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2.
Jpn J Infect Dis ; 73(5): 377-380, 2020 Sep 24.
Article in English | MEDLINE | ID: covidwho-1034439

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a severe infectious disease of the respiratory tract caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2, and has a high mortality rate. The disease emerged from Wuhan, China, in late 2019, and spread to Japan, including Hokkaido, in January 2020. In February 2020, 3 children were diagnosed with COVID-19 in Furano, Hokkaido, Japan. During this period, influenza and human metapneumovirus infections were prevalent among children in the Furano region. Two of the 3 patients experienced co-infection with other respiratory viruses, including influenza virus A or human metapneumovirus. To the authors' knowledge, the cases described in the present report were the first pediatric patients with COVID-19 in Japan. In children with COVID-19, the possibility of co-infection with other respiratory pathogens should be considered.


Subject(s)
Coinfection/diagnosis , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Respiratory Tract Infections/diagnosis , Betacoronavirus/isolation & purification , Child , Child, Preschool , Coinfection/pathology , Coinfection/virology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Humans , Japan/epidemiology , Lung/diagnostic imaging , Lung/pathology , Male , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Respiratory Tract Infections/pathology , Respiratory Tract Infections/virology
7.
Health Place ; 64: 102404, 2020 07.
Article in English | MEDLINE | ID: covidwho-1023586

ABSTRACT

The role of geospatial disparities in the dynamics of the COVID-19 pandemic is poorly understood. We developed a spatially-explicit mathematical model to simulate transmission dynamics of COVID-19 disease infection in relation with the uneven distribution of the healthcare capacity in Ohio, U.S. The results showed substantial spatial variation in the spread of the disease, with localized areas showing marked differences in disease attack rates. Higher COVID-19 attack rates experienced in some highly connected and urbanized areas (274 cases per 100,000 people) could substantially impact the critical health care response of these areas regardless of their potentially high healthcare capacity compared to more rural and less connected counterparts (85 cases per 100,000). Accounting for the spatially uneven disease diffusion linked to the geographical distribution of the critical care resources is essential in designing effective prevention and control programmes aimed at reducing the impact of COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Health Services Accessibility , Hospital Bed Capacity , Intensive Care Units , Pandemics/statistics & numerical data , Pneumonia, Viral , Spatial Analysis , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , Incidence , Models, Theoretical , Ohio/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Rural Population
8.
Health Place ; 64: 102398, 2020 07.
Article in English | MEDLINE | ID: covidwho-1023585

ABSTRACT

Schools have closed worldwide as part of measures to prevent SARS-CoV-2 transmission but are beginning to reopen in some countries. Various measures are being pursued to minimise transmission but existing guidance has not developed a comprehensive framework or theory of change. We present a framework informed by the occupational health hierarchy of control and a theory of change informed by realist approaches. We present measures focused on elimination, substitution, engineering, administration, education and personal protective equipment. We theorise that such measures offer a means of disrupting SARS-CoV-2 transmission via routes involving fomites, faeco-oral routes, droplets and aerosols.


Subject(s)
Coronavirus Infections/prevention & control , Evidence-Based Practice , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Schools/standards , Betacoronavirus/isolation & purification , Humans , Schools/organization & administration
12.
Lung ; 198(5): 771-775, 2020 10.
Article in English | MEDLINE | ID: covidwho-756086

ABSTRACT

PURPOSE: To investigate whether sarcoidosis patients infected with SARS-CoV-2 are at risk for adverse disease outcomes. STUDY DESIGN AND METHODS: This retrospective study was conducted in five hospitals within the Mount Sinai Health System during March 1, 2020 to July 29, 2020. All patients diagnosed with COVID-19 were included in the study. We identified sarcoidosis patients who met diagnostic criteria for sarcoidosis according to accepted guidelines. An adverse disease outcome was defined as the presence of intubation and mechanical ventilation or in-hospital mortality. In sarcoidosis patients, we reported (when available) the results of pulmonary function testing measured within 3 years prior to the time of SARS­CoV­2 infection. A multivariable logistic regression model was used to generate an adjusted odds ratio (aOR) to evaluate sarcoidosis as a risk factor for an adverse outcome. The same model was used to analyze sarcoidosis patients with moderate and/or severe impairment in pulmonary function. RESULTS: The study included 7337 patients, 37 of whom (0.5%) had sarcoidosis. The crude rate of developing an adverse outcome was significantly higher in patients with moderately and/or severely impaired pulmonary function (9/14 vs. 3/23, p = 0.003). While the diagnosis of sarcoidosis was not independently associated with risk of an adverse event, (aOR 1.8, 95% CI 0.9-3.6), the diagnosis of sarcoidosis in patients with moderately and/or severely impaired pulmonary function was associated with an adverse outcome (aOR 7.8, 95% CI 2.4-25.8). CONCLUSION: Moderate or severe impairment in pulmonary function is associated with mortality in sarcoidosis patients infected with SARS­CoV­2.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Pandemics , Pneumonia, Viral , Respiratory Function Tests/methods , Sarcoidosis, Pulmonary , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Female , Hospital Mortality , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Factors , Sarcoidosis, Pulmonary/diagnosis , Sarcoidosis, Pulmonary/epidemiology , Sarcoidosis, Pulmonary/physiopathology , United States/epidemiology
13.
J Nanobiotechnology ; 18(1): 130, 2020 Sep 10.
Article in English | MEDLINE | ID: covidwho-755216

