Transmission Of 2019-nCoV Research Articles

New coronavirus pneumonia and outbreak epidemic virus and eye disease

Since the outbreak of the new coronavirus pneumonia (NCP) in Wuhan City, China, the main transmission mode as well as the diagnosis and treatment of NCP have become a focus of research in China and World Health Organizations. Understanding the mode of infection, transmission and biological behavior of the novel coronavirus (2019-nCoV) is undoubtedly a key of cutting off the spread and prevention of the disease which doctors are fearing to be a worldwide epidemic. In February 2019, Lancet published a correspondence paper, which reviewed a case of NCP patient who first started with conjunctivitis, and raised the issue that the transmission of 2019-nCoV through the ocular surface must not be ignored, causing widespread concern. However, due to a lack of clinical observation data and laboratory research at present, the relationship between NCP pathogen infection and ocular surface infection is not completely clear. So far, there have been many studies and reports on the observation of large-scale epidemic virus infections and eye diseases. This article reviews the eye performance of various types of epidemic virus infections and provides a reference for NCP prevention and control. Key words: Novel coronavirus; Pneumonia; Epidemic; Virus; Infection; Eye disease

Physical distancing, face masks, and eye protection for prevention of COVID-19

Physical distancing, face masks, and eye protection for prevention of COVID-19

Six weeks into the 2019 coronavirus disease outbreak: it is time to consider strategies to impede the emergence of new zoonotic infections.

Six weeks into the 2019 coronavirus disease outbreak: it is time to consider strategies to impede the emergence of new zoonotic infections.

Role of the Eye in Transmitting Human Coronavirus: What We Know and What We Do Not Know.

The outbreak of the current 2019 novel coronavirus (2019-nCoV, now named SARS-CoV-2) infection has become a worldwide health threat. Currently, more information is needed so as to further understand the transmission and clinical characteristics of 2019-nCoV infection and the infection control procedures required. Recently, the role of the eye in transmitting 2019-nCoV has been intensively discussed. Previous investigations of other highly infectious human CoVs, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), may provide useful information. In this review, we describe the genomics and morphology of human CoVs, the epidemiology, systemic and ophthalmic manifestations, and mechanisms of human CoV infection, and recommendations for infection control procedures. The role of the eye in the transmission of 2019-nCoV is discussed in detail. Although the conjunctiva is directly exposed to extraocular pathogens, and the mucosa of the ocular surface and upper respiratory tract are connected by the nasolacrimal duct and share the same entry receptors for some respiratory viruses, the eye is rarely involved in human CoV infection, conjunctivitis is quite rare in patients with 2019-nCoV infection, and the CoV RNA positive rate by RT-PCR test in tears and conjunctival secretions from patients with 2019-nCoV and SARS-CoV infection is also extremely low. This suggests that the eye is neither a preferred organ of human CoV infection nor a preferred gateway of entry for human CoVs for infecting the respiratory tract. However, pathogens that the ocular surface is exposed to might be transported to nasal and nasopharyngeal mucosa by constant tear rinsing through the lacrimal duct system and then cause respiratory tract infection. Considering that close doctor-patient contact is quite common in ophthalmic practice and is apt to transmit human CoVs by droplets and fomites, strict hand hygiene and proper personal protection are highly recommended for health care workers to avoid hospital-related viral transmission during ophthalmic practice.

Transmission Routes and Infection Control of Novel Coronavirus-2019 in Dental Clinics – A Review

The novel Coronavirus (nCoV-19) pandemic began in Wuhan, China with Severe Acute Respiratory Syndrome (SARS) in December, 2019. The virus transmitted from China to other countries by traveling of the infected individuals. The number of infected populations with Coronavirus is increasing day by day with an increased mortality rate. The signs and symptoms of the disease include fever, non-productive cough, dyspnea, and fatigue. The transmission routes of the virus include respiratory secretions or droplet infection and direct contact with the infected person. Dentists are a group of professionals that are highly exposed to infectious diseases. The nCoV-19 is transmitted from patient to dentist and dentist to patient mainly through aerosol and splatter produced by the dental procedure and saliva of an infected person. To avoid transmission of the virus from patient to dentist and from dentist to other patients, screening tests should be done at dental setups. The use of gloves, face shields, masks, gowns, and antiseptic handwash are mandatory for the dentist. Awareness programs should be conducted to prevent further transmission of the disease. We searched Google, Google Scholar, WHO website for coronavirus and National Institute of Health website (nih.org.pk) for relevant literature by using various MeSH terms including ‘2019-nCoV’, ‘transmission of 2019-nCoV in dental clinics’, ‘dentistry and COVID-19’ and ‘infection control’, etcKey words: COVID-19, Dental clinics, Infection control, Transmission

