School-aged children’s movement behaviours and subjective health complaints in Japan: A cross-sectional study during COVID-19 pandemic-related school closure and after school reopening (preprint)

Background: Social restrictions associated with the COVID-19 pandemic have altered children’s movement behaviours and impacted their mental health. However, the influence of social restrictions on subjective health complaints remains inadequately understood. This study compared adherence to 24-hour movement behaviour guidelines and the prevalence of subjective health complaints during school closure and one year after reopening. We also examined how combinations of adherence to movement behaviour recommendations relate to subjective health complaints. Methods: A repeated cross-sectional survey was conducted at two points. The first survey in May 2020 included 1535 (766 boys and 769 girls) participants during school closures, while the second survey from May to July 2021 involved 1125 (583 boys and 542 girls) participants one year after school reopening. The questionnaire covered socio-demographics, physical activity, screen time, sleep, and subjective health complaints. Differences between periods were analysed using chi-square tests. Logistic regression models assessed the association between adherence to guidelines and subjective health complaints. Results: During school closure, children were more likely to meet ‘only sleep’ recommendations and experience irritability and lethargy symptoms as compared to one year after school reopening. Irrespective of sex, those adhering to two or all three recommendations (excluding physical activity and screen time) had a lower risk of symptoms related to physical and mental pain, fatigue, irritability, and lethargy as compared to those who met no recommendation. Conclusions: Children should meet at least one physical activity or screen time recommendation in addition to sleep recommendations for subjective health. Strategies considering the priority of each movement behaviour are crucial, even during abnormal situations, such as pandemic-related social restrictions. This study offers insightful findings concerning children’s mental health issues during unprecedented and massive disasters or crises.

Symptoms of children and adolescents infected with SARS-CoV-2 variants alpha, delta or omicron (preprint)

Symptoms experienced by children and adolescents with SARS-CoV-2 infections in the alpha, delta and omicron variant dominated phases were investigated using an online survey, and the frequencies of reported symptoms and changes over time were analyzed. The most prevalent symptoms were fever above 38 {degrees}C, tiredness, headache, runny or blocked nose, sneezing and dry cough. Lethargy and nausea were reported significantly more frequently in the omicron variant dominated phase than in the earlier phases of the pandemic. Compared to symptoms reported by adults, fever and gastrointestinal symptoms were reported more frequently for children, especially in the omicron variant dominated phase, whereas the frequency of loss of smell and loss of taste was significantly lower in children than in adults.

Prevalence of post-vaccine side effects among COVID-19 immunized community of Southern Pakistan.

BACKGROUND: The response to the vaccine may vary among individuals. Hence, it is important to know how often individuals experience side effects after immunization against COVID-19. OBJECTIVE: This study aimed to assess the incidence of side effects following COVID-19 vaccination across different vaccine recipients in Southern Pakistan and identify the potential factors associated with these side effects in the population. METHODS: The survey was conducted across Pakistan through Google-forms Links from August to October 2021. The questionnaire included demographic information and COVID-19 vaccine information. Chi-square (x2) was performed for comparative analysis to check the significance level with P <0.05. The final analysis included 507 participants who had received COVID-19 vaccines. RESULTS: Of the total 507 COVID-19 vaccines recipients, 24.9% received CoronaVac, 36.5% received BBIBP-CorV, 14.2% received BNT162b2, 13.8% received AZD1222, and 10.7% received mRNA-1273. The most prominent side effects after the first dose were fever, weakness, lethargy, and pain at the site of injection. Moreover, the most commonly reported side effects after the second dose were pain at the injection site, headache, body ache, lethargy, fever, chills, flu-like symptoms, and diarrhea. CONCLUSION: Our results suggested that the side effects due to COVID-19 vaccination can vary between the first and second doses and type of COVID-19 vaccine. Our findings suggest continuing monitoring of vaccine safety and the importance of individualized risk-benefit assessment for COVID-19 immunization.

