Background: The rapid spread of COVID-19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well-being of or changes to training for American resident physicians during the COVID-19 pandemic. We aim to study predictors of trainee well-being and changes to clinical practice using an anonymous survey of American urology residents. Methods: An anonymous, voluntary, 47-question survey was sent to all ACGME-accredited urology programs in the United States. We executed a cross-sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals. Results: Among approximately 1,800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID-19 severity, and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children, and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training. Conclusions: Several potential actions, which could be taken by urology residency program directors and hospital administration, may optimize urology resident well-being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency program and institutional levels, instituting telehealth education programs, and fostering a sense of shared responsibility of COVID-19 patients.

Cardiovascular disease and the impact of COVID-19Running Head: COVID-19 and cardiovascularAnusha Yoganathan1, Menahel Sajjad1, Amer Harky1,2University of Liverpool, Liverpool, UKDepartment of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK

This paper proposes an epidemic model-based approach to inference the incubation period distribution of COVID-19 just utilizing the publicly reported confirmed case number. This method can reduce the biases of traditional survey-based methods, and it can be practiced without the assumption of the shape of the incubation period’s distribution. The most commonly studied metrics (e.g., expectation, median, and 95th percentile) obtained from our estimated incubation period distribution of COVID-19 are in line with current studies’ results. However, due to the mathematical-model-based nature of this method, the inference results are somewhat sensitive to the setting of parameters. Therefore, this method should be practiced reasonably on the basis of a certain understanding of the studied epidemic.

The study explored the role of two dissimilar familial and religious practices in distinctly shaping independent and interdependent self-affirmations in two value systems surfaced to protect self-integrity and self-worth challenged by the threats of COVID-19. A qualitative method was employed which recruited a heterogeneous sample of 19 participants (10 joint and 9 nuclear families) who reported the consequences of COVID-19 and the roles of familial and religious values in facing the pandemic threats through a semi-structured interview. Five themes were generated: the perceived strong threat of COVID-19, positive roles of joint familial values and the religious values, dissimilar roles of individualistic and collectivistic values as well as traditional and modern religious values. Threats were expressed in the experiences of anxiety, uncertainty and mood fluctuations. Interdependence, affiliation and support were joint familial values whereas worshipping, divine interpretation and spiritual practices denoted traditional religious values. Independence, scientific interpretations and personal focus were individualistic family values. Focus on explicit attributes denoted modern while divine interpretation, will of God and dependency on God reflected traditional religious values. Coexistence of independent and interdependent self-affirmations originating from two distinct familial and religious value systems was observed possibly due to the current transitions in the Indian society. KeywordsCOVID-19; Indian family; narrative thematic analysis; pandemic; religious and familial practices; self-affirmation; social practices; threat.

The study explored the lockdown and quarantine on the perceived psychological distress and other life outcomes of children after the outbreak of COVID-19 in recent past. The study employed the Narrative Thematic Research Design and chose a heterogeneous sample of 20 full-time mothers to report the experiences of the restrictions of their children aged 9-11 years. These mothers were the primary source of data about the impacts of lockdown and quarantine on their children. A telephonic semi-structured interview protocol was used to collect data. Four themes were generated: poor social and emotional responsivity, decreased interest in studies and other creative activities, psychological distress symptoms and negative health outcomes. Anxiety, irritation, quarrelling behaviours, anger, frustration, low feeling, reduced interest in games, boredom etc. were observed in children. Sleep disturbances, complaints of indigestion and multiple complaints of body aches were major negative health outcomes. The findings showed a variety of negative psychological and health outcomes for children due to the extreme restrictions, uncertainty, apprehension, reduced positive engagement and lowered social connection after the outbreak of the pandemic. Preventive and protective measures are recommended with concerted efforts of parents, school and community to guard children against the ill-consequences of current and future pandemics. Keywords: children; COVID-19; life outcomes; pandemic; perceived psychological distress, narrative thematic analysis.

