Early Phase Of Pandemic Research Articles

Quality and methodology of clinical practice guidelines on antiviral pharmacotherapy for COVID‑19 during the early phase of the pandemic.

Despite availability of reliable guidelines development methods, the risk of producing less reliable documents may be higher when the guidelines are developed rapidly. The aim of this study was to assess quality of guidelines on coronavirus disease 2019 (COVID-19), developed in the early stages of COVID-19 pandemic and assess if recommendations for pharmacotherapy were supported by evidence. We performed the search for documents, that considered antiviral therapies and contained a recommendations for clinicians. The quality of the guidelines was assessed using the AGREE II-Global Rating Scale Instrument and series of additional criteria. The analysis included 40 publications. The median of quality of documents assessed with the AGREE II-GRS tool was 2.0 (interquartile range 1.5-2.5). Most documents did not fulfill the rigour of guideline development quality criteria. The AGREE II-GRS scores did not differ significantly across the type of the document, issuing institution and the mode of publication. 75% of documents provided recommendations for the use of antiviral medications despite apparent lack of sufficient evidence supporting such treatments. Of the included documents, 75% were not updated within the 2 months after the publication of the first randomized controlled trial on COVID-19 antiviral therapy. Most guidelines or guidance documents published during the early phase of the COVID-19 pandemic were of poor quality, contained recommendations for the use of antiviral therapy for SARS-CoV-2 infection despite only very low quality of evidence available, and were not updated on a regular basis.

Impact of the Coronavirus Disease 2019 Pandemic on Gastrointestinal Procedures and Cancers in the United States: A Multicenter Research Network Study

Impact of the Coronavirus Disease 2019 Pandemic on Gastrointestinal Procedures and Cancers in the United States: A Multicenter Research Network Study

Health inequality among different economies during early phase of COVID-19 pandemic

BackgroundThe new coronavirus outbreak originated in Wuhan, China, started in January 2020 is escalating as a pandemic across the globe in March 2020. It causes unprecedented morbidity and shocked health systems and the supply chains in new epicenters such as Italy, Spain, and the USA, claiming thousands of lives. Meanwhile, the pandemic is reaching swiftly and silently to low-income countries where international media cover less. How likely health outcomes among the countries with different economies may differ during the pandemic has not been reported yet. Methodologically, we conducted an analysis of COVID-19 deaths comparing case fatality rate (CFR) among countries with different income categories, applying COVID-19 global data from the European Centre for Disease Control including 199 countries’ data as of 31 March 2020, in the early phase of the pandemic. We categorized countries into high-income countries (HIC), upper-middle-income countries (UMIC), lower-middle-income countries (LMIC), and low-income countries (LIC) according to World Bank classification by income as of 2020.FindingStatistically, countries in different income groups are significantly different in terms of new cases identified in the last 2 weeks and the case fatality rate (MANOVA, P value < 0.001). New tests and detected case numbers shot up in HICs where CFR shot up in LMICs and LICs. The results of this analysis pointed out an important gap among countries with different economic status during the ongoing pandemic.ConclusionIn the HIC, contact tracing, testing capacity, and outbreak response, as well as clinical services, are strong. In the LICs, there is a low capacity of outbreak response which is reflected by the significantly lower number of diagnostic tests. Consequently, the reported number of COVID-19 cases in LICs may not reflect the actual burden of the pandemic. Without effective prevention, the pandemic can readily break into the weak health system and over-burden the hospitals and clinical services in poor countries.This finding is showing health inequality between the rich and the poor being amplified by the COVID-19 pandemic. Addressing such a gap through the local governance and integrated global responses will not only prevent unprecedented deaths, but also preserve the momentum towards Sustainable Development Goals (SDGs).

Evolutionary Dynamics and Dissemination Pattern of the SARS-CoV-2 Lineage B.1.1.33 During the Early Pandemic Phase in Brazil.