Genomic Determinants of Long COVID (preprint)

Around 5–10% of adults may experience persistence of symptoms/signs beyond 4 to 12 weeks after acute SARS-CoV-2 infection. According to the World Health Organization, up to 40 million people suffer from Long COVID in Europe and the USA alone. The Centers for Disease Control and Prevention have encouraged the recognition of predictors for Long COVID. Any genetic markers associated to the disease have remained elusive to date. Here we explore the potential contribution of genetic traits to Long COVID. We used a well characterized cohort of 50 individuals with definitive diagnostic criteria for Long COVID from an initial set of patients of more than 1,200 with suspected Long COVID. All were attended at Hospital Puerta de Hierro, a large regional hospital in Madrid, Spain. All subjects had tested positive for SARS-CoV-2 RNA and/or antibodies, showed clinical manifestations for more than 6 months, and developed more than 5 persistent symptoms/signs. Low pass whole genome sequencing was performed in blood specimens for our selected cohort. From hundreds of polygenic risk scores (PRS) recorded at the PGS Catalog, we tested in our selected cohort a total of 12 PRS that passed our filtering criteria. Selected PRS encompassed distinct medical conditions, including cancers, hematologic, cardiovascular, endocrine, immunologic and neurological disorders. The calculated PRS in our patients produced a distribution of scores that was compared to a control ancestry-matched general population. We found significant differences for the PRS of traits ‘Tiredness/lethargy in the last 2 weeks’ and suggestive significance for ‘Depression’ when comparing Long COVID patients and controls. Our results strongly support a genetic susceptibility for Long COVID, with those scoring high in genetic predisposition for ‘tiredness’ as more likely to develop the disease. Results shed new light into the physiopathological basis for Long COVID, contrary to opinions considering it a subjective condition.

Canine and feline core vaccinations: US veterinarians' concerns and perceived impact of COVID-19 antivaccination views on veterinary medicine.

OBJECTIVE: Assess US veterinarians' perceptions regarding vaccine concerns (their own and owners') and the association between owners' vaccine concerns and COVID-19 antivaccination sentiments. SAMPLE: Members of the Veterinary Information Network. PROCEDURES: An electronic survey distributed via the Veterinary Information Network data collection portal. RESULTS: 1,341 US veterinarians completed the survey. Top veterinarian concerns for vaccinating a healthy adult dog were anaphylaxis, soreness at injection site, and lethargy; for cats, these concerns included vaccine-associated sarcoma, lethargy, and soreness at injection site. Veterinarians reported that the most common concerns mentioned by owners included that the pet does not go outside, that vaccinations are unnecessary, that vaccinations can lead to chronic or severe illness, and cost. Veterinarians reported an increased number of dog and cat owners reluctant about or resistant to the idea of rabies vaccines and core vaccines since the time that COVID-19 vaccines became widely available. There was an association between veterinarians' perceptions of local COVID-19 antivaccination sentiments and the increase in the number of vaccine-resistant or -concerned clients. CLINICAL RELEVANCE: There appears to be little overlap between veterinarians' primary concerns related to vaccinations and their perception of dog and cat owners' primary concerns. The fact that the number of resistant clients is positively associated with the presence of veterinarians' perceptions of a local COVID-19 antivaccination sentiment suggests that human antivaccination sentiments impact pet owners' views of companion animal vaccinations. A better understanding of the cognitive biases that impact owners' vaccine decisions can help veterinarians better communicate with vaccine-reluctant clients and increase vaccination compliance rates.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is common in post-acute sequelae of SARS-CoV-2 infection (PASC): Results from a post-COVID-19 multidisciplinary clinic. (preprint)

BackgroundThe global prevalence of PASC is estimated to be present in 0{middle dot}43 and based on the WHO estimation of 470 million worldwide COVID-19 infections, corresponds to around 200 million people experiencing long COVID symptoms. Despite this, its clinical features are not well defined. MethodsWe collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the ME/CFS phenotype. FindingsThe median age was 47 years, 59{middle dot}0% were female; 49{middle dot}3% White, 17{middle dot}2% Hispanic, 14{middle dot}9% Asian, and 6{middle dot}7% Black. Only 12{middle dot}7% required hospitalization. Seventy-two (53{middle dot}5%) patients had no known comorbid conditions. Forty-five (33{middle dot}9%) were significantly debilitated. The median duration of symptoms was 285{middle dot}5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86{middle dot}5%), post-exertional malaise (82{middle dot}8%), brain fog (81{middle dot}2%), unrefreshing sleep (76{middle dot}7%), and lethargy (74{middle dot}6%). Forty-three percent fit the criteria for ME/CFS. InterpretationsMost PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype. FundingThe study did not received funding.

