of qRT-PCR were interpreted as per the interpretation chart provided by the supplier. Results: During the study period, a total of 250 currency samples were collected including different denominations of currency notes and coins. Majority of the currency samples were collected from grocery stores followed by food outlets. Following validation, the currency samples were tested, and all turned negative for SARS-CoV-2 by rapid antigen detection test as well as by RT-PCR. Conclusion: This study predicts on Bahraini currency posing no threat of SARS-CoV-2 transmission via currency exchange. © 2021, Arabian Gulf University. All rights reserved.

High Asymptomatic Carriage with the Omicron Variant in South Africa.

We report a 23% asymptomatic SARS CoV-2 Omicron carriage rate in participants being enrolled into a clinical trial in South Africa, 15-fold higher than in trials before Omicron. We also found lower CD4 + T-cell counts in persons with HIV strongly correlated with increased odds of being SARS-CoV-2 PCR positive.

Infant Pneumococcal Carriage in Belgium Not Affected by COVID-19 Containment Measures.

Streptococcus pneumoniae is an important and frequently carried respiratory pathogen that has the potential to cause serious invasive diseases, such as pneumonia, meningitis, and sepsis. Young children and older adults are among the most vulnerable to developing serious disease. With the arrival of the COVID-19 pandemic and the concomitant restrictive measures, invasive disease cases caused by respiratory bacterial species, including pneumococci, decreased substantially. Notably, the stringency of the containment measures as well as the visible reduction in the movement of people appeared to coincide with the drop in invasive disease cases. One could argue that wearing protective masks and adhering to social distancing guidelines to halt the spread of the SARS-CoV-2 virus, also led to a reduction in the person-to-person transmission of respiratory bacterial species. Although plausible, this conjecture is challenged by novel data obtained from our nasopharyngeal carriage study which is performed yearly in healthy daycare center attending children. A sustained and high pneumococcal carriage rate was observed amid periods of stringent restrictive measures. This finding prompts us to revisit the connection between nasopharyngeal colonization and invasion and invites us to look closer at the nasopharyngeal microbiome as a whole.

Modeling the factors that influence exposure to SARS-CoV-2 on a subway train carriage.

We propose the Transmission of Virus in Carriages (TVC) model, a computational model which simulates the potential exposure to SARS-CoV-2 for passengers traveling in a subway rail system train. This model considers exposure through three different routes: fomites via contact with contaminated surfaces; close-range exposure, which accounts for aerosol and droplet transmission within 2 m of the infectious source; and airborne exposure via small aerosols which does not rely on being within 2 m distance from the infectious source. Simulations are based on typical subway parameters and the aim of the study is to consider the relative effect of environmental and behavioral factors including prevalence of the virus in the population, number of people traveling, ventilation rate, and mask wearing as well as the effect of model assumptions such as emission rates. Results simulate generally low exposures in most of the scenarios considered, especially under low virus prevalence. Social distancing through reduced loading and high mask-wearing adherence is predicted to have a noticeable effect on reducing exposure through all routes. The highest predicted doses happen through close-range exposure, while the fomite route cannot be neglected; exposure through both routes relies on infrequent events involving relatively few individuals. Simulated exposure through the airborne route is more homogeneous across passengers, but is generally lower due to the typically short duration of the trips, mask wearing, and the high ventilation rate within the carriage. The infection risk resulting from exposure is challenging to estimate as it will be influenced by factors such as virus variant and vaccination rates.

High levels of gut carriage of antimicrobial-resistant Escherichia coli in community settings in Rio de Janeiro, Brazil.

