Handwashing in averting infectious diseases: Relevance to COVID-19.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Letter: Strategies for Prevention and Control of 2019 Novel Coronavirus Infection Among Medical Staff.

The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making.

In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.

Time to Step Up to the Plate: Adopting the WHO 2006 Growth Curves for US Infants

The novel coronavirus disease 2019 (COVID-19) is now officially declared as a pandemic by the World Health Organization (WHO), and most parts of the world are taking drastic measures to restrict human movements to contain the infection. Millions around the world are wondering, if there is anything that could be done, other than maintaining high personal hygiene, and be vigilant of the symptoms, to reduce the spread of the disease and chances of getting infected, or at least to lessen the burden of the disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The National and International health agencies, including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the WHO have provided clear guidelines for both preventive and treatment suggestions. In this article, I will briefly discuss, why keeping adequate zinc balance might enhance the host response and be protective of viral infections.

PharmacyLibrary® provides the most current resources for a changing profession, featuring APhA’s authoritative textbooks, PharmacotherapyFirst, interactive self-assessments, over 250 Active Learning Exercises easily adaptable for a variety of educational settings, case studies, and more.

Anemia in the Elderly: How Should We Define It, When Does It Matter, and What Can Be Done?

INTRODUCTION The transplant community is well-versed in ethical issues surrounding the allocation of scarce resources, but the COVID-19 pandemic has escalated moral dilemmas of transplantation far beyond simply allocation of limited donor organs. Emanuel et al1 were unfortunately prophetic in their recent NEJM article addressing the ethical principles guiding medical decisions during the COVID-19 pandemic and the associated depletion of resources. Hospital and intensive care resources are becoming severely limited in high-transmission areas, influencing decisions about who should be transplanted and affecting the availability of donated organs.2 The risk of COVID-19 transmission to donors and recipients further alters such risk considerations. Pre–COVID-19 organ allocation schemes, which are complex, transparent, and organ-specific, are by themselves insufficient to determine who should be transplanted under such conditions, particularly in resource-constrained areas. Complex ethical considerations for transplantation during such a pandemic will inherently vary greatly by country, region, and culture—and be dynamic over time, and affected by both COVID-19 disease burden and trajectory. But the broad principles of nonmaleficence, beneficence, distributive justice, and respect for autonomy must continue to guide these difficult decisions. Nonmaleficence, for example, may dictate that living donor operations be held in heavily affected areas because of the potential risk of COVID-19 infection in donors. Indeed the same concern applies to transplant recipients, whose immunosuppression may put them at increased risk of infection posttransplant. Conversely, beneficence might suggest that successful kidney transplantation could, in addition to its other benefits, prevent the need for further dialysis center visits, potentially reducing the risk of nosocomial COVID-19 transmission. From a distributive justice perspective, by contrast, programs may need to curtail certain transplant activity simply as a result of resource constraints imposed by an overwhelming pandemic disease burden. Finally, autonomy dictates that programs communicate both the known and unknown risks of COVID-19 infection—and the policies we are each enacting as a result—to their transplant patients allowing them to make informed decisions about their care. The urgent need to adapt rapidly during the COVID-19 pandemic has challenged traditional dependence on evidence-based data and peer-reviewed literature. Healthcare workers in transplantation are being asked to navigate our patients through a minefield in the absence of conventional pillars that usually guide clinical management and decisions. For treatment protocols, we traditionally rely on approaches that have undergone a thorough evaluation, testing, and review process. In the absence of such an opportunity for gradual and deliberate review, professional societies around the world have been quick to collaborate and share their global experiences,3 and the distribution of information has largely shifted to rapid, online platforms. In making decisions during this uncertain time, it is essential that our own uncertainty, lack of knowledge, and lack of prognostic ability about the pandemic disease course are recognized and factored into our risk-benefit analyses as well as our respect for the patient's autonomy. The availability of resources for transplantation is a moving target in the COVID-19 pandemic, dependent on the position of each region and country on the COVID incidence curve, and its baseline access to healthcare resources (Figure 1). While decisions must be based on available and expected resources, they must also be informed by underlying ethical values that have been and will continue to be the rationale for all our patient-care decisions.FIGURE 1.: Responses on allocation, donor/recipient criteria, and transplant activities will largely depend on the position of centers on the slope of the incidence curve. Geographic and social characteristics will also determine the height of the curve, impacting risk-benefit assessments.RECIPIENT SELECTION AND PROGRAMMATIC POLICIES In the current global snapshot,3 programs in affected areas have been remarkably consistent in distributive justice-based decisions about which patients to transplant. Their approaches begin with practical accounting for availability of essential resources such as ventilators, ICU beds, or blood products required for successful transplantation, availability of COVID-19 free facilities for the immediate posttransplant recovery period, and availability of personal protective equipment (PPE). Of course, the prepandemic starting point of available resources in each region will impact the threshold for transplantation, and there are many places that cannot consider transplantation with any additional strain on the system. After determining who can be transplanted, programs have generally addressed the question of who should be transplanted using the principle of distributive justice to maximize benefits, minimize resource utilization, and treat the highest-need patients first. Programs are also making new risk-benefit calculations by trying to best evaluate how to apply the principles of beneficence and nonmaleficence in the setting of COVID-19. Finally, allocation decisions that are made at the programmatic level often do not account for the individual patient's desire to be transplanted despite the risk of COVID-19, and therefore, risk placing autonomy behind the overriding principles of distributive justice, beneficence, and nonmaleficence. The relative weight of these factors may be influenced by the estimated position of each center and region on the COVID-19 incidence curve and relative to the available healthcare resources (Figure 1). For regions early on the ascending portion of the COVID-19 incidence curve, representing mild to moderate resource constraints, transplantation