DENTAL CONSIDERATIONS AMIDST COVID-19 SCARE

A Novel coronavirus (2019-nCoV) identified in Wuhan city of china capable of causing life threatening respiratory illness declared as a pandemic by WHO and has become a global fear among the community and healthcare professionals in 2020. 2019-nCoV is a positive stranded RNA virus having an origin from bats targets the host cells via the enzyme Angiotensin Converting enzyme 2(ACE2), which is most abundant in the type II alveolar cells of the lungs. This virus has usual incubation period of approximate 5 days and typically spread from one person to another via respiratory droplets produced during coughing and sneezing. Spread of this virus in the community has been reported through direct transmission route such as cough, droplet transmission, aerosols, salivary route, ocular and through the contact spread. As the dental practice compels dentists to come in face to face contact with the patients and aerosols during certain dental procedures leading to the heightened risk of 2019-nCoV transmission from infected patients. We hereby make an attempt to discuss 2019-nCoV infection spread in the community and among dentist, including precautions and considerations pertaining to the practice of dentistry amidst 2019-nCoV scare.

How Should Rehabilitative Departments of Hospitals Prepare for Coronavirus Disease 2019?

To the Editor: On March 11, 2020, the World Health Organization declared the coronavirus disease (COVID-19) a pandemic as it had spread to more than 100 countries worldwide. As can be observed in China and South Korea, COVID-19 caused by the novel coronavirus (2019-nCoV) will challenge the bed capacity, equipment, and healthcare staff of the rehabilitation department, as in other departments, like never before. According to previous reports, COVID-19 seems highly contagious, as seen in the case of infection in a church group and call center in South Korea.1 Considering that 2019-nCoV is easily spread in a limited space, it can also be highly contagious during rehabilitation treatments because of the need for physical contacts and communications between the therapist and the patient. Against the massive influx of patients with COVID-19, how can we prepare to care for patients in need of rehabilitation treatments? FREQUENT CHECKS FOR SYMPTOMS SUCH AS FEVER, COUGH, DYSPNEA, OR RHINORRHEA IN PATIENTS OR STAFF The coronavirus disease is believed to be highly contagious and symptomatic, although silent transmission of asymptomatic cases has also been reported. Frequent symptom check in patients or medical staff before rehabilitation can minimize the spread of the virus in confined spaces such as physical therapy rooms. MASK WEARING DURING TREATMENT The novel coronavirus has been reported to spread through droplets and airborne transmission.2,3 These two main routes of 2019-nCoV infections are categorized by particle size. Droplet infection is defined when large droplets that carry the infectious agent (>5 μm in diameter) become an infection source.4 By contrast, airborne infection is defined when the infection usually occurs via the respiratory route, with the agent present in aerosols (infectious particles of <5 μm in diameter).4 The droplets tend to be heavy and thus do not go far and stay around the patient (within 2 m of indoor air), mainly causing close-contact transmission. On the other hand, aerosols float through the air and can cause both long-distance contactless infections and close-contact transmission. Preliminary studies have shown that the main transmission route of 2019-nCoV is through respiratory droplets, although airborne transmission cannot be completely excluded. The size of coronavirus is approximately 0.12–0.15 μm5; thus, the 2019-nCoV is not easy to directly filter except with a mask such as N95, which has filtration efficiencies for most penetrating particles sized 0.1–0.3 μm.6 However, wearing a mask such as a surgical or dental mask, as well as the N95 mask, has been reported to have an effect of blocking viral transmissions because the mask filters droplets or aerosols containing virus particles rather than the virus itself.7 The surgical mask is also designed to filter 99.9% of aerosols of 3 μm in size that contain bacteria or viruses. Considering this, not only N95 masks but also surgical masks can also filter out all droplets that contain large amounts of viruses entering or leaving the respiratory tract and a significant amount of aerosols. Considering that a significant amount of viral penetration is required for virus infection, mask wearing for both the therapist and the patient during rehabilitation treatment is believed to show a reduction effect on the transmission of 2019-nCoV. AVOIDING FACE-TO-FACE CONVERSATIONS BETWEEN MEDICAL STAFF AND PATIENTS As seen in the 2019-nCoV infection cases in South Korea, droplets and aerosols, which are produced during conversations, prayers, and singing among people who sit densely in a limited space such as religious facilities like churches, seem to be the main cause of COVID-19 propagation. In addition, COVID-19 can also spread through having a meal and conversation together, as can be observed in many countries. Therefore, avoiding talking and having a meal together while facing each other not only between patients and medical staff but also among medical staff may help prevent the spread of COVID-19. CHANGING THE REHABILITATIVE METHODS FOR PATIENTS WITH SYMPTOMS OR CONTACT HISTORY WITH COVID-19 PATIENTS High false-negative rates in real-time polymerase chain reaction tests for 2019-nCoV have been reported.8 Therefore, if the patient has symptoms or contact with a COVID-19 patient, careful observation and changing to bedside physical therapy in isolation for at least 2 weeks may be helpful in decreasing the COVID-19 propagation rate even if real-time polymerase chain reaction results are negative. The COVID-19 outbreak will cause many limitations in the rehabilitation department and other hospital facilities. Protocols for patient management and treatment plans for patients with COVID-19 in the rehabilitation department must begin in full force before the disease spreads further. Min Cheol Chang, MD Department of Rehabilitation Medicine College of Medicine Yeungnam University Daegu, Republic of KoreaDonghwi Park, MD Department of Physical Medicine and Rehabilitation Ulsan University Hospital University of Ulsan College of Medicine Ulsan, Republic of Korea