The prevalence and risk factors for gut carriage of antimicrobial-resistant Escherichia coli among individuals living in the community in Rio de Janeiro, Brazil, are unknown. The aim of this study was to determine the prevalence of colonization with antimicrobial-resistant E. coli, including isolates producing ESBL and harboring plasmid-mediated quinolone resistant (PMQR) genes in this community. We performed a cross-sectional study and analyzed fecal specimens of individuals attending outpatient clinics in the city from January 2015 to July 2019. We investigated susceptibility to antimicrobial agents by disc diffusion tests and used PCR to determine ESBL types, PMQR, and the virulence genes that characterize an isolate as extraintestinal pathogenic E. coli (ExPEC). Among the 623 subjects, 212 (34%) carried an isolate resistant to at least one of the tested antimicrobial agents, with the highest frequencies of resistance to ampicillin (26%), trimethoprim-sulfamethoxazole (19%), cefazolin (14%), and ciprofloxacin (CIP, 9%). In addition, 13% (81) of subjects carried a multidrug-resistant-E. coli (MDR-E), including 47 (8% of all isolates) ESBL-producing E. coli (ESBL-E), mainly of CTX-M-8 (15, 32%) and CTX-M-15 (9, 20%) types. PMQR genes were present in 7% (42) of all isolates, including 60% (32) of the 53 resistant to CIP. Previous use of antimicrobial agents, particularly fluoroquinolones, was a risk factor for colonization with MDR-E (25%, 20/81 vs 13%, 70/542, p = 0.01), ESBL-E (28%, 13/47, vs 13%, 77/576, p = 0.01), and resistance to CIP (26%, 14/53, vs 12%, 70/570, p = 0.01). The most pathogenic phylogroups B2, C, and D were 37% of the MDR-E, 30% of the ESBL-E, 38% of the CIP-resistant, and 31% of PMQR gene carrying E. coli isolates. We show that carriage of MDR-E (mostly ESBL-E) reached high levels in the community in Rio de Janeiro, increased by the selection of antimicrobial agents. Much of the resistant E. coli isolates are potential pathogenic strains. The widespread use of antimicrobial agents during the COVID-19 pandemic in Brazil may have worsened this picture.

Management & Complications of Airway in COVID-19 suspected & confirmed cases: a retrospective cohort epidemiological study in a tertiary care centre

Background: The outbreak of COVID-19 in Pakistan started from February 2020 and over the next few months it affected around a million people, leaving thousands dead in an already burdened healthcare infrastructure. Rising to the challenge of COVID 19 airway management, we adopted components of 'Consensus guidelines for managing airways in patients with COVID 19 to improve success of first pass intubation alongwith minimising risk of infection to self and others. Aim: To analyse the techniques of airway management and complications of suspected or confirmed COVID status at time of their airway management. Methodology: After ethical approval by the institutional review board, data is collected from the Hospital Information System (HIS) for cases fulfilling inclusion criteria, from April to September 2020 in a tertiary care cancer hospital, Pakistan. Results: In our centre, forty-five intubations were performed, 71% of these intubations were out of hours and 43% performed by consultants. It had a high 1st attempt success rate of 84.4%, using Videolaryngoscope (64.4%) and 55.6% confirmed use of capnography. In all cases (100%) PPE was available and used. Minimum number of personnel in room during intubation was kept to four to five in 55.6% of cases. Conclusion: Dedicated airway team used Personal Protective Equipment in all cases (100%) and restricted the number of personnel during the procedure. A high success rate of 1st attempt intubation, widely used videolaryngoscope, single agent induction and consultant intubators were salient features of our practice.

Fecal Carriage and Molecular Characterization of Carbapenemase-Producing Enterobacterales in the Pediatric Population in Qatar.

Whole-genome sequencing was used to characterize carbapenemase-producing Enterobacterales (CPE) strains recovered from rectal screening swab samples obtained from children at a tertiary-care pediatric hospital in Qatar during a 3-year period. A total of 72 CPE isolates recovered from 61 fecal carriers were characterized. Escherichia coli (47 isolates [65.3%]) and Klebsiella pneumoniae (22 isolates [30.6%]) were the most common species identified. High levels of genetic diversity were observed for both species. These 72 isolates produced 78 carbapenemases, characterized as either NDM-type (41 enzymes [52.6%]) or OXA-48-type (37 enzymes [47.4%]). NDM-5 (24 enzymes [30.8%]), NDM-1 (15 enzymes [19.2%]), and OXA-181 (15 enzymes [19.2%]) were the most common variants detected within each type. Twenty-three NDM producers exhibited difficult-to-treat resistance, compared with only 2 of the OXA-48 producers. Multiple comorbidities were identified in 88.5% of the patients, whereas recent travel history to countries in which CPE are endemic was documented for 57.4% of the patients. All 9 blaOXA-48-type-gene-containing E. coli sequence type 38 (ST38) strains were isolated from patients without international travel history. The mean quarterly incidence of fecal carriage decreased more than 6-fold after the implementation of coronavirus disease 2019 (COVID-19)-related international travel restrictions in Qatar in mid-March 2020. Our data suggest that NDM-type and OXA-48-type carbapenemases expressed by a large diversity of E. coli and K. pneumoniae genotypes are largely dominant in the pediatric population of Qatar. Although our data indicate successful local expansion of E. coli ST38 strains harboring blaOXA-244 genes, at least within health care settings, blaOXA-48-type and blaNDM-type genes appear to have been mainly introduced sporadically by asymptomatic carriers who visited or received health care in some nearby countries in which the genes are endemic. IMPORTANCE To the best of our knowledge, this is the first study addressing the molecular characteristics of CPE in a pediatric population in Qatar using whole-genome sequencing. Since several countries in the Arabian Peninsula share relatively similar demographic patterns and international links, it is plausible that the molecular characteristics of CPE in children, at least in the middle and eastern parts of the region, are similar to those observed in our study.

