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3.
J Phys Chem B ; 124(33): 7093-7101, 2020 08 20.
Article in English | MEDLINE | ID: covidwho-646748

ABSTRACT

For estimating the infection risk from virus-containing airborne droplets, it is crucial to consider the interplay of all relevant physical-chemical effects that affect droplet evaporation and sedimentation times. For droplet radii in the range 70 nm < R < 60 µm, evaporation can be described in the stagnant-flow approximation and is diffusion-limited. Analytical equations are presented for the droplet evaporation rate, the time-dependent droplet size, and the sedimentation time, including evaporation cooling and solute osmotic-pressure effects. Evaporation makes the time for initially large droplets to sediment much longer and thus significantly increases the viral air load. Using recent estimates for SARS-CoV-2 concentrations in sputum and droplet production rates while speaking, a single infected person that constantly speaks without a mouth cover produces a total steady-state air load of more than 104 virions at a given time. In a midsize closed room, this leads to a viral inhalation frequency of at least 2.5 per minute. Low relative humidity, as encountered in airliners and inside buildings in the winter, accelerates evaporation and thus keeps initially larger droplets suspended in air. Typical air-exchange rates decrease the viral air load from droplets with an initial radius larger than 20 µm only moderately.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Speech , Aerosols , Air Microbiology , Algorithms , Diffusion , Humans , Pandemics , Particle Size , Risk Assessment , Water
4.
Integr Environ Assess Manag ; 16(5): 552-554, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-761323
6.
Trials ; 21(1): 765, 2020 Sep 05.
Article in English | MEDLINE | ID: covidwho-745677

ABSTRACT

Whilst the issues around early termination of randomised controlled trials (RCTs) are well documented in the literature, trials can also be temporarily suspended with the real prospect that they may subsequently restart. There is little guidance in the literature as to how to manage such a temporary suspension. In this paper, we describe the temporary suspension of a trial within our clinical trials unit because of concerns over the safety of transvaginal synthetic mesh implants. We also describe the challenges, considerations, and lessons learnt during the suspension that we are now applying in the current COVID-19 pandemic which has led to activities in many RCTs across the world undergoing a temporary suspension.There were three key phases within the temporary suspension: the decision to suspend, implementation of the suspension, and restarting. Each of these phases presented individual challenges which are discussed within this paper, along with the lessons learnt. There were obvious challenges around recruitment, delivery of the intervention, and follow-up. Additional challenges included communication between stakeholders, evolving risk assessment, updates to trial protocol and associated paperwork, maintaining site engagement, data-analysis, and workload within the trial team and Sponsor organisation.Based on our experience of managing a temporary suspension, we developed an action plan and guidance (see Additional File 1) for managing a significant trial event, such as a temporary suspension. We have used this document to help us manage the suspension of activities within our portfolio of trials during the current COVID-19 pandemic.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/virology , Pneumonia, Viral/virology , Randomized Controlled Trials as Topic/methods , Research Design , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Early Termination of Clinical Trials , Humans , Pandemics , Patient Safety , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Public Opinion , Risk Assessment , Risk Factors , Time Factors
7.
Eur Respir J ; 56(2)2020 08.
Article in English | MEDLINE | ID: covidwho-744960

ABSTRACT

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) has globally strained medical resources and caused significant mortality. OBJECTIVE: To develop and validate a machine-learning model based on clinical features for severity risk assessment and triage for COVID-19 patients at hospital admission. METHOD: 725 patients were used to train and validate the model. This included a retrospective cohort from Wuhan, China of 299 hospitalised COVID-19 patients from 23 December 2019 to 13 February 2020, and five cohorts with 426 patients from eight centres in China, Italy and Belgium from 20 February 2020 to 21 March 2020. The main outcome was the onset of severe or critical illness during hospitalisation. Model performances were quantified using the area under the receiver operating characteristic curve (AUC) and metrics derived from the confusion matrix. RESULTS: In the retrospective cohort, the median age was 50 years and 137 (45.8%) were male. In the five test cohorts, the median age was 62 years and 236 (55.4%) were male. The model was prospectively validated on five cohorts yielding AUCs ranging from 0.84 to 0.93, with accuracies ranging from 74.4% to 87.5%, sensitivities ranging from 75.0% to 96.9%, and specificities ranging from 55.0% to 88.0%, most of which performed better than the pneumonia severity index. The cut-off values of the low-, medium- and high-risk probabilities were 0.21 and 0.80. The online calculators can be found at www.covid19risk.ai. CONCLUSION: The machine-learning model, nomogram and online calculator might be useful to access the onset of severe and critical illness among COVID-19 patients and triage at hospital admission.


