Community Transmission Of Coronavirus Disease Research Articles

Integration of publicly available case-based data for real-time coronavirus disease 2019 risk assessment, Japan.

In response to the outbreak of coronavirus disease 2019 (COVID-19) in Japan, a national COVID-19 cluster taskforce (comprising governmental and nongovernmental experts) was established to support the country’s Ministry of Health, Labour and Welfare in conducting daily risk assessment. The assessment was carried out using established infectious disease surveillance systems; however, in the initial stages of the pandemic these were not sufficient for real-time risk assessment owing to limited accessibility, delay in data entry and inadequate case information. Also, local governments were publishing anonymized data on confirmed COVID-19 cases on their official web sites as daily press releases. We developed a unique database for nationwide real-time risk assessment that included these case lists from local government web sites and integrated all case data into a standardized format. The database was updated daily and checked systematically to ensure comprehensiveness and quality. Between 15 January 2020 and 15 June 2021, 776 459 cases were logged in the database, allowing for analysis of real-time risk from the pandemic. This semi-automated database was used in daily risk assessments, and to evaluate and update control measures to prevent community transmission of COVID-19 in Japan. The data were reported almost every week to the Japanese Government Advisory Panel on COVID-19 for public health responses.

Commercial motorcycle operators pose high risk for community transmission of coronavirus disease 2019 (COVID-19) in South-South Nigeria

COVID-19 has become a threat to the existence of man as no method of effective treatment has been found. Although the WHO has given guidelines that include physical distancing to prevent the spread of COVID-19, it is not feasible in practice with commercial motorcycle operation, which is a major source of income and means of transportation in Nigeria. We examined the COVID-19 knowledge, awareness, and preventive practices among commercial motorcycle operators (CMOs) and the potentials for community transmission of SARS-CoV-2 in the South-South region of Nigeria. Data used was collected from a cross-sectional survey of 777 CMOs operating in the South-South region of Nigeria. The instrument captured information on their biodata, knowledge, awareness, and preventive practices of COVID-19. The data obtained were subjected to both descriptive and inferential analyses using SAS JMP Statistical Discovery™ software version 14.3 (SAS Institute, Cary, North Carolina, USA). The majority of the CMOs were of age category 26–35 years (36.4%), married (82.1%), under a monogamous union (83.8%), had 3–4 children (43.4%) and resided in rural areas (60.8%). The mean years of experience of the CMOs was 4.9 ± 2.45 years with most depending on daily income of N1,000–2,000 (87.6%). All the CMOs were aware of the existence of COVID-19, but 93.3% of them did not believe it existed in their state. Only 37.8% of them put on facemasks while on duty, although they were aware that they could be infected or infect others in the community. Prevention practices among CMOs were significantly predicted by age category, type of family, number of dependents, and place of residence. We conclude that CMOs have high potentials for transmission of SARS-CoV-2 in the communities because the business does not permit physical distancing. It is recommended that guidelines requiring mandatory screening of operators and riders be implemented.

Implementation of warfarin to direct oral anticoagulant conversion initiative in pharmacist-run anticoagulation clinics during COVID-19 pandemic.

Due to community transmission of coronavirus disease 2019 (COVID‐19), social distancing and stay‐at‐home orders were implemented statewide in an effort to limit the spread of disease. This posed unique challenges for patients on medications requiring close and continued monitoring by clinic staff, such as anticoagulation clinics. Thus, innovative measures were implemented at Cleveland Clinic Health System (CCHS) to maintain the health and care of ambulatory patients. An initiative to evaluate patients for warfarin to direct oral anticoagulants (DOAC) conversion was used in the pharmacist‐run anticoagulation clinics. This article describes how patients were screened for eligibility, the education to pharmacists, the utilization of student learners in the process, and the workflow for provider notification of conversion. Follow up monitoring, challenges encountered, and future directions are also described.

Estimating direct and spill-over impacts of political elections on COVID-19 transmission using synthetic control methods.

Mass gathering events have been identified as high-risk environments for community transmission of coronavirus disease 2019 (COVID-19). Empirical estimates of their direct and spill-over effects however remain challenging to identify. In this study, we propose the use of a novel synthetic control framework to obtain causal estimates for direct and spill-over impacts of these events. The Sabah state elections in Malaysia were used as an example for our proposed methodology and we investigate the event’s spatial and temporal impacts on COVID-19 transmission. Results indicate an estimated (i) 70.0% of COVID-19 case counts within Sabah post-state election were attributable to the election’s direct effect; (ii) 64.4% of COVID-19 cases in the rest of Malaysia post-state election were attributable to the election’s spill-over effects. Sensitivity analysis was further conducted by examining epidemiological pre-trends, surveillance efforts, varying synthetic control matching characteristics and spill-over specifications. We demonstrate that our estimates are not due to pre-existing epidemiological trends, surveillance efforts, and/or preventive policies. These estimates highlight the potential of mass gatherings in one region to spill-over into an outbreak of national scale. Relaxations of mass gathering restrictions must therefore be carefully considered, even in the context of low community transmission and enforcement of safe distancing guidelines.

Transcatheter Aortic Valve Implantation During the COVID-19 Pandemic

Transcatheter aortic valve implantation (TAVI) outcomes during the coronavirus disease 2019 (COVID-19) pandemic have not been fully evaluated and some structural programs in the world have been suspended during this period. We sought to evaluate and compare clinical outcomes in patients undergoing TAVI in pandemic versus nonpandemic era. In a single center, we compared 198 TAVI patients performed during 2019 to 59 patients performed during the COVID-19 pandemic period (March 1st to June 30th, 2020). Primary outcome was procedural success according to VARC criteria and 30-day mortality rates. VARC-defined procedural success was high in both groups (93.3% vs 96.6%; p = 0.53). There were no differences in any vascular complications (26% vs 19%; p = 0.3), permanent pacemaker implantation (11.8% vs 15.3%; p = 0.63), and length of hospital stay (5.2 vs 4.2 days; p = 0.29). Thirty-day mortality was similar (3% vs 3.4%; p = 1.0). We had no documented COVID-19 disease in our patients during follow up. In conclusion, TAVI procedures can be performed effectively and safely during the COVID-9 pandemic, using a minimalist approach, early discharge, and by maintaining proper use of personal protective equipment.

Psychological burden of the COVID-19 pandemic and its associated factors among frontline doctors of Bangladesh: a cross-sectional study.

Background: Frontline doctors are the most vulnerable and high-risk population to get the novel coronavirus disease 2019 (COVID-19) infection. Hence, we aimed to evaluate the anxiety, depression, sleep disturbance and fear of COVID-19 among frontline doctors of Bangladesh during the pandemic, and the associated factors for these psychological symptoms. Methods: In total, 370 frontline doctors who were involved in the treatment of suspected or confirmed COVID-19 patients during the pandemic took part in an online cross-sectional study. Recruitment was completed using convenience sampling and the data were collected after the start of community transmission of COVID-19 in the country. Anxiety and depression, sleep disturbance, and fear of COVID-19 were assessed by the Patient Health Questionnaire-4, two-item version of the Sleep Condition Indicator, and the Fear of Coronavirus-19 scale, respectively. Socio-demographic information, health service-related information, co-morbidity, and smoking history were collected for evaluating risk factors. The proportion of psychological symptoms were presented using descriptive statistics and the associated factors were identified using multinomial logistic regression analysis. Results: Of the doctors, 36.5% had anxiety, 38.4% had depression, 18.6% had insomnia, and 31.9% had fear of COVID-19. In multinomial logistic regression, inadequate resources in the workplace were found as the single most significant predictor for all psychological outcomes: anxiety and/or depression (severe, OR 3.0, p=0.01; moderate, OR 5.3, p=0.000; mild, OR 2.3, p=0.003), sleep disturbance (moderate, OR 1.9, p=0.02), and fear of COVID-19 (severe, OR 1.9, p=0.03; moderate, OR 1.8, p=0.03). Conclusions:The study demonstrated a high burden of psychological symptoms among frontline doctors of Bangladesh during the COVID-19 pandemic situation. Inadequate resources are contributing to the poor mental health of Bangladeshi doctors. The supply of sufficient resources in workplaces and mental health counseling may help to mitigate the burden of the psychological symptoms identifiedamong the respondents..

