Does the CDC COVID-19 Exposure Assessment Criteria for Healthcare Personnel Work in a Healthcare Setting in Pakistan?

OBJECTIVE: To evaluate the real-world performance of the CDC's "Interim US guidance for risk assessment and work restriction for healthcare personnel with exposure to COVID-19" at a private healthcare system in Pakistan. STUDY DESIGN: Retrospective observational study. PLACE AND DURATION OF STUDY: The Aga khan University Hospital, Karachi, and its associated healthcare facilities in all four provinces of Pakistan, from February to September 2020. METHODOLOGY: Healthcare personnel (HCPs) assessed and tested for exposures to COVID-19 were included in the study. An exposure category was assigned to each HCP presenting with exposure to COVID-19 based on the CDC criteria. Percentage positivity was recorded and compared among the different exposure categories. Logistic regression analysis was used to identify variables significantly associated with COVID-19 infection. RESULTS: Three thousand Six hundred and forty-seven HCPs were assessed for exposure to COVID-19 of whom 603 (16.5%) tested positive. Percent positivity was highest in high-risk symptomatic HCPs (18.2%), 15.6% in low-risk symptomatic HCPs, and 11% in high-risk asymptomatic HCPs. After controlling for age, gender, area of work, and source of exposure, compared to low-risk asymptomatic HCPs, the odds of a positive SARS-CoV-2 PCR were 2.13 (95%CI: 1.49-3.04) for high-risk symptomatic, 1.66 (95% CI: 1.12-2.46) for low-risk symptomatic, and 1.18 (95% CI: 0.83-1.68) for high-risk asymptomatic HCPs. CONCLUSION: Regardless of exposure category, HCPs with symptoms consistent with COVID-19 have the highest likelihood of testing positive. The CDC exposure risk assessment criteria work best for symptomatic HCPs. Testing asymptomatic HCPs with high-risk exposures may not be necessary in low-resource settings with a limited healthcare workforce. KEY WORDS: COVID-19, Employee health, Occupational health and safety programs, Medical surveillance/screening, Return to work.

Prospective, randomised, parallel-group, open-label study to evaluate the effectiveness and safety of IMU-838, in combination with oseltamivir, in adults with COVID-19: the IONIC trial protocol.

BACKGROUND: Globally, there is a scarcity of effective treatments for SARS-CoV-2 infections (causing COVID-19). Repurposing existing medications may offer the best hope for treating patients with COVID-19 to curb the pandemic. IMU-838 is a dihydroorotate dehydrogenase inhibitor, which is an effective mechanism for antiviral effects against respiratory viruses. When used synergistically with oseltamivir, therapeutic effects have been observed against influenza and SARS-CoV-2 in rodents. The IMU-838 and Oseltamivir in the Treatment of COVID-19 (IONIC) trial is a randomised controlled trial that will investigate whether time to clinical improvement in patients with COVID-19 is improved following a 14-day course of IMU-838+oseltamivir versus oseltamivir alone. METHODS: IONIC trial is an open-label study in which participants will be randomised 1:1 in two parallel arms: the intervention arm (IMU-838+oseltamivir) and the control arm (oseltamivir only). The primary outcome is time to clinical improvement; defined as the time from randomisation to a two-point improvement on WHO ordinal scale; discharge from hospital, or death (whichever occurs first). The study is sponsored by the University Hospitals Coventry and Warwickshire NHS Trust and funded by LifeArc. DISCUSSION: The IONIC protocol describes an overarching trial design to provide reliable evidence on the effectiveness of IMU-838 (vidofludimus calcium) when delivered in combination with an antiviral therapy (oseltamivir) (IONIC intervention) for confirmed or suspected COVID-19 infection in adult patients receiving usual standard of care. ETHICS AND DISSEMINATION: This study has been independently reviewed and approved by Wales Research Ethics Committee. In addition, required regulatory approvals were received from Medicines and Healthcare products Regulatory Agency. TRIAL REGISTRATION NUMBER: EudraCT 2020-001805-21, ISRCTN53038326, NCT04516915.

Seroprevalence of SARS-CoV-2 Infection Among Working Women and Impact of Workplace Restrictions.