ABSTRACT

Fast point-of-care (POC) diagnostics represent an unmet medical need and include applications such as lateral flow assays (LFAs) for the diagnosis of sepsis and consequences of cytokine storms and for the treatment of COVID-19 and other systemic, inflammatory events not caused by infection. Because of the complex pathophysiology of sepsis, multiple biomarkers must be analyzed to compensate for the low sensitivity and specificity of single biomarker targets. Conventional LFAs, such as gold nanoparticle dyed assays, are limited to approximately five targets-the maximum number of test lines on an assay. To increase the information obtainable from each test line, we combined green and red emitting quantum dots (QDs) as labels for C-reactive protein (CRP) and interleukin-6 (IL-6) antibodies in an optical duplex immunoassay. CdSe-QDs with sharp and tunable emission bands were used to simultaneously quantify CRP and IL-6 in a single test line, by using a single UV-light source and two suitable emission filters for readout through a widely available BioImager device. For image and data processing, a customized software tool, the MultiFlow-Shiny app was used to accelerate and simplify the readout process. The app software provides advanced tools for image processing, including assisted extraction of line intensities, advanced background correction and an easy workflow for creation and handling of experimental data in quantitative LFAs. The results generated with our MultiFlow-Shiny app were superior to those generated with the popular software ImageJ and resulted in lower detection limits. Our assay is applicable for detecting clinically relevant ranges of both target proteins and therefore may serve as a powerful tool for POC diagnosis of inflammation and infectious events.


Subject(s)
Biomarkers/analysis , C-Reactive Protein/analysis , Immunoassay/methods , Interleukin-6/analysis , Quantum Dots/chemistry , Sepsis/diagnosis , Antibodies/immunology , Betacoronavirus/isolation & purification , C-Reactive Protein/immunology , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Humans , Interleukin-6/immunology , Limit of Detection , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Point-of-Care Systems , Sepsis/metabolism , Software , Ultraviolet Rays
14.
Curr Oncol ; 27(5): e512-e515, 2020 10.
Article in English | MEDLINE | ID: covidwho-1024676

ABSTRACT

Sarcoma treatment during the covid-19 pandemic is a new challenge. This patient population is often immunocompromised and potentially more susceptible to viral complications. Government guidelines highlight the need to minimize patient exposure to unnecessary hospital visits. However, those guidelines lack practical recommendations on ways to manage triage and diagnosis expressly for new cancer patients. Furthermore, there are no reports on the efficiency of the guidelines. One of the main issues in treating musculoskeletal tumours is the complexity and variability of presentation. We offer a triage model, used in a quaternary-referral musculoskeletal oncology centre, that allows us to maintain an open pathway for referral of new patients while minimizing exposure risks. A multidisciplinary approach and analysis of existing investigations allow for a pre-clinic evaluation. The model identifies 3 groups of patients: ■ Patients with suspected high-grade malignancy, or benign cases with aggressive features, both in need of further evaluation in the clinic and prompt treatment■ Patients with low-grade malignancy, and benign cases whose treatment is not urgent, that are managed during the pandemic by telemedicine, with reassurance and information about their illness■ Patients who can be managed by their local medical professionals In comparison to a pre-pandemic period, that approach resulted in a higher ratio of malignant-to-benign conditions for new patients seen in the clinic (3:4 vs. 1:3 respectively), thus using available resources more efficiently and prioritizing patients with suspected high-grade malignancy. We believe that this triage system could be applied in other surgical oncology fields during a pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Bone Neoplasms/therapy , Coronavirus Infections/complications , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Soft Tissue Neoplasms/therapy , Telemedicine/methods , Triage/standards , Bone Neoplasms/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Disease Management , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Risk Management , Soft Tissue Neoplasms/virology
15.
Curr Oncol ; 27(5): e501-e511, 2020 10.
Article in English | MEDLINE | ID: covidwho-1024675

ABSTRACT

Objective: We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic. Background: Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods: An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results: Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions: There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.


Subject(s)
Coronavirus Infections/complications , Hepatectomy/statistics & numerical data , Infection Control/methods , Liver Neoplasms/surgery , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Surgeons/standards , Time-to-Treatment/statistics & numerical data , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Humans , Liver Neoplasms/virology , Pandemics , Patient Care Management , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology
17.
Emerg Med J ; 37(9): 565-566, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1024248

ABSTRACT

We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.


Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Noninvasive Ventilation/methods , Pandemics , Pneumonia, Viral , Prone Position , Respiratory Insufficiency , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Oxygen Consumption , Oxygen Inhalation Therapy/methods , Patient Positioning , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Treatment Outcome
19.
Nat Biotechnol ; 38(10): 1164-1167, 2020 10.
Article in English | MEDLINE | ID: covidwho-1023956

ABSTRACT

We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0-2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0-2 d ahead of the percentage of positive tests by date of specimen collection, 1-4 d ahead of local hospital admissions and 6-8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , RNA, Viral/analysis , Waste Water/virology , Wastewater-Based Epidemiological Monitoring , Betacoronavirus/genetics , Biotechnology , Connecticut/epidemiology , Humans , Prevalence , RNA, Viral/genetics , Sewage/virology , Time Factors
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