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Epidemiology and Responses to the current emergency

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31/07/2020 Press Release
SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight ...

SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020

CDC (CENTER FOR DISEASE CONTROL AND PREVENTION)

Authors
Christine M. Szablewski, Karen T. Chang, Marie M. Brown, Victoria T. Chu, Anna R. Yousaf, Ndubuisi Anyalechi, Peter A. Aryee, MBA; Hannah L. Kirking, Maranda Lumsden; Erin Mayweather; Clinton J. McDaniel, Robert Montierth, Pharm; Asfia Mohammed; Noah G. Schwartz, Jaina A. Shah, Jacqueline E. Tate, Emilio Dirlikov, Cherie Drenzek, Tatiana M. Lanzieri, Rebekah J. Stewart



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31/07/2020 Articles
Epidemiological and clinical characteristics of the COVID-19 epidemic ...

Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil

NATURE

Authors
William Marciel de Souza, Lewis Fletcher Buss, Darlan da Silva Candido, Jean-Paul Carrera, Sabrina Li, Alexander E. Zarebski, Rafael Henrique Moraes Pereira, Carlos A. Prete Jr, Andreza Aruska de Souza-Santos, Kris V. Parag, Maria Carolina T. D. Belotti, Maria F. Vincenti-Gonzalez, Janey Messina, Flavia Cristina da Silva Sales, Pamela dos Santos Andrade, Vítor Heloiz Nascimento, Fabio Ghilardi, Leandro Abade, Bernardo Gutierrez, Moritz U. G. Kraemer, Carlos K. V. Braga, Renato Santana Aguiar, Neal Alexander, Philippe Mayaud, Oliver J. Brady, Izabel Marcilio, Nelson Gouveia, Guangdi Li, Adriana Tami, Silvano Barbosa de Oliveira, Victor Bertollo Gomes Porto, Fabiana Ganem, Walquiria Aparecida Ferreira de Almeida, Francieli Fontana Sutile Tardetti Fantinato, Eduardo Marques Macário, Wanderson Kleber de Oliveira, Mauricio L. Nogueira, Oliver G. Pybus, Chieh-Hsi Wu, Julio Croda, Ester C. Sabino, Nuno Rodrigues Faria



ABSTRACT
The first case of COVID-19 was detected in Brazil on 25 February 2020. We report and contextualize epidemiological, demographic and clinical findings for COVID-19 cases during the first 3 months of the epidemic. By 31 May 2020, 514,200 COVID-19 cases, including 29,314 deaths, had been reported in 75.3% (4,196 of 5,570) of municipalities across all five administrative regions of Brazil. The R0 value for Brazil was estimated at 3.1 (95% Bayesian credible interval = 2.4–5.5), with a higher median but overlapping credible intervals compared with some other seriously affected countries. A positive association between higher per-capita income and COVID-19 diagnosis was identified. Furthermore, the severe acute respiratory infection cases with unknown aetiology were associated with lower per-capita income. Co-circulation of six respiratory viruses was detected but at very low levels. These findings provide a comprehensive description of the ongoing COVID-19 epidemic in Brazil and may help to guide subsequent measures to control virus transmission.

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30/07/2020 Letter
Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syn...

Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19)

JAMA

Authors
Taylor Heald-Sargent, William J. Muller, Xiaotian Zheng, Jason Rippe, Ami B. Patel, Larry K. Kociolek


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29/07/2020 Articles
Observations of the global epidemiology of COVID-19 from the prepandem...

Observations of the global epidemiology of COVID-19 from the prepandemic period using web-based surveillance: a cross-sectional analysis

THE LANCET

Authors
Fatimah S Dawood, Philip Ricks, Gibril J Njie, Michael Daugherty, William Davis, James A Fuller, Alison Winstead, Margaret McCarron, Lia C Scott, Diana Chen, Amy E Blain, Ron Moolenaar, Chaoyang Li, Adebola Popoola, Cynthia Jones, Puneet Anantharam, Natalie Olson, Barbara J Marston, Sarah D Bennett



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27/07/2020 Original Investigation
Estimation of Viral Aerosol Emissions From Simulated Individuals With ...

Estimation of Viral Aerosol Emissions From Simulated Individuals With Asymptomatic to Moderate Coronavirus Disease 2019

JAMA

Authors
Michael Riediker, Dai-Hua Tsai



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24/07/2020 News
Covid-19: US cases are greatly underestimated, seroprevalence studies ...

Covid-19: US cases are greatly underestimated, seroprevalence studies suggest

THE BMJ

Authors
Janice Hopkins Tanne


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24/07/2020 Articles
Covid‐19 mortality is negatively associated with test number and gover...

Covid‐19 mortality is negatively associated with test number and government efectiveness

NATURE

Authors
Li-Lin Liang, Ching-Hung Tseng, Hsiu J. Ho, Chun-Ying Wu



ABSTRACT
A question central to the Covid-19 pandemic is why the Covid-19 mortality rate varies so greatly across countries. This study aims to investigate factors associated with cross-country variation in Covid-19 mortality. Covid-19 mortality rate was calculated as number of deaths per 100 Covid-19 cases. To identify factors associated with Covid-19 mortality rate, linear regressions were applied to a cross-sectional dataset comprising 169 countries. We retrieved data from the Worldometer website, the Worldwide Governance Indicators, World Development Indicators, and Logistics Performance Indicators databases. Covid-19 mortality rate was negatively associated with Covid-19 test number per 100 people (RR = 0.92, P = 0.001), government effectiveness score (RR = 0.96, P = 0.017), and number of hospital beds (RR = 0.85, P < 0.001). Covid-19 mortality rate was positively associated with proportion of population aged 65 or older (RR = 1.12, P < 0.001) and transport infrastructure quality score (RR = 1.08, P = 0.002). Furthermore, the negative association between Covid-19 mortality and test number was stronger among low-income countries and countries with lower government effectiveness scores, younger populations and fewer hospital beds. Predicted mortality rates were highly associated with observed mortality rates (r = 0.77; P < 0.001). Increasing Covid-19 testing, improving government effectiveness and increasing hospital beds may have the potential to attenuate Covid-19 mortality.

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24/07/2020 PERSPECTIVE
Mathematical models to guide pandemic response Models can be used to l...

Mathematical models to guide pandemic response Models can be used to learn from

SCIENCE

Authors
C. Jessica E. Metcalf, Dylan H. Morris, Sang Woo Park



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23/07/2020 Report
Evolution and epidemic spread of SARS-CoV-2 in Brazil

SCIENCE

Authors
Darlan S. Candido, Ingra M. Claro, Jaqueline G. de Jesus, William M. Souza, Filipe R. R. Moreira, Simon Dellicour, Thomas A. Mellan, Louis du Plessis, Rafael H. M. Pereira, Flavia C. S. Sales, Erika R. Manuli, Julien Thézé, Luiz Almeida, Mariane T. Menezes, Carolina M. Voloch, Marcilio J. Fumagalli, Thaís M. Coletti, Camila A. M. da Silva, Mariana S. Ramundo, Mariene R. Amorim, Henrique H. Hoeltgebaum, Swapnil Mishra, Mandev S. Gill, Luiz M. Carvalho, Lewis F. Buss, Carlos A. Prete Jr, Jordan Ashworth, Helder I. Nakaya, Pedro S. Peixoto, Oliver J. Brady, Samuel M. Nicholls, Amilcar Tanuri, Átila D. Rossi, Carlos K.V. Braga, Alexandra L. Gerber, Ana Paula de C. Guimarães, Nelson Gaburo Jr, Cecila Salete Alencar, Alessandro C.S. Ferreira, Cristiano X. Lima, José Eduardo Levi, Celso Granato, Giulia M. Ferreira, Ronaldo S. Francisco Jr, Fabiana Granja, Marcia T. Garcia, Maria Luiza Moretti, Mauricio W. Perroud Jr, Terezinha M. P. P. Castiñeiras, Carolina S. Lazari, Sarah C. Hill, Andreza Aruska de Souza Santos, Camila L. Simeoni, Julia Forato, Andrei C. Sposito, Angelica Z. Schreiber, Magnun N. N. Santos, Camila Zolini de Sá, Renan P. Souza, Luciana C. Resende-Moreira, Mauro M. Teixeira, Josy Hubner, Patricia A. F. Leme, Rennan G Moreira, Maurício L. Nogueira, Brazil-UK Centre for Arbovirus Discovery, Diagnosis, Genomics and Epidemiology (CADDE) Genomic Network, Neil M Ferguson, Silvia F. Costa, José Luiz Proenca-Modena, Ana Tereza R. Vasconcelos, Samir Bhatt, Philippe Lemey, Chieh-Hsi Wu, Andrew Rambaut, Nick J. Loman, Renato S. Aguiar, Oliver G. Pybus, Ester C. Sabino, Nuno Rodrigues Faria



ABSTRACT
Brazil currently has one of the fastest growing SARS-CoV-2 epidemics in the world. Owing to limited available data, assessments of the impact of non-pharmaceutical interventions (NPIs) on virus spread remain challenging. Using a mobility-driven transmission model, we show that NPIs reduced the reproduction number from >3 to 1–1.6 in São Paulo and Rio de Janeiro. Sequencing of 427 new genomes and analysis of a geographically representative genomic dataset identified >100 international virus introductions in Brazil. We estimate that most (76%) of the Brazilian strains fell in three clades that were introduced from Europe between 22 February11 March 2020. During the early epidemic phase, we found that SARS-CoV-2 spread mostly locally and within-state borders. After this period, despite sharp decreases in air travel, we estimated multiple exportations from large urban centers that coincided with a 25% increase in average travelled distances in national flights. This study sheds new light on the epidemic transmission and evolutionary trajectories of SARS-CoV-2 lineages in Brazil, and provide evidence that current interventions remain insufficient to keep virus transmission under control in the country.

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21/07/2020 Research
Tracking COVID-19 in the United States

PREVENT EPIDEMICS

Authors
PREVENT EPIDEMICS



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16/07/2020 Communication
All-cause excess mortality observed by age group and regions in the fi...

All-cause excess mortality observed by age group and regions in the first wave of the COVID-19 pandemic in England

EUROSURVEILLANCE

Authors
Mary A Sinnathamby, Heather Whitaker, Laura Coughlan, Jamie Lopez Bernal, Mary Ramsay, Nick Andrews



ABSTRACT
England has experienced one of the highest excess in all-cause mortality in Europe during the current COVID-19 pandemic. As COVID-19 emerged, the excess in all-cause mortality rapidly increased, starting in March 2020. The excess observed during the pandemic was higher than excesses noted in the past 5 years. It concerned all regions and all age groups, except the 0–14 year olds, but was more pronounced in the London region and in those aged ≥ 85 years.

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16/07/2020 Articles
Impact of delays on effectiveness of contact tracing strategies for CO...

Impact of delays on effectiveness of contact tracing strategies for COVID-19: a modelling study

THE LANCET

Authors
Mirjam E Kretzschmar, Ganna Rozhnova, Martin C J Bootsma, Michiel van Boven, Janneke H H M van de Wijgert, Marc J M Bonten



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15/07/2020 News
Covid-19: Data show 5000 fewer hospital admissions for acute coronary ...

Covid-19: Data show 5000 fewer hospital admissions for acute coronary syndrome during pandemic

THE BMJ

Authors
Shaun Griffin


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15/07/2020 Research
Physical distancing interventions and incidence of coronavirus disease...

Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries

THE BMJ

Authors
Nazrul Islam, Stephen J Sharp, Gerardo Chowell, Sharmin Shabnam, Ichiro Kawachi, Ben Lacey, Joseph M Massaro, Ralph B D’Agostino Sr, Martin White



ABSTRACT
Objective To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally.
Design Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis.
Setting 149 countries or regions, with data on daily reported cases of covid-19 from the European Centre for Disease Prevention and Control and data on the physical distancing policies from the Oxford covid-19 Government Response Tracker.
Participants Individual countries or regions that implemented one of the five physical distancing interventions (closures of schools, workplaces, and public transport, restrictions on mass gatherings and public events, and restrictions on movement (lockdowns)) between 1 January and 30 May 2020.
Main outcome measure Incidence rate ratios (IRRs) of covid-19 before and after implementation of physical distancing interventions, estimated using data to 30 May 2020 or 30 days post-intervention, whichever occurred first. IRRs were synthesised across countries using random effects meta-analysis.
Results On average, implementation of any physical distancing intervention was associated with an overall reduction in covid-19 incidence of 13% (IRR 0.87, 95% confidence interval 0.85 to 0.89; n=149 countries). Closure of public transport was not associated with any additional reduction in covid-19 incidence when the other four physical distancing interventions were in place (pooled IRR with and without public transport closure was 0.85, 0.82 to 0.88; n=72, and 0.87, 0.84 to 0.91; n=32, respectively). Data from 11 countries also suggested similar overall effectiveness (pooled IRR 0.85, 0.81 to 0.89) when school closures, workplace closures, and restrictions on mass gatherings were in place. In terms of sequence of interventions, earlier implementation of lockdown was associated with a larger reduction in covid-19 incidence (pooled IRR 0.86, 0.84 to 0.89; n=105) compared with a delayed implementation of lockdown after other physical distancing interventions were in place (pooled IRR 0.90, 0.87 to 0.94; n=41).
Conclusions Physical distancing interventions were associated with reductions in the incidence of covid-19 globally. No evidence was found of an additional effect of public transport closure when the other four physical distancing measures were in place. Earlier implementation of lockdown was associated with a larger reduction in the incidence of covid-19. These findings might support policy decisions as countries prepare to impose or lift physical distancing measures in current or future epidemic waves.