Early in the epidemic: impact of preprints on global discourse about COVID-19 transmissibility

Early in the epidemic: impact of preprints on global discourse about COVID-19 transmissibility

Protein Structure and Sequence Reanalysis of 2019-nCoV Genome Refutes Snakes as Its Intermediate Host and the Unique Similarity between Its Spike Protein Insertions and HIV-1.

As the infection of 2019-nCoV coronavirus is quickly developing into a global pneumonia epidemic, the careful analysis of its transmission and cellular mechanisms is sorely needed. In this Communication, we first analyzed two recent studies that concluded that snakes are the intermediate hosts of 2019-nCoV and that the 2019-nCoV spike protein insertions share a unique similarity to HIV-1. However, the reimplementation of the analyses, built on larger scale data sets using state-of-the-art bioinformatics methods and databases, presents clear evidence that rebuts these conclusions. Next, using metagenomic samples from Manis javanica, we assembled a draft genome of the 2019-nCoV-like coronavirus, which shows 73% coverage and 91% sequence identity to the 2019-nCoV genome. In particular, the alignments of the spike surface glycoprotein receptor binding domain revealed four times more variations in the bat coronavirus RaTG13 than in the Manis coronavirus compared with 2019-nCoV, suggesting the pangolin as a missing link in the transmission of 2019-nCoV from bats to human.

2019 novel coronavirus outbreak: a quiz or final exam?

The 2019 novel coronavirus (2019-nCoV) is an emerging pathogen and is threatening the global health. Strikingly, more than 28 000 cases and 550 deaths have been reported within two months from disease emergence. Armed with experience from previous epidemics in the last two decades, clinicians, scientists, officials, and citizens in China are all contributing to the prevention of further 2019-nCoV transmission. Efficient preliminary work has enabled us to understand the basic characteristics of 2019-nCoV, but there are still many unanswered questions. It is too early now to judge our performance in this outbreak. Continuous and strengthened efforts should be made not only during the epidemic, but also afterwards in order to prepare for any incoming challenges.

Will Coronavirus Pandemic Diminish by Summer?

