cord-007864-kxyu5nzp	2011	Transmission of TB on board a commercial aircraft during long-distance flights has been reported several times, [19] [20] [21] [22] but no case of active TB disease resulting from exposure on board has been identified subsequently. The WHO first published guidelines regarding TB and air travel in 1998 and revised them in 2006 in response to increased concerns about resistant forms of TB and improved international collaboration in dealing with infectious disease risks. Epidemiologic notes and reports nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons-Florida Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa Gerberding, MD, MPH, on recent case of extensively drug resistant TB: CDC''s public health response. CDC investigation of traveler with extensively drug-resistant tuberculosis (XDR TB): questions and answers for passengers and flight crew on affected flights
cord-026738-6jtcf4mz	2020	Early alignment with these 3 strategies has allowed Mayo Clinic to be more effective in responding to the COVID-19 pandemic. Another describes changes in local and federal regulations that served as catalysts for Mayo Clinic to provide home monitoring of patients with COVID-19 and to substantially increase telemedicine options for virtual visits. During the crisis, Mayo Clinic halted all elective and semielective procedures, which resulted in a backlog of patients without COVID-19 who need care. The commentaries also highlight how Mayo Clinic is reaching out to our neighboring communities during this pandemic. Importantly, we will discuss major lessons learned thus far around rapid change management strategies, effective We hope that this series of commentaries will be useful to you and to your organizations during this and any future pandemic or other extremely challenging health care situations. Health Care After the COVID-19 Pandemic and the Influence of Telemedicine 21.
cord-030903-hhhjwoei	2020	title: Implementing Telemedicine in Primary Care: Learning Lessons From Electronic Health Records Inequity in payment for cognitive versus procedural care 2 ; conflating how primary care has been valued with its value; equating the payment allocated for primary care services with the difficulty in their mastery (contributing to the assumption that lesser training is of little consequence in primary care); and a shrinking scope of practice for physicians within the specialty are among the reasons our health system has not benefitted fully from what a well-supported, well-organized model of primary care has to offer. Instead, using an organized system of care, all of the patient''s annual needs for prevention and chronic illness monitoring can be arranged at a single, coordinated appointment rather than being fragmented, with the patient contacted 1 month for their mammogram, the next month for their pneumococcal vaccine, and at yet another time for their urine test for microalbumin.
cord-255389-2fufd0ba	2020	title: Mayo Clinic Strategies for COVID-19 Clinical Guidance and the Delivery of Care for Patients With Coronavirus Disease 2019 Herein, we describe our strategies for developing and successfully implementing a clinical guidance that assists our health care providers in caring for patients with SARS-CoV-2 infection. Likewise, we developed a COVID-19 Treatment Registry that allows us to monitor our clinical practice and optimize our management guidance on the basis of our evolving clinical experience. The clinical guidance has been continually updated and made available to health care providers on a dedicated institutional COVID-19 webpage. This clinical team rapidly developed expertise in COVID-19 care because they served as consultants to frontline health care providers. The COVID-19 clinical guidance continues to evolve as new information is gathered from our clinical experience and as updated management strategies are published in the literature.
cord-256422-4crdzojb	2020	5 Since renin angiotensin system (RAS) antagonists have been suggested to upregulate ACE2 in few animal models, concerns have been raised that these drugs might be associated with increased risk of infection or severe disease from Covid-19. Accordingly, we performed a meta-analysis to study the cumulative evidence for association of ACEI/ARB use with risk of mortality and severe illness with Covid-19. The following key words were used for search in different combinations: "Coronavirus 2019", "Covid-19", "SARS-Cov-2", "Renin angiotensin system", "Angiotensin converting enzyme", "Angiotensin converting enzyme inhibitors", "ACEI", "Angiotensin receptor blockers"; "ARB", and "Outcomes". Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19 Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan
cord-258307-nsdhvc8w	2011	The most recent and perhaps most fearsome emerging infections are the appearance of West Nile virus encephalitis in New York City in 1999 and its rapid spread westward 6 ; inhalation anthrax, deriving from use of Bacillus anthracis spores as a biologic weapon against the US civilian population in 2001 7 ; the global outbreak of severe acute respiratory syndrome (SARS) in 2003 8 ; and the looming threat of pandemic influenza, especially global disease caused by the highly virulent avian subtype A (H5N1). If it is not, the effort will not have been wasted because it is likely that all the planning and resource allocation will prove invaluable for controlling the spread of natural emerging pathogens, such as SARS-CoV or a new strain of influenza virus, which are probably far more likely to pose a serious threat to human and animal health in the United States and worldwide.
cord-260402-9b1ltcf1	2020	To the Editor: Research shows that cigarette smoking upregulates ACE2, the receptor by which SARS-CoV-2 gains entry to the host resulting in COVID-19, in the lungs and therefore potentially leads to increased morbidity [1] . As part of a tobacco treatment campaign implemented at the beginning of the pandemic at McDonald Army Health Center, the authors performed a literature search and found that SARS-CoV-2 and smoking both contribute to myocarditis, thrombosis, immune impairment, and increased inflammation. SARS-CoV-2 and smoking upregulate this cytokine release and lead to an increased risk of coagulopathy [4, 5] . The upregulation of ACE2 in smokers may predispose this population to an increased risk of SARS-CoV-2 infection. The host cell transmembrane protease, serine 2 (TMPSRSS2), which primes the SAR-CoV-2 S protein for entry, may also be upregulated in smokers [6] , which would further increase the odds of viral infectivity. Smoking-Mediated Upregulation of the Androgen Pathway Leads to Increased SARS-CoV-2 Susceptibility
cord-261653-0vtghtp7	2020	Thus, the present narrative overviews the strategy developed by our team to identify and recruit COVID-19 survivors to donate convalescent plasma at the Mayo Clinic Blood Donor Center in Rochester, Minnesota. Rochester, Minnesota required a strategy to interface with the community of recovering COVID-19 patients and recruit eligible convalescent plasma donors. Overall, this recruitment strategy utilized a simple survey, an algorithm for triaging donors, a workflow for connecting donors with Mayo Clinic Blood Donor Center, a team of physician navigators (including medical students) to screen eligible donors, and a support center for donor questions. Our web-based recruitment survey and all e-mail communications to interested potential donors contained the e-mail address for our convalescent plasma service center. The service center team used available resources from the US FDA, Mayo Clinic, and the blood banking community to support questions regarding donor eligibility and COVID-19 testing.
cord-268470-dgxn32ls	2020	To the Editor: In follow-up to recent major state-of-the-art review on Obesity and Outcomes in SARS-CoV-2 (COVID-19), 1 we have additional data regarding the relationship of obesity with outcomes in patients with COVID-19. We performed a rapid review and meta-analysis to evaluate whether obesity is associated with worse outcomes in patients with COVID-19. The following key words were used for search in different combinations: "Coronavirus 2019", "Covid-19", "SARS-CoV2", "Obesity", "Body mass index", and "Outcomes". The primary outcome was critical illness In this rapid review and meta-analysis, obesity was associated with a 39% increased risk of critical illness, defined by individual study protocol as ICU admission, need for IMV, or hospice admission or death. Despite these study limitations, however, our data of a 39% increase in worse outcomes associated with obesity strongly supports the recent paper in Mayo Clinic Proceedings. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City
cord-269568-vwkawh6x	2020	Abbreviations: COVID-19 = coronavirus disease 2019; dB = decibel; ED = Emergency Department; FFP = filtering face piece; FM = frequency modulation; Hz = Hertz; ICU = Intensive Care Unit; N95 mask = a particulate-filtering face mask that filters at least 95% of airborne particles; PPE = personal protective equipment; PSAPs -personal sound amplification products; SARS-CoV-2 = severe acute respiratory syndrome-coronavirus-2. We''d like to call attention to the negative impacts of universal masking and social distancing in both health-care and community settings for individuals with hearing loss. Social Healthcare professionals should recognize that, with the loss of visual cues (i.e., lip reading) and support systems (e.g., family members), current COVID-19 policies such as universal masking, social distancing, and unaccompanied patients may "unmask" significant hearing loss-related issues that previously had been diminished or ignored.
