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1.
MMWR Morb Mortal Wkly Rep ; 69(37): 1300-1304, 2020 Sep 18.
Article in English | MEDLINE | ID: covidwho-782533

ABSTRACT

Nursing homes are high-risk settings for outbreaks of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1,2). During the COVID-19 pandemic, U.S. health departments worked to improve infection prevention and control (IPC) practices in nursing homes to prevent outbreaks and limit the spread of COVID-19 in affected facilities; however, limited resources have hampered health departments' ability to rapidly provide IPC support to all nursing homes within their jurisdictions. Since 2008, the Centers for Medicare & Medicaid Services (CMS) has published health inspection results and quality ratings based on their Five-Star Quality Rating System for all CMS-certified nursing homes (3); these ratings might be associated with facility-level risk factors for COVID-19 outbreaks. On April 17, 2020, West Virginia became the first state to mandate and conduct COVID-19 testing for all nursing home residents and staff members to identify and reduce transmission of SARS-CoV-2 in these settings (4). West Virginia's census of nursing home outbreaks was used to examine associations between CMS star ratings and COVID-19 outbreaks. Outbreaks, defined as two or more cases within 14 days (with at least one resident case), were identified in 14 (11%) of 123 nursing homes. Compared with 1-star-rated (lowest rated) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star-rated facilities (adjusted odds ratio [aOR] = 0.13, 95% confidence interval [CI] = 0.03-0.54) and 94% lower among 4- to 5-star-rated facilities (aOR = 0.06, 95% CI = 0.006-0.39). Health departments could use star ratings to help identify priority nursing homes in their jurisdictions to inform the allocation of IPC resources. Efforts to mitigate outbreaks in high-risk nursing homes are necessary to reduce overall COVID-19 mortality and associated disparities. Moreover, such efforts should incorporate activities to improve the overall quality of life and care of nursing home residents and staff members and address the social and health inequities that have been recognized as a prominent feature of the COVID-19 pandemic in the United States (5).


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks/statistics & numerical data , Nursing Homes/statistics & numerical data , Pneumonia, Viral/epidemiology , Quality of Health Care/standards , Aged , Centers for Medicare and Medicaid Services, U.S. , Humans , Nursing Homes/standards , Pandemics , Risk Assessment/methods , United States/epidemiology , West Virginia/epidemiology
2.
J Biol Dyn ; 14(1): 730-747, 2020 12.
Article in English | MEDLINE | ID: covidwho-740143

ABSTRACT

In this study, we estimate the severity of the COVID-19 outbreak in Pakistan prior to and after lockdown restrictions were eased. We also project the epidemic curve considering realistic quarantine, social distancing and possible medication scenarios. The pre-lock down value of R 0 is estimated to be 1.07 and the post lock down value is estimated to be 1.86. Using this analysis, we project the epidemic curve. We note that if no substantial efforts are made to contain the epidemic, it will peak in mid-September, 2020, with the maximum projected active cases being close to 700, 000. In a realistic, best case scenario, we project that the epidemic peaks in early to mid-July, 2020, with the maximum active cases being around 120, 000. We note that social distancing measures and medication will help flatten the curve; however, without the reintroduction of further lock down, it would be very difficult to make R 0 < 1 .


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Outbreaks , Pneumonia, Viral/epidemiology , Basic Reproduction Number/statistics & numerical data , Biostatistics , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Epidemics , Forecasting/methods , Humans , Mathematical Concepts , Models, Biological , Pakistan/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Quarantine/statistics & numerical data
3.
J Prev Med Public Health ; 53(4): 228-232, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-695886