decisions are guided by anticipating future resource limitations and infectious risks and are weighted toward autonomy, nonmaleficence, and beneficence. For kidney transplantation, for example, many centers are selecting recipients with fewer comorbidities who are unlikely to require prolonged hospitalization or the need for ICU beds. This resource-distribution strategy favors patients likely to benefit from transplantation while utilizing fewer resources and minimizing the risk of nosocomial recipient COVID-19 infection. Other programs have favored reliance on nonmaleficence as the driving principle of kidney transplant allocation because precise risks and benefits of kidney transplantation in this setting remain both highly dynamic and poorly characterized. Patients with end-stage renal disease, for example, may survive for many years on dialysis, albeit with less quality of life and longevity than following successful transplantation. Given the alternative of dialysis, many programs globally have suspended kidney transplantation based on this principle, reasoning that transplantation in the midst of the COVID-19 pandemic may do more harm than good. Several assumptions underpin this decision: that harms may indeed be great if COVID-19 infection is transmitted by an infected donor or acquired by the recipient in hospital or community during maximal infection, and that the incidence and outcomes of COVID-19 infection are less frequent and less lethal among dialysis patients than kidney transplant recipients. Given the potential for the pandemic to run a protracted and potentially recurrent course, testing the validity of these assumptions through research will be a priority. Similarly, using the considerations of maximizing benefit, minimizing risk and limiting resource use, simultaneous pancreas/kidney transplants have been suspended by many programs, based on the length of anticipated hospitalization and the likelihood of readmission in hospitals that may be filled to capacity, with high potential risk for COVID-19 exposure. Programs suspending simultaneous pancreas/kidney transplants have decided that the risks of infection and resource utilization outweigh the potential benefits of transplantation, making a decision based on both distributive justice and nonmaleficence. A unique consideration focused on beneficence and nonmaleficence is an assessment of whether the intended recipient can effectively quarantine after discharge. This makes social considerations all the more pressing in transplant selection, but importantly, while such postdischarge social distancing and quarantine considerations are critical in selection, it is essential that these considerations do not disadvantage certain categories of patients who are already vulnerable. During this challenging COVID-19 era of decreased medical resources, we must maintain a particular focus on disadvantaged populations to ensure equal access to medical care. Programs should also strive to help support social distancing, whether by reducing clinic visits or blood draws, promoting telehealth opportunities where available, or coordinating social and community support mechanisms. As COVID-19 disease burden increases (moderate-severe resource burden, Figure 1), many centers have shifted their ethical framework toward distributive justice considerations, focusing on more urgent patients in greatest need. For example, some programs have limited liver transplantation to candidates with Model for End-Stage Liver Disease (MELD) scores reflective of poor 3-month survival without transplantation, heart transplantation for intermediate- and high-risk patients, and lung transplantation for unstable patients. Of note, some regions have also seen the beneficial effects of public health interventions with flattening the disease incidence curve (dotted line, Figure 1). In these regions, decisions about which patients to transplant may differ from those in regions at a similar level of resource-deprivation but on a different trajectory. Thus, real-time assessment, not just of resources on hand but also estimated disease trajectory, is essential in appropriate planning for all such ethically guided considerations. As the incidence for COVID-19 increases and the resource burden from infectious disease alone approaches the critical threshold of consuming the entire capacity of the system (Figure 1, critical burden), programs shift their distributive justice considerations from urgent to only emergent transplants. At this point, transplantation is limited to only the most emergent cases (ie, fulminant liver failure, highest acuity heart transplantation, and decompensated patients for lung transplantation), and above this threshold, all transplantation is held based on an absolute lack of resources including ventilators, blood products, and PPE.2 At this point care systems are forced to make the most difficult decisions about which patients have claim to limited resources. While it might seem natural to shift all resources to COVID-19, this strategy disadvantages other patients with equally life-threatening conditions, such as end-organ failure. It is, therefore, essential that the sickest transplant patients continue to be considered in resource-allocation schemes because of their equal need for medical care as compared to critically ill COVID-19 patients. Encouragingly, as COVID-19 incidence has begun to decline in some geographic areas, transplant centers in these regions appear to be cautiously resuming practices from the pre–COVID-19 era. Centers and regions emerging from the pandemic will have to determine how to gradually resume transplants in a graded fashion based on capacity, resources, and considerations of other patient needs—as well as factoring in the possibility of COVID-19 recurrence, with bimodal or even multimodal incidence curves. We expect that overall operative volumes will also increase given the backlog of elective and urgent procedures, so the needs of transplant patients will have to be balanced with other patients requiring time-sensitive intervention (eg, cancer, cardiac, or vascular patients). Thus, there will likely be continuing constraints on operating room capacity. In turn, this will influence when and how full transplant activity, and living donation in particular, can be reinstated. It is becoming increasingly clear that resumption of transplant practices (and all medical practices) will be contingent on availability of COVID-19 testing for donors, recipients, and healthcare practitioners. While the availability for testing that includes a detection of COVID-19 nucleic acid or antibodies has improved in some but not all geographic areas, the sensitivity and specificity of these tests still vary. Programs will have to apply distributive justice principles for scaling up volume, determining whether to focus on maximizing benefit while minimizing resource use. They will also have to continue to evaluate the risk of COVID-19 infection in recipients as new data emerges on therapeutics, outcomes in transplant patients, and testing capabilities to make accurate judgments based on beneficence and nonmaleficence. DONOR ACCEPTANCE AND CONSIDERATIONS Decisions to accept organs from deceased donors have also been significantly affected by the COVID-19 pandemic. Many centers have been hesitant to use marginal/extended criteria grafts, believing these transplants are more likely to result in delayed function and increased resource utilization. Many centers also require donor and recipient testing for COVID-19 before organ offer acceptance.3 In addition, donor procurement