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14/07/2020 PRE PUBLICATIONS RELEASE
COVID-19 Disease Severity Risk Factors for Pediatric Patients in Italy

PEDIATRICS

Authors
Stefania Bellino, PhD, Ornella Punzo, MD, PhD, Maria Cristina Rota, MD, Martina Del Manso, DStat, Alberto Mateo Urdiales, MD, Xanthi Andrianou, PhD, Massimo Fabiani, DStat, Stefano Boros, Mr, Fenicia Vescio, MD, Flavia Riccardo, MD, Antonino Bella, DStat, Antonietta Filia, MD, PhD, Giovanni Rezza, MD, Alberto Villani, MD, PhD, Patrizio Pezzotti

13/07/2020 Viewpoint
Airborne Transmission of SARS-CoV-2 Theoretical Considerations and Ava...

Airborne Transmission of SARS-CoV-2 Theoretical Considerations and Available Evidence

JAMA

Authors
Michael Klompas, Meghan A. Baker; Chanu Rhee


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11/07/2020 Editorial
COVID-19: the worst may be yet to come

THE LANCET

Authors
THE LANCET


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10/07/2020 Articles
Inferring change points in the spread of COVID-19 reveals the effectiv...

Inferring change points in the spread of COVID-19 reveals the effectiveness of interventions

SCIENCE

Authors
Jonas Dehning, Johannes Zierenberg, F. Paul Spitzner, Michael Wibral, Joao Pinheiro Neto, Michael Wilczek, Viola Priesemann



ABSTRACT
INTRODUCTION When faced with the outbreak of a novel epidemic such as coronavirus disease 2019 (COVID-19), rapid response measures are required by individuals, as well as by society as a whole, to mitigate the spread of the virus. During this initial, time-critical period, neither the central epidemiological parameters nor the effectiveness of interventions such as cancellation of public events, school closings, or social distancing is known.
RATIONALE As one of the key epidemiological parameters, we inferred the spreading rate λ from confirmed SARS-CoV-2 infections using the example of Germany. We apply Bayesian inference based on Markov chain Monte Carlo sampling to a class of compartmental models [susceptible-infected-recovered (SIR)]. Our analysis characterizes the temporal change of the spreading rate and allows us to identify potential change points. Furthermore, it enables short-term forecast scenarios that assume various degrees of social distancing. A detailed description is provided in the accompanying paper, and the models, inference, and forecasts are available on GitHub (https://github.com/Priesemann-Group/covid19_inference_forecast). Although we apply the model to Germany, our approach can be readily adapted to other countries or regions.
RESULTS In Germany, interventions to contain the COVID-19 outbreak were implemented in three steps over 3 weeks: (i) Around 9 March 2020, large public events such as soccer matches were canceled; (ii) around 16 March 2020, schools, childcare facilities, and many stores were closed; and (iii) on 23 March 2020, a far-reaching contact ban (Kontaktsperre) was imposed by government authorities; this included the prohibition of even small public gatherings as well as the closing of restaurants and all nonessential stores.
From the observed case numbers of COVID-19, we can quantify the impact of these measures on the disease spread using change point analysis. Essentially, we find that at each change point the spreading rate λ decreased by ~40%. At the first change point, assumed around 9 March 2020, λ decreased from 0.43 to 0.25, with 95% credible intervals (CIs) of [0.35, 0.51] and [0.20, 0.30], respectively. At the second change point, assumed around 16 March 2020, λ decreased to 0.15 (CI [0.12, 0.20]). Both changes in λ slowed the spread of the virus but still implied exponential growth (see red and orange traces in the figure).
To contain the disease spread, i.e., to turn exponential growth into a decline of new cases, the spreading rate has to be smaller than the recovery rate μ = 0.13 (CI [0.09, 0.18]). This critical transition was reached with the third change point, which resulted in λ = 0.09 (CI [0.06, 0.13]; see blue trace in the figure), assumed around 23 March 2020.
From the peak position of daily new cases, one could conclude that the transition from growth to decline was already reached at the end of March. However, the observed transient decline can be explained by a short-term effect that originates from a sudden change in the spreading rate (see Fig. 2C in the main text).
As long as interventions and the concurrent individual behavior frequently change the spreading rate, reliable short- and long-term forecasts are very difficult. As the figure shows, the three example scenarios (representing the effects up to the first, second, and third change point) quickly diverge from each other and, consequently, span a considerable range of future case numbers.
Inference and subsequent forecasts are further complicated by the delay of ~2 weeks between an intervention and the first useful estimates of the new λ (which are derived from the reported case numbers). Because of this delay, any uncertainty in the magnitude of social distancing in the previous 2 weeks can have a major impact on the case numbers in the subsequent 2 weeks. Beyond 2 weeks, the case numbers depend on our future behavior, for which we must make explicit assumptions. In sum, future interventions (such as lifting restrictions) should be implemented cautiously to respect the delayed visibility of their effects.
CONCLUSION We developed a Bayesian framework for the spread of COVID-19 to infer central epidemiological parameters and the timing and magnitude of intervention effects. With such an approach, the effects of interventions can be assessed in a timely manner. Future interventions and lifting of restrictions can be modeled as additional change points, enabling short-term forecasts for case numbers. In general, our approach may help to infer the efficiency of measures taken in other countries and inform policy-makers about tightening, loosening, and selecting appropriate measures for containment of COVID-19.

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09/07/2020 Editorial
Meat plants—a new front line in the covid-19 pandemic

THE BMJ

Authors
John Middleton, Ralf Reintjes, Henrique Lopes


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07/07/2020 News
Covid-19: Herd immunity is “unethical and unachievable,” say experts a...

Covid-19: Herd immunity is “unethical and unachievable,” say experts after report of 5% seroprevalence in Spain

THE BMJ

Authors
Shaun Griffin


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06/07/2020 Correspondence
SARS-CoV-2 seroprevalence in COVID-19 hotspots

THE LANCET

Authors
Prof Marina Pollán, Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Jesús Oteo, Miguel A Hernán, Mayte Pérez-Olmeda, Jose L Sanmartín, Aurora Fernández-García, Israel Cruz, Nerea Fernández de Larrea, Marta Molina, Francisco Rodríguez-Cabrera, Mariano Martín, Paloma Merino-Amador, Jose León Paniagua, Juan F Muñoz-Montalvo, Faustino Blanco, Raquel Yotti


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06/07/2020 Articles
Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, populatio...

Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

THE LANCET

Authors
Marina Pollán, Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Jesús Oteo, Miguel A Hernán, Mayte Pérez-Olmeda , Jose L Sanmartín, Aurora Fernández-García, Israel Cruz, Nerea Fernández de Larrea, Marta Molina, Francisco Rodríguez-Cabrera, Mariano Martín, Paloma Merino-Amador, Jose León Paniagua, Juan F Muñoz-Montalvo, Faustino Blanco, Raquel Yotti,


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06/07/2020 Manuscript
It is Time to Address Airborne Transmission of COVID-19

OXFORD ACADEMY

Authors
Lidia Morawska, Donald K Milton



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03/07/2020 Statistics
An Early Warning Approach to Monitor COVID-19 Activity with Multiple D...

An Early Warning Approach to Monitor COVID-19 Activity with Multiple Digital Traces in Near Real-Time

CORNELL UNIVERSITY

Authors
Nicole E. Kogan, Leonardo Clemente, Parker Liautaud, Justin Kaashoek, Nicholas B. Link, Andre T. Nguyen, Fred S. Lu, Peter Huybers, Bernd Resch, Clemens Havas, Andreas Petutschnig, Jessica Davis, Matteo Chinazzi, Backtosch Mustafa, William P. Hanage, Alessandro Vespignani, Mauricio Santillana



ABSTRACT
Non-pharmaceutical interventions (NPIs) have been crucial in curbing COVID-19 in the United States (US). Consequently, relaxing NPIs through a phased re-opening of the US amid still-high levels of COVID-19 susceptibility could lead to new epidemic waves. This calls for a COVID-19 early warning system. Here we evaluate multiple digital data streams as early warning indicators of increasing or decreasing state-level US COVID-19 activity between January and June 2020. We estimate the timing of sharp changes in each data stream using a simple Bayesian model that calculates in near real-time the probability of exponential growth or decay. Analysis of COVID-19-related activity on social network microblogs, Internet searches, point-of-care medical software, and a metapopulation mechanistic model, as well as fever anomalies captured by smart thermometer networks, shows exponential growth roughly 2- 3 weeks prior to comparable growth in confirmed COVID-19 cases and 3-4 weeks prior to comparable growth in COVID-19 deaths across the US over the last 6 months. We further observe exponential decay in confirmed cases and deaths 5-6 weeks after implementation of NPIs, as measured by anonymized and aggregated human mobility data from mobile phones. Finally, we propose a combined indicator for exponential growth in multiple data streams that may aid in developing an early warning system for future COVID-19 outbreaks. These efforts represent an initial exploratory framework, and both continued study of the predictive power of digital indicators as well as further development of the statistical approach are needed.

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02/07/2020 Rapid Communication
Excess all-cause mortality during the COVID-19 pandemic in Europe – pr...

Excess all-cause mortality during the COVID-19 pandemic in Europe – preliminary pooled estimates from the EuroMOMO network, March to April 2020

EUROSURVEILLANCE

Authors
Lasse S Vestergaard, Jens Nielsen, Lukas Richter, Daniela Schmid Natalia Bustos, Toon Braeye, Gleb Denissov, Tatjana Veideman, Oskari Luomala, Teemu Möttönen, Anne Fouillet, Céline Caserio-Schönemann, Matthias an der Heiden, Helmut Uphoff, Theodore Lytras, Kassiani Gkolfinopoulou, Anna Pald, Lisa Domegan, Joan O'Donnell, Francesca de’ Donat, Fiammetta Noccioli, Patrick Hoffmann, Telma Vele, Kathleen England, Liselotte van Asten, Richard A White, Ragnhild Tønnessen Susana P da Silva, Ana P Rodrigues, Amparo Larrauri, Concepción Delgado-Sanz, Ahmed Farah, Ilias Galanis, Christoph Junker, Damir Perisa, Mary Sinnathamby, Nick Andrews, Mark O'Doherty, Diogo FP Marques, Sharon Kennedy, Sonja J Olsen, Richard Pebody, Tyra G Krause, Kåre Mølbak



ABSTRACT
A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March–April 2020. Excess mortality particularly affected  ≥ 65 year olds (91% of all excess deaths), but also 45–64 (8%) and 15–44 year olds (1%). No excess mortality was observed in 0–14 year olds.

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02/07/2020 Risk Assestment
Resurgence of reported cases of COVID-19 in the EU/EEA, the UK and EU ...

Resurgence of reported cases of COVID-19 in the EU/EEA, the UK and EU candidate and potential candidate countries

ECDC

Authors
ECDC



ABSTRACT
Since 31 December 2019 and as of 30 June 2020, 10 273 001 cases of coronavirus disease 2019 (COVID-19) have been reported worldwide, including 505 295 deaths. EU/EEA countries and the UK have reported 1 556 709 cases (15 % of all cases), including 176 800 deaths (35% of all deaths), while EU candidate and potential candidate countries reported 229 112 cases (2% of all cases), including 5 988 deaths (1% of all deaths). The COVID-19 pandemic is posing an unprecedented threat to EU/EEA countries and the UK as well as countries worldwide, many of which have been experiencing widespread transmission of the virus in the community for several months. There is still community transmission reported in most EU/EEA countries, the UK and EU candidate and potential candidate countries. Additionally, some countries are reporting a resurgence of observed cases or large localised outbreaks. The reasons behind this apparent increase in the number or resurgence of cases observed in these countries vary. The increase in the number of cases may reflect changes in case ascertainment (e.g. increasing testing, changes in the case definition) that does not necessarily indicate increased rates of transmission, or may reflect genuine increases in transmission (e.g. associated with the easing of non-pharmaceutical interventions (NPI), large localised outbreaks), or may be due to importation of cases. Some of the observed increases, particularly in countries with a small population, are associat

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02/07/2020 Correspondence
Early lessons from a second COVID-19 lockdown in Leicester, UK

THE LANCET

Authors
Joshua Nazareth, Jatinder S Minhas, David R Jenkins, Amandip Sahota, Kamlesh Khunti, Pranab Haldar, Manish Pareek


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01/07/2020 Editorial
Mortality and Morbidity The Measure of a Pandemic

JAMA

Authors
Jody W. Zylke, Howard Bauchner


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01/07/2020 Articles
Covid-19: Four in 10 cases in Italian town that locked down early were...

Covid-19: Four in 10 cases in Italian town that locked down early were asymptomatic

THE BMJ

Authors
Elisabeth Mahase


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01/07/2020 Articles
Association between mobility patterns and COVID-19 transmission in the...

Association between mobility patterns and COVID-19 transmission in the USA: a mathematical modelling study

THE LANCET

Authors
Hamada S Badr, Hongru Du, Maximilian Marshall, Ensheng Dong, Marietta M Squire, Lauren M Gardner


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01/07/2020 Articles
Inactivated trivalent influenza vaccine is associated with lower mort...

Inactivated trivalent influenza vaccine is associated with lower mortality among Covid-19 patients in Brazil

MEDRXIV

Authors
Günther Fink, Nina Orlova-Fink, Tobias Schindler, Sandra Grisi, Ana Paula Ferrer, Claudia Daubenberger, Alexandra Brentani



ABSTRACT
We analyzed data from 92,664 clinically and molecularly confirmed Covid-19 cases in Brazil to understand the potential associations between influenza vaccination and Covid-19 outcomes. Controlling for health facility of treatment, comorbidities as well as an extensive range of sociodemographic factors, we show that patients who received a recent influenza vaccine experienced on average 8% lower odds of needing intensive care treatment (95% CIs [0.86, 0.99]), 18% lower odds of requiring invasive respiratory support (0.74, 0.88) and 17% lower odds of death (0.75, 0.89). Large scale promotion of influenza vaccines seems advisable, especially in populations at high risk of severe SARS-CoV-2 infectio

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30/06/2020 STUDY PROTOCOL
Protocol of a population-based prospective COVID-19 cohort study Munic...

Protocol of a population-based prospective COVID-19 cohort study Munich, Germany (KoCo19)

BMJ

Authors
Katja Radon, Elmar Saathoff, Michael Pritsch, Jessica Michelle Guggenbühl Noller, Inge Kroidl, Laura Olbrich, Verena Thiel, Max Diefenbach, Friedrich Riess, Felix Forster, Fabian Theis, Andreas Wieser, Michael Hoelscher



ABSTRACT
Background Due to the SARS-CoV-2 pandemic, public health interventions have been introduced globally in order to prevent the spread of the virus and avoid the overload of health care systems, especially for the most severely affected patients. Scientific studies to date have focused primarily on describing the clinical course of patients, identifying treatment options and developing vaccines. In Germany, as in many other regions, current tests for SARS-CoV2 are not conducted on a representative basis and in a longitudinal design. Furthermore, knowledge about the immune status of the population is lacking. Nonetheless, these data are needed to understand the dynamics of the pandemic and hence to appropriately design and evaluate interventions. For this purpose, we recently started a prospective population-based cohort in Munich, Germany, with the aim to develop a better understanding of the state and dynamics of the pandemic.
Methods In 100 out of 755 randomly selected constituencies, 3000 Munich households are identified via random route and offered enrollment into the study. All household members are asked to complete a baseline questionnaire and subjects ≥14 years of age are asked to provide a venous blood sample of ≤3 ml for the determination of SARS-CoV-2 IgG/IgA status. The residual plasma and the blood pellet are preserved for later genetic and molecular biological investigations. For twelve months, each household member is asked to keep a diary of daily symptoms, whereabouts and contacts via WebApp. If symptoms suggestive for COVID-19 are reported, family members, including children < 14 years, are offered a pharyngeal swab taken at the Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, for molecular testing for SARS-CoV-2. In case of severe symptoms, participants will be transferred to a Munich hospital. For one year, the study teams re-visits the households for blood sampling every six weeks.
Discussion With the planned study we will establish a reliable epidemiological tool to improve the understanding of the spread of SARS-CoV-2 and to better assess the effectiveness of public health measures as well as their socio-economic effects. This will support policy makers in managing the epidemic based on scientific evidence.

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30/06/2020 Correspondence
Willingness to vaccinate against COVID-19 in Australia

THE LANCET

Authors
Rachael H Dodd, Erin Cvejic, Carissa Bonner, Kristen Pickles, Kirsten J McCaffery


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27/06/2020 Original Paper
Investigating time, strength, and duration of measures in controlling ...

Investigating time, strength, and duration of measures in controlling the spread of COVID-19 using a networked meta-population model

SPRINGER LINK

Authors
Jiang Zhang, Lei Dong, Yanbo Zhang, Xinyue Chen, Guiqing Yao, Zhangang Han



ABSTRACT
Policy makers around the world are facing unprecedented challenges in making decisions on when and what degrees of measures should be implemented to tackle the COVID-19 pandemic. Here, using a nationwide mobile phone dataset, we developed a networked meta-population model to simulate the impact of intervention in controlling the spread of the virus in China by varying the effectiveness of transmission reduction and the timing of intervention start and relaxation. We estimated basic reproduction number and transition probabilities between health states based on reported cases. Our model demonstrates that both the time of initiating an intervention and its effectiveness had a very large impact on controlling the epidemic, and the current Chinese intense social distancing intervention has reduced the impact substantially but would have been even more effective had it started earlier. The optimal duration of the control measures to avoid resurgence was estimated to be 2 months, although would need to be longer under less effective controls.

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26/06/2020 Articles
Offline: The second wave

THE LANCET

Authors
Richard Horton


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25/06/2020 Articles
COVID-19 in children and adolescents in Europe: a multinational, multi...

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

THE LANCET

Authors
Florian Götzinger, Begoña Santiago-García, Antoni Noguera-Julián, Miguel Lanaspa, Laura Lancella, Francesca I Calò Carducci, Natalia Gabrovska, Svetlana Velizarova, Petra Prunk, Veronika Osterman, Uros Krivec, Andrea Lo Vecchio, Delane Shingadia, Antoni Soriano-Arandes, Susana Melendo, Marcello Lanari, Luca Pierantoni, Noémie Wagner, Arnaud G L’Huillier, Ulrich Heininger, Nicole Ritz, Srini Bandi, Nina Krajcar, Srđan Roglić, Mar Santos, Christelle Christiaens, Marine Creuven, Danilo Buonsenso, Steven B Welch, Matthias Bogyi, Folke Brinkmann, Marc Tebruegge


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25/06/2020 Editorial
Lessons in contact tracing from Germany

THE BMJ

Authors
Ralf Reintjes


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22/06/2020 Articles
The end of social confinement and COVID-19 re-emergence risk

NATURE

Authors
Leonardo López, Xavier Rodó



ABSTRACT
The lack of effective pharmaceutical interventions for SARS-CoV-2 raises the possibility of COVID-19 recurrence. We explore different post-confinement scenarios by using a stochastic modified SEIR (susceptible–exposed–infectious–recovered) model that accounts for the spread of infection during the latent period and also incorporates time-decaying effects due to potential loss of acquired immunity, people’s increasing awareness of social distancing and the use of non-pharmaceutical interventions. Our results suggest that lockdowns should remain in place for at least 60 days to prevent epidemic growth, as well as a potentially larger second wave of SARS-CoV-2 cases occurring within months. The best-case scenario should also gradually incorporate workers in a daily proportion at most 50% higher than during the confinement period. We show that decaying immunity and particularly awareness and behaviour have 99% significant effects on both the current wave of infection and on preventing COVID-19 re-emergence. Social distancing and individual non-pharmaceutical interventions could potentially remove the need for lockdowns.

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22/06/2020 Original Investigation
Assessment of Coronavirus Disease 2019 Community Containment Strategie...

Assessment of Coronavirus Disease 2019 Community Containment Strategies in Shenzhen, China

JAMA

Authors
Xiao-Ming Zhang, Hui-Er Zhou, Wen-Wu Zhang, Qing-Li Dou, Ye Li, Jian Wei, Rui Hu, Jiangping Liu, Andy S. K. Cheng



ABSTRACT
Importance A new outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 in Wuhan, China, is spreading rapidly around the globe. Limited information on control in community settings is available.
Objective To detail measures enacted within a community to prevent the spread of coronavirus disease 2019 (COVID-19) and to evaluate the spread of COVID-19 associated with implementation of the program.
Design, Setting, and Participants This case series study details the implementation of prevention measures in a specific community setting among community-dwelling individuals exposed to or at risk of COVID-19 in Haiyu, Shenzhen, China, from January 23 to April 10, 2020.
Exposures Community containment strategies for tracking, quarantine, and management were strictly, cooperatively, and effectively implemented by a team that included a general practitioner, a community manager, and public safety bureau officials.
Main Outcomes and Measures Number of locally acquired cases with indirect links to confirmed COVID-19 cases. Diagnosis with COVID-19 was confirmed when throat swab samples tested positive for severe acute respiratory syndrome coronavirus 2 on reverse transcription–polymerase chain reaction.
Results Approximately 34 686 individuals live in Haiyu, including 2382 residents aged 65 years or older. Seven individuals with COVID-19 acquired outside the community (age, 20-70 years; 3 [42%] women) were moved from quarantine to a hospital for standard isolation treatment. A total of 20 people who were asymptomatic and who had had direct contact with these individuals were closely observed by health care workers at a nearby hotel. Additionally, 800 individuals considered to be at higher risk were moved from quarantine to home isolation for 14 days. There were no locally acquired cases of COVID-19 with indirect links reported in the Haiyu community from the time that the study began on January 23, 2020, to April 10, 2020.
Conclusions and Relevance These findings suggest that cooperation among the authorities of multiple sectors allowed for the implementation of preventive measures that were associated with limited community transmission.

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20/06/2020 Report
COVID-19 resurgence in Iran

THE LANCET

Authors
SHARMILA DEVI


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18/06/2020 Manuscript
Reconstruction of Transmission Pairs for novel Coronavirus Disease 201...

Reconstruction of Transmission Pairs for novel Coronavirus Disease 2019 (COVID-19) in mainland China: Estimation of Super-spreading Events, Serial Interval, and Hazard of Infection

OXFORD ACADEMY

Authors
Xiao-Ke Xu, Xiao-Fan Liu, Ye Wu, Sheikh Taslim Ali, Zhanwei Du, Paolo Bosetti, Eric H Y Lau, Benjamin J Cowling, Lin Wang



ABSTRACT
Background Knowledge on the epidemiological features and transmission patterns of COVID-19 is accumulating. Detailed line-list data with household settings can advance the understanding of COVID-19 transmission dynamics.
Methods A unique database with detailed demographic characteristics, travel history, social relationships, and epidemiological timelines for 1,407 transmission pairs that formed 643 transmission clusters in mainland China was reconstructed from 9,120 COVID-19 confirmed cases reported during January 15 - February 29, 2020. Statistical model fittings were used to identify the super-spreaders and estimate serial interval distributions. Age and gender-stratified hazard of infection were estimated for household versus non-household transmissions.
Results There were 34 primary cases identified as super-spreaders, with 5 super-spreading events occurred within households. Mean and standard deviation of serial intervals were estimated as 5.0 (95% CrI: 4.4, 5.5) and 5.2 (95% CrI: 4.9, 5.7) days for household transmissions and 5.2 (95% CrI: 4.6, 5.8) and 5.3 (95% CrI: 4.9, 5.7) days for non-household transmissions, respectively. Hazard of being infected outside of households is higher for age between 18 and 64 years, whereas hazard of being infected within households is higher for young and old people.
Conclusions Non-negligible frequency of super-spreading events, short serial intervals, and a higher risk of being infected outside of households for male people of working age indicate a significant barrier to the identification and management of COVID-19 cases, which requires enhanced non-pharmaceutical interventions to mitigate this pandemic.

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18/06/2020 Articles
Prevalence of SARS-CoV-2 specific neutralising antibodies in blood don...

