Misdiagnosis of COVID-19 infection before molecular confirmation in Sulaimaniyah City, Iraq.

BACKGROUND: During the last 2 years, in the Kurdistan Region, Northern Iraq, there were thousands of COVID-19 cases that have not been reported officially, but diagnosed and confirmed by private laboratories and private hospitals, or clinicians based on typical clinical signs, as well as few people using home self-test after appearing of some flu-like clinical symptoms. Thus, this study aims to assess the misdiagnosis and mismanagement of cases before COVID-19 confirmation. METHODS: This study enrolled 100 consecutive patients who visited an outpatient clinic of Shar Hospital that had symptoms highly suspicious of COVID-19 infection while misdiagnosed previously to have other types of disease. Detailed questionnaires were filled for all studied patients, including age, gender, main presenting symptoms, and duration of these symptoms with the following questions: who made the false diagnosis, depending on which diagnostic test the false diagnosis was made, which medication was used for the false diagnosis, who prescribed those medications, and how long those medications were used. They were investigated by RT-PCR on their nasopharyngeal swab for confirmation. RESULTS: Most of the false diagnoses were typhoid (63%), influenza (14%), pneumonia (9%), gastroenteritis (5%), common cold (4%), brucellosis (4%), and meningitis (1%). Regarding the false diagnosis of cases, 92% were made by non-physician healthcare workers, and only 8% were made by physicians. All false diagnoses with typhoid, gastroenteritis, and common cold were made by non-physician healthcare workers, together with about half of the diagnosis of pneumonia and brucellosis, with statistically significant results (P < 0.001). CONCLUSIONS: We realized that some patients had been misdiagnosed before the COVID-19 infection confirmation. Their health conditions improved drastically after correct diagnosis and treatment, and this research is considered the first research to be conducted in Iraq in this regard.

The Italian Mandatory Notification System: An Important Public Health Tool For Continuous Monitoring Of Infectious Diseases.

Infectious diseases still register significant morbidity and mortality worldwide. Surveillance through a mandatory notification system allows the continuous analysis of the situation even at a local level and its importance has been highlighted by the recent COVID-19 pandemic. This paper aimed to outline the importance of the mandatory notification system as a Public Health tool in the continuous monitoring of infectious diseases. To this aim, we carried out a cross-sectional study examining the notifications reported in the Italian territory of Messina, Sicily, in the period 2001-2020. The institutional websites were examined and the notification data were used to obtain the incidences. Overall, a significant reduction of the incidence notification trend was observed. Chickenpox was by far the most notified infectious disease, followed by scabies, pediculosis, and brucellosis. Outbreaks of brucellosis, measles and hepatitis A occurred. All the diseases decreased over time, except syphilis, for which a significant increase was observed. Surveillance of infectious diseases through a mandatory notification system remains a bulwark of public health despite underreporting. Our study reflects the situation of a typical high-income area, although some unexpected criticisms are highlighted. Continuous information about correct behaviors through education campaigns are crucial in order to improve the situation. Keywords: mandatory notifications, infectious diseases, surveillance, public health Corresponding author: Alessio Facciolà, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy. Email: afacciola@unime.it.

Immune complex-mediated glomerulonephritis post COVID-19 vaccination in a patient with concomitant Brucellosis.

COVID vaccinations have been an important step in controlling the COVID-19 pandemic. Despite the fact they were generally safe and effective, a few case reports of renal disorders have been published following COVID vaccines. We report a 29-year-old man with history of Chronic Kidney Disease who presented to our center with flank pain after receiving AstraZeneca COVID vaccine. He also had history of raw milk ingestion. His initial investigations showed high creatinine with high level of proteinuria. A renal biopsy was consistent with immune complex-mediated glomerulonephritis on top of renal fibrosis. His brucella serology also showed high titer. He was started on treatment for Brucellosis and planned for follow-up afterwards for further therapy. To the best of our knowledge, this is the first reported case of concomitant Brucellosis and post COVID vaccine glomerulonephritis.