BACKGROUND: Reports on healthcare worker antibody response to COVID-19 infection are scarce. We aim to determine the COVID-19 antibody prevalence among healthcare workers in a cardiology centre and the relationship between case definition criteria with the COVID-19 antibody result. METHODS: Convenience sampling was applied. Healthcare workers in Sarawak Heart Centre (SHC) cardiology, radiology, and emergency unit were recruited. A survey form on clinical symptoms and close contact history was distributed. HEALGEN COVID-19 IgG/IgM rapid test was performed using serum/ whole blood specimen. Staff with positive COVID-19 antibody results were referred to the infectious disease specialist for assessment. RESULTS: A total of 310 staff were screened. 220(71%) were female, and the mean age was 36±7.7 years old. 46(14.8%) staff reported having clinical symptoms at some stage from the end of January 2020 to the time of this surveillance. Number of staff who had a history of overseas travel, close contact with confirmed COVID-19 patients, or had visited places with identified COVID-19 clusters were 4(1.3%), 24(7.7%) and 24(7.7%) respectively. There were 14 staff (4.5%) with positive tests positive, 2 for IgM, and 12 for IgG. All those with positive antibody were subsequently tested negative with RT-PCR test. The history of having clinical symptoms and exposure to COVID-19 cluster area were independently associated with a positive IgG result. CONCLUSION: The application of COVID-19 antibody serology rapid tests could determine true exposure of staff to the infection and allow us to reassess existing measures of infection control within the hospital.

The unprecedented coronavirus SARS-CoV-2 outbreak at Wuhan, China caused acute respiratory infection to humans. There is no precise vaccine/therapeutic agents available to combat the COVID-19 disease. Some repurposed drugs are saving the life of diseased, but the complete cure is relatively less. Several drug targets have been reported to inhibit the SARS-CoV-2 virus infection, in that TMPRSS2 (Transmembrane protease serine 2) is one of the potential targets, inhibiting this protease stops the virus entry into the host human cell. Camostat mesylate, nafamostat and leupeptin are the drugs, in which the first two drugs are being used for COVID-19 and leupeptin also tested. To consider these as repurposed drugs for COVID-19, it is essential to understand their binding affinity and stability with TMPRSS2. In the present study, we performed the molecular docking and molecular dynamics (MD) simulation for the three molecules with the TMPRSS2. The docking study reveals that leupeptin molecule strongly binds with TMPRSS2 protein than the other two drug molecules. The RMSD and RMSF values of MD simulations shows, leupeptin and the amino acids of TMPRSS2 are very stable than the other molecules. Furthermore, leupeptin forms interactions with the key amino acids of TMPRSS2 and the same have been maintained during the MD simulations. This structural and dynamical information is useful to evaluate these drugs to be used as repurposed drugs, however, the strong binding profile of leupeptin with TMPRSS2, suggests, it may be considered as a repurposed drug for COVID-19 after clinical trial.

Cystic fibrosis (CF) is a disease with chronic lung disease that is exacerbated by viral infection. COVID-19 has caused a worldwide pandemic with high death rates. As science suggests, patients with CF would be severely affected with a high rate of morbidity, hospitalization and mortality. Our aim was to present two cases with CF in highly prevalent COVID-19 regions of the world.