Prevalence of SARS-CoV-2 specific neutralising antibodies in blood donors from the Lodi Red Zone in Lombardy, Italy, as at 06 April 2020

EUROSERVILLANCE

Authors
Elena Percivalle, Giuseppe Cambiè, Irene Cassaniti, Edoardo Vecchio Nepita, Roberta Maserati, Alessandro Ferrari, Raffaella Di Martino, Paola Isernia, Francesco Mojoli, Raffaele Bruno, Marcello Tirani, Danilo Cereda, Carlo Nicora, Massimo Lombardo , Fausto Baldanti



ABSTRACT
We evaluated SARS-CoV-2 RNA and neutralising antibodies in blood donors (BD) residing in the Lodi Red Zone, Italy. Of 390 BDs recruited after 20 February 2020 − when the first COVID-19 case in Lombardy was identified, 91 (23%) aged 19–70 years were antibody positive. Viral RNA was detected in an additional 17 (4.3%) BDs, yielding ca 28% (108/390) with evidence of virus exposure. Five stored samples collected as early as 12 February were seropositive.

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18/06/2020 Reviews
Current epidemiological and clinical features of COVID-19; a global pe...

Current epidemiological and clinical features of COVID-19; a global perspective from China

ELSEVIER

Authors
Huilan Tu, Sheng Tu, Shiqi Gao, Anwen Shao, Jifang Sheng



ABSTRACT
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and represents a potentially fatal disease of great global public health importance. As of March 26, 2020, the outbreak of COVID-19 has resulted in 462,801 confirmed cases and 20,839 deaths globally, which is more than those caused by SARS and Middle East respiratory syndrome (MERS) in 2003 and 2013, respectively. The epidemic has posed considerable challenges worldwide. Under a strict mechanism of massive prevention and control, China has seen a rapid decrease in new cases of coronavirus; however, the global situation remains serious. Additionally, the origin of COVID-19 has not been determined and no specific antiviral treatment or vaccine is currently available. Based on the published data, this review systematically discusses the etiology, epidemiology, clinical characteristics, and current intervention measures related to COVID-19 in the hope that it may provide a reference for future studies and aid in the prevention and control of the COVID-19 epidemic.

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17/06/2020 Articles
Household secondary attack rate of COVID-19 and associated determinant...

Household secondary attack rate of COVID-19 and associated determinants in Guangzhou, China: a retrospective cohort study

THE LANCET

Authors
Qin-Long Jing,Ming-Jin Liu, Zhou-Bin Zhang, Li-Qun Fang, Jun Yuan, An-Ran Zhang, Natalie E Dean, Lei Luo, Meng-Meng Ma, Ira Longini, Eben Kenah, Ying Lu, Yu Ma, Neda Jalali, Zhi-Cong Yang, Yang Yang



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16/06/2020 Articles
Tracking the debate on COVID-19 surveillance tools

NATURE

Authors
Yann Sweeney


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15/06/2020 Articles
Global, regional, and national estimates of the population at increase...

Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study

THE LANCET

Authors
Andrew Clark, Mark Jit, Charlotte Warren-Gash, Bruce Guthrie, Harry H X Wang, Stewart W Mercer, Colin Sanderson, Martin McKee, Christopher Troeger, Kanyin L Ong, Francesco Checchi, Pablo Perel, Sarah Joseph, Hamish P Gibbs, Amitava Banerjee, Rosalind M Eggo


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15/06/2020 News
Covid-19: Cases still rising in at least 23 US states as health offici...

Covid-19: Cases still rising in at least 23 US states as health officials warn against gatherings

THE BMJ

Authors
Janice Hopkins Tanne


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15/06/2020 News
Covid-19: Africa’s case numbers are rising rapidly, WHO warns

THE BMJ

Authors
Jacqui Thornton


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13/06/2020 Original Paper
Studying the pathophysiology of coronavirus disease 2019: a protocol f...

Studying the pathophysiology of coronavirus disease 2019: a protocol for the Berlin prospective COVID‐19 patient cohort (Pa‐COVID‐19)

SPRINGER LINK

Authors
Florian Kurth, Maria Roennefarth, Charlotte Thibeault, Victor M. Corman, Holger Müller-Redetzky, Mirja Mittermaier, Christoph Ruwwe-Glösenkamp, Katrin M. Heim, Alexander Krannich, Saskia Zvorc, Sein Schmidt, Lucie Kretzler, Chantip Dang-Heine, Matthias Rose, Michael Hummel, Andreas Hocke, Ralf H. Hübner, Bastian Opitz, Marcus A. Mall, Jobst Röhmel, Ulf Landmesser, Burkert Pieske, Samuel Knauss, Matthias Endres, Joachim Spranger, Frank P. Mockenhaupt, Frank Tacke, Sascha Treskatsch, Stefan Angermair, Britta Siegmund, Claudia Spies, Steffen Weber-Carstens, Kai-Uwe Eckardt, Dirk Schürmann, Alexander Uhrig, Miriam S. Stegemann, Thomas Zoller, Christian Drosten, Norbert Suttorp, Martin Witzenrath, Stefan Hippenstiel, Christof von Kalle, Leif Erik Sander



ABSTRACT
Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global health emergency. Pa-COVID-19 aims to provide comprehensive data on clinical course, pathophysiology, immunology and outcome of COVID-19, to identify prognostic biomarkers, clinical scores, and therapeutic targets for improved clinical management and preventive interventions.
Methods Pa-COVID-19 is a prospective observational cohort study of patients with confirmed SARS-CoV-2 infection treated at Charité - Universitätsmedizin Berlin. We collect data on epidemiology, demography, medical history, symptoms, clinical course, and pathogen testing and treatment. Systematic, serial blood sampling will allow deep molecular and immunological phenotyping, transcriptomic profiling, and comprehensive biobanking. Longitudinal data and sample collection during hospitalization will be supplemented by long-term follow-up.
Results Outcome measures include the WHO clinical ordinal scale on day 15 and clinical, functional, and health-related quality-of-life assessments at discharge and during follow-up. We developed a scalable dataset to (i) suit national standards of care, (ii) facilitate comprehensive data collection in medical care facilities with varying resources, and (iii) allow for rapid implementation of interventional trials based on the standardized study design and data collection. We propose this scalable protocol as blueprint for harmonized data collection and deep phenotyping in COVID-19 in Germany.
Conclusion We established a basic platform for harmonized, scalable data collection, pathophysiological analysis, and deep phenotyping of COVID-19, which enables rapid generation of evidence for improved medical care and identification of candidate therapeutic and preventive strategies. The electronic database accredited for interventional trials allows fast trial implementation for candidate therapeutic agents.

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12/06/2020 Features
Has Sweden’s controversial covid-19 strategy been successful?

THE BMJ

Authors
Heba Habib


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11/06/2020 Correspondence
Have deaths from COVID-19 in Europe plateaued due to herd immunity?

THE LANCET

Authors
Lucy C Okell, Robert Verity, Oliver J Watson, Swapnil Mishra, Patrick Walker, Charlie Whittaker, Aris Katzourakis, Christl A Donnelly, Steven Riley, Azra C Ghani, Axel Gandy, Seth Flaxman, Neil M Ferguson, Samir Bhatt


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11/06/2020 Rapid Risk Assessment
Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – tenth u...

Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – tenth update

EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL

Authors
European Centre for Disease Prevention and Control


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10/06/2020 Brief Report
Perceived versus proven SARS‐CoV‐2‐specifc immune responses in health‐...

Perceived versus proven SARS‐CoV‐2‐specifc immune responses in health‐care professionals

SPRINGER LINK

Authors
Georg M. N. Behrens, Anne Cossmann, Metodi V. Stankov, Torsten Witte, Diana Ernst, Christine Happle, Alexandra Jablonka



ABSTRACT
There have been concerns about high rates of thus far undiagnosed SARS-CoV-2 infections in the health-care system. The COVID-19 Contact (CoCo) Study follows 217 frontline health-care professionals at a university hospital with weekly SARS- CoV-2-specifc serology (IgA/IgG). Study participants estimated their personal likelihood of having had a SARS-CoV-2 infection with a mean of 21% [median 15%, interquartile range (IQR) 5–30%]. In contrast, anti-SARS-CoV-2 IgG prevalence was about 1–2% at baseline. Regular anti-SARS-CoV-2 IgG testing of health-care professionals may aid in directing resources for protective measures and care of COVID-19 patients in the long run.

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10/06/2020 Letter
Response to ‘Evaluation of modelling study shows limits of COVID-19 im...

Response to ‘Evaluation of modelling study shows limits of COVID-19 importing risk simulations in sub-Saharan Africa’

OXFORD UNIVERSITY

Authors
Najmul Haider, Alexei Yavlinsky, Richard Kock


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08/06/2020 Articles
The effect of large-scale anti-contagion policies on the COVID-19 pand...

The effect of large-scale anti-contagion policies on the COVID-19 pandemic

NATURE

Authors
Solomon Hsiang, Daniel Allen, Sébastien Annan-Phan, Kendon Bell, Ian Bolliger, Trinetta Chong, Hannah Druckenmiller, Luna Yue Huang, Andrew Hultgren, Emma Krasovich, Peiley Lau, Jaecheol Lee, Esther Rolf, Jeanette Tseng, Tiffany Wu



ABSTRACT
Governments around the world are responding to the novel coronavirus (COVID-19) pandemic1 with unprecedented policies designed to slow the growth rate of infections. Many actions, such as closing schools and restricting populations to their homes, impose large and visible costs on society, but their benefits cannot be directly observed and are currently understood only through process-based simulations2–4. Here, we compile new data on 1,717 local, regional, and national non-pharmaceutical interventions deployed in the ongoing pandemic across localities in China, South Korea, Italy, Iran, France, and the United States (US). We then apply reduced-form econometric methods, commonly used to measure the effect of policies on economic growth5,6, to empirically evaluate the effect that these anti-contagion policies have had on the growth rate of infections. In the absence of policy actions, we estimate that early infections of COVID-19 exhibit exponential growth rates of roughly 38% per day. We find that anti-contagion policies have significantly and substantially slowed this growth. Some policies have different impacts on different populations, but we obtain consistent evidence that the policy packages now deployed are achieving large, beneficial, and measurable health outcomes. We estimate that across these six countries, interventions prevented or delayed on the order of 62 million confirmed cases, corresponding to averting roughly 530 million total infections. These findings may help inform whether or when these policies should be deployed, intensified, or lifted, and they can support decision-making in the other 180+ countries where COVID-19 has been reported7.

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08/06/2020 Articles
Estimating the effects of non-pharmaceutical interventions on COVID-19...

Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe

NATURE

Authors
Seth Flaxman, Swapnil Mishra, Axel Gandy, H. Juliette T. Unwin, Thomas A. Mellan, Helen Coupland, Charles Whittaker, Harrison Zhu, Tresnia Berah, Jeffrey W. Eaton, Mélodie Monod, Imperial College COVID-19 Response Team, Azra C. Ghani, Christl A. Donnelly, Steven M. Riley, Michaela A. C. Vollmer, Neil M. Ferguson, Lucy C. Okell, Samir Bhatt



ABSTRACT
Following the emergence of a novel coronavirus1 (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics. In response, many European countries have implemented unprecedented non-pharmaceutical interventions such as closure of schools and national lockdowns. We study the impact of major interventions across 11 European countries for the period from the start of COVID-19 until the 4th of May 2020 when lockdowns started to be lifted. Our model calculates backwards from observed deaths to estimate transmission that occurred several weeks prior, allowing for the time lag between infection and death. We use partial pooling of information between countries with both individual and shared effects on the reproduction number. Pooling allows more information to be used, helps overcome data idiosyncrasies, and enables more timely estimates. Our model relies on fixed estimates of some epidemiological parameters such as the infection fatality rate, does not include importation or subnational variation and assumes that changes in the reproduction number are an immediate response to interventions rather than gradual changes in behavior. Amidst the ongoing pandemic, we rely on death data that is incomplete, with systematic biases in reporting, and subject to future consolidation. We estimate that, for all the countries we consider, current interventions have been sufficient to drive the reproduction number Rt below 1 (probability Rt< 1.0 is 99.9%) and achieve epidemic control. We estimate that, across all 11 countries, between 12 and 15 million individuals have been infected with SARS-CoV-2 up to 4th May, representing between 3.2% and 4.0% of the population. Our results show that major non-pharmaceutical interventions and lockdown in particular have had a large effect on reducing transmission. Continued intervention should be considered to keep transmission of SARS-CoV-2 under control.

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07/06/2020 Original Research
Can the summer temperatures reduce COVID-19 cases?

