Post Coronavirus Disease 2019 Research Articles

Urgent Need for Studies of the Late Effects of SARS-CoV-2 on the Cardiovascular System.

Urgent Need for Studies of the Late Effects of SARS-CoV-2 on the Cardiovascular System.

Strategies to Maximize Available Resources With Minimum Cost Escalation for Improving Radiation Therapy Accessibility in the Post–Coronavirus Disease 2019 Era: An Analysis for Asia

PurposeThere is widespread accord among economists that the coronavirus disease 2019 (COVID-19) pandemic will have a severe negative effect on the global economy. Establishing new radiation therapy (RT) infrastructure may be significantly compromised in the post–COVID-19 era. Alternative strategies are needed to improve the existing RT accessibility without significant cost escalation. The outcomes of these approaches on RT availability have been examined for Asia. Methods and MaterialsThe details of RT infrastructures in 2020 for 51 countries in Asia were obtained from the Directory of Radiotherapy Centers of the International Atomic Energy Agency. Using the International Atomic Energy Agency guidelines, the percent of RT accessibility and the additional requirements of teletherapy (TRT) units were computed for these countries. To maximize the utilization of the existing RT facilities, 5 options were evaluated, namely, hypofractionation RT (HFRT) alone, with/without 25% or 50% additional working hours. The effect of these strategies on the percent of RT access and additional TRT unit requirements to achieve 100% RT access were estimated. ResultsIn 46 countries, 4617 TRT units are available. The mean percent of RT accessibility is 62.4% in 43 countries (TRT units = 4491) where the information on cancer incidence was also available, and these would need an additional 6474 TRT units for achieving 100% RT accessibility. By adopting HFRT alone, increasing the working hours by 25% alone, 25% with HFRT, 50% alone, and 50% with HFRT, the percent of RT access could improve to 74.9%, 78%, 90.5%, 93.7%, and 106.1%, respectively. Correspondingly, the need for additional TRT units would progressively decrease to 4646, 4284, 3073, 2820, and 1958 units. ConclusionsThe economic slowdown in the post–COVID-19 period could severely impend establishment of new RT facilities. Thus, maximal utilization of the available RT infrastructure with minimum additional costs could be possible by adopting HFRT with or without increased working hours to improve the RT coverage.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Recommendations for Testing and Treating Outpatient Cancer Patients in the Era of COVID-19.

The clinical spectrum of coronavirus disease 2019 (COVID-19) is still not fully understood. Cancer patients are uniquely vulnerable to COVID-19, and many have been or will be infected. Although an unfortunate minority will die from the infection, most will recover. This poses a challenge in which clinicians must weigh the benefits of initiation or resumption of antineoplastic therapy against the risks that antineoplastic treatment may worsen outcomes related to COVID-19 infection. A recent study of 423 patients at our institution found that patients in active cancer treatment who develop COVID-19 infection did not fare any worse than other hospitalized patients, yet guidance as to who requires testing prior to antineoplastic therapy and when to resume therapy post–COVID-19 diagnosis remains unknown. Our institution, therefore, commissioned a task force to help create guidelines for treating oncologists using available published literature. The task force focused on the ambulatory care testing guidelines only, because all inpatients receiving antineoplastic therapy are tested for COVID-19 prior to hospital admission. The guidelines focus solely on the safety and well-being of the individual patient undergoing antineoplastic therapy and are not designed to address infection control issues.

COVID-19 After Effects: Concerns for Singers

COVID-19 After Effects: Concerns for Singers

Inequities During COVID-19.

* Abbreviation: COVID-19 — : coronavirus disease 2019 The coronavirus disease 2019 (COVID-19) pandemic has created a time of unprecedented isolation, despair, and harm. Although COVID-19 does not intrinsically discriminate on the basis of race, sex, or socioeconomic class, the effects of the pandemic seem to be more deleterious for minorities. According to some preliminary research, the pediatric population has been relatively spared the severe consequences of COVID-19.1 However, underneath the COVID-19 infections, there is a hidden pandemic that affects minority children in direct and indirect ways with potential long-term consequences. At the end of April 2020, the Centers for Disease Control and Prevention began to systematically collect ethnicity, race, and socioeconomic data at the national level. Although the compiled results are still pending, statewide data have revealed significant inequities in the rates of confirmed cases and mortality. For example, in Massachusetts, an estimated 35% to 40% of Massachusetts General Hospital’s patients with COVID-19 are Hispanic, in comparison with 9% of the patient population before the outbreak.2 Furthermore, the shortage of interpreters also posed additional challenges for communications of treatments and care to minority patients and families with limited English proficiency. Because the rates of COVID-19 among people of color seem to be higher, minority children are presumably even more likely to be exposed to infection from their parents and guardians. In addition, minority children are more likely to have underlying conditions that may exacerbate the severity of COVID-19 infections; for example, minority children are more likely to have major chronic diseases, such as, asthma and … Address correspondence to Adrian Jacques H. Ambrose, MD, MPH, FAPA, Office for Diversity and Community, Harvard University, 164 Longwood Ave, Second Floor, Boston, MA 02115. E-mail: adrianjacques_ambrose{at}hms.harvard.edu

