Transmission Of COVID-19 Infection Research Articles

Abstract #1324959: Graves’ Disease Post SARS-CoV-2 mRNA Vaccination: A Case Report and Literature Review

SARS-CoV-2 vaccinations resulted in a significant reduction in the transmission of COVID-19 infection, hospitalization, and mortality, yet it has been associated with the development and exacerbation of various autoimmune diseases, including thyroid autoimmune disorders. We report the new onset of Graves’ disease (GD) post-mRNA COVID vaccine in a patient with a background history of spontaneously recovered primary hypothyroidism and a prior COVID-19 infection.

Transmission and Cleaning Misconception During the COVID-19 Pandemic Time in Riyadh, Saudi Arabia.

Objectives: This study aimed to investigate the knowledge and attitude of the public in Saudi Arabia toward the concept of surface decontamination during the COVID-19 pandemic.Methods: A cross-sectional, web-based study was conducted over six months, from February 2021 to July 2021. We included adult Saudi and non-Saudi males and females living in Riyadh, Saudi Arabia. Results: Six hundred and twenty-six responses from Saudi (92.7%) and non-Saudi (7.3%) participants with a median age of 24 years and interquartile range (IQR) of 21-29 years were received. Regarding knowledge level, 32.10% of the participants had good knowledge of respiratory virus transmission, and only 3.4% had good knowledge of decontamination products. Overall, 58.1% of the participants had a positive attitude toward decontamination products, and 28% had a negative attitude. Older participants, females, and participants who received their information from the Ministry of Health had higher odds of having a positive attitude toward disinfectant (OR = 1.022, 95% CI: 1.004 to 1.039, p = 0.013), (OR = 3.05, 95% CI: 2.08 to 4.47, p < 0.001), and (OR = 2.95, 95% CI: 1.44 to 6.05, p = 0.003), respectively. Conclusion: The current evidence suggests that the knowledge in the general population of Saudi Arabia is low regarding the transmission of COVID-19 infection and disinfectant products. The prevalence of using decontamination products and attitude toward it is average. Continuous awareness campaigns are required to increase the public's awareness toward such products to change the population's attitude and practice, improve the prevention, and reduce the spread of the infection and its related misconception.

AI-Based Chest CT Analysis for Rapid COVID-19 Diagnosis and Prognosis: A Practical Tool to Flag High-Risk Patients and Lower Healthcare Costs.

Early diagnosis of COVID-19 is required to provide the best treatment to our patients, to prevent the epidemic from spreading in the community, and to reduce costs associated with the aggravation of the disease. We developed a decision tree model to evaluate the impact of using an artificial intelligence-based chest computed tomography (CT) analysis software (icolung, icometrix) to analyze CT scans for the detection and prognosis of COVID-19 cases. The model compared routine practice where patients receiving a chest CT scan were not screened for COVID-19, with a scenario where icolung was introduced to enable COVID-19 diagnosis. The primary outcome was to evaluate the impact of icolung on the transmission of COVID-19 infection, and the secondary outcome was the in-hospital length of stay. Using EUR 20000 as a willingness-to-pay threshold, icolung is cost-effective in reducing the risk of transmission, with a low prevalence of COVID-19 infections. Concerning the hospitalization cost, icolung is cost-effective at a higher value of COVID-19 prevalence and risk of hospitalization. This model provides a framework for the evaluation of AI-based tools for the early detection of COVID-19 cases. It allows for making decisions regarding their implementation in routine practice, considering both costs and effects.

VACCINATION APPLICATIONS FROM THE PERSPECTIVE OF COVID-19 IN CHILDREN AND THE ROLE OF HEALTHCARE PROFESSIONALS SICK A TRADITIONAL REVIEW