Subject(s)
Coronavirus Infections/diagnosis , Hospital Mortality/trends , Machine Learning , Pneumonia, Viral/diagnosis , Triage/methods , Adult , Age Factors , Aged , Area Under Curve , Belgium , China , Clinical Laboratory Techniques , Cohort Studies , Coronavirus Infections/epidemiology , Decision Support Systems, Clinical , Female , Hospitalization/statistics & numerical data , Humans , Internationality , Italy , Male , Middle Aged , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Predictive Value of Tests , ROC Curve , Reproducibility of Results , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Factors , Survival Analysis
8.
S Afr Med J ; 110(7): 621-624, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-743568

ABSTRACT

Infectious diseases pandemics have devastating health, social and economic consequences, especially in developing countries such as South Africa. Scarce medical resources must often be rationed effectively to contain the disease outbreak. In the case of COVID-19, even the best-resourced countries will have inadequate intensive care facilities for the large number of patients needing admission and ventilation. The scarcity of medical resources creates the need for national governments to establish admission criteria that are evidence-based and fair. Questions have been raised whether infection with HIV or tuberculosis (TB) may amplify the risk of adverse COVID-19 outcomes and therefore whether these conditions should be factored in when deciding on the rationing of intensive care facilities. In light of these questions, clinical evidence regarding inclusion of these infections as comorbidities relevant to intensive care unit admission triage criteria is investigated in the first of a two-part series of articles. There is currently no evidence to indicate that HIV or TB infection on their own predispose to an increased risk of infection with SARS-CoV-2 or worse outcomes for COVID-19. It is recommended that, as for other medical conditions, validated scoring systems for poor prognostic factors should be applied. A subsequent article examines the ethicolegal implications of limiting intensive care access of persons living with HIV or TB.


Subject(s)
Coronavirus Infections , HIV Infections/epidemiology , Health Care Rationing/methods , Intensive Care Units , Pandemics , Pneumonia, Viral , Triage/organization & administration , Tuberculosis/epidemiology , Betacoronavirus/isolation & purification , Coinfection , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand/organization & administration , Humans , Intensive Care Units/economics , Intensive Care Units/standards , Pandemics/economics , Patient Selection , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Prognosis , Risk Assessment , South Africa/epidemiology
9.
Pediatrics ; 146(3)2020 09.
Article in English | MEDLINE | ID: covidwho-742563

ABSTRACT

We describe 2 patients with coronavirus disease who had multiple clinical features suggestive of Kawasaki disease (KD). Both patients presented with fever lasting >5 days and were found to have rash, conjunctival injection, and swollen lips. One patient also had extremity swelling, whereas the other developed desquamation of the fingers. In both cases, laboratory results were similar to those seen in KD. These patients had highly unusual but similar features, and both appeared to respond favorably to treatment. It remains unclear whether these patients had true KD or manifestations of coronavirus disease that resembled KD.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Immunoglobulins, Intravenous/administration & dosage , Mucocutaneous Lymph Node Syndrome/diagnosis , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Systemic Inflammatory Response Syndrome/diagnosis , Child, Preschool , Combined Modality Therapy , Diagnosis, Differential , Female , Humans , Male , Mucocutaneous Lymph Node Syndrome/therapy , Pandemics , Risk Assessment , Sampling Studies , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
11.
Medicine (Baltimore) ; 99(35): e21700, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-740200