cord-273150-bz617ovx	2020	2 Herein, we present a patient with chronic lymphocytic leukemia who developed organizing pneumonia (OP) as a late manifestation of COVID-19 after an initial improvement, who was successfully treated with corticosteroids. The patient was enrolled in John 4 the Mayo Clinic COVID-19 expanded access program for convalescent plasma (CCP) on day 9 of her illness and received one dose of CCP. A repeat chest CT, on day 17 of illness ( Figure 1, panel B) , revealed new and migratory ground-glass opacities in both lungs that were consistent with an organizing pneumonia (OP) pattern. 6 John 5 Ibrutinib, a highly potent inhibitor of BTK, is considered to protect against lung injury in COVID-19. Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection The BTK-inhibitor ibrutinib may protect against pulmonary injury in COVID-19 infected patients
cord-276194-4sfc7hal	2020	To the Editor:We read with great interest the letter by Testori regarding our Review article "Treatment Considerations for COVID-19: A Critical Review of the Evidence (or Lack Thereof)," 1 Testori pointed out the important association of pro-inflammatory cytokines in the pathogenesis of Coronavirus disease 2019 , which could account for the worse outcome in older individuals. Baricitinib will be tested as one of the drugs in the National Institute of Allergy and Infectious Diseases (NIAID) Adaptive COVID-19 Treatment Trial (ACTT). Since the online publication of our review, the investigational RNA-dependent RNA inhibitor, remdesivir, has been granted emergency use authorization in United States Food and Drug Administration based on preliminary data obtained from the ACTT. Treatment Considerations for COVID-19: A Critical Review of the Evidence (or Lack Thereof) NIH Clinical Trial Shows Remdesivir Accelerates Recovery from Advanced COVID-19
cord-280123-44206n7t	2020	The pre-covid reasons for the growth in obesity/metabolic syndrome on the one hand, and alcohol use disorder (AUD) on the other are complex, but the trends are unequivocal. Furthermore, the growth in high-risk drinking and DSM-IV Alcohol Use Disorder (AUD) was seen in women, older-adults, racial/ethnic minorities, and lower income/educational levels [4] . [6] They used the Mayo Clinic Biobank to ask the question: how do alcohol consumption, body mass, and fatty liver disorder interact? Their analysis shows that increased body mass and alcohol, particularly with heavy alcohol use, interact in the path to fatty liver, whereas moderate alcohol consumption by persons with normal BMI and overweight is associated with lower mortality. A cohort study examining the interaction of alcohol consumption and obesity in hepatic steatosis and mortality Effect of chronic alcohol consumption on the development and progression of non-alcoholic fatty liver disease (NAFLD) Global Burden of Alcohol Use Disorders and Alcohol Liver Disease
cord-285569-ei9w19i7	2020	A cluster of cases of pneumonia caused by a novel coronavirus, COVID-19, was first reported in Wuhan in the Hubei province in China in late December 2019. 1 Beta coronaviruses include severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and the coronavirus variant COVID-19 virus first described in Wuhan. SARS-CoV disproportionately impacted health care workers (HCWs) in countries with the most reported cases. Similar to SARS-CoV, presentation is typically fever with symptoms of lower respiratory tract infection and radiographic evidence of pneumonia or ARDS. 16 The Centers for Disease Control and Prevention (CDC) has issued interim guidance for HCWs. 17 Novel coronavirus should be suspected if patients meet the criteria described in Table 1 . Clinical features of patients infected with 2019 novel coronavirus in Wuhan Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China
cord-292398-3b2e8x8z	2020	Considering the studies on the role of vitamin D in the prevention of acute respiratory infections, supplementation of vitamin D may be reasonable also for the prevention of SARS-CoV-2 infections and reducing morbidity and mortality in COVID-19 high-risk patients. Studies of vitamin D replacement have demonstrated that vitamin D ameliorates innate immunity (the immediate response of macrophages to invading viruses and bacteria in the mucous membranes), 2 thereby reducing the incidence and severity of acute respiratory infections. Therefore, we suggest it would be reasonable to supplement vitamin D in subpopulations at risk of vitamin D deficiency and unfavorable COVID-19 outcomes, as well as in individuals already infected with SARS-CoV-2 to achieve optimal 25(OH)D3 concentrations as quickly as possible. Decisions should therefore always be evidence informed, but they will very rarely be purely evidence based." 5 In Slovenia, in the view of COVID-19 pandemic, medical doctors were urgently advised by leading experts to supplement vitamin D in high-risk and fragile individuals and in COVID-19 patients.
