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Based on available evidence, the COVID-19 virus is thought to spread through close contact and droplet transmission. However, some have debated that it could be airborne. Airborne transmission occurs when particles of less than 0.5 μm within droplets spread through exhaled air via a process called aerosolisation. These particles can remain in the air for long periods and can disseminate over distances further than 1 meter. In the context of COVID-19, airborne particles can occur during certain aerosolised-generating-procedures (AGP). WHO underlines the use of N95 respirators or equivalent as part of personal protective equipment (PPE) for healthcare workers (HCW) managing COVID-19 positive patients when aerosolised-generating-procedures (AGP) are being conducted.
This retrospective observational study describes the result of COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) in health care workers (HCW) wearing different form of personal protective equipment (PPE) who had had close contact with a confirmed COVID-19 patient during performing such procedures. All HCWs were quarantined for 14 days after the exposure. COVID-19 RT-PCR nasopharyngeal swabs were performed at different intervals. Little is known about the effectiveness of different types of personal protective equipment (PPE) for preventing SARS-CoV-2 in HCWs. We describe the clinical outcome of HCWs exposed to sudden acute respiratory infection patient before the diagnosis of COVID-19 was known.
Determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States.
Retrospective analysis of patient data collected from the routine care of COVID-19 patients.
System of more than 180 acute care facilities in the United States.
All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020.
Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission.
A total of 6180 COVID-19+ patients were identified as of May 12, 2020. The majority of COVID-19+ patients (77.8%, 4808) were admitted directly to a medical/surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR: 1.07, 95% CI 1.06-1.08, p< 0.001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR: 1.09, 95% CI 1.06-1.12, p< 0.001) as was diabetes (OR: 1.57, 95% CI 1.21-2.03, p<0.001).
The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
The pressures exerted by the pandemic of COVID-19 pose an unprecedented demand on health care services. Hospitals become rapidly overwhelmed when patients requiring life-saving support outpace available capacities. We here describe methods used by a university hospital to forecast caseloads and time to peak incidence.
We developed a set of models to forecast incidence among the hospital catchment population and describe the COVID-19 patient hospital care-path. The first forecast utilized data from antecedent allopatric epidemics and parameterized the care path model according to expert opinion (static model). Once sufficient local data were available, trends for the time dependent effective reproduction number were fitted and the care-path was re-parameterized using hazards for real patient admission, referrals, and discharge (dynamic model).
The static model, deployed before the epidemic, exaggerated the bed occupancy (general wards 116 forecasted vs 66 observed, ICU 47 forecasted vs 34 observed) and predicted the peak too late (general ward forecast April 9, observed April 8, ICU forecast April 19, observed April 8). After April 5, the dynamic model could be run daily and precision improved with increasing availability of empirical local data.
The models provided data-based guidance in the preparation and allocation of critical resources of a university hospital well in advance of the epidemic surge, despite overestimating the service demand. Overestimates should resolve when population contact pattern before and during restrictions can be taken into account, but for now they may provide an acceptable safety margin for preparing during times of uncertainty.
The current coronavirus (SARS-CoV-2) pandemic has resulted in severe shortages of personal protective equipment, including respiratory protective equipment such as N95 respirators. This has led some government agencies to suggest the use of cloth face coverings (CFC) by healthcare providers and the general public as a last resort when standard respiratory protective equipment is unavailable. Although such coverings have been in use for over a century and have found widespread usage during some previous pandemics, research data is relatively scant for the protective value of this measure. This article, a literature review, explores the development of CFC and reviews available scientific research regarding the efficacy of this intervention as a preventive measure in the spread of airborne infectious diseases.
The pandemic of Coronavirus disease 2019 (COVID-19) is rapidly progressing, causing significant morbidity and mortality. Various antiviral drugs, anti-inflammatory drugs, and immunomodulators have been tried without substantial clinical benefits. The severe and critical cases of COVID-19 disease are characterised by gut microbiome dysbiosis, immune dysregulation, hyper-inflammation, and hypercytokinemia (cytokine storm). Therefore, the strategies which target these pathophysiological processes may be beneficial. Probiotics are one such strategy that exerts beneficial effects by manipulation of the gut microbiota, suppression of opportunistic pathogens in the gut, decrease translocation of opportunistic organisms, activate mucosal immunity, and modulation of the innate and adaptive immune response. Probiotics are the potential candidates to be tested in moderate and severe cases of COVID-19 due to several beneficial effects, including easy availability, easy to administer, and safe, and economical to use.
In March 2020, the WHO officially declared the spread of COVID-19 as a pandemic. Adolescence and early adulthood are peak times for the onset of mental health difficulties. Exposure to a pandemic during this vulnerable developmental period places young people at significant risk of negative psychological experiences. The objective of this research was to summarise existing evidence on the potential impact of a pandemic on the mental health of 12-25-year-olds.
A rapid review of the published peer-reviewed literature, published between 1985 and 2020, using PsycINFO (Proquest) and Medline (Proquest) was conducted. Narrative synthesis was used across studies to identify key themes and concepts.
This review found 3,359 papers, which was reduced to 12 papers for data extraction. Results regarding the prevalence of psychological difficulties in youth were mixed, with some studies finding this group experience heightened distress during an infectious disease outbreak, and others finding no age differences or higher distress among adults. Gender, coping, self-reported physical health and adoption of precautionary measures appear to play a role in moderating the psychological impact of an infectious disease outbreak. Most studies were conducted after the peak of an epidemic/pandemic or in the recovery period.
More longitudinal research with young people, particularly adolescents in the general population, before and during the early stages of an infectious disease outbreak is needed to obtain a clear understanding of how best to support young people during these events.
Vitamin D deficiency is associated with increased risk of acute respiratory infection. There is an excess of respiratory infections and deaths in schizophrenia, a condition where vitamin D deficiency is especially prevalent. This potentially offers a modifiable risk factor to reduce the risk for and the severity of respiratory infection in people with schizophrenia, although there is as yet no evidence regarding risk of Covid-19. In this narrative review, we describe the prevalence of vitamin D deficiency in schizophrenia, report the research examining the relationship between vitamin D levels and Covid-19 and discuss the associations between vitamin D deficiency and respiratory infection, including its immunomodulatory mechanism of action.
Originated in China in December 2019 Corona virus disease (COVID-19) has rapidly spread to around 216 countries in the world by May 2020. Dentists being at a higher risk of contacting the disease, the present study assessed the fear and anxiety among dental practitioners of COVID-19.
An online cross-sectional questionnaire survey comprising of nine questions was conducted among dental practitioners of Telangana. Age, gender, qualification, type of practice, years of practice, place of residence were the demographic variables recorded. The response to each question was recorded in a YES or NO format, mean fear score calculated to categorize into low and high levels of fear. Comparison of mean fear score was done using t- test for two variables and ANOVA for three or more than three variables. Multiple logistic regression analysis of the levels of fear with demographic variables was done. p<0.05 was considered statistically significant.
The mean fear and anxiety score of this study population reported was high 6.57 +2.07, with 58.31% of the population presenting with a low level of fear and anxiety. Only qualification (p=0.045)and gender (p=0.035) revealed a significant difference in fear to Q7and Q8 respectively. Irrespective of the age, gender, qualification, type of practice and years of practices the levels of fear reported in the present study was high similar. Respondents between 41- 60 yrs age (6.70+ 2.01) and those with individual practices (6.70+2.06) exhibited high level of fear score.
The present study demonstrates a cross sectional data of fear and anxiety among dental practitioners during the COVID-19 outbreak. Heightened levels of fear observed call for a nationwide analysis of fear among dentists and deliberate management strategies for the same.