COVID 19: Understanding the Disease to Implement Containment Strategies
Morbidity, treatment options, Ophthalmologist, personal protection, COVID-19, containment strategies
COVID-19, the novel coronavirus is a global threat which has hit all with the force of a hurricane. The vast biological and economic impact of this virus threatens to crumble our health resources, if not handled with caution. In order to battle this pandemic on all fronts, awareness of nature of virus, its transmission, virulence clinical features, complications and management options is essential. We as comprehensive ophthalmologists and more importantly as responsible clinicians, need to update ourselves with knowledge pertaining to this novel virus to safeguard our human resources including ourselves against this powerful enemy. The article reviews basic information about etiology, transmission patterns, clinical picture, diagnostics, treatment and preventive measures of this infection. This is in concordance with the maxim “Know thy enemy”. It also stresses on the precautions to be observed by all healthcare personnel to ensure safety and contain spread. We bear onus of becoming aware of spreading this awareness to break the chain of contagion.
Nandini Sharma, Kirti Singh, Jatinder Bali, Arshi Singh
Epidemiologic Characteristics, Transmission Chain, and Risk Factors of Severe Infection of COVID-19 in Tianjin, a Representative Municipality City of China
gender, Risk factors, epidemiologic characteristics, transmission chain, SARS-CoV-2, corona virus disease 2019
This study was performed to describe the epidemiologic characteristics of coronavirus disease 2019 (COVID-19) and explore risk factors for severe infection. Data of all 131 confirmed cases in Tianjin before February 20 were collected. By February 20, a total of 14/16 districts reported COVID-19 cases, with Baodi district reporting the most cases (n = 56). A total of 22 (16.8%) cases had a Wuhan-related exposure. Fever was the most common symptom (82.4%). The median duration of symptom onset to treatment was [1.0 (0.0–4.0) days], the duration of symptom onset to isolation [2.0 (0.0–6.0) days], and the duration of symptom onset to diagnosis [5.0 (2.0–8.0) days]. The analysis of the transmission chain showed two cluster infections with 62 cases infected. Transmission from a family member constituted 42%, usually at the end of transmission chain. Compared with patients with non-severe infections, patients with severe infections were more likely to be male (46.2 vs. 77.3%, P = 0.009) and had a Wuhan-related exposure (14.0 vs. 40.9%, P = 0.004). Multivariate logistic regression showed that male (OR 3.913, 95% CI 1.206, 12.696; P = 0.023) was an independent risk factor for severe infection. This study provides evidence on the epidemic of COVID-19 by analyzing the epidemiological characteristics of confirmed cases in Tianjin. Self-quarantine at an outbreak's early stage, especially for those with high-risk exposures, is conducive to prevent the transmission of infection. Further investigation is needed to confirm the risk factors for severe COVID-19 infection and investigate the mechanisms involved.
Huan Hu, Jin Wang, Zhihui Li, Pengyuan Li, Jiahai Lu, Xiaomin Cheng, Zeliang Chen, Cong-Hui Liao
A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19
COVID-19 often leads to acute respiratory distress syndrome complicated by acute kidney injury (AKI). The indications for renal replacement therapy for these patients are those commonly accepted to treat AKI. We describe a continuous veno-venous haemodialysis (CVVHD) protocol for AKI, which aims to provide the best treatment according to the particular patient’s and medical personnels’ needs in biohazard settings with limited human and technological resources. We designed a CVVHD protocol with a high cut-off (HCO) filter in regional citrate anticoagulation (RCA). The HCO filter in diffusion determines the enhanced cytokines clearance with less filter clotting due to a lower filtration fraction. In our hospital, at the beginning of the pandemic outbreak, we treated seven COVID-19 patients with AKI stage 2 and 3 and recorded the circuit lifespan and the number of interventions on monitors. CVVHD in RCA appears to be safe, effective and easy to be performed in a biohazard scenario using lower blood flows and less bag changes with fluid savings, a biohazard reduction and sparing of resources. Although the data come from a very small cohort, our protocol seems related to a low mortality.
Lorenzo A. Calò, Federico Nalesso, Laura Gobbi, Francesco Garzotto, Ivo Tiberio, Leda Cattarin, Laila Qassim, Luca Sgarabotto
Analysis of a Model for Coronavirus Spread
stability, Basic reproduction number, epidemics, dynamical systems, compartment model
The spread of epidemics has always threatened humanity. In the present circumstance of the Coronavirus pandemic, a mathematical model is considered. It is formulated via a compartmental dynamical system. Its equilibria are investigated for local stability. Global stability is established for the disease-free point. The allowed steady states are an unlikely symptomatic-infected-free point, which must still be considered endemic due to the presence of asymptomatic individuals; and the disease-free and the full endemic equilibria. A transcritical bifurcation is shown to exist among them, preventing bistability. The disease basic reproduction number is calculated. Simulations show that contact restrictive measures are able to delay the epidemic’s outbreak, if taken at a very early stage. However, if lifted too early, they could become ineffective. In particular, an intermittent lock-down policy could be implemented, with the advantage of spreading the epidemics over a longer timespan, thereby reducing the sudden burden on hospitals.
Ezio Venturino, Mohamed Helal, Youcef Belgaid
Recomendaciones para la analgesia o anestesia de pacientes obstétricas con COVID-19
Hector Lacassie, Alejandro Jankelevich, Juan Francisco Morales, Diana Carolina Carmona, Claudio Nazar
COVID-19: Evaluación y manejo de la anestesia para procedimientos endoscópicos gastrointestinales
ANESTESIA, Endoscopia, Colonoscopia, equipo de protección personal, SARS-CoV-2, COVID-19
Raúl Guillén Rojas, Lourdes Carolina Pellecer González
COVID-19 in India: Moving from containment to mitigation
Perspectives for repurposing drugs for the coronavirus disease 2019
coronavirus - covid-19 - drugs - host-based - repurposing - severe acute respiratory syndrome coronavirus 2 - virus-based
The newly emerged 2019 novel coronavirus (CoV), named as severe acute respiratory syndrome CoV-2 (SARS-CoV-2), like SARS-CoV (now, SARS-CoV-1) and Middle East respiratory syndrome CoV (MERS-CoV), has been associated with high infection rates with over 36,405 deaths. In the absence of approved marketed drugs against coronaviruses, the treatment and management of this novel CoV disease (COVID-19) worldwide is a challenge. Drug repurposing that has emerged as an effective drug discovery approach from earlier approved drugs could reduce the time and cost compared to de novo drug discovery. Direct virus-targeted antiviral agents target specific nucleic acid or proteins of the virus while host-based antivirals target either the host innate immune responses or the cellular machineries that are crucial for viral infection. Both the approaches necessarily interfere with viral pathogenesis. Here we summarize the present status of both virus-based and host-based drug repurposing perspectives for coronaviruses in general and the SARS-CoV-2 in particular.
Raman R. Gangakhedkar, Balram Bhargava, Megha Agrawal, Atanu Basu, Priya Abraham, Sarah S Cherian
Guidance for building a dedicated health facility to contain the spread of the 2019 novel coronavirus outbreak
biocontainment - biosafety - coronavirus - designated health facility - infection prevention and control
Preparedness for the ongoing coronavirus disease 2019 (COVID-19) and its spread in India calls for setting up of adequately equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. In the wake of other emerging dangerous pathogens in recent times, such as Ebola, Nipah and Zika, it is important that such facilities are kept ready during the inter-epidemic period for training of health professionals and for managing cases of multi-drug resistant and difficult-to-treat pathogens. While endemic potential of such critically ill patients is not yet known, the health system should have surge capacity for such critical care units and preferably each tertiary government hospital should have at least one such facility. This article describes elements of design of such unit (e.g., space, infection control, waste disposal, safety of healthcare workers, partners to be involved in design and plan) which can be adapted to the context of either a new construction or makeshift construction on top of an existing structure. In view of a potential epidemic of COVID-19, specific requirements to handle it are also given.
Rajesh Bhatia, Devendra Mourya, Pranab Chatterjee, Swarup Sarkar, Anup Agarwal, Nazia Nagi, Rima Rakeshkumar Sahay
Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories
covid-19 - diagnosis - preparedness - quality control - quarantine - severe acute respiratory syndrome-cov-2 - virus research and diagnostic laboratory
Background & objectives: An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19. Methods: The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport and their past performance. The case definition for testing included all individuals with travel history to Wuhan and symptomatic individuals with travel history to other parts of China. This was later expanded to include symptomatic individuals returning from Singapore, Japan, Hong Kong, Thailand and South Korea. Results: Within a week of standardization of the test at NIV, all VRDLs could initiate testing for SARS-CoV-2. Till February 29, 2020, a total of 2,913 samples were tested. This included both 654 individuals quarantined in the two camps and others fitting within the case definition. The quarantined individuals were tested twice - at days 0 and 14. All tested negative on both occasions. Only three individuals belonging to different districts in Kerala were found to be positive. Interpretation & conclusions: Sudden emergence of SARS-CoV-2 and its potential to cause a pandemic posed an unsurmountable challenge to the public health system of India. However, concerted efforts of various arms of the Government of India resulted in a well-coordinated action at each level. India has successfully demonstrated its ability to establish quick diagnosis of SARS-CoV-2 at NIV, Pune, and the testing VRDLs.
Amita Jain, Ashok Munivenkatappa, Neeraj Aggarwal, Bharti Malhotra, Aashish Choudhary, Raman R. Gangakhedkar, A P Sugunan, Varsha Potdar, Pragya Yadav, Parul Jain, Sidhartha Giri, Sivasubramanian Srinivasan, Himanshu Sharma, Jayanthi Shastri, Lalit Dar, Anukumar Balakrishnan, Gajanan Sapkal, Ira Praharaj, Ajanta Sharma, Nivedita Gupta, Hasina Banu, Shanta Dutta, Priya Abraham, Disha Patel, Harmanmeet Kaur, R Ambica, G B Shantala, Neetu Vijay, Manish Pathak, Krishnasamy Kaveri, Gitika Rajbongshi, Manohar Lal Choudhary, Kammilli Nagamani, Sharmila Raut, M M Vegad, Megha Brijwal, Jayaswamy Manjunatha, Pakalpati Sunita, Babita Fageria, Jitendra Narayan, Anu Nagar