Fecal Carriage and Epidemiology of Extended-Spectrum Beta-Lactamase/Carbapenemases Producing Enterobacterales Isolates in Bulgarian Hospitals.

The gastrointestinal tract is an important reservoir of extended spectrum beta-lactamase (ESBL)/carbapenemase-producing Enterobacterales isolates. This study included patients from two Bulgarian hospitals. Overall, 98 ESBL producers (including 68 Escherichia coli and 20 Klebsiella pneumoniae isolates) were detected among 99 hospitalized patients, 212 patients at admission, and 92 hospital staff in 42.4%, 24.5%, and 4%, respectively. We observed blaCTX-M-15 in 47% of isolates, blaCTX-M-3 in 39% and blaCTX-M-14 in 11%. Three blaCTX-M-15 positive isolates were also blaKPC-2 positive. High transferability was detected for blaCTX-M-3 carrying plasmids (55%) with L/M and I1 replicon plasmids, followed by CTX-M-14 (36.4%) and CTX-M-15 (27.9%) with IncF plasmids. BlaKPC-2 was carried by FIIAs plasmids. Epidemiology typing revealed 8 K. pneumoniae ST types-ST15(8/20), ST17(4/20), ST37(2/20) and 9 E. coli ST types-ST131 (30.9%, 21/68), ST38 (8/68), ST95(7/68) and ST316(7/68). All ST131 isolates but one was from the highly virulent epidemic clone O25bST131. This is the first report in Bulgaria about ESBL/carbapenemase faecal carriage. We observed high ESBL/carbapenemases prevalence. A predominant number of isolates were members of highly epidemic and virulent PanEuropean clones ST15 K. pneumoniae and O25bST131 E. coli. High antibiotics usage during the COVID pandemic will worsen the situation. Routine screenings and strict infection control measures should be widely implemented.

No SARS-CoV-2 carriage observed in children attending daycare centers during the intial weeks of the epidemic in Belgium.

To gain knowledge about the role of young children attending daycare in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, a random sample of children (n = 84) aged between 6 and 30 months attending daycare in Belgium was studied shortly after the start of the epidemic (February 29th) and before the lockdown (March 18th) by performing in-house SARS-CoV-2 real-time polymerase chain reaction. No asymptomatic carriage of SARS-CoV-2 was detected, whereas common cold symptoms were common (51.2%). Our study shows that in Belgium, there was no sign of early introduction into daycare centers at the moment children being not yet isolated at home, although the virus was clearly circulating. It is clear that more evidence is needed to understand the actual role of young children in the transmission of SARS-CoV-2 and their infection risk when attending daycare.

Pattern of Respiratory Viruses among Pilgrims during 2019 Hajj Season Who Sought Healthcare Due to Severe Respiratory Symptoms.

The aim of our study was to define the spectrum of viral infections in pilgrims with acute respiratory tract illnesses presenting to healthcare facilities around the holy places in Makkah, Saudi Arabia during the 2019 Hajj pilgrimage. During the five days of Hajj, a total of 185 pilgrims were enrolled in the study. Nasopharyngeal swabs (NPSs) of 126/185 patients (68.11%) tested positive for one or more respiratory viruses by PCR. Among the 126 pilgrims whose NPS were PCR positive: (a) there were 93/126 (74%) with a single virus infection, (b) 33/126 (26%) with coinfection with more than one virus (up to four viruses): of these, 25/33 cases had coinfection with two viruses; 6/33 were infected with three viruses, while the remaining 2/33 patients had infection with four viruses. Human rhinovirus (HRV) was the most common detected viruses with 53 cases (42.06%), followed by 27 (21.43%) cases of influenza A (H1N1), and 23 (18.25%) cases of influenza A other than H1N1. Twenty-five cases of CoV-229E (19.84%) were detected more than other coronavirus members (5 CoV-OC43 (3.97%), 4 CoV-HKU1 (3.17%), and 1 CoV-NL63 (0.79%)). PIV-3 was detected in 8 cases (6.35%). A single case (0.79%) of PIV-1 and PIV-4 were found. HMPV represented 5 (3.97%), RSV and influenza B 4 (3.17%) for each, and Parechovirus 1 (0.79%). Enterovirus, Bocavirus, and M. pneumoniae were not detected. Whether identification of viral nucleic acid represents nasopharyngeal carriage or specific causal etiology of RTI remains to be defined. Large controlled cohort studies (pre-Hajj, during Hajj, and post-Hajj) are required to define the carriage rates and the specific etiology and causal roles of specific individual viruses or combination of viruses in the pathogenesis of respiratory tract infections in pilgrims participating in the annual Hajj. Studies of the specific microbial etiology of respiratory track infections (RTIs) at mass gathering religious events remain a priority, especially in light of the novel SARS-CoV-2 pandemic.

A Narrative Review of the W, X, Y, E, and NG of Meningococcal Disease: Emerging Capsular Groups, Pathotypes, and Global Control.

Neisseria meningitidis, carried in the human nasopharynx asymptomatically by ~10% of the population, remains a leading cause of meningitis and rapidly fatal sepsis, usually in otherwise healthy individuals. The epidemiology of invasive meningococcal disease (IMD) varies substantially by geography and over time and is now influenced by meningococcal vaccines and in 2020-2021 by COVID-19 pandemic containment measures. While 12 capsular groups, defined by capsular polysaccharide structures, can be expressed by N. meningitidis, groups A, B, and C historically caused most IMD. However, the use of mono-, bi-, and quadrivalent-polysaccharide-conjugate vaccines, the introduction of protein-based vaccines for group B, natural disease fluctuations, new drugs (e.g., eculizumab) that increase meningococcal susceptibility, changing transmission dynamics and meningococcal evolution are impacting the incidence of the capsular groups causing IMD. While the ability to spread and cause illness vary considerably, capsular groups W, X, and Y now cause significant IMD. In addition, group E and nongroupable meningococci have appeared as a cause of invasive disease, and a nongroupable N. meningitidis pathotype of the hypervirulent clonal complex 11 is causing sexually transmitted urethritis cases and outbreaks. Carriage and IMD of the previously "minor" N. meningitidis are reviewed and the need for polyvalent meningococcal vaccines emphasized.

Variations in respiratory pathogen carriage among a homeless population in a shelter for men in Marseille, France, March-July 2020: cross-sectional 1-day surveys.

We aimed to compare respiratory pathogen carriage by PCR during three different time periods in 2020 in sheltered homeless people in Marseille, France. The overall prevalence of respiratory pathogen carriage in late March-early April (69.9%) was significantly higher than in late April (42.3%) and mid-July (45.1%). Bacterial carriage significantly decreased between late March-early April and late April. SARS-CoV-2 was detected only in late March-early April samples (20.6%). Measures aiming at mitigating SARS-CoV-2 transmission were effective and also impacted bacterial carriage. Seasonal variations of bacterial carriage between winter and summer in this population were not marked.

Dynamics of SARS-CoV-2 RT-PCR positivity and seroprevalence among high-risk healthcare workers and hospital staff.

Staff working in units that were highly exposed to coronavirus disease 2019 were invited to participate in a 6-month study on the carriage and seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The results from visits on Day 1 and Day 15 show that 41 cases of SARS-CoV-2 infection were confirmed by reverse transcriptase polymerase chain reaction and/or serology in 326 participants (overall infection rate 12.6%). The presence of comorbidities or symptoms at the time of sample collection was a risk factor for infection, but working as a physician/nurse was not a risk factor. Universal screening in high-risk units, irrespective of symptoms, allowed the identification of asymptomatic and potentially contagious infected workers, enabling them to self-isolate for 7 days.

Outcome of COVID-19 in liver transplant recipients: A preliminary report from Northwestern Italy.

Covid-19 pandemic is deeply affecting transplant activity worldwide. It is unclear whether solid organ transplant recipients are at increased risk of developing severe complications and how they should be managed, also concerning immunosuppression. This is a report about the course and management of SARS-CoV-2 infection in liver transplant recipients from a single center in Northwestern Italy in the period March-April 2020. Three patients who were treated at our institution are reported in detail, whereas summary data are provided for those managed at peripheral Hospitals. Presentation varied from asymptomatic to rapidly progressive respiratory failure due to bilateral interstitial pneumonia. Accordingly, treatment and changes to immunosuppression were adapted to the severity of the disease. Overall mortality was 20%, whereas Covid-related mortality was 10%. Two cases of prolonged (>2 months) viral carriage were observed in two asymptomatic patients who contracted the infection in the early course after transplant. Besides depicting Covid-19 course and possible treatment scenarios in liver transplant patients, these cases are discussed in relation to the changes in our practice prompted by Covid-19 epidemic, with potential implications for other transplant programs.