To editor,Asthma is one of the most common chronic respiratory diseases in the world and it is possible that asthma-related factors may influence susceptibility to coronavirus disease (COVID-19) or infection severity. There is a great concern about the effect of asthma on COVID-19 morbidity: Centers for Disease Control and Prevention(CDC) stated that people with moderate to severe asthma may have an increased risk for COVID-19 and infection may lead to an asthma attack, pneumonia, or acute respiratory disease. However, available data is limited and there is no concrete evidence that asthma is a risk factor for COVID-19. In Zhang et al. study including 140 community-infected COVID-19 patients, asthma or other allergic diseases were not reported by any of the patients1. Although the prevalence of asthma in China was 4.2% and allergic rhinitis in Wuhan was %9.7, allergy or asthma was not detected as a risk factor for COVID-19 infection [1]. In another article from Wuhan, Li et al. reported the prevalence of asthma as 0.9% in 548 patients with COVID-19 and the asthma rate did not differ between severe and non-severe COVID-19 cases2.Angiotensin converting enzyme-2 (ACE2) receptors mediate the entry of SARS-coronavirus 2 (SARS-CoV-2) into host cells and the virus uses the transmembrane protease serine 2 (TMPRSS2) for S protein priming3. ACE2 receptors are expressed in the heart, vessels, gut, lung, kidney, testis, and brain4 and binding of SARS-CoV-2 to ACE2 receptors markedly down-regulates ACE2 receptors which have protective biological effects on human body. With the loss of the protective effect of these receptors interstitial fibrosis, endothelial dysfunction, enhanced inflammation, oxidative stress and increased coagulation can be seen5. It is interesting to note that severity of the COVID-19 disease is associated with several conditions which may have ACE2 deficiency such as older age, male gender, hypertension, diabetes, or cardiovascular disease.There may be a link between asthma and ACE2 deficiency and based on this hypothesis Peters et al. investigated differences in ACE2 and TMPRSS2 gene expression in sputum cells of 330 asthma patients and 79 healthy controls5. Gene expression of ACE2 and TMPRSS2 was similar in asthma and health. Among asthma patients, higher expressions of ACE2 and TMPRSS2 were observed in males, African Americans, and patients with diabetes mellitus. High expression of ACE2 in the lungs facilitate the entry of corona virus into lungs and may result with down-regulation of ACE2 receptors which make these subgroups more susceptible to severe SARS-CoV-2 infection. Interestingly, use of inhaled corticosteroids was associated with lower expression of ACE2 and TMPRSS2 after adjustment for asthma severity.This is an important study giving clues about possible factors explaining the low prevalence of asthma among COVID-19 patients. Asthma itself or the use of inhaled steroids may have protective effect against SARS-CoV-2 infection. However, there are some limitations. ACE2 receptors are particularly expressed in type 2 pneumocytes which have an effective role on triggering a cascade of inflammation in the lower respiratory tract. Sputum may not reflect the amount of ACE2 receptors in the lower respiratory tract including type 2 pneumocytes. Many of the inhaler steroids have less peripheral airway deposition and so inhaler steroids might not effect ACE2 expression of type 2 pneumocytes. Although direct evidence regarding the role of ACE2 in chronic obstructive pulmonary disease (COPD) and smokers is limited, studies have shown that accumulation of inflammatory cells and the release of proinflammatory cytokines in COPD were mediated by angiotensin II in which ACE2 has an active role in degradation of angiotensin II6. There are also rat studies indicating that ACE2 deficiency may have a role in the pathogenesis and progression of COPD. It is reasonable to infer that ACE2 deficiency in COPD may have a negative effect on severity of SARS-CoV-2 infection like diabetes and hypertension. Smoking status of the patients and asthma endotypes (eosinophilic or neutrophilic, atopic, non-atopic) were not provided in Peters et al study. ACE2 and TMPRSS2 expression in sputum may be different in smokers, neutrophilic asthma, or asthma-COPD overlap (ACO) subgroups and inhaled steroids may not influence ACE2 expression in these subgroups.Asymptomatic nasal carriage of COVID-19 is more common in children, asthmatic children seems to have most likely asymptomatic COVID-19 infection .Therefore to understand the basic underlying mechanisms related with chilhood asthma and mild COVID-19 infection may help to understand the possible mechanistic links for adult asthma and severe COVID-19 infection. Sajuthi et al. used nasal airway transcriptome and network co-expression analysis to identify the cellular and transcriptional factors in COVID-19 infectivity7. They used a children cohort including 695 subjects with asthma and healthy controls between the ages of 8 and 21. They mainly focused on ACE2 and TMPRSS2 expression. Intrestingly, 43% of non-asthmatics in this study were scored as T2-high like asthmatics based on their expression profile. They found that interleukin (IL)-13 mediated T2 high inflammation had a major role in ACE2 downregulation and TMPRSS2 upregulation. The results of this study can be interpreted as T2 rich inflammation may have protective role against COVID-19 by causing ACE2 downregulation or exacerbates COVID-19 infection by causing TMPRSS2 over expression. They showed that ACE2 was expressed in secretory cells and ciliated cells while TMPRSS2 was expressed by all epithelial cell types7. Virus behavior may be different depending on ACE2 and TMPRSS2 expression variations in different part of the airways such as nasal and peripheral airways and TMPRSS2 may have more effective role in peripheral airways compared to ACE2.In conclusion, it is yet to be proved that asthma is a risk factor for COVID-19 infection. Whether there is a link between asthma and COVID-19 infection remains to be determined. The heterogeneous nature of asthma may cause interindividual variation in COVID-19 infection immunology. More clinical studies focusing ACE2 and TMPRSS2 expression in central and peripheral airways are warranted to understand the role of individual factors such as atopy, obesity and smoking habit and treatment related factors such as inhaled/systemic steroid use in different asthma groups (mild/severe, T2‐high and T2- low asthma) for the risk of COVID-19 morbidity.