The novel coronavirus (2019-nCoV) has spread rapidly to multiple countries and has been declared a pandemic by the World Health Organization. While influenza virus has been shown to be affected by weather, it is unknown if COVID19 is similarly affected. In this work, we analyze the patterns in local weather of the regions affected by 2019-nCoV virus until March 22, 2020. So far, 83% of testing have been conducted in non-tropical countries (30N and above) and 90% of the 2019-nCoV cases have been recorded in the same countries within a temperature range of 3 to 17C. Similarly, ~72% of the measurements were done in countries with humidity between 3 and 9g/m3 and 90% of the cases were observed within the same range of absolute humidity (AH). The higher number of tests and global connectivity of the northern-cooler countries may explain the difference in number of confirmed 2019-nCoV cases between cooler and warmer-humid regions. Nonetheless, several countries between 30N and 30S such as Australia, UAE, Qatar, Singapore, Bahrain, Qatar and Taiwan have performed extensive testing per capita and the number of positive 2019-nCoV cases per capita are lower in these countries compared to several European countries and the US. Therefore, even though currently available data is skewed by minimal testing per capita in many tropical countries, it is possible that weather plays a role in the spread of 2019-nCoV which warrants an investigation. In the last 10 days, thousands of new cases have been documented in regions with T >18C suggesting that the role of warmer temperature in slowing the spread of the 2019-nCoV, as suggested earlier might only be observed, if at all, at much higher temperatures. Unlike temperature, however, the range of AH across which most of the cases have been documented has consistently been between 3 and 9g/m3​. Current data, although limited, suggests that it is extremely unlikely that the spread of 2019-nCoV would slow down in the USA or Europe, due to environmental factors, because a large number of cases have already been reported in the range of AH and T experienced by these regions for most part of the year. Given previous associations between viral transmission and humidity and the range of AH across which the majority of the 2019-nCoV cases have been observed till date, the role of absolute humidity merits further investigation with laboratory experiments studying the sensitivity of 2019-nCoV across a range of temperature and humidity conditions. On the other hand, if, new cases in April and May continue to cluster within the current observed range of AH i.e. 3 to 9g/m3, then the countries experiencing monsoon, i.e. having high absolute humidity (>10 g/m3) could see a slowdown in transmissions, due to climatic factors. The data analyzed here are rapidly changing and with several unknowns including how the virus is mutating and evolving, what are the reproductive numbers and the dominant way of spreading. If 2019-nCOV is indeed sensitive to environmental factors, then it could be used to optimize the 2019-nCoV mitigation strategies. Our results in no way suggest that 2019-nCoV would not spread in warm humid regions and effective public health interventions should be implemented across the world to slow down the transmission of 2019-nCoV.

Transmission of 2019-nCoV to Health-Care Workers in the Early Epidemic

Background: A large outbreak of pneumonia associated with 2019 novel coronavirus (2019-nCoV) occurred in Wuhan City, HubeProvince, China in December 2019 We

Unveiling the Origin and Transmission of 2019-nCoV.

A novel coronavirus has caused thousands of human infections in China since December 2019, raising a global public health concern. Recent studies (Huang et al., Chan et al., and Zhou et al.) have provided timely insights into its origin and ability to spread among humans, informing infection prevention and control practices.

The Application of the 2019-nCoV Global Economic Impact Simulator (the 2019-nCoV-GEI-Simulator) in China

This paper intends to establish conceptual foundations of analyzing the economic dimensions of regional or global emerging and endemic infectious disease events such as the case of 2019-nCoV. The 2019-nCoV Global Economic Impact Simulator (the 2019-nCoV-GEI-Simulator) attempts to identify the 2019-nCoV transmission parameters and forecast its trajectories. The model introduces seven basic indicators - (i) the 2019-nCoV contagious spread intensity rate (SI), (ii) the treatment level for 2019-nCoV infected cases rate (T); (iii) the number of 2019-nCoV causalities rate (-C); (iv) the economic wear from the 2019-nCoV epidemic rate (-Π); (v) the 2019-nCoV contagious cases multiplier rate (M); (vi) the total economic leaking from the 2019-nCoV epidemic rate (-Ltotal); and (vii) the economic desgrowth from the 2019-nCoV epidemic rate (-δ2019-nCoV). This specific simulator investigates the 2019-nCoV epidemic final impact on the Chinese economy domestically and internationally.

