Innate immune sensing of viral molecular patterns is essential for development of antiviral responses. Like many viruses SARS CoV-2 has evolved strategies to circumvent innate immune detection including low CpG levels in the genome, glycosylation to shield essential elements including the receptor binding domain, RNA shielding and generation of viral proteins that actively impede anti-viral interferon responses. Together these strategies allow widespread infection and increased viral load. Despite the efforts of immune subversion SARS-CoV-2 infection does activate innate immune pathways inducing a robust type I/III interferon response, production of proinflammatory cytokines, and recruitment of neutrophils and myeloid cells. This may induce hyperinflammation or alternatively, effectively recruit adaptive immune responses that help clear the infection and prevent reinfection. The dysregulation of the renin-angiotensin system due to downregulation of angiotensin converting enzyme 2, the receptor for SARS-CoV-2, together with the activation of type I/III interferon response, and inflammasome response converge to promote free radical production and oxidative stress. This exacerbates tissue damage in the respiratory system but also leads to widespread activation of coagulation pathways leading to thrombosis. Here, we review the current knowledge of the role of the innate immune response following SARS-CoV-2 infection, much of which is based on the knowledge from SARS-CoV and other coronaviruses. Understanding how the virus subverts the initial immune response and how an aberrant innate immune response contributes to the respiratory and vascular damage in COVID-19 may help explain factors that contribute to the variety of clinical manifestations and outcome of SARS-CoV-2 infection.

Introduction: Intense immunological dysregulation including immune cell lesions have been characteristically observed in severe cases of Coronavirus Disease-2019 (COVID-19), for which molecular mechanisms are least understood. A study of physiological expressions of SARS-CoV-2 host cell entry related factors in immune system components may help explain molecular mechanisms involved in COVID-19 immunopathology. Materials and Methods: Transcriptomic and proteomic expression metadata for SARS-CoV-2 host cell entry receptor ACE2 and entry associated proteases (TMPRSS2, CTSL, and FURIN) were analysed in silico across immune system components including blood lineage cells. Results: ACE2 was not-detected in any of the studied immune cell components, however, varying transcriptomic and proteomic expressions were observed, for TMPRSS2, CTSL, and FURIN. Conclusions: Non-detectable expressions of SARS-CoV-2 host cell entry receptor ACE2 in immune system components or blood lineage cells indicate it doesn’t mediate immune cell lesions in COVID-19. Alternative mechanisms need to be explored for COVID-19 immuno-pathogenesis.

The global pandemic of COVID-19 caused by coronavirus has had a profound impact on the delivery of health care in the United States and globally. Boston was among the earliest hit cities in the United States, and within Boston, the Massachusetts General Hospital provided care for more patients with COVID -19 than any other hospital in the region. This necessitated a massive re-allocation of resources and priorities, with near doubling of intensive care bed capacity and a halt in all deferrable surgical cases. During this crisis, the Division of Cardiac Surgery responded in a unified manner, dealing honestly with the necessity to reduce Intensive Care Unit resource utilization, for the benefit of both the institution and our community, by deferring non-emergent cases while also continuing to efficiently care for those patients in urgent or emergent need of surgery. Many of the interventions that we instituted have continued to support teamwork as we adapt to the remarkably fluid changes in resource availability during the recovery phase. We believe that the culture of our division and the structure of our practice facilitated our ability to contribute to the mission of our hospital to support the community in this crisis, and now to its recovery. We describe here the challenge we faced in Boston and some of the details of the structure and function of our division.

This program director survey attempts to determine how coronavirus 2019 (COVID-19) pandemic is impacting current training in cardiothoracic surgery. A transition to virtual didactic sessions may prove beneficial with increasing attendance. On the other hand, decreasing live simulation and case volumes may jeopardize achieving competency in surgical skills.