A previous study demonstrates that most of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Brazilian strains fell in three local clades that were introduced from Europe around late February 2020. Here we investigated in more detail the origin of the major and most widely disseminated SARS-CoV-2 Brazilian lineage B.1.1.33. We recovered 190 whole viral genomes collected from 13 Brazilian states from February 29 to April 31, 2020 and combined them with other B.1.1 genomes collected globally. Our genomic survey confirms that lineage B.1.1.33 is responsible for a variable fraction of the community viral transmissions in Brazilian states, ranging from 2% of all SARS-CoV-2 genomes from Pernambuco to 80% of those from Rio de Janeiro. We detected a moderate prevalence (5–18%) of lineage B.1.1.33 in some South American countries and a very low prevalence (<1%) in North America, Europe, and Oceania. Our study reveals that lineage B.1.1.33 evolved from an ancestral clade, here designated B.1.1.33-like, that carries one of the two B.1.1.33 synapomorphic mutations. The B.1.1.33-like lineage may have been introduced from Europe or arose in Brazil in early February 2020 and a few weeks later gave origin to the lineage B.1.1.33. These SARS-CoV-2 lineages probably circulated during February 2020 and reached all Brazilian regions and multiple countries around the world by mid-March, before the implementation of air travel restrictions in Brazil. Our phylodynamic analysis also indicates that public health interventions were partially effective to control the expansion of lineage B.1.1.33 in Rio de Janeiro because its median effective reproductive number (Re) was drastically reduced by about 66% during March 2020, but failed to bring it to below one. Continuous genomic surveillance of lineage B.1.1.33 might provide valuable information about epidemic dynamics and the effectiveness of public health interventions in some Brazilian states.

Cost-effectiveness of surgical mask, N-95 respirator, hand-hygiene and surgical mask with hand hygiene in the prevention of COVID-19: Cost effectiveness analysis from Indian context

IntroductionIn the absence of specific treatment, preventive strategies are of paramount importance in management of coronavirus disease 2019(COVID-19) pandemic. We estimated cost-effectiveness of non-pharmacological interventions such as hand-hygiene, surgical-mask N-95 respirators and surgical mask in general population. MethodsWe performed a decision tree and markov-model based economic evaluation. We estimated total costs and outcomes from public payer's perspective, based on information available through systematic literature search on relative intervention effect during early pandemic phase. We estimated outcomes as number COVID-19 prevented and Quality Adjusted life year (QALY) over one-year time-horizon with one-day cycle-length. Incremental cost effectiveness ratios (ICER) was calculated multiple sensitivity analyses were applied to assess parameter uncertainty. ResultsUse of surgical mask with hand hygiene, fit tested N-95 respirator, surgical-mask, non-fit tested N-95 and hand-hygiene interventions prevented additional 1139, 1124, 1121, 1043 and 975 COVID-19 cases per-million as compared to using none. Additional costs incurred (in billion) were ₹29.78 ($0.40), ₹148.09 ($1.99), ₹72.51 ($0.98), ₹26.84 ($0.36) and ₹2.48 ($0.03) as well as additional QALYs gained were 357.4, 353.01, 327.95, 351.52 and 307.04 for surgical mask with hand hygiene, fit-tested N-95, non-fit-tested N-95, surgical mask and hand-hygiene respectively. ICERs with surgical with hand hygiene, hand-hygiene alone, surgical-mask alone, N-95 respirator fit and non-fit test were 83.32($1.12), 8.07($0.11), 76.36($1.03), 419.51($5.65) and 221.10 ($2.98) million ₹ ($)/QALY respectively. Results were robust on uncertainty analysis. DiscussionAmong the non-pharmacological interventions to be considered for preventing spread of COVID-19, hand hygiene was cost-effective and avoidance of use of surgical masks and respirators by the general public could save resources.