ELSEVIER

Authors
Chandi C. Mandal, M.S. Panwar



ABSTRACT
Objective Despite huge global, national, and local preventive measures including travel restriction, social distancing, and quarantines, the outbreak of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develops the coronavirus disease 2019 (COVID-19) worldwide pandemic. SARS-CoV-2 emerging from Wuhan, China, took only three months to cover >200 countries worldwide by infecting more than 2.4 million people and killing more than 150,000 people. Although this infection at the early stage creates seasonal flu-like symptoms with a higher illness, it eventually causes a higher mortality. Epidemiological studies not only find the causes of many health issues but also suggest preventive measures. This study aimed to see the link between environment temperature and COVID-19 cases.
Study design The monthly average environment temperature (MAET) and various COVID-19 cases of a country were collected and analyzed to see the relationship between these parameters.
Methods Univariate analysis and statistical modeling were used to determine the relationship between environment temperature and different COVID-19 cases.
Results This study found that the majorities of the countries having higher COVID-19 cases are located in the higher latitude (colder region) in the globe. As of 20th April data available, statistical analyses by various methods have found that strong negative correlations with statistical significance exist between MAET and several COVID-19 cases including total cases, active cases, and cases per million of a country (Spearman correlation coefficients were −0.45, −0.42, and −0.50 for total cases, active cases, and cases/per million, respectively). Analysis by the statistical log-linear regression model further supports that the chance of patients to contract COVID-19 is less in warmer countries than in colder countries.
Conclusion This pilot study proposes that cold environment may be an additional risk factor for COVID-19 cases.

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03/06/2020 Articles
Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated f...

Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study

The Lancet

Authors
Kelvin Kai-Wang To, Vincent Chi-Chung Cheng, Jian-Piao Cai, Kwok-Hung Chan, Lin-Lei Chen, Lok-Hin Wong, Charlotte Yee-Ki Choi, Carol Ho-Yan Fong, Anthony Chin-Ki Ng, Lu Lu, Cui-Ting Luo, Jianwen Situ, Tom Wai-Hin Chung, Shuk-Ching Wong, Grace See-Wai Kwan, Siddharth Sridhar, Jasper Fuk-Woo Chan, Cecilia Yuen-Man Fan, Vivien W M Chuang, Kin-Hang Kok, Ivan Fan-Ngai Hung, Kwok-Yung Yuen

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01/06/2020 Articles
Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo...

Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo’

NATURE

Authors
Enrico Lavezzo, Elisa Franchin, Constanze Ciavarella, Gina Cuomo-Dannenburg, Luisa Barzon, Claudia Del Vecchio, Lucia Rossi, Riccardo Manganelli, Arianna Loregian, Nicolò Navarin, Davide Abate, Manuela Sciro, Stefano Merigliano, Ettore De Canale, Maria Cristina Vanuzzo, Valeria Besutti, Francesca Saluzzo, Francesco Onelia, Monia Pacenti, Saverio Parisi, Giovanni Carretta, Daniele Donato, Luciano Flor, Silvia Cocchio, Giulia Masi, Alessandro Sperduti, Lorenzo Cattarino, Renato Salvador, Michele Nicoletti, Federico Caldart, Gioele Castelli, Eleonora Nieddu, Beatrice Labella, Ludovico Fava, Matteo Drigo, Katy A. M. Gaythorpe, Imperial College COVID-19 Response Team, Alessandra R. Brazzale, Stefano Toppo, Marta Trevisan, Vincenzo Baldo, Christl A. Donnelly, Neil M. Ferguson, Ilaria Dorigatti, Andrea Crisanti



ABSTRACT
On the 21st of February 2020 a resident of the municipality of Vo’, a small town near Padua, died of pneumonia due to SARS-CoV-2 infection1. This was the first COVID-19 death detected in Italy since the emergence of SARS-CoV-2 in the Chinese city of Wuhan, Hubei province2. In response, the regional authorities imposed the lockdown of the whole municipality for 14 days3. We collected information on the demography, clinical presentation, hospitalization, contact network and presence of SARS-CoV-2 infection in nasopharyngeal swabs for 85.9% and 71.5% of the population of Vo’ at two consecutive time points. On the first survey, which was conducted around the time the town lockdown started, we found a prevalence of infection of 2.6% (95% confidence interval (CI) 2.1-3.3%). On the second survey, which was conducted at the end of the lockdown, we found a prevalence of 1.2% (95% Confidence Interval (CI) 0.8-1.8%). Notably, 42.5% (95% CI 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (i.e. did not have symptoms at the time of swab testing and did not develop symptoms afterwards). The mean serial interval was 7.2 days (95% CI 5.9-9.6). We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (p-values 0.62 and 0.74 for E and RdRp genes, respectively, Exact Wilcoxon-Mann-Whitney test). This study sheds new light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides new insights into its transmission dynamics and the efficacy of the implemented control measures.

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01/06/2020 Viewpoint
Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfectio...

Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection

JAMA

Authors
Edward A. Nardell, Ruvandhi R. Nathavitharana

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01/06/2020 Articles
Quantitative assessment of the risk of airborne transmission of SARS-C...

Quantitative assessment of the risk of airborne transmission of SARS-CoV-2 infection: prospective and retrospective applications

MEDRXIV

Authors
Giorgio Buonanno, Lidia Morawska, Luca Stabile



ABSTRACT
Airborne transmission is a recognized pathway of contagion; however, it is rarely quantitatively evaluated. This study presents a novel approach for quantitative assessment of the individual infection risk of susceptible subjects exposed in indoor microenvironments in the presence of an asymptomatic infected SARS-CoV-2 subject. The approach allowed the maximum risk for an exposed healthy subject to be evaluated or, starting from an acceptable risk, the maximum exposure time. We applied the proposed approach to four distinct scenarios for a prospective assessment, highlighting that, in order to guarantee an acceptable individual risk of 10-3 for exposed subjects in naturally ventilated indoor environments, the exposure time should be shorter than 20 min. The proposed approach was used for retrospective assessment of documented outbreaks in a restaurant in Guangzhou (China) and at a choir rehearsal in Mount Vernon (USA), showing that, in both cases, the high attack rate values can be justified only assuming the airborne transmission as the main route of contagion. Moreover, we shown that such outbreaks are not caused by the rare presence of a superspreader, but can be likely explained by the co-existence of conditions, including emission and exposure parameters, leading to a highly probable event, which can be defined as a superspreading event.

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01/06/2020
The COVID-19 Pandemic: Effects on Low- and Middle-Income Countries

ANESTHESIA & ANALGESIA

Authors
Bong, Choon-Looi, Brasher Christopher, Chikumba, Edson, McDougall, Robert, Mellin-Olsen Jannicke, Enright, Angel



ABSTRACT
Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.

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23/05/2020 New Result
The emergence of SARS-CoV-2 in Europe and the US

BIORXIV

Authors
Michael Worobey, Jonathan Pekar, Brendan B. Larsen, Martha I. Nelson, Verity Hill, Jeffrey B. Joy, Andrew Rambaut, Marc A. Suchard, Joel O. Wertheim, Philippe Lemey

ABSTRACT
Accurate understanding of the global spread of emerging viruses is critically important for public health response and for anticipating and preventing future outbreaks. Here, we elucidate when, where and how the earliest sustained SARS-CoV-2 transmission networks became established in Europe and the United States (US). Our results refute prior findings erroneously linking cases in January 2020 with outbreaks that occurred weeks later. Instead, rapid interventions successfully prevented onward transmission of those early cases in Germany and Washington State. Other, later introductions of the virus from China to both Italy and Washington State founded the earliest sustained European and US transmission networks. Our analyses reveal an extended period of missed opportunity when intensive testing and contact tracing could have prevented SARS-CoV-2 from becoming established in the US and Europe.
Competing Interest Statement JOW has received funding from Gilead Sciences, LLC (completed) and the CDC (ongoing) via grants and contracts to his institution unrelated to this research. MAS receives funding from Janssen Research & Development, IQVIA and Private Health Management via contracts unrelated to this research.

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22/05/2020 Articles
AI systems aim to sniff out coronavirus outbreaks

SCIENCE

Authors
Adrian Cho

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22/05/2020 Articles
Approaches to Daily Monitoring of the SARS-CoV-2 Outbreak in Northern ...

Approaches to Daily Monitoring of the SARS-CoV-2 Outbreak in Northern Italy

RESOURCE IN PUBLIC HEALTH

Authors
Giovenale Moirano, Lorenzo Richiardi, Carlo Novara, Milena Maule


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21/05/2020 Medical News and Perspectives
Building an “Army of Disease Detectives” to Trace COVID-19 Contacts

JAMA

Authors
Rita Rubin

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18/05/2020 Editorial
Reassessing advance care planning in the light of covid-19

THE BMJ

Authors
Sarah A Hopkins, Roberta Lovick, Louisa Polak, Ben Bowers, Tessa Morgan, Michael P Kelly, Stephen Barclay

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15/05/2020 Perspectives
Wrong but Useful — What Covid-19 Epidemiologic Models Can and Cannot T...

Wrong but Useful — What Covid-19 Epidemiologic Models Can and Cannot Tell Us

THE NEW ENGLAND JOURNAL OF MEDICINE

Authors
Inga Holmdahl, S.M., and Caroline Buckee, D.Phil

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15/05/2020 Articles
Modeling infectious disease dynamics

SCIENCE

Authors
SARAH COBEY

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15/05/2020 Articles
COVID-19 mortality and ICU admission: the Italian experience

BMC

Authors
Paolo Immovilli, Nicola Morelli, Elio Antonucci, Guido Radaelli, Mario Barbera & Donata Guidetti

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15/05/2020 Articles
Emergency Response to COVID-19 in Canada: Platform Development and Imp...

Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth...

JMIR

Authors
Michael Krausz, Jean Nicolas Westenberg ,Daniel Vigo, Richard Trafford Spence, Damon Ramsey

ABSTRACT

Background: Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation.

Objective: The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic.

Methods: An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system’s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic.

Results: The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture.

Conclusions: Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies

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14/05/2020 Viewpoint
Assessment of Deaths From COVID-19 and From Seasonal Influenza

JAMA

Authors
Jeremy Samuel Faust, Carlos del Rio

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14/05/2020 Research
Use of all cause mortality to quantify the consequences of covid-19 in...

Use of all cause mortality to quantify the consequences of covid-19 in Nembro, Lombardy...

The BMJ

Authors
Marco Piccininni, Jessica L Rohmann, Luca Foresti, Caterina Lurani, Tobias Kurth

ABSTRACT

OBJECTIVE To quantify the impact of coronavirus disease 2019 (covid-19) on all cause mortality in Nembro, an Italian city severely affected by the covid-19 pandemic.

DESIGN Descriptive study.

SETTING Nembro, in the Bergamo province of Lombardy, northern Italy.

POPULATION Residents of Nembro.

MAIN OUTCOME MEASURES Monthly all cause mortality between January 2012 and April 2020 (data to 11 April), number of confirmed deaths from covid-19 to 11 April 2020, and weekly absolute number of deaths between 1 January and 4 April across recent years by age group and sex.

RESULTS Nembro had 11505 residents as of 1 January 2020. Monthly all cause mortality between January 2012 and February 2020 fluctuated around 10 per 1000 person years, with a maximum of 21.5 per 1000 person years. In March 2020, monthly all cause mortality reached a peak of 154.4 per 1000 person years. For the first 11 days in April, this rate decreased to 23.0 per 1000 person years. The observed increase in mortality was driven by the number of deaths among older people (≥65 years), especially men. From the outbreak onset until 11 April 2020, only 85 confirmed deaths from covid-19 in Nembro were recorded, corresponding to about half of the 166 deaths from all causes observed in that period.

CONCLUSIONS The study findings show how covid-19 can have a considerable impact on the health of a small community. Furthermore, the results suggest that the full implications of the covid-19 pandemic can only be completely understood if, in addition to confirmed deaths related to covid-19, consideration is also given to all cause mortality in a given region and time frame.

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13/05/2020 Correspondence
The Post-COVID-19 Functional Status (PCFS) Scale: a tool to measure fu...

The Post-COVID-19 Functional Status (PCFS) Scale: a tool to measure functional status...

EUROPEAN RESPIRATORY JOURNAL

Authors
F.A. Klok, G.J.A.M. Boon, S. Barco, M. Endres, J.J.M. Geelhoed, S. Knauss, S.A. Rezek, M.A. Spruit, J. Vehreschild, B. Siegerink

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13/05/2020 News
Covid-19: Concerns rise as cases expand rapidly in South America

THE BMJ

Authors
Rodrigo de Oliveira Andrade

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12/05/2020 Article
An Italian sacrifice to COVID-19 epidemic

ERS

Authors
Stefano Nava, Roberto Tonelli, Enrico Clini

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08/05/2020 Correspondence
COVID-19: PCR screening of asymptomatic health-care workers at London ...