Surgery in patients diagnosed with COVID-19 infection carries significant mortality and morbidity but the appropriate waiting period before surgical intervention after recovering from COVID-19 is not known. We analysed the outcomes of patients who underwent cardiac surgery after having been diagnosed of COVID-19 on pre-operative screening between March and July 2020. Depending on the clinical urgency we delayed surgery until negative testing and/or radiological clearance or postponed the operation where possible. As a result of waiting until COVID-19 resolution, all of our patients survived surgery without complications.

Background Accurate estimates of SARS-CoV-2 infection in different population groups are important for the health authorities. In Norway, public infection control measures have successfully curbed the pandemic. Military training and service are incompatible with these measures, and therefore stricter infection control measures were necessary in the Norwegian Armed Forces. We present the measures, and discuss the results and their value. We report on the seroprevalence of SARS-CoV-2 and the changes in antibody levels over six weeks. Methods In April 2020, 1170 healthy conscripts (median age 20 years) were enrolled. The infection control measures included a pre-enrollment telephone interview and self-imposed quarantine. Questionnaire data and serial SARS-CoV-2 PCR and serology testing were used to estimate the incidence of confirmed SARS-CoV-2, describe symptoms and monitor titer levels over a six week period. Results The seroprevalence of SARS-CoV-2 was 0. 6 %. Only 0. 2 % had a positive PCR for SARS-CoV-2 at the enrollment day. Serological titer levels increased up to nearly five-fold over the observation period. Eighteen conscripts reported mild respiratory symptoms during the 14 days prior to enrollment (all were PCR negative, one had positive serology), whereas 17 conscripts reported respiratory symptoms and nine had fever at the day of enrollment (all were PCR and serology negative). Conclusions The prevalence of SARS-CoV-2 in young adults in Norway is less than 1%. Testing of asymptomatic conscripts seems of no value in times of low COVID-19 prevalence. SARS-CoV-2 antibody titer levels increased substantially over time in youths with mild symptoms.

Objectives: To assess the characteristics and forecasting of respiratory viruses epidemic among young children with acute respiratory tract infection (ARTI) in west China. Methods: This study retrospected the epidemic characteristics of respiratory viruses among 11813 pediatric patients with ARTI between March 2018 and March 2020. Results: 11813 samples were collected, with a mean age of 2.25 years. The ratio of the boy: the girl was 1.36. The two predominant viruses were influenza (Flu) A and respiratory syncytial virus (RSV), with Flu A accounting for 47.3% (n=1099), 47.5% (n=1333) and RSV accounting for 32.7% (n=760), 24.7% (n=692) of the positive samples in the two respective years. The positive rate of Flu B was 10.9% and 13.1%, and the other four viruses were <7%. The most common virus was RSV in the <5 years group and Flu A in the 5-10 years group. Flu A and RSV demonstrated pronounced seasonality, and their infection rates increased from October. During the pandemic of SARS-CoV-2, isolation measures led to a decline in the number of ARTI. Conclusions: The study provided surveillance of respiratory viruses in west China. It will provide guidance for medical staff to implement the necessary prevention and management strategies before the outbreak of the virus in the future.

SIRT1 inhibitors can reduce replication of many viruses with certain similar characteristics to those of Coronaviruses, while p53 protein is another important factor in down-regulation of growth. Tenovin is a class of small molecules that inhibit Sirtuin 1 and 2, in addition to activate p53 protein, by means of regulation of the interactions used by Coronaviruses as self-defense mechanism. By blocking virus growth and continuous replication, associating the already tested Antiviral medicines, Covid-19 can be definitively eradicated.  