Trust and social relationships in times of the COVID-19 pandemic

Background: It is well known that the quality of social relationships is related to mental health, particularly in the face of adversity. Social relationships are complex and can perhaps not be fully understood from a purely individual perspective. Recent contributions have highlighted the need for a societal or ecological approach (Ajduković, 2013; Bryant, 2016; Maercker & Hecker, 2016). In this study, we expand on previous social relationships research by investigating generalized trust (the belief that most other people can be trusted) during the COVID-19 pandemic, which we conceptualize as a slow-motion disaster. Not only close relationships, but also generalized trust, are associated with better physical and mental health, prosperity, and well-being (Dinesen, 2012). As such, generalized trust is an asset that may help people to cope with adversities. The knowledge about generalized trust in disasters is very limited, but a few studies have indicated that the external threat and the display of mutual aid may stimulate increased connectedness and a sense of community in the general population (Cassar, Healy, & Von Kessler, 2017; Sibley et al., 2020). Directly exposed individuals, however, may feel marginalized and expelled. In this study, we investigate the potential impact of the pandemic on generalized trust. Objectives: The objectives of the current study were to assess whether generalized trust had increased in an early pandemic phase compared to pre-pandemic levels, and whether trust was lower in individuals who felt particularly threatened or were particularly burdened in the pandemic. Methods: We compared levels of generalized trust in a population-representative Norwegian sample (n = 1041) with pre-pandemic levels measured in the European Social Survey (ESS). Age- and gender-adjusted expected scores were compared to observed scores, using weighted data. Secondly, we tested whether indicators of pandemic-related strains, perceived health risk, or pandemic-related worry were associated with a reduced level of generalized trust. This cross-sectional study was conducted in an early opening-up phase (May 2020). Results: The observed levels of generalized trust in an early pandemic phase did not differ significantly from expected levels based on pre-pandemic measures. Increased trust was found for individuals who reported personal experience with COVID-19 (tested positive, admitted to hospital, or lost someone to the disease). Pandemic-related worry and a high perceived health threat were both associated with a lower level of generalized trust. Conclusions: Individuals who had personal experience with the disease may have had first-hand experiences with kindness and helpfulness from medical personnel or from other people, which may have generalized into increased trust in other people. People who feel particularly vulnerable or worried may lose trust in others, which constitutes a loss of a potentially protective factor. Our results suggest that generalized trust in other people may be affected by disasters and adversity, both positively and negatively, depending on the individual’s personal disaster experiences. Generalized trust may be an important, although often overlooked, protective factor for people who face trauma and adversity.

Realistic Expectations and Prosocial Behavioural Intentions to the Early Phase of the COVID-19 Pandemic in the Norwegian Population

The coronavirus pandemic represents a serious challenge for modern societies. Individuals’ perception of risk influences their choice of action, and their collective actions determine the societal impact of the pandemic. The current data paper presents descriptive statistics of a survey from a representative sample of Norwegian citizens (N = 4,083), collected in the early phases of the pandemic (March 20-29, 2020). Most of the population considered the risk for being infected to be small and the risk for becoming seriously ill to be smaller still. On the other hand, most were worried that family members could be infected, and that their daily life could change drastically. The majority of participants were optimistic that they could handle the challenges that the virus would bring, and that they would receive good medical treatment if they were to become sick. Almost all stated that they intended to comply with the authorities’ advice for limiting the contagion. Most stated that following the advice would be effective in preventing themselves and others from becoming sick. Most stated being careful in how they gather information about the pandemic. The survey showed that the Norwegian population at the time had realistic perceptions of risks, optimistic attitudes and intentions for prosocial behaviour that would limit the pandemic spread.

Comparison of Liver Biomarkers in 288 COVID-19 Patients: A Mono-Centric Study in the Early Phase of Pandemic.

Background and Aims: Recent reports have indicated that hepatic dysfunction occurred in a proportion of patients with coronavirus disease 2019 (COVID-19). We aimed to compare and describe the liver biomarkers in different subtypes of COVID-19 patients.Methods: This study enrolled 288 COVID-19 patients in Huangshi Hospital of Traditional Chinese Medicine. All patients were divided into ordinary, severe, and critical groups according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). Demographic, clinical characteristics and liver biomarkers were compared among the three groups.Results: During hospitalization, AST, TBiL, and ALP levels in ordinary and severe patients fluctuated within the normal range with a rising trend in critical patients except AST. ALT and GGT levels fluctuated within the normal range showing an upward trend, while LDH levels in the critical group exceeded the normal range. Prealbumin showed an upward trend, especially in the severe group. At discharge, AST and LDH levels in ordinary and severe groups were lower than their baselines but increased in the critical group. In contrast to albumin, TBiL levels were increased in ordinary and critical groups while decreased in the severe group. The stratified analysis revealed factors affecting liver function in critical cases included highest temperature ≥38.0°C, age ≥60 and symptom of hypoxemia.Conclusions: COVID-19 can cause severe hepatic dysfunction in critical patients, requiring early monitoring and intervention. LDH, ALP, GGT, TBiL, prealbumin, and albumin may be helpful for evaluating and predicting disease prognosis due to their correlation with disease severity in COVID-19.

Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic

ABSTRACT Background: The current COVID-19 pandemic is associated with a variety of stressors. Preliminary research has demonstrated that general public are experiencing a range of psychological problems, including stress-related disturbances. However, to date, there is not much research on the prevalence of adjustment disorder during the current pandemic. Objectives: This study aimed to assess the prevalence and severity of symptoms of adjustment disorder compared to posttraumatic symptoms, depression and generalized anxiety in a large sample of adult Poles, in the first phase of the current pandemic. Method: Self-report data from a web-based sample (N = 1,742) was collected between March 25 and April 27, just after the introduction of nationwide quarantine measures in Poland. Results: The current COVID-19 pandemic was a highly stressful event for 75% of participants and the strongest predictor of adjustment disorder. Increased symptoms of adjustment disorder were reported by 49%, and they were associated with female gender and not having a full-time job. However, after exclusion of co-occurring symptomatology, 14% of the sample were finally qualified as meeting diagnostic criteria of adjustment disorder. A substantial proportion of the sample screened also positive for generalized anxiety (44%) and depression (26%); the rate for presumptive PTSD diagnosis was 2.4%. Conclusions: High rates of negative mental health outcomes were found in the Polish population in the first weeks into the COVID-19 pandemic and lockdown measures. They indicate the intense current stress-related symptoms in the early phase of the pandemic and warrant further monitoring on population’s mental health.

Clinical and Radiological Outcomes of Recovered COVID-19 Patients- An Observational Study during the Early Phase of Pandemic

Introduction: The pandemic caused by the Coronavirus Disease 2019 (COVID-19) has caused huge economic and health crisis. It is reported to have pulmonary sequelae which can overburden the healthcare systems. Survivors needing medical attention in the form of pulmonary rehabilitation should be prioritised. Aim: To study the impact of COVID-19 infection in terms of the pulmonary and extrapulmonary sequelae. Materials and Methods: This cross-sectional observational study was carried out at a tertiary hospital in India. Recovered COVID-19 patients who were admitted from April to July 2020 were enrolled. Participants with radiological evidence of pneumonia during hospitalisation were assessed two months post-discharge. They were evaluated for persistent symptomatology, chest radiography, Six-Minute Walk Test (6MWT). The relationship between the outcome parameters with the baseline epidemiology, laboratory and radiology were evaluated by using student t-test, Mann- Whitney U test and multivariate logistic regression analysis. Results: Thirty participants were recruited. Their mean age was 47.93 years. Males were more than females. Persistent symptoms were reported by 17 (56.66%) and 4 (13.33%) developed pulmonary fibrosis on Chest X-Ray (CXR). Prolonged hospitalisation (mean &gt;20 days) strongly correlated to the fibrosis (p=0.022). A fall in the finger oxygen saturation after the 6MWT was significant (p≤0.001). Higher serum levels of lactate dehydrogenase and D-dimer were associated with a more severe disease (p=0.02 and p≤0.001, respectively). Conclusion: Convalescent phase of COVID-19 is characterised by persistent symptomatology in half of the recovered patients. Simple and inexpensive CXRs and the 6MWT can be used as the primary investigation to identify post COVID-19 patients requiring pulmonary rehabilitation in resource limited settings.

Changes of perceptions and behaviours during the phases of COVID-19 pandemic in German elderly people with neurological disorders: an observational study using telephone interviews

ObjectivesDescribing perceived limitations in everyday life, psychological burden and approval to easing of measures during the COVID-19 phases in elderly people with neurological disorders.DesignObservational, prospective studySettingThis is a monocentric study...

