COVID-19 Literature Situation Report February 20, 2020

• This report for the week ending Feb 8, 2020 includes data on 15 Australian cases with reported travel history to mainland China. 

Walker (Feb 12, 2020). COVID-19, Australia: Epidemiology Report 2: Communicable Diseases Intelligence. https://doi.org/10.33321/cdi.2020.44.14

• Pan et al. describe asymptomatic cases in a family cluster with SARS-CoV-2 infection. Such asymptomatic patients may not isolate themselves or seek treatment and may unknowingly transmit infection.

Pan et al. (Feb 19, 2020). Asymptomatic cases in a family cluster with SARS-CoV-2 infection. Lancet Infect Dis. https://doi.org/10.1016/S1473-3099(20)30114-6 

• Cheng and Shan provide COVID-19 outbreak overview, including reports from outbreak sites and laboratories supporting the investigation. The paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature. 
• From their single-term exponential model, they report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.

Cheng and Shan (Feb 18th, 2020). 2019 Novel coronavirus: where we are and what we know. Infection. https://doi.org/10.1007/s15010-020-01401-y

• Dong et al. introduce a public, online interactive dashboard hosted by the Center for Systems science and Engineering (CSSE) at Johns Hopkins University to visualize and track reported cases of COVID-19. Data from China CDC and WHO for confirmed cases inside and outside China are included.

Dong et al. (Feb 19, 2020). An interactive web-based dashboard to track COVID-19 in real time:  Lancet Infect Dis. https://doi.org/10.1016/S1473-3099(20)30120-1

• Yeo et al. provide evidence from previous outbreaks to support fecal-oral transmission of SARS-CoV and MERS-CoV and that they can remain viable in different environmental conditions that could facilitate fecal-oral transmission. It is possible that 2019-nCoV could also be transmitted via this route. They advocate for research on the possibility of fecal-oral transmission of 2019-nCoV and environmental factors that favor survival and transmission.

Yeo et al. (Feb 19, 2020). Enteric involvement of coronaviruses: is faecal–oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol (2020). https://doi.org/10.1016/S2468-1253(20)30048-0

• Colson et al. recommend investigation into the potential antiviral properties of drugs which have been proven to be harmless and whose pharmacokinetics and optimal dosage are well-known, including chloroquine phosphate. 

Colson et al. (Feb 15, 2020). Chloroquine for the 2019 novel coronavirus. Int J of Antimicrobial Agents. https://doi.org/10.1016/j.ijantimicag.2020.105923 

• The author outlines the roles of a radiologist in clinical setting during the COVID-19 outbreak. 

Kim (Feb 18, 2020). Outbreak of novel coronavirus (COVID-19): What is the role of radiologists? European Radiology. https://doi.org/10.1007/s00330-020-06748-2

• This commentary describes initiation of a new infection control system for the COVID-19 outbreak in China in light of pneumonia of unknown origin.

Chen et al. (Feb 18, 2020). Initiation of a new infection control system for the COVID-19 outbreak:  The Lancet Infectious Diseases. https://doi.org/10.1016/S1473-3099(20)30110-9

• Xu et al. report on clinical findings in a group of COVID-19 patients outside of Wuhan, China. They report that as of Feb 2020, compared with patients initially infected in Wuhan, the symptoms of patients in Zhejiang province are relatively mild. 

Xu et al. (Feb 19, 2020). Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ http://dx.doi.org/10.1136/bmj.m606

• The team at the hematology and clinical lab in Tongli Hospital China report significantly abnormal coagulation parameters that are associated with poor prognosis in patients with COVID-19 pneumonia. 

Tang et al. (Feb 19, 2020). Abnormal Coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia: Brief Report. Journal of Thrombosis and Haemostatis. https://doi.org/10.1111/jth.14768 

• Liu et al. outline critical care response in a recent hospital outbreak of COVID-19 in Shenzhen, China. 