Covid-19 has emerged as a serious public health emergency and has started a process that requires an urgent response. Although Covid-19 is a disease that causes higher mortality and morbidity in adults, it has been seen to affect children as well. While children play an important role in the transmission of Covid-19 infection and epidemic dynamics, they constitute a key target population for effective measures to control these outbreaks. In this direction, it was concluded that the planning and implementation of Covid-19 vaccines should include children in increasing immunity rates. Due to the fact that the Covid-19 vaccine is new and the trials on children continue, it has been observed that these conditions affect the vaccination intention of the parents. The fact that anti-vaccine and vaccine hesitancy has become an increasing problem all over the world, including in our country, has also affected the rate of Covid-19 vaccination. Healthcare workers play a key role in tackling negative attitudes towards Covid-19 vaccination. Health professionals may have responsibilities such as vaccine development, vaccine information and application, following up-to-date information about vaccine side effects, determining parents' intentions regarding their children's Covid-19 vaccine, and informing parents about Covid-19 vaccines. In this rewiew the Covid-19 pandemic in children, the Covid 19 vaccine applications, the role of parents and healthcare professionals have been compiled.

Factors Associated with COVID-19 Infection of Survivors at Dr. Kariadi Hospital Semarang

The transmission of COVID-19 infection is rapidly spreading in Indonesia, All people are at risk of COVID-19 infection, especially health workers. Factors that may increase the risk of COVID-19 transmission necessitate being explored more. This study aims to find out what factors are associated with the incidence of COVID-19 infection in COVID-19 survivors at Kariadi Hospital Semarang. This study has used a retrospective observational design, with a quantitative analysis conducted involving 80 COVID-19 survivors (health workers = 63 respondents, non-health workers = 17 respondents). Respondents' characteristics questionnaire, exposure questionnaires and knowledge, attitude and practice questionnaires were filled out by respondents through google form and then were analyzed by chi-square test. Most of the COVID-19 survivors in this study were male (52.5%), had a bachelor's degree (50%), married (77.5%), had no comorbidities (73.5%), had a high level of knowledge (90%), appropriate attitude (90%), and good preventive practice (95%), and the most common symptom of COVID-19 experienced was fever (15, 95%). The incidence of COVID-19 infection was significantly more in health worker survivors which were male (p = 0.032), as civil servants (ASN) (p = 0.00), had undergraduate education level (p = 0.00) and hospitalized during COVID-19 infection (p = 0.002). Factors related to the incidence of COVID-19 infection in this study were gender, occupation, education level, and hospitalisation place. Adequate screening and mitigation of COVID-19 risk groups are urgently needed.

A Mathematical Model for the Growth Dynamics of Demand in the Fashion Industry within the Era of the COVID-19 Pandemic

The outbreak of COVID-19 infection and its effects have not spared any economy on the globe. The fourth variant has just announced its appearance with its high death toll and impact on economic activities. The basic reproductive number R 0 , which measures the transmission potential of an infectious disease, is extremely important in the study of epidemiology. The main purpose of this study was to derive R 0 and assess the stability of the model around its equilibrium points. The motivation was to simulate the effect of COVID-19 on the demand for fashion products and how its application has impacted the COVID-19 pandemic. A five-compartment susceptible-infection-recovery-susceptible-based model was formulated in an integrated environment with application of fashion-based personal protective equipment (FPPEs) and government policy regulation, using ordinary differential equations. Solution techniques included a mix of qualitative analysis and simulations with data from various publications on COVID-19. The study revealed that the disease-free equilibrium was both locally and globally asymptotically stable (LAS and GAS) for R 0 ≤ 1 , while the disease-endemic equilibrium was both LAS and GAS for R 0 ≥ 1 . As the demand for FPPEs increases, R 0 decreases, and vice versa. The sensitivity analysis indicated that R 0 was very sensitive to the rate of application of FPPEs. This confirms the significance of high demand for FPPEs in reducing the transmission of COVID-19 infection. Again, the pandemic has had both positive and negative impacts on the demand for fashion products; however, the negative impact outweighed the positive impact. Another discovery was that government policy stringency was significant in increasing demand for FPPEs. The sensitivity analyses suggested prioritization of FPPEs application together with all recommended PPEs. We recommend inter alia that FPPEs be used together with other nonpharmaceutical interventions. Operators in the fashion industry must be dynamic in adjusting to the new trends of taste for fashion products. Finally, governments should maintain high policy stringency.

Anxiety, depression, COVID-19 anxiety, and the effects of hospital environment on patients presenting to dermatology outpatient clinic during the pandemic

Background: The World Health Organization has defined the COVID-19 infection as a pandemic. Anxiety and depression are emphasized to increase with the pandemic. Aims: The current study aimed to identify anxiety, depression, and COVID-19 anxiety of patients who presented to the dermatology outpatient clinic and the effects of hospital environment on them during the pandemic. Materials and Methods: A questionnaire was applied, including questions about the sociodemographic characteristics, the state of being hesitant about transmission of COVID-19 infection in hospital, pandemic-associated attitudes in hospital, persons and hospital sites thought to be risky for transmission of the infection, opinion about tele-dermatology, State-Trait Anxiety Inventory (STAI1, STAI2), Hospital Anxiety and Depression Scale (HADS), and the COVID-19 Anxiety Scales (CAS). The diagnoses of skin disorders were recorded after examinations. Results: The study included 458 patients (60.7% females, the mean age was 31.8 years) who presented to the dermatology outpatient clinic in March 2021. Of patients, 64.7% rated their hesitancy as moderate and higher about the transmission of the COVID-19 infection in hospital. With the STAI1 scale, the rate of moderate and severe anxiety was 47.6%; with the HADS, the rate of anxiety was 26.6%; with the HADS, the rate of depression was 37.3%; and with the CAS, the rate of anxiety due to COVID-19 was 3.9%. Conclusion: Dermatology patients should be evaluated to be adversely affected at least as much as the other members of the society. Patients found the hospital environment risky in terms of the transmission of COVID-19 infection, creating an additional stress factor.

Impact of COVID-19 on postgraduate education and mental wellbeing of surgical trainees: a systematic review

IntroductionCoronavirus disease COVID-19 is a global pandemic that has produced adverse effects on many facets of the health care system including surgical specialities. In this systematic review, we aimed to comprehensively analyze the global literature on the impact of COVID-19 on surgical education and the mental wellbeing of surgical trainees.MethodsWe searched PubMed, Scopus, LILACS, Ovid MEDLINE, Web of Science, Google Scholar and Cochrane CENTRAL between 1-January 2020 and 20-January 2021 and performed a systematic review of all observational and experimental studies on the impact of COVID-19 on postgraduate surgical trainees of all specialities. Operative and clinical exposure, surgical education and mental wellbeing were assessed as outcome measures.ResultsFifty-nine studies including 11544 surgical trainees were analyzed. The majority of the trainees were general surgical trainees [n=4435, 38.4%]. Most studies [n=40, 67.8%] were conducted at national level in high income countries [n=9480; 82.1%]. Most studies reported a significant reduction in the operative exposure [range 45.7-100%] including elective, emergency and other clinical encounters. The mental health of trainees was affected [11.3-100%] and depression [10.6- 40.8%], anxiety [31.7-69%] and burnout [7.1-68%] were noticed. Concerns on contraction and transmission of COVID-19 infection and delays in surgical training and career progression were also reported.ConclusionCOVID 19 pandemic had caused a considerable impact on surgical training, teaching, learning activities and mental well-being of the trainees. Measures should be taken to mitigate these effects to improve surgical training in the era of the COVID pandemic.

Evaluation of Patients’ Anxiety about COVID-19 Infection through Dental Visits in Sari Dental School Clinic in 2021

Introduction: Dental treatments have a high-risk nature due to the close relationship between the patient and direct exposure to saliva, blood, etc. Concerns about the transmission of COVID-19 infection have led to the formation of some form of patient fear. Therefore, considering the importance of mental health, the present study was designed to investigate the degree of anxiety in people with COVID-19 through dentistry.Material and Methods: In the present descriptive study, 384 questionnaires were randomly distributed among the patients of Sari Dental Clinic in the period of April to June 2021. After the necessary explanations and obtaining informed written consent, the questionnaires were completed by the clients. Finally, the data were analyzed using SPSS V.22 software and statistical tests. Values greater than 0.05 were also considered significant.Results: In this study, 29.2% were male and 68.8% were female, and corona-related anxiety was more common in women and married people. As they got older, they tended to respond to higher options like most of the time or always. The higher the level of education, the less noticeable the unnecessary visits to the dental clinic.Conclusion: People were more worried about transmitting the disease to those around them and this anxiety was more in women than men. Married people were also more anxious than single people. Anxiety was significantly higher in the unemployed than in the employed. There was a significant relationship between degree and level of anxiety and people with higher education levels showed more anxiety.