First few cases of COVID-19 admitted in a teaching hospital of North Kerala – Insights gained on the clinico-epidemiological presentations, management and patient perceptions on transmission dynamics

Introduction: The first case of COVID-19 in India was confirmed in Kerala on January 2020, with the state effectively crushing the epidemic curve. Objectives: This study aims to describe the clinico-epidemiological profile and transmission dynamics of confirmed COVID-19 cases admitted in our health care facility. Materials and Methods: A case series study of 19 laboratory-confirmed cases in the early pandemic phase was done (13th March–April 9th 2020). Information on sociodemographic variables, exposure histories, clinical symptoms, and treatment were collected from case records and in-depth telephonic interviews. Descriptive analysis of selected variables was done. Incubation periods and receipt of infection were estimated from patient histories. Results: About 78.9% were male, in the age group of 22–86 years (Median-42 years). 18/19 (94.7%) of laboratory-confirmed cases were imported, half of them from UAE. Fever and cough were the predominant symptoms, followed by sore throat, breathlessness, headache, muscle pain, and loose stools with majority (85%) reporting mild symptoms. Five patients were asymptomatic. Mean duration from symptom onset to reporting is 4 ± 4.47 days. Two patients developed complications, one requiring hemodialysis and ventilator support. About 42% of patients had at least one comorbidity. Mean duration of symptom clearance and hospital stay was 6.76 days and 19.41 ± 6.801 days, respectively. Virological clearance was noted in 13.06 ± 7.32 days. Conclusions: Epidemiological findings from these cases aided in prompt public health responses across the districts in Kerala.

Analysis of Scientific Publications During the Early Phase of the COVID-19 Pandemic: Topic Modeling Study.

BackgroundThe COVID-19 pandemic has spread at an alarming speed, and effective treatment for the disease is still lacking. The body of evidence on COVID-19 has been increasing at an impressive pace, creating the need for a method to rapidly assess the current knowledge and identify key information. Gold standard methods such as systematic reviews and meta-analyses are regarded unsuitable because they have a narrow scope and are very time consuming.ObjectiveThis study aimed to explore the published scientific literature on COVID-19 and map the research evolution during the early phase of the COVID-19 pandemic.MethodsWe performed a PubMed search to analyze the titles, keywords, and abstracts of published papers on COVID-19. We used latent Dirichlet allocation modeling to extract topics and conducted a trend analysis to understand the temporal changes in research for each topic, journal impact factor (JIF), and geographic origin.ResultsBased on our search, we identified 16,670 relevant articles dated between February 14, 2020, and June 1, 2020. Of these, 6 articles were reports from peer-reviewed randomized trials on patients with COVID-19. We identified 14 main research topics, of which the most common topics were health care responses (2812/16,670, 16.86%) and clinical manifestations (1828/16,670, 10.91%). We found an increasing trend for research on clinical manifestations and protective measures and a decreasing trend for research on disease transmission, epidemiology, health care response, and radiology. Publications on protective measures, immunology, and clinical manifestations were associated with the highest JIF. The overall median JIF was 3.7 (IQR 2.6-5.9), and we found that the JIF for these publications declined over time. The top countries producing research were the United States, China, Italy, and the United Kingdom.ConclusionsIn less than 6 months since the novel coronavirus was first detected, a remarkably high number of research articles on COVID-19 have been published. Here, we discuss and present the temporal changes in the available COVID-19 research during the early phase of the pandemic. Our findings may aid researchers and policy makers to form a structured view of the current COVID-19 evidence base and provide further research directions.

COVD-12. THE LONGITUDINAL IMPACT OF COVID-19 PANDEMIC ON NEUROSURGICAL PRACTICE

OBJECTIVEThis observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice.METHODSWe included 29 participating neurosurgeons in centers from all geographical regions in the Kingdom of Saudi Arabia. The study period, which was between March 5, 2020 and May 20, 2020, was divided into three equal periods to determine the longitudinal effect of COVID-19 measures on neurosurgical practice over time.RESULTSDuring the 11-week study period, 474 neurosurgical interventions were performed. The median number of neurosurgical procedures per day was 5.5 (interquartile range [IQR]: 3.5–8). The number of cases declined from 72 in the first week and plateaued at the 30’s range in subsequent weeks. The most and least number of performed procedures were oncology (129 [27.2%]) and functional procedures (6 [1.3%]), respectively. Emergency (Priority 1) cases were more frequent than non-urgent (Priority 4) cases (178 [37.6%] vs. 74 [15.6%], respectively). In our series, there were three positive COVID-19 cases. There was a significant among-period difference in the length of hospital stay, which dropped from a median stay of 7 days (IQR: 4 – 18) to 6 (IQR: 3 - 13) to 5 days (IQR: 2 - 8). There was no significant among-period difference with respect to institution type, complications, or mortality.CONCLUSIONOur study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post-pandemic health-care system intolerable overload.