Abstract Objective To study the impacts of obstetric complications and anxiety among pregnant women in non-epizootic area which are caused by COVID-19. Design Retrospective cohort. Setting China. Population or sample the women who delivered in the third trimester of pregnancy in Qingdao Municipal hospital for the year the months March and April, 2019 and 2020. Method This paper is based on the clinical data from This paper makes a detailed analysis of the problems that can arise because of special circumstances related with delivery history, personal physical symptoms, anxiety index, adverse complications as well as neonatal birth weight. Result Comparing with the same period between 2019 and 2020, maternal age(32.12±5.32vs31.01±4.21, P<0.05) and the ratio of macrosomia(12.10%vs2.53%)are increasing steadily. Meanwhile, times of prenatal visits (10.49±2.15vs10.89±1.81, P<0.05) and score of PHQ-9（1.46±2.09vs4.96±1.38, P<0.05）are to fall significantly。 Conclusion It is helpful to relieve the negative emotion of fear and anxiousness for the pregnant women if they can be encouraged and soothed by social support. The leading cause why regular checkups are decreasing is due to the fear of the epidemic and the transport restrictions, which, in return, may result in a lack of effective management in fetal weight. The COVID-19 had no giant effect on the third trimester of pregnant women. Government as well as obstetric practitioners should strengthen the education of fetal weight management during the pregnancy. Keywords Pregnancy; COVID-19; obstetric complications; anxiety Tweetable abstract The COVID-19 had no giant effect on the third trimester of pregnant women in the non-epizootic area China.

Aim: To assess effect of high-dose vitamin C on cardiac injury in coronavirus disease 2019 (COVID-19). Methods: The study was designed based on the severe and critically ill COVID-19 with cardiac injury. Demographics and baseline clinical characteristics were collected and analyzed in addition to laboratory examinations including inflammatory markers on admission and at 14 days after treatment from the electronic medical records. Participants were followed-up for 14 days after treatment with high-dose vitamin C in addition to conventional therapy. Result: The patients (n = 113) were categorized into the improved cardiac injury (ICI) group (n = 70) and the non-improved cardiac injury (NICI) group (n = 43). Overall, 51 (45.1%) patients were administrated with high-dose vitamin C, the percentages of patients treated with high-dose vitamin C were higher in the ICI group than that in the NICI group (52.8% vs 32.5%, P = 0.035). Further analysis showed that concentrations of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin-2 receptor (IL-2R), IL-6 and IL-8 significantly decreased at 14 days after treatment in patients treated with high-dose vitamin C compared with those in patients administrated without high-dose vitamin C. Meanwhile, similar results were also observed regarding changes in inflammatory markers from baseline to 14 days after treatment in patients receiving high-dose vitamin C. Conclusion: High-dose vitamin C can improve cardiac injury through preventing hyper-inflammatory response in severe and critically ill COVID-19.

Background Pediatric patients represent approximately 2% of overall confirmed cases of COVID-19. Illness severity and symptoms differ from adults. Most cases in children are mild but various studies have reported severe and critical cases as well as fatal outcomes. Methods A systematic review and meta-analysis of the available literature was performed. Frequencies were used for reporting categorical variables. Meta-analyses were performed using the binary random effects model for symptoms frequencies in children and illness severity. Results We found 44 studies (n=6026), 38 were used for quantitative synthesis to estimate the frequency of symptoms in the pediatric population with Covid-19 and illness severity, 44 were used for qualitative synthesis. The most common symptoms were fever 64% (CI 95% 54-72%), cough 42% (CI 95% 37-48%) and gastrointestinal symptoms like vomit 31% (CI 95% 17-47%) and diarrhea 28% (CI 95% 17-40%). For illness severity 2% (CI 95%0-5%) were severe and 3% (CI 95% 1-6%) were critical. Children <1-year-old had the higher odds of severe/critical cases with an OR of 2.07 (IC95% 1.40-3.05). All patients were hospitalized, and a total of 10.34% children admitted to PICU. The mortality rate was 0.16% (8/487). A total of 141 patients developed PIMS-TS and only one died. Conclusions: Most cases in children were non-severe, nevertheless children less than 1 year had the higher risk of severe/critical cases. Symptoms frequencies encountered from major to minor were fever, cough and gastrointestinal symptoms. More testing in children should be done in order to understand transmission characteristics in the pediatric population.

