Access to the COVID-19 services during the pandemic - a scoping review.

Appropriate accessibility to coronavirus disease 2019 (COVID-19) services is essential in the efficient management of the pandemic. Different geospatial methods and approaches have been used to measure accessibility to COVID-19 health-related services. This scoping review aimed to summarize and synthesize the geospatial studies conducted to measure accessibility to COVID-19 healthcare services. Web of Science, Scopus, and PubMed were searched to find relevant studies. From 1113 retrieved unique citations, 26 articles were selected to be reviewed. Most of the studies were conducted in the USA and floating catchment area methods were mostly used to measure the spatial accessibility to COVID-19 services including vaccination centres, Intensive Care Unit beds, hospitals and test sites. More attention is needed to measure the accessibility of COVID-19 services to different types of users especially with combining different non-spatial factors which could lead to better allocation of resources especially in populations with limited resources.

Demographic and clinical characteristics of severe Covid-19 infections: a cross-sectional study from Mashhad University of Medical Sciences, Iran.

BACKGROUND: Coronavirus Disease 2019 (Covid-19) is expanding worldwide. The characteristics of this infection in patients varies from country to country. To move forward, clinical data on infected patients are needed. Here, we report a comparison between fatalities and recovery of patients with severe Covid-19, based on demographic and clinical characteristics. METHODS: Between 5 March and 12 May 2020 in Mashhad, Iran, 1278 of 4000 suspected Covid-19 patients were confirmed positive by real-time reverse-transcriptase-polymerase-chain-reaction assay of upper respiratory specimens. We compared the demographic, exposure history and clinical symptoms of 925 survivors and 353 fatal cases with confirmed disease. RESULTS: Mean (SD) age for all confirmed patients was 56.9 (18.7) years, 67.1 (15.9) years in fatal cases and 53.0 (18.3) years in survivors. Multivariate logistic regression analysis showed that the outcome of patients was associated with age (odds ratio = 1.049, P = 0.0001, 95% CI = 1.040-1.057). Despite a high burden of Covid-19 infections in the 30-39 and 40-49 year age groups, most of these (89.6 and 87.2%, respectively) recovered. The median (IQR) duration of hospitalization was 9.0 (6.0-14.0) days. The most prevalent co-morbidities were cardiovascular disorders (21%) and diabetes (16.3%). Dyspnoea (72.7%), cough (68.1%) and fever (63.8%) were the most frequent clinical symptoms. Healthcare workers, of whom two (3%) died, comprised 5.2% of infected cases. Combination antiviral and antibiotic therapy was used in 43.0% of cases. CONCLUSIONS: The characteristics of severe Covid-19 varied substantially between fatal cases and survivors, with diabetes and cardiovascular disorders the most prevalent co-morbidities. In contrast to other studies, there were a higher number of fatalities in younger patients in our setting.

Covid-19 Presented Only with Gastrointestinal Symptoms: A Case Report of a 14-Year-Old Patient

Coronavirus disease 2019 (Covid-19) is expanding worldwide. Although it seems to be a purely respiratory disease, occasional reports of lesions in other organs have been published. We report here an asymptomatic child with Covid-19 and with the main symptom of abdominal pain distension and without any respiratory symptoms. A 14-year-old male patient with main complaints of fever, malaise, anorexia, and severe abdominal pain was admitted to a hospital in Mashhad, Iran. Laparotomy revealed distension of the small intestine and an adhesive ileocaecal band that had produced ileum herniation without free fluid in the abdomen. Chest radiography and high-resolution computed tomography of the lungs showed bilateral and diffuse, peripheral dense areas of ground-glass appearance. A nasopharyngeal swab for diagnosis of Covid-19, was ordered due to lymphopenia together with these diffuse lung infiltrations, which showed a positive result. This led to drug treatment with lopinavir/ ritonavir, hydroxychloroquine, ribavirin/oseltamivir, and meropenem. The patient was febrile and developed tachycardia on the third day, accompanied by a respiratory rate of 44/min. At this point, tracheal intubation was done, but the patient died after 3 hours due to cardiac arrest. The case report brings forth the hypothesis that the gastrointestinal manifestation may be an atypical symptom of Covid-19 infection and highlights the importance of the diagnosis based on combined laboratory-based data and scanning imagery.