The powder keg: Lessons learned about clinical staff preparedness during the early phase of the COVID-19 pandemic

BackgroundLittle is known about clinical staff's perspectives on preparedness for a pandemic. The purpose of this study was to obtain various clinical staff perspectives about preparedness to meet the demands for care during the early phase of the SARS-CoV-2 (COVID-19) pandemic.MethodsWe conducted a qualitative study using semistructured in-person interviews from March 2020 to April 2020 at a large tertiary academic urban hospital center. Interview guides were informed by the Resilience Framework for Public Health Emergency Preparedness and analyzed using a directed content analysis approach.ResultsFifty-five clinical staff participated in the study. Three themes emerged from the data (1) Risk assessment and planning: “The powder keg,” (2) Innovative evolution of roles and responsibilities, and (3) Pandemic response and capacity. In the early phases of the pandemic, participants reported varying levels of risks for dying. However, most participants adapted to practice changes and became innovative in their roles over time. Hierarchies were less relevant during care delivery, whereas team collaboration became crucial in managing workforce capacity.DiscussionAs the pandemic progressed, staff preparedness evolved through a trial-and-error approach.ConclusionsThe pandemic is evolving as is clinical staff preparedness to meet the demands of a pandemic. In order to get a grasp on the crisis, clinical staff relied on each other and resorted to new workarounds.

283 Using Google Trends to Determine Perceived Viral Exposure during the Early Phase of the COVID-19 Pandemic in the United States

Public interest in diseases during outbreaks has been previously studied by examining internet activity via Google Trends (Google, Mountain View, California), a tool that measures the popularity of internet searches longitudinally and geographically. Recently, Google Trends has been used as a surveillance and retrospective epidemiological tool to study the impact of COVID-19 in China, Taiwan, France, and Iran. However, studies that focus on the United States are significantly lacking. Using Google Trends, our aim in this study was to assess the extent of the public’s perceived exposure to COVID-19 as it relates to disease prevalence during the early phase of the pandemic in the United States. We utilized Google Trends to determine the search activity for: “Do I have coronavirus,” “How to get tested for coronavirus,” “What is coronavirus,” “Signs and symptoms of coronavirus” and “How is coronavirus spread.” We collected four weeks of Search Volume Index (SVI) data between February 17th and March 16th, 2020. The mean SVIs for the 5 states with the highest and lowest number of COVID-19 confirmed cases (as of March 16, 2020) were calculated for each query. To obtain the number of confirmed COVID-19 cases in the United States, we referred to a tracker provided by Johns Hopkins University. Scatterplots were then created to compare SVI and number of COVID-19 cases on a state level. Pearson correlations were determined to examine the association between SVI and the number of COVID-19 confirmed cases as of March 16, 2020. Peak SVI for all queries took place on March 12, just a day prior to the U.S. declaration of national emergency. “Do I have coronavirus” (p=0.005), “How to get tested for coronavirus” (p=0.01), and “Signs and symptoms of coronavirus” (p=0.05) were identified as having statistically significant differences in mean SVI between states with the highest and lowest number of COVID-19 cases (Table 1). Mean SVI for “Do I have coronavirus” and “How to get tested for coronavirus” was higher in the states with the most COVID-19 cases compared to the bottom 5 states with the least cases. However, mean SVI for “Signs and symptoms of coronavirus” was higher in the bottom 5 states compared to the top 5 states. There were no statistically significant differences in mean SVI for the remaining queries: “What is coronavirus” (p=0.48) and “How is coronavirus spread” (p=0.21).When looking at all 50 states and the District of Columbia, we found that SVI also positively correlated with the number of confirmed COVID-19 cases for “Do I have coronavirus” and “How to get tested for coronavirus” (R=.387, p=0.005; R=0.367, p=0.008). No statistically significant correlations were found for “How is coronavirus spread” (p=0.45), “What is coronavirus” (p=0.39), and “Signs and symptoms of coronavirus” (p=0.22). Non-generic queries in Google Trends may yield better insights into health information-seeking behavior. Specifically, queries formatted as “How to get tested for ____” and “Do I have _____” could reflect perceived exposure to a communicable disease on a population level. To our knowledge, our study is the first to use Google Trends to distinguish queries that reflect perceived exposure to COVID-19 from those that are borne out by general interest in the United States. Early access to population health data is crucial and potentially life-saving during outbreaks. Digital tools such as Google Trends may help bridge the gap in knowledge and transparency.Table 1This table shows the Google queries and their corresponding SVIs for states that have the highest and lowest number of confirmed COVID-19 casesGoogle QueriesStates most affected by COVID-19 (# of confirmed cases)States least affected by COVID-19 (# of confirmed cases)Mean SVI for top 5 states (SD)Mean SVI for bottom 5 states (SD)P-value“Do I have coronavirus”New York (732) Washington (643) California (426) Massachusetts 164) Colorado (131)Oklahoma (7) Hawaii (6) Idaho (5) Missouri (5) Wyoming (3)* Alaska (1)* North Dakota (1)*76 (7)54 (11)0.005“How to get tested for coronavirus”59 (5)38 (14)0.01“Signs and symptoms of coronavirus”28 (4)45 (16)0.05“What is coronavirus”81 (7)85 (10)0.48“How is coronavirus spread”56 (7)65 (13)0.21* For some queries, these states did not yield an SVI due to insufficient data in Google Trends and were therefore not included in the analysis. Open table in a new tab