Having lived through the havoc of COVID-19 in a hospital situated in one of the hardest hit zip codes in the United States, the thought that another wave could loom in the fall is bracing. Obstetricians at our institution have cared for well over 200 COVID-19-infected pregnant women, and are acutely aware of the herculean effort it took to reorganize the service to accommodate the needs of women infected with this new pathogen.1 Many institutions, including ours, modified the frequency of prenatal visits, among other measures, to minimize in-person contacts, in an effort to reduce the likelihood of viral spread. However, it is those changes, along with our prior experience of treating women unimmunized against influenza that leads to our concern that a singular focus on COVID-19 could leave pregnant women at risk from a more familiar threat.While COVID-19 is a threat to the health of individuals and society, its effect on pregnancy is less clear. Thus far, few COVID-19-infected pregnant women have required ICU care, and to date three maternal deaths has been reported in the United States.2-4 The toll of influenza in pregnancy is more clearly documented and is more severe.5Now that the first wave is ebbing in New York, we are seeing fewer and fewer cases but still diagnose about 15 infections per week in our hospital. That pattern is the converse of what is being seen in large swaths of the country. Despite the higher prevalence seen earlier in the epidemic in New York, and the fact that many of those women needed respiratory support, only two women in our hospital required admission to the intensive care unit (ICU), and only one needed ventilator support. Mercifully, none died. During the preceding influenza season, whose end overlapped with the start of the COVID-19 pandemic, we treated six women with influenza who required admission to the ICU, only one of whom had been vaccinated against influenza. As opposed to our COVID-19 cases (putting aside the more rigorous application of social distancing), there were clearly missed opportunities to have prevented some of the morbid events caused by influenza.Admittedly, the higher admission rate to the ICU may be misleading. It is certainly possible that criteria for admission to ICUs, like almost all other aspects of care, evolved during the COVID-19 crisis. There was such a rapid and dramatic increase in the need for ICU beds in our hospital (from a baseline of 40 mid-March, 2020 to a peak of 140 mid-April; 2020, internal data) that more stringent criteria for admission may have been applied and some of our COVID-19 patients that were cared for on the wards, may have been cared for in an ICU in less harrowing times. But even given that possibility, the fact that a similar number of women were extremely ill with influenza raises grave concerns going forward.In the first instance, co-infection with COVID-19 and influenza, as well as other viruses, has been reported.6 Co-infection events will make diagnosis of either entity more difficult, and could potentially increase morbidity. Thus, both because of the risks of co-infection, and the known risks of influenza in pregnancy, providers can’t afford to take their “eye off the ball,” and become less vigilant about vaccinating patients, even if some of the new protocols for fewer visits or telehealth visits remain in place. With fewer visits comes the risk of missing both the vaccination “window” and the opportunity to incorporate vaccination as an essential component of health maintenance. In addition, obstetricians’ performance as vaccinators has been less than ideal as only approximately half of pregnant women get influenza vaccines.7In addition to vaccination, obstetricians must remain vigilant in order to prevent progression of disease among those who get infected. Oseltamivir provides the opportunity for secondary prevention.8 It has been shown to reduce maternal ICU admission and mortality.9 Yet, as with vaccination, even before the COVID-19 epidemic, it was underutilized.10Beyond committing to better use of medical interventions for influenza, obstetricians have to assure that just because they have lived through COVID-19, and the world’s attention remains fixed on COVID-19, they don’t become so COVID-19-focused, that they fail to include influenza in the differential diagnosis of women reporting respiratory symptoms in the fall. Every fever and ache will not be COVID-19. If we delay consideration of the diagnosis of influenza, we will lose the opportunity to use Oseltamivir before the window of eligibility closes. In the post-pandemic world, it will be hard to avoid cognitive biases, such as the availability heuristic (a strategy for making judgments about likelihood of occurrence based on the salience of the information) and confirmation bias (the tendency to gather evidence that confirms preexisting expectations, typically by emphasizing or pursuing supporting evidence while dismissing or failing to seek contradictory evidence). These can result in physicians being hammers and every respiratory symptom, a COVID-19 nail; especially when rapid COVID-19 tests are not uniformly available and don’t yet have uniformly high quality. This is the reverse of one of the most cited examples of the availability heuristic, “In influenza season, it is tempting to consider all patients with fever and myalgias as having influenza.”11 An enhanced situational awareness, i.e., recognizing the influence of recent diagnoses on your diagnostic proclivities, will become an ever more crucial antidote to the hard earned reflex response to fevers and aches that developed during the first wave of COVID-19.We know from history that influenza recurs both in epidemic and pandemic forms, and that an initial wave can be a “herald wave” for the following one.12 Hence, it is our responsibility not to let the current COVID pandemic prevent us from properly dealing with the possibility of overlapping epidemics (seasonal influenza and COVID) in the fall. Vaccination, rapid recourse to antivirals (e.g., Oseltamivir), and community mitigation measures will be more important than ever. COVID-19 can kill, but so can influenza, and if we do our jobs, we can reduce that toll.