cord-292606-tqjmg3qb	2020	The vast majority of the deaths caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) are patients over the age of 55, which died of Acute Respiratory Distress Syndrome (ARDS). IL -10 is another anti-inflammatory molecule that could be tested and it could be administered via a genetherapy approach using naked plasmid DNA vectors 4 engineered to produce IL-10 inside the recipient cells, thus reducing the cost and simplifying production. Countries need to invest in technologies like DNA vaccines 5 and antiviral gene therapy strategies, like RNAi technology, which is an ideal tool for inhibiting viral replication in host cells as the siRNA can interact with certain viral genes and silence their expression. We need to develop detailed protocols now on how to quickly produce vaccines and antivirals, that can be adapted to future viral pandemics.
cord-294728-fefkvg0a	2020	title: GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY AND COVID-19 INFECTION 2 There is evidence to suggest an association between G6PD deficiency and increased susceptibility to, and severity of illness with, COVID-19 infection. Vascular endothelial dysfunction and coagulopathy have been suggested as complications of COVID-19, based on a report of large vessel ischemic stroke occurring in five U.S. patients under age 50, including two without preexisting conditions. However, a recent report described an acute hemolytic episode occurring in a COVID-19 patient with G6PD deficiency who was treated with hydroxychloroquine. 12 Hydroxychloroquine may increase the oxidative stress in COVID-19 patients with G6PD deficiency, thereby serving as a trigger for hemolytic anemia. Studies are needed to determine whether a positive correlation exists between G6PD deficiency and COVID-19, with respect to increased susceptibility to infection and severity of illness. Acute hemolysis by hydroxychloroquine was observed in G6PD-deficient patient with severe COVID-19 related lung injury
cord-298094-ctikhqvr	2020	
cord-298368-vuxp0l50	2020	title: Mayo Clinic Strategies for COVID-19 Avoiding a Medical Education Quarantine During the Pandemic To protect everyone involved from potential exposure to COVID-19, we implemented various strategies in order to provide educational conferences, including technology-based solutions such as Zoom (Zoom Video Communications, Inc), Skype for Business (Microsoft), Webex (Cisco Systems), and Slido (Slido). Another key component of medical education for trainees is hands-on patient care supplemented by teaching rounds. 1 Mayo Clinic implemented a moratorium on bedside group-teaching rounds to limit provider exposures to potentially infected patients, as well as to adhere to an institutional mandate to preserve personal protective equipment. A similar approach was implemented in the clinics, where virtual visits using telemedicine resources, including video conferencing, and telephone visits were Besides providing continued training, it was imperative for the institution and individual training programs to provide trainees with additional support for mental and physical health during the emotionally and psychologically taxing pandemic.
cord-299150-1noy0z88	2020	However, clinical trials of agents tested for severe COVID19 may not necessarily test for mortality outcomes as the primary endpoint, as was highlighted in the press release of the recent remdesivir trial. Since drugs improving mortality in severe COVID-19 is the most important endpoint to achieve both from clinical and public policy standpoint, we evaluated the type of primary endpoints currently being assessed in randomized controlled trials (RCTs) in severe COVID19. Our analysis found that only 6/19 (30%) ongoing phase III RCT in severe COVID19 have mortality as the standalone primary endpoint or a part of composite endpoint. Given that mortality is as high as 25% in severe COVID19 who need ICU care and average time to death is 3-6 days [2, 3] , the number of mortality events needed and follow-up time do not pose an impediment for analysis of mortality as the primary endpoint.