The longitudinal impact of COVID-19 pandemic on neurosurgical practice

ObjectiveThis observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice. MethodsWe included 29 participating neurosurgeons in centers from all geographical regions in the Kingdom of Saudi Arabia. The study period, which was between March 5, 2020 and May 20, 2020, was divided into three equal periods to determine the longitudinal effect of COVID-19 measures on neurosurgical practice over time. ResultsDuring the 11-week study period, 474 neurosurgical interventions were performed. The median number of neurosurgical procedures per day was 5.5 (interquartile range [IQR]: 3.5–8). The number of cases declined from 72 in the first week and plateaued at the 30′s range in subsequent weeks. The most and least number of performed procedures were oncology (129 [27.2 %]) and functional procedures (6 [1.3 %]), respectively. Emergency (Priority 1) cases were more frequent than non-urgent (Priority 4) cases (178 [37.6 %] vs. 74 [15.6 %], respectively). In our series, there were three positive COVID-19 cases. There was a significant among-period difference in the length of hospital stay, which dropped from a median stay of 7 days (IQR: 4–18) to 6 (IQR: 3–13) to 5 days (IQR: 2–8). There was no significant among-period difference with respect to institution type, complications, or mortality. ConclusionOur study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post pandemic health-care system intolerable overload.

Martini-Klinik experience of prostate cancer surgery during the early phase of the COVID-19 pandemic.

Martini-Klinik experience of prostate cancer surgery during the early phase of the COVID-19 pandemic.

COVID-19: Wissensstand, Risikowahrnehmung und Umgang mit der Pandemie

IntroductionIn order to stem the spread of an epidemic, widespread adherence to safety measures and their acceptance within the German population are of key importance.This survey examines the levels of knowledge and the perception of risk within the population and analyses implementation and adherence to the recommended and legally mandated safety measures in the early phase of the COVID-19 pandemic. MethodsIn March 2020, participants registered on the HeReCa-Online-Panel from Saxony-Anhalt, Berlin and Schleswig Holstein were invited to complete a 65-question survey. Results1048 respondents answered the questionnaire, which amounts to a response of 3.5%. 83% of respondents stated that they felt themselves to be well-informed or very well-informed concerning COVID-19 and the coronavirus. The majority of respondents reported fears for the well-being of family members (60%) or the health of the German population as a whole (45%); 79% reported concerns regarding adverse economic impacts. 79% of respondents have implemented individual protective measures, such as reducing social contacts and maintaining the recommended physical distance in public spaces. Most respondents regarded the government-mandated safety measures as predominantly reasonable and appropriate. ConclusionsIn the early phase of the pandemic, most people kept themselves informed about of COVID-19 and started to take individual measures for risk reduction. Acceptance of governmental measures to stem the spread of the pandemic was high.

Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic

On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring. To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms. This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020. The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19. Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms. Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently.