# ent

id: cord-260444-ooi5x9p3
type: WORK_OF_ART
entity:
  Case Report Coronavirus Disease and Pulmonary Tuberculosis in Patients with Human Immunodeficiency Virus Report of Two Cases


id: cord-264140-5cxzc3z8
type: PROTEIN
entity:
  H influenzae type B 82 3 H influenzae non type B 31 5 Klebsiella pneumoniae 14 6 Staphylococcus aureus 8 5 and Streptococcus pneumoniae 8 5


id: cord-257377-x5xijo8m
type: CHEMICAL
entity:
  20 0433 sha 2647aa01ebef19549ccb025142b61481beb1ae9f doc_id 257377 cord_uid x5xijo8m Because of the pandemic of COVID 19 the


id: cord-278283-uoy54dds
type: ORG
entity:
  Provincial Health Department Provincial Development and Reform Commission Provincial Education Department Provincial Science and Technology Department Provincial Economic and Information Commission Provincial Public Security Department Provincial Finance Department Provincial Commerce Department Provincial Entry Exit Inspection


id: cord-278283-uoy54dds
type: ORG
entity:
  Quarantine Bureau Provincial Radio Film and Television TV Bureau and Provincial Tourist Administration


id: cord-296556-fr8x8j3i
type: WORK_OF_ART
entity:
  A Pilot Study of Hydroxychloroquine in Treatment of Patients with Common Coronavirus Disease 19 COVID 19


id: cord-285490-tpsf05ca
type: PROTEIN
entity:
  creatine kinase CK 400 000 U L lactate dehydrogenase LDH aspartate aminotransferase alanine aminotransferase


id: cord-287247-vv0zc0gd
type: ORG
entity:
  Strategies for Mitigation and Suppression United Nations Department of Economic and Social Affairs Population Division Introduction


id: cord-287247-vv0zc0gd
type: ORG
entity:
  Contacts FFX Investigation Protocol for Coronavirus Disease 2019 COVID 19 World Health Organization 2020 Operational Considerations


id: cord-321514-knyw023l
type: DNA
entity:
  GABRIEL Global Approach to Biological Research Infectious Diseases and Epidemics in Low Income Countries


id: cord-321514-knyw023l
type: ORG
entity:
  the Department of Microbiology Bangladesh Institute of Child Health Dhaka Shishu Hospital Bangladesh


id: cord-321514-knyw023l
type: CHEMICAL
entity:
  ceftriaxone N 135 26 0 amoxicillin N 120 23 1 ampicillin N 51 9 8 amoxicillin sulbactam N 36 6 9 amoxicillin clavulanic acid N 35 6 7 oxacillin N 35 6 7


# bib

id: cord-003360-mkv1jc7u
author: Chen, Yirong
date: 2018-10-22
txt: ./txt/cord-003360-mkv1jc7u.txt
cache: ./cache/cord-003360-mkv1jc7u.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283473/
doi: 10.4269/ajtmh.18-0099
summary:
  title: The Effect of School Closure on Hand, Foot, and Mouth Disease Transmission in Singapore: A Modeling Approach Singapore implements a school closure policy for institutional hand, foot, and mouth disease (HFMD) outbreaks, but there is a lack of empirical evidence on the effect of closure on HFMD transmission. The effects of school closure due to 1) institutional outbreaks, 2) public holidays, and 3) school vacations were assessed using a Bayesian time series modeling approach. These policies provide data that enable us to obtain three sources of information on the effect of school closure: 1) the reduction in the numbers of cases after a public holiday, when childcare centers and schools close; 2) the reduction during school vacations; and 3) the impact within childcare centers of school closure in response to an ongoing outbreak. To measure the effect of school vacations on HFMD transmission, we built time series models, fit Bayesianly, for the weekly number of children with HFMD aged 12 years and younger.

title:
  The Effect of School Closure on Hand, Foot, and Mouth Disease Transmission in Singapore: A Modeling Approach

abstract:
  Singapore implements a school closure policy for institutional hand, foot, and mouth disease (HFMD) outbreaks, but there is a lack of empirical evidence on the effect of closure on HFMD transmission. We conducted a retrospective analysis of 197,207 cases of HFMD over the period 2003–2012 at the national level and of 57,502 cases in 10,080 institutional outbreaks over the period 2011–2016 in Singapore. The effects of school closure due to 1) institutional outbreaks, 2) public holidays, and 3) school vacations were assessed using a Bayesian time series modeling approach. School closure was associated with a reduction in HFMD transmission rate. During public holidays, average numbers of secondary cases having onset the week after dropped by 53% (95% credible interval 44–62%), and during school vacations, the number of secondary cases dropped by 7% (95% credible interval 3–10%). Schools being temporarily closed in response to an institutional outbreak reduced the average number of new cases by 1,204 (95% credible interval 1,140–1,297). Despite the positive effect in reducing transmission, the effect of school closure is relatively small and may not justify the routine use of this measure.


id: cord-253459-tcn10pho
title: Evaluation of K18-hACE2 Mice as a Model of SARS-CoV-2 Infection
author: Moreau, Gregory Brett
date: 2020-07-28
txt: ./txt/cord-253459-tcn10pho.txt
cache: ./cache/cord-253459-tcn10pho.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0762
doi: 10.4269/ajtmh.20-0762
summary:
  4 A transgenic mouse model to study SARS-CoV-1 infection was developed that expresses the hACE2 gene under the control of the human cytokeratin 18 promoter. To investigate the potential of this transgenic mouse strain as a model for COVID-19 infection, five K18-hACE2 mice were intranasally inoculated with 8 × 10 4 Median Tissue Culture Infectious Dose (TCID50) of SARS-CoV-2, and five mice were mock-infected with sterile Dulbecco''s Modified Eagle''s Medium (DMEM). In the mouse model expressing hACE2 under the mouse ACE2 promoter, infected mice did not exhibit any clinical symptoms other than maximal weight loss on day 3 postinfection, and those mice recovered. 10 In contrast to these models, in which mice exhibited mild symptoms and recovered, only 60% of the mice survived past day 5 in the mouse strain expressing hACE2 under the lung ciliated epithelial cell HFH4 promoter.

abstract:
  Murine models of SARS-CoV-2 infection are critical for elucidating the biological pathways underlying COVID-19. Because human angiotensin-converting enzyme 2 (ACE2) is the receptor for SARS-CoV-2, mice expressing the human ACE2 gene have shown promise as a potential model for COVID-19. Five mice from the transgenic mouse strain K18-hACE2 were intranasally inoculated with SARS-CoV-2 Hong Kong/VM20001061/2020. Mice were followed twice daily for 5 days and scored for weight loss and clinical symptoms. Infected mice did not exhibit any signs of infection until day 4, when no other obvious clinical symptoms other than weight loss were observed. By day 5, all infected mice had lost around 10% of their original body weight but exhibited variable clinical symptoms. All infected mice showed high viral titers in the lungs as well as altered lung histology associated with proteinaceous debris in the alveolar space, interstitial inflammatory cell infiltration, and alveolar septal thickening. Overall, these results show that the K18-hACE2 transgenic background can be used to establish symptomatic SARS-CoV-2 infection and can be a useful mouse model for COVID-19.


id: cord-255062-7ozdmb09
author: Ogoina, Dimie
date: 2020-08-04
txt: ./txt/cord-255062-7ozdmb09.txt
cache: ./cache/cord-255062-7ozdmb09.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0886
doi: 10.4269/ajtmh.20-0886
summary:
  This article highlights the likely benefits of face mask containers in promoting safe, appropriate, and extended use of medical masks by healthcare workers in settings where a sustainable supply of medical masks may be limited. However, if medical masks are to be worn continuously by healthcare workers for up to 8 hours or more every working day, then there should be provision to temporarily and safely store them for extended use during the day, especially when they are not visibly soiled, wet, damp, or damaged. In the wake of global supply shortages, 7 appropriately designed face mask containers could be useful in promoting safe extended use of medical masks, especially in resourcelimited healthcare settings. With the growing call for universal masking as a key costeffective strategy to combat the COVID-19 pandemic, it is my view that the benefits of face mask containers in promoting appropriate use of masks and enabling extended and safe use far outweigh the risks.

title:
  Improving Appropriate Use of Medical Masks for COVID-19 Prevention: The Role of Face Mask Containers

abstract:
  Use of medical masks is a key strategy for COVID-19 prevention among healthcare workers. Unfortunately, there are global shortages of this essential commodity, and many have resulted in inappropriate usage to conserve supply. This article highlights the likely benefits of face mask containers in promoting safe, appropriate, and extended use of medical masks by healthcare workers in settings where a sustainable supply of medical masks may be limited.


id: cord-255940-chb4iuis
title: Facility-Level Approaches for COVID-19 When Caseload Surpasses Surge Capacity
author: Walton, David A.
date: 2020-06-26
txt: ./txt/cord-255940-chb4iuis.txt
cache: ./cache/cord-255940-chb4iuis.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32597389/
doi: 10.4269/ajtmh.20-0681
summary:
  We present two COVID-19 treatment center designs that leverage lessons learned from previous outbreaks of communicable infectious diseases and provide potential solutions when caseload exceeds existing capacity, with and without access to SARS-CoV-2 testing. These designs are intended for settings in which health facilities and testing resources for COVID-19 are surpassed during the pandemic, are adaptable to local conditions and constraints, and mitigate the likelihood of nosocomial transmission while offering an option to care for hospitalized patients. To respond to the immediate crisis facing health workers and patients, we propose a COVID-19 treatment center design ( Figure 1 ) that harnesses lessons learned from other outbreaks and adheres to infection prevention and control principles recommended by the WHO for the novel coronavirus. The design assumes that two thresholds have been reached: first, the health center no longer has space to individually isolate COVID-19 patients, and second, laboratory capacity is limited or surpassed, such that rapid, accurate testing for COVID-19 may not be available, as is the reality facing our colleagues in Haiti.

abstract:
  As COVID-19 cases continue to increase globally, fragile health systems already facing challenges with health system infrastructure, SARS-CoV-2 diagnostic capacity, and patient isolation capabilities may be left with few options to effectively care for acutely ill patients. Haiti—with only two laboratories that can perform reverse transcriptase PCR for SARS-CoV-2, a paucity of hospital beds, and an exponential increase in cases—provides an example that underpins the need for immediate infrastructure solutions for the crisis. We present two COVID-19 treatment center designs that leverage lessons learned from previous outbreaks of communicable infectious diseases and provide potential solutions when caseload exceeds existing capacity, with and without access to SARS-CoV-2 testing. These designs are intended for settings in which health facilities and testing resources for COVID-19 are surpassed during the pandemic, are adaptable to local conditions and constraints, and mitigate the likelihood of nosocomial transmission while offering an option to care for hospitalized patients.


id: cord-256852-lrz17bdx
title: Responding to the Pandemic of Falsified Medicines
author: Nayyar, Gaurvika M. L.
date: 2015-06-03
txt: ./txt/cord-256852-lrz17bdx.txt
cache: ./cache/cord-256852-lrz17bdx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.14-0393
doi: 10.4269/ajtmh.14-0393
summary:
  15 The U.S. Institute of Medicine (IOM) has published a report "Countering the Problem of Falsified and Substandard Drugs." 16 The IOM recommendations to "stem the global trade" in such products are laudable in advising that the U.S. Food and Drug Administration (FDA), the National Institute of Standards and Technology, and other U.S. and international pharmaceutical and financing agencies be more actively involved in setting standards and financing improvements; yet this report falls far short of making a strong call for standardized, agreed-upon quality assessment technologies; an international law convention; and a more activist, internationally recognized lead organization, all three of which are essential for stopping the many health threats of fake drugs.

abstract:
  Over the past decade, the number of countries reporting falsified (fake, spurious/falsely labeled/counterfeit) medicines and the types and quantities of fraudulent drugs being distributed have increased greatly. The obstacles in combating falsified pharmaceuticals include 1) lack of consensus on definitions, 2) paucity of reliable and scalable technology to detect fakes before they reach patients, 3) poor global and national leadership and accountability systems for combating this scourge, and 4) deficient manufacturing and regulatory challenges, especially in China and India where fake products often originate. The major needs to improve the quality of the world's medicines fall into three main areas: 1) research to develop and compare accurate and affordable tools to identify high-quality drugs at all levels of distribution; 2) an international convention and national legislation to facilitate production and utilization of high-quality drugs and protect all countries from the criminal and the negligent who make, distribute, and sell life-threatening products; and 3) a highly qualified, well-supported international science and public health organization that will establish standards, drug-quality surveillance, and training programs like the U.S. Food and Drug Administration. Such leadership would give authoritative guidance for countries in cooperation with national medical regulatory agencies, pharmaceutical companies, and international agencies, all of which have an urgent interest and investment in ensuring that patients throughout the world have access to good quality medicines. The organization would also advocate strongly for including targets for achieving good quality medicines in the United Nations Millennium Development Goals and Sustainable Development Goals.


id: cord-257377-x5xijo8m
title: COVID-19: The Need for Rational Use of Face Masks in Nigeria
author: Ogoina, Dimie
date: 2020-05-15
txt: ./txt/cord-257377-x5xijo8m.txt
cache: ./cache/cord-257377-x5xijo8m.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0433
doi: 10.4269/ajtmh.20-0433
summary:
  Because of the pandemic of COVID-19, the federal government of Nigeria has instituted a mandatory policy requiring everyone going out in public to wear face masks. Inappropriate use and disposal of face masks in Nigeria could promote the spread of the novel coronavirus in the country and negate the country''s efforts to contain the COVID-19 pandemic. 11 The rising spate of misuse and abuse of face masks is a source of worry for the Nigerian COVID-19 Presidential Task Force, which observed "unhygienic and ill-advised use and sharing of masks, especially multiple fittings before buying from vendors." 13 It is noteworthy that medical masks meant for healthcare workers, such as surgical masks and respirators, are being routinely worn by the general public and government officials, when there are complaints that these masks are not available in sufficient quantities in Nigerian hospitals.

abstract:
  Because of the pandemic of COVID-19, the federal government of Nigeria has instituted a mandatory policy requiring everyone going out in public to wear face masks. Unfortunately, the Nigeria media is awash with images of misuse and abuse of face masks by the public, government officials, and healthcare workers. Medical masks are used widely in community settings amid reported scarcity within healthcare facilities. It is observed that some people wear face masks on their chin and neck, and mask wearers give no attention to covering their mouth and nose, especially when talking. Used face masks are kept with personal belongings or disposed indiscriminately in public spaces, leading to self and environmental contamination. Inappropriate use and disposal of face masks in Nigeria could promote the spread of the novel coronavirus in the country and negate the country’s efforts to contain the COVID-19 pandemic. In the implementation of the universal masking policy in Nigeria, federal and state governments ought to consider local applicability, feasibility, and sustainability, as well as identify and mitigate all potential risks and unintended consequences. Also critical is the need for intensive public sensitization and education on appropriate use and disposal of face masks in the country.


id: cord-260444-ooi5x9p3
author: Gadelha Farias, Luís Arthur Brasil
date: 2020-08-18
txt: ./txt/cord-260444-ooi5x9p3.txt
cache: ./cache/cord-260444-ooi5x9p3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0737
doi: 10.4269/ajtmh.20-0737
summary:
  Coinfection of SARS-CoV-2/Mycobacterium tuberculosis (MTB) in patients with HIV/AIDS has not been previously reported. 6, 7 The coinfection of SARS-CoV-2 and Mycobacterium tuberculosis (MTB) in patients with HIV infection is a matter of concern and has not been well studied. Here, we present two cases of triple coinfections (HIV/SARS-CoV-2/MTB) in patients admitted to Sao José Hospital of Infectious Diseases, Fortaleza, Ceará, Brazil. To the best of our knowledge, this is the first reported case of coinfection of SARS-CoV-2/MTB in patients with HIV/AIDS. The present article reports two cases of COVID-19 in patients with HIV/MTB coinfections. Although the risk factors for COVID-19 still need to be fully understood, the two cases presented here may indicate that HIV/MTB coinfection could be another risk factor to be considered when evaluating SARS-CoV-2-infected patients. Herein, we studied only two cases of SARS-CoV-2 and MTB coinfection in HIV-infected patients.

title:
  Case Report: Coronavirus Disease and Pulmonary Tuberculosis in Patients with Human Immunodeficiency Virus: Report of Two Cases

abstract:
  Coinfection of SARS-CoV-2/Mycobacterium tuberculosis (MTB) in patients with HIV/AIDS has not been previously reported. Here, we present two cases of coinfection of SARS-CoV-2 and MTB in patients with HIV. The first case is a 39-year-old patient who was admitted with a 7-day history of fever, myalgia, headache, and cough. The second patient is a 43-year-old man who had a 1-month history of cough with hemoptoic sputum, evolving to mild respiratory distress in the last 7 days. Both patients already had pulmonary tuberculosis and subsequently developed SARS-CoV-2 infection during the 2020 pandemic. Nonadherence to antiretroviral treatment may have been a factor in the clinical worsening of the patients.


id: cord-260871-dtn5t8ka
title: SARS-CoV-2: Should We Be Concerned about the Nervous System?
author: Silva, Marcus Tulius T.
date: 2020-07-17
txt: ./txt/cord-260871-dtn5t8ka.txt
cache: ./cache/cord-260871-dtn5t8ka.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0447
doi: 10.4269/ajtmh.20-0447
summary:
  Besides, several neurological manifestations had been described as complications of two other previous outbreaks of CoV diseases (SARS ad Middle East respiratory syndrome). Several neurological manifestations were described as complications of two other previous outbreaks of CoV diseases, namely, SARS and the Middle East respiratory syndrome (MERS). Stroke is one of the most frequent neurological diseases associated with SARS-CoV-2 infection, 8 and large-vessel stroke in younger patients was recently reported in five patients. Detection of SARS coronavirus RNA in the cerebrospinal fluid of a patient with severe acute respiratory syndrome Mechanisms of host defense following severe acute respiratory syndrome-coronavirus (SARS-CoV) pulmonary infection of mice Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2 Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the central nervous system

abstract:
  The COVID-19 pandemic has proved to be an enormous challenge to the health of the world population with tremendous consequences for the world economy. New knowledge about COVID-19 is being acquired continuously. Although the main manifestation of COVID-19 is SARS, dysfunction in other organs has been described in the last months. Neurological aspects of COVID-19 are still an underreported subject. However, a plethora of previous studies has shown that human CoVs might be neurotropic, neuroinvasive, and neurovirulent, highlighting the importance of this knowledge by physicians. Besides, several neurological manifestations had been described as complications of two other previous outbreaks of CoV diseases (SARS ad Middle East respiratory syndrome). Therefore, we should be watchful, searching for early evidence of neurological insults and promoting clinical protocols to investigate them. Our objectives are to review the potential neuropathogenesis of this new CoV and the neurological profile of COVID-19 patients described so far.


id: cord-264140-5cxzc3z8
author: Tam, Clarence C.
date: 2018-09-04
txt: ./txt/cord-264140-5cxzc3z8.txt
cache: ./cache/cord-264140-5cxzc3z8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30182916/
doi: 10.4269/ajtmh.18-0219
summary:
  Our results emphasize the need for improved infection prevention and control in military environments, given the high burden of illness and potential for intense transmission of respiratory pathogens. 2 Studies among military recruits have found high rates of illness and infection with respiratory viruses. 9, 10 Studies in military populations can provide valuable information regarding the epidemiology and transmission of respiratory infections in adults because of the availability of well-defined populations that can be followed up over time. 12, 13 We also tested acute samples (from both camps) and the routine enrolment and follow-up specimens (from one camp) using a multiplex real-time PCR assay comprising 33 bacterial, viral, and fungal targets (FTD33 kit; Fast Track Diagnostics, Esch-sur-Alzette, Luxembourg). A quarter of URI cases in our study were prescribed broad-spectrum antibiotics, of whom 50% were more likely to have infections caused by viral pathogens based on multiplex PCR results.

title:
  Epidemiology and Transmission of Respiratory Infections in Thai Army Recruits: A Prospective Cohort Study

abstract:
  Military recruits are at high risk of respiratory infections. However, limited data exist on military populations in tropical settings, where the epidemiology of respiratory infections differs substantially from temperate settings. We enrolled recruits undertaking a 10-week military training at two Royal Thai Army barracks between May 2014 and July 2015. We used a multiplex respiratory panel to analyze nose and throat swabs collected at the start and end of the training period, and from participants experiencing respiratory symptoms during follow-up. Paired sera were tested for influenza seroconversion using a hemagglutinin inhibition assay. Overall rates of upper respiratory illness and influenza-like illness were 3.1 and 2.0 episodes per 100 person-weeks, respectively. A pathogen was detected in 96% of samples. The most commonly detected microbes were Haemophilus influenzae type B (62.7%) or non–type B (58.2%) and rhinovirus (22.4%). At baseline, bacterial colonization was high and included H. influenzae type B (82.3%), H. influenzae non–type B (31.5%), Klebsiella pneumoniae (14.6%), Staphylococcus aureus (8.5%), and Streptococcus pneumoniae (8.5%). At the end of follow-up, colonization with H. influenzae non–type B had increased to 74.1%, and S. pneumoniae to 33.6%. In the serology subset, the rate of influenza infection was 3.4 per 100 person-months; 58% of influenza infections resulted in clinical disease. Our study provides key data on the epidemiology and transmission of respiratory pathogens in tropical settings. Our results emphasize the need for improved infection prevention and control in military environments, given the high burden of illness and potential for intense transmission of respiratory pathogens.


id: cord-270495-2u072mtp
title: Diagnosis of COVID-19 in a Dengue-Endemic Area
author: Lokida, Dewi
date: 2020-08-05
txt: ./txt/cord-270495-2u072mtp.txt
cache: ./cache/cord-270495-2u072mtp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32762798/
doi: 10.4269/ajtmh.20-0676
summary:
  When SARS-CoV-2 is negative and clinical indication is present (at least fever and thrombocytopenia), DENV NS1 antigen and/or IgM/IgG antibody testing may be performed. Clinicians from Singapore reported two COVID-19 cases that were misdiagnosed as dengue among patients who presented with clinical manifestations and hematology profiles, suggesting dengue infection and false-positive DENV IgM antibody using a rapid diagnostic test (RDT). COVID-19 cases were defined as inpatients who met the COVID-19 criteria based on a predetermined combination of symptoms, laboratory testing, imaging, and risk exposure at Tangerang District Hospital, Indonesia (see Supplemental Table 1 ), and had a positive nasopharyngeal or oropharyngeal real-time RT-PCR for SARS-CoV-2. None of the 42 subjects was positive for dengue NS1 or showed seroconversion or increasing DENV IgM and IgG index values, suggesting no acute DENV infection among these COVID-19 cases. The third patient did not recall having a fever before acute COVID-19 illness, suggesting asymptomatic or mild dengue, the most common presentation of DENV infection.