Transmission dynamics and evolutionary history of 2019-nCoV.

To investigate the time origin, genetic diversity, and transmission dynamics of the recent 2019‐nCoV outbreak in China and beyond, a total of 32 genomes of virus strains sampled from China, Thailand, and the USA with sampling dates between 24 December 2019 and 23 January 2020 were analyzed. Phylogenetic, transmission network, and likelihood‐mapping analyses of the genome sequences were performed. On the basis of the likelihood‐mapping analysis, the increasing tree‐like signals (from 0% to 8.2%, 18.2%, and 25.4%) over time may be indicative of increasing genetic diversity of 2019‐nCoV in human hosts. We identified three phylogenetic clusters using the Bayesian inference framework and three transmission clusters using transmission network analysis, with only one cluster identified by both methods using the above genome sequences of 2019‐nCoV strains. The estimated mean evolutionary rate for 2019‐nCoV ranged from 1.7926 × 10−3 to 1.8266 × 10−3 substitutions per site per year. On the basis of our study, undertaking epidemiological investigations and genomic data surveillance could positively impact public health in terms of guiding prevention efforts to reduce 2019‐nCOV transmission in real‐time.

Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak - United States, December 31, 2019-February 4, 2020.

On December 31, 2019, Chinese health officials reported a cluster of cases of acute respiratory illness in persons associated with the Hunan seafood and animal market in the city of Wuhan, Hubei Province, in central China. On January 7, 2020, Chinese health officials confirmed that a novel coronavirus (2019-nCoV) was associated with this initial cluster (1). As of February 4, 2020, a total of 20,471 confirmed cases, including 2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had been reported by the National Health Commission of China (2). Cases have also been reported in 26 locations outside of mainland China, including documentation of some person-to-person transmission and one death (2). As of February 4, 11 cases had been reported in the United States. On January 30, the World Health Organization (WHO) Director-General declared that the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern.† On January 31, the U.S. Department of Health and Human Services (HHS) Secretary declared a U.S. public health emergency to respond to 2019-nCoV.§ Also on January 31, the president of the United States signed a "Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus," which limits entry into the United States of persons who traveled to mainland China to U.S. citizens and lawful permanent residents and their families (3). CDC, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow transmission of 2019-nCoV in the United States (4,5). These measures require the identification of cases and their contacts in the United States and the appropriate assessment and care of travelers arriving from mainland China to the United States. These measures are being implemented in anticipation of additional 2019-nCoV cases in the United States. Although these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States, they are being implemented to 1) slow the spread of illness; 2) provide time to better prepare health care systems and the general public to be ready if widespread transmission with substantial associated illness occurs; and 3) better characterize 2019-nCoV infection to guide public health recommendations and the development of medical countermeasures including diagnostics, therapeutics, and vaccines. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action by CDC and state and local health departments.

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited. To describe the epidemiological and clinical characteristics of NCIP. Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020. Documented NCIP. Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked. Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 109/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0). In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.

Clarification: Asymptomatic 2019-nCoV Transmission in Germany

Additional details have become available about the Chinese businesswoman who transmitted 2019-nCoV in Germany when she had unrecognized infection (NEJM

Coronavirus epidemic: preparing for extracorporeal organ support in intensive care

Coronavirus epidemic: preparing for extracorporeal organ support in intensive care

Novel coronavirus 2019-nCoV: Could this virus become a possible global pandemic

In December 2019, the emerging of a new coronavirus-induced pneumonia created a distress among people in China and the international community. This virus was identified as novel coronavirus 2019-nCoV. At the time this Review went to press, the virus has spread to across 27 countries, infecting 17,488 people and caused 362 deaths. The transmission of 2019-nCoV to individuals of different countries is predominantly through close contact with an infected person. Based on the available data, there is a rising trend of infected and death cases. At this point, there is no specific drug or vaccine to treat infected patients besides supportive care. Nevertheless, researchers and doctors around the world have reported the success of using existing antiviral drugs to treat patients.