COVID-19: PCR screening of asymptomatic health-care workers at London hospital

The Lancet

Authors
Thomas A Treibel, Charlotte Manisty, Maudrian Burton, &Aacute;ine McKnight, Jonathan Lambourne, Jo&atilde;o B Augusto, Xos&eacute; Couto-Parada, Teresa Cutino-Moguel, Mahdad Noursadeghi, James C Moon

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08/05/2020 Editorial
Combination prevention for COVID-19

SCIENCE

Authors
Myron S. Cohen, Lawrence Corey

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06/05/2020 Review Article
COVID-19: The first documented coronavirus Q7Q5 pandemic in history

SCIENCE DIRECT

Authors
Yen-Chin Liu, Rei-Lin Kuo, Shin-Ru Shih

ABSTRACT
The novel human coronavirus disease COVID-19 has become the fifth documented pandemic since the 1918 flu pandemic. COVID-19 was first reported in Wuhan, China, and subsequently spread worldwide. The coronavirus was officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses based on phylogenetic analysis. SARS-CoV-2 is believed to be a spillover of an animal coronavirus and later adapted the ability of human-to-human transmission. Because the virus is highly contagious, it rapidly spreads and continuously evolves in the human population. In this review article, we discuss the basic properties, potential origin, and evolution of the novel human coronavirus. These factors may be critical for studies of pathogenicity, antiviral designs, and vaccine development against the virus.

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05/05/2020 Letter
Wuhan Covid19 data – more questions than answers

ELSEVIER

Authors
Harald Walach &amp; Stefan Hockertz

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05/05/2020 Articles
COVID-19: The first documented coronavirus Q7 pandemic in history

BIOMEDICAL JOURNAL

Authors
Yen-Chin Liu, Rei-Lin Kuo, Shin-Ru Shih

ABSTRACT
The novel human coronavirus disease COVID-19 has become the fifth documented pandemic since the 1918 flu pandemic. COVID-19 was first reported in Wuhan, China, and subsequently spread worldwide. The coronavirus was officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses based on phylogenetic analysis. SARS-CoV-2 is believed to be a spillover of an animal coronavirus and later adapted the ability of human-to-human transmission. Because the virus is highly contagious, it rapidly spreads and continuously evolves in the human population. In this review article, we discuss the basic properties, potential origin, and evolution of the novel human coronavirus. These factors may be critical for studies of pathogenicity, antiviral designs, and vaccine development against the virus.

Read More »

04/05/2020 Report
Impatto Dell’epidemia Covid-19 Sulla Mortalità Totale Della Popolazion...

Impatto Dell’epidemia Covid-19 Sulla Mortalità Totale Della Popolazione Residente Primo Trimestre 2020

ISTAT/ISS

Authors
ISTAT/ISS

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01/05/2020 Insights
Public Health Measures and the Reproduction Number of SARS-CoV-2

JAMA

Authors
Thomas V. Inglesby

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28/04/2020 Letter
Is a more aggressive COVID-19 case detection approach mitigating the b...

Is a more aggressive COVID-19 case detection approach mitigating the burden on ICUs?...

NCBI

Authors
Giulia Lorenzoni, Corrado Lanera, Danila Azzolina, Paola Berchialla, Dario Gregori

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27/04/2020 News
Covid-19: Leading statistician slams UK’s reporting of swab tests as “...

Covid-19: Leading statistician slams UK’s reporting of swab tests as “travesty of science”

THE BMJ

Authors
Jacqui Wise

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24/04/2020 Correspondence
COVID-19 deaths in Lombardy, Italy: data in context

The Lancet

Authors
Anna Odone, Davide Delmonte, Thea Scognamiglio, Carlo Signorelli

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24/04/2020 Articles
COVID-19 Trend Estimation in the Elderly Italian Region of Sardinia

FRONTIERS IN PUBLIC HEALTH

Authors
Mariangela Valentina Puci, Federica Loi, Ottavia Eleonora Ferraro, Stefano Cappai, Sandro Rolesu, Cristina Montomoli

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24/04/2020 Opinion
Does COVID-19 Spread Through Droplets Alone?

FRONTIERS IN PUBLIC HEALTH

Authors
Thushara Galbadage, Brent M. Peterson, Richard S. Gunasekera

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23/04/2020 Viewpoint
Information Technology–Based Tracing Strategy in Response to...

JAMA

Authors
Sangchul Park, Gina Jeehyun Choi, Haksoo Ko

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22/04/2020 Highlights
Estimation of COVID-19 prevalence in Italy, Spain, and France

ELSEVIER

Authors
Zeynep Ceylan

ABSTRACT

At the end of December 2019, coronavirus disease 2019 (COVID-19) appeared in Wuhan city, China. As of April 15, 2020, >1.9 million COVID-19 cases were confirmed worldwide, including >120,000 deaths. There is an urgent need to monitor and predict COVID-19 prevalence to control this spread more effectively. Time series models are significant in predicting the impact of the COVID-19 outbreak and taking the necessary measures to respond to this crisis. In this study, Auto-Regressive Integrated Moving Average (ARIMA) models were developed to predict the epidemiological trend of COVID-19 prevalence of Italy, Spain, and France, the most affected countries of Europe. The prevalence data of COVID-19 from 21 February 2020 to 15 April 2020 were collected from the World Health Organization website. Several ARIMA models were formulated with different ARIMA parameters. ARIMA (0,2,1), ARIMA (1,2,0), and ARIMA (0,2,1) models with the lowest MAPE values (4.7520, 5.8486, and 5.6335) were selected as the best models for Italy, Spain, and France, respectively. This study shows that ARIMA models are suitable for predicting the prevalence of COVID-19 in the future. The results of the analysis can shed light on understanding the trends of the outbreak and give an idea of the epidemiological stage of these regions. Besides, the prediction of COVID-19 prevalence trends of Italy, Spain, and France can help take precautions and policy formulation for this epidemic in other countries.

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22/04/2020 Correspondence
COVID-19: a need for real-time monitoring of weekly excess deaths

ANNALS OF INTERNAL MEDICINE

Authors
David A Leon, Vladimir M Shkolnikov, Liam Smeeth, Per Magnus, Mark&eacute;ta Pechholdov&aacute;, Christopher I Jarvis

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21/04/2020 Features
Tackling covid-19: are the costs worth the benefits?

THE BMJ

Authors
John Appleby

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21/04/2020 Articles
Connecting clusters of COVID-19: an epidemiological and serological in...

Connecting clusters of COVID-19: an epidemiological and serological investigation

The Lancet

Authors
Sarah Ee Fang Yong, Danielle Elizabeth Anderson, Wycliffe E Wei, Junxiong Pang, Wan Ni Chia, Chee Wah Tan, Yee Leong Teoh, Priyanka Rajendram, Matthias Paul Han Sim Toh, Cuiqin Poh, Valerie T J Koh, Joshua Lum, Nur-Afidah Md Suhaimi, Po Ying Chia, Mark I-Cheng Chen, Shawn Vasoo, Benjamin Ong, Yee Sin Leo, Linfa Wang, Vernon J M Lee

ABSTRACT

Background Elucidation of the chain of disease transmission and identification of the source of coronavirus disease 2019 (COVID-19) infections are crucial for effective disease containment. We describe an epidemiological investigation that, with use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays, established links between three clusters of COVID-19.

Methods In Singapore, active case-finding and contact tracing were undertaken for all COVID-19 cases. Diagnosis for acute disease was confirmed with RT-PCR testing. When epidemiological information suggested that people might have been nodes of disease transmission but had recovered from illness, SARS-CoV-2 IgG serology testing was used to establish past infection.

Findings Three clusters of COVID-19, comprising 28 locally transmitted cases, were identified in Singapore; these clusters were from two churches (Church A and Church B) and a family gathering. The clusters in Church A and Church B were linked by an individual from Church A (A2), who transmitted SARS-CoV-2 infection to the primary case from Church B (F1) at a family gathering they both attended on Jan 25, 2020. All cases were confirmed by RT-PCR testing because they had active disease, except for A2, who at the time of testing had recovered from their illness and tested negative. This individual was eventually diagnosed with past infection by serological testing. ELISA assays showed an optical density of more than 1·4 for SARS-CoV-2 nucleoprotein and receptor binding domain antigens in titres up to 1/400, and viral neutralisation was noted in titres up to 1/320.

Interpretation Development and application of a serological assay has helped to establish connections between COVID-19 clusters in Singapore. Serological testing can have a crucial role in identifying convalescent cases or people with milder disease who might have been missed by other surveillance methods.

Funding National Research Foundation (Singapore), National Natural Science Foundation (China), and National Medical Research Council (Singapore).

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21/04/2020 Articles
Effect of changing case definitions for COVID-19 on the epidemic curve...

Effect of changing case definitions for COVID-19 on the epidemic curve and...

The Lancet

Authors
Tim K Tsang, Peng Wu, Yun Lin, Eric H Y Lau, Gabriel M Leung, Benjamin J Cowling

ABSTRACT

Background When a new infectious disease emerges, appropriate case definitions are important for clinical diagnosis and for public health surveillance. Tracking case numbers over time is important to establish the speed of spread and the effectiveness of interventions. We aimed to assess whether changes in case definitions affected inferences on the transmission dynamics of coronavirus disease 2019 (COVID-19) in China.

Methods We examined changes in the case definition for COVID-19 in mainland China during the first epidemic wave. We used exponential growth models to estimate how changes in the case definitions affected the number of cases reported each day. We then inferred how the epidemic curve would have appeared if the same case definition had been used throughout the epidemic.

Findings From Jan 15 to March 3, 2020, seven versions of the case definition for COVID-19 were issued by the National Health Commission in China. We estimated that when the case definitions were changed, the proportion of infections being detected as cases increased by 7·1 times (95% credible interval [CrI] 4·8–10·9) from version 1 to 2, 2·8 times (1·9–4·2) from version 2 to 4, and 4·2 times (2·6–7·3) from version 4 to 5. If the fifth version of the case definition had been applied throughout the outbreak with sufficient testing capacity, we estimated that by Feb 20, 2020, there would have been 232 000 (95% CrI 161 000–359 000) confirmed cases in China as opposed to the 55 508 confirmed cases reported.

Interpretation The case definition was initially narrow and was gradually broadened to allow detection of more cases as knowledge increased, particularly milder cases and those without epidemiological links to Wuhan, China, or other known cases. These changes should be taken into account when making inferences on epidemic growth rates and doubling times, and therefore on the reproductive number, to avoid bias.

Funding Health and Medical Research Fund, Hong Kong.

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17/04/2020 Perspectives
Africa in the Path of Covid-19

THE NEW ENGLAND JOUNAL OF MEDICINE

Authors
Wafaa M. El‐Sadr, Jessica Justman

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17/04/2020 Articles
Impact assessment of non-pharmaceutical interventions against coronavi...

Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019...

THE LANCET

Authors
Benjamin J Cowling, Sheikh Taslim Ali, Tiffany W Y Ng, Tim K Tsang, Julian C M Li, Min Whui Fong, Qiuyan Liao, Mike YW Kwan, So Lun Lee, Susan S Chiu, Joseph T Wu, Peng Wu, Gabriel M Leung

Summary

Background
A range of public health measures have been implemented to suppress local transmission of coronavirus disease 2019 (COVID-19) in Hong Kong. We examined the effect of these interventions and behavioural changes of the public on the incidence of COVID-19, as well as on influenza virus infections, which might share some aspects of transmission dynamics with COVID-19. Methods We analysed data on laboratory-confirmed COVID-19 cases, influenza surveillance data in outpatients of all ages, and influenza hospitalisations in children. We estimated the daily effective reproduction number (Rt) for COVID-19 and influenza A H1N1 to estimate changes in transmissibility over time. Attitudes towards COVID-19 and changes in population behaviours were reviewed through three telephone surveys done on Jan 20–23, Feb 11–14, and March 10–13, 2020. 