Liu et al. (Feb 19, 2020). Critical care response to a hospital outbreak of the 2019-nCoV infection in Shenzhen, China. Critical Care. https://doi.org/10.1186/s13054-020-2786-x

• Gao et al. report that Chloroquine phosphate (an antimalarial drug) has apparent efficacy in treatment of COVID-19 associated pneumonia in multicenter clinical trial studies in China. The drug is now recommended to be included in the next version of the Guidelines for the Prevention, Diagnosis, and Treatment of Pneumonia Caused by COVID-19 issued by the National Health Commission.

Gao et al. (Feb 19, 2020). Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. BioScience Trends. https://doi.org/10.5582/bst.2020.01047 

• Fang et al. investigated sensitivity of chest CT for COVID-19 in early diagnosis of disease. RT-PCR was used as gold standard and were conducted using throat swabs (45 patients) or sputum samples (6 patients) of 51 patients. Sensitivity of chest CT was greater than that of RT-PCR (98% vs 71%, respectively, p<.001). Limitation of RT-PCR as diagnostic tool is described.

Fang et al. (Feb 19, 2020) Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. https://doi.org/10.1148/radiol.2020200432 

• Liem et al. describe an often neglected group of individuals during outbreaks: international migrant workers (IMW). There are currently about 150 million IMW worldwide, of which 95% reside in areas with confirmed COVID-19. The authors highlight barriers IMW encounter in accessing health services during outbreaks and call for IMW health needs to be made an urgent public health priority.

Liem et al. (Feb 18, 2020) The Neglected Health of International Migrant Workers in the COVID-19 epidemic. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(20)30076-6 

• Mental health services for healthcare workers were quickly established for 5 large healthcare organizations in China.  These included psychologist teams and online support.  However, medical staff refused to participate in the psychological resources offered, explaining that they did not meet their actual needs. These included feeling more exhausted than worried, not wanting families to worry, stress over a lack of knowledge on how to deal with uncooperative patients, and worry about lack of PPE.
  • The healthcare organizations adapted to meet these needs, offering: a quiet and removed area where staff could get away and rest, additional PPE and training in how to use PPE, security staff to deal with uncooperative patients, leisure activities, teaching relaxation tools, having counselors available as needed

Chen et al. (Feb 18, 2020). Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet. https://doi.org/10.1016/S2215-0366(20)30078-X 

• Yang et al. describe the critical support needs for 30 million citizens in China who are older than 80, and the 40 million citizens who have long-term disabilities.  Both of these criteria are related to much higher COVID-19 morbidity and mortality, which worsens the mental health issues already common in this population.
• Online mental health services are available, but older individuals have limited access and knowledge to take advantage of these resources.  The authors also note very long wait times for these patients to access direct mental health care.  They encourage more attention to be paid to these vulnerable members of the society. 

Yang et al. (Feb 18, 2020). Mental health services for older adults in China during the COVID-19 outbreak. The Lancet. https://doi.org/10.1016/S2215-0366(20)30079-1 

• Health care providers and the National Health Commission of China have noted increased stress among providers and the public due to COVID-19.  
• Early in the outbreak, China began publishing guidelines for crisis interventions. In contrast to the SARS outbreak, current resources include smartphones and online interventions such as chat groups. 
• A Feb 2020 survey reveals significant levels of depression, anxiety, and insomnia.  In response, people have been offered online counseling by professional mental health providers, and online self-help using Cognitive Behavioral Therapies. Artificial Intelligence programs are also able to recognize and identify suicidal risks. These strategies may improve the efficacy of emergency response efforts going forward.

Liu et al. (Feb 18, 2020). Online mental health services in China during the COVID-19 outbreak. The Lancet. https://doi.org/10.1016/S2215-0366(20)30077-8

• Atlani-Duault et al. report that the COVID-19 outbreak is giving rise to worldwide anxieties, rumors, and online misinformation. They advocate gathering data on local perceptions to help public authorities mount a more robust response and better targeted health communication strategies to identify and counter attempts to blame, scapegoat, and spread misinformation 

Atlani-Duault et al. (Feb 18, 2020). Tracking online heroisation and blame in epidemics. The Lancet. https://doi.org/10.1016/S2468-2667(20)30033-5