Background: The pandemic caused by Coronavirus disease 2019, has caused great impact worldwide. Risk factors for severe outcomes have been identified, but asthma seems not to be one of them. Objectives: Our principal purpose is to analyze personal characteristics in severe asthma patients, in treatment with monoclonal antibody, belonging to the Health Department of Castellon, in order to see if these variables affect the probability of being infected by SARS-Cov-2. Methods: This is an observational study. Patients recruited had severe asthma in treatment with monoclonal antibody. A questionnaire was elaborated. Aspects evaluated were: COVID-19 symptoms, asthma control, exposition to the disease, and lifestyle before the pandemic. Serological tests were done by using total SARS-Cov-2 antibody test. Results: 108 patients were enrolled in the study, of whom 106 patients were included. 11 patients declared suggestive COVID-19 symptoms. A total of 21 patients had a serology test done, giving positive results 2 of them. 27 patients needed medical attention, being asthma exacerbation the most common symptom. 71,7% of patients had a normal or high level of social activity before the pandemic. Statistic significance was achieved for medical assistance, asthma control and contact with SARS-Cov-2 positive patients. Conclusion: Personal external factors in severe asthma patients do not influence the probability of being affected by the disease. We can hypothesize that these patients do not have an increased susceptibility for being infected by the virus. Bad asthma control was the main reason for medical assistance during the pandemic.

A novel virus, severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19) worldwide appeared in 2019. Currently, we do not have a medicament that treats the disease. One of the rea-sons for the absence of treatment is related to the scarcity of detailed scientific knowledge of the members of the Coro-naviridae family, including the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Structural studies of the MERS-CoV proteins in the current literature are extremely limited. We present here detailed characterization of the struc-tural properties of MERS-CoV macro domain in aqueous solution at the atomic level with dynamics. For this study, we conducted extensive replica exchange molecular dynamics simulations linked to a generative neural networks and we use the resulting trajectories for structural analysis. We perform structural clustering based on the radius of gyration and end-to-end distance of MERS-CoV macro domain in aqueous solution with dynamics at the atomic level. We also report and analyze the residue-level intrinsic disorder features, flexibility and secondary structure. Furthermore, we study the pro-pensities of this macro domain for protein-protein interactions and for the RNA and DNA binding. Results are in agree-ment with available nuclear magnetic resonance spectroscopy findings and present more detailed insights into the struc-tural properties of MERS CoV macro domain. Overall, this work further shows that neural networks can be used as an exploratory tool for the studies of CoV family molecular conformational space at the nano level.