ABSTRACT

The coronavirus disease 2019 (COVID-19) outbreak has become a global health threat and will likely be one of the greatest global challenges in the near future. The battle between clinicians and the COVID-19 outbreak may be a "protracted war."The objective of this study was to investigate the risk factors for in-hospital mortality in patients with COVID-19, so as to provide a reference for the early diagnosis and treatment.This study retrospectively enrolled 118 patients diagnosed with COVID-19, who were admitted to Eastern District of Renmin Hospital of Wuhan University from February 04, 2020 to March 04, 2020. The demographics and laboratory data were collected and compared between survivors and nonsurvivors. The risk factors of in-hospital mortality were explored by univariable and multivariable logistic regression to construct a clinical prediction model, the prediction efficiency of which was verified by receiver-operating characteristic (ROC) curve.A total of 118 patients (49 males and 69 females) were included in this study; the results revealed that the following factors associated with in-hospital mortality: older age (odds ratio [OR] 1.175, 95% confidence interval [CI] 1.073-1.287, P = .001), neutrophil count greater than 6.3 × 10 cells/L (OR 7.174, (95% CI 2.295-22.432, P = .001), lymphocytopenia (OR 0.069, 95% CI 0.007-0.722, P = .026), prothrombin time >13 seconds (OR 11.869, 95% CI 1.433-98.278, P = .022), D-dimer >1 mg/L (OR 22.811, 95% CI 2.224-233.910, P = .008) and procalcitonin (PCT) >0.1 ng/mL (OR 23.022, 95% CI 3.108-170.532, P = .002). The area under the ROC curve (AUC) of the above indicators for predicting in-hospital mortality were 0.808 (95% CI 0.715-0.901), 0.809 (95% CI 0.710-0.907), 0.811 (95% CI 0.724-0.898), 0.745 (95% CI 0.643-0.847), 0.872 (95% CI 0.804-0.940), 0.881 (95% CI 0.809-0.953), respectively. The AUC of combined diagnosis of these aforementioned factors were 0.992 (95% CI 0.981-1.000).In conclusion, older age, increased neutrophil count, prothrombin time, D-dimer, PCT, and decreased lymphocyte count at admission were risk factors associated with in-hospital mortality of COVID-19. The prediction model combined of these factors could improve the early identification of mortality risk in COVID-19 patients.


Subject(s)
Coronavirus Infections , Fibrin Fibrinogen Degradation Products/analysis , Leukocyte Count , Pandemics , Pneumonia, Viral , Procalcitonin/analysis , Prothrombin Time , Adult , Aged , Betacoronavirus , China/epidemiology , Coronavirus Infections/blood , Coronavirus Infections/immunology , Coronavirus Infections/mortality , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Leukocyte Count/methods , Leukocyte Count/statistics & numerical data , Male , Pneumonia, Viral/blood , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Predictive Value of Tests , Prognosis , Prothrombin Time/methods , Prothrombin Time/statistics & numerical data , Retrospective Studies , Risk Assessment/methods , Risk Factors
12.
R I Med J (2013) ; 103(7): 15-20, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-739560

ABSTRACT

In December 2019 a respiratory illness known as Coronavirus 2 (SARS-CoV-2, COVID-19) broke out in a region in China and rapidly spread to become a pandemic affecting all sporting events worldwide. The Summer Olympics scheduled to be held in Tokyo were postponed until 2021, and all professional leagues in the United States postponed or canceled events. As the United States has begun to open up, there remains uncertainty of when sporting events can safely be held. Many professional leagues and the National Collegiate Athletic Association have established guidelines and recommendations for their athletes to compete safely. In this article, we review the protocols that have been established to allow athletes to return to play, and we review briefly the effects COVID-19 infection may have on athletes.


