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THE LANCET
Authors John Zarocostas
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Authors Thierry Lefrançois*, Denis Malvy*, Laetitia Atlani-Duault, Daniel Benamouzig, Pierre-Louis Druais, Yazdan Yazdanpanah, Jean-François Delfraissy, Bruno Lina
Authors Dominique Farge*, Corinne Frere*, Jean M Connors, Alok A Khorana, Ajay Kakkar, Cihan Ay, Andres Muñoz, Benjamin Brenner, Pedro H Prata, Dialina Brilhante, Darko Antic, Patricia Casais, María Cecilia Guillermo Esposito, Takayuki Ikezoe, Syed A Abutalib, Luis A Meillon-García, Henri Bounameaux, Ingrid Pabinger, James Douketis
UK HEALTH SECURITY AGENCY
Authors GOV.UK
THE BMJ
Authors Kit Yates
Authors ADRIAN JAMES
Authors Chris Baraniuk
NATURE
Authors Quan-Hui Liu, Juanjuan Zhang, Cheng Peng, Maria Litvinova, Shudong Huang, Piero Poletti, Filippo Trentini, Giorgio Guzzetta, Valentina Marziano, Tao Zhou, Cecile Viboud, Ana I. Bento, Jiancheng Lv, Alessandro Vespignani, Stefano Merler, Hongjie Yu, Marco Ajelli
Abstract There are contrasting results concerning the effect of reactive school closure on SARS-CoV-2 transmission. To shed light on this controversy, we developed a data-driven computational model of SARS-CoV-2 transmission. We found that by reactively closing classes based on syndromic surveillance, SARS-CoV-2 infections are reduced by no more than 17.3% (95%CI: 8.0–26.8%), due to the low probability of timely identification of infections in the young population. We thus investigated an alternative triggering mechanism based on repeated screening of students using antigen tests. Depending on the contribution of schools to transmission, this strategy can greatly reduce COVID-19 burden even when school contribution to transmission and immunity in the population is low. Moving forward, the adoption of antigen-based screenings in schools could be instrumental to limit COVID-19 burden while vaccines continue to be rolled out. Introduction The novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has dramatically changed the life of nearly every human on the planet. In Europe, Italy was the first country to experience the pandemic and it has been considered a natural experiment for large scale non-pharmaceuticals interventions. The first locally transmitted COVID-19 case in Italy was identified on February 21, 2020; since then, the country went through two distinct major epidemic waves. During the first wave, a national lockdown was put in place on March 11, 20201. After the lifting of the lockdown on May 18, 20202, the number of COVID-19 cases remained relatively low throughout the rest of the spring and summer of 2020. However, after school reopening and further relaxation of control measures, a second major epidemic wave started in mid-September 2020. At that point, case isolation, contact tracing, and other social distancing measures (e.g., limited size of gatherings, closure of theaters and cinemas3) were still in place along with a newly established reactive class closure protocol based on active surveillance of students4. To counter the rapid rise of cases, a set of nationwide restrictions were imposed by the Italian government on October 14, 20205. New restrictions included an extended mandatory use of face masks, reduction of opening hours or full closure of commercial/recreational venues, and partial or full suspension of in-person education. Control measures gradually increased in the following 3 weeks6,7,8. Since November 6, 2020, more restrictive measures were applied on a regional basis to further mitigate COVID-19 burden of the second wave9, fueled in early 2021 by the more transmissible Alpha variant10. Italy is not an isolated example. A similar upsurge of COVID-19 cases right after school reopening in September–October 2020 was observed in several other European countries such as Finland, Ireland, Latvia, Belgium, and Slovakia11,12. Moreover, whether associated with school transmission or not, a decrease in the average age of cases was observed, with a larger fraction of cases in the school-age population13,14. A similar issue has been experienced in the US in early March 2021 as schools resumed in-person learning amidst rising incidence of the Alpha variant (e.g., Michigan15). While the virus is still circulating in 2021 in the form of a more transmissible variant (Delta)16,17,18, understanding whether and how in-person education can be maintained is paramount. The aim of this paper is twofold. First, we developed a computational model of SARS-CoV-2 transmission to estimate the contribution of the reactive school closure strategies implemented in Italy when historical lineages were circulating in the fall of 2020 to mitigate the second major COVID-19 wave and understand the reason of their limited effect. Second, we tested an alternative policy based on rapid antigen-based screening of students. We found that this strategy may have a considerably larger mitigation effect on SARS-CoV-2 spread, which may be crucial while COVID-19 vaccines continue to be rolled out throughout 2021 and beyond.
Authors Gareth Iacobucci
CDC
Authors Sarah Mbaeyi, Sara E. Oliver, Jennifer P. Collins, Monica Godfrey, Neela D. Goswami, Stephen C. Hadler, Jefferson Jones, Heidi Moline, Danielle Moulia, Sujan Reddy, Kristine Schmit, Megan Wallace, Mary Chamberland, Doug Campos-Outcalt, Rebecca L. Morgan, Beth P. Bell, Oliver Brooks, Camille Kotton, H. Keipp Talbot, Grace Lee, Matthew F. Daley, Kathleen Dooling
Authors Daniel Sleat, Kirsty Innes, Imogen Parker
Authors Michael Bang Petersen
JAMA
Authors Mark P. Lythgoe; Paul Middleton
Authors Lynne Peeples
AIFA
Authors AIFA (Agenzia Italiana del Farmaco)
CENTERS FOR DISEASE CONTROL AND PREVENTION
Authors National Center for Immunization and Respiratory Diseases
Authors Tamara Pilishvili, Katherine E. Fleming-Dutra, Jennifer L. Farrar, Ryan Gierke, Nicholas M. Mohr, David A. Talan, Anusha Krishnadasan, Karisa K. Harland, Howard A. Smithline, Peter C. Hou, Lilly C. Lee, Stephen C. Lim, Gregory J. Moran, Elizabeth Krebs, Mark Steele, David G. Beiser, Brett Faine, John P. Haran, Utsav Nandi, Walter A. Schrading, Brian Chinnock, Daniel J. Henning, Frank LoVecchio, Joelle Nadle, Devra Barter, Monica Brackney, Amber Britton, Kaytlynn Marceaux-Galli, Sarah Lim, Erin C. Phipps, Ghinwa Dumyati, Rebecca Pierce, Tiffanie M. Markus, Deverick J. Anderson, Amanda K. Debes, Michael Lin, Jeanmarie Mayer, Hilary M. Babcock, Nasia Safdar, Marc Fischer, Rosalyn Singleton, Nora Chea, Shelley S. Magill, Jennifer Verani, Stephanie Schrag, DPhil
EMA (EUROPEAN MEDICINES AGENCY)
Authors EMA Press office
U.S. FOOD AND DRUGS ADMINISTRATION
Authors FDA Office of Media Affairs
Authors Johnathan H Duff, Anicca Liu, Jorge Saavedra, Jacob N Batycki, Kendra Morancy, Barbara Stocking, Lawrence O Gostin, Sandro Galea, Stefano Bertozzi, Jose M Zuniga, Carmencita Alberto-Banatin, Akua Sena Dansua, Carlos del Rio, Maksut Kulzhanov, Kelley Lee, Gisela Scaglia, Cyrus Shahpar, Andrew J Ullmann, Steven J Hoffman, Michael Weinstein, José Szapocznik
THE ECONOMIST
Authors THE ECONOMIST
Authors Gery P. Guy Jr, Greta M. Massetti, Erin Sauber-Schatz
Authors Tasnime Osama, Mohammad S Razai, Azeem Majeed
THE NEW ENGLAND JOURNAL OF MEDICINE
Authors Mark A. Hall, David M. Studdert
Authors Ganna Rozhnova, Christiaan H. van Dorp, Patricia Bruijning-Verhagen, Martin C. J. Bootsma, Janneke H. H. M. van de Wijgert, Marc J. M. Bonten, Mirjam E. Kretzschmar
Abstract The role of school-based contacts in the epidemiology of SARS-CoV-2 is incompletely understood. We use an age-structured transmission model fitted to age-specific seroprevalence and hospital admission data to assess the effects of school-based measures at different time points during the COVID-19 pandemic in the Netherlands. Our analyses suggest that the impact of measures reducing school-based contacts depends on the remaining opportunities to reduce non-school-based contacts. If opportunities to reduce the effective reproduction number (Re) with non-school-based measures are exhausted or undesired and Re is still close to 1, the additional benefit of school-based measures may be considerable, particularly among older school children. As two examples, we demonstrate that keeping schools closed after the summer holidays in 2020, in the absence of other measures, would not have prevented the second pandemic wave in autumn 2020 but closing schools in November 2020 could have reduced Re below 1, with unchanged non-school-based contacts.