Background: New corona virus (COVID-19), as an international health threat poses a challenge to physical and psychological resilience globally. The aim of this survey is to explore the level of awareness, health seeking behaviors and preventive measures towards COVID19 among Najran university students. Methodology: By adopting a convenient sampling technique, a cross-sectional study was carried out at Najran university. A self-reporting electronic questionnaire had been utilized for collecting data. A total of 684 students were voluntary completed the questionnaire. Results: The mean age of the participants was 20.2±14.1, The most cited source for obtaining information about COVID-19 was the social media (51%). Females showed higher level of knowledge and awareness about the symptoms of the disease than males (74.3% vs 69.9%) respectively, although the difference was not significant with (P-value >0.05). In regard to compliance with preventive measures, medical students were significantly aware and complying with various preventives measures towards COVID-19 (P-value <0.05). Moreover, females seem to be very keen in seeking medical advices when needed significantly more than males (P-value<0.05). Almost more than 66% of the respondents know the recommended precautions in terms of wearing masks, not to touch outdoors surfaces directly and avoiding crowded places. 556(81.3%) of the participants believe that they should wear face masks outdoors. 6% of the participants prefer to take some herbs daily in different forms to avoid getting infected with COVID-19. Females had an overall higher mean of tension level towards getting infected than males (mean± SD was 5.61 ±1.65 vs 4.55± 1.63) respectively. Conclusion: It was concluded that our students have high level of knowledge and awareness about COVID-19, beside positive attitudes preventive measures and acceptable health seeking behaviors. It is highly recommended to assess the entire Najran community level of awareness so as to design educational programs when needed.

Background: Echocardiography derived myocardial performance may be impaired.Objectives: To evaluate cardiac involvement including cardiac biomarkers, echocardiographic findings in patients with COVID-19 and to explore the effect of cardiac impairment on short-term outcome.Methods: This study cohort was conducted from February 9, 2020, to March 28, 2020, in a single center at Wuhan Leishenshan Hospital. 213 patients whose echocardiography were included. Demographic data, laboratory results, echocardiographic findings were analyzed. Results:Among 213 patients confirmed with COVID-19,150 non-critical patients and 35 critical patients were discharged. 28 critical patients needed invasive mechanical ventilation, 16 of whom died during the hospitalization, and another 12 patients were transferred for continued treatment with tracheotomy. The incidence of cardiovascular complications including acute myocardial injury, arrhythmia and acute myocardial infarction was higher in critical group . A total of 108 patients had abnormities on echocardiography. 26(12.2%) patients have presented the signs of pulmonary hypertension and the presence of pulmonary hypertension in critical group was higher than that in non-critical group The cardiac biomarkers at admission in critical patients were significantly higher compared with non-critical patients.Multivariate analysis showed high-sensitivity cardiac troponin I elevation and echocardiographic signs of pulmonary hypertension ere independent risk factors of adverse outcome.CONCLUSIONS: The elevation of cardiac markers and echocardiographic signs of pulmonary hypertension are risk factors of adverse outcome in patients with COVID-19. It’s meaningful to combine echocardiography with cardiac markers to evaluate the prognosis of patients with COVID-19.

During the first phase of COVID-19 pandemic in Italy, several strategies have been taken to deal with the pandemic outbreak. The Regional Authority of Lombardy remodeled the hospitalization system in order to allocate appropriate resources to treat COVID-19 patients and to identify “Hub/Spoke” hospitals for highly specialized medical activities. The Hubs hospitals were required to guarantee full time evaluation of all patients presenting with cardiovavascular diseases with an independent pathway for patients with suspect or confirmed COVID-19 infection. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and the Vascular Surgery Department was remodeled to face this epidemic situation. Surgical treatment was reserved only to symptomatic, urgent or emergent cases. Large areas of the hospital were simultaneously reorganized to assist COVID-19 patients. During this period, 135 patients were referred to San Raffaele Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and, among them, acute limb ischemia was the most common cause of admission. At this time, the COVID-19 trend is in decline in Italy and the local authorities reorganized the health care system in order to return to normal activities avoiding new escalations of COVID-19 cases. Several strategies have been taken to ensure the safety of the San Raffaele hospital, and maintaining potentially suspected patients with COVID-19 separated from other patients. The aim of this paper is to report the remodeling of the Vascular Surgery Department of San Raffaele Hospital as regards the strategies of preparation, escalation, de-escalation and return to normal activities during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic introduced an abrupt change in human behavior globally. Here, we discuss unique insights into the eco-evolutionary role of pathogens in ecosystems and present data that indicates the pandemic can fundamentally change our learning choices. This pathogen has indirectly affected many organisms and processes by globally changing the behavior of humans to avoid being infected. The pandemic also changed our learning behavior by affecting the relative importance of information and forcing teaching and learning into a framework that accommodates human behavioral measures to avoid disease transmission. Not only are these indirect effects on the environment occurring through a unique mechanistic pathway in ecology, the pandemic along with its effects on us provides a profound example of the role risk can play in the transmission of information between the at-risk. Ultimately, these changes in our learning behavior led to this special issue “Taking learning online in Ecology and Evolution.” The special issue was a call to the community to take learning in new directions, including online and distributed experiences. The topics examined include a significant component of DIY ecology and evolution that is experiential and but done individually, opportunities to use online tools and apps to be more inclusive, student-focused strategies for teaching online, how to reinvent conferences, strategies to retain experiential learning safely, emerging forms of teaching such as citizen science, apps and podcasting, and ideas on how to accommodate ever changing constraints in the college classroom, to name a few. The collective consensus in our fields is that these times are challenging but we can continue to improve and innovate on existing developments, and more broadly and importantly, this situation may provide an opportunity to reset some of the existing practices that fail to promote an effective and inclusive learning environment.