Objective: To determine the prevalence of SARS-CoV-2 virus infection among female workers who were restricted to working from home compared with those who continued to attend in-person work. Methods: As part of national surveillance program, serum samples for SARS-CoV-2 antibody testing and nasopharyngeal swabs for SARS-CoV-2 PCR were obtained on 1636 female school staff and salon/spa workers who were restricted to work remotely (restricted group) and 1190 female health-care workers who continued in-person work (unrestricted group). Results: Seropositivity rate was 5.1% among the restricted and 22.7% among the unrestricted group (P < 0.0001). Presence of symptoms at baseline (adjusted odds ratio [aOR], 2.88; 95% CI 2.09-3.97), contact with a confirmed case (aOR 2.34; 95% CI 1.37-3.98), and unrestricted work type (aOR 4.71; 95% CI 3.24-6.86) were associated with a higher risk of infection, while increasing age was associated with a lower risk of infection. Conclusion: Prevalence of SARS-CoV-2 infection as determined by seropositivity was higher among women who were not subject to workplace restrictions.

Cognitive appraisal, Coping, Stress and Fear Contracting Covid-19 in Working People in Pakistan.

The present study aimed to examine the relationship and prediction of cognitive appraisal and coping with Stress and Fear contracting COVID-19 among the working population of Pakistan. Cross-sectional research design was employed. The data was collected from 980 participants of almost 39 different professions using the purposive sampling technique. Stress Appraisal Measure (Peacock et al., in Stress Med 6:227-236, 1990, http://www.drpaulwong.com/wp-content/uploads/2018/03/Stress-Appraisal-Measure-SAM-Peacock-Wong-1990-Paper.pdf). Brief COPE Inventory (Caver, in Int J Behav Med 4:92-100, 1997), and Perceived Stress Scale (Cohen et al., in J Health Soc Behav 24:385-396, 1983) were used to measure cognitive appraisal, coping, and stress, respectively. Fear was measured by using Fear contracting COVID-19 questionnaire (Ali et al., in J Pakistan Soc Int Med 2(2):140-144, 2021). Age, education, and previously attended stress management training were significantly positively correlated with stress and fear. Females were more stressed and fearful than males. Average time spent on social media was significantly positively correlated with stress. Participants, who were employed, had family members of the older age group above 50 years and had family members with the history of biological diseases were more fearful. Results of hierarchical multiple regression analyses showed that threat, centrality, stressfulness appraisal, and avoidant emotional coping significantly positively predicted stress, whereas control-self appraisal and active emotional coping significantly negatively predicted stress. Moreover, threat, challenge, centrality, stressfulness appraisal, and problem-focused coping significantly positively predicted fear contracting COVID-19, whereas control-self appraisal and active emotional coping significantly negatively predicted fear contracting COVID-19 after controlling for covariates. This study will address the administrative authorities and government institutions to provide first-aid mental health services for emergencies, epidemics, or pandemics in the future.

Investigating the Role of Perceived Information Overload on COVID-19 Fear: A Moderation Role of Fake News Related to COVID-19

During crises and uncertain situations such as the coronavirus disease 2019 (COVID-19) pandemic, social media plays a key function because it allows people to seek and share news, as well as personal views and ideas with each other in real time globally. Past research has highlighted the implications of social media during disease outbreaks;nevertheless, this study refers to the possible negative effects of social media usage by individuals in the developing country during the COVID-19 epidemic lockdown. Specifically, this study investigates the COVID-19 fear using the survey data collected from a developing country. In total, 880 entries were used to analyze the COVID-19 fear using the AMOS software. Findings indicated that information-seeking and sharing behavior of individuals on social media has a significant impact on perceived COVID-19 information overload. Perceived COVID-19 information overload has a positive impact on COVID-19 fear. In addition, fake news related to COVID-19 strengthens the relationship between perceived COVID-19 information overload and COVID-19 fear. The implication and limitations of the study are also discussed in the final section of the study.

Health Risk Factors among Doctors, Psychologists and Nurses of Pakistan during COVID-19 Pandemic.