cord-302513-u9n56pnb	2020	During the COVID-19 era, telemedicine has been an essential method to ensure the continuation of health care services while allowing for social distancing and reducing rates of COVID-19 transmission. With the increased exposure and comfort with virtual health care amongst patients and providers, the demand for expanded access to telehealth services is not likely to wane once the pandemic has passed. 8 Loosening restrictions on telehealth reimbursement under COVID-19 emergency orders has resulted in a dramatic expansion of virtual care, which has allowed for providing crucial medical services to vulnerable patient populations during the COVID-19 pandemic. • Federal legislation could be used to redefine the "place of service." Instead of the site of the patient arbitrarily defined as the virtual place of service, the site of the clinician redefined as the site of care delivery would alleviate the need for providers to have multiple state licenses to practice telemedicine. The expansion of telehealth during the COVID-19 pandemic has allowed many providers and patients to experience better access to effective care.
cord-303747-o09canse	2020	This approach, however, must be balanced against the need for a rapid and precise diagnosis in COVID-19 patients with STE due to an acute myocardial infarction in order for timely and appropriate reperfusion therapy including coronary revascularization to be implemented when appropriate. April 7, 2020 ST-segment Elevation, Myocardial Injury, and COVID-19 into account severity of illness coupled with risk stratification utilizing cardiac imaging in select cases to assess the potential benefit from coronary revascularization rather than a blanket policy of proceeding with diagnostic catheterization, often triggered by prehospital ECG testing, for all STE patients with suspected or known COVID-19. Our current approach in patients with a high suspicion for acute coronary occlusion who are candidates for coronary angiography with an expected benefit from coronary artery revascularization is to continue with the standard pre-hospital or emergency department (ED)-triggered STEMI activation of the cardiac catheterization laboratory (CCL) for anticipated primary percutaneous coronary intervention.
cord-315388-8sv00zqz	2020	
cord-317668-cc5oyiwp	2020	title: Mayo Clinic Strategies for COVID-19 Community Engagement With Vulnerable Populations The coronavirus disease 2019 (COVID-19) pandemic has impacted vulnerable populations disproportionately, including those affected by socioeconomic disadvantage, racial discrimination, low health literacy, immigration status, and limited English proficiency. Preexisting disparities in chronic diseases that are associated with worse COVID-19 outcomes and less access to health care have resulted in a higher case-fatality rate. Community engagement, "the process of working collaboratively with and through groups of people… to address issues affecting the well-being of those people," 2 can help empower communities in promoting COVID-19 prevention and containment. Herein, we describe some of the CEnR approaches used at Mayo Clinic in response to the needs of medically underserved and socioeconomically disadvantaged communities. Leveraging community engaged research partnerships for crisis and emergency risk communication to vulnerable populations in the COVID-19 pandemic
cord-318205-qxkel0ww	2020	This was an observational study of 394 health care workers in a surgical environment who were exposed to 2 known SARS-CoV-2–positive coworkers. Infections of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) among health care workers is a serious consequence of the coronavirus disease 2019 (COVID-19) pandemic. Of the COVID-19 cases reported to the US Centers for Disease Control and Prevention (CDC) between February 12 and April 9, 2020, that contained information about workers, 19% were identified as health care personnel. 2, 3 Here we report the outcome of a widespread surveillance program in a surgical area which was implemented as a result of health care workers testing positive for SARS-CoV-2 at Mayo Clinic, Jacksonville, Florida. Employee Health determined that 394 other employees worked in the surgical area at the same time as the index cases, and all were recommended to undergo SARS-CoV-2 PCR testing as surveillance.
cord-319023-ucm8frol	2020	Model parameters included percentage population ordered to shelter-in-place, adoption rate of AACT, and percentage individuals who appropriately follow recommendations. Conclusion Wide adoption of digital contact tracing can mitigate infection spread similar to universal shelter-in-place, but with considerably fewer individuals isolated. Such Advanced Automated Contact Tracing (AACT) systems -which could infer exposure risk and propagate warnings to people at risk -may help curb disease spread by facilitating targeted self-isolation rather than universal mandates such as shelter-inplace. In AACT, an additional compartment Sq (Traced contacts that are exposed and under selfisolation) was used while for shelter-in-place, the compartment Q (Individuals isolated through universal enforcement measures) was used. The basic difference between the models is that isolation/quarantine is based solely on exposure history in AACT, while isolation orders apply to the entire population in universal shelter-in-place. Contact tracing can mitigate disease spread through a curated approach of identifying and isolating exposed individuals, as opposed to shelter-in-place orders.