THE INFLUENCE OF MATERNAL ANXIETY TOWARDS THE SELECTION OF MATERNITY PLACES DURING COVID- 19

Corona Virus Disease (COVID-19) pandemic is currently engulfing almost the entire world, including Indonesia. As of August 12, 2021, there were 3,774,155 positive cases of Covid-19 in Indonesia, 24,709 new cases and 113,664 deaths. The group of maternal is a vulnerable group, where there are 4.9% of pregnant women who are confirmed positive for COVID-19 from 1,483 confirmed cases that have accompanying condition data. Therefore, maternal, perinatal, postpartum and newborns are vulnerable targets for transmission of COVID-19 infection and this condition is feared to increase maternal and perinatal morbidity and mortality. The general objective of this study was to determine the effect of the anxiety level of pregnant women on the choice of place of delivery during the COVID-19 period. This study used a survey method with a cross sectional approach. The study was conducted in Aceh Barat Regency, in March-June 2021. The population in this study were 637 third trimester pregnant women in 2021. The number of samples in this study was 246 samples calculated by the slovin formula and using accidental sampling technique. Data analysis used logistic regression test. The results of the bivariate analysis showed that there was a significant effect between the level of mild anxiety and the choice of place of delivery during the COVID-19 pandemic with a value (OR=5.6, 95% CI=2.04-15.3, p-value=0.001), . While the level of moderate anxiety had no significant effect on the choice of place of delivery during the Covid-19 period (OR=2.1, 95% CI=0.4-12.4, p-value=0.383) The level of severe anxiety in pregnant women was also not significant. effect on the choice of place of delivery during the Covid-19 period (OR=1.1, 95% CI=0, p-value=0.989). Expected to the government can improve education programs and supervision of the prevention and control of the Covid 19 pandemic, especially groups of pregnant women in order to minimize the possibility of excessive anxiety in pregnant women during the Covid 19 pandemic.

Possible transmission of Covid-19 infection among healthcare professionals; first defense to early wave of the pandemic

Objective: Healthcare professionals play an essential role in the COVID-19 pandemic on the front lines. There have been a limited number of publications and national status reports on COVID-19 infected healthcare professionals. We aimed to determine the factors that play a role in transmitting COVID-19 infection to healthcare professionals.&#x0D; Material and methods: Among healthcare professionals, those evaluated as a possible COVID-19 case and whose Polymerase Chain Reaction (PCR) tests were studied in our Emergency Service and Employee Health Polyclinic were included in the study. Age, gender, task, unit, working in COVID-19 units, Thorax Computerized Tomography (CT) and PCR test result, hospitalization status, suspicious contact, and appropriate use of personal protective equipment (PPE) in the work environment and social environment were investigated.&#x0D; Results: A total of 369 cases were included in the study. 54.7% (n = 207) of potential COVID-19 healthcare professionals worked in COVID-19 units, 22.5% (n = 83) had PCR positive. Employee groups with the highest PCR positivity rate were security guards (88.9%), cleaning staff (31.6%), doctors (26.3%) and nurses (18.8%), respectively. When contact histories with COVID-19 infection were examined; 46.3% of the cases had in-hospital social contact (PCR positivity rate 21.6%), 39.6% had a history of contact with COVID-19 patients (PCR positivity rate 11%). It was determined that 3.3% of the cases (n = 12) were treated in the COVID-19 service, 0.3% (n = 1) was hospitalized in intensive care, 26% (n = 96) were isolated at home, and 70.5 % (n = 260) continued to work. All of the participants were discharged after treatment and returned to their duties.&#x0D; Conclusion: Adequate training should be given to healthcare professionals to protect them against COVID-19 infection. Additionally, healthcare professionals should show the care to prevent infection in social areas inside and outside the hospital as well as at contact points with patients.