The Impact of Intervention to Routine Surveillance of Natural Focal Diseases During the Outbreak of COVID-19 in Jiangsu Province, China (preprint)

Background: With the strength intervention of China, the outbreak of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) had a great control effect. The measures may influence the development and progression of others infectious diseases.Method: The data of daily coronavirus virus disease 2019 (COVID-19) confirmed cases from January 3, 2020 to April 30, 2020 and natural focal disease cases from January, 2005 to April, 2020 were collected from Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial CDC). We describe and compare the data of natural focal diseases from January to April, 2020 with the same months from 2015 to 2019 in the four aspects: trend of incidence, regional, age and sex distribution. Nonparametric tests were used to analyzed to the difference between the duration from onset of illness to date of diagnosis of natural focal diseases and the same period of the previous year. Results: The incidence of malaria in February (0.9 per 10,000,000 people), March (0.3 per 10,000,000 people) and April (0.1 per 10,000,000 people) 2020 less than the lower limit for range of February (1.6-4.5 per 10,000,000 people), March (0.8-3.3 per 10,000,000 people) and April (1.0-2.9 per 10,000,000 people) from 2015 to 2019 respectively. The incidence of brucellosis in February was 0.9 (per 10,000,000 people), less than the lower limit for the range from 2015 to 2019 (1.6-4.5 per 10,000,000 people). The incidence of hemorrhagic fever (HF) in March was 1.0 (per 10,000,000 people), less than the lower limit for the range from 2015 to 2019 (1.4-2.6 per 10,000,000 people). However, the incidence of Severe Fever with Thrombocytopenia Syndrome (SEFT) in March was 0.3 (per 10,000,000 people), higher than the upper limit for the range from 2015 to 2019 (0.0-0.1 per 10,000,000 people). Furthermore, we respectively observed the incidence with various degree of reduction in male, 20-60 years old and both rural and urban areas. Conclusions: In Jiangsu province, the incidence of natural focal diseases decreased during the outbreak of COVID-19 in 2020, especially malaria, HF and SEFT. The impact of interventions were felt most by male individuals within the age group of 20-50 years. The interventions for COVID-19 may control the epidemics of natural focal diseases.

The “Essential” Free Exercise Clause (preprint)

In the span of a year, COVID-19 would affect every corner of the globe. During this period, governments were confronted with difficult choices about how to respond to the evolving pandemic. In rapid succession, states imposed lockdown measures that ran headlong into the Constitution. Several states deemed houses of worship as non-essential, and subjected them to stringent attendance requirements. In short order, states restricted the exercise of a constitutional right, but allowed the exercise of preferred economic privileges. And this disparate treatment was premised on a simple line: whether the activity was “essential” or “non-essential.” If the activity fell into the former category, the activity could continue. If the activity fell into the latter category, it could be strictly regulated, or even halted immediately. Houses of worship challenged these measures as violations of the Free Exercise Clause of the First Amendment. This article provides an early look at how the courts have interpreted the “essential” Free Exercise Clause during the pandemic. This ongoing story can be told in six phases. In Phase 1, during the early days of the pandemic, the courts split about how to assess these measures. And for the first three months of the pandemic, the Supreme Court stayed out of the fray. In Phase 2, the Supreme Court provided its early imprimatur on the pandemic. In South Bay Pentecostal Church v. Newsom, the Court declined to enjoin California’s restrictions on religious gatherings. Chief Justice Roberts wrote a very influential concurring opinion that would become a superprecedent. Over the following six months, more than one hundred judges would rely on Roberts’s opinion in cases that spanned across the entire spectrum of constitutional and statutory challenges to pandemic policies.In Phase 3, the Roberts Court doubled-down on South Bay. A new challenge from Nevada, Calvary Chapel Dayton Valley Church v. Sisolak, upheld strict limits on houses of worship. Once again, the Court split 5 - 4. Justice Kavanaugh wrote a separate dissent. He treated the Free Exercise of Religion as a “most-favored” right. Under Justice Kavanaugh’s approach, the free exercise of religion is presumptively “essential,” unless the state can rebut that presumption. South Bay and Calvary Chapel would remain the law of the land through November.Phase 4 began when Justice Ruth Bader Ginsburg was replaced by Justice Amy Coney Barrett. The new Roberts Court would turn the tide on COVID-19 cases in Roman Catholic Diocese of Brooklyn v. Cuomo. Here, a new 5 - 4 majority enjoined New York’s “cluster initiatives,” which limited houses of worship in so-called “red” zones to ten parishioners at a time. Now, Chief Justice Roberts dissented. Roman Catholic Diocese effectively interred the South Bay superprecedent.Phase 5 arose in the wake of Roman Catholic Diocese. Over the course of five months, the Court consistently ruled in favor of the free exercise of religion. South Bay II and Harvest Rock II enjoined California’s prohibitions on indoor worship. And Tandon v. Newsom recognized the right of people to worship privately in their homes. We are now in the midst of Phase 6. States are beginning to recognize that absolute executive authority cannot go unchecked during ongoing health crises. Going forward, states should impose substantive limits on how long emergency orders can last, and establish the power to revoke those orders.The COVID-19 pandemic will hopefully soon draw to a close. But the precedents set during this period will endure.