operations are frequently being done by local surgeons rather than travel teams when possible to decrease the risks of exposure. As a result, some programs, particularly those that commonly perform their own donor operations, may be hesitant to accept offers because of the inability to assess the donor organs in person. The risks of prolonged hospitalization and increased resource utilization associated with extended criteria grafts are taking precedence over the risk of organ failure. Further, where resources are constrained at recipient hospitals, it is likely that the same will be true at donor hospitals. In this setting, centers and healthcare systems need to determine if those resources being used for donor care—ICU beds, nursing care, PPE, medications, and operating room time—are needed for the care of other patients. If so, their use for donor care may be in conflict. Donors are normally prioritized for such resources because a single donor can save multiple lives, and the donor often occupies those ICU resources for only a short time. As recipient operations are curtailed to only those in greatest need during this pandemic, the ability of a single donor to acutely save multiple lives becomes all the more evident. Thus, if resources permit the continued transplantation of recipients in acute need, donor care should be prioritized wherever possible because of the potential to maximize lives saved during the pandemic. Allocation of organs should be done as expeditiously as possible to minimize the burden of donor care on the system. Similarly, as resources become constrained, procurement organizations may need to become more selective in donor workup, and prioritize only those donors healthy enough to provide multiorgan donation. Ultimately, as resource constraints become critical, difficult decisions may need to be made by each center, including even halting deceased-donor care and procurement—but knowing that this also means losing the supply of life-saving organs and recognizing that critically ill transplant patients have an equally legitimate claim to scarce resources when compared to critically ill COVID-19 patients.1 Living donation is also being evaluated differently in COVID-19 affected regions. As the regional incidence of COVID-19 increases and resources necessary for safe transplantation are depleted, many centers have stopped living donation related to the risks of exposing healthy donors to COVID-19 during their hospitalizations, and due to the potential risk for asymptomatic donor disease transmission to recipients. In these decisions, nonmaleficence is taking precedence over autonomy, meaning that the risk of harm is perceived to be too great to offer the option of living donation to individual potential donors. To decrease the risk of harm, donor and recipient COVID-19 testing are necessary for any center continuing to perform living donation in this era. In areas of high prevalence, even these measures may be insufficient for harm mitigation, given the nonzero risk of nosocomial infection and the nonzero false-negative rate of testing. TRANSPARENCY AND COMMUNICATION Organ supply has run behind demand for decades. Allocation has thus traditionally been based on transparent and clear communication providing patients, providers, and the community with a framework on how to deal with fair distribution of a scarce resource. While the current crisis has not changed national allocation systems, the allocation decisions about which patients to transplant have shifted to regional and program levels. These decisions utilize different material principles of distributive justice, depending on the status of that region and its position on the COVID-19 incidence curve. Because programs are constantly adapting to the changing environment, decisions about which patients will be considered for transplantation will continue to evolve, making it all the more important to assure continuing public and patient confidence in the system with transparency and consistency. For those centers that decide to systematically pause or alter the transplantation patterns of certain waitlisted patients, centers should officially notify their patients. This approach has been selected by some institutions particularly for simultaneous kidney/pancreas, pancreas after kidney, or pancreas alone transplants. As most centers have applied more nuanced center-specific modifications to donor and recipient criteria, it is also important to update patients and providers on these developments as they occur. Such communication should provide clear information on temporary changes to selection and allocation approaches, in a language facilitating general insight on the reasons behind these decisions. Moreover, programs must determine the best way to communicate both the known and unknown risks of COVID-19 infection with patients who are being considered for a transplant so that patients can make informed decisions consistent with their personal goals and values. Clear communication with waitlisted patients about programmatic changes during the shifting risk-landscape of the COVID-19 pandemic will allow transplant programs to maintain respect for patient autonomy as well as patient trust during this critical time. Transparency in communication is not only critical for the trust and effective flow of information between providers and patients but also between government healthcare agencies and transplant providers. Accurate reporting of the incidence of COVID-19, real-time and realistic appraisals of the current and expected availability of resources, and effective strategies to alter the course of the pandemic should be shared across regions within and between countries. COVID-19 does not recognize borders or discriminate between countries and continents, and this pandemic has demonstrated unequivocally that global cooperation is imperative to blunt its devastating impact. As one such mechanism for facilitating international collaboration and coordination, The Transplantation Society is currently providing an online dashboard of up-to-date global information and experience in response to the crisis (https://tts.org/covid-19). CONCLUSIONS The same ethical principles that have always been used to guide transplant practices continue to apply during the COVID-19 era, but the balance between autonomy, beneficence, nonmaleficence, and justice will be inherently fluid, dependent on baseline resources, local practices, and where a given region resides—and is headed—on the COVID-19 incidence curve (Figure 1).4 Programmatic decisions about transplantation will weigh more heavily on distributive justice, beneficence and nonmaleficence than respect for autonomy. The overriding material principle of distributive justice will change, and be weighted more or less heavily, throughout the stages of the incidence curve based on available resources. Beneficence and nonmaleficence calculations must be continually reassessed as more data become available regarding the risk of COVID-19 infections in transplant patients, the availability and accuracy of testing, and the efficacy of new therapeutic modalities. While the complexity, threats, and consequences of COVID-19 are immense, it is reassuring to see the transplant and medical communities rallying together in such a time, and to see, as a result, such thoughtful and consistent responses to dealing with this situation around the globe. Putting aside the jargon of classical medical ethics, these global responses reflect the straightforward principles of doing the right thing for our patients, at the right time, for the right reasons.