Subject(s)
Communicable Disease Control , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Pandemics , Pneumonia, Viral , Return to Sport , Sports/trends , Athletes , Betacoronavirus , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Risk Assessment
13.
BMJ Open ; 10(8): e040448, 2020 08 30.
Article in English | MEDLINE | ID: covidwho-739117

ABSTRACT

OBJECTIVE: To assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours. DESIGN: 2×3 experimental design. SETTING: Online. PARTICIPANTS: 1204 adults from a UK research panel. INTERVENTION: Participants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test). MAIN OUTCOME MEASURES: Primary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing. RESULTS: When using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate-as opposed to Test-had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)). CONCLUSIONS: Using the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/tjwz8/files/.


Subject(s)
Antibodies, Viral , Communication , Coronavirus Infections , Health Behavior , Health Knowledge, Attitudes, Practice , Immunity , Pandemics , Pneumonia, Viral , Adult , Antibodies, Viral/blood , Betacoronavirus , Certification , Coronavirus Infections/blood , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Disclosure , Female , Humans , Internet , Male , Odds Ratio , Pandemics/prevention & control , Pneumonia, Viral/blood , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , Risk Assessment , United Kingdom
14.
Z Rheumatol ; 79(7): 686-691, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-738390

ABSTRACT

The recommendations of the German Society of Rheumatology (DGRh) update, which update and expand the guidance on the management of patients with inflammatory rheumatic diseases in view of SARS-CoV­2 created at the beginning of the COVID-19 pandemic, correspond in many points with the recommendations for action of the American (ACR) and European (EULAR) societies, but also differ in some points. Therefore, this article discusses the core recommendations of the DGRh update on the prevention of SARS-CoV-2/COVID-19, the risk assessment for inflammatory rheumatic diseases and the use of antirheumatic treatments in the context and in comparison to the ACR and EULAR recommendations, and provides an overview of the risk assessment of individual antirheumatic drugs.


Subject(s)
Antirheumatic Agents/therapeutic use , Coronavirus Infections/epidemiology , Inflammation/therapy , Pneumonia, Viral/epidemiology , Rheumatic Diseases/therapy , Rheumatology , Betacoronavirus , Europe , Germany , Humans , Pandemics , Practice Guidelines as Topic , Risk Assessment , Societies, Medical , United States
15.
Adv Respir Med ; 88(4): 366-368, 2020.
Article in English | MEDLINE | ID: covidwho-737868

ABSTRACT

We discuss the hypothesis that common Chest Drain Systems collected to a COVID-19 patient, could be a possible source of contamination for health care staff in a Thoracic Surgery ward and we propose an alternative way to minimize this further risk of transmission.


Subject(s)
Chest Tubes/adverse effects , Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Thoracic Surgical Procedures/methods , Clinical Competence , Coronavirus Infections/prevention & control , Drainage/adverse effects , Humans , Pandemics/prevention & control , Patient Care Management/methods , Pneumonia, Viral/prevention & control , Risk Assessment , Thoracostomy/methods
16.
J Transl Med ; 18(1): 328, 2020 08 31.
Article in English | MEDLINE | ID: covidwho-736397

ABSTRACT

BACKGROUND: Patients with severe Coronavirus Disease 2019 (COVID-19) will progress rapidly to acute respiratory failure or death. We aimed to develop a quantitative tool for early predicting mortality risk of patients with COVID-19. METHODS: 301 patients with confirmed COVID-19 admitted to Main District and Tumor Center of the Union Hospital of Huazhong University of Science and Technology (Wuhan, China) between January 1, 2020 to February 15, 2020 were enrolled in this retrospective two-centers study. Data on patient demographic characteristics, laboratory findings and clinical outcomes was analyzed. A nomogram was constructed to predict the death probability of COVID-19 patients. RESULTS: Age, neutrophil-to-lymphocyte ratio, D-dimer and C-reactive protein obtained on admission were identified as predictors of mortality for COVID-19 patients by LASSO. The nomogram demonstrated good calibration and discrimination with the area under the curve (AUC) of 0.921 and 0.975 for the derivation and validation cohort, respectively. An integrated score (named ANDC) with its corresponding death probability was derived. Using ANDC cut-off values of 59 and 101, COVID-19 patients were classified into three subgroups. The death probability of low risk group (ANDC < 59) was less than 5%, moderate risk group (59 ≤ ANDC ≤ 101) was 5% to 50%, and high risk group (ANDC > 101) was more than 50%, respectively. CONCLUSION: The prognostic nomogram exhibited good discrimination power in early identification of COVID-19 patients with high mortality risk, and ANDC score may help physicians to optimize patient stratification management.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Early Warning Score , Nomograms , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Adult , Aged , Betacoronavirus/physiology , China/epidemiology , Cohort Studies , Female , History, 21st Century , Humans , Male , Middle Aged , Pandemics , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors
18.
Z Rheumatol ; 79(7): 686-691, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-734832