Varying Psychological Impacts of COVID-19 and Functional/Dysfunctional Coping Strategies: A Mixed-Method Approach

The current focus on the transmission of COVID-19 infection all over the world may probably distract public attention from psychosocial consequences of the outbreak in the affected individuals and in the general population. However, there is limited empirical information about its psychological impact on the people of diverse regions and nationalities. Hence, the study aims to understand the psychological impacts of COVID-19 and associated pandemic distress on the demographically diverse Indian population and the ways people are adopting to cope with them. A total of 261 respondents aged 18−73 years, representing more than 17 states of India, filled an electronic survey questionnaire. Survey research methodology following the mixed-method approach adopting both qualitative and quantitative methodologies was adopted. Results of the first phase of the study indicated significant psychological impacts of the COVID-19 pandemic on respondents during the first three weeks of lockdown, especially the pandemic anxiety and social isolation. Physical health, fitness, self-care, family connect, learning of the new skill sets and self-growth opportunity were found to be some of the functional ways to cope with pandemic in this phase, whereas passive acceptance was expressed as a dysfunctional strategy to cope with pandemic coupled with negative emotions such as fear, anxiety, frustration and irritability for others. However, phase two of the study with 20% of respondents in the sixth week of lockdown revealed the exhaustion of the learning phase, limited efforts for self-growth and increasing anxiety and frustration. A great proportion of respondents expressed fear of losing global business scenario and its direct or indirect impact on them. A need for consistent and dedicated mental health care was recommended.

Factors Associated with Transmission of COVID-19 Infection among Nursing Staff in Kafr Eldawar Fever Hospital 2021

Background: COVID-19 seriousness may result from its pandemic infection from human-to-human transmission and evidence of transmission from animal to human as well. Mainly COVID-19 is transmitted by respiratory droplets while aerosol transmission can occur in specific situation mainly in crowded poor ventilated spaces. This transmission affects individual, health care workers (HCWs), health institutions and the whole community Aim of the Study: to identify factors associated with transmission of COVID-19 infection among nursing staff in Fever hospital, Kafr Eldawar, 2021. Research Design: Cross sectional research design was used. Setting: The present study was conducted at This study was conducted in Kafr Eldawar Fever hospital. Subjects: A convenient sample of 104 nurses out of total number of hospital nursing staff (who are on duty, accessible at the time of the study and agreed to participate in the study) is 169 nurses in all hospital units. Tools: one tool was developed by the researchers in the form of self-administered questionnaires “factors associated with COVID-19 infection”. It consisted of four parts, part I: socio-occupational data, part II: Factors predisposing nursing staff to part III: Adherence to infection prevention and control (IPC) measures and part IV: Nursing staff opinions. Results: Majority of nurses were directly assigned beds to patients diagnosed with COVID-19, more than two thirds of them worked in a COVID-19 isolation ward and were touching their cheeks, nose, or mouth at work. Conclusion: There is significant relation between Participation in in-service training program related to dealing with COVID-19 infection and previous COVID-19 infection and factors predisposing one to COVID-19. Recommendation: Well-established hospital information systems (MIS), personal digital assistant (PDA) systems, and a local intranet to avoid unnecessary contact with COVID-19 infection.

Impact of domestic travel restrictions on transmission of COVID-19 infection using public transportation network approach

The international spread of COVID-19 infection has attracted global attention, but the impact of local or domestic travel restriction on public transportation network remains unclear. Passenger volume data for the domestic public transportation network in Japan and the time at which the first confirmed COVID-19 case was observed in each prefecture were extracted from public data sources. A survival approach in which a hazard was modeled as a function of the closeness centrality on the network was utilized to estimate the risk of importation of COVID-19 in each prefecture. A total of 46 prefectures with imported cases were identified. Hypothetical scenario analyses indicated that both strategies of locking down the metropolitan areas and restricting domestic airline travel would be equally effective in reducing the risk of importation of COVID-19. While caution is necessary that the data were limited to June 2020 when the pandemic was in its initial stage and that no other virus spreading routes have been considered, domestic travel restrictions were effective to prevent the spread of COVID-19 on public transportation network in Japan. Instead of lockdown that might seriously damage the economy, milder travel restrictions could have the similar impact on controlling the domestic transmission of COVID-19.

Face masks help control transmission of COVID-19

Face masks help control transmission of COVID-19

Knowledge and Preventive Measures Adopted by Allied Health Care Professional Students to Control Transmission of COVID-19 Pandemic Infection During Lockdown

Introduction: After declaration of COVID-19 infection as pandemic by World Health Organisation (WHO),various preventive strategies have been intended to mitigate disease spread and control the infection ratesuch as isolation of patients, social distancing, hygienic practices; covering mouth and nose, restriction ofmass gathering in society. Hence we planned this survey to assess the knowledge and preventive measuresadopted by students to control COVID-19 infection during lockdown.Methods: This cross sectional study was conducted among students of School of Allied Health Sciences,DMIMS, Wardha during April-May 2020. First year was selected randomly and all 168 students wereapproached by internet for sharing questionnaire after IEC approval. Received responses is analysed in theform of descriptive statistics.Results: Total 139 students responded. 38.85% students understood the relationship between massgathering and transmission of COVID-19 infection at community level. Only 34(24.46%) students wereaware about safe social distance. Less than half of the students 66(47.48%) were aware about minimum 20seconds needed to hand-rub by the alcohol based sanitizer. About 108(77.7%) students maintained the socialdistancing sincerely, only 74(52.5%) students always used to wear the mask and; 100(71.94%) participantsalways used to wash their hands.Conclusions: Though some of the students adopted standards practices, others observed to be consideringit as less important. Such survey can be conducted among in various institutions to assess the awareness andshortfall in practices. Awareness level can be raised through dedicated online awareness program.

Laparoscopic Surgery in COVID-19 Era in a Tertiary Hospital in Nepal

Introduction: There is great concern and risk of transmission of COVID-19 infection from the aerosolized smoke during laparoscopic surgery although there is a lack of enough literature to prove this. To minimize these risks and get the benefi t of laparoscopic surgery, we used a low-cost fi ltration system connected to an underwater seal bag fi lled with a 5% sodium hypochlorite solution.Materials and Methods: This is a retrospective study of prospectively maintained data of cases of laparoscopic surgeries using a low-cost fi ltration device system connected with an underwater seal bag fi lled with 5% sodium hypochlorite solution. Use of personal protective equipment, minimal staff in operative theatre, preoperatively testing of patients before admission for surgery was done. During surgery, minimal use of electrocautery in low power setting maintaining low pneumoperitoneum and cautious desuffl ation of smoke during and end of the procedure from one of the trocars fi tted to heat and moisture exchanger Filter, connected through a tube to 5 % sodium hypochlorite solution in underwater seal bag was performed.Results: During the lockdown from May 2020 to October 2020, 41 elective laparoscopic surgeries were done. All patients were tested negative before the procedure. No staff in operation theatre developed symptoms of COVID-19 or tested positive for COVID-19 infection for up to 2 weeks period.Conclusions: In this Pandemic situation, we have to co-habit with this SARS-Cov-2 virus. Minimally invasive surgeries can be continued with safety measures with modifications like the use of low-cost filtration devices for smoke filtration and evacuation.

Determinación de contactos cercanos con riesgo de transmisión durante las medidas de cuarentena y distanciamiento social para el Covid-19 en personal de salud