Objectives: We determined the clinical and imaging features of patients with severe COVID-19 that were associated with survival. Methods: Sixty-seven patients hospitalised with severe laboratory-confirmed COVID-19, were consecutively enrolled. Clinical data, blood measurements and chest computed tomographic (CT) scans were analyzed. Results: We compared the findings between 39 survivors and 28 non-survivors. At admission, although there were no differences in white blood cell (WBC) and platelet (PLT) counts, there was an increase of WBC, neutrophil, platelet distribution width and mean platelet volume with a marked decrease of lymphocyte, monocyte, eosinophil and PLT in non-survivor group on their last day compared to survivors (P < 0.05). Non-survivors had higher ratios of peak creatinine(P<0.05) and peak lactate dehydrogenase (LDH) (P<0.05). Compared to survivors, the incremental rate of total lesion area, ground-glass opacity (GGO) area and consolidation area on CT scans was increased in non-survivors (P<0.05).The deceleration rate of total lung volume was greater in non-survivors than survivors(P<0.05). Using the univariate survival analysis, the following were predictive of non-survival: time from admission to peak of D-dimer (D2D)<16 days , initial pro-BNP>319.0 pg/ml, peak procalcitonin (PCT) ≥0.19 ng/ml, peak creatinine>96.5 μmol/l ,peak alkaline phosphatase (ALP)>81.5 u/l, median time from admission to peak ALP<18 days, the acceleration rate of total lesional area> -11.5 cm3 /day, incremental rate of GGO area> 2.4 cm3 /day and the acceleration of consolidation area> 2.3 cm3 /day. Conclusion: Hematological counts, serum analytes and radiological indicators, the latter assessed by artificial intelligence, are robust predictors of survival outcome in COVID-19.

There is a renewed interest in the Renin-angiotensin system (RAS) as the coronavirus SARS-CoV2 enters the human body through the host ACE2 receptor. The infection is associated with down regulation of ACE2 leading to the imbalance in the RAS. We provided mechanistic insight on immunopathology of COVID-19 with respect to innate immune activation and ensuing adaptive immune response resulting in production of viral antigen-specific antibodies. The mini-review tries to drive home the anti-inflammatory role of ACEI/ARBs as an attractive treatment option in hypertensive or heart failure patients suffering from COVID19. The hypothesis is based on the available evidence of favorable immuno-mechanistic and clinical outcome data. The review tinkers with the immuno-mechanistic pathway with a probable role type I IFN response in case of SARS-CoV2, which is not yet clear. The review interconnected the role of principal players involved in RAS such as Angiotensin-converting enzyme (ACE), ACE2, decapeptide angiotensin I (ANG I), octapeptide angiotensin II (ANG II), heptapeptide angiotensin-(1–7), nonapeptide angiotensin-(1–9), ACE inhibitors (ACEI), AT1R blockers (ARBs) with respect to cardiovascular physiology and pathology.