ABSTRACT

Coronavirus disease 2019 (COVID-19) is inflicting a brutal blow on humankind, and no corner of the world has been exempted from its wrath. This study analyzes the chief control measures and the distinctive features of the responses implemented by Korea and the United States to contain COVID-19 with the goal of extracting lessons that can be applied globally. Even though both nations reported their index cases on the same day, Korea succeeded in flattening the curve, with 10 752 cases as of April 28, 2020, whereas the outbreak skyrocketed in the United States, which had more than 1 million cases at the same time. The prudent and timely execution of control strategies enabled Korea to tame the spread of the virus, whereas the United States paid a major price for its delay, although it is too early to render a conclusive verdict. Information pertaining to the number of people infected with the virus and measures instituted by the government to control the spread of COVID-19 was retrieved from the United States Centers for Disease Control and Prevention and the Korea Centers for Disease Control and Prevention websites and press releases. Drawing lessons from both nations, it is evident that the resolution to the COVID-19 pandemic lies in the prudent usage of available resources, proactive strategic planning, public participation, transparency in information sharing, abiding by the regulations that are put into place, and how well the plan of action is implemented.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Public Health/methods , Quarantine/statistics & numerical data , Disease Outbreaks/statistics & numerical data , Humans , Pandemics/statistics & numerical data , Republic of Korea/epidemiology , Time , United States/epidemiology
6.
J Med Internet Res ; 22(5): e18707, 2020 05 28.
Article in English | MEDLINE | ID: covidwho-678506

ABSTRACT

The ongoing coronavirus disease outbreak demonstrates the need for novel applications of real-time data to produce timely information about incident cases. Using health information technology (HIT) and real-world data, we sought to produce an interface that could, in near real time, identify patients presenting with suspected respiratory tract infection and enable monitoring of test results related to specific pathogens, including severe acute respiratory syndrome coronavirus 2. This tool was built upon our computational health platform, which provides access to near real-time data from disparate HIT sources across our health system. This combination of technology allowed us to rapidly prototype, iterate, and deploy a platform to support a cohesive organizational response to a rapidly evolving outbreak. Platforms that allow for agile analytics are needed to keep pace with evolving needs within the health care system.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Delivery of Health Care/statistics & numerical data , Medical Informatics/methods , Pneumonia, Viral/epidemiology , Public Health Surveillance/methods , Disease Outbreaks/statistics & numerical data , Humans , Pandemics , Time Factors
8.
J R Soc Interface ; 17(168): 20200144, 2020 07.
Article in English | MEDLINE | ID: covidwho-665024

ABSTRACT

A novel coronavirus (SARS-CoV-2) emerged as a global threat in December 2019. As the epidemic progresses, disease modellers continue to focus on estimating the basic reproductive number [Formula: see text]-the average number of secondary cases caused by a primary case in an otherwise susceptible population. The modelling approaches and resulting estimates of [Formula: see text] during the beginning of the outbreak vary widely, despite relying on similar data sources. Here, we present a statistical framework for comparing and combining different estimates of [Formula: see text] across a wide range of models by decomposing the basic reproductive number into three key quantities: the exponential growth rate, the mean generation interval and the generation-interval dispersion. We apply our framework to early estimates of [Formula: see text] for the SARS-CoV-2 outbreak, showing that many [Formula: see text] estimates are overly confident. Our results emphasize the importance of propagating uncertainties in all components of [Formula: see text], including the shape of the generation-interval distribution, in efforts to estimate [Formula: see text] at the outset of an epidemic.


Subject(s)
Basic Reproduction Number , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disease Outbreaks , Models, Biological , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Basic Reproduction Number/statistics & numerical data , Bayes Theorem , China/epidemiology , Disease Outbreaks/statistics & numerical data , Epidemics/statistics & numerical data , Humans , Markov Chains , Monte Carlo Method , Pandemics , Probability , Uncertainty
9.
Eur Respir Rev ; 29(157)2020 Sep 30.
Article in English | MEDLINE | ID: covidwho-662439

ABSTRACT

According to the Third International Consensus Definition for Sepsis and Septic Shock, sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Epidemiological data about sepsis from the 2017 Global Burden of Diseases, Injuries and Risk Factor Study showed that the global burden of sepsis was greater than previously estimated. Bacteria have been shown to be the predominant pathogen of sepsis among patients with pathogens detected, while sepsis caused by viruses is underdiagnosed worldwide. The coronavirus disease that emerged in 2019 in China and now in many other countries has brought viral sepsis back into the vision of physicians and researchers worldwide. Although the current understanding of the pathophysiology of sepsis has improved, the differences between viral and bacterial sepsis at the level of pathophysiology are not well understood. Diagnosis methods that can broadly differentiate between bacterial and viral sepsis at the initial stage after the development of sepsis are limited. New treatments that can be applied at clinics for sepsis are scarce and this situation is not consistent with the growing understanding of pathophysiology. This review aims to give a brief summary of current knowledge of the epidemiology, pathophysiology, diagnosis and treatment of viral sepsis.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks/statistics & numerical data , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/epidemiology , Sepsis/diagnosis , Sepsis/epidemiology , Cause of Death , China/epidemiology , Consensus , Coronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Humans , Male , Respiratory Syncytial Viruses/isolation & purification , Respiratory Tract Infections/therapy , Risk Assessment , Sepsis/therapy , Shock, Septic/diagnosis , Shock, Septic/epidemiology , Shock, Septic/therapy , Survival Analysis
12.
Am J Manag Care ; 26(7): 284-285, 2020 07.
Article in English | MEDLINE | ID: covidwho-651518