abstract:
  Emergence of SARS-CoV-2 in dengue virus (DENV)–endemic areas complicates the diagnosis of both infections. COVID-19 cases may be misdiagnosed as dengue, particularly when relying on DENV IgM, which can remain positive months after infection. To estimate the extent of this problem, we evaluated sera from 42 confirmed COVID-19 patients for evidence of DENV infection. No cases of SARS-CoV-2 and DENV coinfection were identified. However, recent DENV infection, indicated by the presence of DENV IgM and/or high level of IgG antibodies, was found in seven patients. Dengue virus IgM and/or high IgG titer should not exclude COVID-19. SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) testing is appropriate when dengue nonstructural protein 1 (NS1) or RT-PCR is negative. Given the possibility of coinfection, testing for both DENV and SARS-CoV-2 is merited in the setting of the current pandemic.


id: cord-271906-2nm55024
author: Quincho-Lopez, Alvaro
date: 2020-07-23
txt: ./txt/cord-271906-2nm55024.txt
cache: ./cache/cord-271906-2nm55024.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0815
doi: 10.4269/ajtmh.20-0815
summary:
  title: Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review We performed a literature review of COVID-19 pneumonia cases that developed pneumothorax, pneumomediastinum, or both. 3, 4 Herein, we report two cases of patients infected with SARS-CoV-2, who developed pneumomediastinum, and one of them also presented pneumothorax. 14 Table 1 presents a summary of case reports of patients infected with SARS-CoV-2 who presented pneumothorax, pneumomediastinum, or both. In conclusion, pneumothorax and pneumomediastinum are possible complications of COVID-19 pneumonia, causing acute decompensation that can worsen the prognosis of patients, especially those with underlying lung diseases. Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: case report Secondary tension pneumothorax in a COVID-19 pneumonia patient: a case report Spontaneous pneumomediastinum in a patient with coronavirus disease 2019 pneumonia and the possible underlying mechanism Spontaneous pneumomediastinum: a probable unusual complication of coronavirus disease 2019 (COVID-19) pneumonia

title:
  Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review

abstract:
  As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumothorax and pneumomediastinum. Recent evidence suggested that these can occur in the context of COVID-19 pneumonia, even in the absence of mechanical ventilation–related barotrauma. We present two patients with COVID-19 pneumonia complicated by pneumomediastinum. The first patient was a 55-year-old woman who developed COVID-19 pneumonia. Her clinical course was complicated by pneumothorax and pneumomediastinum, and, unfortunately, she died 2 days following the admission. The second patient was a 31-year-old man who developed a small pneumomediastinum and was managed conservatively. He had a spontaneous resolution of the pneumomediastinum and was discharged 19 days later. None of our patients required invasive or noninvasive positive pressure ventilation. We performed a literature review of COVID-19 pneumonia cases that developed pneumothorax, pneumomediastinum, or both. The analysis showed that the latter had high mortality (60%). Thus, it is necessary to pay attention to these complications as early identification and management can reduce the associated morbidity and mortality.


id: cord-275243-knr3mat0
author: Larsen, Kevin
date: 2020-07-01
txt: ./txt/cord-275243-knr3mat0.txt
cache: ./cache/cord-275243-knr3mat0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0597
doi: 10.4269/ajtmh.20-0597
summary:
  title: Detection of Pulmonary Embolism in Returning Travelers with Hypoxemic Pneumonia due to COVID-19 in Reunion Island All returning travelers to Reunion Island with hypoxemic pneumonia due to COVID-19 underwent computed tomography pulmonary angiography (CTPA) and were included in the cohort. 4 The aim of this study was to evaluate the occurrence of pulmonary embolism in returning travelers with hypoxemic pneumonia due to COVID-19. 4 The aim of this study was to evaluate the occurrence of pulmonary embolism in returning travelers with hypoxemic pneumonia due to COVID-19. To our knowledge, this is the only study that has consecutively evaluated the occurrence of pulmonary embolism in returning travelers with hypoxemic pneumonia due to COVID-19. Returning travelers with hypoxemic pneumonia due to COVID-19 should be systematically screened for pulmonary embolism or deep vein thrombosis regardless of the level of D-dimers.

title:
  Detection of Pulmonary Embolism in Returning Travelers with Hypoxemic Pneumonia due to COVID-19 in Reunion Island

abstract:
  The aim of this study was to evaluate the occurrence of pulmonary embolism in returning travelers with hypoxemic pneumonia due to COVID-19. All returning travelers to Reunion Island with hypoxemic pneumonia due to COVID-19 underwent computed tomography pulmonary angiography (CTPA) and were included in the cohort. Thirty-five patients were returning travelers with hypoxemic pneumonia due to COVID-19 and had recently returned from one of the countries most affected by the COVID-19 outbreak (mainly from France and Comoros archipelago). Five patients (14.3%) were found to have pulmonary embolism and two (5.9%) were incidentally found to have deep vein thrombosis on CTPA. Patients with pulmonary embolism or deep vein thrombosis had higher D-dimer levels than those without pulmonary embolism or deep vein thrombosis (P = 0.04). Returning travelers with hypoxemic pneumonia due to COVID-19 should be systematically screened for pulmonary embolism.


id: cord-278283-uoy54dds
title: Malaria in Zhejiang Province, China, from 2005 to 2014
author: Chen, Hualiang
date: 2015-08-05
txt: ./txt/cord-278283-uoy54dds.txt
cache: ./cache/cord-278283-uoy54dds.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/26078321/
doi: 10.4269/ajtmh.15-0080
summary:
  To summarize the changing epidemiological characteristics of malaria in Zhejiang Province, China, we collected data on malaria from the Chinese Notifiable Disease Reporting System (NDRS) and analyzed them. Malaria incidence decreased in recent years in Zhejiang Province, but there were hundreds of imported malaria cases every year and epidemiological characteristics changed. Furthermore, the number of imported cases was relative to the frequency of travel and trade to malaria-endemic areas. In summary, the number of malaria cases decreased in recent years, and no indigenous cases were reported in Zhejiang Province from 2012 to 2014. These results informed that imported cases were the emphases for the control and prevention of malaria, and measures should be taken in all months in Zhejiang Province. Measures to better intercept imported cases should include health education and preventive medication among travelers to malaria-endemic areas, the screening of malaria among travelers with high fever, and collaborating with the neighboring countries.

abstract:
  To summarize the changing epidemiological characteristics of malaria in Zhejiang Province, China, we collected data on malaria from the Chinese Notifiable Disease Reporting System (NDRS) and analyzed them. A total of 2,738 malaria cases were identified in Zhejiang Province from 2005 to 2014, of which 2,018 were male and 720 were female. Notably, only 7% of malaria cases were indigenous and the other cases were all imported. The number of malaria cases increased from 2005 to 2007, peaked in 2007, and then decreased from 2007 to 2011. There were no indigenous cases from 2012 to 2014. Of all cases, 68% of cases contracted Plasmodium vivax, 27% of cases contracted P. falciparum, and two cases contracted P. malariae. About 88% of malaria cases during 2005–2011 occurred yearly between May and October, but the number of malaria cases in different months during 2012–2014 was similar. The median age was 33 years, and 1,892 cases occurred in persons aged 20–50 years. The proportion of businessmen increased and the proportion of migrant laborers decreased in recent years. The median time from illness onset to confirmation of malaria cases was 5 days and it decreased from 2005 to 2014. Some epidemiological characteristics of malaria have changed, and businessmen are the emphases to surveillance in every month.


id: cord-280164-dukccrjb
author: Nachega, Jean B.
date: 2020-06-19
txt: ./txt/cord-280164-dukccrjb.txt
cache: ./cache/cord-280164-dukccrjb.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32563272/
doi: 10.4269/ajtmh.20-0642
summary:
  With other African countries, the DRC faces the challenge of striking a balance between easing public health lockdown measures to curtail the spread of SARS-CoV-2 and minimizing both economic hardships for large sectors of the population and negative impacts on health services for other infectious and noninfectious diseases. Building on the DRC''s 40 years of experience with 10 previous EVD outbreaks, we highlight the DRC''s multi-sectoral public health approach to COVID-19, which includes community-based screening, testing, contact-tracing, risk communication, community engagement, and case management. [2] [3] [4] The Democratic Republic of the Congo (DRC) recently experienced its tenth Ebola virus disease (EVD) outbreak, the second largest globally after the 2014-2016 West African epidemic, which was recently brought under control. A multi-sectoral national committee to organize the COVID-19 response was created following the diagnosis of the first confirmed cases ( Figure 2 ) using lessons learned from the tenth EVD outbreak.

title:
  Responding to the Challenge of the Dual COVID-19 and Ebola Epidemics in the Democratic Republic of Congo—Priorities for Achieving Control

abstract:
  As of June 11, 2020, the Democratic Republic of the Congo (DRC) has reported 4,258 COVID-19 cases with 90 deaths. With other African countries, the DRC faces the challenge of striking a balance between easing public health lockdown measures to curtail the spread of SARS-CoV-2 and minimizing both economic hardships for large sectors of the population and negative impacts on health services for other infectious and noninfectious diseases. The DRC recently controlled its tenth Ebola virus disease (EVD) outbreak, but COVID-19 and a new EVD outbreak beginning on June 1, 2020 in the northwest Équateur Province have added an additional burden to health services. Although the epidemiology and transmission of EVD and COVID-19 differ, leveraging the public health infrastructures and experiences from coordinating the EVD response to guide the public health response to COVID-19 is critical. Building on the DRC’s 40 years of experience with 10 previous EVD outbreaks, we highlight the DRC’s multi-sectoral public health approach to COVID-19, which includes community-based screening, testing, contact-tracing, risk communication, community engagement, and case management. We also highlight remaining challenges and discuss the way forward for achieving control of both COVID-19 and EVD in the DRC.


id: cord-285369-ktg2b9jb
author: Mohamed, Mouhand F. H.
date: 2020-06-02
txt: ./txt/cord-285369-ktg2b9jb.txt
cache: ./cache/cord-285369-ktg2b9jb.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32500849/
doi: 10.4269/ajtmh.20-0371
summary:
  title: Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. We used a proportion meta-analysis to summarize or pool the frequency of various findings on lung US (based on our scoping review, we concluded that the sensitivity, specificity, and diagnostic accuracy could not be computed from the constituent studies). Forest plot presenting (A) the pooled proportion of B-pattern and (B) consolidation (the higher frequency of subpleural or pulmonary consolidations reported by the primary study) detected by lung ultrasound in symptomatic COVID-19 patients. 2020: Point-of-care lung ultrasound findings in patients with novel coronavirus disease (COVID-19) pneumonia

title:
  Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

abstract:
  The COVID-19 pandemic has resulted in significant morbidity, mortality, and strained healthcare systems worldwide. Thus, a search for modalities that can expedite and improve the diagnosis and management of this entity is underway. Recent data suggested the utility of lung ultrasound (LUS) in the diagnosis of COVID-19 by detecting an interstitial pattern (B-pattern). Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. We conducted a systematic review (PubMed, MEDLINE, and EMBASE until April 25, 2020) and a proportion meta-analysis. We included seven studies examining the role of LUS in 122 COVID-19 patients. The pooled proportion (PP) of B-pattern detected by lung ultrasound (US) was 0.97 (95% CI: 0.94–1.00 I(2) 0%, Q 4.6). The PP of finding pleural line abnormalities was 0.70 (95% CI: 0.13–1.00 I(2) 96%, Q 103.9), of pleural thickening was 0.54 (95% 0.11–0.95 I(2) 93%, Q 61.1), of subpleural or pulmonary consolidation was 0.39 (95% CI: 0.21–0.58 I(2) 72%, Q 17.8), and of pleural effusion was 0.14 (95% CI: 0.00–0.37 I(2) 93%, Q 27.3). Our meta-analysis revealed that almost all SARS-CoV-2–infected patients have abnormal lung US. The most common abnormality is interstitial involvement depicted as B-pattern. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. A sizable diagnostic accuracy study comparing LUS, computed tomography scan, and COVID-19–specific tests is warranted to further test this finding and to delineate the diagnostic and prognostic yield of each of these modalities.