Authors Athalia Christie, Sarah A. Mbaeyi, Rochelle P. Walensky
EUROPEAN RESPIRATORY JOURNAL
Authors James D. Chalmers, Megan L. Crichton, Pieter C. Goeminne, Bin Cao, Marc Humbert, Michal Shteinberg, Katerina M. Antoniou, Charlotte Suppli Ulrik, Helen Parks, Chen Wang, Thomas Vandendriessche, Jieming Qu, Daiana Stolz, Christopher Brightling, Tobias Welte, Stefano Aliberti, Anita K. Simonds, Thomy Tonia, Nicolas Roche
Abstract Introduction Hospitalised patients with coronavirus disease 19 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require non-invasive respiratory support or invasive ventilation. Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes. Methods A task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this “living guideline” using the PICO (population, intervention, comparator, outcome) format. The GRADE approach was used for assessing the quality of evidence and strength of recommendations. Systematic literature reviews were performed, and data pooled by meta-analysis where possible. Evidence tables were presented and evidence to decision frameworks were used to formulate recommendations. Results Based on the available evidence at the time of guideline development (February 20th, 2021) the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients. The panel makes a conditional recommendation for IL-6 receptor antagonist monoclonal antibody treatment and high flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure. The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir. Conditional recommendations are made against the use of azithromycin, hydroxychloroquine and azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation. No recommendation was made for remdesivir in patients requiring supplemental oxygen. Further recommendations for research are made. Conclusion The evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions. These guidelines will be regularly updated as further evidence becomes available.
Authors Gery P. Guy Jr., Florence C. Lee, Gregory Sunshine, Russell McCord, Mara Howard-Williams, Lyudmyla Kompaniyets, Christopher Dunphy, Maxim Gakh, Regen Weber, Erin Sauber-Schatz, John D. Omura, Greta M. Massetti
GOV.UK
Authors Medicines and Healthcare products Regulatory Agency
EUROPEAN MEDICINES AGENCY
Authors François Lamontagne, Thomas Agoritsas, Reed Siemieniuk, Bram Rochwerg, Jessica Bartoszko, Lisa Askie, Helen Macdonald, Wagdy Amin, Frederique Jacquerioz Bausch, Erlina Burhan, Maurizio Cecconi, Duncan Chanda, Vu Quoc Dat, Bin Du, Heike Geduld, Patrick Gee, Harley Nerina, Madiha Hashimi, Beverley J Hunt, Sushil Kabra, Seema Kanda, Leticia Kawano-Dourado, Yae-Jean Kim, Niranjan Kissoon, Arthur Kwizera, Yee-Sin Leo, Imelda Mahaka, Hela Manai, Greta Mino, Emmanuel Nsutebu, Natalia Pshenichnaya, Nida Qadir, Shalini Sri Ranganathan, Saniya Sabzwari, Rohit Sarin, Michael Sharland, Yinzhong Shen, Joao Paulo Souza, Miriam Stegemann, Sebastian Ugarte, Sridhar Venkatapuram, Dubula Vuyiseka, Jacobus Preller, Romina Brignardello-Petersen, Elena Kum, Anila Qasim, Dena Zeraatkar, Andrew Owen, Gordon Guyatt, Lyubov Lytvyn, Janet Diaz, Per Olav Vandvik, Michael Jacobs
Abstract Clinical question What is the role of drugs in preventing covid-19? Why does this matter?There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. Recommendation The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the new recommendation The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.
WHO (WORLD HEALTH ORGANIZATION)
Authors Pan-European Commission on Health and Sustainable Development
FDA
Authors Janssen Biotech, Inc.
Authors Quirin Schiermeier
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FOOD AND DRUG ADMINISTRATION CENTER FOR DRUG EVALUATION AND RESEARCH
Authors U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research
GAVI (THE VACCINE ALLIANCE)
Authors Meghana Sharafudeen
ECDC (EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL)
Authors ECDC (EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL)
WORLD HEALTH ORGANIZATION
Authors WHO (WORLD HEALTH ORGANIZATION)
MINISTERO DELLA SALUTE - DIREZIONE GENERALE DELLA PREVENZIONE SANITARIA
Authors MINISTERO DELLA SALUTE - DIREZIONE GENERALE DELLA PREVENZIONE SANITARIA
NIH (NATIONAL INSTITUTES OF HEALTH)
Authors NIH (NATIONAL INSTITUTES OF HEALTH)
Authors Hans Henri P. Kluge
MINISTERO DELLA SALUTE
Authors COMIRNATY BioNTech Manufacturing GmbH
Authors MINISTERO DELLA SALUTE
Authors Chad R. Wells, Jeffrey P. Townsend, Abhishek Pandey, Seyed M. Moghadas, Gary Krieger, Burton Singer, Robert H. McDonald, Meagan C. Fitzpatrick, Alison P. Galvani
Abstract For COVID-19, it is vital to understand if quarantines shorter than 14 days can be equally effective with judiciously deployed testing. Here, we develop a mathematical model that quantifies the probability of post-quarantine transmission incorporating testing into travel quarantine, quarantine of traced contacts with an unknown time of infection, and quarantine of cases with a known time of exposure. We find that testing on exit (or entry and exit) can reduce the duration of a 14-day quarantine by 50%, while testing on entry shortens quarantine by at most one day. In a real-world test of our theory applied to offshore oil rig employees, 47 positives were obtained with testing on entry and exit to quarantine, of which 16 had tested negative at entry; preventing an expected nine offshore transmission events that each could have led to outbreaks. We show that appropriately timed testing can make shorter quarantines effective.
