Implications of COVID-19 for the busy gastroenterologist.

Coronavirus disease 2019 (COVID-19) is an infection caused by a novel coronavirus (SARS-CoV-2) originated in China in December 2020 and declared pandemic by WHO. This coronavirus mainly spreads through the respiratory tract and enters cells through angiotensin-converting enzyme 2 (ACE2). The clinical symptoms of COVID-19 patients include fever, cough, and fatigue. Gastrointestinal symptoms (diarrhea, anorexia, and vomiting) may be present in 50% of patients and may be associated with worst prognosis. Other risk factors are older age, male gender, and underlying chronic diseases. Mitigation measures are essential to reduce the number of people infected. Hospitals are a place of increased SARS-CoV-2 exposure. This has implications in the organization of healthcare services and specifically endoscopy departments. Patients and healthcare workers safety must be optimized in this new reality. Comprehension of COVID-19 gastrointestinal manifestations and implications of SARS-CoV-2 in the management of patients with gastrointestinal diseases, under or not immunosuppressant therapies, is essential. In this review, we summarized the latest research progress and major societies recommendations regarding the implications of COVID-19 in gastroenterology, namely the adaptations that gastroenterology/endoscopy departments and professionals must do in order to optimize the provided assistance, as well as the implications that this infection will have, in particularly vulnerable patients such as those with chronic liver disease and inflammatory bowel disease under or not immunosuppressant therapies.

COVID-19 in South Korea.

A novel coronavirus (severe acute respiratory syndrome-CoV-2) that initially originated from Wuhan, China, in December 2019 has already caused a pandemic. While this novel coronavirus disease (COVID-19) frequently induces mild diseases, it has also generated severe diseases among certain populations, including older-aged individuals with underlying diseases, such as cardiovascular disease and diabetes. As of 31 March 2020, a total of 9786 confirmed cases with COVID-19 have been reported in South Korea. South Korea has the highest diagnostic rate for COVID-19, which has been the major contributor in overcoming this outbreak. We are trying to reduce the reproduction number of COVID-19 to less than one and eventually succeed in controlling this outbreak using methods such as contact tracing, quarantine, testing, isolation, social distancing and school closure. This report aimed to describe the current situation of COVID-19 in South Korea and our response to this outbreak.

The role of children in transmission of SARS-CoV-2 variants of concern within households: an updated systematic review and meta-analysis, as at 30 June 2022.

BackgroundMeta-analyses and single-site studies have established that children are less infectious than adults within a household when positive for ancestral SARS-CoV-2. In addition, children appear less susceptible to infection when exposed to ancestral SARS-CoV-2 within a household. The emergence of SARS-CoV-2 variants of concern (VOC) has been associated with an increased number of paediatric infections worldwide. However, the role of children in the household transmission of VOC, relative to the ancestral virus, remains unclear.AimWe aimed to evaluate children's role in household transmission of SARS-CoV-2 VOC.MethodsWe perform a meta-analysis of the role of children in household transmission of both ancestral SARS-CoV-2 and SARS-CoV-2 VOC.ResultsUnlike with the ancestral virus, children infected with VOC spread SARS-CoV-2 to an equivalent number of household contacts as infected adults and were equally as likely to acquire SARS-CoV-2 VOC from an infected family member. Interestingly, the same was observed when unvaccinated children exposed to VOC were compared with unvaccinated adults exposed to VOC.ConclusionsThese data suggest that the emergence of VOC was associated with a fundamental shift in the epidemiology of SARS-CoV-2. It is unlikely that this is solely the result of age-dependent differences in vaccination during the VOC period and may instead reflect virus evolution over the course of the pandemic.

Feasibility and parental perception of home sleep studies during COVID-19: a tertiary sleep centre experience.

OBJECTIVE: Rapid implementation of home sleep studies during the first UK COVID-19 'lockdown'-completion rates, family feedback and factors that predict success. DESIGN: We included all patients who had a sleep study conducted at home instead of as inpatient from 30 March 2020 to 30 June 2020. Studies with less than 4 hours of data for analysis were defined 'unsuccessful'. RESULTS: 137 patients were included. 96 underwent home respiratory polygraphy (HRP), median age 5.5 years. 41 had oxycapnography (O2/CO2), median age 5 years. 56% HRP and 83% O2/CO2 were successful. A diagnosis of autism predicted a lower success rate (29%) as did age under 5 years. CONCLUSION: Switching studies rapidly from an inpatient to a home environment is possible, but there are several challenges that include a higher failure rate in younger children and those with neurodevelopmental disorders.

Interferon resistance of emerging SARS-CoV-2 variants.

The emergence of SARS-CoV-2 variants with enhanced transmissibility, pathogenesis, and resistance to vaccines presents urgent challenges for curbing the COVID-19 pandemic. While Spike mutations that enhance virus infectivity or neutralizing antibody evasion may drive the emergence of these novel variants, studies documenting a critical role for interferon responses in the early control of SARS-CoV-2 infection, combined with the presence of viral genes that limit these responses, suggest that interferons may also influence SARS-CoV-2 evolution. Here, we compared the potency of 17 different human interferons against multiple viral lineages sampled during the course of the global outbreak, including ancestral and five major variants of concern that include the B.1.1.7 (alpha), B.1.351 (beta), P.1 (gamma), B.1.617.2 (delta), and B.1.1.529 (omicron) lineages. Our data reveal that relative to ancestral isolates, SARS-CoV-2 variants of concern exhibited increased interferon resistance, suggesting that evasion of innate immunity may be a significant, ongoing driving force for SARS-CoV-2 evolution. These findings have implications for the increased transmissibility and/or lethality of emerging variants and highlight the interferon subtypes that may be most successful in the treatment of early infections.

Mask Use During COVID-19: A Social-Ecological Analysis.

To limit the spread of coronavirus disease 2019 (COVID-19), the Centers for Disease Control and Prevention issued recommendations that individuals wear face masks in public. Despite these recommendations, the individual decision to adhere and wear a mask may not be a simple decision. In this article, we examine the decision to wear a mask from a social-ecological perspective. Through critical analysis of societal, interpersonal and community, and intrapersonal influences, it is clear that the decision to wear a mask is multifaceted and influenced by constructs including public health recommendations and government mandates, racism and cultural norms, geography, household income, age, and personal attitudes. Understanding the multifactorial influences on mask wearing during COVID-19 is crucial for informing the creation and distribution of inclusive public health messaging regarding mask wearing now in the midst of an unprecedented health crisis, and in future unforeseen public health emergencies.

COVID-19 epidemic phases and morbidity in different areas of Chinese mainland, 2020.

Background: In the early stage of COVID-19 epidemic, the Chinese mainland once effectively controlled the epidemic, but COVID-19 eventually spread faster and faster in the world. The purpose of this study is to clarify the differences in the epidemic data of COVID-19 in different areas and phases in Chinese mainland in 2020, and to analyze the possible factors affecting the occurrence and development of the epidemic. Methods: We divided the Chinese mainland into areas I, I and III, and divided the epidemic process into phases I to IV: limited cases, accelerated increase, decelerated increase and containment phases. We also combined phases II and III as outbreak phase. The epidemic data included the duration of different phases, the numbers of confirmed cases, asymptomatic infections, and the proportion of imported cases from abroad. Results: In area I, II and III, only area I has a Phase I, and the Phase II and III of area I are longer. In Phase IV, there is a 17-day case clearing period in area I, while that in area II and III are 2 and 0 days, respectively. In phase III or the whole outbreak phase, the average daily increase of confirmed cases in area I was higher than that in areas II and III (P = 0.009 and P = 0.001 in phase III; P = 0.034 and P = 0.002 in the whole outbreak phase), and the average daily in-hospital cases were most in area I and least in area III (P = 0.000, P = 0.000, and P = 0.000 in phase III; P = 0.000, P = 0.000, and P = 0.009 in the whole outbreak phase). The average number of daily in-hospital COVID-19 cases in phase III was more than that in phase II in each area (P = 0.000, P = 0.000, and P = 0.001). In phase IV, from March 18, 2020 to January 1, 2021, the increase of confirmed cases in area III was higher than areas I and II (both P = 0.000), and the imported cases from abroad in Chinese mainland accounted for more than 55-61%. From June 16 to July 2, 2020, the number of new asymptomatic infections in area III was higher than that in area II (P = 0.000), while there was zero in area I. From July 3, 2020 to January 1, 2021, the increased COVID-19 cases in area III were 3534, while only 14 and 0, respectively, in areas I and II. Conclusions: The worst epidemic areas in Chinese mainland before March 18, 2020 and after June 15, 2020 were area I and area III, respectively, and area III had become the main battlefield for Chinese mainland to fight against imported epidemic since March 18, 2020. In Wuhan, human COVID-19 infection might occur before December 8, 2019, while the outbreak might occur before January 16 or even 10, 2020. Insufficient understanding of COVID-19 hindered the implementation of early effective isolation measures, leading to COVID-19 outbreak in Wuhan, and strict isolation measures were effective in controlling the epidemic. The import of foreign COVID-19 cases has made it difficult to control the epidemic of area III. When humans are once again faced with potentially infectious new diseases, it is appropriate to first and foremost take strict quarantine measures as soon as possible, and mutual cooperation between regions should be explored to combat the epidemic.

Cryptic SARS-CoV-2 lineage identified on two mink farms as a possible result of long-term undetected circulation in an unknown animal reservoir, Poland, November 2022 to January 2023.

In late 2022 and early 2023, SARS-CoV-2 infections were detected on three mink farms in Poland situated within a few km from each other. Whole-genome sequencing of the viruses on two of the farms showed that they were related to a virus identified in humans in the same region 2 years before (B.1.1.307 lineage). Many mutations were found, including in the S protein typical of adaptations to the mink host. The origin of the virus remains to be determined.

Chinese Parental Awareness of Children's COVID-19 Protective Measures.

Objectives: In this research our aim was to investigate Chinese parents' awareness of pediatric COVID-19 in relation to protecting their children. Methods: A cross-sectional study was conducted in Fujian provinces in China using a Web-based questionnaire to survey parents of children aged 6 to 16 years old. Results: The sample included 1222 participants. Overall, 99.2% of participants were aware of respiratory transmission of COVID-19, and 75.6% also believed fecal-oral transmission to be possible. Although 98.3% of participants claimed to know how to wear and remove masks properly, some parents were unaware of good handwashing techniques and answered incorrectly regarding cough etiquette. Parents also seemed uncertain about pediatric COVID-19 symptoms. Awareness scores significantly differed across parental role, educational attainment levels, and social-economic levels (p value < .005), with fathers, more educated parents, and those of higher income showing greater levels of awareness.Conclusion: Research results suggest an urgent need for parental education regarding COVID-19 in children, especially regarding handwashing techniques and cough etiquette; educational outreach for both parents and schoolchildren is critical.

Entry, egress and vertical transmission of SARS-CoV-2.

The high infectivity and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have caused the COVID-19 outbreak, one of the most devastating pandemics in more than a century. This pandemic has already left a trail of destruction, including enormous loss of life, a global economic slump, and widespread psychological damage. Despite assiduous world-wide endeavors, an effective cure for COVID-19 is still lacking. Surprisingly, infected neonates and children have relatively mild clinical manifestations and a much lower fatality rate than elderly adults. Recent studies have unambiguously demonstrated the vertical transmission of SARS-CoV-2 from infected pregnant women to fetuses, which creates yet another challenge for disease prevention. In this review, we will summarize the molecular mechanism for entry of SARS-CoV-2 into host cells, the basis for the failure of the lungs and other organs in severe acute cases, and the evidence for congenital transmission.

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study.

BACKGROUND: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19-positive patients and infections in the surgical team were determined by univariate analysis. RESULTS: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. CONCLUSIONS: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. LAY SUMMARY: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment.

Mobility-Guided Estimation of COVID-19 Transmission Rates.

It is of critical importance to estimate changing disease-transmission rates and their dependence on population mobility. A common approach to this problem involves fitting daily transmission rates using a susceptible-exposed-infected-recovered-(SEIR) model (regularizing to avoid overfitting) and then computing the relationship between the estimated transmission rate and mobility. Unfortunately, there are often several very different transmission-rate trajectories that can fit the reported cases well, meaning that the choice of regularization determines the final solution (and thus the mobility-transmission rate relationship) selected by the SEIR model. Moreover, the classical approaches to regularization-penalizing the derivative of the transmission rate trajectory-do not correspond to realistic properties of pandemic spread. Consequently, models fitted using derivative-based regularization are often biased toward underestimating the current transmission rate and future deaths. In this work, we propose mobility-driven regularization of the SEIR transmission rate trajectory. This method rectifies the artificial regularization problem, produces more accurate and unbiased forecasts of future deaths, and estimates a highly interpretable relationship between mobility and the transmission rate. For this analysis, mobility data related to the coronavirus disease 2019 pandemic was collected by Safegraph (San Francisco, California) from major US cities between March and August 2020.

Advances in Facemasks during the COVID-19 Pandemic Era.

The outbreak of coronavirus disease (COVID-19) has transformed the daily lifestyles of people worldwide. COVID-19 was characterized as a pandemic owing to its global spread, and technologies based on engineered materials that help to reduce the spread of infections have been reported. Nanotechnology present in materials with enhanced physicochemical properties and versatile chemical functionalization offer numerous ways to combat the disease. Facemasks are a reliable preventive measure, although they are not 100% effective against viral infections. Nonwoven materials, which are the key components of masks, act as barriers to the virus through filtration. However, there is a high chance of cross-infection because the used mask lacks virucidal properties and can become an additional source of infection. The combination of antiviral and filtration properties enhances the durability and reliability of masks, thereby reducing the likelihood of cross-infection. In this review, we focus on masks, from the manufacturing stage to practical applications, and their abilities to combat COVID-19. Herein, we discuss the impacts of masks on the environment, while considering safe industrial production in the future. Furthermore, we discuss available options for future research directions that do not negatively impact the environment.

Quantifying Uncertainty in Mechanistic Models of Infectious Disease.

This primer describes the statistical uncertainty in mechanistic models and provides R code to quantify it. We begin with an overview of mechanistic models for infectious disease, and then describe the sources of statistical uncertainty in the context of a case study on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the statistical uncertainty as belonging to 3 categories: data uncertainty, stochastic uncertainty, and structural uncertainty. We demonstrate how to account for each of these via statistical uncertainty measures and sensitivity analyses broadly, as well as in a specific case study on estimating the basic reproductive number, ${R}_0$, for SARS-CoV-2.