ABSTRACT

The recommendations of the German Society of Rheumatology (DGRh) update, which update and expand the guidance on the management of patients with inflammatory rheumatic diseases in view of SARS-CoV­2 created at the beginning of the COVID-19 pandemic, correspond in many points with the recommendations for action of the American (ACR) and European (EULAR) societies, but also differ in some points. Therefore, this article discusses the core recommendations of the DGRh update on the prevention of SARS-CoV-2/COVID-19, the risk assessment for inflammatory rheumatic diseases and the use of antirheumatic treatments in the context and in comparison to the ACR and EULAR recommendations, and provides an overview of the risk assessment of individual antirheumatic drugs.


Subject(s)
Antirheumatic Agents/therapeutic use , Coronavirus Infections/epidemiology , Inflammation/therapy , Pneumonia, Viral/epidemiology , Rheumatic Diseases/therapy , Rheumatology , Betacoronavirus , Europe , Germany , Humans , Pandemics , Practice Guidelines as Topic , Risk Assessment , Societies, Medical , United States
19.
Medicine (Baltimore) ; 99(34): e21874, 2020 Aug 21.
Article in English | MEDLINE | ID: covidwho-733315

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused serious damage to public health. COVID-19 has no vaccine or specific therapy; its mortality rate increases significantly once patients deteriorate. Furthermore, intensive monitoring of COVID-19 is limited by insufficient medical resources and increased risks of exposure to medical staff. We therefore aim to build an early warning and rapid response system (EWRRS) to address these problems. METHOD: The research is designed as a prospective cohort study, to verify a dynamic and interactive evaluation system; it includes patient self-reporting, active monitoring, early alarming and treatment recommendations. Adult patients diagnosed with COVID-19 will be recruited from Sept 2020 to Aug 2021 at a tertiary contagious hospital. Patients with life expectancy <48 hours, pregnant or lactating, in immunosuppression states or end-stage diseases will be excluded. The intervention is implementation of EWRRS to detect early signs of clinical deterioration of COVID-19 patients, to provide timely and efficient treatment suggestions by the system. EWRRS can determine the classification and interactive evaluation of patient information; the determination is based on the application of 3 different scenario modules, separately driven by patients, nurses, and physicians. The primary outcome is change in disease severity category after treatment. Secondary outcomes include the proportion of patients with different disease severity types; critical deterioration events; patients who had unplanned transfers to an intensive care unit (ICU) and required critical care interventions; intervals from warning to implementation of clinical interventions; hospital mortality; length of ICU and hospital stay; workload of medical staff and risks of exposure to COVID-19. DISCUSSION: Our hypothesis is that EWRRS provides an example of an early identification, warning, and response system for COVID-19. In addition, EWRRS can potentially be extended to use as a grading metric for general critically ill patients in an ICU setting.


Subject(s)
Clinical Deterioration , Coronavirus Infections/physiopathology , Critical Illness , Pneumonia, Viral/physiopathology , Betacoronavirus , Humans , Intensive Care Units , Monitoring, Physiologic , Pandemics , Prospective Studies , Research Design , Risk Assessment , Severity of Illness Index
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