Authors DEPARTMENT OF HEALTH AND SOCIAL CARE UK
Authors EMA (EUROPEAN MEDICINES AGENCY)
AIOM (ASSOCIAZIONE ITALIANA DI ONCOLOGIA MEDICA)
Authors AIOM
QUOTIDIANO SANITA'
Authors SIN - SIP - SIMP - SIGO - AOGOI - SIMIT
AMERICAN COLLEGE OF RHEUMATOLOGY
Authors AMERICAN COLLEGE OF RHEUMATOLOGY
Summary Over the last few weeks, the United Kingdom (UK) has faced a rapid increase in COVID-19 cases in South East England, leading to enhanced epidemiological and virological investigations. Analysis of viral genome sequence data identified a large proportion of cases belonged to a new single phylogenetic cluster. The new variant is defined by multiple spike protein mutations (deletion 69-70, deletion 144, N501Y, A570D, D614G, P681H, T716I, S982A, D1118H) present as well as mutations in other genomic regions. While it is known and expected that viruses constantly change through mutation leading to the emergence of new variants, preliminary analysis in the UK suggests that this variant is significantly more transmissible than previously circulating variants, with an estimated potential to increase the reproductive number (R) by 0.4 or greater with an estimated increased transmissibility of up to 70%. This new variant has emerged at a time of the year when there has traditionally been increased family and social mixing. There is no indication at this point of increased infection severity associated with the new variant. A few cases with the new variant have to date been reported by Denmark and the Netherlands and, according to media reports, in Belgium. Given that there is currently a lack of evidence to indicate the extent to which the new virus variant is spread outside the UK, timely efforts to prevent and control its spread are needed, and include the following: − Public health authorities and laboratories are urged to analyse and sequence virus isolates in a timely manner to identify cases of the new variant. People with an epidemiological link to cases with the new variant or travel history to areas known to be affected should be identified immediately to test, isolate and follow up their contacts in order to stop the spread of the new variant. − If cases infected with this new SARS-CoV-2 variant or other new SARS-CoV-2 variants of potential concern are identified, countries should notify through the Early Warning and Response System of the European Union. − The importance of strict adherence to non-pharmaceutical interventions according to national policies needs to be communicated to the public, and in particular guidance on the avoidance of non-essential travel and social activities should be stressed. − Laboratories should review the PCR performance and drop-out of the S-gene. PCR could be used as an indicator for cases with the new variant for further sequencing and investigation. − Suspected cases of COVID-19 reinfection should be followed up, closely accompanied by sequencing respective virus isolates from these cases. Similarly, cases with treatment failures using convalescent plasma or monoclonal antibodies should be further studied. − With the implementation of vaccination, close monitoring of COVID-19-vaccinated individuals needs to be ensured to identify possible vaccination failure and breakthrough infections. Virus isolates from these cases should be sequenced and characterised genetically and antigenically
GOVERNMENT OF CANADA
Authors GOVERNMENT OF CANADA
Authors Philipp Koehler, Matteo Bassetti, Arunaloke Chakrabarti, Sharon C A Chen, Arnaldo Lopes Colombo, Martin Hoenigl, Nikolay Klimko, Cornelia Lass-Flörl, Rita O Oladele, Donald C Vinh, Li-Ping Zhu, Boris Böll, Roger Brüggemann, Jean-Pierre Gangneux, John R Perfect, Thomas F Patterson, Thorsten Persigehl, Jacques F Meis, Luis Ostrosky-Zeichner, P Lewis White, Paul E Verweij, Oliver A Cornely
MINISTERO DELLA SALUTE - PRESIDENZA DEL CONSIGLIO DEI MINISTRI - ISS - AGENAS - AIFA
Authors MINISTERO DELLA SALUTE - PRESIDENZA DEL CONSIGLIO DEI MINISTRI - ISS - AGENAS - AIFA
Authors Stefan Flasche, W John Edmunds
Authors Giovanni Rezza, Andrea Urbani
Authors EUROPEAN MEDICINES AGENCY
Authors Nils Haug, Lukas Geyrhofer, Alessandro Londei, Elma Dervic, Amélie Desvars-Larrive, Vittorio Loreto, Beate Pinior, Stefan Thurner, Peter Klimek
Abstract Assessing the effectiveness of non-pharmaceutical interventions (NPIs) to mitigate the spread of SARS-CoV-2 is critical to inform future preparedness response plans. Here we quantify the impact of 6,068 hierarchically coded NPIs implemented in 79 territories on the effective reproduction number, Rt, of COVID-19. We propose a modelling approach that combines four computational techniques merging statistical, inference and artificial intelligence tools. We validate our findings with two external datasets recording 42,151 additional NPIs from 226 countries. Our results indicate that a suitable combination of NPIs is necessary to curb the spread of the virus. Less disruptive and costly NPIs can be as effective as more intrusive, drastic, ones (for example, a national lockdown). Using country-specific ‘what-if’ scenarios, we assess how the effectiveness of NPIs depends on the local context such as timing of their adoption, opening the way for forecasting the effectiveness of future interventions.
Authors RITA RUBIN
Authors Patrik Bachtiger, Alexander Adamson, Jennifer K. Quint, Nicholas S. Peters
Abstract Contact tracing and lockdown are health policies being used worldwide to combat the coronavirus (COVID-19). The UK National Health Service (NHS) Track and Trace Service has plans for a nationwide app that notifies the need for self-isolation to those in contact with a person testing positive for COVID-19. To be successful, such an app will require high uptake, the determinants and willingness for which are unclear but essential to understand for effective public health benefit. The objective of this study was to measure the determinants of willingness to participate in an NHS app-based contact-tracing programme using a questionnaire within the Care Information Exchange (CIE)—the largest patient-facing electronic health record in the NHS. Among 47,708 registered NHS users of the CIE, 27% completed a questionnaire asking about willingness to participate in app-based contact tracing, understanding of government advice, mental and physical wellbeing and their healthcare utilisation—related or not to COVID-19. Descriptive statistics are reported alongside univariate and multivariable logistic regression models, with positive or negative responses to a question on app-based contact tracing as the dependent variable. 26.1% of all CIE participants were included in the analysis (N = 12,434, 43.0% male, mean age 55.2). 60.3% of respondents were willing to participate in app-based contact tracing. Out of those who responded ‘no’, 67.2% stated that this was due to privacy concerns. In univariate analysis, worsening mood, fear and anxiety in relation to changes in government rules around lockdown were associated with lower willingness to participate. Multivariable analysis showed that difficulty understanding government rules was associated with a decreased inclination to download the app, with those scoring 1–2 and 3–4 in their understanding of the new government rules being 45% and 27% less inclined to download the contact-tracing app, respectively; when compared to those who rated their understanding as 5–6/10 (OR for 1–2/10 = 0.57 [CI 0.48–0.67]; OR for 3–4/10 = 0.744 [CI 0.64–0.87]), whereas scores of 7–8 and 9–10 showed a 43% and 31% respective increase. Those reporting an unconfirmed belief of having previously had and recovered from COVID-19 were 27% less likely to be willing to download the app; belief of previous recovery from COVID-19 infection OR 0.727 [0.585–0.908]). In this large UK-wide questionnaire of wellbeing in lockdown, a willingness for app-based contact tracing over an appropriate age range is 60%—close to the estimated 56% population uptake, and substantially less than the smartphone-user uptake considered necessary for an app-based contact tracing to be an effective intervention to help suppress an epidemic. Difficulty comprehending government advice and uncertainty of diagnosis, based on a public health policy of not testing to confirm self-reported COVID-19 infection during lockdown, therefore reduce willingness to adopt a government contact-tracing app to a level below the threshold for effectiveness as a tool to suppress an epidemic.
Authors BMJ BEST PRACTICE
Authors WORLD HEALTH ORGANIZATION SPOTLIGHT
Authors ECDC AN AGENCY OF THE EUROPEAN UNION
INAIL
IDSA (INFECTIOUS DISEASES SOCIETY OF AMERICA)
Authors Thomas File, Judith Feinberg
Authors Laetitia Atlani-Duault Bruno Lina Denis Malvy Yazdan Yazdanpanah Franck Chauvin Jean-François Delfraissy
Authors The Editors
Authors Connie Celum, Ruanne Barnabas, D.Phil., Myron S. Cohen, Ann Collier, Wafaa El-Sadr, King K. Holmes, Christine Johnston, Peter Piot
CDC (CENTERS FOR DISEASE CONTROL AND PREVENTION)
Authors National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases
Authors Clare Dyer
Authors Jacqui Wise
THE INDEPENDENT SAGE
Authors The Independent Scientific Advisory Group for Emergencies (SAGE)
OXFORD ACADEMY
Authors Kimberly E Hanson, Angela M Caliendo, Cesar A Arias, Janet A Englund, Mary K Hayden, Mark J Lee, Mark Loeb, Robin Patel, Osama Altayar, Abdallah El Alayli, Shahnaz Sultan, Yngve Falck-Ytter, Valéry Lavergne, Rebecca L Morgan, M Hassan Murad, Adarsh Bhimraj, Reem A Mustafa
Abstract Background The availability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic testing has rapidly increased. Current assays use a variety of technologies, measure different classes of immunoglobulin or immunoglobulin combinations and detect antibodies directed against different portions of the virus. The overall accuracy of these tests, however, has not been well-defined. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the coronavirus disease 2019 (COVID-19) serology literature and construct best practice guidance related to SARS-CoV-2 serologic testing. This guideline is the fourth in a series of rapid, frequently updated COVID-19 guidelines developed by IDSA. Objective IDSA’s goal was to develop evidence-based recommendations that assist clinicians, clinical laboratories, patients and policymakers in decisions related to the optimal use of SARS-CoV-2 serologic tests in a variety of settings. We also highlight important unmet research needs pertaining to the use of anti-SARS-CoV-2 antibody tests for diagnosis, public health surveillance, vaccine development and the selection of convalescent plasma donors. Methods A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists and experts in systematic literature review identified and prioritized clinical questions related to the use of SARS-CoV-2 serologic tests. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. Results The panel agreed on eight diagnostic recommendations. Conclusions Information on the clinical performance and utility of SARS-CoV-2 serologic tests are rapidly emerging. Based on available evidence, detection of anti-SARS-CoV-2 antibodies may be useful for confirming the presence of current or past infection in selected situations. The panel identified three potential indications for serologic testing including: 1) evaluation of patients with a high clinical suspicion for COVID-19 when molecular diagnostic testing is negative and at least two weeks have passed since symptom onset; 2) assessment of multisystem inflammatory syndrome in children; and 3) for conducting serosurveillance studies. The certainty of available evidence supporting the use of serology for either diagnosis or epidemiology was, however, graded as very low to moderate.
