\ BIP! Finder for COVID-19 - Impact-based ranking

BIP! Finder for COVID-19

This version of BIP! Finder aims to ease the exploration of COVID-19-related literature by enabling ranking articles based on various impact metrics.

Last Update: 18 - 01 - 2023 (628506 entries)

Provided impact measures:
Popularity: Citation-based measure reflecting the current impact.
Influence: Citation-based measure reflecting the total impact.
Reader Attention: The current number of Mendeley readers.
Social Media Attention: The number of recent tweets related to this article.
*More details on these impact measures can be found here.
Score interpretations:
Exceptional score (in top 0.01%).
Substantial score (in top 1%).
Average score (in bottom 99%).
Score not available.
Main data sources:
CORD-19 dataset(1) (list of papers)
LitCovid hub(2) (list of papers)
PMC & PubMed (citations)
Mendeley (number of readers)
COVID-19-TweetIDs(3) (tweets)

Use:  Impact  Relevance & Impact
TitleVenueYearImpactSource
5851Associations between COVID-19 lockdown and post-lockdown on the mental health of pregnant women, postpartum women and their partners from the Queensland family cohort prospective study  

N/A

BMC Pregnancy Childbirth2022       LitCov
5852Differences in Multi-Faceted Lifestyles in Response to the COVID-19 Pandemic and Their Association with Depression and Quality of Life of Older Adults in South Korea: A Cross-Sectional Study  

Background: The World Health Organization declared COVID-19 a global pandemic on 11 March 2020, due to the number of newly reported confirmed cases and the rapid increase in deaths. Therefore, countries around the world limited their population to policies such as “social distancing” or “staying at home” to prevent the spread of the virus. The purpose of this study was to evaluate differences in lifestyle pre and post the outbreak COVID-19 among older adults in South Korea and to identify the impact of lifestyle differences on depression and quality of life. Methods: An online single questionnaire covering sociodemographic data, lifestyle details, depression status, and quality of life level was distributed using mailing lists and social media. To assess lifestyles differences in older people pre and post the outbreak of COVID-19 pandemic, the online single questionnaire was used post COVID-19 pandemic. Based on the participants’ memories, they responded lifestyles at two time points (pre and post COVID-19 pandemic). Results: The results showed that there was a significant decrease in physical activity and activity participation during the pandemic. In terms of nutrition, there was no statistically significant change pre and post the outbreak COVID-19, except for the intake of protein, fat, and vitamins. Additionally, the results showed that the resulting lifestyle differences seem to have had a negative impact on depression and quality of life among older adults in South Korea. Conclusion: There was a significant difference the lifestyle patterns among the participants in South Korea between the current period and pre COVID-19 pandemic. Additionally, it is observed that these differenced lifestyles were associated with depression and quality of life among the participants. Our findings may help to develop public health programs that support healthy lifestyles in pandemic conditions.

Nutrients2021       LitCov and CORD-19
5853Digitization and Health in Germany: Cross-sectional Nationwide Survey  

BACKGROUND: Digital technologies are shaping medicine and public health. OBJECTIVE: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. METHODS: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. RESULTS: The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001). CONCLUSIONS: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions.

JMIR Public Health Surveill2021       LitCov and CORD-19
5854Novel Immunoglobulin Domain Proteins Provide Insights into Evolution and Pathogenesis of SARS-CoV-2 Related Viruses  

A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was recently identified as the causative agent for the coronavirus disease 2019 (COVID-19) outbreak that has generated a global health crisis. We use a combination of genomic analysis and sensitive profile-based sequence and structure analysis to understand the potential pathogenesis determinants of this virus. As a result, we identify several fast-evolving genomic regions that might be at the interface of virus-host interactions, corresponding to the receptor binding domain of the Spike protein, the three tandem Macro fold domains in ORF1a, and the uncharacterized protein ORF8. Further, we show that ORF8 and several other proteins from alpha- and beta-CoVs belong to novel families of immunoglobulin (Ig) proteins. Among them, ORF8 is distinguished by being rapidly evolving, possessing a unique insert, and having a hypervariable position among SARS-CoV-2 genomes in its predicted ligand-binding groove. We also uncover numerous Ig domain proteins from several unrelated metazoan viruses, which are distinct in sequence and structure but share comparable architectures to those of the CoV Ig domain proteins. Hence, we propose that SARS-CoV-2 ORF8 and other previously unidentified CoV Ig domain proteins fall under the umbrella of a widespread strategy of deployment of Ig domain proteins in animal viruses as pathogenicity factors that modulate host immunity. The rapid evolution of the ORF8 Ig domain proteins points to a potential evolutionary arms race between viruses and hosts, likely arising from immune pressure, and suggests a role in transmission between distinct host species.

mBio2020       LitCov and CORD-19
5855SARS-CoV-2 infection and vaccination trigger long-lived B and CD4+ T lymphocytes with implications for booster strategies  

BACKGROUND: Immunization against SARS-CoV-2, the causative agent of COVID-19, occurs via natural infection or vaccination. However, it is currently unknown how long infection- or vaccination-induced immunological memory will last. METHODS: We performed a longitudinal evaluation of immunological memory to SARS-CoV-2 up to 1 year after infection and following mRNA vaccination in naive individuals and individuals recovered from COVID-19 infection. RESULTS: We found that memory cells are still detectable 8 months after vaccination, while antibody levels decline significantly, especially in naive individuals. We also found that a booster injection is efficacious in reactivating immunological memory to spike protein in naive individuals, whereas it was ineffective in previously SARS-CoV-2–infected individuals. Finally, we observed a similar kinetics of decay of humoral and cellular immunity to SARS-CoV-2 up to 1 year following natural infection in a cohort of unvaccinated individuals. CONCLUSION: Short-term persistence of humoral immunity, together with the reduced neutralization capacity versus the currently prevailing SARS-CoV-2 variants, may account for reinfections and breakthrough infections. Long-lived memory B and CD4(+) T cells may protect from severe disease development. In naive individuals, a booster dose restored optimal anti-spike immunity, whereas the needs for vaccinated individuals who have recovered from COVID-19 have yet to be defined. FUNDING: This study was supported by funds to the Department of Experimental and Clinical Medicine, University of Florence (Project Excellence Departments 2018–2022), the University of Florence (project RICTD2122), the Italian Ministry of Health (COVID-2020-12371849), and the region of Tuscany (TagSARS CoV 2).

J Clin Invest2022       LitCov and CORD-19
5856The COVID-19 Humoral Immunological Status Induced by CoronaVac and AstraZeneca Vaccines Significantly Benefits from a Booster Shot with the Pfizer Vaccine  

A third vaccine dose against COVID-19 is already a reality in some countries around the world. In this study, we aimed to evaluate the effectiveness of the Brazilian immunization policy for COVID-19, which involves a booster shot. Participants (n = 210) provided serum samples, which were subjected to enzyme-linked immunosorbent assay (ELISA). Immunological profiles were defined as individuals with or without previous SARS-CoV-2 infection who received at least one vaccine dose in the immunization regimens of AstraZeneca, CoronaVac, or CoronaVac plus a booster shot with Pfizer. In addition, nonvaccinated/infected individuals were also included. As main results, we observed that the numbers of infected individuals were significantly reduced among those who were vaccinated, even with one dose. This result indicates that vaccines are highly protective against COVID-19. However, we observed a significant tendency of serum level decreases of specific antibodies over the time after the second dose. In contrast, the booster shot with the Pfizer vaccine after a CoronaVac immunization regimen showed a significant increase in the specific SARS-CoV-2 IgG serum levels. Moreover, we found that vaccination induced a significantly higher humoral immunological status than only the natural infection with SARS-CoV-2. Collectively, results presented here indicate that vaccines are necessary to induce a robust immunological status, which is maintained, restored, or even improved by booster shots. IMPORTANCE COVID-19 continues to spread around the world despite significant progress in vaccine distribution and population immunity. The dynamics of the antiviral antibody response postvaccination is critical to evaluate vaccine effectiveness across different vaccine platforms and over time. In this study, we evaluate the serum levels of antiviral antibodies in patients from Brazil that received either the CoronaVac or the AstraZeneca vaccine. We found that antibody levels wane over time, vaccines induce protective immunity, and humoral immunity is enhanced with a third vaccine dose. This study reveals that the COVID-19 humoral immunological status induced by vaccines significantly benefits from a booster shot.

J Virol2022       LitCov and CORD-19
5857Intimate partner violence and associated factors among reproductive age women during COVID-19 pandemic in Southern Ethiopia, 2020  

BACKGROUND: World health organization (WHO) defines intimate partner violence (IPV) is physical, sexual, or emotional abuse by an intimate partner or ex-partner or spouse to a woman. From all forms of violence, ~ 1.3 million people worldwide die each year, accounting for 2.5% of global mortality. During the COVID-19 crisis, control and prevention measures have brought women and potential perpetrators together which increase the risk of IPV. Therefore, this study was aimed to assess the magnitude and associated factors of IPV against women during COVID-19 in Ethiopia. METHODS: Community based cross-section study was employed among 462 reproductive-age women to assess IPV and associated factors during COVID-19 pandemic. To select study participants one-stage cluster sampling technique was used. The data were entered into Epi data version 4.2 and exported to SPSS for analysis. Bivariate and multivariate analysis was used to check the association of dependent and independent variables and statistical significance was declared at P < 0.05. RESULT: A total of 448 study subjects were responded making a response rate of 96.97%. Two- third (67.6%) of the respondent's age range was between 20 and 29 years. All of the participants heard about the pandemic of COVID-19 at the time of onset. The lifetime and the last twelve months prevalence of women with IPV was 42.19% and 24.11%, respectively. About 58 (12.9%) had experienced all three types of violence. Participants age ≥ 35 (AOR = 2.02; 95% CI: 1.99–4.29), rural residence (AOR = 3.04; 95% CI: 2.59–6.25), husband’s educational status of diploma and above (AOR = 0.35; 95% CI: 0.14–0.83), COVID-19 pandemic (AOR = 4.79; 95% CI: 1.13–6.86), and low social support (AOR = 3.23; 95% CI: 1.99–6.23) were independent predictors. CONCLUSIONS: In this study two in five women undergo one type of violence in their lifetime. The occurrence of the COVID-19 pandemic has its impact on violence. Age ≥ 35, rural residence, husband’s educational status of diploma and above, history of child death, COVID-19 pandemic, and low social support were independent predictors of violence. This implies insight to concerned bodies like policymakers and stakeholders to design appropriate policies to avert this magnitude and making zero tolerance for violence in society. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12978-021-01297-3.

Reprod Health2021       LitCov and CORD-19
5858Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic  

N/A

Am J Manag Care2021       LitCov and CORD-19
5859Communication and Virtual Visiting for Families of Patients in Intensive Care during the COVID-19 Pandemic: A UK National Survey  

Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members’ ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.

Ann Am Thorac Soc2021       LitCov and CORD-19
5860In Silico Evaluation of Prospective Anti-COVID-19 Drug Candidates as Potential SARS-CoV-2 Main Protease Inhibitors  

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a recently emanating human infectious coronavirus that causes COVID-19 disease. On 11th March 2020, it has been announced as a pandemic by the World Health Organization (WHO). Recently, several repositioned drugs have been subjected to clinical investigations as anti-COVID-19 drugs. Here, in silico drug discovery tools were utilized to evaluate the binding affinities and features of eighteen anti-COVID-19 drug candidates against SARS-CoV-2 main protease (M(pro)). Molecular docking calculations using Autodock Vina showed considerable binding affinities of the investigated drugs with docking scores ranging from − 5.3 to − 8.3 kcal/mol, with higher binding affinities for HIV drugs compared to the other antiviral drugs. Molecular dynamics (MD) simulations were performed for the predicted drug-M(pro) complexes for 50 ns, followed by binding energy calculations utilizing molecular mechanics-generalized Born surface area (MM-GBSA) approach. MM-GBSA calculations demonstrated promising binding affinities of TMC-310911 and ritonavir towards SARS-CoV-2 M(pro), with binding energy values of − 52.8 and − 49.4 kcal/mol, respectively. Surpass potentialities of TMC-310911 and ritonavir are returned to their capabilities of forming multiple hydrogen bonds with the proximal amino acids inside M(pro)'s binding site. Structural and energetic analyses involving root-mean-square deviation, binding energy per-frame, center-of-mass distance, and hydrogen bond length demonstrated the stability of TMC-310911 and ritonavir inside the M(pro)'s active site over the 50 ns MD simulation. This study sheds light on HIV protease drugs as prospective SARS-CoV-2 M(pro) inhibitors. [Image: see text] SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s10930-020-09945-6) contains supplementary material, which is available to authorized users.

Protein J2021       LitCov and CORD-19
5861Atlas of currently available human neutralizing antibodies against SARS-CoV-2 and escape by Omicron sub-variants BA.1/BA.1.1/BA.2/BA.3  

N/A

Immunity2022       LitCov
5862Clinical assessment of the Roche SARS-CoV-2 rapid antigen test  

N/A

Diagnosis (Berl)2021       LitCov and CORD-19
5863Long-term strategies to control COVID-19 in low and middle-income countries: an options overview of community-based, non-pharmacological interventions  

In low and middle-income countries (LMICs), strict social distancing measures (e.g., nationwide lockdown) in response to the COVID-19 pandemic are unsustainable in the long-term due to knock-on socioeconomic and psychological effects. However, an optimal epidemiology-focused strategy for ‘safe-reopening’ (i.e., balancing between the economic and health consequences) remain unclear, particularly given the suboptimal disease surveillance and diagnostic infrastructure in these settings. As the lockdown is now being relaxed in many LMICs, in this paper, we have (1) conducted an epidemiology-based “options appraisal” of various available non-pharmacological intervention options that can be employed to safely lift the lockdowns (namely, sustained mitigation, zonal lockdown and rolling lockdown strategies), and (2) propose suitable application, pre-requisites, and inherent limitations for each measure. Among these, a sustained mitigation-only approach (adopted in many high-income countries) may not be feasible in most LMIC settings given the absence of nationwide population surveillance, generalised testing, contact tracing and critical care infrastructure needed to tackle the likely resurgence of infections. By contrast, zonal or local lockdowns may be suitable for some countries where systematic identification of new outbreak clusters in real-time would be feasible. This requires a generalised testing and surveillance structure, and a well-thought out (and executed) zone management plan. Finally, an intermittent, rolling lockdown strategy has recently been suggested by the World Health Organization as a potential strategy to get the epidemic under control in some LMI settings, where generalised mitigation and zonal containment is unfeasible. This strategy, however, needs to be carefully considered for economic costs and necessary supply chain reforms. In conclusion, while we propose three community-based, non-pharmacological options for LMICs, a suitable measure should be context-specific and based on: (1) epidemiological considerations, (2) social and economic costs, (3) existing health systems capabilities and (4) future-proof plans to implement and sustain the strategy.

Eur J Epidemiol2020       LitCov and CORD-19
5864One academic year under COVID-19 conditions: two multicenter cross-sectional evaluation studies among medical students in Bavarian medical schools, Germany students' needs, difficulties and concerns about digital teaching and learning  

N/A

BMC Med Educ2022       LitCov
5865Assessing a novel, lab-free, point-of-care test for SARS-CoV-2 (CovidNudge): a diagnostic accuracy study  

BACKGROUND: Access to rapid diagnosis is key to the control and management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory RT-PCR testing is the current standard of care but usually requires a centralised laboratory and significant infrastructure. We describe our diagnostic accuracy assessment of a novel, rapid point-of-care real time RT-PCR CovidNudge test, which requires no laboratory handling or sample pre-processing. METHODS: Between April and May, 2020, we obtained two nasopharyngeal swab samples from individuals in three hospitals in London and Oxford (UK). Samples were collected from three groups: self-referred health-care workers with suspected COVID-19; patients attending emergency departments with suspected COVID-19; and hospital inpatient admissions with or without suspected COVID-19. For the CovidNudge test, nasopharyngeal swabs were inserted directly into a cartridge which contains all reagents and components required for RT-PCR reactions, including multiple technical replicates of seven SARS-CoV-2 gene targets (rdrp1, rdrp2, e-gene, n-gene, n1, n2 and n3) and human ribonuclease P (RNaseP) as sample adequacy control. Swab samples were tested in parallel using the CovidNudge platform, and with standard laboratory RT-PCR using swabs in viral transport medium for processing in a central laboratory. The primary analysis was to compare the sensitivity and specificity of the point-of-care CovidNudge test with laboratory-based testing. FINDINGS: We obtained 386 paired samples: 280 (73%) from self-referred health-care workers, 15 (4%) from patients in the emergency department, and 91 (23%) hospital inpatient admissions. Of the 386 paired samples, 67 tested positive on the CovidNudge point-of-care platform and 71 with standard laboratory RT-PCR. The overall sensitivity of the point-of-care test compared with laboratory-based testing was 94% (95% CI 86–98) with an overall specificity of 100% (99–100). The sensitivity of the test varied by group (self-referred healthcare workers 93% [95% CI 84–98]; patients in the emergency department 100% [48–100]; and hospital inpatient admissions 100% [29–100]). Specificity was consistent between groups (self-referred health-care workers 100% [95% CI 98–100%]; patients in the emergency department 100% [69–100]; and hospital inpatient admissions 100% [96–100]). Point of care testing performance was similar during a period of high background prevalence of laboratory positive tests (25% [95% 20–31] in April, 2020) and low prevalence (3% [95% 1–9] in inpatient screening). Amplification of viral nucleocapsid (n1, n2, and n3) and envelope protein gene (e-gene) were most sensitive for detection of spiked SARS-CoV-2 RNA. INTERPRETATION: The CovidNudge platform was a sensitive, specific, and rapid point of care test for the presence of SARS-CoV-2 without laboratory handling or sample pre-processing. The device, which has been implemented in UK hospitals since May, 2020, could enable rapid decisions for clinical care and testing programmes. FUNDING: National Institute of Health Research (NIHR) Imperial Biomedical Research Centre, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University in partnership with Public Health England, NIHR Biomedical Research Centre Oxford, and DnaNudge.

Lancet Microbe2020       LitCov and CORD-19
5866Respiratory physiology of COVID-19 induced respiratory failure compared to ARDS of other etiologies  

BACKGROUND: Whether respiratory physiology of COVID-19-induced respiratory failure is different from acute respiratory distress syndrome (ARDS) of other etiologies is unclear. We conducted a single-center study to describe respiratory mechanics and response to positive end-expiratory pressure (PEEP) in COVID-19 ARDS and to compare COVID-19 patients to matched-control subjects with ARDS from other causes. METHODS: Thirty consecutive COVID-19 patients admitted to an intensive care unit in Rome, Italy, and fulfilling moderate-to-severe ARDS criteria were enrolled within 24 h from endotracheal intubation. Gas exchange, respiratory mechanics, and ventilatory ratio were measured at PEEP of 15 and 5 cmH(2)O. A single-breath derecruitment maneuver was performed to assess recruitability. After 1:1 matching based on PaO(2)/FiO(2), FiO(2), PEEP, and tidal volume, COVID-19 patients were compared to subjects affected by ARDS of other etiologies who underwent the same procedures in a previous study. RESULTS: Thirty COVID-19 patients were successfully matched with 30 ARDS from other etiologies. At low PEEP, median [25th–75th percentiles] PaO(2)/FiO(2) in the two groups was 119 mmHg [101–142] and 116 mmHg [87–154]. Average compliance (41 ml/cmH(2)O [32–52] vs. 36 ml/cmH(2)O [27–42], p = 0.045) and ventilatory ratio (2.1 [1.7–2.3] vs. 1.6 [1.4–2.1], p = 0.032) were slightly higher in COVID-19 patients. Inter-individual variability (ratio of standard deviation to mean) of compliance was 36% in COVID-19 patients and 31% in other ARDS. In COVID-19 patients, PaO(2)/FiO(2) was linearly correlated with respiratory system compliance (r = 0.52 p = 0.003). High PEEP improved PaO(2)/FiO(2) in both cohorts, but more remarkably in COVID-19 patients (p = 0.005). Recruitability was not different between cohorts (p = 0.39) and was highly inter-individually variable (72% in COVID-19 patients and 64% in ARDS from other causes). In COVID-19 patients, recruitability was independent from oxygenation and respiratory mechanics changes due to PEEP. CONCLUSIONS: Early after establishment of mechanical ventilation, COVID-19 patients follow ARDS physiology, with compliance reduction related to the degree of hypoxemia, and inter-individually variable respiratory mechanics and recruitability. Physiological differences between ARDS from COVID-19 and other causes appear small.

Crit Care2020       LitCov and CORD-19
5867Two further cases of Graves' disease following SARS-Cov-2 vaccination  

J Endocrinol Invest2021       LitCov and CORD-19
5868Herding behaviour in energy stock markets during the Global Financial Crisis, SARS and ongoing COVID-19  

Environmental change created worldwide interest in investing in renewable energy. Less reliance on fossil fuels would have a substantial influence on investors for alternative energy, especially renewable energy. The literature has concentrated on empirical studies of herding behaviour in finance, but not in renewable energy. This paper fills the gap by investigating herding in renewable energy, using daily closing prices in renewable and fossil fuel energy stock returns in the USA, Europe, and Asia, for March 24, 2000–May 29, 2020, which covers the Global Financial Crisis (GFC) (2007–2009), the coronavirus crises of SARS (2003). And the ongoing COVID-19 (2019–2020) pandemic. The paper shows that: (1) for low extreme oil returns, investors are more likely to display herding in the stock market; (2) for SARS and COVID-19, herding is more likely during extremely high oil returns after the GFC; and (3) herding is more likely during periods of extremely low oil returns during the coronavirus crises. These results suggest that after the GFC, investors are more sensitive to asset losses, so they will be more likely to display herding in the stock market. However, during SARS and COVID-19, investors panic so they may unwisely sell their assets. There are strong cross-sector herding spillover effects from US fossil fuel energy to renewable energy, especially before the GFC, while the US fossil fuel energy market has a significant influence on the Europe and Asia renewable energy returns during COVID-19. During SARS, which was not a pandemic, US fossil fuels only had an impact on US renewable energy returns.

Renew Sustain Energy Rev2020       LitCov and CORD-19
5869Odds of Testing Positive for SARS-CoV-2 Following Receipt of 3 vs 2 Doses of the BNT162b2 mRNA Vaccine  

N/A

JAMA Intern Med2022       LitCov and CORD-19
5870COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems  

Abstract Background and aim The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. Methods We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and reviewed the references of retrieved articles for additional studies. The search was limited to the terms: Covid-19 AND: acute respiratory distress syndrome (ARDS), SARS, MERS, non invasive ventilation (NIV), high flow nasal cannula (HFNC), pronation (PP), health care workers (HCW). Results Protection of Health care workers should be paramount, so full Personal Protective Equipment and Negative pressure rooms are warranted. HFNC alone or with PP could be offered for mild cases (PaO2/FiO2 between 200-300); NIV alone or with PP may work in moderate cases (PaO2/FiO2 between 100-200). Rotation and coupled (HFNC/NIV) strategy can be beneficial. A window of opportunity of 1-2hours is advised. If PaO2/FIO2 significantly increases, Respiratory Rate decreases with a relatively low Exhaled Tidal Volume, the non-invasive strategy could be working and intubation delayed. Conclusion Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients and HCW. Indirectly, non invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.

Pulmonology2020       LitCov and CORD-19
5871Anxiety and depression levels of the general population during the rapid progressing stage in the COVID-19 outbreak: a cross-sectional online investigation in China  

OBJECTIVE: The outbreak of COVID-19 has major impacts on the psychological health of the public. This study aimed to investigate the anxiety and depression levels of the general population during the rapid progressing stage of COVID-19 pandemic in China and to explore the associated factors. DESIGN AND SETTING: A cross-sectional online survey. PARTICIPANTS: 2651 Chinese people. MEASURES: The Hospital Anxiety and Depression Scale was used to measure their psychological health. A structured questionnaire collected possible associated factors, including sociodemographic characteristics, health information, contact history-related information, experience and perceptions, knowledge and education and adopted precautions. Multiple linear regression was conducted to explore the factors associated with anxiety and depression. RESULTS: The mean score of anxiety and depression was 4.35 and 4.38, respectively. The rates of people with anxiety and depressive symptoms (with >7 score in the subscale) were 14.15% and 17.35%, respectively. Participants without political party membership, with contact history of COVID-19, going out or gathering, taking Chinese medicine herbs, being unsatisfied with current precautions, perceiving higher risks of infection, lower knowledge and poorer health presented higher anxiety and depression levels. Moreover, those who were females, married, lived alone and wore mask were more anxious; whereas people who were younger, experienced public health crisis, did not take precautions (regular work-rest, exercise) had higher depression level. CONCLUSIONS: During the rapid progressing stage of COVID-19 pandemic in China, one-seventh and one-sixth respondents presented anxiety and depression symptoms, respectively. The risk factors for anxiety and depression included the following: without political party membership, with contact history of COVID-19, going out or gathering, wearing masks, taking Chinese medicine herbs, being unsatisfied with current precautions, perceiving higher susceptibility, lower knowledge and poorer health status. Extensive information and psychological support should be provided to improve the mental health of the general population.

BMJ Open2021       LitCov and CORD-19
5872Prevalence and Drivers of COVID-19 Vaccine Booster Hesitancy Among German University Students and Employees  

COVID-19 booster hesitancy (VBH) is a serious public health challenge which acts simultaneously with the waning vaccine-elicited immunity and the emerging viral variants to prolong the pandemic interval. Therefore, this study aimed to evaluate the prevalence of COVID-19 VBH among a highly educated subset of the German population and to explore the potential demographic, anamnestic, and psychosocial determinants of this problem. A cross-sectional survey-based study was conducted in December 2021 among German university students and employees to evaluate their attitudes toward COVID-19 vaccine booster (VB) doses. The study used a self-administered questionnaire that was developed and disseminated digitally, and the questionnaire inquired about participants' demographic characteristics, COVID-19-related anamnesis, COVID-19 vaccine-related anamnesis, and psychosocial predictors of COVID-19 VBH. A total of 930 participants were recruited, of which 608 (65.4%) were students, 682 (73.3%) were females, and their mean age was 29.08 ± 10.93 years. Fifty-five participants (5.9%) had been previously infected by COVID-19 and the vast majority of infections happened before the first vaccine dose. Over 95% of the participants had received at least one vaccine dose, and the most commonly administered vaccine was BNT162b2. The overall COVID-19 VB acceptance was satisfactory (87.8%) and induced by various altruistic promoters, e.g., family health protection, community health protection, and patients' health protection. The students (86.3%), the previously infected participants (76.4%), the participants who did not receive primer doses of COVID-19 vaccines (2.5 %), and those who were hospitalized (40%) and sought medical care/treatment after receiving primer doses (86.8%) were less likely to accept COVID-19 VB compared to the employees (90.7%), the participants who were not previously infected (88.6%) and those who received primer dose (91.7%), and the participants who were not hospitalized (92%) nor sought medical care/treatment after primer doses (92.9%), respectively. The perceived effectiveness of COVID-19 VB against severe illness (adjusted odds ratio “AOR”: 47.65–95% confidence interval “CI”: 23.65–96.49), symptomatic infection (AOR: 9.87–95% CI: 5.20–18.71), community transmission (AOR: 5.34–95% CI: 3.00–9.49) and emerging variants (AOR: 19.12–95% CI: 10.57–34.55) were key predictors for COVID-19 VB acceptance; therefore, it needs to be highlighted in vaccine messaging. In addition, the perceived safety of COVID-19 VB and ethical dilemmas of vaccine justice need to be addressed publicly.

Front Public Health2022       LitCov and CORD-19
5873Automatic detection of coronavirus disease using X-ray images and deep convolutional neural networks  

The 2019 novel coronavirus disease (COVID-19), with a starting point in China, has spread rapidly among people living in other countries and is approaching approximately 101,917,147 cases worldwide according to the statistics of World Health Organization. There are a limited number of COVID-19 test kits available in hospitals due to the increasing cases daily. Therefore, it is necessary to implement an automatic detection system as a quick alternative diagnosis option to prevent COVID-19 spreading among people. In this study, five pre-trained convolutional neural network-based models (ResNet50, ResNet101, ResNet152, InceptionV3 and Inception-ResNetV2) have been proposed for the detection of coronavirus pneumonia-infected patient using chest X-ray radiographs. We have implemented three different binary classifications with four classes (COVID-19, normal (healthy), viral pneumonia and bacterial pneumonia) by using five-fold cross-validation. Considering the performance results obtained, it has been seen that the pre-trained ResNet50 model provides the highest classification performance (96.1% accuracy for Dataset-1, 99.5% accuracy for Dataset-2 and 99.7% accuracy for Dataset-3) among other four used models.

Pattern Anal Appl2021       LitCov and CORD-19
5874Myocarditis, Pericarditis and Cardiomyopathy After COVID-19 Vaccination  

Heart Lung Circ2021       LitCov and CORD-19
5875Low 30-day mortality in South African orthopedic patients undergoing surgery at an academic hospital during the first wave of the COVID-19 pandemic: It was safe to perform orthopedic procedures at our hospital during the first COVID-19 peak  

N/A

S Afr Med J2021       LitCov and CORD-19
5876Evaluation of simple nucleic acid extraction methods for the detection of SARS-CoV-2 in nasopharyngeal and saliva specimens during global shortage of extraction kits  

BACKGROUND: The severe shortage of nucleic acid extraction kits during the current COVID-19 pandemic represents a key limiting factor in testing capacity. OBJECTIVES: This study compared the results of SARS-CoV-2 RT-PCR using different simple nucleic acid extraction methods on nasopharyngeal and saliva specimens. STUDY DESIGN: Fifty nasopharyngeal swab and saliva specimens previously tested positive for SARS-CoV-2 were retrieved. Three different methods of nucleic acid extraction were compared. The first method involves incubating the specimen, with proteinase K, and then heat treatment at 98°C for 5 min (PHK); the second method involves heat treatment at 98°C fir 5 min without proteinase K pre-incubation (heat only); the third method involves no pre-processing steps (direct). The products from all 3 methods were tested by SARS-CoV-2 RT-PCR. RESULTS: PKH had significantly higher positive rate in SARS-CoV-2 RT-PCR (80%)than those of heat only (58%; P=0.001) or direct (56%; P=0.002). The median Ct value was significantly earlier for PKH (median Ct: 37.0, IQR 31.7-40) than that of heat only (median Ct: 40, IQR 36.2-41; P<0.0001) and direct (median Ct, 37.5; IQR 33.9-41.0; P=0.0049). Subgroup analysis showed that PKH had higher detection rate, lower limit of detection and earlier Ct values than the other two groups for both NPS and saliva specimens. CONCLUSIONS: PKH pre-processing resulted in the highest detection rate of SARS-CoV-2 by RT-PCR, and can serve as an alternative for nucleic acid extraction when commercial extraction kits are not available.

J Clin Virol2020       LitCov and CORD-19
5877COVID-19 in pregnant women: a report based on 116 cases  

Abstract Background The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health emergency. Data on the effect of COVID-19 in pregnancy are limited to small case series. Objectives To evaluate the clinical characteristics and outcomes in pregnancy and the vertical transmission potential of SARS-CoV-2 infection. Study Desigh Clinical records were retrospectively reviewed for 116 pregnant women with COVID-19 pneumonia from 25 hospitals in China between January 20 and March 24, 2020. Evidence of vertical transmission was assessed by testing for SARS-CoV-2 in amniotic fluid, cord blood, and neonatal pharyngeal swab samples. Results The median gestational age on admission was 38+0 (IQR 36+0-39+1) weeks. The most common symptoms were fever (50.9%, 59/116) and cough (28.4%, 33/116); 23.3% (27/116) patients presented without symptoms. Abnormal radiologic findings were found in 96.3% (104/108) of cases. There were eight cases (6.9%, 8/116) of severe pneumonia but no maternal deaths. One of eight patients (1/8) that presented in the first- and early-second-trimester had a missed spontaneous abortion. Twenty-one of 99 patients (21.2%, 21/99) that had delivered had preterm birth, including six with preterm premature ruptured of membranes. The rate of spontaneous preterm birth before 37 weeks was 6.1% (6/99). There was one case of severe neonatal asphyxia that resulted in neonatal death. Eighty-six of the 100 neonates that had testing for SARS-CoV-2 had negative results, of these ten neonates had paired amniotic fluid and cord blood samples that were tested negative for SARS-CoV-2. Conclusions SARS-CoV-2 infection during pregnancy is not associated with an increased risk of spontaneous abortion and spontaneous preterm birth. There is no evidence of vertical transmission of SARS-CoV-2 infection when the infection manifests during the third-trimester of pregnancy.

Am J Obstet Gynecol2020       LitCov and CORD-19
5878Myocardial involvement in children with post-COVID multisystem inflammatory syndrome: a cardiovascular magnetic resonance based multicenter international study-the CARDOVID registry  

BACKGROUND: Recent evidence shows an association between coronavirus disease 2019 (COVID-19) infection and a severe inflammatory syndrome in children. Cardiovascular magnetic resonance (CMR) data about myocardial injury in children are limited to small cohorts. The aim of this multicenter, international registry is to describe clinical and cardiac characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 using CMR so as to better understand the real extent of myocardial damage in this vulnerable cohort. METHODS AND RESULTS: Hundred-eleven patients meeting the World Health Organization criteria for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having clinical cardiac involvement and having received CMR imaging scan were included from 17 centers. Median age at disease onset was 10.0 years (IQR 7.0–13.8). The majority of children had COVID-19 serology positive (98%) with 27% of children still having both, positive serology and polymerase chain reaction (PCR). CMR was performed at a median of 28 days (19–47) after onset of symptoms. Twenty out of 111 (18%) patients had CMR criteria for acute myocarditis (as defined by the Lake Louise Criteria) with 18/20 showing subepicardial late gadolinium enhancement (LGE). CMR myocarditis was significantly associated with New York Heart Association class IV (p = 0.005, OR 6.56 (95%-CI 1.87–23.00)) and the need for mechanical support (p = 0.039, OR 4.98 (95%-CI 1.18–21.02)). At discharge, 11/111 (10%) patients still had left ventricular systolic dysfunction. CONCLUSION: No CMR evidence of myocardial damage was found in most of our MIS-C cohort. Nevertheless, acute myocarditis is a possible manifestation of MIS-C associated with SARS-CoV-2 with CMR evidence of myocardial necrosis in 18% of our cohort. CMR may be an important diagnostic tool to identify a subset of patients at risk for cardiac sequelae and more prone to myocardial damage. Clinical trial registration: The study has been registered on ClinicalTrials.gov, Identifier NCT04455347, registered on 01/07/2020, retrospectively registered.

J Cardiovasc Magn Reson2021       LitCov and CORD-19
5879SARS-CoV-2 antibody seroprevalence in Lebanon: findings from the first nationwide serosurvey  

BACKGROUND: Lebanon, a small country in the Middle East, remains severely affected by the COVID-19 pandemic. Seroprevalence surveys of anti-SARS-CoV-2 antibodies provide accurate estimates of SARS-CoV-2 infection and hence evaluate the extent of the pandemic. The present study aimed to evaluate the prevalence of SARS-CoV-2 antibodies in Lebanon and to compare the estimated cumulative number of COVID-19 cases with the officially registered number of laboratory-confirmed cases up to January 15, 2021. METHODS: A nationwide population-based serosurvey study was conducted in Lebanon between December 7, 2020, and January 15, 2021, before the initiation of the national vaccination program. The nCOVID-19 IgG & IgM point-of-care (POCT) rapid test was used to detect the presence of anti-SARS-COV-2 immunoglobulin G (IgG) in the blood. Seroprevalence was estimated after weighting for sex, age, and area of residence and adjusting for the test performance. RESULTS: Of the 2058 participants, 329 were positive for IgG SARS-COV-2, resulting in a crude seroprevalence of 16.0% (95% CI 14.4–17.6). The weighed seroprevalence was 15.9% (95% CI of 14.4 and 17.4). After adjusting for test performance, the population weight-adjusted seroprevalence was 18.5% (95% CI 16.8–20.2). This estimate implies that 895,770 individuals of the general population were previously infected by COVID-19 up to January 15, 2021 in Lebanon. The overall estimated number of subjects with previous SARS-CoV-2 infection was three times higher than the officially reported cumulative number of confirmed cases. Seroprevalence was similar across age groups and sexes (p-value > 0.05). However, significant differences were revealed across governorates. CONCLUSIONS: Our results suggest that the Lebanese population is still susceptible to SARS-CoV-2 infection and far from achieving herd immunity. These findings represent an important contribution to the surveillance of the COVID-19 pandemic in Lebanon and to the understanding of how this virus spreads. Continued surveillance for COVID-19 cases and maintaining effective preventive measures are recommended to control the epidemic spread in conjunction with a national vaccination campaign to achieve the desired level of herd immunity against COVID-19. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07031-z.

BMC Infect Dis2022       LitCov and CORD-19
5880A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients  

ABSTRACT Background The pandemic of COVID-19 is growing, and a shortage of masks and respirators has been reported globally. Policies of health organizations for healthcare workers are inconsistent, with a change in policy in the US for universal face mask use. The aim of this study was to review the evidence around the efficacy of masks and respirators for healthcare workers, sick patients and the general public. Methods A systematic review of randomized controlled clinical trials on use of respiratory protection by healthcare workers, sick patients and community members was conducted. Articles were searched on Medline and Embase using key search terms. Results A total of 19 randomised controlled trials were included in this study – 8 in community settings, 6 in healthcare settings and 5 as source control. Most of these randomised controlled trials used different interventions and outcome measures. In the community, masks appeared to be more effective than hand hygiene alone, and both together are more protective. Randomised controlled trials in health care workers showed that respirators, if worn continually during a shift, were effective but not if worn intermittently. Medical masks were not effective, and cloth masks even less effective. When used by sick patients randomised controlled trials suggested protection of well contacts. Conclusion The study suggests that community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings. Trials in healthcare workers support the use of respirators continuously during a shift. This may prevent health worker infections and deaths from COVID-19, as aerosolisation in the hospital setting has been documented.

Int J Nurs Stud2020       LitCov and CORD-19
5881An update on COVID-19 and pregnancy  

Physiologic, mechanical and immunologic alterations in pregnancy could potentially affect susceptibility to and severity of COVID-19 during pregnancy. Due to lack of comparable incidence data and challenges with disentangling differences in susceptibility from different exposure risks, data are insufficient to determine whether pregnancy increases susceptibility to SARS-CoV-2 infection. Data support pregnancy as a risk factor for severe disease associated with COVID-19; some of the best evidence comes from the Centers for Disease Control and Prevention’s (CDC’s) COVID-19 surveillance system, which reported that pregnant persons were more likely to be admitted to an intensive care unit (ICU), require invasive ventilation, require extracorporeal membrane oxygenation, and die compared with nonpregnant women of reproductive age. Although intrauterine transmission of SARS-CoV-2 has been documented, it appears to be rare, possibly related to low levels of SARS-CoV-2 viremia and decreased co-expression of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) needed for SARS-CoV-2 entry into cells in the placenta. Evidence is accumulating that SARS-CoV-2 infection during pregnancy is associated with a number of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth, especially among pregnant persons with severe COVID-19 disease. In addition to the direct impact of COVID-19 on pregnancy outcomes, there is evidence that the pandemic and its effects on healthcare systems have had adverse effects on pregnancy outcomes, such as increased stillbirths and maternal deaths. These trends may represent widening disparities and an alarming reversal of recent improvements in maternal and infant health. All three COVID-19 vaccines currently available under an Emergency Use Authorization by the United States Food and Drug Administration can be administered to pregnant or lactating persons, with no preference for vaccine type. Although safety data in pregnancy are rapidly accumulating and no safety signals in pregnancy have been detected, additional information about birth outcomes, particularly among persons vaccinated earlier in pregnancy, are needed.

Am J Obstet Gynecol2021       LitCov and CORD-19
5882Predictors of households at risk for food insecurity in the United States during the COVID-19 pandemic  

OBJECTIVE: To examine associations between sociodemographic and mental health characteristics with household risk for food insecurity during the COVID-19 outbreak. DESIGN: Cross-sectional online survey analysed using univariable tests and a multivariable logistic regression model. SETTING: The United States during the week of 30 March 2020. PARTICIPANTS: A convenience sample of 1965 American adults using Amazon’s Mechanical Turk platform. Participants reporting household food insecurity prior to the pandemic were excluded from analyses. RESULTS: One thousand two hundred and fifty participants reported household food security before the COVID-19 outbreak. Among this subset, 41 % were identified as at risk for food insecurity after COVID-19, 55 % were women and 73 % were white. On a multivariable analysis, race, income, relationship status, living situation, anxiety and depression were significantly associated with an incident risk for food insecurity. Black, Asian and Hispanic/Latino respondents, respondents with an annual income <$100 000 and those living with children or others were significantly more likely to be newly at risk for food insecurity. Individuals at risk for food insecurity were 2·60 (95 % CI 1·91, 3·55) times more likely to screen positively for anxiety and 1·71 (95 % CI 1·21, 2·42) times more likely to screen positively for depression. CONCLUSIONS: An increased risk for food insecurity during the COVID-19 pandemic is common, and certain populations are particularly vulnerable. There are strong associations between being at risk for food insecurity and anxiety/depression. Interventions to increase access to healthful foods, especially among minority and low-income individuals, and ease the socioemotional effects of the outbreak are crucial to relieving the economic stress of this pandemic.

Public Health Nutr2021       LitCov and CORD-19
5883Long COVID, or Post-COVID Syndrome and the Global Impact on Healthcare  

During 2020, increasing numbers of case reports, case series, and small observational studies reported long-term complications of coronavirus disease 2019 (COVID-19) in patients who had recovered from acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Long COVID has a prevalence of between 10–30% in patients with a recent history of SARS-CoV-2 infection. Pulmonary, hematologic, cardiovascular, neuropsychiatric, renal, endocrine, gastrointestinal and hepatobiliary, and dermatologic involvement, and chronic multisystem inflammatory syndrome in children (MIS-C) highlights the requirement for a multidisciplinary approach to the management of patients with long COVID. This Editorial aims to present the current status of long COVID, or post-COVID syndrome, and its global impact on health and the provision of health care.

Med Sci Monit2021       LitCov and CORD-19
5884Neuroinvasion of SARS-CoV-2 in human and mouse brain  

Although COVID-19 is considered to be primarily a respiratory disease, SARS-CoV-2 affects multiple organ systems including the central nervous system (CNS). Yet, there is no consensus on the consequences of CNS infections. Here, we used three independent approaches to probe the capacity of SARS-CoV-2 to infect the brain. First, using human brain organoids, we observed clear evidence of infection with accompanying metabolic changes in infected and neighboring neurons. However, no evidence for type I interferon responses was detected. We demonstrate that neuronal infection can be prevented by blocking ACE2 with antibodies or by administering cerebrospinal fluid from a COVID-19 patient. Second, using mice overexpressing human ACE2, we demonstrate SARS-CoV-2 neuroinvasion in vivo. Finally, in autopsies from patients who died of COVID-19, we detect SARS-CoV-2 in cortical neurons and note pathological features associated with infection with minimal immune cell infiltrates. These results provide evidence for the neuroinvasive capacity of SARS-CoV-2 and an unexpected consequence of direct infection of neurons by SARS-CoV-2.

J Exp Med2021       LitCov and CORD-19
5885Clinical and Pulmonary CT Characteristics of Patients Infected With the SARS-CoV-2 Omicron Variant Compared With Those of Patients Infected With the Alpha Viral Strain  

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Front Public Health2022       LitCov
5886Critical Determinants of Cytokine Storm and Type I Interferon Response in COVID-19 Pathogenesis  

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), a rapidly evolving pandemic worldwide with at least 68 million COVID-19-positive cases and a mortality rate of about 2.2%, as of 10 December 2020. About 20% of COVID-19 patients exhibit moderate to severe symptoms. Severe COVID-19 manifests as acute respiratory distress syndrome (ARDS) with elevated plasma proinflammatory cytokines, including interleukin 1β (IL-1β), IL-6, tumor necrosis factor α (TNF-α), C-X-C motif chemokine ligand 10 (CXCL10/IP10), macrophage inflammatory protein 1 alpha (MIP-1α), and chemokine (C-C motif) ligand 2 (CCL2), with low levels of interferon type I (IFN-I) in the early stage and elevated levels of IFN-I during the advanced stage of COVID-19. Most of the severe and critically ill COVID-19 patients have had preexisting comorbidities, including hypertension, diabetes, cardiovascular diseases, and respiratory diseases. These conditions are known to perturb the levels of cytokines, chemokines, and angiotensin-converting enzyme 2 (ACE2), an essential receptor involved in SARS-CoV-2 entry into the host cells. ACE2 downregulation during SARS-CoV-2 infection activates the angiotensin II/angiotensin receptor (AT1R)-mediated hypercytokinemia and hyperinflammatory syndrome. However, several SARS-CoV-2 proteins, including open reading frame 3b (ORF3b), ORF6, ORF7, ORF8, and the nucleocapsid (N) protein, can inhibit IFN type I and II (IFN-I and -II) production. Thus, hyperinflammation, in combination with the lack of IFN responses against SARS-CoV-2 early on during infection, makes the patients succumb rapidly to COVID-19. Therefore, therapeutic approaches involving anti-cytokine/anti-cytokine-signaling and IFN therapy would favor the disease prognosis in COVID-19. This review describes critical host and viral factors underpinning the inflammatory “cytokine storm” induction and IFN antagonism during COVID-19 pathogenesis. Therapeutic approaches to reduce hyperinflammation and their limitations are also discussed.

Clin Microbiol Rev2021       LitCov and CORD-19
5887Current therapeutic options for COVID-19-lessons learned from severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) therapy: a systematic review protocol  

N/A

Ann Transl Med2020       LitCov and CORD-19
5888Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation  

BACKGROUND: : Since the outbreak of 2019 new coronavirus (COVID-19) pneumonia, healthcare workers (HCW) have suffered psychological stress. The present study is to examine the prevalence of stress, anxiety and depression of HCW in China during the COVID-19 epidemic, and to determine the risk factors predicting psychological morbidities that can be used as psychological intervention targets. METHODS: : A cross-sectional survey was conducted to investigate the psychological levels of HCW in multiple centers in China. The prevalence of stress, anxiety and depression were determined by using Perceived Stress Scale (PSS-14) and Hospital Anxiety / Depression scale (HAD). Psychology related factors were evaluated and correlation between job title and contact history was analyzed. RESULTS: : We received 958 of effective responses, 73.6% of which were from Wuhan and 67.2% were female participants. 55.1% of respondents had psychological stress that is higher than that of HCW during SARS. 54.2% and 58% of participants had symptoms of anxiety and depression. Stress levels of HCW were different in job titles and years of work experience. Anxiety and depression levels were different between different gender, job titles, degrees of protective measures and levels of contact history. Gender, intermediate title, protective measures and contact history were the independent risk factors for anxiety. Protective measures and contact history were the independent risk factors for depression. CONCLUSIONS: : The COVID-19 epidemic has induced stress levels for HCW, and high percentages of HCW have anxiety and depression. The situation of HCW is worrying and intervention service is urgent.

J Affect Disord2020       LitCov and CORD-19
5889Safety and immunogenicity of an inactivated COVID-19 vaccine, BBIBP-CorV, in people younger than 18 years: a randomised, double-blind, controlled, phase 1/2 trial  

BACKGROUND: Although SARS-CoV-2 infection often causes milder symptoms in children and adolescents, young people might still play a key part in SARS-CoV-2 transmission. An efficacious vaccine for children and adolescents could therefore assist pandemic control. For further evaluation of the inactivated COVID-19 vaccine candidate BBIBP-CorV, we assessed the safety and immunogenicity of BBIBP-CorV in participants aged 3–17 years. METHODS: A randomised, double-blind, controlled, phase 1/2 trial was done at Shangqiu City Liangyuan District Center for Disease Control and Prevention in Henan, China. In phases 1 and 2, healthy participants were stratified according to age (3–5 years, 6–12 years, or 13–17 years) and dose group. Individuals with a history of SARS-CoV-2 or SARS-CoV infection were excluded. All participants were randomly assigned, using stratified block randomisation (block size eight), to receive three doses of 2 μg, 4 μg, or 8 μg of vaccine or control (1:1:1:1) 28 days apart. The primary outcome, safety, was analysed in the safety set, which consisted of participants who had received at least one vaccination after being randomly assigned, and had any safety evaluation information. The secondary outcomes were geometric meant titre (GMT) of the neutralising antibody against infectious SARS-CoV-2 and were analysed based on the full analysis set. This study is registered with www.chictr.org.cn, ChiCTR2000032459, and is ongoing. FINDINGS: Between Aug 14, 2020, and Sept 24, 2020, 445 participants were screened, and 288 eligible participants were randomly assigned to vaccine (n=216, 24 for each dose level [2/4/8 μg] in each of three age cohorts [3–5, 6–12, and 13–17 years]) or control (n=72, 24 for each age cohort [3–5, 6–12, and 13–17 years]) in phase 1. In phase 2, 810 participants were screened and 720 eligible participants were randomly assigned and allocated to vaccine (n=540, 60 for each dose level [2/4/8 μg] in each of three age cohorts [3–5, 6–12, and 13–17 years]) or control (n=180, 60 for each age cohort [3–5, 6–12, and 13–17 years]). The most common injection site adverse reaction was pain (ten [4%] 251 participants in all vaccination groups of the 3–5 years cohort; 23 [9·1%] of 252 participants in all vaccination groups and one [1·2%] of 84 in the control group of the 6–12 years cohort; 20 [7·9%] of 252 participants in all vaccination groups of the 13–17 years cohort). The most common systematic adverse reaction was fever (32 [12·7%] of 251 participants in all vaccination groups and six [7·1%] of 84 participants in the control group of the 3–5 years cohort; 13 [5·2%] of 252 participants in the vaccination groups and one [1·2%] of 84 in the control group of the 6–12 years cohort; 26 [10·3%] of 252 participants in all vaccination groups and eight [9·5%] of 84 in the control group of the 13–17 years cohort). Adverse reactions were mostly mild to moderate in severity. The neutralising antibody GMT against the SARS-CoV-2 virus ranged from 105·3 to 180·2 in the 3–5 years cohort, 84·1 to 168·6 in the 6–12 years cohort, and 88·0 to 155·7 in the 13–17 years cohort on day 28 after the second vaccination; and ranged from 143·5 to 224·4 in the 3–5 years cohort, 127 to 184·8 in the 6–12 years cohort, and 150·7 to 199 in the 13–17 years cohort on day 28 after the third vaccination. INTERPRETATION: The inactivated COVID-19 vaccine BBIBP-CorV is safe and well tolerated at all tested dose levels in participants aged 3–17 years. BBIBP-CorV also elicited robust humoral responses against SARS-CoV-2 infection after two doses. Our findings support the use of a 4 μg dose and two-shot regimen BBIBP-CorV in phase 3 trials in the population younger than 18 years to further ascertain its safety and protection efficacy against COVID-19. FUNDING: National Program on Key Research Project of China, National Mega projects of China for Major Infectious Diseases, National Mega Projects of China for New Drug Creation, and Beijing Science and Technology Plan. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Lancet Infect Dis2021       LitCov and CORD-19
5890Immunogenicity and Reactogenicity of Vaccine Boosters after Ad26.COV2.S Priming  

BACKGROUND: The Ad26.COV2.S vaccine, which was approved as a single-shot immunization regimen, has been shown to be effective against severe coronavirus disease 2019. However, this vaccine induces lower severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein (S)–specific antibody levels than those induced by messenger RNA (mRNA)–based vaccines. The immunogenicity and reactogenicity of a homologous or heterologous booster in persons who have received an Ad26.COV2.S priming dose are unclear. METHODS: In this single-blind, multicenter, randomized, controlled trial involving health care workers who had received a priming dose of Ad26.COV2.S vaccine, we assessed immunogenicity and reactogenicity 28 days after a homologous or heterologous booster vaccination. The participants were assigned to receive no booster, an Ad26.COV2.S booster, an mRNA-1273 booster, or a BNT162b2 booster. The primary end point was the level of S-specific binding antibodies, and the secondary end points were the levels of neutralizing antibodies, S-specific T-cell responses, and reactogenicity. A post hoc analysis was performed to compare mRNA-1273 boosting with BNT162b2 boosting. RESULTS: Homologous or heterologous booster vaccination resulted in higher levels of S-specific binding antibodies, neutralizing antibodies, and T-cell responses than a single Ad26.COV2.S vaccination. The increase in binding antibodies was significantly larger with heterologous regimens that included mRNA-based vaccines than with the homologous booster. The mRNA-1273 booster was most immunogenic and was associated with higher reactogenicity than the BNT162b2 and Ad26.COV2.S boosters. Local and systemic reactions were generally mild to moderate in the first 2 days after booster administration. CONCLUSIONS: The Ad26.COV2.S and mRNA boosters had an acceptable safety profile and were immunogenic in health care workers who had received a priming dose of Ad26.COV2.S vaccine. The strongest responses occurred after boosting with mRNA-based vaccines. Boosting with any available vaccine was better than not boosting. (Funded by the Netherlands Organization for Health Research and Development ZonMw; SWITCH ClinicalTrials.gov number, NCT04927936.)

N Engl J Med2022       LitCov and CORD-19
5891Early rate reductions of SARS-CoV-2 infection and COVID-19 in BNT162b2 vaccine recipients  

Lancet2021       LitCov and CORD-19
5892A Comparative Study of Real-Time RT-PCR-Based SARS-CoV-2 Detection Methods and Its Application to Human-Derived and Surface Swabbed Material  

Real-time reverse transcription polymerase chain reaction (RT-PCR) remains a gold standard in detection of various viral diseases. In the COVID-19 pandemic, multiple RT-PCR based tests were developed to screen for viral infection. As an emergency response to growing testing demand, we established a SARS-CoV-2 PCR diagnostics platform for which we compared different commercial and in-house RT-PCR protocols. Four commercial (CDC 2019-nCoV, Applied BiosystemsTM 2019-nCoV Assay Kit v1 TF-SinglePlex, 2019-nCoV Assay Kit v2 TF-MultiPlex, and EURORealTime SARS-CoV-2), one customized (Institute Pasteur), and one in-house RT-PCR protocols were evaluated with 92 SARS-CoV-2 positive and 92 SARS-CoV-2 negative samples. Furthermore, economical and practical characteristics of these protocols were compared. Additionally, a highly sensitive digital droplet PCR (ddPCR) method was developed and application of RT- and ddPCR methods on SARS-CoV-2 environmental samples was examined. Very low limits of detection (1 or 2 viral copies/μL), high sensitivities (93.6-97.8%) and specificities (98.7-100%) for the tested RT-PCR protocols were found. Furthermore, the feasibility of downscaling two of the commercial protocols, which could optimize testing capacity was demonstrated. Tested commercial and customized RT-PCR detection kits show very good and comparable sensitivity, and specificity, and the kits could be further optimized for use on SARS-CoV-2 viral samples derived from human and surface swabbed samples.

J Mol Diagn2021       LitCov and CORD-19
5893Severe vitamin D deficiency is not related to SARS-CoV-2 infection but may increase mortality risk in hospitalized adults: a retrospective case-control study in an Arab Gulf country  

PURPOSE: As the world continues to cautiously navigate its way through the coronavirus disease 2019 (COVID-19) pandemic, several breakthroughs in therapies and vaccines are currently being developed and scrutinized. Consequently, alternative therapies for severe acute respiratory coronavirus 2 (SARS-CoV-2) prevention, such as vitamin D supplementation, while hypothetically promising, require substantial evidence from countries affected by COVID-19. The present retrospective case–control study aims to identify differences in vitamin D status and clinical characteristics of hospitalized patients screened for SARS-CoV-2, and determine associations of vitamin D levels with increased COVID-19 risk and mortality. METHODS: A total of 222 [SARS-CoV-2 (+) N = 150 (97 males; 53 females); SARS-CoV-2 (−) N = 72 (38 males, 34 females)] out of 550 hospitalized adult patients screened for SARS-CoV-2 and admitted at King Saud University Medical City-King Khalid University Hospital (KSUMC-KKUH) in Riyadh, Saudi Arabia from May–July 2020 were included. Clinical, radiologic and serologic data, including 25(OH)D levels were analyzed. RESULTS: Vitamin D deficiency (25(OH)D < 50 nmol/l) was present in 75% of all patients. Serum 25(OH)D levels were significantly lower among SARS-CoV-2 (+) than SARS-CoV-2 (−) patients after adjusting for age, sex and body mass index (BMI) (35.8 ± 1.5 nmol/l vs. 42.5 ± 3.0 nmol/l; p = 0.037). Multivariate regression analysis revealed that significant predictors for SARS-CoV-2 include age > 60 years and pre-existing conditions (p < 0.05). Statistically significant predictors for mortality adjusted for covariates include male sex [Odds ratio, OR 3.3 (95% confidence interval, CI 1.2–9.2); p = 0.02], chronic kidney disease [OR 3.5 (95% CI 1.4–8.7); p = 0.008] and severe 25(OH)D deficiency (< 12.5 nmol/l), but at borderline significance [OR 4.9 (95% CI (0.9–25.8); p = 0.06]. CONCLUSION: In hospital settings, 25(OH)D deficiency is not associated with SARS-CoV-2 infection, but may increase risk for mortality in severely deficient cases. Clinical trials are warranted to determine whether vitamin D status correction provides protective effects against worse COVID-19 outcomes.

Aging Clin Exp Res2021       LitCov and CORD-19
5894Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis  

OBJECTIVE: To report mode of delivery and immediate neonatal outcome in women infected with COVID‐19. DESIGN: Retrospective study. SETTING: Twelve hospitals in northern Italy. PARTICIPANTS: Pregnant women with COVID‐19‐confirmed infection who delivered. EXPOSURE: COVID 19 infection in pregnancy. METHODS: SARS‐CoV‐2‐infected women who were admitted and delivered from 1 to 20 March 2020 were eligible. Data were collected from the clinical records using a standardised questionnaire on maternal general characteristics, any medical or obstetric co‐morbidity, course of pregnancy, clinical signs and symptoms, treatment of COVID 19 infection, mode of delivery, neonatal data and breastfeeding. MAIN OUTCOME AND MEASURES: Data on mode of delivery and neonatal outcome. RESULTS: In all, 42 women with COVID‐19 delivered at the participating centres; 24 (57.1%, 95% CI 41.0–72.3) delivered vaginally. An elective caesarean section was performed in 18/42 (42.9%, 95% CI 27.7–59.0) cases: in eight cases the indication was unrelated to COVID‐19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI 29.8–61.3) cases: of these, 7/19 (36.8%, 95% CI 16.3–61.6) required oxygen support and 4/19 (21.1%, 95% CI 6.1–45.6) were admitted to a critical care unit. Two women with COVID‐19 breastfed without a mask because infection was diagnosed in the postpartum period: their newborns tested positive for SARS‐Cov‐2 infection. In one case, a newborn had a positive test after a vaginal operative delivery. CONCLUSIONS: Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS‐Cov‐2 transmission to the newborn. TWEETABLE ABSTRACT: This study suggests that vaginal delivery may be associated with a low risk of intrapartum SARS‐Cov‐2 transmission to the newborn.

BJOG2020       LitCov and CORD-19
5895Attitudes and Perceptions of Multidisciplinary Cancer Care Clinicians Towards Telehealth and Secure Messages  

IMPORTANCE: Telehealth use including secure messages has rapidly expanded since the COVID-19 pandemic, including for multidisciplinary aspects of cancer care. Recent reports described rapid uptake and various benefits for patients and clinicians, suggesting that telehealth may be in standard use after the pandemic. OBJECTIVE: To examine attitudes and perceptions of multidisciplinary cancer care clinicians toward telehealth and secure messages. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional specialty-specific survey (ie, some questions appear only for relevant specialties) among multidisciplinary cancer care clinicians, collected from April 29, 2020, to June 5, 2020. Participants were all 285 clinicians in the fields of medical oncology, radiation oncology, surgical oncology, survivorship, and oncology navigation from all 21 community cancer centers of Kaiser Permanente Northern California. MAIN OUTCOMES AND MEASURES: Clinician satisfaction, perceived benefits and challenges of telehealth, perceived quality of telehealth and secure messaging, preferred visit and communication types for different clinical activities, and preferences regarding postpandemic telehealth use. RESULTS: A total of 202 clinicians (71%) responded (104 of 128 medical oncologists, 34 of 37 radiation oncologists, 16 of 62 breast surgeons, 18 of 28 navigators, and 30 of 30 survivorship experts; 57% (116 of 202) were women; 73% [147 of 202] between ages 36-55 years). Seventy-six percent (n = 154) were satisfied with telehealth without statistically significant variations based on clinician characteristics. In-person visits were thought to promote a strong patient-clinician connection by 99% (n = 137) of respondents compared with 77% (n = 106) for video visits, 43% (n = 59) for telephone, and 14% (n = 19) for secure messages. The most commonly cited benefits of telehealth to clinicians included reduced commute (79%; n = 160), working from home (74%; n = 149), and staying on time (65%; n = 132); the most commonly cited negative factors included internet connection (84%; n = 170) or equipment problems (72%; n = 146), or physical examination needed (64%; n = 131). Most respondents (59%; n = 120) thought that video is adequate to manage the greater part of patient care in general; and most deemed various telehealth modalities suitable for any of the queried types of patient-clinician activities. For some specific activities, less than half of respondents thought that only an in-person visit is acceptable (eg, 49%; n = 66 for end-of-life discussion, 35%; n = 58 for new diagnosis). Most clinicians (82%; n = 166) preferred to maintain or increase use of telehealth after the pandemic. CONCLUSIONS AND RELEVANCE: In this survey of multidisciplinary cancer care clinicians in the COVID-19 era, telehealth was well received and often preferred by most cancer care clinicians, who deemed it appropriate to manage most aspects of cancer care. As telehealth use becomes routine in some cancer care settings, video and telephone visits and use of asynchronous secure messaging with patients in cancer care has clear potential to extend beyond the pandemic period.

JAMA Netw Open2021       LitCov and CORD-19
5896Parents' Intentions to Vaccinate Their Children Against COVID-19  

INTRODUCTION: With the COVID-19 vaccine rollout is well underway now beginning in children ages 12 and over, it is unknown what percent of parents plan to vaccinate their children against COVID-19. METHOD: The purpose of this descriptive correlational study was to examine parents’ attitudes, beliefs, and behaviors in administering a COVID-19 vaccine. RESULTS: Only 21.93% of the subjects reported overall VH. Half of parents (49.45%) say they want the COVID vaccine for their child, and 44.17% plan to vaccinate against COVID once the vaccine becomes available to them. Concern for vaccine side effects (61.5%) and vaccine safety (48.96%) were significant factors that increased VH. In addition, there was a significant correlation between parents who were planning to vaccinate their child against the flu and being less VH about a COVID-19 vaccine for their child. DISCUSSION: This is the first known study to describe parental perceptions’ of COVID-19 VH and identify factors that increase VH for parents.

J Pediatr Healthcare2021       LitCov and CORD-19
5897Coronaviruses-drug discovery and therapeutic options  

In humans, infections with the human coronavirus (HCoV) strains HCoV-229E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1 usually result in mild, self-limiting upper respiratory tract infections, such as the common cold. By contrast, the CoVs responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which were discovered in Hong Kong, China, in 2003, and in Saudi Arabia in 2012, respectively, have received global attention over the past 12 years owing to their ability to cause community and health-care-associated outbreaks of severe infections in human populations. These two viruses pose major challenges to clinical management because there are no specific antiviral drugs available. In this Review, we summarize the epidemiology, virology, clinical features and current treatment strategies of SARS and MERS, and discuss the discovery and development of new virus-based and host-based therapeutic options for CoV infections. SUPPLEMENTARY INFORMATION: The online version of this article (doi:10.1038/nrd.2015.37) contains supplementary material, which is available to authorized users.

Nat Rev Drug Discov2016       CORD-19
5898Endogenous Antibody Responses to SARS-CoV-2 in Patients With Mild or Moderate COVID-19 Who Received Bamlanivimab Alone or Bamlanivimab and Etesevimab Together  

BACKGROUND: Neutralizing monoclonal antibodies (mAbs) to SARS-CoV-2 are clinically efficacious when administered early, decreasing hospitalization and mortality in patients with mild or moderate COVID-19. We investigated the effects of receiving mAbs (bamlanivimab alone and bamlanivimab and etesevimab together) after SARS-CoV-2 infection on the endogenous immune response. METHODS: Longitudinal serum samples were collected from patients with mild or moderate COVID-19 in the BLAZE-1 trial who received placebo (n=153), bamlanivimab alone [700 mg (n=100), 2800 mg (n=106), or 7000 mg (n=98)], or bamlanivimab (2800 mg) and etesevimab (2800 mg) together (n=111). A multiplex Luminex serology assay measured antibody titers against SARS-CoV-2 antigens, including SARS-CoV-2 protein variants that evade bamlanivimab or etesevimab binding, and SARS-CoV-2 pseudovirus neutralization assays were performed. RESULTS: The antibody response in patients who received placebo or mAbs had a broad specificity. Titer change from baseline against a receptor-binding domain mutant (Spike-RBD E484Q), as well as N-terminal domain (Spike-NTD) and nucleocapsid protein (NCP) epitopes were 1.4 to 4.1 fold lower at day 15-85 in mAb recipients compared with placebo. Neutralizing activity of day 29 sera from bamlanivimab monotherapy cohorts against both spike E484Q and beta variant (B.1.351) were slightly reduced compared with placebo (by a factor of 3.1, p=0.001, and 2.9, p=0.002, respectively). Early viral load correlated with the subsequent antibody titers of the native, unmodified humoral response (p<0.0001 at Day 15, 29, 60 and 85 for full-length spike). CONCLUSIONS: Patients with mild or moderate COVID-19 treated with mAbs develop a wide breadth of antigenic responses to SARS-CoV-2. Small reductions in titers and neutralizing activity, potentially due to a decrease in viral load following mAb treatment, suggest minimal impact of mAb treatment on the endogenous immune response.

Front Immunol2021       LitCov and CORD-19
5899Care homes, their communities and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study  

BACKGROUND: From late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed. METHODS: Ten managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals. RESULTS: Three key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care. CONCLUSIONS: This study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.

BMC Geriatr2021       LitCov and CORD-19
5900Concerns for low-resource countries, with under-prepared intensive care units, facing the COVID-19 pandemic  

BACKGROUND: Low-resource countries with fragile healthcare systems lack trained healthcare professionals and specialized resources for COVID-19 patient hospitalization, including mechanical ventilators. Additional socio-economic complications such as civil war and financial crisis in Libya and other low-resource countries further complicate healthcare delivery. METHODS: A cross-sectional survey evaluating hospital and intensive care unit's capacity and readiness was performed from 16 leading Libyan hospitals in March 2020. In addition, a survey was conducted among 400 doctors who worked in these hospitals to evaluate the status of personal protective equipment. RESULTS: Out of 16 hospitals, the highest hospital capacity was 1000 in-patient beds, while the lowest was 25 beds with a median of 200 (IQR 52-417, range 25 – 1000) hospital beds. However, a median of only eight (IQR 6-14, range 3 – 37) available functioning ICU beds were reported in these hospitals. Only 9 (IQR 4.5-14, range 2 – 20) mechanical ventilators were reported and none of the hospitals had a reverse transcription-polymerase chain reaction machine for COVID-19 testing. Moreover, they relied on one of two central laboratories located in major cities. Our PPE survey revealed that 56.7% hospitals lacked PPE and 53% of healthcare workers reported that they did not receive proper PPE training. In addition, 70% reported that they were buying the PPE themselves as hospitals did not provide them. CONCLUSIONS: This study provides an alarming overview of the unpreparedness of Libyan hospitals for detecting and treating patients with COVID-19 and limiting the spread of the pandemic.

Infect Dis Health2020       LitCov and CORD-19

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(3) Currently tweets of June 23rd to June 29th 2022 have been considered.

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