The present study aimed to find out differences in health risk factors of COVID-19 among doctors, nurses and psychologists by determining the relationship of cognitive appraisal, coping styles, stress and fear among health professionals. Cross-sectional research design was used. Sample comprised of 3 groups; doctors, nurses and psychologists (n = 145 in each group) working in tertiary care hospitals. Stress appraisal measure, Brief COPE inventory, Perceived stress scale and Fear contracting COVID-19 questionnaire were used to assess cognitive appraisal, coping, stress and fear respectively. Results showed that nurses had high uncontrollable, stressfulness and primary appraisal, used more avoidant emotional and problem focused coping, were more stressed and fearful as compared to doctors and psychologists. Psychologists had a high appraisal of control-self and control-others as compared to doctors and nurses and were more fearful than doctors. Doctors and psychologists used more coping of humor as compared to nurses. Moreover, primary appraisal and avoidant emotional coping positively predicted stress whereas control-self appraisal negatively predicted stress among health professionals. Uncontrollable and stressfulness appraisal positively correlated with fear. This study will direct the administrative authorities to take effective measures to improve psychological wellbeing and to deal with fear and stress of health professionals.

MDR BACTERIAL INFECTIONS IN CRITICALLY ILL COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL (OF PAKISTAN)

Objective: To identify antimicrobial susceptibility pattern of multidrug resistant bacteria causing secondary infections in COVID-19 patients in ICU's of a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Pak Emirates Military Hospital, Rawalpindi, from Apr to Jul 2020. Methodology: This study included blood samples and endotracheal aspirates from 114 critically ill COVID-19 patients. Peripheral blood specimens were collected from the patients with secondary bacterial blood stream infections and endotracheal aspirates were collected from patients with ventilator associated pneumonia for culture and sensitivity. The results were interpreted according to Clinical and Laboratory Standard Institute (CLSI) 2020. Results: A total of 114 COVID-19 patients were admitted in ICU during that time period. Fourteen (12.28%) were female and 100 (87.71%) were male, age distribution was between 36-82 years. Sixty six paired blood samples were sent to the microbiology lab out of which 51 (77.2%) showed bacterial growth while 15 (22.7%) samples were negative. Out of 50 endotracheal aspirates, 42 showed bacterial growth (84%) and 8 samples did not show any significant bacterial growth (16%). Most of the endotracheal aspirates showed growth of >1 bacterial isolates. The most common gram-negative organisms were Acinetobacter baumannii (n=54) and Klebsiella Pneumoniae (n=26) and most common gram-positive organism isolated was Enterococcus faecium (n=9). All isolated organisms were multidrug resistant. Conclusion: Poor antimicrobial stewardship particularly in critical care units resulted in secondary bacterial infections in COVID-19 patients. The pathogens isolated were multidrug resistant including Acinetobacter baumannii, Klebsiella Pneumoniae and Enterococcus faecium.

Hyperbaric oxygen therapy for the treatment of long COVID: early evaluation of a highly promising intervention.

BACKGROUND: Long COVID is a common occurrence following COVID-19 infection. The most common symptom reported is fatigue. Limited interventional treatment options exist. We report the first evaluation of hyperbaric oxygen therapy (HBOT) for long COVID treatment. METHODS: A total of 10 consecutive patients received 10 sessions of HBOT to 2.4 atmospheres over 12 days. Each treatment session lasted 105 minutes, consisting of three 30-minute exposures to 100% oxygen, interspersed with 5-minute air breaks. Validated fatigue and cognitive scoring assessments were performed at day 1 and 10. Statistical analysis was with Wilcoxon signed-rank testing reported alongside effect sizes. RESULTS: HBOT yielded a statistically significant improvement in the Chalder fatigue scale (p=0.0059; d=1.75 (very large)), global cognition (p=0.0137; d=-1.07 (large)), executive function (p=0.0039; d=-1.06 (large)), attention (p=0.0020; d=-1.2 (very large)), information processing (p=0.0059; d=-1.25 (very large)) and verbal function (p=0.0098; d=-0.92 (large)). CONCLUSION: Long COVID-related fatigue can be debilitating, and may affect young people who were previously in economic employment. The results presented here suggest potential benefits of HBOT, with statistically significant results following 10 sessions.

Integrating Spatial Modelling and Space-Time Pattern Mining Analytics for Vector Disease-Related Health Perspectives: A Case of Dengue Fever in Pakistan.