Severity and Symptom Characteristics between Omicron and Delta SARS-CoV-2 Variant Infections in the Australian Capital Territory: A Cross-Sectional Study (preprint)

Background: Despite the widespread dominance of SARS-CoV-2 Delta (B.1.617.2 lineage) and Omicron (B.1.1.529 lineage) variants, there has been little information detailing differences in the presentation of symptoms and clinical characteristics. Characterising symptom and severity profile is important for understanding emerging SARS-CoV-2 variants. Methods: We conducted a retrospective cross-sectional study of all laboratory-confirmed SARS-CoV-2 infections notified in the Australian Capital Territory (ACT), Australia, between 12 August 2021 and 21 January 2022. Symptom data were ascertained through the initial case investigation interview, and by using either an automated survey or phone interview through routine public follow-up. The routine follow-up for the full isolation period collected individual symptom status and the specific symptoms experienced. We used validated vaccination status through the Australian Immunisation Register (AIR). We used a multivariable logistic regression model to estimate adjusted odds ratios (aOR) for hospitalisation with the Delta and Omicron SARS-CoV-2 variants. We compared the difference in proportions of individual symptoms experienced using Pearson’s χ2 tests, Wilcoxon rank sum test or Fisher’s exact tests. We considered results significantly different where p-value was less than 0.05. Results: We found that a higher proportion of individuals infected with Omicron (32% 144/452) were asymptomatic compared to those infected with Delta (12% 74/613). The most commonly reported symptoms for Delta infections are cough (62%, 381/613), headache (55% 338/613), fever (47% 290/613) and runny nose (47% 289/613). The most commonly reported symptoms for Omicron infections are runny nose (54% 242/452), cough (53% 240/452), sore throat (41% 181/452) and lethargy (39% 176/452). Cases infected with the Omicron variant had a lower odds of hospitalisation compared to cases infected with the Delta variant (OR 0.29, 95% CI 0.16-0.53). Conclusion: We found that symptom characteristics for Omicron and Delta SARS-CoV-2 infections were significantly different. Furthermore, we found that individuals infected with Omicron were more likely to report no symptoms at all, although vaccination status may have played a role in this cohort. Overall, infection with Delta was more likely to result in hospitalisation.

COVID-19 associated multisystemic inflammatory syndrome in 614 children with and without overlap with Kawasaki disease-Turk MIS-C study group.

Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9-12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells × µL, p = 0.028; platelet count 166 vs. 216 cells × 103/µL, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 µg/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% (p < 0.001, 95% CI 0.217-0.550), lethargy increased the risk of overlap with KD by 2.6-fold (p = 0.011, 95% CI 1.244-5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% (p < 0.001, 95% CI 0.298-0.559). CONCLUSION: Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD. WHAT IS KNOWN: • In some cases of MIS-C, the clinical symptoms overlap with Kawasaki disease. • Compared to Kawasaki disease, lymphopenia was an independent predictor of MIS-C. WHAT IS NEW: • Half of the patients had clinical features that overlapped with Kawasaki disease. • In patients whose clinical features overlapped with KD, procalcitonin levels were almost 15 times higher than normal. • Lethargy increased the risk of overlap with KD by 2.6-fold in MIS-C patients. • Transient bradycardia was noted in approximately 10% of our patients after initiation of treatment.

A lethargic child with COVID-19 infection.

ABSTRACT: COVID-19 infection in children is less understood than COVID-19 infection in adults, and although it is believed to cause mild or asymptomatic infections, several cases of severe or atypical presentations have been reported. Children presenting with gastrointestinal symptoms, even those without respiratory symptoms, should raise the suspicion for possible COVID-19 infection. This case report describes a 20-month-old girl with a clear history of COVID-19 exposure whose acute abdomen and lethargy were diagnosed as COVID-19 infection complicated by intussusception.