Objectives: The recent outbreak of COVID-19 has culminated in the unbearable negative life outcomes for all. The study explored the perceived psychological distress and consequent health outcomes caused by COVID-19. Design: The Narrative Thematic Analysis design was used. Methods: A heterogeneous sample of 18 participants (12 males and 6 females) responded about their experiences of the recent outbreak of COVID-19. The data were collected through a telephonic semi-structured interview that was analyzed through the Thematic Analysis Method.  Results: Four themes were generated: perceived psychological distress, lower social support, enhanced religious practices and enhanced negative health outcomes. Extreme anxiety, panic experiences, insecurity, helplessness, hyper-vigilance and negative attributions represented the psychological distress while decreased social interactions and imposed social distancing characterized the perceived social support. Increased reliance on myths, divine interpretations and faith in God showed religious practices. Decreased hunger, insomnia, headache, breathing problems and palpitation were ill-health outcomes.Conclusions: The epidemic was sudden, unknown and fatal that shaped the nature and extent of perceived psychological distress, social support and religious practices. The first two may have caused negative health outcomes while the religious practices maintained equilibrium among the rest three. Immediate trans-disciplinary efforts for the effective prevention, treatment and promotion of the affected people are recommended. KeywordsCOVID-19; pandemic; psychological distress; health consequences; social support; religious practices; narrative thematic analysis.

This study explored the nature, dynamics and role of collective-affirmation in attracting mass cooperation and support to check further spreading and to motivate people to observe preventive measures to reduce the casualties of COVID-19. A Narrative Thematic Analysis Design was employed in which a heterogeneous sample (N= 32, Age range = 36-61 years) was chosen through a purposive sampling method. The participants were interviewed about their experiences of lockdown. The novelty, suddenness and incurability of COVID-19 caused a set of perceived psychological distress and danger to individual and collective life. The Janata (public) curfew was perceived as a curfew of the people, by the people and for the people. The lockdown denoted a strong faith of the Indian government in the positive virtues of Indian People and vice versa. The mass support and adherence to the suggested preventive government measures were facilitated by collective-affirmation in the well-known positive Bhartiya (Indian) cultural and moral values. Collective-affirmation inherent in the Bhartiya collective cultural values catalyzed mass behaviours change in the form of adherence to the essential restrictions and recommendations. Collective-affirmation may have occurred due to the faith of the government in the virtues of the Indians and their perceived administrative capability of the government. A culture-specific collective-affirmation seems to emerge which initiated mass behavioural changes. The findings may have implications for changing people to face difficult situations, to accept social policies aimed at eradicating poverty, illiteracy, corruption and violence, and to adopt a healthy lifestyle to enhance their well-being.KeywordsBhartiya cultural heritage; Collective-affirmation; COVID-19; lockdown; mass behaviour change.

Background: Whether there is also a correlation between viral shedding duration and the clinical course of illness in COVID-19 has not yet been determined. Methods: In this retrospective study, we included 239 adult inpatients (all ≥18 years old) with laboratory-confirmed COVID-19 from the Wuhan Tongji Hospital (Wuhan, China). Results: Of the subset of 239 patients included in this study, 33 patients died due to COVID-19 and 45 patients demonstrated clinical progression to critical illness. Patients with a long duration of viral RNA shedding as compared to short duration of viral RNA shedding also had significantly lower mortality rates ((9.5% vs. 18.6%, P= 0.04) and a lower rate of progression to critical illness (16.7% vs. 21.2%, P= 0.37). Viral RNA shedding is an independent risk factor for mortality within 28 days of observation (OR 0.94, 95% CI: 0.88-0.99, P= 0.025, by multivariable regression analyses) and increased duration of viral shedding is correlated with a significant survival advantage (P =0.047) and lower risk of progression to critical illness (P =0.029, by Kaplan-Meier analyses). Conclusions: Prolonged viral RNA shedding duration is associated with improved patient prognosis and reduces the risk of progression to critical illness in this subset of COVID-19 patients. Further clinical studies are necessary to determine if a longer duration of viral RNA shedding with COVID-19 is predictive of an overall better patient prognosis and outcome.

