Background: Co-infections of SARS-CoV-2 with respiratory viruses, bacteria and fungi have been reported to cause a wide range of illness. Objectives: We assess the prevalence of co-infection of SARS-CoV-2 with seasonal respiratory viruses, document the respiratory viruses detected among individuals tested for SARS-CoV-2, and describe characteristics of individuals with respiratory virus co-infection detected. Methods: Specimens included in this study were submitted as part of routine clinical testing to Public Health Ontario Laboratory from individuals requiring testing for SARS-CoV-2 and/or seasonal respiratory viruses. Results: Co-infection was detected in a smaller proportion (2.5%) of individuals with laboratory confirmed SARS-CoV-2 than those with seasonal respiratory viruses (4.3%); this difference was not significant. Individuals with any respiratory virus co-infection were more likely to be younger than 65 years of age and male than those with single respiratory virus infection. Those with SARS-CoV-2 co-infection manifested mostly mild respiratory symptoms. Conclusions: Findings of this study may not support routine testing for seasonal respiratory viruses among all individuals tested for SARS-CoV-2, as they were rare during the study period nor associated with severe disease. However, testing for seasonal respiratory viruses should be performed in severely ill individuals, in which detection of other respiratory viruses may assist with patient management.

Coronavirus disease2019(COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. Therefore, for COVID-19 patients, Convalescent plasma, could prove lifesaving, such as improving the clinical symptoms, increasing the neutralizing antibody, decreasing the viral load , reducing the death rate, with safety and without seriously ADE. Meanwhile, it is urgent to perform large sample randomized controlled trials to confirm the transfusion timing, dosage, frequency and actively prevent adverse outcomes that may occur, establishing a standard procedure for treatment from convalescent plasma collection, preservation, transport, to transfusion.

Background. Patients with severe asthma may have a greater risk of dying from COVID-19 disease. Angiotensin converting enzyme-2 (ACE2) and the enzyme proteases, transmembrane protease serine 2 (TMPRSS2) and FURIN, are needed for viral attachment and invasion into host cells. Methods. We examined microarray mRNA expression of ACE2, TMPRSS2 and FURIN in sputum, bronchial brushing and bronchial biopsies of the European U-BIOPRED cohort. Clinical parameters and molecular phenotypes, including asthma severity, sputum inflammatory cells, lung functions, oral corticosteroid (OCS) use, and transcriptomic-associated clusters, were examined in relation to gene expression levels. Results. ACE2 levels were significantly increased in sputum of severe asthma compared to mild-moderate asthma. In multivariate analyses, sputum ACE2 levels were positively associated with OCS use and male gender. Sputum FURIN levels were significantly related to neutrophils (%) and the presence of severe asthma. In bronchial brushing samples, TMPRSS2 levels were positively associated with male gender and body mass index, whereas FURIN levels with male gender and blood neutrophils. In bronchial biopsies, TMPRSS2 levels were positively related to blood neutrophils. The neutrophilic molecular phenotype characterised by high inflammasome activation expressed significantly higher FURIN levels in sputum than the eosinophilic Type 2-high or the pauci-granulocytic oxidative phosphorylation phenotypes. Conclusion. Levels of ACE2 and FURIN may differ by clinical or molecular phenotypes of asthma. Sputum FURIN expression levels were strongly associated with neutrophilic inflammation and with inflammasome activation. This might indicate the potential for a greater morbidity and mortality outcome from SARS-CoV-2 infection in neutrophilic severe asthma.

Purpose: The aim of this study is to determine the problems occurring during the COVID-19 pandemic period in patients treated with intravitreal (IV) injection for diabetic retinopathy, and to provide recommendations for treatment management in these patients. Methods: Twenty-nine eyes of 17 patients were included in this prospective, observational study. The frequency of hospital visits, treatments performed, and detailed ophthalmological examination findings, including optical coherence tomography findings and glycated haemoglobin (HbA1c) values, were recorded in the period before the COVID-19 pandemic. During the COVID-19 pandemic period, the detailed ophthalmological examination findings and HbA1c values were noted after the patients who had delayed their routine control time (>90 days) applied to the hospital. New treatments were planned according to the current situation. Results: Seventeen patients who were diagnosed with diabetic macular edema were included in the study; 10 were female (58.8%) and seven were male (41.2%). The mean time interval between following visits was 45.52±5.85 days during the pre-pandemic period, but it increased to 110.41±13.47 days during the COVID-19 pandemic period (p<.001). Visual acuity (LogMAR) was 0.44±0.36 in the pre-pandemic period and 0.76±0.48 during the COVID-19 pandemic period (p=.003). Central macular thickness was 300.10±85.56 µm in the pre-pandemic period and it increased to 387.10±144.48 µm during the COVID-19 pandemic period (p=.007). In three patients, complications of diabetic retinopathy that could not be cured by medical treatment developed and surgical treatment was recommended. Conclusions: Delays in the treatment of diabetic retinopathy may cause permanent impairment in visual functions. The COVID-19 pandemic has caused an increase in the hospital visit intervals of patients, and this situation has resulted in disruptions in the follow-up and treatment of patients with diabetic retinopathy. Alternative diagnosis and treatment practices are needed in order to manage these and similar processes smoothly.

Objective To evaluate relationships between cycle threshold values and COVID-19 presentations and clinical courses in women presenting for childbirth. Cycle threshold values from polymerase chain reaction (PCR) testing are inversely proportional to viral burden and may be important predictors of disease state and infectivity risk. Design Retrospective cohort study Setting Three Yale-New Haven Health Hospitals between 4/2/2020-5/14/2020 Population Women presenting for childbirth who underwent SARS-CoV-2 PCR testing Methods Electronic health records were reviewed for socio-demographics, medical comorbidities, pregnancy and postpartum course, and COVID-19 symptoms and exposures. Records of SARS-CoV-2 positive women were reviewed for symptom onset, duration, and relation to test timing, disease course, and neonatal SARS-CoV-2 results. Main Outcome Measures SARS-CoV-2 real-time PCR cycle threshold values from positive tests were compared between asymptomatic and symptomatic women and in relation to disease severity. In women with symptomatic COVID-19, cycle threshold values were evaluated as a function of time since symptom onset. Results 1,210 women gave birth during the study period with 84 (6.9%) positive for SARS-CoV-2. Higher cycle threshold values were seen in asymptomatic SARS-CoV-2 positive patients (8/38 (21.1%) of asymptomatic women had cycle threshold <30 compared to 22/32 (68.0%) of symptomatic women, p<0.0001). In symptomatic women, values increased as time from symptom onset increased. Conclusion This study demonstrates higher cycle threshold values in asymptomatic patients and symptomatic patients tested remote from symptom onset, signifying older infections and detection of lower levels of viral RNA. Assessment of standardized cycle threshold values may help to understand disease characteristics and progression.

Objectives: To follow-up pediatric CF patients—in terms of health status and nutritional status—via Telehealth services during the COVID-19 pandemic. Additional aims were to measure the level of anxiety in the patients and their parents, and to determine the COVID-19 transmission status in the CF patients. Materials and Methods: The CF team supported the patients via remote contact, including dedicated telephone lines. During Telehealth Services interviews, in addition to obtaining information about the patients’ anthropometric measurements, health status, and CF-related complaints, the State-Trait Anxiety Inventory (STAI) was administered to the patients and the Hospital Anxiety and Depression Scale (HAD) was administered to their parents. Results: The study included 144 pediatric CF patients (74 male and 70 female). Mean age of the patients was 8.9 years. In all, 42 (29.2%) of the patients were tested for COVID-19, of which 4 were positive. The mean STAI score was significantly lower in the patient group than in the control group (P < 0.001). The mean HAD anxiety score was significantly higher in the parents of the CF patients, as compared to the parents of the controls (P = 0.005). The mean HAD depression score was also statistically higher in the parents of the CF patients (P < 0.001). Conclusion: Telehealth is an innovative method for providing healthcare services while maintaining social distancing, avoiding the risk of exposure and spread of COVID-19. Telehealth services reduce patients’ and parents’ anxiety, and increases their confidence in managing CF-related complications.

Newborn screening (NBS) of cystic fibrosis (CF) is not available currently in Hungary. Pediatricians should be able to recognize the illness based on the symptoms alone. Lack of NBS causes differential diagnostic challenges for physicians and delayed diagnosis of CF. We present a case of a two-year-old girl who was transferred to our hospital as a suspected Covid-19 patient with one week history of fever and coughing in March 2020. As Covid-19 was excluded, the severity of the clinical picture pointed towards an acute exacerbation of an underlying chronic condition. Her symptoms such as tachypnea, wheezing, lung crackles, hepatomegaly and clubbing of the fingers were all consistent with undiagnosed CF. In the end, sweat chloride level and genetic test verified the diagnosis. This case emphasizes the need of NBS in Hungary.

I agree with their implications on the weakness of the US healthcare systeml,2. As of Oct. 30 in 2020 using the last 200 days open data3, the number of daily deaths due to the COVID-19 in the US can be predicted by the state-of-the-art curve fitting with the 6th degree polynomial:Nov. 6 daily deaths 959,Nov. 13 daily deaths 1017, andNov. 20 daily deaths 1002.Fig. 1 shows the predicted three red points on the number of deaths on Nov. 6, Nov. 13 and Nov. 21 respectively. The graph was created by the curve-fitting Python program: usdaily.py4. If the US does not change the current policy against the COVID-19 pandemic, the number of daily deaths will not be alleviated in the next three weeks.

Rationale, aims and objectives: This study aimed to determine the residents’ perspectives on clinical practice during the pandemic of coronavirus disease 2019 (COVID-19). Methods: A cross-sectional survey was carried out online among medical residents in our hospital. The survey covered basic information, condition of clinical practice, and perspectives related to the COVID-19. Results: total 174 (26.8%) residents responded and completed the survey. Nearly half of the residents (51.7%) expressed willingness of going to the frontline to fight against the virus and 62.3% of the residents showed good morale. Online courses were delivered to 87.9% of the residents with satisfaction at 89.7%. Approximate one third of the residents concerned the impact of the epidemic on graduation (34.0%) and taking up an occupation (32.8 %). Majorities (79.3%) determined to be a doctor after the pandemic. Notablely 40.2% of the residents thought they were underpaid. 21.8% of the residents reported to be unfairly treated in clinical practice. Overall no statistical differences were revealed between internal medicine and surgery residents, and between those married and singles, regarding the perceptions related to the COVID-19. Conclusion: Administrators should take cognizance of perspective of the residents and formulate corresponding strategies to reassure trainees’ safety and continuous training, address the residents’ concerns and get prepared for the second wave of COVID-19.

The coronavirus disease-2019 (COVID-19) pandemic has rapidly spread across the world. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first appeared in Wuhan, China in December, 2019. Ever increasing data is emerging about COVID-19 and its effects on the arterial and venous circulation. Clinical features associated with COVID-19 suggest that endothelial cell dysfunction and microvascular thrombosis are to a large part contributing to resultant multi-organ complications. This review is aimed at highlighting the critical aspects associated with COVID-19 and its presumed microvascular angiopathic complications leading to multi-organ dysfunction.