Aim. Repurposing strategies to address the COVID-19 pandemic have been accelerated. As both pregnant and pediatric patients are likely to be excluded from most planned investigations, the list of repurposed options and the available data on these drugs and vaccines provides a baseline risk assessment and identifies gaps for targeted investigation. Methods. Clinical trials have been searched and reviewed; twenty-three repurposed drugs and drug combinations and 9 candidate vaccines have been assessed regarding the availability of relevant data in pediatrics and pregnant women and to evaluate expected or unanticipated risk. Results. Thirteen of the repurposed drugs or drug combinations are indicated for use in pediatrics in some age category albeit for indications other than COVID-19; 10 of these are indicated for use in pregnant women. Even in cases where these drugs are indicated in the populations, source data from which safety and or dosing could be extrapolated for use in COVID-19 is sparse. Vaccine trials are ongoing and generally exclude pregnant women; only in a few instances have pediatric subgroups been planned for enrollment. Data from individual case studies and RWD may suggest that subpopulations of both pediatric patients and pregnant women may be more at risk, particularly those in an increased inflammatory state. Conclusion. In conjunction with more prospective collaboration, plans are evolving to ensure that we will be better prepared to address similar situations especially in pediatrics and pregnant women where experience is limited and actual practice relies heavily on leveraging data from other populations and indications.

AIM: To report on the clinical, laboratory and radiological findings of adolescents who presented during the SARS-CoV-2 surge with symptoms of COVID-19, did not test positive for the infection and were diagnosed with e-cigarette and vaping product use associated lung injury (EVALI). Methods: A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children’s Hospital between February 2020 and June 2020 was conducted. Results: The ages of the patients ranged from 14 to 19 years. There were 6 males and 6 females. Three patients had a past history of anxiety, depression or other psychiatric/mental health disorder, nine had prolonged coagulation profile (PT,PTT and/or INR) and eleven had elevated inflammatory markers. Eleven needed respiratory support. All 12 were negative for SARS-CoV-2 PCR. Four were tested for IgG Antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. Steroids were started only after SARS-CoV-2 PCR was shown to be negative. Urine THC was positive in all cases. CXR and CT findings showed ground glass opacities. CONCLUSIONS: Clinical and radiological features are similar in both EVALI and SARS-CoV-2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with ‘typical’ COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health care providers need to be aware of other conditions that can masquerade as SARS-CoV-2.

Susceptibility of turkeys, chickens and chicken embryos to SARS-CoV-2 virus was evaluated by experiment inoculation. Turkeys and chickens were inoculated using a combination of intranasal, oral and ocular routes. Both turkeys and chickens did not develop clinical disease or antibodies to the virus following inoculation. Viral RNA was not detected in oral and cloacal swabs and in tissues using quantitative real-time RT-PCR. In addition, chicken embryos were inoculated using the yolk sac, intravenous, chorioallantoic membrane and allantoic cavity routes did not support replication of the virus. SARS-COV-2 virus does not affect both turkeys and chickens in the current genetic state and does not pose any potential risk to establish in both species of domestic poultry.