Humans are exposed to a number of "heavy metals" such as cadmium, mercury and its organic form methylmercury, uranium, lead, and other metals as wel as metalloids, such as arsenic, in the environment, workplace, food, and water supply. Exposure to these metals may result in adverse health effects, and national and international health agencies have methodologies to set health-based guidance values with the aim to protect the human population. This chapter introduces the general principles of chemical risk assessment, the common four steps of chemical risk assessment: hazard identification, hazard characterization, exposure assessment, risk characterization, and toxicokinetic and toxicity aspects. Finally, the risk assessments performed by international health agencies such as the World Health Organisation, the Environmental Protection Agency of the United States, and the European Food Safety Authority are reviewed for cadmium, lead, mercury, uranium, and arsenic.

Analyzing The Ebola ViruAnalyzing The Impact That The Ebola Virus Disease Has on Children

Public health affords important and exciting career opportunities for veterinarians. The Epidemic Intelligence Service Program (EIS) of the Centers for Disease Prevention and Control (CDC) is a two-year post-graduate program of service and on-the-job training for health professionals, including veterinarians, who are interested in careers in epidemiology and public health. EIS serves as a major point of entry into the public health arena. Veterinarians applying to the program must have a Master of Public Health or equivalent degree, or demonstrated public health experience or course work. EIS officers are assigned to positions at CDC headquarters or in state and local health departments. During two-year assignments, they are trained in applied epidemiology, biostatistics, conducting outbreak investigations, emergency preparedness and response, and scientific communications. They conduct epidemiologic outbreak and other investigations, perform applied research and public health surveillance, serve the epidemiologic needs of state health departments, present at scientific and medical conferences, publish in the scientific literature, and disseminate vital public health information to the media and the public. EIS officers apply their training and skills to actual public health problems and issues, establish mentorships with recognized experts from CDC and other national and international health agencies, and travel domestically and internationally. Since 1951, 195 veterinarians have graduated from the program and gone on to make substantial contributions to public health in positions with federal, state, or local governments, academia, industry, and non-governmental organizations.

Dear Editor, The Covid-19 pandemic affected human life globally, inducing much stress on daily living (Çakıroğlu et al. 2020). Although assessments of general mental health during the Covid-19 pandemic have been widely reported, there is not adequate research on how schizophrenia patients have been affected. According to the World Health Organization (2020), individuals with chronic diseases who do not pay attention to their personal hygiene and the rules of protection from COVID-19 have a higher risk of getting infected than the healthy individuals who observe these measures. It is well known that the risk of Covid-19 infection is raised among schizophrenia patients due to negligence on the requisite control of personal hygiene and health conditions related to smoking and diabetes ( Cohn et al., 2004; Dinan et al., 2004; Krieger et al. 2019). The cognitive impairment in this disorder which reduces the perceptions on the necessity of self protection and the awareness of the risks proposed to underlie this raised risk of COVID-19 positivity (Yao et al. 2020). These patients have difficulty in following the preventive regulations (Palomar-Ciria et al., 2020). Apart from the risk of infection, there is also the risk of pandemic related development of auditory or visual hallucinations and delusional symptoms by acute and chronic psychosis patients during and after the pandemic (Brown et al. 2020, Cowan 2020). Therefore, this survey has been organised to evaluate the reaction developed by schizophrenia patients to the pandemic conditions. The first Covid-19 case was reported in Turkey on 11 March 2020 (Anadolu Agency, 11.03.2020) which was followed by the gradual increase in case numbers. In order to prevent the spread of Covid-19 and maintain the existing public health, the Republic of Turkey Ministry of Health established a 'Scientific Committee'' and prepared effective strategies including social isolation, quarantine, school closures, social distancing and wearing face mask in the community. During this process, the approximately 250 schizophrenia and schizoaffective disorder patients followed up by the Psychosis Outpatient Unit of Dokuz Eylul University Hospital Psychiatry Department (DEUPD) were instructed to visit the outpatient unit only in emergency conditions. It was determined that there were 176 schizophrenia patients whose follow up visit appointments for the period of April 1 - June 22, 2020, scheduled before the announcement of the pandemic, were cancelled. Therefore, the survey reported here was conducted with the schizophrenia patients of the DEUPD online and by telephone connections during 10- 20 May, 2020, the 9th and the 10th weeks of the pandemic. Only 76 (43.19%) of the 176 patients joined the survey, since 4 (2.27%) refused to participate and 96 (54.4%) could not be contacted. The survey aimed to determine the incidence of Covid-19 diagnosis among these schizophrenia patients and their attitude to the preventive measures against the infection during the first 2 months of the pandemic, together with how they felt and their needs for psychiatric consultation on outpatient basis during this period. The surveyed 76 patients consisted of 49 (64%) males and 27 (35%) females, with 73 (96.1%) dwelling in urban and 3 (3.9%) in suburban areas; and only 11 (14.5%) employed while 65 (85.5%) were not working. Only two patients reported consulting emergency services for Covid-19 symptoms. The rest of the patients did not report consulting a healthcare facility for suspecting Covid-19 symptoms or Table 1. Data on the demographic, clinical and social features of the schizophrenia patients during the COVID-19 pandemic n=76 Mean SD Gender (F/M) 27 (35.5%) / 49 (64.5%) Age 44.54 12.21 Disease duration 16.62 9.96 Patients living /with Alone 3 (3.9%) Parent(s) 43 (56.6%) Spouse/children 25 (32.9%) Sibling (s) 1 (1.3%) Relative(s) 2 (2.6%) Friend(s) 2 (2.6%) Yes No Need to see a psychiatrist 23 (30.3%) 53 (69.7%) Subjective psychiatric complaints 32 (42.1%) 44 (57.9%) Consultation with an emergency service 2 (2.6%) 74 (97.4%) Planning to go to the hospital in the post-quarantine period 58 (76.3%) 18 (23.7%) Wearing a mask in community 67 (88.2%) 4 (5.3%) Keeping social distancing 68 (89.5%) 3 (3.9%) Expressed feeling Loneliness 26 (34.2%) 49 (64.5%) Depressed 31 (40.8%) 44 (57.9%) Despaired 22 (28.9%) 52 (68.4%) Anxious 25 (32.9%) 49 (64.5%) Difficulty of going to the hospital in the quarantine period 53 (69.7%) 23 (30.3%) hospital admission for Covid-19 infection or psychotic attack or incidences of Covid-19 related hallucination or delusions. During this 2-month period, 4 patients had experienced fatigue, 2 had episodes of dry cough and 7 had experienced shortness of breath, which can be associated with the nature of schizophrenia, the sedentary life style.and cigarette smoking. Medication was prescribed by a psychiatrist for 10 patients and by a family doctor for 16 patients or supplied directly by pharmacies for 45 patients on the basis of prescriptions with 1-year validity issued by the hospital* (Table 1). Much as it had been aimed to contact all patients with cancelled appointments, this objective was not attainable The patients who were not reached are likely to include those with low awareness and difficulty of adapting to infection prevention strategies. On the other hand, regardless of the level of awareness of the pandemic and compliance with the rules, phone use by these patients might have been limited by economic and environmental reasons, as well as the difficulties imposed by the pandemic. In conclusion, it is possible to say that most of the patients with schizophrenia were aware of the risk of COVID-19 infection, and understood and mostly obeyed the general health rules and advices of healthcare professionals even if they had difficulty in doing so. This could also have resulted from the nature of schizophrenia with preference for social isolation even if this can worsen the prognosis. On the other hand, patients need to be in contact with a mental healthcare professional in extraordinary situations of a pandemic. This survey did not find a remarkable increase in positive symptom severity in association with COVID-19 as most patients included in the survey had not seen a psychiatrist or mental healthcare professional for two months with 53 patients stating that they did not have to need. However, 58 patients also stated that despite planning to make a consultation after normalization of the quarantine measures, the anxiety of contagion outweighed the option of visiting outpatient clinics. This anxiety over Covid-19 infection, however, may make it difficult for patients to understand the level of the need to see a psychiatrist and may be associated with the assumption that the pandemic would be taken under control in the normalization process with a decrease in the risk of contagion. On the results of this survey, it may be concluded that strategies for prevention of COVID-19 spread were effective among schizophrenia patients and that there is need to develop a system that reaches all patients and keeps them socially connected during the COVID-19 pandemic. *In Turkey, prescription reports with 1-year validity are issued for patients with chronic disorders. The medications can only be prescribed by a specialist, and in the case of pyshchiatric disorders, by a consultant psychiatrist. When the report is confirmed by a hospital committee of specialists, a family doctor is able to issue prescriptions. According to the decision of the Ministry of Health, patients who have medication prescription reports valid for one year would be able to get their medicines directly from pharmacies without having to consult a psychiatrist or family doctor during the pandemic. REFERENCES Anadolu Agency (2020, Mach 11). Sağlık Bakanı Koca Türkiye'de ilk koronavirüs vakasının görüldüğünü açıkladı, https://www.aa.com.tr/tr/kor onavir us/ saglik-bakani-koca-turkiyede-ilk-koronavirus-vakasinin-goruldugunu- acikladi/1761466. Accessed 28 May 2020. Brown E, Gray R, Lo Monaco S et al (2020) The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophr Res 222:79-87. Cohn T, Prud'homme D, Streiner D et al (2004) Characterizing coronary heart disease risk in chronic schizophrenia: High prevalence of the metabolic syndrome. Can J Psychiatry 49:753-60. Cowan, HR (2020) Is schizophrenia research relevant during the COVID-19 pandemic?. Schizophr Res 220:271-2. Çakıroğlu S, Ertaş E, and Alyanak B (2020) Letter To The Editor - The Covid-19 Pandemic And Mental Health As Issues Considered Within The Context Of Adjustment Disorder And Psychosocial Interventions. Turk Psikiyatri Derg 31:148-50. Dinan T, Holt R, Kohen D et al (2004) "Schizophrenia and diabetes 2003" expert consensus meeting, Dublin, 3-4 october 2003: Consensus summary. Br J Psychiatry 184 (Suppl. 47): 0-2. Krieger I, Bitan DT, Comaneshter D et al (2019) Increased risk of smoking- related illnesses in schizophrenia patients: A nationwide cohort study. Schizophr Res 212:121-5. Palomar-Ciria N, del Valle PB, Hernández-Las Heras MÁ et al (2020) Schizophrenia and COVID-19 delirium. Psychiatry Res 290:113137. Yao H, Chen JH, and Xu YF (2020) Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry 7: e21. World Health Organization (2020, Mart 25). Covid-19: Vulnerable and High Risk Group, Geneva, Switzerland: World Health Organization, https:// www.who.int/westernpacific/emergencies/covid-19/information/high-risk- groups. Accessed 28 May 2020.

Centres for Disease Control and prevention (CDC) reports that there are limited data and information about the impact of underlying medical conditions and the risk of infection. To date, there are no studies that report on the risk of infection among patients with haematological diseases or abnormalities. This cross-sectional study reports on the baseline complete blood count in patients attending publicly funded primary care settings with a diagnosis of suspected COVID-19 infections in the state of Qatar. The study will report on the descriptive characteristics of the population, including gender, age and prior abnormalities to their blood test results. We will compare the results of those with positive and negative PCR test results, where appropriate. Nine hundred sixty-two adult patients attended publicly funded primary health care settings in the state of Qatar between February the 10th and April the 30th 2020 with a diagnosis of suspected COVID-19 infections had prior recorded blood investigations in the last six months and were included in this study. The population was young, mean of age is 38.8±11.6. (Median: 36 [Min: 19 - Max: 85]). Complete blood count of the sample had minimal missing data points. Females were more presented in our samples, Female (n=560, 58.21%) and Male (n=402, 41.79%). Most of our sample had a documented PCR test result, negative (n=831, 86.38%); positive (n=123, 12.79%) and missing (n=8, 0.83%). Low haemoglobin values (n=265, 27.5%) and low red blood cell count (n =170, 17.7%) were the most prevalent complete blood count abnormality in the population. Leukopenia was less common (n=50, 8.2%). Most of the population had normal platelet count (n=895, 93%). Gender was the most influential factor in our sample to increase the odds of having a positive PCR test results; males were more likely to be affected (P<0.001, Chi-square test) (OR 2.56, 95% CI 1.73-3.77). Categories for haematological abnormalities were not associated with increased risk of having a positive PCT test result. In a population attending primary healthcare settings with early presentation of symptoms of COVID-19 infection, the risk of infection among our cohort was not affected by the prior haematological values of those patients. Gender was the most influential parameter in the risk of infection in our population. Analysis of the results using gender-specific categories for different haematological parameters suggested that patients with abnormal haematological values were not at increased risk of having a positive COVID-19 infection.

AGA Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic