Acute Respiratory Syndrome Coronavirus Disease Research Articles

Spanish Dentists’ Awareness, Knowledge, and Practice Regarding COVID-19: A Multiple Regression Analysis

IntroductionDuring the first months of the coronavirus disease 2019 (COVID-19) pandemic, Spain had the highest mortality rate and the second-highest infection rate in the world. ObjectiveTo analyze the occupational situation of dentists, hygienists, and dental auxiliary staff during the peak of the pandemic, after the state of alarm was declared in Spain, and when the state of alarm was declared. In addition, a possible relationship between the geographical distribution of infected people and the availability of individual protection systems was investigated. Material and MethodsA cross-sectional questionnaire was answered by 6470 dentists and dental staff via WhatsApp and social media. ResultsA total of 1 in 4 dental professionals ceased working completely. Of those that kept working, 25.28% of dentists and 19.61% of hygienist-auxiliary were equipped with filtering face piece (FFP) 2 masks (P < .05), and 61.8% complied with the official protection recommendations set by the General Council of Dentists of Spain. Nearly 59.4% of respondents had symptoms, but only 1.5% of dentists were tested, with 14% of dentists in isolation at the time of response. Overall, it is suggested that 10% of dental professionals may have been in direct contact with the coronavirus. ConclusionsDirect contact of Spanish dental health professionals with severe acute respiratory syndrome coronavirus disease 2 (SARS CoV-2) has been high during the most active phase of the pandemic. Dental professionals did not have personal protective equipment (PPE) necessary to care for patients, a situation that justified the reduction in scheduled dental care and only emergencies being treated. The Spanish geographical regions with the highest number of contagions had the least amount of individual protective resources (FFP2 and FFP3 masks).

SARS-CoV-2 infection as a trigger of autoimmune response.

Currently, few evidences have shown the possible involvement of autoimmunity in patients affected by coronavirus disease 2019 (COVID‐19). In this study, we elucidate whether severe acute respiratory syndrome coronavirus disease 2 (SARS‐CoV‐2) stimulates autoantibody production and contributes to autoimmunity activation. We enrolled 40 adult patients (66.8 years mean age) admitted to Alessandria Hospital between March and April 2020. All the patients had a confirmed COVID‐19 diagnosis and no previously clinical record of autoimmune disease. Forty blood donors were analyzed for the same markers and considered as healthy controls. Our patients had high levels of common inflammatory markers, such as C reactive protein, lactate dehydrogenase, ferritin, and creatinine. Interleukin‐6 concentrations were also increased, supporting the major role of this interleukin during COVID‐19 infection. Lymphocyte numbers were generally lower compared with healthy individuals. All the patients were also screened for the most common autoantibodies. We found a significant prevalence of antinuclear antibodies, antineutrophil cytoplasmic antibodies, and ASCA immunoglobulin A antibodies. We observed that patients having a de novo autoimmune response had the worst acute viral disease prognosis and outcome. Our results sustain the hypothesis that COVID‐19 infection correlates with the autoimmunity markers. Our study might help clinicians to: (a) better understand the heterogeneity of this pathology and (b) correctly evaluate COVID‐19 clinical manifestations. Our data explained why drugs used to treat autoimmune diseases may also be useful for SARS‐CoV‐2 infection. In addition, we highly recommend checking patients with COVID‐19 for autoimmunity markers, mainly when deciding on whether to treat them with plasma transfer therapy. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? ☑ Recent data sustain the idea that autoimmune phenomena exist in patients with coronavirus disease 2019 (COVID‐19), but other investigations are necessary to define the possible link between severe acute respiratory syndrome coronavirus disease 2 (SARS‐CoV‐2) infection and autoimmune disease onset. WHAT QUESTION DID THIS STUDY ADDRESS? ☑ In this monocentric study, we demonstrated how SARS‐CoV‐2 infection could be associated with an autoimmune response and development of autoantibodies. WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? ☑ Patients with COVID‐19 having an increased level of inflammatory markers and strong autoantibodies positivity (i.e., antinuclear antibodies and antineutrophil cytoplasmic antibodies) presented the worst clinical outcome. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? ☑ These results suggest that the drugs normally used to treat autoimmune diseases should also be considered during SARS‐CoV‐2, improving public health. In addition, before starting a transfer plasma therapy, it is important to also evaluate the autoimmunity conditions of the patients with COVID‐19. Transferring antibodies or trying to neutralize them should be done with precaution. It is possible that the risk of developing or increasing the autoimmune response may enhance.

Neuroimaging Offers Low Yield in Children Positive for SARS-CoV-2.

The coronavirus disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome coronavirus disease 2 (SARS CoV-2) most commonly presents with respiratory disease, but neurologic complications are being reported. We aimed to investigate the rate of positive neuroimaging findings in children positive for SARS-CoV-2 referred for neuroimaging between March 18 and September 30, 2020. We found that 10% (n = 2) had acute findings. Our results may suggest that in children, neurologic involvement in COVID-19 is rare, neuroimaging has a low yield in diagnosis, and acute neuroimaging should involve careful risk-benefit analysis.

The Main Issues and Challenges Older Adults Face in the SARS-CoV-2 Pandemic: A Scoping Review of Literature.

Background:The Severe Acute Respiratory Syndrome Coronavirus Disease 2019 (SARS-CoV-2) severely affects those above the age of 60 yr and those with other conditions. This study aimed to review the available evidence on older adult’s issues in facing the COVID-19 pandemic.Methods:The framework is based on scoping review of literature published from Jan 10 to Jul 31, 2020. Medline, Scopus, Web of Science, and Google Scholar databases and other sources of information, to identify grey literature, were selected for data collection. Two researchers independently screened all studies and extracted data. All types of studies published about SARS-CoV-2 and related to older adults’ issues were eligible.Results:Overall, 210 documents were included in the final analysis. Letter to the editor was the most frequent article format (20.95%). Most of the papers were from the United States (38.09%) and published in Jun 2020 (29.52%). After content analysis, six following themes were extracted: Supporting and information sources, e-health services, access to essential supplies, Long Term Care Facilities (LTCFs), physical and mental consequences of self-isolation, neglect of older adults, ageism and age discrimination.Conclusion:In the pandemic, there is an urgent need for interventional research and innovational implementations to address issues related to providing services for older adults. This can help older adults to maintain their physical and mental health, and reduce the spread of infection in nursing homes. Further studies focusing on the rights of the older adults are needed on all issues associated with COVID-19.

Sliding Doors During COVID-19: Choose the Right One!

The need to resume scheduled hospital activities requires accurate screening for severe acute respiratory syndrome–Coronavirus disease 2019 (SARS–COVID-19) represented by real-time polymerase chain reaction on the nasal swab for each patient admitted. In order to prevent cross-contamination, we propose a model in which only two entry points are available: one for the urgent/emergent pathway and the other for all patients needing scheduled admission. If the patient needs emergent procedure and the swab test is not yet available, it will be viewed as a positive COVID-19 test. The hospital should be divided into two different areas: a green zone for negative-test patients and a blue zone for positive or undetermined patients in need of urgent care.

Investigating the association between ethnicity and health outcomes in SARS-CoV-2 in a London secondary care population.

BackgroundBlack, Asian and minority ethnic (BAME) populations are emerging as a vulnerable group in the severe acute respiratory syndrome coronavirus disease (SARS-CoV-2) pandemic. We investigated the relationship between ethnicity and health outcomes in SARS-CoV-2.Methods and findingsWe conducted a retrospective, observational analysis of SARS-CoV-2 patients across two London teaching hospitals during March 1 –April 30, 2020. Routinely collected clinical data were extracted and analysed for 645 patients who met the study inclusion criteria. Within this hospitalised cohort, the BAME population were younger relative to the white population (61.70 years, 95% CI 59.70–63.73 versus 69.3 years, 95% CI 67.17–71.43, p<0.001). When adjusted for age, sex and comorbidity, ethnicity was not a predictor for ICU admission. The mean age at death was lower in the BAME population compared to the white population (71.44 years, 95% CI 69.90–72.90 versus, 77.40 years, 95% CI 76.1–78.70 respectively, p<0.001). When adjusted for age, sex and comorbidities, Asian patients had higher odds of death (OR 1.99: 95% CI 1.22–3.25, p<0.006).ConclusionsBAME patients were more likely to be admitted younger, and to die at a younger age with SARS-CoV-2. Within the BAME cohort, Asian patients were more likely to die but despite this, there was no difference in rates of admission to ICU. The reasons for these disparities are not fully understood and need to be addressed. Investigating ethnicity as a clinical risk factor remains a high public health priority. Studies that consider ethnicity as part of the wider socio-cultural determinant of health are urgently needed.

Pooled saliva samples for COVID-19 surveillance programme

Health-care staff are at increased risk of COVID-19, thus putting themselves, their families, and their patients at risk. This increased risk negatively affects patient and staff mortality and morbidity (physical and mental). Furthermore, the need to isolate if either infected or exposed to severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) limits the ability of the UK NHS to deliver care when staff are absent from work. This potentially represents one of the biggest threats to providing timely health care as the second wave of SARS-CoV-2 infection develops. Locally, approximately one fifth of our patient-facing respiratory physicians were infected during the first COVID-19 surge in the UK (March–July, 2020), and one third have had to isolate with symptoms or symptomatic contacts at least once. Local ward-based outbreaks have also occurred. Hence, there is a clear need for a robust COVID-19 surveillance system for NHS staff, enabling both staff and patients to have confidence that the risk of workplace nosocomial infection is as low as it can be.

Ocular Manifestations and Clinical Characteristics of Children With Laboratory-Confirmed COVID-19 in Wuhan, China

Ocular manifestations and outcomes in children with confirmed coronavirus disease 2019 (COVID-19), relevant affecting factors, and differences in ocular disease between children and adults have yet to be fully understood. To investigate ocular manifestations and clinical characteristics of children with laboratory-confirmed COVID-19. This cross-sectional study was conducted at Wuhan Children's Hospital in Wuhan, China. Children with COVID-19 confirmed by severe acute respiratory syndrome coronavirus disease 2 nucleic acid tests of upper respiratory tract specimens between January 26 and March 18, 2020, were included. Onset clinical symptoms and duration, ocular symptoms, and needs for medication. A total of 216 pediatric patients were included, among whom 134 (62%) were boys, with a median (interquartile range) age of 7.25 (2.6-11.6) years. Based on the exposure history, 193 children (89.4%) had a confirmed (173 [80.1%]) or suspected (20 [9.3%]) family member with COVID-19 infection. The most common symptoms among symptomatic children were fever (81 [37.5%]) and cough (79 [36.6%]). Of 216 children, 93 (43.1%) had no systemic or respiratory symptoms. All children with mild (101 [46.8%]) or moderate (115 [53.2%]) symptoms recovered without reported death. Forty-nine children (22.7%) showed various ocular manifestations, of which 9 had ocular complaints being the initial manifestations of COVID-19. The common ocular manifestations were conjunctival discharge (27 [55.1%]), eye rubbing (19 [38.8%]), and conjunctival congestion (5 [10.2%]). Children with systemic symptoms (29.3% vs 14.0%; difference, 15.3%; 95% CI, 9.8%-20.7%; P = .008) or with cough (31.6% vs 17.5%; difference, 14.1%; 95% CI, 8.0%-20.3%; P = .02) were more likely to develop ocular symptoms. Ocular symptoms were typically mild, and children recovered or improved. In this cross-sectional study, children hospitalized with COVID-19 in Wuhan, China, presented with a series of onset symptoms including fever, cough, and ocular manifestations, such as conjunctival discharge, eye rubbing, and conjunctival congestion. Patients' systemic clinical symptoms or cough were associated with ocular symptoms. Ocular symptoms recovered or improved eventually.

Current coronavirus (SARS-CoV-2) epidemiological, diagnostic and therapeutic approaches: An updated review until June 2020.

Coronaviruses are a group of enveloped viruses with non-segmented, single-stranded, and positive-sense RNA genomes. In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in Wuhan City, China. The World Health Organization (WHO) declared the coronavirus outbreak as a global pandemic in March 2020. Fever, dry cough and fatigue are found in the vast majority of all COVID-19 cases. Early diagnosis, treatment and future prevention are keys to COVID-19 management. Currently, the unmet need to develop cost-effective point-of-contact test kits and efficient laboratory techniques for confirmation of COVID-19 infection has powered a new frontier of diagnostic innovation. No proven effective therapies or vaccines for SARS-CoV-2 currently exist. The rapidly increasing research regarding COVID-19 virology provides a significant number of potential drug targets. Remdesivir may be the most promising therapy up till now. On May 1, 2020, Gilead Sciences, announced that the U.S. Food and Drug Administration (FDA) has granted emergency use authorization (EUA) for the investigational Remdesivir as a potential antiviral for COVID-19 treatment. On May 7, 2020, Gilead Sciences, announced that the Japanese Ministry of Health, Labour and Welfare (MHLW) has granted regulatory approval of Veklury® (Remdesivir) as a treatment for SARS-CoV-2 infection, the virus that causes COVID-19 acute respiratory syndrome, under an exceptional approval pathway. Also, Corticosteroids are recommended for severe cases only to suppress the immune response and reduce symptoms, but not for mild and moderate patients where they are associated with a high-risk side effect. Based on the currently published evidence, we tried to highlight different diagnostic approaches, side effects and therapeutic agents that could help physicians in the frontlines.

Patients With Lung Cancer and Coronavirus Disease 2019 Epidemic: An Experience From an Italian University Hospital

The rapid onset of the coronavirus outbreak in Italy, and later on in Europe, forced urgent decisions to be taken by medical oncologists. It is well known that patients suffering from oncological or oncohematological neoplastic diseases and other chronic diseases associated with immunosuppression (e.g., congenital immunodeficiencies, transplants of solid organs or hematopoietic stem cells, and autoimmune pathologies in immunosuppressive treatment) are particularly at risk, both with regard to morbidity and fatality related to respiratory virus infections, such as influenza1 and severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2).

Implications of Obesity for the Management of Severe Coronavirus Disease 2019 Pneumonia.

Objectives:To investigate patients’ characteristics, management, and outcomes in the critically ill population admitted to the ICU for severe acute respiratory syndrome coronavirus disease 2019 pneumonia causing an acute respiratory distress syndrome.Design:Retrospective case-control study.Setting:A 34-bed ICU of a tertiary hospital.Patients:The first 44 coronavirus disease 2019 acute respiratory distress syndrome patients were compared with a historical control group of 39 consecutive acute respiratory distress syndrome patients admitted to the ICU just before the coronavirus disease 2019 crisis.Interventions:None.Measurements and Main Results:Obesity was the most frequent comorbidity exhibited by coronavirus disease 2019 patients (n = 32, 73% vs n = 11, 28% in controls; p < 0.001). Despite the same severity of illness and level of hypoxemia at admission, coronavirus disease 2019 patients failed more high flow oxygen via nasal cannula challenges (n = 16, 100% vs n = 5, 45% in controls; p = 0.002), were more often intubated (n = 44, 100% vs n = 22, 56% in controls; p < 0.001) and paralyzed (n = 34, 77% vs n = 3, 14% in controls; p < 0.001), required higher level of positive end-expiratory pressure (15 vs 8 cm H2O in controls; p < 0.001), more prone positioning (n = 33, 75% vs n = 6, 27% in controls; p < 0.001), more dialysis (n = 16, 36% vs n = 3, 8% in controls; p = 0.003), more hemodynamic support by vasopressors (n = 36, 82% vs n = 22, 56% in controls; p = 0.001), and had more often a prolonged weaning from mechanical ventilation (n = 28, 64% vs n = 10, 26% in controls; p < 0.01) resulting in a more frequent resort to tracheostomy (n = 18, 40.9% vs n = 2, 9% in controls; p = 0.01). However, an intensive management requiring more staff per patient for positioning coronavirus disease 2019 subjects (6 [5–7] vs 5 [4–5] in controls; p < 0.001) yielded the same ICU survival rate in the two groups (n = 34, 77% vs n = 29, 74% in controls; p = 0.23).Conclusions:In its most severe form, coronavirus disease 2019 pneumonia striked preferentially the vulnerable obese population, evolved toward a multiple organ failure, required prolonged mechanical ventilatory support, and resulted in a high workload for the caregivers.

Epidemiological Determinants of Acute Respiratory Syndrome Coronavirus-2 Disease Pandemic and The Role of the Bacille-Calmette-Guerin Vaccine in Reducing Morbidity and Mortality

This study analyzed the determinants of morbidity, mortality, and case fatality rate (CFR) of the ongoing pandemic of severe acute respiratory syndrome coronavirus-2 disease 2019 (COVID-19). Data for 210 countries and territories available in public domains were analyzed in relation to mandatory vaccination with Bacille-Calmette-Guerin (BCG), population density, median age of the country population, health care expenditure per capita, life expectancy at birth, healthy life expectancy, literacy rate, per capita gross domestic production adjusted to purchasing power (PPP), burden of tuberculosis (TB), acquired immunodeficiency disease caused by human immunodeficiency virus (HIV-AIDS), malaria, cardiovascular disease (CVD), neoplasm, diabetes, deaths due to energy-protein (food) deficiency (EPD), and per capita government spending on safe water and sanitation. Mandatory BCG vaccination showed a highly significant (p&lt;0.0001) negative correlation with COVID-19 morbidity (r = -0.62) and mortality (r = -0.58) rates, but no significant correlation with CFR. The median age of the nation showed a significant (p&lt;0.0001) positive correlation with COVID-19 morbidity (r= 0.40) and mortality (r = 0.34) rates, but no significant correlation with CFR. The pandemic resulted in higher morbidity (r= 0.47, p&lt;0.0001) and mortality (r= 0.25, p = 0.01) rates in countries with a higher PPP than in those with a lower PPP. COVID-19 CFR and morbidity and mortality rates showed no significant correlation with population density, the burden of malaria or diabetes, or the level of spending on safe water and sanitation. Only the burden of TB showed a positive correlation with CFR (r = 0.17, p = 0.05). However, COVID-19 morbidity showed a significant (p ≤0.05) negative correlation with the burden of TB, HIV-AIDS, CVD, and EPD. Mortality and morbidity in COVID-19 patients showed a positive correlation with per capita health expenditure, life expectancy, the burden of neoplasia, and PPP.

Coronavirus disease 2019: A new severe acute respiratory syndrome from Wuhan in China.

An outbreak of new severe acute respiratory syndrome coronavirus disease, coronavirus disease 2019 (COVID-19), has emerged during December 2019. The ongoing outbreak in Wuhan City spread rapidly throughout China, where the fatality rateranged from 2.1 to 4.9%. Due to its high transmissibility, the World Health Organization (WHO) declared a public health emergency of international concern on 30 January 2020. The current outbreak has the potential to become the first pandemic of the new millennium. Most patients who were first diagnosed with COVID-19 worked at or lived in the vicinity of the local Huanan Seafood Wholesale Market, where live animals were also on sale. The concerted efforts of Chinese scientists led to the independent isolation from patients and identification of a novel coronavirus, SARS coronavirus 2 (SARS-CoV-2), on 6 January 2020; this has been an important step in the development of treatment. The purpose of this article is to overview the history, epidemiology, clinical characteristics, diagnosis, and treatment of COVID 2019 reported in recently published studies. Based on the results of virus genome sequencing and a model of the interaction between host cells and the virus, we propose several possible targets for antiviral drugs, which may provide new ideas for epidemic control and vaccine development. Keywords: 2019 novel coronavirus; pneumonia; SARS-CoV-2; Coronaviridae; COVID-19.