‌Introducción: El personal de salud por su ámbito laboral sanitario es de alto riesgo para la adquisición y transmisión de la infección por Covid-19. Los contactos cercanos del personal de salud fuera del ambiente hospitalario son frecuentes y variados. El objeto de la investigación es determinar la frecuencia de contactos cercanos para infecciones Covid-19 del personal de salud en su ambiente sanitario, social y familiar previo y durante la pandemia marzo y abril 2020. Métodos: Estudio de corte transversal por cuestionario autoadministrado por vía digital dirigido al personal de salud. La población objeto son profesionales activos adscritos a Sociedades Científicas y la UCV. Variables demográficas: edad, sexo, año académico, cohabitante y los contactos cercanos durante traslados, actividades académicas, hospitalarias y sociales. Medidas de tendencia central y dispersión, distribuciones de frecuencia y figuras. Chi cuadrado e intervalos de confianza al 95%, medidas de correlación, comparación con t con error alfa de 0,05. Resultados: 194 trabajadores de la salud completaron la encuesta, Sexo femenino 124 (63,9%), edad promedio 49,6 y mediana 53 años. La gran mayoría médicos 88,6%. Se dedican a actividades asistenciales 81%. El promedio de contactos diarios del personal de salud es 38. Los contactos intrahospitalario promedio diario son la mayoría 71%, (27,1 contactos/día). De estos con colegas 5,6, con enfermeras y paraclínicos 3,7; otro personal 4,7; pacientes y sus familiares 7,5 y 5,4. Conclusión: El personal de salud tiene un alto número de contactos cercanos diarios para la transmisión de infecciones respiratorias agudas, lo que representa un alto riesgo para adquirir y son potenciales dispersores de las infecciones a familiares y sociales

Potential Impact of Climate on Novel Corona Virus (COVID-19) Epidemic.

To the Editor: The Covid-19 epidemic outbreak, which initially spread across China's Hubei province,1 is currently hitting Italy, with an epicenter in the provinces of Lodi, Cremona, and Piacenza (LCP). The diffusion of the infection appears to have occurred faster in Hubei (Fig. 1) in comparison with LCP, which seems to be reaching now its peak in the epidemic, despite the stricter preventive measures adopted by the Chinese government. This apparent difference in kinetics could be explained by different biological characteristics of the virus strains or the host population. Besides, the number of recorded cases is only a fraction of total infected individuals, since a large number of oligosymptomatic cases may remain undetected, and differences in screening policies may have contributed to differences in daily incidence estimates. It is also possible that climatic factors contributed to the evolution of the epidemic in the two areas.2 The number of new cases in Hubei decreased at the same time of an increase in average daily temperatures; furthermore, temperatures in LCP area at the time of the development of the epidemic (beginning of March) were higher than those recorded in Hubei between January and February (Fig. 1). The trend toward a rise in Italian temperatures in the subsequent days could have helped in containing the epidemic.FIGURE 1: Number of new recorded cases (bars) and average temperatures (line) every 2 days in Hubei province and Lodi/Cremona/Piacenza area.In order to verify the hypothesis of temperatures playing a role in the modulation of the epidemic spread of Covid-19, we retrieved data on the total number of recorded cases per million inhabitants (as of March 9th) in each Country,3 and data on average temperatures.4 In a linear regression model weighted for population size, the number of cases per million inhabitants, excluding China's People Republic, showed a significant inverse correlation (r = −0.23, P = 0.001) with average temperatures in February. The possible impact of climatic factors on the transmission of Covid-19 infection is potentially very relevant. If the viral infection was inhibited by higher temperatures, a spontaneous slowdown of the epidemic could be expected in the Northern hemisphere in the next weeks, whereas risks could be increased in the Southern hemisphere.

Novel coronavirus infection and pregnancy

In summary, based on the available clinical and research data, the clinical characteristics of patients with COVID-19 infection presenting from mid-trimester onwards are similar to those of non-pregnant adults. Currently, there is no evidence that pregnant women are more susceptible to COVID-19 infection and that those with COVID-19 infection are more prone to developing severe pneumonia. There is also no evidence of vertical mother-to-baby transmission of COVID-19 infection when the maternal infection manifests in the third trimester. Our opinions are in line with the recommendations of the Centers for Disease Control and Prevention11. COVID-19 infection should not be the sole indication for delivery; rather, the patient should be duly assessed, and management, timing and mode of delivery should be individualized, dependent mainly on the clinical status of the patient, gestational age and fetal condition14. Ongoing collection of clinical data and research is underway with the aim of answering questions in relation to the risk of congenital infection and the optimal intrapartum management, and timing and mode of delivery. Lastly, we would like to pay tribute to all frontline medical professionals who are working tirelessly to bring the COVID-19 epidemic under control.