Leveraging telecommuting pharmacists in the post–COVID-19 world

In response to the coronavirus disease 2019 (COVID-19) pandemic, many industries, including pharmacy, rapidly expanded the use of telecommuting workers to assure business continuity and address social distancing needs. Advances in electronic health records and telepharmacy over the past 2 decades enabled pharmacy leaders to easily adapt their practice models to allow for telecommuting alternatives during the pandemic. While these changes were generally intended to be part of the short-term response, the sustained expansion of telecommuting within the pharmacy profession merits further exploration. Documented experience with telepharmacy and telehealth indicate a wide array of clinical and operational pharmacist activities that could be conducted by telecommuters. In addition, experience with telecommuters in other industries suggests potential benefits ranging from improving pharmacists' work-life balance to mitigating postpandemic financial burden. Health care organizations should consider integrating part-time telecommuter pharmacists into contemporary practice models to address other frontline issues and facilitate ongoing expansion of clinical pharmacy services to meet emerging patient needs.

An Empirical Examination of the Socio-Economic Consequences of Corona Virus Disease 2019 (Covid-19) Outbreak in US, UK, Germany and China: A Structural Equation Modelling Approach

This paper critically examines the socio-economic impact of the Corona virus Disease 2019 (COVID-19), focusing on four developed nations of the world, including China, Germany, UK and US. Survey data was used to analyze the relationship between eight critical socio-economic variables, including economic stability, daily living, mental health, worry about COVID-19, satisfaction with the national government's response to the COVID-19, people's personal finances, satisfaction with fellow citizens' response to the COVID-19, and satisfaction with hospitals' response to the COVID-19. Considering the complexity of the interrelationship between the variables, a structural equation modelling approach was used to assess the impact of the COVID-19 on these variables. Result shows that the COVID-19 pandemic has affected the daily lives of people. This is also having negative effect on their ability to contribute meaningfully to economic activities, which ultimately affects the economic stability of their nations as a whole. The result from this study also shows the importance of the health sector in nation-building. The health sector has critical roles to play beyond taking care of the sick that have contracted the COVID-19. The health sector is critical in inspiring confidence in the public and causing citizens to be mentally, psychologically and emotionally stable. Mental stability is needed for citizens to carry out their economic activities and contribute meaningfully to economic stability; therefore, the health sector has important role to play during and after the COVID-19 outbreak. The findings from this paper draws the attention of the government as a critical force in resuscitating the economy post COVID-19. The government would have to formulate and implement policies that will inspire confidence as at present, people are somewhat not satisfied with the national government's response to the COVID-19 / coronavirus pandemic, as the level of satisfaction is just average. Keywords: corona virus; COVID-19; disease; pandemic, economic stability; socio-economic; wellbeing, structural-equation. DOI: 10.7176/IAGS/68-04 Publication date: July 31 st 2020

Radical Incrementalism and Trust in the Citizen: Income Security in Canada in the Time of COVID-19.

This article documents Canada’s main public policy responses to promote income security among working-age adults during the coronavirus disease 2019 (COVID-19) crisis between March and early June 2020. This period of rapid policy change unfolded broadly in three phases, starting with minor adjustments to existing policy instruments, followed by larger amendments to a wider range of programs, and finally ending with the creation of new and quite generous benefits. The pathway of policy change is best described as incremental, but it resulted in a more radical shift to “trust but verify” to administer benefits rather than the pre–COVID-19 practice of verifying eligibility before paying benefits. The reasons and precedents for this decision are discussed. I conclude with some observations on the applicability and limitations of trust but verify for income security policy in the post–COVID-19 period.

COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors

Up to 20%–30% of patients hospitalized with coronavirus disease 2019 (COVID-19) have evidence of myocardial involvement. Acute cardiac injury in patients hospitalized with COVID-19 is associated with higher morbidity and mortality. There are no data on how acute treatment of COVID-19 may affect the convalescent phase or long-term cardiac recovery and function. Myocarditis from other viral pathogens can evolve into overt or subclinical myocardial dysfunction, and sudden death has been described in the convalescent phase of viral myocarditis. This raises concerns for patients recovering from COVID-19. Some patients will have subclinical and possibly overt cardiovascular abnormalities. Patients with ostensibly recovered cardiac function may still be at risk of cardiomyopathy and cardiac arrhythmias. Screening for residual cardiac involvement in the convalescent phase for patients recovered from COVID-19–associated cardiac injury is needed. The type of testing and therapies for post COVID-19 myocardial dysfunction will need to be determined. Therefore, now is the time to plan for appropriate registries and clinical trials to properly assess these issues and prepare for long-term sequelae of “post–COVID-19 cardiac syndrome.”

Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging

ObjectivesThis study evaluated cardiac involvement in patients recovered from coronavirus disease-2019 (COVID-19) using cardiac magnetic resonance (CMR). BackgroundMyocardial injury caused by COVID-19 was previously reported in hospitalized patients. It is unknown if there is sustained cardiac involvement after patients’ recovery from COVID-19. MethodsTwenty-six patients recovered from COVID-19 who reported cardiac symptoms and underwent CMR examinations were retrospectively included. CMR protocols consisted of conventional sequences (cine, T2-weighted imaging, and late gadolinium enhancement [LGE]) and quantitative mapping sequences (T1, T2, and extracellular volume [ECV] mapping). Edema ratio and LGE were assessed in post–COVID-19 patients. Cardiac function, native T1/T2, and ECV were quantitatively evaluated and compared with controls. ResultsFifteen patients (58%) had abnormal CMR findings on conventional CMR sequences: myocardial edema was found in 14 (54%) patients and LGE was found in 8 (31%) patients. Decreased right ventricle functional parameters including ejection fraction, cardiac index, and stroke volume/body surface area were found in patients with positive conventional CMR findings. Using quantitative mapping, global native T1, T2, and ECV were all found to be significantly elevated in patients with positive conventional CMR findings, compared with patients without positive findings and controls (median [interquartile range]: native T1 1,271 ms [1,243 to 1,298 ms] vs. 1,237 ms [1,216 to 1,262 ms] vs. 1,224 ms [1,217 to 1,245 ms]; mean ± SD: T2 42.7 ± 3.1 ms vs. 38.1 ms ± 2.4 vs. 39.1 ms ± 3.1; median [interquartile range]: 28.2% [24.8% to 36.2%] vs. 24.8% [23.1% to 25.4%] vs. 23.7% [22.2% to 25.2%]; p = 0.002; p < 0.001, and p = 0.002, respectively). ConclusionsCardiac involvement was found in a proportion of patients recovered from COVID-19. CMR manifestation included myocardial edema, fibrosis, and impaired right ventricle function. Attention should be paid to the possible myocardial involvement in patients recovered from COVID-19 with cardiac symptoms.

A Roadmap to Reopening a Neurosurgical Practice in the Age of COVID-19

BackgroundThe Coronavirus disease 2019 (COVID-19) outbreak has left a lasting mark on medicine globally.MethodsHere we outline the steps that the Lenox Hill Hospital/Northwell Health Neurosurgery Department—located within the epicenter of the pandemic in New York City—is currently taking to recover our neurosurgical efforts in the age of COVID-19.ResultsWe outline measurable milestones to identify the transition to the recovery period and hope these recommendations may serve as a framework for an effective path forward.ConclusionsWe believe that recovery following the COVID-19 pandemic offers unique opportunities to disrupt and rebuild the historical patient and office experience as we evolve with modern medicine in a post–COVID-19 world.

Primary and Secondary Prevention of Cardiovascular Disease in the Era of the Coronavirus Pandemic.

No abstract available Keywords: COVID-19; cardiovascular diseases; primary prevention; secondary prevention.

Tele-education for hepatology residents in Bangladesh during the Covid-19 pandemic.

Tele-education for hepatology residents in Bangladesh during the Covid-19 pandemic.

Quick Clinical Note: Emergency care includes prevention of influenza

To address the lack of information about clinical sequelae of coronavirus disease 2019 (COVID-19).Previously hospitalized COVID-19 patients who were attending the outpatient clinic for post–COVID-19 patients (ASST Ovest Milanese, Magenta, Italy) were included in this retrospective study. They underwent blood draw for complete blood count, C-reactive protein, ferritin, D-dimer, and arterial blood gas analysis and chest high-resolution computed tomography (HRCT) scan. The primary endpoint was the assessment of blood gas exchanges after 3 months. Other endpoints included the assessment of symptoms and chest HRCT scan abnormalities and changes in inflammatory biomarkers after 3 months from hospital admission.Eighty-eight patients (n = 65 men; 73.9%) were included. Admission arterial blood gas analysis showed hypoxia and hypocapnia and an arterial partial pressure of oxygen/fractional inspired oxygen ratio of 271.4 (interquartile range [IQR]: 238-304.7) mm Hg that greatly improved after 3 months (426.19 [IQR: 395.2-461.9] mm Hg, P<.001). Forty percent of patients were still hypocapnic after 3 months. Inflammatory biomarkers dramatically improved after 3 months from hospitalization. Fever, resting dyspnea, and cough were common at hospital admission and improved after 3 months, when dyspnea on exertion and arthralgias arose. On chest HRCT scan, more than half of individuals still presented with interstitial involvement after 3 months. Positive correlations between the interstitial pattern at 3 months and dyspnea on admission were found. C-reactive protein at admission was positively associated with the presence of interstitial involvement at follow-up. The persistence of cough was associated with presence of bronchiectasis and consolidation on follow-up chest HRCT scan.Whereas inflammatory biomarker levels normalized after 3 months, signs of lung damage persisted for a longer period. These findings support the need for implementing post–COVID-19 outpatient clinics to closely follow-up COVID-19 patients after hospitalization.