Characteristics in Pediatric Patients with Coronavirus Disease 2019 in Korea.

BackgroundBased on the reports of low prevalence and severity of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, the Korean government has released new SARS-CoV-2 infection response and treatment guidelines for children under the age of 12 years. The government has further directed school reopening under strict preventive measures. However, there is still considerable concern on the impact of school reopening on community transmission of Coronavirus disease 2019 (COVID-19). In the present study, we aimed to evaluate the appropriateness of these directives and the severity of SARS-CoV-2 infections in children as compared to adults using sufficient national sample data.MethodsIn the present study, we evaluated the severity of SARS-CoV-2 infection in pediatric patients as compared to adults by analyzing the length of hospital stays (LOS), medical expenses, and hospital and intensive care unit (ICU) admission rates. A multivariate linear regression analysis was carried out to examine the effects of COVID-19 patients that the characteristics on the LOS and medical expenses, and multivariate logistic regression analysis were performed to identify COVID-19 characteristics that affect hospital and ICU admission rates and to prove the low SARS-CoV-2 infection severity in pediatric patients.ResultsThe hospitalization period for children aged 0–9 was 37% shorter and that of patients aged 10–19 years was 31% shorter than those of older age groups (P < 0.001). The analysis of the medical expenses by age showed that on average, medical expenses for children were approximately 4,900 USD lower for children than for patients over 80 years of age. The linear regression analysis also showed that patients who were 0–9 years old spent 87% and those aged 10–19 118% less on medical expenses than those aged 70 and over, even after the correction of other variables (P < 0.001). The probability of hospitalization was the lowest at 10–19 years old (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.03–0.09), and their ICU admission rate was also the lowest at 0.14 (OR, 0.14; 95% CI, 0.08–0.24). On the other hand, the likelihood of hospitalization and ICU admission was the highest in children aged 0–9 years, and among patients under the age of 50 years in general.ConclusionThis study demonstrated the low severity of SARS-CoV-2 infection in younger patients (0–19 years) by analyzing the LOS, medical expenses, hospital, and intensive care unit admission rates as outcome variables. As the possibility to develop severe infection of coronavirus at the age of 10–19 was the lowest, a mitigation policy is also required for middle and high school students. In addition, children with underlying diseases need to be protected from high-risk infection environments.

Preparing the western pacific region for the onset of large-scale community transmission of coronavirus disease 2019

The Corona Virus Disease-2019 (COVID-19) pandemic continues to remain a public health emergency of international concern. In the Western Pacific region, the estimates pertaining to the caseload and death rates have shown a big improvement, as the region accounts for 1.8% and 1.3% of the global caseload and deaths worldwide. The available estimates clearly suggest that now the epicenter of the disease has shifted to the European and the American region. However, it will be a wrong assumption to presume that the epidemic is over in the Western Pacific region, and thus it will be a premature decision to be complacent about the outbreak readiness and emergency response action plan. In conclusion, the decline in the number of COVID-19 cases in the Western Pacific region is not a time to relax, as any lacunae on our part will result in a resurgence of the disease. The right approach will be to continue the fight against the disease with the support of individuals, families, societies and the health sector and thus prepare ourselves for a large-scale community transmission.

A proposed framework to limit post-lockdown community transmission of COVID-19 in Africa.

As of March 11, 2021, 3,992,044 coronavirus disease 2019 (COVID-19) cases and 106,615 deaths (case fatality rate 2.67%) have been reported on the African continent. In March 2020, even before the first case of COVID-19 was registered, some African countries implemented total lockdown measures, which limited movement of people, banned mass gatherings, and closed schools and borders. However, these control measures, which affect individuals and society's well-being, cannot be implemented for a long time. There is an urgent need for a robust framework to guide African countries to make evidence-based decisions on easing these restrictive measures and reapply them when the infection rates increase significantly. This article presents a proposed framework to guide lockdown easing while limiting the community spread of COVID-19 in Africa. Due to lack of information on the impact of relaxing restrictions on peoples' movement on the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the causative agent for COVID-19) and how businesses will respond, it is almost clear that there is no single grand lockdown exit strategy. African governments should develop flexible, iterative lockdown exit plans based on epidemiological disease data, economic indicators, and peoples' views to inform decisions, all of which are paramount for success. A phased approach of changes and willingness to adapt methods will allow governments to minimize the pandemic's adverse impact and respond accordingly as new control tools become available.

Psychological burden of the COVID-19 pandemic and its associated factors among frontline doctors of Bangladesh: a cross-sectional study

Background: Frontline doctors are the most vulnerable and high-risk population to get the novel coronavirus disease 2019 (COVID-19) infection. Hence, we aimed to evaluate the anxiety, depression, sleep disturbance and fear of COVID-19 among frontline doctors of Bangladesh during the pandemic, and the associated factors for these psychological symptoms. Methods: In total, 370 frontline doctors who were involved in the treatment of suspected or confirmed COVID-19 patients during the pandemic took part in an online cross-sectional study. Recruitment was completed using convenience sampling and the data were collected after the start of community transmission of COVID-19 in the country. Anxiety and depression, sleep disturbance, and fear of COVID-19 were assessed by the Patient Health Questionnaire-4, two-item version of the Sleep Condition Indicator, and the Fear of Coronavirus-19 scale, respectively. Socio-demographic information, health service-related information, co-morbidity, and smoking history were collected for evaluating risk factors. The proportion of psychological symptoms were presented using descriptive statistics and the associated factors were identified using multinomial logistic regression analysis. Results: Of the doctors, 36.5% had anxiety, 38.4% had depression, 18.6% had insomnia, and 31.9% had fear of COVID-19. In multinomial logistic regression, inadequate resources in the workplace were found as the single most significant predictor for all psychological outcomes: anxiety and/or depression (severe, OR 3.0, p=0.01; moderate, OR 5.3, p=0.000; mild, OR 2.3, p=0.003), sleep disturbance (moderate, OR 1.9, p=0.02), and fear of COVID-19 (severe, OR 1.9, p=0.03; moderate, OR 1.8, p=0.03). Conclusions: The study demonstrated a high burden of psychological symptoms among frontline doctors of Bangladesh during the COVID-19 pandemic situation. Inadequate resources are contributing to the poor mental health of Bangladeshi doctors. The supply of sufficient resources in workplaces and mental health counseling may help to mitigate the burden of the psychological symptoms identified among the respondents..

Psychological burden of the COVID-19 pandemic and its associated factors among frontline doctors of Bangladesh: a cross-sectional study

Background: Frontline doctors are the most vulnerable and high-risk population to get the novel coronavirus disease 2019 (COVID-19) infection. Hence, we aimed to evaluate the anxiety, depression, sleep disturbance and fear of COVID-19 among frontline doctors of Bangladesh during the pandemic, and the associated factors for these psychological symptoms. Methods: In total, 370 frontline doctors who were involved in the treatment of suspected or confirmed COVID-19 patients during the pandemic took part in an online cross-sectional study. Recruitment was completed using convenience sampling and the data were collected after the start of community transmission of COVID-19 in the country. Anxiety and depression, sleep disturbance, and fear of COVID-19 were assessed by the Patient Health Questionnaire-4, two-item version of the Sleep Condition Indicator, and the Fear of Coronavirus-19 scale, respectively. Socio-demographic information, health service-related information, co-morbidity, and smoking history were collected for evaluating risk factors. The proportion of psychological symptoms were presented using descriptive statistics and the associated factors were identified using multinomial logistic regression analysis. Results: Of the doctors, 36.5% had anxiety, 38.4% had depression, 18.6% had insomnia, and 31.9% had fear of COVID-19. In multinomial logistic regression, inadequate resources in the workplace were found as the single most significant predictor for all psychological outcomes: anxiety and/or depression (severe, OR 3.0, p=0.01; moderate, OR 5.3, p=0.000; mild, OR 2.3, p=0.003), sleep disturbance (moderate, OR 1.9, p=0.02), and fear of COVID-19 (severe, OR 1.9, p=0.03; moderate, OR 1.8, p=0.03). Conclusions: The study demonstrated a high burden of psychological symptoms among frontline doctors of Bangladesh during the COVID-19 pandemic situation. Inadequate resources are contributing to the poor mental health of Bangladeshi doctors. The supply of sufficient resources in workplaces and mental health counseling may help to mitigate the burden of the psychological symptoms identified among the respondents..

Rapid deployment of a telemedicine service in orthopaedic surgery during the COVID-19 pandemic.

Rapid deployment of a telemedicine service in orthopaedic surgery during the COVID-19 pandemic.

Psychological burden of the COVID-19 pandemic and its associated factors among frontline doctors of Bangladesh: a cross-sectional study

Background: Frontline doctors are the most vulnerable and high-risk population to get the novel coronavirus disease 2019 (COVID-19) infection. Hence, we aimed to evaluate the anxiety, depression, sleep disturbance and fear of COVID-19 among frontline doctors of Bangladesh during the pandemic, and the associated factors for these psychological symptoms. Methods: In total, 370 frontline doctors who were involved in the treatment of suspected or confirmed COVID-19 patients during the pandemic took part in an online cross-sectional study. Recruitment was completed using convenience sampling and the data were collected after the start of community transmission of COVID-19 in the country. Anxiety and depression, sleep disturbance, and fear of COVID-19 were assessed by the Patient Health Questionnaire-4, two-item version of the Sleep Condition Indicator, and the Fear of Coronavirus-19 scale, respectively. Socio-demographic information, health service-related information, co-morbidity, and smoking history were collected for evaluating risk factors. The proportion of psychological symptoms were presented using descriptive statistics and the associated factors were identified using multinomial logistic regression analysis. Results: Of the doctors, 36.5% had anxiety, 38.4% had depression, 18.6% had insomnia, and 31.9% had fear of COVID-19. In multinomial logistic regression, inadequate resources in the workplace were found as the single most significant predictor for all psychological outcomes: anxiety and/or depression (severe, OR 3.0, p=0.01; moderate, OR 5.3, p=0.000; mild, OR 2.3, p=0.003), sleep disturbance (moderate, OR 1.9, p=0.02), and fear of COVID-19 (severe, OR 1.9, p=0.03; moderate, OR 1.8, p=0.03). Conclusions: The study demonstrated a high burden of psychological symptoms among frontline doctors of Bangladesh during the COVID-19 pandemic situation. Inadequate resources are contributing to the poor mental health of Bangladeshi doctors. The supply of sufficient resources in workplaces and mental health counseling may help to mitigate the burden of the psychological symptoms identified among the respondents..

Screening and Testing Pregnant Patients for SARS-CoV-2: First-Wave Experience of a Designated COVID-19 Hospitalization Centre in Montréal.

ObjectiveCoronavirus disease 2019 (COVID-19) may present asymptomatically in a large proportion of cases in endemic areas. Accordingly, universal testing has been suggested as a potential strategy for reducing transmission in the obstetrical setting. We describe the clinical characteristics of patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy at a designated COVID-19 hospitalization centre in Montréal, Québec.MethodsA single-centre retrospective cohort was constructed to include all pregnant patients who tested positive for SARS-CoV-2 between March 22 and July 31, 2020, and received care at the Jewish General Hospital. Initially, testing was restricted to at-risk patients, identified through the use of a screening questionnaire. Beginning on May 15, 2020, universal testing was implemented, and all pregnant patients admitted to the hospital were tested. Data were collected through chart review.ResultsOf 803 patients tested for SARS-CoV-2 during the study period, 41 (5%) tested positive. Among those patients who were symptomatic, the most commonly reported symptoms were cough (53%), fever (37%), dyspnea (30%), and anosmia and/or ageusia (20%). Before the implementation of universal testing, 13% (3 of 24) of patients with SARS-CoV-2 were asymptomatic. After implementation of universal testing, 80% (8 of 10) of patients with SARS-CoV-2 were asymptomatic.ConclusionOur findings suggest that most pregnant patients with SARS-CoV-2 are asymptomatic or have mild symptoms of COVID-19. Particularly in endemic areas, universal testing of pregnant patients presenting to the hospital should be strongly considered as an important measure to prevent in-hospital and community transmission of COVID-19.

Comparing Associations of State Reopening Strategies with COVID-19 Burden.

BackgroundThe novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied.ObjectiveTo estimate excess COVID-19 cases and deaths after reopening compared with trends prior to reopening for two groups of states: (1) states with an evidence-based reopening strategy, defined as reopening indoor dining after implementing a statewide mask mandate, and (2) states reopening indoor dining rooms before implementing a statewide mask mandate.DesignInterrupted time series quasi-experimental study design applied to publicly available secondary data.ParticipantsFifty United States and the District of Columbia.InterventionsReopening indoor dining rooms before or after implementing a statewide mask mandate.Main MeasuresOutcomes included daily cumulative COVID-19 cases and deaths for each state.Key ResultsOn average, the number of excess cases per 100,000 residents in states reopening without masks is ten times the number in states reopening with masks after 8 weeks (643.1 cases; 95% confidence interval (CI) = 406.9, 879.2 and 62.9 cases; CI = 12.6, 113.1, respectively). Excess cases after 6 weeks could have been reduced by 90% from 576,371 to 63,062 and excess deaths reduced by 80% from 22,851 to 4858 had states implemented mask mandates prior to reopening. Over 50,000 excess deaths were prevented within 6 weeks in 13 states that implemented mask mandates prior to reopening.ConclusionsAdditional mitigation measures such as mask use counteract the potential growth in COVID-19 cases and deaths due to reopening businesses. This study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. States should delay further reopening until mask mandates are fully implemented, and enforcement by local businesses will be critical for preventing potential future closures.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-06277-0) contains supplementary material, which is available to authorized users.

Changing Age Distribution of the COVID-19 Pandemic - United States, May-August 2020.

As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in more than 6,800,000 reported U.S. cases and more than 199,000 associated deaths.* Early in the pandemic, COVID-19 incidence was highest among older adults (1). CDC examined the changing age distribution of the COVID-19 pandemic in the United States during May-August by assessing three indicators: COVID-19-like illness-related emergency department (ED) visits, positive reverse transcription-polymerase chain reaction (RT-PCR) test results for SARS-CoV-2, the virus that causes COVID-19, and confirmed COVID-19 cases. Nationwide, the median age of COVID-19 cases declined from 46 years in May to 37 years in July and 38 in August. Similar patterns were seen for COVID-19-like illness-related ED visits and positive SARS-CoV-2 RT-PCR test results in all U.S. Census regions. During June-August, COVID-19 incidence was highest in persons aged 20-29 years, who accounted for >20% of all confirmed cases. The southern United States experienced regional outbreaks of COVID-19 in June. In these regions, increases in the percentage of positive SARS-CoV-2 test results among adults aged 20-39 years preceded increases among adults aged ≥60 years by an average of 8.7 days (range=4-15 days), suggesting that younger adults likely contributed to community transmission of COVID-19. Given the role of asymptomatic and presymptomatic transmission (2), strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce their risk for infection and subsequent transmission of SARS-CoV-2 to persons at higher risk for severe illness.

The probability of the 6-week lockdown in Victoria (commencing 9 July 2020) achieving elimination of community transmission of SARS-CoV-2.

The probability of the 6-week lockdown in Victoria (commencing 9 July 2020) achieving elimination of community transmission of SARS-CoV-2.

Spatiotemporal patterns and trends of community transmission of the pandemic COVID-19 in South Asia: Bangladesh as a case study

South Asian (SA) countries have been fighting with the pandemic novel coronavirus disease 2019 (COVID-19) since January 2020. Earlier, the country-specific descriptive study has been done. Nevertheless, as transboundary infection, the border sharing, shared cultural and behavioral practice, effects on the temporal and spatial distribution of COVID-19 in SA is still unveiled. Therefore, this study has been revealed the spatial hotspot along with descriptive output on different parameters of COVID-19 infection. We extracted data from the WHO and the worldometer database from the onset of the outbreak up to 15 May, 2020. Europe has the highest case fatality rate (CFR, 9.22%), whereas Oceania has the highest (91.15%) recovery rate from COVID-19. Among SA countries, India has the highest number of cases (85,790), followed by Pakistan (38,799) and Bangladesh (20,065). However, the number of tests conducted was minimum in this region in comparison with other areas. The highest CFR was recorded in India (3.21%) among SA countries, whereas Nepal and Bhutan had no death record due to COVID-19 so far. The recovery rate varies from 4.75% in the Maldives to 51.02% in Sri Lanka. In Bangladesh, community transmission has been recorded, and the highest number of cases were detected in Dhaka, followed by Narayanganj and Chattogram. We detected Dhaka and its surrounding six districts, namely Gazipur, Narsingdi, Narayanganj, Munshiganj, Manikganj, and Shariatpur, as the 99% confidence-based hotspot where Faridpur and Madaripur district as the 95% confidence-based spatial hotspots of COVID-19 in Bangladesh. However, we did not find any cold spots in Bangladesh. We identified three hotspots and three cold spots at different confidence levels in India. Findings from this study suggested the “Test, Trace, and Isolation” approach for earlier detection of infection to prevent further community transmission of COVID-19.

Retrospective Analysis of Inflammatory Markers and Patient Characteristics in Hospitalized Covid-19 Patients: An Early Experience in Louisiana.

BackgroundThe community transmission of coronavirus disease 2019 (Covid-19) was detected in Baton Rouge, Louisiana, in March 2020. Several previous studies have reported elevations of inflammatory markers in Covid-19 positive patients and suggested a possible correlation to disease severity.MethodsWe identified 69 patients from Baton Rouge General (BRG) Hospital who were admitted with acute hypoxic respiratory failure and laboratory confirmed positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between March 13 and April 5, 2020. Demographic and laboratory data were obtained through a review of medical records. Statistical analysis was performed on several inflammatory markers in association with clinical disease severity.ResultsWe identified 69 patients with confirmed Covid-19 infection. The mean (±SD) age of the patients was 65±14 years, 68% were male and 32% were female. A total of 13 patients (19%) were considered to have mild disease, 25 (36%) had moderate disease, and 31 (45%) were considered to have severe disease. A total of nine patients died (13%), 25 (36%) have been discharged from the hospital, 20 (29%) remain in the ICU, and 15 (22%) remain admitted to the hospital at the time of writing. Lymphopenia was common among hospitalized patients (39%) and was found to be statistically more pronounced in patients with severe disease (p<0.05). Inflammatory marker elevations were also seen in several patients, with statistically significant elevations in C-reactive protein (CRP) and lactate dehydrogenase (LDH) (p <0.05). We found no statistically significant associations between ferritin, D-dimer, troponin I, body mass index (BMI), or creatine kinase (CK) with disease severity.ConclusionsDuring the first three weeks of the Covid-19 outbreak in Baton Rouge, Louisiana, the most common reason for admission amongst Covid-19 positive patients was acute hypoxic respiratory failure. Previously, several studies have suggested a correlation between elevated inflammatory markers and disease severity. The presence of lymphopenia and elevations of CRP and LDH may be helpful in the risk stratification of these patients. In an effort to guide clinical decision making and provide insight into disease severity, further characterization of Covid-19 infection in hospitalized patients is urgently needed.

The Use of Fabric Masks in Prevention of Community Transmission of COVID-19

Introduction: COVID-19 (Coronavirus Disease 2019) is a new disease due to SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) which can be transmitted through droplets. One effort to prevent transmission of COVID-19 is to use a mask. Medical masks are effective in preventing transmission of COVID-19, but their numbers are very limited and are very much needed by medical personnel when treating COVID-19 patients. Therefore, to prevent the spread of COVID-19 more broadly, alternative medical masks are needed, namely by using cloth masks which have not been discussed much about the purpose of their use to the public. Discussion: SARS-CoV-2 is a cause of COVID-19 and infects the respiratory tract, especially in the lungs (pulmo) through the ACE2 receptor (Angiotensin-Converting Enzyme 2). SARS-CoV-2 has a diameter of around 120 nm. Cloth masks as an alternative to the scarcity of medical masks are recommended for public use. The recommended cloth masks are made of cotton or a cloth towel. A cloth mask is able to hold large droplets (&gt; 5 μm), but not small droplets. Conclusion: Cloth masks can be used by the community in an effort to minimize transmission of COVID-19 by holding large droplets, but it is not effective in preventing transmission of COVID-19 because it can still be passed by SARS-CoV-2. Suggestion: Cloth masks can be optimized using nanoparticles to resist SARS-CoV-2.