Background: Coronavirus disease (COVID-19) has overwhelmed healthcare systems worldwide often at the cost of patients with serious non-COVID-19 conditions. Outcomes and risks of contracting COVID-19 in patients hospitalized during the pandemic are unknown. Objective: To report our experience in safely performing electrophysiology procedures during the COVID-19 pandemic. Methods: We examined non-COVID-19 patients who underwent electrophysiology procedures during the peak of the pandemic between March 16, 2020 and May 11, 2020 at seven Northwell Health hospitals. We developed a priority algorithm to stratify inpatients and outpatients requiring electrophysiology procedures and instituted a protocol to minimize hospital length of stay (LOS). All patients underwent post discharge 30-day tele-health follow-up and chart review up to 150 days. Results: A total of 217 patients underwent electrophysiology procedures, of which 86 (39%) patients were outpatients. A total of 108 (49.8%) patients had a LOS less than 24 hours, including 74 device implantations and generator changes, 24 cardioversions, five ablations, and one electrophysiology study. There were eleven (5.1%) procedure or arrhythmia related re-admissions and two (0.9%) minor procedural complications. Overall average hospital LOS was 83.4±165.1 hours and a median of 24.0 hours. For outpatient procedures, average hospital LOS was 9.4±13.4 hours and a median of 4.3 hours. Overall follow-up time was 83.9 ±42 days and a median of 84 days. During follow-up, two (0.9%) patients tested positive for COVID-19 and recovered uneventfully. No deaths occurred. Conclusion: During the peak of the COVID-19 pandemic, patients safely underwent essential electrophysiological procedures without increased incidence of acquiring COVID-19.

A document by Shivraj Nile, written on Authorea.

The proposed approach presents substantial scientific evidence based on physics and clinical data to support a clinical trial of an energetic SARS-CoV-2 vaccine. This is particularly imperative in the absence of a pharmaceutical vaccine as well as its uncertain future efficacy and safety, considering the limited time for testing and rapid mutations of the virus. Some of the vaccine trials have already been halted due to volunteers falling ill. Physics and biophysics of the fundamental electromagnetic nature of the living matter, including microbes as well as water, support the imprinting of electromagnetic fields of microbes in water that elicits an immune response. Energetic vaccines can be rapidly mass-produced for both prophylaxis and treatment of the public and healthcare personnel against the original as well as mutated viral strains. These can be prepared through a standard homeopathic process, as well as an energy field imprinting device,* offering a unique potential in versatility, speed, and low cost in mass protection against the current and future public health emergencies. Other viral infections, epidemics, antibiotic-resistant, and vector-borne infections could be similarly addressed. Paradoxically, in spite of a general perception of homeopathy by physicians as the most alien and least scientific, among complementary and alternative medicine (CAM), it is just the opposite. Homeopathy carries formidable scientific support, with the specific proposed homeopathic model being fully in line with physicians’ superior knowledge of infectious diseases and medicine, making its adaptation into their practice intuitive and more effective than in the hands of non-MDs or DOs homeopaths. The practical advantage of the proposed homeopathic model in acute infections versus its oldest one of multisystemic, totality approach, yielding mixed results in chronic diseases, parallels a similar prevailing success of the corresponding conventional modalities in acute versus chronic diseases.

Wilensky reported his lessons from severe covid-19 experience1. In science, an objective view is important for solving a problem. In the world, many nations have different individual past and on-going lessons through the covid experience. From the viewpoint of human perspective, the number of deaths due to the covid pandemic should be used for grading the success of individual policies. Successful policies can provide a pleasant lesson to their citizens while the unsuccessful policy can bring harsh lessons to them. According to the worldometer, the successful policy based on digital fence using smart phones is implemented by Taiwan where isolating-all-at-risk strategy has been used2. The successful policy was deduced by their past lessons from SARS3. Taiwan has cumulative seven deaths due to the covid-19 with a population of 23.8 million. Since we have no vaccine and no effective therapy against the covid-19, isolating-all-at-risk in real time is one and only one effective policy against the pandemic. The US has an enough capability to perform the best similar policy for mitigating the pandemic.References:1.October 22, 2020 N Engl J Med 2020; 383:e96 DOI: 10.1056/NEJMp20232042. https://www.loc.gov/law/help/coronavirus-apps/taiwan.php3. WHO, Severe Acute Respiratory Syndrome (SARS),https://www.who.int/health-topics/severe-acute-respiratory-syndrome

Objective We profile the maternal and fetal response to SARS-CoV-2 infection in symptomatic and asymptomatic pregnant women and make an assessment of passive immunity to the neonate, Design Multicentre prospective study. Setting Dublin, Ireland Methods RT-PCR for viral RNA via a nasopharyngeal swab was performed using the Cobas SARS-CoV-2 6800 platform. Maternal, and fetal serological antibody response, via umbilical cord bloods, was measured using both the Elecsys® immunoassay, Abbott SARS-CoV-2 IgG Assay and the IgM Architect assay. Main outcome Measure Prevalence of RT PCR positive SARS-CoV-2. Assessment of IgM and IgG anti-SARS-CoV-2 serology antibodies. Results Ten of twenty three symptomatic women had SARS-CoV-2 RNA in a nasopharyngeal swab. Five (5/23, 21.7%) demonstrated serological evidence of anti-SARS-CoV-2 IgG antibodies and seven (30.4%, 7/23) were positive for IgM antibodies. In the asymptomatic cohort, the prevalence of SARS-CoV-2 infection in RNA was 0.16% (1/608). IgG SARS-CoV-2 antibodies were detected in 1·67% (10/598, 95% CI 0·8%-3·1%) and IgM in 3·51% (21/598, 95% CI 2·3–5·5%). Nine women had repeat testing between post baseline. Four (4/9, 44%) remained IgM positive, one IgG positive. IgG anti SARS-CoV-2 antibodies were detectable in cord bloods from babies born to five seropositive women who delivered during the study. Conclusion Using two independent serological assays, we present a comprehensive illustration of the antibody response to SARS-CoV-2 in pregnancy, and show a low prevalence of asymptomatic SARS-CoV-2. Transplacental migration of anti-SARS-CoV-2 antibodies was identified in cord blood of women who demonstrated antenatal anti-SARS-CoV-2 antibodies, raising the possibility of passive immunity.

In the COVID-19 pandemic, we performed a series of echocardiograms using subcostal views. After placing a patient in prone position during invasive mechanical ventilation, the echocardiogram transducer was placed under the patient in the left subcostal position. This performance allowed us to evaluate the function of the pulmonary valve and estimate pulmonary pressure. This is a complement to the monitoring with transthoracic echocardiogram in prone position.

We report a COVID19 case with acute heart and kidney failure in a healthy young male. Echocardiography showed severe systolic and diastolic left ventricle dysfunction, with diffuse myocardial thickening. Cardiac MRI showed aspects of focal myocarditis, and hypertensive cardiomyopathy. Renal biopsy demonstrated limited acute tubular injury, and hypertensive kidney disease. Coronary angiography excluded critical stenoses. Unlike what we initially suspected, myocardial inflammation had a limited extent in our patient; severe hypertension causing cardiomyopathy and multi-organ damage, not diagnosed before, was primarily responsible for severe illness. Correct diagnosis and guidelines-directed treatment allowed a favorable course.

A document by Marisol Perez-Toledo, written on Authorea.

The clinical characteristics of COVID-19 patients with pneumonia in family clustersGuangchuan Dai1*, Yating Gao2*, Likun Zhou3,4*, Zhen Zhou3*, Weiwei Gao1, XiangrongZhang1, Tingqiu Ge1, Yi zeng1#, Xia Zhang1#, Yongxiang Yi1#1Affiliated Hospital of Nanjing University of Chinese Medicine, The Second Hospital of Nanjing, Nanjing Municipal Public Health Medical Center, Nanjing, Jiangsu 210003, P.R. China2Graduate School, Anhui University of Chinese Medicine, Hefei, Anhui 230012, P.R. China3Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, School of Life Sciences, Nanjing University, Nanjing 210023, P.R. China4Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China*These authors contributed equally# Correspondence: Yi Zeng(960559051@qq.com) or Xia Zhang(zhangxia365@sina.com) or Yongxiang Yi (ian0216@yeah.net)Affiliated Hospital of Nanjing University of Chinese Medicine, The Second Hospital of Nanjing, Nanjing Municipal Public Health Medical Center, No.1, Kangfu Road, Jiangning District, Nanjing City, Jiangsu Province, P.R. China.Tel:+86-025-85091652Keywords: COVID-19 ; clinical characteristics ; family clusters

This case highlights an atypical presentation of a patient with no history of mental illness who has been diagnosed with a bipolar disorder associated with severe COVID-19 symptoms. Neuroimaging was only positive for subtle white matter changes; he was treated with antipsychotics and mood-stabilizing agents until he reached partial remission.