U.S. FOOD AND DRUG
Authors U.S. Department of Health and Human Services Food and Drug Administration Center for Biologics Evaluation and Research
Authors François Lamontagne, Thomas Agoritsas, Helen Macdonald, Yee-Sin Leo, Janet Diaz, Arnav Agarwal, John Adabie Appiah, Yaseen Arabi, Lucille Blumberg, Carolyn S Calfee, Bin Cao, Maurizio Cecconi, Graham Cooke, Jake Dunning, Heike Geduld, Patrick Gee, Hela Manai, David S Hui, Seema Kanda, Leticia Kawano-Dourado, Yae-Jean Kim, Niranjan Kissoon, Arthur Kwizera, Jon Henrik Laake, Flavia R Machado, Nida Qadir, Rohit Sarin, Yinzhong Shen, Linan Zeng, Romina Brignardello-Petersen, Lyubov Lytvyn, Reed Siemieniuk, Dena Zeraatkar, Jessica Bartoszko, Long Ge, Brittany Maguire, Bram Rochwerg, Gordon Guyatt, Per Olav Vandvik
ABSTRACT Clinical question What is the role of drug interventions in the treatment and prevention of covid-19? Recommendations The first version on this living guidance focuses on corticosteroids. It contains a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19, and a weak or conditional recommendation against systemic corticosteroids in patients with non-severe covid-19. Corticosteroids are inexpensive and are on the World Health Organisation list of essential medicines. How this guideline was created This guideline reflects an innovative collaboration between the WHO and the MAGIC Evidence Ecosystem Foundation, driven by an urgent need for global collaboration to provide trustworthy and living covid-19 guidance. A standing international panel of content experts, patients, clinicians, and methodologists, free from relevant conflicts of interest, produce recommendations for clinical practice. The panel follows standards, methods, processes, and platforms for trustworthy guideline development using the GRADE approach. We apply an individual patient perspective while considering contextual factors (that is, resources, feasibility, acceptability, equity) for countries and healthcare systems. The evidence A living systematic review and network meta-analysis, supported by a prospective meta-analysis, with data from eight randomised trials (7184 participants) found that systemic corticosteroids probably reduce 28 day mortality in patients with critical covid-19 (moderate certainty evidence; 87 fewer deaths per 1000 patients (95% confidence interval 124 fewer to 41 fewer)), and also in those with severe disease (moderate certainty evidence; 67 fewer deaths per 1000 patients (100 fewer to 27 fewer)). In contrast, systemic corticosteroids may increase the risk of death in patients without severe covid-19 (low certainty evidence; absolute effect estimate 39 more per 1000 patients, (12 fewer to 107 more)). Systemic corticosteroids probably reduce the need for invasive mechanical ventilation, and harms are likely to be minor (indirect evidence). Understanding the recommendations The panel made a strong recommendation for use of corticosteroids in severe and critical covid-19 because there is a lower risk of death among people treated with systemic corticosteroids (moderate certainty evidence), and they believe that all or almost all fully informed patients with severe and critical covid-19 would choose this treatment. In contrast, the panel concluded that patients with non-severe covid-19 would decline this treatment because they would be unlikely to benefit and may be harmed. Moreover, taking both a public health and a patient perspective, the panel warned that indiscriminate use of any therapy for covid-19 would potentially rapidly deplete global resources and deprive patients who may benefit from it most as potentially lifesaving therapy.
CHEST JOURNAL
Authors Momen M. Wahidi, MD; Samira Shojaee, MD, MPH; Carla R. Lamb, MD; David Ost, MD, MPH; Fabien Maldonado, MD; George Eapen, MD; Daniel A. Caroff, MD, MPH; Michael P. Stevens, MD, MPH; Daniel R. Ouellette, MD; Craig Lilly, MD; Donna D. Gardner, DrPH, RRT, FCCP; Kristen Glisinski, MD; Kelly Pennington, MD; Raed Alalawi,
Authors Victoria T. Chu , Brandi Freeman-Ponder1, Scott Lindquist, Christopher Spitters, Vance Kawakami, Jonathan W. Dyal, Shauna Clark, Hollianne Bruce, Jeffrey S. Duchin, Chas DeBolt, Sara Podczervinski, Marisa D’Angeli, Kristen Pettrone, Rachael Zacks, Grace Vahey, Michelle L. Holshue, Misty Lang, Rachel M. Burke, Melissa A. Rolfes, Mariel Marlow, Claire M. Midgley, Xiaoyan Lu, Stephen Lindstrom, Aron J. Hall, Alicia M. Fry, Natalie J. Thornburg, Susan I. Gerber, Satish K. Pillai, Holly M. Biggs
ABSTRACT We describe the contact investigation for an early confirmed case of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the United States. Contacts of the case-patient were identified, actively monitored for symptoms, interviewed for a detailed exposure history, and tested for SARS-CoV-2 infection by real-time reverse transcription PCR (rRT-PCR) and ELISA. Fifty contacts were identified and 38 (76%) were interviewed, of whom 11 (29%) reported unprotected face-to-face interaction with the case-patient. Thirty-seven (74%) had respiratory specimens tested by rRT-PCR, and all tested negative. Twenty-three (46%) had ELISA performed on serum samples collected ≈6 weeks after exposure, and none had detectable antibodies to SARS-CoV-2. Among contacts who were tested, no secondary transmission was identified in this investigation, despite unprotected close interactions with the infectious case-patient.
ECDC
Authors ECDC
UNICEF
Authors UNICEF - WHO
IDSA
Authors IDSA
Authors Gabriel A. Brat, Griffin M. Weber, Nils Gehlenborg, Paul Avillach, Nathan P. Palmer, Luca Chiovato, James Cimino, Lemuel R. Waitman, Gilbert S. Omenn, Alberto Malovini, Jason H. Moore, Brett K. Beaulieu-Jones, Valentina Tibollo, Shawn N. Murphy, Sehi L’ Yi, Mark S. Keller, Riccardo Bellazzi, David A. Hanauer, Arnaud Serret-Larmande, Alba Gutierrez-Sacristan, John J. Holmes, Douglas S. Bell, Kenneth D. Mandl, Robert W. Follett, Jeffrey G. Klann, Douglas A. Murad, Luigia Scudeller, Mauro Bucalo, Katie Kirchoff, Jean Craig, Jihad Obeid, Vianney Jouhet, Romain Griffier, Sebastien Cossin, Bertrand Moal, Lav P. Patel, Antonio Bellasi, Hans U. Prokosch, Detlef Kraska, Piotr Sliz, Amelia L. M. Tan, Kee Yuan Ngiam, Alberto Zambelli, Danielle L. Mowery, Emily Schiver, Batsal Devkota, Robert L. Bradford, Mohamad Daniar, Christel Daniel, Vincent Benoit, Romain Bey, Nicolas Paris, Patricia Serre, Nina Orlova, Julien Dubiel, Martin Hilka, Anne Sophie Jannot, Stephane Breant, Judith Leblanc, Nicolas Griffon, Anita Burgun, Melodie Bernaux, Arnaud Sandrin, Elisa Salamanca, Sylvie Cormont, Thomas Ganslandt, Tobias Gradinger, Julien Champ, Martin Boeker, Patricia Martel, Loic Esteve, Alexandre Gramfort, Olivier Grisel, Damien Leprovost, Thomas Moreau, Gael Varoquaux, Jill-Jênn Vie, Demian Wassermann, Arthur Mensch, Charlotte Caucheteux, Christian Haverkamp, Guillaume Lemaitre, Silvano Bosari, Ian D. Krantz, Andrew South, Tianxi Cai, Isaac S. Kohane
ABSTRACT We leveraged the largely untapped resource of electronic health record data to address critical clinical and epidemiological questions about Coronavirus Disease 2019 (COVID-19). To do this, we formed an international consortium (4CE) of 96 hospitals across five countries (www.covidclinical.net). Contributors utilized the Informatics for Integrating Biology and the Bedside (i2b2) or Observational Medical Outcomes Partnership (OMOP) platforms to map to a common data model. The group focused on temporal changes in key laboratory test values. Harmonized data were analyzed locally and converted to a shared aggregate form for rapid analysis and visualization of regional differences and global commonalities. Data covered 27,584 COVID-19 cases with 187,802 laboratory tests. Case counts and laboratory trajectories were concordant with existing literature. Laboratory tests at the time of diagnosis showed hospital-level differences equivalent to country-level variation across the consortium partners. Despite the limitations of decentralized data generation, we established a framework to capture the trajectory of COVID-19 disease in patients and their response to interventions.
Authors Colin J. Worby, Hsiao-Han Chang
ABSTRACT The ongoing novel coronavirus disease (COVID-19) pandemic has already infected millions worldwide and, with no vaccine available, interventions to mitigate transmission are urgently needed. While there is broad agreement that travel restrictions and social distancing are beneficial in limiting spread, recommendations around face mask use are inconsistent. Here, we use mathematical modeling to examine the epidemiological impact of face masks, considering resource limitations and a range of supply and demand dynamics. Even with a limited protective effect, face masks can reduce total infections and deaths, and can delay the peak time of the epidemic. However, random distribution of masks is generally suboptimal; prioritized coverage of the elderly improves outcomes, while retaining resources for detected cases provides further mitigation under a range of scenarios. Face mask use, particularly for a pathogen with relatively common asymptomatic carriage, is an effective intervention strategy, while optimized distribution is important when resources are limited.
Authors A. David Paltiel, Amy Zheng, Rochelle P. Walensky
ABSTRACT Importance The coronavirus disease 2019 (COVID-19) pandemic poses an existential threat to many US residential colleges; either they open their doors to students in September or they risk serious financial consequences. Objective To define severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening performance standards that would permit the safe return of students to US residential college campuses for the fall 2020 semester. Design, Setting, and Participants This analytic modeling study included a hypothetical cohort of 4990 students without SARS-CoV-2 infection and 10 with undetected, asymptomatic SARS-CoV-2 infection at the start of the semester. The decision and cost-effectiveness analyses were linked to a compartmental epidemic model to evaluate symptom-based screening and tests of varying frequency (ie, every 1, 2, 3, and 7 days), sensitivity (ie, 70%-99%), specificity (ie, 98%-99.7%), and cost (ie, $10/test-$50/test). Reproductive numbers (Rt) were 1.5, 2.5, and 3.5, defining 3 epidemic scenarios, with additional infections imported via exogenous shocks. The model assumed a symptomatic case fatality risk of 0.05% and a 30% probability that infection would eventually lead to observable COVID-19–defining symptoms in the cohort. Model projections were for an 80-day, abbreviated fall 2020 semester. This study adhered to US government guidance for parameterization data. Main Outcomes and Measures Cumulative tests, infections, and costs; daily isolation dormitory census; incremental cost-effectiveness; and budget impact. Results At the start of the semester, the hypothetical cohort of 5000 students included 4990 (99.8%) with no SARS-CoV-2 infection and 10 (0.2%) with SARS-CoV-2 infection. Assuming an Rt of 2.5 and daily screening with 70% sensitivity, a test with 98% specificity yielded 162 cumulative student infections and a mean isolation dormitory daily census of 116, with 21 students (18%) with true-positive results. Screening every 2 days resulted in 243 cumulative infections and a mean daily isolation census of 76, with 28 students (37%) with true-positive results. Screening every 7 days resulted in 1840 cumulative infections and a mean daily isolation census of 121 students, with 108 students (90%) with true-positive results. Across all scenarios, test frequency was more strongly associated with cumulative infection than test sensitivity. This model did not identify symptom-based screening alone as sufficient to contain an outbreak under any of the scenarios we considered. Cost-effectiveness analysis selected screening with a test with 70% sensitivity every 2, 1, or 7 days as the preferred strategy for an Rt of 2.5, 3.5, or 1.5, respectively, implying screening costs of $470, $910, or $120, respectively, per student per semester. Conclusions and Relevance In this analytic modeling study, screening every 2 days using a rapid, inexpensive, and even poorly sensitive (>70%) test, coupled with strict behavioral interventions to keep Rt less than 2.5, is estimated to maintain a controllable number of COVID-19 infections and permit the safe return of students to campus.
COVID-19 HG
Authors COVID-19 hg
Authors Francesco Pagnini, Andrea Bonanomi, Semira Tagliabue, Michela Balconi, Mauro Bertolotti, Emanuela Confalonieri, Cinzia Di Dio, Gabriella Gilli, Guendalina Graffigna, Camillo Regalia, Emanuela Saita, Daniela Villani
ABSTRACT Importance At the beginning of a public health crisis, such as the coronavirus disease 2019 (COVID-19) pandemic, it is important to collect information about people’s knowledge, worries, and behaviors to examine their influence on quality of life and to understand individual characteristics associated with these reactions. Such information could help to guide health authorities in providing informed interventions and clear communications. Objectives To document the initial knowledge about COVID-19 and recommended health behaviors; to assess worries (ie, one’s perception of the influence of the worries of others on oneself), social appraisal, and preventive behaviors, comparing respondents from areas under different movement restrictions during the first week after the outbreak; and to understand how worries, perceived risk, and preventive behaviors were associated with quality of life and individual characteristics among Italian adults. Design, Setting, and Participants This convenience sample, nonprobablistic survey study recruited adult participants with a snowballing sampling method in any Italian region during the first week of the COVID-19 outbreak in Italy from February 26, 2020, to March 4, 2020. Data were analyzed from March 5 to 12, 2020. Exposures Information was collected from citizens living in the quarantine zone (ie, red zone), area with restricted movements (ie, yellow zone), and COVID-19–free regions (ie, green zone). Main Outcomes and Measures Levels of knowledge on the virus, contagion-related worries, social appraisal, and preventive behaviors were assessed with ratings of quality of life (measured using the Short Form Health Survey). Additionally, some individual characteristics that may be associated with worries and behaviors were assessed, including demographic characteristics, personality traits (measured using Big Five Inventory-10), perceived health control (measured using the internal control measure in the Health Locus of Control scale), optimism (measured using the Revised Life Orientation Test), and the need for cognitive closure (measured using the Need for Closure Scale). Results A total of 3109 individuals accessed the online questionnaire, and 2886 individuals responded to the questionnaire at least partially (mean [SD] age, 30.7 [13.2] years; 2203 [76.3%] women). Most participants were well informed about the virus characteristics and suggested behaviors, with a mean (SD) score of 77.4% (17.3%) correct answers. Quality of life was similar across the 3 zones (effect size = 0.02), but mental health was negatively associated with contagion-related worries (β = –0.066), social appraisal (β = –0.221), and preventive behaviors (β = –0.066) in the yellow zone (R2 = 0.108). Social appraisal was also associated with reduced psychological well-being in the green zone (β = –0.205; R2 = 0.121). In the yellow zone, higher worries were negatively correlated with emotional stability (β = –0.165; R2 = 0.047). Emotional stability was also negatively associated with perceived susceptibility in the yellow (β = –0.108; R2 = 0.040) and green (β = –0.170; R2 = 0.087) zones. Preventative behaviors and social appraisal were also associated with the need for cognitive closure in both yellow (preventive behavior: β = 0.110; R2 = 0.023; social appraisal β = 0.115; R2 = 0.104) and green (preventive behavior: β = 0.174; R2 = 0.022; social appraisal: 0.261; R2 = 0.137) zones. Conclusions and Relevance These findings suggest that during the first week of the COVID-19 outbreak in Italy, people were well informed and had a relatively stable level of worries. Quality of life did not vary across the areas, although mental well-being was challenged by the social appraisal and worries related to the contagion. Increased scores for worries and concerns were associated with more cognitive rigidity and emotional instability.
E&P (EPIDEMIOLOGIA E PREVENZIONE)
Authors Paolo Vineis, Lucia Bisceglia, Francesco Forastiere, Stefania Salmaso, Salvatore Scondotto
CDC (CENTER FOR DISEASE CONTROL AND PREVENTION)
Authors National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases home
Authors Abrar A. Chughtai, Holly Seale, C. Raina Macintyre
ABSTRACT Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.
Authors Marco Vinceti Tommaso Filippini Kenneth J. Rothman Fabrizio Ferrari Alessia Goffi Giuseppe Maffeis Nicola Orsini
ABSTRACT Background Italy's severe COVID-19 outbreak was addressed by a lockdown that gradually increased in space, time and intensity. The effectiveness of the lockdown has not been precisely assessed with respect to the intensity of mobility restriction and the time until the outbreak receded. Methods We used processed mobile phone tracking data to measure mobility restriction, and related those data to the number of new SARS-CoV-2 positive cases detected on a daily base in the three most affected Italian regions, Lombardy, Veneto and Emilia-Romagna, from February 1 through April 6, 2020, when two subsequent lockdowns with increasing intensity were implemented by the Italian government. Findings During the study period, mobility restriction was inversely related to the daily number of newly diagnosed SARS-CoV-2 positive cases only after the second, more effective lockdown, with a peak in the curve of diagnosed cases of infection occurring 14 to 18 days from lockdown in the three regions and 9 to 25 days in the included provinces. An effective reduction in transmission must have occurred nearly immediately after the tighter lockdown, given the lag time of around 10 days from asymptomatic infection to diagnosis. The period from lockdown to peak was shorter in the areas with the highest prevalence of the infection. This effect was seen within slightly more than one week in the most severely affected areas. Interpretation It appears that the less rigid lockdown led to an insufficient decrease in mobility to reverse an outbreak such as COVID-19. With a tighter lockdown, mobility decreased enough to bring down transmission promptly below the level needed to sustain the epidemic. Funding No funding sources have been used for this work.
SAGE JOURNALS
Authors Kurosh Parsi, Andre M van Rij, Mark H Meissner, Alun H Davies, Marianne De Maeseneer, Peter Gloviczki, Stephen Benson, Oscar Bottini, Victor Manuel Canata, Paul Dinnen, Antonios Gasparis, Sergio Gianesini, David Huber, David Jenkins, Brajesh K Lal, Lowell Kabnick, Adrian Lim, William Marston, Alberto Martinez Granados, Nick Morrison, Andrew Nicolaides, Peter Paraskevas, Malay Patel, Stefania Roberts, Christopher Rogan, Marlin W Schul, Pedro Komlos, Andrew Stirling, Simon Thibault, Roy Varghese, Harold J Welch, Cees HA Wittens
ABSTRACT The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30–90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6–12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.
ELSEVIER
Authors Francesco Lanza, Valeria Seidita, Antonio Chella
Monitoring patients through robotics telehealth systems is an interesting scenario where patients’ conditions, and their environment, are dynamic and unknown variables. We propose to improve telehealth systems’ features to include the ability to serve patients with their needs, operating as human caregivers. The objective is to support the independent living of patients at home without losing the opportunity to monitor their health status. Application scenarios are several, and they spread from simple clinical assisting scenarios to an emergency one. For instance, in the case of a nursing home, the system would support in continuously monitoring the elderly patients. In contrast, in the case of an epidemic diffusion, such as COVID-19 pandemic, the system may help in all the early triage phases, significantly reducing the risk of contagion. However, the system has to let medical assistants perform actions remotely such as changing therapies or interacting with patients that need support. The paper proposes and describes a multi-agent architecture for intelligent medical care. We propose to use the beliefs-desires-intentions agent architecture, part of it is devised to be deployed in a robot. The result is an intelligent system that may allow robots the ability to select the most useful plan for unhandled situations and to communicate the choice to the physician for his validation and permission.
Authors Lala Tanmoy Das, Erika L. Abramson, Rainu Kaushal
EUROPEAN UNION AVIATION SAFETY AGENCY (EASA) - EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL (ECDC)
Authors European Union Aviation Safety Agency (EASA) - European Centre for Disease Prevention and Control (ECDC)
Authors Urs Gasser, Marcello Ienca, James Scheibner, Joanna Sleigh, Effy Vayena
Authors Sera Whitelaw, Mamas A Mamas, Eric Topol, Harriette G C Van Spall
Authors Richard Horton
Authors Howard Bauchner, Phil B. Fontanarosa, Robert M. Golub
SCIENCE
Authors Kimberly A. Prather, Chia C. Wang, Robert T. Schooley
Authors WHO TEAM
Authors Amer M Zeidan*, Prajwal C Boddu*, Mrinal M Patnaik, Jan Philipp Bewersdorf, Maximilian Stahl, Raajit K Rampal, Rory Shallis, David P Steensma, Michael R Savona, Mikkael A Sekeres, Gail J Roboz, Daniel J DeAngelo, Andre C Schuh, Eric Padron, Joshua F Zeidner, Roland B Walter, Francesco Onida, Amir Fathi, Amy DeZern, Gabriela Hobbs, Eytan M Stein, Paresh Vyas, Andrew H Wei, David T Bowen, Pau Montesinos,Elizabeth A Griffiths, Amit K Verma, Alla Keyzner, Michal Bar-Natan, Shyamala C Navada , Marina Kremyanskaya, Aaron D Goldberg, Aref Al-Kali, Mark L Heaney, Aziz Nazha, Huda Salman, Selina Luger, Keith W Pratz, Heiko Konig, Rami Komrokji, Michael Deininger, Blanca Xicoy Cirici, Vijaya Raj Bhatt, Lewis R Silverman, Harry P Erba, Pierre Fenaux, Uwe Platzbecker, Valeria Santini, Eunice S Wang, Martin S Tallman, Richard M Stone, John Mascarenhas
EUROPEAN COMMISSION
Authors EUROPEAN COMMISSION
MONALDI ARCHIVES FOR CHEST DISEASE 2020
Authors Antonio Mazza, Roberto Pedretti, Filippo Sarullo, Francesco Fattirolli, Pompilio Faggiano, Francesco Giallauria, Carlo Vigorito, Elisabetta Angelino, Silvia Brazzo, Matteo Ruzzolini
ABSTRACT The COVID-19 outbreak is having a significant impact on both cardiac rehabilitation (CR) inpatient and outpatient healthcare organization. The variety of clinical and care scenarios we are observing in Italy depends on the region, the organization of local services and the hospital involved. Some hospital wards have been closed to make room to dedicated beds or to quarantine the exposed health personnel. In other cases, CR units have been converted or transformed into COVID-19 units. The present document aims at defining the state of the art of CR during COVID-19 pandemic, through the description of the clinical and management scenarios frequently observed during this period and the exploration of the future frontiers in the management of cardiac rehabilitation programs after the COVID-19 outbreak.
WILEY ONLINE LIBRARY
Authors Carmen Riggioni, Pasquale Comberiati, Mattia Giovannini, Ioana Agache, Mübeccel Akdis, Magna Alves‐Correia, Josep M. Antó, Alessandra Arcolaci, Ahmet Kursat Azkur, Dilek Azkur, Burcin Beken, Cristina Boccabella, Jean Bousquet, Heimo Breiteneder, Daniela Carvalho, Leticia De las Vecillas, Zuzana Diamant, Ibon Eguiluz‐Gracia, Thomas Eiwegger, Stefanie Eyerich, Wytske Fokkens, Ya‐dong Gao, Farah Hannachi, Sebastian L. Johnston, Marek Jutel, Aspasia Karavelia, Ludger Klimek, Beatriz Moya, Kari Nadeau, Robyn O'Hehir, Liam O'Mahony, Oliver Pfaar, Marek Sanak, Jürgen Schwarze, Milena Sokolowska, María J. Torres, Willem van de Veen, Menno C. van Zelm, De Yun Wang, Luo Zhang, Rodrigo Jiménez‐Saiz, Cezmi A. Akdis
ABSTRACT In December 2019, China reported the first cases of the coronavirus disease 2019 (COVID-19). This disease, caused by the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), has developed into a pandemic. To date it has resulted in~5.6 million confirmed cases and caused 353,334 related deaths worldwide. Unequivocally, the COVID-19 pandemic is the gravest health and socioeconomic crisis of our time. In this context, numerous questions have emerged in demand of basic scientific information and evidence-based medical advice on SARS-CoV-2 and COVID-19. Although the majority of the patients show a very mild, self-limiting viral respiratory disease, many clinical manifestations in severe patients are unique to COVID-19, such as severe lymphopenia and eosinopenia, extensive pneumonia, a "cytokine storm" leading to acute respiratory distress syndrome, endothelitis, thrombo-embolic complications and multiorgan failure. The epidemiologic features of COVID-19 are distinctive and have changed throughout the pandemic. Vaccine and drug development studies and clinical trials are rapidly growing at an unprecedented speed. However, basic and clinical research on COVID-19-related topics should be based on more coordinated high-quality studies. This paper answers pressing questions, formulated by young clinicians and scientists, on SARS-CoV-2, COVID-19 and allergy, focusing on the following topics: virology, immunology, diagnosis, management of patients with allergic disease and asthma, treatment, clinical trials, drug discovery, vaccine development and epidemiology. Over 140 questions were answered by experts in the field providing a comprehensive and practical overview of COVID-19 and allergic disease.
ACCADEMIA NAZIONALE DEI LINCEI
Authors Lincei Committee on Covid-19
Authors Commissione Covid-19 ACCADEMIA NAZIONALE DEI LINCEI
Authors WORLD HEALTH ORGANIZATION
EUROSURVEILLANCE
Authors Kostas Danis, Laure Fonteneau, Scarlett Georges, Côme Daniau, Sibylle Bernard- Stoecklin, Lisa Domegan, Joan O’Donnell, Siri Helene Hauge, Sara Dequeker, Eline Vandael, Johan Van der Heyden, Françoise Renard, Natalia Bustos Sierra, Enrico Ricchizzi, Birgitta Schweickert, Nicole Schmidt, Muna Abu Sin, Tim Eckmanns, José-Artur Paiva , Elke Schneider
ABSTRACT Residents in long-term care facilities (LTCF) are a vulnerable population group. Coronavirus disease (COVID-19)-related deaths in LTCF residents represent 30–60% of all COVID-19 deaths in many European countries. This situation demands that countries implement local and national testing, infection prevention and control, and monitoring programmes for COVID-19 in LTCF in order to identify clusters early, decrease the spread within and between facilities and reduce the size and severity of outbreaks.
CIOMS
Authors Council for International Organizations of Medical Sciences (CIOMS) International Expert Working Group
Authors DIREZIONE GENERALE DELLA PREVENZIONE SANITARIA, DIREZIONE GENERALE DELLA PROGRAMMAZIONE SANITARIA, DIREZIONE GENERALE DELLA DIGITALIZZAZIONE, DEL SISTEMA INFORMATIVO SANITARIO E DELLA STATISTICA
Authors I. Glenn Cohen; Lawrence O. Gostin; Daniel J. Weitzner
US FOOD & DRUG
Authors US FOOD & DRUG
American Journal of Physical Medicine & Rehabilitation
Authors Lopez Marielisa, Bell Kathleen, Annaswamy Thiru, Juengst Shannon, Ifejika Nneka
ABSTRACT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – also known as COVID-19 – is primarily known for respiratory illness. While it is clear that patients with moderate to severe cases of COVID-19 will require pulmonary rehabilitation, physiatrists will need to consider effective management plans for COVID-19 survivors with extra-pulmonary involvement. This report will summarize key non-pulmonary considerations to guide rehabilitation clinicians who may be involved in the care of COVID-19 survivors with the best available early evidence.
Authors Nicholas M Selby, Lui G Forni, Christopher M Laing, Kerry L Horne ,Rhys Evans, Bethany J Lucas, Richard J Fluck
Ministero della Salute DIREZIONE GENERALE DELLA PREVENZIONE SANITARIA Ufficio 4
Authors Kavita Shah Arora, Jaclyn T. Mauch, Kelly Smith Gibson
EASA (EUROPEAN UNION AVIATION SAFETY AGENCY)
Authors EASA (EUROPEAN UNION AVIATION SAFETY AGENCY)
Authors Francis S. Collins, Paul Stoffels
The BMJ
Authors Andrew Dagens, Louise Sigfrid, Erhui Cai, Sam Lipworth, Vincent Cheung,, Eli Harris, librarian, Peter Bannister,, Ishmeala Rigby, Peter Horby
ABSTRACT Objective To appraise the availability, quality, and inclusivity of clinical guidelines produced in the early stage of the coronavirus disease 2019 (covid-19) pandemic. Design Rapid review. Data sources Ovid Medline, Ovid Embase, Ovid Global Health, Scopus, Web of Science Core Collection, and WHO Global Index Medicus, searched from inception to 14 Mar 2020. Search strategies applied the CADTH database guidelines search filter, with no limits applied to search results. Further studies were identified through searches of grey literature using the ISARIC network. Inclusion criteria Clinical guidelines for the management of covid-19, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) produced by international and national scientific organisations and government and non-governmental organisations relating to global health were included, with no exclusions for language. Regional/hospital guidelines were excluded. Only the earliest version of any guideline was included. Quality assessment Quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The quality and contents of early covid-19 guidelines were also compared with recent clinical guidelines for MERS and SARS. Results 2836 studies were identified, of which 2794 were excluded after screening. Forty two guidelines were considered eligible for inclusion, with 18 being specific to covid-19. Overall, the clinical guidelines lacked detail and covered a narrow range of topics. Recommendations varied in relation to, for example, the use of antiviral drugs. The overall quality was poor, particularly in the domains of stakeholder involvement, applicability, and editorial independence. Links between evidence and recommendations were limited. Minimal provision was made for vulnerable groups such as pregnant women, children, and older people. Conclusions Guidelines available early in the covid-19 pandemic had methodological weaknesses and neglected vulnerable groups such as older people. A framework for development of clinical guidelines during public health emergencies is needed to ensure rigorous methods and the inclusion of vulnerable populations
Authors Abigail Kaminski, Abby Payne, Sarah Roemer, Denise Ignatowski, Bijoy K.Khandheria
Chinese Medical Journal
Authors Jie-Ming Qu, Chen Wang, Bin Cao
ABSTRACT In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.
Science
Authors Luca Ferretti, Chris Wymant, Michelle Kendall, Lele Zhao, Anel Nurtay, Lucie Abeler-Dörner, Michael Parker, David Bonsall, Christophe Fraser
SIMIT
Authors SIMIT
The Lancet
Authors Mark Honigsbaum
Authors Aurélie Gouel-Cheron, CamilleCouffignale, Yoann Elmaleh, Elie Kantor, Philippe Montravers
BMJ
Authors Tippi K Mak, John CW Lim, Prapassorn Thanaphollert, Gugu N Mahlangu, Emer Cook, Murray M Lumpkin
Authors Angel Desai
EUROPEAN MEDICINE AGENCY
Authors JAN JACOBS
BJS SOCIETY
Authors F. Di Marzo, M. Sartelli, R. Cennamo, G. Toccafondi, F. Coccolini, G. La Torre, G. Tulli, M. Lombardi, M. Cardi
INSTITUTE OF TROPICAL MEDICINE ANTWERP
Authors National Institute for Health and Care Excellence (NICE) in collaboration with NHS England and NHS Improvement
ISDA
Authors Adarsh Bhimraj, Rebecca L. Morgan, Amy Hirsch Shumaker, Valery Lavergne, Lindsey Baden, Vincent Chi-Chung Cheng, Kathryn M. Edwards, Rajesh Gandhi, Jason Gallagher, William J. Muller, John C. O’Horo, Shmuel Shoham, M. Hassan Murad, Reem A. Mustafa, Shahnaz Sultan, Yngve Falck-Ytter
ABSTRACT Background: There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19). There is a need for frequently updated practice guidelines on their use, based on critical evaluation of rapidly emerging literature. Objective: Develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19. Methods: In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Results: On April 11, 2020, IDSA released online initial treatment recommendations and narrative summaries of other treatments under evaluation. Since that time, the guideline panel and methodologists have continued to monitor the literature and issue updates and addendums to these guidelines in response to evolving research. Conclusions: Since the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that we could not make a determination whether the benefits outweigh harms for most treatments.
Authors Trisha Greenhalgh, Manuel B Schmid, Thomas Czypionka, Dirk Bassler, Laurence Gruer
CIRCULATION
Authors Dana P. Edelson, Comilla Sasson , Paul S. Chan, Dianne L. Atkins, Khalid Aziz, Lance B. Becker, Robert A. Berg, Steven M. Bradley, Steven C. Brooks, Adam Cheng, Marilyn Escobedo, Gustavo E. Flores, Saket Girotra, Antony Hsu, Beena D. Kamath-Rayne, Henry C. Lee, Rebecca E. Lehotzky, Mary E. Mancini, Raina M. Merchant, Vinay M. Nadkarni, Ashish R. Panchal, Mary Ann R. Peberdy, Tia T. Raymond, Brian Walsh, David S. Wang, Carolyn M. Zelop, Alexis Topjian
Authors Babak Javid, Michael P Weekes, Nicholas J Matheson
Authors Elisabeth Mahase
Authors Steven Sanche, Yen Ting Lin, Chonggang Xu, Ethan Romero-Severson, Nick Hengartner, Ruian Ke
ABSTRACT Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R0) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period. We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R0 value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus.
Authors AIFA
World Health Organization
Authors T. M. Cook K. El‐Boghdadly B. McGuire A. F. McNarry A. Patel A. Higgs
ABSTRACT Severe acute respiratory syndrome-corona virus-2, which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID-19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID-19. The advice in this document is designed to be adapted in line with local workplace policies.
ACCADEMIA DEI LINCEI
Authors Maurizio Cecconi, Guido Forni, Alberto Mantovani
Johns Hopkins Medicine
Authors Paul G. Auwaerter
European Medicines Agency Science Medicine Health
ITS (ITALIAN THORACIC SOCIETY)
Authors Harari Sergio Alfonso, Vitacca Michele, Blasi Francesco, Centanni Stefano, Santus Pier Achille, Tarsia Paolo
ECDC TECHNICAL REPORT
Authors ECDC TECHNICAL REPORT
MDPI - Journal of Clinical Medicine
Authors Péter Boldog, Tamás Tekeli, Zsolt Vizi, Attila Dénes, Ferenc A. Bartha and Gergely Röst
Abstract: We developed a computational tool to assess the risks of novel coronavirus outbreaks outside of China. We estimate the dependence of the risk of a major outbreak in a country from imported cases on key parameters such as: (i) the evolution of the cumulative number of cases in mainland China outside the closed areas; (ii) the connectivity of the destination country with China, including baseline travel frequencies, the effect of travel restrictions, and the efficacy of entry screening at destination; and (iii) the efficacy of control measures in the destination country (expressed by the local reproduction number Rloc). We found that in countries with low connectivity to China but with relatively high Rloc, the most beneficial control measure to reduce the risk of outbreaks is a further reduction in their importation number either by entry screening or travel restrictions. Countries with high connectivity but low Rloc benefit the most from policies that further reduce Rloc. Countries in the middle should consider a combination of such policies. Risk assessments were illustrated for selected groups of countries from America, Asia, and Europe. We investigated how their risks depend on those parameters, and how the risk is increasing in time as the number of cases in China is growing. Keywords: novel coronavirus; transmission; risk assessment; interventions; travel; outbreak; COVID-19; compartmental model; branching process Target audience Public health authorities in the EU/EEA Member States (MS) and the UK.
NICE guideline
Abstract: The purpose of this guideline is to provide recommendations for managing COVID‑19 symptoms for patients in the community, including at the end of life. It also includes recommendations about managing medicines for these patients, and protecting staff from infection. This guideline is for: health and care practitioners health and care staff involved in planning and delivering services commissioners The recommendations bring together existing national and international guidance and policies advice from specialists working in the NHS from across the UK. These include people with expertise and experience of treating patients for the specific health conditions covered by the guidance during the current COVID-19 pandemic. Keywords: novel coronavirus; transmission; risk assessment; interventions; travel; outbreak; COVID-19; compartmental model; branching process Target audience Public health authorities in the EU/EEA Member States (MS) and the UK.
Authors Emma Wallace, Maike J M Uijen, Barbara Clyne, Atieh Zarabzadeh, Claire Keogh
ABSTRACT Objectives Following appropriate validation, clinical prediction rules (CPRs) should undergo impact analysis to evaluate their effect on patient care. The aim of this systematic review is to narratively review and critically appraise CPR impact analysis studies relevant to primary care. Setting Primary care. Participants Adults and children. Intervention Studies that implemented the CPR compared to usual care were included. Study design Randomised controlled trial (RCT), controlled before–after, and interrupted time series. Primary outcome Physician behaviour and/or patient outcomes. Results A total of 18 studies, incorporating 14 unique CPRs, were included. The main study design was RCT (n=13). Overall, 10 studies reported an improvement in primary outcome with CPR implementation. Of 6 musculoskeletal studies, 5 were effective in altering targeted physician behaviour in ordering imaging for patients presenting with ankle, knee and neck musculoskeletal injuries. Of 6 cardiovascular studies, 4 implemented cardiovascular risk scores, and 3 reported no impact on physician behaviour outcomes, such as prescribing and referral, or patient outcomes, such as reduction in serum lipid levels. 2 studies examined CPRs in decision-making for patients presenting with chest pain and reduced inappropriate admissions. Of 5 respiratory studies, 2 were effective in reducing antibiotic prescribing for sore throat following CPR implementation. Overall, study methodological quality was often unclear due to incomplete reporting. Conclusions Despite increasing interest in developing and validating CPRs relevant to primary care, relatively few have gone through impact analysis. To date, research has focused on a small number of CPRs across few clinical domains only
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