Findings
COVID-19 transmissibility measured by Rt has remained at approximately 1 for 8 weeks in Hong Kong. Influenza transmission declined substantially after the implementation of social distancing measures and changes in population behaviours in late January, with a 44% (95% CI 34–53%) reduction in transmissibility in the community, from an estimated Rt of 1·28 (95% CI 1·26–1·30) before the start of the school closures to 0·72 (0·70–0·74) during the closure weeks. Similarly, a 33% (24–43%) reduction in transmissibility was seen based on paediatric hospitalisation rates, from an Rt of 1·10 (1·06–1·12) before the start of the school closures to 0·73 (0·68–0·77) after school closures. Among respondents to the surveys, 74·5%, 97·5%, and 98·8% reported wearing masks when going out, and 61·3%, 90·2%, and 85·1% reported avoiding crowded places in surveys 1 (n=1008), 2 (n=1000), and 3 (n=1005), respectively. Interpretation Our study shows that non-pharmaceutical interventions (including border restrictions, quarantine and isolation, distancing, and changes in population behaviour) were associated with reduced transmission of COVID-19 in Hong Kong, and are also likely to have substantially reduced influenza transmission in early February, 2020. Funding Health and Medical Research Fund, Hong Kong.

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15/04/2020 Intervention
Personal protective equipment for preventing highly infectious disease...

Personal protective equipment for preventing highly infectious diseases due to exposure...

COCHRANE LIBRARY

Authors
Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci

ABSTRACT

Background In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID‐19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed.

Objectives To evaluate which type of full‐body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols.

Search methods We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020.

Selection criteria We included all controlled studies that evaluated the effect of full‐body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes.

Data collection and analysis Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random‐effects meta‐analyses were appropriate.

Main results Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi‐RCT and nine had a non‐randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air‐purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non‐compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants), people with a long gown had less contamination than those with a coverall, and coveralls were more difficult to doff (low‐certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) −10.28, 95% CI −14.77 to −5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI −0.15 to 3.35) compared to more water‐repellent material but may have greater user satisfaction (MD −0.46, 95% CI −0.84 to −0.08, scale of 1 to 5). Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown‐wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low‐certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD −5.44, 95% CI −7.43 to −3.45). One‐step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double‐gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD −0.9, 95% CI −1.4 to −0.4) and to fewer contamination spots (MD −5, 95% CI −8.08 to −1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol‐based hand rub.

Training The use of additional computer simulation may lead to fewer errors in doffing (MD −1.2, 95% CI −1.6 to −0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face‐to‐face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only.

Authors' conclusions We found low‐ to very low‐certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort, and may therefore even lead to more contamination. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one‐step glove and gown removal, double‐gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face‐to‐face training in PPE use may reduce errors more than folder‐based training. We still need RCTs of training with long‐term follow‐up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real‐life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.

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15/04/2020 Letter
Clinician Education and Adoption of Preventive Measures for COVID-19: ...

Clinician Education and Adoption of Preventive Measures for COVID-19: A Survey of a...

ANNALS OF INTERNAL MEDICINE

Authors
Gionata Fiorino, Matteo Colombo, Carmela Natale, Elena Azzolini, Michele Lagioia

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14/04/2020 PERSPECTIVE
COVID-19 in Brazil: Epidemiological update and perspectives

Asian Pacific Journal of Tropical Medicine

Authors
Marli C Cupertino, Graziela A Cupertino, Andréia P Gomes, Nicholas AJ Mayers, R Siqueira-Batista

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14/04/2020 Articles
Spread of SARS-CoV-2 in the Icelandic Population

THE NEW JOURNAL OF MEDICINE

Authors
D.F. Gudbjartsson, A. Helgason, H. Jonsson, O.T. Magnusson, P. Melsted, G.L. Norddahl, J. Saemundsdottir, A. Sigurdsson, P. Sulem, A.B. Agustsdottir, B. Eiriksdottir, R. Fridriksdottir, E.E. Gardarsdottir, G. Georgsson, O.S. Gretarsdottir, K.R. Gudmundsson, T.R. Gunnarsdottir, A. Gylfason, H. Holm, B.O. Jensson, A. Jonasdottir, F. Jonsson, K.S. Josefsdottir, T. Kristjansson, D.N. Magnusdottir, L. le Roux, G. Sigmundsdottir, G. Sveinbjornsson, K.E. Sveinsdottir, M. Sveinsdottir, E.A. Thorarensen, B. Thorbjornsson, A. L&ouml;ve, G. Masson, I. Jonsdottir, A.D. M&ouml;ller, T. Gudnason, K.G. Kristinsson, U. Thorsteinsdottir, and K. Stefansson

ABSTRACT

BACKGROUND
During the current worldwide pandemic, coronavirus disease 2019 (Covid-19) was first diagnosed in Iceland at the end of February. However, data are limited on how SARS-CoV-2, the virus that causes Covid-19, enters and spreads in a population.

METHODS
We targeted testing to persons living in Iceland who were at high risk for infection (mainly those who were symptomatic, had recently traveled to high-risk countries, or had contact with infected persons). We also carried out population screening us- ing two strategies: issuing an open invitation to 10,797 persons and sending random invitations to 2283 persons. We sequenced SARS-CoV-2 from 643 samples.

RESULTS
As of April 4, a total of 1221 of 9199 persons (13.3%) who were recruited for tar- geted testing had positive results for infection with SARS-CoV-2. Of those tested in the general population, 87 (0.8%) in the open-invitation screening and 13 (0.6%) in the random-population screening tested positive for the virus. In total, 6% of the population was screened. Most persons in the targeted-testing group who received positive tests early in the study had recently traveled internationally, in contrast to those who tested positive later in the study. Children under 10 years of age were less likely to receive a positive result than were persons 10 years of age or older, with percentages of 6.7% and 13.7%, respectively, for targeted testing; in the population screening, no child under 10 years of age had a positive result, as compared with 0.8% of those 10 years of age or older. Fewer females than males received positive results both in targeted testing (11.0% vs. 16.7%) and in population screening (0.6% vs. 0.9%). The haplotypes of the sequenced SARS-CoV-2 viruses were diverse and changed over time. The percentage of infected participants that was determined through population screening remained stable for the 20-day duration of screening.

CONCLUSIONS
In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males. The proportion of infected persons identified through population screening did not change substantially during the screening period, which was consistent with a beneficial effect of containment efforts. (Funded by deCODE Genetics–Amgen.)

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14/04/2020 Report
Projecting the transmission dynamics of SARS-CoV-2 through the postpan...

Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

Science

Authors
Stephen M. Kissler, Christine Tedijanto, Edward Goldstein, Yonatan H. Grad, Marc Lipsitch

ABSTRACT

It is urgent to understand the future of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission. We used estimates of seasonality, immunity, and cross-immunity for betacoronaviruses OC43 and HKU1 from time series data from the USA to inform a model of SARS-CoV-2 transmission. We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022. Additional interventions, including expanded critical care capacity and an effective therapeutic, would improve the success of intermittent distancing and hasten the acquisition of herd immunity. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to SARS-CoV-2. Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.

Read More »

13/04/2020 Review
Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19)

JAMA

Authors
James M. Sanders, Marguerite L. Monogue, Tomasz Z. Jodlowski, James B. Cutrell

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12/04/2020 Link
Brescia COVID 19 Respiratory Severity Scale

SIMIT

Authors
SIMIT (Societ&agrave; Italiana Malattie Infettive e Tropicali)

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11/04/2020 Article
Management of the COVID-19 epidemic by public health establishments—An...

Management of the COVID-19 epidemic by public health establishments—Analysis by...

ELSEVIER

Authors
K. Barroa, A. Malone b, A. Mokedea, C. Chevancec

Read More »

10/04/2020 Editorial
Public Health Interventions for COVID-19 Emerging Evidence and Implica...

Public Health Interventions for COVID-19 Emerging Evidence and Implications for...

JAMA

Authors
David M. Hartley, Eli N. Perencevich

Read More »

09/04/2020 Comment
COVID-19: Respiratory support outside the intensive care unit

The Lancet

Authors
Tom McEnery, Ciara Gough, Richard W Costello

Read More »

09/04/2020 Perspectives
Disease Control, Civil Liberties, and Mass Testing — Calibrating Restr...

Disease Control, Civil Liberties, and Mass Testing — Calibrating Restrictions during the Covid-19 Pandemic

The New England Journal of Medicine

Authors
David M. Studdert, L.L.B., Sc.D., and Mark A. Hall, J.D.

Read More »

09/04/2020 Correspondence
Delayed access or provision of care in Italy resulting from fear of CO...

Delayed access or provision of care in Italy resulting from fear of COVID-19

The Lancet

Authors
Marzia Lazzerini, Egidio Barbi, Andrea Apicella, Federico Marchetti, Fabio Cardinale, Gianluca Trobia

Read More »

09/04/2020 Perspectives
Ensuring and Sustaining a Pandemic Workforce

The New England Journal of Medicine

Authors
Erin P. Fraher, Patricia Pittman, Bianca K. Frogner, Joanne Spetz, Jean Moore, Angela J. Beck, David Armstrong, Peter I. Buerhaus

Read More »

08/04/2020 Articles
First-wave COVID-19 transmissibility and severity in China outside Hub...

First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures...

THE LANCET

Authors
Kathy Leung, Joseph T Wu, Di Liu, Gabriel M Leung

Summary

Background
As of March 18, 2020, 13 415 confirmed cases and 120 deaths related to coronavirus disease 2019 (COVID-19) in mainland China, outside Hubei province—the epicentre of the outbreak—had been reported. Since late January, massive public health interventions have been implemented nationwide to contain the outbreak. We provide an impact assessment of the transmissibility and severity of COVID-19 during the first wave in mainland Chinese locations outside Hubei.

Methods
We estimated the instantaneous reproduction number (Rt) of COVID-19 in Beijing, Shanghai, Shenzhen, Wenzhou, and the ten Chinese provinces that had the highest number of confirmed COVID-19 cases; and the confirmed case-fatality risk (cCFR) in Beijing, Shanghai, Shenzhen, and Wenzhou, and all 31 Chinese provinces. We used a susceptible–infectious–recovered model to show the potential effects of relaxing containment measures after the first wave of infection, in anticipation of a possible second wave. 

Findings
In all selected cities and provinces, the Rt decreased substantially since Jan 23, when control measures were implemented, and have since remained below 1. The cCFR outside Hubei was 0·98% (95% CI 0·82–1·16), which was almost five times lower than that in Hubei (5·91%, 5·73–6·09). Relaxing the interventions (resulting in Rt >1) when the epidemic size was still small would increase the cumulative case count exponentially as a function of relaxation duration, even if aggressive interventions could subsequently push disease prevalence back to the baseline level.

Interpretation
The first wave of COVID-19 outside of Hubei has abated because of aggressive non-pharmaceutical interventions. However, given the substantial risk of viral reintroduction, particularly from overseas importation, close monitoring of Rt and cCFR is needed to inform strategies against a potential second wave to achieve an optimal balance between health and economic protection.

Funding
Health and Medical Research Fund, Hong Kong, China.

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08/04/2020 Articles
Effective containment explains subexponential growth in recent confirm...

Effective containment explains subexponential growth in recent confirmed COVID-19 cases in China

Science

Authors
Benjamin F. Maier, Dirk Brockmann

ABSTRACT

The recent outbreak of COVID-19 in Mainland China was characterized by a distinctive subexponential increase of confirmed cases during the early phase of the epidemic, contrasting an initial exponential growth expected for an unconstrained outbreak. We show that this effect can be explained as a direct consequence of containment policies that effectively deplete the susceptible population. To this end, we introduce a parsimonious model that captures both, quarantine of symptomatic infected individuals as well as population-wide isolation practices in response to containment policies or behavioral changes and show that the model captures the observed growth behavior accurately. The insights provided here may aid the careful implementation of containment strategies for ongoing secondary outbreaks of COVID-19 or similar future outbreaks of other emergent infectious diseases.

Read More »

07/04/2020 Viewpoint
What Other Countries Can Learn From Italy During the COVID-19 Pandemic

AMA

Authors
Boccia, Ricciardi, Ioannidis

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07/04/2020 Features
Covid-19: Why Germany’s case fatality rate seems so low

The BMJ

Authors
Ned Stafford

Read More »

06/04/2020 Review
Initial success in the identification and management of the coronaviru...

Initial success in the identification and management of the coronavirus disease 2019 (COVID-19)...

IJBS

Authors
Annoor Awadasseid, Yanling Wu, Yoshimasa Tanaka, Wen Zhang

ABSTRACT

Coronavirus (CoV) has been one of the major pandemic threats to human health in the last two decades. The human coronavirus was first identified in 1960s. CoVs 229E, NL63, OC43, HKU1, SARS-CoV, and MERS-CoV have caused numerous disasters or human deaths worldwide. Recently, an outbreak of the previously unknown deadly CoV disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV 2 (SARS-CoV-2, early named 2019-nCoV) occurred in Wuhan, China, and it had caused 81238 cases of confirmed infection, including 3250 deaths until March 19, 2020. Its risks and pandemic potential have brought global consideration. We summarized epidemiology, virological characteristics, clinical symptoms, diagnostic methods, clinical treatments, and prevention methods for COVID-19 to present a reference for the future wave of probable CoV outbreaks.