id: cord-285428-fcrunf38
title: COVID-19: The Need for Immunoprevention at Industrial Scale
author: Halstead, Scott B.
date: 2020-04-08
txt: ./txt/cord-285428-fcrunf38.txt
cache: ./cache/cord-285428-fcrunf38.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0239
doi: 10.4269/ajtmh.20-0239
abstract: Novel Coronavirus Disease (COVID-19): The Need for Immunoprevention at Industrial Scale.
summary:
  Efforts to develop vaccines against Coronavirus disease-19 (COVID-19) are well advanced, based in part on experience with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). 3 Convalescent SARS antibodies given early in illness have been shown to reduce disease severity. 7 Gamma globulin prepared from immune donors or protective monoclonal antibodies offer possibilities of short-term protection for care givers and healthcare workers and, in particular, for those at high risk of severe or fatal COVID-19. To avoid possible enhancement of COVID-19, antibodies might be given to prevent SARS-CoV-2 infections after the removal or inactivation of the IgG Fc terminus. Efforts are well underway by many groups to derive monoclonal antibodies or manufacture gamma globulin from the huge cohort of COVID-19 convalescent immunes. Immune responses in COVID-19 and potential vaccines: lessons learned from SARS and MERS epidemic Perspectives on monoclonal antibody therapy as potential therapeutic intervention for Coronavirus disease-19 (COVID-19)


id: cord-285486-99trkti1
title: Hydroxychloroquine in the Treatment of COVID-19: A Multicenter Randomized Controlled Study
author: Abd-Elsalam, Sherief
date: 2020-08-14
txt: ./txt/cord-285486-99trkti1.txt
cache: ./cache/cord-285486-99trkti1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32828135/
doi: 10.4269/ajtmh.20-0873
summary:
  Univariate logistic regression analysis showed that HCQ treatment was not significantly associated with decreased mortality in COVID-19 patients. So, adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients. 1. Hydroxychloroquine group: This group included 97 patients who received HCQ 400 mg twice daily (in day 1) followed by 200 mg tablets twice daily added to the standard of care treatment adopted by the Egyptian MOH for 15 days. 18 Although cardiac toxicity is a known adverse event requiring monitoring during treatment, HCQ showed promise in treating SARS-CoV-2-infected patients with multiple comorbidities including coronary artery disease. 12 studied the change in symptom severity over 14 days in nonhospitalized patients between HCQ and control groups and did not find any significant difference (P = 0.12).

abstract:
  The COVID-19 pandemic is showing an exponential growth, mandating an urgent need to develop an effective treatment. Indeed, to date, a well-established therapy is still lacking. We aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) added to standard care in patients with COVID-19. This was a multicenter, randomized controlled trial conducted at three major university hospitals in Egypt. One hundred ninety-four patients with confirmed diagnosis of COVID-19 were included in the study after signing informed consent. They were equally randomized into two arms: 97 patients administrated HCQ plus standard care (HCQ group) and 97 patients administered only standard care as a control arm (control group). The primary endpoints were recovery within 28 days, need for mechanical ventilation, or death. The two groups were matched for age and gender. There was no significant difference between them regarding any of the baseline characteristics or laboratory parameters. Four patients (4.1%) in the HCQ group and 5 (5.2%) patients in the control group needed mechanical ventilation (P = 0.75). The overall mortality did not differ between the two groups, as six patients (6.2%) died in the HCQ group and 5 (5.2%) died in the control group (P = 0.77). Univariate logistic regression analysis showed that HCQ treatment was not significantly associated with decreased mortality in COVID-19 patients. So, adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients.


id: cord-285490-tpsf05ca
title: Case Report: Rhabdomyolysis in a Patient with COVID-19: A Proposed Diagnostic-Therapeutic Algorithm
author: Solís, José Gabriel
date: 2020-07-29
txt: ./txt/cord-285490-tpsf05ca.txt
cache: ./cache/cord-285490-tpsf05ca.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0692
doi: 10.4269/ajtmh.20-0692
summary:
  title: Case Report: Rhabdomyolysis in a Patient with COVID-19: A Proposed Diagnostic-Therapeutic Algorithm He developed acute kidney injury requiring renal replacement therapy without reversibility, despite optimal treatment. 2 We report the case of a patient with confirmed SARS-CoV-2 infection who presented with rhabdomyolysis as a cardinal manifestation, discuss the possible mechanisms, and propose a diagnostic-therapeutic algorithm. Laboratory tests revealed grade 3 acute kidney injury (AKI) with a creatinine level of 11 mg/dL (basal value 0.7 mg/dL); increased blood levels of creatine kinase (CK) (> 400,000 U/L), lactate dehydrogenase (LDH), aspartate aminotransferase, alanine aminotransferase; and electrolyte disturbances with hyperkalemia, hyperphosphatemia, hypocalcemia, and severe metabolic acidosis. The underlying cause of muscle injury must be identified and treated, which is difficult in patients with COVID-19 because there is no specific therapy. Kidney disease is associated with in-hospital death of patients with COVID-19 Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review

abstract:
  COVID-19 represents the greatest health challenge of modern years. The spectrum of illness comprises respiratory and non-respiratory manifestations. We report the case of an adult man with COVID-19 who presented with rhabdomyolysis as a principal extrapulmonary manifestation. Our patient presented with dyspnea, fever, and muscle pain. After a comprehensive approach, the diagnosis of COVID-19 and rhabdomyolysis was made. He developed acute kidney injury requiring renal replacement therapy without reversibility, despite optimal treatment. We performed a literature search for similar cases, discuss the potential mechanisms implied, and propose a diagnostic-therapeutic algorithm.


id: cord-286543-mtjk59rp
title: Healthcare Crisis in Bangladesh during the COVID-19 Pandemic
author: Al-Zaman, Md. Sayeed
date: 2020-08-20
txt: ./txt/cord-286543-mtjk59rp.txt
cache: ./cache/cord-286543-mtjk59rp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0826
doi: 10.4269/ajtmh.20-0826
summary:
  This article also identifies three responsible issues for the country''s deteriorating health care: 1) poor governance and increased corruption, 2) inadequate healthcare facilities, and 3) weak public health communication. As one of the world''s most densely populated countries (1,115 people/km 2 ) with 21.8% of people living below the poverty line, 2 Bangladesh has a healthcare system that lacks reliability, responsiveness, and empathy, and that has already been proved inadequate to deliver proper health care to the public on many occasions. 3, 5 Amid such a situation, the COVID-19 pandemic reveals many loopholes in the healthcare system that can be summarized under three themes: 1) poor governance and increased corruption, 2) inadequate healthcare facilities, and 3) weak public health communication. 6 In such a situation, many private medicals around the country were either unwilling or abstained from treating COVID-19 patients, and thus healthcare denial intensified.

abstract:
  The COVID-19 pandemic has had a severe impact worldwide. Developed countries, such as the United States, United Kingdom, Italy, and Spain, had their highly efficient medical infrastructure greatly stressed and suffered from high death tolls. Similarly, Bangladesh, a poverty-stricken South Asian country, is losing its battle against the pandemic, but mainly because of its incompetent healthcare system. The casualties are escalating and public sufferings are becoming unimaginable. On this backdrop, this perspective piece discusses the healthcare crisis in Bangladesh during the pandemic. This article also identifies three responsible issues for the country’s deteriorating health care: 1) poor governance and increased corruption, 2) inadequate healthcare facilities, and 3) weak public health communication.


id: cord-287247-vv0zc0gd
title: Malaria and Parasitic Neglected Tropical Diseases: Potential Syndemics with COVID-19?
author: Gutman, Julie R.
date: 2020-06-01
txt: ./txt/cord-287247-vv0zc0gd.txt
cache: ./cache/cord-287247-vv0zc0gd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0516
doi: 10.4269/ajtmh.20-0516
summary:
  With many LMICs implementing movement restrictions or ordering their populations to stay at home to limit SARS-CoV-2 transmission, the threat to essential health services is likely to be immediate, causing delays to diagnosis and treatment for other diseases, including malaria and NTDs. During the Ebola epidemic in West Africa, there were substantial reductions in all-cause outpatient visits and patients treated with antimalarial drugs 2 ; modeling the potential for similar disruptions in malaria control due to COVID-19 suggests that there could be up to an estimated 769,000 deaths due to malaria in 2020 (approximately double the number seen in 2018), mostly among children younger than 5 years. 58 Thus, coinfection with parasitic NTDs could result in altered risks and severity of clinical manifestations of SARS-CoV-2 infection, with the potential for decreased development of immunity with increased viral loads.

abstract:
  The COVID-19 pandemic, caused by SARS-CoV-2, have surpassed 5 million cases globally. Current models suggest that low- and middle-income countries (LMICs) will have a similar incidence but substantially lower mortality rate than high-income countries. However, malaria and neglected tropical diseases (NTDs) are prevalent in LMICs, and coinfections are likely. Both malaria and parasitic NTDs can alter immunologic responses to other infectious agents. Malaria can induce a cytokine storm and pro-coagulant state similar to that seen in severe COVID-19. Consequently, coinfections with malaria parasites and SARS-CoV-2 could result in substantially worse outcomes than mono-infections with either pathogen, and could shift the age pattern of severe COVID-19 to younger age-groups. Enhancing surveillance platforms could provide signals that indicate whether malaria, NTDs, and COVID-19 are syndemics (synergistic epidemics). Based on the prevalence of malaria and NTDs in specific localities, efforts to characterize COVID-19 in LMICs could be expanded by adding testing for malaria and NTDs. Such additional testing would allow the determination of the rates of coinfection and comparison of severity of outcomes by infection status, greatly improving the understanding of the epidemiology of COVID-19 in LMICs and potentially helping to mitigate its impact.


id: cord-294624-d71za6hi
author: Kapepula, Paulin M.
date: 2020-07-23
txt: ./txt/cord-294624-d71za6hi.txt
cache: ./cache/cord-294624-d71za6hi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0820
doi: 10.4269/ajtmh.20-0820
summary:
  authors: Kapepula, Paulin M.; Kabengele, Jimmy K.; Kingombe, Micheline; Van Bambeke, Françoise; Tulkens, Paul M.; Sadiki Kishabongo, Antoine; Decloedt, Eric; Zumla, Adam; Tiberi, Simon; Suleman, Fatima; Tshilolo, Léon; Muyembe-TamFum, Jean-Jacques; Zumla, Alimuddin; Nachega, Jean B. Derivatives from the herb Artemisia annua have been used as traditional medicine over centuries for the treatment of fevers, malaria, and respiratory tract infections. This highlights the urgent need for further research on herbal compounds to evaluate efficacy through controlled trials, and for efficacious compounds, to establish the active ingredients, develop formulations and dosing, and define pharmacokinetics, toxicology, and safety to enable drug development. 6, 7 Among many, derivatives from the herb Artemisia annua (Figure 1 ) have been used as traditional medicine over centuries for the treatment of fevers, malaria, and respiratory tract infections. Annua for COVID-19 following claims from politicians and others in low-income countries highlights the need for hard data to establish the active ingredients; develop formulations and dosing; define the pharmacokinetics, toxicology, and safety; and evaluate efficacy through controlled trials.