We should be considering age, comorbidities and health-care system performance to relax Covid-19 related social distancing measuresDear Editor,Aiming to avoid a health system collapses due to the COVID-19 pandemic; social distancing measures were taken broadly.1 The very high or high-risk population is of specific concern, once expected to have an increase rate of admission.2 Besides criticised, the strategy seems to be working properly and now brings the discussion about how the measures could be relaxed safely.Comparisons with other pandemics are not entirely appropriate, but it seems reasonable to look back at the past and consider valuable lessons learned. The direct association between death and age, as well as for comorbidities or clinical risk, observed on previous viral infections outbreak  is similarly to the current pandemic trends.3-13 Age is also a known as an independent survival factor. On the other hand, it should be highlighted that young children are the exception once have an immature immune system, main reasons why we generally see a J curve shape as schematically represented by the Figure 1. Although, age-mortality rate seems to be similar amongst world regions, the poor healthcare quality index is associate with increase death rate.14Unfortunately, we were relying on certainties that are fragile for the moment. There is no solid evidence about herd immunity in patients with asymptomatic disease. Moreover, we all expect that the patients that recovered from the infection are hopefully immune or at least have a mild disease in case of re-infection but the knowledge about the immune response and anti-bodies nature is currently imature.15, 16 There is also scare evidence about mass use disposable barrier methods will diminish the viral transmission , such as face masks or gloves.17 Although community use of personal protection equipment might give a sensation of safety in some cultures, the misuse or re-use could be dangerous and there is no evidence assuring the benefit provided by community manufactured masks.18,19Therefore, once the evidence is being gathered and a vaccine, probably the most reliable scientific based way out of this crisis, will take at least some months to be available, we should consider relax social distancing measures based on age adjusted by comorbidities and healthcare system performance as a first step whilst continuing with hand washing associated with high standards of self-hygiene when possible.Bruno H R de Paula1*, Renan G A Carraretto2, Nathalia M P B Barreto31 Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust,Cambridge CB2 0QQ, UK2 Universidad Privada del Este, Ciudad Presidente Franco - Paraguay3 Division of Cardiology, Hospital Pró-Cardiaco, Rio de Janeiro, Brazil* Correspondent authorCompeting InterestsThe authors declare that they have no competing interestsReferences:1. Lewnard, Joseph A., and Nathan C. Lo. ”Scientific and ethical basis for social-distancing interventions against COVID-19.” The Lancet. Infectious diseases (2020).2. nhs.uk. 2020. Who’s At Higher Risk From Coronavirus - Coronavirus (COVID-19) . [online] Available at: <https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from-coronavirus/whos-at-higherrisk-from-coronavirus/> [Accessed 4 May 2020].3. Ramiro, Diego, et al. ”Age-specific excess mortality patterns and transmissibility during the 1889–1890 influenza pandemic in Madrid, Spain.” Annals of epidemiology 28.5 (2018): 267-272.4. Cilek, Laura, Gerardo Chowell, and Diego Ramiro Fariñas. ”Age-specific excess mortality patterns during the 1918–1920 influenza pandemic in Madrid, Spain.” American journal of epidemiology187.12 (2018): 2511-2523.5. Viboud, Cécile, et al. ”Global mortality impact of the 1957–1959 influenza pandemic.” The Journal of infectious diseases 213.5 (2016): 738-745.6. Ma, Junling, Jonathan Dushoff, and David JD Earn. ”Age-specific mortality risk from pandemic influenza.” Journal of theoretical biology 288 (2011): 29-34.7. Donaldson, Liam J., et al. ”Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study.” Bmj 339 (2009): b5213.8. Chan‐Yeung, Moira, and Rui‐Heng Xu. ”SARS: epidemiology.” Respirology 8 (2003): S9-S14.9. Verity, Robert, et al. ”Estimates of the severity of coronavirus disease 2019: a model-based analysis.” The Lancet Infectious Diseases (2020).10. Glynn, Judith R. ”Protecting workers aged 60–69 years from COVID-19.” The Lancet Infectious Diseases (2020).11. Onder, Graziano, Giovanni Rezza, and Silvio Brusaferro. ”Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy.” Jama (2020).12. www1.nyc.gov. 2020. COVID-19: Data - NYC Health. [online] Available at:<https://www1.nyc.gov/site/doh/covid/covid-19-data.page> [Accessed 4 May 2020].13. Cromer, Deborah, et al. ”The burden of influenza in England by age and clinical risk group: a statistical analysis to inform vaccine policy.” Journal of Infection 68.4 (2014): 363-371.14. Global - Paget, John, et al. ”Global mortality associated with seasonal influenza epidemics: New burden estimates and predictors from the GLaMOR Project.” Journal of global health 9.2 (2019).15. Wu, Fan, et al. ”Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications.” (2020).16. Altmann, Daniel M., Daniel C. Douek, and Rosemary J. Boyton. ”What policy makers need to know about COVID-19 protective immunity.”The Lancet (2020).17. Cheng, Kar Keung, Tai Hing Lam, and Chi Chiu Leung. ”Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity.” The Lancet (2020).18. Leung, Chi Chiu, Tai Hing Lam, and Kar Keung Cheng. ”Mass masking in the COVID-19 epidemic: people need guidance.” Lancet 395.10228 (2020): 945.19. Liu, Xiaopeng; Zhang, Sisen. COVID-19: face masks and human-to-human transmission.  Influenza And Other Respiratory Viruses,[s.l.], p. 1-2, 5 abr. 2020. Wiley. http://dx.doi.org/10.1111/irv.12740.