TYPE OF THE ARTICLE: LETTERTITLE: BIOLOGICAL THERAPIES IN CHILDREN WITH RHEUMATIC DISEASES DURING THE COVID-19 PANDEMIC: A SINGLE CENTER EXPERIENCERUNNING TITLE: BIOLOGICAL THERAPIES DURING THE COVID-19 PANDEMIC

Background: The possible differences in characteristics and prognosis, among patients with coronavirus disease 2019 (COVID-19), with vs. without changes in red cell distribution width (RDW) during hospitalization, have not been investigated. Methods: For 477 adults hospitalized with COVID-19, demographic, laboratory and clinical characteristics, in-hospital outcomes and all-cause mortality were compared according: to high (>14.7%, n=146) vs. normal (≤14.7%, n=331) RDW values at admission, and according to RDW changes (n=150) vs. stable RDW (n=262) during hospitalization. Results: Both high RDW at admission and change in RDW during hospitalization were significantly associated with older age, more severe clinical and laboratory characteristics, and poor in-hospital outcomes. On median follow-up lasting 83 days, the mortality rates were higher among patients with high vs. normal RDW on admission (26.7% vs. 10.0%, P < .001) and RDW changes vs. stable RDW (34.7% vs. 5.7%, P < .001). On multivariate analysis, change in RDW was strongly associated with decreased survival (relative risk 1.50 and 95% confidence interval 1.29–1.75), while high RDW on admission was not found to be most significantly associated with mortality. Conclusions: Among patients with COVID-19, RDW changes during hospitalization were associated with a severe clinical profile, poor in-hospital outcomes and increased short-term mortality. Repeated assessment of RDW may provide useful information for improving the care of hospitalized patients with COVID-19.

In recent months, since the Sars-Cov-2 pandemic has hit the entire world landscape, one of the most heated debates involving researchers has concerned the potential role that vitamin D could play in relation to infection by COVID-19.In particular, numerous scientific studies have shown that the deficiency of this vitamin is present in a large part of the sick subjects, in a Spanish study1 this association was reported in about 80% of the sample considered, furthermore other studies2,3,4 attribute to this hormone a potentially protective role by stimulating type I interferon and enhancing innate immunity.This review of the literature investigating, through a bibliographic search in the Pubmed - Medline database, aims to evaluate the possible association between vitamin D and Sars-Cov-2 infection in terms of outcomes such as: association between levels of vitamin D and infection, disease severity, mortality, analyzing a total of 274 studies, of which 8 reviews were finally evaluated, which allowed, through a review of the literature, to demonstrate a positive association of vitamin D in the prevention and treatment of infection from Sars-Cov-2 and in other pathologies such as flu, pneumonia and chronic diseases such as diabetes, obesity and arterial hypertension, or conditions favorable to complications during Covid-19 infection.

Background: The potential protective role of eosinophils in the COVID-19 pandemic has aroused great interest, given their potential virus clearance function and the infection resistance of asthma patients to this coronavirus. However, it is unknown whether eosinophil counts could serve as a predictor of the severity of COVID-19. Methods: A total of 1004 patients with confirmed COVID-19 who were admitted to Leishenshan Hospital in Wuhan, China, were enrolled in this study, including 905 patients in the general ward and 99 patients in the ICU. We reviewed their medical data to analyze the association between eosinophils and intensive care unit (ICU) admission and death. Results: Of our 1004 patients with COVID-19, low eosinophil counts/ratios were observed in severe cases. After adjusting for confounders that could have affected the outcome, we found that eosinophil counts might not be a predictor of intensive care unit (ICU) admission. In 99 ICU patients, 58 of whom survived and 41 of whom died, low eosinophil level was an indicator of death in patients with severe COVID-19, with a cutoff value of 0.04 × 109/L for the prediction of death. Conclusion: Our research revealed that a low eosinophil level was a predictor of death in ICU patients rather than a cause of ICU admission.