ABSTRACT

Daily fluctuations in new confirmed cases of coronavirus disease 2019 (COVID-19) reveal a weekly cycle, with increasing risk of infection through the workweek, but an overall negative trend.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Disease Outbreaks/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Forecasting , Humans , Pandemics , Risk Factors , Time Factors
13.
Respir Res ; 21(1): 180, 2020 Jul 14.
Article in English | MEDLINE | ID: covidwho-647137

ABSTRACT

BACKGROUND: In December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy. OBJECTIVE: Analyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators. METHODS: This retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined. RESULTS: All patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function. CONCLUSIONS: COVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks/statistics & numerical data , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/diagnostic imaging , Respiratory Distress Syndrome, Adult/epidemiology , Tomography, X-Ray Computed/methods , Academic Medical Centers , Aged , Aged, 80 and over , Blood Chemical Analysis , Blood Sedimentation , C-Reactive Protein/analysis , China/epidemiology , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Hospital Mortality/trends , Hospitalization/statistics & numerical data , Humans , Incidence , Leukocyte Count , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Procalcitonin/metabolism , Radiography, Thoracic/methods , Respiratory Distress Syndrome, Adult/physiopathology , Retrospective Studies , Risk Assessment , Survival Analysis
14.
Postgrad Med J ; 96(1137): 408-411, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-639885

ABSTRACT

All animal life on earth is thought to have a common origin and have common genetic mechanisms. Evolution has enabled differentiation of species. Pathogens likewise have evolved within various species and mostly come to a settled dynamic equilibrium such that co-existence results (pathogens ideally should not kill their hosts). Problems arise when pathogens jump species because the new host had not developed any resistance. These infections from related species are known as zoonoses. COVID-19 is the latest example of a virus entering another species but HIV (and various strains of influenza) were previous examples.


Subject(s)
Disease Outbreaks/statistics & numerical data , HIV Infections/transmission , HIV-1/pathogenicity , Simian Acquired Immunodeficiency Syndrome/transmission , Simian Immunodeficiency Virus/pathogenicity , Zoonoses/transmission , Animals , Betacoronavirus/genetics , Betacoronavirus/pathogenicity , Coronavirus Infections/transmission , Coronavirus Infections/virology , Evolution, Molecular , HIV Infections/virology , HIV-1/genetics , Humans , Pandemics , Phylogeny , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Primates/virology , Simian Acquired Immunodeficiency Syndrome/virology , Simian Immunodeficiency Virus/genetics , Zoonoses/virology
15.
J Public Health (Oxf) ; 42(3): 656-658, 2020 Aug 18.
Article in English | MEDLINE | ID: covidwho-639185

ABSTRACT

An ongoing outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread in the world, whereas asymptomatic carriers may also play a critical role in the pandemic. We report a familial cluster of COVID-19 caused by one family member before his onset of illness, indicating that it seems to be potentially infectious during the incubation period, even earlier than we expected. Close contact, especially in a small enclosed space, might be the cause of familial transmission. The unsynchronized changes in the clinical symptoms and COVID-19 nucleic acid were found in this case, so consecutive nucleic acid detection of pretty suspected cases was recommended. Family members, especially of whom the confirmed cases contacted with since one incubation period before onset rather than 2 days before onset, should be regarded as close contact and centrally isolated in case of asymptomatic infection already existed in the family.