COVID-19 has undergone rapid spread worldwide, with the number of infected patients and death events being increased at exponential rates, and thus considered an epidemic disaster. However, SARS-CoV-2 has reduced case-fatality rate and enhanced transmission capacity that favor its propagation and make it evolutionarily more advanced than the other coronaviruses. Further, SARS-CoV-2 preserves virulence to certain patients while keeping some patients symptom-free. It is hypothesized here that SARS-CoV-2 functions as a natural selection pressure for human evolution. That is, COVID-19 is an epidemic disaster at the individual level but may be evolutionarily beneficial for the human at the population level, and survived individuals from SARS-CoV-2 infection may be more tolerable to redox pressure and not suffer anymore from diseases such as hypertension if without external intervention.

Abstract Background In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Finding markers that predict the prognosis of patients with severe COVID-19 are of great value. Methods In this single-center，retrospective study, 157 patients with severe COVID-19 were recruited from a consecutive series. After screening, a total of 105 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death. Results The dominant symptoms observed in the study included fever on admission, cough, fatigue and shortness of breath. The most frequent comorbidities were hypertension and diabetes. Compared with patients with higher CD4+T cells level, patients with lower CD4+T cells level were older and were more frequently male. In terms of laboratory findings, lymphocyte percentage, lymphocyte absolute value, CD3+T cell count, CD4+T cell count, CD8+T cell count were significantly lower in low group than in high group. The case in-hospital death rate was significant higher in patients with lower CD4+T level than in those with higher CD4+T level. After adjusting for potential confounding factors, CD4+T cells count below normal values showed independent prognostic value for all-cause in-hospital death in patients with severe COVID-19. Conclusions In patients with severe COVID-19, lower CD4+T cells count are independently associated with an increased rate of in-hospital death.

Objectives: To distinguish between primary mild COVID-19 patients and the patients with recovery positive virus detection after discharge (recovery positive patients), the clinical characteristics and biochemical indicators were analyzed. Methods: By evaluation of correlations between biochemical indicators and serum ferritin (FE) through univariate and multivariate analyses, we evaluated the differences of FE index and analyzed the effectiveness of the FE* pre-albumin (PA) on discrimination between primary mild and recovery positive COVID-19 patients. The area under curve (AUC) and a predictive nomogram were further employed to evaluate the effectiveness of discrimination. Results: In comparison with recovery positive patients, liver damage-related indicators such as serum FE and PA were significantly lower in primary COVID-19 patients with mild symptoms. Area under the ROC curve values of FE, PA and FE*PA were 0.81, 0.78 and 0.83, respectively. In combination with multivariate analysis and nomogram, FE and FE*PA can be considered as reasonable evaluation systems for predicting primary mild and recovery positive patients. Conclusions: FE*PA was an independent predictive biomarker for distinguishing primary mild and recovery positive COVID-19 cases.

COVID-19 causes significant hypoxia along with an inflammatory milieu, which may lead to secondary myocardial infarction and also atherosclerotic plaque rupture. Here we present a case of COVID-19 presented with ACS followed by PTE and CVA.

Adam Klocperk1, M.D., Ph.D., Zuzana Paračková1, MSc., Jitka Dissou2, M.D., Hana Malcová3, M.D., Ph.D., Petr Pavlíček4, M.D., Tomáš Vymazal4, M.D., As. Prof., Pavla Doležalová5, M.D., Prof., Anna Šedivá1, M.D., Prof.1Department of Immunology, 2ndFaculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic2Emergency Department for Children, University Hospital in Motol, Prague, Czech Republic3Department of Children and Adult Rheumatology, University Hospital in Motol , Prague, Czech Republic4Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic5Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Adolescent Medicine, General University Hospital in Prague and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic

Introduction: The new SARS-CoV2 pandemic is not equally affecting all ages. Children are showing milder symptoms across the globe. We reviewed the incidence and the severity in the pediatric populations of several Middle Eastern countries. Materials and Methods: We contacted the Lebanese Ministry of Health and colleagues in different countries of the region for information about their local cases, we reviewed updated information from the CDC and searched Pubmed for publications related to COVID-19 in pediatric patients till the end of April 2020. Results: Different countries had different number of affected children and different percentage of pediatric versus adult cases confirmed to be tested positive. Qatar showed the highest number of total cases but had one of the lowest percentage of pediatric infection versus adults. Conclusion: Our local experience was similar to other affected countries worldwide with children less than 18 years old showing milder symptoms and are less affected than adults.

Background: Over 2,000,000 infected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Although there are more and more reports on coronavirus disease 2019 (COVID-19), it is unclear why infected children show the milder symptoms than adults. Methods:A retrospective case study was performed in two designated hospitals for COVID-19 .Patients (56 children and 63 adults) with confirmed SARS-CoV-2 infection and mild pneumonia were randomly enrolled in this study. Results: The median age of children was 7.0 years, and 51.79% of them were boys. For the adults, the median age was 57 years, and47.62% were men.The most common symptoms were fever , cough , sputum and diarrhea.There were not significant different in symptoms between children and adult patients.In immunological indices on admission , adult patients displayed typical leukopenia, and markedly higher lever of IL-2, IL-4, IL-6 compared to child patients. The elevation of IL-2,IL-4 and IL-6 in adult induced to more extensive lung injury. Conclusion: The effective and non-aggressive immune response successfully resisted SARS-CoV-2 invasion to maintain the mild symptom in child patients.The correlation of higher IL-2,IL-4,IL-6 to lung injury distribution might be a evidence to prevent the excessive cytokine for avoiding further lung damage.

Physical/social distancing, handwashing, respiratory hygiene, and face-masking have been recommended as realistic counterstrategies to control the COVID-19 pandemic. These strategies have been critical in the fight against the present pandemic in many countries. Here, we detail the background to such countermeasures, present some examples in different settings, and finally emphasize that they should remain in place worldwide as a cultural and behavioral “new normal” until a vaccine or a decisive treatment for COVID-19 is developed and made available globally.

The emergence of new type of viral pneumonia cases in China, on December 31, 2019; identified as the cause of human coronavirus, labeled as “COVID-19,” took a heavy toll of death and reported cases of infected people all over the world, with the potential to spread widely and rapidly, achieved worldwide prominence but arose without the procurement guidance. There is an immediate need for active intervention and fast drug discovery against the 2019-nCoV outbreak. Herein, the study provides numerous candidates of drugs (either alone or integrated with another drugs) which could prove to be effective against 2019-nCoV, are under different stages of clinical trials. This review will offer rapid identification of a number of repurposable drugs and potential drug combinations targeting 2019-nCoV and preferentially allow the international research community to evaluate the findings, to validate the efficacy of the proposed drugs in prospective trials and to lead potential clinical practices.