title:
  Artemisia Spp. Derivatives for COVID-19 Treatment: Anecdotal Use, Political Hype, Treatment Potential, Challenges, and Road Map to Randomized Clinical Trials

abstract:
  The world is currently facing a novel COVID-19 pandemic caused by SARS-CoV-2 that, as of July 12, 2020, has caused a reported 12,322,395 cases and 556,335 deaths. To date, only two treatments, remdesivir and dexamethasone, have demonstrated clinical efficacy through randomized controlled trials (RCTs) in seriously ill patients. The search for new or repurposed drugs for treatment of COVID-19 continues. We have witnessed anecdotal use of herbal medicines, including Artemisia spp. extracts, in low-income countries, and exaggerated claims of their efficacies that are not evidence based, with subsequent political controversy. These events highlight the urgent need for further research on herbal compounds to evaluate efficacy through RCTs, and, when efficacious compounds are identified, to establish the active ingredients, develop formulations and dosing, and define pharmacokinetics, toxicology, and safety to enable drug development. Derivatives from the herb Artemisia annua have been used as traditional medicine over centuries for the treatment of fevers, malaria, and respiratory tract infections. We review the bioactive compounds, pharmacological and immunological effects, and traditional uses for Artemisia spp. derivatives, and discuss the challenges and controversies surrounding current efforts and the scientific road map to advance them to prevent or treat COVID-19.


id: cord-296363-qgoxlqoq
author: Khan, Yusra Habib
date: 2020-06-22
txt: ./txt/cord-296363-qgoxlqoq.txt
cache: ./cache/cord-296363-qgoxlqoq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0654
doi: 10.4269/ajtmh.20-0654
summary:
  We believe that ethical and responsible behavior of mass media, a careful advisory from the Pakistan Electronic Media Regulatory Authority, stern measures from healthcare authorities, effective maneuvers to increase public awareness on COVID-19, vigorous analysis of information by data or communications scientists, and publication of counter opinions from health professionals against such theories will go a long way in neutralizing such misleading claims. Of these, alleged poor quality of vaccines, questioning of dosing recommendations, religious prohibitions ("infidel vaccine"), and rumors related to the presence of active virus in the vaccines are some leading claims obstructing the anti-polio campaign in the country. 1 Unfortunately, a conspiracy theory against COVID-19 vaccine is currently being spread in Pakistan. A similar approach was adopted by the country when the polio vaccine campaign was hindered by a conspiracy theory claiming that these vaccines were monkey-or pig-derived products, which are forbidden in Islam.

title:
  Threat of COVID-19 Vaccine Hesitancy in Pakistan: The Need for Measures to Neutralize Misleading Narratives

abstract:
  Immediately after declaring COVID-19 as a pandemic, numerous wild conspiracy theories sprouted through social media. Pakistan is quite vulnerable to such conspiracy narratives and has experienced failures of polio vaccination programs because of such claims. Recently, two well-known political figures raised conspiracy theories against COVID-19 vaccines in Pakistan, stating that COVID-19 is a grand illusion and a conspiracy against Muslim countries. This theory is much discussed in the local community, supporting COVID-19 vaccine hesitancy. We urge healthcare authorities in Pakistan to take necessary measures against such claims before they penetrate to the general community. Anti-vaccine movements could undermine efforts to end the COVID-19 pandemic. We believe that ethical and responsible behavior of mass media, a careful advisory from the Pakistan Electronic Media Regulatory Authority, stern measures from healthcare authorities, effective maneuvers to increase public awareness on COVID-19, vigorous analysis of information by data or communications scientists, and publication of counter opinions from health professionals against such theories will go a long way in neutralizing such misleading claims. Because Pakistan is experiencing a large burden of disease, with a sharp rise in confirmed cases, immediate action is of paramount importance to eradicate any potential barriers to a future COVID-19 vaccination program.


id: cord-296556-fr8x8j3i
title: Ivermectin and COVID-19: Keeping Rigor in Times of Urgency
author: Chaccour, Carlos
date: 2020-04-16
txt: ./txt/cord-296556-fr8x8j3i.txt
cache: ./cache/cord-296556-fr8x8j3i.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0271
doi: 10.4269/ajtmh.20-0271
abstract: Ivermectin and Novel Coronavirus Disease (COVID-19): Keeping Rigor in Times of Urgency.
summary:
  10 recently reported that ivermectin is a potent inhibitor of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in vitro. 13 However, even with this dose, which is 10-fold greater than those approved by the US Food and Drug Administration, the C max values reported were ∼250 ng/mL, 13 one order of magnitude lower than effective in vitro concentrations against SARS-CoV-2. Very recently, preliminary findings on a potential effect of hydroxychloroquine combined with azithromycin against SARS-CoV-2 were widely publicized, 15 leading to a surge in demand and self-medication, which resulted in serious harm in some cases and a stock shortage that jeopardized drug availability for other critical conditions for which hydroxychloroquine or chloroquine is the standard of care, that is, vivax malaria, rheumatoid arthritis, and systemic lupus erythematosus. 20, 21 Second, boosted antiretrovirals such as lopinavir/ritonavir and darunavir/cobicistat, which have been widely used against SARS-CoV-2 based on limited evidence, and a number of other drugs, are potent inhibitors of cytochrome P 450 3A4, the main metabolic pathway for ivermectin.


id: cord-305073-8301zqj9
title: Case Report: COVID-19–Associated Bilateral Spontaneous Pneumothorax—A Literature Review
author: Alhakeem, Ayat
date: 2020-07-14
txt: ./txt/cord-305073-8301zqj9.txt
cache: ./cache/cord-305073-8301zqj9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32666917/
doi: 10.4269/ajtmh.20-0680
summary:
  We report a case of COVID-19 pneumonia with bilateral spontaneous pneumothorax with no known underlying lung disease or risk factors. Most of the reported cases of pneumothorax associated with COVID-19 lack traditional risk factors or underlying predisposing lung disease. Highresolution computed tomography (CT) chest showed multiple bilateral bullae in the lungs complicated by the pneumothorax because of rupture ( Figure 1D ). The bullous changes could represent an undiagnosed underlying pulmonary disease, which became apparent after the inflammatory changes and excessive mechanical forces introduced by the SARS-CoV-2 infection, leading to a unilateral spontaneous pneumothorax, followed by bilateral pneumothorax. Review of the literature shows 18 case reports describing COVID-19 patients with spontaneous pneumothorax. Diagnosis and treatment of severe COVID-19 complicated with spontaneous pneumothorax: a case report Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: case report Spontaneous pneumomediastinum in a patient with coronavirus disease 2019 pneumonia and the possible underlying mechanism

abstract:
  COVID-19 is a pandemic caused by SARS-CoV-2, primarily affecting the respiratory tract. Pulmonary complications of COVID-19 may include acute respiratory distress syndrome and pulmonary embolism. Pneumothorax has been recently reported in association with COVID-19. We report a case of COVID-19 pneumonia with bilateral spontaneous pneumothorax with no known underlying lung disease or risk factors.


id: cord-306149-sd0s0jup
title: Critical Care Management of Patients with COVID-19: Early Experience in Thailand
author: Ratanarat, Ranistha
date: 2020-05-18
txt: ./txt/cord-306149-sd0s0jup.txt
cache: ./cache/cord-306149-sd0s0jup.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32431287/
doi: 10.4269/ajtmh.20-0442
summary:
  Case fatality in Thailand has been low (1.7%), at least in part due to early stratification according to risk of disease severity and timely initiation of supportive care with affordable measures. We present our initial experience with COVID-19 in Thailand, focusing on several aspects that may have played a crucial role in curtailment of the pandemic, and elements of care for severely ill COVID-19 patients, including stratification, isolation, and affordable diagnostic approaches and supportive care measures. We also have promising experience with the "Kigali modification of the Berlin definition for acute respiratory distress syndrome (ARDS)" in the early detection and management of COVID-19 patients. In Thailand, awaiting definitive results of randomized clinical trials, critically ill COVID-19 patients receive combination therapies with at least three different mechanisms of action, including favipiravir for 10 days, depending on clinical symptoms. Respiratory support in novel coronavirus disease (COVID-19) patients, with a focus on resource-limited settings

abstract:
  Since late December 2019, the world has been challenged with an outbreak of COVID-19. In Thailand, an upper middle–income country with a limited healthcare infrastructure and restricted human resources, nearly 3,000 confirmed COVID-19 cases have been reported as of early May 2020. Public health policies aimed at preventing new COVID-19 cases were very effective in halting the pandemic in Thailand. Case fatality in Thailand has been low (1.7%), at least in part due to early stratification according to risk of disease severity and timely initiation of supportive care with affordable measures. We present our initial experience with COVID-19 in Thailand, focusing on several aspects that may have played a crucial role in curtailment of the pandemic, and elements of care for severely ill COVID-19 patients, including stratification, isolation, and affordable diagnostic approaches and supportive care measures. We also discuss local considerations concerning some proposed experimental treatments.


id: cord-308680-moligska
author: Wong, Justin
date: 2020-08-14
txt: ./txt/cord-308680-moligska.txt
cache: ./cache/cord-308680-moligska.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0771
doi: 10.4269/ajtmh.20-0771
summary:
  We report findings from the epidemiological investigation of the initial 135 COVID-19 cases in Brunei and describe the impact of control measures and travel restrictions. Regular and ongoing testing of high-risk groups to supplement the existing surveillance program and a phased easing of physical distancing measures has helped maintain suppression of the COVID-19 outbreak in Brunei, as evidenced by the identification of only six additional cases from April 5 to August 5, 2020. Here, we report findings from the first 135 COVID-19 cases, detected within the first 5 weeks of the local epidemic, along with their epidemiological, clinical, and transmission characteristics. In Hong Kong, case isolation and contact tracing were combined with other physical distancing measures (but no lockdown), which resulted in an estimated effective reproduction number near 1 for 8 weeks.

title:
  Epidemiological Investigation of the First 135 COVID-19 Cases in Brunei: Implications for Surveillance, Control, and Travel Restrictions

abstract:
  Studies on the early introduction of SARS-CoV-2 in a naive population have important epidemic control implications. We report findings from the epidemiological investigation of the initial 135 COVID-19 cases in Brunei and describe the impact of control measures and travel restrictions. Epidemiological and clinical information was obtained for all confirmed COVID-19 cases, whose symptom onset was from March 9 to April 5, 2020. The basic reproduction number (R0), incubation period, and serial interval (SI) were calculated. Time-varying R was estimated to assess the effectiveness of control measures. Of the 135 cases detected, 53 (39.3%) were imported. The median age was 36 (range = 0.5–72) years. Forty-one (30.4%) and 13 (9.6%) were presymptomatic and asymptomatic cases, respectively. The median incubation period was 5 days (interquartile range [IQR] = 5, range = 1–11), and the mean SI was 5.4 days (SD = 4.5; 95% CI: 4.3, 6.5). The reproduction number was between 3.9 and 6.0, and the doubling time was 1.3 days. The time-varying reproduction number (Rt) was below one (Rt = 0.91; 95% credible interval: 0.62, 1.32) by the 13th day of the epidemic. Epidemic control was achieved through a combination of public health measures, with emphasis on a test–isolate–trace approach supplemented by travel restrictions and moderate physical distancing measures but no actual lockdown. Regular and ongoing testing of high-risk groups to supplement the existing surveillance program and a phased easing of physical distancing measures has helped maintain suppression of the COVID-19 outbreak in Brunei, as evidenced by the identification of only six additional cases from April 5 to August 5, 2020.