Ischemic Lesions in the Brain of a Neonate With SARS-CoV-2 Infection.

AIM: To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain. BACKGROUND: Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported. CASE DESCRIPTION: We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented. CONCLUSIONS: SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found. CLINICAL SIGNIFICANCE: Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.

Side Effects and Perceptions Following Sinopharm COVID-19 Vaccination (preprint)

Objectives Vaccines are one of the best interventions developed for eradicating COVID-19 the rapid creation of vaccinations was increased the risk of vaccine safety problems. The aim of this study to provide evidence on Sinopharm COVID-19 vaccine side effects. Methods A cross-sectional survey study was conducted between January and April 2021 to collect data on the effects of COVID-19 vaccine among individuals in the UAE. Demographic data chronic conditions side effects of the 1st and 2nd dose toward the vaccination, and the response of unwilling taking COVID-19 vaccine were reported. Results The most common side effects of post 1st dose (less than 49 years old vs >49 years) were normal injection site pain, fatigue, and headache while pain at the vaccination site fatigue lethargy headache and tenderness were the most side effects of the post 2nd dose in both groups. All the side effects in both doses were more prevalent among the participants less than 49-year-old group. Among females vs males side effects were more common in females compared with males in both doses in both doses. The most common adverse reactions of 1st dose in (females vs males) were fatigue lethargy headache while in 2nd dose were fatigue sever injection site pain. The most common reason of not willing to take the COVID-19 vaccine were the vaccines are not effective and they were not authorized to take vaccine. Conclusion The 1st and 2nd dose post-vaccination side effects were mild predictable and there were no hospitalization cases this data will help to reduce the vaccine hesitancy.

Clinicopathological features and outcome of COVID-19- early experiences from three covid hospitals, Chittagong, Bangladesh (preprint)

Introduction: COVID 19 is an unknown virus affecting mankind creating a deadly experience to all. It is true for Bangladesh also. So the objectives of the present study is to find the clinicopathological features and outcome of COVID patients admitted in three COVID dedicated hospitals of Chittagong, Bnagladesh. Methods: This was an observational study where a total of 209 patients admitted in three COVID dedicated hospital were recruited. Clinicopathological data were recorded and patients were under observation till discharge and thus outcome were recorded. Prior consent was taken from the patients and ethical clearance was also taken. Data was compiled and analyzed by SPSS-20. Results: Among 209 patients most of them were male 139(66.5%) and male to female ratio was 1.98:1. Age group distribution revealed more were aggregated in age group 41-50 years 36(17.2%), 51-60 years 54(25.8%) and 61-70 years 57(27.3%). Among all 92(44%) patients were RT-PCR positive and 117(56%) were probable cases. Fever was present in 195(93.3%) cases, cough in 180(86.1%), respiratory distress in 105(50.2%) anosmia in 123(58.8% ), aguesea in 112 (53.58%) and lethargy was present in 143( 68.42%). Chest X-ray findings revealed 73(34.9%) had bilateral patchy opacities, 20(9.6%) had unilateral opacities 65(31.1%) had consolidations, 6(2.9%) had ground glass opacities and 2(1.0%) had pleural effusion. Supplemental O2 was given in 173(82.8%) patients, Favipiravir in 59(28.2%), Remdisivir in 111(53.1%), Methylprednisolone in 87(41.6%), Dexamethasone in 93(44.5%), Antibiotics in 204(97.60%), Toccilizumab in 34(16.3%), plasma in 18(8.6%) and LMWH in 200(95.7%) patients. Regarding outcome of the COVID patients admitted, 85(92.4%) patients improved, 6(6.5%) died who were RT-PCR positive and 107(91.15%) improved, 9(7.7%) died who were probable cases. Total death rate was 7.1%. Conclusion: Present study findings were some early activities among COVID patients in the years 2020. Male were more affected and middle age group people were the most victims.