Read More »

06/04/2020 Review
School closure and management practices during coronavirus outbreaks i...

School closure and management practices during coronavirus outbreaks including COVID-19...

The Lancet

Authors
Russell M Viner, Simon J Russell, Helen Croker, Jessica Packer, Joseph Ward, Claire Stansfield, Oliver Mytton, Chris Bonell, Robert Booy

ABSTRACT

In response to the coronavirus disease 2019 (COVID-19) pandemic, 107 countries had implemented national school closures by March 18, 2020. It is unknown whether school measures are effective in coronavirus outbreaks (eg, due to severe acute respiratory syndrome [SARS], Middle East respiratory syndrome, or COVID-19). We undertook a systematic review by searching three electronic databases to identify what is known about the effectiveness of school closures and other school social distancing practices during coronavirus outbreaks. We included 16 of 616 identified articles. School closures were deployed rapidly across mainland China and Hong Kong for COVID-19. However, there are no data on the relative contribution of school closures to transmission control. Data from the SARS outbreak in mainland China, Hong Kong, and Singapore suggest that school closures did not contribute to the control of the epidemic. Modelling studies of SARS produced conflicting results. Recent modelling studies of COVID-19 predict that school closures alone would prevent only 2–4% of deaths, much less than other social distancing interventions. Policy makers need to be aware of the equivocal evidence when considering school closures for COVID-19, and that combinations of social distancing measures should be considered. Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods.

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06/04/2020 Correspondence
Covid-19 in South Korea — Challenges of Subclinical Manifestations

The New England Journal of Medicine

Authors
Joon-Young Song, Jin-Gu Yun, Ji-Yun Noh, Hee-Jin Cheong, Woo-Joo Kim

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06/04/2020 Short Communication
Evaluation of the lockdowns for the SARS-CoV-2 epidemic in Italy and S...

Evaluation of the lockdowns for the SARS-CoV-2 epidemic in Italy and Spain...

ELSEVIER

Authors
Aurelio Tob&iacute;as

ABSTRACT

From the end of February, the SARS-CoV-2 epidemic in Spain has been following the footsteps of that in Italy very closely. We have analyzed the trends of incident cases, deaths, and intensive care unit admissions (ICU) in both countries before and after their respective national lockdowns using an interrupted time-series design. Data was analyzed with quasi-Poisson regression using an interaction model to estimate the change in trends. After the first lockdown, incidence trends were considerably reduced in both countries. However, although the slopes have been flattened for all outcomes, the trends kept rising. During the second lockdown, implementing more restrictive measures for mobility, it has been a change in the trend slopes for both countries in daily incident cases and ICUs. This improvement indicates that the efforts overtaken are being successful in flattening the epidemic curve, and reinforcing the belief that we must hold on.

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03/04/2020 Link
Conditions of use, conditions for distribution and patients targeted a...

Conditions of use, conditions for distribution and patients targeted and conditions for...

European Medicines Agency Science Medicines Health

Authors
European Medicines Agency

Read More »

03/04/2020 Link
Summary on compassionate use for Ledipasvir/Sofosbuvir

European Medicines Agency Science Medicines Health

Authors
European Medicines Agency

Read More »

02/04/2020 Health Policy
Fangcang shelter hospitals: a novel concept for responding to public h...

Fangcang shelter hospitals: a novel concept for responding to public health emergencies

The Lancet

Authors
Simiao Chen, Zongjiu Zhang, Juntao Yang, Jian Wang, Xiaohui Zhai, Till B&auml;rnighausen, Chen Wang

ABSTRACT

Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.

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02/04/2020 Summary Report
Global regulatory workshop on COVID-19 therapeutic development

ICMRA

Authors
ICMRA

Read More »

01/04/2020 Articles
Using observational data to quantify bias of traveller-derived COVID-1...

Using observational data to quantify bias of traveller-derived COVID-19...

The Lancet

Authors
Rene Niehus, Pablo M De Salazar, Aimee R Taylor, Marc Lipsitch

Summary

Background
The incidence of coronavirus disease 2019 (COVID-19) in Wuhan, China, has been estimated using imported case counts of international travellers, generally under the assumptions that all cases of the disease in travellers have been ascertained and that infection prevalence in travellers and residents is the same. However, findings indicate variation among locations in the capacity for detection of imported cases. Singapore has had very strong epidemiological surveillance and contact tracing capacity during previous infectious disease outbreaks and has consistently shown high sensitivity of case-detection during the COVID-19 outbreak.

Methods
We used a Bayesian modelling approach to estimate the relative capacity for detection of imported cases of COVID-19 for 194 locations (excluding China) compared with that for Singapore. We also built a simple mathematical model of the point prevalence of infection in visitors to an epicentre relative to that in residents. 

Findings
The weighted global ability to detect Wuhan-to-location imported cases of COVID-19 was estimated to be 38% (95% highest posterior density interval [HPDI] 22–64) of Singapore’s capacity. This value is equivalent to 2·8 (95% HPDI 1·5–4·4) times the current number of imported and reported cases that could have been detected if all locations had had the same detection capacity as Singapore. Using the second component of the Global Health Security index to stratify likely case-detection capacities, the ability to detect imported cases relative to Singapore was 40% (95% HPDI 22–67) among locations with high surveillance capacity, 37% (18–68) among locations with medium surveillance capacity, and 11% (0–42) among locations with low surveillance capacity. Treating all travellers as if they were residents (rather than accounting for the brief stay of some of these travellers in Wuhan) contributed modestly to underestimation of prevalence. Interpretation Estimates of case counts in Wuhan based on assumptions of 100% detection in travellers could have been underestimated by several fold. Furthermore, severity estimates will be inflated several fold since they also rely on case count estimates. Finally, our model supports evidence that underdetected cases of COVID-19 have probably spread in most locations around the world, with greatest risk in locations of low detection capacity and high connectivity to the epicentre of the outbreak.

Funding
US National Institute of General Medical Sciences, and Fellowship Foundation Ramon Areces

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01/04/2020 Editorial
Ten Weeks to Crush the Curve

THE NEW ENGLAND JOURNAL OF MEDICINE

Authors
Harvey V. Fineberg

Read More »

01/04/2020 Perspective
Universal Masking in Hospitals in the Covid-19 Era

The New England Journal of Medicine

Authors
Michael Klompas, Charles A. Morris, Julia Sinclair, Madelyn Pearson, Erica S. Shenoy

Read More »

01/04/2020 Correspondence
Essential care of critical illness must not be forgotten in the COVID-...

Essential care of critical illness must not be forgotten in the COVID-19 pandemic

The Lancet

Authors
Tim Baker, Carl Otto Schell, Dan Brun Petersen, Hendry Sawe, Karima Khalid, Samson Mndolo, Jamie Rylance, Daniel F McAuley, Nobhojit Roy, John Marshall, Lee Wallis, Elizabeth Molyneux

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31/03/2020 Comment
Ensuring global access to COVID-19 vaccines

The Lancet

Authors
Gavin Yamey, Marco Sch&auml;ferhoff, Richard Hatchett, Muhammad Pate, Feng Zhao, Kaci Kennedy McDade

Read More »

30/03/2020 Viewpoint
Optimizing the Trade-off Between Learning and Doing in a Pandemic

The Lancet

Authors
Derek C. Angus

Read More »

24/03/2020 Articles
Communication on COVID-19 to community – measures to prevent a second ...

Communication on COVID-19 to community – measures to prevent a second wave of epidemic

OSFPREPRINTS

Authors
Boris Bibkov, Alexander Bibkov

ABSTRACT

The manuscript highlights available data on gap in public awareness about recent clinical and scientific facts about COVID-19, insufficient community knowledge about symptoms and preventive measures during COVID-19 and previous MERS-CoV epidemic, and lack of monitoring the community perception and adherence to preventive measures. We also summarize literature evidence about reluctance to change social behavior and disregard recommendations for social distancing among persons who percept to having low risk of infection or complications, and briefly describe destructive psychological response and misleading communications. Our analysis could be translated into important policy changes in two directions: (1) to communicate recent scientific discoveries about COVID-19 pathophysiology to better prepare public opinion to longer period of extraordinary measures; (2) to implement sociological feedback on knowledge, attitudes and practices among general public and some vulnerable social groups.

Read More »

21/03/2020 Articles
At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in I...

At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation

NEJM

Authors
Mirco Nacoti, Andrea Ciocca, Angelo Giupponi, Pietro Brambillasca, Federico Lussana, Michele Pisano, Giuseppe Goisis, Daniele Bonacina, Francesco Fazzi, Richard Naspro, Luca Longhi, Maurizio Cereda, Carlo Montaguti

In a pandemic, patient-centered care is inadequate and must be replaced by community-centered care. Solutions for Covid-19 are required for the entire population, not only for hospitals. The catastrophe unfolding in wealthy Lombardy could happen anywhere. Clinicians at a hospital at the epicenter call for a long-term plan for the next pandemic.

Read More »

20/03/2020 Articles
Initial Investigation of Transmission of COVID-19 Among Crew Members D...

Initial Investigation of Transmission of COVID-19 Among Crew Members During Quarantine of a Cruise Ship — Yokohama, Japan, February 2020

Morbidity and Mortality Weekly Report

Authors
Kensaku Kakimoto, Hajime Kamiya, Takuya Yamagishi, Tamano Matsui, Motoi Suzuki, Takaji Wakita

Read More »

13/03/2020 Viewpoint
Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy

JAMA Network

Authors
Giacomo Grasselli, Antonio Pesenti, Maurizio Cecconi

Read More »

11/03/2020 Articles
Early dynamics of transmission and control of COVID-19: a mathematical...

Early dynamics of transmission and control of COVID-19: a mathematical modelling study

The Lancet

Authors
Adam J Kucharski, Timothy W Russell, Charlie Diamond, Yang Liu, John Edmunds, Sebastian Funk, Rosalind M Eggo

Background An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to 95333 confirmed cases as of March 5, 2020. Understanding the early transmission dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Combining a mathematical model of severe SARS-CoV-2 transmission with four datasets from within and outside Wuhan, we estimated how transmission in Wuhan varied between December, 2019, and February, 2020. We used these estimates to assess the potential for sustained human-to-human transmission to occur in locations outside Wuhan if cases were introduced.

Methods We combined a stochastic transmission model with data on cases of coronavirus disease 2019 (COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how transmission had varied over time during January, 2020, and February, 2020. Based on these estimates, we then calculated the probability that newly introduced cases might generate outbreaks in other areas. To estimate the early dynamics of transmission in Wuhan, we fitted a stochastic transmission dynamic model to multiple publicly available datasets on cases in Wuhan and internationally exported cases from Wuhan. The four datasets we fitted to were: daily number of new internationally exported cases (or lack thereof), by date of onset, as of Jan 26, 2020; daily number of new cases in Wuhan with no market exposure, by date of onset, between Dec 1, 2019, and Jan 1, 2020; daily number of new cases in China, by date of onset, between Dec 29, 2019, and Jan 23, 2020; and proportion of infected passengers on evacuation flights between Jan 29, 2020, and Feb 4, 2020. We used an additional two datasets for comparison with model outputs: daily number of new exported cases from Wuhan (or lack thereof) in countries with high connectivity to Wuhan (ie, top 20 most at-risk countries), by date of confirmation, as of Feb 10, 2020; and data on new confirmed cases reported in Wuhan between Jan 16, 2020, and Feb 11, 2020.

Findings
We estimated that the median daily reproduction number (Rt) in Wuhan declined from 2·35 (95% CI 1·15–4·77) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1·05 (0·41–2·39) 1 week after. Based on our estimates of Rt, assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population.

Interpretation
Our results show that COVID-19 transmission probably declined in Wuhan during late January, 2020, coinciding with the introduction of travel control measures. As more cases arrive in international locations with similar transmission potential to Wuhan before these control measures, it is likely many chains of transmission will fail to establish initially, but might lead to new outbreaks eventually.

Funding Wellcome Trust, Health Data Research UK, Bill & Melinda Gates Foundation, and National Institute for Health Research.

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29/02/2020 Correspondence
Minimise nosocomial spread of 2019-nCoV when treating acute respirator...

Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure

THE LANCET

Authors
Luca Cabrini, Giovanni Landoni, Alberto Zangrillo


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28/02/2020 Editorial
Covid-19: preparedness, decentralisation, and the hunt for patient zer...

Covid-19: preparedness, decentralisation, and the hunt for patient zero

The BMJ

Authors
Fabrizio Carinci

Read More »

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