cord-322714-s0wge7o4	2020	Recently, our investigation of key safety indicators in 5,000 patients transfused with COVID-19 convalescent plasma demonstrated an incidence of transfusion-related serious adverse events (SAE) of less than 1% and a mortality rate of 14.9% 10 . Web-based, standardized data reporting surveys were completed to assess clinical status of patients at regular time intervals (four-hours and seven-days after convalescent plasma transfusion) using the Research Electronic Data Capture system (REDCap, v.9.1.15 Vanderbilt University, Nashville, TN) 14, 15 . In this safety update of the US Convalescent Plasma Expanded Access Program of 20,000 hospitalized patients in the US with severe or life-threatening COVID-19, the overall frequency of SAEs classified as attributable or likely secondary to convalescent plasma transfusion continued to be low (<1% of all transfusions) and the seven-day mortality rate in this extremely high risk cohort was 8.6%.
cord-322724-7l1668bf	2020	In general, we agree that repeat testing may be helpful in certain situations of ongoing high suspicion for active infection where alternative approaches are not feasible; however, we believe that testing should not be applied indiscriminately in a resource-constrained situation. Several studies have suggested that the number of unique patient specimens tested for SARS-CoV-2 is directly related to the positive identification of the virus and that there may be a high false-negative rate of molecular testing. 2, 3 The study by Zhang et al reported 41 hospitalized patients with an initial negative PCR test who had at least one positive result on subsequent testing. 4 We agree that there may be a role for repeat testing in patients with high clinical suspicion of Low Utility of Repeat Real-Time PCR Testing for SARS-CoV-2 in Clinical Specimens Distinct characteristics of COVID-19 patients with initial rRT-PCRpositive and rRT-PCR-negative results for SARS-CoV-2
cord-324660-w81jgw7p	2020	To the Editor: As noted by Choo and Rajkumar 1 in the June 2020 issue of Mayo Clinic Proceedings, the COVID-19 (coronavirus disease 19) pandemic has exposed extreme vulnerabilities in our nation''s drug supply chain. d Create a national database for tracking of essential drug supplies and use predictive analytics to identify surge, production problems, and future shortages. 1 As supply chain management leaders at Mayo Clinic, we appreciate the attention these authors draw towards the issue of drug shortages and drug costs. 5 Because of the high use of vasopressin in critically ill COVID-19 patients and the greater than 6000% price increase that has occurred after completing the Unapproved Drugs Initiative process, vasopressin will likely become a top 10 drug expense within the hospital sector by the end of 2020. The FDA Unapproved Drugs Initiative: an observational study of the consequences for drug prices and shortages in the United States
cord-325938-hb6fvgem	2020	Amid increasing concerns of medical professionals about the harms associated with invasive ventilation, there is interest to explore the role of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) due to In this commentary we aim to summarize what is known about the role of NIPPV in patients with AHRF and ARDS due to COVID-19 and other viral infections, point out evidence gaps and make a case for consideration of NIPVV as a possible alternative to early intubation in patients with COVID-19. Severity of respiratory failure and outcome of patients needing a ventilatory support in the Emergency Department during Italian novel coronavirus SARS-CoV2 outbreak: Preliminary data on the role of Helmet CPAP and Non-Invasive Positive Pressure Ventilation
cord-328548-5kjq9xqs	2020	A subsequent high-profile paper associating the use of hydroxychloroquine with increased mortality in the treatment of COVID-19 had to be retracted 2 after scientists pointed out issues such as mismatched mortality rates when compared to Australian official reports, no release of the dataset for independent analysis, and lack of thorough ethical review. The term "flexibilization" here refers to a loosening of methodological standards and the development of low-quality studies, leading to the creation of unreliable data and, later in the cycle, of anecdotal evidence. Within this context, science and clinical research have been creating rigorous methodological standards in order to produce high-quality studies that allow us to have greater confidence in the evidence while mitigating unnecessary damage. During the COVID-19 pandemic, the early adoption of new interventions by clinicians and policy makers based on promising but often low-quality data is creating a scenario from which anecdotal evidence may emerge.