Clinicopathologic features of a feline SARS-CoV-2 infection model parallel acute COVID-19 in humans (preprint)

The emergence and ensuing dominance of COVID-19 on the world stage has emphasized the urgency of efficient animal models for the development of therapeutics and assessment of immune responses to SARS-CoV-2 infection. Shortcomings of current animal models for SARS-CoV-2 include limited lower respiratory disease, divergence from clinical COVID-19 disease, and requirements for host genetic modifications to permit infection. This study validates a feline model for SARS-CoV-2 infection that results in clinical disease and histopathologic lesions consistent with severe COVID-19 in humans. Intra-tracheal inoculation of concentrated SARS-CoV-2 caused infected cats to develop clinical disease consistent with that observed in the early exudative phase of COVID-19. A novel clinical scoring system for feline respiratory disease was developed and utilized, documenting a significant degree of lethargy, fever, dyspnea, and dry cough in infected cats. In addition, histopathologic pulmonary lesions such as diffuse alveolar damage, hyaline membrane formation, fibrin deposition, and proteinaceous exudates were observed due to SARS-CoV-2 infection, imitating lesions identified in people hospitalized with ARDS from COVID-19. A significant correlation exists between the degree of clinical disease identified in infected cats and pulmonary lesions. Viral loads and ACE2 expression were quantified in nasal turbinates, distal trachea, lung, and various other organs. Natural ACE2 expression, paired with clinicopathologic correlates between this feline model and human COVID-19, encourage use of this model for future translational studies.

Molecular Detection and Clinical Characteristics of Bacterial and Viral Main Etiological Agents Causing Respiratory Tract Infections in Tehran, Iran (preprint)

Background: Respiratory tract infections are one of the most important infections among military personals, worldwide. The present study aimed to survey the prevalence of bacterial and viral main etiological agents causing respiratory tract infections among the military personnel in Iran. A cross-sectional study was performed from September 2020 to February 2021. Nasopharyngeal swabs were taken from patients, military personnel with respiratory tract infection symptoms. Detection of COVID-19 was performed with one step qRT-PCR method. TaqMan probe-based real-time PCR assay was used for the detection of influenza A and B viruses. The prevalence of adenovirus and M. pneumoniae were determined using nested PCR. Moreover, B. pertussis and S. pyogenes were identified by conventional PCR assay. The detection of H. influenzae was performed by multiplex PCR method. Results: Overall, 145 patients were included. Among viral pathogens, COVID-19, influenza A virus, and adenovirus were identified in 85.5%, 4.1%, and 1.4% of patients, respectively. Influenza B virus was not detected among military personnel. The frequency of bacteria etiological agents was as follows: S. pyogenes (2%), M. pneumoniae (0.7%), H. influenzae (0%), and B. pertussis (0%). Muscle aches (75.9%), headache (70.3%), lethargy (69%), cough (66.2%), stuffy nose (56.6%), fever (53.8%), and sore throat (53.1%) were amongst the most common clinical symptoms. Conclusions: Results showed that the military personals are the susceptible group to COVID-19 infection. Therefore, the accurate detection and implementation of control strategies such as vaccination are necessary.

Impacts of Coronavirus on Farm and Pet Animals (preprint)

Coronaviruses are positive sense RNA virus belonging to the Coronaviridae family, which are further subdivided into four genera: Alpha, Beta, Gamma, and Delta Coronaviruses. Infectious bronchitis virus and SARS-CoV belong to Beta Coronaviridae family. Infectious bronchitis virus causes respiratory and nephritic signs that includes tracheal rales, urate crystals, lethargy and nasal discharge. In livestock and pets, the Coronavirus infection causes mostly gastrointestinal lesions, which may be prevented through vaccination and biosecurity. Recent infections of SARS-CoV-2 (also known as COVID-19) on farm and pet animals were summarized in this study. Besides, zoo animals were reported with infections in some countries/regions. Although the damage of COVID-19 has not been reported as serious as highly pathogenic avian influenza (HPAI) and African Swine Fever (ASF) on farm animals so far, the transmission mechanism of COVID-19 among group animals/farms and its long-term impacts are still not clear. The impact of Coronavirus on animals and potential prevention strategies, such as vaccine development and farm biosecurity measures, were discussed. Prior to the development of the effective vaccine, the biosecurity measures (e.g., conventional disinfection strategies and innovated technologies) may play roles in preventing potential spread of diseases/viruses.