The current COVID-19 pandemic has a huge impact on society and economy and represents one of the biggest challenges for healthcare systems all over the world. Reports from health-care-institutions in different countries show a variety of crisis exit strategies. Although experiences in handling of the pandemic have accumulated over the last 7 months, it is clear that measures to prevent a collapse of the health-care-systems have to be adapted to local political and socioeconomic structures. The aim of this review is to give insight in crisis exit strategies in Switzerland, highlighting the role and impact of COVID-19 in the field of cardiac surgery.

Background: Several predictors for the severity of coronavirus disease 2019 (COVID-19) have been reported. However, chronic airway inflammation characterized by accumulated lymphocytes or eosinophils may affect the pathogenesis of COVID-19. Methods: In this retrospective cohort study, we reviewed medical records of all laboratory confirmed COVID-19 patients with chronic bronchitis, chronic obstructive pulmonary disease (COPD) and asthma admitted in Sino-French New City Branch of Tongji Hospital, a large regional hospital in Wuhan, China, from January 26th to April 3rd. The Tongji Hospital ethics committee approved this study. Results: There were 59 patients with underlying chronic airway inflammation including chronic bronchitis, COPD and asthma. When compared with non-severe patients, severe patients were more likely to have decreased lymphocyte counts (0.6vs.1.1×10⁹/L, p<0.001), eosinopenia (<0.02×10⁹/L, 73%vs.24%, p<0.001), increased lactate dehydrogenase (LDH) (471.0vs.230.0 U/L, p<0.001) and elevated IL-6 level (47.4vs.5.7 pg/ml, p=0.002) on admission. Eosinopenia and elevated LDH were significantly associated with disease severity in both univariate and multivariate regression models included the above variables. Eosinopenia was also an independent risk factor for mortality of this cohort in a multivariate model included the above variables. Moreover, eosinophil counts and LDH levels tended to return to normal range over time in both groups after treatment and severe patients recovered slower than non-severe patients, especially eosinophil counts. Conclusions: Eosinopenia and elevated LDH are potential predictors of disease severity in COVID-19 patients with underlying chronic airway diseases. Theses predictors may help clinicians identify the severe COVID-19 patients with chronic bronchitis, COPD and asthma.

BACKGROUND: The coronavirus disease-2019 (COVID-19) is still rapidly spreading worldwide, and remains a global health crisis. We investigated the impact of asthma on the prevalence and outcomes of COVID-19 and identify the risk factors for delayed viral clearance. METHODS: Adult patients with COVID-19 admitted to 10 hospitals in Daegu were retrospectively registered, and their clinical information was collected. Delayed viral clearance was divided into two groups based on 30 days. RESULTS: A total of 2,200 patents were evaluated, and the prevalence of asthma in COVID-19 was 3.2%. Compared with Korea nationwide survey data, there were no differences in asthma prevalence. In the univariate analysis, the risk of death (13.6% vs 6.4%, P = 0.021) and high flow oxygen therapy (18.2% vs 10.5%, P = 0,048) was increased in asthma patients, with a stronger tendency among elderly, women, and overweight patients. However, in a multivariate analysis using the logistic regression model, any clinical outcomes according to asthma was not significant. The risk factors for delayed viral clearance were older age >65 years (Odds ratio [95% confidence interval] 2.002 [1.292–3101]), dementia (3.123 [1.833–5.321]), skin rash (15.943 [1.613–157.535]), and anemia (2.156 [1.061–2.377]), whereas headache (0.673 [0.485–0.932]) lowered the risk. CONCLUSIONS: There may be a difference depending on phenotypes, but asthma prevalence was not significantly different in patients with COVID-19, and asthma did not affect outcomes of COVID-19. Older age, dementia, headache, skin rash, and anemia were independently associated with delayed viral clearance.