cord-329779-5sauq4gp	2020	
cord-330104-wgo4pml6	2020	In the ensuing weeks, health care organizations, industry partners, and government agencies worldwide have quickly come together to address pandemic challenges such as scaling high-quality laboratory tests, conducting treatment research, and enabling virtual health care in a time of social distancing. What we have accomplished together to date demonstrates the opportunity for future cross-sector partnerships in science and technology to fight the disease, while simultaneously creating the new digital health care solutions that our world greatly needs. Instead, we must seize the opportunity for cross-sector partnerships in science and technology to fight the disease, while simultaneously deploying new digital health care solutions that our world greatly needs. The Federal Communications Commission (FCC) facilitated expanding access with The COVID-19 Telehealth Program, fasttracking application processes and funding to help health care providers quickly establish telehealth services for remote patients.
cord-331754-4cssullk	2020	
cord-334708-lbmktall	2020	
cord-337172-vgw8uz83	2020	Four months into the pandemic, there are models of possible trajectories of the disease but there are still no clear, national recommendations to guide practice that could reduce the spread of infection in hospitals facing limited availability of personal protective equipment (PPE) including surgical masks and N95 masks. Anticipating even greater need as the virus spreads in communities across the country, many have opted to limit the use of PPEs, especially N95 masks, to only certain clinical procedures and patient encounters. While current rationing helps preserve the supply of N95s and procedural masks, it comes at the risk of adding to the problem by infecting those working in hospitals. We recommend that all persons entering clinics and hospitals, in clinical settings as well as any other non-clinical areas where healthcare workers convene, should wear a mask.
cord-343227-6n5el4hz	2020	And yet we wish to gently challenge a tendency towards solipsism-a propensity for self-absorption -as aspiring medical students face what Bhatt and Bhatt describe as "an increased sense of stress as carefully charted paths to medical school become so utterly disrupted." 1 That is, we want to remind applicants this season that they are not alone in having to deal with disruptions. A recent New York Times Op-Ed by Frank Bruni focuses on the ideas of Jeffrey Selingo, author of the recently published Who Gets In and Why: A Year Inside College Admissions. "The pandemic,"Bruni writes, "put many of those activities on hold, creating a pause in which [Selingo] believes some schools and some students will recognize the lunacy of this overkill." 2 Admissions committees have the opportunity to recalibrate their criteria to emphasize quality over quantity in selecting what truly matters in building the best future doctors.
cord-345058-jfzzngce	2020	We show that expression levels of ACE2 and TMPRSS2 are overall comparable between males and females in multiple tissues suggesting that differences in the expression levels of TMPRSS2 and ACE2 in the lung and other non-sex-specific tissues may not explain the gender disparities in SARS CoV-2 severity. Given the increased severity of disease among older males with SARS-CoV-2 infection, we also address the potential roles of ACE2 and TMPRSS2 in their contribution to the sex differences in disease severity. Given the necessity of ACE2 and TMPRSS2 genes for SARS CoV-2 infection, we evaluated their expression in human tissues using data from the Genotype-Tissue Expression (GTEx) Project (https://gtexportal.org). Combined, these findings suggest that differences in the expression levels of TMPRSS2 and ACE2 in the lung and other non-sex-specific tissues likely do not explain the gender disparities in SARS CoV-2 severity. This suggests that expression differences of TMPRSS2 and ACE2 in the lung and other non-sex-specific tissues may not explain the gender disparities in SARS CoV-2 severity.
cord-346607-1mewok8l	2020	This article reviews current literature for the use of tele/virtual interventions in the treatment of SUDs and offers recommendations on safe an effective implementation strategies based on the current literature. The COVID-19 pandemic makes it imperative for clinical practice to adapt rapidly in order to meet patient needs for SUD treatment while reducing risk of COVID-19 infection; hence, many providers are now using telehealth for the first time. When compared to treatment as usual for Alcohol Use Disorder, the addition of telephone-based services has been shown to improve abstinence rates and reduce binge drinking in the short term but not after the cessation of the interventions examined with no increase in adverse outcomes. A number of studies have shown group based treatment by videoconference, both support groups and treatment groups, including those targeting tobacco, alcohol and opioid use disorders have been shown to provide safe intervention, high patient satisfaction and appear to have similar outcomes to in person treatments.