The presentation of spontaneous splenic rupture in a COVID-19 patient: a case report (preprint)

Introduction: Splenic rupture is an emergency condition and the vast numbers of cases are secondary to trauma. Several underlying pathologies have also been associated with splenic rupture, such as hematological diseases, malignancies, and infectious and inflammatory diseases.Presentation of case: The patient was a 52-year-old man who referred to the Poursina Hospital in Rasht while complaining of abdominal pain from the day before hospitalization. The patient reported a history of lethargy, fever, and nausea. In the examinations performed, there was a brief tenderness in the patient's epigastrium. The patient was monitored and about 12 hours after hospitalization, ill appearance, respiratory (respiratory distress) symptoms, and high fever were reported for the patient. According to the examination, the patient was immediately transferred to the operating room and underwent laparotomy. During the operation, contrary to our expectations, a lot of blood (about 1000 cc) was observed in the patient's abdomen. After blood suctioning, the left upper quadrant (LUQ) was bleeding and the rupture of the spleen could also be observed. Therefore, a splenectomy was performed .In the examinations performed for the patient, the patient's rtPCR test confirmed COVID-19.Conclusion: The evaluation of the spontaneous splenic rupture (SSR) in our case shows that this type of risk should also be considered in patients with COVID-19 who referred to medical centers with abdominal pain, and if more cases are reported, the correctness of this process can be commented on.

Prolonged nucleic acid conversion and false-negative RT-PCR results in Indonesian patients with COVID-19: A case series (preprint)

Background: Prolonged nucleic acid conversion and false-negative results of real-time reverse transcription polymerase chain reaction (RT-PCR) might occur in some patients with COVID-19 rather than recurrence of infection. Here, we reported four cases of COVID-19 with prolonged nucleic acid conversion and false-negative results of RT-PCR in our institution.Case presentation: Case 1: A 36-year-old-male patient complained of coughing up phlegm one week before admission. His chest X-rays showed mild pneumonia in the right lung. His swab test was confirmed positive for SARS-Cov-2. Besides the last two consecutive negative results, he also had negative results of RT-PCR twice (the 6th and 8th tests) from a total of 11 swab tests. Case 2: A 54-year-old-male patient complained of shortness of breath that worsened with activity. He had a comorbidity of diabetes. His chest X-rays showed inhomogeneous opacity on bilateral paracardial and lateral aspects. His swab test was confirmed positive for SARS-Cov-2. Besides the last two consecutive negative results, he also had negative results of RT-PCR once (the 5th test) from a total of 8 swab tests. Case 3: A 47-year-old man presented with complaints of fever, cough, sore throat, and diarrhea. He had comorbidities of asthma and heart rhythm disorders. His chest X-rays showed bilateral pneumonia. His swab test was confirmed positive for SARS-Cov-2. Besides the last two consecutive negative results, he also showed negative results of RT-PCR twice (the 4th and 6th tests) from a total of 11 swab tests. Case 4: A 56-year-old-female complained of lethargy and diarrhea. She has a history of hyperthyroidism. His chest X-rays showed bilateral pneumonia. She was confirmed positive for SARS-Cov-2. Besides the last two consecutive negative results, she also had negative results of RT-PCR twice (the 2nd and 10th tests) from a total of 14 swab tests.Conclusions: Our cases further confirmed the occurrence of prolonged nucleic acid conversion and the possibility of false negative results of RT-PCR in patients with COVID-19 instead of recurrence of infection. These findings might have an implication on the management of patients with COVID-19 who have already clinically and radiologically recovered, particularly related to subsequent spreading of the infection in the community.

A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak.

OBJECTIVE: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. METHODS: Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated. RESULTS: Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. CONCLUSIONS: Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.