The spatial-temporal assessment of vector diseases is imperative to design effective action plans and establish preventive strategies. Therefore, such assessments have potential public health planning-related implications. In this context, we here propose an integrated spatial disease evaluation (I-SpaDE) framework. The I-SpaDE integrates various techniques such as the Kernel Density Estimation, the Optimized Hot Spot Analysis, space-time assessment and prediction, and the Geographically Weighted Regression (GWR). It makes it possible to systematically assess the disease concentrations, patterns/trends, clustering, prediction dynamics, and spatially varying relationships between disease and different associated factors. To demonstrate the applicability and effectiveness of the I-SpaDE, we apply it in the second largest city of Pakistan, namely Lahore, using Dengue Fever (DF) during 2007-2016 as an example vector disease. The most significant clustering is evident during the years 2007-2008, 2010-2011, 2013, and 2016. Mostly, the clusters are found within the city's central functional area. The prediction analysis shows an inclination of DF distribution from less to more urbanized areas. The results from the GWR show that among various socio-ecological factors, the temperature is the most significantly associated with the DF followed by vegetation and built-up area. While the results are important to understand the DF situation in the study area and have useful implications for public health planning, the proposed framework is flexible, replicable, and robust to be utilized in other similar regions, particularly in developing countries in the tropics and sub-tropics.

Difference in stress-related indicators between employees experiencing partial and complete lockdowns during the COVID-19 pandemic in Pakistan.

OBJECTIVES: The present study aimed to compare the stress experience of employees facing to differentiated types of lockdown situations: total vs. partial. It also aimed to identify the cognitive appraisal, coping, stress, and fear of contracting COVID-19 associated with lock down situations among employees. METHOD: A cross-sectional research design was employed. The sample comprises two groups (n = 490 in each group), complete lockdown (people working from home) and partial lockdown (people going to workplace), and was drawn from Pakistan using purposive sampling technique. Stress Appraisal Measure, Brief COPE Inventory, Perceived Stress Scale, and Fear of Contracting COVID-19 Questionnaire were used to measure cognitive appraisal, coping, stress, and fear, respectively. RESULTS: Independent sample t-test showed that the threat and uncontrollable appraisal was high in people going to workplace as compared to people working from home. Results of binary logistic regression showed that people going to workplace were more likely to cope with COVID-19 situation through seeking instrumental support, behavior disengagement, acceptance, and religion as compared to people working from home. Moreover, people working from home were 0.84 times more likely to cope through emotional support than people going to workplace. Fear was found to be 1.1 times more likely associated with people going to workplace than people working from home. CONCLUSION: This study would help administrative authorities and government institutions in designing mental health services for working population. It would help the emergency departments in devising first aid management plan to deal with the psychological needs of the workers under pandemic/lockdown situations.

Emergency preparedness and response to the COVID-19 pandemic: our experience from the emergency department of a tertiary care hospital in Pakistan

Aga Khan University Hospital (AKUH), Karachi, where they work, is one of the best tertiary care hospitals and is known for its outstanding healthcare services. Emergency preparedness and response to provide adequate care for patients suspected of suffering from acute respiratory illness related to the coronavirus is urgently needed at this time. The hospitals, as a whole, must rapidly develop a robust and effective strategy to address the impending pandemic. Initially, when disease burden was low, Emergency Department (ED) divided the triage area into COVID-19 and non-COVID-19 sections, so that patient cohorts could be separated. Patients were referred to Community Health Center (CHC), a family medicine clinic area, for COVID-19 tests after screening. This was done in conjunction with Pakistani governments. As the number of cases increased, AKUH prepared field triage for screening purposes beyond the main ED. In addition, a COVID-19 triage tool was developed for adult and paediatric patients to simplify screening and to speed up the admissions process. Confirmed COVID-19 patients were treated in single rooms for strict isolation for 14 days as for government and hospital policies. Over time, there was a rapid spike of patients who came for COVID-19 tests. At that time, they decided to order COVID-19 tests only for the AKUH staff and of the sickest patients requiring hospitalisation. In addition, they started removing suspected and confirmed COVID-19 patients from emergency rooms, who are clinically stable with strict home isolation instructions or in government-designated hospitals. Meanwhile, hospital management has converted intensive care units (ACUs), 10-bed units previously used to accommodate patients requiring highly addictive treatment when intensive care/high addiction care units are completed in complete negative pressure areas, which dedicated to COVID-19 positive patients. This unit was built near ED to optimise the flow of critically ill patients. Ultimately, they believe that with this multifaceted approach, they will be better equipped in terms of process flows and clinical knowledge to address these challenges more strategically and to provide safe care to these patients in a safer ED manner.

Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar.

We investigated what proportion of the population acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and whether the herd immunity threshold has been reached in 10 communities in Qatar. The study included 4,970 participants during June 21-September 9, 2020. Antibodies against SARS-CoV-2 were detected by using an electrochemiluminescence immunoassay. Seropositivity ranged from 54.9% (95% CI 50.2%-59.4%) to 83.8% (95% CI 79.1%-87.7%) across communities and showed a pooled mean of 66.1% (95% CI 61.5%-70.6%). A range of other epidemiologic measures indicated that active infection is rare, with limited if any sustainable infection transmission for clusters to occur. Only 5 infections were ever severe and 1 was critical in these young communities; infection severity rate of 0.2% (95% CI 0.1%-0.4%). Specific communities in Qatar have or nearly reached herd immunity for SARS-CoV-2 infection: 65%-70% of the population has been infected.

Changes in Air Quality Associated with Mobility Trends and Meteorological Conditions during COVID-19 Lockdown in Northern England, UK

The COVID-19 pandemic triggered catastrophic impacts on human life, but at the same time demonstrated positive impacts on air quality. In this study, the impact of COVID-19 lockdown interventions on five major air pollutants during the pre-lockdown, lockdown, and post-lockdown periods is analysed in three urban areas in Northern England: Leeds, Sheffield, and Manchester. A Generalised Additive Model (GAM) was implemented to eliminate the effects of meteorological factors from air quality to understand the variations in air pollutant levels exclusively caused by reductions in emissions. Comparison of lockdown with pre-lockdown period exhibited noticeable reductions in concentrations of NO (56.68–74.16%), NO2 (18.06–47.15%), and NOx (35.81–56.52%) for measured data. However, PM10 and PM2.5 levels demonstrated positive gain during lockdown ranging from 21.96–62.00% and 36.24–80.31%, respectively. Comparison of lockdown period with the equivalent period in 2019 also showed reductions in air pollutant concentrations, ranging 43.31–69.75% for NO, 41.52–62.99% for NOx, 37.13–55.54% for NO2, 2.36–19.02% for PM10, and 29.93–40.26% for PM2.5. Back trajectory analysis was performed to show the air mass origin during the pre-lockdown and lockdown periods. Further, the analysis showed a positive association of mobility data with gaseous pollutants and a negative correlation with particulate matter.

Validating a Phenomenological Mathematical Model for Public Health and Safety Interventions Influencing the Evolutionary Stages of Recent Outbreak for Long-Term and Short-Term Domains in Pakistan

During the outbreak of an epidemic, it becomes significantly essential to monitor the effects of containment measures and forecast the outbreak, including the epidemic peak. Many countries have either implemented strict lockdown to counter the spread of coronavirus disease or taken necessary preventive measures across the world to reduce the outbreak of this epidemic war. Several epidemic models have been presented across the world to examine the effects of public health-related strategies on mitigating the spread of current infectious disease, yet no reputable model has been presented for Pakistan as well as other South-Asian developing countries as per the authors’ knowledge. In this research, an actual coronavirus prediction in Pakistan is presented, which may guide the decision-makers as to how this pandemic has spread across the country and how it can be controlled. Furthermore, in the absence of targeted medicines, the analysis helps to develop a precise plan for the eradication of the outbreak by adopting the calculated steps at the right time. The mathematical phenomenological models have been adopted in this study to predict, project, and simulate the overall affected cases reflected due to the recent outbreak in Pakistan. These models predict the expected growth, and the estimated results are almost well matched with the real cases. Through the calibration of parameters and analyzing the current situation, forecast for the appearance of new cases in Pakistan is reported till the end of this year. The constant level of number of patients and time to reach specific levels are also reported through the simulations. The drastic conditions are also discussed which may occur if all the preventive restraints are removed. This research quantitatively describes the significant characteristics of the spread of corona cases. It acknowledges and provides an understanding of a short-term and long-term transmission of coronavirus outbreak in the country as three evolutionary phases. Therefore, this research provides a pathway to cope with the emerging threat of a severe outbreak in developing and nondeveloping countries.

Evidence for and level of herd immunity against SARS-CoV-2 infection: the ten-community study (preprint)

Background: Qatar experienced a large severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic that disproportionately affected the craft and manual workers (CMWs) who constitute 60% of the population. This study aimed to investigate level of immunity in communities within this population as well as infection exposure required to achieve herd immunity. Methods: Anti-SARS-CoV-2 seropositivity was assessed in ten CMW communities between June 21 and September 9, 2020. PCR positivity, infection positivity (antibody and/or PCR positive), and infection severity rate were also estimated. Associations with anti-SARS-CoV-2 positivity were investigated using regression analyses. Results: Study included 4,970 CMWs who were mostly men (95.0%) and <40 years of age (71.5%). Seropositivity ranged from 54.9% (95% CI: 50.2-59.4%) to 83.8% (95% CI: 79.1-87.7%) in the different CMW communities. Pooled mean seropositivity across all communities was 66.1% (95% CI: 61.5-70.6%). PCR positivity ranged from 0.0% to 10.5% (95% CI: 7.4-14.8%) in the different CMW communities. Pooled mean PCR positivity was 3.9% (95% CI: 1.6-6.9%). Median cycle threshold (Ct) value was 34.0 (range: 15.8-37.4). The majority (79.5%) of PCR-positive individuals had Ct value >30 indicative of earlier rather than recent infection. Infection positivity (antibody and/or PCR positive) ranged from 62.5% (95% CI: 58.3-66.7%) to 83.8% (95% CI: 79.1-87.7%) in the different CMW communities. Pooled mean infection positivity was 69.5% (95% CI: 62.8-75.9%). Only five infections were ever severe and one was ever critical, an infection severity rate of 0.2% (95% CI: 0.1-0.4%). Conclusions: Based on an extended range of epidemiological measures, active infection is rare in these communities with limited if any sustainable infection transmission for clusters to occur. At least some CMW communities in Qatar have reached or nearly reached herd immunity for SARS-CoV-2 infection at a proportion of ever infection of 65-70%.

Evolution of COVID-19 Pandemic in India (preprint)

A mathematical analysis of patterns for the evolution of COVID-19 cases is key to the development of reliable and robust predictive models potentially leading to efficient and effective governance against COVID-19. Towards this objective, we study and analyze the temporal growth pattern of COVID-19 infection and death counts in various states of India. Our analysis up to June 16, 2020 shows that several states (namely Maharashtra, Tamil Nadu, Delhi, Uttar Pradesh) have reached t-squared power-law growth, while some others like Gujarat, Rajasthan, and Madhya Pradesh have reached linear growth. Karnataka and Kerala are exhibiting a second wave. In addition, we report that the death counts exhibit similar behavior as the infection counts. These observations indicate that Indian states are far from flattening their epidemic curves.

Evolution of COVID-19 pandemic: Power law growth and saturation (preprint)

In this paper, we analyze the real-time infection data of COVID-19 epidemic for 21 nations up to May 18, 2020. For most of these nations, the total number of infected individuals exhibits a succession of exponential growth and power-law growth before the flattening of the curve. In particular, we find a universal {surd}t growth before they reach saturation. India, Singapore, and Sri Lanka have reached up to linear growth (I(t) {approx} t), and they are yet to flatten their curves. Russia and Brazil are still in the power-law (t^2) growth regime. Thus, the polynomials of the I(t) curves provide valuable information on the stage of the epidemic evolution. Besides these detailed analyses, we compare the predictions of an extended SEIR model and a delay differential equation-based model with the reported infection data and observed good agreement among them, including the {surd}t behaviour.

COVID-19 epidemic: Power law spread and flattening of the curve (preprint)

In this paper, we analyze the real-time infection data of COVID-19 epidemic for nine nations. Our analysis is up to 7 April 2020. For China and South Korea, who have already flattened their infection curves, the number of infected individuals (I(t)) exhibits power-law behavior before flattening of the curve. Italy has transitioned to the power-law regime for some time. For the other six nations-USA, Spain, Germany, France, Japan, and India-a power-law regime is beginning to appear after exponential growth. We argue that the transition from an exponential regime to a power-law regime may act as an indicator for flattening of the epidemic curve. We also argue that long-term community transmission and/or the transmission by asymptomatic carriers traveling long distances may be inducing the power-law growth of the epidemic.