id: cord-309900-4nln90jn
author: Doornekamp, Laura
date: 2017-07-12
txt: ./txt/cord-309900-4nln90jn.txt
cache: ./cache/cord-309900-4nln90jn.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/28719318/
doi: 10.4269/ajtmh.16-0661
summary:
  In the context of this study, we measured the effects of a secondary school education module, named Viruskenner, on knowledge, attitude, and risk behavior as these relate to virus infections. A nonrandomized intervention study was conducted between April and August 2015 to assess the effect of this 2-month education module on knowledge, attitude, and behavior of 684 secondary school students in the Netherlands, Suriname, and Indonesia. When becoming an international education module, it was interesting to see the impact of Viruskenner in different countries on knowledge, attitudes, and behavior as they relate to virus infections, and find out which educational factors play a role in these changes. During the intervention, students could use the modules'' website (www.viruskenner.nl) and other supportive resources, like a YouTube channel and a Facebook page (all in Dutch and English and available for all participating countries), to find more information on the project and on virus infections and to disseminate information about their prevention tools.

title:
  Experience with a Multinational, Secondary School Education Module with a Focus on Prevention of Virus Infections

abstract:
  Worldwide, virus infections are responsible for many diseases in terms of morbidity and mortality. Vaccinations and therapies are only available for relatively few virus infections and not always where they are needed. However, knowledge of transmission routes can prevent virus infection. In the context of this study, we measured the effects of a secondary school education module, named Viruskenner, on knowledge, attitude, and risk behavior as these relate to virus infections. A nonrandomized intervention study was conducted between April and August 2015 to assess the effect of this 2-month education module on knowledge, attitude, and behavior of 684 secondary school students in the Netherlands, Suriname, and Indonesia. For the Netherlands, a control group of a further 184 students was added. Factor analysis was performed on questions pertaining to attitude and behavior. Comparative analyses between pre- and posttest per country were done using multiple linear regression, independent sample T-tests, and one-way analysis of variance. These showed a significant increase in knowledge about virus infections and the prevention of infectious diseases among the Dutch and Surinamese groups, whereas a trend of increased knowledge was evident among the Indonesian participants. The Dutch control group showed an overall decrease in knowledge. Regression analyses showed that there was a significant interaction effect between participation and time on knowledge, attitude, and awareness and behavior and risk infection. Attitudes improved significantly in the intervention group. Pearson correlation coefficients between knowledge, attitude, and behavior were found to be positive.


id: cord-310868-rqmny4r2
title: How Do We Combat Bogus Medicines in the Age of the COVID-19 Pandemic?
author: Tesfaye, Wubshet
date: 2020-08-18
txt: ./txt/cord-310868-rqmny4r2.txt
cache: ./cache/cord-310868-rqmny4r2.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0903
doi: 10.4269/ajtmh.20-0903
summary:
  15 For the Global South, the pandemic exacerbates the existing proliferation of substandard and falsified medical products, and these trends are likely to continue as effective drugs continue to emerge from ongoing trials. The WHO defines substandard products as "authorized medical products that fail to meet quality standards or specifications, or both" and falsified products as "products that deliberately/ fraudulently misrepresent identity, composition, or source." 16 Considering less than 30% of regulatory agencies in the world can ensure the adequacy of medicines and vaccines, 17 pandemics of COVID-19 proportion would inevitably present enormous regulatory challenges. There is a risk that when the COVID-19 pandemic further spreads in LMICs, there will be an increased potential for the distribution of falsified and counterfeit medicines, something the international community needs to be alert to and work against. In meeting these needs, governments, pharmaceutical regulatory agencies, and associate supply chains must have practical and financially supported strategies to ensure quality-assured medicines are made available for the determined need.

abstract:
  The COVID-19 pandemic has brought concurrent challenges. The increased incidence of fake and falsified product distribution is one of these problems with tremendous impact, especially in low- and middle-income countries. Up to a tenth of medicines including antibiotics and antimalarial drugs in the African market are considered falsified. Pandemics make this worse by creating an ecosystem of confusion, distraction, and vulnerability stemming from the pandemic as health systems become more stressed and the workload of individuals increased. These environments create opportunities for substandard and falsified medicines to be more easily introduced into the marketplace by unscrupulous operators. In this work we discuss some of the challenges with fake or falsified product distribution in the context of COVID-19 and proposed strategies to best manage this problem.


id: cord-312841-g948h572
author: Kalkeri, Raj
date: 2020-05-13
txt: ./txt/cord-312841-g948h572.txt
cache: ./cache/cord-312841-g948h572.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32406369/
doi: 10.4269/ajtmh.20-0279
summary:
  Infection of such extrapulmonary organs may serve as a reservoir for SARS-CoV-2, representing a potential source of viral shedding after the cessation of respiratory symptoms in recovered patients or in asymptomatic individuals. Considering this possibility, this perspective is focused on extrapulmonary organs affected by SARS-CoV-2 and the implications of their involvement for disease transmission, clinical management strategies, and medical countermeasure discovery and development. 17 Liver, kidney, and heart abnormalities are also observed in COVID-19 patients, 18, 19 and although SARS-CoV-2 RNA is not reported in these tissues after autopsy, the detection of viral RNA in the liver of the hamster model 20 suggests the infection of these organs in patients. The identification of non-respiratory tissue reservoirs of SARS-CoV-2 suggests that further studies are needed to address implications for COVID-19 disease progression, effects on extrapulmonary tissues harboring the virus, and development of optimal medical countermeasures and disease management strategies.

title:
  SARS-CoV-2 Shedding from Asymptomatic Patients: Contribution of Potential Extrapulmonary Tissue Reservoirs

abstract:
  The ongoing pandemic COVID-19, caused by SARS-CoV-2, has already resulted in more than 3 million cases and more than 200,000 deaths globally. Significant clinical presentations of COVID-19 include respiratory symptoms and pneumonia. In a minority of patients, extrapulmonary organs (central nervous system, eyes, heart, and gut) are affected, with detection of viral RNA in bodily secretions (stool, tears, and saliva). Infection of such extrapulmonary organs may serve as a reservoir for SARS-CoV-2, representing a potential source of viral shedding after the cessation of respiratory symptoms in recovered patients or in asymptomatic individuals. It is extremely important to understand this phenomenon, as individuals with intermittent virus shedding could be falsely identified as reinfected and may benefit from ongoing antiviral treatment. The potential of SARS-CoV-2 infection to rapidly disseminate and infect extrapulmonary organs is likely mediated through the nonstructural and accessory proteins of SARS-CoV-2, which act as ligands for host cells, and through evasion of host immune responses. The focus of this perspective is the extrapulmonary tissues affected by SARS-CoV-2 and the potential implications of their involvement for disease pathogenesis and the development of medical countermeasures.


id: cord-312861-6ayidmj3
title: Accelerating Clinical Evaluation of Repurposed Combination Therapies for COVID-19
author: Rayner, Craig R.
date: 2020-08-21
txt: ./txt/cord-312861-6ayidmj3.txt
cache: ./cache/cord-312861-6ayidmj3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32828137/
doi: 10.4269/ajtmh.20-0995
summary:
  As the global COVID-19 pandemic continues, unabated and clinical trials demonstrate limited effective pharmaceutical interventions, there is a pressing need to accelerate treatment evaluations. As the global COVID-19 pandemic continues, unabated and clinical trials demonstrate limited effective pharmaceutical interventions, there is a pressing need to accelerate treatment evaluations. We describe a clinical evaluation strategy using adaptive combination platform trials to rapidly test combination therapies to treat COVID-19. We describe a clinical evaluation strategy using adaptive combination platform trials to rapidly test combination therapies to treat COVID-19. Instead of sequentially testing monotherapies that will likely have modest clinical effects on their own, additive or synergistic effects can potentially be gained by combining antiviral drugs exploiting pharmacology throughout the spectrum of COVID-19 illness. 5, 6 This low success rate might be due to the fact that the majority of COVID-19 clinical trials (87%) are evaluating repurposed drugs as monotherapy.

abstract:
  As the global COVID-19 pandemic continues, unabated and clinical trials demonstrate limited effective pharmaceutical interventions, there is a pressing need to accelerate treatment evaluations. Among options for accelerated development is the evaluation of drug combinations in the absence of prior monotherapy data. This approach is appealing for a number of reasons. First, combining two or more drugs with related or complementary therapeutic effects permits a multipronged approach addressing the variable pathways of the disease. Second, if an individual component of a combination offers a therapeutic effect, then in the absence of antagonism, a trial of combination therapy should still detect individual efficacy. Third, this strategy is time saving. Rather than taking a stepwise approach to evaluating monotherapies, this strategy begins with testing all relevant therapeutic options. Finally, given the severity of the current pandemic and the absence of treatment options, the likelihood of detecting a treatment effect with combination therapy maintains scientific enthusiasm for evaluating repurposed treatments. Antiviral combination selection can be facilitated by insights regarding SARS-CoV-2 pathophysiology and cell cycle dynamics, supported by infectious disease and clinical pharmacology expert advice. We describe a clinical evaluation strategy using adaptive combination platform trials to rapidly test combination therapies to treat COVID-19.


id: cord-314921-u74jut63
title: Case Report: The First Case of COVID-19 in Bhutan
author: LeVine, Shankar
date: 2020-04-20
txt: ./txt/cord-314921-u74jut63.txt
cache: ./cache/cord-314921-u74jut63.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32314685/
doi: 10.4269/ajtmh.20-0259
summary:
  The patient''s swab reverse transcriptase-polymerase chain reaction test for COVID-19 was confirmed positive at midnight, and by morning, the Ministry of Health had traced approximately 90 contacts from the healthcare sector and hotel and restaurant staff; based on their degree of exposure, the patient contacts were instructed to either home quarantine or present to a quarantine facility. As the COVID-19 pandemic continues to spread to new countries, some aspects pertaining to the patient''s presentation, interventions to provide patient care, and the country''s measures of containment in response to this first case in Bhutan may be of broad interest. 6 The patient''s presentation did not fall into the case definition for COVID-19 that Bhutan was using at that time, which was limited to fever and respiratory symptoms. The public health strategies initiated by Bhutan''s Ministry of Health and government are beyond the scope of this case report, but the immediate steps pertaining to the patient''s contacts and medical staff caring for the patient are of interest.

abstract:
  The initial cases of novel coronavirus disease-19 (COVID-19) in a country are of utmost importance given their impact on healthcare providers, the country’s preparedness response, and the initial molding of the public perception toward this pandemic. In Bhutan, the index case was a 76-year-old immunocompromised man who had traveled from the United States and entered Bhutan as a tourist. He presented initially with vague gastrointerestinal symptoms and later a cough. His atypical presentation led to a delay in diagnosis, but ultimately he was isolated and tested. On confirming the diagnosis of COVID-19, the patient was isolated in a separate hospital with a dedicated medical care team. All contacts were traced and quarantined. The patient’s respiratory status deteriorated despite broad-spectrum antivirals, antibiotics, and intensive supportive care. He required intubation and was given a trial of intravenous immunoglobulin to modulate his likely aberrant immune response. Subsequently, the patient’s clinical status improved, and after 8 days of hospitalization, he was transferred out of the country, where he recovered. This was a learning experience for the treating medical staff, the government, and the people of Bhutan.


id: cord-315695-9sg7s1a1
author: Brett-Major, David M.
date: 2020-03-30
txt: ./txt/cord-315695-9sg7s1a1.txt
cache: ./cache/cord-315695-9sg7s1a1.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0205
doi: 10.4269/ajtmh.20-0205
summary:
  It cared for patients with Ebola virus disease from West Africa; received persons exposed to other high consequence pathogens; established and maintained the Nebraska Biocontainment Unit; with partners Emory University, Bellevue Hospital, and the CDC, led the National Ebola Training and Education Center (NETEC); launched the National Quarantine Unit funded by the Health and Human Services (HHS) Assistant Secretary of Preparedness and Response office; and established the Global Center for Health Security to coordinate its other national and international health emergency initiatives. The University of Nebraska Medical Center and its clinical partner Nebraska Medicine quickly established a prospective, observational cohort study for severe emerging infections during the 2020 COVID-19 emergency, while supporting national quarantine and isolation care activities and launching an NIAID randomized, controlled drug trial.