Subject(s)
Asymptomatic Infections/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disease Outbreaks/statistics & numerical data , Disease Transmission, Infectious/statistics & numerical data , Family/psychology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Betacoronavirus , China/epidemiology , Cluster Analysis , Humans
17.
Eur J Clin Invest ; 50(9): e13342, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-636108

ABSTRACT

COVID-19 pandemia is a major concern for patients and healthcare systems. The fear of infection by patients with concomitant rheumatic diseases (either adult or children) and connective tissue diseases is arising worldwide, because of their immunological background and immunological therapies. Analysing the basic biology of single diseases, the data suggest that there is an "immunological umbrella" that seems to protect against the infection, through IFN type 1 and NK cell function. To date, reports from China, United States and Europe did not reveal an higher risk of infection, either for rheumatoid arthritis, juvenile idiopathic arthritis nor for lupus erythematosus. Antimalarials, anti-IL6-Anti-IL6 receptor, anti-IL1, anti-GM-CSF receptor and JAK1/2/3 inhibitors, are under investigation in COVID-dedicated clinical trials to control the inflammation raised by SARS-CoV-2 infection. Initial reports on the occurrence of autoimmune phenomena in the convalescence phase of SARS-CoV-2 infection suggests that the immunological consequences of the infection need to be strictly understood. Reporting of the study conforms to broad EQUATOR guidelines (Simera et al January 2010 issue of EJCI).


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Immunosuppressive Agents/administration & dosage , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Rheumatic Diseases/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Adaptive Immunity/drug effects , Adaptive Immunity/immunology , Aged , Antirheumatic Agents/administration & dosage , Comorbidity , Coronavirus Infections/drug therapy , Disease Outbreaks/statistics & numerical data , Female , Humans , Hydroxychloroquine/administration & dosage , Immunity, Innate/drug effects , Immunity, Innate/immunology , Immunologic Factors/administration & dosage , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Rheumatic Diseases/drug therapy , Rheumatic Diseases/immunology , Risk Assessment , Severe Acute Respiratory Syndrome/drug therapy , Severe Acute Respiratory Syndrome/immunology
18.
Ital J Pediatr ; 46(1): 94, 2020 Jul 08.
Article in English | MEDLINE | ID: covidwho-635582

ABSTRACT

Using available official data we found 248 epidemics curves caused worldwide by the 2019-nCoV in the period December 2019-March 31st 2020. The analysis of this material allowed two main observations: 1) it is possible to describe the main geographical pathway of the diffusion of the virus in different directions. This strongly suggests a unique point of origin of the pandemics in Wuhan, China, from where it spread in many different directions. 2) of the 74 epidemics which were characterized by at least 1000 cases, 65 (90%) were located in the geographic region of the world delimitated by 52-30 degrees latitude North. Viceversa 110 (60%) of the 176 epidemics with less than 1000 cases were located outside the cited geographical world region. These results suggest considerations on the pandemic characteristics of 2019-nCoV.


Subject(s)
Betacoronavirus/isolation & purification , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Global Health , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Case-Control Studies , China/epidemiology , Coronavirus Infections/prevention & control , Disease Outbreaks/statistics & numerical data , Female , Geography , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Factors , Severity of Illness Index
19.
S Afr Fam Pract (2004) ; 62(1): e1-e5, 2020 06 26.
Article in English | MEDLINE | ID: covidwho-635555

ABSTRACT

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent public health crisis threatening the current world health establishment. The SARS-Co-2 was first identified in Wuhan, Hubei Province, China, in December 2019. There have been about 6.5 million reported cases of coronavirus disease 2019 (COVID-19) and about 350 000 reported deaths throughout the world within the last 6 months from the onset of the epidemic. The virus is primarily transmitted by inhalation or contact with infected droplets. The COVID-19 patient usually presents with fever, cough, sore throat and breathlessness. Currently, available data indicate that the majority of people with the disease have mild symptoms, while about 20% present with moderate-to-severe disease. About 5% of these may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction. To date, there is no recommended medical treatment, and supportive measures are a crucial part of management. The case fatality rate of SARS-CoV-2 is lower than that of its two coronavirus predecessors, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The full impact of this new pandemic on health, social and economic well-being of humankind is yet to be ascertained.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Outbreaks/statistics & numerical data , Global Health/statistics & numerical data , Pneumonia, Viral/epidemiology , Humans , Pandemics , South Africa/epidemiology
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