Frontiers in medicine
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Frontiers in medicine · Jan 2020
COVID-19 Infection Among Healthcare Workers: Serological Findings Supporting Routine Testing.
A growing body of evidence demonstrates that asymptomatic and pre-symptomatic transmission of SARS-CoV-2 is a major contributor to the COVID-19 pandemic. Frontline healthcare workers in COVID-19 hotspots have faced numerous challenges, including shortages of personal protective equipment (PPE) and difficulties acquiring clinical testing. The magnitude of the exposure of healthcare workers and the potential for asymptomatic transmission makes it critical to understand the incidence of infection in this population. ⋯ These results indicate that there is considerable asymptomatic infection with SARS-CoV-2 within the healthcare workforce, despite current mitigation policies. Furthermore, presuming that asymptomatic staff are not carrying SARS-CoV-2 is inconsistent with our results, and this could result in amplified transmission within healthcare settings. Consequently, aggressive testing regiments, such as testing frontline healthcare workers on a regular, multi-modal basis, may be required to prevent further spread within the workforce and to patients.
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Frontiers in medicine · Jan 2020
Coagulopathy as a Prodrome of Cytokine Storm in COVID-19-Infected Patients.
Background: The rapid coronavirus disease 2019 (COVID-19) pandemic has hit hard on the world and causes panic since the virus causes serious infectious respiratory illness and easily leads to severe conditions such as immune system overactivation or cytokine storm. Due to the limited knowledge on the course of infection of this coronavirus and the lack of an effective treatment for this fatal disease, mortality remains high. The emergence of a cytokine storm in patients with a severe condition has been reported as the top reason of the death of patients with COVID-19 infection. ⋯ In addition, we observed that D-dimer rises earlier than the cytokine storm represented by IL-6 surge, which suggests that coagulopathy might act as a trigger to potentiate a cytokine storm. Conclusion: Integrated analysis revealed a positive correlation of coagulopathy with cytokine storm in COVID-19-infected patients; the D-dimer rises early, which indicates that coagulopathy acts as a prodrome of cytokine storm. Coagulopathy can be used to monitor early cytokine storm in COVID-19-infected patients.
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Frontiers in medicine · Jan 2020
Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study.
Background: The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies. ⋯ Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy. Conclusions: In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.
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Frontiers in medicine · Jan 2020
Prevention and Control of COVID-19 Infection in a Chinese Mental Health Center.
Faced with the rapid spread of the novel coronavirus disease (COVID-19), a global public health threat, psychiatric hospitals are under huge pressure to prevent and control nosocomial infection. The current research analyzed the COVID-19 infection control practices in a regional mental health center in China and addressed how this type of medical institutions could enhance their ability to prevent and control hospital transmission of major respiratory diseases and general management of nosocomial infection risks. Firstly, hospital-related risks of COVID-19 were analyzed, and targeted prevention and control measures were then established. ⋯ Up to the submission of this paper, the mental health center had obtained no suspected or confirmed case of COVID-19 infection due to hospital transmission. The findings provide empirical evidence for the effectiveness of the COVID-19 preventive strategies and have important implications for integrated and characterized infection control in mental health centers during a major epidemic. The establishment of the transitional isolation ward and air fumigation using traditional Chinese medicine for patients and staff are preventive measures worthy of further discussion and dissemination.
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Frontiers in medicine · Jan 2020
Correlation Between the COVID-19 Respiratory Triage Score and SARS-COV-2 PCR Test.
Background: COVID-19 clinical presentation is usually non-specific and includes commonly encountered symptoms like fever, cough, nausea, and vomiting. It has been reported that COVID-19 patients can potentially transmit the disease to others before developing symptoms. Thus, extensive surveillance and screening of individuals at risk of the disease is required to limit SARS-COV-2 spread. ⋯ Clinical characteristics that independently predicted positive COVID-19 PCR test include male sex (adjusted OR: 1.47; p = 0.034), healthcare workers and their family members (adjusted OR: 1.99; 95%; p = 0.016), fever (adjusted OR: 2.98; p < 0.001), and moderate disease severity (adjusted OR: 5; p < 0.001). Conclusion: The current COVID-19 respiratory triage score has marginal diagnostic performance characteristics. Its performance can improve by including additional predictors to the respiratory symptoms in order to avoid missing COVID-19 patients with atypical presentation and to limit unnecessary SARS-COV-2 PCR testing.