title:
  Advanced Preparation Makes Research in Emergencies and Isolation Care Possible: The Case of Novel Coronavirus Disease (COVID-19)

abstract:
  The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high-quality research may launch during an emergency under the right conditions. These include an appropriate context, clarity in scientific aims, preexisting resources, strong operational and research structures that are facile, and good governance. Here, Nebraskan rapid research efforts early during the 2020 coronavirus disease pandemic, while participating in the first use of U.S. federal quarantine in 50 years, are described from these aspects, as the global experience with this severe emerging infection grew apace. The experience has lessons in purpose, structure, function, and performance of research in any emergency, when facing any threat.


id: cord-316712-1ngcwdln
title: India’s Battle against COVID-19: Progress and Challenges
author: Laxminarayan, Ramanan
date: 2020-08-24
txt: ./txt/cord-316712-1ngcwdln.txt
cache: ./cache/cord-316712-1ngcwdln.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0992
doi: 10.4269/ajtmh.20-0992
abstract: India's Battle against COVID-19: Progress and Challenges.
summary:
  The first reported case of infection with the SARS-CoV-2, the virus that causes COVID-19, in India was reported on January 30, 2020 in an Indian student evacuated from Wuhan, and the first death was reported on March 12, 2020. Model-based estimates 8 produced in March 2020 had indicated that a national lockdown could reduce the number of infections at the peak of the pandemic-expected in early May-by 70-80%, depending on the degree of public compliance with physical distancing. Mortality rates (based on reported cases and deaths) appear to be low in India, as they are in most countries in the region, perhaps indicative of both limited testing and other unexplained factors. 12 At the current time, India has conducted approximately 18,000 tests per million population, a rate that is a third that of South Africa, about 60% that of Nepal, and among the lowest of any large country.


id: cord-318994-1xngjndu
title: Case Report: Disseminated Strongyloidiasis in a Patient with COVID-19
author: Lier, Audun J.
date: 2020-08-14
txt: ./txt/cord-318994-1xngjndu.txt
cache: ./cache/cord-318994-1xngjndu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0699
doi: 10.4269/ajtmh.20-0699
summary:
  We report a case of a COVID-19 patient who developed disseminated strongyloidiasis following treatment with high-dose corticosteroids and tocilizumab. Screening for Strongyloides infection should be pursued in individuals with COVID-19 who originate from endemic regions before initiating immunosuppressive therapy. This report describes the clinical features of a case of disseminated strongyloidiasis infection and polymicrobial bacteremia in an individual who received immunosuppressive treatment for COVID-19. 11 Given our patient''s epidemiologic risk factor and development of Gram-negative bacteremia, the clinical diagnosis of disseminated strongyloidiasis was further supported. The initial Strongyloides serology on hospital day 21 was negative, but the repeat was positive on day 38. 8 This case highlights important considerations when using immunosuppressive therapies for COVID-19 treatment, particularly in patients with risk factors for prior Strongyloides infection. Clinical suspicion for disseminated strongyloidiasis should be maintained in patients from endemic areas who develop Gram-negative sepsis or meningitis.

abstract:
  The SARS-CoV-2 virus has emerged and rapidly evolved into a current global pandemic. Although bacterial and fungal coinfections have been associated with COVID-19, little is known about parasitic infection. We report a case of a COVID-19 patient who developed disseminated strongyloidiasis following treatment with high-dose corticosteroids and tocilizumab. Screening for Strongyloides infection should be pursued in individuals with COVID-19 who originate from endemic regions before initiating immunosuppressive therapy.


id: cord-321514-knyw023l
author: Bénet, Thomas
date: 2017-07-12
txt: ./txt/cord-321514-knyw023l.txt
cache: ./cache/cord-321514-knyw023l.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/28719310/
doi: 10.4269/ajtmh.16-0733
summary:
  The objectives were to evaluate the microbiological agents linked with hypoxemia in hospitalized children with pneumonia from developing countries, to identify predictors of hypoxemia, and to characterize factors associated with in-hospital mortality. The objectives of the present study are to assess the microbiological agents linked to hypoxemia in hospitalized children with pneumonia in developing countries, to identify clinical and para-clinical predictors of hypoxemia and to pinpoint factors associated with death within 2 weeks after admission. The present study selectively comprised sites with better quality data on oxygen saturation (SO 2 ) at admission, mortality among pneumonia cases, and documented recording of patient follow-up during hospitalization. One of the objectives of this study was to assess microbiological agents and other predictors of hypoxemia and death in under 5-year-old hospitalized children with pneumonia from developing countries.

title:
  Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study

abstract:
  Pneumonia is the leading cause of death in children. The objectives were to evaluate the microbiological agents linked with hypoxemia in hospitalized children with pneumonia from developing countries, to identify predictors of hypoxemia, and to characterize factors associated with in-hospital mortality. A multicenter, observational study was conducted in five hospitals, from India (Lucknow, Vadu), Madagascar (Antananarivo), Mali (Bamako), and Paraguay (San Lorenzo). Children aged 2–60 months with radiologically confirmed pneumonia were enrolled prospectively. Respiratory and whole blood specimens were collected, identifying viruses and bacteria by real-time multiplex polymerase chain reaction (PCR). Microbiological agents linked with hypoxemia at admission (oxygen saturation < 90%) were analyzed by multivariate logistic regression, and factors associated with 14-day in-hospital mortality were assessed by bivariate Cox regression. Overall, 405 pneumonia cases (3,338 hospitalization days) were analyzed; 13 patients died within 14 days of hospitalization. Hypoxemia prevalence was 17.3%. Detection of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) in respiratory samples was independently associated with increased risk of hypoxemia (adjusted odds ratio [aOR] = 2.4, 95% confidence interval [95% CI] = 1.0–5.8 and aOR = 2.5, 95% CI = 1.1–5.3, respectively). Lower chest indrawing and cyanosis were predictive of hypoxemia (positive likelihood ratios = 2.3 and 2.4, respectively). Predictors of death were Streptococcus pneumoniae detection by blood PCR (crude hazard ratio [cHR] = 4.6, 95% CI = 1.5–14.0), procalcitonin ≥ 50 ng/mL (cHR = 22.4, 95% CI = 7.3–68.5) and hypoxemia (cHR = 4.8, 95% CI = 1.6–14.4). These findings were consistent on bivariate analysis. hMPV and RSV in respiratory samples were linked with hypoxemia, and S. pneumoniae in blood was associated with increased risk of death among hospitalized children with pneumonia in developing countries.


id: cord-325498-4yciuh1n
title: Incident SARS-CoV-2 Infection and a Shared Latrine
author: Del Brutto, Oscar H.
date: 2020-07-22
txt: ./txt/cord-325498-4yciuh1n.txt
cache: ./cache/cord-325498-4yciuh1n.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0793
doi: 10.4269/ajtmh.20-0793
abstract: Incident SARS-CoV-2 Infection and a Shared Latrine.
summary:
  title: Incident SARS-CoV-2 Infection and a Shared Latrine Incident SARS-CoV-2 Infection and a Shared Latrine. In a recent serosurvey, we found that the use of open latrines (instead of flushing toilet systems) was significantly associated with seropositivity to SARS-CoV-2 on lateral flowbased antibody testing (BIOHIT Health Care Ltd., Cheshire, United Kingdom), suggesting a contributory role for fecal-oral transmission of the disease, as previously proposed by others. Here, we present a cluster of incident cases of SARS-CoV-2 involving a woman who lived alone (house A), and a five-member family (house B) who were seronegative during the first survey. Two weeks after our baseline serosurvey, a 22-year-old grandson of the old woman moved into Atahualpa from Guayaquil (a heavily infected urban center), staying at her house and using the shared latrine. There were no other incident cases in the entire block, where only one person in a distant house had tested positive at baseline, and several other inhabitants of other houses remained seronegative (Figure 2, left) .


id: cord-328661-spxgox52
author: Yu, Jianhai
date: 2019-08-05
txt: ./txt/cord-328661-spxgox52.txt
cache: ./cache/cord-328661-spxgox52.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/31392945/
doi: 10.4269/ajtmh.18-0951
summary:
  The lack of sufficient epidemiological data and evidence on the local mosquito-borne DENV emphasizes the importance of studying the molecular evolutionary features and establishing a well-established phylogenetic tree for dengue prevention and control in Guangdong. Since 1990, however, DENV1 has been mainly isolated from the infected cases, and its continued existence in Guangdong Province indicated that endemic infectious agents of dengue may be circulating locally. With the epidemiological data since 2005 supplied by the Guangdong Provincial CDC, we studied phylogenetics, molecular characteristics, and epidemiology to strengthen the foundational research of DENV1 for the prevention of large-scale dengue epidemics, providing preventive and control measures of DF with important evidence. Based on representative strains of the E gene in lineages of the 2014 outbreak, as well as the molecular evolution database, we analyzed molecular characterization and possibility of local circulation for DENV1 since 2005 in Guangdong.

title:
  Epidemiological and Evolutionary Analysis of Dengue-1 Virus Detected in Guangdong during 2014: Recycling of Old and Formation of New Lineages

abstract:
  The incidence of dengue is increasing in Guangdong, China, with the largest outbreak to date in 2014. Widespread awareness of epidemiological and molecular characteristics of the dengue virus (DENV) is required. In 2014, we isolated the virus from patients and sequenced its genome. The sequences of DENV isolated from Guangdong and other countries screened since 2005 were studied to establish molecular evolutionary databases along with epidemiological data to explore its epidemiological, phylogenetic, and molecular characteristics. Causes underlying the occurrence of the dengue epidemic included importation and localization of the virus. The number of indigenous cases significantly exceeded that of imported cases. Dengue virus 1 is the most important serotype and caused the long-term epidemic locally. Based on the data available since 2005, DENV1 was divided into three genotypes (I, IV, and V). Only genotypes I and V were detected in 2014. In 2014, an epidemic involving old lineages of DENV1 genotype V occurred after 2 years of silence. The genotype was previously detected from 2009 to 2011. Genotype I, which caused recent epidemics, demonstrated a continuation of new lineages, and a predictive pattern of molecular evolution since 2005 among the four lineages was present. The DENV isolated from Guangdong was closely related to those causing large-scale epidemics in neighboring countries, suggesting the possibility of its import from these countries. The lack of sufficient epidemiological data and evidence on the local mosquito-borne DENV emphasizes the importance of studying the molecular evolutionary features and establishing a well-established phylogenetic tree for dengue prevention and control in Guangdong.


id: cord-331109-a8e7r80d
title: Case Report: Paralytic Ileus: A Potential Extrapulmonary Manifestation of Severe COVID-19
author: Ibrahim, Yassmin S.
date: 2020-08-31
txt: ./txt/cord-331109-a8e7r80d.txt
cache: ./cache/cord-331109-a8e7r80d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0894
doi: 10.4269/ajtmh.20-0894
summary:
  We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. We describe two cases of severe COVID-19 pneumonia who developed paralytic ileus during their disease course, which may represent one of the luminal manifestations of severe SARS-CoV-2 infection. 7 A review of 29 studies noted that 12% of patients with SARS-CoV-2 infection had gastrointestinal symptoms, including diarrhea, nausea, and vomiting. In conclusion, we report paralytic small and large bowel ileus as a complication of COVID-19. The added value of the present case report is the detailed histopathological evidence supporting a role for COVID-19-induced micro-thrombosis, thereby compromising microcirculatory function and resultant colonic bowel dilatation and perforation in the first patient.

abstract:
  The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19–induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.


id: cord-340021-pj6fywwc
author: Norooznezhad, Amir Hossein
date: 2020-06-24
txt: ./txt/cord-340021-pj6fywwc.txt
cache: ./cache/cord-340021-pj6fywwc.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0512
doi: 10.4269/ajtmh.20-0512
summary:
  Based on the results of Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression, age, and suggestive chest X-ray (CXR) findings for SARS-CoV-2 infection, cardiovascular diseases, diabetes mellitus, chronic lung diseases, and intensive care units admission had significant associations with positive RT-PCR results for COVID-19 infection. This study showed that some symptoms including cough and dyspnea, as well as abnormal CXR, could be proper predictors of positive RT-PCR result for SARS-CoV-2 infection. There was a significant association between variables, including age, abnormal CXR findings, cardiovascular diseases, diabetes mellitus, chronic lung diseases, and ICU admission, with confirmative RT-PCR results for SARS-CoV-2 infection. As it is shown ( Figure 1B) , age (IG = 13.7%), cardiovascular disease (IG = 2.4%), and ICU admission (IG = 2.2%) have the most important main effects, and they have interaction effects with abnormal CXR, elevated body temperature, myalgia, sore throat, diabetes mellitus, and malignancy for the prediction of death among positive RT-PCR patients.

title:
  Primary Symptoms, Comorbidities, and Outcomes of 431 Hospitalized Patients with Confirmative RT-PCR Results for COVID-19

abstract:
  This study aimed to evaluate the primary symptoms, comorbidities, and outcomes of inpatients with confirmed reverse transcription–PCR (RT-PCR) for SARS-CoV-2 infection among 2077 suspected/diagnosed cases of COVID-19. Based on the results of Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression, age, and suggestive chest X-ray (CXR) findings for SARS-CoV-2 infection, cardiovascular diseases, diabetes mellitus, chronic lung diseases, and intensive care units admission had significant associations with positive RT-PCR results for COVID-19 infection. Also, the highest area under the curve (AUC) was related to cough (AUC = 0.53, 95% CI: 0.51–0.56), dyspnea (AUC = 0.52, 95% CI: 0.50–0.54), and abnormal CXR (AUC = 0.52, 95% CI: 0.50–0.54), as significant predictors. This study showed that some symptoms including cough and dyspnea, as well as abnormal CXR, could be proper predictors of positive RT-PCR result for SARS-CoV-2 infection. It seems that patients with underlying disease(s), such as cardiovascular diseases, diabetes mellitus, and chronic lung diseases, had a higher probability to have positive RT-PCR for SARS-CoV-2 infection than those with no underlying disease(s).


id: cord-342790-70vn1nrm
title: Keep Politics out of Funding Decisions for Medical Research and Public Health
author: Rosenthal, Philip J.
date: 2020-07-22
txt: ./txt/cord-342790-70vn1nrm.txt
cache: ./cache/cord-342790-70vn1nrm.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0850
doi: 10.4269/ajtmh.20-0850
abstract: Keep Politics out of Funding Decisions for Medical Research and Public Health.
summary:
  As leaders of the society, we are compelled to speak up for the integrity of science, and specifically for research funding and public health decisions based on merit, with policies rooted in data. The Department of Health and Human Services justified the cut with the claim that "the grantee was not in compliance with NIH''s grant policy," but the director of the NIH Institute that funded the study later stated in congressional testimony that "it was canceled because the NIH was told to cancel it." Clearly, the actual reason for cancellation was political, apparently based on an attempt to assign blame for the COVID-19 pandemic to China, and consistent with claims that the pandemic was the result of a laboratory accident or a deliberate attempt to initiate a viral outbreak in Wuhan.


id: cord-344503-gw5d721n
title: Case Report: Death due to COVID-19 in Three Brothers
author: Yousefzadegan, Sedigheh
date: 2020-04-10
txt: ./txt/cord-344503-gw5d721n.txt
cache: ./cache/cord-344503-gw5d721n.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4269/ajtmh.20-0240
doi: 10.4269/ajtmh.20-0240
summary:
  We report fatal cases of novel coronavirus disease (COVID-19) in three brothers in Iran. We report fatal cases of novel coronavirus disease in three brothers in Iran. Considering the fact that most of them who are affected by COVID-19 recover, deaths in three brothers who lived separately and had no known underlying disease suggest genetic predisposition to COVID-19 in some individuals. Considering the fact that most of them who are affected by COVID-19 recover, deaths in three brothers who lived separately and had no known underlying disease suggest genetic predisposition to COVID-19 in some individuals. Novel coronavirus disease (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was identified in late 2019 in Wuhan, China. Although most critically ill COVID-19 patients are either elderly or have underlying medical problems such as cardiovascular disease, hypertension, diabetes mellitus, or cancer, some previously healthy and even relatively young individuals have died from COVID-19.

abstract:
  We report fatal cases of novel coronavirus disease (COVID-19) in three brothers in Iran. An increased susceptibility to specific pathogens has been reported for a number of genetic defects. Considering the fact that most of them who are affected by COVID-19 recover, deaths in three brothers who lived separately and had no known underlying disease suggest genetic predisposition to COVID-19 in some individuals.


id: cord-345067-kummh0g7
title: Mobile Health Technology for Enhancing the COVID-19 Response in Africa: A Potential Game Changer?
author: Nachega, Jean B.
date: 2020-05-29
txt: ./txt/cord-345067-kummh0g7.txt
cache: ./cache/cord-345067-kummh0g7.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32476643/
doi: 10.4269/ajtmh.20-0506
abstract: Mobile Health Technology for Enhancing the COVID-19 Response in Africa: A Potential Game Changer?
summary:
  title: Mobile Health Technology for Enhancing the COVID-19 Response in Africa: A Potential Game Changer? Mobile Health Technology for Enhancing the COVID-19 Response in Africa: A Potential Game Changer? 3 However, as lockdowns and social distancing measures are currently being lifted in stages by most African countries, governments will need to ensure that public health infrastructure and needed resources are put in place for community surveillance to identify cases and clusters of new infections through active case finding, large-scale testing, and contact tracing. 7 Mobile phone technology (mHealth) platforms are effective in improving service delivery and outcomes for many health conditions in Africa and globally, including HIV infection, tuberculosis, and chronic noncommunicable diseases. 7, 8 With the support of global mobile technology companies and small and medium enterprises within Africa, mHealth offers opportunities ranging from text messaging to mobile apps to mitigate the spread of COVID-19. COVID-19 AND MOBILE HEALTH TECHNOLOGY IN AFRICA


id: cord-345554-x9q6pqgw
title: It Ain’t Over Till It''s Over: The Triple Threat of COVID-19, TB, and HIV
author: Kay, Alexander W.
date: 2020-08-31
txt: ./txt/cord-345554-x9q6pqgw.txt
cache: ./cache/cord-345554-x9q6pqgw.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32876009/
doi: 10.4269/ajtmh.20-1089
abstract: It Ain't Over Till It's Over: The Triple Threat of COVID-19, TB, and HIV.
summary:
  As the SARS-CoV-2 outbreak rapidly spread to pandemic proportions, the global tuberculosis (TB) and HIV care communities voiced increasing concerns. Although an estimated 58 million lives were saved through TB diagnosis and treatment between 2000 and 2018, 1 the current SARS-CoV-2 pandemic threatens to reverse these gains by overwhelming the healthcare system, disrupting patient access to care, and spurring reallocation of resources from TB and HIV services. In this issue of the AJTMH, two articles describe four patients with triple infection with drug-sensitive Mycobacterium tuberculosis, HIV, and SARS-CoV-2. Although comorbidities associated with HIV and TB may primarily drive COVID-19 disease severity in these populations, the disruption to health systems caused by the COVID-19 pandemic is likely to have a greater impact on the lives of people with HIV infection and TB than is coinfection with COVID-19.


id: cord-348192-ibohbjfb
title: Could Water and Sanitation Shortfalls Exacerbate SARS-CoV-2 Transmission Risks?
author: Odih, Erkison E.
date: 2020-06-09
url: https://www.ncbi.nlm.nih.gov/pubmed/32524953/
doi: 10.4269/ajtmh.20-0462
abstract:
  SARS-CoV-2, the etiologic agent of COVID-19, is shed in stool. SARS coronaviruses have been detected in wastewater during outbreaks in China, Europe, and the United States. In this perspective, we outline the risk fecal shedding poses at locations without safely managed sanitation, as in most of Nigeria where we work. We believe that feco-oral transmission could occur if community transmission becomes high and sustained in densely populated cities without proper sanitation in Nigeria and many other African and Asian settings. In the absence of basic sanitation, or where existing sanitation is not safely managed, groundwater, which is often drawn up from wells and boreholes for drinking and household use, can become contaminated with enteric bacteria and viruses from fecal matter. Endemic and epidemic transmission of multiple feco-oral pathogens via this route continues to be documented in areas without safely managed sanitation, and, therefore, the risk of SARS-CoV-2 transmission needs to be evaluated, tracked, and forestalled in such settings. We suggest that fecal matter from treatment facilities and recovered patients should be carefully and properly disposed. Furthermore, environmental surveillance of SARS-CoV-2 in wastewater and accumulated human waste, as well as efforts to mitigate the virus’ entry into unprotected household water sources, should be a priority part of the COVID-19 response in settings without safely managed sanitation for the duration of the pandemic.


id: cord-355850-jgcjscjq
author: Elhadi, Muhammed
date: 2020-06-18
txt: ./txt/cord-355850-jgcjscjq.txt
cache: ./cache/cord-355850-jgcjscjq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32563273/
doi: 10.4269/ajtmh.20-0330
summary:
  title: Assessment of Healthcare Workers'' Levels of Preparedness and Awareness Regarding COVID-19 Infection in Low-Resource Settings Less than 7% of participants received training on how to manage COVID-19 cases, whereas 20.6% of doctors and 26.3% of nurses felt that they were personally prepared for the outbreak. The questionnaire evaluates information sources, training experience with COVID-19, diagnosis and management of COVID-19 patients, use of PPE, safety precautions, isolation procedures, measures to prevent infection, and reporting procedures. In conclusion, our study has illuminated the current level of knowledge and awareness of COVID-19 among doctors and nurses, with special consideration for those working in departments responsible for caring for COVID-19 patients. The respondents had a lower level of preparedness, which highlights the importance of education and training programs for healthcare workers, to control and prevent infection from COVID-19.

title:
  Assessment of Healthcare Workers’ Levels of Preparedness and Awareness Regarding COVID-19 Infection in Low-Resource Settings

abstract:
  COVID-19, caused by the SARS-CoV-2 virus, is spreading rapidly worldwide, with devastating consequences for patients, healthcare workers, health systems, and economies. As it reaches low- and middle-income countries, the pandemic puts healthcare workers at high risk and challenges the abilities of healthcare systems to respond to the crisis. This study measured levels of knowledge and preparedness regarding COVID-19 among physicians and nurses. A cross-sectional survey was conducted among healthcare workers in Libya between February 26 and March 10, 2020. We obtained 1,572 valid responses of a possible 2,000 (78.6%) participants from 21 hospitals, of which 65.1% were from physicians and 34.9% from nurses. The majority of participants (70%) used social media as a source of information. A total of 47.3% of doctors and 54.7% of nurses received adequate training on how to effectively use personal protective equipment. Low confidence in managing suspected COVID-19 patients was reported by 83.8% of participants. Furthermore, 43.2% of healthcare workers were aware of proper hand hygiene techniques. Less than 7% of participants received training on how to manage COVID-19 cases, whereas 20.6% of doctors and 26.3% of nurses felt that they were personally prepared for the outbreak. Awareness and preparedness for the pandemic were low among frontline workers during the study. Therefore, an effective educational training program should be implemented to ensure maintenance of appropriate practices during the COVID-19 pandemic.


